I am highly sensitive and things affect me greatly. I have an incredible amount of empathy to a fault. It affects my ability to do what I need to do. The first example of this that I remember is when I was 4 or 5 years old. My mom brought me home some Strawberry Shortcake dolls. The next day I traded these dolls with a friend for I forget what. Later that day I felt absolutely awful because I thought it would hurt my mom’s feelings that I traded the dolls that she bought for me. I was so upset about this and started crying because of what I thought my mom would feel. I could feel it. I made my mom call the friend’s mom to undo the trade. Now, in reality I’m sure that my mom didn’t give a damn about the dolls and will probably not remember what the hell I’m talking about. But this story is ingrained in my memory for some reason.
This is a rare, rare trait. I’ve only met a few people in my life that are like this. A high degree of empathy is a rare, rare thing. I’m not saying that this is a great thing and that I’m some kind of special person because of this, this trait has made my life hell quite a lot. I recently read a book that really helped me. It helped me to understand this trait of mine that always made me feel like a freak. It’s called The Highly Sensitive Person: How to Thrive When the World Overwhelms You. The world overwhelms me. I’m especially overwhelmed by the culture in this country. I’m especially overwhelmed by the culture in this city in this country. I’ve spent the vast majority of my life trying to fit in to a world that I didn’t really want to be a part of. But I was never told that it’s ok to be different, to be exactly who you are and this trait of mine was not nurtured. If you’re like me, read this book.
It’s also called lurch gait. This gait pattern I bet is really, really common in stroke survivors. Trendelenburg gait happens when one side of the body has really weak hip abductor muscles. This is what happens……when you’re walking…let’s use the right leg, I’m gonna describe what you’ll see with the right leg. When you’re walking and it’s time for the right leg to leave the ground and advance forward, you need muscles to kick in so that your right foot can clear the ground. A lot of times after a stroke your leg will have trouble clearing the ground because of weak shin muscles leading to foot drop meaning you must strengthen your tibialis anterior muscle. In this case, it’s weak hip muscles. Stand on both feet, now lift up your right leg, do your hips stay level and unmoving or when you lifted your right leg off the ground did your right hip drop? The correct answer is that your hips stayed level. When you lift up your right leg, the hip abductor muscles on the OPPOSITE side of the body turn on to prevent your hip from dropping. Since your left leg is stationary, the only way to ABDUCT(move away from the body) the left leg is to raise the right hip. If the hip abductor muscles on the left side are weak, the right hip will drop when the right leg is lifted off of the ground. So if you see a hip drop on the right side, it means that the left hip muscles are weak.
This drop of the hip is called the Trendelenburg sign. Sometimes, the body has compensated in order to find a way to clear the foot when walking. This compensation is by the upper body leaning to the left(in the case of right hip drop) in order to pull the right leg up and allow the foot to clear the ground. So the body will lean to the affected side during advancement of the opposite leg. If you’re affected on the left, the upper body will lean to the left when advancing your right foot forward during the gait cycle. If you’re right side affected, the upper body will lean to the right when advancing the left leg forward. So if this happens to you, you’ll want to exhaustively strengthen the hip abductor muscles.
This is yet another phrase I haven’t seen in a few years that I saw the other day doing my chart reviews. This goes for every joint in the body. Depending on the position you place the joint in, it’s called either open or closed pack. Open pack means the joint is all loosey-goosey, that the ligaments holding the joint together are not taut. The joint is considered rather unstable in the open pack position. Closed-pack position is the opposite. The ligaments surrounding the joint are pulled taut. A sprain of a ligament usually will happen when a joint is in closed pack position and an extreme force is applied. I mean if the force is great enough a sprain or tear can happen in the open pack position too. In the open pack position the joint is really unstable so…you have more of a chance of performing a movement that will cause an extreme force because of the instability of the joint so forget what I just said I’m just thinking out loud. No I’m not, I’m thinking out typing??? Whatever. Think of the elbow, easy example. Straighten the arm, your forearm barely moves – that’s closed pack. Bend the arm 70 degrees, it’s a heck of a lot easier to move the forearm around right? That’s open pack. When performing joint mobilizations, the joint should be placed in the open pack position.
I have written many, many times about how the transfer of thoughts in my head to words out of my mouth is all messed up. My mind works light years faster than my mouth. There is a HUGE disconnect there. It’s not the same when I write and it never has been. From day one, I could write coherently and express myself that way, not that anyone gave a damn what I had to say. But when I tried to speak – not only was speaking physically taxing and my speech was all messed up but what I said was at times completely different from what was in my head. It was never like that when I would write, well type, never. If only I could write and didn’t have to rely on typing.
I was at a friend’s house this weekend and we were playing the game Catch Phrase. Know what that is? It’s a game where you’re given a word and you’re supposed to make your partner guess that word. Before the stroke, I was a spitfire at games like this. Now, not so much. When it was my turn to guess the word, I had it in my head but it wouldn’t come out of my mouth. When it was my turn to try to make my partner guess a word, again I had stuff to say in my head, but I couldn’t get it out of my mouth. Every turn was timed and that did me in. The pressure of a timer just totally made my attempts futile. I highly recommend you do not play games with other people that are timed unless you know the people really, really well because you will NOT do well.
A search term on my blog is frequently “up with the good, down with the bad.” I wrote a post entitled that same thing over 2 years ago when I thought I knew something. Now what I know is very, very, very different from what I thought I knew then. My boyfriend sent me this link about the scariest stairs in the world and said we should visit all these places. My response: HELL NO! I will never know what it’s like to climb to the top of The Statue of Liberty, or climb the Cape Horn stairs in Chile, or the Inca Stairs in Peru, or the Mount Huashan Heavenly Stairs in China. Ah well, such is life. I probably wasn’t gonna do any of that stuff before I had a stroke anyway. If I climbed any of those staircases, provided I didn’t fall to my death – which is probably what would happen, this is how I would do it.
Up with the good, down with the bad means that you should lead with your “good” leg to lift you up a step, then do the opposite on the way back down and lead with the “bad” leg going down steps. The reason for this is that the raising and lowering of your body up and down the steps you want to be done with the muscle control of the “good” leg. Using the “up with the good, down with the bad” technique is how to accomplish this. Climbing stairs like this means that you will be climbing stairs with both feet landing on the same step each stair you climb.
I no longer do this. I can now negotiate up and down stairs reciprocally, meaning one leg after the other, one foot on each step. Normally. As long as there is a handrail at the proper height and on the proper side, I think I might even look normal negotiating stairs. Carrying stuff up and down stairs is a whole different ballpark.
The company that I work for is 100% orthopedic. My boss has told me that down the road they would like me to maybe do some neuro rehab. Neurological physical therapy. This won’t happen for a few years, I certainly can’t be a practicing PT right now. Well, I guess I could – I don’t know. I’m assuming my bosses have the opinion that I sure shit know some things when it comes to rehabilitating a brain. And I also get emails/questions from people around the entire world about things to do after a stroke. Everyone who reads this blog regularly knows I am a HUGE advocate of meditation and its beneficial effects on the brain and body.
As far as physical therapy stuff is concerned – I got that covered. But there is a crapload of other stuff that you should be doing that doctors will not tell you so I’d like to know. Dean, I read your blog daily and believe me I will be sharing the research you’ve devoted your life to finding that is currently being ignored in the medical establishment. To everyone else that isn’t Dean 🙂 – if something has really helped you, please tell me so that I can pass that information on.
Please go here for a better, affordable alternative to learning Transcendental Meditation.
In my previous life, I let people walk all over me, never expressed how I truly felt, and wallowed in anger in private. All of this anger and stress probably contributed to my stroke. Well, a few things have changed and now when I’m upset with someone I tell that person, if it’s worth telling that is. Sometimes it’s just not worth it. There have been a few instances in the past few years where other people have tried to take credit for my ideas. When I went back to OT last summer, I did mirror therapy which helped me greatly. It was completely my idea and my request that we do that. At the end of my sessions, my OT (who I adore) said to me “now aren’t you glad I convinced you to come back for treatment and do mirror therapy?” No honey, it was 100% my decision to go back for some OT and it was my request to do mirror therapy. When I started the therapeutic yoga that I do, it was for a very specific purpose that was completely unrelated to my stroke. I started KY because of research that I found about it. There are many protocols/kriyas in KY that have lots of published research to support them. For the entire first year of doing KY, it was like this. I would find a protocol that I wanted to do based on my research and it would be taught to me at my request. Singing lessons were started because my therapist – talk therapist, NOT speech therapist recommended that I try that. I’m kind of disgusted that my singing lessons have helped me so much more than any speech therapy ever did. Oh well. I want to give credit where credit is due and I absolutely, most definitely have – and then some. The point of this post is to tell everyone that other people have had very little to do with the decision-making process of my recovery so far.
My former yoga teacher is the #1 person who tried to take credit for my research, my discoveries, my work, MY recovery. I have referred some people to and am now very embarrassed about it
The first couple of years that I was a practicing physical therapist, I was scared of everything. It’s really scary when someone that’s already in a lot of pain and coming to you for help tells you that the exercises that you asked them to do caused more pain. That’s a scary thing. That’s when confidence and experience become critical. Now, I only have 4 years of work experience so I don’t want to give the wrong impression but that being said, I kinda know a lot and I was really good at what I did. I only have 4 years of work experience but I have personal experience now that most health care practitioners with decades of work experience don’t and never will have. It took a few years after getting a lot of good results with people to have the confidence to say to someone “I know it hurts a little more or in a different spot, that’s ok. Keep doing the exercises and I promise you’ll feel better.” That wasn’t always the case of course but I knew what to do and how to deal with it after a while.
When I got sick, and when I was doing inpatient rehab, I could have done a whole heck of a lot more than I was asked to do. But I’m sure my therapists were absolutely terrified of me. First of all, I was the youngest person in the stroke unit so that alone probably scared them. I was bald, I had an enormous scar on the back of my head, I was shaking uncontrollably due to my tremors and ataxia, I could barely speak. I looked like absolute, utter hell. So I’m sure they were scared shitless and were terrified to ask me to do any real exercise. It’s not their fault, it’s what they were taught and how they’re told to treat. In therapy I was tired as hell because I wasn’t allowed to sleep when I needed to be asleep. I was scheduled to go therapy based on THEIR schedule, not mine. I wasn’t AT ALL getting what I needed.
To say that I have a bit of a different perspective on some things than I did 4 years ago is an understatement. Neuro rehab is really messed up right now. The things I described above are why we need protocols in stroke rehab. Many, many, many stroke survivors that I know have said things like “it seems like no one knew what to tell me to do.” It’s true, therapists don’t know what to say to you. Don’t get me started on neurologists. I’m supposed to take aspirin everyday, well I asked 3 different doctors how much aspirin I should take and got 3 different responses. One extremely arrogant neurologist that I went to told me that the fatigue I experience is not a result of the stroke. Jesus, what an asshole.
I could’ve done a lot more but the PTs were afraid to have me do stuff. I get it. I would have been afraid too. I blame the doctors and researchers for not knowing a GD thing when it comes to stroke rehab. That confidence and experience that I mentioned up above does not apply when it comes to rehab after a stroke. It just doesn’t exist because there is no standard of care in stroke rehab whatsoever. As an orthopedic PT, I would get protocols every day about how specifically my post-op patients should be treated and when they should be asked to do certain things. Nothing like that exists for stroke rehab. Nothing, not even close. Don’t have a stroke in the next 20-30 years. Hopefully by then some standards of care will be set in place and then you can have a stroke, no biggie, but not in the next decade or two.
I recently SERIOUSLY misjudged someone who I formerly had on a pedestal. I was lied to by this person and severely taken advantage of at a time when I was incredibly, incredibly vulnerable. Shame on that person. That person should be ashamed. This person would be quite well aware of whom I am speaking so to that person if you ever read this, SHAME.ON.YOU. You should be ashamed of the things you said and did to me. When I figured everything out and came to the conclusion that in my opinion this person is extremely toxic, a complete hypocrite, fraud, and not at all what I had thought for quite some time, I was really embarrassed. I was so embarrassed that I had previously spoken so highly of this person. If someone speaks really highly of someone, like really really highly, like the way I used to speak of my former yoga teacher (a 150% narcissist) on this blog, be very cautious because the person saying those things might be being badly manipulated and brainwashed like I was. But I realized that this kind of thing happens to everyone. So if it has happened to you and now you’re embarrassed about it, it’s all good. 😊 It happened to me, and it’s not the first time that it’s happened but hopefully will be the last. Well, the next time that this kind of thing comes my way I’ll spot it from a mile away and won’t allow it into my life. Live and learn.
If you plan to contact someone, particularly the person of whom I am speaking, that I formerly recommended on my blog and pay for their services, pay for help, please e-mail me first and I’ll tell you what happened to me which cannot happen to anyone else which is a severe, severe abuse of the power that this person thinks that she has.
Here is my review on Angie’s List of my former yoga teacher which I have referred some people to and am now very embarrassed about…….
I want to warn you, keep reading and you’re going to get very angry. If you choose to read the article that I’m going to link to, read it sitting down because your blood pressure will rise dramatically. High blood pressure is a risk factor for stroke….so maybe don’t read this. But read it. Have you been curious as to why the abbreviation NFL now stands for National Felons’ League? Well, here is why that is. This is an article about how a doctor said that the brains of these players are really f’ed up because of the repeated blows to the head and how it was causing lifelong disabilities, and the NFL IGNORED IT. Not only did they ignore it, but they tried to discredit this guy and his research and said it wasn’t so. The NFL wanted their own doctors to make a statement and these NFL doctors IGNORED the truth and tried to say otherwise because they were getting PAID to say otherwise. Because they were being paid to say otherwise. Talk about a severe abuse of power. Talk about not wanting to genuinely help anyone. This is the overwhelming attitude of the majority of doctors that I have encountered after my illness. I’m so f’ing sick of this culture. This article is 5 years old but is really relevant right now because a movie is currently being filmed about this doctor.
A lot of my posts recently have been really orthopedic because of my job. I’m seeing all these words that I didn’t use for 3 years and it’s triggering ideas for blog posts. Your calf muscle. Your calf muscle is actually 2 muscles, the gastrocnemius and the soleus. The gastrocnemius is the muscle that everyone thinks of when they say ‘calf muscle’ and is the muscle that’s really defined when someone says ‘look at her calves.’ Underneath the gastroc lay the other calf muscle, the soleus. Ok, here’s the difference in those muscles. The gastrocnemius crosses two joints, both the knee and the ankle. The gastroc when contracted both points the toe and bends the knee. The soleus on the other hand only crosses and affects the ankle joint, so its only action is to point the toe. Because of that, when you stretch these muscles, you have to bend the knee in order to stretch out the soleus to take the gastroc out of the equation. These muscles are very important in your gait cycle and are responsible for ‘toe-off’ which means that when one leg is about to lift off of the ground at the end of the stance phase of the gait cycle, your gastroc/soleus complex is engaged and as a result of these muscles causing your toe to point – since your foot is stabilized on the ground the only way that your toe can be pointed is if your body is lifted. So you have toe-off because after that you’ll swing that leg forward. If you think you need to stretch out your calf, stretch both muscles. Here is what the stretches look like…..
The answer to this question is because I had a stroke and can’t run GC.
A search term on my blog today was “soap note for hip lateral shift mckenzie.” That was written by a physical therapist. That is really specific and it uses therapist speak. I didn’t realize how much I loved and missed this stuff until recently when I started being immersed in it again because of my chart review job and realizing that I will most likely never do it again. A lateral shift means your low back hurts. Or maybe your hip hurts. When a lateral shift is present, your upper body is shifted to either the right or left because (probably because) an intervertebral disc in your low back is displaced (bulging) out to the side preventing your spine from being straight up and down like a good spine should. Your upper body is “leaning away from the pain.” It looks like this……
(Pic from here, they have British accents and say physiotherapist, I love it!) That picture is a bit exaggerated. The shift is always named by the superior segment so in the picture that would be called a left lateral shift. So how do you fix it? Well…….if your shoulders are shifted to the left and you have low back pain, I’ll bet you a million dollars that your pain is on the right side of your low back. Or in your right hip. Or you have pain going down your right leg. To eliminate the pain, first you want to see that pain ‘centralize’ meaning moving the pain to the middle of your low back and not just to one side. So first you have to address the shift. There are ways to try this yourself but you might need a PT’s help the first few times. Here’s the exercise to try on your own. This is for a left lateral shift which means your shoulders are shifted to the left relative to your hips and your low back pain is on the right. If the exercises don’t work, here is what a therapist would do. Then this kind of thing would typically be followed by some by some extension exercises. These extension exercises would be progressed as much as need be and you would be lectured to about having good posture and then you would be tested bending forward to make sure that doesn’t bring the pain back and if it doesn’t you would be discharged never to be seen in PT again unless you have a stroke.
DISCLAIMER: I had a stroke, so don’t you dare listen to my advice.
Barb, who had a stroke in the temporal and frontal lobes of the cerebrum 5 years ago, just published a book about her recovery process. It’s about fighting to get back to be able to do the thing she loves most in the world when doctors told her it was hopeless. I just ordered it here and you should all too.
Someone landed on my blog yesterday by googling “what is the physiologic reason for wrapping an ACE bandage from the bottom to the top?” Good question, here’s the answer. There’s gravity ok? So because of gravity all the fluid in your body goes down. Let’s use the example of a sprained ankle. If you sprain your ankle, it will swell as a result of the body doing its thing as the first step of the healing process. So you wrap up the ankle and the proper way to do this is tighter at the bottom and getting looser as you continue to wrap up the leg. The reason for that is this…..you want to direct all that inflammatory fluid towards the heart so that you encourage it to get back into the circulatory system and be processed. You know the acronym RICE? That stands for rest, ice, compression, elevation. Rest – self-explanatory. Ice – cool down the area and it slows down the arteries and other vessels and stuff and cuts down on swelling. Compression – also cuts down on swelling but make sure it’s not compressed too much so that it cuts off blood supply. Elevation – same reason that you wrap something “from the bottom to the top” – you want to direct fluid towards the heart and encourage it to get back into the circulatory system.
My grandfather was insanely stubborn and for the reason above he was repeatedly told that he needed to elevate his legs at home, to direct fluid towards the heart. But he wouldn’t do it. So finally one day his health care practitioner person was fed up and told him “if you don’t start elevating your legs I’m gonna have to amputate them.” I have no idea if he then started to elevate his legs at home.
Another way to direct fluid towards the heart is through exercise. Ever been told to do ankle pumps on an airplane and get up and walk a few times during the flight? Exercise gets the muscles moving which manually makes the veins move and moves blood so that it doesn’t pool at the bottom of your legs.
The first time that I wrote about neglect I wrote it from the viewpoint of an arrogant PT who because I learned about it in school, thought that that made me some kind of authority on the subject. That by NO means makes you an authority on ANYTHING. That makes you someone that other people can use as a resource for information. An authority – no. I am still no kind of authority whatsoever about unilateral neglect because I never had it. I did however have a massive stroke so it’s ok if some people look to me as an authority on the general topic of stroke and brain injury, but not some specific things that can happen as a result of a stroke. I remember – this was like a month after the stroke – right after being discharged from the hospital and before I began outpatient therapy, that I had a few sessions of home PT. One time when a physical therapist was there, a different one came for every home session, I reached across my body with my left hand for a tissue that was on my right side. To this my therapist said to me, “Honey don’t neglect your right side, you have to be aware that that side is there.” Sigh. It wasn’t unilateral neglect that caused me to do that. Neglect almost always happens to the left side of the body anyway. I knew perfectly well that I COULD have used my right arm to reach for that tissue had it been cooperating and would very very very much have preferred to reach for it with my right arm. But my brain wouldn’t allow me to do that at at time. So I had to use my left arm, it wasn’t because I was neglecting my right side or had lost any awareness of my right. My right side just didn’t work. It still doesn’t work anywhere close to normal but I can do a lot of things with it now that I couldn’t then. I could do nothing with it then, nothing. Now I can use it for any gross motor movement like opening doors and stuff. I can use it some when driving. I don’t use it too much because if I do my tremor starts and it will cause my entire body to shake and that’s not a good thing when operating a motor vehicle. But it helps some. I can use it to help stabilize the steering wheel for a few seconds or use it a little when I’m turning. I make right turns, I’m not neglectful of what’s on my right. Writing with my right hand is out of the question. I’m very much afraid that it might forever be out of the question. I don’t have much hope anymore for getting fine motor movements back.