Saturday, February 11, 2012

State of the Newman

I had my strokes starting four months ago today; time for a round-up of what I think is happening in my brain and body at the moment.

Apart from, the problems common to most strokes, I have three principal deficits: left side facial paralysis, vision and right side weakness. The change in side (at the base of my neck) is because I had several strokes: different strokes, different deficits.

The left side facial paralysis has undoubtedly improved since I was last in New York, nearly three months ago, but slower than it did initially. I expect it to keep improving, but over months, rather than weeks, and it would not surprise me (and no longer horrifies me) that it might take years to effectively eliminate. One of the difficulties is in activating the many muscles of the face. I find I focus on muscles that I feel responding, often long before they visibly respond, and exercise those, there being no other way to get facial muscles to move independently.

One thing that helps get the paralyzed side moving unconsciously is conversation. Although it is hard to get stuck in to a good chat when much of my side is limited to the somewhat boring topic of me, my stroke, and my recovery. Anyway, if you see me in a hangout, or with video chat enabled and have exciting news, are morbidly curious, or just feel like saying hello, then do so!

My vision can be broken, think, into two discrete deficits: double vision(diplopia) and "one and a half syndrome." They're obviously related, but from where I'm sitting, can be addressed separately. The diplopia has been enormously debilitating: unaltered, I can't see well enough to walk without falling over, or even read, which has been a keystone in my life. To function, I've had my left eye occluded for most of the last few months: I can see a blurred, misty version of the world form my left, which my brain has got quite comfortable at rejecting, in favour of the sharper, more consistent and usually more reliable image that my right eye generates.

I'm starting to see signs that the diagonal diplopia is resolving. With many brain-related injuries to the sight, though, it can be hard to tell. I have never understood quite so well that the brain sees, while the eyes provide data. Nevertheless, this is on target for the ophthalmologists, who essentially said"wait 4-6 months and call us after that." It turns out that most visual problems resulting from stroke resolve themselves, although that's not guaranteed. I should add that to say they "resolve themselves" is to ignore the fact that I have been exercising particularly my left eye as best I can: what recovery is possible is, in my opinion, accelerated by effort if not initiated by it. Note that it is quite difficult to engage paralyzed extra-ocular muscles.

Which brings me to the one and a half syndrome which turns out to be really quite rare. Rare enough that I was asked if I would mind being in a database of patients with conditions that could be used for live neurology exam questions! Again, this seems to be improving with hard work: my left eye tracks past the midline now, where once it did not at all. Even if it doesn't resolve, I now find that this isn't so bad a thing, by comparison to the diplopia. It's far easier to compensate for, and would be much easier to live with. In other words, my vision overall is troubling me a lot less.

Finally, there's my right-side weakness. Recovering from this goes hand-in-hand with gaining cardiovascular fitness, because it's impossible to do the strength and endurance work necessary without being a lot fitter than a stroke and hospitalization left me. For pure CV fitness, recumbent cycle, rowing machine and treadmill are my staples. The elliptical walker / cross trainer is too hard--for now. With the treadmill, I've been increasing the incline rather than the speed to get an increase in heart rate, keeping the machine at a pace where I can still concentrate on my gait, and not limping. Re-learning how to walk before I run.

Almost all of the work to date has been focusing on walking and balance, somewhat ignoring my right arm. Part of the problem is that my arm is fairly strong--or seems that way with a traditional neurological assessment. But it's not nearly as strong as my brain expects it to be, and it's not strong enough for me to write smoothly. Added to which, my grip strength is greatly reduced, and my fingers are still less sensitive, leaving me clumsy. It's a bit like having two left hands, only the right-hand one is feebler. I've added in seated row, shoulder press and chest press to start working on the arm and shoulder, and next week more grip exercises shall ensue.

Swimming seems to allow me to address the right-side more holistically. Maintaining even buoyancy is instinctive and uses many more muscles of my body than anything else. Added to which, it's almost impossible to hurt yourself just by swimming. So, lots of swimming which seems to be having a generally beneficial effect. 

All in all, I'm definitely feeling better. Today I felt, I think for the first time, more like someone recovering from a stroke, than like someone surviving after a stroke.

(For the non-USians, this was a heeeelarious pun on the President's State of the Union address. A pun I am likely to perpetrate again.)