Don't Kid Yourself, Push Yourself

I just got back from the pool again, but instead of swimming for two hours, I only swam one. 2,100m in an hour, breast stroke, isn't too shabby for a brain damaged old fart like me, but I would rather have been swimming lengths for twice as long without pause.

Alas, it is a sunny day and right in the midst of resolution season, so at noon the pool filled up. I've mentioned before that I become extremely intolerant in the pool, and that does not seem to be something that is changing. I'm not trying to change it, either. I spent much of the hour I did manage to swim dodging the pair having a leisurely chat while ambling up and down the pool, mostly keeping out of the way of the guy who swam, turned and repeated (me).

In the middle of this, ungenerous thoughts filled my mind, often along the lines of "get out of my damn way," with a sprinkling of "your screw kick is horrible" for good measure. One thought is applicable to anyone gripped by resolution fervor but feeling the drudgery of slow progress, or the gradual sapping of their will, and it was exemplified by the slow pair in the pool: "stop kidding yourself!"

The duo were maintaining a steady and unfettered chat throughout their 'exercise.' They were not short of breath (they were nattering for England), and if they were warm at all, it was because the pool is too hot. They might as well have been having a cup of coffee instead. They certainly don't deserve any plaudits for working.

It's an easy trap to fall into: "it used to be difficult, but is easy now, it must be enough". Complacency is a surefire way to stop making any progress, though. If you have enough breath to maintain a conversation while swimming you are either phenomenally fit or you are deluded and doing it wrong.

As we get fitter, what was once hard becomes easier. Great! That means we have to work harder to get the same effect. It should never be trivial, it will always be hard work. Deal.

Scoring Goals

Two years ago and change, I had a clear goal: I wanted to get home. It was not very generous to the home I had lived in for most of the recovery until then, my father, stepmother and sister's home. Nor very generous to them, or the many people around me who were invested in my recovery. Nevertheless I wanted to be well enough to go home to New York City, where I've lived all millennium.

Without realizing, I had a clear and attainable goal for exercise, and through exercise, recovery. Returning home, though, has been a problem. Sure I have a ton of friends here, and a great support network, but my goals for recovery have been too distant, and I have often failed completely and fallen into a mire of doubt, depression and inactivity. My goal to walk on my hands again is too far away to be useful.

I also have a different perception of expectations here in New York. When I don't go to the gym or pool, then I feel as though I'm the only person who suffers. Back in England, I feel more keenly that I am disappointing the people around me. It doesn't make a lot of sense: people in the US are just as invested in my recovery, and people in the UK are invested regardless of where I am (not to mention those elsewhere). It may not be wholly rational, but I find it easier to exercise in the UK than in the US.

Of course, since I'm aware of the problem, I'm trying to fix it, but setting a goal that makes sense is hard. Right now, I'm lucky: I have a definite date by which I want to be in as good shape as possible. That means swimming 3-4 times a week, and going to the gym 1-3 times weekly. Or I fail. No excuses, no alternative.

Come January, though, what then? Goals to lift weights aren't very useful to me. I already swim for at least an hour and a half, non-stop. What next? Something attainable, achievable through diligence, beneficial. If I think of something, I'll let you know.

Recovery Blues

About two weeks ago, I swam 4km, without pause, in just under a couple of hours. I was pleased with myself. Then a conflation of circumstance provided a good excuse not to go to the pool or gym for about two weeks, setting me on a vicious circle that I will try to illuminate. Our demons have less power over us in the light of day.

There seems to be no escaping the fact that recovery is so slow most of the time, that it feels as though I'm making no progress. Nearly two years after the strokes, I feel, if anything, in a worse place physically than a year ago. This is objectively false. A year ago, I could not swim for two solid hours. That doesn't alter how I feel about it though: my brain is pretty stupid and impatient. Unless I actively work to contradict this feeling, it reigns. 

Then there the deficits that are most debilitating, whose changes are so slow that I have to wonder whether I'm improving or delusional. Physical strength is relatively easy, wobbling eyeballs and shaking arms are hard. I have to sustain a high level of trust that these things are improving, and will continue to do so, although there's no way to verify that there is any change. 

So, I'm already facing a struggle up a slow hill. Add in the unfortunate reality that it takes about three days of rest before I have deteriorated enough physically to notice a reduction in function, and the struggle is Sisyhpean. The memory of how easy things used to be, the casual eptitude of the people around me is Tantalizing. To stretch this analogy, whenever I feel like I have accomplished something, the eagles of depression come and feast on the liver of my optimism. Prometheus-like, it regrows, but not overnight. 

When I take a longer rest from exercise, as little as a few days, I don't want to start again because my progress is so slow, and so easily reversible that it feels pointless. Worse, I know that starting again means never stopping. Not, at least for more years than I can effectively compass. There is no end state. I can tie my activity to other goals, but recovery itself is too elusive to have meaningful expectations. 

The only refuge, it seems, is to be bloody, bold and resolute. Rationally, I know that I am better now than I was a year ago, and so I must let Reason dominate while Emotion endures. Boo-hoo.

Sabotage!

On Tuesday, my roommate left for Gen Con, where he'll be showing off his excellent new game, Torchbearer, and hanging out with a load of people I would love to see. I'm a little jealous, but quite glad I am not there because right now I can live without the punishing schedule and lack of a gym. 

I have been exercising more again, after gaining a bunch of weight when depressed earlier this year, and fighting to remind myself that "good enough" is no such thing when it comes to my recovery. It gets easier to accept compromise and not recovery, so I have to actively remind myself first, that I want to recover physically as much as humanly possible, and second that such a recovery only happens if I take exercise. 

To build up my overall endurance, I swim laps of a pool that is miraculously on my block, but is a bit skeevy. Fellow New Yorkers will know how unusual it is to have a pool right there, so the skeeve is a minor hindrance. I go to the pool on weekdays, typically, and to the gym on the weekends. Since swimming in a straight line requires concentration, my vision is poor and the pool has enough chemicals in to be murky, those are the times I can go and hope for fewest other people to collide with.

Anyway, on the Tuesday, I was primed and ready to go to the pool, when Thor set off, and a naughty thought popped into my brain: I could stay at home, not go the pool, and nobody would ever know! Never mind that this is not true, because I log all my exercise on Fitocracy, and that it makes no appreciable difference to Thor whether I swim or not, there was the delicious temptation to get away with something.

It didn't matter that I would, in the long run, suffer for not going, nor that after the first half dozen or so lengths I settle into a pleasant rhythm; the opportunity to pull a fast one was almost irresistible. Almost, but not quite: I told my brain to go screw itself and went to the pool. 

Unfortunately, my brain had a few tricks lurking in the grey matter. When I got to the pool, I discovered that I had left my fancy new swimming watch behind. I went and got it. Back home, I was again tempted to be all huffy about being jerked around by my brain and just not go, but I quashed the temptation, and set off again. 

I got about two steps out of my front door, before realizing that my brain had made one last desperate attempt to skive off: I had left my walking stick behind. Happily this all had the reverse of the desired effect: I was more determined than ever to go swimming, and I did. 

My brain has had the last laugh, though. This morning, I took my time getting up, and faffed around on the Internet, until my brain gleefully remembered that I have an acupuncture appointment today. There's not enough time to go swimming and to make it to happy fun needle time. Bugger.  

Taking Fatigue In My Stride

Last week, I worked quite hard: I swam on the five weekdays, for a total of a hair under 10km, and then went to the gym at the weekend. I went to acupuncture twice, and managed a few social engagements as well. After each bout of exercise, I felt 'good' tired; my muscles felt like they had done some work, but not sore. I might be a bit achy the next day, but I hadn't overstressed anything.

I have to watch my overall level of tiredness as well as, though. If I do too much on one day, then I'm often much less effective the next day, sometimes to the point of being a total spud.

Having to watch my fatigue is often counterintuitive, because I'm gauging neurological tiredness, and we've evolved to be better judges of muscular states. Pumping a bunch more adrenaline out is not going to help me escape the hungry lion, if it's my brain that is not going; my legs are still going to flail about.

The problem with taking too much rest is figuring out how much is 'too much'. If I don't stress my system just the right amount, then it will take longer to recover. I am already comfortable with the notion that it will take years of work to get better, but if I can shave months off that time, I want to.

So, yesterday, on Monday, I had to decide whether to go swimming or not. It was a crappy rainy morning, which definitely influenced my mood, but rain often makes the pool less busy. Muscularly, I was a little sore, but I expected that after working out my upper body on Sunday. However, I felt tired yesterday morning, and decided not to go, full of misgiving that I was just being lazy and self-indulgent. I spent much of the day feeling itchy to go swimming, but tired enough to take a short nap.

It was the right call. I'm sore today from the Tui Na massage I had yesterday, but I just swam two and a half kilometers, and I feel 'good' tired again. Sore, but ready to go again tomorrow. It wasn't the first time I've had to make that call, it wasn't even the first time I made the right call, and it won't be the last. I'll be making those calls for years to come. I just hope that I get a little better at balancing efficient recovery with living a real life.

Taking Advantage of the Stupid Brain–an Exercise Hack

A lot of recovery focuses on how amazing the brain is, how it is astoundingly good at picking up the slack left by damage, and how resilient it is. To be this way, the brain itself has to be stupid and lazy, at least when it comes to self-aware animals like us. If we're cunning, though we can use some of that stupidity and laziness to our advantage.

The brain is evolutionarily geared to prefer activity that takes least effort for greatest reward. Throughout our lives, it tries to make our actions, in particular, as efficient as possible. Not only do we use less energy that way, but we end up using fewer neurons for things that we do repeatedly, and have more brain left over for complex, abstract thought. If you have ever got to work but don't remember the coffee you drank on the way, you've felt this.

This process can be seen in children when they go through adolescence and prune an amazing number of neural pathways to leave optimal paths, and the clumsy duckling becomes an elegant swan. It's what is really going on when we talk about "muscle memory"—when a complex sequence of physical actions is neurally optimized as an atomic unit that, once initiated, completes without conscious intervention.

It's impossible to decide consciously which path is going to be optimized, and which is going to be discarded; repetition tends to be the key, at least for physical activity. How do we determine, though, what habits of mind we can form?

Although the impetus to exercise was clear to me, a year ago, it's not so clear now, not so immediate. Put another way, the small incremental gains I get in function are proportionately less significant, so I appear to be getting less reward for more effort. Put yet another way, it's gotten harder to go to the gym and pool.

So I tried a hack on my brain, to see if I could make going to the gym (and pool) easier. I've already made the going as efficient (and energetically cheap) as possible, so the idea was to front-load the reward. Typically the benefits of exercise that we can sense, and the brain can operate on, come too late for us to associate the action of going to exercise with the reward of having exercised. The hack was simple: any time I thought about the action of going to exercise, I would then say to myself, with a mental tone of glee, "ooh, goodie! I'm going swimming tomorrow!"

That was it. I didn't have to mean it, and I frequently didn't, I just had to think (or say) it, no matter how artificial. That was the totality of my experiment.

It worked.

I was far more likely to actually go to the pool or gym, after I had thought "yippee! gym tomorrow! and legs, I love legs!" (I don't), the night before. I'm hoping that in two or three years' time, I won't have to say my silly fake mantra, because my brain will have associated the benefits of the exercise with the (short and painless) drudgery of getting to the exercise. Until then, "Yay! Skeevy pool tomorrow!"

Brain Experiment

As part of my effort to transform my life so it's not defined by brain damage, I'm trying a brain experiment.

People often waffle on about the 'power of positive thinking' and it seems to me to me to be so much superstitious magical thinking rubbish. By contrast, however, I am convinced of the brain's plasticity, and our ability to change the patterns of the brain--our habits--by the action of our conscious mind.

So here's the experiment: every time I think "Ugh. Gotta go to the gym (or pool)." I am going to stop myself at "Ugh" and change that into "Yay! Time to go to the gym (or pool)."

It's going to be easier with the gym than the pool, because although the gym tends to be more physically strenuous, the pool I go to is kind of sketchy: it is a stupid length (22m, I ask you), is cloudy with chemicals, and the changing room is frankly nasty. The pool is on my block though, which easily outweighs any flaws.

The brain doesn't change without repetition, attention and intention, though, so it won't be enough just to think the words. I'll have to focus on the after-effects of exercise before they've happened, to strengthen that association; the pleasant glow of used and tired muscles, and how good that can feel.

If it works at all, it will take a long time for the artificial to become automatic, especially in an adult brain, but if it does, I'll let you know.

Young Adulthood Is a Trap

As I look at my life and swing between feeling ancient (when I'm outpaced by geriatrics in the pool, or struggling to keep up with my walking stick) and between feeling the same age as I did in college (a surprising amount), I think the calorific bounty of our age lays a terrible trap for younger people; a trap that I walked right in to.

When I was in my teens I was strong, fit, lean and healthy. I also ate a frankly vast amount, and it didn't affect me much: I was growing enough and active enough that I could shovel great piles of junk food in my mouth and be little the worse for it.

College involved less food, but also less activity, and a lot more booze (lots of calories!). In my early twenties, I could still eat a bunch, drink plenty, and stay in reasonable shape with as little as 45 minutes of squash every week.

What I didn't realize, until it was too late, I was 40, and I'd had a stroke, was that I had encoded the idea that I could eat anything, do a little exercise, and be just fine, into my brain's world view. Because it seemed to be true. I made a habit of eating large amounts, and exercising only rarely.

Therein lies the trap: it is true, but only for the quarter to a fifth of your life (assuming you'll be 80-100 years old) when your brain is most malleable. The sad reality is that for the majority of your life, you will need to eat less and exercise more to stay healthy, all evidence to the contrary.

I guess it's one of the modern tests of adulthood: can you override your biology to account for our time of plenty, and thereby survive to old age? Not everyone is as lucky as I was and gets to retake a failing grade.

(Of course I'm aware that not everyone is living in a calorie glut; I hope this isn't obscene and offensive.)

Starting Strength and Stroke

Lest you think I know what I'm talking about (or that anybody does when it comes to non-geriatric stroke recovery): This dude had a stroke with similar gross effects to mine, and has made similar gains using Starting Strength. In fact in some areas he's done better: his balance has improved more than mine. Probably because I am very bored by many of the balance exercises (which is why Tai Chi works well... not boring). Anyway, I was interested.

Exercise, Meditation and Brains

I've been wondering about this thing that we do; it's not just me, because I've heard others describe basically the same thing, so I'm going to go with it being universal. If it doesn't affect you at all then please say so. In my case, it applies most clearly to meditation and exercise, but other things too. Things that I like doing, even.

Both meditation and exercise make me feel better. I went to the gym this morning, worked hard, and feel better than before I worked out. Both things are work, though, or perceived as hard. As a result, I don't want to do them. Right up until the moment when I see myself as starting them, I'm looking for reasons not to do them. Despite the fact that I know I will feel better for doing them.

I want to crush this aversion (then bottle and sell the crushing formula for a gazillion moneys). So far, the best I can do is strategize to mitigate the effects, which is little more than hacking, and not a real solution. The  strategies I use most are:

* Trick my brain into starting before it knows what's going on. This only works about once a day, if I get up and am halfway to the gym before I have quite woken up.

* Trick my brain into perceiving the start time as sooner. The moment I start getting my gym kit, or touch my meditation stool, then I have started. I haven't quite managed to extend that forward.

I suspect there's some neat bit of neurological cruft left over from our evolution that doesn't reward deferred benefit adequately, so I have also been crudely trying to hack my brain while I'm at the gym: moving some heavy thing around is hard, but I am trying to concentrate on the good feeling in muscles immediately afterwards.

Perhaps I should also spend more time 'miring my guns.

(There was some good commentary on the original Google+ post.)

Anatomy of Movement

Recently arrived from Amazon, Anatomy of Movement, by Blandine Calais-Germain, and its companion volume of exercises. They're great books, lavishly illustrated, and both volumes are serving me well, in conjunction with all the other exercise I'm doing.

That the exercises are helpful is no surprise: they're well explained and well illustrated (with drawings and photos--terrible hair), cover stretching and strengthening, and have accurate correlations between exercise and specific muscles. There are plenty of muscles affected by the stroke that are not obvious in their failure, although the effect is pretty evident (I fall over), and the volume of "Exercises" helps target them where free weights, Pilates or yoga cannot.

Slightly surprising, though, is that gaining a better understanding of my own anatomy from the first volume has been useful by itself. I have mentioned in the past that every action involving my right side has a conscious component: I can't simply raise my leg, I must think about it. It turns out that knowing what the principal muscles involved and not involved are is useful, and seems to be helping my brain recover.

I'm pretty sure that the deep muscles of my spine are affected, for example, but my brain has not had to work on them for 40 years or more. Knowing what they are, and having tools to exercise them will help with getting them more brain time, which, I hope, means less falling over.

Exercise Made Easy

Since +Terry Romero and +John Stavropoulos said they've been getting back to exercise with [my] swole kick ass workout, I think it only fair to come clean about what I'm doing, and the simple rules of thumb I've been using. Bear in mind that my goal has been to get fit and healthy, but I have to be patient with my post-stroke body, so I haven't set any time or weight targets.

If I can't do a set of 8 reps, with good form then the weight is too heavy.
If I can do a set of 12 reps with good form then the weight is too light.
If I hurt and thus can't function the next day, the weight is too heavy,
If I get the weight wrong but do a set anyway, i.e. the weight was too light, then that's the set I did that day. I know better for next time.
If I did better than the last time on at least one exercise, then that is progress, and that's all I ask for.
If I look at what anybody else is doing, then I'm an idiot: I have no idea if they even have a clue, nor what their goals are, nor what their history is.
If I am comfortable, rather than putting in a somewhat uncomfortable amount of work, then I am doing it wrong.
If I am not certain how to use a piece of equipment, then I ask. Not only are there people paid to tell me, but they are also glad to help.
If I weigh a pound or two more or less, I don't care. A 5-day moving average is a better measure. (Same with BP which I track more.)

The first two are really the core of what I have been doing when it comes to free weights. I'm doing an upper body/lower body split program, with each half twice a week and going to Pilates on the other days. I was swimming on the Pilates days, but my stuff got nicked; I'll be back either when I find my old goggles, or can afford new ones.

For a workout, I warm up for 5 minutes on a recumbent bike (the other kind hurts my ass), always following the rule about not getting comfortable. If you can read while doing anything at the gym, you are doing it wrong. Then I go straight in to the weights; I'm using dumbbells more than anything else, because that works my stability most. I do two sets to go for a low volume, high intensity program that is quite efficient. The first is a warm-up set at about 60% of the weight of the second set, and I'm aiming for muscle failure in the second. Then I add some cardio: rowing machine on lower body days. 

Finally, I stretch for about 40-60 minutes a day, covering all of the major muscle groups. This seems pretty essential for me, if I want my right side to function correctly, but unless you want a laughable range of motion, you will stretch, too.

Because I'm a big nerd, I want to be as efficient as possible, and to be measurable. Two sites in particular have been helpful: +Fitocracy, and ExRx. Fitocracy has been great for keeping me honest, but also for tracking what exercise I did at what weight, and allowing me to see clear improvement, week on week. The community is cool, and knowledgeable, and has something to offer pretty much every fitness goal. You can find me as Ironcinder.

ExRx is an equally valuable site that has imagery for almost every imaginable exercise. When I put together the program I use now, I went there. When it's time to change it up, I'll go back. Also useful was the /fitness sub-Reddit.

Allow months to pass before you feel the benefits. Avoid pain, concentrate on feeling good (because you should be), and don't be crazy: I loved my uncle, but I'm still mad at him for having a fatal coronary on an exercise bike. There is no excuse for not starting now. Your future self is more likely to be around to thank you.

First Full Day Back in New York

Yesterday was busier perhaps than I had planned, but a good first full day home. I re-awoke my gym membership from suspension, worked out for a bit, and checked out the pool on the other side of the block. It's not an ideal pool, but it will do the trick, and it's not insanely expensive if I pony up for a year. In fact, the gm and pool memberships combine to slightly less than what I was paying in Dorset. Sadly, the staff at the Sherborne Sports Center were a lot more awesome than much of the staff here, but the gym is friendly without being too full of scary scary muscle Marys. Except me.

Then onto lunch and a delicious Thali, and a little shopping to get a laundry bag that has two back straps. Essential for balance from now on, and I had a secondary task to do with it. Through al this, I had a sanely solicitous guide. The 59th St interchange can be hairy if you're able-bodied, so it was good to have someone with me for the journey. 

Home after that, and immediately on to pick up the CSA share that some other friends cant pick up this week (because they're in CA) using the aforementioned laundry bag. It was still bloody heavy, but quite manageable, and promises to be delicious. The apples already are. As soon as the next sign-up period rolls around I will be joining. There is no good reason not to.

Finally I was going to put my feet up and watch Murderball only to have a moment of sheer, unadulterated terror: I was not sure I could remember how to work the TV and attendant bits. The ignominy! It turns out I remembered just fine, Muderball isn't available streaming, it's at the top of my queue now. and I watched the School for Scoundrels instead, which was charming.

On balance a good, full first day back with exercise, friends and a final flop.

August Update

Oops, the 10-month update is a bit late, but I promise there's no cause for alarm! Instead, with the prospect of the next update coming from back home in Queens, things are good, all things considered. Of course when "all things" includes brain damage, the devil is in the details.

Generally, I'm doing well; my Dad, stepmom and sister have been away for a few weeks, which has given me more of an opportunity to do things for myself that were once routine, but are no longer. It turns out, for example, that a tremor does not help with egg-beating, so I shan't be making chocolate souffle until I have some motor control back. Similarly, heavy shopping isheavy! And fresh fruit and veg are not light.

Even with my newly-invigorated drive to eat well, I get caught out by supermarket trickery, not sadly limited to the "2 for £3" variety either. I've been buying granola at the local health food shop, but when I saw Sainsbury's (a big chain here) own-brand kilo bag was half the price, I didn't think twice. How bad can granola be? It turns out that, relatively speaking, very bad. It may be half the price, but somehow they have managed to triple the amount of saturated fat, make it lots sweeter, and disappear the nuts. I'll be going back to the more expensive granola that won't give me diabetes, thanks.

Many things are still much slower than they were, and its been especially noticeable in the kitchen. I've avoided finding the whole process depressing by caring far less about some ingredients. Finely chopped onion? This is as fine as its getting until I can hold my knife hand still. I should cook smarter and prepare meals to eat tonight and reheat tomorrow, but I end up eating quite a lot, so that hasn't happened much. I'm also slowly losing weight, while eating what feels like a ton, which tells you perhaps how much exercise I'm getting.

Acupuncture continues to make me feel better, and is the major contributor to the improvements in my face. The paralysis thing anyway; the needles can't make me beautiful! I can feel, and just about see more muscle activity in my left face, so while it will be obvious I had a palsy for some time, I'm confident that eventually my phizog will be back to parity. I chatted with someone who'd had a stroke four years ago at 42, who had no obvious sign of the palsy he had once had, but it was soon obvious that his was due to brain swelling interrupting the nerve, rather than my case where the nerve is OK, but routes to tissue that is dead.

There's every sign that living brain tissue is taking over though, everywhere I've been affected. I'll have definitive proof that my double vision is improving when I go back for another eye exam. Either I'll need less of a prism, or I'm delusional. Unfortunately, the double vision is a binary kind of thing, like the tremor. They are both improving, but while they exist at all they make life interesting. I am a little tired of sidewalks appearing flat when they are not.

I think at this point, my brain is working to adapt itself to having a bit missing. At the same time as its putting in place new pathways to activate muscles from my right little toe to my neck, it still sends expectant impulses to brain matter that isn't there any more. I can know that I'm leaning to the right, and fully expect the neuro-muscular bit of me that learned to deal with that lean at the age of one+, but unless I do something consciously about it,  I will soon be on the floor.

Eventually, I won't have to think about it at all, but walking, for example, is still far from automatic. It's certainly smoother and faster, but I have to pay attention. Sadly this means I meander when walking and talking. Stagger would probably be more accurate. I do not chew gum.

All of which means its worth it going to the gym as much as I have been; it's been worth stretching for up to an hour six days a week. Going to Pilates class has been good for me, so has the ab workout, so has doing some Tai Chi every day. All of these things have made me work muscles in ways that they're supposed to be able to work, hard as that is sometimes, and as a consequence laid down neural paths that I will be reinforcing and one day optimizing for years to come. Getting quite buff at the same time doesn't suck, either.

Member of the Month!

I've been trying to smile for about 8 months; by which I mean smile with both sides of my mouth. So far I've had no success, but it will come. Sadly, I'll work out the palsy too late for the photo they took of me at the gym yesterday to immortalize me in laminate as "Member of the Month" for August.

Being made Member of the Month was great; it felt like an acknowledgement that I have put in a lot of effort to my recovery, and that although the recovery itself and the improvement in my health and physique are reward enough, the effort did not go unnoticed by the staff at the gym. I tend to be at the gym five days a week, now, and I find that if I slack off, then I deteriorate. I'm still functional, just not as good. I hope at some point to have consolidated some of those gains, but I have no idea how long that might take.

Until then walking evenly is deliberate; it takes conscious effort. I could relax and limp and stagger, but that isn't good enough for me. I guess that's why (and I mean no disrespect to them) I feel some modest kinship with some of the Olympians and Paraolympians. They put in an almost superhuman effort to become the best in the world at what they do, while I'm doggedly plugging away with my above-average work to get back to normal function. They concentrate to nail a landing, I concentrate to land each step.

Gaining an understanding of the level of effort, consistent daily work, required to compete at the level of demigods has spurred me on; I can work harder. I may not be the generation they're talking about, but I'm certainly inspired.

Becoming Superhuman

There's no question that I lost some brain matter: that's what having a stroke and having brain damage entails. But as I work to get fitter and stronger and to recover (which is going at least as well as expected because I work hard) I have also been reading about neural plasticity and learning a bit how the brain works.

To that end, I decided that, if I'm going to get fit (and I am), then there's really no reason not to get flexible at the same time. I mean, fifteen years ago, I could walk on my hands, and I was fairly gymnastic. Since I do physio exercises 6 days out of 7, I add to that a bit of work stretching the muscles themselves, and re-educating my stretch reflexes.

Recovery is a slow process; at six months muscles in my leg that were paralysed quite suddenly started to work again. Since I'm in it for the long haul, I shall remake myself into a flexible person. I've got time.

I even went out and got a copy of the 4th ed. of Stretching Scientifically, not because I expect to be able to (or want to) do the splits, which I think are pretty gruesome on a guy, but because I want to learn about the brain-muscle interactions as much as I want to learn about good form for the exercises I do.

On which, more anon...

ASPIRE

I said I had a bunch of posts owing, and this is the first of them, about the ASPIRE program I was fortunate to take part in, at nearby Yeovil District Hospital.

ASPIRE stand for "Acute stroke Self-management support, secondary stroke Prevention, Information, Rehabilitation and Exercise" program. Too many letters, but trust me it looks better on the page, and you end up with ASPIRE. Which I thought was lame as all hell, but I was game to try anything to aid my recovery when I was assessed on Christmas Eve 2011.

As far as I know, it was the first and for a while the only such program in the country; I've not heard of anything like it in the US. It proved to be almost indescribably useful for me.

The program is simple enough to grasp: It runs for twelve weeks, and participants, who have all had strokes and are encouraged to attend with their primary carer if there is one, do an hour of exercise, choosing whether that's before or after the half-hour chat with a cup of tea and a biscuit.

The chats are directed, and cover the bases of providing information about stroke itself, as well as things like medication, nutrition, stress, exercise and relationships, and how they relate particularly to stroke. The conversation often drifted (particularly when I got involved).

The exercise was tailored to people's deficits, and always seemed included a combination of rehabilitation, simple cardio and strength. We were helped into machines if we needed it, encouraged and cheered on by the two stroke ward nurses who run the program, Debbie and Caroline, and a physiotherapist, Donna, as well as the volunteers, all of whom had had strokes in the past.

I never thought that I would be glad to get on a treadmill, but the feeling of being able to walk, even slowly, and even holding on desperately was magnificent. Being in the hospital gym gave me the confidence to start going to a regular gym again, and gave me measurable results for the work I was putting in (see below for details).

Both have proven very useful: I have been enjoying going to the gym and pool four times a week for a while now, and making measurable gains in fitness means I have something to point myself to when I feel like I'm making no progress. The pace of neurological change and recovery is sometimes so slow that the effort it requires seems almost not to be worth it. So I stagger, I think, is that so bad? Can I live with double vision, after all, I'm functioning? 

I refuse to accept neurological deficits, though, and making progress at the gym or pool, however small, gives me enough feedback to persist until my brain does a lot better job of recovery than just good enough.

At least as useful as the exercise, though, were the tea'n'biscuit (cookie!) chats. Less for their content, which was still excellent pragmatic advice of the sort you're more likely to get from a nurse or therapist than you are from a doctor. More for the fact of being in a room with a couple of dozen other people who had had strokes too.

I'm not much of one for support groups. I mean, sure, in theory, but for me? I would have said not, and I would have been wrong. I had underestimated how isolating my stay in the hospital and in-patient rehab facility had been. I think in the twelve weeks before ASPIRE I talked to maybe three people who had had strokes, and that just wasn't enough.

With ASPIRE we had people to share notes with, tips, gripes, and everything else. People who understood in a way that nobody who hasn't had a brain injury truly can what it is like to be recovering from neurological deficits. How it feels when you're worse at everything you put your hand to, if you can even do that. And more, the volunteers were two or three years past having had their strokes and were back doing some of the ordinary things that are still beyond me.

It's hard to say which aspect of the program benefited me the most; they worked together to set me on a solid path of recovery. I recognise that there's quite a way to go, but I'm far better equipped for the journey, now.

Penultimately, the posts I'm making about stroke recovery and so on are now public, whereas before you had to be a special flower just to see them. As soon as I figure out how to make the old ones public, even the Ultimate Urine Victory, I shall.

Addendum: boring progress part (weeks 1 -> 12)
Treadmill: 10mins @ 2kph, no incline -> 10mins @ 4.5kph, 5.0 incline.
Cycle: 10mins @ L2 flat, 58rpm, 5.88km -> 15mins @ L7 Hill, 80+rpm 8.07km
Rowing machine: 3.29m/500m for 500m R5 -> 2.09m/500m for 1500m, R7.
Trampette: 4'30" holding on for dear life -> 5m, no hands
Free weights: 3 x 10 x 1kg curls -> 10,8 x 8kg, super: hammer curls, raise, squat
Lat pull-down: 3 x 10 x 6.25kg -> 3 x 12 x 16.25kg
Weight: 91.4kg -> 85.7kg

I'm fitter and stronger now. Find me on Fitocracy.

Daily Routine

This is roughly what a typical day, looks like at the moment:

6:30-7:00 Wake up and get up. Time dictated by Sleep Cycle app. Take enormous quantities of drugs, mostly blood pressure meds. Getting up is slow, and I'm usually fairly unsteady first thing.
7:15-8:15 Physio and other exercises. I've started to include things like crunches and planks to further improve core strength. By the end, I am a bit more steady.
8:30-9:15 Shower, shave, dress. I'm back to wet shaving myself, and showering is much less of a chore than it was for a while. My balance while in the shower itself is good, and toweling off is easier. I use the whole shower through dressing experience as an opportunity to keep stretching myself. Mostly involving balancing on one leg for short controlled periods, which is now far from automatic.
9:15-9:30 Another exercise with the balance mat; a block of special foam that I have to stand on, or step onto and off. This thing becomes increasingly irritating, as it's very hard to see any progress. Of course, the reality is that I can do things on it now that I couldn't attempt six weeks ago, but it's still annoying.
9:30-10:00 Breakfast. Pineapple juice and cereal with milk. I get about 2 servings of fruit from the juice and dried fruit in the cereal. I should go back to making oatmeal because the soluble fibre is so good, but I've been a bit lazy.
10:11:30 Email, some writing, getting ready for the gym, a bit of G+, whatever. Touch typing is faster than it was 5 months ago, but definitely slower in the right hand than it was 6 months ago.
11:45-13:00 Gym. Typically 25-40 minutes of cardio, some weights and then finish off with some walking practice on the treadmill. Everything now gets logged in Fitocracy, except the walking, since I tend not to get my heart rate high enough.
13:00-13:30 Swim. I'm up to 600m breast stroke, and I'm working on extending that. I stretch between each set of 4 or 2 25m lengths, counting the stretch in breaths.
14:00-14:30 Lunch. I've usually had some fruit before going to the gym, but I'm often quite hungry by now. Fortunately (?) I can only eat slowly.
14:30-18:30 "Work" which is variously email, writing. dealing with whatever's come up. Most recently converted my sister's old laptop to dual-boot ubuntu as a first step to weaning the family off Windows, which I may have mentioned is inherently bad for my blood pressure.
18:30-19:00 Some more physio on the wretched balance cushion.
19:00-20:00 Watch my excellent cousin Cathy read the news on Channel 4. There are other people, too, but she's the best, obviously. Try not to stab their culture correspondent in the neck.
20:00-21:00 Dinner. Om nom nom. Again, I've often snacked on fruit at about 5 or 6 pm, and drink plenty of water during the day.
21:00-22:00 Read, telly, or whatever; I'm not that taken by most telly, but I do like to read before...
22:00 Bedtime! This drifts out towards 23:00, but rarely much later than that.

I also work face, mouth and hand exercise into there, whenever I remember to have a spare moment. Often while lying in bed.

I'm working on speeding up some of the slownesses, so that it will become feasible to be rising early and going to the gym, having a full day's work, and a bit of evening time, but I reckon my working day is going to be pretty full when I do get back to work. That's OK, some of the crazier expectations of US working practice can be managed away with hard work. 

There's gaps because sometimes things just take longer than they used to (or ought to), and that's the way it goes. I keep telling myself it's getting better, and I'm sure it is, but probably too slowly to notice.

March Update

It's five months to the day since I had my first strokes, including the big old brain stem bleed, so it's time for a round-up.

I'm down to 85kg / 187.5lb. and 32" waits pants (trousers!), I go to the gym and swim five times a week, on top of doing 45-60 minutes of physio and other exercise first thing in the morning. The effects are clearly showing (I peaked somewhere north of 230lb.), but the paunch and muffin-top will be the last to go. I'm in no rush, since I'm able to do a little bit more of somethingpretty much ever day. So, in general terms I'm fitter and healthier than I've been for a while, especially since my blood pressure is medicated under control, futzing with Windows not withstanding.

My walking has improved. I can get around more confidently without my stick, but still need it, especially when tired. I still lean to the right involuntarily, and have yet to get whatever musculature is lacking there to get a grip. It's quite likely to be a neurological problem, which just means it will take effort and time. Although I have plenty of both, it is frustrating in the extreme to be toppling to the right and both not know why and not be able to fix it. I concentrate as much as possible on what I can affect, which is mostly my general health and fitness. Fitocracy has been a boon there.

I believe the diplopia is resolving, but it's taking so long it remains hard to tell for sure. It's easy to doubt what I think I'm seeing. My guess is that the maculae will get lined up first, so I have binocular vision at the focal point, and then the eyes will work on twisting so they have the same horizon, and my hope is that somewhere in there, the oscillopsia will go away. Hope springs eternal.

In real terms my ability to stay upright has improved, thanks to persistence with exercise, but I still don't think my actual balance has changed in months. I still fall over if I lose concentration or turn around too quickly, or just stand up forgetting that I had a stroke. Most recently, and rather embarrassingly, I fell in the hospital gym, scratching my elbow on a mirror. It was stupid, and really only partly my fault, and my pride (what little is left of it) was the most injured part of me, but it served to keep any hint of hubris at bay. I've retained much of my dexterity, though lacking the equilibrium to back it up sucks.

Since proprioception is such a large part of my working balance, low light doesn't actually make me less steady, although of course some other part of my brain thinks it should. I've recently got myself a pair of "VIVO Barefoot" shoes (I think sold as Vibrams in the US), which are designed for runners to have the proprioception of being barefoot, with thin, puncture-proof soles. I love them so much that I can't imagine wearing any other kind of shoe. It amazes me that there's no research study into using barefoot-style shoes for post-stroke (and other brain injury) balance. 

Since I'm in the mood, some fun statistics about haemorrhagic and other strokes:

• Survival rate for haemorrhagic stroke is 26.7% within a period of five years. [1997-2003 study] (Well, that sucks.)
• Survival rate for haemorrhagic stroke is 60.5% within a period of five years if you're 41-50 years old, though. [Same study.] (That sucks less.)
• 10 percent of stroke sufferers recover almost completely. (I'm aiming for this end of the bell curve)
• 10 percent of stroke sufferers require care in a nursing home or other long-term care facility. (Yeah, no thanks.)
• 15 percent die shortly after the stroke. (Dodged that one.)

• 14 percent of people who have a stroke or TIA will have another within a year. (I'll pass, thanks.)
• About 25 percent of stroke sufferers will have another within five years. (No, really, I'll pass.)
• People with uncontrolled high blood pressure are seven times more likely to have a stroke than people with controlled high blood pressure. (Ah. Good to know. Bit late.)
• Statin use before a haemorrhagic stroke improves short- and long-term survival rate. (Well, I'm taking some now.)
Statistics are, of course, for suckers. The best any of us can do is look at our major risk factors and eliminate them. My naturally high (and at the time unnaturally elevated) blood pressure is under control. I don't smoke, drink very little, and don't have diabetes mellitus. My weight is heading in the right direction (and you had better believe it's going to stay there), and I am going to stay fit. Beyond that, worrying about having another stroke is only going to make me more likely to have one... so why worry?
I still think 'victim' is preposterous, since no malicious agent victimized me, 'survivor' is entirely redundant, since I'm evidently not a corpse, so I've settled on 'sufferer.' Although any pain is related to exercise, typically, and hardly unpleasant, the experience has not been without anguish.

On Exercise, Weight and Weight Loss

I've been thinking about exercise lately, since it's one of the things in my life that is more-or-less under my control (unlike my vision, say, or my balance).

Five months ago, the idea of going to the gym for an hour five times a week, followed by a 30 minute swim seemed plausible, but was far too much effort. My primary motivation then was to lose weight in order to get laid (more).

Twelve weeks ago, the idea of ever working out in a gym again seemed impossibly remote. I was still struggling to walk even a step or two unaided, and a half hour of physio would wipe me out for much of the day. The stroke damage was still overwhelming.

Six weeks ago, I began to feel like the standard fitness goal of doing 5x30m a week* was going to be difficult, but achievable within the nine remaining weeks of my excellent post-stroke program.

Today I'm about to do my 30 minutes of physio exercises this morning, and looking forward to getting to the gym a bit earlier, so I can do more work before the time allowed for supervised swimming. It's the third week I'll have been five times. Achievement unlocked!

Obviously, my persistence and determination have played a part, and it's hard to replicate my sense that my current physical deficits are unacceptable, but I think there's more going on that is generally useful.

First, my motivation has changed from "get laid" to "don't die," For me, this was a fairly easy shift to make. Having some strokes was less of a warning shot, and more of a breach at water level. It's harder if you're like the me of five months ago, where the statistics about stroke, heart disease and diabetes are difficult to absorb on a personal level. That's your problem, and not one I can really help with, except to say many of you, my friends, are too fat, and that's making you sicker, and more likely to drop dead.

Second, and actually maybe useful, has been that with the physical deficits I find so intolerable, my ability in the gym had to be completely recalibrated. I simply couldn't run on the treadmill (I still can't actually run, or even let go). That meant that I had to throw out every expectation I had about what I could reasonably do, start listening to my body, and be fine with being a pathetic cripple loser: not easy.

A year or so ago, when I re-joined the gym on my block, I took the free session of personal training. At the time, I weighed in excess of 230lb, and I hurt so much afterwards, that even though I already knew experientially that I could work through the discomfort, I still didn't want to go back three days later, let alone the next day.

Now I have to tread a balance between doing enough and exhausting myself (when everything, speech, motion, thought, it all slows down), I find I do enough to feel like I've worked, and I do notice days off, but never so much that I've been in pain. The results have been excellent. I got fitter faster than I expected, I've continuously lost weight, and I want to go to the gym more than ever.

By concentrating on the extremely low bar of basic aerobic fitness (the 5x30), and being unable to care that the person next to me might be running along at full tilt while I'm working hard to walk 2km/h, I've met goals that I couldn't otherwise have met, and not lost my motivation. You can do this, too.

TL;DR: You're too fat, my friends, lose weight or die. Care only about what you can do in the gym. Screw those other people, they're probably doing it wrong**.

* That's 30 minutes of moderate aerobic exercise, five times a week. You should be slightly hot, slightly sweaty; that's all. The 30 minutes can be broken into chunks within a day, but nothing shorter than 10 minutes, or you no longer gain the cardiovascular benefit. That's enough to get continuously fitter. As the nurse said, "it's better to be fit and fat, than just fat."

** I pay a lot more attention to form these days, than weight. It's paid off.