Saturday, September 29, 2012

Saturdays News - Understanding Atrial Fibrillation

Definition: Atrial Fibrillation from Wikipedia, the Free Encyclopedia.

Atrial fibrillation (AF or A-fib) is the most common cardiac arrhythmia (irregular heart beat). It may cause no symptoms, but it is often associated with palpitations, fainting, chest pain, or congestive heart failure. However, in some people atrial fibrillation is caused by otherwise idiopathic or benign conditions.

ECG of atrial fibrillation (top) and normal sinus rhythm (bottom).
The purple arrow indicates a P wave, which is lost in atrial fibrillation.
AF increases the risk of stroke; the degree of stroke risk can be up to seven times that of the average population, depending on the presence of additional risk factors (such as high blood pressure). It may be identified clinically when taking a pulse, and the presence of AF can be confirmed with an electrocardiogram (ECG or EKG) which demonstrates the absence of P waves together with an irregular ventricular rate.

In AF, the normal regular electrical impulses generated by the sinoatrial node are overwhelmed by disorganized electrical impulses usually originating in the roots of the pulmonary veins, leading to irregular conduction of impulses to the ventricles which generate the heartbeat. AF may occur in episodes lasting from minutes to days ("paroxysmal"), or be permanent in nature. A number of medical conditions increase the risk of AF, particularly mitral stenosis (narrowing of the mitral valve of the heart).

Atrial fibrillation may be treated with medications to either slow the heart rate to a normal range ("rate control") or revert the heart rhythm back to normal ("rhythm control"). Synchronized electrical cardioversion can be used to convert AF to a normal heart rhythm. Surgical and catheter-based therapies may be used to prevent recurrence of AF in certain individuals. People with AF often take anticoagulants such as warfarin to protect them from stroke, depending on the calculated risk. The prevalence of AF in a population increases with age, with 8% of people over 80 having AF. Chronic AF leads to a small increase in the risk of death. A third of all strokes are caused by AF.

See the full article Atrial fibrillation From Wikipedia, the free encyclopedia.

AF and The Risk of Stroke (by Boehringer Ingelheim)

Strokes happen in atrial fibrillation when pools of blood form in the heart because of the upper chambers of the heart (the atria) not contracting properly.

Understanding Atrial Fibrillation (AF)

AF is a condition that causes the heart to beat too quickly and in a disorganized way. As you probably know, the heart’s job is to pump blood around the body. It does so with a regular squeezing action which we call our heartbeat, and normally our heart beats in a steady rhythm.

AF interferes with this usual rhythm which means blood cannot be pumped around the body as efficiently.

Atrial fibrillation affects approximately 350,000 people in Canada and is the most common heart rhythm abnormality for adults. This website is designed to give you a better understanding of AF and the importance of following your doctor’s advice.

Know the Symptoms of AF 

People experience AF differently. For some there are no symptoms during an AF episode, particularly if their heart rate is not very fast, but those who do have symptoms might experience:
  • palpitations,
  • dizziness,
  • chest pains,
  • breathlessness, particularly with exertion or anxiety,
  • irregular and fast heartbeat.
This is not a complete list of symptoms patients may experience. While some people may experience symptoms on a daily basis, others may rarely have them.

Why Having AF Increases Your Stroke Risk

If you have atrial fibrillation (AF), your risk of stroke is considered three to five times higher than those without AF. Fortunately – with your physician’s help and by taking some practical steps – you can take action to lower this risk.

The irregular heartbeat caused by AF means the blood moves unevenly in the chambers of the heart. Sometimes it can pool and get stuck in the heart, which may result in the formation of a blood clot. A clot formed this way can be transported in the blood stream to the brain where it can cause a stroke.

Please go to to get further information about Stroke and Atrial Fibrillation.

 Watch the TV ad - Stroke and Atrial Fibrillation

Can we talk about stroke? 

It may be an awkward topic, but it’s important to talk about the link between AF and stroke and how people can help reduce their risk. We enlisted a few friends to help have that talk with your mom or dad. In just a few easy steps, create and email a personalized video and be on your way to starting “The Talk” with your loved one.  See Build a Video Message on

Meet Our Friends

Meet Jonathan.

His father died from atrial fibrillation-related stroke and his mother and brother have now been diagnosed.

Meet Mary.

 Her husband has atrial fibrillation.

Meet Adam.

His father has atrial fibrillation.

Meet Hannah.

Her husband suffered an AF-related stroke, and she is his caregiver. Hannah also has atrial fibrillation.

Meet John and His Wife Donna. 

John has been diagnosed with atrial fibrillation.

Please go to to get further information about Stroke and Atrial Fibrillation.

SSTattler: This article is showed by SSTattler and Copyright by Privacy Policy by and the according private communication between SSTattler and Boehringer Ingelheim (Canada) Ltd. 
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Use: All content on this website belongs to and is protected by copyright. Permission to use documents (such as white papers, press releases, datasheets and FAQs) from this site is granted, provided that (1) this permission notice appears in all copies, (2) use of such documents from this site is for informational, media and non-commercial or personal use only and will not be copied or posted on any network computer or broadcast in commercial media, and (3) no modifications of any documents are made. Any other use of the documents from this site must be expressly permitted by

YouTube: Atrial Fibrillation and Stroke - Beat Your Odds, Drugs or Advanced Surgery, ...

Atrial Fibrillation and Stroke - Beat Your Odds

Atrial fibrillation (AF) is a major risk factor for stroke, making a person five times more likely to have a stroke. About 15 percent of all people who have strokes have AF, too. People who have been diagnosed with AF have already taken the first step to preventing AF-related stroke. Unfortunately, many Americans who have AF don’t know it. Three out of four AF-related stroke can be prevented — if you are already diagnosed, Beat Your Odds℠ of having a stroke due to AF by understanding stroke symptoms, response and available treatments to control AF. Most Americans over the age of 40 are at risk for having AF. Take preventive steps by self-testing for an irregular heartbeat with the Check Your Pulse℠ technique and discuss your risk for AF and stroke with your doctor.

AF to Stroke & Heart Failure - Drugs or Advanced Surgery

It's been shown that people whose hearts are in atrial fibrillation (also known as irregular heartbeats) live shorter lives than people whose hearts are not in atrial fibrillation. That's because it can lead to congestive heart failure or stroke. What makes atrial fibrillation so insidious and dangerous is the range of symptoms can go from asymptomatic to a racing heartbeat, shortness of breath or even a feeling of impending doom. This atrial fibrillation video will define the condition and cover these topics: danger associated with atrial fibrillation, connection to stroke and congestive heart failure, symptoms and treatments, and advanced treatments.

Understanding Atrial Fibrillation

SSTattler: This YouTube is about one and a half hours but it is very good.

An irregular heartbeat might be linked with a more serious medical condition such as Atrial Fibrillation (AF), the most common type of heart arrhythmia in the United States. Professors and physicians at Stanford University Medical Center stress the importance of early diagnosis and appropriate treatment for a number of cardiac arrhythmias that affect more than 2 million Americans. What is the difference between a benign palpitation and a life-threatening affliction?

Saturdays Comics - Sept/29/2012

For Better and For Worse
Lynn Johnston / 2007-05-10
"Thank God for family and friends!"

Scott Adams / 2012-09-28
"Whatever I think you're dumb enough to pay..."

Jim Davis / 2012-09-28
"Mice cheered as the cheese fairy said goodbye."

Delainey & Rasmussen / 2012-09-23
"Get off the computer now, or I'll cuff you with ..."
For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well  the author Lynn Johnston).
** I tried to get low or free price at the people for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using and
*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.

Saturday - Eclectic Stuff & Articles - Sept/29/2012

Definition:Eclectic(noun) a person who derives ideas, style, or taste from a broad and diverse range of sources.

Article: Mark - Blog Talk Radio Part #2 for Successful Strategies for Speech Therapy

Mark - Teaching of Talking
We have some previous episodes of our show should you wish. They are located under the Media tab on  See as well

You will find a drop down menu where you can clik on the blog talk radio icon.

In that same media tab dropdown box you can also find video tips: fun videos about different beliefs that I have ...

Teaching of Talking live (live seminar of persons with aphasia that I do in Houston with the Stroke Warriors), Audio: Driving with Mark Episodes. These are audio clips of ideas that I have that would be of value to caregivers and speech language pathologists.

You may also want to visit, at your convenience the Blog (clik on it within the website of teaching of talking and it will take you to more video information for your education and enjoyment. (I don't like to be too serious... always prefer to have a good time with anything that I do and hope that is ok with you...) But you know I am darn serious with anything I may say, even though I may do so in a joking, or "folksy" way. Dr. Daniel Boone, a colleague speech pathologist says my approach is "folksy." And yes, that is my intention!

As you can tell, I'm just a simple, passionate guy on a mission, who wants to share what I know so that caregivers and speech language pathologists can get some different "views" on very different approaches to speech therapy. And then I want you to implement those approaches and you will find that they work wonderfully to help people speak better!

Thanks for tuning in tonight! Oh, by the way we started a new facebook page for Teaching of Talking! Please clik on this link and be our friend there. You will find additional information on our facebook page that will add a great deal of value to you!

I wish for all of you a great day and a wonderful life. I plan on getting to know each one of you and helping you on your path to speech and language stimulation and developing your knowledge base for speech therapy. If you haven't already done so I would suggest ordering "The Teaching of Talking, Learn to Do Expert Speech Therapy at Home, with Children and Adults." and getting your autographed copy. (first 250 orders) We will be taking delivery of the initial shipment in mid to late June.

Tonight's Show

Best regards,

-- Mark A. Ittleman, M.S., CCC/SLP

See the original article, May 24, 2012, Blog Talk Radio Part #2 for Successful Strategies for Speech .Therapy.

Eclectic: SSTattler - Nice Comments From Mark Ittleman.

From Mark Ittleman

"... I have not posted in quite a while, and I have been amiss!  I hope you will go to the Mark Ittleman page of facebook to see my recent post and submission of the last newsletter from Teaching of Talking, our revolutionary new book which helps teach speech pathologists and caregivers how to do expert speech and language stimulation.  I would like to share some articles from the SSTattler, a publication out of Canada for those who suffer from stroke.  Here it is, and I would like to thank John Anderson for his faith in our work and his support in helping us get our message out there ... "

We will try to get the message out there, absolutely, every week ... !

Regards / Dr. Cranium & SSTattler

Article: Dean - Excessive Amounts Of Vitamin D Linked To Onset Of Atrial Fibrillation

Dean's Stroke Musing
Be careful out there. -- Dean's Stroke Musing. Original article Excessive Amounts Of Vitamin D Linked To Onset Of Atrial Fibrillation in Medical News Today.

SSTattler: Lots of AF articles at Dean's Stroke Musing -- try search with parameters afib and atrial fibrillation.  You'll get 20+ articles.

While previous studies have linked vitamin D deficiency to an increased risk for cardiovascular disease, new research at the Intermountain Medical Center Heart Institute shows that too much vitamin D can lead to the onset of a dangerous heart condition known as atrial fibrillation.

Researchers at Intermountain Medical Center, the flagship facility for the Intermountain Healthcare system, studied more than 132,000 patients and found the risk of developing atrial fibrillation was two and a half times greater in those with excess levels of vitamin D compared to patients with normal levels.

Results of the study were presented at the American Heart Association Scientific Sessions in Orlando, Fla.

Atrial fibrillation is a condition in which the heart's upper chambers quiver instead of beating rhythmically, which can cause blood to pool and clot. Atrial fibrillation has been linked to an increased risk of stroke, heart failure, heart attack, dementia and even Alzheimer's disease.

Article: Diane - A Real Shock at Rehab

Diane - The Pink House OTC
On Wednesday afternoon, at about 2:00 p.m., if you heard a loud crash -- well, maybe not so much of a crash as a rather loud THUD! --  that was the sound of my heart dropping to the floor. Because that was the moment that Bob and I were at Rehab, finishing up with the occupational therapist when the physical therapist came up to us carrying Bob's file.

That was when the PT said, "I was going to do Bob's re-evaluation today, and to tell you the truth, I was prepared to discharge him. But I see he has one more appointment scheduled on Friday, and if I discharge him today, the insurance wont pay for Friday, so let's just do the paperwork on Friday."

Discharge him?

And that was when my heart hit the floor. And the PT keeps talking, but I really can't even hear the rest of the stuff he's saying, because truthfully, I can't believe it. I mean, Bob is progressing, every time he comes to Rehab the therapists tell him how great he's doing, how much better and improved he is, and how he even looks better, able to hold his head up a bit more...

I am just numb sitting there. But I do hear the PT say this all too familiar phrase: "No Functional Improvement."

And then I hear something about Medicare capping off the amount of sessions they will pay for at Outpatient Rehab beginning Oct. 1, and Bob being close to being cut-off anyway, which is news to me, so I find my voice and tell him that Bob has a Medicare Advantage Plan and those plans don't follow strict Medicare guidelines.

But he says, "Well, even if the insurance covered it, it really comes down to no functional improvement. An Outpatient Rehab Center is just not equipped for this kind of long-term maintenance that Bob needs."

I am still numb, and the PT keeps talking, as if he is strangely arguing with me, even though ...

See the full article  A Real Shock at Rehab at The Pink House on The Corner.

Eclectic: Diane - A Surreal Anniversary

Diane - The Pink House OTC
Sunday was our 18th wedding anniversary, and I almost decided to skip it... I mean, what does one do to celebrate? Pre-stroke, Bob would wake me up in the morning with a kiss and "Happy Anniversary, Sweets!" and a cup of coffee and flowers or some other trinket. He never forgot our anniversary.

We used to go out for dinner and dancing, or spend a day at the beach, or take a little road trip, do some antiquing in the neighboring villages and towns. All that is out of the question now, since Bob can't eat (has a peg tube) and his mobility issues prevent the others.

I did ponder other options: a movie? a stroll in the park? Going to movie brought visions of Bob having to pee half-way through, and movie theaters do not have a pause button. A stroll in the park brings up worries about weather conditions -- always a concern with a wheelchair.

Bob at The Dali
(behind him is an artistic rendition of Salvador Dali's famous mustache).
I almost skipped it, because, sadly, unless I tell him, Bob wouldn't even know it's our wedding anniversary.

But then, I had a grim thought. What if this would be our last anniversary together? What if we had no "19th"? These days, I do not take things for granted. So I decided we must do something to celebrate.  I began to research local museums, looking for something nearby and wheelchair accessible and not too pricey. Well, turns out they are all pricey, but I rationalized -- what the heck? I just saved $48.00 talking to the neuro doc on the phone instead of going in for an appointment. Besides we deserve it, right? And finally, I made arrangements with the wheelchair transport to take us to "The Dali", a museum housing a large collection Salvador Dali's artwork.

Bob's favorite painting. He spent a long time 
gazing at this, it's called "Birth of a New Man"

I figured Bob, an rather surreal artist himself, would enjoy The Dali. And the museum bills itself as handicap accessible. Plus they have a cafe. So my thought was to take a tour of the exhibit, perhaps a cup of thickened coffee in the cafe afterward for Bob. Sounded like a leisurely way to spend a few quiet hours on a Sunday afternoon ...

See the full article A Surreal Anniversary at The Pink House on The Corner.

Eclectic: Monty - Taken Flight Yet Again ...

Yessian Music has taken flight yet again... this time over America, in its latest installation in Shenzhen, China via Super 78 and directed by Brent Young.

Thousands comments; here is a few:

Lots of fun and a very interesting mix of great video and computer graphics, hard to tell what's real and what's realistic CGI. The Biplane and Golden Gate bridge are clearly CGI but most of the scenic shots look like actual HD video. Very nice job and a great choice of music.

-- topsailbeachnc

The contrast between the video and the comments about it is both horrifying and amusing. First, watch and listen to some amazing creativity. Totally free of charge, just something for you to enjoy. Then, if you have extra time, read some of the most ignorant selfish ridiculousness that can possibly be crapped out of a human brain. Political, geographic arguments, you name it.

At least the beauty will always be on top. Good work! I really enjoyed it.

-- jbnewberry

Countries are legal entities with fixed internationally recognized names.
Continents are not; they have no owners and the very concept of continent varies. Latin nations teach a geopolitical and arguably less scientific system of continents.

"America" and "Americans" have been used in their current English sense since the 1600s. But I would not tell a native speaker of a foreign language what a similar word in their language must mean to them.

-- Calenyita

An interesting promotional view of the United States of America. But if we talk about America, geographic space is far ahead. Once in the U.S. understand that America is a conglomerate of peoples, peoples, cultures, religions, interests, markets etc.. we talk about integration and respect everyone.

-- Alcides Hair

.... and many more ....

Eclectic: Jackie - PORK CHOPS !!

In a zoo in California , a mother tiger gave birth to a rare set of triplet tiger cubs. Unfortunately, due to complications in the pregnancy, the cubs were born prematurely and due to their tiny size, they died shortly after birth.

The mother tiger after recovering from the delivery, suddenly started to decline in health, although physically she was fine.  The veterinarians felt that the loss of her litter had caused the tigress to fall into a depression.

The doctors decided that if the tigress could surrogate another mother's cubs, perhaps she would improve. After checking with many other zoos across the country, the depressing news was that there were no tiger cubs of the right age to introduce to the mourning mother. The veterinarians decided to try something that had never been tried in a zoo environment.

Sometimes a mother of one species will take on the care of a different species. The only orphans' that could be found quickly, were a litter of weanling pigs. The zoo keepers and vets wrapped the piglets in tiger skin and placed the babies around the mother tiger.

Would they become cubs or pork chops?

Take a look... you won't believe your eyes.

Now, please tell me one more time... Why can't the rest of the world get along?

Eclectic: Regina - The Importance of Friends


By Regina Price

This week I thought about the importance of friendships and how  it helps us. Being a good friend makes us feel better and optimistic and valued — three things that are very supportive to us -- and it makes the friendship last for years.

After my aneurysm, I met a man who had been in a serious car accident, years ago, and because of it, he is disabled. He became  my art teacher every week through an organization called AABIS (Alberta Artists with Brain Injury Society). He doesn’t go anymore because of his health and I don’t go anymore because I am so busy going to yoga for my health, etc. but we keep in contact though email. Last week, Normand Berube wrote to me and said: “Friendships are a bloodline that motivates and give us the energy to live life!” I was so impressed about his thoughts that I asked him whether I can use his quote in my story and he said okay! Because of Normand, this story became a reality.

It makes me realize how friendships grow and make us heal — in our body and soul. Being a good friend means listening and if possible, without serious speech problems, giving our opinions and being there, in our substance — wherever and whatever this means. These vibrations make us feel good and important to our friends and it makes our brains and bodies help to heal us, physically and mentally.

Most of us lost many of our colleagues because we lost our jobs and the status of having a position. Nowadays, we don’t have what we had before. Most of us are disabled and our lives changed immensely. Most of us live with spouses or in homes for disabled people. We don’t have some contact with some of our “old” friends.

How can we find new friends? There are many places to go and meet people — but sometimes we need to meet lots of people to find a lasting friendship. Don’t get discouraged even when you go to places to meet new people and can’t find new friends -- at first. I imagine that it is like panning for gold. When I was younger, I used live in the Yukon and lots people there tried to pan for gold but very few found a nugget or lots of fragments. When you finally find a friend, congratulate yourself and your friend and claim the first meeting as a friendship day.

How can we find places to meet new people? Well, you can find interesting places so that you can enjoy the activity including sports, games and reading books or discussing movies. Other place to meet new people would be volunteering with organizations that you like -- to help others which can increase your self-confidence and the amount of fun. Maybe, during the time volunteering, you might find new friends as well.

I remember my speech therapist talking to me about meeting new people and using the skills I learned from her and practice, practice, practice. Now, 5 years later, after my aneurysm, I can hardly believe that I couldn’t say three words to many who I had never met before. Nowadays, I talk to store clerks, ask questions at the library, and chat with new people without mentioning my aphasia — very, very uplifting.

Famous quotes about friendships:
  • C.S. Lewis: “Friendship is born at that moment when one person says to another: "What! You too? I thought I was the only one.”
  • Elbert Hubbard: “A friend is someone who knows all about you and still loves you.”
  • A.A. Milne: “Piglet sidled up to Pooh from behind. "Pooh?" he whispered. "Yes, Piglet?" "Nothing," said Piglet, taking Pooh's hand. "I just wanted to be sure of you.”
  • Alfred Tennyson:  “If I had a flower for every time I thought of you... I could walk through my garden forever.”
  • William Shakespeare: “A friend is one that knows you as you are, understands where you have been, accepts what you have become, and still, gently allows you to.”

Eclectic: Randy - Pro Coro Canada Chamber Choir presents "Once Upon a Time"

SUNDAY, SEP 30, 2012, 2:30 – 4:30PM
Location The Winspear Centre 
                4 Sir Winston Churchill Square
City / Town Edmonton
Event Venue Winspear Centre
Description Alberta Culture Days
Event Category Concerts / Performances
Cost            Free
PurchaseTickets Free tickets can be reserved 
                at the Winspear Box Office at
Contact Name Pro Coro Canada
Contact Phone 780.420.2147
Contact Email

Pro Coro Canada, a professional chamber choir resident in Edmonton, is pleased to present its first concert of the season in the Francis Winspear Centre for Music at 2:30 PM on Sunday, September 30, 2012. Making his conductor’s debut this concert is Michael Zaugg, the newly appointed Artistic Director and Principal Conductor for Pro Coro Canada. Michael is known for his ability to create an environment where choristers give their best. He chooses repertoire that will both challenge the musicians and delight the audience.

The Sept. 30 concert, entitled Once Upon a Time, takes texts from Hans Christian Andersen’s stories and fairy tales that have been set to music, ranging from Orlando Gibbons’ 16th-century “Cries of London” through Latvian composer Ugis Praulins’ contemporary “The Nightingale” in its North American premiere. This latter piece, as well as Grieg’s classic “Morning Mood” (from the Peer Gynt Suite), will be accompanied on solo recorder by Matthias Maute. Since winning first prize in the renowned Early Music Competition in Bruges (Belgium) in 1990, he has been the featured recorder soloist at Boston’s Early Music Festival (2003 and 2005), and made his debut at New York’s Lincoln Centre in December 2008. In this concert, another highly anticipated work will be Rain and Rush and Rosebush by Danish composer Bo Holten — the piece which inspired Michael to become a conductor.

Article: Long Term Split Belt Treadmill Training for Stroke Recovery

To whom this may concern:

I am running a research study at the Kennedy Krieger Institute in Baltimore, MD to see if a particular type of treadmill training can help improve the gait asymmetry that many stroke survivors are left with.  The study involves 12 weeks of training, 3 times a week at our facility in Baltimore on our treadmill.  Is there any way you can mention something on your group so that anyone in the Baltimore, MD area who is interested can either email me at or call me at the office at 443-923-2716 if they are interested in hearing more?  Our study is also on the website too.  Just search for the title of our study "Long term split belt treadmill training for stroke recovery."

Thank you very much.


Katharine E. Amenabar, M.S.
Research Coordinator
Motion Analysis Lab
Kennedy Krieger Institute
707 North Broadway
Baltimore, MD 21205
Ph# 443-923-2716
Fax# 443-923-2715

Article: Sharon - Care-Partners / Caregivers

Did you know that over 80% of stroke survivors are discharged to their pre-stroke residence? 

Homecare is becoming more important and a larger part of the health system as patients are discharged from hospital earlier, number of assisted living spaces increases, and number of nursing home beds decline.  Roy Romanow (2002) estimated that 85 to 90% of home care is provided by family and friends.  Informal caregivers like you, play a critically important role in providing ongoing care, support, and advocacy for people with physical disabilities (Romanow, 2002).  According to the data on hours of care provided taken from the General Social Survey unpaid care-partners provide care equivalent to 276,000 full-time jobs (LeGoff, 2002).

Caregivers save the Canadian health system billions of dollars!  The estimated economic cost to replace family caregivers with the paid workforce at the 2009 market rates and usual employee benefits and support would be $25 billion (Hollander, M. et al, 2009).

In stroke, the interactions of family members with stroke survivors are very important in determining outcomes.  Better family functioning is associated with improved ability to carry out the activities of daily living and participation in social activities (Clarke & Smith, 1999).  Stroke survivors who received moderate practical help and support, but high emotional support had significantly better functional recovery (Glass & Maddox, 1992).   Yet, many stroke survivors report that their families provide too much support and overprotect them (King & Semik, 2006).  As a care-partner, I certainly had no idea how much support to provide.

In most studies, family members report they lack information and education about what to do with the stroke survivor. They feel unprepared to deal with the emotional and physical stroke crisis and on top of that need to learn to negotiate an unfamiliar and often ever- changing multi-tiered multidisciplinary acute care and rehabilitation system (Palmer, Glass, Palmer, Loo, and Wegener, 2004).   The inclusion of families in stroke treatment and support for families has been advocated for some time.  The uncertainty and lack of knowledge is stressful for most caregivers.  Depression is common in up to 50% of stroke survivors and family carers in acute care situations and 20% or more in community studies.  Care-partner strain and burden is high.

A 1999 study found caregivers experiencing the strain of caregiving had 63% higher mortality rates (Schultz and Beach 1999) and a recent study of care-partners to cancer patients discovered that they are at significantly higher risk of hemorrhagic and ischemic stroke (Ji et al., 2012).  These studies call for increased health monitoring and support.

In a recent review of the published research literature on what is available for relatives of stroke survivors, a Quebec Group from the University of Montreal noted that in “rehabilitation there is no consensus regarding what should be done with relatives; guidelines exist but are not applied in practice. Little has been formally reported regarding ethical issue likely to emerge for relatives” (Pellerin, Rochette, Racine, 2011).

So as a spouse, son or daughter, or relative of a stroke survivor, if you didn’t know what to do in acute care and rehabilitation, lacked guidance from the health professionals, or felt left out of the treatment and planning processes you are not alone.  Consistently in this review, health professionals thought it was less important to help the family of a person with stroke than the client him or herself.  Moreover, involving families raises ethical issues and organizational challenges, records management and confidentiality issues.

What’s your experience? We would love to hear your experience about being a care-partner after stroke.  

As a care-partner to a stroke survivor do you feel supported?   Who supported you? What type of support were you offered?  What type of supports would you like? 

Sara Palmer, a psychologist at John Hopkins University, has written a book on caring after stroke that you may find helpful.   The Amazon link to it is below.

More information:

Article: Sharon - The Quality And Quantity Of Social Support

The Quality And Quantity Of Social Support: Stroke Recovery As Psycho-Social Transition

Thomas A. Glass and George L. Maddox
Social Science & Medicine, 1992, vol. 34, issue 11, pages 1249-1261

Abstract: The impact of various types and amounts of social support is examined in the context of recovery from first stroke. We conceptualize the rehabilitation process as a psychosocial transition. In a longitudinal design, 44 patients were followed for 6 months following first stroke. Growth-curve analysis (repeated measures MANOVA) was utilized to examine the impact of three types of social support on changes in functional status during recovery. While all three types of support (emotional, instrumental and informational) were shown to be significantly related to recovery of functional capacity, substantial differences were found in the nature of those effects. The impact of social support does not appear during the first month of rehabilitation, indicating the importance of longitudinal designs and longer observation. Patients reporting high level of emotional support showed dramatic improvement despite having the lowest baseline functional status. Instrumental support is most closely related to positive outcomes when provided in moderate amounts. Unlike the other two types, the effect of informational support is mediated by disease severity.

Translation:  What does moderate instrumental support and high emotional support mean?

Emotional support relates to affirming and reassuring the person they are important, loved, wanted, and that you value what they are doing.

Instrumental or practical support relates to doing things for the person—for example,  giving them money, putting on their socks, cutting their meat.

So if the family does many of the tasks for the stroke survivor, even the things that they can do —essentially provide more support than they need, the survivor does not use their skills or learn what they can do.

 It may seem unfair and even mean to let someone with one hand struggle to put on their socks when you can do it quickly for them with your two hands, but this is not unlike the old parody of, “Give a man a fish and you will feed him for a day; teach a man to fish and he will have food for a lifetime.”

Striking a balance between supporting and over-supporting and ensuring the risk of stroke survivor falling/hurting themselves is not too great is difficult!   Let me give you an example from our situation.
About a month after John came home from rehabilitation, he asked me to get money for him.  I easily could have driven to the bank and gotten it.  At that time, I really didn’t know if he could handle money, but I said “Why don’t you get money yourself? You can go on your scooter.”  At the physiotherapist’s suggestion, we had purchased a very sturdy scooter and he was able to ride around the neighborhood. The bank was less than a mile from us by a bike path with only 2 main road crossings. 
John was furious. He stormed off on his scooter. I was really uncertain. My heart was in my throat and my stomach was sore, so I followed in the car at a distance.  Seemingly he didn’t have any trouble as he pulled up to the drive-through machines and got the cash.  I drove home. 
Later, he told me that he was angry because he was scared. When he go to the bank machine, he couldn’t remember his PIN and had to try a couple of times, but got it.  This particular experience was a turning point in many ways. I really saw the benefits of letting him take risks and figure out how to solve problems, rather than me just doing everything for him.  For him, it was a stepping stone to more confidence.  He recognized that he wasn’t dependent on me to do everything for him.

  • Hollander, M., Lui, G., Chappelle, N. (2009) Who Cares and How Much?  The imputed economic contribution to the Canadian healthcare system of middle-aged and older unpaid caregivers providing care to the elderly.  Healthcare Quarterly, 12(2) 2009: 42-49.
  • Ji, J., Zoller, B., Sundqusit, K., Sudqusit, J., (2012). Increasted risks of coronary heart disease and stroke among spousal caregivers for cancer patients. Circulation. 125, 1742-1747. 
  • LeGoff, P. (2002). Home care sector in Canada: Economic problems.
  • Palmer, S., Glass, T.A., Palmer, J.B., Loo, S, Wegener, S.T. (2004). Crisis intervention with individuals and their families following stroke: A model for psychosocial service during in-patient rehabilitation. Rehabilitation Psychology. 49 (4),  338-343. 
  • Pellerin, C., Rochette, A., & Racine, E. (2011). Social participation of relatives post stroke: the role of rehabilitation and related ethical issues. Disability and Rehabiliation, 33(13-14), 1055-1064. 
  • Romanow, R. (2002). Building on values: The future of healthcare in Canada.


Saturday, September 22, 2012

Saturdays News - Swallowing (Dysphagia)

(SSTattler: Many YouTube's about Swallowing (Dysphagia). This article has 12 YouTube's, 3 YouTube's at the first and 9 more if you want it - just click "Read more --->>". They will show Swallowing Disorders, Thicken Liquids, Diet, Young Adult, Gastrostomy Tube and Nasogastric Tube. The swallowing topic is complex -- maybe I will tackle in another Saturday News/YouTube with a sub-topic of swallowing later).

Dysphagia From Wikipedia, the free encyclopedia 

Dysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, the term is sometimes used as a condition in its own right. Sufferers are sometimes unaware of their dysphagia.

It is derived from the Greek dys meaning bad or disordered, and phago meaning "eat". It may be a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach, a lack of pharyngeal sensation, or various other inadequacies of the swallowing mechanism. Dysphagia is distinguished from other symptoms including odynophagia, which is defined as painful swallowing, and globus, which is the sensation of a lump in the throat. A psychogenic dysphagia is known as phagophobia.

It is also worthwhile to refer to the physiology of swallowing in understanding dysphagia.

Some patients have limited awareness of their dysphagia, so lack of the symptom does not exclude an underlying disease. When dysphagia goes undiagnosed or untreated, patients are at a high risk of pulmonary aspiration and subsequent aspiration pneumonia secondary to food or liquids going the wrong way into the lungs. Some people present with "silent aspiration" and do not cough or show outward signs of aspiration. Undiagnosed dysphagia can also result in dehydration, malnutrition, and renal failure.

Some signs and symptoms of oropharyngeal dysphagia include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and dysphagia (patient complaint of swallowing difficulty). When asked where the food is getting stuck, patients will often point to the cervical (neck) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived.

The most common symptom of esophageal dysphagia is the inability to swallow solid food, which the patient will describe as 'becoming stuck' or 'held up' before it either passes into the stomach or is regurgitated.

Pain on swallowing or odynophagia is a distinctive symptom that can be highly indicative of carcinoma, although it also has numerous other causes that are not related to cancer.

Achalasia is a major exception to usual pattern of dysphagia in that swallowing of fluid tends to cause more difficulty than swallowing solids. In achalasia, there is idiopathic destruction of parasympathetic ganglia of the auerbach submucosal plexus of the entire esophagus, which results in functional narrowing of the lower esophagus, and peristaltic failure throughout its length.

Dysphagia is classified into two major types:
  • oropharyngeal dysphagia and
  • esophageal dysphagia. 
  • Functional dysphagia is defined in some patients as having no organic cause for dysphagia that can be found.
Causes of oropharyngeal dysphagia include:
  • Cerebrovascular Stroke ...
See the full article Dysphagia From Wikipedia, the free encyclopedia.
See also Swallowing From Wikipedia, the free encyclopedia.

Normal Swallow Tutorial with Modified Barium Swallow - This video shows what happens when a person swallows from an X-ray as well as endoscopic view. To best illustrate what is going on, a modified barium swallow study is shown. NO REAL PATIENTS IN THIS VIDEO. ACTORS WERE USED.  Read more about swallowing problems here here Ear, Nose & Throat Consultants.

Understanding Dysphagia

Dr. Steven Feinberg Discusses Swallowing Disorders

Saturdays Comics - Sept/22/2012

For Better and For Worse
Lynn Johnston / 2007-05-09
"Yes, with a cane. You can do it!"

Scott Adams / 2012-09-21
"Carl choked the pooch on the platform decision ..."

Jim Davis / 2012-09-21
"Still on chapter one ..."

Delainey & Rasmussen / 2012-09-19
"Do you know what a cloud is ??"
For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well  the author Lynn Johnston).
** I tried to get low or free price at the people for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using and
*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.

Saturday - Eclectic Stuff & Articles - Sept/22/2012

Definition:Eclectic(noun) a person who derives ideas, style, or taste from a broad and diverse range of sources.