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The Aftermath of My Stroke


As I may have said earlier, the major effect of my stroke is that my “executive functions” are not functioning properly. Primarily it has affected my short-term memory. ALOT. I get distracted very easily, even with a span of time as little as a minute or less. Almost every day, when I am making breakfast, I open the refrigerator, and see something else…. and I forget why I was looking in the refrigerator, after a few seconds I finally remember why I was in the refrigerator in the first place.

You have no idea how many times I look through the grocery store to try to remember why I was there until I see what I there in the first place.

Yes, I make lists. And I forget the list often.

In addition to my “executive functions”, I have right-side weakness, I have a blood clot in  my right wrist, the result of which my right hand is always cold, even in the heat of summer.

The vision in my left eye is a bit… “wonky”. My ophthalmologist tells me that my retina is supposed to be a smooth surface, however in my case it is no longer smooth, and it look “sort of like” it was once smooth, but it has been “wrinkled”… all because of my stroke.

So, yes, I am a bit of a wreck.

One effect of my stroke is that my wife divorced me because I am unable to work. I don’t have trouble being hired, but I generally get fired after a few days. Apparently, most businesses cannot really deal with me and my… behavior…. my inhibitions are broken.

But, I am happy. I am free from my (ex-)wife, I have enough money to live on, and, overall, life is good for me.

 

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Concerning My Loss of Ability: Part One


Yes, yet again, I am whining and complaining about my stroke. That is because I have never gotten over my stroke, and it has been almost five years ago that I have had my stroke.

I know that many other stroke survivors are far worse off than me. I really don’t care. The thing that bothers me the most is that I was taking Warfarin, an anti-coagulant, for three years before I had my stroke. I was doing what the doctors had suggested to prevent a stroke, and I had a stroke anyway.

Why?

The VA had increased my Warfarin dosage after my stroke. And the doctors at the VA were very good at that sort of thing. Nevertheless, I guess I needed a higher dosage of Warfarin than I had had. However, I had been trying to remember to ask my doctor to allow a higher INR with my monthly blood tests.

As an aside, INR stands for “International Normalized Ratio” it is an evaluation of the extrinsic pathway of coagulation (also called “ProTime INR” or “PT/INR”). This is a rough measure of the ratio of how long it takes to form a clot. Thus, and INR of 3.0 would, I think, have it take three times as a normal person to clot.

Anyway, the VA doctors (actually pharmacists) want my INR to be 2.5-3.0. I, on the other hand would like an INR of about 3.5, just to be safe. Yes, I am in no way a medical professional, I don’t even pretend to know anything about medical stuff. But, I would much rather bleed out than have another stroke. Really!

And, so, since I know about Warfarin, and how the combination of alcohol and Warfarin interact with each other, I try to drink one or two beers a day, every day, except for the day before I get my blood tested. See, the alcohol will increase my INR to about where I think I want it. So, while I am not allowed to increase my Warfarin intake, I compensate with alcohol.

And, for the record, I am not an alcoholic, I am merely a harmless drunkard.

As I may have said before, my pre-stroke life was working with and on my mind, I was a mathematician and a philosopher by training, I had an almost PhD (don’t ask) in Mathematics and undergraduate degrees in Mathematics and Philosophy. I was in college for a total of FIFTEEN years from 1989-2011, I had worked for Sun Microsystems as an educational developer. Everything in my post-military life was focused on my mind.

Then I had the stroke.

That stroke ruined my life. Forever. Yes, neural pathways can be rebuilt over time, but the rebuilt neural pathways will NEVER be as efficient as they were originally. Never! Thus, I will never be as good as I was pre-stroke. Period.

Nevertheless, I will continue to try my best. I will persevere.

So, what do I do? What do I remember?

In a real sense, it doesn’t really matter anymore. Pre-stroke, I had specific ideas and ways of doing things that many people had questioned, but, I was really really good at everything, except playing a piano. I was the kind of guy who could get away with wearing a kilt in public, and no one questioned my masculinity. Actually, I got positive responses from women, and… well… aggressive responses from men. And, I think that I can still get away with wearing a kilt even today. Except, for the past two previous years, it was a bit chilly on 6 April for me to wear my kilt on that date. {April 6 is Tartan Day. Look it up on duckduckgo.com}

So, I do the things I remember as long as I can get away with these things. Now, I am uncertain about many of these pre-stroke things that I have done. Well… it’s more like, I remember the things I have done, but I don’t know if I am good enough to do these things post-stroke.

For example: My Mathematical knowledge is sorely lacking. I need to use a calculator when I subtract two numbers. Some people will think that that is OK, but I know it is not. Some people will proudly proclaim that their math skills suck. I do not. For me, it would be the equivalent of saying “Well, I don’t really understand the English language at all”. But, yet, it seems to some people to claim that they cannot do simple arithmetic and are proud of that shortcoming. I know that I cannot do basic arithmetic, and I feel ashamed of that fact.

I used to know mathematics, advanced mathematics. I used to know philosophy. I used to be a shell scripting maniac. I could program in C, C++, Ada, Prolog, Pascal (sorry), and I even did some assembly language programming. I knew why C++ is not really better than the original K&R C. I knew why, exactly, the C-shell was a piece of crap, and that the original Bourne shell, or the Bash shell were far superior to that C-Shell (or the TENEX, or tsch). I was an educational developer for Sun Microsystems. I was a great many things, I did some very diverse things in my past.

I do remember doing these things, but after my stroke, they are all gone except the memories, but not the details.

And as I have said, I have known some stroke survivors that are far worse off than me. And, again, I don’t care. It seems to me like a cruel thing that left me a memory of my once former glory, but not the ability to regain it. And I know that there is no god, there is no “higher power”, there is nothing but other people. BUT, if there was a god, I hate his guts for what he/she/it has done to me. For such a god would not, and could not, be omnibenevolent, omniscience, nor omnipotent. This god would be evil.

Luckily, I am still an atheist.

And these are the things that I remember what I have lost. These are the abilities I once had, but are gone because of my stroke. That is why, exactly, I am so pissed off almost all the time. That is the source of my shame and my anger.

Let’s Talk About Executive Functions: Part One


As I have stated before, a major result of my stroke in 2011 is the loss of my executive functions. I got this diagnosis from having had two Neuropsychological test (which I refer to as Neuro-psyche evaluations) which were taken in 2012 and 2014. And that was the most surprising result from those two evaluations.

Now, let me tell you that a Neuro-psyche evaluation is not cheap. These things take all day and they are given by a psychologist who also interprets the results. They are a series of tests and each test is somewhat grueling and tedious. But they seem to test EVERYTHING within the context of the patient’s psychological state. And in my opinion, they are no fun at all.

Now, when I say that my executive functions took a major “hit”, this does not mean that my executive functions are gone. Rather, these functions are in some way, damaged. And also, I can probably regain those functions over time, if I am given the time, and if I work on these functions, actively.

As I have stated before, the executive functions are a set of cognitive processes which include, but are not limited to:

  • attentional control,
  • inhibitory control,
  • working memory,
  • cognitive flexibility,
  • reasoning,
  • problem solving,
  • planning, and
  • stimulus control

Let us consider each of these functions one at a time.

ATTENTIONAL CONTROL:

This is my ability to pay attention to things, or the ability to not be distracted by things. And, yes, I do find it harder to focus my attention for more than a few minutes.

Hell, sometimes when I am talking, I distract myself and I forget what I was saying, and with that coupled with the remnants of Aphasia, I “lose words” sometimes, which causes other people some confusion, can cause amusement as I try to remember what I was talking about. I was talking in a small audience recently, concerning friends and friendship, and I could not remember the term “acquaintance”, the only word I could use was “associate” which was the wrong word. Fortunately, someone helped me out and gave me the proper word.

However, my attention does wander a bit, and it is quite easily for someone to completely derail myself.

INHIBITORY CONTROL:

This causes all kinds of problem for me. My inhibitions are really damaged. You have no idea how hard it is for me to behave and say things that are appropriate. I am the guy that says thing that need saying, but everyone else is afraid to say them. And here I am who says what they think and feel.

Really, as an employer, how many people want to have an employee like me? I am generally labeled as a “wise-ass”, because I generally just say what I think, and I don’t concern myself with the consequences.

However, I do recognize that my inhibitions are broken. I have recently “come out of my shell”, and I am trying to “fix” my inhibitions. But you have no idea how hard it is for me to behave appropriately. Now, my “shell” was mostly self-imposed. I had a stroke in 2011, I knew I had a stroke, I knew that I had lost a great deal of my cognitive functionality, and I was, and still am, embarrassed by that fact. So ever since my stroke, (FIVE years ago), I have pulled within myself and kept everyone away from me, primarily for my own protection.

Now, in addition, Inhibitory Control is necessary for one to override “stimulus-driven behavioral responses”. And that is yet another part of my downfall. It is really hard to resist buying things I see at Costco that I like. The only positive I can see in my behavior is that I am not interested in most things I see at Costco. But that didn’t prevent me from buying 500, yes FIVE HUNDRED, envelopes. They were cheap, but, I am probably die of old age before I even use half of them. And, on three different occasions, I purchased yet another multi-tool. I have a drawer in my kitchen that is half full of these multi-tools, I just cannot resist. And once, I saved the money to buy an expensive telescope. Fortunately, I had finally done the appropriate research and had learned to discover that I would have to drive an hour and a half to go to a totally dark sky so I could use the telescope in the most efficient manner.

WORKING MEMORY:

Once upon a time, pre-stroke, my memory was a steel trap. Now, while I didn’t remember everything, I retained alot of information. Post-stroke? Forget it! (pun intended). Working Memory is also called Short-Term Memory, and my short term memory is broke. I cannot remember a three-digit number for even five minutes. About once a week, I read two formal definitions on “Injective functions” and “Surjective functions”, and I totally forget the definitions within about five minutes or less.

However, since I know that my short term memory is damaged, I need to be honest. Yes, I really need to be honest with other people. That is because I do not have the memory to remember what I have lied about. I knew that back in 2011, and I know it now. And since I moved to Fargo North Dakota in 2013, I have always been honest with people. My memory loss cannot allow me to lie. So, for better or for worse, I am condemned to tell the truth, probably for the rest of my life.

And, really, would you like to know a man who always told the truth? Ya know, if your wife were ummm… a little chubby… would you really like to hear the truth? I have no idea. And while I am under no obligation to say what I think, if we combine that short-term memory loss, my honesty, and my broken inhibition control… well, I could conceivably say the wrong thing to the wrong man, or the wrong woman.

COGNITIVE FLEXIBILITY:

That is the functionality of a person when doing task switching. First off, I need to say that the human mind is totally and irrevocably unable to “multitask”. Let’s face it, while people claim that they can “multitask” that statement is pure fantasy. The best that humans can do is “task switching”.

And poorly at that.

However, me, the guy with broken executive functions, am even worse at task switching than a slug. Yes, my Neuro-Psych evaluation had tested my task switching capabilities, and to be honest, in my own words, they sucked. Alot!

I am able to focus on a single task, especially playing games. I am and have always been a gamer. Now, my game-playing skills have become crappier since my stroke, but that has become the only thing that I can enjoy. So I game.

But, I did notice something earlier today. I was getting severely beaten in a boss battle, I was getting my butt kicked repeatedly, like fifteen times in a row before I finally killed the boss. and I had realized that I had been holding my breath for about a minute and a half throughout the final battle. I almost passed out from lack of oxygen. Thus, my task switching skills really need to improve before I pass out during another boss battle.

REASONING:

Pre-stroke, while I was not a “Randroid”, I did pride myself on my reasoning ability. I was working in a lab in 2009-2011 and there was a lab procedure that we require to mix “stuff” together to use as a reagent in animal testing. The person who had made that reagent previously told me that it needed to be mixed in really really hot water in order for the chemicals go into suspension. I had tried that about three times and then I started to think. Maybe this previous lab-tech was wrong? The previous lab tech was dead wrong, I even used a “failed” batch of that perticular reagent to go into suspension quite easily once it had cooled down to room temperature.

The point being that I didn’t believe the previous lab-tech, and I had thought a little, did a test, and it was successful. Easy Peasy.

Then the stroke happened. Since my stroke, I have tried to remain rational, I have tried to reason everything out. And eventually, I guess I do the right thing. However, I am, to some degree, ruled by my emotions. And while I know that emotions are an effect, and never a cause, when it comes down to the real life in real-time it is difficult for me to think rationally and reasonably, and I sometime “think” with my emotions, often to my detriment.

PROBLEM SOLVING:

OK, in my defense, I think my problem solving capabilities took a hit. However, that did not dissuade me from replacing the high-pressure power steering fluid hose, the heater blower/fan, and change my oil in my car last year. Now, it did take me about four days to replace that hose, about an hour to replace the fan, and about four hours to change my oil (don’t ask). So, I am still able to, eventually, solve problems successfully. But, my problem solving skills have been somewhat limited due to my stroke.

PLANNING:

Generally, I don’t plan anything. I am always early for all appointments, because after 2_1/2 years, I still have no idea how long it takes me to drive four miles to the VA hospital, drive/walk 1/2 mile to my local UU church. And while I generally go for a walk every day, I don’t actually plan when I will leave for my walk or when I will be back from my walk. I just walk, and then I go home, and 2-3 hour later, I am back home and I take a nap, usually.

So, my planning skills are probably the worst. I had to drive to the VA hospital in Minneapolis last year, I checked maps.google.com and made my best guess of how long it would take to drive there, added an hour for a meal on the way, and then multiplied my estimate my +50% “just in case”. Of course, I was early, as usual. But, I accept that as a part of my normal daily life. At least I am never late,

STIMULUS CONTROL:

Now, among all the damage to my executive functions, I think that my stimulus control is mostly intact. I know that I should stop when I am near a stop sign, I know these things and I have never forgotten these things. So, in my opinion, my stimulus control is pretty good, I guess. I can look at the situation and make a relatively quick assessment of how to change my behavior to avoid getting in trouble.

So, at least my executive functions aren’t entirely broken.

CONCLUSION:

Now, I think I have run down my impressions on what happened to me with my stroke.

As a brief comment, what generally happens to the brain such that the executive functions have taken a hit?

Now, the prefrontal cortex is necessary, but not solely sufficient, for executive functions. Thus, I would imagine that the physical damage of my brain had impacted my prefrontal cortex. However, the caudate nucleus and the subthalamic nucleus, whatever those things are, are also involved in inhibitory control and the behavior. Thus, my best guess is that not only did my prefrontal cortex take a “hit” but also my caudate nucleus and subthalamic nucleus as well. So for all readers who understand the geography of the brain, this is for you. Because I cannot understand anything in this paragraph.

So, what do I do about this executive functions being broken?

I deal with them as much as I can. I know that these executive functions change naturally over time. With my stroke, I imagine that it will be slower for me than with a normal person. So, as always, I will persevere.

I know that many stroke survivors “give up” after 2-3 years. I am not one of those people. Yes, I have isolated myself for about five years, but I have recently, as I had said, “come out of my shell”. I actually talk to total strangers when I go for a walk, on some occasions these conversations have lasted fifteen minutes or more. Recently, I have been having conversations with a person that have been lasting for an hour or more, we have drunk coffee, we have played scrabble (PS: I am really bad at scrabble), and we have just talked. And for the first time since my stroke, and probably since 2003, I see a decent and kind person and I think that I might have been wrong when I have said to myself that with my stroke, my life is over.

Now, I don’t know. Nevertheless, I will persevere.

 

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