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Welcome to Episode 2 of Strokecast. This week -- it's all in my head and new standards for tpA.

It's All in my Head!

Normally, when someone says that something is, "all in your head," they mean it derisively. They mean you're making it up. When it comes to my stroke though, the problem literally (yes, literally) is all in my head. So let's explore this concept in a little more depth.

To begin with: What is a stroke?

There are two main types of CVA, or cerebrovascular accident (the official name for a stroke). They are ischemic and hemorrhagic.

My stroke was ischemic. That means a blood clot formed in one of the blood vessel in my brain and blocked the flow of blood to part of my brain.

In a hemorrhagic stroke, a blood vessel in the brain leaks or bursts. Blood escapes the circulatory system and starts pouring over neurons and into the critical space between brain cells.

Blood is great for the brain when it stays in the circulatory system and flows through it bringing nutrients and oxygen to the cells of the brain. When it's outside the blood vessels, it's poison for the cells. Or if it just doesn't flow, the cells can't get oxygen.

Regardless of the type of stroke, when the blood flow in the brain breaks, neurons, or nerve cells, die. The longer it goes on, the more cells can die and the more function a stroke survivor loses. A stroke gets worse as it goes on.

The interesting thing, though, is that the problem is all in my head. There's nothing wrong with my arm. There's nothing wrong with my leg. My brain just can't communicate well with them.

The point of occupational therapy and physical therapy isn't to fix the limbs. The point is to teach the brain to control the limbs again. The connection my brain use to have to my limbs is now just a chunk of scar tissue in my brain. So now my brain has to repurpose neurons and grow new ones to make that connection again. Thanks to neuroplasticity, this is possible.

Of course, the longer recovery takes, the more problems can develop outside my head, including:

• Shoulder subluxation
• Knee hyperextension
• Muscle atrophy
• Circulation issues
• Falls
• Sedentary lifestyle
• Dietary changes

Sleep is more important than ever. The brain of a stroke survivor is working harder than ever to work around the damaged section. It burns a ton of energy. That's one reason fatigue is such a common issue for stroke survivor. All the activities of life take a lot more effort than before, and the brain is burning a lot more energy to try to make things right. A stroke survivor naps and sleeps more not because they are lazy, but because they are working harder than at any time in their life.

tpA and Thrombectomy Updates

New guidelines from the American Heart Association expand the window for medical intervention in the event of an ischemic stroke. Previously, treatment could only be made available within 4-6 hours of the onset of stroke symptoms. That means if you woke up in the morning with stroke symptoms (like I did), clot removal was not an option. Under the new standards, mechanical or medicinal clot removal may be an option up to 24 hours after the onset of a stroke.

You can learn more from the American Heart Association here. Obviously, your personal medical team's recommendations should trump anything you read on the internet.

Hack of the Week

Getting stuff out of the refrigerator can be tough when you have only one functional hand and mobility challenges. I found the door kept trying to close on my head. Then I figured out a trick: I open the vegetable draw. This props open the door so I can search through the shelves at my leisure.

Call to Action

1. Do you have any thoughts on this episode? Let me know in the comments below.
2. If you have a story to share with the Strokecast audience, let me know. I'd love to have you on a future episode. Email me at Bill@strokecast.com
3. Subscribe to Strokecast in your favorite podcast app. If you can't find Strokecast in the directory, you can add it by RSS. Here is the RSS feed.
4. Don't get best…get better.