What is a Stroke?
A cardiovascular accident is commonly called a stroke. It is one of the top causes of death in the whole world. There are two kinds of strokes. A hemorrhagic stroke is from bleeding inside the brain. The other type is ischemic.
An ischemic stroke is when a part of the brain does not get enough blood supply. Usually, it is from a blood clot. When brain cells don’t have enough oxygen, they cannot function. The symptoms of a stroke depend on what part of the brain is affected. Different parts of the brain control diverse body functions like movements, sensations, swallowing, speech, and sight. That is why strokes can present in different ways. The larger the area of a loss of blood supply, the more symptoms are manifested. For this article, the stroke will refer to an ischemic stroke.
A ministroke is a collective term for Transient Ischemic Attacks or TIAs. A stroke is called a TIA if the symptoms like weakness or slurred speech recover completely within hours or days. However, several TIAs can cause memory problems in time. That is called multi-infarct dementia.
RS had a Stroke
RS is a 90-year-old female. She has medical conditions that make her prone to developing a brain stroke. She also has multi-infarct dementia from previous ministrokes thru the years.
Because of all of her medical problems, her family decided not to go for anything medically aggressive for RS. The term for that accepted form of care is called “comfort measures only.”
Within the past year, RS had three strokes, where she recovered within hours using conservative measures like elevating her legs while lying down. Doing so increases the blood flow to the brain by gravity.
About 2 weeks go, RS had another stroke. This stroke is the worst. RS lost her speech and swallowing functions, and she was not able to move the right side of her body from the face to her feet. A full paralysis of one side of the body is called hemiplegia.
When the swallowing is affected, if anything is given by mouth, it can go to the lungs and cause pneumonia. That presents an added problem to stroke patients. Lack of fluid decreases the blood flow to the brain, making the stroke worse and recovery impossible.
On the third day of her stroke, inserting a tube thru her nose into her stomach was considered. The purpose is to give water and possibly food thru the tube. However, with her dementia, she will not have the proper insight to keep it in and most likely will pull it out with her left hand. It seemed that the situation was hopeless.
Enter the Humble Medicine Dropper
In the beginning, a medicine dropper was used just to moisten RS’s mouth. Initially, a few drops at a time were given to see if she can tolerate it. If she doesn’t cough and her neck muscles moved like she swallowed the water, that means the water was consumed without a problem.
The amount of water was then increased from 1/4 teaspoon or 1.25 ml to 1/2 to 3/4 teaspoon or 3.75 ml at a time. If RS coughs, we stop until her breathing settles down. The number of drops was tallied and recorded to know the exact amount she was getting.
As the amount of water that she tolerated increased, half-inch cubes of jello were introduced to as much as she can tolerate. She was also started on mashed bananas.
Restricted Blood Flow Therapy
On the fourth day after the stroke, her right side was still paralyzed. A week or two before her stroke, Jesse was writing about the KAATSU method as a means for physical therapy. At that time, what was available was an elastic band that is being used for Restricted Blood Flow Training or RBF. RBF is a way to restrict venous return from the extremities. It is mainly used for muscle growth and has similarities to KAATSU.
As the elastic band was applied to RS’s weak arm, passive flexion was done. Passive means the therapist is the one initiating and making the patient’s limb move. The RBF therapy was also done to the other arm and both legs.
The Recovery
Five hours after the RBF therapy, the paralyzed arm moved. On the second day that the medicine dropper was used, her swallowing improved such that RS was able to drink from a straw without difficulty. She also started talking with short but intelligible sentences and regained some use of her right leg enough.
That was enough for her to be able to transfer and walk with someone helping her. Standing is very important in this situation because prolonged bed rest will further weaken her muscles and expose her to bedsores.
On that same day or the fourth day after the stroke, RS was able to walk with assistance to the dinner table and ate with a fork on her own using her previously paralyzed hand.
How is RS Doing Now?
At present, RS can eat on her own. She gets some hand-holding when she walks just to be on the “safe-side” on our part. But she can go to the bathroom on her own. She continues to have the RBF therapy with the elastic band on her thighs while doing a 10-minute walk for the legs and upper extremity range of motion exercises every day.
RS still has memory issues, and she has good days and bad days, but she continues to have small improvements with movement. Her memory and motor functions fluctuate by little increments. She can read again and sing with memorized lyrics.
Dr. Charito Saludades is an Internist and Geriatrician. She is also Mrs. Santiano
What is the Science behind the Recovery?
- This part by Jesse Santiano, M.D.
Ischemic Preconditioning
One week before her stroke, the elastic bands were applied to RS during her walking exercises and arm exercises. That was done at that time to increase her muscle mass to make her stronger. Weeks prior, I wrote several articles about ischemic preconditioning. Could her brain had ischemic preconditioning from the RBF training?
Ischemic preconditioning increases the mitochondria or power plant of each cell, making them more resistant to ischemia. It is currently being used in some hospitals to improve surgical outcomes. This may have contributed to RS recovery.
Restricted Blood Flow Therapy
Ischemic preconditioning and Restricted Blood Flow Therapy are similar in a way that a tight band is applied to an extremity.
Restricted blood flow therapy increases the anabolic hormones like growth hormones, insulin-like growth factor 1 (IGF-1), and vascular endothelial growth factor to facilitate recovery, faster healing, and muscle growth.
The Benefits to the Brain of Oral Stimulation and Chewing
The tactile stimulation with water and jello stimulates the sensory nerve endings present in the gum. The temperature and proprioception or position sensors are also activated. All of these sensory stimuli are received and activates neurogenesis or production of new brain cells and increase stress resistance.
The movement of the mouth with chewing and swallowing activates the muscles of the face and throat. This increases the flow of blood to the brain.
Muscle Activity Promotes Muscle Improvement
Skeletal muscle activity, whether in the mouth or the extremities, stimulates the rest of the body systems like the cardiovascular and respiratory system to contribute to the effort and meet the challenge. That is how exercise improves general well being.
Proper Diet
A diet low in sugar diet prevents inflammation of the blood vessels and assures a good blood flow.
The body has a way of forming blood clots and a system of dissolving blood clots. The blood vessels produce tissue plasminogen activator or TPA and functions to dissolve blood clots. As long as there is a balance between clot formation and dissolution, the risk for uncontrolled clot formation is small. One way to have that balance is to prevent excessive pro-inflammatory cytokine formation like the Plasminogen Activator Inhibitor or PAI. PAI excess contributes to clot formation and enlargement.
Concluding Thoughts
I do not recommend anyone to do the same thing we did if they witnessed anyone having a stroke. The best is to call 911 so that they can be brought to a stroke facility.
What happened to the stroke recovery of RS is mainly an anecdote, but it proves to me that stroke recovery is possible with inexpensive and scientific techniques.
What is essential is that RS can eat, talk, and walk again and celebrate one more Christmas with her loved ones.
Related Reading:
- The Story of KAATSU. The Incredible Technique for Muscle Toning and Hypertrophy
- The Science of KAATSU Training
- The Game-Changing Uses of KAATSU
- Precautions in KAATSU or Blood Flow Restriction Training
- 8 Ways Decent Dental Care Defies Dementia
- The Magical Endothelium
- High Blood Sugar, Even for a Short Period, Causes Atherosclerosis
- What is Ischemic Preconditioning?
- High-Intensity Interval Training can Activate Ischemic Preconditioning
- How Does Exercise Prolong Life?
Image Credit
- Stroke By Blausen Medical Communications, Inc. – Donated via OTRS, see ticket for details, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=26986798
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