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After Your Stroke: Getting a Second Chance
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Richard C Senelick, MD posted:


I am delighted to start in my new role as your Stroke Community Expert. I am a Neurologist who specializes in Neurorehabilitation and have over 35 years of experience in direct patient care, teaching and writing. I hope that we can create a very active community with lively discussions and an interchange of ideas. I need your help to suggest topics so that we can best meet your needs. Welcome to our Community.

Over the years, I have found that many stroke survivors have difficulty after they complete their initial course of rehabilitation and return home. They are no longer seeing their rehabilitation physician and are getting regular check-ups for their diabetes, hypertension, and other medical problems. Many of the chronic issues that affect the quality of one's life do not get addressed. These may include depression, pain, swallowing disturbance, bladder and bowel incontinence, or sexuality issues. At this point, it may be months following the stroke but, it is a perfect time for a "Second Chance Program". You should be re-evaluated by a speech, physical or occupational therapist to see what else can be done at this point. This is a good opportunity for you to share with me what problems you find most debilitating following your stroke or that of a loved one.

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Which one of the following is giving you the most trouble after your stroke?
  • Depression
  • Bladder or Bowel Incontinence
  • Spasticity ( tight muscles)
  • Driving
  • Fatigue
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mendomom responded:
I was diagnosed with a thalamic lacune on left side of brain in early November. No previous history of stroke or high blood pressure. Since stroke, I have facial numbness of the upper lip and chin area, balance issues and am very fatigued. Walking takes a very focused effort but is improving. No longer using a walker.


Physical therapist is reluctant to prescribe exercises because my lower back keeps going out more than I do. I am concerned about how deconditioned I am. I can drive and do a few household chores but get fatigued very easily and back pain is almost constant. Cognitively and emotionally I am fine. I run a small nonprofit and am fully engaged in the activities to do this but find myself exhausted. Good family and community support. I have been prescribed medication for pain. Reluctant to use but realize it is probably necessary if I am going to stop hurting.
Could the lower back pain be caused by the stroke?

Previous history of stenosis and chronic pain but have not had pain for several years. Hard to exercise when I hurt so badly. I feel like time is flying by that should be focused on rehabilitation.n
Any suggestions gratefully accepted. I am 65 so there is a limit as to how much PT I will qualify for. through Medi-Care.
 
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Richard C Senelick, MD replied to mendomom's response:
We have an expression in medicine, " Measles and a broken leg." In other words, two things that have nothing to do with each other. I think that is the situation with you back pain and your stroke. If theback pain is interferring with your ability to do rehab then I think you need to see whomever you have been seeing for your back. What have you done in the past when your back flares up? I don't want to suggest medicines without knowing your full history, but a good rehabilitation doctor should be able to handle this , as should your previous back doctor. If a course of steroids or an epidural steroid injection worked in the past, it may work again. I think you need to work on both problems at the same time.

Fatigue is one of the most common complaints after a stroke or brain injury . It will improve over time. Depending on the patient and the situation I will prescribe a mild stimulant like Ritalin or Provigil. They work very well to combat fatigue and improve attention and concentration. Not all physicians feel comfortable doing this, but most rehabilitation physicians who take care of stroke patients have this is their "bag of tricks." Chronic or even acute severe pain adds to the fatigue, so try to get your back pain controlled as soon as possible.

Good luck.
 
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StopObama responded:
I recently read of a new 4th indicator of a stroke and I would like to verify with you whether or not this is true. Along with the other 3 indicators (Face/smile, Arms/lift both, Speech/simple sentence) I read where you have the victim stick out his Tongue. If the tongue veers off to one side, that may also indicate a stroke. Is this true? If so, can you give me a medically credible reference? Thank you. I need this as soon as possible.
 
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tac12254 replied to StopObama's response:
hi there yes the tongue is a indicator that my docor uses ..... if in doubt and symptoms occur my Dr. say to always call at the very least Good Luck!
 
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Richard C Senelick, MD replied to StopObama's response:
I apologize for taking so long to respond, but I was at a meeting.

Here is a reference for tongue deviation in stroke (http://www.ncbi.nlm.nih.gov/pubmed/11070377 ). 29% of stroke patients will have an extended tongue point toward the side of their weak limbs.

However, I have not found it a very useful sign in stroke. The person usually has other signs and problems that help us make the correct diagnosis. I would be cautious about going around and asking people to stick out their tongues. You never know what trouble you might get into.
 
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jep1000 responded:
depession was immediate ,ireuested antdepessant and was give lexapro 10 mg aftertwo weeks depression was much improved,fatigue is still a problem
 
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frankie7459 responded:
i have been a stroke victim now for 5 years. i have problems with bladder incontinence and fatigue. my stroke affects my left side. i walk with a 4 prong cane. i'm not able to lift my left leg very high, and my left arm.is there any exercises to help this?


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Richard C. Senelick M.D. is a physician specializing in both neurology and the subspecialty of neurorehabilitation. He did his undergraduate and medic...More

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