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    Stroke recovery and fatigue
    strokewife posted:
    My 49-year old husband had a cerebellum stroke last year. He has had a full recovery in every sense of the word except he has exteme fatique when doing exercise activities. He is not overweight and was used to an extremely active lifestyle playing tennis, golf, racquetball, running, and hiking. When he had his stroke, they discovered that he has a patet formen ovule and a factor 8 blood clotting disorder. He has been on high blood pressure since he was 18 years old.

    He is getting depressed because he can no longer play tennis longer than 20-30 minutes, golf 18 holes or run up to 2 miles. Prior to the stroke, he was very active.

    Why is he so fatigued? What can he do?

    Richard C Senelick, MD responded:
    Fatigue is common following a stroke or brain injury. It can be the most common complaint in people with disabilities because everything from thinking to physical activities can be more difficult. There is probably also an "unknown factor" that leads to this feeling of no energy.

    Your husband is functioing at a high level following his stroke and is missing his "old self." He is beyond the usual suggestions of rest, pacing and energy conservation. If you went to a health food store they would suggest a variety of supplements and vitamins to improve his energy. I am not a big fan of these, particularly in your husband's case. Many of the supplements can affect blood clotting and lining of blood vessels. For instance, Gingko biloba can cause excessive bleeding.

    There are a number of medications that we use to improve fatigue in disability. Many have been tried in multiple sclerosis, brain injury, stroke and spinal cord injury patients. They all fall into the category of stimulants and can be safely administered to the right patients under the supervsion of a physician. I am not sure if your husband would be a candidate since they can make high blood pressure worse and this would need to be closely monitored. The use of all of these medications is what is called "off label" and you will need to find a physician who is comfortable working with your husband. Off Label means the drug company cannot promote their use in certain unapproved areas, but many physicians and patients will use the medication for things they know from experience are helpful.

    If you primary care physician is not comfortable treating fatigue, then ask for a referral to a rehabilitation physician who cares for stroke and brain injury patients. Some rehabilitation physicians specialize in sports medicine, back or neck pain. This type of physician may sound like what your husband needs, but he needs one who deals with stroke patients all of the time.

    Don't forget to remind all his doctors about his high blood pressure and clotting disorder. Trust the judgement of those who know his condition. They can also determine if there are other medical reasons to account for his fatigue.

    Good Luck.
    After your stroke you may be experiencing a new normal, but remember what George Eliot said- It is never too late to be what you might have been. You still can achieve new goals.
    strokewife replied to Richard C Senelick, MD's response:
    Thank you so very much. My husband has a doctors appointment on August 11 th and he will be sure to discuss this with him. In your opinion, do you think there is any way that has his blood could be depeleted of oxygen which could be causing fatigue. The reason I ask is that his tennis game is still sharp as it was prior to the stroke. However, after playing 30 minutes he is absolutely exhausted and lacks the stamina to continue. I know that I've heard of athletes adding oxygen to their blood to improve stamina. Please understand, I am not advocating for that at all, it just seems to be the exact opposite of that.

    We are so grateful of his complete recovery but would love to have some energy.

    lostbythis replied to Richard C Senelick, MD's response:
    My bleed was in my caudate nucleus which I understand is associated with fatigue, which I suffer from terribly. Is their any specific treatment for this?
    atti_editor replied to lostbythis's response:
    Hi lostbythis,

    Just wanted to pop in and let you know that the discussion you are replying to is 3 years old, and the original poster may not be following it anymore. I encourage you to start a new discussion with your question by selecting the orange "Post Now" button at the top of the page so that your post is not overlooked. If you are seeking the help of our expert, you might put Attention Dr. Senelick in your question's title.

    Best wishes,

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