Stroke



  • I recently suffered a "mild" stroke. I had the stroke 1800 miles from home and have now returned and awaiting my referral appointment with a local neurologist. The residual effects have been numbness and slight impairment on my right side as well as difficulty maintaining my balance. I was advised to refrain from playing for for 4 weeks. After 4 weeks I began playing again, bur also followed my doctors advice to not exert myself when I play for another couple of months--nothing particularly high or particularly loud. I am having some problem syncing my tongue and fingers, but hopefully that will get better as I continue to work on it. Has anyone had any experience with strokes? Can you offer any insights? Is there anything I should be telling my neurologist?



  • @amzi

    I'm sure Kehaulani will respond once he sees this thread.



  • @GeorgeB said in Stroke:

    @amzi

    I'm sure Kehaulani will respond once he sees this thread.

    Agreed, as there is nothing like getting the advice of someone who has "been there".

    However, as a physician, referral of patients to physical therapy is in my mind, as important a part of the immediate treatment plan as being placed on blood thinners and imaging the neck, cerebral vessels and getting an echocardiogram for ruling out a cardiac etiology to the stroke. I think getting back to playing as you are amzi is the best plan possible. This work and re-work of muscle and sensory nerves by repeat practice experience will help to recruit alternative neurons that well be able to reconnect muscle in a unique way to help support the "new" performance demand,

    Of course the NEXT important part is preventing the possibility of the NEXT stroke and that will require medication that I will leave to the recommendation of your neurologist.



  • NEXT LEVEL of PREVENTION:

    First, I will post a disclaimer, what follows in this post is completely MY OWN medical opinion and practice as a physician, and is not discussed in any standard medical text or guidelines to POST stroke management.

    The number one cause of death in a stroke patient is a myocardial infarction (MI). This face IS well established in the medical literature. So if the medical community is going out of their way (which the should) to prevent the possibility of the next stroke, I believe they should be going out of the way to prevent the most deadly outcome for the post-stroke patient.

    So all of my patients that come to me after having a stroke get an order from me to go to the cardiovascular lab to have a cardiac stress test performed. If it is positive, it is time to address the management of coronary artery disease to prevent an impending heart attack, and this takes a completely separate range of management options.



  • I am really sorry, Amzi. I hope you continually improve.

    To qualify what I am saying, I have had two major strokes and several minor ones. My vision's impaired, I have some physical coordination problems, am wheelchair borne, and have trouble with concentration.

    Probably a big thing you will have to deal with is patience. One just can't do what one, formerly, could do and it's frustrating and depressing. For example, I haven't gotten better than Lesson Seven in Harold Mitchell's Book One (Beginner). By contrast, I could, formerly, play in Book Three with a range of Double High C.

    I would say, one thing that might be critical to you is to get good and consistent physical therapy. And listen to your therapist.

    Amzi, you might not recover at a pace you want. For those of us that had former lives being goal-oriented, it's a major paradigm shift is to go from blazing towards an end goal but to become more aware and engrossed in the process. You may have to go from practicing to play the Haydn to practicing for the sake of practicing.

    At any rate, patience and optimism. Good luck.



  • Dr. GO: I had the good fortune to be admitted to a hospital that has a specialized stroke unit. Before I left I had a TEE and an Echocardiogram, dopler examinations of my legs neck and cranial nerves. I also had a couple of MRI exams and a CT, I even had a :Bubble Study with transcranial dopler--and yes, I have a PFO and likely a AV Shunt in my lungs also (The cardiologist recommended that I not have the PFO repaired at this time, but that it would bear future monitoring). Due to the fact that I suffer from Persistent Intermittent Atrial Fib I have been on blood thinners for years the only medication change was to add a baby asprin to the regimen. I also exercise regularly. It was nice to receive your reply. I feel medical advise from someone who knows the ins and outs of trumpet playing is always a good thing and often gives me insight into interacting with my doctors.

    Kehaulani: Thank you so very much for your response. Your advice has given me some things to think about, especially your advice about patience and realistic goals. My original goal has been to be able to play next season in the symphony, but now I realize I need to be prepared for the possibility that I will need to take a hiatus.

    Well, onward and upward. I'll keep working to regain as much as I can. Once again, thanks.



  • @amzi

    I admire Kehaulani greatly for his courage and determination and I will now add your name to the list, amzi. My very best wishes go out to you.



  • @amzi So sorry to hear about this. I hope that your recovery is going well so far. @Kehaulani I've been on most of these forums for a few years now, and was unaware of your situation until I read one of your posts recently. I 2nd @GeorgeB 's comment.

    I actually had a minor stroke, or TIA back in March. It was actually a couple of days after Luke Perry passed away, and strangely enough, that probably saved my life. I was listening to NPR, and they were talking about how to recognize a stroke, which must have sank in, because I recognized the symptoms.

    I was lucky to be at home when it happened. I had a bad cold, and stayed on the couch downstairs as to not get my wife sick. I overslept, and was late for work. When I tried to call them to say I'd be late, I couldn't talk. I hung up. Cleared my throat, blew my nose, and called back a few minutes later. Couldn't talk. I went upstairs to use the bathroom, and when I brushed my teeth, I couldn't spit the toothpaste out normally. The left side of my face was partially numb.

    I walked into the bedroom, and woke my wife up. She thought I was joking around making noises, but she called 911. I was able to talk a bit in the ambulance about halfway to the ER. FYI, Afrin Nasal Spray and Tylenol cold medicine contain Oxymetazoline, which is a vaso-constrictor. I took them both the night before. I had been having bad headaches for almost a month while I had been using the nose spray, and thought it was just sinus pressure. Anyway...

    I won't say that I'm fine now. If you don't know me, you wouldn't notice, but my speech is sluggish, and I sometimes struggle to find words, or just get stuck. My right hand is affected. A month ago, I couldn't type. The first week or so, I couldn't keep my fingers on the valves of my horn. I was off for a week and a half afterwards, and was determined to be able to play. I didn't care much about the typing. My embouchure is different now, as I rely a bit more on the muscles on the right side of my face now. I switched to a bigger rim diameter, as a 3C just didn't work anymore. (I told my doctors that I played the trumpet, and none of them specifically said not to play. I didn't ask them specifically, as I didn't want to hear the answer if it was no.)

    What I've learned as a stroke newbie, is that if I'm tired, or under stress, my symptoms get much worse. When I get tired, I am completely wiped out, unlike anything I've felt before. I won't go as far as to say I get confused now, but my thought process is different now. My train of thought jumps the tracks frequently now. I went for physical, occupational, and speech therapy, and they all pretty much told me that I'm fine. I know that I'm not 100%, but like I said, they didn't know me, so they didn't really notice the difference.

    I still have a few follow up appointments, and another MRI. I just had a cardio stress test last week, and was hooked up to a heart monitor for a month. (My chest hair is slowly growing back, but at least it's not itchy anymore.)

    I'm doing my best to eat better, get exercise, and manage my stress (Mostly out of my control.)

    Some days are frustrating, not just with playing, but with just everyday tasks. Other days are pretty good, and I need to remind myself not to push it too hard.

    They say some things will come back, but I tend to look at it as needing to learn a new way to do certain things, which includes playing the trumpet. So far, it's my best occupational therapy. I'll be 50 next month, and my big present is my Martin Committee (Charlie Melk has it at the moment.) I'll be damned if I can't play it.

    Be patient. Try not to get frustrated. Most importantly, take care of yourself.



  • We all go through unfortunate crap. The reward for surviving them is living longer to pursue our interests;) Almost 20 years ago, i spent 7 weeks in the hospital. I was 36 and had just suffered my second bout with Pancreatitis. Almost killed me. The last few weeks, i had 3 different roommates who all got better and left before me. All over 60;) So i have a number of problems still too, but keep fighting the fight;)



  • I had an elderly tuba playing student that got back to playing before he could even speak again. Tongue/breath coordination helped a whole lot as did forming the embouchure. What helped most was playing in front of a mirror which offered at least optical feedback before the sense of „feel“ came back.

    My recommendation for practice is to take notes and rejoice in accomplished „small steps“! This is my strategy for all students, but especially if we have a temporary or permanent handicap, we need all of the objectiveness that we can find.



  • So far, so good! I'm now 8 weeks removed from my stroke and my playing is progressing quite well. One more month and I can start playing without restrictions. Right now I'm playing second parts so I don't have to play any high notes. The only thing that has seemed to suffer is my endurance. My lip is fine, but I'm just physically tired. The fatigue seems to be my problem with everything I do--getting better but not where I want it to be. I'll be working on my endurance this summer getting in shape for next season. I'll be posting periodically to be keeping you advised of my progress. Thanks for all the good advice and encouragement.



  • one day at a time. its an overused phrase, but so true.



  • 8 weeks removed from your stroke/
    You're lucky. There's a full year and a half that I don't remember. at all. It'll get better, just keep on doing what you're doing.


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