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Post by David Dansereau for Know-Stroke.org

This is one exercise I sometimes  still visualize in my sleep and continue to work on to improve my balance post  stroke.  I’ve since been able to give it a boost by trying it with heavier weights, with my front leg on a Total Gym glideboard,  and at times even successfully with my eyes closed.

Use caution and modify to your level of fitness / rehabilitation when needed*

Intensity Level:  Moderate Difficulty with disc as shown

Lunge with Balance Disc
1) Stand with feet hip width apart. Take leg and step back approximately 2 feet standing on the ball of the foot. Place the front foot on a balance disc (or use the floor without disc for beginners).
2) Start position: Feet should be positioned at a staggered stance with head and back erect and straight in a neutral position.  Hold medicine ball in front of your chest for added challenge.
3) Lower body by bending at hip and knee until thigh is parallel to floor. Body should follow a straight line down towards the floor.
4) Return to start position while raising the medicine ball overhead and repeat. Alternate or switch to other leg after prescribed reps.

5)Stroke Rehab Tip:  Use a mirror and focus on a central point straight in front of you and always train both sides

This exercise is from my PT coaching site-My-Physical-Therapy-Coach.com

*You should follow a rep and set sequence that makes sense for your level of rehab or conditioning.  If you are working with a physical therapist or qualified trainer consult with them first about adding this full body balance exercise to your  stroke recovery training.

Launches First Patient Survey

We want to hear from you! Please take a few minutes to help us learn more about the PFO patient experience by taking our first PFO Patient Survey.

This survey is only for patients diagnosed with patent foramen ovale (PFO). If you have a PFO, your answers to this survey could help other patients and the medical community alike to understand how PFO’s are being diagnosed and treated.

Learn more and take the PFO survey here

Wöhrle J. J Am Coll Cardiol Img. 2010;3:833–839.

Image Courtesy of PFO Research Foundation

“It adds to the growing body of evidence that a PFO has multiple, potentially adverse, consequences that are often not noticed. Although a plethora of literature addresses stroke in patients with a PFO, no systematic study has evaluated embolism in other organ systems,” he wrote. “[This study] also encourages the introduction of better imaging to detect currently unidentified pathology.”

Read the full article

Learn more about PFO at PFOResearch.org

1 mg Tablet Blister Packs only

Recall Notice :  Posted  from FDA / MedWatch

AUDIENCE: Hematology, Cardiology, Risk Manager

RECALL INFO: Bristol-Myers Squibb determined that some of the tablets, over time, may not meet specification for isopropanol. Isopropanol is used to maintain the active ingredient, Coumadin, in the crystalline state, and could affect the therapeutic levels of the active ingredient. A decrease of active ingredient may increase the risk of clots which could lead to heart attack or stroke, and if there is too much active ingredient, there is an increased risk of bleeding.

The following lot numbers are included in this recall: Physician Sample Blister Packs: Lot# 9A48931A, 9A48931B, 9A48931C, expiration January 2012; HUD Blister Pack: Lot# 8F34006B, 8K44272A, 8K46168A, 9F44437A and 9K58012B with expiry dates between June 2011 and November 2012.

BACKGROUND: The recall only involves Coumadin 1 mg tablet blister-packs distributed in the U.S. This recall does not involve Coumadin 1 mg supplied in bottles or any other strengths and dosage forms of the product. Patients who may have product from the subject lots should contact their physicians to ensure that their anticoagulation therapy is not interrupted.

RECOMMENDATION: See the company Press Release for additional contact information. Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

• Online: http://www.fda.gov/MedWatch/report.htm
• Phone: 1-800-332-1088
• Fax: 1-800-FDA-0178

To Read the MedWatch safety alert, including a link to the company press release click here

Life after a stroke can be like living with a ticking time bomb.  The reality is that a second, possibly fatal stroke can very well follow the first.  In 2006, I survived a second stroke and shortly thereafter I vowed to make that one my last.  I researched all my treatment options, and as it turns out after 9 months of frustration I guess you could say I finally “qualified” to have my PFO closed “off label”.   What that really means is essentially my wife and I fought like hell to get a better chance at a treatment outcome we could both live with.   In the end, I weighed medical management (drug therapy) vs. surgically correcting my underlying heart defect.  My stroke could not be attributed to a disease process like hypertension or uncontrolled hyperlipidemia and no drugs or lifestyle modifications were going to be effective at reversing my risk of another stroke without possibly putting me at risk of further potential drug complications.  As the title of this post suggests, I was born with a congenital heart defect called a PFO that caused my stroke, and I decided a drug (yes, also used to kill rats) was not the therapy of choice for me for the rest of my life.

My decision was not an easy one, but either is rehabilitating from a stroke and I say this cautiously knowing that many reading this may now be faced with the same difficult decision of how to best respond to take back their own health.

I emphasize, you should speak with your own physician throughout the course of your own therapy and ask plenty of questions.  The decision I made was unique to how I envisioned I wanted to live my life after my stroke.  Your life goals should provide the blueprint for your own health plan, not your insurance carriers plan for your care.

Honestly, I’ve had this article ready to post for several weeks now.  I actually started this response after a comment that appeared on my blog (know-stroke.org) about alternatives to thinning your blood. In response to my post I was asked through a private comment on my blog why I didn’t just stay on drug therapy after my stroke since Coumadin seemed like the “simple solution” to prevent another stroke.  Well, I have to put this out there that it simply isn’t quite that “simple”.

Here’s what you should know:

Yes, Warfarin is still used as rat poison.  This fact certainly got my attention when I was advised to start Coumadin therapy. I hope that you have already researched this medication on your own.  I mention it not to scare you but to make an important point:  If taken in large quantities, Warfarin (brand name Coumadin) can cause severe and even fatal bleeding. When given as a medication however and monitored by blood tests, it is reported to be safe but not without a long list of potential drug complications as reported by the National Institute of Health’s (NIH) Pub Med Website.  Here’s what they have to disclose on what side effects this antithrombotic medicine can cause:

Warfarin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• gas
• change in the way things taste
• tiredness
• pale skin
• loss of hair
• feeling cold or having chills

If you experience any of the following symptoms, or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• hives
• rash
• itching
• difficulty breathing or swallowing
• swelling of the face, throat, tongue, lips, or eyes
• hoarseness
• chest pain or pressure
• swelling of the hands, feet, ankles, or lower legs
• fever
• infection
• nausea
• vomiting
• diarrhea
• loss of appetite
• pain in the upper right part of the stomach
• yellowing of the skin or eyes
• flu-like symptoms
• joint or muscle pain
• difficultly in moving any part of your body
• feelings of numbness, tingling, pricking, burning, or creeping on the skin
• painful erection of the penis that lasts for hours

You should also know that Warfarin may cause necrosis or gangrene (death of skin or other body tissues). Call your doctor immediately if you notice a purplish or darkened color to your skin, skin changes, ulcers, or an unusual problem in any area of your skin or body, or if you have a severe pain that occurs suddenly, or color or temperature change in any area of your body. Call your doctor immediately if your toes become painful or become purple or dark in color. You may need medical care right away to prevent amputation (removal) of your affected body part.

Warfarin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

In case of emergency / overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• bloody or red, or tarry bowel movements
• spitting or coughing up blood
• heavy bleeding with your menstrual period
• pink, red, or dark brown urine
• coughing up or vomiting material that looks like coffee grounds
• small, flat, round red spots under the skin
• unusual bruising or bleeding
• continued oozing or bleeding from minor cuts

Even rats it turns out can’t survive for long with all these possible complications of Warfarin (without getting their blood levels checked regularly I guess).  So, don’t be a rat.  If you are using blood thinning meds please get your blood checked regularly.

Certainly, both drug and device-based therapy for PFO carries risks. Antithrombotic medications, like all medicines, have their long list of warnings, but many times we do not take the time to read the fine print.  PFO closure devices, however, are also associated with device-specific complications such as fracture of device elements, device embolization or thrombus formation.

Bottom Line:

Optimal stroke prevention strategies in patients with PFOs have not been established.  I am confident a solution to improving patient care for PFO conditions exists and my involvement with the PFO Research Foundation supports this mission. Yes, I do hold a bias towards PFO closure because my own results have been incredibly positive.   While I did try medical options including antithrombotic medical therapy prior to PFO closure, they did not work in my case.  What I do know is I do think about the long term impact of the implantation of my PFO closure device, because the benefit of PFO closure in patients with stroke has not been clearly demonstrated, and remains unclear and at times controversial.   I hope to help do my part to advance this important PFO research, so I guess you could say I will need to be a rat to help advance the science.

Resources:

Pub Med Health

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000634#a682277-sideEffects

Wikipedia

http://en.wikipedia.org/wiki/Warfarin

Doctor: Help for migraines is in the heart.

How’d I know? Get on the PFO Research Foundation mailing list and you could know too…

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Bret Michaels suffers stroke from PFO

by David Dansereau

know-stroke.org

Bret Michaels, who just taped his interview with Oprah Winfrey before this recent setback from a minor stroke from a PFO, is expected to recover (again).   His condition is reported as “operable and treatable”, so there will certainly be many following  Bret’s progress as well as more interest in PFO and related disorders.  I certainly wish him a swift recovery as well.

According to E Online Bret was scheduled to return this Sunday to a finale of Celebrity Apprentice , and it is reported his status for this event is in doubt, as well as his planned return to the concert circuit on May 28.

To learn more about PFO,stroke and to join in on the conversation with patient discussions about PFO please visit pforesearch.org

For more on Bret Michaels see this LA Times article

Heart disease and stroke are the number one and three causes of death in the United States.  Inflammation has been shown to be a primary factor in the development of atherosclerosis, the major cause of cardiovascular disease.  But did you ever think you could be “digging your grave with your teeth”.

If you keep up with the articles and posts from my nutrition site, my-nutrition-coach.com you might naturally think I’m referring to the heart disease and stroke risks associated with all the poor food choices we make.

While studies show dietary choices do contribute to the disease process and can lead to an early grave, the focus of this post is on the link between heart disease and gum disease.

A private comment on my stroke blog recently asking me about what meds one would need to take after PFO closure initiated this post.  I generally leave specific medical advice to the docs, and most of the controversy and need for better patient guidelines post PFO closure surround the topic of continued blood thinning. One very important medication, and the one most often minimized after PFO closure, is the need to take some form of prophylaxis by antibiotics before dental procedures.  Why?

Some surgical and dental procedures can cause a brief bacteremia (bacteria in the bloodstream).  No big deal, right?  Well, if you have abnormal heart valves, prosthetic cardiac valves, congenital heart disease or have had cardiac procedures like stenting or occluders (PFO closure devices) placed then these bacteria can become lodged on these abnormal surfaces.  The life threatening medical condition that results is called bacterial endocarditis and it is a heart risk that occurs when this normal bacteria from your mouth (source can also come from the respiratory tract, intestines or urinary tract) enters the bloodstream and causes inflammation in heart tissue.

Bottom line:

The people with the highest risk for bacterial endocarditis include those who have:

• Prosthetic cardiac valve
• Previous endocarditis
• Congenital heart disease
• Cardiac transplantation with cardiac valve abnormalities

For all others:

The obvious-Avoid periodontitis by brushing and flossing regularly and get those regular checkups and cleaning from your dentist-to help your cardiovascular system and keep you from “digging a grave with your teeth”.

[Sidebar and Quick Tip for those new members of the “heart plug club”]

Keep an extra dose of antibiotics on hand in case of dental emergencies and remember to take your dose as prescribed before you arrive at your dentist for your regular check-ups.

Article by David Dansereau for know-stroke.org

Sources:

Ide M et al,J of periodontology,2004

Yong-Hee P et al, J of Periodontal Research,2007

Know-Stroke.org

As you might be aware May is Stroke Awareness Month.

Play the Stroke Awareness Presentation

Act FAST and call 911

Either way, be sure you Know Stroke !