Many people return to their usual diet after stroke however others may need to modify their diet if they experience short or long-term difficulties with eating or drinking.

After a stroke, there is a greater risk of poor nutrition, poor fluid intake and weight loss.

This is often due to: swallowing problems (called dysphagia) problems with movement (eg using a knife and fork) problems with thinking (eg forgetting to eat) loss of appetite

Who can help?

A Dietitian can assess your diet and provide ways to help you meet your nutritional needs and prevent poor nutrition from slowing down your recovery. Dietitians often work with Speech Pathologists who look at the consistency of foods and fluids that you can swallow safely.

If you have severe swallowing problems you may have to be given nutrition and fluid through a feeding tube especially in the first month after stroke. If you require tube feeding for a longer period of time, your doctor may recommend a PEG tube which is placed directly into your stomach. Your Doctor, Speech Pathologist and Dietitian can provide more information on this.

Dietitians can provide a nutritional assessment and advice to decrease your risk of another stroke. These risk factors include high cholesterol, high blood pressure, being overweight, low fruit and vegetable intake and diabetes.

While you are recovering in hospital, nursing staff and/or your Dietitian should weigh you weekly and monitor how much you are eating and drinking. If you are at home, you may like to do this yourself.

For more infomation or to find an APD (Accredited Practising Dietitian) go to the Dietitics Association of Australia

Ishbel was just seven years old when she suffered a massive stroke in 2003.

She had fallen out of bed when her father found her in the middle of the night. No one knows how long it had been since Ishbel’s stroke so clot-clearing medication was not an option.

With no more warning than Ishbel’s sudden and severe headache on that hot summer’s day before she went to sleep, Ishbel’s life took an unexpected turn. To this day, and despite many tests and checks, there is no explanation for the stroke.

The stroke left Ishbel paralysed on the right side of her body, unable to talk and walk and she spent months in and out of hospital, although she remembers being allowed to go home for Christmas: “That was the best, not to have to spend Christmas in hospital,” she says.

Right-handed, Ishbel has managed to teach herself how to write with her left hand but has muscle constriction on the right which can be painful.  She remains resolutely upbeat despite the fact she can’t run – she can, after all, swim with the best of them and walks with the aid of a splint.

Her mum says it was the seven-year-old Ishbel herself who led her through the recovery process. “I am dragged on by Ishbel every step of the way”.  Those first days and months after the stroke were a haze of “just getting through”. “I didn’t have time to feel sorry for myself or even Ishbel”. “There was just so much to do. There wasn’t time to reflect. We just had to manage.”

Overall, her mum says she feels her family is “just incredibly lucky to have Ishbel with us today”. She insists Ishbel’s story is one of true survival and that her young daughter has shown courage and strength beyond her years. “I feel incredibly proud that she has survived everything in her own way and with an amazing resilience and determination. I thought at one stage that our worlds might shrink but in actual fact I’d say that my perspective has enlarged.”

Ishbel herself wants to work in a hospital one day. “I’m not sure doing what but they just do such amazing work and I want to be a part of that.” Her options are still open – the year 9 St Vincent’s College student was recently treated to a personal master class with Sydney chef Simon Sandall from Opera Point Events Just ahead of the National Stroke Foundation’s annual Stroke of Art – Food for Thought event, Ishbel spent an afternoon with Simon at the main kitchen of the Opera House.

To see a Video shot at the Food for Thought exhibition.

Matt Lee Photography: food for thought

Cooking can be an activity that presents challenges for some stroke survivors, but it remains one of life’s necessities and, for some, great pleasures. Depending on where you are at in your stroke recovery journey you may be feeling frustrated at not cooking the way you used to. After the terrific response we received from readers when we recently posted our NSF colleague Emma’s recipe for a one-pot dish we thought we’d have a peek at the web for ideas other people have had – and kindly shared – about how to get around in the kitchen when your body responds differently to the way it used to.

TIPS:

• Bench tops: If bench tops are at an inconvenient height and modification is too expensive a butcher’s block or similar, height-adjustable table can be helpful for food preparation.

• Knife: A rocking knife can make it easier to chop with one hand.

• Chopping Board: Securing a chopping board to the bench prevents slip.

• Bowls & Pots: Bowls and pots can be secured to a surface with non-slip pads.

• Reading: If reading fine print is a problem, you can organise to have spices and other small items placed into a bigger container with instructions or use-by dates, etc, copied in large print.

• Frozen Veges: Frozen vegetables can be a healthy alternative when chopping is too difficult.

• Regularly used foods:  spreads, bread, cereal, can be more accessible if they already opened and at eye height.

• Oven mits & Pan holders: Make sure oven mitts and pan holders are in clear view.

• Preparation: Look for recipes that healthy and can be prepared in large amounts without using too many pots (such as casseroles and soups).

• Safety: We think safety is paramount, whether you go back to cooking hot meals or even just a snack for yourself, so if you can, have someone look over your kitchen for any potential hazards.

Happy eating!

Go to an Independent Living Centre for modified utensils

Manage your medication to manage your health

Every year, up to 210,000 Australians are admitted to hospital due to medication problems. At least 50 percent of these admissions could be avoided by better medicine management.

What is a Home Medicines Review?

A Home Medicines Review is a free health service funded by the Commonwealth
Government. A pharmacist will visit you at home and review all your medicines. The pharmacist then works with your doctor to develop a plan to manage and record the medicines you take.

By working together they can identify any problems and make sure your medicines are:

• The best treatment option for you
• Suitable and safe to take together
• Taken correctly

Why have a Home Medicines Review?

A Home Medicines Review will help you better manage your medicines. It will help:

• Increase your knowledge about your medicines
• Increase your confidence in using your medicines
• Reduce your risk of an avoidable trip to hospital

The Pharmacy Guild of Australia 2010

If you would like more information please contact your pharmacist or visit: www.askyourpharmacist.com.au

Remembering your medication

If your doctor prescribes medication, it is important to continue taking it unless your doctor tells you to stop. If you have difficulty remembering to take your medications then you can try: Taking your medication at the same time every day. It is important to get into a routine.

Using a pillbox or dispenser that notes day and times. You can organise this with your
local pharmacist. Using a medication diary or daily chart to keep track of your medications.

Your doctor will help you to work out the right medication, dosage and timing for your lifestyle.

Never stop taking your medication or change how much you take without talking
to your doctor.

In some cases, suddenly stopping your medication can be dangerous.

Side effects

Medications occasionally have side effects. It is important to remember and report these to your doctor, no matter how big or small. In order to report these, you must first understand the particular side effects your medications can produce.

Your pharmacist or doctor can discuss these with you. Your doctor may be able to make
changes that reduce or remove these side effects.

Other medication

You may be taking a number of medications for different reasons. For example, you may use injections or tablets to control your diabetes or you may take tablets for arthritis.

Sometimes prescribed medications will interact with and/or cause more side effects for overthe- counter medications or herbal remedies. It is important that you talk to your doctor or pharmacist about all the medications you are taking including natural remedies or vitamin supplements.

Travelling

If you plan to travel, it’s a good idea to take a list of your medications with you. Ask your
pharmacist or doctor to provide a list together with dosages. If you have to visit a doctor or hospital interstate or overseas, this list will ensure you are given the correct medication and dosage.

Know your stroke risk

Medication is only one aspect of lowering your risk of stroke. You should be aware of what else you can do to lower your risk.

Risks you cannot change include, age (your risk of stroke increases as you get older), gender (women are more likely to have a stroke because they live longer) and family and/or personal history of stroke or heart problems.

Risks you can change include, controlling and monitoring blood pressure and cholesterol levels, stopping smoking, eating a healthy diet, doing regular exercise, minimising your alcohol use, controlling and monitoring your diabetes.

More information

Speak to your doctor, pharmacist or health professional if you have any further questions.

For more information medications and to down load other fact sheets click here.

If you have had a stroke or transient ischaemic attack (TIA), also known as a mini-stroke, you have a greater chance of having a second stroke or TIA.

There are several things you can do to lower the chance of having another stroke including reducing your blood pressure and cholesterol, quitting smoking, exercising regularly, eating healthy foods and taking the right medications.

Medication to prevent stroke

There are many different medications your doctor may prescribe to reduce your risk of having another stroke or TIA. It is important that you understand:

• what medication(s) you are taking
• why you are taking them
• how and when you should take them (eg. with or without food)
• any side effects of your medication
• what happens if you suddenly stop taking your medication.

Blood pressure

High blood pressure is the most important risk factor for stroke. Keeping your blood pressure controlled is essential. Medications to reduce your blood pressure are called ‘antihypertensives’ (anti = against + hypertensive = high blood pressure).

All people with a previous stroke or TIA should be on medication to reduce blood pressure. Blood pressure therapy is recommended even if your blood pressure is normal. This reduces your risk of subsequent events.

There are different types of blood pressure-lowering medications. Your doctor will work with you to find the medication, or the combination of medications, that is best for you.

You may also be advised to modify your diet or increase the amount of exercise to help reduce your blood pressure (refer to the National Stroke Foundation’s ‘High blood pressure and stroke’ brochure for more information).

Blood thinners
Blood thinners help reduce the risk of blood clots forming which can lead to a stroke. There are two types of blood thinners:

1. Antiplatelet medication (Platelet Aggregation Inhibitors). This group of medications keep tiny cells (platelets) in the blood from sticking together and forming blood clots.
There are three common types of antiplatelet medication including:

• Aspirin
• A combination of Aspirin and Dipyridamole
• Clopidogrel

Different medications may be prescribes depending on which ones are appropriate.

2. Anticoagulant medication also stops your blood from forming clots, however this medication uses a different chemical process. Common examples include Heparin and Warfarin. If you are taking Warfarin, you may need to have your blood tested regularly to see if you have the right level of medication in your blood.

Anticoagulant medication may also be prescribed if you have atrial fibrillation (irregular heart beat) or those with particular heart conditions (eg. A prosthetic heart valve).

You may bleed more easily when taking these medications. It is important you try to prevent accidents or injuries (eg. falling over) or that you tell your health professional before undergoing other medical treatment (eg. surgery). Your doctor will help you decide the most effective medication for your condition.

Cholesterol

High cholesterol is another risk factor for stroke. You should take medication to lower your cholesterol if you’ve had an ischaemic stroke or TIA (blood clot).

You should also be given advice on how to lower your cholesterol by changing your diet, increasing regular exercise and/or reducing your weight. The most common type of medication to lower cholesterol is called ‘statins’.

Please refer to the National Stroke Foundation’s ‘High cholesterol and stroke’ brochure for more
information. You can download here.

For more infomation about medications and to download fact sheets, click here.

Neuroplasticity is the term given to the brain’s ability to change after experience the idea that the brain is malleable and even “plastic”.

This understanding of the brain’s ability to adapt to new experience is relatively new—previously it was widely believed that the brain did not adapt, that any damage or injury was irreversible and that changes to the brain were impossible after infancy.

The term “plasticity” refers to the possibility of forming new cells and new connections after an event such as stroke. While it is still a hot topic of scientific research it is a subject that we expect will be of great interest to our community of stroke survivors.

Here, survivor Allison Bakker gives us her own review of a fascinating book, Norman Doidge’s The Brain that Changes Itself. Alison believes that she can try to retrain her own brain post-stroke by focusing activity and movement on the parts of her body that were most affected. It’s tiring and frustrating but worth it, she believes.

Book Review by Alison Bakker

Norman Doidge has written an amazing book about neuroplasticity. The simplest definition of neuroplasticity I found was by Leigh Sales on the ABC’s Lateline program: Neuroplasticity means that, “Brains can build new connections to compensate for injury or disease”.

That means to me that your brain can do the old things in a new way. In his book, Norman Doidge explores different therapies that use the brains neuroplasticity to recover from injury.

One therapy specifically for stroke-affected folk is called Constraint Induced Movement Therapy (CI Therapy) devised by Edward Taub. Basically, as far as I understand it, this involves intensive practice with your stroke-affected side to the exclusion of your unaffected side.

So your unaffected side is constrained, usually with a mitt or sling. By practicing new movement, getting better and better at it, you are reprogramming your brain to do the old tasks through a new pathway bypassing the old damaged one.

Some of the results have been amazing. The book discusses one case involving a man who recovered fine motor movement in his hand and balance skills 45 years after his stroke.

And another story is about a boy who stroked in-utero and had no use of his left hand. He did CI Therapy aged four and can now play baseball with his friends.

I heard Dr. Doidge speak at the Melbourne Writers Festival recently. His words were interesting but just as interesting were the questions that followed from the audience.

Although his theories on neuroplasticity were science-based, what was interesting was the hope he created in the audience. Brain injury is usually devastating. It affects people physically, mentally and psychologically and alters lives in irreversible
ways.

Maybe, looking at neuroplasticity, people can see hope for themselves or their loved ones. The questions involved many different types of brain injury, from acquired brain injury to cerebral palsy and even mental illness.

Dr. Taub’s CI Therapy clinic is in, Alabama, USA. Looking at the website the application demands passion and commitment from the potential patient, unwavering determination and the motivation to work hard.

The rehabilitation is 6 hours a day for 10 to 15 days and the cost from Australia would, I imagine, be prohibitive for most of us.

I can’t afford to go Alabama. I have a family to run; cricket, swimming lessons, part-time work and the rest but I will take on some of these principles as I can.

To improve my fine motor skills I’ve started to unpack the cutlery tray from the dishwasher with my affected hand, using my hand to get all cutlery round the right way before putting it in the drawer. It’s a pain really—and it annoys me—but I keep at it because I can feel it working and doing good.

Dr. Doidge’s exploration of neuroplasticity reminds us of good, old fashioned principles. Perseverance, persistence, doggedness, and practice, practice, practice!

And the way I figure it, I’ve got 40 more years of unpacking the dishwasher to go, that’s 40 years of hand rehab, so things really should improve, eventually.

Alison Bakker is a stroke survivor and sometime writer. She lives in Melbourne with her husband and two children, and works part time as a registered nurse.

When 50 year old Debi suffered her first “mini-stroke” in June 2010 she wasn’t sure just what was going on.

“I was driving the car when the left side of my body felt very tingly - very heavy and tired,” she says. “I thought I’d pinched a nerve… the movement was there, but it felt really dull and heavy.”

Debi was unsure what to do. “I wasn’t in any pain but I wasn’t feeling at all right.” What had started as a purely physical sensation became all-encompassing. Debi recalls an “out-ofbody” type experience and pulled over so her partner could drive. “That’s when the tremors in my hand started,” Debi says. “And I felt that my left hand and my left foot were swollen—I didn’t know what was going on.”

Looking back, she says, all the signs were there. Seeing a friend later that afternoon Debi remembers listening to her friend speaking but being unable to take in the words.The whole event lasted about two and a half hours and afterwards, Debi says she felt overwhelmed with tiredness.

A scan showed Debi had suffered a bleed in the brain which led to a transient ischaemic attack, or TIA. A TIA is sometimes called a “mini-stroke” and is often a warning that stroke may occur. The signs are the same as those of a stroke but they do not last as long.

While Debi has made immediate changes to her lifestyle to reduce her chances of a recurrence of a TIA or of a stroke, the emotional aspects of her experience have been more difficult to come to terms with. “I was devastated, suffered depression and I got angry and frustrated… all of a sudden I felt like everything had changed.”

A nurse told Debi about the National Stroke Foundation and StrokeLine—a free service that provides information and advice on stroke prevention, treatment, rehabilitation, recovery and life after stroke.

The service is available to all callers who are affected by stroke and also provides information to health professionals. Through StrokeLine, Debi was able to get some support for the way she felt and she was also referred to the phone peer program where she linked up via telephone with another survivor.

“I felt like I had someone to help me put things in perspective again,” Debi says. “I can ring up when things get a bit too much and it really helps me stay focused.”

If you have a stroke story you would like to share please contact Ebru at:

eyaman@strokefoundation.com.au or call: 03 9670 1000

Image via apartmenttherapy.com

What you can do to help

The first step is to know that fatigue after stroke is a genuine concern for many stroke survivors. Recovering from a stroke and learning new ways of doing things can be tiring.

Here are some suggestions which may help you with fatigue:

Know your limits. Be aware of the activities which cause fatigue and spread them out.

Plan rest breaks during the day. Arrange breaks either side of activities. For example, you may have a therapy session, so try to plan a break before and after.

Break large tasks into smaller tasks. For example, instead of eating a whole meal, put your dessert aside for later, or break your shopping up over a number of days rather than getting everything at once. You may consider preparing for an evening meal by slicing vegetables in the morning and refrigerating.

Prioritise which tasks are most important to you. On days when you feel tired, only do the tasks which are high priority.

Having a short sleep in the afternoon may give you more energy to help you through the day. Establishing a good sleep routine is important. Try going to bed at the same time each night.

Establish a healthy balanced diet that provides enough fuel for your body. Some foods can help restore your energy while others can make you feel more fatigued. You may need to eat regular snacks throughout the day. Talk to your General Practitioner (GP) or local Dietitian about the best diet for your needs.

Despite your fatigue, it’s important to incorporate physical activity into your daily routine, in order to increase your stamina. Talk to your GP or Physiotherapist for an exercise program that can help you.

Talk to your family and friends about your fatigue. If they know how you feel, they will know how to support you better. Know when to ask for help. Don’t think you have to do everything yourself.

More information

Your Occupational Therapist and Physiotherapist can give you advice on how to conserve your energy. Speak to your Dietitian about maintaining a balanced diet.

Note: This fact sheet is number 4 in a series. For a complete list of fact sheets, click here

Image via www.brisbanetimes.com.au

Fatigue is common after a stroke. It can be frustrating and make everyday activities slower. People who have had a mild or severe stroke or a transient ischaemic attack (TIA) may feel fatigued. It can present in the initial weeks or months after a stroke and for some stroke survivors, persist years later. For many people however it does improve with time.

What is fatigue?

Fatigue is a feeling of early exhaustion, weariness or feeling too tired to do something. It results in reduced ability to perform a task that requires physical or mental activity.

Fatigue can affect all areas of your life including your home, work, sex and social life and also your ability to participate in therapy.

What is the link between fatigue and stroke?

You may notice changes after a stroke. On a physical level, it can lead to difficulty moving and swallowing but it can also affect the way you think and feel.

Although fatigue can be more common as you get older, a stroke can also increase fatigue. Between 40-70% of people who have had a stroke experience fatigue even one year after.

You may experience some of the following after a stroke:

Muscle weakness or paralysis – you may now need more physical and mental energy
for day-to-day activities like walking, dressing and shopping.

Changes in medications – some medications have side effects which may increase levels of fatigue. Talk to your doctor about different medications.

Disturbed sleep patterns – you may find it difficult to fall asleep, and stay asleep.

Stress and anxiety is common after a stroke, leading to sleep disturbances.

Depression can also be associated with stroke, which may lead to fatigue.

Problems with your bladder and bowel movements may make you tired.

Weight loss caused by changes in eating patterns, poor appetite or difficulty swallowing. Without adequate nutrition, you may not have enough energy to get you through the day.

For more information about fatigue or download a fact sheet click here