There are physiotherapists and there are physiotherapists; and as the Bard in his wisdom once said, “a rose by any other name would smell as sweet”. While I agree in principle with the spirit of this declaration I do have differences with it in one regard, namely one cannot generalise. I say this with special reference to physiotherapists. I have by now been treated almost continuously by physiotherapists since early 2007 and can safely claim to be something of an authority on them.

Therefore, I beg to differ with the bard insofar as physiotherapists are concerned. They are not all the same. They may all have the same or similar qualifications but each one differs from the other and not only because they are individuals but also in their approach to treatment, behaviour and consequently results.

I have come across physiotherapists who consider their duty adequately performed if they are regular and punctual without paying any heed to the varying needs of their patients and with no evaluation of the results obtained. I remember one physiotherapist who would ask me to repeat exercises in exactly the same way as I had done previously with no thought whatsoever about the effect these exercises had on me or about any improvements – or lack of – that were achieved.

We must remember that ‘physiotherapy’ is a branch of medical treatment that relies heavily on the effort and commitment of both the patient and the practitioner. I dare say that this is also true of other branches of medicine but probably more so in this case, where the treatment operates jointly on the physical and mental level.

The inadequacies of my earlier physiotherapists became more apparent to me when I started treatment with my latest therapist. For the sake of convenience and anonymity I shall refer to her as “N.S.”

N.S. is a young slim and tall girl whose slender build belies her strength and it is this that separates her from run of the mill physiotherapists. This strength is not just a physical attribute but one that also aplies to her mind. Other features that distinguish her are:

• She extracts feedback from me on a regular basis
• Every day before she starts she asks me to demonstrate the exercises I have done on my own time – this keeps me on my toes
• She maintains a continuous flow of feedback to me on my performance and makes immediate corrections when I make mistakes
• She thinks beyond the day’s exercises and relates these, with my performance, to my daily life so that improvements are achieved. In other words her treatment is not isolated and removed from the everyday
• In addition she is lavish in giving positive and negative points where deserved
• She has a sense of humour which lightens the mood and makes the exercise a fun thing.

Thanks to her in the past several months my ability to walk has improved considerably and I have learnt to walk on different surfaces, including grass.

This is a short story, but I hope it will have a big impact. Obama said, “Yes, you can” and if any one person, that I know has followed that dictum, it is Mike Austin, once a talented art director and a well-loved, much admired, and highly awarded art director. And he followed the spirit of “Yes, you can,” long before Obama was heard of by the world at large and well before his famous slogan became the battle cry that called a vast majority of Americans to seek change.

Mike andLesley, his wife, have fought a battle against all odds and they are finally, I believe and hope, climbing out of the very depths of despair. Honestly, I don’t know how they’ve done it. Where they found the strength, the will and the ability to persevere.

Although this post, isn’t the one in which I will delve into the sad story of how poorly Mike was treated by the advertising agency he worked for in Bahrain, I may well add it as another story some day.

Mike had a massive stroke, the year before I did. The fallout was incapacity, especially in his ability to speak, I understand that the term for this is aphasia.

However, perhaps in his desire to communicate, or his innate artistic instinct, whichever it was, he decided to re-learn how to draw, and how to use his computer again. He still cannot talk as clearly as he once could, but he does understand what people say. He has a beautiful voice and when he’s at a loss for words, the one word he resorts to is, ‘fantastic’.

That’s Mike. And that’s his work too. To see his work visit  http://mikeaustin.carbonmade.com/

He is keen on getting meaningful, remunerative work. So, if anyone visiting this site has a job for Mike Austin, please leave a comment here and I will forward it to him.

TED talk – brain scientist describes the journey of her own stroke ! This is an incredible story and for anyone who hasn’t seen it or read it, it’s an eye-opener.

Jill Bolte Taylor got a research opportunity few brain scientists would wish for: She had a massive stroke, and watched as her brain functions — motion, speech, self-awareness — shut down one by one. An astonishing story. TED has so many inspiring talks on different subjects.

Here’s the link: http://www.ted.com/index.php/talks/jill_bolte_taylor_s_powerful_stroke_of_insight.html

I hope our visitors will find this useful.

An easy-to-do home pedicure

Put a little shampoo or liquid hand soap and vegetable oil into a basin large enough to hold both feet and stir it around with your hand to raise a little lather. Next place both feet of the stroke patient in this bath and soak for 10 – 15 minutes. After soaking, rub the feet, especially soles, with a pumice stone. It’s also a good time to clean the nails. Get the patient to curl his or her toes in an action of trying to pick something up with your feet. For the affected foot see what the patient can do from his own will power, if he or she can’t then physically work the toes to simulate the action done with the active foot. If possible try and do this for ten minutes every day to strengthen muscles and provide relief to aching feet

Another easy home pedicure

A fast, effective easy home pedicure can also be done using a few (four to five) drops of vinegar or lemon or limejuice in four or five table spoons (40-50 grams) of yogurt. Mix well in a dish. Rub this mixture well on the feet, ankles, heels and soles of the feet especially between the toes. Let it stay on for ten minutes and then wash off with warm water. This process will rejuvenate the skin on the feet, remove dead cells and stimulate blood circulation.

Improving blood circulation

If possible, a weekly massage that involves a rotating and kneading action on both legs will help to stimulate blood circulation and provide relief to aching foot muscles.

Another easy way to improve blood circulation
To give relief to aching feet use a simple hot and cold foot bath. Prepare two basins. Put hot (as hot as can be borne) water in one to which a little (20 ml ) mustard oil has been added. In the second basin, put cold water. Let your feet soak in the hot water for up to 3- 4 minutes and then shift the feet to the cold water basin. Repeat this between 5 to 7 times and then dry the feet thoroughly with a rough dry towel. Now apply some moisturizing cream on the feet after they are dry to replenish skin oils.  

More home remedies and natural foot care tips
To soften rough feet, try this regimen every night before going to bed, for two weeks. Dip the feet in warm water to which a teaspoon of (preferably herbal) shampoo and a teaspoon of baking powder has been added. Soak for 10- 15 minutes. Drying and then apply a foot cream. Of course this could be used by anyone, not just stroke patients!

Treat dry skin on feet and cracked heels as well as hands with this old grandma’s recipe – equal volumes of glycerin, fresh cream and honey, or glycerin and rosewater, or glycerin and fresh lemon or lime juice. Beware, the lemon/ limejuice mixture can sting a little – but oh the relief, once the stinging dies down! Apply this mixture to the feet, especially to the cracked heels and let it stay on for 15 minutes. Some people wash off  this mixture with warm water while others wear clean old socks over the feet and sleep with it on, guaranteed, your patient’s and your feet will be soft as satin.

If you have a tendency to develop cracks on your heels, try this natural remedy once in three days before bed time.  Immerse feet in warm water to which 10 ml lemon juice and 20 ml coconut oil or any other vegetable oil like olive oil has been added. Scrub the heel area after twenty minutes with a pumice stone. Dry thoroughly and apply a foot cream.  The improvement can be seen after the second treatment and it should become a weekly feature after the first month.

Alone, alone, all all alone

Alone on a wide, wide sea

And ne’er a saint took

Pity on my soul in agony

Last night I watched a programme on TV on the National Geographic channel. This features the FBI and some American prison where a prisoner was given severe punishment for his subversive behaviour with the other cell mates. The punishment meted out to him was “150 days of isolation”. They made a big song and dance about 150 days in isolation. I cannot understand what all the noise and fireworks were about. I feel I’ve been in “isolation” for all of last year; yes all 365 days. 150 days? No big deal!

Certain oddities occur as an aftermath to a stroke and remain with one even when walking along the road to recovery. As to whether these oddities remain with one for life; only time will tell I cannot comment on that. Some of the oddities are listed below, not necessarily in priority or severity but at random.

 Oddity – 1: By God’s grace I have retained my sight. By this I mean I am not blind but my vision does play tricks on me. I’m not sure whether its my vision or my mind that is the culprit. There is a tendency to hallucinate. For example; I might see a door as being left open when actually it is closed. My “left field vision” is definitely impaired. This results in my having nil vision on my left side. Often when I meet a person for the first time they probably think I am a very rude and socially crude person. This is because I have ignored their right hand which might have been extended in greeting. How do I tell them that in actual fact I have not seen the gesture and therefore have not taken cognizance of it?

Oddity – 2: Over, the last few days, I have developed the feeling of being pulled to my left. It is almost as if my centre of gravity has shifted. This disturbs or hampers my attempts at walking. Add to the shift of the centre of gravity, a vague feeling of being in a drunken stupor and then try to walk on a rope bridge. (I have mentioned this earlier at some point) and the simple task of “walking” takes on Herculean proportions.

The net result of this faulty vision is that I have learnt not to trust my sight. As a result of this if someone were to tell me that the Titanic was sinking through the road at 10 o’clock, I would give them the benefit of doubt and tend to believe it.

At times I see little dogs being chased by kids, a little older than toddlers across my path. Over a period of time I have learnt to ignore them. The normal average person cannot I suppose empathise with the stroke victim’s aversion to walking. But believe you me it is real.

Oddity – 3: Inability to sit for a length of time. I do not know the medical reasons

Odditiy – 4: At the risk of repeating myself I need to also mention the fact that my ability to speak and enunciate words has also been shot to hell and back.

And, whereas I once had a voice that was a deep and rich baritone. Mine was a voice which would penetrate through any furore at official meetings and draw attention to itself. I know, I have used it often to my advantage. Now all I am capable of is a slight squeaky sound that is absent mindedly ignored by all within ear shot.

Yes, I have had to make huge adjustments to continue the onerous task of living through an ordinary day. This adjustment is at the intellectual and emotional levels and also includes exclusion at social and personal levels.

Oddity – 5 : There is this story about an 85 year old fellow who went to the doctor and told him

 “Doc can I lower my sex drive”.

 The doctor was taken aback and asked him “Granddad how old are you”?

 Replied the old codger – “85 years today!”

To which the surprised doctor asked “ What do you mean “lower your sex drive”?

The old man replied “it’s all in my head, Doc, it’s all in my head!”

I try not to laugh too loudly at this anecdote, because my life now runs much along the same lines.

Anyone who is bedridden or bound to the bed will be familiar with the term “bedsores”. These are horrible little eruptions resemble sores, because they are sores. Hence the nomenclature. They are uncomfortable to the point of being downright painful. As is the case with most medical problems, the old dictum of prevention being superior to cure applies very aptly here.

These little volcanic eruptions are caused on the back because of the tendency of an individual who, for whatever reason, tends to spend long periods of time lying supine on a bed. Take it from me, these are best avoided. Common sense dictates that the most effective way of avoiding bedsores is by not spending too much time on one’s back in bed. Mind you, post stroke, this is easier said than done.

Consider the facts: one cannot read; it is difficult to sit for long without developing a pain in the tailbone region; what alternative is there but to return to bed. Yes! This is worse than the forbidden fruit, only there is no garden of Eden!

In fact if the truth be told this was the factor that is the genesis of this written account – an effort to keep myself off the bed.

So far I have dwelt on the letter of one’s fight against the trials and limitations one experiences in cases such as mine. More important, perhaps, is the spirit with which one travels the road to recovery from a stroke.

In fact, I’d go as far as saying that the spirit is about 75% of the battle.

But, what of the spirit? That is the natural question that arises. Essentially it’s the spirit of fighting! That part somewhere deep inside one which says to itself and all else, who care to listen, “Never say die”. In practical terms it means having the guts, the zeal, the energy, the strength, the desire, to struggle seven days a week; no Sundays off!  It’s this spirit and gumption that one draws upon to pull oneself up from the deep chasms of loneliness and despair and desperation.  The spirit to kick yourself in the backside and egg yourself on even when redemption seems lost and disappears over the horizon into an eternity that is bleak, cold and far too distant to contemplate.

Yes, this spirit is the equivalent to the strength, the stamina and perseverance one is able to generate from within one’s self. Because it won’t come from anywhere else! That I am sure of. I know because I’ve tried.

Family and friends do help by assisting this “spirit”, but one cannot bank on that assistance. It may or may not be forthcoming.

However, the inevitable question that does arise is, what if the spirit falters? Then what?

I have found that the normal or average human being has tremendous reserves. A large portion, of which even he may not be aware. One needs to delve deep within one’s self in order to call up these reserves and often times, I have found, they answer the clarion call.

There is also no shame in leaning on external support if one can find it. This may be in the form and shape of one’s friend, spouse, children or even work associates. Together they should see you through your lean period. Remember to use all you spare no effort.

Remember the stakes are high.

A few days back, I had a very hard and disastrous fall which resulted in me cracking my skull on the handle of the wheel chair which was parked in the corner. The result of this terrible fall was that I had to be rushed to the hospital where the doctors put two stitches in my head. The whole operation, while being hard, was not devastating at the physical level in terms of pain inflicted, but it had worse repercussions at the psychological level.

The thought of being sown up by needle and thread was quite awe inspiring and quite frankly, scared the hell out of me. As a result of this fall and its consequences I have developed a fear of walking independently. I also eye the hard tiled floor as belonging to the enemy camp. There is, I believe, an old theory, or saying that when a rider falls from a horse, the best remedy is to put him back on the horse and let him ride on immediately.

This makes a lot of sense to me now. At this point of time; which is quite a while after the fall, I still carry that fear of falling. I still carry a baggage of fear, where fear should be none and this inhibits my walking, an exercise which has to be done.

My advice is to avoid, to the extent possible, accidents such as this because it takes a long while to come out of the pitfall this has created.

The title of this section, appears, at first glance to be a sequel to the much acclaimed piece of work by the renowned psychologist Erica Jong: “Fear of Flying”. The similarity in the titles are a mere coincidence. In fact, there is no connection between the two. If the truth be told, I have not even read that account thus any conncetion would be quite unlikely. My future mini-projects are to try and overcome this fear and hesitation.

One among many common problems to be dealt with:

 I think the biggest “common problem” I have is that of sitting. No chair in the house nor anywhere else is comfortable for a sitting spell lasting more than half an hour to forty five minutes. As a result of this there is a great temptation and a tendency to lie supine on the bed which appears to be the only position of comfort. 

When I use the term “comfort” it may not be the same as that understood by people at large. “comfort” to me means absence of pain caused by muscular pulls and tensions. “Comfort” to me is a term implying enjoyment, rather it is a term which means relatively less pain and the pleasure derived from this!

Desolation

The word “desolation” strikes fear in my heart. I think this is a post-stroke factor that needs to be dealt with. Earlier on this narrative I have mentioned the journey as being one through a dark dismal seemingly unending tunnel with no light (or exit at its end). This, combined with the monotony and boredom which arises out of having nothing to do and all the time in the world to it. The combination is a powerful mix. The parentage of which gives birth to this bastard child called “desolation”. The only first cousin to cancer. The only difference being that while cancer eats into and destroys the physical portion of the individual till he dies. Desolation attacks the soul and is in some ways worse than cancer since it causes the individual to give up the good fight/struggle.

Barbed steel 

Barbed wire across a stretch of land

:i.                    can divide nations

ii.                  can divide communities

iii.                can bifurcate families

iv.                break up relationships

v.                  can pulverize hopes and ambitions and ones aspirations

vi.                can stand between a repentant prisoner and his freedom  

when it crosses an individual the psyche separates his well being and confuses it with ailment. 

Paralysis explained to the lay man.

I don’t have a medical degree and do not have any pretensions to being a doctor, so, the following account is without any medical jargon. I have tried to keep it simple and used every day language to explain a severe medical condition (wish me luck)

Paralysis

i.                    close your eyes

ii.                  now imagine hundreds of Lilliputians with ropes tied to your left limbs - arms and legs and sides.

iii.                Remember, these Lilliputians may be small and immature in size, but not so in strength. They have the power of  a normal man, maybe, more.

iv.                Now… (keep your eyes closed)

v.                  All these guys are pulling on their ropes in tandem and try to pull you off balance as if their lives depended on it. This has the terrible consequence of, well, putting you off balance.

vi.                In other words, your left leg; your left arm and your centre of gravity have a left-wards tilt, one the Tower of Pisa has never experienced.

vii.              Now try to stand or walk; and the best of british luck to you my friend. 

You are now in the clutches of an aftermath of paralysis (of the left side). Oh! I forgot to mention these little Fuhrers have the same arrangement with your face and mouth.

If you can still have a smile on your face, you should be given an award; if in the USA: The purple heart, if in the UK: the Victoria cross, if in India: the Maha vir chakra. And this is the condition, not for 5 minutes, or for an hour, but what seems to be for rest of your life.

If you have understood and felt the plight of this individual. I can welcome you to my little world; the world of the stroke recoveree.

I have, on occasion, tried to compare the pain and discomfort of a stroke with its aftermath. Mind you, the comparison is not quite fair, since I was not conscious most of the time during the stroke and immediately afterwards. Whereas the aftermath, that is the recovery period, is only too deeply imprinted on my brain and conscious being. The stroke: All I can recollect is that I was on the point of being discharged from hospital – I had earlier been admitted for other ailments – and since I had lost a lot of weight I wanted to show off my weight loss from 84kgs to a delightful 73kgs. As soon as I put my foot on the weighing scale an intense and excruciating pain coursed through my left leg and the – oblivion; a bottomless pit of dark, terrifying nothingness.  

The following are images I have of being in the ICU, most probably hallucinatory; I’m not sure. There are marauding gangs of nurses/ interns surrounding me, force-feeding me and laughing deliriously. It was, to say the least, a frightening scene from the deepest circle of Hell.    As was gleaned from my files, there was a massive haemorrhage in the brain due to high blood pressure. This in turn caused severe lesions in the brain. The result was curtailment of bodily functions and limitation of arm and limb movements as well as defects in my vision and speech.  

The aftermath: the only phrase that can come close to describing my initial reaction, when I reached a state of consciousness is: TOTAL DISORIENTATION in all dimensions of time, space and physical surroundings.   I did not know who I was, where I was and how I came to be there. I had the impression that I was in Baroda which had been recreated as Manipal and that both localities were co-existing in my mind, though at different sites. They were complete with identical features – the house, the roads, the people. It was as if the entire city of Baroda had been transposed on Manipal. These were of course impressions of my confused mind.   My first task was to successfully rearrange myself to the new situation which I found tremendously difficult. While the cast had not changed, the actors had metamorphosed. This brought about an entirely new landscape. I found I had to readjust myself to this new and disturbing scene. It was a monstrously large and difficult task.   My own capabilities and faculties had been reduced considerably. For example my speech was totally distorted and I was difficult to understand. My left hand and arm hung on my left side – a limp and useless appendage without any life of its own. The left side of my vision was gone. In practical terms this meant I could not see items on my left. While eating I could not see food on the left side of my plate. If I met a person and he extended his right arm to shake my hand I was not aware of his right arm.    

There was a constant pain in my left arm that could only be dealt with something called “mobilization”. This entailed brisk and vigorous pumping of the arm. Up and down, up and down. This, I felt rendered my left arm even more useless. My life had become a series of pain.  

My sense of balance was shot to hell. I found it difficult to either sit or stand without falling down. When I first went to the physiotherapists and they told me they were going to teach me how to sit and stand, I thought they were joking and I refused to take them seriously.   Obviously I couldn’t return to work. I had already officially retired in 2005 as Vice Principal of the Welcomgroup Graduate School of Hotel Administration. At that time they had requested, and I had agreed, to an extension until March 2007.Then, just before “the stroke” in December 2006, the company had offered me yet another extension to 2009. I had declined this as I was at last looking forward to returning to my home in Gurgaon in north India and hanging up my pen and laptop or whatever it is that Vice Principals do when they call it a day. All in all it was a harrowing experience. But, as I was soon to learn, this was just the beginning. However, even this, the darkest of clouds had a silver lining. Mine was the realization that the wealth of a man is not measured in terms of the number of cows or goats he possesses, nor on the size of his bank balance, but in the love and support of family and friends and well-wishers which provided a motive for my return. 

My advice: Be careful about your diet and food intake – this is coming from a guy who ate nothing but red meat and had three large drinks every day has to be serious. Smoking is also a big no-no; like they said, ‘a cigarette is a piece of paper with a fire at one end and a fool at the other’.