Wednesday 1 October 2014

Stroke Rehabilitation - Rebuilding After The Fire In The Brain

"One of the hardest literary genres in which to write is the medical memoir. Pain makes us recoil into ourselves, licking our wounds. Writing about it may serve as a necessary catharsis, but the results are not necessarily good art, rather the reverse. ''Poor pitiful me'' is the narrative, which only in good hands can interest anyone else."
Doris Brett - 
a psychologist, acclaimed poet and prose writer (her book, The Twelfth Raven - A Memoir Of Stroke, Love And Recovery & an article in The Sydney Morning Herald, Medical Hell Charted With Skill are some goodies to feast your eyes on) who has survived ovarian cancer, had a double mastectomy after the BRCA gene was identified in her own genetic make-up and was made to be her husband's carer when he suffered a severe stroke in 2009 - one she directly and promptly identified - which caused a loss of speech and mobility. A woman I am so warmed to see sharing her insight on real life, and in particular, 'the terrible spell cast by a stroke' (spell is the perfect word for it!), blokes (/hubby), magical neuroplasticity and her extraordinary spirit in the face of adversity. 

Let's hope her pieces and my own 'medical' memoir, Strokes Get The Blokes, are the exception to the "poor pitiful me" perception (definitely not my intention here) - after all, there is skill involved (that stroke survivors ought to be proud of) in this medical hell - strokes do get the blokes! 

Get to know your brain's intriguing 'rooms' for its (figurative) lights are what make your complete, individual package that shines every day!
When someone experiences a stroke, it will instantly strike a location in the brain that is used for a range of purposes (with severity dependent on time and medical intervention).  The unique 'stroke snowflakes' hitting different regions (odds are likely - perhaps it's the same theory as lightning never striking the same place twice!) meant my two acquired brain injuries, in particular, each displayed completely different symptoms (whilst still showing typical symptoms when assessing each using the simple FAST Test) in the lead up. Some people can get warning signs in weeks/days that last for a brief time leading up (i.e.: headaches, balance issues, facial weakness/numbness, which disturbingly are ignored/dismissed, approximately one in ten who suffer a Transient Ischemic Attack/TIA will go on to have a stroke within a week if left untreated), as they were occurring and their lasting effects in the aftermath have also varied (Stroke #1's range of effects still with me today are mostly due to a delay in acting FAST - not only by the stroke sufferer, but also the stroke heroes in their company)- that fierce 'balloon/neuron-popping party', in particular, went on for hours in July 2012! It's truly fortunate I am still here alive and kicking - especially kicking!.  
If you know of someone who has had a stroke (young people having strokes is on the rise), chances are their effects are/were not the exact repercussions I have experienced, but the constant struggle and plight for a healthy life are similar for all stroke survivors with substantial brain damage and I do hope that Strokes Get The Blokes sheds some light on a subject that is not often spoken about - especially with people under retirement age. 
 This Special K's own problems stem from the brain's Occipital Lobe (Stroke 1 - see photographic evidence of the actual event and consequent damage from hours of neglect by delaying medical assistance - below) and Hippocampus (Stroke 2 - see location - below), but it could have been far worse if we didn't Act FAST (i.e.: I could have very well died in the days/weeks/months after or we all could be wishing I was dead, which we surely are not) by eventually identifying the 2012 'fires in the brain' and then seeking medical assistance.
Above: This is how one may look as a fire in the brain's Occipital Lobe (displayed in top illustration - located at back of brain) was progressing (photo taken with my gracious Queen at our end-of-school-year staff party). A pretty dodgy looking Kitty, but not all that shocking like you'd assume someone having a stroke would look like.
Can you identify Stroke #1's presence just by looking at my face like so many people presume is the sure-fire sign of a brain attack? 
My smile still looks straight, I'm standing upright, engaging in social celebrations and neither of us looks concerned in the slightest, yet the stroke was in full flight, aggressively killing sacred neurons at an alarming rate.
The 'fire in the brain' was already well established in the above photograph and we initially ignored the textbook stroke symptoms. They included pins and needles down one side of your body, facial weakness and speech problems that may only last a short time before going back to 'normal' - not one of us thought to do the simple FAST Test at the staff party, which may have signified I was experiencing a serious stroke, acquiring considerable brain damage the more time passed and was incredibly close to death (or - some may say - worse than death, a severe long-term disability with all its cruel losses, directly and indirectly, acquired in your youth with such horrible uncertainty about your future).
Let our blatant ignorance on the night of my first stroke be a lesson to you - it surely was for this Kitty the second time 'round with obtaining prompt medical assistance (within minutes 'take two')!
Last-Day-Of-School Celebrations/Last Moments Of An Intact Kitty Brain, Twickenham, UK
July 2012
White 'blob' at bottom right = 
Damage (dead brain) to the Occipital Lobe
Stroke 1
July 2012
 Above: The brain's 'seahorse', hipoocampus,' is deep inside the fascinating limbic system and is responsible for your spatial navigation, controlling of emotions and most importantly (in my humble opinion), your memory reception, where your short-term memory converts to long-term memory if needed and the rest is eventually lost. 
My brain is just a lot faster at ridding itself of the unimportant information!

Hollywood movies, 50 First Dates and The Hangover, are just two of a range of popular films that attempt to depict Anterograde Amnesia (short-term memory loss) - us amnesia-ridden souls are so incredibly intriguing!
We are all indeed special little (figurative) snowflakes and brain damage is no exception to one's individuality
Reflecting on my own injuries and their respective effects, talking to fellow stroke survivors, neurologists, wise registered nurses, occupational therapists + speech & language therapists, as well as immersing myself in a range of neuro literature (i.e.: the intriguing concept of Neuroplasticity) from all around the globe, it is truly fascinating to discover just how distinct and individual each person's damage, cause, struggles, progress and accomplishments are post acquired brain injuries (hence why I've referred to us and them as 'snowflakes' - I hope it helps others make sense of such.  While it is easy to initially categorise snowflakes as all looking the same, close inspection shows striking individuality, just like a sufferer's special, unique stroke/s and the consequent damage and effects they cause).  It's never black and white (and I am someone who likes black and white!).  

After suffering a stroke and it has been identified (through a brief physical examination, in particular, the FAST Test, to identify parts of the mind/body that have stopped working effectively, often reflecting the brain hemisphere - left or right - that is being deprived its blood supply - this FAST Test *pun intended* can even be executed by you!) and given appropriate medical intervention (i.e.: surgery, carotid endarterectomy or angioplasty to open blocked arteries where they use a MERCI'anticoagulant' medicines aka blood thinners, anti-platelet medicine aka tissue plasminogen activator - which need to be given within four hours of the stroke symptoms, acting FAST is essential - etc, the faster you get these, the more neurons you may just be able to saveby the gurus, an ECG, angiogram (it felt like I was going to pee myself!) and MRI (shut your eyes and think of glorious FNQ for the entirety of this 'aggressively-hammering-the-lid-of-a-coffin-down-with-alive-little-you-inside' procedure) will then promptly identify the location of damage and the extent of such (see above MRI brain art - Banksy inspired). Yeah, pretty terrifying times!  The actual cause of a stroke isn't always identified immediately (or at all!) as there are many causes out there (the initial focus is on medical intervention to restore blood flow to the brain so that you survive/the effects are minimal and manageable) - it took months of regular (and a broad range of) outpatient testing for this particular Special K (and we're still not 100% certain it is ole Vascullitis that caused my particular strokes in 2012 as the docs are simply deducing it was after all other medical testing came back 'healthy' - even had perfect cholesterol which may come as a shock to people who know how much I love to eat) and Stroke #2 unfortunately beat us to the punch just three months after the first acquired brain injury (a second stroke is typically more severe than the first. Of course! The brain loves a sequel more than the '80s). Being in denial of the first stroke (let's call it grief-stricken mourning of the former Kitty) meant I was avoiding/ignoring the fact that 25% of all stroke survivors will have a recurrent stroke within the first four years (Kitty-Brain had one just three months after the first - ever so prompt!). 
An angiogram - although incredibly uncomfortable and a tender groin during + in the aftermath where the dye and camera are inserted into a specific artery - offers such a glorious supply of entertainment for all parties concerned (namely my supportive mates who you can see would regularly visit for hours! The staff were sometimes lenient on such given the severity of my condition)
St George's Hospital
Initial weeks post Stroke 2
November 2012

Below: Supportive friends repeating my pun about needing a boyfriend (/manfriend) to help soothe the pain of invasive procedures post stroke. A true sign of brain damage is when you can't even remember your own punny jokes and when buddies repeat it the next day (ultimate sign of respect), you compliment their sense of humour - thank goodness they didn't claim it (and I had lunch - definitely counteracts a painful procedure).
Life as Special K
St George's Hospital
November 2012

Below: An angiogram first requires a long flexible tube, you may know as a catheter, to be inserted into the groin and then threaded ever so delicately through a carotid artery to the affected tiny artery/arteries in the brain (they had machines/screens and what not to guide the tube).  The angiogram was done under local anaesthetic (probably for the sake of entertainment) as I vividly recall when they'd 'spray' dye into my blood supply for it felt like I was peeing my pants in front of a bunch of medical hot shots! It must be fun for them to watch patients squirm at the unnatural feeling of comfortably (seemingly) going to the toilet in front of everyone. It'd be interesting to see who didn't mind this sensation - guilty pool-peeing sorts (we know who you are), no doubt would relish in this sensation whilst in a room full of people!
Above: This particular angiogram image shows abnormal narrowing and inflammation of blood vessels aka Vasculitis - the rare disease which has been deduced (not identified) as the cause for my two strokes (blood vessels were inflamed which meant blood could not travel effectively through them, depriving the brain of oxygen = Bam! Strokes strike)

Being a fair Miss Laird, the two strokes struck in two incredibly different areas (hence the vastly distinct effects of these 'stroke snowflakes') & the rehabilitation for both has also differed. Stroke #1's rehabilitation was a mere one week long whilst at hospital - my ignorant, yet determined insistence on finishing then. In hindsight, I definitely could have done with more (I'd regularly come back to hospital for outpatient testing during September - October 2012 to identify the cause, however no official outpatient rehab after discharge in July), but I had Europe to explore and finding my way back to the campsite at a music festival in Budapest was enough 'rehab' at the time! Stroke #2's rehabilitation - due to the acute short term memory loss acquired after the second dose of brain damage - was almost two years long. That's 104 weeks of biweekly sessions including speech and language therapyoccupational therapy and rehabilitation sessions. It was an enlightening experience that I relished in, valued the therapists immensely and the moment I showed signs of boredom + frustration at the patronising tasks, I was healthy enough to 'graduate'! A bad attitude when given childlike tasks (which at first were out of my reach post Stroke 2) meant I was 'better' and currently the mind therapy is purely volunteering at a school which is far more rewarding than baking cookies at rehab (a skill I still hold, so do not need 'tests' at therapy of such - still had to do it though. Humbling times!).  Everyone is their own li'l snowflake and whilst optimal recovery is the intention, being the person of yesteryear is never a likelihood post considerable brain damage (especially if it's squared! Being told this fact by my doctor in those early months caused mass tears as I was ignorant of the damage's severity and permanent disabilities), but I am making astonishing progress considering the serious situation that has been thrust upon this Special K whilst in my 20s when I almost died as a consequence of losing that 'inner baboon' in neurons and my life hanging in the balance for so long.

Beautiful stroke snowflakes!

Opposites attract

Stroke #1 Rehabilitation
Stage One: Suffering

Stroke#1 was at the back of the brain in the occipital lobe (see diagram above for clear visual of a brain's map and location of occipital lobe - as well as above shots of Stroke #1's particular brain damage MRI residue and physical effects in the form of a social photograph as the stroke itself was occurring at our work party in July 2012. See earlier entries for more examples of how people are when they suffer a stroke so that you are familiar i.e: Serene Branson's live news piece as she was in the midst of a brain attack).  You may have already known that eyesight comes from the back of your brain (in this particular lobe, to be precise) - so it's no surprise that the hours of delay in identifying & treating Stroke #1 (which initially started as just a fierce headache and a strong desire to sleep - that would have reflected a stroke if I was swiftly given the FAST Test by stroke-smart people in my company from get go) meant I acquired a broad 
range of deficits.
FREE porridge and comfy/sexy hospital attire (sending shots to mates 'trying' to make them jealous - I reckon it worked) = 
Rehabilitation's Suffering Phase - Special K style 
(I love my porridge, don't I, St Mary's staff?! Yessss - what a dream)!
Charing Cross Hospital, London, UK
August 2012
Stroke #1 hitting occipital lobe - and being ignored/dismissed for several hours - consequently gave this Special K -  
Do you see what I see?
Given
the delay in response 

following Stroke #1, 
50% vision was lost - now it
is less than 25% deficit.
If any sight does comes
back, it shall in the first

years post brain damage
before going stagnate
  • over 50% loss of vision (currently less than 25% sight deficit due to Neuroplasticity's role in rerouting - known specifically as axonal sprouting - the past two years. Go Kitty-Brain, go!) which is referred to as homonymous hemianopia (this is considered a common effect of a stroke in the occipital lobe - sorry I'm 'so textbook'!) - the shaded parts in the visual field test (to the right) are what I initially could not see (alllmost got an A+!) out of both eyes after the first stroke (it may interest you to learn that this was the least of my troubles! Eyes are hard workers naturally and compensate for the deficit accordingly). Thank you to all my devoted 'seeing-eye dogs' all around the globe 'leading the way'!
  • constant tingling down body's RHS (intensity varies - rarely hurts, sometimes tickles, always present - I'm thankfully not bothered by it) known as paraesthesia (I could tell you were about to ask for its scientific name!) - could be far worse than it is, very fortunate. Thanks for all the tickles, Klubbers!
  • a mild (although not debilitating) RHS weakness (identified when tested by medical professionals - balance was slightly off - can still ride a horse just like yesteryear with ease so no worries) labelled hemiparesis, which affects roughly 80% of stroke survivors. In severe cases, hemiparesis's weakness or inability to move one side of the body can affect arms, hands, legs and/or facial muscles to the extent it impacts on everyday activities such as eating, dressing, bathroom and grabbing objects.
  • increased fatigue and irritability levels, in particular, hypersensitive to sound & light (my supersonic hearing makes me feel like Spiderman! Boom!) known as Photophobia (light) and Phonophobia (sound). Furthermore, Hyperacusis reflects being agitated by certain frequencies of sounds and not being able to tolerate them (which is confusing for others to grasp - they just think you're being crazy and irrational. I promise I'm not - 90% of the time). When a certain nurse would walk around our hospital's Neuro Ward with her keys dangling (LOUDLY!), I'd instantly become anxious. The sounds of the machines (with ah..alarming alarms) that were permanently attached caused mass agitation (that is not in direct proportion to the cause of irritability) as well. Krazy brain-damaged Kitty (whilst being incredibly frustrated, I'd also have my Aussie-Battler-inspired attitude of 'pull yourself together, you whinger' - my own version of Dr Jekyll and Mr Hyde)! Happy to say the anxiety and irritability is reducing - thank you to all my dear Klubbers who have let me have regular Kat-Naps during the pinnacle of a party (with light-blocking eye masks!) and patiently let the steam out of my *figurative* little teapot without ever casting judgement - 'tis the damage's fault (I promise not to use this excuse forever - just in the 'short term' hehe!). Pseudobulbar Affect (PBA) is a common effect of strokes which causes survivors to lose support from those who do not understand how damage has affected their emotions - a condition I'd love for you to take on board when dealing with someone who has acquired brain damage
  • Anterograde amnesia aka the infamous short term memory loss (extent of which was/is constantly reducing every day thanks to neuroplasticity working its magic! Yippee!!!).  This was definitely noticeable after Stroke #1 by my Klubbers (I was on par with our parents' short term memory, not a big deal and sometimes even entertaining), but I was eager to go back to full-time school duties after our school's Summer Holidays that had conveniently started the day of the first stroke, fully aware it would require working that little bit harder to store information in the damaged brain. Due to my brain's progress over the 6.5 weeks of school holidays (we need short-term memory even more so whilst on holidays!), my determination and 21st Century technology (i.e.: alarms, emails, reminders, even phone photographs - thank goodness!), I was able to work with increased focus on rest and small memory prompts/strategies were swiftly put in place (no worries!) to ensure I remembered necessary short-term memory information (i.e.: what to photocopy, who to write an email to, meetings, what to add to a lesson etc)
Stroke #1 had no official sick days (rehab was had during the school's Summer Holidays and I wanted to go back on the first day of the school year) = Aussie Battler!
Brain damage (a few weeks prior to this above shot when I got the bloke/s) resulting in 
hemiparesis, homonymous hemianopia, hyperacusis and anterograde amnesia = 
(a - above)
'Requiring' a guide (affectionately known as seeing-eye-dog for blogging purposes) for Special K when Czeching out quaint European towns like Prague in the Czech Republic (in initial weeks following Stroke #1); and 
(b - below) Devoted assistance to do the hard-to-see hair in the months following injury (milllllked it) and the lingering hemiparesis and homonymous hemianopia concerns. Some have even offered to dress me (although my strokes didn't technically affect this - was indeed tested!). Sweeties.
Alllllright - if you insist!

Strokes Get The Blokes - London Edition 
I was so (literally) blind (from the damage to occipital lobe) this (lucky) lad needed to 'help' me do my hair - mere hours after being discharged from hospital and I was already getting the blokes (whilst watching the London Olympics - dreaaaam).
Obviously relishing in such!
London, UK
August 2012

Stroke #2 Rehabilitation 
Stage One: Suffering

After 6 weeks' rehab from Stroke #1 and two months back at school (just over three months' in total time from first acquired brain injury - 'two years' is typically given for a stroke rehab before improvements lesson), we had reached late October 2012 and it was time for Term One's Half-Term Break.  This - when the brain had no important duties and could relax for a week - was when Stroke #2 hit the teeny tiny hippocampus (see diagram above for clear visual of a brain's map and location of hippocampus - unfortunately, nothing to do with a hippopotamus camping *my initial thought and I'm sure yours too*. It's in fact linked to the Greek word for 'seahorse' for it has a similar shape - cute?!) which was identified immediately as needing urgent medical help (perhaps due to our recently acquired stroke smarts) when I woke one morning (strokes as you wake are somewhat common due to your brain starting for the day and kapow! It 'strokes' out straight up as you awaken - about 15% of all strokes in fact) at a friend's house utterly confused with absolutely no ability to store any new information (i.e.: took a while for my brain to remember that I actually even had a second stroke - friends and family had to constantly remind me! Also, whose maroon pants I was wearing - mine, of course!) in my brain's short-term memory bank.  That otherwise-typical morning, my friend had come back from having a shower to see this anxious Special K worrying about being at a friend's house on a school night (we had previously discussed it was my school's Half-Term Break so my angst & concern rang alarm bells in their mind).  This confusion is one of many reasons why someone experiencing a stroke may be considered inebriated (even by medical professionals who should know better ala my first stroke) - and not just as they are experiencing the stroke, but in the months/years post. 

Given my chronic memory loss (i.e.: I thought Queen Lizzie II was no longer alive - of course, that was the first short term memory query asked by a bunch of Brits!), I could not tell you the current day/month nor what I ate just ten minutes earlier - I'd assume a Twirl/Ripple chocolate bar (you'd assume correctly, Kitty! Did retain when friends ate my chocolate - long-term memory bank, Mr PB!), so an infection of the brain was initially (and understandably) suspected (we thought I was about to die - especially when old mate, Master B, labelled it 'meningococcal'Turns out strokes actually have a far higher fatality rate than such, but we were none the wiser at the time - ignorance is bliss) and a range of tests including complete blood count (CBC), blood sugar levels, electrolytes, liver and kidney function (especially considering I had a kidney infection just a few months prior to strokes, which I also initially dismissed & so did everyone around me *who had to endure my 'subtle' whinging*) and prothrombin time (PT - blood test that measures the time it takes for the liquid portion of your blood to clot) were swiftly conducted as some conditions may cause symptoms similar to a stroke.  Eventually, yet another stroke (c'mon brain, get your act together!) was identified & appropriate medical intervention was finally executed (thank you dear St George's Hospital for saving this Special K). Years later, I am still on such 'intervention' (that is slowly reducing in dosage - hence why face is no longer referred to as chubby 'moon face') to help prevent future strokes. Will I be on blood-thinning drugs (i.e.: Aspirin) for the rest of my life? It can't hurt!

Suffering the Special K way!
(clockwise from top)
Making a dear mate organise all my finances, sending many pics of giving more blood whilst friends were complaining about their Monday mornings, 'buddies' encouraging the notion of being fat & colleagues teasing my confusion at blood sugar tests. So in summary, it was not all bad an experience after all! Laughs galore!
2-Stroke Oil = Special Mind Medicine
Where there's a pun, there's a Kitty-way

Stroke #2 striking good ole 'hippo-c' instantly gave this Special K -
  • A severe case of anterograde amnesia (substantially more than Stroke #1's case - independence was achieved within weeks post Stroke #1 - due to a mix of determination and ignorance. Stroke #2 has been two years thus far of gradual build-up to full independence one day) - the worst my neurologist has ever seen (I was/am wishing I had the vast range of deficits from Stroke #1 again as opposed to this one major problem that has affected my life immensely for 2+ years). 
  • Intense anxiety, feelings of helplessness and worthlessness due to sudden loss of abilities whilst in my youth, staring death in the face, drastic change in life's direction (and location of such - London, my love!) and general loss of support/quality of life and its usual rate of progress (although there certainly is extraordinary progress by the damaged brain, it does feel like a rather stagnate Bart On Snow Day experience that is only just starting to gain some momentum) in my 20s - it's an out of body experience with these feelings as I've never had them prior to brain damage
  • Constant fatigue that requires regular 'Kat'-naps (this in particular is due to the brain working vigilantly at generating new paths - fatigue is a common effect of strokes. Thank you to those who supported my disco naps during a party and woke me up when it had reached its pinnacle - some even did so with some dances i.e.: Jack Attack). 
Given such a range of effects from strokes and their consequent brain damage, the Pseudobulbar Affect (PBA) has shown some people to neglect our once-were-strong friendships. Keep PBA in mind if ever you find someone in your life experiencing a stroke and try not to leave them when the going gets tough!
The hippocampus (cute little seahorse part of your brain depicted above) is all about -
  • the formation of memories & recalling recent past
  • spatial navigation
  • controlling emotions
Despite such damage in the hippocampus (a minor amount of damage in comparison to stroke #1 given we knew to act FAST 'take two' - such stroke awareness undoubtedly saved my life - lucky for you!), long term memories from before the strokes have remained firmly intact, hence why I can still be Miss Laird without the wise little ones noticing (it's ingrained in this bossy boots!), win Trivial Pursuit against people with unscathed minds with whom I also am able to retain as important people in my life (i.e.: Jack Attack - sorry I beat you *again*), walk, skip, run, dance - even ride a horse (these can be confronting stroke obstacles), swiftly write emails (may just be too effective in this department!), talk on the phone with precise and appropriate (colourful) language (minimal swear words, I promise), use numeracy to solve daily problems (also as Miss Laird annnd as a patient at therapy - number one student! Received first-class honours!), have a splendid night out with loved ones (cash is generally required in case I suddenly 'forget' my card's pin! Learnt that the hard way.  Banks are now starting to take notice of brain-damaged peeps with easier methods in place - wonderful!) and remember all my dear friends' birthdays (don't even need social media to remind me as I now am aware of the current date), our adventures together (before the strokes and some post brain damage as they are important events to my mind!), as well as their embarrassing tales they wish I had forgotten (DARRELL, dear Z.Hanson! Potatoes, KG! Disco Time, Miss Schoop!). 

In acknowledging what I can still do, there is so much I cannot, so thank you to my dear Klubbers who are mindful (heh) of my (textbook) damaged mind and its current (operative word - it will get better!) ways/deficits. Some wise ones have already done the research on what to expect from strokes, the emotional toll and the particular effects to damage in each hemisphere - amazing souls. If ever you are faced with someone who acquires a brain injury (the odds are likely, one-in-six of us will), actively research the location, cause, effects and extent (also through additional research - not just medical sites either, firsthand online pieces too, as I have found other stroke survivors' blogs incredibly informative of this health obstacle - even if you don't know anyone in particular with an acquired brain injury!) so that you can fully grasp what can happen to a person after they experience a stroke. There is a distinct difference between supportive, educated and empathetic people who are aware + understanding of brain damage with its lingering effects & its drastic loss of quality of life and the people who do not truly grasp what has happened and the sheer loss one experiences when they suffer a severe stroke, nor how our intriguing brains function, so tend to be judgemental, ignorant, impatient and aggressive. Dear Klubbers, I applaud your empathy, patience, awareness and especially your humour.

Considering what I could have permanently lost and what I still have (/have regained) - 
No Worries! 

Stroke 1 & 2 Rehabilitation
Stage Two:  Struggling

July - August 2012 (Stroke #1) and November 2012 - April 2014 (Stroke #2)
When we were all worried about a third stroke (and fiercely preventing such from occurring which they so often do - frightening times considering it could be the death of you - or often worse, more severe disabilities) and/or dying from the necessary operations and tests, buddies would deflect during this Struggling Stage the best way they knew how. With humour, of course (a strategy, I wholeheartedly recommend)! 

'Dammit Smithers! This isn't rocket science - it's brain surgery!'
(One of The Simpsons' finest pieces of dialogue in my humble opinion)
Kitty is having surgery that may be the death of her?! Opportune time to quote The Simpsons!

Below, one of the lovely British roomies, Oli, is brushing my hair (what's left of - plenty, but in my stroke-ridden brain, I thought the neurosurgeon shaved majority! Reading of other stroke survivors' damaged mind concoctions i.e.: hearing voices, phantom limbs, Contard's Syndrome  *an alarming effect in the brain's right hemisphere which maintains sense of self - there was definitely moments where I felt like I was dead and/or in a coma - very scary times* and invincibility, this apparent bald head was merely entertaining) to cover the shaved scalp and ('holy') missing piece of skull (cut away during a brain biopsy - see below for image of new 'do' and sweet scar) - it was pretty creepy/hilarious. This was a few days after I had accepted (with sheer anxiety that they didn't want nor arrange for my immediate family to be in London beforehand, mind you) that I was about to die from the brain biopsy. 
Alive and loving it!  Understandably, it felt pretty amazing to be alive at this point - more so than when the strokes actually happened! Strangely, I trusted my own abilities at living when I quite plainly failed, yet lost it at the thought of world-class neurosurgeons doing one of their normal  daily procedures. Definitely brain damaged - thank you to all who calmed my nerves (some examples of such depicted below).

Getting the blokes within days of brain surgery - not surprised!
(/one of my doting British roomies covering that gruesome burr hole)

The residual effects (below) of a brain biopsy (performed in November 2012 with inconclusive results = pointless test!) - not only survived such an operation (the odds are extremely likely but I had no faith in my survival abilities), but also received this sophisticated scar and blatant burr hole in the skull to flash around (mostly at parties)! 
Also had the blokes wanting to brush my hair (above) to hide the shaved spot (that did NOT get an extension like I had initially asked for and insisted was there!). Definitely thanked my lovely surgeons for this 'work of art'!
St George's Hospital, London
December 2012


A test known as a 'brain biopsy' where surgeons (and a lovely anaesthetist) you met briefly in days leading up to such, put you to sleep, commence a craniotomy that involves shaving a section of your head, drilling away (specifically known as a 'burr hole' - great name!) at your skull in order to take a piece of your brain (don't worry - didn't need it! Still witty!), sew up your scalp (but not replace the skull nor give you a hair extension like I initially thought they had for many weeks! Why on Earth would neurosurgeons bother when they have such pressing matters to attend to, none of which of the superficial variety?! This was just as funny as it seems - most people mocked my damaged mind with this memory deficit and colourful concoction of a vanity savour, it was rather funny after all), leaving a vivid scar and hole in your head (as shown above - the bone & hair eventually grows back) to tell the tale/have friends tease the tale.
Scars get the fell-as.
Struggling post Stroke #2's brain damage (above) and 
consequent brain surgery (the bandage on top of head is 
not where the brain biopsy was - this was another gateway to the brain), 
yet so elated to have my little sister, Jack Attack (with Mother Duck
and Jack's PA, Mark), swiftly fly over from Down Under to brush 
the 'extension' in place - yes, that's purely why they rushed over!
St George's Hospital, London
December 2012
















21st Century Support
During The Struggling Phase
Friends' supportive dark-humour engulfed messages moments after brain surgery
Surviving a brain biopsy and buddies loving it with their supportive texts, hospital company, foot tickles and Kitty Feeding Time!
November 2012

  

Visitor time at the 'pital = PARTY, foot tickles and affection -
…+ they're all trying to steal my treats and force me to wear baby-butt cream on my lips!
(Despite smiles on our dials, this is STILL the Struggling Phase)
November - December 2012
St George's Hospital
London UK

Good times in the 'pital - only if you're Kitty Kat!



Stroke 1 and 2 Rehabilitation
Stage Three: Conquering 
Rehabilitation in London's hospitals, back home Down Under 
as Miss Laird - BACK in the classroom

Rehabilitation after a stroke typically happens immediately post acquiring brain damage (and after it has been given medical intervention to restore blood flow) as the most optimal time for progress is in the initial two yearsInitially, this was incredibly confronting as my capabilities from just yesterday were suddenly now distinct incapabilities (hat goes off to all those who specialise in this selfless career).

There was a lovely American OT at London's St George's Hospital who would regularly come see me to perform brain activities (to encourage brain's rerouting and axonal sprouting - very important to start that day one of rehabilitation, regardless of patient's mood and newfound inabilities!) that you'd typically play with young children.  Given I was a primary school teacher (and still an aware one at that!), not only was the way I was treated (which was necessary given my brain damaged state at the time) awfully patronising and confronting ('let's go to the local grocery store - remember the three items we need and how to get back to our ward 150m away in a few minutes' time' and/or 'let's play a card game that you last played when you were seven'), but it was also testament to the extent of brain damage (for a while there, I'd lie in bed at night, alone with my thoughts, intensely angry at myself for becoming so aware, which I wasn't initially, yet so incredibly - and suddenly - incapable)! Asking what my age was in November 2012 (first weeks/months post Stroke #2) was an upsetting obstacle and I was indeed aware that to not be able to recall my own birthday, the date (give or take a few days/months would have even been acceptable!), Internet banking details (that would have been used several times a week, every week, for years leading up to strokes - thank you to PB for initially paying all my bills in my memory's absence and without any qualms. Here's hoping every stroke survivor has a PA like him in their corner) and/or who I lived with, meant the inflamed blood vessels, their subsequent brain damage and updated future life hurdles of a twenty-something firecracker were substantial.  Eventually, I accepted this new 'normal' for still being alive despite these awful events was something I ought to embrace, not hide.

Merely having a shower was an eerie sensation for my body didn't even feel like mine (free rudie nudie sightings every day! Damn - that Kitty-Body!) and I lived in fear every time I went in (hygiene has thankfully stayed with me, although poor hygiene can be a confronting effect of brain damage), not only because I worried I'd do it all wrong, but also that the nurses would notice a distressed Special K and force themselves into the bathroom with me (I was far too aware for that)! Suddenly, I found myself not being able to use this brain that was renowned (just a few hours' prior to the stroke/s) for being youthful, spirited, on the ball, quick witted and fiercely independent.  The elephant memory is currently *operative word!* a goldfish (progressed from the 'Dory' memory though!) one! It was one of my most prized attributes and then I woke up one day at just 26 years old & it was all gone!  

Can you imagine what it's like to find your brain's ultimate strengths instantly turn into concerning weaknesses (Did I just create the plot for the next Hollywood blockbuster)
How do I get those renowned strengths back?  
To be patient and persevere with a decent dose of humour, whilst always being surrounded strictly by positive 'pumps' (whilst also getting the blokes) will ensure quality of life returns!

Conquering Back At School
Being The Funniest & The Best
(as many, MANY students can attest to - evidence below)
Definitely Conquering Phase!
Above: First full day back at school post Stroke #1 (with no official sick days yet accumulated due to 6.5 week Summer Holidays) encountered many unforeseen (and confusing) issues - was I able to dress myself appropriately (Team GB from London Olympics 2012 t-shirt - can you get any more appropriate!)? Could I make my way to work on public transport independently (do I get a sweet badge to wear so other commuters let me sit down at all times…ah no, stroke survivors are still not that considered!)? What if I forget how to *and what to* teach? The biggest hurdle on Day One was my computer's username and password that I hadn't used since July 2012 - no biggie! Planning effective units and lessons, successfully executing such with the little souls, creating appropriate resources and assessment pieces and having energy for full-time work is a tall ask (and if a colleague asked me, 'how did you do this last year?', I couldn't always answer - it was almost like I was a beginning teacher again! Thank goodness for technology to fill in the blanks). Luckily, I had supportive colleagues and my strokes occurred in the 21st Century where there are a range of sophisticated pieces of assistance, alarms, memory prompts and even apps on our smart devices to help and manage such otherwise-confronting times. This, I have found is a problem only if your attitude makes it. 
Be proactive - this is your life, your attitude and you're in control (I tell myself this every single day!).
Just minor setbacks that I have since conquered - one at a time, with patience, persistence and most importantly, humour (just the sort of traits a teacher needs). Boom.
September 2012

Conquering With Uplifting Messages 
Above: These supportive (and rather precise!) words from my dear British students (whom I miss more than London itself. I do adore them ever so much!!) was/is the best medicine - EVER!  Students' messages were one important display of support that got me through the 6 weeks in scary ole hospital (your mind is focused on and motivated by who loves you and wants you to be alive post brain damage and its drastic effects). I'd regularly read them and their notes from two years ago still put a spring in my step and help conquer the brain damage!
Such insightful, empathetic beings.
November 2012

Humour is indeed part of the Conquering Process!
 
Conquering With Hygiene
Clever-thinking KG would write
every single day to check I had gone for a shower (and I'd compliment myself when successfully
having a shower - as shown to left - you should try this yourself!).
How many people are applauded whenever they change their underwear? 
How many people applaud you for changing your underwear? You're a supernova, dear KG.

Conquering With 'Perfect Anatomy' Status
P.N.: Daniel - above - is my protective (yet oh-so-lovely) big brother, hence his concern over who
was 'examining' my body. Fortunately (for him), I didn't tell him about Dr (call me) Angelo 'massaging' my 'heart' to check for irregular heartbeat that may cause stroke (fyi - Angelosaid ticker is fine, anatomy too).

Conquering With Humour
(& Ultimate Student Respect)
Phenomenal words of encouragement (just what the doctor had ordered!) and support from dear Klubbers (above) and (below) my British students upon hearing that I was unwell (initially - before a second stroke was eventually identified - told 'give it a week' hence my student's 'for the week' reference, below - two years later, here I still am!)
Above: This...is true
BTW - This Special K - despite forgetting most - has never forgotten who is the funniest and the best (nor have I forgotten how precisely children judge others!)
Twickenham, UK
November 2012

Conquering with the 'Bare Essentials' 
- namely chocolate and Happy Meals
(on top of regular meals from my efficient 'employees' aka NHS) dear mates would bring in every single night! They are the best medicine (is 'they' the mates or the treats?! Can't decide!)
Kitty's 'Office' @ Neuro Ward
St George's Hospital, London, UK
December 2012

After acquiring a brain injury, where medical assistance and a vast range of operations, procedures and tests have been applied, many stroke survivors have a long road ahead of them after being released from hospital (you are released to get better - not because you are necessarily 'healed' - as hospital does not challenge one's mind in the slightest!).  It makes me think of Shawshank Redemption when Brooks is released from jail and that's when he doesn't know how to cope with the real world and life.  Age (and humour) is definitely on my side during these initial years of Stroke Rehabilitation. You could say I'm at the top of my rehabilitation class. YES! My daily therapy post Stroke #2 has included volunteering at a local supportive school for a few sessions each week (for over 18 months now) which I proudly (as motivation is commonly affected by brain damage) initiated myself (with hours gradually increasing as brain continually reroutes and fatigue hopefully decreases), playing games at rehabilitation (including humbling, otherwise-simple, ones you last played as a child) with a range of occupational therapists - which indeed concluded (I graduated to Rehab, then recently to 'nothing'! Ultimate stroke-survivor graduation, right there!) - where because it's 2014, such fun brain training activities are also conveniently on the ever-handy smart phone (even for you - the person without brain damage). SCORE! Lumosity - a web-based application created by neurologists - in particular, gives clear insight into your brain's abilities (and inabilities). Having fun while learning and learning while having fun, indeed (teacher 101 lingo). The below 'Brain Profile' screenshots clearly show the progress in every piece of criteria since acquiring a substantial chunk of brain damage (squared) in 2012 (the speed games are exited before they begin, as I do not need to work on this particular aspect - so dismiss these particular, inaccurate results - fortunately, I never lost my 'speed-demon' typing abilities from the dual brain damage!), with memory now as high rating as the other criteria.
PROGRESS CITY FOR KONQUERING KITTY!
Get Luminosity (an app on your phone, smart device and/or computer) for yourself (even if you don't acquire a brain injury) and see your own progress as you rewire your brain.
2013 - 2014
GO Kitty Brain, GO!  


People who have also been seriously unwell (stroke or otherwise) will undoubtedly identify with these distinct stages in their own rehabilitation. However, people who have not faced death in the face and/or severe loss (or at the very least, had someone who was/is in direct and constant relations to them experience such), can be quick to judge, label you and dismiss/ignore you - especially when your illness is invisible. This lack of understanding, awareness, patience and sympathy is partly why this little Strokes Get The Blokes Blog was initially created in early 2013 (roughly six months post second stroke). The good news is I am (hopefully) now through the Suffering and Struggling phases of the Stroke Rehabilitation, ridding myself of those vacuums, focusing on all the uplifting pumps and all the torment I have suffered will be reflected as a necessary experience to achieve my ultimate goals in conquering my future endeavours. This, I am confident, is relatable to many stroke survivors and even fellow young people who may be struggling in life. 

Conquering Hospital Life
One of my dear pumps helping to feed a 1/2 blind Special K. 
Zac Hanson never ever complained about this new, challenging role and would bring so much contagious energy into our ward, that everyone in earshot would fall in love with her and admire the bond we had (the world honestly feels like my oyster whilst in her company)! It was like I wasn't unwell - just the same ole Kitty - she'd pop straight in after getting off an international flight (other mates did this, with their luggage in tow - amazing, selfless people!), enjoy graphic chats about fascinating anecdotes, lead a confused Special K to the bathroom (and escort back to the correct hospital bed given the memory reset whilst in the 'loo' for a few short minutes!) and inspire a sad Kitty with tales of our joyous adventures together from yesteryear (with photos accessible on the smart phone to help jog the dodgy memory) to not only deflect from the serious situation at hand, but also to serve as a reminder of the amazing souls in my world. Lucky me, right?!
Little Kitty Feeding Time In The Neuro Ward = 
Attracting more crowds than the big kitties at a zoo!
Mere days following Stroke #1 - July 2012 
(Being able to feed myself despite distinct visual-field deficit to 50% was indeed conquering! YESSS! Still had beautiful mates by my side to pump vitality into this unwell soul & share the yummy hospital lasagne!)
Charing Cross Hospital, London

We must first suffer and struggle in order to overcome and conquer. Conquering feels so incredible, all the suffering and struggling may just be reflected on (in the future) as worth it (Registered Nurse, Mother Duck, and li'l sister, Jack Attack, my humble around-the-clock PAs may not necessarily agree).

My stroke brotherthe intriguing authorMr Charles Dickens once said, 
'I have been bent and broken - but I hope - into better shape'
Wouldn't you agree?
Watch this blog-space for many more conquering moments (i.e.: ability to hike as a stroke survivor with UK's lovely 'flowers of tomorrow' in sweet British fashion just a few months post Stroke #1 in early Octotber 2012, mere weeks before Stroke #2 hit) by this brain-damaged, yet still brain-abled Miss Laird (and many more stroke survivors who have rebuilt their lives despite fires in the brain).
MEOW!

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