Fatigue is a frustrating reality for many of us who have had a stroke. Often times I get angry because I know I have lots to do, but my body, and brain, for that matter, won't comply. Slowly I've come to accept that I just don't have the same energy I once had and probably never will again.I have forgiven myself for needing rest.

I can usually predict how my activities will affect my level of fatigue. If on any particular day I am very active; I have scheduled too many meetings say; or even after gabbing too long with my friends at coffee, I become exhausted, and the next day I pay for it.My husband, Ian, usually gauges my fatigue level by the number of walls I walk into,things I trip over, or by my unintelligible speech. The more tired I am, the more slurred I get. It's actually quite amusing to see him trying to understand what I've just said. I just become too tired to enunciate or to really care, and "thingy" becomes my favourite word. "Please pass me the thingy", for example. Ian's becoming fairly adept at understanding strokie language.Occasionally all I have the energy to do is wave my arms around and point. Although, to be fair, thingy is a favourite word of my friends too, and may simply be a function of middle-age. When we are discussing a book we loved for example, it can take all five of us together to come up with the name! And we're not even drinking!

Usually these busy days  mean that I have to spend the entirety of the following day,sometimes two, resting. The only cure for me is sleep. Some times I get up in the morning, eat breakfast, and if I feel "fuzzy", go back to sleep for several hours.And I hate that!For example; if I expect visitors for a weekend, I need to plan well in advance how I will portion out my days, always reserving the day before they come as a total rest day. So any food preparation or cleaning  must be done bit by bit, days ahead of time. Better yet, if you can afford it, hire a cleaning company and cater, get take out, or dine out. Fortunately my husband is a great cook. Your loved ones will be happier to have "an alert you" than a clean house. My family knows that I need rest periodically and don't expect me to go,go,go all day. When I have company, I am best in the morning after a night's sleep, then usually nap for several hours in the afternoon in order to be alert at night.

Sometimes there doesn't seem rhyme nor reason for fatigue. It just " is", and it's maddening. There are times I can write on this blog for several hours, and others when I can do very little.  Cloudy humid weather for example really does me in. Hot, humid weather-forget it. But instead of getting frustrated now, I am more willing to accept it.What else can you do? But I find I need fewer naps as the years go by. As a new post-stroke patient I remember needing so much sleep; like a baby; wake up, eat, dress, go to sleep again. It was incredible how much energy you'd consume just to put on a sock. Don't worry, it gets better. Your brain urgently needs sleep after a stroke to heal itself, but, with time, it needs less and less.

There is medicine called Alertec that helps with alertness, but I found it raised my blood pressure too much and only take it on the rare occasion. It's best to thoroughly discuss the pros and cons of any medication with your neurologist or general practitioner before you decide what's best for you. But it doesn't hurt to remind them about medications you've heard of; after all they might not know fatigue is a particular problem for you unless you tell them. It's important to remember some medications may not be appropriate for some people and that a particular doctor may not have the expertise to prescribe a certain medication and may have to refer you to a specialist.It's always better to be safe than sorry, and a doctor who is willing to accept his or her limitations is, in my opinion, a good doctor.

I generally drink only decaffeinated beverages, but the occasional cup of caffeinated coffee or tea with food will give me the oomph I need in a clutch. I do this only rarely though, because too much caffeine interferes with sleep, a vital part of recovery.Caffeine can also increase nervousness and anxiety.

Remember, eat well, sleep well , and exercise appropriately to stave off that fatigue monster.Fatigue can be dangerous, causing you to be less careful and may bring about a fall. And don't hesitate to say: "NO, I'M TOO TIRED".


Spirituality is a vital component in stroke recovery, and by spirituality, I am not necessarily referring to religious beliefs; I am a dyed-in-the-wool atheist myself.  I define spirituality as that warm feeling when you are feeling content with life, and I honestly think you can attain that good feeling even when you have been broadsided by adversity.

Let’s be perfectly clear right from the beginning, I am no Pollyanna; I have had feelings of rage, extreme frustration and despondency, not to mention flat-out depression in the years following my stroke. I have to monitor my mood constantly. But I’ve always been an optimist, and I feel that my determination not to be defeated by this disease has been key to my good recovery. I like to think of myself as a Weeble that always bounces back. As the old TV ad says:”Weebles wobble but they never fall down”. (I kind of look like one too!)

And in my work with stroke thrivers I have found that those people who have a determined attitude to do better, and don’t wallow in self-pity, do the best.How else are you going to find out that life can be great after a stroke?

Spirituality is a very individual thing and can be enriched by many different means, be it religion, meditation, coffee with your buds, or simply walking your dog on a country lane. Many people feel content to be by themselves, and it’s always tempting after a stroke, but research shows that interconnectedness is vital to emotional well-being, especially with stroke-thrivers.

The You Docs, Dr.Mike Roizen and Dr, Mehmet Oz of the Toronto Star Newspaper (see links) say:”your spiritual health is somehow hard-wired to your physical well-being. A good connection helps your heart and blood vessels, your brain, your immune system and even your anxiety levels.”

So if you are feeling lonely and down, force yourself to go out in public, join a church, an exercise class, volunteer, do anything to increase your socialization. People tend to hold back from stroke thrivers because they are afraid and don’t know how to respond. Don’t wait for them to make the first move-I always thrust my left hand forward for a handshake and smile. It’s confusing for some people, but most adapt quickly. And I think they are put at ease for the most part. Unfortunately, and frustrating though it may be, it’s often up to the stroke patient to chip away at the ice. Don’t think you are the only one whose been traumatized by your stroke. Try a little empathy. If people are avoiding you, ask yourself why. Are you pushing them away with your foul moods and demanding behaviour? Instead show what you can do for them. Be a Weeble.


A few years after my stroke I signed up to volunteer at the Toronto Rehabilitation's Cardiac Rehabilitation Centre and was honoured to be asked to assist a brilliant young pharmacolgy PHD student Walter Swardfager in his research on the effect of exercise on mood following a cardiovascular event.

We followed  cardiac patients during the course of their rehab to see if regular exercise had an effect on their overall mood as well as their memory and other cognitive functions.The results were very encouraging. TRI has a similar exercise rehabilitation program for stroke patients (which luckily I have been through) that is producing amazing results.

Walter agreed to write a short summary of some of the latest research on the effect of exercise on cardiovascular disease and the alarming way depression can mitigate the results:

The past few decades have seen a growing appreciation for the importance of interactions between stress, depression and cardiovascular disease. In particular, a substantial body of evidence suggests that depression increases the risk of mortality and recurrence of coronary events independently of other known cardiac risk factors in patients recovering from an acute coronary syndrome[1]. Interestingly, depression is often a stronger predictor than the traditional cardiac risk factors that are routinely monitored. For patients with cardiovascular disease, not only can mood changes dull the experience of life, but they can also be “medically important” – but why?
Further investigation has suggested many possible explanatory factors including stress hormone imbalance, increased inflammation and lifestyle/behavioural factors such as less physical activity. For instance, one large study by Whooley and colleagues showed that being less active largely explained the association between depressive symptoms and recurrent coronary events[2]. This is not surprising given that feelings of stress and the lack of motivation that often accompany depression do not promote leisure activity or adherence to rigorous exercise programs. For instance, we found that patients with depression are less likely to complete a cardiac rehabilitation exercise program, and on average, they show poorer improvements in fitness than non-depressed patients even when they do[5]. However, physical activity is of tremendous importance for these patients. Even very small gains in fitness substantially reduce the risk of mortality - an increase of just 10% can reduce the chances of mortality by 20%[6].
Physical activity has been shown to reduce inflammatory markers and the process of arterial thickening that can lead to heart attack and stroke. The build up of arterial plaque is intimately associated with inflammation. Our Toronto studies in patients with heart disease have shown that physical fitness is associated with lower concentrations of the same inflammatory markers that are elevated in those with depressive symptoms[3]. These markers are regulated, to an extent, by stress hormones. A recent randomized study provided some of the strongest clinical evidence to date linking psychological stress and poorer outcomes in patients with cardiovascular disease, showing that a form of cognitive behavioral therapy aimed specifically at reducing stress lowered the odds of recurrent cardiovascular events by 41% compared to the group randomized to receive just the usual treatment)[4].
Just like the situation after a heart attack, depression is strongly associated with poorer functional recovery after stroke. Albeit depressing in itself, this observation is an important clue for researchers. For instance, Chollet and colleagues turned the question around: if depression worsens functional recovery, can depression treatments improve motor function? The answer was yes. Antidepressant therapy enhanced recovery of movement over 3 months in a group of patients with motor deficits after stroke compared to patients who undertook physiotherapy alone[7]. The implication is that the same drugs that protect the mood-regulating centres in the brain might also aid in remodeling of damaged motor networks.
Studies of mice and men suggest that exercise can also help protect and regenerate brain tissue. In heart patients, depressive symptoms typically decline over the course of cardiac rehabilitation as physical activity levels increase, resulting in an overall increase in quality of life. Although cardiac rehabilitation is not currently indicated for patients after stroke, innovative studies from the Toronto Rehabilitation Institute Cardiac Program suggest that it can be feasible for some patients, and that fitness can be safely improved post-stroke[8]. This study opens the door to explore other potential benefits of cardiac rehabilitation for those recovering from stroke, and how the program might be tailored specifically to their needs. The goal of this exciting research is to offer every possible advantage in restoring physical function, independence and vitality.

Walter Swardfager, MSc
Neuropsychopharmacology Research Group
Sunnybrook Health Sciences Centre

1.Wassertheil-Smoller S, Applegate WB, Berge K, et al. Change in de- pression as a precursor of cardiovascular events. SHEP Cooperative Research Group (Systolic Hypertension in the elderly). Arch Intern Med. 1996;156(5):553–561.

2. Whooley MA, de Jonge P, Vittinghoff E, et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronaryheartdisease.JAMA.2008;300(20):2379–2388.

3. Swardfager W, Herrmann N, Dowlati Y, Oh PI, Kiss A, Walker SE, Lanctôt KL. Indoleamine 2,3-dioxygenase activation and depressive symptoms in patients with coronary artery disease. Psychoneuroendocrinology. 2009;34(10):1560–1566.

4. Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, Svärdsudd K. Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease: Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM). Arch Intern Med. 2011;171(2):134-40.

5. Swardfager W, Herrmann N, Marzolini S, Saleem M, Farber S, Kiss A, Oh P, Lanctôt KL. Major depressive disorder predicts completion, adherence and outcomes in cardiac rehabilitation: A prospective cohort study of 195 patients with coronary artery disease. J Clin Psychiatry. Epub, Nov 2, 2010.

6. Vanhees L, Fagard R, Thijs L, et al. Prognostic value of training-induced change in peak exercise capacity in patients with myocardial infarcts and patients with coronary bypass surgery. Am J Cardiol. 1995;76(14):1014–1019.

7. Chollet F, Tardy J, Albucher JF, Thalamas C, Berard E, Lamy C, Bejot Y, Deltour S, Jaillard A, Niclot P, Guillon B, Moulin T, Marque P, Pariente J, Arnaud C, Loubinoux I. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol. 2011;10(2):123-30.

8. Tang A, Marzolini S, Oh P, McIlroy WE, Brooks D. Feasibility and effects of adapted cardiac rehabilitation after stroke: a prospective trial. BMC Neurol. 2010;10:40.

Aug 7 /2011

Patient-Centered care: It’s about relationships:

Aug 16/2011

Beyond BMI: New obesity tool better at predicting risk of death, studies say

Aug 19/2011

Toxic Thinking Patterns – How Pseudo “Feel-Goods” Put a Hold On Your Brain

Self-Talk Works

Sept 1/2011

“Embrace whatever comes.
  Running away saps your energy.
  What is held close can be seen
  Clearly, faced, and befriended.
  All will be well.”

Getting Older, Getting Wiser, Elf-help books/2000

Sept 14/ 2011

How Conscious Attention Effects Positive Change in the Brain, Part 1

Sept 15/2011

Conscious Attention and Emotion – Sculpting Neural Changes in the Brain, Part 2

The Neuroscience of Changing Toxic Thinking Patterns (1 of 2)

By Athena Staik, Ph.D.

Seven Toxic Thinking Patterns to Break – How Pseudo “Feel-Goods” Trick Your Brain (2 of 2)

Sept 21/2011
Looking in to your soul

“Your insurance agent may speak
  of life expectancy.  But what
  your soul requires is expectant life.  What do you expect of
  this day? What can you do
  to make it happen”

Getting Older, Getting Wiser, Elf-help books/2000

Sept 26

Why Free Your Subconscious of “Limiting Beliefs”? (To Thrive, Not Just Survive!)

Sept 27/2011

"It’s a question of being present to our own emotional experience of life by developing our capacity to remain calm, confident, centered regardless what is going on around us. You cannot fully love and accept yourself if you skip this step, and without this step, regardless how much someone loves you, your perceptions will block the experience."

Athena Staik, Ph.D.

Getting to Know You – Five Essentials About Your Brain

Sept 28


Your Brain and The Power of “Rehearsing” Your Future

Sept 29/2011

Keeping track of information and switching from task to task require an efficient “working memory”.

Well-Functioning Memory


Non-Functioning ? 

 Oct 13

Combating isolation

Oct 19/2011

Although this article is written specifically about teenage suicides, I think it has bearing on depression at any age.


Turning to Biology to Explain Hopelessness

Oct 25

 Even in Grief There Can Be Joy

Oct 27/2011

Measured Hope: An excellent article by Sonia Grgr. Sonia tells of her emotional journey after receiving the diagnosing of breast cancer but I think anyone of us can identify with her difficult journey.


Nov 3/2011

Timing Meds Could Transform Treatment

Nov 18/2011

50 Secrets Life Secrets From High Existence

NB The recommendation to cut down on sleep is not advocated by the stroke community-see for a discussion on rest after stroke.

* Opinions in this article are not necessarily those of the author.
Nov 21/2011

Dry Is Skin a Major Issue For People With Diabetes

Dec 13/2011

Depression Associated With Increased Risk of Stroke and Stroke-Related Death

…”researchers speculate that depression may contribute to stroke through a variety of mechanisms, including having known neuroendocrine (relating to the nervous and endocrine systems) and immunological/inflammation effects; poor health behaviors (i.e., smoking, physical inactivity, poor diet, lack of medication compliance) and obesity; having other major comorbidities, such as diabetes and hypertension, both of which are major risk factors for stroke; and antidepressant medication use, which may contribute to the observed association”

Dec 14/2011

Women More Likely Than Men To Suffer Depression After Stroke

"Post-stroke depression is often unrecognized, both by the patient and the provider," Williams said. "Patients may have symptoms, but they think that's a natural reaction to having a stroke. Providers may think it is natural that the patient feels down after having this major life event. So there is a watch-and-see approach instead of a more of an aggressive screening-and-treatment approach."

Dec 15/2011

Psychosocial Therapy With Antidepressants More Effective In Helping Depressed Stroke Patients

“Depression following stroke is an important public health problem,” said Richard C. Veith, M.D., co-author of the study and professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. “One-third of patients who have strokes develop clinical depression, which makes them less able to recover from the stroke, worsens cognitive functioning, impairs social functioning and is associated with other adverse consequences.”

*The author does not endorse any one product or company.


Music as medicine

“One of the next big medical trends will tap into the healing powers of music”:

*The author does not endorse any one product or company.

Jan. 6/2012

BRCA1 may be a ‘critical gatekeeper of heart health’

 Jan 16/ 2012

Researchers Unravel How Stress Leads to Depression

Nature: Aug 3/2011

Jan 18/ 2012-01-08

Manage Your Depression Through Exercise: A Five-Week Plan to a Happier, Healthier You: Author Dr. Jane Baxter

Jan 19/2012

Mental Health Providers Should Prescribe Exercise More Often for Depression, Anxiety, Research Suggests

Jan 20/2012

One Road to Recovery: CNT as a Way to Quickly Reduce Depression: Concreteness Training

Feb 1/2012

 Rage is a Life Force, not to be ignored, dismissed, or spat out

Feb 28/2010

Why You should Really Wear Proper Boots and a Hat in the Winter

Chaos Out, Serenity In: How to create a Harmonious Home

Over the years since I've had my stroke, and perhaps because I'm getting older, I've found I've wanted to get rid of more and more clutter. For one thing a less cluttered home give you less to trip over and it also lends a feeling of calm and peacefulness which we strokies need. You'll find that you waste less energy on cleaning useless stuff, allowing you to concentrate on the work you really need the energy for, to make the most of your new life.

All week The Globe and Mail is exploring great ways to declutter your life.

Try it you'll like it!

                  April 7/2012

         Replacing losses with accomplishments

Accomplishment Cycle

April 17/2012

Volunteering was always something I meant to do when I was working; but with a full-time job, schoolwork (mine), children, husband, meals, chores...and so on, I simply did not have time-or so I thought. Turns out volunteering is very good for what ails you. People who volunteer live much happier lives and reap other good health benefits. I began to volunteer about a year after my stroke and now it fills many of my days.I find volunteering intellectually stimulating and emotionally gratifying and it keeps me connected to the hustle and bustle of modern life. Societal connection is vital for a strokie's well being (even if you don't think so ;  >  ); it helps chase those blues away and helps you come to terms with your new reality. And it can be fun! No pressure, take it or leave it, would it be work was like that! Choose to do volunteer work in an area where you have a lot of expertise, or try something entirely new.You'll feel much better for it.

Volunteer in Your Golden Years (or anytime)

April 26/2012

New Theory for Origins of Alzheimer's

How Zinc Deposits Might Be Causing Alzeimer's

April 30/2012

How to Build a Better Brain

Building a Better Brain: Strenghtening Your Inner Muscle

Aug 27/2012

Psychological distress may be linked to increased mortality from cerebrovascular disease as well as from coronary artery disease, new research suggests.

Oct 12, 2012

People Suffering Stroke At Younger Ages, study finds

Nov 8/2012

Hot Or Cold, Winter Is Bad For Your Health


Drugs  +  Herbal Remedies  =  Trouble

Nov 12/2012

What is a Polypill and Why it May be Good For You?

Is Boredom Bad For Your Health?


7 ways to keep stress — and blood pressure — down
When it comes to preventing and treating high blood pressure, one often overlooked strategy is managing stress. If you often find yourself tense and on edge, try these seven strategies to reduce stress.
Get enough sleep. Inadequate or poor quality sleep can negatively affect your mood, mental alertness, energy level, and physical health.
Learn relaxation techniques. Meditation, progressive muscle relaxation, guided imagery, deep breathing exercises, and yoga are powerful stress-busters.
Strengthen your social network. Connect with others by taking a class, joining an organization, or participating in a support group.
Hone your time-management skills. The more efficiently you can juggle work and family demands, the lower your stress level.
Try to resolve stressful situations if you can. Don’t let stressful situations fester. Hold family problem-solving sessions and use negotiation skills at home and at work.
Nurture yourself. Treat yourself to a massage. Truly savor an experience: for example, eat slowly and really focusing on the taste and sensations of each bite. Take a walk or a nap or listen to your favorite music.
Ask for help. Don’t be afraid to ask for help from your spouse, friends, and neighbors. If stress and anxiety persist, ask your doctor whether anti-anxiety medications could be helpful.

Add in a healthy lifestyle — maintaining a healthy weight, not smoking, regular exercise, and a diet that includes fruits, vegetables, whole grains, lean protein, and healthful fats — and high blood pressure could be a thing of the past.
For more information on lifestyle changes to treat high blood pressure and choosing the right medication, buy Hypertension: Controlling the “Silent Killer” by Harvard Medical School.

April 21/2013

In this issue:
Depression and illness: Chicken or egg?
Get your copy of Understanding Depression.

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HEALTHbeatHarvard Medical School
March 23, 2013
HomeHealth NewslettersSpecial Health ReportsHealth BooksBrowse By TopicBlog
Depression and illness: Chicken or egg?
More information

Understanding Depression
Read More
Get your copy of Understanding Depression
Depression is more than a passing bout of sadness or dejection, or feeling down in the dumps. It can leave you feeling continuously burdened and can sap the joy out of once-pleasurable activities. Effective treatment can lighten your mood, strengthen your connections with loved ones, allow you to find satisfaction in interests and hobbies, and make you feel more like yourself again.
When depression strikes, doctors usually probe what’s going on in the mind and brain first. But it’s also important to check what’s going on in the body, since certain medical problems are linked to mood disturbances. In fact, medical illnesses — and medication side effects — may be behind nearly 10% to 15% of all cases of depression.
It’s not uncommon for a physical illness to trigger depression. Up to half of heart attack survivors and those with cancer report feeling blue, and many are diagnosed with depression. Many people who have diabetes, Parkinson’s and other chronic conditions become depressed.
It works in the other direction, too. Depression can affect the course of a physical disease. Take heart disease — depression has been linked with slower recovery from a heart attack and an increased risk for future heart trouble.
Here’s another chicken-or-egg example. Two common thyroid disorders are well known to affect mood. If the thyroid makes too much hormone (hyperthyroidism), manic symptoms can result. If the gland makes too little thyroid hormone (hypothyroidism), exhaustion and depression can appear. Treating thyroid disease can often relieve the mood problems.
The list doesn’t stop there. Other medical conditions associated with mood disorders include certain neurological conditions (multiple sclerosis, Parkinson’s disease, Alzheimer’s), other hormonal imbalances, and some nutritional deficiencies, such as a lack of vitamin B12.
The take-home message is that if you have depression, or think you might, a thorough physical exam and careful medical history could help pinpoint a physical source of the problem — and the most appropriate treatment.
For more on diagnosing and finding the right treatment on the different types of depression, buy Understanding Depression, a Special Health Report from Harvard Medical School.

Learn the secrets and strategies that can sharpen your memory.
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March 24, 2013
Special AnnouncementHarvard Medical School

Don't be frustrated by "senior moments."

Learn the secrets and strategies
that can sharpen your memory

You've spent a lifetime building your memories, Now find out how to keep them safe and at the same time improve your powers of recall and boost your mental fitness.
Improving Memory
Read More
Dear Marilyn,
The human brain is remarkable. It weighs just three pounds but holds the sum total of all you remember, what you've done, who you've known, where you've been — in short, who you are.
Like other parts of the body, the brain changes with age. You may find yourself forgetting things more frequently, or finding it harder to concentrate. You may have trouble remembering names or where you put the car keys.
The good news is that, no matter what your age, it's not too late to take steps to prevent memory loss. There's a lot you can do to keep your brain healthy and resilient and even improve its ability to create, retain, and recall facts and memories.
Improving Memory, a Special Health Report from Harvard Medical School is an instructive and empowering guide for keeping your brain healthy, your mind active, and your thinking skills sharp.
Ever wonder how much forgetting is normal and how much is too much? Or why we remember exactly where we were when certain events occur? Why there are some memories we can't forget even when we want to? If medications could be contributing to your memory loss? Or if it's true that a daily drink improves one's ability to remember? The report will tell you.
With easy-to-adopt recommendations, the report will show you the practical steps that lead to better brain health. You'll be briefed on the value of both physical and mental exercise (and the best activities for each), the role of sleep and dreams, which foods are most beneficial (is fish really a brain food?), and which vitamins are not.
Plus, the report will give you specific techniques to improve your ability to retain new information. You'll learn effective memory-enhancing tools and organizational strategies to help you remember more and forget less. Even tricks for remembering those elusive names and disappearing keys.
So, for all the memories you've made, and for those yet to come, order your copy of this important Special Health Report now!
To your good health,
Anthony Komaroff, M.D.
Professor of Medicine, Harvard Medical School
Senior Physician, Brigham and Women's Hospital
Editor in Chief, Harvard Health Publications

*Many of these pamphlets are available at Toronto Rehabiltation Instititute's new Sunlife Patient and Family Resource Centre on the main floor of the University campus and can be taken out of the library for 3 weeks.

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