Podcasts about Stroke

The idea might seem like something out of a fantasy, but “Foreign Accent Syndrome” is a genuine, albeit very rare, neurological condition! It sees a person begin to speak with an accent different to the one they had prior to having a stroke; one which makes them sound like they come from an entirely different country! Since the first case was discovered in France in 1907, there have only been about 100 documented cases worldwide, according to the Cleveland Clinic. But certain cases have attracted the attention of the media and scientific researchers alike. One dates back to 1941 in Oslo, Norway, during a period of German occupation.  What is the foreign accent syndrom? What exactly happens in the brain in such cases? How serious can the syndrome be? In under 3 minutes, we answer your questions! To listen to the last episodes, you can click here: ⁠⁠⁠How to spot, prevent and treat heatstroke ?⁠⁠⁠ ⁠⁠⁠What are the strangest reactions caused by an orgasm?⁠⁠⁠ ⁠⁠⁠How can I learn 1000 words in a new language?⁠⁠⁠ A podcast written and realised by Amber Minogue. First Broadcast: 10/1/2025 Learn more about your ad choices. Visit megaphone.fm/adchoices

Imagine being 21 years old, trapped in a two-week coma, completely unable to move or speak, while your sister leans over your bed and confesses her deepest darkest secret to you, and you hear the whole thing.This week, we sit down with Melanie, who at 21 years old, went from a "parking lot" migraine on the 401 to a life-saving brain surgery that left her in a two-week coma . But Melanie wasn't just "asleep"—she describes a vivid, "locked-in" experience where she heard every secret her friends whispered and saw her aunt's birthday wishes in brushstrokes of pink and purple. Melanie shares her "heritage moment" journey of proving every ableist professor wrong by becoming the first legally blind person to graduate from teachers' college in Ontario, despite the system betting she wouldn't make it to Christmas. Melanie's story is a masterclass in why you should never tell a "determined" woman what she can't do.Check out the incredible work Melanie does: https://connect4life.ca/Follow Sickboy: Instagram: https://www.instagram.com/sickboypodcastTiktok: https://www.tiktok.com/@sickboypodcastDiscord: https://discord.gg/expeUDN

Imagine being 21 years old, trapped in a two-week coma, completely unable to move or speak, while your sister leans over your bed and confesses her deepest darkest secret to you, and you hear the whole thing.This week, we sit down with Melanie, who at 21 years old, went from a "parking lot" migraine on the 401 to a life-saving brain surgery that left her in a two-week coma . But Melanie wasn't just "asleep"—she describes a vivid, "locked-in" experience where she heard every secret her friends whispered and saw her aunt's birthday wishes in brushstrokes of pink and purple. Melanie shares her "heritage moment" journey of proving every ableist professor wrong by becoming the first legally blind person to graduate from teachers' college in Ontario, despite the system betting she wouldn't make it to Christmas. Melanie's story is a masterclass in why you should never tell a "determined" woman what she can't do.Check out the incredible work Melanie does: https://connect4life.ca/Follow Sickboy: Instagram: https://www.instagram.com/sickboypodcastTiktok: https://www.tiktok.com/@sickboypodcastDiscord: https://discord.gg/expeUDN

this year is full of possibilities!

Season 3 Episode 12 of The Run TMC podcast features a lively coaches' roundtable at The Hub with Archie Williams' Mikey Clagett, San Marin's Chris Lavdiotis and Branson's Demetrius Roquemore. Hosts Duffy and Big Brain Dave open with an MLK quote and then dive into a three-point range of topics with their guests which include scouting, practice drills, game‑day routines and player leadership . Show Notes Our friend and former guest Dave Albee is battling kidney disease and needs help. More about his battle here.  (G): Content is Mostly Global Interest Topics (M): Content is Mostly Inside Mrin Topics Musical intro credit to Stroke 9//Logo credit to Katie Levine Content and opinions are those of Dave, Duffy and their guests and not of affiliated organizations or sponsors. email us at: theruntmcpodcast@gmail.com follow us on Instagram @theruntmcpodcast check out our website at: theruntmcpodcast.com thank you to our sponsors: The Hub in San Anselmo Encore Custom Apparel online and in downtown San Rafael  The Social Klub in Sausalito San Domenico Nike Summer Basketball Camps The Marin County Free Throw Championship returns on Jan. 25 — at Archie Williams High from 8:30-11:30 a.m. — with proceeds from the event going to help the needy in the community through the St. Vincent de Paul Society. There are competitions and prizes in several categories for individuals and teams, as well as a raffle. For more information, email saintvincentdepaul@strita.edu or call 415-454-6420.  

This week Dan has been to a small wedding and managed to cause his ankle to double in size. Gavin has been hanging out with his canine friends and really enjoyed a film. Dan has a quiz to celebrate MLK day and it's not as offensive as it could have been. Gavin shares the story of a drunk man and a tiger and how Hartlepool United got massive interest in a tweet. Oh and let us know if you want a t-shirt!   This weeks recommendations : Gilfoyle : Gavin Belson 2026 : Gbnga Raspberry Fair : Tom Basden, Carey Mulligan To Have And To Have Not : Billy Bragg   Talk to us here : Email : betherewithbelson@gmail.com X : @therewithbelson Instagram : @betherewithbelson TikTok : @betherewithbelson  

Breaking: Devendra Fadnavis Finishes Shiv Sena with One Final Stroke | BMC Mayor | Eknath Shinde

Dr. Dee Trudeau Poskas, founder of Blue Egg Leadership, a leadership development company that helps growth-minded leaders and entrepreneurs think bigger, communicate with confidence, and lead with clarity.Through transformational programs like Stroke of Genius Masterminds and Mindshift Labs, Dee blends neuroscience, strategy, and practical tools to help clients elevate emotional intelligence, break through limiting patterns, and create lasting impact.Now, Dee's journey of expanding her business into new directions - embracing both wins and setbacks - demonstrates the power of resilience and experimentation in leadership.And while preparing to launch her upcoming book on the hidden power of disappointment, she's helping high achievers turn challenges into opportunities for growth, presence, and influence.Here's where to find more:Website: www.blueeggleadership.comLinkedIn: linkedin.com/in/drdenisetrudeauposkasFacebook: facebook.com/blueeggleadership________________________________________________Welcome to The Unforget Yourself Show where we use the power of woo and the proof of science to help you identify your blind spots, and get over your own bullshit so that you can do the fucking thing you ACTUALLY want to do!We're Mark and Katie, the founders of Unforget Yourself and the creators of the Unforget Yourself System and on this podcast, we're here to share REAL conversations about what goes on inside the heart and minds of those brave and crazy enough to start their own business. From the accidental entrepreneur to the laser-focused CEO, we find out how they got to where they are today, not by hearing the go-to story of their success, but talking about how we all have our own BS to deal with and it's through facing ourselves that we find a way to do the fucking thing.Along the way, we hope to show you that YOU are the most important asset in your business (and your life - duh!). Being a business owner is tough! With vulnerability and humor, we get to the real story behind their success and show you that you're not alone._____________________Find all our links to all the things like the socials, how to work with us and how to apply to be on the podcast here: https://linktr.ee/unforgetyourself

Longevity, Success, Healthy Living, and Nutrition Made Simple Join Our Health Club Community FREE https://www.drasa.com/health-club   Visit Us At Our Health Club Retreats https://www.drasa.com/retreats/ It's Dr. Asa Here... Ask Me Your Question! Text Me: 407-255-7076 Call Me: 888-283-7272

On Episode 60 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the January 2026 issue of Stroke: "Impaired Perfusion and Early Ischemic Stroke Recurrence in Symptomatic Intracranial Atherosclerosis: BIORISK ICAS Study" and "Systematic Genetic Assessment in Young Patients With Cryptogenic Stroke: The ES-EASY project." She also interviews Dr. Fabiano Cavalcante and Prof. Charles Majoie about their article "Acute Carotid Stenting for Tandem Lesions in Patients Randomized to Endovascular Treatment With or Without Thrombolysis: Results From the IRIS Individual Participant Data Meta-Analysis." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260114.701495

In this powerful episode of Walk and Roll Live – Disability Stories, host Doug Vincent welcomes Mike Kent, a stroke survivor whose life changed in an instant after a routine surgery in Paris went catastrophically wrong. What was meant to be a simple nose operation in 2019 resulted in a massive hemorrhagic stroke, an induced coma, and doctors giving Mike just 90 minutes to live. Eight weeks later, he woke up unable to move the right side of his body, unable to recognize his own life, and uncertain whether he wanted to go on. Spending six months in a wheelchair, Mike began the slow, painful, and deeply human process of rebuilding—learning to walk again, write again, think again, and ultimately believe again. Today, Mike helps disabled professionals break free from anxiety and reclaim their sense of purpose after medical trauma. In this raw and honest conversation, he shares the emotional realities of stroke recovery, identity loss, mental health, and what it truly means to rebuild a life from the inside out. This episode is a must-listen for anyone navigating disability, recovery, medical trauma, or searching for hope without sugarcoating the journey. Walk and Roll Live 

Wedgitative State, Blocking the Disease Slot, The Dictatormocracy, Ethical Gun, Sheath the Beatht, Star Wars Sphincter Doors, Gifting Coffin, Kevlard Body Armour, Burial VanYou can now purchase A Listener hats by emailing twointhethinktank@gmail.comCatch up on the 500th episode hereCheck out the sketch spreadsheet by Will Runt hereAnd visit the Think Tank Institute website:Check out our comics on instagram with Peader Thomas at Pants IllustratedOrder Gustav & Henri from Andy and Pete's very own online shopYou can support the pod by chipping in to our patreon here (thank you!)Join the other TITTT scholars on the TITTT discord server hereHey, why not listen to Al's meditation/comedy podcast ShusherAlasdair Tremblay-Birchall: @alasdairtb and instaAnd you can find us on the Facebook right here(Oh, and we love you) Hosted on Acast. See acast.com/privacy for more information.

Why do we struggle to talk about grief? Why that matters and what we can do about it, is the subject of this episode.SummaryGrief is something almost all of us will experience, and yet something we still struggle to talk about openly. Not because it's rare, but because it makes us uncomfortable. We lack a shared language for it, feel uneasy about how long it lasts, and often don't know how to sit with people who don't simply “move on”. On this episode, I'm joined by Amy Kean, founder of Good Shout, for a deeply human conversation about grief, work, identity, and what it really means to give people space to be themselves.Amy has been on the podcast before. Since first encountering her work, I have been consistently inspired by her willingness to be unashamedly herself: thoughtful, curious, and open about experiences many of us keep hidden. When she recently shared reflections on grief on LinkedIn, it sparked a desire to invite her back; not for a tightly structured discussion, but for a conversation that could explore the wider dynamics around loss. What follows is an unusual episode. It begins with grief, but moves into related territory: compassionate leave versus compassionate return, what actually helps when someone is struggling, why workplaces are often so bad at dealing with loss, and why talking about difficult things might be one of the most important human skills we have.Rather than offering neat frameworks or tidy conclusions, this conversation creates space; for reflection, for discomfort, and for honesty. If you've experienced loss, this episode may offer comfort or recognition. If you haven't, it may give you insight into how to show up better for others when the time comes. And above all, it helps normalise the idea that grief is not something to be hidden or hurried past, but something we should be able to talk about.The episode is dedicated to Amy's dad, Lord Terence Kean.Relevant LinksGood Shout, Amy's company — https://goodshoutcommunity.com/Amy on LinkedIn — https://www.linkedin.com/in/amycharlottekean/Amy's previous appearance on the show talking aboiut Communicating Effectively —https://www.humanriskpodcast.com/amy-kean-on-communicating-effectively/Death of an Ordinary Man by Sarah Perry —https://www.goodreads.com/book/show/60324067-death-of-an-ordinary-manAI-Generated Timestamp Summary01:05 – Why Amy, why now03:40 – Remembering Amy's dad08:30 – Double grief and anticipatory loss10:40 – Stroke, hope, and uncertainty14:40 – Grief, work, and performance17:35 – Naming emotions out loud22:05 – Talking about grief on LinkedIn27:40 – Compassionate return 30:05 – The cognitive cost of grief33:05 – Why we don't talk about death35:05 – How to help someone who's grieving 41:05 – Creativity, curiosity, and grief49:05 – AI, voice, and being human53:05 – Shameless and deathbed economics01:02:00 – Final reflections and dedication

Understanding Stroke Medications and Personalized Recovery In this essential episode, host Rosa Hart, BSN, RN, SCRN sits down with Dr. Bryan Eckerle to demystify one of the most overwhelming aspects of stroke recovery: medications. If you or a loved one has ever left the hospital clutching a bag of pill bottles and wondering "Why am I taking all of these?" - this episode is for you. Dr. Eckerle, with his expertise in stroke care and patient-centered treatment, breaks down the critical medications prescribed after stroke, explaining not just what they do, but why they matter for your recovery and long-term health. From blood thinners to cholesterol medications, we cover the science, the side effects, and the strategies for staying on track. Want more inspiring stories and real-life resources? Subscribe and share "Stronger After Stroke" with someone who needs a little extra support navigating life after stroke. For more support after stroke, check out the programs available online and in person through  Norton Neuroscience Institute Resource Centers: https://nortonhealthcare.com/services-and-conditions/neurosciences/patient-resources/resource-center/ If you enjoyed this podcast, listen to Norton Healthcare's "MedChat" podcast, available in your favorite podcast app. "MedChat" provides continuing medical education on the go and is targeted toward physicians and clinicians.  Norton Healthcare, a not-for-profit health care system, is a leader in serving adult and pediatric patients throughout Greater Louisville, Southern Indiana, the commonwealth of Kentucky and beyond. A strong research program provides access to clinical trials in a multitude of areas. More information about Norton Healthcare is available at NortonHealthcare.com.   Date of original release: January 12, 2025

Season 3, Episode 11 features some of the really best moments from Run TMC's 2025 interviews and roundtables — coaching insights, player perspectives, expert conversations and more... Our guests provide practical teaching methods—layup progressions, finishing through contact, small-sided constraint drills, and how to use practice film to build confidence and decision-making. We also explores defensive identity (presses and the 1-3-1), in-game coaching styles, pregame routines, NIL/transfer-era impacts, and simple mental routines for players and coaches. This is the Run TMC year in review and it chock full of useful basketball nuggets  Our friend and former guest Dave Albee is battling kidney disease and needs help. More about his battle here.  Show Notes:  (G): Content is Mostly Global Interest Topics (M): Content is Mostly Inside Marin Topics Musical intro credit to Stroke 9//Logo credit to Katie Levine Content and opinions are those of Dave, Duffy and their guests and not of affiliated organizations or sponsors. email us at: theruntmcpodcast@gmail.com follow us on Instagram @theruntmcpodcast check out our website at: theruntmcpodcast.com thank you to our sponsors: The Hub in San Anselmo Encore Custom Apparel online and in downtown San Rafael  The Social Klub in Sausalito San Domenico Nike Summer Basketball Camps    

This is the world's first entire arm exoskeleton, giving stroke patients more ‘independence' Contact the Show: coolstuffdailypodcast@gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Office Hours is back in business for 2026 and business is good on the first and last day of Jaynuary with our good friend comedian Jay Weingarten (Jay's LA) and 19-year old musician/alcoholic with degenerative conditions Jim E. Brown performing "I Know I'm Going To Die of A Stroke." Jay shared his 2026 mood board, Jim shared his salad cream butties, music legend Gary Wilson surprised us on Zoom, and the trinity shared advice with some callers.Support Office Hours, watch another hour of today's episode with another song from Jim, Vic's full Kennedy Center Honors coverage and tons more every week with OFFICE HOURS+ - get a FREE seven-day trial at patreon.com/officehoursliveSupport Jay's passion by becoming a Patreon of Jay's LA at patreon.com/jayslaRest in peace to our friend Devin Jorgenson. Support his family at gofundme.com/f/support-sonnys-bright-futureF*ck ICE. Rest in power Renee Good. Support her family at gofund.me/33e0e4063 Shop our new merch items now at officehours.merchtable.comWatch the latest season of On Cinema at the Cinema and get tickets to The Certified Five Bags of Popcorn tour now at heinetwork.tv See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Stuck in the same gear? Not happy with your race speed? It might mean you need more work on being responsive. How do you build another gear? Glad you asked. Today, we get into why triathletes often feel stuck at the same speed and how to break the cycle. We look at swimming, biking, and running and give some thought on how to create more of a range, especially when you need it. Going fast can feel good and fun, but sometimes our Zone 4 effort equals our Zone 2 speed in a race. Today, we look at solid and proven ways to break out of being a one-speed wonder, but note, it's not always easy. Topics: Last week on C26 Coming at you consistently We're the podcast version of an age-grouper that outlasts everyone to qualify for Kona New Orleans 70.3 memories Swim rant? One speed wonders Turnover vs. Stroke length in swimming Natural cadence vs. being uncomfortable Hill sprints Something needs to be a priority Increasing FTP vs. Losing weight Swimming more or strength work? Trying to change everything at once Focus on one thing Swim form Hard 25's and 50's What about your base? Not thinking in the water Building another gear Being Responsive One speed Without ranges we tend to not be present RPE - Bodymind Fitness vs. Form We can't skip steps Focus on moving correctly When Zone 4 effort equals Zone 2 speed   Mike Tarrolly - mike@c26triathlon.com Robbie Bruce - robbie@c26triathlon.com

INterview with Moma Begum, MD, and Ron Miller, MD

Demetrius Jelatis can be reached at info@mnpoolbootcamp.com and details of his training are available at www.mnpoolbootcamp.com. If you enjoy the show and want to support the future of the show, consider joining Cue It Up Networks Patreon program here. https://www.patreon.com/cueitup   If you would like to become a sponsor to the show.... Email cueituppodcast@gmail.com

This podcast is brought to you by Outcomes Rocket, your exclusive healthcare marketing agency. Learn how to accelerate your growth by going to⁠ outcomesrocket.com Nurses are at the forefront of healthcare innovation, yet their voices are often overlooked. In this episode, Rosa Hart, a nurse, media consultant, and author recognized globally for advancing health communication, digital engagement, and nursing innovation, discusses her journey of hosting podcasts to educate stroke survivors and caregivers, as well as exploring the role of AI in healthcare. She shares how she created Stronger After Stroke and Nurse Rose's Insights to provide guidance and ask bold questions about improving healthcare. Rosa discusses the challenges women face in stroke outcomes, the burdens on caregivers, and the importance of neuroplasticity and timely treatment. She also reflects on her experiences learning about AI and the importance of empowering nurses in technology adoption. Tune in to hear Rosa's insights on transforming healthcare through education, innovation, and advocacy! Resources Connect with and follow Rosa Hart on LinkedIn. Follow Rosa Hart Media Consulting on LinkedIn and discover their website! Check out Rosa Hart's podcasts here!

Debra Meyerson and the “Slow Fall Off a Cliff”: Aphasia After Stroke, Identity, and What Recovery Really Means There are stroke stories that arrive like lightning. And then there are the ones that feel like a quiet, terrifying slide hour by hour until you wake up and everything is different. For Debra Meyerson (also known as Deborah), that difference had a name: “the slow fall off a cliff.” Her husband Steve describes watching the change unfold overnight in the hospital, neurological tests every hour, skills fading, the unknown getting heavier with each check-in. And the scariest part? Not knowing where the bottom was. This episode isn't only about what Debra lost. It's about what she rebuilt with aphasia, with grief, with a fierce independence that made asking for help its own mountain, and with a new definition of recovery that doesn't depend on going back in time. When Stroke Doesn't “Hit”… It Develops One of the most jarring elements of Debra's experience was the way the stroke revealed itself. Steve shares that Debra left the emergency room still talking, slurring a little, but still planning. Still believing she'd be back teaching soon. Then the overnight monitoring began, and the decline became visible. From midnight to morning, her movement and speech changed dramatically. By morning, she couldn't move her right side. And she couldn't make a sound. That's what makes Debra's phrase so powerful: it captures the reality many survivors and families live through, watching ability disappear in stages, not all at once. It's not just a medical event. It's an emotional one. And it changes how you experience time. The mind starts bargaining. The heart starts bracing. The body is suddenly not predictable anymore. The Hidden Clue: Dissection, Headaches, and Near-Misses Debra's stroke was ischemic, but the cause wasn't a typical blood clot. Steve explains that it was due to a dissection, a tear in the inner wall of an artery. In the months leading up to the stroke, there were warning signs: severe headaches episodes where she nearly lost consciousness a moment where she told their son, “I think I'm having a stroke,” but the symptoms resolved before EMS arrived Steve describes a likely “opening and closing” pattern of temporary interruptions to blood flow that didn't show up clearly during exams because, in the moment, she appeared okay. This is one reason caregivers can feel so haunted after the fact: you did the right things, you sought help, you went to specialists… and the stroke still happened. That's not failure. That's reality. 20230922-GSE headshots at CERAS building in Stanford, CA Aphasia After Stroke: When Words Don't Do What You Want Aphasia isn't one experience. It's a spectrum, and Debra's challenge is word-finding, both in speaking and writing. When Bill asks whether writing is easier than speaking, Debra's answer is simple and blunt: it's hard either way. She also notes that dictation isn't a shortcut. What makes Debra's story especially moving is how Steve describes the long arc of speech returning: weeks before she could even form sounds a month or two before repeating words then, months later, the first original word that made it out unprompted, not as an exercise It happened during a normal moment at a table with family, searching for the name of the pig from a movie no one could remember. And Debra suddenly blurted out: “Babe.” It might sound small to someone who's never experienced aphasia. But for anyone who has, or for anyone who's loved someone through it, that moment is enormous. It's proof that the brain is still reaching for language. Proof that the person is still in there, still trying to connect. And yes, Steve mentions melodic intonation therapy, a method that attempts to engage the brain's musical/singing pathways to support speech. Debra's improvement, even years later, is described as gradual marginal gains that add up over time. The Identity Problem Nobody Prepares You For When Bill asks what part of her old identity was hardest to let go, Debra points to the heart of it: Stanford professor athlete fiercely independent skiing (a love that mattered deeply) the ability to do life without needing so much help This is the part many survivors don't see coming: you're not only recovering movement or speech. You're grieving a version of yourself that once felt automatic. And that grief can be complicated, because you might still look like you. Inside, everything is renegotiated. This is where Debra and Steve offer something that can change the trajectory of recovery: adaptation instead of abandonment. Debra couldn't ride a single bike anymore, but they began riding a tandem, and it became the thing they could do together vigorously, something athletic, meaningful, and shared. Not the same. But real. Cycles of Grief: Joy Can Trigger Loss Debra describes grief as something that shows up constantly, “every day… every hour.” Steve offers a powerful example: becoming grandparents. Debra was ecstatic. Over the moon. And then, the next morning, she was furious, spring-loaded into a bad mood, snapping at everything. Why? Because beneath the joy was a private inventory of what she couldn't do: hold the baby safely change a diaper be alone with their grandson the way she wanted to be chase a toddler the way she imagined This is what “cycles of grief” looks like. Not sadness replacing joy. Sadness sitting next to joy. And if survivors don't understand that's normal, they can interpret it as brokenness or failure. It's not. It's grief doing what grief does: reminding you of what mattered. The Care Partner Trap: Guilt, Burnout, and the “Fix It” Reflex Care partners often disappear inside the role. Steve names a different approach, one supported early by friends who told him plainly: if you don't take care of yourself, you're no use to Deb. So he set priorities: exercise eating well sleeping well He also acknowledges how support made that possible: family help, flexible work, and friends showing up. Then comes a line that many couples will recognize immediately: toxic positivity. Steve admits he struggles with sadness; he tends to solve problems, cheer people up, and push toward the bright side. But Debra doesn't always want to be talked out of it. Sometimes she needs space to grieve without being “fixed.” That's the lesson: Support isn't always uplifting someone. Sometimes support is staying present while they feel what they feel. “True Recovery Is Creating a Life of Meaning” Debra's philosophy shows up in the opening of her book and in the arc of this conversation: “True recovery is creating a life of meaning.” At first, recovery was about returning to who she used to be, therapy, effort, pushing hard. Then something shifted: writing a book became a turning point. It helped her stop using her old identity as the measuring stick and start asking a new question: “How do I rebuild a life I can feel good about with the cards I've been dealt?” That idea is the bridge for so many survivors: You don't have to pretend you're fine. You don't have to deny what you lost. But you also don't have to wait for a full return to start living again. Debra Meyerson: Aphasia After Stroke Interview Debra Meyerson's “slow fall off a cliff” stroke led to aphasia, grief, and a new definition of recovery: rebuilding identity with meaning. Stroke Onward: InstagramX.COMFacebookLinkedInYouTubeTikTokVimeo Debra Meyerson X.COMLinkedInFacebookInstagramSteve:LinkedIn Highlights: 00:00 Introduction and Background06:11 The Experience of a Stroke: A Slow Fall Off a Cliff22:45 Navigating Caregiving: Balancing Needs and Support32:01 Understanding Aphasia: A Spectrum of Experiences43:05 The Importance of Sadness in Healing50:08 Finding Purpose Through Advocacy53:31 Building the Stroke Onward Foundation57:12 Advice for New Stroke Survivors Transcript: Introduction and Background –  Steve Zuckerman and Debra Meyerson Bill Gasiamis (00:00)Welcome to the recovery after stroke podcast. name is Bill. And if you’re a stroke survivor or you love someone who is you’re in the right place before we begin a genuine thank you to my Patreon supporters. After more than 10 years of hosting this show solo, your support helps cover the costs of keeping it online and helps me keep showing up for stroke survivors who need hope and direction. And thank you to everyone who supports the show in the simple ways to YouTube comments, Spotify, Apple reviews. people who’ve grabbed my book, and even those who stick around and don’t skip the ads. It all matters more than you know. Today you’re going to meet Deborah Meyerson and her husband, Steve Zuckerman. Deborah describes her stroke as a slow fall off a cliff. And that phrase captures something so many stroke survivors experience but struggle to explain. We talk about aphasia after stroke, word finding. The moment a single word returned and what happens when recovery stops meaning going back and starts meaning rebuilding a life you can actually feel proud of. Deborah and Steve Myerson. Welcome to the podcast. Debra and Steve (01:08)Steve Zuckerman That’s okay. I don’t mind being Mr. Meyerson from time to time. Bill Gasiamis (01:17)Steve Zuckerman, of course. I mean, I’ve seen it on every email. I’ve seen it on every conversation we’ve had, but that’s okay. I mean, you’ve probably been called worst, Steve. Debra and Steve (01:29)Absolutely, much worse. Bill Gasiamis (01:32)Debra, before the stroke, how would you have described yourself professionally, socially and personally? Debra and Steve (01:39)Outgoing, social, comfortable, no time to to to other’s time. Not taking up other people’s time? Yes. In contrast to me. Bill Gasiamis (01:59)Yes, David, you’re very needy. Debra and Steve (02:02)Yeah, and ⁓ yeah, it’s really outgoing. Bill Gasiamis (02:09)Outgoing, yeah, fantastic. Debra and Steve (02:11)I’ll add, because you didn’t say it, a incredibly hardworking, self-demanding professional for whom good was never good enough. Yeah. Yeah. Yeah. Something like that. Bill Gasiamis (02:23)perfectionist. Fair enough Steve. What roles defined you back then? you’re a partner, you’re a father. How did you go about your day? Debra and Steve (02:37)I mean, I think, you know, very similar to Deb, we were both hard driving professionals who had serious careers. We had three kids that we were raising together and both took parenting very seriously. So worked really hard, you know, to not travel at the same time, to be home for dinner, ⁓ to be at sports games. And we were both very athletic. So both things we did together and things we did separately. I think, you know, before Deb’s stroke, most of our time and attention was focused on career and family and, you know, sort of friends were a third, but, ⁓ staying healthy and staying fit. So those were kind of all parts of, I think, who we both were. met mother, ⁓ athletic sailor, biker, ⁓ ⁓ family is first in academics. Bill Gasiamis (03:44)and academic and what field were you guys working in? Debra and Steve (03:48)No, am a, Steve is not academic. I am an academic. ⁓ Deb was, you know, immediately before the stroke. Deb was a tenured professor at Stanford. She had had lots of other academic jobs before that. ⁓ We met when I was in grad school for an MBA and Deb was getting her PhD. ⁓ So, you know, she is lot smarter than I am and was willing to work a lot harder academically than I ever was. ⁓ I’ve bounced back and forth between kind of nonprofit roles, nonprofit management roles, and a career in finance and business. So I sort of… have moved back and forth between for-profit and not-for-profit, but always sort of on the business side of things. Bill Gasiamis (04:50)often say when people meet my wife, Christine, for the first time and we talk about what we do and the things that we say. I always say to people that between me and my wife, we have four degrees. And then I qualify that. say, she has four and I have zero. And ⁓ she has a master’s in psychology, but ⁓ I never went to university. I never did any of that stuff. Debra and Steve (05:10)Yeah. Bill Gasiamis (05:19)So it’s very interesting to meet somebody who’s very academic and to be a part of her life when she’s in the study zone. my gosh, like I have never studied that much, that intensely, that hard for anything. And it’s a sight to behold. And I’m not sure how people go through all the academic side, all the requirements. And then also Deb, being a mom, being a friend. being active in your community and doing all the things that you do. I just don’t know how people fit it in. So it’s a fascinating thing to experience and then to observe other people go through. Debra and Steve (05:57)It’s really that we had really a lot of time to talk. It was a full life. Debra Meyerson – The Experience of a Stroke: A Slow Fall Off a Cliff Bill Gasiamis (06:11)Yeah, fantastic. What you did, Deb has described the ⁓ stroke as a slow fall off a cliff. What did it actually feel like in the first moments that the stroke happened? Debra and Steve (06:28)Two weeks after my stroke, I am going to the, back to the classroom. I am really not aware of the damage. So right at the outset, Deb was kind of in denial. As the symptoms were first starting to set in, she was still talking about you know, okay, this is annoying, but in three weeks I’m starting the semester ⁓ and genuinely believed she would. actually the slow fall off a cliff was really how I described the first full night in the hospital. This was in Reno, Nevada. ⁓ And Deb sort of left the emergency room talking. slurring her words a little bit, but talking about how she was going to be back in the classroom. And then over the course of that night, from midnight to eight in the morning, they woke her every hour to do a neurological test, you move your arm, move your leg, point to this, you know, say this word and just her skills got worse and worse and worse. And in the morning, She couldn’t move her right side at all and couldn’t make a sound. And that was the, that’s what we called the slow fall off the cliff because we knew at midnight that there was significant brain damage, but we didn’t see the ramifications of that damage. sort of happened over that eight hour period. ⁓ that Deb really wasn’t aware of any of that. was. you know, kind of her brain was in survival mode. ⁓ But for myself and our oldest son, Danny, you know, that was sort of a feeling of helplessness. was watching the person you love kind of fade away or the capabilities fade away. And we didn’t know how low the bottom would be ⁓ without being able to do anything. Bill Gasiamis (08:53)Is there an explanation for that? Now, obviously Deb had a stroke, so that’s the overarching issue, the problem. But I’ve had a lot of stroke survivors explain their symptoms in that slow onset ⁓ situation, whereas mine were just there. I had a blade in my brain, the symptoms were there. Another person ⁓ had an ischemic stroke, bang, the symptoms were there. So why does it take so long for some people to, for the symptoms to develop? Debra and Steve (09:25)I had a dissection five months ago for this stroke. I had really bad headaches. Yeah, so five, six months before Deb’s stroke, she was having bad headaches. She had two episodes where she kind of almost lost consciousness. And one of them, she actually said to our son, call dad, I think I’m having a stroke. And by the time the EMS got there, she was fine. ⁓ Her stroke, it turned out was caused by a dissection, which is a tear. in the inner wall of the artery. So in some ways it’s like a blood clot. It is an ischemic stroke because it’s the blockage of blood flow. But unlike most ischemic strokes, it’s not because of a blood clot. It’s because of this flap of, it’s not biologically skin, but it’s like a flap of skin coming across and blocking off the blood flow. And what they think happened, and it’s really just educated guessing, is that for that six month period, the flap was there, but it kind of kept opening, closing, opening, closing. So she’d have temporary loss of blood flow to the brain, but not permanent loss. Bill Gasiamis (11:04)We’ll be back with more of Deborah Meyers’ remarkable story in just a moment, but I wanna pause here because what Deborah and Steve are describing is something a lot of us live with quietly. That feeling, you can be having a good moment and then grief shows up out of nowhere, or you’re working so hard to stay positive and it starts to feel like pressure instead of support. In the second half, we’ll go deeper into the cycles of grief. the trap of toxic positivity and the shift that changed everything for Deborah when she stopped measuring recovery by who she used to be and started rebuilding identity with meaning. If this podcast has helped you feel less alone, you can support it by sharing this episode with one person who needs it, leaving a comment or subscribing wherever you’re watching or listening. All right, back to Deborah and Steve. Debra and Steve (11:58)And when she had those two events, it was probably stayed closed a little bit longer, but then opened up. But she had a scan, she went to neurologists and because every time she was examined, it was okay. They didn’t find the problem. And then when she had the stroke, it was a permanent blockage that just didn’t open back up again. And Your question is a great one that I’ve never asked. I don’t know why, because what they told us was we can see the damage to the brain. The brain has been damaged. They can tell that on the scan, but that the impact of that damage, how it will affect your motion and your speech will play out over time. And I don’t know why that was true for Deb, whereas, as you say, for some people, it seems like the impact is immediate. And that’s a, that’s a good one. I’m going to, I’m going to Try to research that a little bit. Bill Gasiamis (12:58)That’s just a curious thing, isn’t it? to sort of understand the difference between one and the other. I’m not sure whether if we find out what the difference is, whether there’s say something that a stroke survivor listening can do or a caregiver can do in that situation, like what can be done? How can it be resolved? Maybe different steps that we need to take. I don’t know, but I’d love to know if there was a doctor or a neurologist or somebody who might be able to answer that. Maybe we need to find someone. Debra and Steve (13:29)The doctor and the neurologist didn’t see it. Yeah, in the period before the stroke, they didn’t see it. While we were in the hospital when the stroke was happening, what they told us was at that point, there really wasn’t anything that could be done. The damage was done. So no intervention. would lessen the damage. ⁓ again, we are far from doctors. So there’s a lot about that that we don’t know. Bill Gasiamis (14:08)understood. Deb, what part of your old identity was the hardest to let go? Debra and Steve (14:14)The Stanford professor, athlete, had really a lot of… One hand is so difficult and independent person. Bill Gasiamis (14:33)Yeah. Debra and Steve (14:34)I am, skiing is so, I really love to ski and I am not, I am really not able to ski. Bill Gasiamis (14:52)understood so you were a professor, you were independent, you were physically active and all that stuff has had to stop happening at this point in time. Debra and Steve (15:03)I am the…striking…crossing…cycling…we are the…the…Sieve and I… Bill Gasiamis (15:19)You guys used to do something tandem. Debra and Steve (15:21)Yes, a lot of time in the stroke across America. Well, so I think we’re sort of answering a couple of different questions at the same time. I think what Deb was saying was early on, kind of in that first three or four years, she really, you know, was giving up her role as a Stanford professor, giving up skiing, cycling, sailing, and just the… not being a fully independent person needing so much help. That was really a lot of the struggle early on. Deb did return to a lot of those things. And that was a big part of the recovery process was realizing that she may not be able to do them the same way she used to, but there were a lot of different things. And then the cycling, Deb can’t ride a single bike, but we started riding a tandem. And that adaptation has proven really important for us because it’s, it’s the thing we can now do together vigorously for long periods of time. That is really a, a sport that we can do together, ⁓ and love. And so that that’s really been a, an adaptive way to get back to something, not exactly the same way as she used to do it before the stroke, but in a way that is very meaningful. Bill Gasiamis (16:46)A lot of stroke survivors tend to have trouble with letting go of their old identity in that they feel like they need to completely pause it and put the whole identity aside rather than adapt it and change it so that you bring over the parts that you can and you make the most of them, know. And adaptive sport is the perfect way. You see a lot of people in the Paralympics becoming gold medalists after they’ve been injured. a sports person before their injury and now all of a sudden they’re champion gold medal winning athletes because they decided to adapt and find another way to participate. And that’s what I love about what you guys just said. That’s still able to meet the needs of that identity, but in a slightly different way. What about you, Steve? Like when Deb goes through a difficult time and she has a stroke and then you guys come home from hospital, you’re dealing with, ⁓ well, all the changes in your life as well because you become a care, while you guys describe it as a care partner, we’ll talk about that in a moment. But as a care partner, ⁓ how do you go about doing that without, and also at the same time, protecting a little bit of your needs and making sure that your needs are met? Because a lot of caregivers, care partners, put all their needs aside and then they make it about the person who is ⁓ recovering from stroke. And then it leads to two people becoming unwell in different ways. One potentially emotionally, mentally, and the other person physically and all the other things that stroke does. Debra and Steve (18:36)Yeah, I mean, I think, um, Kyle was lucky in a couple of ways. One, a very close friend very early on who had been through similar situations said, you know, don’t forget, you’ve got to take care of yourself. If you don’t, you’re of no use to Deb. And so from the very beginning, I had people reminding me. I also had a ton of support in supporting Deb. Deb’s mom, you know, came up and lived with us for six months. ⁓ So I could go back to work a lot sooner than I otherwise would have been able to go back to work. And I was fortunate that my job was fairly flexible. ⁓ But, you know, I loved my work and it meant I wasn’t focused on the caregiving or care partnering aspects of my role 24 seven. I got to go do something else independently. ⁓ We also had a lot of friends lend support as well. So, you know, I think I basically said, I’ve got to organize around supporting Deb, no question about it. But with guidance from friends, I sort of said, okay, my three priorities are going to be exercising, eating well, and sleeping well. And I really just set those out as my goals and I created ways to do that. wall and that was sort of my physical health but also my mental health. And so, you know, sort of a problem solver and compartmentalizer by nature. So I guess maybe I was lucky that dividing up those roles was a little more natural to me than maybe it is for others. But it also took, you know, took deliberate choice to make sure not to let myself get sucked so far into the caring piece. that I got in healthy and was lucky enough to have support so that I was able to not let that happen. Bill Gasiamis (20:42)Yeah, a lot of people feel guilt like this unnecessary guilt that, I can’t leave that person alone or I can’t ⁓ look after myself or take some time to myself because the other person needs me more than I need me. And that’s an interesting thing to experience people talk about in the caregiver role where they become so overwhelmed with the need to help support the other person that they… ⁓ that they have guilt any time that they step away and allocate some care to themselves. They see caring as a role that they play, not as a thing that they also need to practice. Debra and Steve (21:29)Yeah, yeah. Well, I think I was also lucky because Deb is so fiercely independent that she wanted as little help as she could possibly get away with. So ⁓ she was not the kind of stroke survivor that was sort of getting mad when I walked out of the room. It was like she was trying to kick me out of the room at times that I shouldn’t leave the room. And so, you know, again, ⁓ Deb was not a demanding, again, she just wanted as little help as she could possibly survive with. And that probably made it easier for me to not feel guilty because it’s like, well, that’s what she wants. She wants me to get out of here as long as she was safe. Navigating Caregiving: Balancing Needs and Support Bill Gasiamis (22:16)That mindset is a really useful one. It makes it possible for people to activate neural plasticity in the most ⁓ positive way. Because some people don’t realize that when it’s hard to do something and then the easier thing is to say, Steve, can you go get me that or can you do this for me? That neural plasticity is also activated, but in a negative way. ⁓ How does your recovery or your definition of recovery evolve over time? How did it change over time? Debra and Steve (22:57)⁓ How did how you think about recovery change over time? The realizing I had to build realizing I had the of my identity and my life. The same past and writing a book. ⁓ Three, four years ago, four years after my stroke, really, well, ⁓ I am really, I am so committed to doing the best. No. I mean, you know, the first three or four years after Deb’s stroke, it really was all about trying to get back to who she used to be. Therapy, therapy, therapy, therapy, therapy, work hard, we’ll get back to life as we do it. And when Deb said, when she lost tenure and said she wanted to write a book, I thought she was nuts. was like, you know, her speech wasn’t as good then as it is now. you I was at her side when she wrote her first academic book and that was brutal and she didn’t have aphasia. So I was like, I really thought she was nuts. But in hindsight, it really was that process of writing a book that got her to turn her knowledge about identity onto herself. that really changed her view of what recovery meant. She sort of started to let go of recovery means getting back to everything I used to be doing and recovery means how do I rebuild an identity that I can feel good about? May not be the one I’d ideally want, but in the face of my disabilities, how do I rebuild that identity so that I can rebuild a good and purposeful and meaningful life? that really was an evolution for both of us. over the five-year book writing period. I sometimes say it was the longest, cheapest therapy session we could have gotten because it really was that kind of therapeutic journey for us. And really a lot of the 25 people are in the book and the friends and colleagues are in the book, really a lot of the colleagues. Deb was a social scientist and a researcher and she didn’t want to write a memoir. She wanted to write a research book. It has elements of a memoir because her story and our story is threaded throughout. But, you know, we learned so much from the interviews Deb did and and I was not involved in the interviewing process, but having that diversity of stories and understanding some of the things that were very common for stroke survivors and other things that were so different from survivor to survivor helped her, helped us on our journey. So that book writing process had so many benefits. Bill Gasiamis (26:49)Very therapeutic, isn’t it? I went on a similar journey with my book when I wrote it and it was about, again, sharing other people’s stories, a little bit about mine, but sharing what we had in common, know, how did we all kind of work down this path of being able to say later on that stroke was the best thing that happened. Clearly not from a health perspective or from a ⁓ life, ⁓ you know. the risk of life perspective, from a growth perspective, from this ability to be able to ⁓ look at the situation and try and work out like, is there any silver linings? What are the silver linings? And I get a sense that you guys are, your idea of the book was in a similar nature. Do you guys happen to have a copy of the book there? Debra and Steve (27:39)Yes. Of course. Don’t we have it everywhere? Bill Gasiamis (27:42)Yeah, I hope so. Identity theft, yep. I’ve got my copy here somewhere as well. Now, how come I didn’t bring it to the desk? One second, let me bring mine. Yes. There you go, there’s mine as well. I’ve got it here as well. So it’s a really lovely book. ⁓ Hard copy. ⁓ Debra and Steve (27:52)Yeah. You must have the first edition not the second edition. Because we didn’t print the second edition in hard copy so it’s not a white cover can’t tell in the photo. Bill Gasiamis (28:07)okay, that’s why. That is a blue cover. Debra and Steve (28:17)⁓ No, the paper cover on the front. Bill Gasiamis (28:20)The paper cover is a white cover. Debra and Steve (28:22)Yeah. So that’s actually the first edition of the book that came out in 2019. And then the second edition just came out about two months ago. ⁓ And they are largely the same. But the second edition has a new preface that sort of, because we wrote that in 2019 and then had five years of working on Stroke Onward and learning more, we kind of brought our story up to 2020. 2024 and then two chapters at the end, one with some of the insights we’ve learned ⁓ kind of since writing the first book and a final chapter about what we think might need to change in the US healthcare system to better support stroke survivors. So we’ll have to get you a copy of the new one. Yeah. Bill Gasiamis (29:13)Yeah, why not? Signed copy, thank you very much. ⁓ Debra and Steve (29:15)Yeah, and the Julia Wieland. ⁓ It’s available on audiobook as well via, we were fortunate to be able to work with a great narrator named Julia Wieland, who’s an award winning audiobook narrator and actually has a business called Audio Brary that she started to really honor narrators and help promote the narrating of audio. the narrators of audio books. ⁓ well, make sure you send us an email with the right mailing address and we’ll get you new copy. Bill Gasiamis (29:55)Yeah, that’d be lovely. So what I’ll do also is on the show notes, there’ll be all the links for where people can buy the book, right? We won’t need to talk about that. We’ll just ensure that they’re included on the show notes. I love the opening page in the book. ⁓ It’s written, I imagine, I believe that’s Deborah’s writing. Debra and Steve (30:14)⁓ yeah, yeah. yes, we have a signed copy of the first edition. Yeah. Bill Gasiamis (30:20)So it says true recovery is creating a life of meaning. Deborah Meyerson. Yeah, you guys sent me that quite a while ago. By the time we actually connected, so much time had passed. There was a lot of people involved in getting us together. And you know, I’m a stroke survivor too. So things slipped my mind and we began this conversation to try and get together literally, I think about a year earlier. So I love that I have this. this copy and I’m looking forward to the updated one. ⁓ And it’s just great that one of the first things that Deb decided to do was write a book after all the troubles. Now your particular aphasia Deb, I’m wondering is that also, does that make it difficult for you to get words out of your head in your writing as well and typing? Debra and Steve (31:13)Yes, dictation is my dictation. It’s so hard. Speaking and writing isn’t the same. Bill Gasiamis (31:31)Speaking and writing is the same kind of level of difficulty. Understanding Aphasia: A Spectrum of Experiences Debra and Steve (31:35)Yeah, and the ⁓ other survivors in aphasia didn’t, Michael is. Want me to help? Yeah. Yeah, just that, and I think you know that there are so many different ways aphasia manifests itself and word finding is Deb’s challenge and it’s true whether she’s speaking or writing. other people and a guy who rode cross country with us, Michael Obellomiya, he has fluent aphasia. So he speaks very fluently, but sometimes the words that come out aren’t what he means them to be. So the meaning of what he says, even though he says it very fluently, and he also has, I think, some degree of receptive aphasia so that he hears what people are saying, but sometimes the instruction or the detail doesn’t. register for him and so aphasia can be very very different for different people. Bill Gasiamis (32:37)Yeah, there’s definitely a spectrum of aphasia. then sometimes I get to interview people really early on in their journey with aphasia and, ⁓ and speech is extremely difficult. And then later on, if I meet them again, a few years down the track, they have ⁓ an improvement somewhat. ⁓ perhaps there’s still some difficulty there, but they can often improve. ⁓ how much different was the Debra and Steve (33:08)15 years ago? I don’t know speech at all. Bill Gasiamis (33:23)No speech at all. Debra and Steve (33:24)Yeah. So Deb, it took several weeks for her to even be able to create sounds, maybe a month or two before she was sort of repeating words. ⁓ We have a great story of the first time Deb actually produced a word out of her brain. So it wasn’t an answer to a question or a therapy exercise. but we were sitting around a table and a bunch of people who hadn’t had strokes were saying, what’s that? No, my family. Yeah, with your brother. No, our family. Yeah. Danny and… Okay, anyway. We were talking about, what was that movie where the guy trained a pig to… do a dog show and what was the pig’s name and none of us could remember it and Deb just blurted out, babe. And it was like we started screaming and shouting because it was the first time that something that started as an original thought in her head actually got out. And that was like four months after her stroke. ⁓ A year after her stroke, it was really just isolated words. ⁓ She then did a clinical trial with something called melodic intonation, a kind of speech therapy that tries to tap into the other side of the brain, the singing side of the brain. And then I would say, you know, it’s been, mean, Deb’s speech is still getting better. So it’s just marginal improvement ⁓ over time. Bill Gasiamis (35:10)Yeah, Deb, what parts of Professor Deborah Meyerson remain and what’s entirely new now? Debra and Steve (35:19)⁓ The sharing knowledge and trading knowledge is the same. The new is how I do it. More constraints, I need help. really help and I am so bad at asking. Really bad at asking. I have really a lot of phases of classes and Ballroom classes, you know ballroom dancing. Yeah, no In the work we do Deb’s favorite thing to do is to teach so we’ve been invited, you know ⁓ Quite a few speech therapists in the United States are using identity theft as part of the curriculum in their aphasia course in the speech language pathology programs Bill Gasiamis (36:28)So speaker-2 (36:28)I’ll be. Debra and Steve (36:48)⁓ and we’ve been invited to visit and talk in classes. And Deb just loves that because it’s back to sharing knowledge. It’s a different kind of knowledge. It’s not about the work she did before her stroke, but it’s about the work and the life experience since. that is still, Professor Deb is still very much with us. Bill Gasiamis (37:14)Yeah, Professor Deb, fiercely independent, ⁓ doesn’t like to ask for help, ⁓ still prefers to kind of battle on and get things done as much as possible and suffer through the difficulty of that and then eventually ask for help. Do you kind of eventually? Debra and Steve (37:32)Yeah, yeah, you skipped the part about correcting everything her husband says. That’s not quite exactly right. Bill Gasiamis (37:40)Well, that’s part of the course there, Steve. That’s exactly how it’s meant to be. And you should be better at being more accurate with what you have to say. Debra and Steve (37:49)I thought we’d be on the same side on this one. Bill Gasiamis (37:53)Sometimes, sometimes as a host, you know, I have to pick my hero and as a husband, I truly and totally get you. Deb, you describe experiencing cycles of grief. ⁓ What does that actually look like in a day-to-day life now? And I kind of get a sense of what cycles of grief would mean, but I’d love to hear your thoughts, your version of what that means. Debra and Steve (38:22)Every day, hour every day, small ways and big ways. Like one year ago, Well, grandmothers. Can I correct you? It was 16 months ago. I’m going to get her back. Yeah. That’s what she does to me all the time. I am really happy. Make sure you explain. don’t know if they would have caught what it was that made you so happy. Grandmother. Sarah, Danny and Vivian. I know, you don’t have to tell me. Just that we became grandparents for the first time. And Deb was ecstatic. I am so happy and also really frustrated. And I don’t… crawling… no. You want me to help? I mean, you know, it’s sort of the day we got there, the day after the baby was born in New York and Deb was over the moon and the next morning… We were walking back to the hospital and Deb was just spring-loaded to the pissed off position. She was getting mad at me for everything and anything and she was clearly in an unbelievably bad mood. And when I could finally get her to say what was wrong, it was that she had been playing all night and all morning all the ways in which she couldn’t be the grandmother she wanted to be. She couldn’t hold the baby. She couldn’t change a diaper. She couldn’t, you know, spell the kids later on to give them a break by herself because she wouldn’t be able to chase no one is our grandson around. And so she had had really kind of gone into grieving about what she had lost just in the moment when she was experiencing the greatest joy in her life. And that’s an extreme example of a cycle of grief. And but it happens, as Deb was saying, it happens. every hour, maybe three times an hour where you’re doing something that’s good, but then it reminds you of how you used to do that same thing. so, you know, when we talk about and write about cycles of grief, it’s the importance of giving yourself that space to grieve because it’s human. You lost something important and it’s human to let yourself acknowledge that. But then how do you get through that and get back to the good part and not let that grief trap you? And that story from 16 months ago in New York is sort of the, that’s the poster child, but it happens in big ways and small ways every day, 10 times a day. Bill Gasiamis (42:00)Sadness is a thing that happens to people all the time and it’s about knowing how to navigate it. And I think people generally lack the tools to navigate sadness. They lack the tools to ⁓ deal with it, to know what to do with it. But I think there needs to be some kind of information put out there. Like you’re sad. Okay. So what does it mean? What can it mean? What can you do with it? How can you transform it? Is it okay to sit in it? ⁓ What have you guys learned about the need for sadness in healing? Debra and Steve (42:35)grief and sadness is so important and through the really once it’s an hour. The Importance of Sadness in Healing From my perspective, I have learned a ton about sadness because I don’t have a good relationship with sadness. In most cases, it’s a great thing. just, you know, I’m a cup is nine tenths full person all the time and I tend to see the positive and that’s often very good. But it makes it really hard for me to live with other people’s sadness without trying to solve the problem. Bill Gasiamis (43:12)Hmm. Debra and Steve (43:35)And we actually came up with a phrase because sometimes if I get positive when Deb is sad, it just pisses her off. She doesn’t want to be talked out of it. And so we now talk about that dynamic as toxic positivity because, you know, most people think of positivity as such a positive thing. And yet If someone needs to just live in sadness for a little while, positivity can be really toxic. And I think that’s been my greatest learning, maybe growth is sort of understanding that better. I still fall into the trap all the time. devil tell you there are way too many times when, you know, my attempts to cheer her up are not welcomed. but at least I’m aware of it now. ⁓ And a little less likely to go there quite as quickly. Bill Gasiamis (44:38)Hmm. What I, what I noticed when people were coming to see me is that it was about them. They would come to see me about them. It wasn’t about me and what they made them do. What made what their instinct was, was to, if I felt better, they felt better and all they wanted to do was feel better and not be uncomfortable and not be struggling in their own ⁓ mind about what it’s like. to visit Bill who’s unwell. And that was the interesting part. It’s like, no, no, I am feeling unwell. I am going to remain feeling unwell. And your problem with it is your problem with it. You need to deal with how you feel about me feeling unwell. And I appreciate the empathy, the sympathy, the care I do. But actually, when you visit me, it shouldn’t be about you. It shouldn’t be, I’m gonna go and visit Bill. and I hope he’s well because I don’t want to experience him being unwell. It should be about you’re just gonna go visit Bill however you find him, whatever state he’s in, whatever condition he’s in, and therefore ⁓ that I think creates an opportunity for growth and that person needs to consider how they need to grow to adapt to this new relationship that they have with Bill. ⁓ which is based now around Bill’s challenges, Bill’s problems, Bill’s surgery, Bill’s pos- the possibility that Bill won’t be around in a few months or whatever. Do you know what I mean? So it’s like, ⁓ all, all the, ⁓ the well-meaning part of it is well received, but then it’s about everyone has a, has to step up and experience growth in this new relationship that we have. And some people are not willing to do it and then they don’t come at all. They’re the people who I find other most interesting and maybe ⁓ the most follow their instincts better than everybody where they might go, well, I’m going to go and say, Bill, he’s all messed up. ⁓ I don’t know how I’m going to deal with that. can’t cope with that. And rather than going there and being a party pooper or not knowing what to say or saying the wrong thing, maybe I won’t go at all. And they kind of create space. Debra and Steve (46:58)So. Bill Gasiamis (47:01)for your recovery to happen without you having to experience their version of it. Debra and Steve (47:09)Yeah, that’s it. That’s really interesting to hear you talk about it that way. And I would say very generous to hear you talk about it that way, because most of the time when we’ve heard people talk about it’s that because people talk about the fact that because other people don’t know what to say, they don’t say anything or they don’t come. But that then creates an isolation that’s unwanted. You’re talking about it as a, maybe that’s a good thing. They’re giving me space, given their skill or willingness to deal with it. Whereas I think a lot of people feel that when people just disappear because they don’t know what to say, that’s a lack of caring and a lack of engagement. ⁓ interesting to hear your take on it. think there’s a close cousin to this that Deb felt very intensely is that some people in the attempt to be understanding and supportive really took on an air of pity. And that there were some people that that we had to ask not to come if they couldn’t change how they were relating to Deb because it was such a like, ⁓ you poor thing that was incredibly disempowering. Whereas there were other people who had the skill to be empathetic in a supportive way. And so, I mean, in some ways, I think we’ve learned a lot, not that we necessarily do it right all the time, but we’ve learned a lot about how to try to support other people by what has and hasn’t worked in supporting us. Bill Gasiamis (49:20)Yeah, it’s a deeply interesting conversation because people get offended when they need people the most that don’t turn up. And I, and I understand that part of it as well. And then in, in time, ⁓ I was, I was like that at the beginning, but then in time, I kind of realized that, okay, this is actually not about me. It’s about them. They’re the ones struggling with my condition. They don’t know how to be. And maybe it’s okay for them. not to be around me because I wouldn’t be able to deal with their energy anyway. ⁓ yeah. So Deb, what made you turn to advocacy? What made you decide that you’re gonna be an advocate in this space? Finding Purpose Through Advocacy Debra and Steve (50:08)⁓ Feeling purpose and meaning. Survivors? Yes. And caregivers? Yes. Really a lot of risky is really… ⁓ medical, medical. Yeah. I mean, I I, I know what Deb is trying to say, which is, you know, once she got past the life threatening part and kind of on her way and was relatively independent, she was drawn back to saying, I want to live a life that has meaning and purpose. And so how in this new state, can I do that? And Deb, as I’m sure you know by now, doesn’t think small, she thinks big. And so what she’s saying is, yes, I want to help other people, other survivors, other care partners, but really we need a better system. Like I can only help so many people by myself, but if we can actually advocate for a better healthcare system in the United States that treats stroke differently. then maybe we can make a difference for a lot of people. that’s kind of the journey we’re on now. the survivors and caregivers, advocacy is so important to California or even the state. Building the Stroke Onward Foundation Bill Gasiamis (52:05)Yeah, advocacy is very important ⁓ and I love that I Love that you become an advocate and then you find your purpose and your meaning you don’t set out to Find your purpose and your meaning and then think what should I do to find my purpose of my meaning it tends to catch Catch go around the other way. I’m gonna go and help other people and then all of a sudden it’s like, ⁓ this is really meaningful I’m enjoying doing this and raising awareness about that condition that we’ve experienced and the challenges that we are facing. And wow, why don’t we make a change on a as big a scale as possible? Why don’t we try to influence the system to take a different approach because it’s maybe missing something that we see because we’re in a different, we have a different perspective than the people who are providing the healthcare, even though they’ve got a very big kind of, you know, their purpose is to help people as well. their perspective comes from a different angle and lived experience, I think is tremendously important and ⁓ missed and it’s a big missed opportunity if ⁓ lived experience is not part of that defining of how to offer services to people experiencing or recovering a stroke or how to support people after they’ve experienced or recovering from a stroke. ⁓ I love that. So that led you guys to develop the foundation, stroke onward. it a foundation? it a, tell us a little bit about stroke onward. Debra and Steve (53:42)In US jargon, we’d call it a nonprofit. Generally, foundations are entities that have a big endowment and give money away. We wish we had a big endowment, but we don’t. We need to find people who want to support our work and make donations to our nonprofit. And yeah, we now have a small team. ⁓ Deb and I given our age, given that we’re grandparents, we were hoping not to be 24 sevens. So needed people who were good at building nonprofits who were a little earlier in their careers. And we’ve got a small team, a CEO, a program manager and a couple of part-time people ⁓ who are running a bunch of programs. We’re trying to stay focused. We’re trying to build community with stroke survivors, care partners, medical professionals. We’ve got an online community called the Stroke Onward Community Circle that we just launched earlier this year. We’re hosting events, ⁓ some in medical settings that we call Stroke Care Onward to really talk with both ⁓ a diverse group of medical professionals, as well as survivors and care partners about what’s missing in the system and how it can be improved. ⁓ And then a program that we call the Stroke Monologues, which is sort of a a TEDx for stroke survivors where survivors, care partners, medical professionals can really tell their story of the emotional journey in recovery. And we want to use all of that to sort of build a platform to drive system change. That’s kind of what we’re trying to build with Stroke Onward. Bill Gasiamis (55:32)I love that. I love that TEDx component of it. ⁓ People actually get to talk about it and put out stories and content in that way as well. Debra and Steve (55:35)Yeah. ⁓ Yeah. Denver, Pittsburgh, ⁓ Boston, and Oakland and San Francisco. We’ve now done six shows of the stroke monologues and a big part about our work in the coming year. is really trying to think about how that might scale. can we, you know, it’s a very time consuming and therefore expensive to host events all the time. So how we can work with other organizations and leverage the idea ⁓ so that more people can get on stage and tell their story. ⁓ Also how we capture those stories on video and how we can do it virtually. So that’s a big part of what the team is thinking about is, you know, how do we Cause you know, at the end of the day, we can only do as much as we can raise the money to hire the people to do. So, that, that developing a strategy that hopefully can scale and track the resources that it takes to make more impact. That’s kind of job one for 2026. Bill Gasiamis (57:05)Yeah, I love it. Lucky you haven’t got enough jobs. That’s a good job to have though, right? ⁓ So if you were sitting, if you guys were both sitting with a couple just beginning this journey, what would you want them to know? What’s the first thing that you would want them to know? Debra Meyerson – Advice for New Stroke Survivors Debra and Steve (57:12)Yeah. Don’t have a stroke. Bill Gasiamis (57:28)Profound. Debra and Steve (57:29)Yeah. Yeah. I mean, I think, you know, it’s a journey and think of it as a journey and try to get as much as much of your capabilities back as you can. But don’t think of recovery as just that. It’s a much broader journey than that. It’s rebuilding identity. It’s finding ways to adapt. to do the things you love to do, to do the things that bring you meaning and purpose and create that journey for yourself. Nobody else’s journey is gonna be the right model for yours. So give yourself the time, space, learn from others, but learn from what’s in your heart as to the life you wanna build with the cards you’ve been dealt. Bill Gasiamis (58:25)Yeah. What are some of the practices or habits that have helped you guys as a couple, as partners stay connected? Debra and Steve (58:34)⁓ It’s, it’s hard. mean, and we’ve gone through phases, ⁓ where I think, you know, in some ways early on after the stroke, we may have been as close or closer than we’ve ever been. as Deb got better ironically and wanted to do more. Bill Gasiamis (58:39)You Debra and Steve (59:01)that created a different kind of stress for us. ⁓ stress is the key. No, stress is not the beauty. I had so much stress. Yeah. And sometimes I say stress is a function of the gap between aspiration and capability and while Deb’s capabilities keep growing, I think maybe her aspirations grow faster. And the question then says, how do you fill that gap? And so I think Deb struggles with that. And then for me, a big struggle is, so how much do I change my life to support Deb in filling that gap versus the things I might want to do that I still can do? So. You know, when Deb decided to write a book, I really wasn’t willing to give up my other nonprofit career, which was very meaningful to me. And I felt like I was midstream, but we had to find other ways in addition to my help nights and weekends to get Deb help so she could write the book she wanted to write. Whereas when the book came out and we decided to create Stroke Onward, that was a different point in time. And I was sort of willing to. cut back from that career to come build something with Deb. So I think again, we hate to give advice because everybody’s journey is different, but things change and go with that change. Don’t get locked into a view of what the balance in relationship should be. Recognize that that’s gonna be a never ending process of creating and recreating and recreating a balance that works for both of us. Bill Gasiamis (1:01:04)Hmm. What’s interesting. Some of the things that I’ve gone through with my wife is that I’ve kind of understood that she can’t be all things that I needed to be for me. And I can’t be all things that she needs me to be for her. And we need to seek that things where we lack the ability to deal to provide those things for the other person. The other person needs to find a way to accomplish those tasks needs, have those needs met, whatever with in some other way. for example, my whole thing was feeling sad and I needed someone to talk me through it and my wife wasn’t skilled enough to talk me through it, well, it would be necessary for me to seek that support from somebody else, a counselor, a coach, whomever, rather than trying to get blood out of a stone, somebody who doesn’t have the capability to support me in that way. Why would I expect that person to… all of a sudden step up while they’re doing all these other things to get through the difficult time that we were going on to that we’re dealing with. So that was kind of my learning. was like, I can’t expect my wife to be everything I need from her. There’ll be other people who can do that. Who are they? And that’s why the podcast happened because I’ve been talking about this since 2012 and since 2012 and ⁓ well, yeah, that’s 2012 as well. 2012 anyhow. ⁓ I’ve been talking about it since. Debra and Steve (1:02:41)You’re both our roles. You’re saying it and then correcting yourself. Bill Gasiamis (1:02:45)Yeah. Yeah. Yeah. I have a part of me that corrects me as I go along in life. Yeah. Sometimes I don’t listen to it. ⁓ but today was a good one. The thing about it is I have a need, a deep need to talk about it all the time. That’s why I’ve done nearly 400 episodes and those 400 episodes are therapy sessions. Every time I sit down and have a conversation with somebody and I, and even though my wife has a I, ⁓ masters in psychology. I wouldn’t put her through 400 conversations about my stroke every single day or every second day. You know, it’s not fair because it’s not her role. I, ⁓ I talked to her about the things that we can discuss that are important, for the relationship and for how we go about our business as a couple. But then there’s those other things that. she can’t offer her perspective because only stroke survivors know how to do that. And I would never want her to know how to ⁓ relate to me having had a stroke and having the deficits that I have and how it feels to be in my body. I would never want her to be able to relate to me. So ⁓ it’s, that’s kind of how I see, you know, the couple dynamic has to play out. have to just honor the things that each of us can bring to the table and then go elsewhere to ⁓ have our needs met if there’s needs that are left unmet. Debra and Steve (1:04:23)Yeah. Really. Well, it’s good to know that if this is a ⁓ helpful therapy session for you, you won’t mind if we send you a bill. Yeah. Bill Gasiamis (1:04:32)Yeah. Yeah. Send it along with the book. Just put it in the front cover and then, and then I’ll make a payment. ⁓ Well guys, it’s really lovely to meet you in person and have a conversation with you. Have the opportunity to share your mission as well. Raise awareness about the book, raise awareness about stroke onward. I love your work. ⁓ And I wish you all the best with all of your endeavors, personal, professional, not for profit. And yeah, I just love the way that this is another example of how you can respond to stroke as individuals and then also as a couple. Debra and Steve (1:05:18)Yeah, thank you. Well, and we hope you’ll join our online community and that includes the opportunity to do live events. yes. And maybe there are some additional therapy sessions. Yes. On our platform and chat with people and well, all over the place. So yeah, please join us. Bill Gasiamis (1:05:43)That sounds like a plan. Well, that’s a wrap on my conversation with Deborah and Steve. If Deborah’s slow fall off a cliff description resonated with you, leave a comment and tell me what part of your recovery has been the hardest to explain to other people. And if you’re a care partner, I’d love to hear what you needed most early on. You’ll find the links to Deborah and Steve’s work, their book, identity theft and their nonprofit stroke onward in the show notes. And if you’d like to go deeper with me, grab my book, The Unexpected Way That a Stroke Became the Best Thing That Happened via recoveryafterstroke.com/book. Also, you can support the podcast on Patreon by going to patreon.com/recoveryafterstroke. Thank you for being here. And remember, you’re not alone in this journey. Importantly, we present many podcasts designed to give you an insight and understanding into the experiences of other individuals. Opinions and treatment protocols discussed during any podcast are the individual’s own experience, and we do not necessarily share the same opinion, nor do we recommend any treatment protocol discussed. All content on this website and any linked blog, podcast or video material controlled this website or content is created and produced for informational purposes only and is largely based on the personal experience of Bill Gassiamus. Content is intended to complement your medical treatment and support healing. It is not intended to be a substitute for professional medical advice and should not be relied on as health advice. The information is general and may not be suitable for your personal injuries, circumstances or health objectives. Do not use our content as a standalone resource to diagnose, treat, cure or prevent any disease for therapeutic purposes or as a substitute for the advice of a health professional. Never delay seeking advice or disregard the advice of a medical professional, your doctor or your rehabilitator. program based on our content. you have any questions or concerns about your health or medical condition, please seek guidance from a doctor or other medical professional. If you are experiencing a health emergency or think you might be, call 000 if in Australia or your local emergency number immediately for emergency assistance or go to the nearest hospital emergency department. Medical information changes constantly. While we aim to provide current quality information in our content, we do not provide any guarantees and assume no legal liability or responsibility for the accuracy, currency or completeness of the content. If you choose to rely on any information within our content, you do so solely at your own risk. We are careful with links we provide. However, third party links from our website are followed at your own risk and we are not responsible for any information you find there.   The post Debra Meyerson and the “Slow Fall Off a Cliff”: Aphasia After Stroke, Identity, and What Recovery Really Means appeared first on Recovery After Stroke.

This issue will review: 1.     Evolocumab in Patients without a Previous Myocardial Infarction or Stroke 2.     SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria 3.     Continuous SGLT-2, GLIP-1RA and Frailty Progression in Older Adults with Type 2 Diabetes   4.     Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria 5.     Tirzepatide in Adults With Type 1 Diabetes: A Phase 2 Randomized Placebo-Controlled Clinical Trial 6.     Listening to Hypoglycemia: Voice as a Biomarker for Detection of a Medical Emergency Using Machine Learning Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

S3E10, A late breaking podcast right before 2026. Dave gives us a comprehensive update from the Bambauer tournament and other post Christmas tourneys.  Happy New Year Run TMC!  Show Notes:  (G): Content is Mostly Global Interest Topics (M): Content is Mostly Inside Marin Topics Musical intro credit to Stroke 9//Logo credit to Katie Levine Content and opinions are those of Dave, Duffy and their guests and not of affiliated organizations or sponsors. email us at: theruntmcpodcast@gmail.com follow us on Instagram @theruntmcpodcast check out our website at: theruntmcpodcast.com thank you to our sponsors: The Hub in San Anselmo Encore Custom Apparel online and in downtown San Rafael  San Domenico Nike Fall and Summer Basketball Camps

Join us live at cre8tive con in february! http://www.cre8tivecon.com “A Stroke of Love” — Nancy Spano's Near-Death Experience and Her Journey Back to Life In this heartfelt episode of Get Obsessed, host Julie Lokun sits down with Nancy Spano, the inspiring author of Stroke of Love. Nancy shares the day her life changed forever when she suffered a massive stroke at age 46 and the profound near-death experience that followed. Nancy's story is raw, emotional, and filled with hope. She takes listeners through the moments leading up to her stroke, describing the changes in her vision, behavior, and thinking that she didn't realize were warning signs. She also opens up about her remarkable recovery and the lessons she learned about resilience, faith, and finding purpose in the aftermath. In this episode, you'll hear:• The subtle symptoms Nancy noticed before her stroke and how she nearly ignored them• What her near-death experience felt like and the spiritual moment that brought her back• How her husband and family supported her through recovery• The life lessons that gave her a renewed sense of purpose and gratitude Recognizing the Warning Signs of Stroke Nancy's experience is a reminder that strokes can happen at any age and that early recognition saves lives. Symptoms Nancy experienced include:• Vision loss on one side• Sudden irritability and mood changes• Confusion and short-term memory loss• Trouble completing simple tasks• Weakness or paralysis on one side of the body• Panic attacks and disorientation Her stroke was linked to high blood pressure worsened by medication, something she had not been warned to monitor. Now, Nancy is dedicated to raising awareness so others can recognize early warning signs and take quick action. If you or someone you know experiences sudden numbness, confusion, slurred speech, vision loss, or loss of balance, call 911 immediately. Time is critical. About Nancy Spano Nancy Spano is a stroke and cancer survivor, wife, mother, and advocate who turned her near-death experience into a message of hope. Her book, Stroke of Love, tells her story of survival, healing, and the strength of the human spirit. Learn more at: www.strokeoflovebook.com Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

and auld lang syne

Send Zorba a message!Dr. Zorba digs into new research that shows heavy drinking can lead to an increased stroke risk. Zorba helps out a caller (another Karl Christenson) with Barrett's Esophagus. The caller suggests that Zorba should bottle and prescribe his laugh as medicine. Zorba also helps a listener who has extremely itchy skin, we hear a Mom Joke, and we learn about glasses from the 1980s that were purported to help folks lose weight.Support the showProduction, edit, and music by Karl Christenson Send your question to Dr. Zorba (he loves to help!): Phone: 608-492-9292 (call anytime) Email: askdoctorzorba@gmail.com Web: www.doctorzorba.org Stay well!

Send Zorba a message!Dr. Zorba digs into new research that shows heavy drinking can lead to an increased stroke risk. Zorba helps out a caller (another Karl Christenson) with Barrett's Esophagus. The caller suggests that Zorba should bottle and prescribe his laugh as medicine. Zorba also helps a listener who has extremely itchy skin, we hear a Mom Joke, and we learn about glasses from the 1980s that were purported to help folks lose weight.Support the showProduction, edit, and music by Karl Christenson Send your question to Dr. Zorba (he loves to help!): Phone: 608-492-9292 (call anytime) Email: askdoctorzorba@gmail.com Web: www.doctorzorba.org Stay well!

In this episode, we'll explore emerging strategies to enhance recovery after stroke. Stroke rehabilitation has long relied on physical, occupational, and speech therapy, but advances in neuroscience are opening new opportunities to directly modulate brain networks, promote plasticity, and hopefully help patients regain function. Dr. Sean Dukelow's work focuses on neurorehabilitation and the mechanisms of recovery after stroke. He's a professor and head of Physical Medicine and Rehabilitation in the Department of Clinical Neurosciences at the University of Calgary. Dr. Dukelow was interviewed by Dr. Cheran Elangovan, vascular neurologist at University of Tennessee Health Science Center. Series 7, Episode 3  Disclosures: Dr. Dukelow serves on the advisory board for Merz and Ipsen, provides consultation for AbbVie, receives speaker fees from Merz

AD FREE DOPEY at www.patreon.com/dopeypodcast This week on Dopey! We start wrapping up 2025 with a candid check-in: feeling under the weather amid a family stomach virus, craving a Sopranos binge, and doubting plans for "Five Days of Dopey" in January (Wednesday/Thursday shows likely intermittent—send opinions to dopeypodcast@gmail.com). We share the ultimate post-Christmas blues remedy: a trip to Elizabeth A. Morton National Wildlife Refuge in Sag Harbor, NY, where chickadees, titmice, and woodpeckers eat seeds straight from your hand in the snowy quiet—described as magical, healing, and the true "opposite of addiction."Dave addresses backlash from replaying Nick Reiner episodes (including harsh comments like "Narcissist Grifter" and "Exploitative Jew"), explains his intent to share old conversations without commentary, notes new listeners discovered Dopey through them, and mentions turning down media interviews. He plugs ad-free listening on Patreon (patreon.com/dopeypodcast) and urges positive iTunes reviews.Listener Emails (Oldies Read Aloud)Wendy: Proposes a dedicated recovery-focused social media platform to avoid bans for "junky" content.James D. Hart: Highlights interracial bands like Prince and the Revolution (inspired by Sly & the Family Stone), Jimi Hendrix Experience, and Smashing Pumpkins.Christy Adams: Celebrates 3 years clean, praises an older neuroscience/meth/GLP-1 episode, and misses the original Dave/Chris dynamic.Stickers or socks for anyone whose email/voicemail gets read—email dopeypodcast@gmail.com.Main Feature: Classic Darrell Hammond Interview Replay (2017) The legendary SNL cast member (longest-tenured before Keenan) gets raw about:SNL highs/lows, iconic impressions (Clinton, Connery), working with Lorne Michaels, and celebrity encounters.Childhood trauma and abuse, flashbacks, and blaming himself to protect the idea of parental love.Alcoholism starting at 14 (first beers felt like "the world turning from black-and-white to color").Self-harm as a "problem solver" and crisis creator during prolific periods.Wild Harlem crack house story (mistaken for a cop, defended as "that motherfucker old TV," spotting the St. Francis Prayer on the wall).Multiple relapses, including after a sponsor's suicide.Stroke-ward epiphany that finally led to lasting sobriety—seeing patients struggle to speak inspired desperation for change.Recovery tools: St. Francis (11th Step) Prayer, connection with others, cognitive therapy, yoga, meetings, and the "law of threes" (expect ⅓ great days, ⅓ okay, ⅓ rough).Wrap-Up Dave re-reads old Spotify comments on the Hammond episode (debates over "This or That," therapy questions, possum facts, etc.) and closes with his heartfelt acoustic cover of "Good So Bad"—the song from the first Dopey episode he heard that inspired him to get clean.All that and more on this weeks installment of that good old Dopey Replay Show! Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Dee Trudeau Poskas's BIO:  Dr. Denise Adele Trudeau Poskas—known widely as Dr. Dee—is a scientist at heart, a coach by craft, and a catalyst by nature. With a background in biological sciences and neuroscience, paired with advanced degrees in leadership and team empowerment, Dr. Dee has spent her career decoding what truly drives human potential—especially in high achievers, entrepreneurs, and visionary leaders. She is the co-founder of Blue Egg Leadership, a certified ICF coach, and the architect behind breakthrough methodologies including EQ-Edge©, SynoVation Valley Leadership Academy, Stroke of Genius©, +Mind Framing+©, and Brilliant Teams©. As a member of the Forbes Coaches Council, she contributes expert insight to global conversations on leadership, neuroscience, and emotional intelligence. In this episode, Virginia and Dr. Dee talked about: Dr. Dee's passion for science & coaching Self-leadership vs. self-management Why you get stuck and how to get out of a rut Takeaways: Thoughts create emotions — control your thoughts. Your brain only does what you tell it to do. Stop thinking the same old thoughts. Treat your network as an extension of your marketing team.   Connect with Dr. Dee on her LinkedIn account to learn more about her work and insights into networking effectively: LinkedIn URL: https://www.linkedin.com/in/drtrudeau/    Connect with Virginia: https://www.bbrpodcast.com/

Stroke etanercept injection 18 months on: what lasted, what changed, and what Andrew learned after the PESTO trial Some stroke survivors are told a version of the same sentence in hospital: “After three months, what you have is what you'll have.” Andrew Stops didn't buy it, not because he was naïve, but because he needed a reason to keep showing up for rehab when nobody could give him a straight answer about what “recovery” would look like. Four years after his ischemic stroke, and 18 months after a stroke etanercept injection, Andrew is back to share what improved quickly, what continued to evolve, and how he made peace with research results that didn't match his lived experience. The question so many survivors are really asking When people reach out about perispinal etanercept (often discussed as “etanercept after stroke”), they're rarely asking for a science lecture. They're asking: Will this help me get my life back? Will I be the person it works for… or the person it doesn't? How do I decide without being misled by hype, fear, or my own desperation? Those questions are valid. They're also heavy, because the stakes are high: the treatment is expensive, travel can be intense, and the emotional cost of hoping—then not getting results—can be brutal. Andrew's baseline: what his stroke took at the start Andrew's stroke most impacted his right side. Early on, he had: No use of his right arm or hand A weaker right leg Right foot drop A slight speech impediment He worked hard to walk again quickly, using practical supports early (including an elastic extension on his shoe to help keep his foot up). But his bigger mission was clear: find ways to complement rehab—because medical staff couldn't give him a timeline, and he felt a “lack of hope” from their perspective. That's a common moment for survivors: you're doing the work, but you also want a map. The “complement” phase: why hyperbaric helped, even without perfect measurement Before etanercept entered the picture, Andrew leaned on what had helped him before: hyperbaric oxygen therapy (HBOT). He had a history of a brain tumor and had used hyperbaric previously for healing, so he rented a soft-shell chamber at home for three months and went in daily for 90 minutes. Andrew was careful with his claims: he couldn't measure physiological changes in real time at home. But he could measure something important, his ability to cope. HBOT became a daily “warm cocoon” where he could breathe oxygen-rich air and calm his nervous system. For him, that mental-health benefit wasn't a side note. It was fuel. And when you're rebuilding your life after stroke, fuel matters. The etanercept decision: hope, uncertainty, and the reality of the “roll the dice” problem Andrew discovered perispinal etanercept through a media story about Dr. Tobinick's clinic, and after about a year, decided he needed to know he'd tried everything he reasonably could. He crowdfunded to afford the trip and treatment. That detail matters because it introduces the single biggest ethical challenge around treatments like this: Even if you try to stay balanced, it's hard not to hang hope on something that costs time, money, energy, and pride. Andrew doesn't tell people to go. In fact, when people contact him now (he's spoken to more than 50), he's careful: He explains it worked for him, but might not work for them He encourages going without expectation He frames it as “knowing you tried everything,” not a guaranteed fix That's responsible guidance from someone who understands how fragile hope can become when it's under financial pressure. What changed fast (and what stayed improved 18 months later) Andrew's report of early changes is striking not because it proves causality, but because it describes specific, functional shifts: Cognitive fatigue and sensory overload He noticed cognitive fatigue dial down immediately. He still experiences it, but it takes far more to trigger now. The most vivid example: on the way to the clinic, he used an eye mask, noise-cancelling headphones, and had medication ready for overload. On the return flight 24 hours later, he didn't need any of it. He stood in the airport like any other traveler. Pain and cramping A persistent cramp in his right calf eased significantly. Emotional regulation He noticed improvement in emotional control, something many stroke survivors quietly struggle with and often feel ashamed about. Hand function and fine motor control His right hand went from feeling like it moved “in molasses” to loosening up. And here's where the “18 months on” part becomes powerful: Andrew recently discovered he could play scales on his clarinet again, covering holes with independent finger movement, something he hadn't been able to do since the stroke. That's not framed as: “etanercept did this.” It's framed as: recovery kept unfolding. “Your stroke recovery doesn't stop. There's no end date.” The PESTO trial: when research challenges your story Then came the PESTO trial results, which (as discussed in your episode) reported that etanercept was not more effective than placebo in the studied group. This is where Andrew's story gets even more human. He didn't just shrug it off. He described feeling guilt, even fraudulence, because he couldn't reconcile the research headline with his lived experience. That response is deeply relatable: when something helps you, and others don't get the same outcome, it can feel like survivor's guilt, especially when people have spent enormous money and emotional energy. A careful theory: the blood–brain barrier question In your conversation, Bill raises a hypothesis, not a proven conclusion that deserves careful attention: If etanercept struggles to cross the blood–brain barrier in general, could certain people have a more permeable barrier due to factors like stroke, surgery, or radiation therapy (which Andrew had)? Andrew himself wonders if radiation could be part of his “why.” This isn't a sales pitch. It's a research direction, a possible explanation for why outcomes might vary so dramatically between people. If that line of thinking ever becomes clinically actionable, it could change the whole decision-making process for survivors, because the question would shift from “roll the dice” to “are you likely to be a candidate?” What a stroke survivor can take from this without being sold to If you're reading this because you're considering a stroke etanercept injection, here are the grounded takeaways from Andrew's 18-month update: Recovery can continue for years. Don't let a timeline kill your momentum. Treatments don't have to be “proven” to feel meaningful, but meaning isn't the same as certainty. Hope needs guardrails. Don't stake your whole future on one intervention. If you pursue something controversial, protect your mindset. Go in informed, realistic, and supported. You deserve respect, not ridicule, for wanting your life back. If you want ongoing encouragement and tools to navigate recovery (and the emotional complexity that comes with it), Bill's work is built for that: Book: recoveryafterstroke.com/book Patreon: patreon.com/recoveryafterstroke This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. Andrew's 18-Month Etanercept Update: Fatigue, Function, and What the Research Says 18 months later, Andrew shares what improved after etanercept fatigue, function, and the tough questions raised by the PESTO trial. Highlights: 00:00 Introduction and Background 06:15 Exploring Treatment Options 08:59 Stroke Etanercept Injection And It’s Impact 12:14 Research Findings and Controversies 17:59 Conversations with Other Survivors 23:26 Reflections on Treatment and Guilt Transcript: Stroke Etanercept Injection – Introduction and Background Bill Gasiamis (00:00) Hey again there everyone. Welcome back to the Recovery After Stroke podcast. Before we get started, a quick thank you to everyone who supports this podcast on Patreon. Your support helps cover hosting costs and after more than 10 years of doing this largely solo, it’s what helps me keep showing up for stroke survivors who need hope and real conversations. A huge shout out to everyone who comments on YouTube, leaves reviews on Spotify and Apple podcasts. has bought my book, The Unexpected Way That a Stroke Became the Best Thing That Happened, and even the folks who don’t skip the ads, thank you. All of it helps this podcast reach the people who are searching for answers late at night when recovery feels heavy. Now today’s episode is a follow-up many of you have asked for. Andrew Stopps is back, and we’re talking about stroke and etanusept injections 18 months on. We’ll unpack what changed for him, what’s continued to improve and how he processed the PESTO trial results that found Etanercapt wasn’t more effective than the placebo. If you’re considering this treatment or you’re trying to make sense of conflicting stories and research, this conversation will help you think more clearly without hype and without fear. All right, let’s get into it. Bill Gasiamis (01:17) Andrew stops. Welcome back. Andrew (01:20) Thank you for having me. It’s good to back. Bill Gasiamis (01:22) It is so good to have you back. The last time we spoke, was March 26, 2024. At least that’s the date that I uploaded the podcast Andrew (01:30) it would have been before that even, probably a couple of weeks before that. Bill Gasiamis (01:34) Yeah, something like that. So a good 18 months since we last spoke. And the original reason why you reached out and kind of we connected was I think because you had found my podcast, I had maybe had a couple of conversations about Etanercept like, and I had no idea what it was, how it worked, if it worked. And then you reached out and said, hey, I’ve had this injection. I’ve tried it. Why don’t connect about it? Andrew (01:36) So a good 18 months. Bill Gasiamis (02:03) And then we connected and we had a really great conversation and that interview has had like 19 and a half thousand views since then. And then what’s been happening a lot about that interview is heaps of people have reached out to me to say, can I speak with Andrew? Can you connect me with Andrew? Andrew (02:23) And he’s people reached out to me because of that. And also they found me on the interwebs somehow and contacted me that way. So I’ve probably been spoken now, well over 50 people. Bill Gasiamis (02:40) Wow, man, that is fascinating. So and what I love about it is that we put out information. What we hope is we hope people make a more informed decision. Right. That’s kind of the idea is like, how do I help people make people make a more informed decision, especially when I haven’t experienced something and I’m trying to get across the benefits or the pitfalls or, you know, what to avoid on a product. It’s just impossible. But You were very gracious as well as you. I’ve interviewed, by the way, a bunch of other about Etanercept. And one of them was Dwayne Simple. Dwayne also gets a few people who I sent to him that are in Canada because Dwayne is in Canada. He’s had Etanercept and it worked out for And then I’ve spoken to another lady from Australia, Karen. who also a shot or two of Etanercept and had positive results. But of course, Etanercept is extremely controversial. And one of the challenges with it is that it doesn’t work for everybody. And there’s only one way of knowing if it’s going to work is to go and get the injection to pay the money and then to kind of roll the dice and see what happens. Now, that’s what we’re going to talk about today. But before we talk about the new Andrew (03:37) Mm-hmm. Mm-hmm. Bill Gasiamis (03:58) research that has come out, the PESTO trial research. Before we talk about that, we’ll briefly talk about your condition, where you started. We’ll have a real short version of that, where you started, what happened, and then how you ended up overseas experiencing Dr. Tobinick’s procedure, and then update us on what happened in the last 18 months. Andrew (04:17) Okay, so I had my stroke exactly four years ago last Thursday. So I’m a four year old stroke survivor now. And my most damage was done to my right side. So I had no use of my right arm or hand at all. My right leg was weak, but it was okay. But my right foot just fell. I had a slight speech impediment. But otherwise physically that was really it for the stroke. And I worked really hard to get myself walking again as quickly as I could. And so when I got home I could walk but I’d had an elastic extension on my shoe to help keep my foot up. And I… From that moment, I was looking for ways to complement my rehab to help me recover fully from the stroke because the doctors and people in the hospital, no one could say to me like how long, how I was going to be, how much recovery, what I could expect, like anything. was just everyone’s unique. And I understand that, but there was a ⁓ lack of like hope from their perspective. So the first thing we did when we got me home was I’d heard, well, I knew that hyperbaric chambers helped healing. And I knew that because I had a, previously had a brain tumor and I used hyperbaric to help me heal from that. It was really, really good. So we hired one, we rented one for three months and had a soft shell chamber at home, which I went in every day. for 90 minutes and it was fantastic. I can’t say how, if that physiologically helped because I don’t have access to an MRI at home or anything. Yeah, I can’t measure it, but it did wonders for my mental health. Like it was brilliant because for an hour and half every day, I got to sit in this nice warm cocoon shell, they do not over me. Bill Gasiamis (06:01) You can’t measure it. Exploring Treatment Options Andrew (06:15) and listen to really nice music and breathe in almost, you know, pure, very heavily oxygenated air. And so it was like meditation for an hour and half. And the hour and a half went just like that. It was so quick. And I was really sad to have to, you know, give it up after three months. But yeah, it very much helped with my mental health during that time. And I mean, It’s hard to say if it helped me physically, but I certainly got back my ability to move my foot. My arm was another beast though, and that took a long time. That took about two months before it even moved slightly before I could just, you know, move it up and down. So getting back the function of my arm was a longer process. So I kept researching online and finding, you know, other ways that I could help myself to recover. That’s when came across the 60 minutes interview with Dr. Tobinick and the clinic and the lady from Australia. Bill Gasiamis (07:17) Which by the way, 60 minutes has taken down. You can only find that on Dr. Tobinick’s YouTube channel now. Yeah, right. So that’s interesting just as a thing that I observed that people might find interesting as well to hear. It doesn’t mean anything perhaps. Andrew (07:24) really? Interesting. Yeah, I mean, yeah, can be anything anyway, so I found that I watched it. I was really really inspired and I thought well I’ve got to know that I have tried everything like if this is how I’m going to be and this was After one year and I was told that you know after three months or That pretty much what I had after three months was was how I was going to be so I figured after one year, I’ve got to try everything. And so I crowdfunded and had about 30 or 1000. Bill Gasiamis (08:13) You raised how much? US, New Zealand dollars. Andrew (08:22) Yes, so that was to that was to fly that was for the flights accommodation the shots like the whole the whole package And yeah, and we flew out in in February Last last year 2025 Was it last year? can’t remember Bill Gasiamis (08:37) I did 20, 24, 18 months ago. Stroke Etanercept Injection And It’s Impact Andrew (08:40) 2024. And yeah, had the shot and it was it was amazing how fast I found things start to to wake up and recover. By then I had had more movement in my arm, but my hand was very sluggish. And I really didn’t have any fine motor control at all. ⁓ So yeah, that was the 32nd story of Andrew’s stroke recovery. Bill Gasiamis (09:04) Yeah, that’s a cool story. So we did a full deeper dive interview for Andrew’s story, an hour and 18 minutes worth of conversation. And the link to the original interview with Andrew about Etanercept will be available in the show notes, right, and in the YouTube description of this video. So anyone who wants to go back and watch that can do that as well. Now, like I said, it’s had 19,000 views. It’s 521 likes and it has just a ton of comments, just a ton, a ton of comments. Now, one other thing that has happened since then is I haven’t been able to find people who are willing to talk about Etanercept who did not have positive results when they went to Dr. Tobinick’s clinic. just, people don’t want to be interviewed if it’s about that. It seems as though it’s been really hard, right? So. I can’t give this balanced view of here’s somebody who has had good results, here’s somebody who hasn’t had results. They comment on the YouTube comments and they send me emails about it, but they don’t really tell me whether or not they will join me on the podcast to discuss it properly. recently the Griffith University study came out about Perispinal Etanercept and it had some positive results. It didn’t find that it was able to help restore certain functions, et cetera, but it did have an impact on pain relief for some people. Now, after that, the highly anticipated study was the one from the Flory Institute here in Australia called the PESTO trial. I’ll share my screen and I’ll put it on the screen while we chat about it, right? We’re gonna chat about what if. what it found, Andrew, just so that we can bring people up to speed so they can just hear a conversation about it. Bill Gasiamis (10:50) We’ll be back with more of Andrew’s story in just a moment, but if you’re listening right now and you feel stuck, want you to hear this clearly. Recovery isn’t a three month window. It’s not even a one year window. Your brain can keep adapting for a long time. And the real challenge is learning how to keep hope without putting all your hope in one thing. In the second half of this episode, Andrew shares what actually lasted 18 months on. What still improved over the time. And we’ll talk about the biggest question. If the PESTO trial says the Etanercept shouldn’t work better than the placebo, then why do some people still report a night and day difference? Bill Gasiamis (11:30) OK, so this is the PESO trial. Now, I interviewed recently ⁓ Vincent Thijs the doctor who headed the study. but the Flory Institute is basically reporting on his findings. He has presented these findings at stroke conferences around the world. And what was interesting was that this study started in, I think, 2018. And then because of COVID had to be paused, amongst other things. And then finally, all the research was reviewed and it became available at the beginning of 2025. And then it’s been out probably for about seven or eight months now. Stroke Etanercept Injection Research Findings and Controversies And what they found was that the, and they’re being a little bit provocative here calling it a miracle cure, but what they found was that a perispinal etanusept, the arthritis drug, ⁓ was not effective in treating people that were experiencing symptoms because of a stroke anymore. than the placebo. So what they found was that the people on the placebo who ⁓ received the placebo, 56 % of them had a positive result from the placebo as opposed to less than 56 % of people who were actually using the Etanusept. And the reason being, they say, is because the drug doesn’t have the capability of crossing the blood-brain barrier to get to where the ⁓ inflammation is and to actually ⁓ decrease the inflammation. In arthritis, for example, the inflammation is in the joints, which are not part of the brain. There is no blood-brain barrier or some barrier that stops the atanasip from going there. And therefore, when people get injected to experience relief from ⁓ the symptoms of rheumatoid arthritis, they do experience that relief sometimes almost immediately, et cetera. And ⁓ as a result of that, the guys published the study and basically concluded that it is not effective and more research needs to be done to understand why or why not it works for some people and why it doesn’t for others. And I’ve had a couple of kind of ideas since then. And I’ll stop sharing my screen now because we can go back to just you and I, Andrew. And I’ve had some ideas as to how do I then talk to people about that, right? So I know I’ve interviewed Andrew, five other people that I’ve interviewed at least who said they had a positive result. And I should tell people there’s people who had a positive result, right? And then there’s the other people on the other side of the spectrum, which are really hostile saying like, it’s snake oil. My idea is that even if you go there and you receive Etanercept and it works when it’s not meant to and it’s just a placebo working because you’ve got high expectations of it working. You need it to work. You’ve invested $30,000. You you’ve traveled half a way across the world. Even if it works and it didn’t cross your blood brain barrier, to me, that’s a tick, right? That’s like. It worked fantastic. People improve their function. They got their life back. The body is very powerful. It can achieve amazing things. Who cares how it did that? A B, your blood brain barrier might be compromised. So there is a thing called leaky gut. We’ve heard about leaky gut. It is a compromised gut barrier which allows toxins to escape the gut and get into the blood. and causes a lot of autoimmune conditions. The same thing is possible for the blood brain barrier. If you’ve got a really compromised blood brain barrier because you’ve had a stroke or you’ve had brain surgery or something like that, it’s possible. Andrew (15:47) we’ve had radiation therapy, which I have. Bill Gasiamis (15:50) or you’ve had radiation therapy because of previous medical conditions, et cetera, then there could be a more permeable blood brain barrier, which enables the Etanercept to actually penetrate it and get to the root cause of the stroke inflammation or the root location of the stroke inflammation. And therefore, some people through no… ⁓ you know, through no fault of their own, I either have a really healthy blood brain barrier and Etanercept can’t cross it or have a compromised blood brain barrier and Etanercept can cross it. And therefore they experience positive results. But the issue then is how do we know? How can we work that out for people, you know, before they go and drop 30 grand on a treatment that they may not get a result for. Now. That’s my thinking about it, right? But I still send people to you and I still send you these studies as they come up, just so that I can say, Andrew, I need your feedback. I need you to talk to me. I need you to tell me something. Like, where do you stand on all of this? I’m going to keep sending people to you who reach out to me to speak to Andrew because they’re interested. So like, how does that conversation go in your head and then with the people that you connect with? Andrew (17:09) Okay, so having having been a teacher, career teacher, I’m really careful of what I advise people like I would be really careful what I advise my students. So I never say to people, yes, you’ve to do it because it worked for me. God, do do it, do drop it again. I never ever say that I tried to give them the balance for you. And and even though it worked for me, I make sure it’s I’m very clear that they understand that it worked for me, but it might not work for you. Conversations with Other Survivors So you’ve got to go like I did and don’t go with any expectations. Just go, just know that you’ve tried everything you can to help your recovery. That’s all. And so that’s how that conversation usually goes. They ask me lots of questions about what it feels like, what the place is like, what Dr. Tobinick was like. just all the sort of the mechanical questions around it. But generally, it’s, I don’t know whether I should go. And it’s also, I want to go, but my family don’t want to go. And I can’t go because they don’t support me, because they think it’s snake oil. Bill Gasiamis (18:18) Okay, that’s an interesting conversation. So I often try and advise stroke survivors to be careful who they share information with. Not saying that you shouldn’t share information with your loved ones and your family members after a stroke. What I’m saying is like, even in situations where things are not that critical, where you’re not talking about spending 30 grand, I’m just talking about people who have the experience sometimes Andrew where they say, oh, I wanna try this meditation thing, you know, and. somebody hasn’t meditated before, thinks it’s woo woo and says, don’t worry about that stuff. What do you wanna be? Like a hippie or something? There’s those types of people who hang out in our world who do intervene with things that we’re curious about and we wanna kind of shift away from perhaps old habits to new habits, especially around alcohol as well. I found that people would go, aren’t you gonna have one drink? Like what’s the point of going out if we can’t have a drink? It’s like, dude, like I’m a completely different version of myself. I’ve had a stroke, I can’t drink. But understanding how to deal with people like that is a bit of an issue. So then you’ve spoken to about 50 people who have either gone or not gone. Like have some people gone and contacted you and said it worked and some people gone and contacted you and said it hasn’t worked. Andrew (19:40) Yes. Yep. And I’ve. The contact normally starts to go quiet once they actually go, whether it works or doesn’t work. And I usually just get a quick message saying, hey, I went and it worked and that’s great. And, you know, have a good life. You know, I don’t want to keep bugging them. But the people that it didn’t work for have been pretty gutted. Bill Gasiamis (20:03) Right. Andrew (20:04) Because I’ve, you know, even though I’ve tried not to make it something they hang all their hopes on, you know, they still do to a certain extent. And so they come back pretty, not bitter or angry at me, just at the situation, that it didn’t work. And they don’t know where to turn next. Bill Gasiamis (20:22) So they might’ve had all their hopes kind of set on this working, all their eggs in one basket, so to speak, didn’t work and now they feel like maybe they’ve lost hope or they haven’t got another alternative or option. Andrew (20:35) Yeah, yeah. And what I’ve learned in the last 18 months is that your stroke recovery doesn’t stop. There’s no end date. So when you’re told in hospital that after three months that’s what you’ve got, no, no. doesn’t, like your brain is constantly evolving and working and learning and repending itself. If you want to work something and exercise something and rehab part of your body, eventually it’s going to improve. Even if it’s only by a little bit and it’s really slow, it’s going to improve. Bill Gasiamis (21:09) Yeah. So you’ve been 18 months down the track. One of the questions I got asked recently was, does the procedure need to be repeated every couple of years? Does it last? What have you found about how you have changed or experienced your body in the last 18 months? ⁓ Tell us first what you got back and how quickly and then what that led to, what you were able to achieve as a result of what you got back. Andrew (21:34) Yeah, okay. So, um, immediately the things that came back is is that my cognitive fatigue like just just lowered like straight away. Um, and I was when I had the shot, I was exhausted because they take it through a battery of tests. So I like was an hour and a half of tests. And so I was I was done. I was ready to go lie down. Um, And that just lifted like straight away and it didn’t come back. I still get cognitive fatigue now, but I really have to be doing stuff that that really taxes my brain to do it. And or I have to be really tired. But before I had the injection, I would get I would be on the verge of fatigue all the time. So it wouldn’t take much to push me over into it. So that was gone. I had a ⁓ really nasty cramp in my right calf that never went away. That went away. That literally just dialed down as I was sitting there after the shot. the emotional control also came back. Bill Gasiamis (22:42) Uh-huh. Andrew (22:43) which was good. Now, for me, I was, for the first shot, I was only in Florida for 24 hours. So we flew down from Memphis and I had the shot the next day and then we flew back that afternoon. So when we flew down, because of my cognitive fatigue and sensory overload, I had eye mask, had noise-canceling headphones, had like, lorazepam in my pocket. Like, you know, I had all the, you know, all this stuff to, you know, save my senses. When we flew back, I didn’t need any of it, and that was 24 hours later. So I just stood in the airport like any other traveler. And that was… Reflections on Stroke Etanercept Injection Treatment and Guilt Bill Gasiamis (23:26) Yeah. Andrew (23:28) That was the biggest sign that something profound had happened. Bill Gasiamis (23:33) Yeah. Andrew (23:34) The other thing was that my hand, my right hand went from feeling like it was sort of like moving in molasses really slow to loosening up and being more independent. And I found only a month ago that I was able to start to play scales on my clarinet again. So I can move my fingers independently. I could cover the holes with my clarinet here. Bill Gasiamis (23:52) Wow, man. Andrew (23:57) I can the holes in my fingers. It’s something that I haven’t been able to do since the stroke. To be able to play the thing, to be able to just play a scale, just says to me, at some point in the future, you’re gonna be able to play the thing again. Bill Gasiamis (24:11) So things are still improving. Your function is changing still. you, being able to play the clarinet, would you can attribute that to a tenor sept that long ago or just things getting better? Andrew (24:26) I think because it was if I come home and was able to play the clarinet then I would have a definite causality you know so I would rather say the definite yeah it was a tenor step that did it because before I went away I couldn’t even you know I couldn’t pick up things one more right hand so but because it’s been 18 months I think it’s because that that skill has come back Bill Gasiamis (24:50) Yeah, okay. What about work wise? Were you working or not working before the injection? Andrew (24:57) No, no. So I was able to go back to relief teaching. The classroom as a music teacher is ⁓ in a high school is too busy and there’s too many moving parts. So that’s not something I’ll be able to do again, at least not in the foreseeable future. And I don’t know if I want to now. Bill Gasiamis (25:11) Wow. Andrew (25:20) I have done some relief teaching. There are days where I’m in a school and I just feel that it’s a bit too much. And that could be because I had a bad night the night before or it was hot and I couldn’t sleep. And that wasn’t like that before the stroke. yeah, coming up with a new career now has been an interesting journey itself. Bill Gasiamis (25:41) Yeah. So there isn’t a need for another injection or anything like that. Nobody ever told you about another injection or what will happen in two years or anything like that. Andrew (25:51) No, If I can go there and get one, if I think it’s going to make even more improvement, because I had improvement from, you know, from the first. But yeah, there was no compelling sort of needs to go back. And I’m thinking that I probably would like maybe to have a second one, a second trip there and have. having the shot but ⁓ I don’t know I’ll see how my improvement goes. Bill Gasiamis (26:20) Yeah, okay. Andrew (26:22) It’s so hard to One of the things I did do, I had an MRI about two months ago. And it was an MRI to check the status of my tumor and to see where it was. And obviously they also had a look at the stroke site. And comparing the stroke site now to when it was taken when I had the stroke. there’s a day and night difference. Whereas I had a hole in my brain after the stroke, all I had was a little bit of glial, called glial scar tissue. So scar tissue of the brain cells, a little white line in my brain. ⁓ Bill Gasiamis (27:08) as opposed to a round circle of what appeared to be offline or dead brain cells. Yeah, which, you know, it sounds like to me, it’s like where the inflammation was, that area they usually call, they often call, sometimes called the penumbra, which is the area that’s able to be rehabilitated, which is around the site of the stroke, which is offline but not dead, which HBOT targets, the right kind of, Andrew (27:15) Yes. Yeah. Bill Gasiamis (27:38) hyperbaric oxygen therapy can target those as well and try and reduce them. So day and night, like a proper difference between one and the other. Andrew (27:47) Yeah, I was expecting to see when I saw the scan, know, where my brain tumor was and also the big hole and the hole was gone and there was just this like, this is a little, a little line there with scar tissue. Bill Gasiamis (28:01) Yeah, fabulous. How long has the brain tumor been there for? Andrew (28:05) 20 years. Bill Gasiamis (28:07) Okay, and what does it do just sort of sit around and ⁓ Andrew (28:10) Yeah, so ⁓ what happened is it just gradually grows bigger and bigger and bigger and then eventually if you don’t get it treated, it crushes your brain stem and that kills you. So I had mine irradiated 20 years ago and it’s got growing and it’s just started dying off and now it’s just like a… dead mess in there and they check every four years to make sure it hasn’t done anything naughty and It hasn’t so they actually said of this last scan look it hasn’t changed in the last 12 years, so no more scans Bill Gasiamis (28:41) I hear you, okay. So it’s benign now. Andrew (28:46) Yeah. Bill Gasiamis (28:47) Yeah, okay. So you’ve through the rigor, mate. You’ve had an interesting neurological experience, Andrew (28:54) Yeah, yeah, yeah, yeah, feels like my brain’s out to get me. Bill Gasiamis (29:00) Yeah. Well, seems like the interventions have been really helpful in prolonging your life and then your life experience, like how you go about life. So as far as you’re concerned, like it’s all it’s all. You know, it’s been a good outcome, both both interventions. Andrew (29:19) Yes. Yeah. Yeah, I think so. I mean, my biggest challenge this year has actually not been the stroke or the brain tumor, but it’s been the medications for stroke to prevent another one. So my stroke was caused by an overactive adrenal or adrenal glands producing too much aldosterone. Bill Gasiamis (29:31) What man which man say you want? Andrew (29:43) And that was only diagnosed and found last year. So What was happening is that my body was? Was was keeping salt it was it was send my blood pressure sky-high and then crash it down And for 10 years we thought that was anxiety. But what it was was that because my blood pressure wasn’t consistently high, I could go to the doctors and I could be normal. And then my other doctors didn’t have high blood pressure. It was not consistent. So I was just treated for anxiety and given a sort of a low dose blood pressure medication. But actually what it was is both glands like over producing this hormone and that’s what gave me the stroke. So they’ve they’ve given me a hormone suppressant which helps, but they’ve been trying to. to juggle multiple types of blood pressure medication to also bring my blood pressure down to a consistent normal. And so up until about three weeks ago, my blood pressure was still all over the place. And they had me on a really nasty cocktail at one point this year where I literally could not function. I couldn’t even get up. It suppressed my whole system so much. that every time I stood my blood pressure would drop 50 points and I would almost pass out. So I was like a zombie. ⁓ It was just the combination of too many blood pressure medications at once. And finally, I’ve seen a different specialist and he changed my medication and I’ve just got one little pill at the minimum dose and it’s actually stabilized my blood pressure to normal. Bill Gasiamis (30:51) All right. Righto, that’s good. Andrew (31:18) So like when I took it today, was 122 over 72. So it hasn’t been like that for I don’t even know how long. Bill Gasiamis (31:25) Yeah. Fantastic, what kind of stroke did it cause? Andrew (31:31) are ischemic, so a clot. Bill Gasiamis (31:34) ⁓ huh, okay. Wow, man. What an interesting journey you’ve been on. And this insight into Etanercept and how and why it might work for some people and not for others is probably helpful for it again, for a whole bunch of people to hear and kind of get a better understanding about scientifically speaking, Etanercept is not a viable solution for people who have had stroke and there will be some people who will become all, what’s the word? Like they will, they’ll be all, this is snake oil stuff. And then there will be people who brag about it as being the best thing they’ve ever done, which seems to be kind of the camp that you’re in. I think, no, no, no, no. I mean, it’s one of the best things you’ve ever done with regards to your stroke recovery, right? Andrew (32:18) I don’t feel like complaining about it though. Yeah, yeah, and I found that when I got the results for the for the pesto test I really had to do a lot of soul searching because because I couldn’t explain to myself Why it seemed to have worked for me and yet the study was saying hey, doesn’t really have any effect and and I had to to Bill Gasiamis (32:36) Wow. Did you feel remorse or guilt about that? Wow, Wow. Andrew (32:47) Yes, very much. I felt like a fraud. Because why? I couldn’t explain how I had such a huge night and day difference. And that couldn’t be placebo and it’d be still working 18 months later. Bill Gasiamis (33:08) Yeah, I think our hunch about the blood brain barrier is where the research needs to go. And I don’t know how you investigate the blood brain barrier. But if you can go there and investigate the blood brain barrier and if you can understand who has a compromised blood brain barrier and therefore. Andrew (33:15) Yeah. Bill Gasiamis (33:31) due to a compromised blood-barrier barrier, a candidate for a Etanercept I think that’s kind of where it needs to go. Because the biggest issue that people have with clinics who offer a Etanercept perispinally, like Dr. Tobinick’s, the biggest issue that people have that makes it hard for them to make a decision is will I be the right candidate? Will I be the one who will it work for? Or will I be the one that it doesn’t, you know? But I… I find it very fascinating that you would respond that way, that you would feel guilty and remorseful that it worked for you and the pesto child says it shouldn’t have. Andrew (34:10) I feel guilty that it worked for me and didn’t work for someone else. You know, as well. Yeah, yeah, I mean, it’s like survivor’s guilt in a way. Yeah, that’s that and that’s how I felt. so the way I’ve thought of it is, well, OK, if it was placebo, it worked for me. Bill Gasiamis (34:14) Yeah. just wishing for the best for everybody. Yeah, I can relate to that. Yeah. Andrew (34:37) like it just it worked for me whatever it was it worked for me so and that’s that’s that’s all I can all I can say but I think this blood brain theory is is a good one and I would like to I would like to research and understand what what makes the brain leaky like what what events can make your brain Bill Gasiamis (34:41) Yeah. Yeah. Andrew (35:00) ⁓ better suited to receiving Etanercept Like for me, probably the main cause could have been the fact that I had radiation on my brain years ago. Bill Gasiamis (35:05) Yeah. Andrew (35:13) Or it could be that I have a high blood pressure for 10 years. Or it could be I have my appendix out when I’m 17. But I would like to do some research into what it is, what factors make people more likely to have a leaky brain. Bill Gasiamis (35:17) Who knows? Yeah, I think that’s a great thing. I want to research that too, because I have known about it. I’ve understood it. I appreciated that I might be somebody who has had a leaky brain because of the strokes that I experienced, the brain surgery and all the stuff that I went through. And I know that if you restore the blood brain barrier, you can really decrease the fatigue that happens to people after a stroke. And you can make it impenetrable again to toxins. and heavy metals and all that kind of stuff, which is often the cause of real chronic neurological fatigue, even in people who haven’t had a stroke, who are, quote unquote, normal. So that’s fascinating. I really appreciate your continued willingness to have conversations about this topic and sharing your story more than once with me. And then also being being an ear to the people who are curious about whether or not they should go down this path and then kind of just like, you know, being honest about your story, sharing what happened to you, what you experienced and even your own reservations because I don’t think you have anything to, and you probably know this cognitively anyway, right? You don’t have anything to be guilty about or feel bad about or. anything like that. But I understand why emotionally you might go down that path because you’re a guy that cares deeply for other people. You appreciate how hard it is for people to go through stroke and you wish them the same solution or other solutions that you had so that we don’t have to suffer. I know exactly what’s behind it. Andrew (37:08) Yeah, yeah, that’s exactly right. Yeah. Bill Gasiamis (37:12) Yeah. Well, hopefully this continues the conversations to give people more things to think about. Leave us a comment in the YouTube comments section. Reach out via email. Yeah, drop us a comment. Reach out to us and we’d be happy to continue the conversation, support you, guide you. Just being here and I don’t know, help you make a more informed decision. That’s all we can do. We’re not going to suggest. Andrew (37:35) Yeah, definitely. Bill Gasiamis (37:41) that you should or should not go and experience Perispinal Etanercept one way or another. Bill Gasiamis (37:46) Well, that was Andrew Stopps again. What a fascinating conversation. If today’s episode connected with you, I’d love to hear your thoughts in the YouTube comments, especially if you’ve looked into Etanercept Try it. I decided not to. Your experience can help someone else make a more informed decision. And if you found this helpful, please subscribe on YouTube and follow the podcast on Spotify or Apple podcasts. Reviews and comments genuinely help more. stroke survivors find these conversations. If you want to go deeper, you can grab my book at recoveryafterstroke.com slash book. And if you’d like to support the podcast and help keep it going, you can join us on Patreon at patreon.com slash recovery after stroke. Thanks again for being here. You’re not alone in this recovery journey and I’ll see you in the next episode. The post Stroke etanercept injection 18 months on: Andrew's update after the PESTO trial appeared first on Recovery After Stroke.

Two Largest COVID Vax Studies- Horrifying, White Community Poured TRILLIONS into Black Community, Teaching People to Hate Each Other, Islam's Beginnings.   Nicolas Hulscher, MPH. The two largest COVID-19 “vaccine” safety studies ever conducted (n=184 MILLION) confirm they are NOT SAFE FOR HUMAN USE the white community has already poured TRILLIONS of dollars of resources into the black community. you don't build a future by teaching people to hate themselves—or each other—based on myths. This Video Will Change How You See Islam   Post Nicolas Hulscher, MPH @NicHulscher The two largest COVID-19 “vaccine” safety studies ever conducted (n=184 MILLION) confirm they are NOT SAFE FOR HUMAN USE: Heart Attack (+286%, dose 2) Stroke (+240%, dose 1) Brain/Spinal Cord Inflammation (+278%, dose 1) Myocarditis (+510%, dose 2) Brain Clots (+223%, dose 1) Coronary Artery Disease (+244%, dose 2) Cardiac Arrhythmia (+199%, dose 1) Guillain-Barré Syndrome (+149%, dose 1) 5:50 AM · Dec 24, 2025 173.7K Views   Post Andrew Branca Show @TheBrancaShow The American black community keeps whining for "reparations," when in fact the white community has already poured TRILLIONS of dollars of resources into the black community. And what do we have to show for it? More crime? More degeneracy? More multi-generation poverty? There are things you cannot fix with money. 1:03 PM · Dec 19, 2025 37.3K Views   Post Andrew Branca Show @TheBrancaShow This is how propaganda works: repeat a false historical claim until it becomes moral dogma. Polling result exposes the problem—not to attack people, but to show how misinformation about slavery is used to assign collective guilt to people who had nothing to do with it. History is clear: slavery existed across civilizations for millennia, and it was Western legal institutions that formally abolished it where they held power. Turning history into a blame narrative isn't education—it's dehumanization, the same tool every regime uses before justifying coercion. You don't fix the past by lying about it. And you don't build a future by teaching people to hate themselves—or each other—based on myths. 3:27 AM · Dec 25, 2025 27.7K Views       This Video Will Change How You See Islam Most Muslims and even non-muslims grow up hearing a perfect, polished version of Muhammad's life. But the original Islamic sources tell a very different story. In this critical biography, I break down Muhammad's life chronologically - his upbringing, his rise to power and political scandals you've never heard of before. It's Islam's own earliest history retold, examined through a secular lens. Created for Ex-Muslim Awareness Month, this video is for anyone questioning the story they were taught, or for non-muslims who've never really heard the full story of Muhammad. Most Asked Question: Why do you wear a mask Because as an ex-muslim, I get extremely peaceful threats from peaceful followers of a particularly peaceful faith. https://youtu.be/6zp6i6e7e3U?si=6VyWcNKCi8nafRKA The Cyberpunk Dingo 125K subscribers 108,841 views Dec 9, 2025 ✪ Members first on December 9, 2025 #Islam #muhammad Get upto 60% off ProtonVPN here: https://go.getproton.me/SH1lv Exclusive Content + Support the channel here: Patreon:   / thecyberpunkdingo   The Cyberpunk Dingo Theme Song:    • The Cyberpunk Dingo Theme - As Seen On Outros   Get in Touch: X: https://x.com/cyberpunkdingo Discord:   / discord   #Islam #muhammad  

We are proud to announce our NEW Christmas Podcast A Very Shining Christmas! The podcast drops Black Friday at the Stroke of Midnight! Click this link to stay up to date on pre-order information! https://reviewinghistory.bandcamp.com/follow_me We also have limited edition Christmas merch available! https://www.reviewinghistorypod.com/merch Remember hearing stories about the Battle of the Bulge being fought in sunny and dry weather? Neither do we! This week we're celebrating Christmas by defending the Allied powers from a German offensive. Join us as we get talking all about 1965's The Battle Of The Bulge which was directed by Ken Annakin, and stars Henry Fonda, Robert Shaw, and Charles Bronson. Join us as we talk all about The Battle Of The Bulge! We are proud to announce our NEW Patreon is available: https://www.patreon.com/reviewinghistory LIKE AND SUBSCRIBE PLEASE! Please give us a rating and a review on ApplePodcasts or Spotify. It helps potential sponsors find the show! Sign up for @Riversidefm: www.riverside.fm/?via=reviewi... Sign up for @BetterHelp: betterhelp.com/reviewinghistory Email Us: Reviewinghistorypod@gmail.com Follow Us: www.facebook.com/reviewinghistory twitter.com/rviewhistorypod letterboxd.com/antg4836/ letterboxd.com/spfats/ letterboxd.com/BrianRuppert/ letterboxd.com/brianruppert/list…eviewing-history/ twitter.com/Brianruppert #comedy #history #podcast #comedypodcast #historypodcast #tellemstevedave #tesd #ww2 #battleofthebulge #americanhistory #warfare #christmas #germany #movie #cinema #moviereview #filmcriticisms

Severe acute brain injury presents acute and longitudinal challenges. Addressing total pain involves managing physical symptoms and providing emotional, social, and spiritual support to enhance quality of life for patients and their families. In this episode, Kait Nevel, MD, speaks with Claire J. Creutzfeldt, MD, author of the article "Neuropalliative Care in Severe Acute Brain Injury and Stroke" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Liewluck is a professor in the department of neurology at the University of Washington in Seattle, Washington. Additional Resources Read the article: Neuropalliative Care in Severe Acute Brain Injury and Stroke With Dr. Claire Creutzfeldt Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guest: @cj_creutzfeldt Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Claire Creutzfeldt about her article on neuropalliative care in severe acute brain injury and stroke, which appears in the December 2025 Continuum issue on neuropalliative care. Claire, welcome to the podcast, and please introduce yourself to the audience. Dr Creutzfeldt: Thanks, thanks for having me. Yeah, I'm an associate professor of neurology at the University of Washington. I'm a stroke neurologist and palliative care researcher and really have focused my career on how we can best integrate palliative care principles into the care of patients with severe stroke and other neurocritical illness. Dr Nevel: Wonderful. Well, I'm looking forward to talking to you today about your excellent article that I really enjoyed reading. To get us started, can you tell us what you feel is the most important takeaway from your article for the practicing neurologist? Dr Creutzfeldt: Yeah. You know, I think one is always a little biased by what one is working on currently. And I think what I'm most excited about or feel more strongly about is this idea that stroke and severe acute brain injury are not an event, but really a chronic illness that people are left with usually for the rest of their lives, that change their life radically. And I think that education, research funding, also the clinical setting, current healthcare models aren't set up for that. And this idea that severe acute brain injury, you know, should be viewed as a lifelong condition that requires support across all ranges of goals of care. So curative, restorative, palliative and end-of-life care. Dr Nevel: Yeah, I love that part of your article, how you really highlighted that concept. And I think obviously that's something that we see in neurology and learn, especially as we transition out of our residency stages. But I think especially for the trainees listening, can sometimes be hospital inpatient-heavy, if you will, that kind of you can lose sight of that, that these acute strokes, severe acute brain injury, it turns into a chronic illness or condition that patients are dealing with lifelong. Dr Creutzfeldt: Often what we do in a very acute setting is like, is really cool and sexy and like, we can cure people from their stroke if they come, you know, at the right time with the right kind of stroke to the right hospital. And often the symptoms that people come in with much later on are harder to treat and address, partly because the focus in education, clinical and research just hasn't been as much on that time. Dr Nevel: Yeah, absolutely. So, can you talk to us about this concept of total pain? What does it mean, and how do we incorporate this concept into the way that we view our approach, our patient care? Dr Creutzfeldt: Total pain is a very old word, but it's sort of coming back into fashion in the palliative care world because it really describes all those sources of suffering or sources of distress, like, beyond what we sort of really think of as sort of the physical symptoms in recovery of stroke. As many of you know, palliative care often thinks in this multidimensional way of the physical distress, physical pain, but also psychological, emotional, social and spiritual, existential. And both- we sort of created sort of a figure that incorporates all of them and also includes both patients and their family members. They share some of these sources of distress, but they also have distinct ones that need to be addressed. And at the core of that total pain is what we need to provide, is sort of optimal communication and goals-of-care prognosis. Dr Nevel: Yeah, I'm thinking about all of those aspects and not just focusing on one. How does the disease trajectory of severe acute brain injury and stroke play a role in the palliative care approach? And how should we kind of going back to that original point of this idea of severe acute brain injury being an acute event and then oftentimes turning into kind of a chronic condition? How does that play a role in how we address palliative care with our patients, or kind of the stages of palliative care with our patients? Dr Creutzfeldt: Yeah, I think several things, especially for neurologists, is the more traditional palliative care illnesses, like cancer or congestive heart failure, illnesses where people are diagnosed when they're still functioning at a relatively high level and tend to have time to consider their prognosis and their goals of care in the end of life wishes and to meet with palliative care and to consider their personhood. Who am I? What's most important for me? And stroke, people with stroke, they not only present at their worst, they meet us at their worst, at a time when the patient themselves usually can't speak for themselves, when their personhood has been stripped from them. And then as providers, we, you know, we often really just get that one opportunity to get the conversation right and to guide people towards, you know, what we would call optimal and goal-concordant care. So, the challenges are many. I do think that the burden of these early conversations is on neurologists and really requires the neurologists to show compassion, to learn communication skills, think really hard about how you want to communicate prognosis and goals of care early on, because it's going to color people's experiences and decisions longitudinally. You asked about, sort of, this trajectory. And I do think it's important to think about, you know, what really happens even after the thrombectomy or even after we discharge people, especially from the ICU. Because for us, often after sort of day five or six, you know, we're sort of done. We're thinking about secondary stroke prevention. And, you know, how do I get the patient to rehab or out of the hospital? For the patients and families, this is when it really all just starts. You know, this is when they- when they're first memories are usually, you know, they hardly remember that acute setting. And so, when they are medically stable, we're done with the acute blood pressure treatment where we've removed the Foley, we've made a decision about nutrition. For us that tends to be a time where we let go a little; for patients and families that tends to actually be the time when they have to think about how am I going to live with this and what are the next several months or years going to look like? And so being there for them is important. Dr Nevel: That's such a, I think, important point, that when we have our plan in place, we know medically what the plan is for that patient and we're starting to step back, think about rehab or discharge. That's when oftentimes more quote-unquote "reality" steps in for patients and families about what their future is going to look like. Dr Creutzfeldt: And medical stability is not even close to neurological stability. And so, they are still in the middle of real prognostic uncertainty, and often waxing and waning symptoms or new symptoms coming up for them. Like pain, you know, post thalamic pain syndrome, just as an example, tends to be something that doesn't develop until later. Dr Nevel: Right, right. Absolutely. And since you touched on this concept of prognostic uncertainty, and, you know, that's something that's so challenging in severe acute brain injury, especially the early days when you talk about this, you know, that things tend to become a little bit more certain as more time passes. But these are really hard conversations because a lot of times feel like big decisions that need to be made early on, you know? Dr Creutzfeldt: Huge! Dr Nevel: Sometimes things like trach and PEG and things like that. How do you approach that conversation? I know you talk about that a little bit in your article. You touch on that, some of the, kind of, strategies or concepts that we use in palliative care to approach this prognostic uncertainty with patients. Dr Creutzfeldt: Yeah, I think the challenge is to balance this acknowledging uncertainty with still being able to guide the families and allow them to trust you. So, there are a few things that I have said in the past, and I have taught in the past, and I don't use anymore. They include sentences like I don't have a crystal ball, for example. Nobody was asking you for one. The other one that I want us to avoid, I think, is the sentence we are terrible at prognosticating. Because what I have seen is that that sentence carries on for families. And families at nine months are still saying, well, you guys are terrible at prognosticating. That's what you told me. First of all, it's all relative, and relative to non-neural providers---even at this time using Google and AI, we're actually quite good at prognosticating. It's just that a wide range early on. So that's how I would change that sentence is, early on after stroke, the range of possible outcomes is still very wide. And so, you've communicated uncertainty without saying I have no idea what I'm doing, which is not true. That is in order to help families be able to trust you and also to trust the person who comes after you, because we all know that a week or two after admission, we do know a lot more. And if we told them on day one that we're terrible at prognosticating, it's hard to sort of build that trust again later. You also asked about, you know, communication strategies. And I think it's this range of possible outcomes that I think is a good guideline for us to work on. And that range, sort of like a confidence interval, is still very wide early on. And as we collect more information over time, both about the clinical scenario that is evolving in front of us and about the patient who we are learning more about over time, this confidence interval becomes smaller. And that's where this idea of the best case/worst case scenario sort of conversation, for example, comes from: that range of possible outcomes. Dr Nevel: So, what to you is most challenging about palliative care for patients with severe acute brain injury and stroke? Dr Creutzfeldt: I think the biggest challenge in stroke care is balancing restorative and curative care with palliative and end-of-life. And that is especially early on when sort of everything is possible, when patients and families want to hear the good news and, I think, are also quite willing to hear the bad news, and probably should. So, I think that that communication is hard when, you know, really we want to provide goal-concordant care. We want to make sure that people get that care that is most important to them and can meet the outcomes that are most important to them. Dr Nevel: Yeah, agree. What is most rewarding? Dr Creutzfeldt: I think these patients and families have enormous needs and are extremely grateful if they can find someone that they can trust and who can guide them and who will stick with them. And when I say someone, I think that can be a team. That always depends on how we communicate. In the ideal world, it would be the same person following someone over time, the patient and the family over time. But in our current healthcare system, we're usually moving on from one place to another and being able to communicate with the people that come after you. Telling the family that you're a team and supporting them through that, I think, is really important. Dr Nevel: Yeah. And like you touched upon, patients and families, I think oftentimes they're looking for, you mentioned, you know, the sharing and communication and they're looking for information. Dr Creutzfeldt: You know, what's really rewarding is working with a team. And health care has really excelled at that. And I think we have a lot done from them is that it's not always the MD that family needs. And we have a lot of people at our side, and I think we need more of them. Chaplains, social workers; psychologists, actually, I think; and nurses or- in an ideal world, would really work together to support these multidisciplinary, multidimensional symptoms. Dr Nevel: Yeah. I think it benefits both the patient and the care team, too. Dr Creutzfeldt: Absolutely! Dr Nevel: It's helpful to be part of a team. You know, there's camaraderie in that and, like, a shared goal, and I think the thought is rewarding, too. Dr Creutzfeldt: If we really try and think about severe stroke as a chronic illness or severe acute brain injury as a chronic illness not unlike cancer, then if you think about the systems that have been built for cancer where an entire team of providers follows the patient and their family member over time, I think we need that, too. Dr Nevel: Yeah, I agree. That point, every member of the team has overlapping things, but has a slightly individual role to a degree too, which is also helpful to the patient and the family. You talked about this a little bit in your article, and I want to hear more from you about what we know about healthcare disparities in this area of medicine and in providing palliative care for patients with severe acute brain injury and stroke. Dr Creutzfeldt: Yeah, I think actually a lot of the huge decisions that we make, especially early on, are highly variable. And can identify people by various things, whether it's their race or ethnicity or sex or age, or even where they live in the United States. But decisions tend to be made differently. And so, just as an example, we know that I think people who identify as black, for sure, are less likely to receive the acute, often life-saving interventions like TNK or thrombectomy and more likely to undergo longer-term, life-prolonging treatment like PEG and trach. That seems true, after adjusting for clinical severity and things like that. And so disparities like that may be based on cultural preferences or well-informed decisions, and then we can support them. But of course, unfortunately there's a clear idea when we see, often, unexplained variability that a lot is due to uninformed decisions and poor communication and possibly racism in certain parts. And that is, of course, something that has to be addressed. Dr Nevel: Yeah, absolutely. What are future areas of research in this area? I know you do a lot of research in this area and I'd love to hear about some of it and what you think is exciting or kind of new and going to change the way we think about things, perhaps. Dr Creutzfeldt: I think every aspect of stroke continues to be exciting and just, you know, our focus of today and my research is on palliative care. I mean, obviously, the things we can do in rehab these days have to be embraced, and the acute stuff. But I think this longitudinal support, an ideally longitudinal multidisciplinary support for patients and families, requires more research. I think it will help us with prognosis. It will help us with communicating things early on and learning more about sort of multidimensional symptoms of these patients over time. That requires more research. And then, how can we change the healthcare system---in a sustainable way, obviously---to maximize quality of life for the survivors and their families? Dr Nevel: Going back to that total pain again, making sure that we're incorporating that longitudinally. Dr Creutzfeldt: I think there are currently 94 million people worldwide living with the aftermath of a stroke. I joined a stroke survivor support group recently. People are supporting each other that have that had their stroke, like, 14 years ago and are still in that just to show that this is not one and done. People are still struggling with symptoms afterwards and want support. Dr Nevel: Before we close out, is there anything else that you'd like to add? Dr Creutzfeldt: Your questions have all been great, and I think one observation is that we've talked a lot about, sort of, new ideas of the need for longitudinal care for patients after severe stroke. There's still a ton for all of us to do to optimize the care we provide in the very acute setting, to optimize the way we communicate in the very acute setting. To make sure we are, for example, providing the same message as our team members and providing truly compassionate goal-concordant care from the time they hit the emergency room throughout. Including time-limited trials, for example. Dr Nevel: Well, thank you so much for chatting with me today about your article on this really important topic. Again, today I've been interviewing Dr Claire Creutzfeldt about her article on neuropalliative care in severe acute brain injury and stroke, which appears in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues. And as always, to our listeners, please check out the article. It's great, highly recommend. And thank you to our listeners for joining us today. And thank you so much, Claire, for sharing your expertise with us today. Dr Creutzfeldt: Thanks for having me. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Sign up for “Different by Design: A Retreat for Gifted, Sensitive & Neurodivergent Adults” happening January 30-31, 2026 https://retreatwithdianne.com/   In this episode of Someone Gets Me, Dianne A. Allen shares the mic with Judy Kim Cage, author of “SUPERSURVIVOR: How Denial, Resistance, and Persistence Can Lead to Success (and a Better Life) after Stroke”, to talk about how neurodivergent people can define success on their own terms.   Judy shares how her definition of success changed when years of hustling led to affecting her health. She talks about her recovery process, how she moved through resistance, and the inspiration and vision behind her book.   Watch the Someone Gets Me Podcast – How to Define Success On Your Own Terms   Did you enjoy this episode? Subscribe to the channel, tap the notification bell, and leave a comment!   You can also listen to the show on Spotify, Apple Podcasts, and Amazon Music.   In January 2019, at age 39, Judy Kim Cage survived a massive hemorrhagic stroke caused by Moyamoya Syndrome—a rare condition affecting just 3.5 people per million. Hemorrhagic strokes account for only 15% of strokes but 40% of stroke deaths, and she was given a 26.7% chance of surviving in five years. Against all odds, Judy was walking within two months and back to work in six. Now approaching her seven-year survival milestone, she has rebuilt a thriving life, inspiring many through her journey of resilience, self-advocacy, and transformation. Her upcoming book, SUPERSURVIVOR, shares her story and lessons on overcoming trauma and redefining success.   Instagram: https://www.instagram.com/judykimcagetheauthorpage/    Grab a copy of her book, “SUPERSURVIVOR,” on Amazon: a.co/d/fkGw3xm    How to Connect with Dianne A. Allen   Dianne A. Allen, MA is an intuitive mentor, speaker, author, ambassador, hope agent, life catalyst, and the CEO and Founder of Visions Applied. She has been involved in personal and professional development and mental health and addiction counseling. She inspires people in personal transformation through thought provoking services from speaking and podcasting to individual intuitive mentoring and more. She uses her years of experience coupled with years of formal education to blend powerful, practical, and effective strategies and tools for success and satisfaction. She has authored several books, which include How to Quit Anything in 5 Simple Steps - Break the Chains that Bind You, The Loneliness Cure, A Guide to Contentment, 7 Simple Steps to Get Back on track and Live the Life You Envision, Daily Meditations for Visionary Leaders, Hope Realized, and Where Do You Fit In?   Website: https://msdianneallen.com/ Instagram: https://www.instagram.com/dianne_a_allen/ Facebook: https://www.facebook.com/msdianneallen/ LinkedIn: https://www.linkedin.com/in/dianneallen/# Twitter: https://x.com/msdianneallen   Check out Dianne's new book, Care for the Neurodivergent Soul. https://a.co/d/cTBSxQv   Visit Dianne's Amazon author page. https://www.amazon.com/stores/author/B0F7N457KS   You have a vision inside to create something bigger than you. What you need is a community and a mentor. Personal mentoring will inspire you to grow, transform, and connect in new ways. The Someone Gets Me Experience could be that perfect solution to bringing your heart's desire into reality. You will grow, transform, and connect. https://msdianneallen.com/someone-gets-me-experience/   For a complimentary “Get to Know You” 30-minute call: https://visionsapplied.as.me/schedule.php?appointmentType=4017868   Join our Facebook: https://www.facebook.com/groups/someonegetsme   Follow Dianne's Facebook Page: https://www.facebook.com/msdianneallen   Email contact: dianne@visionsapplied.com   Dianne's Mentoring Services: https://msdianneallen.com/    

This week's episode of Make It Happen Mondays hits deeper than most—with someone who's more than just a guest: Roderick Jefferson is family. A globally respected sales enablement leader, keynote speaker, and author of The Stroke of Success, Roderick shares the story of how a relentless hustle nearly cost him everything—after suffering a stroke that left him with just a 2% chance of survival.We unpack what really matters when life slams the brakes on your career, your health, and your identity. From the early warning signs he ignored, to the mental, emotional, and physical battles of recovery, Roderick opens up about the shift from burnout to balance—and how vulnerability, connection, and purpose have taken center stage in his leadership and life.This is not just a conversation about sales or business—this is about perspective, resilience, and redefining success. If you're feeling the weight of burnout, or just need a moment of clarity in the chaos, don't miss this one.And if you're looking for a keynote speaker who speaks with power, purpose, and lived experience—book Roderick. You won't regret it.Are you interested in leveling up your sales skills and staying relevant in today's AI-driven landscape? Visit www.jbarrows.com and let's Make It Happen together!Connect with John on LinkedIn: https://www.linkedin.com/in/johnbarrows/Connect with John on IG: https://www.instagram.com/johnmbarrows/Check out John's Membership: https://go.jbarrows.com/pages/individual-membership?ref=3edab1 Join John's Newsletter: https://www.jbarrows.com/newsletterConnect with Roderick on LinkedIn: https://www.linkedin.com/in/roderickjefferson/Check out Roderick's Website: https://www.roderickjefferson.com/Get Roderick's Book "Stroke of Success": https://www.roderickjefferson.com/stroke-of-success

PESTO Trial Results: What Stroke Survivors Need to Know About Perispinal Etanercept If you've spent any time in stroke recovery communities, you've probably seen the same pattern: a treatment gets talked about with real intensity, people share personal stories that pull you in, and suddenly you're left trying to sort hope from hype from “maybe.” When the decision also involves significant cost, that uncertainty can feel even heavier. That's exactly why I recorded this episode: to help stroke survivors and their families understand the PESTO trial results in plain language without drama, without attacks, and without jumping to conclusions. In this interview, Professor Vincent Thijs explains what the PESTO trial set out to test, why it was designed the way it was, and what the results can (and can't) tell us about perispinal etanercept in stroke recovery. The real problem: not “hope vs skepticism”… it's confusion If you're a stroke survivor, you're already doing something heroic: you're living inside a recovery journey that demands patience, grit, and constant adjustment. The challenge isn't that you “don't want to believe” in something. The challenge is that it's genuinely hard to make an informed decision when: People report different outcomes Online conversations become polarised fast Scientific studies use unfamiliar language The same treatment can be described in completely different ways depending on who you're listening to My goal here isn't to tell you what to do. It's to help you think clearly, ask better questions, and understand what the best available evidence from this trial actually tested. What the PESTO trial was trying to investigate (in simple terms) Professor Thijs explains that the PESTO trial was designed in response to strong community interest. Stroke survivors wanted to know whether the way perispinal etanercept is currently administered in some settings could be demonstrated to work under the standards used for medicines to become widely accepted as part of routine care. So the researchers designed a randomized, placebo-controlled clinical trial. In this type of study: A computer assigns participants to either the treatment or a placebo Participants and clinicians are kept “blinded” (they don't know who got what) Outcomes are measured in a consistent way at set time points In the PESTO trial, the focus was on stroke survivors with moderate to severe disability and reduced quality of life. The primary question was straightforward: Does quality of life improve after one or two injections compared with placebo, over the measured timeframe? Why this study looked at quality of life (not one symptom) One key detail Professor Thijs highlights is the design choice: the trial didn't only target one issue, like pain or walking. It aimed to be more “pragmatic,” reflecting how treatment is used in real-world settings where people seek help for different post-stroke challenges (mobility, fatigue, speech, cognition, pain, and more). That means the main outcome wasn't “Did walking speed improve?” or “Did pain reduce?” It was broader: Quality of life at 28 days And again after the second injection timeframe (56 days total) This matters because your results can look different depending on what you measure. A trial targeting one symptom might see a signal that a broad quality-of-life measure doesn't detect (and vice versa). What the PESTO trial results found In Professor Thijs' words, the trial did not show a difference in quality of life between the treatment and placebo groups at the measured time points: No clear quality-of-life improvement at 28 days No clear improvement after two injections at 56 days That's the central outcome. But there's another finding that grabbed my attention—and it's one many listeners will find surprising. Quote block (mid-article): “We saw that 58% of the people also had that improvement [with placebo] and 53% had it with etanercept… our initial guess was very wrong.” — Professor Vincent Thijs The “placebo signal” and why it matters A strong placebo response doesn't mean “it was all in their heads.” It means that in a blinded clinical trial, people can improve for multiple reasons that aren't specific to the drug itself, such as: Expectation and hope Natural fluctuations in symptoms The impact of being monitored and supported Regression to the mean (symptoms often move toward average over time) The structure and attention that come with trial participation Professor Thijs describes how, during the blinded phase, participants reported improvements in a variety of areas (like sensation, vision, speech). The crucial point is: the team didn't know who had a placebo or an active treatment at the time, which is exactly why blinding exists. For you, the listener, this is a reminder of something empowering: Personal stories can be real and meaningful—and still not answer the question of efficacy on their own. “Am I a candidate?” The trial's honest answer: we don't know how to predict it (yet) One of the most important parts of this conversation is the desire to identify who might benefit most. Professor Thijs explains that the team looked at subgroups (for example: age, sex, severity, diabetes, time since stroke). In this trial, they didn't find a clear subgroup where the treatment stood out as reliably beneficial compared with placebo. He also adds an important caveat: subgroup analysis is difficult, especially in trials that aren't extremely large. So the absence of a clear “responder profile” here doesn't automatically prove none exists—it means this trial didn't reveal one. What this episode is (and isn't) saying Let's keep this grounded and fair. This interview is not about attacking any person, provider, or clinic. It's not about shaming stroke survivors who tried something. It's not even about telling you that you should or shouldn't pursue a treatment. It is about this: Understanding what the PESTO trial tested Understanding what the results showed within their timeframe Knowing the limits of what the trial can conclude Using evidence to reduce confusion before making big decisions A simple “clarity plan” before you decide anything big If you're considering any high-stakes treatment decision, here's a neutral, practical way to move forward: 1) Ask: “What outcome matters most for me?” Is it pain? walking? fatigue? speech? cognition? daily function? quality of life? A treatment might be studied for one outcome and discussed online for another. 2) Ask: “What does the best evidence say—specifically?” Not “Does it work?” in general, but: In what population? Using what method? At what dose? Over what timeframe? Compared with what? 3) Ask: “What are my options and trade-offs?” Talk with a qualified healthcare professional who understands your medical history, risk factors, and rehab plan. Ask about: Potential risks and side effects Opportunity cost (what else could you do with the same time, money, and energy?) Evidence-based rehab and supports that match your goals Listen to the full interview If you want the clearest explanation of the PESTO trial results—from the lead researcher himself—listen to the full episode with Professor Vincent Thijs. And if you'd like to support the podcast (and help keep these conversations going for stroke survivors who need hope and clarity): Bill's book: recoveryafterstroke.com/book Patreon: patreon.com/recoveryafterstroke Medical disclaimer This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. PESTO Trial Results (Etanercept After Stroke) | Interview with Professor Vincent Thijs Confused about perispinal etanercept after stroke? Prof Vincent Thijs explains the PESTO trial results clearly, calmly, and evidence-first. More About Perispinal Etanercept: Etanercept Stroke Recovery: Wesley Ray's Relentless Comeback Dwayne Semple's Remarkable Stroke Journey and Perispinal Etanercept Etanercept for Stroke Recovery – Andrew Stopps Support The Recovery After Stroke Podcast on Patreon Highlights: 00:00 Introduction and Overview of the PESTO Trial 04:19 Design and Objectives of the PESTO Trial 11:23 Recruitment and Methodology of the Trial 18:31  PESTO Trial Results and Findings 24:28 Implications and Future Directions for Research 32:15 Conclusions and Final Thoughts Transcript: Introduction: PESTO Trial Results Bill Gasiamis (00:00) Hello and welcome back to Recovery After Stroke. Before we get started, a quick thank you to my Patreon supporters. Your support helps cover the hosting costs after more than 10 years of me doing this show solo. And it helps me keep creating episodes for stroke survivors who need hope and practical guidance. And thank you as well to everyone who comments on YouTube, leaves reviews on Spotify and Apple podcasts. buys the book and even to those of you who don’t skip the ads. Every bit of that supports keep this podcast going. Now today’s episode is about the PESTO trial results and I’m interviewing Professor Vincent Theis. If you’ve ever felt confused by the conversation online about perisponal antenna sept, some people sharing positive experiences while others are feeling disappointed and plenty of strong opinions in between, this episode is designed to bring clarity. We talk about what the PESTO trial set out to test, how the study was designed, what it found within the measured timeframes and what the results can and can’t tell us. Just a quick note, this conversation is educational and not medical advice. Always speak with a qualified health professional about your situation. All right, let’s get into it. Professor Vincent Dase, welcome to the podcast. Vincent Thijs (01:24) Thank you for having me, Bill. Bill Gasiamis (01:26) I’m really looking forward to this conversation. Atenosept is one of the most hotly discussed topics in stroke recovery. And there’s a lot of misconceptions about whether or not it is or is not efficacious. And while there’s a lot of anecdotal evidence where some people have had positive outcomes from injections, there’s also a lot of people’s feedback, which is very negative about their experience with the Etanercept injections and the lack of results. So today, the reason I reached out is because I wanted to get to the bottom of the findings of the PESTO trial. And I’m hoping that you can shed some light on that. The first question basically is, can you start by explaining in simple terms what it was that the PESTO trial set out to investigate? Vincent Thijs (02:22) All right. The PESTO trial was in response to community members, stroke survivors, wanting to find out whether the current practice of administering Etanercept has done in the U.S. in private practice. In Denmark, I hear there are some sites that provide this treatment. Whether the treatment and genders can be actually proven according to the standards that we use in the pharmaceutical industry to get it to become accepted as a standard of care treatment. For that, you need to do what we call a randomized controlled clinical trial, preferably two that show evidence that treatment does what it’s set out to do. And that’s why with this background and the community pressuring the minister several years ago, Mr. Hunt at the time, to fund a trial that would help answer that question. Design and Objectives of the PESTO Trial There was a call was set out to do this trial and several groups in Australia applied and then an independent committee decided to award the trial to the PESTO study group. And then we tried to design this trial to give an answer. So it’s mostly about people that have moderate to severe disability after their stroke that have reduced quality of life. And We wanted to know, does their quality of life improve when Etanercept is administered? And we wanted to test whether one or two injections were needed. Because that’s what we heard from stroke survivors that from Australia and internationally that went over to the US. Well, this is how it’s done. You get one or two injections and there was a paper that had shown big effects with one injection. So that was the primary endpoint, but then we also looked at whether two injections could help. And when you design a trial, you have to make a decision, will we focus on people with. pain after stroke, or will we look at people who have mobility issues or speech issues or cognitive issues? And we saw that current clinical practice actually was people with various impairments after stroke were accepted and received the treatment. And what would have been the advantage of doing say only mobility or only pain? Well, you can then look at the outcome of pain or mobility, does it improve? Or is your cognition improved? But because we wanted to be pragmatic and we know that recruitment in clinical trials needs to reflect how is current practice. So we thought let’s put in all the people with moderate to severe disability, whatever their impairment after stroke and reduce quality of life. And then we looked at quality of life as an outcome rather than an individual impairment. And so what we did then was to use the randomized technique and where it’s left up to the computer to decide what treatment a person will receive, the active Etanercept or a similar looking placebo, and then look at 28 days and we had to make a decision what makes sense 28 days, what is practical. to see whether that injection then had improved quality of life. And then we did another injection again with a placebo or the active drug. And then after 28 days again, we looked again whether that had made a difference. So we have people that had received two times the placebo, one time the placebo, and one active injection. And then we have people that had received two active injections. And then we were able to compare those and see whether they had made bigger improvements if you receive two injections versus one or zero. Unfortunately, we couldn’t show a difference in quality of life at 28 days. And we also couldn’t show an improvement at 56 days after people had two injections. But that was in a nutshell how we designed and the background of the study. Bill Gasiamis (07:25) So the main difference then between the Griffith University study and your particular study was that they did go after a specific improvement in one area, I believe. it in? Okay. So although those guys went after pain, you guys went after just a general improvement in quality of life after the injection and your stroke survivors. Vincent Thijs (07:39) Mostly, think. Bill Gasiamis (07:54) would have been as far as 15 years post stroke. Is that right? Vincent Thijs (07:59) Yes, correct. We wanted to have people early after stroke between one and five years, and then also between people five to 15 years after stroke. That was also for practical reasons. Once you start trial, you see how good recruitment is, how many people want to participate in the study. And we saw that if we went to up to five years. Recruitment was relatively slow. So we added this additional group of people later on after their stroke. that because many people, I’m five years, I’m six years after stroke. Why can’t I get the treatment? And you know, so we also wanted to expand the pool. And that’s also what happens in clinical practice. Current clinical practice, I don’t think the sites and the US and they would refuse the patient six years or so. We just wanted to reflect the people that we see on the website going for this treatment. Bill Gasiamis (09:01) Yeah, yeah. And then the difference between the Griffith trial and your trial as well was the actual dosage of Etanercept the amount that was in the injection. I do believe that your trial was a 25 milligram injection. And I believe that the Griffith University trial was 25 milligram. injection to 50 milligram injection. Vincent Thijs (09:34) Yeah, we just based on what people told us they received when they went to the clinic, also the other sites and then also 35 milligram was chosen because that’s in the patent for the street. Bill Gasiamis (09:49) Okay, I see. So you’re trying to as much as possible mimic what was happening out there in in the private practice Vincent Thijs (10:00) We wanted to answer the question, is current clinical practice, is that beneficial? And that’s what sort of what the call was to do a clinical trial in current clinical practice. You can, you have to make decisions, right? And I think this was the most relevant for a stroke survivor. Bill Gasiamis (10:17) Now that’s really interesting that stroke survivors were able to twist the arm of a minister to get the funding to begin that process of the trial. How long ago did this actually start? Vincent Thijs (10:28) I think it was 2016, 2017 or so. So it takes a while to get the minister and then I think that the trial started in 2019. took a while to complete as well. Bill Gasiamis (10:43) Right understood. Okay So then you recruit people they come along and they go through the trial through the particular trial How does that work on the day do they turn up are they admitted? We’ll be back with more of professor face explanation in just a moment But I want to pause here because if you’ve ever felt stuck between hope and uncertainty, you’re not alone When you’re recovering from stroke, you’re constantly making decisions and some decisions feel high stakes, especially when confronting information that’s conflicting. Recruitment and Methodology of the Trial In the second half of this conversation, we get into the parts that really help you think clearly. What the trial results do and don’t mean, and why placebo responses matter in blinded research, and how to frame smarter questions before you commit time, money, or energy to any path. If you want to support the podcast and keep these episodes coming, You can grab my book at recoveryafterstroke.com/book or join the Patreon at patreon.com/recoveryafterstroke All right, back to the episode. Vincent Thijs (11:51) All right, so we recruited from a variety of sources. So we had kept a log of people that were interested in this. We had a Facebook post in New Zealand, for instance, where we recruited as well. We had people from the Stroke Clinical Registry that were approached. We had a website and people could register their interest if they were doing a search online to participate in clinical trial. So the variety of sources and then we have to determine eligibility that was mostly done either via an in-person visit or remotely via telehealth. We tried to get their medical information, what type of stroke they had. And then we also questioned whether they had this modified rank in scale, the disability they had, the impairments they had from their stroke. so then people came. they were considered eligible, then we scheduled a visit and they would typically come in no overnight stay needed. It was a day procedure that was done. People were then receiving another questionnaire on the day itself to measure their quality of life and other measures like their fatigue levels and how much help they required, etc. And then we proceeded with the injection, which was done. We had bought a special bed that was able to do the, the, the tilting that was required. So we set the people up, injected and then tilted the table. so, we received the drug. It was prepared independently by the pharmacist. So the pharmacist, they took the drug off the shelf or the made the placebo. and they made sure it looked exactly alike. So then somebody from the trial team picked it up from the pharmacist. The pharmacist didn’t tell, of course, what it was. And then the administration happened. So the doctor who administered and the participant did not know what they received. So after the procedure, they were left like this for four minutes. And then after four minutes, people could sit up again. And we waited about half an hour. then we asked them how they were doing, whether there were any adverse reactions, ⁓ and ⁓ then after that half an hour of observation people could go back to their habitual situation. ⁓ it’s a very simple ⁓ procedure to do. Bill Gasiamis (14:35) I believe there was a was there 126 participants Vincent Thijs (14:40) Yes, 126 people participated. had anticipated a little bit more people to participate. So we had hoped 168, but recruitment fell flat after a while and we were not able to find more people to recruit. So we made a decision and then, you know, these clinical trials, they have some funding ⁓ and they require the treatment team to be paid, et cetera, and that ran out. So we had to stop at a certain time. Bill Gasiamis (15:13) Was the study stopped early because of a decrease in the amount of funding or was there an issue with the funding at some point? Vincent Thijs (15:23) Funding ran out. You hire people for a certain amount of years and then you have fewer patients than you anticipate. So you have to stop. Bill Gasiamis (15:32) huh, okay. So would that affect the outcome of the trial? Would you say the lack of funding or the lack of the ability to take the trial further? Vincent Thijs (15:42) Yeah, well, what we had when you do the trial, when you plan the trial, you say, well, this is what we’re going to expect in terms of efficacy. You have to make a guess and say, well, that many people will have an improvement in quality of life if we give them the placebo and that many people will have an improvement in quality of life with the trial drug. And we had thought that about 11 % would improve with the placebo based on an earlier study. And then we had to make a guess because nobody had done this type of study on what Etanosap would provide. But reading the report that was published several years ago now, where 90 % of the people reported improvement in their impairments, we thought, well, Let’s not go for 90%, but a 30 % improvement. And so that was based on that we needed 168 people to participate in the trial. So that was what we call the pre-planned sample size estimation, which is a guess. When we stopped at 126 participants, actually we saw that the results were very different. There was not that 11 % actually in the placebo arm. saw that 58 % of the people also had that improvement and 53 % had it with ethanosab. So our initial guess was very wrong based on some statistical advanced statistical techniques we have. We have quite a lot of power to estimate whether there was a difference. So I think the trial can provide us an answer. It’s large enough to give us an answer about this particular question. Is current clinical practice in these people with this range after their stroke, does it improve? quality of life after a month or after two months. I’m not speaking about early improvement, I’m not speaking about six months down the line. We only can decide what we see in this study. Bill Gasiamis (18:05) So you have some limitations because you can’t have the funding to test one month, two months, six months, 12 months. You have the funding to basically meet the design of your study and then you can report on that. Now what’s really interesting is that the placebo had such a large result. PESTO Trial Results and Findings Vincent Thijs (18:34) What kind of things were people reporting that improved for the people who had the placebo injection?Look, this is, course, when we were in the blinded phase, when neither myself or my colleagues who did these scales, we were totally blinded. And that’s, remember vividly people saying, it didn’t do anything for me. But then there were also people said that they could see again. And so people that had improvement in sensation. Some people had improvement in their speech. there were, we, we observed these things, but we didn’t know whether they were active or placebo. And then surprisingly we had some people in whom we thought, they must have had active drug that turned out to have the placebo, but that’s years after, right? Because it takes a little bit of time to accumulate a sufficient number of patients. And we were only reporting and breaking the blind when the trial was finished. because otherwise you may be biased in all your analysis, et cetera. You don’t want to do that. So you wait until the end of the study to break the blind. And that’s very frustrating for the participants because there were many people that said, I must have had the placebo because it didn’t do anything for me. And there were other people that were, and some people like that, they said, I still want to go to the US. Bill Gasiamis (19:37) I see. Vincent Thijs (19:59) And please, can you tell me if I received a placebo? And I understand it was terribly frustrating for these participants. But we were very strict. No, we don’t want to break the blind. This is against the rules that you have to adhere to in a clinical trial. And so we didn’t do that. Of course, once the trial was finished, we were able to report the results back to the the participants. And then there were some people that were very surprised that they had received the active drug. I remember one person vividly who said, you have to tell me now because I’m going. And then I said, hold off, hold off. And then we told them you had twice the active drug. And so they decided not to go anymore. So you see how From a clinical trial perspective, it’s very important to remain very objective and not being able to see what people have received. From a humane level, of course, I understand it was very important to these people. Bill Gasiamis (21:02) Yeah, that’d be difficult. ⁓ And then I imagine that had the placebo not worked and then the tenisept did work, then there would have been people who would have said, well, I’ve received the placebo. It didn’t work for me. Other people received the tenisept. It did work for them. Why can’t I get the tenisept injection now? Vincent Thijs (21:26) Yeah, and we also had two people, people that had twice the placebo who noticed an improvement and have told me the improvement is still there. Bill Gasiamis (21:35) Wow. Vincent Thijs (21:36) So it. Bill Gasiamis (21:38) That’s amazing. Now was the. Vincent Thijs (21:40) And often that, and I must tell you, often those were relatively little things that seemed to improve both with the placebo and in the active group. And you see that there are changes in quality of life that people have reported, but it happens as well with the placebo. Bill Gasiamis (21:58) Wow. Was the intention of the study that was funded at the very beginning in 2016 by Minister Hunt, was it to determine whether or not this was going to be an effective treatment for people in stroke and therefore to roll it out somehow in the Australian medical system for stroke survivors? What was the thinking for Minister Hunt? Do you know? Vincent Thijs (22:24) Of course, I was not involved in that lobbying to the minister or anything, but it was to bring it on a pathway towards regulatory approval. We know that Etanercept is a relatively cheap drug that you can get ⁓ and is approved already for some indications, especially in people with rheumatoid arthritis, the condition of the joints, but it’s not approved for stroke. And to be officially approved and then potentially re- reimbursed on the PBS. You need to have some trials that have been done such as PESTO. We do different trial phases. One would be a phase two trial and a phase three trial. So phase one is typically in people just to assess the safety and some dosages usually in healthy people. And then a phase two is safety amongst stroke survivors. and preliminary efficacy. And that’s where PESTO was what we call a phase two B trial. And then a phase three trial would then be a trial in many more participants based usually on the results of a phase two B trial. And then usually when you have a phase three trial and it’s convincing and the authorities may approve such a trial. Bill Gasiamis (23:46) So in this case, the phase two B trial, this PESTO trial didn’t find that it’s efficacious. And as a result, there’s not going to be a further trial. Would that be accurate? Vincent Thijs (23:56) Well, based on the findings we have in this particular type of ⁓ way of administering in this particular group of people, I don’t think there’s enough evidence to argue for a phase three trial. It may be that you could say, well, we want to focus on pain because that was more promising. Well, you’ll need to do another trial in that condition. Implications and Future Directions for Research After stroke or maybe within a year after stroke. I mean, there are other possibilities, but at the moment, current clinical practice type trials, I don’t think there’s enough evidence to move forward with that. Bill Gasiamis (24:43) What would the numbers have had to look like for the trial to conclude that there was evidence of efficacy? Vincent Thijs (24:51) Well, I think based on what we have now, you would need to design a much, much bigger trial because there was only a 5 % difference between the placebo and the active group. And actually it was in favor of the placebo. So the placebo did a little bit better, not statistically significant. So it could just be by chance, but you would need probably thousands of people. Bill Gasiamis (25:15) I see. And I imagine there’s not a lot of excitement about funding something like that by the people who fund these trials. Vincent Thijs (25:25) Yes, typically the funders will look at how good is the evidence to pursue this. And if you were a pharmaceutical company on a pathway to development for a drug, you probably would say, well, it looks safe, but it didn’t do what it intended to do. So let’s stop the development of this drug for this indication. Bill Gasiamis (25:45) I say so. I think one of the challenges with the path of administering a TANACEP to stroke survivors is that there seems to be a missing step. And the step to me is determining whether or not somebody is a candidate for a TANACEP. perhaps if we knew more about the stroke survivor, what was actually happening in their particular brain, and we were able to determine some similarities between the people who have had a positive result and we developed a method, then that would make it a lot easier. to say, well, I’m a stroke survivor. I’d like to have a TANACYPT and then go through a process of determining whether or not I was a candidate rather than just guessing whether I’m a candidate or not and then having to pay money to find out whether in fact I was a candidate. Vincent Thijs (26:33) The trial provides a little bit of answers to that. ⁓ You want to identify a marker or a subgroup of people in whom the drug will work particularly well. And so you could look at, and we looked at different things like females versus males, if you’re younger versus older, if you have very severe disability or less severe disability, if you have diabetes, are you early after your stroke or later? That one to five versus six to 15 category. And we could not identify a group in whom the the drug worked particularly well. Now there’s a caveat when you do a clinical trial, it’s really hard to look at subgroups, especially if your trial is relatively small and the PESTO trial is relatively small. So you have to take this with a grain of salt, but it was nothing really promising. that we could identify. So probably you need other markers. If you believe in Etanercept as a drug, you would possibly need to look at what are the levels of TNF alpha, the drug, the molecule that actually is targeted. Unfortunately, there’s nothing like readily available to do that. Could it be that people with a… a stroke in a particular location that would work particularly more than in others, but we don’t have any real way at the moment to do that. Bill Gasiamis (28:08) Okay, so we’re assuming that the people who experience an improvement after they’ve had an attempt to shut that the markers of TNF alpha were lower or higher or Vincent Thijs (28:21) Well, the theory is that they have a lot higher TNF-alpha. Now, as you know, the premise is Etanercept works by reducing this molecule and we have good evidence that it reduces this molecule in the blood, but we don’t have good evidence that it reduces the levels in the brain. That’s where you want it to be. And one of the difficulties and many scientists that work on the Etanercept and ⁓ have said, look, it doesn’t cross the blood-brain barrier. It doesn’t. go against the natural defense that we have to protect the brain against substances that could potentially be harmful for the brain or that have a large size. And the Tandacep we know has a large size would not cross the blood-brain barrier. So it doesn’t reach the brain. And many people look at it with relative skepticism that it actually enters the brain. Bill Gasiamis (29:18) ⁓ And then with regards to rheumatoid arthritis, doesn’t need to cross the blood-brain barrier. It just somehow gets to this, position or the place where inflammation is occurring. TNF-alpha is active and it can easily mitigate the impact that TNF-alpha is causing. In the brain, the brain is protected by the blood-brain barrier and it cannot cross the blood-brain barrier under normal conditions and therefore it can’t get to where the TNF-alpha is. if there’s any TNF alpha, if inflammation is the issue and it cannot resolve it one way or another. So for some people perhaps it can’t resolve it. Now, I don’t understand about Etanercept a lot. I don’t understand exactly how the molecule works, et cetera. But if it was injected into a blood vessel, is that not something that can occur? And if it was, if it can occur, would that then cross the blood brain barrier? Vincent Thijs (30:15) That wouldn’t cause a blood brain barrier, no. You would have to do what we call a lumbar puncture or put a little ⁓ injection into the ventricles and then hope that it would enter the area that is stark where the TNF alpha is elevated. Those experiments have not been done. Bill Gasiamis (30:17) Either. Okay, so a lumbar puncture is probably riskier than… Vincent Thijs (30:44) Well, it’s uncomfortable. It’s uncomfortable and we do it to administer drugs if needed. Some people with brain cancer receive it. There are other trials ongoing in certain areas of stroke where it’s done. Bill Gasiamis (30:58) Then the difficulty is, and my job here is to report back to the community how they should proceed with Etanercept going forward. Now, I don’t expect you to answer that. However, your study probably gives enough information for people to be able to make an even more informed decision than they did before. Previously, what I think was happening is people, and it still happens every day. And I’ve interviewed a lot of stroke survivors who’ve had positive results with Etanercept. The challenge is getting interviews with stroke survivors who have had negative results with Etanercept. That is something I haven’t been able to do. So if somebody happens to be watching and listening to this and they have had the Etanercept shots and they didn’t get positive results, please reach out so that we can share a balanced story of what’s happening out there in the community. Would there be a reason for the community to perhaps begin again to lobby a government or a minister of a government to look at perisponinal tenosept and study it in a different way, like administration via a lumbar puncture. Conclusions and Final Thoughts Vincent Thijs (32:08) I think we need more, probably go back to the drawing table to see whether, because we’re just taking a step back. The idea is that there is inflammation after stroke and we know that there is inflammation after stroke. We don’t, we just don’t know how long it is. We don’t have a good marker. Is it present only for weeks or months after stroke or can it persist for years? The theory is that it persists for years, but if you look at the actual experiments that have been done, it’s really hard to study in humans because we don’t have good tests. But if you look in animals, it’s also hard to do long-term studies in animals, but nobody has really proven that conclusively that there is still after the stroke causes a scar, that process is still really active. Is TNF-alpha years after a stroke still present? Yes, it’s present because we use TNF as a transmitter in the brain or a chemical in the brain, but is it still worth reducing its activity? That’s probably, I think, a bigger question that science needs to answer is to understand that all inflammation piece and the time after stroke that it persists in my Bill Gasiamis (33:35) Yeah, because it could still be the fact that the person has had brain damage. The particular part of their brain that’s damaged has, for example, taken offline one of their limbs and there is no way to recover that once it’s gone. there is no, there may also be no inflammation ⁓ there. So somebody in that situation receiving Etanercept wouldn’t get a result even if it was able to cross the blood-brain barrier because the damage is done and that’s the challenge with the brain is once it’s damaged restoring the damaged part is not possible. Vincent Thijs (34:15) Yeah, look, after this experience with the PESTA trial, I think we need to work on other avenues and I’m not as hopeful with this based on the data that I have seen. Bill Gasiamis (34:28) Yeah Well, my final question then is, are you planning on exploring inflammation and recovery after stroke with any work that you’re doing in the future? Is there any more of this type of work being done? Vincent Thijs (34:46) we’ve just launched a new study, which is not a randomized trial, but it’s trying to get at this common symptom that people have after stroke, which is fatigue and cognitive changes. And one of my post-docs, Dr. Emily Ramech, she’s a physio by background. We just launched what we call the deep phenotyping study after stroke. And we are looking at young people that have had a stroke up to age 55 and we’re taking them into the scanner. We will do a PET scan that’s looking at inflammation. We’re taking their bloods and looking at markers of inflammation and see how that relates to fatigue after stroke. This is between the first month and the sixth month after stroke. That will give us a little bit of timeline of inflammation after stroke. It will give us some information about fatigue, which is very common, but I have no plans at the moment to look at ethanocephaly. Bill Gasiamis (35:53) Fair enough. I appreciate your time. Thank you so much. All right, well, that brings us back to the end of the episode with Professor Vincent Dease on the PESLO trial results. My hope is that this conversation gives you more clarity, especially if you’re felt caught between personal stories, strong opinions, and a lot of uncertainty. The goal here isn’t to tell you what to do. It’s to help you ask better questions and make decisions with your eyes open alongside a qualified healthcare professional who knows your situation. If this episode helped you, please do a couple of things. Subscribe on YouTube or follow the podcast on Spotify or Apple. Leave a review if you can. It really helps more stroke survivors find the show. And if you’ve had an experience you’re willing to share respectfully, positive, negative or mixed, add a comment. Those real-world perspectives help community feel less alone. And if you’d like to support the podcast and keep it going, my book is at recoveryafterstroke.com/book. And you can join the Patreon at patreon.com/recoveryafterstroke. Thanks for being here with me. And remember you’re not alone in this recovery journey. Importantly, we present many podcasts designed to give you an insight and understanding into the experiences of other individuals. Opinions and treatment protocols discussed during any podcast are the individual’s own experience, and we do not necessarily share the same opinion, nor do we recommend any treatment protocol discussed. All content on this website and any linked blog, podcast or video material controlled this website or content is created and produced for informational purposes only and is largely based on the personal experience of Bill Gassiamus. Content is intended to complement your medical treatment and support healing. It is not intended to be a substitute for professional medical advice and should not be relied on as health advice. The information is general and may not be suitable for your personal injuries, circumstances or health objectives. Do not use our content as a standalone resource to diagnose, treat, cure or prevent any disease for therapeutic purposes or as a substitute for the advice of a health professional. Never delay seeking advice or disregard the advice of a medical professional, your doctor or your rehabilitator. program based on our content. you have any questions or concerns about your health or medical condition, please seek guidance from a doctor or other medical professional. If you are experiencing a health emergency or think you might be, call 000 if in Australia or your local emergency number immediately for emergency assistance or go to the nearest hospital emergency department. Medical information changes constantly. While we aim to provide current quality information in our content, we do not provide any guarantees and assume no legal liability or responsibility for the accuracy, currency or completeness of the content. If you choose to rely on any information within our content, you do so solely at your own risk. We are careful with links we provide. However, third-party links from our website are followed at your own risk and we are not responsible for any information you find there. The post PESTO Trial Results (Etanercept After Stroke) | Interview with Professor Vincent Thijs appeared first on Recovery After Stroke.

How a Stroke, a Year of "Yes," and LinkedIn Mastery Shaped a Media Maverick Join host Brad Burrow as he sits down with Michael Mackie—author, journalist, business coach, and LinkedIn guru—for a candid conversation about life in and out of the spotlight. Mackie pulls back the curtain on his journey from Iowa newsrooms to interviewing Hollywood's biggest stars, shares the pivotal moment a stroke changed his perspective, and reveals how embracing resilience and authenticity led to unexpected opportunities. Packed with behind-the-scenes anecdotes, practical advice for standing out on LinkedIn, and heartfelt stories of recovery and personal growth, this episode is a masterclass in turning adversity into advantage. Whether you're a media pro, a LinkedIn hopeful, or looking for inspiration to say "yes" to life's next chapter, don't miss this engaging and uplifting episode of In a World With Real Media. To learn more about Michael, visit: https://www.michaelmackie.com To learn more about Real Media, visit: https://www.realmediakc.com/ BUY Michael's new book on Amazon! https://a.co/d/frAaxoL

This is Season 3, Episode 9 of The RUN TMC Podcast.  This episode features another player roundtable recorded at the Hub. Four Marin County high school players—Jake Post (Redwood), Evan Brewster (Terra Linda), Kitty White (Redwood), and Abby Bartolo (San Marin)—discuss pregame routines, scouting reports, in-game coaching, leadership, club basketball and staying healthy through a busy season. This interview occurred on December 14th, 2025. Show Notes:  (G): Content is Mostly Global Interest Topics (M): Content is Mostly Inside Marin Topics Musical intro credit to Stroke 9//Logo credit to Katie Levine Content and opinions are those of Dave, Duffy and their guests and not of affiliated organizations or sponsors. email us at: theruntmcpodcast@gmail.com follow us on Instagram @theruntmcpodcast check out our website at: theruntmcpodcast.com thank you to our sponsors: The Hub in San Anselmo Encore Custom Apparel online and in downtown San Rafael  San Domenico Nike Fall and Summer Basketball Camps  

Introduction After a stroke, recovery doesn't end when rehab does. For many survivors, that's when confusion begins. Fatigue, brain fog, limited appointment time, and conflicting advice make it incredibly hard to know what actually helps. And while research is advancing rapidly, most survivors are left trying to piece together answers from podcasts, Facebook groups, and late-night Google searches. That's why this conversation with Jessica Dove London, founder of turnto.ai, matters. The Hidden Problem in Stroke Recovery: Information Overload Stroke survivors aren't lacking motivation. They're drowning in disconnected information — and often too exhausted to process it. Bill shares how, after stroke and brain surgery, even short bursts of research felt impossible. Jessica explains how parents and patients are expected to become full-time researchers — on top of surviving life-changing diagnoses. Why “Just Ask Your Doctor” Isn't Enough Doctors care deeply. But no clinician can keep up with thousands of new stroke-related publications every week. This gap leaves survivors feeling dismissed — not because professionals don't care, but because systems aren't built for rapid knowledge sharing. “You shouldn't have to rely on luck or Facebook groups to find something that could change your recovery.” How Tunrto.ai Changes the Stroke Recovery Equation turnto.ai doesn't replace doctors. It reduces the cognitive load on survivors. Jessica explains how the platform: Reads thousands of new stroke resources weekly Filters by your stage of recovery and priorities Surfaces research, patient experience, and expert insight together Updates automatically as your needs change For survivors managing fatigue, this alone is transformative. Real Examples: From Spasticity to Stem Cells Bill demonstrates how Tunrto.ai can instantly surface: Evidence and cautions around emerging treatments Patient experiences that add real-world context Research trends and unanswered questions Instead of hours of searching, survivors gain clarity — and better conversations with their care teams. Why This Restores Hope After Stroke Hope doesn't come from miracle cures. It comes from visibility — knowing what exists, what's emerging, and what's worth asking about. Tunrto.ai doesn't promise answers. It promises orientation — and that changes everything. Conclusion & CTA If you're a stroke survivor who feels lost, overwhelmed, or unsure where to look next, tools like turnto.ai represent a new way forward. Learn more at turnto.ai Read Bill's book at recoveryafterstroke.com/book Support the podcast at patreon.com/recoveryafterstroke You're not alone — and better answers are closer than you think. Footer disclaimer: This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. When Stroke Recovery Meets AI — Finding Clarity Faster with Jessica Dove London After stroke, finding answers shouldn't depend on luck. Discover how AI is changing stroke recovery with Jessica Dove London. Turnto.ai Jessica’s LinkedIn Support The Recovery After Stroke Podcast on Patreon Highlights: 00:00 Introduction to the Journey 09:17 The Birth of Turn2.ai 19:07 Navigating Information Overload 27:10 The Onboarding Process Explained 35:28 Real-Life Applications and Success Stories 43:57 Empowering Patients Through Collaboration Transcript: Introduction to AI for stroke recovery Bill Gasiamis (00:00) Hey everyone, if you’ve ever struggled to find information about tools, treatments, or resources that could actually help you on your stroke recovery journey, this interview is a game-changer. One of the reasons I’m so passionate about doing this podcast is because of my purpose behind it. And that purpose is simple, to connect people with information, to connect people with tools, and to connect people with other people. who truly understand what this journey is like. After a stroke, finding reliable up-to-date information is exhausting. You’re dealing with fatigue, brain fog, limited time, and often very little guidance beyond rehab. In today’s episode, you’re going to hear from Jessica Dove London, my new hero, the founder of Turnto.ai, a tool designed to help people like us find relevant stroke recovery information much faster with less effort and far less energy delivered straight into your email inbox. This is not a sponsored episode, but it is an episode about a solution I genuinely believe can change how stroke survivors find answers. Let’s get into it. Bill Gasiamis (01:13) Jessica Dove London, welcome to the podcast. Jessica Dove London (01:16) Great to be here Bill Bill Gasiamis (01:17) Sometimes when people send me emails, they go into the inbox and then they’re kind of like, I’ll look at that when I get back to it, when I get back to it, I get back to it. And I saw the email that you sent to me when you reached out to tell me about this amazing new product. And I thought, well, another amazing new product. There’s plenty of them. And usually the products that people kind of email me about are not relevant to Stroke. And people are just trying to get onto podcasts and all that kind of stuff. And I get it. I’ve got no issue with that. If they’re relevant, I love sending new information to people. And one of the biggest challenges is determining what’s going to be the most helpful thing. How can I get things out that are not just another thing to talk about for the sake of talking about it? And then I didn’t respond to your email because it kind of goes down to the bottom of the list when all the other new ones come in and I’ll get to that. get to that. And then I saw a link in my I comment on my LinkedIn and I thought, okay, this is familiar. I’ve seen this before. Let me check it out. And then I checked it out and thought, what an idiot. Why haven’t I contacted this person back quicker? This product is amazing. But before we talk about turnto.ai, give me a little bit of a background. I just want to get a sense of how it is that somebody comes up with the idea. I know what I’m going to do. I’m going to create a product that brings information to people. more rapidly than ever before so that they can decrease the amount of time it takes to learn new and amazing things that are coming up about their condition. Jessica Dove London (02:50) Yeah, well, Bill, I did really like your podcast. That’s why I linked in you as well. I actually really liked your podcast because, you know, from where I come from, my son has a rare type of cerebral palsy. We actually don’t have a podcast like this where it’s a patient-led, you know, quest for finding the most useful, cutting-edge, relevant type information. So I really liked your channel. But I guess where do, where do, you know, where do a lot of these things come from? from my lived experience. So when my son was 18 months old, he was diagnosed with a rare type of cerebral palsy, which is a little bit similar to Parkinson’s in his rare type. And when I went along, when he got diagnosed, I went along to his appointment, we knew he had something and I took a big research paper along systematic review and the doctor said, nothing you can do to help him. There’s no medication, surgery. She even told me, don’t bother reading those papers. And I just, went on this journey that maybe a lot of people listening relate to when you are given something or you’re recovering, we have this huge life change of wondering what can I do to improve my son’s quality of life? And this real question, like, can I do anything? He’s amazing as he is, but we want to unlock the whole world for him. So I just went on this journey for years, finding treatments for him. And we just kept finding treatments and some were incredibly life impacting. And almost all of them were in the medical literature. I just had to decipher them. I traveled the world, how did every world leader ended up studying neuroscience? We, we had a big YouTube channel where we shared our stories and I went to a huge conference with all these academics and this one world leader got up on the stage and she shared these incredible things coming for cerebral palsy, which actually is some relevance for stroke because there’s a lot of things that are free. They’re, sort of based on neuroplasticity. They’re very accessible. And I actually put my hand up and said, I shouldn’t have to fly around the world. to learn about cutting edge things that could help my son or help people right now. you know, I guess I just live this experience that think many people do where all the cutting edge information can be all over the place. It can live in these research papers. It can live in the patient community. It can live in those incredible healthcare providers, but you have to sign or in clinical trials, you know, you don’t know, you have to piece it all together and then work out what’s relevant for me. because you know, you could be sitting in a Facebook group, you could be listening to podcasts like this, but there’s so much time that is wasted and opportunity that is wasted while you’re trying to work out all these things. And for most people, you don’t have the world leading best healthcare providing team. Who knows everything doing that work for you. You have to do it on your own. So yeah, just live that problem of trying to find the cutting edge thing to help my son and you know, For two years, it took me two years, we did find a whole lot of things. Bill Gasiamis (05:40) Yeah, two years. my gosh. And I mean, you’d give more than two years to your son, but it’s not about that. It’s about, doing it more quickly than two years. And from stroke perspective, do you have a stroke? Your brain doesn’t work properly. And then trying to sit there and get through, data, texts, videos, all that kind of stuff. I only was able to find like very small amounts of time in between. ⁓ feeling terrible most of the time. And then, ⁓ my gosh, I’m feeling good right now. And then it’s a priority. Like what do I do now that I’m feeling good for five minutes or 10 minutes or an hour? And for me, I, I was very keen to kind of, understand what I can do to support myself. And I knew for certain there was stuff that doctors weren’t delivering when able to deliver, didn’t know about, weren’t telling me that if I did the research that, and I found that I could implement something that was easy for me to implement. for me, just perfect example would be nutrition. But in my conversations with doctors, when I asked them about, this something I can stop eating or start eating to help my brain? There was no information out. There’s probably nothing that wouldn’t matter. Just go about the treatment that we’re offering. And then as a mom or a parent, let’s say as a parent who has a child who has needs beyond the quote unquote normal. It’s like, I’ve got to do all these extra things as a parent for my child. And I’ve got to have my life. I’ve got to do work and do all the things that parents do other than just parenting. And then somehow in there, I’ve got to find a flight to a conference to the other side of the world to hear a researcher maybe, and it’s only like a maybe share something that’ll be life-changing and supportive. And that’s kind of… where I was at, was in the same place. And I thought, what I’ll do is I’ll create a conversation so that people can come to me. We can chat about it amongst other things, share stories. But then hopefully somebody on my YouTube channel says, do you know about this? And then that happened. And then that was a problem as well, because it’s like, I don’t know about this. I don’t even know where to begin to have a conversation about that with you. And if I needed to… do the research on something that I was asked about will take ages. Now, one of the questions I had recently was, you know about methylene blue? And it’s this ridiculously kind of current topic about improving mitochondrial function for people. And as a result of that, people are finding out how you can take that and they’re taking it, which I wouldn’t recommend. And, and now I don’t… The Birth of Turnto.ai And now I’ve got to go and do, I don’t know how many searches to find all the data on Methylene Blue and I don’t know where they’re hiding. Read them, spend my entire time to read them, know, spend all my time to read them and then somehow kind of give people feedback on what I’ve read because that’s the role that I’ve decided to play. And now that’s what they’re expecting of me, but it takes ages. It’s forever. So then a little while later, what happened was you, you said, you know, have a look at turnto.ai. check it out, tell me what you think. And then I did. And I was able to see the power of being able to have the research just sent to me in my inbox because I asked the AI to do it and it does it on a regular basis. And in a moment we’ll share about it. But then tell me a little bit about that transition for you from I’m traveling all over the world to nah, stuff that. I’m gonna do that from. my office in Brisbane, in Australia. I’m not going to travel the whole world to find out this information. It’s not efficient enough. How do you move from mum with a problem to mum with a massive solution? Jessica Dove London (09:31) I mean, I guess, you know, those first five years I was just full-time mom and just doing, you know, we did all the things we did into all the therapy centers. And I, you know, I guess it’s really interesting that question you had. you have these really tricky questions or people ask you questions or you’re on a Facebook group and you see people talking about something you’ve never heard about. Yeah. I was just trying to pull those pieces together because I had the capacity to do that reading. Often it was late at night. think one of the biggest challenges is often at the beginning of your journey, you don’t have the context. You don’t know the map that you’re even looking at. All you know is the impact it’s having immediately and the potential future impact and all those really hard things that you’re facing. so probably for those first five years, I was just pulling everything together messily and someone’s trying things, low risk things, all these different things, trying to get the best people to give us that advice. However, you know, after those five years, I went to that REITs big conference and actually initially got an AI grant to do a research project, an AI research project. And I had a really good friend get lung cancer, stage four lung cancer and a good friend get MS. And they just had the same problem that I was having. And so I just knew there was something here. And so initially what we did is we actually just brought all the treatments that exist for cerebral palsy in one place. And there were over 220 treatments and most patient knew about five to 10. And these are, science backed different protocol treatments people are doing and having some impact on. They having some evidence of things that are working. And so the problem is just really wild because you again, you’re told, I’ll just try these few things, but there’s actually legitimate scientific leading people with all these other ideas and some of it’s really working. So I just, I initially I did that. And then when my kids started school, ⁓ I decided to start a tech platform because I saw this as a really huge problem, but I knew I needed a world-class engineering team because I knew AI had to be part of this. And this was before all the LLM, all the open AI. don’t know if people’s familiar with AI, familiarity with AI is. Before all of this amazing sort of last few years, I was using sort of different, more sort of machine learning to try and just bring the data in and categorize it. but really just trying to make it accessible for people. Bill Gasiamis (11:51) Before we continue, want to pause for just a moment. If you’ve been listening to this conversation and thinking, I don’t have the energy to search research papers, Facebook groups, podcasts, and forums just to find one useful thing, you’re not alone. exact problem is why this episode matters. What Jessica has built with turnto.ai is a way to reduce the mental and physical effort it takes to stay informed. after a stroke. Instead of searching endlessly, relevant information is found for you based on where you are in your recovery and sent straight to your inbox. There’s a listener discount available which you’ll find in the show notes and I’ve also created a page with more details at recoveryafterstroke.com/turnto that’s recoveryafterstroke.com/turnto But stay around, listen to the rest of this episode before you go and check out recoveryafterstroke.com/turnto, to get the discount code. All right, let’s get back to the conversation. Jessica Dove London (12:55) yeah, I guess it was definitely a journey I didn’t go from, know, the first few years it was just heads down, fully in care mode, trying to deliver all the care, trying to access all the experts. And then slowly I just went on this journey to eventually being full time running this team of amazing people from the tech space. I knew this should be a tech solution because You know, I think one of the unfortunate things is, is amazing groups out there, amazing orgs out there, but they often are technology specialists. So I don’t build things that can continue to be relevant. They often make really high quality resources and then the resources are actually not relevant even for you doing a search. You know, you do a search and then what happens in a month when there’s something new that’s come out about that. So yeah, we’re on that journey and probably the cornerstone of what we’ve built is this belief we have that all the voices matter. And so research matters, patient experience matter, leading professionals, experts matter. And actually they sometimes can hold different pieces of the puzzle. probably unlike other tools that you’ll see out there and when we show what we’ve built and how we build it, that’s the key thing. The other thing we believe is that new information matters and it’s too much work for one person, let alone a doctor, a specialist can’t even stay up to date on the disease because know, stroke is actually got an unbelievable amount of things that are created every week. can be over 2000 new things every week in stroke that are being published from expert interviews to new research to clinical trials to patient discussions to incredible events. It’s just wild. Like there’s actually so much incredible stuff happening. But you can’t find it all and you can’t read it all. Bill Gasiamis (14:39) Yeah, absolutely. And that’s why when I had a little bit of a play with Tony, with Turn 2… It was cool because I’m not interested in everything that stroke has to offer me. The research has taught me, but I’m interested in certain things and I’m interested on things specifically that my followers and listeners on my podcast want to know about, you know, so I’d love to be able to bring that to them. So then I had a bit of a play and then we’re going to move to that. I’m going to share the screen in a minute and we’ll talk about that actual screen and the solution, but there is an onboarding process, which we’re not going to. show today but can we talk about it a little bit just to give people a sense of how people they’ll come across turn to and then they’ll go okay ⁓ i want to start and then i want to make sure i get information information for just the stuff that i’m interested in how does the onboarding work Jessica Dove London (15:21) Yeah. Yeah, I guess this is again, thing of like, you know, we’ve built a tool that you’re about to see where we want to keep you up to date, read every single new thing and just give you a handful of things. So how do we do that? And so the way we designed this is to find out what’s on top right now. If you’ve just had a stroke, you’re in a very different stage to one year post, two year post, five year post. the reality is of a patient journey is Bill Gasiamis (15:40) Hmm. Jessica Dove London (16:02) you are always changing, know, you know, we have things, new things come up and then you suddenly feel like you’re at the beginning again or new symptoms come up and you get very confused. Like, is this related? I’m like, I have to talk to my doctor. What’s happening here? I’ve just started a new medication. There’s always things happening. So we ask just five questions and the questions are just all about right now. and sort of some key different attributes around your recovery journey or your journey because Sometimes some information is less relevant for certain groups than others. I’m in a cerebral palsy space, your subtype really matters because it’s actually completely different neurology. And so you might find this incredible breakthrough and it just not be relevant for the subtype, which is actually the case for my son. My son has a very rare subtype, which makes like, you know, anything published on his subtype is like gold because you’re like, wow, a new sort of thing has come out. Yeah. So what we’ve done is, made the onboarding about what are you facing this week with your stroke recovery? You know, what is the symptom you’re worried about? And the thing about the tool is, you know, that week it’ll, it’ll go and read the thousands of new things and it will then match you according to what’s on top for you. And it’ll also go and do specific searches on your location. So if you’re living in Sydney, you’re living in anyway, Los Angeles, London, it’ll search for that week for stroke. what is happening in that city. And the reason that’s so helpful sometimes is there are groups, there’s new clinical trials, there’s so many things that are all these incredible people are putting on webinars, like online support, online educational things. So we match you to all of those things every single week. But yeah, really it’s what are you doing with dealing with right now? And then if you get to Sunday, cause that’s when we send our update out and you’ve got something new that’s come up, you just can talk or type and say, hey, I’m not interested, I’m now interested in keto and I’m interested in this and it will just make you, it’ll create new priorities. Cause that’s the real journey of living with a competition. Bill Gasiamis (18:05) I love that it does change at the beginning. It was all about fatigue. How do I improve my fatigue? And then later on it was like, how do I improve my sleep? And then later on it was after, you know, after brain surgery, it’s a completely different, uh, um, inquiries that I was making on YouTube, Google, wherever I was like, you know, how do I overcome a brain surgery, all that kind of stuff. Um, and then also at the beginning, some of those problems I solved like, then Jessica Dove London (18:25) Yeah. Yeah. Exactly. Bill Gasiamis (18:35) I thought, okay, what’s the next one I need to solve? Jessica Dove London (18:38) Yeah, that’s right. The funny thing about health information is though, cause one of the things we’ve built, if let’s say you’ve tried something though, and there has been new research that’s come out about post impact, you may get that in your update because, know, let’s say you did a surgery or you did sort of some sort of intervention there. Sometimes studies coming out about five years post that intervention. And actually that’s really useful for you because what if it, this new potential thing you should be testing for? I think the key to what we, Navigating Information Overload Have learned from building these tools is you don’t actually know what you don’t know. And like, I think most people here have had that experience of sitting in a Facebook group, listening to your podcast. You learn something new and you go, ⁓ I wish I knew this. ⁓ it feels like luck. And I think that is just a really challenging thing because your health is so much more important than luck, but it can feel like that. You know, I can literally remember when I’ve been in a Facebook group and someone first mentioned this surgery that we ended up doing. took us a year to make the decision, but it was like, ⁓ my goodness, what is this they’re talking about? And then I went to my, our surgeon and the surgeon was very, very dismissive even though there was huge body of literature behind this particular intervention. So then I had to find another specialist and so it begins. Bill Gasiamis (19:53) Yeah. That’s a great thing too, as well. Like if you could be facing roadblocks that are based on other people and that, and then if you don’t have like some kind of ammunition to take to them to say, but you know, how about this? That’s one of the challenges. Cause then, you know, they kind of say, well, there’s no data. I haven’t seen it. If I haven’t seen, I’m a doctor. Like, you know, what do you know? How are you going to be the perfect person that makes the decision? gatekeepers of information bother the hell out of me. Like I hate people who have information and think that because they have it, that they sort of hold the key to how that information is disseminated. But then also people who discourage people from doing searches on what may help them, you know, this is my life, it’s my condition. I wanna be able to find things to help me to make my life better. So I don’t have to be in the hospital system so I can go back to life. so I can improve things. So luck is not part of the equation. If I didn’t jump into that Facebook group today and didn’t see that post, I would have missed it for years maybe. Jessica Dove London (20:56) And this stuff just is always happening. It is pretty wild. And again, the reality is that there is just information is everywhere. And I think even for people who favor research, research takes years to come out. And who decides what should be researched? When we did our first research project, when I started this work, one of the things we did is we collected patient stories of treatment reviews. popular treatment at the time, had no research behind it in the cerebral palsy space, but very low risk. It was like an intensive physio type protocol. And I actually shared this with a whole bunch of academics and a world leader came up to me and said, she’s now going to study this treatment. Because again, you know, are not academics sitting in Facebook groups. or they’re not always, know, they’re not, you know, it takes years for these things to even begin to be getting researched. However, at the same time, are, like research has been, can be very, very helpful and it can also, you know, there are definitely a variety of things out there. Some things are snake oil, some things are, some things can look like snake oil and actually be the next best thing because there’s actually a sign, you know, reason why it’s working or we don’t know why it’s working. It is very hard to decide for all of this. Yeah. Bill Gasiamis (22:17) used to be hard. Now it’s a lot easier. Thank you very much. So I’m going to share my screen now so we can have a bit of a look at what we’re talking about. Jessica Dove London (22:19) Yeah. Bill Gasiamis (22:26) so this is the screen. Now, I’ve purposely resisted from clicking on the first two weekly updates at the top because I wanna kind of tell people what happened, why they’re there. But then I wanna go all the way down to the very first catch up that ⁓ I had with the software after I was onboarded, after I answered all the questions and did all that stuff. It came to me, it said, these are some things that we found for you. And, ⁓ it said it found 18 things. It gave me this, ⁓ bar chart thingy, me jiggy here, which is not a bar chart. It’s actually an audio file telling me what it found. ⁓ and it gave me top insights, six things, and it told me one thing that was near me now, just for context. said, I’m in Australia, in Melbourne, but I said I was in New York, New York. Okay. Just so that I can kind of get a sense of what happens when people from ⁓ other places in the world do a search. I kind of have an idea that if I had done the same thing, what type of results I would have got here. But the reason I did that is because I believe it or not, stroke survivors have reached out to me from New York and said, do I know any stroke survivors in New York? I’m in Australia, in Melbourne. Like technically that answer should be no. but I know heaps of people in other areas. But what I don’t know is what’s happening in those other areas. And what Tony found was ⁓ groups, meetups or something along those lines that were happening in New York for people. So I found that really interesting. So I could immediately do that search and get that I click near you, all right, I’m not in New York guys, but if I click near you, look what it found. Hybrid event stroke support groups at Mount Sinai, Sinai, I know I butchered that, but it’s. probably an event that is happening ⁓ in that area. Union Square, I think I know what that is. I think that is in Manhattan. And then it gives its thoughts. It says, this group could help you connect with survivors for emotional regulation and post-traumatic growth. Like, what? That was like a few minutes of searching immediately now. If I had even moved. to New York, it was a brand new place where I’m living and I want to connect with people, I’ve automatically found that. mean, that is fantastic. Jessica Dove London (24:58) So Bill, when you get your update, you go to the, I found you, you can actually flick through all of the updates. And for people as well, can, if you go to click on what I found you, or if you just go back into it and then you can actually flick through them all. So you can flick through the research, the expert interviews, the patient discussions, the online events. And also for people who like email, you can get it all in an email. That’s sort of an easier experience for you, but you can just really quickly flick. Bill Gasiamis (25:06) what I found. Yeah. Jessica Dove London (25:28) through all the relevant things that have found you. And it’s just matching to what you’ve said. So you would have said all those different sort of key things that are important to you. And then the whole thing we believe is we try not to use AI to give you necessarily a generic answer. We’re trying to use AI to find you the most interesting resources that already exist. Bill Gasiamis (25:30) Yeah. Yeah. Yeah, I love it. this one, this week’s daily update. So I’ve had a few of those updates and I’ve clicked a lot of them. And they, as I was going through my mind a few weeks after I logged in for the first time, I would then put in a new search. And then the most recent email that I got or update that I got was this one here. And It has found 17 new things for me and the top insights have been updated because one of the additional searches that I put in later after I did the onboarding was about hand spasticity. And then also I did, and look at this, I did a podcast with, a stroke survivor called Jonathan and it has already found it and brought that to my attention as if I didn’t know about it. And Jonathan Aravello shares his story. That’s an interview that I did with a stroke survivor a little while ago and it already knows that it’s there. And then if you scroll down, I found if you scroll down, you just go through other things that people are talking about. Vivastim is a new product that stroke survivors are talking about because it’s an implantable and it attaches to autonomic, to the vagus nerve and somehow it supports people to improve function and it helps with neuroplasticity and all that kind of stuff. I’m just stunned by all the information that came to me and… The Onboarding Process Explained And I had a question this week in my YouTube channel. Let me tell you what it is. And let’s see if we can just do a search and find some information on that product. STC30 stem cell treatment. I’ve got no idea where to start. How would I answer that question for the person? They asked me a lovely question. What can you say about the effectiveness of STC30 stem cell treatment? So I’m getting asked like I’m an expert in these areas. I don’t mind, but that’s the kind of information that people are looking for. They’re going, how do I find information about that thing when nobody else out there will talk to me about it? They’re kind of like doing a Hail Mary shot. They’re going, I’m going to ask this guy on the podcast, maybe he knows about stem cells. Who would know about that? But check this out. If I do ask a question, if I say,tell me. about ST. C 30. stem cells. I’m going to generate. And I love this part about it too, the searching and the thinking that it does. ⁓ What specific outcomes or improvements are you hoping to achieve? And I’ll just say. ⁓ Less brain fatigue. That’s brain fatigue. Jessica Dove London (28:52) It’s okay. It’s actually you can make spelling mistakes. Bill Gasiamis (28:56) It knows it’s smarter than me. Jessica Dove London (28:58) mean, AI is very good at that. And probably for people watching this, you what would be the difference of this with ChatGPT? Because ChatGPT is amazing and it’s going to get better and better. But the difference of people to understand is we actually have an intelligent data set on stroke. So what we’ve done is we’ve taken the past 10 years of all the stroke information. So from research papers, we’ve actually gone through YouTube and found webinars with experts. We’ve gone through patient discussions, we’ve collected resources. And the reason we’ve done this is because Bill Gasiamis (29:00) Yeah. Jessica Dove London (29:27) Again, I really love Chatjibity. I highly recommend people use it. However, the difference is our belief is all voices matter. So when you ask questions, we’re actually going to give you answers from experts, from patients and from research. So that would be the difference of this tool. And the reason it can take probably up to a minute to find you an answer is Stroke actually has, I Stroke has 450,000 resources in the database that we built for Stroke. So Stroke’s a really, really big database. I mean, it’s trying to look for that answer and then it’s trying to match you to it. I think that’s just, it hasn’t actually restarted. It’s just. Bill Gasiamis (30:05) It’s doing its thinking. It did seventy nine thousand searches. Jessica Dove London (30:09) And it’s trying to just match it to your profile, give you that answer. And it can get, there we go. Bill Gasiamis (30:15) Wow. And then here we go, ST stem cells is marketed as a supplement that claims to support cellular repair and regeneration, but its efficacy and safety are not well established in clinical research. So that’s like a little bit of ⁓ initial information. And then here you go, the patient view, which is so important in this, isn’t it? It’s important to find people who may have had a procedure and have something to share about it. That’s so, so helpful. And then what the research says, how many research papers has it got here? Wow. Look at that one, two, three, four, five, six, seven already research papers. And they’ll all have links to other research papers that, you know, made those ⁓ studies that sort of give those studies the initial information to get the ball rolling on them. And then, systemic review here which check Jessica Dove London (31:15) Sometimes there’s not actually even a full paper on that. I actually don’t know this topic, obviously, but if you go up to the summary, might even say, sometimes you might learn, there’s actually not specific papers on this. However, here are papers that are relevant. you click show style. It’s on the research here. you click post. So if you go down to what research says. Bill Gasiamis (31:31) Where’s the summary? do I do that? Jessica Dove London (31:37) You just scroll down, yep. And then you click show summary, see that pink little, but here we go. It shows you research trends, key findings, unknowns and mixed opinions, and all of it’s referenced. And that’s just because again, we’re trying to show patients as quickly as possible. Is there information? Is there mixed opinions? Because I think sometimes there’s been a tendency to have one answer to these things and there isn’t one answer. And sometimes there isn’t papers, you know? So we actually have trained our tool to Bill Gasiamis (32:01) Yeah. Yeah. Jessica Dove London (32:07) to sometimes not make up answers. And so, you know, we tested it on very rare protocols and it often says, hey, there is no protocol for your subtype. However, here are protocols that are being studied in other sort of use cases. Bill Gasiamis (32:19) Yeah. And then if I do this view source, this is cool too, right? It just goes directly to the article PubMed article. And you can read that. That’s brilliant. Okay. So then, ⁓ And look, here we go again. It’s found my podcast two times here. ⁓ that is brilliant. love it. And then I did this. went, I think I went back and then I asked the question here because I had like a thing that popped up in my brain today. Right. Somebody kind of said, Hey, have you heard about that? And, ⁓ somebody did that. And, ⁓ and then I just can go. immediately into that and go okay where is it i’m just trying to search on my Jessica Dove London (33:05) While you’re searching, guess the thing that we built with our weekly tool as well, so let’s say you really want to learn about STC 30. I think that’s it’s called. You can just put that in your weekly, your profile, and every week our tool will look for that specific topic because that’s the other thing. So if you click strengthen my profile, can you see that purple box down at the bottom? Yep. If you click on strength, you click on that, you can just say, you can type anything new in here and it’s going to then keep searching it. Bill Gasiamis (33:20) How do I do that? Why would I do that? ⁓ yeah? There you go, there’s all of my data that I put in at the beginning, New York, New York, early 50s age group, approximately 13 years post stroke, all the topics that I was interested in. And where would I put that? Would I put that here, add new? Jessica Dove London (33:34) Or if you Yeah, yeah. And if you start, then we’ll know that that’s at the top. Yeah. But you can, to be act, to actually be honest, you can actually, if you go back, I’ll show you an easier way. So at the end of every weekly update, there’s a huge box that just says, me anything new. but if you go back, I’ll show you something on the dashboard as well. Yep. So if you see, do you see want to do a deep dive, see how this says update me the top on the right. Bill Gasiamis (33:52) ⁓ dashboard. Jessica Dove London (34:13) next to ask, yeah, if you just talk at it and say, I’m now interested in this as a priority, it’ll then put it at the top for your next week’s update. Bill Gasiamis (34:13) ⁓ ⁓ okay. Next question I had a day ago, somebody wanted to know about red light therapy. So why don’t I do that? If I press that and then do that, right? Click this button here. Is that the one? Jessica Dove London (34:31) Or you can talk or type, whatever works for you. Bill Gasiamis (34:34) I’m gonna talk, let’s see if it does. Jessica Dove London (34:36) Let’s see if it works with the podcast, whether it’s taken them. Yeah, I think it’s not working just because you’re doing a podcast, because you’re using the speaker. Bill Gasiamis (34:39) Alright. ⁓ no. Okay, so I’ll type I’ll just say ⁓ red light therapy. Jessica Dove London (34:53) This won’t give you an answer. This is just going to go on to your weekly update now, Bill. Bill Gasiamis (34:58) Okay, okay, so if I if I do that Jessica Dove London (34:59) Yeah. And now, yep. So now it’s actually just added it to your health profile whenever you want to know. So for your next Sunday’s update, you’re now going to have red light therapy in there. But yeah, but the reason we put the voice box is it’s actually sometimes useful to talk a bit more like, Hey, I’m thinking about doing red light therapy. I’m really worried about this, this, this, just actually giving more context. Cause at the of the day, if there’s a thousand new things a week in stroke, you know, this is just a matter of how do you, how does Bill Gasiamis (35:11) my gosh, that’s ugly. Jessica Dove London (35:28) How does any sort of system get you what’s relevant? AI for Stroke Recovery – Real-Life Applications and Success Stories Bill Gasiamis (35:32) It’s a game changer. I’m telling you now. ⁓ I mean, you know that, I don’t know why I’m telling you, but you know that this is the one that was the weirdest thing, methylene blue. Do know it’s a food dye? Sorry. No, it’s not a food dye. It’s a clothes dye. I think it’s like a Indigo clothes dye and people take it. And it’s very risky because, ⁓ it’s very few people that, ⁓ actually experiencing the exact condition that’s related to, ⁓ Jessica Dove London (35:41) Okay. Really? Bill Gasiamis (36:01) neurological dysfunction or mitochondrial dysfunction that methylene blue can help for. And then if you take methylene blue and you take too much of it, ⁓ then it decreases mitochondrial function if you don’t have a need for it. And there’s no way of knowing whether you have mitochondrial dysfunction unless you have the right kind of doctor take you through that process and determine whether your mitochondria are functioning properly. I mean, not many people have access to that, but this is what happened when I, ⁓ put that in there, came up with a whole bunch of information again. This is just like the most obscure thing that everyone’s talking about now. And unfortunately, people are taking Methylene Blue ⁓ without knowing whether or not they’re a candidate. And when they request information from me, I want to be able to give them accurate information and don’t be like that. person who holds onto the data and then doesn’t release it. But I’m confident it could say if you’re somebody considering taking Methylene Blue, do not take Methylene Blue. is so, ⁓ it’s such a nuanced bit of like tool. It’s such a nuanced tool and you need to know like the most amazing people in that space and there’s probably only two of them in the world. So it’s like great that everyone’s talking about it. But I feel really confident now about having the information in front of me to share with stroke survivors. And I would not have felt like that if this tool did not exist. Jessica Dove London (37:34) Again, you could also put that into your weekly updates so that it keeps looking for that particular topic. Because I guess the challenge, the reality is, and the challenge for all of us is we hear these things or we don’t even know things exist. And I think, you know, there is the reality. Like I think you’re always looking for that one thing as well, right? Particularly with any sort of neuro condition, you’re like, is there something really big I’m missing? Bill Gasiamis (37:40) Yeah. you Jessica Dove London (38:00) You know, is there something that could really improve when you’re facing something that maybe, maybe there’s a symptom that won’t go away or, you know, in cerebral palsy, it’s a lifelong condition. So you’re all often like, looking for that. Is there something we’re missing kind of experience or there’s a new topic. like just to give you one example, which is a real example is I was worried about my son having osteoporosis. So I told the tool, I’m worried about my son having osteoporosis. I went to the doctor’s consultant and the consultant said, don’t worry, we don’t need to scan. He said we’re going try and them. But the doctor said, don’t worry. And then the week later, my son got very bad knee pain. We ended up doing an x-ray, which showed potential osteoporosis. I pushed and we got a dextrose. And doctor rings me and he says, yes, your son has osteoporosis. And I said, what can we do to treat this? And he actually told me. we wait for children to break their bones when they have cerebral palsy. Now, if you’re a wheelchair user and you break a bone, that could be a year of rehab for your life. Now I’d put this into the tool and in the period of two to three weeks, it had found me two papers studying children with osteoporosis with cerebral palsy and an expert interview. I said to the doctor, why are we not testing his calcium? Why are we not looking at his vitamin D? And the doctor said, you’re right. We need to test those levels. Now like, One, the reality is that consultant just can’t stay to date. Like I actually understand he’s busy. He’s actually serving lots of different conditions. And so like my passion and my hope is that we can do that work for people. because I have organized my son to get these blood tests now because we’re being proactive. Cause I don’t want him to break, break his bones. You know, I care more than anybody. He, know, it’s quality of life. And also when you have a label like cerebral palsy or stroke, Sometimes things can be disregarded, you know, it’s really, they think, ⁓ this is complex. We don’t really know. Well, maybe we just haven’t read the paper from three months ago or that really useful webinar from a conference that was last week. I’m talking about that exact symptom that is legitimate. So yeah, that’s my real passion, Bill is empowering people because, know, I think we all have these stories of being disregarded or. You know, and I do have a lot of hope for the future and I love medical professionals. I have some incredible people that I work with, but curiosity is just not usually the experience of most professionals when they’re, you know, they are just humans doing their best overwhelmed and usually not fully up to date. Bill Gasiamis (40:39) Yep. And they also don’t know what they don’t know. It’s no different to us, right? If they have, if it hasn’t fallen onto their lap and if they haven’t had a lucky day where they saw an article or, know, they’re in the same boat and as frustrating as it can be, and as much as you want to kind of dude, you know, you’re the guy leading my, my healthcare, you know, like I, I’m entrusting you with more than just this blasé attitude at that, like Jessica Dove London (40:43) Yes! That’s right. Bill Gasiamis (41:06) And that’s not helpful either. I totally get it as well. Jessica Dove London (41:08) That’s right. That’s right. You want to do it together. You know, I was on a call this week with not someone from stroke or cerebral palsy, but it was a consult specialist from another disease. I won’t mention what disease, but they said to me on the call, they picked up something from their desk and they said, I have a journal sitting here from early October and I’ve been trying to read it every day. But this person is a surgeon and is very, very busy. And they were telling me to build my tool, like this tool for doctors. She was like, We can’t stay up to date and we really want to, and we do. Like she will read that paper. But it’s such a burden on healthcare professionals. So my real hope in the future is that we go to our professionals and we look together at the evidence. know, there is that, cause you know, the truth is some world leaders obviously in a lot of professionals know a lot more and their lens is very useful of going, actually that is interesting. this is something we hadn’t thought about, or let’s look at this. Just that there’s time limitation. All right, sound good. Bill Gasiamis (42:08) I know they care. And when you’re a surgeon and somebody says, ⁓ emergency just rocked up through the door and it’s 1am, they drop everything and they go right. So then you want to give that person a break as well and say to my care what what do you want to sleep tomorrow morning? Okay, no worries, by all means sleep. And it makes complete sense why a journal could be on somebody’s desk and not get read. I mean, that happens with my taxes. They’re there forever. Jessica Dove London (42:19) Yeah. actually. Bill Gasiamis (42:35) and they need to get done. And I can come up with a million things that I prioritize over that thing because it’s actually a priority. I’m not saying that I don’t pay my taxes. I definitely do. But with a surgeon, you can understand where they would rather spend their time is helping people get through that particular situation that they’re finding themselves in. the, what is it like? It’s like, ⁓ by the way, there’s this journal there yet. I’m going to spend an hour reading that. what somebody needs surgery. No problem. Let’s go. I totally get it. I get it. And this tool kind of enables patients, I think, to have more information and take that to a meeting with a surgeon with a clinical, you know, in a clinical setting, wherever they are, and begin a conversation that perhaps wouldn’t have begun again. That information then does go kind of in that Jessica Dove London (43:09) That’s right. Bill Gasiamis (43:31) either at the front of the mind of that person or at the back of the mind of that person so that they can access it when they need it and then go, you know, I’m going to be curious about that. I’m going to go down that path. Or if you take that to your doctor or a clinician or someone in that space and they say, don’t worry about that, then that’s also a good sign for I need to find a new doctor. I need to find a new clinician, someone who’s going to take the feedback and the information that I bring them seriously. Empowering Patients Through Collaboration Jessica Dove London (43:57) Yeah. 100%. 100%. I think it’s that collaboration. know, we have a person on our team right now. He’s not the most knowledgeable, but just, and he isn’t the specialist, but he’s very supportive and really wants to look at evidence and is always helping us find the right specialist. And it’s just an incredibly wonderful experience to have someone who’s on that side of always validating. then she knows that we’re reading more than she is on some of these topics. And I want to help. don’t want to be doing this alone. Like that’s the other thing you want. You want people to help you and have the answers and give you better. You know, you don’t want to be doing the wrong treatment or wasting that, you know, I always think you can’t try everything even if lots of things worked. But you can do things that don’t work or you can do things that are risky. And I think for so long, has been very risk averse. However, there are so many treatments that are You know, have huge outcomes. You know, we, one of the things we did with our son, he started school in continent. And I listened to a podcast interviewing a world leader out of UCLA. They, um, you know, we’ve actually got a lot of these stories, barely we’ve been able to talk before about some of the things we’ve tried, but it’s a, an external device giving, uh, this is a different one building what we talked about, but it’s a device you put on your back. And it was this new breakthrough about, uh, the spine is connected to motor planning and he. within two days became fully continent. And this is a $300 machine. It was free. The protocol was free and he’s completely continent at school. Like that’s his whole life changed. And the reason I did it is because I listened to a podcast with a world leader and it’s heaps of evidence. There just wasn’t yet evidence in cerebral palsy because they just brought it to cerebral palsy from spinal cord injury. And his whole life changed and I actually have a friend who’s a world leading researcher in this space in cerebral palsy and me and him have spoken about this technology and it’s very exciting. But not everyone can go and talk to this world leading research to go, yeah, this is valid. This makes total sense. You should be trying this. And so how many people are incontinent because of that one particular insight that’s not being shared. know, there’s just so many stories like this of things that are low risk, that have really good. ⁓ potential to change people’s lives. Bill Gasiamis (46:17) Yeah, that’s brilliant. We’re going to obviously get the link to that particular device and we’re going to put it in the show notes. Jessica Dove London (46:23) We should do a session just on devices. I love technology. ⁓ Bill Gasiamis (46:28) Yeah, but that’s the beauty of it, right? We wouldn’t have had that information hadn’t it been for this particular product coming up in the search in the results. ⁓ Jessica Dove London (46:37) That’s right. So one of the things I tell Tony is I want new technology and new equipment. And so last week in my update, it found me a patient comment of someone who’s built a device, a hand device to hold things and they have a web link, but they themselves went and built this device. All the plans are online. And because I’m obsessed with new technology, it’s doing that for me. I’m also obsessed with like new wheelchairs and new, you know, know, new scooters and it’s all. Bill Gasiamis (46:44) you Jessica Dove London (47:06) I love this, like that’s one of my personal sort of like things I’m always looking for. But again, that tool is doing some of that, a lot of that lifting for me, because I can’t read it all. Bill Gasiamis (47:17) Yeah, brilliant. love it. I can’t read it all either. And I definitely don’t know what the obscure things are that people ask for my podcast. And I’m expected to know which is a really, it’s a really lovely thing. Like, you know, like people are coming to me for advice and I want to, I want to be the guy I want to be the connector. want to see people to read. Jessica Dove London (47:37) You can actually share that page when you ask Tony, you can do a URL and share that for your listeners so they can get access to it. Just so you know the bottom so they can just share it and see if it’s useful or not. And that’s the thing like it’s more about is it useful or not for you. Bill Gasiamis (47:44) Yeah, I will be doing that. Yeah, I think what I’ll be doing is answering people’s questions because they’re so lovely to ask them. What I’ll do is I’ll do a search for them on tourney. I’ll record the whole thing and I’ll tell them, you know, one of my stroke survivors who listens to my podcast wants to know about this information. Give me the data. We’ll come up with some research. I’ll answer the question. And then like, I’ll feel amazing that that happened relatively quickly as well, which is going to before for me to actually my gosh, I just had that feeling where I’m like that doctor who gets asked these questions and doesn’t know. So says, my God, I’m going to leave that unanswered or or I’ll tell them there’s nothing about that that we can talk about because there’s no information. I just felt like that doctor where somebody asked him the question and I was like, I’ve got no idea what you’re talking about. Just keep doing what you’re doing or what I’m telling you to do. Whereas now that goes away. That feeling of I don’t think I can help you, goes away. We might not be able to have the answers. We might find out that in fact there is nothing available yet in that space, right? So that’s kind of where Tony will also go. It’ll go, well, there’s nothing here. Jessica Dove London (49:04) and might just find things that are related because that’s the other thing. Like if I’d asked Tony about this, this technology, it’s called spinal. It’s confusing because there’s a few things called spinal stimulation, but it’s trans trans. I’m not going to, I’ll give, can put it in a note. So it’s a technical term, but in the cerebral palsy community, call it spinal stim. Yeah. If I’d put that in, nothing would come back because it was only last year that two research papers had come out about this. However, it would find related things because there is a lot of related concepts. that particular technology and that thinking. Like there was actually a surgery of how that was using the same, doing the same amount of healing. But the benefit of obviously using a machine that you put on your back is it’s not, or brain surgery, which is hugely risky or implanting devices and all that. It’s just not always answers. There’s not always evidence, but there is things, there’s not much happening. And that’s probably my last thought to share is just. Bill Gasiamis (49:49) Yeah. Jessica Dove London (49:57) There is so much happening and I think you’ve lived this bill, like there is a lot of new technologies, new treatments, lifestyles. There’s so much happening in the recovery space and you know, there’s a lot of hope to be had. And that’s one of my biggest feelings of this tool when I use it for myself is hope. literally it found me an advantage. my son is very adventurous and wants to be a, I do not want him to be this, but he wants to be like a wheelchair stunt person. And there was an online event about teenagers getting into skate parks. And I just had such hope that there’s all these people out there trying to make like a Yeah, I didn’t attend because I’m like, he’s only 10. I’m like, no, we can’t do this yet. Bill Gasiamis (50:40) I love that you don’t want to I love that you don’t want him to break his arm roller skating. Jessica Dove London (50:47) You Bill Gasiamis (50:48) I love it. love it. That’s what normal, normal moms do. Right. But there you go. Yeah. Oh, of course it does. That’s Yeah, I love it. Absolutely. Um, that’s exactly why I like Tony because it will do things that we’ve struggled to do for a long time is find resources, information, all that kind of thing. And it’ll do it quickly and it’ll do it. Jessica Dove London (50:51) That’s right. dad does take him to the skate park. His dad takes him. And he goes down. It’s terrible. It’s so scary. Bill Gasiamis (51:15) specifically for you and it’ll send it to your inbox. You don’t have to go anywhere. Now there will be a link for people to click on and go across and get a little discount or some kind of like a, can we talk about that briefly? Jessica Dove London (51:31) Yeah, yeah. So we, this is a low cost AI tool. So we charge two US dollars a week for that weekly update. And it actually costs us $2.80 per update just because we read a million tokens per person to generate that. And we want to provide the most valuable, those value and the most accessible, valuable focus. Not everybody can be spending $30, $40 a month on the really advanced AI tools either. But you can try it for free. So you can just try it for three weeks and see if it’s valuable because end of the day, that’s all we want. And you know, we want your feedback. If you’re like, I’d love it to do this, to do that. We’re a team that really just want to, you know, that’s the beauty of being a technology team is we can build some of these solutions pretty easily. So yeah, you can go through the link and get a 10 % discount, but you can also just try it for free and see if this is valuable for you. Bill Gasiamis (52:22) Yeah, I tried it for free for three weeks and the it’s like having subscribed to the full thing because you’ve got everything that it can possibly do in that three weeks. I’ve got a really good feel for it. So I’ll have that linked as well in the show notes. And then if you’re watching this video and you want to get a sense of ⁓ what this thing is like, what it’s like when I use it, et cetera, I’ll be doing my answers to red light therapy and STC 30. Jessica Dove London (52:29) Yeah, 100%. That’s right. That’s right. Bill Gasiamis (52:49) I’ll be doing all those types of videos. People will be able to see it. The website is turnto.ai. So it’s T-U-R-N-T-O.ai. I’ll have the links in the show notes for that as well. Jessica, thank you so much for reaching out, persevering when I was being a little bit slack with my inbox and then, yeah, kind of developing this tool with your team and bringing it to us. really appreciate it. that you’ve done that and that it’s there because it’s definitely going to improve. It’s going to decrease the amount of time that I take to find information to help me as well because I’m a stroke survivor and I’ve got my own stuff I go through. So thank you for that. Jessica Dove London (53:30) been great to be here, Bill Gasiamis (53:31) You’ve just heard how AI can fundamentally change the way stroke survivors find recovery information, not by replacing doctors, but by reducing overwhelm and helping us ask better questions. In this episode, we explored why stroke recovery information feels so scattered, how fatigue and brain fog makes searching harder and how tools like turnto.ai can bring clarity, speed and hope back into the process. If this conversation resonated with you, I encourage you to explore the tool for yourself. You’ll find a listener discount code in the show notes. More information at recoveryafterstroke.com/turnto, and remember this podcast exists so that no stroke survivor ever has to feel like they’re doing this alone. If you would like to support the work that I do here, you can support me on Patreon at patreon.com/recoveryafterstroke. Your support helps me continue recording these conversations and working toward my goal of a thousand episodes. Thanks for listening. I’ll see you in the next episode. The post Tunrto.ai for Stroke Recovery: Why This Tool Is a Game Changer for Survivors appeared first on Recovery After Stroke.

Stupid News 12-17-2025 6am …This is one way to get a continuance for your court case …Nobody is shocked he had a stroke …Chinese Zootopia Fans are buying up Indonesian Pit Vipers

We are proud to announce our NEW Christmas Podcast A Very Shining Christmas! The podcast drops Black Friday at the Stroke of Midnight! Click this link to stay up to date on pre-order information! https://reviewinghistory.bandcamp.com/follow_me We also have limited edition Christmas merch available! https://www.reviewinghistorypod.com/merch Now I've heard there was a secret pod, that David played, and it pleased God, but you don't really care for podcast descriptions do you? This week we're getting Jewish and celebrating Hannukah by talking about the bible, and King David. Join us as we get talking all about 1985's King David which was directed by Bruce Beresford, and stars Richard Gere, Edward Woodward, and Alice Krige. Join us as we talk all about King David! We are proud to announce our NEW Patreon is available: https://www.patreon.com/reviewinghistory LIKE AND SUBSCRIBE PLEASE! Please give us a rating and a review on ApplePodcasts or Spotify. It helps potential sponsors find the show! Sign up for @Riversidefm: www.riverside.fm/?via=reviewi... Sign up for @BetterHelp: betterhelp.com/reviewinghistory Email Us: Reviewinghistorypod@gmail.com Follow Us: www.facebook.com/reviewinghistory twitter.com/rviewhistorypod letterboxd.com/antg4836/ letterboxd.com/spfats/ letterboxd.com/BrianRuppert/ letterboxd.com/brianruppert/list…eviewing-history/ twitter.com/Brianruppert #comedy #history #podcast #comedypodcast #historypodcast #tellemstevedave #tesd #kingdavid #bible #biblical #jewish #judiasm #christianity #christian #oldtestament #newtestament #isreal #Chanukah #hannukah #movie #cinema #moviereview #filmcriticisms

People with both gum disease and cavities have nearly double the risk of suffering an ischemic stroke compared to those with healthy teeth and gums Chronic oral inflammation allows harmful bacteria and toxins to enter your bloodstream, damaging arteries and increasing blood clot formation that blocks blood flow to your brain MRI brain scans show that gum disease alone causes silent brain injuries known as white matter lesions, which are early signs of stroke and cognitive decline Regular cleanings, good oral hygiene, and biological dental care dramatically reduce stroke risk by preventing infection, lowering inflammation, and protecting the health of blood vessels Healing your mouth through better nutrition, natural oral care, and toxin-free dentistry strengthens your gums, restores circulation, and supports long-term brain and heart health

In part two of this two-part series on this year's World Stroke Congress, Dr. Andy Southerland and Dr. Seemant Chaturvedi discuss the ATLAS meta-analysis.  Learn more on the World Stroke Congress website. 

On this episode we get into the different fashion trends that was loved by the masses but were terrible during the early 2000's. Shoes that used to hold weight during the 90's that wouldn't do well if released currently. Aging out of rap: are rap artists given the same room as other legacy acts to grow old and still make music? We've got that and much more... This is Views From The 7!

Inserted ad free shows:www.patreon.com/dopeypodcastThis week on Dopey! Comedy Legend and serious recovery survivor Darrel Hammond comes on the show! We dispose of a dead opossum. We reads listener messages about Patreon, Pearl Jam, the Charlotte McKinney episode, Spotify reviews, Theo Von speculation, “Many Rivers to Cross,” NA vs AA, and future guests like Tim Dillon. There's a voicemail about colonoscopy propofol and an email from Canadian listener Dylan about secretly smoking purple fent in rehab and still graduating before getting three years clean on methadone. Dave tells his own stories about using in treatment and invites more “using in rehab” emails.The main interview is a long, raw conversation with Darrell Hammond about childhood abuse, feeling like an outsider, drinking his first Bush beers, baseball, impressions as survival, and finally uncovering buried trauma in intense psychodrama therapy. Darrell talks about self-blame around his sponsor's suicide, years of in-and-out sobriety, cutting as a way to control panic and signal pain, and trying to work at SNL while hiding self-harm and drinking after the show. He gets into Clinton, the Comedy Cellar, how he finds the “funny” in impressions, the crack-house story on 137th Street, and the stroke that finally terrified him into fully embracing recovery, meetings, cognitive therapy, yoga, connection, and a “life of consultation.” He closes with his “religion” (improve myself, contribute to others' happiness) and his take on God, gravity, Einstein, and serenity. Dave wraps with Patreon/Zoom plugs, Safe Spot and sticker/mustard ads, a quick Andrew Dice Clay impression, a mini rant about Instagram, and a sincere reminder that recovery is the best thing that ever happened to him. All that and more on this weeks installment of the good old dopey show! Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Wilson's Stroke and the League of Nations in the 1920 Election — David Pietrusza — The 1920 presidential election opened with the tragedy of President Woodrow Wilson's stroke in October 1919, leaving him profoundly incapacitated for the remainder of his life. His relentless advocacy for American membership in the League of Nations dominated the electoral debate. This issue deeply fractured the Republican Party into competing factions: isolationists rejecting international entanglement, reservationists demanding conditional participation, and internationalists supporting unconditional commitment—divisions reflecting broader American public skepticism regarding binding international obligations. 1913 WILSON