Podcasts about stroke foundation

Moyamoya Syndrome Stroke Recovery: Judy Kim Cage's Comeback From “Puff of Smoke” to Purpose At 4:00 AM, Judy Kim Cage woke up in pain so extreme that she was screaming, though she doesn't remember the scream. What she does remember is the “worst headache ever,” nausea, numbness, and then the terrifying truth: her left side was shutting down. Here's the part that makes her story hit even harder: Judy already lived with Moyamoya syndrome and had undergone brain surgeries years earlier. She genuinely believed she was “cured.” So when her stroke began, her brain fought the reality with everything it had. Denial, resistance, bargaining, and delay. And yet, Judy's story isn't about doom. It's about what Moyamoya syndrome stroke recovery can look like when you keep going, especially when recovery becomes less about “getting back to normal” and more about building a new, honest, meaningful life. What Is Moyamoya Syndrome (And Why It's Called “Puff of Smoke”) Moyamoya is a rare cerebrovascular disorder where the internal carotid arteries progressively narrow, reducing blood flow to the brain. The brain tries to compensate by creating fragile collateral vessels, thin-walled backups that can look like a “puff of smoke” on imaging. Those collateral vessels can become a risk. In Judy's case, the combination of her history, symptoms, and eventual deficits marked a devastating event that would reshape her life. The emotional gut punch wasn't only the stroke itself. It was the psychological whiplash of thinking you're safe… and discovering you're not. The First Enemy in Moyamoya Stroke Recovery: Denial Judy didn't just resist the hospital. She resisted the idea that this was happening at all. She'd been through countless ER visits in the past, having to explain Moyamoya to doctors, enduring tests, and then being told, “There's nothing we can do.” That history trained her to expect frustration and disappointment, not urgent help. So when her husband wanted to call emergency services, her reaction wasn't logical, it was emotional. It was the reflex of someone who'd been through too much. Denial isn't weakness. It's protection. It's your mind trying to buy time when the truth is too big to hold all at once. The Moment Reality Landed: “I Thought I Picked Up My Foot” In early recovery, Judy was convinced she could do what she used to do. Get up. Walk. Go to the bathroom. Handle it. But a powerful moment in rehab shifted everything: she was placed into an exoskeleton and realized her brain and body weren't speaking the same language. She believed she lifted her foot, then saw it hadn't moved for several seconds. That's when she finally had to admit what so many survivors eventually face: Recovery begins the moment you stop arguing with reality. Not because you “give up,” but because you stop wasting energy fighting what is and start investing energy into what can be. The Invisible Battle: Cognitive Fatigue and Energy Management If you're living through Moyamoya syndrome stroke recovery, it's easy for everyone (including you) to focus on the visible stuff: walking, arms, vision, and balance. But Judy's most persistent challenge wasn't always visible. It was cognitive fatigue, the kind that makes simple tasks feel impossible. Even something as ordinary as cleaning up an email inbox can become draining because it requires micro-decisions: categorize, prioritize, analyze, remember context, avoid mistakes. And then there's the emotional layer: when you're a perfectionist, errors feel personal. Judy described how fatigue increases mistakes, not because she doesn't care, but because the brain's bandwidth runs out. That's a brutal adjustment when your identity has always been built on competence. A practical shift that helped her Instead of trying to “finish” exhausting tasks in one heroic sprint, Judy learned to do small daily pieces. It's not glamorous, but it reduces cognitive load and protects energy. In other words: consistency beats intensity. Returning to Work After a Moyamoya Stroke: A Different Kind of Strength Judy's drive didn't disappear after her stroke. If anything, it became part of the recovery engine. She returned slowly, first restricted to a tiny number of hours. Even that was hard. But over time, she climbed back. She eventually returned full-time and later earned a promotion. That matters for one reason: it proves recovery doesn't have one shape. For some people, recovery is walking again. For others, it's parenting again. For others, it's working again without losing themselves to burnout. The goal isn't to recreate the old life perfectly. The goal is to build a life that fits who you are now. [Quote block mid-article] “If you couldn't make fun of it… it would be easier to fall into a pit of despair.” Humor Isn't Denial. It's a Tool. Judy doesn't pretend everything is okay. She's not selling toxic positivity. But she does use humor like a lever, something that lifts the emotional weight just enough to keep moving. She called her recovering left hand her “evil twin,” high-fived it when it improved, and looked for small “silver linings” not because the stroke was good, but because despair is dangerous. Laughter can't fix Moyamoya. But it can change what happens inside your nervous system: tension, stress response, mood, motivation, and your willingness to try again tomorrow. And sometimes, tomorrow is the whole win. Identity After Stroke: When “Big Stuff Became Small Stuff” One of the most profound shifts Judy described was this: the stroke changed her scale. Things that used to feel huge became small. Every day annoyances lost their power. It took something truly significant to rattle her. That's not magical thinking. That's a perspective earned the hard way. Many survivors quietly report this experience: once you've faced mortality and rebuilt your life from rubble, you stop wasting precious energy on what doesn't matter. Judy also found meaning in mentoring others because recovering alone can feel like walking through darkness without a map. Helping others doesn't erase what happened. But it can transform pain into purpose. If You're In Moyamoya Syndrome Stroke Recovery, Read This If your recovery feels messy… if you're exhausted by invisible symptoms… if the old “high achiever” version of you is fighting the new reality… You're not broken. You're adapting. And your next step doesn't have to be dramatic. It just has to be honest and repeatable: Simplify the day Protect energy Build routines Accept help Use humor when you can And find one person who understands Recovery is not a straight line. But it is possible to rebuild a life you actually want to live. If you want more support and guidance, you can also explore Bill's resources here: recoveryafterstroke.com/book 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. Judy Kim Cage on Moyamoya Stroke Recovery, Cognitive Fatigue, and Finding Purpose Again She thought Moyamoya was “fixed.” Then a 4 AM headache proved otherwise. Judy's comeback will change how you see recovery. Judy’s Instagram Highlights: 00:00 Introduction and Guest Introduction 01:43 Life Before the Stroke 11:17 The Moment of the Stroke 19:56 Moyamoya Syndrome Stroke Recovery 25:36 Cognitive Fatigue and Executive Functioning 34:50 Rehabilitation Experience 42:29 Using Humor in Recovery 46:59 Finding Purpose After Stroke 54:19 Judy’s Book: Super Survivor 01:05:20 Conclusion and Final Thoughts Transcript: Introduction and Guest Introduction Bill Gasiamis (00:00) Hey there, I’m Bill Gasiamis and this is the Recovery After Stroke podcast. Before we jump in a quick thank you to my Patreon supporters. You help cover the hosting costs after more than 10 years of doing this independently. And you make it possible for me to keep creating episodes for stroke survivors who need hope and real guidance. And thank you to everyone who supports the show in the everyday ways too. The YouTube commenters, the people leaving reviews on Spotify and Apple. The folks who bought my book and everyone who sticks around and doesn’t skip the ads. I see you and I appreciate you. Now I want you to hear this. My guest today, Judy Kim Cage, woke up at 4am with the worst headache of her life and she was so deep in denial that she threatened to divorce her husband if he called 911. Judy lives with Moyamoya syndrome, a rare cerebrovascular condition often described as the puff of smoke on imaging. She’d already had brain surgeries and believed she was cured until the stroke changed everything. Judy also wrote a book called Super Survivor and it’s all about how denial, resistance and persistence can lead to success and a better life after stroke. I’ll put the links in the show notes. In this conversation, we talk about Moyamoya Syndrome, stroke recovery, the rehab moment where reality finally landed. and what it’s like to rebuild life with cognitive fatigue and executive functioning challenges and how Judy used humor and purpose to keep moving forward without pretending recovery is easy. Let’s get into it. Judy Kim Cage, welcome to the podcast. Life Before Moyamoya Syndrome Judy Kim Cage (01:43) Thank you so much, Bill Bill Gasiamis (01:45) Thanks for being here. Can you paint us a picture of your life before the stroke? What were your days like? Judy Kim Cage (01:51) Hmm. Well, my life before the stroke was me trying to be a high achiever and a corporate nerd. I think so. I think so. I, you know, I was in the Future Business Leaders of America in high school and then carried that forward to an accounting degree. Bill Gasiamis (02:04) Did you achieve it? Judy Kim Cage (02:20) and finance and then ⁓ had gone to work for Deloitte and the big four. ⁓ And after that moved into ⁓ internal audit for commercial mortgage and then risk and banking and it all rolled into compliance, which is a kind of larger chunk there. But ⁓ yeah, I was living the corporate dream and Traveling every other week, basically so 50 % of the time, flying to Columbus, staying there, and then flying back home for the weekend and working in a rented office for the week after. And I did that for all of 2018. And then in 2019 is when my body said, hang on a second. And I had a stroke. Bill Gasiamis (03:17) How many hours a week do you think you were working? Judy Kim Cage (03:19) Well, not including the treble, ⁓ probably 50-55. Bill Gasiamis (03:26) Okay. Judy Kim Cage (03:26) Oh, wish, that wasn’t that that really wasn’t a ton compared to my Deloitte days where I’d be working up to 90 hours a week. Bill Gasiamis (03:37) Wow. in that time when you’re working 90 hours a week. Is there time for anything else? you get to squeeze in a run at the gym or do you get to squeeze in a cafe catch up with a friend or anything like that? Judy Kim Cage (03:51) There are people that do. think, yeah, I mean, on certain particular weekends and my friends, a lot of my friends were also working with me. So there was time to socialize. And then, of course, we would all let off some steam, you know, at the pub, you know, at the end of a week. But ⁓ yeah, I remember on one of my very first jobs, I had been so excited because I had signed up to take guitar lessons and I was not able to leave in order to get there in time. ⁓ so that took a backseat. Bill Gasiamis (04:40) Yes, it sounds like there’s potentially lots of things that took a backseat. Yeah, work tends to be like that can be all consuming and when friendships especially are within the work group as well, even more so because everyone’s doing the same thing and it’s just go, Judy Kim Cage (04:44) Yeah, definitely. Absolutely. We started as a cohort essentially of, I want to say 40 some people all around the same age. And then, you know, as the years ticked by, we started falling off as they do in that industry. Bill Gasiamis (05:19) Do you enjoy it though? Like, is there a part of you that enjoys the whole craziness of all the travel, all the hours, the work stuff? it? Is it like interesting? Judy Kim Cage (05:31) Yeah, I do love it. I actually do love my job. I love compliance. I love working within a legal mindset with other lawyers. And basically knowing that I’m pretty good at my job, that I can be very well organized, that it would be difficult even for a normal healthy person and challenging and that I can do well there. And yeah, no, was, when I had put in a year, when I was in ⁓ acute therapy, ⁓ I had spoken with a number of students and they had interviewed me as a patient, but also from the psych side of it all, ⁓ asking, well, what does it feel like to all of a sudden have your life stop? And I said, well, ⁓ and things got a bit emotional, I said, I felt like I was at the top of my game. I had finally achieved the job that I absolutely wanted, had desired. ⁓ I felt like I’d found a home where I was now going to retire. And all of a sudden that seems like it was no longer a possibility. Bill Gasiamis (06:55) So that’s a very common thing that strokes have over say who I interviewed. They say stuff like I was at the top of my game and there’s this ⁓ idea or sense that once you get to the top of the game, you stay there. There’s no getting down from the top of the game and that it just keeps going and keeps going. And, I think it’s more about fit. sounds like it’s more about fit. Like I found a place where I fit. found a place where I’m okay. or I do well, where I succeed, where people believe in me, where I have the support and the faith or whatever it is of my employers, my team. Is that kind of how you describe on top of your game or is it something different? Judy Kim Cage (07:41) I think it was all of those things, ⁓ but also, you know, definitely the kindness of people, the support of people, their faith in my ability to be smart and get things done. But then also ⁓ just the fact that I finally said, okay, this was not necessarily a direct from undergrad to here. However, I was able to take pieces of everything that I had done and put it together into a position that was essentially kind of created for me and then launched from there. So I felt as though it was essentially having climbed all of those stairs. So I was at the top. Yeah. you know, looking at my Lion King kingdom and yeah. Bill Gasiamis (08:43) just about to ascend and, and it was short lived by the sound of it. Judy Kim Cage (08:49) It was, it was, it was only one year beforehand, but I am actually still at the company now. I ⁓ had gone and done ⁓ well. So I was in the hospital for a few months and following that. Well, following the round of inpatient and the one round of outpatient, said, okay, I’m going back. And I decided, I absolutely insisted that I was going to go back. The doctor said, okay, you can only work four hours a week. I said, four hours a week, what are you talking about? ⁓ But then I realized that four hours a week was actually really challenging at that time. ⁓ And then ⁓ I climbed back up. was, you know, I’m driven by deadlines and… ⁓ I was working, you know, leveraging long-term disability. And then once I had worked too many hours after five years, you know, I graduated from that program, or rather I got booted out of the program. ⁓ And then a year later, I was actually, well, no, actually at the end of the five years I was promoted. So, ⁓ after coming back full time. Bill Gasiamis (10:20) Wow. So this was all in 2019, the stroke. You were 39 years old. Do you remember, do you remember the moment when you realized there was something wrong? We’ll be back with more of Judy’s remarkable story in just a moment. If you’re listening right now and you’re in that stage where recovery feels invisible, where the fatigue is heavy, your brain feels slower. or you’re trying to explain a rare condition like Moyamoya and nobody really gets it. I want you to hear this clearly. You’re not failing. You’re recovering. If you want extra support between episodes, you can check out my book at recoveryafterstroke.com slash book. And if you’d like to help keep this podcast going and support my mission to reach a thousand episodes, you can support the podcast at Patreon by visiting patreon.com/recoveryafterstroke. All right, let’s get back to Judy. The Moment of the Stroke Judy Kim Cage (11:16) Yes, although I was in a lot of denial. ⁓ So we had just had dinner with ⁓ my stepdaughter and her husband ⁓ and ⁓ we were visiting them in Atlanta, Georgia. ⁓ And we said, OK, we’ll meet for brunch tomorrow. You know, great to see you. Have a good night. It was four in the morning and I was told I woke up screaming and I felt this horrible, horrible worst headache ever ⁓ on the right side. And I think because I have, I have Moyamoya syndrome, because of that and because I had had brain surgeries, ⁓ 10 years or back in December of 2008, I had a brain surgery on each side. And that at the time was the best of care that you could get. You know, that was essentially your cure. And so I thought I was cured. And so I thought I would never have a stroke. So when it was actually happening, I was in denial said there’s no way this could be happening. But the excess of pain, ⁓ the nausea and ⁓ it not going away after throwing up, the numbness ⁓ and then the eventual paralysis of my left side definitely ⁓ was evidence that something was very very wrong. Bill Gasiamis (13:09) So it was four in the morning, were you guys sleeping? Judy Kim Cage (13:14) ⁓ yeah, we were in bed. Yep. And yeah, I woke up screaming. According to my husband, I don’t remember the screaming part, but I remember all the pain. Bill Gasiamis (13:24) Yeah, did he ⁓ get you to hospital? Did he the emergency services? Judy Kim Cage (13:30) I apparently was kind of threatening to divorce him if he called 911. Bill Gasiamis (13:38) Wow, that’s a bit rough. Oh my lord. Judy Kim Cage (13:41) I know. mean, that could have been his out, but he didn’t. Bill Gasiamis (13:45) There’s worse things for a human to do than call 911 and get your support. Like marriages end for worse things than that. Judy Kim Cage (13:53) because I’ve been to the ER many, many, many times. And because of the Moyamoya, you would always, it being a rare disease, you would never be told, well, you would have to explain to all the doctors about what Moyamoya was, for one. For two, to say if I had a cold, for instance, that Moyamoya had nothing to do with it. Bill Gasiamis (14:11) Wow. Judy Kim Cage (14:19) But also, you know, they would give me an MRI, oof, the claustrophobia. I detested that. And I said, if you’re getting me into an MRI, please, please, please, a benzodiazepine would be incredible. Or just knock me out, whatever you need to do. But I’m not getting into that thing otherwise. But, you know, they would take the MRI, read it. and then say, hours and hours and hours later, there’s nothing we can do. The next course of action, if it was absolutely necessary, would be another surgery, which would have been bur holes that were drilled into my skull to relieve some sort of pressure. ⁓ In this particular case, the options were to ⁓ have a drain put in my skull. and then for me to be reliant on a ventilator. Or they said, you can have scans done every four hours and if the damage becomes too great, then we’ll move on. Otherwise, we’ll just keep tabs on it, essentially. Bill Gasiamis (15:37) Yeah. So I know that feeling because since my initial blade in February, 2012, I’ve lost count how many times I’ve been to the hospital for a scan that was unnecessary, but necessary at the time because you, you know, you tie yourself up in knots trying to work out, is this another one? Isn’t it another one? Is it, it, and then the only outcome that you can possibly come up with that puts your mind at ease and everybody else around you is let’s go and get a scan and then, and then move on with life. Once they tell you it was, ⁓ it was not another bleed or whatever. Yeah. However, three times I did go and three times there was a bleed. So it’s the whole, you know, how do you wrap your head around like which one isn’t the bleed, which one is the bleed and It’s a fricking nightmare if you ask me. And I seem to have now ⁓ transferred that concern to everybody else who has a headache. On the weekend, my son had a migraine. And I tell you what, because he was describing it as one of the worst headaches he had ever had, I just went into meltdown. I couldn’t cope. And it was like, go to the hospital, go to the hospital, go to… He didn’t go, he’s an adult, right? Makes his own decisions. But I was worried about it for days. And it wasn’t enough that even the next few days he was feeling better because I still have interviewed people who have had a headache for four or five or six days before they went to hospital and then they found that it was a stroke. it’s just become this crazy thing that I have to live with now. Judy Kim Cage (17:26) I essentially forced Rich to wait 12 hours before I called my vascular neurologist. And once I did, his office said, you need to go to the ER. And I said, okay, then that’s when I folded and said, all right, we’ll go. ⁓ And then, ⁓ you know, an ambulance came. Bill Gasiamis (17:35) Wow. Judy Kim Cage (17:53) took me out on a gurney and then took me to a mobile stroke unit, which there was only one of 11, there were only 11 in the country at the time. And they were able to scan me there and then had me basically interviewed by a neurologist via telecall. And this was, you know, before the days of teams and zoom and that we all tested out ⁓ from COVID. ⁓ yeah, that’s. Bill Gasiamis (18:35) That’s you, So then you get through that initial acute phase and then you wake up with a certain amount of deficits. Judy Kim Cage (18:37) Yeah. my gosh. ⁓ Well, yeah, absolutely. ⁓ Massive amounts of pain ⁓ from all the blood absorbing back into the brain. ⁓ The left side, my left side was paralyzed. My arm fell out of my shoulder socket. So it was hanging down loosely. ⁓ I had dropped foot, so I had to learn to walk again. Double vision and my facial group on the left and then. Bluff side neglect. Bill Gasiamis (19:31) Yeah. So, and then I see in our, in your notes, I see also you had diminished hearing, nerve pain, spasticity, cognitive fatigue, ⁓ bladder issues. You’d also triggered Ehlers-Danlos symptoms, whatever that is. Tell me about that. What’s that? Moyamoya Syndrome Stroke Recovery Judy Kim Cage (19:56) So I call myself a genetic mutant because the Moyamoya for one at the time I was diagnosed is discovered in 3.5 people out of a million. And then Ehlers-Danlos or EDS for short is also a genetic disorder. Well, certain versions are more genetic than others, but it is caused by a defect in your collagen, which makes up essentially your entire body. And so I have hypermobility, the blood, I have pots. So my, my blood basically remains down by my feet, it pulls at my feet. And so not enough of it gets up to my brain, which also could, you know, have affected the moimoya. But Essentially, it creates vestibular issues, these balance issues where it’s already bad enough that you have a stroke, but it’s another to be at the risk of falling all the time. Yeah. Or if you get up a little too fast, which I still do to this day, sometimes I’ll completely forget and I’ll just bounce up off the sofa to get myself a drink and I will sway and all of a sudden Bill Gasiamis (21:07) Yeah. Judy Kim Cage (21:22) onto the sofa or sit down right on the floor and say, okay, why did I not do the three-step plan to get up? ⁓ But sometimes it’s just too easy to forget. Bill Gasiamis (21:37) Yeah, yeah. You just act, you just move out of well habit or normal, normal ways that people move. And then you find yourself in a interesting situation. So I mean, how, how do you deal with all of that? Like you, you go from having experienced more and more by the way, let’s describe more and more a little bit, just so people know what it is. Judy Kim Cage (22:02) Absolutely. So, my way is a cerebrovascular disorder where your internal carotid progressively constricts. So for no known reason, no truly known reason. And so because it keeps shrinking and shrinking, not enough brain, blood gets to your brain. So what the brain decides to do to compensate is it will form these collateral vessels. And these collateral vessels, which there are many of them usually, you know, the longer this goes on, ⁓ they have very thin walls. So due to the combination of the thin walls, and if you have high blood pressure, these walls can break. And that is what happened in my case. ⁓ Well, the carotids will continue to occlude, but what happens is, ⁓ least with the surgery, they took my temporal artery, removed it from my scalp, had taken a plate off of my skull and stitched that. temporal artery onto my brain so that it would have a separate source of blood flow so that it was no longer reliant on this carotid. So we know that the carotid, sorry, that the temporal artery won’t fail out. ⁓ So usually, ⁓ and this was my surgery was actually done at Boston Children’s Hospital ⁓ by the man who pioneered the surgery. And he was basically head of neurosurgery at Harvard Medical School and Boston Children’s because they more often find this in children now. And the sooner they find it, the fewer collateral vessels will form once the surgery is performed. Bill Gasiamis (24:17) Okay, so the long-term risk is that it’s decreased, the risk of a blade decreases if they do the surgery early on too. I love that. Judy Kim Cage (24:25) The rest. But I was diagnosed at the age of 29. So I had quite a while of these collateral vessels forming in what they call a puff of smoke that appears on the MRI. ⁓ And that is what, you know, Moyamoya essentially means in Japanese, is translated to in Japanese, it’s puff of smoke. Bill Gasiamis (24:50) Wow, you have been going through this for a while then. So I can understand your whole mindset around doctors, another appointment, another MRI. Like I could totally, ⁓ it makes complete sense. You you’re over it after a certain amount of time. Yeah, I’m the same. I kind of get over it, but then I also have to take action because you know what we know what the previous Judy Kim Cage (25:07) Absolutely. Bill Gasiamis (25:19) outcome was and now you’re dealing with all of these deficits that you have to overcome. Which are the deficits that you’re still dealing with that are the most, well, the most sort of prolonged or challenging or whatever you want to call them, whatever. Cognitive Fatigue and Executive Functioning Judy Kim Cage (25:34) The most significant, I guess it’s the most wide ranging. But it is. ⁓ Energy management and cognitive fatigue. ⁓ I have issues with executive functioning. ⁓ Things are, you know, if I need to do sorting or filing. ⁓ That actually is. one of my least favorite things to do anymore. Whereas it was very easy at one point. ⁓ And now if I want to clean up my inbox, it is just a dreaded task. ⁓ And so now I’ve learned that if I do a little bit of it every day, then I don’t have, it doesn’t have to take nearly as long. ⁓ Bill Gasiamis (26:26) What it’s dreaded about it is it making decisions about where those emails belong, what to do to them or. Judy Kim Cage (26:33) Oh, no, it’s just the time and energy it takes to do it. It drains me very quickly. Because you have to evaluate and analyze every line as you’re deciding what project it belongs to. And there’s a strategic way to do it in terms of who you normally deal with on each project, etc. etc. This chunk of time, calendar dates you’ve worked on it, etc. But, know, That might by the time I get to this tedious task, I’m not thinking about it strategically. ⁓ Yeah, I’m just dragging each individual line item into a little folder. ⁓ So, ⁓ but yeah, like the cognitive deficits. gosh. mean, I’m working on a computer all day. I am definitely a corporate desk rat or mouse, you know, on the wheel. ⁓ And a lot of Excel spreadsheets and just a lot of very small print and sometimes I get to expand it. ⁓ And it really is just trying not to, well, the job involves making as few errors as you possibly can. Bill Gasiamis (28:01) Yeah. Judy Kim Cage (28:02) ⁓ Now when I get tired or overwhelmed or when I overdo it, which I frequently frequently do, ⁓ I find out that I’ve made more errors and I find out after the fact usually. So nothing that’s not reversible, nothing that’s not fixable, but it still is pretty disheartening for a perfectionist type such as myself. Bill Gasiamis (28:30) Wow. So the perfectionism also has to become something that you have to deal with even more so than before, because before you were probably capable of managing it now, you’re less capable. yeah, I understand. I’m not a perfectionist by all means. My wife can tend to be when she’s studying or something like that. And she suffers from, you know, spending Judy Kim Cage (28:46) the energy. Bill Gasiamis (29:00) potentially hours on three lines of a paragraph. Like she’s done that before and I’ll just, and I’ve gone into the room after three hours and her, and her going into the room was, I’m going to go in and do a few more lines because she was drained or tired or, you know, her brain wasn’t working properly or whatever. I’m just going to go do three more lines and three hours later, she’s still doing those three lines. It’s like, wow, you need to get out of the, you need to get out. need to, we need to. break this because it’s not, it’s not good. So I totally get what it’s liked to be like that. And then I have had the cognitive fatigue where emails were impossible. Spreadsheets forget about it. I never liked them anyway. And they were just absolutely forget about it. Um, I feel like they are just evil. I feel like the spreadsheets are evil, you know, all these things that you have to do in the background, forget about it. That’s unbelievable. So, um, What was it like when you first sort of woke up from the initial stroke, got out of your unconscious state and then realized you had to deal with all of this stuff? I know for some time you were probably unable to speak and were you ⁓ trapped inside your body? Is that right or? Judy Kim Cage (30:19) I was in the ICU. I was paralyzed on the left side, so I was not able to get up, not really able to move much. ⁓ I was not speaking too much, definitely not within the first week. I was in the ICU for 10 days. ⁓ And yeah, I just wasn’t able to do much other than scream from the beam. ⁓ And then I, once I became more aware, I insisted that I could get up and walk to the bathroom myself. I insisted that I could just sit up, get up, do all the things that I had done before. And it being a right side stroke as well, you know, I think helps contribute to the overestimation or the… just conceitedness, guess, and this self-confidence that I could just do anything. Yes, absolutely. And I was told time and time again, Judy, can’t walk, Judy, can’t go to the bathroom, Judy, you can’t do these things. And I was in absolute denial. And I would say, no, I can, I can get up. And meanwhile, I would say that Bill Gasiamis (31:30) Delusion Judy Kim Cage (31:51) husband was so afraid that I was going to physically try to get up and fall over, which would not have been good. ⁓ And so, you know, there was, there were some expletives involved. ⁓ And, ⁓ and then eventually once I was out of the ICU, ⁓ I didn’t truly accept that I couldn’t walk until Bill Gasiamis (32:00) but. Judy Kim Cage (32:20) one of the PT students had put me into an exoskeleton and I realized that my foot did not move at all, you know, like a full five seconds after I thought I picked it up. And I said, wait, hang on, what’s going on here? And I said, ⁓ okay, I guess I have to admit that I can’t walk. And then I can’t, I can’t sit upright. I can’t. You know, and like you had mentioned, you know, I had lost the signals from my brain to my bladder. They were slow or whatnot. And I was wetting the bed, like a child at a sleepover. And I was pretty horrified. And that happened for, you know, pretty much my, pretty much all my time at Kratie, except I got the timing down. ⁓ eventually, which was fantastic. But then when I moved to post-acute, ⁓ then I had to learn the timing all over again, just because, you know, of different, rules being different, the transfers being different, and then, ⁓ you know, just ⁓ the timing of when somebody would answer the call button, et cetera. Bill Gasiamis (33:45) Yeah. Do you, what was it like going to rehab? I was really excited about it. I was hanging out because I learned that I couldn’t walk when the nurse said to me, have you been to the toilet yet? And I said, no, I hadn’t been to the toilet. We’re talking hours after surgery, you know, maybe within the first eight or nine hours, something like that. And I went to put my left foot down onto the ground. She was going to help me. She was like a really petite Asian. framed lady and I’m and I’m probably two feet taller than her, something like that, and double her weight. And then she said, just put your hand on my shoulder and then I’ll support you. So I did that. I put my hand on her shoulder, stepped onto my left foot and then just collapsed straight onto the ground and realized, ⁓ no, I’m not walking. I can’t walk anymore. And then I was then waiting. hanging out to go to rehab was really excited about that. ⁓ What was it like for you? Moyamoya Syndrome Stroke Rehabilitation Experience Judy Kim Cage (34:48) Initially, well, do you so you mean. ⁓ Bill Gasiamis (34:56) Just as in like, were you aware that you could ⁓ improve things? Were you kind of like, we’re gonna overcome this type of stuff? Because you had a lot more things to overcome than I did. So it’s like, how is that? How do you frame that in your head? Were you the kind of person who was like, ⁓ rehab’s around the corner, let’s do that? Or were you kind of reluctant? Judy Kim Cage (35:19) It was a combination of two things. One, I had been dying to go home. I said, I absolutely, why can’t I go home? I was in the hospital for three weeks before we moved to the rehab hospital. And once we had done that, I was there basically for the entire weekend and then they do evaluations on Tuesday. And so I was told on Tuesday that I would be there for another at least four to six weeks. And so that was even before therapies really began. So there was a part of me saying, I don’t care, let me go home and I’ll do outpatient every day and everything will be fine. At least I get to go home. But then the other part. Bill Gasiamis (35:52) Thanks. Judy Kim Cage (36:11) said, okay, well, once I realized I was stuck and that I couldn’t escape, I couldn’t go anywhere, ⁓ I actually, I did love therapy. ⁓ I loved being in speech therapy, being in OTE, being in PT even, because my girls were fantastic. They were so caring, so understanding. They made jokes and also laughed at mine, which was even better. And when you’re not in therapy, especially on the weekends, you’re just in your room by yourself. And you’re not watching TV because that input is way too heavy. Listening to music. maybe a little bit here and there. ⁓ You know, all the things that you know and love are nowhere to be found, you know, really. ⁓ Yeah, absolutely. Yeah, yeah. And I get claustrophobic in the MRI, in the hospital, et cetera. yeah. Bill Gasiamis (37:14) Oscillating. Yeah. I was on YouTube, searching YouTube videos that were about neuroplasticity, retraining the brain, that kind of stuff, meditations, type of thing. That really helped me on those weekends. The family was always around, but there was delays between family visits and what have you that couldn’t be there that entire time. ⁓ So I found that very interesting. And you know, rehab was a combination of frustration and excitement, excitement that I was getting the help, frustration that things weren’t moving as quickly as I wanted. ⁓ And I even remember the occupational therapist making us make breakfast. And I wouldn’t recommend this breakfast for stroke survivors. I think it was cereal and toast or something like that. And I remember being frustrated, why are they making me make it? My left side doesn’t work. Like I can barely walk. I cannot carry the glass with the tea or anything like that to me. What are these people doing? They should be doing it for us. I wasn’t aware. I wasn’t aware that that was part of the therapy. I just thought they were making us make our own bloody breakfast. I thought these people are so terrible. And it took a while for me to clue on like, ⁓ okay. Judy Kim Cage (38:44) you Bill Gasiamis (38:52) They want me to be able to do this when I get home. ⁓ understood. Took a while. I’m thick like that. Judy Kim Cage (39:00) Fortunately, wasn’t made to cook until close to the end. And also during outpatient, I was tasked to make kind of a larger, you know, crock pot dinner so that, you know, I could do that at home. Meanwhile, the irony of it all is that. I can cook and I used to love cooking, but I don’t do it nearly as much as I used to. So that skill did not really transfer over. ⁓ I have Post-it notes up by the microwave that tell me right hand only because if I use my left hand, the temperature differential I will burn myself ⁓ without even realizing it or even reaching for a certain part of a pan that I think is going to be safe and is somewhat heat resistant. And I touch it and then poof, well, you know, get a burn. So there are post-it notes everywhere. There’s one by the front door that says, watch the steps, because I had a couple of times flown down them and gashed my knee. Bill Gasiamis (40:13) Yeah. Judy Kim Cage (40:26) And it’s amazing actually how long a Post-It note with its temporary stick will stay up on a wall. Bill Gasiamis (40:35) Well, there’s another opportunity for you there, like do a project, ⁓ a longevity of Post-it Notes project, see how long we can get out of one application. Judy Kim Cage (40:46) Yeah, well, this one actually, so I think it was three months after I had moved in, which would have been 10 months into my stroke recovery. And that’s when I fell down these steps. And that’s when I put up the Post-It note. it has been, a piece of tape has been added to it. but it only fell down, I think, a couple of years ago. Bill Gasiamis (41:18) Yeah. So 3M need to shift their entire focus. I feel like 3M. Yeah. I think 3M needs to have a permanent ⁓ post-it note application, but easy to remove. if I want to take it down, like it’s permanent once I put it up, but if I want to take it down, it’s still easy to remove and it doesn’t ruin my paint or leave residue. Judy Kim Cage (41:44) They do actually have that tech. have it for, they call it command. It’s what they have for the hooks for photos and whatnot. And then if you pull the tab and then release it, it will come off and leave the wall undamaged, but it will otherwise stay there for a long. Bill Gasiamis (42:04) Yes, yes, I think you’re right. Most of the time it works, yes. Okay, well, we’re moving on to other things. You’ve overcome a lot of stuff. You’re dealing with a lot of stuff. And yet, you have this disposition, which is very chirpy and happy, go lucky. Is it real, that disposition, or is it just a facade? Using Humor in Moyamoya Syndrome and Stroke Recovery Judy Kim Cage (42:29) No, no, it’s real. It’s real. ⁓ I think I’ve always ⁓ tried to make light of things. ⁓ Humors, probably my first defense mechanism. ⁓ And I think that helped out a lot ⁓ in terms of recovery. And also, ⁓ it put my therapist in a great mood. Also, because not many people did that apparently. You know, most people curse them off or, you know, were kind of miserable. And there were times when I was miserable too. Absolutely. But, but I probably took it out more on my husband than I did the staff. And he, and he would call, you know, I said, I was so mean to you, Rich. was so mean to you. And he said, yeah, you were nicer to the nurses than to me. And I. I apologized for it, but at the same time I’m like, yeah, but sometimes, bud, you are so annoying. Bill Gasiamis (43:33) You had it coming. Judy Kim Cage (43:34) Yeah. Why are you so overprotective? Why do you point out every crack in the sidewalk? Why do you know, you still say I have to stop to tie up my hair when we’re walking on the sidewalk, you know, because you’re not supposed to do two things at once. ⁓ Yeah. So I felt as though I would make jokes all the time. I when my left hand would start to regain function. I called it my evil twin because I didn’t even recognize that it was mine. But then I would give it a high five every time I started gaining function back. And I would say things like, yeah, hey, evil twin, congrats. Or ⁓ I would say, I guess I don’t have to clean the house anymore. I don’t have to use my left hand to dust. I’m not capable of doing it. So why do it? Bill Gasiamis (44:29) Yeah. Judy Kim Cage (44:30) And I’m like, let’s always look for the silver lining. And it would usually be a joke. But, you know, if you couldn’t make fun of it or think about the ridiculousness of it, then I think it would be easier to fall into a pit of despair. Bill Gasiamis (44:48) I agree with you and laughing and all that releases, know, good endo, good endorphins and good neurochemicals and all that kind of stuff really does improve your blood pressure. It improves the way that your body feels, you know, the tightness in your muscles and all that kind of stuff. Everything improves when you laugh and you have to find funny things about a bad situation to laugh at, to kind of dial down the seriousness of the situation. can you know, really dial it down just by picking something strange that happened and laughing at it. I found myself doing that as well. And I’m similar in that I would go to rehab and they would, you know, we would chit chat like I am now with you and would have all sorts of conversations about all kinds of things. And the rehab was kind of like the, the, it was like the vessel, you know, to talk shit, have a laugh. ⁓ you know, be the clown of the rehab room. And I get it, everyone’s doing it tough, but it lightened the mood for everybody. You know, was, it’s a hard thing. You know, imagine it being just constantly and forever hard. And it was like, I don’t want to be that guy and wish they have fun as well. And, and I think my, my, my tough times were decreased as a result. Like, you know, those stuff, mental and emotional days, they, they come, but they go. then you have relief from them. And I think you need relief. Judy Kim Cage (46:23) Absolutely. Otherwise, just could feel perpetual and just never ending. ⁓ And why or how could you possibly survive feeling that way? Bill Gasiamis (46:39) Yeah. So who are you now? as in your, how does your idea of who you are sort of begin to shift after the initial acute phase and now six years in, almost seven years into your stroke journey? Finding Purpose After Stroke Judy Kim Cage (46:59) I think I am. I’m pretty confident in who I am, which is funny. ⁓ I ⁓ actually lean more into making more jokes or ⁓ lean into the fact that things don’t, they don’t have nearly the importance or the impact that you would otherwise think. ⁓ One of my sayings, I guess I say all the, you know, how they say don’t sweat the small stuff. my big stuff, like big stuff became small stuff, you know. So it would have to be something pretty big in order for me to really, really, you know, think about it. And a lot of the little things, you know, the nuisances in life and stuff, would usually just laugh or if I tripped or something, then I would just laugh at it and just keep moving on. ⁓ And I think, you know, It’s funny because some people will say, ⁓ gosh, like stop, you know, there is toxic positivity, right? And there’s plenty of that. And ⁓ I stay away from that, I think. But when I try to give people advice or a different outlook, ⁓ I do say, well, you you could think of it this way, you know. It’s not all sunshine and rainbows and flowers and, you know, care bears, but it is, you know, but it, but you can pull yourself out of a situation. You can try to figure out a way to work around it. You can, you know, choose differently for yourself, you know, do things that you love. You know, you’re only given a certain amount of limited time on the earth. So how do you want to spend it? And if you are on your deathbed, you know, would you have, do you have any regrets? You know, like you did read the books about, you know, that, ⁓ why am I forgetting? Doctors ⁓ that perform palliative care and, you know, they’ve written books about you know what people’s regrets have been after, know, once they are about to pass and you know, that not taking action was a regret. You know, like why didn’t I do this? Or why didn’t I do this? Why didn’t I try this? Like really, what would have been the downfall to trying something? ⁓ And I find that, you know, aside from just naturally being able to see things to laugh at or, or positive sides of things. ⁓ I tried, like, I wish that people could experience that without having gone through what we went through. ⁓ but that’s virtually impossible. I think. Bill Gasiamis (50:18) I think it’s impossible, totally, 100 % impossible because everybody thinks they’re doing okay until they’re not. You just cannot prevent somebody from going through something by taking the learning first. The learning has to come second. Sad as that is. Judy Kim Cage (50:39) ⁓ Well, and we all think we’re invincible to a large extent. ⁓ But ⁓ I think what I’ve been trying to do or me now, I’ve always, you know, volunteered in various ways, but now I take and hold extra value in being a mentor for other stroke patients. Bill Gasiamis (51:03) Yeah, yeah, that’s Judy Kim Cage (51:04) And for, you know, individuals that even just come up to me and talk about all of their medical problems, it doesn’t matter if it’s circulated or not, you know, it’s medically they’re like, there’s some white matter on my MRI, what do think I should do? I’m like, it’s not that simple of an answer. I think you should go to the doctor. Get on a list. Bill Gasiamis (51:29) Yeah. Your journey seems like you’re growing through this adversity, like as in it’s very post-traumatic growth type of experience here. Something that I talk about on my book, the unexpected way that a stroke became the best thing that happened. Not something that I recommend people experience to get to the other side of that, of course. But in hindsight, like it’s all those things that you’re describing. Judy’s Book: Super Survivor And I look at the chapters because in fact, you’ve written a book and it’s going to be out after this episode goes live, which is awesome. And the book that you’ve written is called Super Survivor. And indeed that is a fitting title. Indeed it is. How denial, resistance and persistence can lead to success and a better life after stroke. Right? So just looking at some of the chapters, there’s a lot of overlap there, right? And one of the chapters that there’s overlap in is the volunteering and purpose. I’ve got parts of my book that specifically talk about doing stuff for other people and how that supports recovery and how the people who said that stroke was the best thing that happened to them, the ones that I interviewed to gather the data, one of the main things that they were doing was helping other people, volunteering in some way, shape or form. And that helped shape their purpose in life. and their meaning in life. And it’s how I got there as well. It was like, okay, I’m gonna go and prevent stroke. I’m gonna go talk on behalf of the Stroke Foundation. We’re gonna raise awareness about what stroke is, how to take action on stroke, what to do if somebody’s having a stroke. And I started to feel like I gained a purpose in my life, which was gonna to not allow other people to go through what I went through. And then, With that came public speaking and then with that came the podcast and then the purpose grew and it became really ⁓ all encompassing. It’s like, wow, like I know what my mission is. I didn’t seek to find it. I stumbled across it and the chapter in my book is called stumbling into purpose because you can’t think it up. You just have to take action and then bam, bam, it appears. Like, is that your experience? Judy Kim Cage (53:53) ⁓ Well, so much of my identity had been wrapped up in my occupation. ⁓ And so when, you know, the stroke first happened, et cetera, but then as time has passed, ⁓ yeah, I’ve absolutely found more meaning in providing comfort to other stroke patients. whether it’s because they see me as inspiring that I was able to recover so quickly or that I was able to go back to work, you know, permanently. And just to give them hope, really. And ⁓ when I was in acute, I felt as though like, We do so much of the recovery alone ⁓ and there isn’t a ton of, you know, of course our therapists are fantastic and they’re, you know, they’re loving and they’re caring. But in terms of having to make it through, you know, certain darkness alone or, ⁓ you know, just feeling sorry for yourself even sometimes, or feeling like, hey, I can do everything, but nobody’s encouraging that. because they think it’s dangerous. ⁓ I had wished that, you know, there were more people who could understand ⁓ what survival and then recovery was, you know, truly like. And so I had read that in a number of books before hearing people tell me their stories in person because Emotionally, I absorbed too much of it. ⁓ I wanted to, I think I passed that five-year survival mark of the 26.7%, which I know varies for everybody. ⁓ at the same time, I said, wow, I did, I made it to the other side, I beat these odds. I think I wanted to keep it secret from all the people I worked with. which I still have actually, it won’t be for too much longer. ⁓ But ⁓ just being able to share that and to be vulnerable and to say all the deficits that I have and what I have overcome, ⁓ I think it’s also given people some hope that they can, if she was able to do it, then maybe it isn’t as tough as I think it is. Bill Gasiamis (56:43) Anyone can. Yeah, I love that. That’s kind of my approach to, you know, I’m just a average, humble, normal, amazing guy. You could do it too. You know, I could, I could teach you to what you need to do is learn. ⁓ but that’s true. It’s that it’s that we are, I get, I get people come on the podcast going, I’m so nervous to meet you. You’re on the, I’m on your podcast. Dude, you don’t know who I am. Like if you think I’m the podcast guy, you’ve got no idea. I’m in the back of my, in my garden, in a shed. what was something that’s meant to be a shed that looks like a studio and amazing and all this kind of stuff. Like, dude, I’m just. Judy Kim Cage (57:29) would not have known if you hadn’t told me. Bill Gasiamis (57:32) That’s right, because looks can be deceiving and that ideas that we get of people are just, you know, they’re just not accurate until we get to spend time with people and understand them. And I always try and play down who I am so that people can see that I am just a regular guy who went through this and had no, no equipment. had no ⁓ knowledge. had no skills overcoming learning. Like I just, I picked up what I needed when I could just so that I can stumble through to the next hurdle and stumble through that one and then keep going. I really want people to understand that even the people who appear to be super fabulous at everything, like they’re just not, nobody is that, everyone is just doing their best they can. Even the guy who’s got more money than you, a bigger house, whatever, a better investment, all that stuff, they’re all faking it until shit hits the fan and then they’ve got to really step up to be who they are. You know, that’s what I find. But attitude, mindset, ⁓ approach, know, laughing, doing things for other people all help. They are really important steps, you know. The other chapter that kind of. made me pay attention and take note ⁓ was you talk about the night everything changed, complicated medical history, lifesavers, volunteering and purpose, the caregivers, ⁓ easing back into life, which I think is a really important chapter, returning to work, which is really important. then chapter nine, life after stroke continued. That kind of really is something that made me pay attention because that’s exactly what it is, right? It’s life after stroke. It’s like a continuation. It’s a never ending kind of ⁓ unattainable thing. Judy Kim Cage (59:27) It just keeps rolling on. doesn’t stop. You know, even if you’ve gone through a hardship and overcome it, it doesn’t mean that life stops. You’ve got to keep learning these lessons over and over and over again. Even if you don’t want to learn them, however stubborn you are. ⁓ And I, you know, I one thing that I had written about was that I had resented ⁓ you know, what I had gone through for a little while. I said, why do I still have to learn the same lessons that everybody else has to learn? You know, if I’ve gone through this kind of transcendental thing, why do I still have to learn, you know, these other things? But then I realized that I was given the opportunity ⁓ from surviving, was given another chance to be able to truly realize what it was like to be happy and to live. And I’d never, I mean, I had, I had been depressed, you know, for an anxious for years. And, you know, I’ve been in therapy for years and, ⁓ you know, it really wasn’t truly until kind of getting this push of the fast forward button on learning lessons that it truly became happy, like true, true happiness. And I said, wow, that was the gift. And then to try to pass that on. Bill Gasiamis (1:01:10) It’s a pretty cool life hack. A shit way to experience it, but a pretty cool life hack. Judy Kim Cage (1:01:15) Yeah, yeah, yeah, definitely don’t I don’t recommend it I don’t Bill Gasiamis (1:01:20) Yeah. You get the learning in a short amount of time instead of years of years of wisdom and developing and learning and overcoming, which you avoided up until your first, you know, 38 years. And then, you know, you then, and then you kind of all of a sudden go, okay, well, I really have to buckle down and do these, ⁓ these modules of learning and I’ve got no choice. And I was the same. ⁓ and I have my days, I have my Good days, bad days, and I even recently had a bit of a day where I said to my wife, I got diagnosed with high blood pressure, headaches, migraines, a whole bunch of stuff, and then just tomorrow, I’m I’ve had enough. Why do I need to to be diagnosed with more things? Why do I need to have more medical appointments? Enough, it’s enough. I need to stop this stuff. It’s not fun. And then it took me about half a day to get over myself and go, well, I shouldn’t be here, really. Technically, Somebody has three blades in the brain, you know, I don’t know, maybe 50 years ago, they weren’t gonna make it. So now you’ve made it also high blood pressure. If you had high blood pressure 50 years ago, there was nothing to do to treat it. It was just gonna be high until you had a heart attack or ⁓ a brain aneurysm burst or something. And it’s like, I get to live in a time when interventions are possible and it is a blip on the radar. Like just all you do is take this tablet and you’re fine. Not that I revert to give me the tablet solution. I don’t, I’m forever going under the underlying cause. I want to know what the underlying cause is trying to get to the bottom of all of that. But in the meantime, I can remain stable with this little tablet and ⁓ decrease the risk of another brain hemorrhage. So it’s cool, know, like whatever. And that kind of helps me get through the, why me days, you know, cause They’re there, they come, they turn up, especially if it’s been one day after the next where things have been really unwell and we’ve had to medical help or whatever. When it’s been kind of intense version of it, it’s like, okay, I don’t want any more of this. So I get the whole, I’ve experienced the whole spectrum in this last 13, 14 years. We’re coming up to, I think the 20th or 21st, I think is my, maybe the 25th of my anniversary of my brain surgery. Jeez, I’ve come a long way. It’s okay. It’ll be like 11 years since my brain surgery. A lot of good things have happened since then. We got to live life for another 13 years, 11 years. I keep forgetting the number, it doesn’t matter. Yeah. Judy Kim Cage (1:04:17) Mine will have been my 17th ⁓ anniversary of my brain surgery ⁓ will be in January, sorry, in December. And then the seventh anniversary of the stroke is in January. So lot of years. Bill Gasiamis (1:04:33) Yeah, yeah. A lot of years, a lot of years, great that they’ve happened and I’m really happy with that. Keep doing these podcasts, makes me forget about myself. It’s about other people, so that’s cool. know, meet people like you, putting out awesome books. And when I was going through early on, there wasn’t a lot of content. It was hard to get content on stroke surviving, recovery, all the deficits, all the problems. That’s part of the reason why I started this. And now I think I’ve interviewed maybe 20 or 30 people who have written a book about stroke, which means that the access to information and stories is huge, right? So much of it. ⁓ Your book comes out in early December. Where is it going to be available for people to buy? Conclusion and Final Thoughts Judy Kim Cage (1:05:20) It is currently available to download ⁓ through the Kindle app and through Amazon. The hard copies will be available to order through Amazon and hopefully in other booksellers, but that’s TBD. Bill Gasiamis (1:05:39) Yeah, well, we’ll have all the current links by then. We’ll have all the current links available in the show notes. ⁓ At the beginning of this episode, I would have already talked about the book and in your bio when I’m describing the episode and who I’m about to chat to. So people would have already heard that once and hopefully they’ll be hearing it again at the end of the episode. So guys, if you didn’t pay attention at the beginning, but now you’re at the end, it’s about to come. I’m going to give all the details. Judy Kim Cage (1:06:07) stuck around. Bill Gasiamis (1:06:09) Yeah. If you stuck around, give us a thumbs up, right? Stuck around in the comments or something, you know? ⁓ Absolutely. Thank you so much for joining me, reaching out, sharing your story. It is lovely to hear and I wish you well in all of your endeavors, your continued recovery. yeah, fantastic. Great stuff. Thank you so much. Thank you. Well, that’s a wrap for another episode. want to thank Judy for sharing her story so openly. The way she spoke about denial, rehab, reality, cognitive fatigue and rebuilding identity is going to help a lot of people feel less alone. If you’re watching on YouTube, let us know in the comments, what part of Moyamoya Syndrome stroke recovery has been the hardest to explain to other people for you? Was it the physical symptoms or is it the invisible ones? like fatigue and cognition. And if you’re listening on Spotify or Apple podcasts, please leave a review. It really helps other stroke survivors find these conversations when they need them most. Judy’s book is called Super Survivor, How Denial Resistance and Persistence can lead to success and a better life after stroke. And you’ll find the links in the show notes. And if you want more support from me, you can Grab a copy of my book at recoveryafterstroke.com/book, and you can become a Patreon supporter at patreon.com/recoveryafterstroke. It genuinely helps keep this show alive. Thanks again for being here. Remember you’re not alone in this recovery journey and I’ll see you in the next episode. 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 Gasiamis The content is intended to complement your medical treatment and support healing. It is not intended to be a substitute for professional medical 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. 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Hemorrhagic Stroke Patients Recovery: Jonathan's Journey Through Chaos and Renewal When the clock struck midnight on January 1st, 2021, most people were celebrating a fresh start. Jonathan, at just 35 years old, was unknowingly entering the most challenging chapter of his life. His speech had begun to slur, his head pulsed with pain he couldn't explain, and within hours he was rushed to the hospital during the height of COVID restrictions. That moment was the dividing line between the life he once knew and the life he would rebuild from the ground up. This is a story about what hemorrhagic stroke patients recovery really looks like, the kind that forces you to confront who you used to be and decide who you're going to become next. Before the Stroke — A Life Built on Momentum Before everything changed, Jonathan was thriving. He worked in food science — a field he loved, filled with global imports, inspections, and ensuring food safety for the public. He enjoyed hiking, biking, dinners with friends, and a vibrant social life in the city. He'd finally built independence, moved into his own space, and was exploring a new relationship. His life had rhythm, structure, forward motion. But as many survivors later recognize, stroke doesn't appear at a convenient time. It arrives abruptly, often when everything seems stable. And for people seeking to understand hemorrhagic stroke patients recovery, this contrast before and after becomes a core part of the journey. When the Body Sends Signals In the days before the stroke, something felt off. Jonathan experienced intense migraines, stronger and stranger than anything he'd felt before. But like so many young survivors, he didn't recognize them as warning signs. Then, on New Year’s Eve, his speech began to fall apart. Words wouldn't line up. Sounds emerged out of order. His girlfriend noticed instantly: something was horribly wrong. In minutes, Jonathan went from preparing to welcome the new year to being rushed through hospital doors under strict pandemic protocols. He had no idea this day would reshape him forever. Early symptoms often become the first chapter of hemorrhagic stroke patients recovery, because they reveal how quickly life can break open. The Diagnosis No One Expects at 35 Doctors discovered an AVM — an arteriovenous malformation on the left side of Jonathan's brain. It had ruptured, causing a hemorrhagic stroke. The bleed had stopped on its own and even drained naturally, something his neurologists called miraculous. Still, the damage was significant: His speech was severely impaired His mobility weakened His memory disrupted His emotional world destabilised He heard the words “hemorrhagic stroke” and “AVM rupture,” but they didn't make sense at the time. Many survivors describe this moment as surreal, as if the diagnosis is happening to someone else. “When your own words disappear, your whole identity feels like it's gone with them.” Recovery in Isolation — A Stroke During COVID After only seven days in the hospital, Jonathan was sent home in a wheelchair. There were no open rehabilitation centres, no inpatient programs, and no in-person speech therapy available. Therapists arrived at his family home wearing full PPE, “like a movie scene.” Everything felt unreal. Occupational therapy Physiotherapy Cognitive rehabilitation Speech therapy (virtual for an entire year) Social work support Nutrition guidance All delivered at home, all while the world was shut down. This is the reality for many navigating hemorrhagic stroke patients recovery during unpredictable times: healing becomes a collaboration between professionals, family, and faith. Losing Everything — And Feeling All of It The physical deficits were challenging, but the emotional costs cut deepest. Jonathan lost: His job His independence His ability to drive His long-term relationship His financial stability His sense of identity Anger, sadness, frustration, and confusion were constant companions. These emotional injuries rarely show up on scans, but they shape recovery just as strongly as the physical ones. And like many survivors, he wondered: Who am I now? Will I ever get myself back? This is where recovery becomes something deeper than rehab. It becomes a reorientation of the self. The Turning Point — Gratitude and Mindset Shift One of the most powerful moments in Jonathan's story came when he realized he could walk again. And speak again. And see his family. And simply breathe. He realized: I am still here. I have another chance. Gratitude is rarely the first emotion during a stroke recovery. But eventually, it becomes one of the most transformative. Mindset is one of the greatest predictors of hemorrhagic stroke patients recovery, not because positivity fixes everything, but because a resilient mindset helps survivors keep trying even when the path is uncertain. I've been there myself. When I experienced my strokes, I knew instantly that certain habits and patterns in my life had to change. Not because anyone told me to, but because something inside me shifted. You begin to recognize what no longer serves you. And you begin to aim your life differently. Faith, Identity, and Rebuilding From the Inside Out For Jonathan, faith became a compass. He studied scripture. He leaned into prayer. He found community in his church and mentorship in his pastor. Whether someone practices religion or not, the principle is universal: Recovery requires trust — in yourself, in the process, in the possibility of your future. Faith, in its many forms, becomes a stabilizing force in chaos. From Survivor to Guide — Serving Others Through His Pain As Jonathan regained strength, he realized he wanted to give back. He became a volunteer with: March of Dimes Canada Heart & Stroke Canada He now supports survivors aged 20–80 in both English and Spanish, one of the most unique and powerful aspects of his journey. The moment a survivor steps into service, their recovery deepens. Helping others expands meaning, connection, and purpose. I saw this in my own journey when I became a stroke advocate and launched this podcast. Jonathan discovered a simple truth: Helping others helps you heal too. Visit: recoveryafterstroke.com/book patreon.com/recoveryafterstroke Building a New Life — Marriage, Mentorship, and Hope In 2024, against all expectations, Jonathan got married. He started his own mentorship initiative for survivors, still volunteers across Canada, and continues to rebuild his life with clarity and gratitude. His story is less about “getting back to normal” and more about discovering a new, purposeful version of himself. What Jonathan Teaches Us About Hemorrhagic Stroke Patients Recovery Recovery is not linear. Identity gets rebuilt, not restored. You don't need to do this alone. Emotional healing is just as real as physical healing. Gratitude can shift your entire experience. Community accelerates recovery. Most importantly, your life didn't end with your stroke — a new one began. A Young Man's Fight Back: Jonathan's Hemorrhagic Stroke Story A young survivor's journey shows what hemorrhagic stroke patients recovery can look like — courage, faith, and rebuilding life step by step. Instagram Youtube Facebook TikTok Website Support The Recovery After Stroke Podcast on Patreon Highlights: 00:00 Introduction to Jonathan’s Journey 01:31 Life Before the Stroke 05:41 The Day of the Stroke 14:02 Hemorrhagic Stroke Patients Recovery 23:05 Emotional Challenges Post-Stroke 31:38 Overcoming Bad Habits and Health Challenges 37:38 Finding Purpose Through Volunteering 45:31 The Role of Faith in Recovery 55:32 Understanding Suffering and Connection to God 01:01:01 Building Community and Fellowship 01:05:31 Future Goals and New Beginnings Transcript: Introduction to Jonathan’s Journey Bill Gasiamis (00:00) Today’s episode is one that really stayed with me long after we finished recording. You’re going to meet Jonathan, a young stroke survivor whose life changed in a moment he never expected. And what makes this conversation so powerful isn’t just what happened to him, but how he tried to make sense of it, rebuild from it, and eventually find direction again. I won’t give away the details. That’s Jonathan’s story to tell. But I will say this. If you’ve ever struggled with the fear, uncertainty, or emotional weight that comes after a stroke, You may hear something in this journey that feels uncomfortably familiar and surprisingly reassuring. Now, before we get into it, I want to mention something quickly. Everything you hear, the interviews, the hosting, the editing, exists because listeners like you keep this going. When you visit patreon.com/recoveryafterstroke, you’re supporting my goal of recording a thousand episodes so no stroke survivor ever has to feel like they’re navigating this alone. And if you’re looking for something you can lean on, throughout your recovery or while supporting someone you love, my book, The Unexpected Way That a Stroke Became the Best Thing That Happened is available at recoveryafterstroke.com/book. It’s the resource I wish I had had when I was trying to find my way. All right, let’s dive into my conversation with Jonathan now. Jonathan Arevalo, welcome to the podcast. Jonathan Arevalo (01:23) Yes, hi there Bill. Bill Gasiamis (01:26) Jonathan, tell me a little bit about what life was like before the stroke. Life Before the Stroke Jonathan Arevalo (01:31) Well, life before stroke at 35 years old was good. It was really good. I had the opportunity to travel a lot and also I worked for a company related in foods. And it was something that I had a passion for since I studied that in university when it came to studying chemistry. biology and also food sciences. And during that time is what led prior to my stroke, which was in January 1st, 2021. Bill Gasiamis (02:14) So you did, ⁓ you worked in food sciences. What kind of work did that involve? What does a food scientist do? Jonathan Arevalo (02:24) So for that type of job, worked as ⁓ specifically, it was QA coordinator, which I was in charge of all food products that come from all over the world into Canada, where I had to do audit checks, inspections, and make sure that every single fruits and vegetables had to meet the requirements, which are government requirements, and also meeting specifications. for the safety, the safety before it goes out to the public. Bill Gasiamis (02:57) Wow. Was that a government job? Jonathan Arevalo (03:00) It was not a government job. It was more of a food company that is known all over North America. Bill Gasiamis (03:11) So just a very popular food importer for example that brings different products in and you’ve got to check them and inspect them So what do you do you opening boxes and looking literally at the food before? ⁓ gets the tick Jonathan Arevalo (03:26) Yes. So before anything gets accepted, ⁓ I receive C of As, which are certificate of analysis that come from different countries. And I need to go through all of those to make sure it meets government regulations and at the same time for the health and safety. So all of that, ⁓ I had to make sure both reading it and as well physically inspecting myself. Yeah. Bill Gasiamis (04:01) I understood. What about home life? What was that like? How were you? Where were you living? Who were you living with? Jonathan Arevalo (04:08) Yes. So when it came to that, I was living in the city and I was living with ⁓ an ex-girlfriend who I was during that time. And what it was, it was a different change in life where I started to adjust a new relationship. And at the same time, I was adjusting in building my independence outside from home. and starting like my own life differently. But everything went well until things started to change when it came to relationships and also work and also other things that came along with it over time. Bill Gasiamis (04:58) What did you do for downtime? Do you have some hobbies or are there some things that you enjoy doing after work or on the weekend? Jonathan Arevalo (05:07) Yes, yes. Usually, ⁓ would mostly hang out with friends, go out to meet up with friends to different places. We’d go out for dinner, out in the city. And also, I was very active, so we would go to different trails to do hiking. ⁓ Or also biking, like riding the bike and all that. So different activities like that to stay active. The Day of the Stroke Bill Gasiamis (05:41) Do you remember the day of the stroke? did you start noticing something going wrong? What happened on that particular day? What was different about that day? Jonathan Arevalo (05:52) Yes, well leading to the stroke, was more during Christmas time. So in ⁓ this exact same time in December, where it was leading to my stroke that I started to get certain signs of, I wasn’t too sure what it was though, because I was getting some headaches and something very intense that I never had before, which are migraines. And that was leading prior to the stroke and starting the new year. so then pretty much like on the 31st, leading to January the 1st, was the moment that I had my stroke. And then my ex-girlfriend who I was with during that time, which is already almost five years, ⁓ she noticed that my speech was, was, was going off. I had a lot of slurs in my words. I was getting like very intense headaches and it just didn’t seem normal. So she started to question and ask me questions that didn’t, didn’t make sense. So she automatically ended up calling emergency and I got rushed, ⁓ through emergency to, the hospital. starting the new year. Bill Gasiamis (07:22) Well, so first of January 2021, was it? Jonathan Arevalo (07:27) Yes, January 1st, 2021. Correct. Bill Gasiamis (07:30) Wow, man. First day of the new year, straight into hospital. Jonathan Arevalo (07:34) straight to the hospital, but not only straight to the hospital, but it was also during the time of COVID. And so that made it even more complicated because in the hospital, there was different cases going on at the same time. And whether it’s doctors, nurses, or different people entering and going out, ⁓ there was Bill Gasiamis (07:42) Uh-huh. Jonathan Arevalo (08:04) a lot of restrictions that was going on that certain people weren’t allowed to go in unless it was an emergency purposes. And also I had to wear a mask and all that because they weren’t sure whether I had COVID or it was something else. Bill Gasiamis (08:26) So do you, is this a story that you remember or somebody has told you about what happened that day? Because sometimes people hear the story from others, but they don’t remember going through it or what they were thinking or what they were feeling. What were you thinking or feeling during this whole thing with the strange migraine and then being taken to the hospital? Jonathan Arevalo (08:49) Yeah, for me, I slightly remember since I had ⁓ very, very like, like vague ⁓ scenarios that I was ⁓ that I still remember. But there’s other occasions that I don’t remember anymore. Like I lost a lot of that memory during that period of time because it happened so quickly that that it was also a first time experiencing having a stroke. But I do remember like certain scenarios of being picked up from paramedics and then being rushed to the hospital. And then from there, not that much what happened afterwards, are certain things that I’ve forgotten or it’s hard to remember. Bill Gasiamis (09:46) Yeah, so you’re in the hospital. Do you understand when they tell you that we’ve discovered that you’ve had a hemorrhagic stroke? Like, are you aware of that? Or is it just noise? What’s it like to be told that you ever had a bleed on the brain? Jonathan Arevalo (10:04) Yeah, I find it that it’s very hard to understand that because I didn’t know what a stroke was in that time. And not only a stroke in general, but also the type of stroke that I had, which was a hemorrhagic stroke. But not only was it hemorrhagic stroke, it was as like the couple of days passed by, I was also transferred to another hospital since the hospital where I was at, didn’t have the adequate ⁓ neurologist and specialist for stroke. So I believe it was on the third day or something like that. I was taken to another hospital where they do have specialists, neurologists and all that related to stroke. So they took my case because it was something very important. And at the same time, they didn’t understand how I survived it as well because it wasn’t just a stroke on the left side of my brain. They found that it was an AVM. So it’s called anterior venous malformation, which could be caused from childbirth. As you get older, it could start to develop where you really don’t know because it’s internal. So what triggered it was an aneurysm that made it rupture. Bill Gasiamis (11:43) We’ll be back to Jonathan’s story in just a moment. wanna pause for a second and ask you something important. Why do you listen to this podcast? For many people, it’s because they finally hear someone who understands what they’re going through or because they learn something that helps them feel less alone in their recovery. And here’s the part most listeners never think about. This show only stays alive because of people like you help it keep it going. There’s no big company funding it, no medical organization covering the costs. It’s just me, a fellow survivor doing everything I can to make sure these episodes exist for the next person who wakes up after a stroke and has no idea what happens next. When you support the podcast, you’re making sure these conversations stay online. You’re helping cover hosting and production fees, and you’re making it possible for new survivors months or even years from now to find hope when they need it most. Hemorrhagic Stroke Patients Recovery Some people think my support won’t make a difference, but that’s a misunderstanding. Every single contribution is what keeps this podcast available for free to the people who need it most. And if you want to go even deeper on your recovery, you can also grab a copy of my book, The Unexpected Way That a Stroke Became the Best Thing That Happened at recoveryafterstroke.com/book. Yeah, I know all about arteriovenous malformations. That’s why I’m… talking to you on this podcast because I had one of those in my head on the right side, near the cerebellum and it bled for the first time in November, in February 2012 was the first time my one bled. ⁓ But ⁓ I had numbness on my left side, the entire left side for a whole week before I went to the hospital. And then when they scanned my head, they said, we found a… a shadow on your brain. The shadow on my brain is the white part on the brain scan on the MRI that reveals the bleed and the bleed. The bleed was caused by this blood vessel, faulty blood vessel that they called an AVM that burst and then created a lot of trouble, right? And then the whole journey begins and then it’s just, you know, starting out. So, with mine, eventually they removed it from my head with brain surgery. How did they rectify the bleed in your brain? What did they do to stop it bleeding? Jonathan Arevalo (14:15) Well, it didn’t, it stopped on its own actually. ⁓ Bill Gasiamis (14:19) Sometimes they do that. I was told that sometimes they stop on their own and they don’t have to take any further action. But with mine, it bled another two times and they had to have brain surgery. But with yours, luckily, it stopped bleeding on its own. Jonathan Arevalo (14:34) Yes, Bill. So in reality, it was a miracle. It was a miracle behind it because it stopped the bleeding, but it also drained the bleeding that was inside. So it was like a drainage on its own. And that’s the miracle itself. And the doctors had a team of 10 in the hospital trying to monitor me. and see exactly how did it happen and at a young age and someone that’s healthy and doesn’t have a history of being in the hospital or anything such as that. So that was the miracle itself. So the neurologist ended up ⁓ with their team. They ended up having, I had an angiogram. And the angiogram was done through the side of the groin that goes up to your head, which they tried to ⁓ detect exactly the AVM. And that’s how they were able to find only one specific one that ruptured. Bill Gasiamis (15:53) Yeah, I had the same procedure through the groin and ⁓ they put the the contrast into the brain and then they take photos of that and it shows exactly where it’s bleeding. And that’s an interesting experience because you’re awake the whole time and they go past your heart and they go up into through your neck and then they go into your brain. Jonathan Arevalo (16:11) Yes. Yes, it is. was like an experience that it’s hard to explain, but I felt like electricity in my body. And I don’t know why I felt electricity in my body, but I felt like shocks in my brain or like fireworks. And I was thinking, what’s happening? Bill Gasiamis (16:19) Pretty crazy. Fireworks. Jonathan Arevalo (16:47) But the hardest part, Bill, was the fact that I had lot of difficulties in speaking. So words wouldn’t come out. For me, was like I tried to explain myself through, I don’t know how to say it, emotion. So like facial, facial expression, kind of like when you feel in pain or something like that, or you’re trying to say things. So I had a lot of difficulty for that period of time. And also, since it happened on the left side of my brain, on the opposite side from arm to leg, I had ⁓ difficulty with my mobility. And also with my memory, my memory was affected. ⁓ about a percentage amount. it was very hard ⁓ my first year. It was very difficult. Bill Gasiamis (17:59) I was 37 when I had mine and you were 35. Jonathan Arevalo (18:04) 35. Bill Gasiamis (18:07) Yeah, very young, very young age and then a lot of challenges. So who was supporting you when you were at hospital? Was it your girlfriend at the time and other family members or nobody able to come because of the lockdowns? Jonathan Arevalo (18:21) Yes. So because of the lockdowns and all that, the only person that I had the permission ⁓ for that support was my sister, my older sister. So she ⁓ would be the only one that just by phone, so not in person, because ⁓ my family lived two hours away from the city. And since they live very far away, ⁓ ⁓ My sister was the only one that had communication with the doctors, with the nurses and any specialist when it came to my case. Bill Gasiamis (19:02) Wow. After surgery, after you woke up from hospital, the first seven days, you said the better week you’re in ⁓ that situation. Jonathan Arevalo (19:17) Yes, for a week. ⁓ so they ended up not doing anything. I’m not too sure why. And they let me go home. Bill Gasiamis (19:29) Wow, so they had drained the blood already out of your head and then just sent you home Jonathan Arevalo (19:35) They sent me home on a wheelchair. So what happened was that I ended up getting picked up by my sister and I didn’t go back to where I was currently living in the city. Instead, I went back to the countryside with my parents who ended up becoming my caregivers. Bill Gasiamis (19:59) So you had a, they sent you home in a wheelchair. Did that mean you couldn’t walk when you were sent home? Jonathan Arevalo (20:08) I could walk a bit, but not too well. Bill Gasiamis (20:12) So there was no rehabilitation option, you didn’t get rehabilitated, they didn’t give you occupational therapy or anything? Jonathan Arevalo (20:19) They did that at home as well. Because of COVID, I ended up receiving rehabilitation at home. ⁓ When it came to walking, speaking, understanding, cognitive, and social worker, and nutritionist, all of those types of therapists, ⁓ they had to dress up in a suit as if… As if they’re going to see someone who’s with a virus or something. So it was like watching a movie. Bill Gasiamis (20:55) Wow Yeah, pretty crazy times. So you did get rehabilitation. They did ⁓ support you with therapy for speech and all that kind of stuff. ⁓ How long did all of those therapies last? Was it? Jonathan Arevalo (21:16) Yes, that lasted for seven months. Bill Gasiamis (21:20) Wow man, all at home. Jonathan Arevalo (21:23) all at home, ⁓ in person, and also virtually the way we’re doing right now. Bill Gasiamis (21:29) Yeah, was it virtually for speech therapy? Jonathan Arevalo (21:34) Yes, virtually it lasted longer than seven months for speech therapy. It lasted a year. Bill Gasiamis (21:40) Wow, Yeah, that that’s kind of cool that even though they were going through a really difficult time in Canada, with lockdowns with all the stuff that ⁓ happened because of COVID that you still got access to all of the necessary tools to help you overcome what it was that you went home with. Jonathan Arevalo (22:02) Yes, yes, I’m very thankful. I’m very thankful that I received the support that I needed and also the support of my caregivers, my parents and my older sister, because mainly my older sister was the one that was on top of everything. So that way I may receive everything the moment that I got released from the hospital. she ended up getting everything that I needed, so that way I get that support automatically right away, over the time, yeah. Bill Gasiamis (22:40) Wow, that’s excellent. So, however, now you’re living in different circumstances under lockdown, very difficult to access all these things, like things are seriously have gone wrong for you, know, quote unquote, in your health journey, okay? What is it like dealing with the emotional side of that? Emotional Challenges Post-Stroke Jonathan Arevalo (23:05) Very difficult. I was very angry. I was very frustrated. I was very upset. I was confused. Those are the different emotions that I felt. And I believe that many other stroke survivors would feel the same way. Because I find it that whenever something has been taken away from you, then it hurts a lot. And it hurts you a lot because it’s kind of like not being yourself anymore. So you have something that’s been taken away from you. And so I did lose quite a lot. I lost my job. I lost the ability to drive. So I had to sell my car. And I also ⁓ lost that relationship that I was in. that relationship ended. And I also wasn’t earning any money as well. So the only caregivers were my parents. had to live with them again. And for the past four years of recovery, which I’m still in that recovery stage of stroke, but I’ve improved a lot though. I’ve improved a lot and which I’m very, very thankful. And that just goes based on just having faith. And that’s where I started to change my life. I started to change my life the moment I started to change my mindset, the way I think. And because the moment I started to change the way I think, it was the moment that I was just much more grateful for even though I lost everything. I was simply grateful to be alive. And that was much, much more meaningful than everything that I had. Bill Gasiamis (25:08) than being grateful for a car, for example. Jonathan Arevalo (25:11) Being much grateful for having the second opportunity to live when possibly I wouldn’t be here telling my story. Bill Gasiamis (25:20) Yeah, I totally get that. I went through a similar experience, know, gratitude. Even if you’re not able to come up with something that’s as meaningful as I’m grateful to be alive, like maybe you’re grateful because, I don’t know, there’s a roof over your head or, I don’t know, somebody said something nice to you or whatever. Like you can be grateful about many things, but- being grateful to be alive. Well, that was an easy one for me as well. I totally get it. That’s what I went through. And I had another opportunity to make things right, to support ⁓ myself in a different way, to think in a different way, have it, to try different things and experience things that I’d never experienced before. What, what was the thing that kind of made you feel grateful to be alive? I know that Do you know what I mean? There’s a layer beneath that. is, I’m alive, okay, but what does that mean that you’re grateful to be alive? I get it, but there’s more to that. Jonathan Arevalo (26:33) Yes, of course. Yes. I’m grateful for being alive because I have a second opportunity to change my life to something even better when it comes to helping others, when it comes to being a difference from our old self. Sometimes we don’t get a second opportunity to reflect, but I had… four years, and it’s going to be almost five years, of the opportunity to reflect, of being thankful for, as you said, a place to live, for having my parents, for having my sister, and for having other loved ones that were there praying for me so that way I may live and not die. And at the same time, ⁓ Just being able to walk, to see, to speak, to understand. I was able to regain all of that that was lost. those were the reasons why I was grateful for. Bill Gasiamis (27:48) Yeah, your, ⁓ so your mindset and who you were and how you acted and how you behaved. Like, are you a very different person than the person beforehand? Like, what were the issues with your mindset? What were the issues with the way that you turned up in the world that you needed to tweak to be a better version of yourself back then? Now, I say that because many stroke survivors will say, I want to go back to how things were before stroke. And I’m like, I didn’t want to do that. Like, that’s not a good place to go. You’re smiling. So I’m imagining that you think a similar way. Jonathan Arevalo (28:30) Yes, agree with you, Bill. I find it that sometimes we don’t change our old habits, let’s say. Sometimes we carry habits or cycles in our life that we think it’s good, but in reality, it’s not something good that actually ⁓ represents us. or does good for others or even for ourselves. So myself, I can say that I had everything that I wanted and I had the opportunity to do pretty much everything that I wanted. But at the same time, I wasn’t completely happy. And at the same time, we carry certain bad habits because we think according to society, where society will will accept you based on the things and the patterns that you follow society. When it comes to doing certain bad habits that you think that’s good, but in reality, it’s not really good because you’re actually hurting and damaging who? Yourself. Which is something internally, both mentally, physically, and emotionally. But over time, When you start to reflect on your old habits that weren’t completely fulfilling or bringing that happiness or that peace or that joy, then in reality, it’s nothing good. It’s only for the moment. And sometimes we keep on rushing and doing things for the moment to get that pleasure. But that pleasure only lasts for a moment. So I had to change. And this recovery over these almost five years was a recovery not to just change myself, but to change the way I think, the way I speak and the way I act, because it’s a full connection. And that full connection is the reason why now what I’m currently doing is helping other people, other stroke survivors and other people with disability and also mental health, because we find it that each day The world is getting worse, not better, but worse. Why? Because we live in a broken world. And the fact that we live in a broken world is a reason why there’s many, many men and women that are looking for pleasure, but for the moment. And that’s something that I had to learn for myself the hard way. Even though I wasn’t in drugs, even though I wasn’t an alcoholic, even though I wasn’t doing harm to people, but I would still have bad vices or certain things that still didn’t make me happy. So that’s the main reason why. Overcoming Bad Habits and Health Challenges Bill Gasiamis (31:38) Yeah, it’s exactly my experience as well. Like I had some bad vices that were not ideal. They seemed minor, but the behavior, the habit behind it was not minor. It was major because it was there for many, many years. And if it continued to go on, wouldn’t be helping in a positive way. It wouldn’t be achieving a positive outcome. will be achieving something that my head thought was a good idea at the time, but not really something that is meaningful, purposeful, useful in life. Smoking was one of those things I used to smoke. And people, often I had a friend of mine who would say that that thing will kill you if you keep doing it. And I was like, yeah, don’t worry about it. That’s a problem for Bill in the future. It’s not a problem for Bill today. However, Bill of the future had a bloody brain and… a brain AVM bleed in his head. that became a 37. Really, that became a problem for Bill. Now. And I was smoking from about the age of 13, something like that, on and off. And my friend was telling me that from probably the age of 17, 18, 19, 20, 21. It didn’t take a lot of years to get to 37 and then be experiencing you know, negative impact of a health situation. And I realized that I’ve got to make some massive changes. And obviously, to me at least, it was the most obvious thing that I have to give up smoking. Also alcohol, even though I wasn’t an alcoholic, I had to stop drinking alcohol. And now I very, very rarely drink alcohol. Even 13, 14 years past the first bleed, I very rarely have an alcoholic drink. ⁓ So it’s amazing what came to my mind. I immediately knew the things that I had to change. No one had to tell me, ⁓ well, since you’re ⁓ having a stroke, since you can’t walk properly yet, since your left arm doesn’t work correctly, why don’t you think about fixing this, changing that, doing this, doing that? No one had to tell me. Inside of me, instinctively, I knew what I was doing that was not supporting me, was not supporting my mission in life and my goal in life. And it was the easiest thing to change. ⁓ I did receive some help though. I didn’t do it alone, right? So I had a counselor, I had a coach, a life coach. ⁓ I sought out the wisdom of people that were older than me, smarter than me, know, been on the planet longer than me whatever. And I did it together with other people, not just on my own, because change is not very easy, especially when you remove an old habit and then you have to replace it with something. Initially, replacing it with something feels a bit strange and you don’t know if it’s the right thing that you’ve replaced it with and how that’s going to look like in six months or 12 months. So that’s what I found was that in order to help me find the right things to replace the things that needed to be left behind. I needed to seek the support of other people, counselors, coaches, et cetera. Did you have some support in that part of your recovery so that you can kind of make sense of all the changes that were happening in your body, in your emotions and in your life? Jonathan Arevalo (35:15) Yes. So I ended up joining a nonprofit organization here in Canada called March of Dimes. And March of Dimes provides support for stroke survivors, people with disability, and they have peer support. And it’s a form of counseling with other stroke survivors. And they do this within all of Canada. And also through Heart and Stroke as well, which is another nonprofit organization, Heart and Stroke. So both of them, would do this virtually where I would seek support to talk to someone based on what I’m going through, my thoughts, my emotions, and also telling my story. And from that moment, I said to myself, I want to do the same. I want to give back to the community and to other survivors. So I ended up becoming a volunteer. And for the past three years, I’ve been a volunteer at ⁓ March of Dimes and also Heart and Stroke, where I ended up becoming an advocate. for both nonprofit organizations. And you can also see me on their website on both of them where it tells my story, but also the fact that I volunteer helping out people from the ages of 20 to the ages of 80 years old in two languages now. So I do it in English and Spanish. And it feels really, really good. It really does. Bill Gasiamis (37:09) Yeah, we have very similar stories and journeys. So I went and connected with the Stroke Foundation here in Australia and then provided became an advocate so that we can raise awareness about stroke and then started doing some speaking on their behalf at different organizations. And and like you said, like it gives you a lot of purpose and meaning. It makes what happened to you worthwhile. You know, it’s a very important part of, well, why did this happen to me? I don’t know. You could come up with a lot of negative reasons why something bad happened to you, but what am I going to do about this? And how can I transform this in a way that can help other people? Well, that is a better question to ask. And then volunteering is the best way to do that. I volunteered probably from 2013 through to about 2019. Finding Purpose Through Volunteering For about six years I volunteered. And at the same time I was running the podcast, I started the podcast in 2015. ⁓ And it was just ⁓ meeting other people who had understood me as well in those communities. That was fantastic. Being able to connect with people like that and feeling like, you know, this person really understands what happened to me because it happened to them in a different way, but they have a similar kind of recovery. And… we are aligned in our mission to support others and make a difference and not to make it just about us because that’s a really difficult thing to ⁓ do is you you become anxious and depressed when you just make it about yourself so making it about other people’s stops that thinking pattern ⁓ and I just love the journey that you’re on because you’re very early on in the journey and I can see it’s going to continue ⁓ to be that kind of meaning making journey. I found that I said that I discovered my purpose after the stroke. Now you would have thought that somebody who was married had two children, had plenty of purpose in their life, plenty of meaning. Why do I exist for my children? To support them, to teach them, to make them great men, to ⁓ give them the opportunities in the world, in the community, except They move out of home eventually, and then they become independent. And then your purpose and meaning has to shift. It cannot just be about them. You can include them in your purpose and meaning because you love them, they’re your children, et cetera, in my case. But, you know, they don’t need me now to be the guy that shows them the way of the world and… educate them and prepare them and all that kind of stuff. They are doing it on their own. When they do need me, they come for five minutes or 10 minutes. We have a conversation and they’re done. So it’s important to shift that energy that I had as a parent to other people who need support in the early days of their experience when they have a negative health experience so that we can help guide them through that adversity and overcome and then maybe grow and be a better version of themselves in a few years down the track. Jonathan Arevalo (40:41) Yes, I think that it’s important to be a good example, a good leader, whether it’s at home or everywhere we go. We always need to be a good testimony. And the way I’ve learned that is also through my dad, which he taught me at a young age to be to be a man of righteousness, where he shows a good example through his good actions, but not only through words, but through actions, right? Because sometimes we may speak and say a lot of things, but we don’t live it. But when you live it, it makes a huge difference. And whenever we show those examples, whether it’s… to anyone, any family members, strangers, or anything like that. We need to be like that everywhere we go. And that’s something that I’ve learned a lot, that we need to be a good example to anyone. Bill Gasiamis (41:47) Yeah, I imagine that in the last five years you would have had some setbacks as well. What was the hardest challenge to overcome, do you think, for you? Was it physically or was it emotionally? Jonathan Arevalo (41:59) ⁓ I think it was more emotionally than physically. But it’s something that I was able to work on because even myself, ended up seeking support. And not only through these nonprofit organizations, but also within the church. So I ended up going to church and I had one of the pastors being my mentor ⁓ for a year and a half, and he ended up helping me out a lot. And it was a big amount of support that I received also from my dad and my mom and my sister. So I always had ⁓ a close family support. Yeah. Bill Gasiamis (42:54) Yeah, the church is very common in people’s recovery. You hear a lot about people reconnecting with their church or even if they were still connected with their church, getting supported and having people turn up, ⁓ provide food, provide counseling, provide encouragement, all sorts of things. ⁓ And it sounds like it’s a fantastic community. And then you also hear from people who had ⁓ non-church type of. communities who come forward, support them and give them ⁓ the things that they need to kind of get them settled and in some kind of routine where they can continue recovery in their own way. ⁓ But there would have also been hard times, right? Where, because most people, and on my podcast, we talk about all the amazing things that stroke survivors do and they overcome, et cetera, but there’s also a… really, really hard times. I went through what I would call rock bottom moments, found myself in the abyss. Did you find yourself there at all? Had you experienced kind of that really down negative part of stroke ⁓ in your mental state and your emotional state as well? Jonathan Arevalo (44:09) Yes, ⁓ within the first year. So the first year was everything like I mentioned earlier about feeling angry, frustrated, ⁓ sad and all that. The first year was the hardest part of ⁓ just not knowing what to do. And the only support was ⁓ through my parents that helped me a lot to kind of take away those negative thoughts. And also getting into the church where I had support with the pastor. And then myself just changing my mindset where I had to start looking more into, more to God because I find it that without God we’re nothing. And based on my faith, that’s what gave me the strength, the encouragement, and the joy that was taken away the moment I had my stroke. So my faith in God was what gave me the strength and gave me the encouragement to move on forward. The Role of Faith in Recovery Bill Gasiamis (45:31) Let’s talk about faith for a moment because people may not believe in God. Some people may not believe in God, a God, their God, whatever. faith on its own as a experience is something that we, if we practice, ⁓ is really supportive of recovery. So faith in ourselves, faith in the medical system, faith in any situation where We have to put our kind of our life in the hands of other people. That’s what we’re practicing for people who don’t have faith in God or who don’t have a God or don’t believe in God. You still have to practice faith and you practice faith every single day. ⁓ I wanna go and receive one of my medications. You have to have faith in the medication that is going to work for you and it’s going to actually do the job. that it’s meant to do. Keep your blood pressure down, for example. I’m on blood pressure medication. ⁓ When I drive my car, I have to have faith that the other person is gonna stay on their side of the road and they’re not gonna come on my side of the road. And you know, 99.999 times out of 100, that’s exactly what happens. know, ⁓ when I have, when I’m driving the car, once again, I have to have faith that the lights that I stop at are going to, in fact, when it’s red on my side, it’s going to be green on the other side. And at some point it’s going to switch and it’s going to go green on my side and it will definitely go red on the other side so that we don’t collide. You know, there’s faith. We practice faith all the time throughout our day, throughout our whole life without even really knowing it and without needing to practice faith in a religious way. ⁓ And that’s what I’ve kind of got out of my whole, my whole journey is I didn’t find God so much in that I see God differently these days. I kind of believe that God is me. I am God, God is within me. So when I request a solution, if I use the word God in the sentence, God guide me to find the answer to this difficult question, what I’m actually doing is I’m having an internal conversation with myself. And I’m asking myself, my unconscious self to guide me to find the answer in this particular way. And that way I can combine God, the non-religious version of God, we’ll call it spirit or our creator or whatever you want to call it. And I can embody that and then make it part of me. And then in the right context, I can access the wisdom of God, the creator, nature, whoever, and I can be guided instinctively to follow my gut to an answer. And then if I go down a particular path that was not that way, and I find the wrong path, I can redirect, go back in, redirect and go again. So I became I suppose more, maybe the word is spiritual, it’s probably not the right word, but it’s how I kind of practice my, what you might call connection to God and faith. That’s how I practice it. How does that sound to you? Jonathan Arevalo (49:08) Yes, for me, it’s having faith is believing without seeing. And whenever you build a relationship with God is the moment that you start to learn who God is. And when you read God’s Word, God’s Word teaches us about His promises. His promises that He has for each one of His children, which God created, heaven and earth and everything that we see. And the fact that we breathe and and all that, that’s God who does that. there was this, the other day I was reading and it’s ⁓ in the Bible in the book of Isaiah, who’s a prophet. And it was based on the story of a king and the king is his name is Hezekiah. And Hezekiah had an illness, but not only that, it said, actually, can I read it in? in a second. So it says in his book that It says in Isaiah 38, it says, In those days, Hezekiah became ill and was at the point of death. The prophet Isaiah, son of Amoz, went to him and said, What is what the Lord says? Put your house in order, because you are going to die. You will not recover. Hezekiah turned his face to the wall and prayed to the Lord. Remember, Lord, how I have walked before you faithfully and with wholehearted devotion and have done what is good in your eyes. And Hezekiah wept bitterly. Then the word of the Lord came to Isaiah. Go and tell Hezekiah, this is what the Lord, the God of your father, David, says. I have heard your prayer and seen your tears. I will add 15 years to your life and I will deliver you and this city from the hand of the king of Azariah. I will defend this city. This is the Lord’s sign to you that the Lord will do what he has promised.” So when I read that, I said, wow, how amazing God is that not only does he give promises to either kings and all of that during 2000 years ago in history and how God is still faithful to each one of us. Why? Because each one of us have a purpose and because God has created us with purpose is the reason why his love and mercy is so great. And that’s why I’m thankful for it I know that God is faithful and because his faithfulness He’s given me a second opportunity to live. Bill Gasiamis (52:16) Yeah. So you you take your Bible everywhere now. Jonathan Arevalo (52:21) I take his word everywhere in my heart and I find it that his word is real and is truthful because without God’s word, there’s no life. Bill Gasiamis (52:28) Yeah. So what about before stroke? Were you somebody that knew the scripture? Were you somebody that ⁓ had that type of connection to the word? Jonathan Arevalo (52:47) I didn’t have that connection as much as I have it now. Bill Gasiamis (52:51) Yeah. That’s cool. Jonathan Arevalo (52:53) And that goes based on like we spoke earlier about having a relationship. It’s not really following a religion. It’s knowing that there’s something greater than us. That’s the difference. Bill Gasiamis (53:05) Yeah. I agree with that. Jonathan Arevalo (53:09) And when we know that there’s something greater than us, then we can see that things change. But only things change only if we change ourselves in the inside. Because remember, this world that we live in, as I said earlier, we live in a broken world, right? A broken world where we find a lot of chaos and a lot of things going on. But without that love, without that peace, without that joy, that can only come. through the creator, which is God. And that’s the only way that you can actually be molded to the righteous man of who God has created in us. But we just need to know how to find that. And that way is through His word. His word teaches us that. And the moment that we apply that to our lives, day by day, the same way like with our health, our sickness, our weakness, our insecurities, How can we change that? We can only change it the moment that we apply it into our lives, little by little. And through that is the moment that we can see transformation and a step of moving forward and also breakthrough. Breakthrough is only done through changing our old selves. Because our old self is very hard to break, because we still carry that. Understanding Suffering and Connection to God Bill Gasiamis (54:35) Yeah, I agree with a lot of what you’re saying. Some people will be listening and going, well, if God is so good, why did God do this to me? You know, some people are far more injured because of stroke than you or I, even though your injuries and mine are all valid. There’s people who won’t walk again. There’s people who lose their memory, who can’t remember anymore. There’s people who cannot get their speech back. There’s people who’s… left arm, right leg won’t work again, then there’s people who will pass away. And then some of those people find that they’ve been harshly treated by God, by their maker, their creator. How do you talk to people like that to make them feel like it’s not personal? God, your creator, your maker has not gone after you and ⁓ is not punishing you. Like what do you say to people who lose connection with spirit, with God, with their creator? Jonathan Arevalo (55:40) Yeah, well, what I can say is that that God is so merciful, right? And because God is so merciful and through His love, we see in God’s Word that He died for us in the cross for our sins and is due to sin that we go through all these challenges. And that’s the connection through a broken world that we live in. is because everything comes from sin. And sometimes it’s hard to say, why is this happening to me? Or why am I not getting better? Well, everything goes back to sin. And because until we kind of, until we accept Jesus Christ, but not only accept Jesus Christ, but at the same time, God allows certain things that we have to go through. We have to go through certain challenges or obstacles, right? But it’s really hard to say. I find it. Maybe to answer that question. Bill Gasiamis (56:47) Yeah. I actually don’t mind the word sin when you use the word sin, because I’ve recently discovered ⁓ some people’s meaning of the word sin is to take that an incorrect aim to aim in the wrong direction. And I really relate to that. So when I sin, I don’t kind of see it as a, ⁓ you good, me bad. Like, do you know, don’t, I don’t sort of see that type of thing. It’s just aiming in the wrong direction. For example, previously my life was led by my head. It was my head that was telling me this sounds like a good idea. Yeah, we should have three cars. We should have the biggest house possible. We should do all of that. My head was guiding my life, whereas now my head is supporting my heart to guide my life. That’s why the podcast exists, because the podcast is not about what my head thinks is a good idea. Because if my head thought it was a good idea, this podcast should be making a shitload of money and it’s not making a ton of money. That’s why I request support from Patreon. That’s why I wrote a book to make a little bit of money so that I can ⁓ cover the costs of recording, editing, uploading, hosting a podcast. Like that’s the reason why it needs to make money, but it doesn’t need to make hundreds of thousands or millions and millions of dollars. My head in the old days would be going, dude. Don’t ever do 400 episodes of stroke survivors podcast. I’m not interested in that. And I, and I would be going, okay, what do I need to do? And my head would be going, you need to 24 hours a day, seven days a week and make as much money as you can. So you can have all the things that we’re told by the marketing companies that you need to have. I see that as a sin. Do you understand? That is the wrong aim. I’ve taken aim. dude and I’m putting all my energy into the wrong things. Whereas now I’ve taken aim and adjusted and now I think I’m aiming in the right direction. It’s about purpose, meaning, connecting with other people, helping other people, supporting other people. I’m no longer sinning in that particular way. That’s the literal description of the word sin. So it’s really important that I learned that because if I didn’t learn that I would be taking when I hear the word sin as a me bad, everyone else good. And that’s definitely not what it is. And that’s what I think the, the bleeding in my brain helped me adjust the aim, redirect where I was heading in my life, who was important, why they were important to me. ⁓ and, and my community is not a church. but I’m creating my own community on this podcast, know, 400 interviews, people who reach out from you all around the world. It’s the same kind of community, giving community as a church community is. We support each other, we help each other, we give people information, we connect other people with ⁓ doctors and conditions and solutions. So it’s like, yeah, that’s what I was lacking. I was lacking community. Jonathan Arevalo (1:00:01) community. Bill Gasiamis (1:00:02) I was lacking people who understood me and who were similarly aligned to me. You know, I was connecting with people who were sinning in their own way because their direction was all wrong and we were finding each other and we were making life harder for ourselves by being all in our heads and not connected to our body and our heart, right? Jonathan Arevalo (1:00:23) Yeah, that’s right. Bill Gasiamis (1:00:25) That’s kind of my religious journey without connecting it to a religion or to a religious chapter or to a church in a particular location. But I still feel like it’s a religious journey, you know? Jonathan Arevalo (1:00:39) Yes, like the moment that you build fellowship as we’re doing right now, we’re sharing our stories and we’re sharing our journey as stroke survivors. And through this story is what shows which is what shows purpose and also can leave an impact to others, survivors. Because if we don’t show a difference and if we don’t help support other people, then what purpose do we have on this earth? Right? We’re here to help one another and to be different in a good way. Building Community and Fellowship Because every single time we’re always going to be going through different challenges. Whether it’s negative thoughts or everything that we see on TV. Because every single time that we’re looking at the news is always bad news, So all those negative thoughts are something that we are affected day by day. And the only way that we’re able to overcome those negative thoughts is by putting ourselves surrounded in other things. Other things that can help us strengthen our mind, our body, and emotions. But that’s something that takes day by day. Bill Gasiamis (1:02:14) Yeah, I love it. I love your journey. I love how similar we are in our path, even though we talk about it in a slightly different way. ⁓ Leading a good example is something that was very important to me. I want to be a good example for my kids. In my book, ⁓ the dedication says to all the stroke survivors who are dealing with the aftermath of stroke. and despite it all are seeking transformation and growth. And that’s the first part of the dedication. And the second part of the dedication says to my family, I hope that that I have set a good example. I mean, my only goal, my only goal is to set a good example, to show them when adversity comes, how you can respond. There’s a Jonathan Arevalo (1:02:59) Thank Bill Gasiamis (1:03:10) I think there’s a way to respond that’s wrong. And then there’s many ways to respond that are right. There’s a one, there’s unfortunately, you know, responding by going back to the way that you were before, think is the wrong way to respond. then finding a new path forward, taking aim and choosing the wrong direction, sinning, and then readjusting, and then going again in another direction, I believe. like is the example that we need to set for other people just so that my kids can see in the future when they go through a tough time, they go, I think I remember one way that my dad did it that might be supportive of my recovery down the path and see, okay, this is what dad did. I don’t need to do what dad did, but this is kind of how he thought about that and how he approached that. That’s really. what I was sitting out to achieve. And I think I’ve achieved that and I feel really good about that, you know. Jonathan Arevalo (1:04:17) Yeah, no, I think that’s excellent, Bill. I’m glad that you were able to create a podcast. And ⁓ thank you for this opportunity because I never thought I’d be able to share my story. And as well for the fact that your sharing was called, ⁓ that you created a book to tell about your stroke survival. And I think that that’s going to impact many, many, many other survivors. They’re going through difficult times and I think that’s amazing. Bill Gasiamis (1:04:52) Yeah, thank you. A lot of people have bought it. I think there’s at least 600 copies being sold at this stage. And that’s not a lot. It’s not a million copies, but ⁓ it was never about the number. It was just about having it available just so that people can come across it if they need to and ⁓ read it and just see a different perspective of how you can approach your recovery. ⁓ You can get the book at recoveryafterstroke.com/book for anyone that’s watching and listening. So as we kind of get to the end of this interview, tell me what’s next for you. What’s on the to-do list? What goals do you have that you want to achieve? Future Goals and New Beginnings Jonathan Arevalo (1:05:31) Yes, well, what I’ve been able to achieve ⁓ was that I ended up getting married this year. Thank you. It wasn’t something expected because I thought maybe it’s not going to be possible to meet someone based on my condition and everything, but… Everything changed. And so I got married on April 11th of this year. So I’m now married. And the other thing that I started this year was besides the volunteering, I also created ⁓ my own like small business when it comes to mentorship to help other people, which are people that are either stroke survivors. People with disability and also mental health. And I created my website on that to help a lot of people. And it’s ⁓ non-profit at the moment, which is donation-based. And I’m still helping in the community. I still volunteer. And I still ⁓ help out in the church and many other places. So those are the things that I’m still currently doing. Bill Gasiamis (1:07:02) Fantastic, man. So the website, we will have the links to all of the different social media and your website, et cetera, for people to follow if they want to connect with you. ⁓ The journey that you’re on, you’re calling it the 20, the project 21. Jonathan Arevalo (1:07:28) Yes. The reason I called it Project 21, because this journey that I’m going through is like a form of a project. And everything started in 2021. So that’s why I decided to pick something unique and different and call it Project 21. Bill Gasiamis (1:07:51) Yeah, fantastic, Jonathan. I really appreciate our conversation. Thank you for reaching out and joining me on the podcast. I love the work that you’re doing and will continue to do. There’s many, many years ahead of you of doing fantastic work and I look forward to keeping in touch and finding out how your journey unfolds. Jonathan Arevalo (1:08:14) Yes, thank you, Bill. I appreciate it. Bill Gasiamis (1:08:17) Well, thanks so much for listening to this episode of the Recovery After Stroke podcast. And thank you to Jonathan for sharing a story that takes a lot of courage to revisit. One thing I hope you take from this conversation is that recovery is never just physical. It’s emotional, it’s messy, it’s confusing, but it is also an opportunity to rediscover who you can become. Jonathan’s journey shows that healing doesn’t always look like we expect. And sometimes the smaller steps forward end up becoming the most meaningful ones. If this episode helped you feel understood or gave you something to think about on your recovery path, remember to visit patreon.com/recoveryafterstroke. Some people believe their support won’t make a difference, but that’s an assumption that simply isn’t true. Every contribution helps me continue producing these episodes, keep them online and moving toward my goal of recording a thousand conversations. So no stroke survivor ever has to feel like they’re going through this alone. And if you haven’t already, you can also order my book, The Unexpected Way That a Stroke Became the Best Thing That Happened at recoveryafterstroke.com/book. Many listeners expect it to be just my personal story, but it’s actually something much more useful. It’s the guide I wish existed when I was confused, overwhelmed, and trying to figure out how to rebuild my life after stroke. Thank you again for being here, for listening, and for supporting the work in whatever way you can. You’re not alone in this. and I’ll see you on the next episode. 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. The 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 subst

In this edition of 32 Thoughts The Podcast, Kyle Bukauskas and Elliotte Friedman begin the podcast by unpacking the Edmonton Oilers' woes as they crumbled 8-3 against the Dallas Stars on Tuesday night. The discussion moves to the thriving Ottawa Senators as they get Brady Tkachuk back into the lineup (21:55). Kyle and Elliotte talk about the Calgary Flames who extended GM Craig Conroy (30:00). They talk about the Canucks winning a big game in Anaheim after management sent that memo out (33:16). The fellas focus on the Craig Berube-William Nylander dynamic in Toronto (35:00). The Final Thought focuses on the juggernaut Colorado Avalanche and their successful focus on defence (47:30).  Kyle and Elliotte answer your emails and voicemails in the Thoughtline (52:38).Today we highlight Toronto rock musician Keegan Powell and his track Drown. Check his music out here.Listen to all the 32 Thoughts music here.Donate to the Canadian Heart and Stroke Foundation here.Email the podcast at 32thoughts@sportsnet.ca or call the Thought Line at 1-833-311-3232 and leave us a voicemail.This podcast was produced and mixed by Dominic Sramaty and hosted by Elliotte Friedman & Kyle Bukauskas.The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the position of Rogers Sports & Media or any affiliates

In this edition of 32 Thoughts, Kyle Bukauskas and Elliotte Friedman open with the growing concern around several struggling Canadian teams, especially in Toronto, where the pressure is creeping into the room and the trade options are limited. The guys discuss Montreal signing Alexandre Texier (17:30), Vancouver's loss to Calgary, and why the Canucks are poised to become rumour central as they gauge the market on their players (19:46). They dig into the Flames' dilemma between avoiding a rebuild and handling players who may want out, plus reaction to Don Maloney's recent comments (23:54). The fellas touch on Edmonton's hard-earned road win in Florida (37:26), Minnesota's sudden defensive surge with back-to-back shutouts (47:12), and a shoutout to Ottawa (47:41). Elliotte shares a note about Pittsburgh's goalies being potentially available (49:37), checks in on Andrei Svechnikov's trade availability (52:54), and provides an update on the NHL/NHLPA's Milan arena visit (58:35). The Final Thought focuses on Mikko Rantanen's one-game suspension for his hit on Matt Coronato (1:04:05).Kyle and Elliotte answer your emails and voicemails in the Thoughtline (1:10:33).Today we highlight Toronto emo power pop band Heavy Sweater and their track X-Ray. Check them out here.Listen to all the 32 Thoughts music here.Donate to the Canadian Heart and Stroke Foundation here.Email the podcast at 32thoughts@sportsnet.ca or call the Thought Line at 1-833-311-3232 and leave us a voicemail.This podcast was produced and mixed by Dominic Sramaty and hosted by Elliotte Friedman & Kyle Bukauskas.The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the position of Rogers Sports & Media or any affiliates

In this edition of 32 Thoughts, Kyle Bukauskas and Elliotte Friedman open with the struggling Edmonton Oilers heading into Sunrise and why their goaltending remains the biggest issue under the microscope. The fellas look at Montreal's 8–4 loss to Washington and similar concerns in net (12:38) before shifting to Nashville and whether it's time for the Predators to consider selling pieces (19:09). Elliotte gives the Avalanche their flowers (24:07). They discuss Matthew Schaefer being placed on the Olympic drug-testing protocol and whether he fits on Team Canada (30:58), as well as Connor Bedard earning an ‘A' in Chicago and the debate around bringing him to the Olympics (38:23). The guys touch on Adam Lowry's extension in Winnipeg (44:53), Brad Lambert receiving permission to seek a trade (49:49), and Ottawa aiming for a home-run swing on the market (55:20). The Final Thought highlights Alex Ovechkin and a Capitals team that's heating up (57:52).Kyle and Elliotte answer your emails and voicemails in the Thoughtline (1:05:26).Today we highlight Toronto-based band Heaven For Real and their song Unlimited Time. Check them out here.Listen to all the 32 Thoughts music here.Donate to the Canadian Heart and Stroke Foundation here.Email the podcast at 32thoughts@sportsnet.ca or call the Thought Line at 1-833-311-3232 and leave us a voicemail.This podcast was produced and mixed by Dominic Sramaty and hosted by Elliotte Friedman & Kyle Bukauskas.The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the position of Rogers Sports & Media or any affiliates

In this edition of 32 Thoughts, Kyle Bukauskas and Elliotte Friedman open with Adrian Kempe's extension talks before shifting to the growing conversation around Tage Thompson and why Buffalo has no interest in moving him (7:37). The guys look at a tough week of injuries across the league, including Sam Honzek and Jack Hughes' freak incident (11:04). They discuss the NHL and NHLPA's upcoming visit to Milan to monitor Olympic rink construction (20:49). They explore whether Andrew Brunette is feeling pressure in Nashville (26:29), Toronto's five-game slide and how different the Blackhawks and Connor Bedard look under Jeff Blashill (30:23), and Hockey Canada's hesitation about taking Schaefer, Bedard, and Celebrini to Milan (38:47). The Leafs' search for roster-for-roster trades comes up (46:45), as does Vancouver winning the David Kämpf sweepstakes while Montreal hunts for a stop-gap centre (56:31). Elliotte also breaks down Mark Scheifele's misconduct after a hot mic caught his comments (1:04:41), plus the chaos between the Rangers and Red Wings following an empty-net goal after time expired (1:08:05). The Final Thought spotlights the Dallas Stars' Hall of Fame Weekend (1:13:25).Kyle and Elliotte answer your emails and voicemails in the Thoughtline (1:33:14).Today we highlight Vancouver-based electronic-indie duo Carbon Mass and their single Impulse. Check them out here.Listen to all the 32 Thoughts music here.Donate to the Canadian Heart and Stroke Foundation here.Email the podcast at 32thoughts@sportsnet.ca or call the Thought Line at 1-833-311-3232 and leave us a voicemail.This podcast was produced and mixed by Dominic Sramaty and hosted by Elliotte Friedman & Kyle Bukauskas.The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the position of Rogers Sports & Media or any affiliates

Project Red talk fashion, the Heart and Stroke Foundation, meeting celebrities, tarot cards and life lessons.

In this edition of 32 Thoughts, Kyle Bukauskas and Elliotte Friedman open with the Maple Leafs' early-season struggles after a 4–3 loss to the Kings, and why Toronto can still afford to be patient on the trade front. The guys provide an update on David Kämpf's situation and whether Montreal could be a fit (16:11) before touching on Adrian Kempe beginning extension talks in Los Angeles (20:56). They run through notes from the GM Meetings (24:10), check in on Ottawa's seven-game point streak and Shane Pinto's new deal (27:05), and discuss the concern in Vancouver after Thatcher Demko's injury (39:40). Elliotte weighs in on the mood in Buffalo with no update on Tage Thompson (47:16). The fellas unpack the exciting Islanders-Golden Knights tilt from Thursday (50:32). Plus Elliotte talks about his latest “For You Page” discovery (56:07). The Final Thought pays tribute to the late New York sports writer Larry Brooks (58:30).Kyle and Elliotte answer your emails and voicemails in the Thoughtline (1:07:15).Today we highlight Montreal singer-songwriter Nadia Hawa Baldé aka HAWA B and her single Je veux rester. Check her out here.Listen to all the 32 Thoughts music here.Donate to the Canadian Heart and Stroke Foundation here.Email the podcast at 32thoughts@sportsnet.ca or call the Thought Line at 1-833-311-3232 and leave us a voicemail.This podcast was produced and mixed by Dominic Sramaty and hosted by Elliotte Friedman & Kyle Bukauskas.The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the position of Rogers Sports & Media or any affiliates

In this edition of 32 Thoughts, Kyle Bukauskas and Elliotte Friedman open with the red-hot Anaheim Ducks, their seven straight wins, and a new challenge ahead: paying Leo Carlsson. The guys discuss the clear power imbalance between conferences and break down Colorado's 9-1 demolition of Edmonton, asking when it's time to truly worry about the Oilers (9:30). They touch on Toronto's scoring prowess contrasted by their leaky defense and goaltending issues, plus an update on David Kämpf (24:33). Elliotte revisits the Blues' brutal loss to Seattle and whether Doug Armstrong might go back to his familiar “holiday sale” playbook (40:52). The segment wraps with fallout from the U.S. government shutdown's impact on NHL travel (46:52) and a Final Thought on the uncertainty around designated 19-year-olds in the AHL (48:55). Kyle and Elliotte answer your emails and voicemails in the Thoughtline (57:25).Today we highlight Heartland New Brunswick's Seth Anderson and his newest single Leafs Are Out. Check him out here.Listen to all the 32 Thoughts music here.Donate to the Canadian Heart and Stroke Foundation here.Email the podcast at 32thoughts@sportsnet.ca or call the Thought Line at 1-833-311-3232 and leave us a voicemail.This podcast was produced and mixed by Dominic Sramaty and hosted by Elliotte Friedman & Kyle Bukauskas.The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the position of Rogers Sports & Media or any affiliates

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In this poignant and powerful final episode of The Gritty Nurse Podcast, we close this chapter with a truly essential conversation. We are honoured to welcome former Minister Mark Holland, who offers an exclusive look into the federal government's pivotal efforts to improve Canadian healthcare. From the pressing issue of Pharmacare to strategies for a healthier nation, Minister Holland addresses what's being done on a federal level to make a tangible difference in the lives of Canadians. Amie & Sara dive deep into the critical issues that define our healthcare landscape. We discuss the pervasive problem of healthcare silos across Canada and the urgent need to address health misinformation and improve health literacy. We bring into sharp focus the national nursing shortage, exploring how the government plans to integrate and rely on nursing to fortify primary care. Finally, we raise a crucial concern about protecting Canada's borders from potential health threats, particularly in light of recent public health challenges in the US. Join us for this unmissable episode as we reflect on the journey of The Gritty Nurse, celebrate the grit of healthcare professionals, and look towards a healthier future for all Canadians. Thank you for being a part of our community. Mark Holland Bio: The Honourable Mark Holland was first elected as the Member of Parliament for Ajax in 2004, serving until 2011, and was re-elected in 2015, 2019, and 2021. A lifelong resident of the Ajax-Pickering area, Minister Holland has served his community for over 20 years. Before entering federal politics, he was elected as a Durham Regional Councillor, serving from 1997 to 2004. As a Member of Parliament, Minister Holland has served in many roles including as the Leader of the Government in the House of Commons, and as Chief Government Whip. He has been a staunch advocate of marriage equality rights, and played a key role in helping to reform Canada's animal cruelty laws. In both public and private roles, Minister Holland has backed health-related initiatives, serving as Executive Director of the Heart and Stroke Foundation of Canada's Ontario Mission, as well as its National Director of Children and Youth. As Minister of Health, Minister Holland has worked to sign bilateral health care funding agreements with provinces and territories to improve health care across the country, launched the Canadian Dental Care Plan that will help up to 9 million Canadians get the essential dental care they need, and recently has introduced pharmacare legislation that will provide universal access to contraception and diabetes medications. Social Media Links: Mark Holland (@markhollandlib) • Instagram photos and videos https://x.com/markhollandlib?s=21   Thank You to Our Gritty Nurse Community As we close this final chapter, we want to extend our deepest gratitude to everyone who has been a part of The Gritty Nurse journey. To our loyal listeners, your unwavering support and engagement have fueled every episode. To our incredible friends, guests, and guest co-hosts, thank you for sharing your invaluable insights, stories, and expertise—you've enriched every conversation and truly made this podcast what it is. We also want to acknowledge the media for amplifying our voice and helping us reach a wider audience. And to everyone who has cheered us on, shared an episode, or simply been along for the ride, your belief in our mission has meant the world. It has been an honour and a privilege to connect with you all, and we are profoundly grateful for every moment of this incredible journey. Sincerely, With GRIT and Gratitude Amie & Sara Order our Book, The Wisdom Of Nurses! Leave us a review on Amazon! https://www.harpercollins.ca/9781443468718/the-wisdom-of-nurses/  https://www.grittynurse.com/ YouTube: https://www.youtube.com/@grittynursepodcast  Facebook: https://www.facebook.com/grittynurse Instagram: https://www.instagram.com/gritty.nurse.podcast/ X: https://x.com/GrittyNurse  LinkedIn: https://www.linkedin.com/company/grittynurse  

Today is World No Tobacco Day. The global theme this year is "Unmasking the appeal: exposing industry tactics on tobacco and nicotine products. A study conducted by the South African Tobacco-Free Youth Forum shows how the tobacco industry employs aggressive and calculated strategies to appeal directly to young people. Now experts and advocacy groups are calling for decisive action. For more Bongiwe Zwane spoke to Sister Juandre Watson, Health Promotion & Health Risk Assessment Programme Team Lead at the Heart and Stroke Foundation

Women make up half the population in Canada yet there are still major gaps in women's health research. Experts say investments addressing this gap could add years to life and boost the global economy. The Agenda invites Carmen Wyton, Chair and Founder of Women's Health Coalition of Canada; Dr. Amanda Black, Professor of, Obstetrics and Gynecology at The University of Ottawa; and Christine Faubert, Vice President of Health Equity & Mission Impact, at the Heart and Stroke Foundation of Canada to discuss.See omnystudio.com/listener for privacy information.

Dr. Lisa Murphy, CEO of the Stroke Foundation, discusses stroke recovery, advocacy, and the support services stroke survivors need now more than ever. The post Dr. Lisa Murphy on Stroke Recovery, Advocacy, and a New Vision for Survivors appeared first on Recovery After Stroke.

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Suster Juandre Watson, spanleier van die Heart & Stroke Foundation se gesondheidsbevordering en gesondheidsrisiko-evalueringsprogram, praat oor Wêreldgesondheidsdag.

Cari Erasmus 'n geregistreerde dieëtkundige by The Heart & Stroke Foundation oor Wêreldvetsugdag.

He is “The Man for All Seasons”.Name the sport and Rod Black has more than likely called the game.For 40 years, the award-winning broadcaster has had a front row seat and provided a soundtrack to many of Canada's greatest sports moments.From his early days as a young reporter at CKY TV in Winnipeg to his network commitments as a host and play by play announcer with CTV and TSN, Black has done it all. From NHL hockey to the NBA, Major League Baseball to the NFL and CFL, PGA & LPGA golf, World Championship boxing, ATP and WTA tennis, international figure skating, Indy Car and Formula One auto racing, the Masters, the Kentucky Derby, World Cup Soccer, speedskating, cycling, Canadian & USA college sports and of course both the Summer and Winter Olympics where Black not only hosted prime time shows in 1992 and1994 but also called several historic gold medals in 2010 and 2012.A consummate professional who displays passion and excitement in all that he does, Black is a nine time Canadian Screen Award & Gemini nominee. In 2005, Rod received the Sports Media Canada award for Most Outstanding Broadcaster.Inducted into the media wing of the Manitoba Sports Hall of Fame, Black's broadcasting abilities are not limited to the sports world. The ultra-adaptable announcer is a popular guest speaker, a voice and film actor, an author, and the former co-host of Canada AM-Canada's most-watched national morning show.Despite his chaotic work schedule Rod still has found time to lend his voice and donate his time to a great number of Canadian charities – Special Olympics, Sick Kids Hospital, Childrens Aid Foundation, Easter Seals, United Way, Right to Play, Pro Action Cops and Kids, Kids Help Phone, Canadian Cancer Society, CNIB, CAMH, the Heart and Stroke Foundation, and many more.An honorary spokesperson and ambassador for Plan Canada, Rod has received the Queen's medallion and Diamond Jubilee medal for volunteerism.When asked what his favorite moment has been in his acclaimed career, Rod pauses and says, “The next one. Truly, I absolutely love every memory, but I also wake up every day knowing that there are new great memories to discover. That is what sport teaches us. To enjoy the moments and create new ones. Learn all the lessons from these games – good and bad - and hopefully adapt them into our day to day lives. Nothing can do that like sport.”#rodblack #mediapersonality #playbyplayannouncer #chrispomay #livewithcdp #barrycullenchevrolet #cebl #scarboroughshootingstarshttps://beacons.ai/chrisdpomayhttps://www.cameo.com/chrispomayhttps://www.barrycullen.com/Want to create live streams like this? Check out StreamYard: https://streamyard.com/pal/d/54200596...

This week we meet some non-voters in northern Ontario, Sudbury NHLer Nick Foligno and his wife Janelle talk about becoming Heart and Stroke Foundation ambassadors, a look at how the health centre on Manitoulin keeps its emergency room open, we hear about a new card game company in Sudbury, and the Baxter Cup marks a 100 year rivalry between the curling clubs in Espanola and Little Current.

Jessica Pang-Parks is a volunteer engagement thought leader who helps organizations build trust, create impact, and inspire belonging. She is the recipient of the 2021 Alison Caird Young Leader Award in recognition of her leadership and excellence in volunteer engagement and the recipient of the 2023 VMPC Exemplary Leader Impact Award in recognition of her contributions to the field as a mentor, leader, trainer, and advocate.Jessica earned her CVA credential in April 2023 and has facilitated Fleming College's Volunteer Management: Spectrum of Engagement course since May 2022. She has held professional volunteer and community engagement roles at Crohn's and Colitis Canada, Pathways to Education Canada, the Heart & Stroke Foundation, Volunteer Toronto, and WWF-Canada.Jessica has the privilege to work on the traditional land of the Huron-Wendat, the Seneca, and the Mississaugas of the Credit. Learn more about Jessica at www.learnwithjpp.com.In this episode of The Nonprofit Insider Podcast, we dive into the volunteer side of the nonprofit world with volunteer engagement thought leader Jessica Pang-Parks. As the recipient of multiple leadership awards and a CVA credential holder, Jessica brings a wealth of knowledge on how nonprofits can build trust, create impact, and inspire belonging through effective volunteer management.We explore:Jessica's “State of the Union” on the current state of volunteerism.The unique challenges volunteer managers face and whether they're underappreciated.Her personal journey into consulting and the strategies she uses to combat nonprofit burnout.Key insights for hiring the right volunteer management consultant.Her outlook on nonprofit priorities in 2025.A captivating #NonprofitHorrorStory that sheds light on the realistic challenges behind the scenes.Whether you're an executive leader, board member, or volunteer coordinator, Jessica's insights will help you reimagine the role of volunteer engagement in your organization.Episode BreakdownState of the Nonprofit Volunteer Space – Jessica's take on how volunteer engagement is evolving.Challenges for Volunteer Management Leaders – Exploring the complexity and undervaluing of this critical role.Getting to Know Jessica – Her personal journey into volunteer engagement leadership and consulting.Burnout & Beyond – Insights into the growing issue of burnout among nonprofit professionals.Hiring a Volunteer Management Consultant – What to consider for ROI and organizational fit.Looking Ahead to 2025 – Jessica's advice on key priorities for nonprofit leaders this year.#NonprofitHorrorStory – A behind-the-scenes look at real-life mishaps in the nonprofit world.Connect with JessicaWebsite: www.learnwithjpp.com

Trey and Brian lace up their sneakers and hit the road with inspiring ultramarathoner Ryan Keeping. Ryan Keeping is a Canadian ultramarathoner who devoted himself to running coast-to-coast across his home country in under 100 days to honor the memory of Terry Fox and raise funds and awareness for the Heart and Stroke Foundation. During his historic and inspiring journey, he not only broke the limits of what he once thought was possible, but raised more than $250,000.   Brian Phelps is an American radio personality, actor, and comedian best known for co-hosting the nationally and globally syndicated Mark & Brian Morning Show in Los Angeles for 25 years. As the co-lead of his own television series, with multiple roles in movies, and a Star on the Hollywood Walk of Fame, Phelps is also an inductee in the Radio Hall of Fame.Trey Callaway is an American film and TV writer and producer who wrote the hit movie I Still Know What You Did Last Summer, and has produced successful TV series like CSI:NY, Supernatural, Rush Hour, Revolution,  The Messengers, APB,  Station 19 and 9-1-1 LONE STAR. He is also a Professor at USC.___________________________________Make sure to follow us on social media at:begoodhumanspodcast.cominstagram.comtiktok.comthreads.netfacebook.com

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My guest today is Trisha Fuller. Trisha Fuller is a Master Hypnotist/ NLP Practitioner, Trainer and International Speaker. Owner of Sherwood Park Hypnosis Center and The Canadian Hypnosis Academy. Trisha is passionate about helping others achieve their goals and design their successful future with hypnosis and NLP skills with private online sessions, corporate trainings, seminars and courses. Her inspiration and motivation stems from her own personal triumphs with hypnosis, Quitting Smoking and Hypnotic Childbirth. These successes inevitably changed the course of her life. Once a Laboratory and X-ray Technician, now a successful business owner with multiple clinic locations and a vocational school. Her teaching background is enhanced from years of teaching First Aid and CPR with the Canadian Red Cross and the Heart and Stroke Foundation, as well as Hypnosis for Childbirth with Hypnobabies. As a wife and mother of 3, living in a remote rural location she has had to learn to become curious and discover alternatives to building her business, balancing career and family, while commuting. This has broadened her perception of opportunities that people truly have. Helping clients, students and entrepreneurs, find their unique solutions, using hypnosis and NLP is her main focus. In this episode we discuss hypnotherapy, NLP, forgiveness, transformation and asking for help.Website - https://learnhypnosis.ca/IG - https://www.instagram.com/learnhypnosis.ca/FB - https://www.facebook.com/trisha.fuller.5/LinkedIn - https://www.linkedin.com/in/canadianhypnosisacademy/YouTube - https://www.youtube.com/@LearnHypnosis.caTrishaFullerX (Twitter) - https://x.com/hypnosisablearnIn this episode you will learn:1. What some common misconceptions about Hypnosis and NLP.2. The difference between a Hypnotherapist and a Master Hypnotherapist.3. Some of the most common reasons that people use Hypnotherapy. "Let's just start at the beginning. There is definitely basic hypnosis. Like you just learn the actual skills and then there's like clinical, there's advanced hypnosis, NLP practitioner, NLP master pack, all of these things." - 00:05:03"I'm a guide with a very specific tool set. And I think this is a future question for you. I don't do other modalities. I do hypnosis and NLP."- 00:25:49"You are the exact person you were meant to be. And everything that you have gone through was meant to happen and there's no shame and guilt in that." - 00:53:24Are you an author speaker coach or entrepreneur building a brand in today's very crowded marketplace? How do you stand out? Join me on Sept 27th and learn how to empower your message and shine as a guest on podcasts for just $97. Imagine stepping into that interview with clarity and conviction, connecting deeply with listeners who are eager to hear what you have to say. Imagine the satisfaction of knowing you've nailed it, leaving your audience inspired and wanting more. This would position you as an authority to thousands of people in your industry. Let's turn those nerves into excitement and make sure you shine on your podcast appearance. Together, we'll boost your confidence, polish your messaging for impact, and get you ready to deliver an interview that makes people fall in love with your from the first words. Ready to shine on podcasts? Let's do this! Click the link below to register.https://empowerographypodcast.com/empower-your-messageContact Brad:WebsiteInstagramLinkedInYouTubeX (Twitter)TikTok#empowerographypodcast #women #womensempowerment #empowherment #entrepreneurship #womeninentrepreneurship #empoweredwomen #empowerelevateeducate #findingyourpurpose #podcast #womensupportingwomen #soulalignment #heartcentered #selflove #resilience #personalgrowth #mindset #spirituality #healing #heartspace #forgiveness #hypnotherapy #masterhypnotherapist #NLP #alignment #transformation #intuition #askingforhelp #innergrowth #innerjourney #receiving

New research has found the number of Australians suffering a stroke each year is increasing. More than 45,000 Aussies experienced a stroke last year, equivalent to  one person every 11 minutes. Luke Grant chats with CEO of the Stroke Foundation, Dr Lisa Murphy, to find out why stroke numbers are on the rise and to discuss this month's Stride4Stroke campaign, which sees participants set an activity goal to to lower their own stroke risk and raise funds for prevention and research. You can find more details here Listen to Luke Grant live on air from 9am Saturday & Sunday on Weekends with Luke Grant.See omnystudio.com/listener for privacy information.

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In this powerful and inspiring bonus episode, we delve into the remarkable journey of Shruti Kothari, a 34-year-old actress and stroke survivor. On March 7, 2020, just before the pandemic shook the world, Shruti experienced a stroke while hosting friends at her apartment. Her left side went numb, and thanks to a quick-thinking friend trained in recognizing stroke symptoms, paramedics were called immediately. Shruti's story is not just one of survival but thriving against all odds. She talks about her rehabilitation process, an innovative program that helped her regain movement in her arm, and her determination to continue her acting career. Despite the challenges, Shruti's optimism and drive to give back to the community shine through. Additional ResourcesUHN's Stroke Prevention ClinicDr. Pikula was interviewed in the Your Complex Brain episode "The Rise of Stroke in Young Adults"UHN Foundation video "Shruti's journey back to the stage, with some help from Team UHN"Heart and Stroke Foundation of Canada – Women's Digital HubWorld Stroke Academy podcast featuring Dr. LindsayThe Your Complex Brain production team is Heather Sherman, Jessica Schmidt, Dr. Amy Ma, Kim Perry, Alley Wilson, Sara Yuan, Meagan Anderi, Liz Chapman, and Lorna Gilfedder.The Krembil Brain Institute, part of University Health Network, in Toronto, is home to one of the world's largest and most comprehensive teams of physicians and scientists uniquely working hand-in-hand to prevent and confront problems of the brain and spine, such as Parkinson's, Alzheimer's, epilepsy, stroke, spinal cord injury, chronic pain, brain cancer or concussion, in their lifetime. Through state-of-the-art patient care and advanced research, we are working relentlessly toward finding new treatments and cures.Do you want to know more about the Krembil Brain Institute at UHN? Visit us at: uhn.ca/krembilTo get in touch, email us at krembil@uhn.ca or message us on social media:Instagram - @krembilresearchTwitter - @KBI_UHNFacebook - https://www.facebook.com/KrembilBrainInstituteThanks for listening!

Join Manuel Arango, the director of Health Policy & Advocacy at the Heart and Stroke Foundation of Canada. We dive into the pressing issue of food marketing to children, exploring how these strategies impact kids' health and dietary habits. Manuel shares insights into the ongoing efforts to regulate unhealthy food and beverage marketing in Canada, why it's crucial for the government to act, and how parents can navigate the challenges posed by aggressive marketing tactics. Manuel Arango is the director of Health Policy & Advocacy at the Heart and Stroke Foundation of Canada. He discusses the KevinMD article, "Why my 5-year-old is helping with my PhD thesis." Our presenting sponsor is DAX Copilot by Microsoft. Do you spend more time on administrative tasks like clinical documentation than you do with patients? You're not alone. Clinicians report spending up to two hours on administrative tasks for each hour of patient care. Microsoft is committed to helping clinicians restore the balance with DAX Copilot, an AI-powered, voice-enabled solution that automates clinical documentation and workflows. 70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences. Help restore your work-life balance with DAX Copilot, your AI assistant for automated clinical documentation and workflows. VISIT SPONSOR → https://aka.ms/kevinmd SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme I'm partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus

Matthew Pantelis speaks with Dr Lisa Murphy, CEO, Stroke Foundation who says more people are having strokes. Listen live on the FIVEAA Player. Follow us on Facebook, X and Instagram.See omnystudio.com/listener for privacy information.

Ryan Keeping of Halifax ran 75 kilometers a day to get from St. John's, Nfld., to Victoria, B.C., to complete his cross-country journey in just 99 days. He joins host Jeff Douglas to talk about why it was important to him to raise money for the Heart and Stroke Foundation.

A stroke happens when there is a sudden blockage of blood flow to the brain or bleeding in the brain, which can result in symptoms such as numbness or weakness, trouble speaking, confusion, or dizziness. The type of symptoms one might experience depends largely on the type of stroke, and the area of the brain affected. But one thing is clear – despite the many advances in stroke care over the past 30 years, it's women who often suffer the most.  In today's episode, we discuss why women are more susceptible to stroke, what the unique risk factors are, and what women need more of to help them recover, not only from the medical condition, but the impacts to their careers, their mental health and their families. Featuring: Dr. Aleksandra Pikula, MD, PhD, is a neurologist and clinician-investigator at UHN's Krembil Brain Institute and the newly appointed Jay and Sari Sonshine Chair in Stroke Prevention and Cerebrovascular Brain Health at UHN. Dr. Pikula advocates for a holistic approach to brain care, specifically targeting stroke and dementia prevention during midlife through evidence-based lifestyle medicine pillars.Patrice Lindsay, PhD, is currently the Lead for the People With Lived Experience (PWLE) Engagement and Stroke Strategy at the Heart and Stroke Foundation of Canada. Dr. Lindsay leads strategic directions for health systems design and change for people with stroke and heart conditions across Canada and internationally. Shruti Kothari is an actress born, raised, and residing in Toronto. Her career was focused largely on Shakespeare and Musical Theatre until her life took an unexpected turn when she suffered a life-altering brain hemorrhage and stroke at the age of 30. Over the past four years, Shruti has focused on reshaping her life and raising awareness about brain injuries in younger people. Additional resources: UHN's Stroke Prevention ClinicDr. Pikula interviewed in the Your Complex Brain episode “The Rise of Stroke in Young Adults”UHN Foundation video “Shruti's journey back to the stage, with some help from Team UHN”Heart and Stroke Foundation of Canada – Women's Digital HubWorld Stroke Academy pThe Your Complex Brain production team is Heather Sherman, Jessica Schmidt, Dr. Amy Ma, Kim Perry, Sara Yuan, Meagan Anderi, Liz Chapman, and Lorna Gilfedder.The Krembil Brain Institute, part of University Health Network, in Toronto, is home to one of the world's largest and most comprehensive teams of physicians and scientists uniquely working hand-in-hand to prevent and confront problems of the brain and spine, such as Parkinson's, Alzheimer's, epilepsy, stroke, spinal cord injury, chronic pain, brain cancer or concussion, in their lifetime. Through state-of-the-art patient care and advanced research, we are working relentlessly toward finding new treatments and cures.Do you want to know more about the Krembil Brain Institute at UHN? Visit us at: uhn.ca/krembilTo get in touch, email us at krembil@uhn.ca or message us on social media:Instagram - @krembilresearchTwitter - @KBI_UHNFacebook - https://www.facebook.com/KrembilBrainInstituteThanks for listening!

With Carissa Gravelle at Heart and Stroke Foundation. The link between experiences of discrimination and your health and wellness is undeniable. It's all about the “social determinants of health”. Discrimination based on gender and other connected factors like our race and ability impacts our health in so many ways. For example, we get treated differently based on our gender in healthcare settings. Our access to relevant health services and options differs wildly depending on our gender. Even the medical research that gets funded and acted on depends on our gender.   In honour of International Day of Action for Women's Health, we're focusing on gender and health matters we may know bits and pieces of but probably need to learn more about.  Our guest Carissa Gravelle is passionate about anti-racism, diversity, inclusion, young people, under-represented populations, mental health, and wellness. Carissa has worked in the non-profit sector for over a decade spearheading equity, diversity, inclusion, and access initiatives. Carissa works to advance health equity for marginalized populations and believes in the importance of educating through storytelling and meaningful conversations to change perceptions and inspire social change.  Relevant Links: Heart and Stroke Foundation  Episode ⁠Transcripts⁠  Please listen, subscribe, rate, and review this podcast and share it with others. If you appreciate this content, if you want to get in on the efforts to build a gender equal Canada, please donate at ⁠canadianwomen.org⁠ and consider becoming a monthly donor.  Facebook: Canadian Women's Foundation  LinkedIn: The Canadian Women's Foundation  Instagram: @canadianwomensfoundation  TikTok: @cdnwomenfdn  X: @cdnwomenfdn

The Stroke Foundation wants mandatory standards introduced to reduce the amount of salt in processed foods, which it says will save thousands of New Zealand lives lost or impacted by strokes each year. The foundation says many people are consuming much more than the recommended 5-gram daily intake daily with most of the salt content hidden in the everyday foods we eat. It is calling on the government to regulate the industry and to make it easier for people to eat less salt. Jess Winchester, general manager of marketing and fundraising at Stroke Foundation of New Zealand, joins Jesse.

In this episode we dive more into the definition of “plucky” –what it is and isn't. I give examples of plucky people including my friend, Mandy, and Susan Atkey, who writes about her stroke recovery on Medium. She is swimming 100k and raising awareness and funds for the Heart & Stroke Foundation.  Learn to be plucky like a baby duck learns to fly–by winging it. Watch baby ducks courageously jumping from their nest here.  Connect with me, Coach Carrie, @carriejobradley. If you're doing something that requires determined courage, use the hashtag #pluckynotperfect and tag me. I always love to reshare and cheer you on.   

Does caffeine make you jittery? Can you drink it and go straight to bed?Are you a "coffee person"?That answer might have something to do with your genes.  And that's what we're talking about today with Registered Dietitian Devon Peart. It's an insightful conversation with lots of useable nuggets, and I hope you enjoy it as much as I did!We're covering:the contradictory information around caffeine's benefits how caffeine works and the adenosine connectionhow genetics play a part when it comes to caffeinewhat genetic testing iscoffee chat Devon's "thing" when it comes to sleepDevon's feelgoodthingAbout Devon:Devon Peart is a Registered Dietitian and Nutritionist with Cleveland Clinic Canada's Executive Health program, lead of the Nutrigenomics program at Cleveland Clinic, and a private nutrition coach. Devon is dedicated to helping her patients live their healthiest lives. She specializes in brain health, nutrigenomics, hormone health, sport nutrition and heart health. Devon has written extensively for a variety of outlets including Huffington Post Canada, and is frequently interviewed for print and web platforms including Costco, Narcity Toronto, Yahoo Canada and Cleveland Clinic Health Essentials. She has worked in both private and public sectors including Mount Sinai Hospital and Heart and Stroke Foundation of Canada, and as an Instructor in the Fitness and Health Promotion program at Humber College. After completing a Bachelor of Arts in Political Science and Sociology at the University of Toronto, Devon decided to follow her passion for health. She obtained a Bachelor of Applied Science in Nutrition from Toronto Metropolitan University, and then returned to University of Toronto where she completed a Master of Health Science in Nutrition, and the Collaborative program in Women's Studies. Devon believes there is not one “right” way to eat; including good quality, minimally processed foods is key. She takes a holistic approach to nutrition that incorporates lifestyle, stress management and always—enjoyment of food! When she's not working, Devon enjoys yoga and strength training. She loves literary fiction, seeing live music, spending time with friends, and with her husband and three sons. Devon's Instagram: @devon_peartDevon's Email: peartd@ccf.orgThe Key Moments in this episode are:00:02:15 - my clumsy start to the day 00:05:50 - caffeine studies confusion00:10:00 - different caffeine genes00:11:30- how Devon does genetic testing00:19:00 - how long to test a caffeine break for 00:25:00 - amount of coffee to drink depending now how you process caffeine00:20:35 - Devon's thing00:33:30 - Devon's feelgood thing00:34:00 - what to remember when it comes to genetics and your health 

This week on the podcast I speak to dr Scott Lear, professor in at Simon Fraser University on mental health, lifestyle strategies and speaking out in order to help foster awareness and acceptance  amongst those around you. We spent most of our time discussing Professor Lear's own depression diagnosis after several years of feeling down but for no (what Scott calls) good reason for it. We discuss the stigma that is attached to mental health diagnoses and the impact this can have on people talking about their mental health. We talk about the strategies he employed (both professional and also personal) to help recover from it and how important it was for him to receive treatment even though he was doing a lot of what is recommended we do to help our mental health (like exercise, diet etc). and how this led him to become interested in (and an advocate for) the impact that lifestyle has on mental health.Dr Scott Lear is a Professor in the Faculty of Health Sciences at Simon Fraser University and holds the Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul's Hospital. He is also a member of the Division of Cardiology at Providence Health Care.Over the past 20 years, he's been conducting research in the prevention and management of heart disease focusing on supporting healthy lifestyles and improving access to timely health care.In addition to publishing over 160 research papers, his work has been featured in various media outlets including The Vancouver Sun, The Conversation, The Heart and Stroke Foundation, CityTV and Global News. He also has an active blog and regularly podcasts on issues to do with health, including heart health, mental health and overall health. Link is below for his blog.https://www.sfu.ca/fhs/about/people/profiles/scott-lear.htmlBLOG https://drscottlear.com/category/patient-journey/ Contact Mikki:https://mikkiwilliden.com/https://www.facebook.com/mikkiwillidennutritionhttps://www.instagram.com/mikkiwilliden/https://linktr.ee/mikkiwillidenSave 20% on all NuZest Products WORLDWIDE with the code MIKKI at www.nuzest.co.nz, www.nuzest.com.au or www.nuzest.comCurranz supplement: MIKKI saves you 25% at www.curranz.co.nz or www.curranz.co.uk ooff your first order

Charles Tam is the Director of Regulatory Affairs and a member of the Leadership Team at Edwards Lifesciences. He joins Linda today on the Lifesciences Professional Podcast to explain what Regulatory Affairs is and the potential career opportunities. Charles joined Edwards Lifesciences in 2014 and previously held progressive regulatory leadership roles at Abbott Laboratories, Johnson & Johnson Medical Companies, and Becton-Dickinson and Company Inc. Bridging experiences across academia, government, and the private sector, Charles is passionate about enabling greater access to clinical research and medical technology innovation for all Canadians. He is a Sub-Committee Chair and Regulatory Affairs Steering Committee member at MedTech Canada and is an Advisor at the University of Toronto's Health Innovation Hub (H2i), part of the Temerty Faculty of Medicine. Previously, he has served as a Councillor on the Coronary Artery and Vascular Disease Council at the Heart and Stroke Foundation of Canada, retained on the roster of experts for Investigational Testing by Health Canada's Health Products and Food Branch, and served as an elected Senator on the Toronto Metropolitan University's Senate (formerly Ryerson University). Charles obtained his MBA at the Toronto Metropolitan University (formerly Ryerson University) and holds an Honours BSc from the University of Toronto.

Subscribe to Mamamia The story of Jessica Watson's unbelievable solo sailing trip around the world at age 16 has been etched into Australian lore. More than a decade after that achievement, the details of how she survived 210 days of severe storms, isolation and even her boat flipping upside down 15 feet underwater, will astound you. She still holds the record for youngest person to sail solo, nonstop and unassisted around the world. No mean feat. But that trip wasn't the only storm the now 29-year-old has had to endure. Speaking to Claire Murphy, Jessica reveals the challenge of working on her newly released Netflix biopic True Spirit, while her life was falling apart. This is Jessica Watson's story. THE END BITS: With thanks to Jessica Watson. Watch True Spirit on Netflix. Find out more about the Stroke Foundation, and how to check your blood pressure. Feedback? We're listening! Call the pod phone on 02 8999 9386 or email us at podcast@mamamia.com.au Need more lols, info, and inspo in your ears? Find more Mamamia podcasts here. CREDITS: Host: Claire Murphy. Claire also hosts Mamamia's daily news podcast, The Quicky. Executive Producer: Elissa Ratliff Assistant Producer: Emmeline Peterson Audio Producer: Madeline Joannou Mamamia acknowledges the Traditional Owners of the Land we have recorded this podcast on, the Gadigal people of the Eora Nation. We pay our respects to their Elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander cultures. Just by reading or listening to our content, you're helping to fund girls in schools in some of the most disadvantaged countries in the world - through our partnership with Room to Read. We're currently funding 300 girls in school every day and our aim is to get to 1,000. Find out more about Mamamia at mamamia.com.au Become a Mamamia subscriber: https://www.mamamia.com.au/subscriber-hubSee omnystudio.com/listener for privacy information.

Nate is joined on this episode by Norfolk County Mayor Amy Martin. Mayor Martin is the kind of Mayor we could all use more of. She's passionate, smart, kind, and she's driven to make a difference in her home community. She served as a counsellor starting in 2018, and she defeated an incumbent mayor this past fall. She is also a product of Norfolk County herself, and at the age of 34, she represents the generational change we very much need with an approach to politics that we very much need. She comes to politics with experience in the nonprofit sector, including stints with the Heart and Stroke Foundation and the MS Society. This is the first in a series of podcasts we plan to do with new civic leaders to hear about the issues in different communities and to highlight a new generation of municipal leadership. Be sure to check back as we continue to post new episodes in this series

Improving your stroke risk factors can reduce your chance of having another stroke. Some factors you can talk to your doctor about, like high blood pressure, type 2 diabetes, cholesterol and atrial fibrillation, or irregular heartbeat. Then there are things that are part of a healthy life, like quitting smoking, avoiding alcohol, and eating well and staying physically active. In this podcast, we talk about these risk factors, and we'll look at a new website to help stroke survivors to eat well and move more, i-Rebound. We speak to stroke lived-experience advocate Meredith Burke, researcher and physiotherapist Dina Pogrebnoy, and registered nurse Fi Camino from StrokeLine.

i-REBOUND: Full Chat With Emma Gee by Stroke Foundation

This podcast was created and is hosted by Sue Bowden (www.moonriverturkey.com.au), a young survivor of stroke. This podcast series is part of Stroke Foundation's Young Stroke Project. Sue was living a full life. She was happily married, pregnant with her first child and training to be a nurse. However, she could sense that something wasn't quite right. Sue is joined with David Cumming, life coach and counsellor at Mindmyself.net. In this episode Sue talks about the passion behind her work in wanting to see more current and relatable information to assist Young Stroke Survivors and their support crews.

This podcast was created and is hosted by Paul Burns, a young survivor of stroke. This podcast series is part of Stroke Foundation's Young Stroke Project. Ash Gordon is a young survivor of stroke and traditional Chinese medicine practitioner. In this episode Paul and Ash discuss the early stages of Ash's stroke and long recovery, getting back to study after his stroke, how the University accommodated him, mental health, goal setting…and more!

This podcast was created and is hosted by Paul Burns, a young survivor of stroke. This podcast series is part of Stroke Foundation's Young Stroke Project. Beth has a strength and determination that has seen her to go on to smash it after the stroke she suffered when she was 19 years old. She's organised a major fundraiser for the Stroke Foundation. She has also completed her studies in Nursing and has just begun her first role in the industry. She talks about how she accomplished all this whilst dealing with post stroke symptoms such as fatigue and navigating the associated changes to her social life that an event like a stroke brings.

On Episode 17 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the June 2022 issue of Stroke: "Vitamin D Enhances Hematoma Clearance and Neurologic Recovery in Intracerebral Hemorrhage" and "Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns." She also interviews Dr. Bruce Campbell on his article "Role of Intravenous Thrombolytics Prior to Endovascular Thrombectomy." Dr. Negar Asdaghi:         Let's start with some questions. 1) Is vitamin D that golden key to recovery from intracerebral hemorrhage? 2) Endovascular therapies seem to have prevailed where thrombolytics have failed. In the era of fast and furious thrombectomy, what is the role of pre-thrombectomy thrombolysis? 3) And finally, 20 years of clinical research has failed to demonstrate the superiority of anticoagulation over antiplatelet therapies for treatment of patients in sinus rhythm with low left ventricular ejection fraction, and yet, our practice patterns have not changed. Why do we remain resolute in prescribing anticoagulation despite the lack of evidence? We're back here to tackle the toughest questions with our Stroke Alert Podcast because this is the latest in Stroke. Stay with us. Dr. Negar Asdaghi:         Welcome back to another extremely motivating Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. The June 2022 issue of Stroke contains a number of interesting articles. As part of our Advances in Stroke, we have two articles, one on the topic of cost-effectiveness of stroke care to inform health policy and the second on the current state and the future of emerging stroke therapies. As part of our Original Contributions category, we have an interesting study by Dr. [Ben] Assayag and colleagues from the Department of Neurology at Tel Aviv Sourasky Medical Center, where we learned that just over 10% of patients with TIA and stroke developed post-traumatic stress disorder, or PTSD. Higher presenting stroke severity, preexisting white matter disease, and having anxious coping styles are risk factors for development of post-stroke PTSD. Dr. Negar Asdaghi:         In another Original Contribution, by Dr. Daehoon Kim and colleagues from Yonsei University College of Medicine in Seoul, South Korea, we read with interest on the topic of whether or not we should be anticoagulating frail patients with atrial fibrillation. In this large population-based cohort, which included patients with atrial fibrillation older than 65 years of age with frailty as defined by a score of equal or greater than five on Hospital Frailty Risk Score, we learned that despite their frailty, patients with atrial fibrillation still significantly benefit from oral anticoagulation therapy. In this study, those treated with anticoagulation had lower net adverse clinical events as compared to those untreated. We also learned that direct oral anticoagulants provided lower incidence of stroke, bleeding, and mortality over Coumadin. This paper really provided practical information on treatment of frail patients with atrial fibrillation. So, I encourage you to review these papers in addition to listening to our podcast today. Later in the podcast, I have the great pleasure of interviewing Dr. Bruce Campbell from University of Melbourne in Australia on an especially timely topic, that is the role of intravenous thrombolytics prior to endovascular therapy. Dr. Campbell is a leading authority on the topic, and his interview does not disappoint. But first, with these two articles. Dr. Negar Asdaghi:         In the setting of intracerebral hemorrhage, or ICH, aside from the primary brain insult that occurs at the time of hemorrhage, secondary brain injuries continue for days and sometimes to months mostly due to the pathological response of the brain to byproducts of hematoma lysis or RBC degradation products. Today, the majority of spontaneous ICH cases are not surgically evacuated, so we rely on the body's own ability to clear blood for hematoma clearance, and obviously the faster the clearance, the better the outcome. Erythrophagocytosis by monocyte-derived macrophages contributes to hematoma clearance and ultimately to the functional recovery from ICH. So, it's conceivable that therapeutic approaches to enhance the endogenous erythrophagocytosis can potentially improve ICH outcomes. Vitamin D has been known to have variety of functions within the central nervous system, and it turns out that it may also be one such therapeutic option to improve the much needed erythrophagocytosis in intracerebral hemorrhage. Dr. Negar Asdaghi:         In the current issue of the journal, in the study titled "Vitamin D Enhances Hematoma Clearance and Neurologic Recovery in Intracerebral Hemorrhage," a group of researchers led by Dr. Jiaxin Liu from the Department of Surgery at Queen Mary Hospital at the University of Hong Kong studied the effects of oral vitamin D administered two hours after the induction of hematoma in a rodent model of ICH using direct collagenase injection into the striatum of the mouse. Eighty-nine young mice and 78 middle-aged mice were included in the study and randomly divided into three groups. Group one were sham-operated mice; group two, ICH mice treated with vehicle, which was corn oil; and group three, vitamin D-treated ICH mice. In the third group, 1000 international unit per kg of vitamin D diluted in corn oil was administered orally using a pipette two hours after the induction of ICH to mice, and then daily afterwards. And here are their top three findings of this study. Dr. Negar Asdaghi:         Number one, vitamin D-treated mice did better than vehicle on two neurobehavioral tests that were completed in the study. On the cylinder test, treatment with vitamin D significantly alleviated the asymmetric usage of four limbs at day seven, and vitamin D elongated the duration that the mice could run on the accelerated rod at day 10 on the rotarod test. Dr. Negar Asdaghi:         Number two, in terms of hematoma resolution and perihematoma edema, it's an issue that we deal with, with ICH, they used MRI imaging for edema measurement on T2-weighted images, and then sacrificed the mice and used digital quantification of hematoma volume with fresh brain specimens. And they found that treatment with vitamin D significantly alleviated both the ICH-associated brain swelling on MR and resulted in significant reduction in hematoma volume on the fresh brain specimens when compared with the vehicle-treated group at day three and day five. Dr. Negar Asdaghi:         And finally, their third main finding is in terms of erythrophagocytosis. So, the pathway that is mediated by the monocyte-derived macrophages is an endogenous pathway, that is, PPAR-γ (which stands for peroxisome proliferator-activated receptor γ) and its downstream scavenger receptor CD36 mediated. This pathway is essential for directing the endogenous erythrophagocytosis. Using flow cytometry, they found that vitamin D-treated mice had more mature macrophages expressing the scavenger receptor CD36, which was not expressed by the undifferentiated monocytes. Dr. Negar Asdaghi:         Western blot analysis confirmed that vitamin D treatment increased the tissue levels of CD36 and the upstream PPAR-γ levels in the brain at day five after collagenase model. Locally, vitamin D-enriched phagocytes that were positive for PPAR-γ and CD36 in the perihematoma regions. So, in summary, vitamin D increased the number of mature macrophages rather than undifferentiated monocytes in the perihematoma region and accelerated the differentiation of reparative macrophages from bone marrow-derived monocytes. So, bottom line is that in vitamin D, we have a simple, accessible, and well-tolerated agent to improve both the ICH outcomes and enhance hematoma resolution, but this we all observed in rodents. So, we stay tuned with interest to find out whether the same success will be seen in humans treated with vitamin D after intracerebral hemorrhage. Dr. Negar Asdaghi:         Patients with depressed left ventricular ejection fraction, or low EF, are at risk of development of ischemic stroke even if they remain in sinus rhythm. The optimal antithrombotic treatment for these patients is still unknown. Over the past two decades, we have a number of randomized trials studying the efficacy of oral anticoagulation, predominantly Coumadin, over aspirin therapy in prevention of all forms of stroke, that is ischemic and hemorrhagic, and death in patients with a low EF in sinus rhythm. Dr. Negar Asdaghi:         The meta-analysis of WASH, HELAS, WATCH, and WARCEF trials showed that treatment of low ejection fraction patients in sinus rhythm with Coumadin does reduce the subsequent risk of stroke, but it comes at the cost of a higher major bleeding risk in this population. The COMMANDER HF clinical trial published in New England Journal of Medicine in October 2018 studied whether low-dose rivaroxaban at 2.5 milligram BID was superior to placebo in patients with recent worsening of chronic heart failure, reduced ejection fraction, coronary artery disease, but no atrial fibrillation, and very similar to its prior counterparts, it did not show that rivaroxaban was associated with a lower rate of combined death, myocardial infarction, or stroke as compared to placebo. But very similar to prior studies, it also showed that rivaroxaban-treated patients had a lower risk of subsequent ischemic stroke. This poses a conundrum for stroke neurologists treating patients with this condition, especially after they present with an embolic-appearing stroke. So, the question is, how often do we encounter this situation, and what do we do in routine practice? We know that when there is equipoise, there's practice variation. Dr. Negar Asdaghi: In the current issue of the journal, in the study titled "Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm," Dr. Richa Sharma from the Department of Neurology at Yale School of Medicine and colleagues examined the prevalence of heart failure with sinus rhythm among hospitalized patients with acute ischemic stroke and the physician's practice patterns with regard to the choice of antithrombotics in this population. Dr. Negar Asdaghi:         So, let's look at their study. The study was comprised of five separate study cohorts of hospitalized acute ischemic stroke patients in the Greater Cincinnati Northern Kentucky Stroke Study for the year 2005, 2010, and 2015, and then four additional academic hospital-based cohorts in the United States during different timeframes. These were the Massachusetts General Hospital from 2002 to 2016, Rhode Island Hospital from 2016 to 2018, Yale-New Haven Hospital 2015 to 2017, and Cornell Acute Stroke Academic Registry from 2011 to 2018. All of these cohorts combined contributed to the 19,155 total number of patients in this study, which included over 14,000 patients that had documented left ventricular ejection fraction. Amongst those, 1,426 had a depressed EF and were included in this study. The investigator obviously excluded those with documented atrial fibrillation and flutter. And so the sample size for this analysis was 805 patients. And here are their main results. Dr. Negar Asdaghi:         The overall prevalence of this condition, that is low ejection fraction and sinus rhythm, among hospitalized acute ischemic stroke patients was 5%. It varied slightly between the different cohorts in this study from 4 to 6%. In terms of the antithrombotic treatment patterns, this information was available in close to 500 patients in the cohort. Overall, 59% of patients were discharged on an antiplatelet treatment alone, and 41% on anticoagulation. But these percentages significantly varied between the different institutions and was as low as 22% in one of the cohorts and as high as 45% in another cohort. Dr. Negar Asdaghi:         So, what were the factors that were associated with the use of anticoagulation at discharge? They found that the absolute percentage of left ventricular ejection fraction and the presenting NIH Stroke Scales were associated with anticoagulation use. That is, the lower the percentage of EF and the higher the presenting NIH Stroke Scale, the more likely physicians were to discharge the patients on an anticoagulation in univariate analysis, but in multivariate analysis, only the study site and presenting NIH Stroke Scale over eight were independently associated with anticoagulation use. Dr. Negar Asdaghi:         Now, interestingly, 2002 to 2018, which was their overall study period, was a time during which some of the largest and neutral randomized trials on the topic of anticoagulation versus antiplatelet were published, including the WATCH and the WARCEF trial. But the authors found no temporal variation in anticoagulation practice patterns before and after the publication of the results of these trials. So, it appears that we didn't change our minds. So, overall, we have some important takeaway messages from this study. We learned that 5% of hospitalized acute ischemic stroke patients have low left ventricular ejection fraction and remain in sinus rhythm without atrial fibrillation. Today, over 40% of patients with this condition are anticoagulated at discharge despite the results of the randomized trials, but the practice is widely variable among different institutions, and a higher presenting NIH Stroke Scale is a significant predictor of anticoagulation use at discharge in this population. Dr. Negar Asdaghi:         Almost 20 years after the approval of intravenous thrombolysis for treatment of patients with acute ischemic stroke, endovascular therapy was approved for treatment of select ischemic stroke patients with a large vessel occlusion. The two treatments are, therefore, entangled, as one was the standard of care while the second one was being tested. Therefore, all endovascularly treated patients enrolled in randomized trials would've received intravenous thrombolysis if eligible. Now, with the overwhelming success of endovascular therapy in achieving reperfusion in areas where IV thrombolysis has drastically failed, there're still critical questions regarding the added value of IV thrombolysis to endovascularly treated patients. The critical question remains as to whether eligible ischemic stroke patients who have immediate access to endovascular thrombectomy should receive prior IV thrombolysis, or should we skip the thrombolysis step altogether and just move to the angio suite as fast as possible. And there are, of course, arguments for and against each approach. Dr. Negar Asdaghi:         In this issue of the journal, in an invited topical review titled "The Role of Intravenous Thrombolytics Prior to Endovascular Thrombectomy," we learn about these arguments as the authors go through a comprehensive review of the current literature on this issue. I'm joined today by the first author of this review, Dr. Bruce Campbell, to discuss this paper. Dr. Campbell absolutely needs no introduction to our Stroke listeners. He's a professor of neurology and head of neurology and stroke at Royal Melbourne Hospital, University of Melbourne, in Australia. He's a pioneer in the field of acute stroke therapies and acute neuroimaging. He has served as the lead investigator of multiple landmark randomized trials, including EXTEND-IA and EXTEND-IA TNK, and holds multiple leadership roles. He's the clinical director of the Stroke Foundation and co-chairs the Australian Stroke Guidelines Working Party and the coordinator of the National Brain School Training Program for Neurologists in Training. And, of course, last but not least, he's my friend. So, I'm delighted to welcome him to our podcast today. Top of the morning to you, Bruce, 6:00 a.m. in Melbourne. That's quite some dedication. Thank you for being here. Dr. Bruce Campbell:       It's great to be with you. Thanks for the invitation. Dr. Negar Asdaghi:         Congrats on the paper, really exciting topic. So, let's just start with this question as part of a case. We have a patient with an M1 occlusion, a large clinical syndrome presenting two hours out from their symptom onset, and we are at a hospital where the angio suite is ready. What are some of the benefits of basically spending time in giving IV thrombolytics first rather than quickly going to the angio suite? Dr. Bruce Campbell:       I think a key element of this case is that the patient has presented directly to a hospital with immediate access to thrombectomy. Thrombolytic used in drip-and-ship transfer patients really isn't controversial, and the recent randomized trials excluded them. So, the debate's all about this context of bridging thrombolytics in patients presenting directly to a comprehensive stroke center. And you mentioned spending time giving lytics, but in fact, if you do things in parallel, that shouldn't be the case. It shouldn't delay thrombectomy if you go and give thrombolysis. Dr. Bruce Campbell:       So, the general principle is that getting the artery open faster by any means is better, and IV thrombolytic certainly has the potential to open the artery before thrombectomy in a proportion of patients, perhaps not that many, but it may also facilitate the thrombectomy. So, in the randomized trials, reperfusion after the thrombectomy was significantly better when patients had had bridging thrombolytic despite a low rate of pre-endovascular reperfusion. Other reasons for giving the lytics are the potential safety net it provides if the thrombectomy procedure is unexpectedly delayed or fails to get the artery open, and there's also this potential for lytics to dissolve distal embolic fragments and perhaps improve microvascular reperfusion. Dr. Negar Asdaghi:         So, great. So, let me summarize for our listeners what you mentioned. First off, so these are arguments in favor of giving lytics. As you mentioned, we're not really wasting time. These processes occur in parallel, so it's not like we're wasting time in giving a therapy that is potentially not as efficacious as thrombectomy is. And number two, we have improved the possibility of early reperfusion, perhaps, with the lytics. And if there are some fragments or distal clots that thrombectomy wouldn't have reached, then the lytics would. And then also there is also the chance that the thrombectomy might have failed in difficult access, and so on and so forth, and at least the patient has some chance of revascularization with the lytics. So, if these are the arguments for giving lytics, what are the arguments against giving lytics in this scenario? Dr. Bruce Campbell:       The main argument is the potential to reduce both the intracerebral and systemic hemorrhagic complications. There's also potential cost saving by skipping thrombolytics. That's probably more relevant in low-resource settings, particularly when relatives may have to pay for the thrombolytic before treatment is initiated, and that can be burdensome and also potentially delay the thrombectomy. There's a theoretical concern about thrombus fragmentation with lytics and potential migration of the clot out of reach of the thrombectomy or to new territories. But final reperfusion, as I mentioned, was, on average, better with the patient having a lytic on board in the randomized trials. Dr. Negar Asdaghi:         Perfect. And I want to highlight this issue of thrombus fragmentation because I think our readers will read more and more about this idea of, as you mentioned, fragmentation will potentially make an accessible clot for thrombectomy inaccessible. But I see that later in our questions, we're going to address that as part of the findings of randomized trials as well. So, these are some of the arguments for and against. And before we go to the randomized trials, I'd like to get an overview of what we knew as part of observational studies and non-randomized studies prior to more recent randomized trials on this topic. Dr. Bruce Campbell:       There've been a couple of nice systematic reviews and meta-analyses of the observational data, and notably in most of these studies, the direct thrombectomy patients had contraindications to lytics, and that introduces confounding factors that are difficult to adjust for. For what that's worth, the functional independence, mortality outcomes were better in the bridging patients. Hemorrhage rates weren't always higher with the lytic, and one study by Jonathan Coutinho in JAMA Neurology for the SWIFT and STAR studies showed the opposite despite them having really careful adjustment for all the confounders they could think of. And the meta-analysis by Eva Mistry in Stroke did not detect a difference in symptomatic ICH between the direct and bridging strategies. One thing that should be less affected by the patient characteristics would be the technical efficacy outcomes, and it was interesting that in the observational data, the patients who'd had bridging lytic had higher mTICI 2b-3 rates and also fewer device passes. Dr. Negar Asdaghi:         Okay. And now we do have further information with all of these new randomized trials. So, why don't we start with some of the earlier studies, the three, SKIP, DEVT, and DIRECT-MT, and start with those studies first before we move to some more recent European trials. Dr. Bruce Campbell:       SKIP was performed in Japan, and it used the lower 0.6 milligram per kilogram dose of alteplase that's standard there, and DEVT and DIRECT-MT were performed in China. All three of them showed numerically similar functional outcomes with slight trends favoring direct thrombectomy. SKIP had a smaller sample size and did not meet its non-inferiority criteria, and the other two trials did meet their specified non-inferiority margin, but it could be argued those margins were overly generous. If you think about non-inferiority trials, we generally try to set a margin for non-inferiority such as lower 95% confidence interval for the trial intervention would sacrifice up to 50% of the reference treatment effect. And it's difficult to estimate the effect of alteplase in this specific population. But if you think of the Emberson meta-analysis of alteplase, overall zero to three hours alteplase versus placebo has a 10% effect size and mRS 0-1, three to four and a half hours of 5% effect size. And we regard that as clinically important. So, half of 5%, 2.5%, is a lot tighter margin than any of the direct randomized trials employed. Dr. Negar Asdaghi:         So, Bruce, let me recap what you just mentioned. Two out of the three earlier trials seem to suggest that perhaps skipping IV therapy is the way to go rather than bridging as these two trials met the non-inferiority criteria if we believe that non-inferiority margins you mentioned. And now we have a couple of more trials, more recent trials. Can you tell us about these trials please? Dr. Bruce Campbell:       MR CLEAN-NO IV in a European population did not demonstrate non-inferiority, and the point estimate slightly favored bridging. Interestingly, in that trial, the symptomatic intracerebral hemorrhage risk, which was one of the main drivers for trying this strategy, was 5.9% in the direct and 5.3 in the bridging group. So, there's no hint of benefit from dropping the lytic on that metric. SWIFT-DIRECT was more selective in only enrolling internal carotid and M1 occlusions, which had a lower chance of early recanalization with lytic. But the protocol also specified giving the full dose of lytic. In the other trials, it seems the alteplase infusion was often stopped once the patient was in the angio suite, so the full dose may not have been delivered. And despite very low pre-endovascular recanalization in that selected group in SWIFT-DIRECT, the end of procedure reperfusion was significantly better in the bridging group, which is a consistent finding across the trials and suggests that the lytic may improve the thrombectomy outcome. Dr. Bruce Campbell:       DIRECT-SAFE, the final of those trials, was interesting in that the patients were enrolled roughly 50:50 from Australia, New Zealand, versus Asia. And in contrast to the original three randomized trials in Asian patients, DIRECT-SAFE found a significant benefit of bridging lytic in Asian patients. So, it'd be very interesting to see the results of the IRIS individual patient data meta-analysis, but we may not find a difference in Asian versus Caucasian patients despite those initial trials and despite substantial differences in the prevalence of intracranial atherosclerosis, which has often been proposed as something that would increase the risk of having bridging thrombolytic on board. Dr. Bruce Campbell:       The original study level estimate of symptomatic hemorrhage had a borderline significant 1.8% absolute reduction in the direct group. Whether those data were not all core lab adjudicated and the final analysis may show a smaller difference than that. Notably, given that trend with symptomatic intracerebral hemorrhage, mortality did not differ significantly, and, in fact, the trend favored bridging patients. So, the symptomatic hemorrhage slight trend into increase did not translate into any hint of increased mortality. Dr. Negar Asdaghi:         So, Bruce, a lot of information, and I need a recap for me. So, let me try to recap some of the things you said, and please jump in. So, so far, the newer data really basically don't show us any convincing evidence that skipping is the way to go, and direct endovascular we really don't have data in favor of going directly to the angio suite. And the jury is still out regarding an increase in the symptomatic intracerebral hemorrhage rate amongst those that actually are pre-treated with IV therapy. Is that correct? Dr. Bruce Campbell:       That's correct. So, none of the three recent trials met their non-inferiority margins. And again, we had this issue of relatively generous non-inferiority margins, and the symptomatic hemorrhage, it would make sense that there's a small difference, but it's not really been borne out in the data to be statistically significant at this stage. And again, this individual patient data meta-analysis is keenly awaited to get the most accurate estimate on that. Dr. Negar Asdaghi:         So, while we wait that, I'm going to digress a little bit and ask you a question that's not addressed in the paper that you have in this issue of the journal, and that's the CHOICE trial. So, by now, we have the results of CHOICE trial. Do you mind first give us a brief overview of what CHOICE was and how you feel that the results of CHOICE would affect this field of direct versus bridging in general? Dr. Bruce Campbell:       CHOICE is a very interesting study in that it tested giving the intra-arterial lytic at the end of a thrombectomy procedure that had achieved an mTICI 2b or better, which is what we traditionally regarded as angiographic success. The idea was to improve microvascular flow, and that may be the case. The trial was terminated early due to logistic reasons and showed a very large effect size that requires replication. The subgroup analyses are interesting in that the benefits seem to mostly accrue in patients who'd not already had intravenous lytic. Dr. Bruce Campbell:       So, perhaps giving the IV lytic before thrombectomy can still benefit patients after the thrombectomy, as well as achieving early recanalization in a proportion of patients and perhaps facilitating the thrombectomy. The other issue to address with the DIRECT trials is that with the exception of a few patients in DIRECT-SAFE, the comparator was alteplase and not tenecteplase. And we have data from EXTEND-IA TNK that tenecteplase bridging is not just non-inferior, but superior to alteplase bridging. There's an ongoing Brazilian trial of exactly that, tenecteplase versus the direct approach, which will be very interesting. Dr. Negar Asdaghi:         So, great, Bruce. I just want to repeat this segment again for our listeners. So, CHOICE is a very interesting study, looked at giving intraarterial alteplase to patients after endovascular therapy was completed and after they'd already achieved the complete and successful revascularization, and the trial was terminated early because of logistic reasons. So, we have to keep in mind, this was a smaller study, early termination, but the effect size was pretty large in favor of giving lytics. Dr. Negar Asdaghi:         So, what you mentioned is interesting, and I think that it's really worth paying attention to, that the majority of the benefits seem to have occurred from intraarterial thrombolytics in patients that have not been given intravenous lytics prior to endovascular therapy. So, in other words, you need some sort of lytics either before or after the endovascular thrombectomy to achieve that ultimate improved outcome. So, moving forward now from the randomized trials that we have on bridging versus direct thrombectomy, you have mentioned in the paper some interesting subgroups that may benefit or not benefit as much from bridging versus direct thrombectomy. Do you want to elaborate a little more about those subgroup analyses? Dr. Bruce Campbell:       The idea of precision selection or individualized treatment is being talked about a lot given there didn't seem to be much overall difference between strategies in the randomized trials, but it's important to note that the randomized trial actually disadvantages the bridging group by delaying lytic until the patient was firstly confirmed eligible for thrombectomy and then consented and randomized. Putting that aside, if we could identify a subgroup who clearly benefit from skipping lytic and, importantly, identify them without delaying lytic for those who likely benefit, that's clearly attractive. Dr. Bruce Campbell:       Currently, I'd say we have not identified that kind of subgroup, and the planned IRIS individual patient data meta-analysis will be critical for that. Patients with a large ischemic core are one potential group where there's a high risk of bleeding hypothesized. To date, there is no definitive data to indicate the risk is lower with the direct approach. Patients who need stents certainly may benefit from not having a lytic on board because they often need adjuvant antithrombotics that could increase the bleeding risk. But the question there is whether we can confidently identify those patients before the procedure, and I think that's unclear at this stage. Patients with really large clot burdens and proximal occlusions have sometimes been said not to benefit from IV lytic based on the low rates of pre-endovascular reperfusion, but the randomized trials really hinted other benefits like this potential facilitative thrombectomy. So, that hypothesis may be insecure as well. Dr. Negar Asdaghi:         And how about age? Have you come across and has there been any signal towards an impact or interaction between age and benefit from pre-endovascular thrombectomy and thrombolytics? Dr. Bruce Campbell:       It's an interesting question because age has not generally been a treatment effect modifier in previous stroke studies with thrombolytics and thrombectomy, and the individual direct thrombectomy trials that have reported subgroups haven't shown any convincing heterogeneity by age. There's certainly no indication that older patients are at risk from bridging in what I've seen so far. Dr. Negar Asdaghi:         So, this question comes up in clinical practice all the time, that a person's older, perhaps more atrophy, more vascular risk factors and white matter disease, and they're more prone, so to speak, of having a symptomatic intracerebral hemorrhage. So, what you're saying is, from the data we have, there's really no signal in favor of withholding pre-thrombectomy lytics in this population. So, it's important to know this. Bruce, what should be our final takeaway message from this study? Dr. Bruce Campbell:       I tend to agree with the recent European Stroke Organization and ESMINT guideline that for now, patients should receive lytic as early as possible and in parallel with the decision to perform thrombectomy such that neither treatment delays the other. I think if we can identify a subgroup that benefits from direct thrombectomy, and that's confirmed in the individual patient data and meta-analysis, and we can identify them without disadvantaging the majority of patients, and also that the ongoing improvements in IV lytic strategies don't render the existing trial data obsolete, then we may, in future, skip lytic for some patients, but we are not there yet. Dr. Negar Asdaghi:         So, that's amazing, Bruce. We look forward to reviewing the paper and individual data meta-analysis and interviewing you, hopefully at a better hour your time, on that. Thank you very much for joining us on the podcast today. Dr. Bruce Campbell:       Thanks again for the invitation. It's been great talking to you. Dr. Negar Asdaghi:         Thank you. Dr. Negar Asdaghi:         And this concludes our podcast for the June 2022 issue of Stroke. Please be sure to check out this month's table of contents for the full list of publications, including three very interesting images that are presented as part of a new article type, Stroke Images, and a special report in Comments and Opinions section on "Bias in Stroke Evaluation: Rethinking the Cookie Theft Picture." June is the month of Pride, and in spirit of equality, we hope to do our part to reduce all biases in stroke processes of care, diagnosis, and outcomes as we continue to stay alert with Stroke Alert. Dr. Negar Asdaghi:         This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.

On Episode 17 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the June 2022 issue of Stroke: “Vitamin D Enhances Hematoma Clearance and Neurologic Recovery in Intracerebral Hemorrhage” and “Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns.” She also interviews Dr. Bruce Campbell on his article “Role of Intravenous Thrombolytics Prior to Endovascular Thrombectomy.” Dr. Negar Asdaghi:         Let's start with some questions. 1) Is vitamin D that golden key to recovery from intracerebral hemorrhage? 2) Endovascular therapies seem to have prevailed where thrombolytics have failed. In the era of fast and furious thrombectomy, what is the role of pre-thrombectomy thrombolysis? 3) And finally, 20 years of clinical research has failed to demonstrate the superiority of anticoagulation over antiplatelet therapies for treatment of patients in sinus rhythm with low left ventricular ejection fraction, and yet, our practice patterns have not changed. Why do we remain resolute in prescribing anticoagulation despite the lack of evidence? We're back here to tackle the toughest questions with our Stroke Alert Podcast because this is the latest in Stroke. Stay with us. Dr. Negar Asdaghi:         Welcome back to another extremely motivating Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. The June 2022 issue of Stroke contains a number of interesting articles. As part of our Advances in Stroke, we have two articles, one on the topic of cost-effectiveness of stroke care to inform health policy and the second on the current state and the future of emerging stroke therapies. As part of our Original Contributions category, we have an interesting study by Dr. [Ben] Assayag and colleagues from the Department of Neurology at Tel Aviv Sourasky Medical Center, where we learned that just over 10% of patients with TIA and stroke developed post-traumatic stress disorder, or PTSD. Higher presenting stroke severity, preexisting white matter disease, and having anxious coping styles are risk factors for development of post-stroke PTSD. Dr. Negar Asdaghi:         In another Original Contribution, by Dr. Daehoon Kim and colleagues from Yonsei University College of Medicine in Seoul, South Korea, we read with interest on the topic of whether or not we should be anticoagulating frail patients with atrial fibrillation. In this large population-based cohort, which included patients with atrial fibrillation older than 65 years of age with frailty as defined by a score of equal or greater than five on Hospital Frailty Risk Score, we learned that despite their frailty, patients with atrial fibrillation still significantly benefit from oral anticoagulation therapy. In this study, those treated with anticoagulation had lower net adverse clinical events as compared to those untreated. We also learned that direct oral anticoagulants provided lower incidence of stroke, bleeding, and mortality over Coumadin. This paper really provided practical information on treatment of frail patients with atrial fibrillation. So, I encourage you to review these papers in addition to listening to our podcast today. Later in the podcast, I have the great pleasure of interviewing Dr. Bruce Campbell from University of Melbourne in Australia on an especially timely topic, that is the role of intravenous thrombolytics prior to endovascular therapy. Dr. Campbell is a leading authority on the topic, and his interview does not disappoint. But first, with these two articles. Dr. Negar Asdaghi:         In the setting of intracerebral hemorrhage, or ICH, aside from the primary brain insult that occurs at the time of hemorrhage, secondary brain injuries continue for days and sometimes to months mostly due to the pathological response of the brain to byproducts of hematoma lysis or RBC degradation products. Today, the majority of spontaneous ICH cases are not surgically evacuated, so we rely on the body's own ability to clear blood for hematoma clearance, and obviously the faster the clearance, the better the outcome. Erythrophagocytosis by monocyte-derived macrophages contributes to hematoma clearance and ultimately to the functional recovery from ICH. So, it's conceivable that therapeutic approaches to enhance the endogenous erythrophagocytosis can potentially improve ICH outcomes. Vitamin D has been known to have variety of functions within the central nervous system, and it turns out that it may also be one such therapeutic option to improve the much needed erythrophagocytosis in intracerebral hemorrhage. Dr. Negar Asdaghi:         In the current issue of the journal, in the study titled "Vitamin D Enhances Hematoma Clearance and Neurologic Recovery in Intracerebral Hemorrhage," a group of researchers led by Dr. Jiaxin Liu from the Department of Surgery at Queen Mary Hospital at the University of Hong Kong studied the effects of oral vitamin D administered two hours after the induction of hematoma in a rodent model of ICH using direct collagenase injection into the striatum of the mouse. Eighty-nine young mice and 78 middle-aged mice were included in the study and randomly divided into three groups. Group one were sham-operated mice; group two, ICH mice treated with vehicle, which was corn oil; and group three, vitamin D-treated ICH mice. In the third group, 1000 international unit per kg of vitamin D diluted in corn oil was administered orally using a pipette two hours after the induction of ICH to mice, and then daily afterwards. And here are their top three findings of this study. Dr. Negar Asdaghi:         Number one, vitamin D-treated mice did better than vehicle on two neurobehavioral tests that were completed in the study. On the cylinder test, treatment with vitamin D significantly alleviated the asymmetric usage of four limbs at day seven, and vitamin D elongated the duration that the mice could run on the accelerated rod at day 10 on the rotarod test. Dr. Negar Asdaghi:         Number two, in terms of hematoma resolution and perihematoma edema, it's an issue that we deal with, with ICH, they used MRI imaging for edema measurement on T2-weighted images, and then sacrificed the mice and used digital quantification of hematoma volume with fresh brain specimens. And they found that treatment with vitamin D significantly alleviated both the ICH-associated brain swelling on MR and resulted in significant reduction in hematoma volume on the fresh brain specimens when compared with the vehicle-treated group at day three and day five. Dr. Negar Asdaghi:         And finally, their third main finding is in terms of erythrophagocytosis. So, the pathway that is mediated by the monocyte-derived macrophages is an endogenous pathway, that is, PPAR-γ (which stands for peroxisome proliferator-activated receptor γ) and its downstream scavenger receptor CD36 mediated. This pathway is essential for directing the endogenous erythrophagocytosis. Using flow cytometry, they found that vitamin D-treated mice had more mature macrophages expressing the scavenger receptor CD36, which was not expressed by the undifferentiated monocytes. Dr. Negar Asdaghi:         Western blot analysis confirmed that vitamin D treatment increased the tissue levels of CD36 and the upstream PPAR-γ levels in the brain at day five after collagenase model. Locally, vitamin D-enriched phagocytes that were positive for PPAR-γ and CD36 in the perihematoma regions. So, in summary, vitamin D increased the number of mature macrophages rather than undifferentiated monocytes in the perihematoma region and accelerated the differentiation of reparative macrophages from bone marrow-derived monocytes. So, bottom line is that in vitamin D, we have a simple, accessible, and well-tolerated agent to improve both the ICH outcomes and enhance hematoma resolution, but this we all observed in rodents. So, we stay tuned with interest to find out whether the same success will be seen in humans treated with vitamin D after intracerebral hemorrhage. Dr. Negar Asdaghi:         Patients with depressed left ventricular ejection fraction, or low EF, are at risk of development of ischemic stroke even if they remain in sinus rhythm. The optimal antithrombotic treatment for these patients is still unknown. Over the past two decades, we have a number of randomized trials studying the efficacy of oral anticoagulation, predominantly Coumadin, over aspirin therapy in prevention of all forms of stroke, that is ischemic and hemorrhagic, and death in patients with a low EF in sinus rhythm. Dr. Negar Asdaghi:         The meta-analysis of WASH, HELAS, WATCH, and WARCEF trials showed that treatment of low ejection fraction patients in sinus rhythm with Coumadin does reduce the subsequent risk of stroke, but it comes at the cost of a higher major bleeding risk in this population. The COMMANDER HF clinical trial published in New England Journal of Medicine in October 2018 studied whether low-dose rivaroxaban at 2.5 milligram BID was superior to placebo in patients with recent worsening of chronic heart failure, reduced ejection fraction, coronary artery disease, but no atrial fibrillation, and very similar to its prior counterparts, it did not show that rivaroxaban was associated with a lower rate of combined death, myocardial infarction, or stroke as compared to placebo. But very similar to prior studies, it also showed that rivaroxaban-treated patients had a lower risk of subsequent ischemic stroke. This poses a conundrum for stroke neurologists treating patients with this condition, especially after they present with an embolic-appearing stroke. So, the question is, how often do we encounter this situation, and what do we do in routine practice? We know that when there is equipoise, there's practice variation. Dr. Negar Asdaghi: In the current issue of the journal, in the study titled "Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm," Dr. Richa Sharma from the Department of Neurology at Yale School of Medicine and colleagues examined the prevalence of heart failure with sinus rhythm among hospitalized patients with acute ischemic stroke and the physician's practice patterns with regard to the choice of antithrombotics in this population. Dr. Negar Asdaghi:         So, let's look at their study. The study was comprised of five separate study cohorts of hospitalized acute ischemic stroke patients in the Greater Cincinnati Northern Kentucky Stroke Study for the year 2005, 2010, and 2015, and then four additional academic hospital-based cohorts in the United States during different timeframes. These were the Massachusetts General Hospital from 2002 to 2016, Rhode Island Hospital from 2016 to 2018, Yale-New Haven Hospital 2015 to 2017, and Cornell Acute Stroke Academic Registry from 2011 to 2018. All of these cohorts combined contributed to the 19,155 total number of patients in this study, which included over 14,000 patients that had documented left ventricular ejection fraction. Amongst those, 1,426 had a depressed EF and were included in this study. The investigator obviously excluded those with documented atrial fibrillation and flutter. And so the sample size for this analysis was 805 patients. And here are their main results. Dr. Negar Asdaghi:         The overall prevalence of this condition, that is low ejection fraction and sinus rhythm, among hospitalized acute ischemic stroke patients was 5%. It varied slightly between the different cohorts in this study from 4 to 6%. In terms of the antithrombotic treatment patterns, this information was available in close to 500 patients in the cohort. Overall, 59% of patients were discharged on an antiplatelet treatment alone, and 41% on anticoagulation. But these percentages significantly varied between the different institutions and was as low as 22% in one of the cohorts and as high as 45% in another cohort. Dr. Negar Asdaghi:         So, what were the factors that were associated with the use of anticoagulation at discharge? They found that the absolute percentage of left ventricular ejection fraction and the presenting NIH Stroke Scales were associated with anticoagulation use. That is, the lower the percentage of EF and the higher the presenting NIH Stroke Scale, the more likely physicians were to discharge the patients on an anticoagulation in univariate analysis, but in multivariate analysis, only the study site and presenting NIH Stroke Scale over eight were independently associated with anticoagulation use. Dr. Negar Asdaghi:         Now, interestingly, 2002 to 2018, which was their overall study period, was a time during which some of the largest and neutral randomized trials on the topic of anticoagulation versus antiplatelet were published, including the WATCH and the WARCEF trial. But the authors found no temporal variation in anticoagulation practice patterns before and after the publication of the results of these trials. So, it appears that we didn't change our minds. So, overall, we have some important takeaway messages from this study. We learned that 5% of hospitalized acute ischemic stroke patients have low left ventricular ejection fraction and remain in sinus rhythm without atrial fibrillation. Today, over 40% of patients with this condition are anticoagulated at discharge despite the results of the randomized trials, but the practice is widely variable among different institutions, and a higher presenting NIH Stroke Scale is a significant predictor of anticoagulation use at discharge in this population. Dr. Negar Asdaghi:         Almost 20 years after the approval of intravenous thrombolysis for treatment of patients with acute ischemic stroke, endovascular therapy was approved for treatment of select ischemic stroke patients with a large vessel occlusion. The two treatments are, therefore, entangled, as one was the standard of care while the second one was being tested. Therefore, all endovascularly treated patients enrolled in randomized trials would've received intravenous thrombolysis if eligible. Now, with the overwhelming success of endovascular therapy in achieving reperfusion in areas where IV thrombolysis has drastically failed, there're still critical questions regarding the added value of IV thrombolysis to endovascularly treated patients. The critical question remains as to whether eligible ischemic stroke patients who have immediate access to endovascular thrombectomy should receive prior IV thrombolysis, or should we skip the thrombolysis step altogether and just move to the angio suite as fast as possible. And there are, of course, arguments for and against each approach. Dr. Negar Asdaghi:         In this issue of the journal, in an invited topical review titled "The Role of Intravenous Thrombolytics Prior to Endovascular Thrombectomy," we learn about these arguments as the authors go through a comprehensive review of the current literature on this issue. I'm joined today by the first author of this review, Dr. Bruce Campbell, to discuss this paper. Dr. Campbell absolutely needs no introduction to our Stroke listeners. He's a professor of neurology and head of neurology and stroke at Royal Melbourne Hospital, University of Melbourne, in Australia. He's a pioneer in the field of acute stroke therapies and acute neuroimaging. He has served as the lead investigator of multiple landmark randomized trials, including EXTEND-IA and EXTEND-IA TNK, and holds multiple leadership roles. He's the clinical director of the Stroke Foundation and co-chairs the Australian Stroke Guidelines Working Party and the coordinator of the National Brain School Training Program for Neurologists in Training. And, of course, last but not least, he's my friend. So, I'm delighted to welcome him to our podcast today. Top of the morning to you, Bruce, 6:00 a.m. in Melbourne. That's quite some dedication. Thank you for being here. Dr. Bruce Campbell:       It's great to be with you. Thanks for the invitation. Dr. Negar Asdaghi:         Congrats on the paper, really exciting topic. So, let's just start with this question as part of a case. We have a patient with an M1 occlusion, a large clinical syndrome presenting two hours out from their symptom onset, and we are at a hospital where the angio suite is ready. What are some of the benefits of basically spending time in giving IV thrombolytics first rather than quickly going to the angio suite? Dr. Bruce Campbell:       I think a key element of this case is that the patient has presented directly to a hospital with immediate access to thrombectomy. Thrombolytic used in drip-and-ship transfer patients really isn't controversial, and the recent randomized trials excluded them. So, the debate's all about this context of bridging thrombolytics in patients presenting directly to a comprehensive stroke center. And you mentioned spending time giving lytics, but in fact, if you do things in parallel, that shouldn't be the case. It shouldn't delay thrombectomy if you go and give thrombolysis. Dr. Bruce Campbell:       So, the general principle is that getting the artery open faster by any means is better, and IV thrombolytic certainly has the potential to open the artery before thrombectomy in a proportion of patients, perhaps not that many, but it may also facilitate the thrombectomy. So, in the randomized trials, reperfusion after the thrombectomy was significantly better when patients had had bridging thrombolytic despite a low rate of pre-endovascular reperfusion. Other reasons for giving the lytics are the potential safety net it provides if the thrombectomy procedure is unexpectedly delayed or fails to get the artery open, and there's also this potential for lytics to dissolve distal embolic fragments and perhaps improve microvascular reperfusion. Dr. Negar Asdaghi:         So, great. So, let me summarize for our listeners what you mentioned. First off, so these are arguments in favor of giving lytics. As you mentioned, we're not really wasting time. These processes occur in parallel, so it's not like we're wasting time in giving a therapy that is potentially not as efficacious as thrombectomy is. And number two, we have improved the possibility of early reperfusion, perhaps, with the lytics. And if there are some fragments or distal clots that thrombectomy wouldn't have reached, then the lytics would. And then also there is also the chance that the thrombectomy might have failed in difficult access, and so on and so forth, and at least the patient has some chance of revascularization with the lytics. So, if these are the arguments for giving lytics, what are the arguments against giving lytics in this scenario? Dr. Bruce Campbell:       The main argument is the potential to reduce both the intracerebral and systemic hemorrhagic complications. There's also potential cost saving by skipping thrombolytics. That's probably more relevant in low-resource settings, particularly when relatives may have to pay for the thrombolytic before treatment is initiated, and that can be burdensome and also potentially delay the thrombectomy. There's a theoretical concern about thrombus fragmentation with lytics and potential migration of the clot out of reach of the thrombectomy or to new territories. But final reperfusion, as I mentioned, was, on average, better with the patient having a lytic on board in the randomized trials. Dr. Negar Asdaghi:         Perfect. And I want to highlight this issue of thrombus fragmentation because I think our readers will read more and more about this idea of, as you mentioned, fragmentation will potentially make an accessible clot for thrombectomy inaccessible. But I see that later in our questions, we're going to address that as part of the findings of randomized trials as well. So, these are some of the arguments for and against. And before we go to the randomized trials, I'd like to get an overview of what we knew as part of observational studies and non-randomized studies prior to more recent randomized trials on this topic. Dr. Bruce Campbell:       There've been a couple of nice systematic reviews and meta-analyses of the observational data, and notably in most of these studies, the direct thrombectomy patients had contraindications to lytics, and that introduces confounding factors that are difficult to adjust for. For what that's worth, the functional independence, mortality outcomes were better in the bridging patients. Hemorrhage rates weren't always higher with the lytic, and one study by Jonathan Coutinho in JAMA Neurology for the SWIFT and STAR studies showed the opposite despite them having really careful adjustment for all the confounders they could think of. And the meta-analysis by Eva Mistry in Stroke did not detect a difference in symptomatic ICH between the direct and bridging strategies. One thing that should be less affected by the patient characteristics would be the technical efficacy outcomes, and it was interesting that in the observational data, the patients who'd had bridging lytic had higher mTICI 2b-3 rates and also fewer device passes. Dr. Negar Asdaghi:         Okay. And now we do have further information with all of these new randomized trials. So, why don't we start with some of the earlier studies, the three, SKIP, DEVT, and DIRECT-MT, and start with those studies first before we move to some more recent European trials. Dr. Bruce Campbell:       SKIP was performed in Japan, and it used the lower 0.6 milligram per kilogram dose of alteplase that's standard there, and DEVT and DIRECT-MT were performed in China. All three of them showed numerically similar functional outcomes with slight trends favoring direct thrombectomy. SKIP had a smaller sample size and did not meet its non-inferiority criteria, and the other two trials did meet their specified non-inferiority margin, but it could be argued those margins were overly generous. If you think about non-inferiority trials, we generally try to set a margin for non-inferiority such as lower 95% confidence interval for the trial intervention would sacrifice up to 50% of the reference treatment effect. And it's difficult to estimate the effect of alteplase in this specific population. But if you think of the Emberson meta-analysis of alteplase, overall zero to three hours alteplase versus placebo has a 10% effect size and mRS 0-1, three to four and a half hours of 5% effect size. And we regard that as clinically important. So, half of 5%, 2.5%, is a lot tighter margin than any of the direct randomized trials employed. Dr. Negar Asdaghi:         So, Bruce, let me recap what you just mentioned. Two out of the three earlier trials seem to suggest that perhaps skipping IV therapy is the way to go rather than bridging as these two trials met the non-inferiority criteria if we believe that non-inferiority margins you mentioned. And now we have a couple of more trials, more recent trials. Can you tell us about these trials please? Dr. Bruce Campbell:       MR CLEAN-NO IV in a European population did not demonstrate non-inferiority, and the point estimate slightly favored bridging. Interestingly, in that trial, the symptomatic intracerebral hemorrhage risk, which was one of the main drivers for trying this strategy, was 5.9% in the direct and 5.3 in the bridging group. So, there's no hint of benefit from dropping the lytic on that metric. SWIFT-DIRECT was more selective in only enrolling internal carotid and M1 occlusions, which had a lower chance of early recanalization with lytic. But the protocol also specified giving the full dose of lytic. In the other trials, it seems the alteplase infusion was often stopped once the patient was in the angio suite, so the full dose may not have been delivered. And despite very low pre-endovascular recanalization in that selected group in SWIFT-DIRECT, the end of procedure reperfusion was significantly better in the bridging group, which is a consistent finding across the trials and suggests that the lytic may improve the thrombectomy outcome. Dr. Bruce Campbell:       DIRECT-SAFE, the final of those trials, was interesting in that the patients were enrolled roughly 50:50 from Australia, New Zealand, versus Asia. And in contrast to the original three randomized trials in Asian patients, DIRECT-SAFE found a significant benefit of bridging lytic in Asian patients. So, it'd be very interesting to see the results of the IRIS individual patient data meta-analysis, but we may not find a difference in Asian versus Caucasian patients despite those initial trials and despite substantial differences in the prevalence of intracranial atherosclerosis, which has often been proposed as something that would increase the risk of having bridging thrombolytic on board. Dr. Bruce Campbell:       The original study level estimate of symptomatic hemorrhage had a borderline significant 1.8% absolute reduction in the direct group. Whether those data were not all core lab adjudicated and the final analysis may show a smaller difference than that. Notably, given that trend with symptomatic intracerebral hemorrhage, mortality did not differ significantly, and, in fact, the trend favored bridging patients. So, the symptomatic hemorrhage slight trend into increase did not translate into any hint of increased mortality. Dr. Negar Asdaghi:         So, Bruce, a lot of information, and I need a recap for me. So, let me try to recap some of the things you said, and please jump in. So, so far, the newer data really basically don't show us any convincing evidence that skipping is the way to go, and direct endovascular we really don't have data in favor of going directly to the angio suite. And the jury is still out regarding an increase in the symptomatic intracerebral hemorrhage rate amongst those that actually are pre-treated with IV therapy. Is that correct? Dr. Bruce Campbell:       That's correct. So, none of the three recent trials met their non-inferiority margins. And again, we had this issue of relatively generous non-inferiority margins, and the symptomatic hemorrhage, it would make sense that there's a small difference, but it's not really been borne out in the data to be statistically significant at this stage. And again, this individual patient data meta-analysis is keenly awaited to get the most accurate estimate on that. Dr. Negar Asdaghi:         So, while we wait that, I'm going to digress a little bit and ask you a question that's not addressed in the paper that you have in this issue of the journal, and that's the CHOICE trial. So, by now, we have the results of CHOICE trial. Do you mind first give us a brief overview of what CHOICE was and how you feel that the results of CHOICE would affect this field of direct versus bridging in general? Dr. Bruce Campbell:       CHOICE is a very interesting study in that it tested giving the intra-arterial lytic at the end of a thrombectomy procedure that had achieved an mTICI 2b or better, which is what we traditionally regarded as angiographic success. The idea was to improve microvascular flow, and that may be the case. The trial was terminated early due to logistic reasons and showed a very large effect size that requires replication. The subgroup analyses are interesting in that the benefits seem to mostly accrue in patients who'd not already had intravenous lytic. Dr. Bruce Campbell:       So, perhaps giving the IV lytic before thrombectomy can still benefit patients after the thrombectomy, as well as achieving early recanalization in a proportion of patients and perhaps facilitating the thrombectomy. The other issue to address with the DIRECT trials is that with the exception of a few patients in DIRECT-SAFE, the comparator was alteplase and not tenecteplase. And we have data from EXTEND-IA TNK that tenecteplase bridging is not just non-inferior, but superior to alteplase bridging. There's an ongoing Brazilian trial of exactly that, tenecteplase versus the direct approach, which will be very interesting. Dr. Negar Asdaghi:         So, great, Bruce. I just want to repeat this segment again for our listeners. So, CHOICE is a very interesting study, looked at giving intraarterial alteplase to patients after endovascular therapy was completed and after they'd already achieved the complete and successful revascularization, and the trial was terminated early because of logistic reasons. So, we have to keep in mind, this was a smaller study, early termination, but the effect size was pretty large in favor of giving lytics. Dr. Negar Asdaghi:         So, what you mentioned is interesting, and I think that it's really worth paying attention to, that the majority of the benefits seem to have occurred from intraarterial thrombolytics in patients that have not been given intravenous lytics prior to endovascular therapy. So, in other words, you need some sort of lytics either before or after the endovascular thrombectomy to achieve that ultimate improved outcome. So, moving forward now from the randomized trials that we have on bridging versus direct thrombectomy, you have mentioned in the paper some interesting subgroups that may benefit or not benefit as much from bridging versus direct thrombectomy. Do you want to elaborate a little more about those subgroup analyses? Dr. Bruce Campbell:       The idea of precision selection or individualized treatment is being talked about a lot given there didn't seem to be much overall difference between strategies in the randomized trials, but it's important to note that the randomized trial actually disadvantages the bridging group by delaying lytic until the patient was firstly confirmed eligible for thrombectomy and then consented and randomized. Putting that aside, if we could identify a subgroup who clearly benefit from skipping lytic and, importantly, identify them without delaying lytic for those who likely benefit, that's clearly attractive. Dr. Bruce Campbell:       Currently, I'd say we have not identified that kind of subgroup, and the planned IRIS individual patient data meta-analysis will be critical for that. Patients with a large ischemic core are one potential group where there's a high risk of bleeding hypothesized. To date, there is no definitive data to indicate the risk is lower with the direct approach. Patients who need stents certainly may benefit from not having a lytic on board because they often need adjuvant antithrombotics that could increase the bleeding risk. But the question there is whether we can confidently identify those patients before the procedure, and I think that's unclear at this stage. Patients with really large clot burdens and proximal occlusions have sometimes been said not to benefit from IV lytic based on the low rates of pre-endovascular reperfusion, but the randomized trials really hinted other benefits like this potential facilitative thrombectomy. So, that hypothesis may be insecure as well. Dr. Negar Asdaghi:         And how about age? Have you come across and has there been any signal towards an impact or interaction between age and benefit from pre-endovascular thrombectomy and thrombolytics? Dr. Bruce Campbell:       It's an interesting question because age has not generally been a treatment effect modifier in previous stroke studies with thrombolytics and thrombectomy, and the individual direct thrombectomy trials that have reported subgroups haven't shown any convincing heterogeneity by age. There's certainly no indication that older patients are at risk from bridging in what I've seen so far. Dr. Negar Asdaghi:         So, this question comes up in clinical practice all the time, that a person's older, perhaps more atrophy, more vascular risk factors and white matter disease, and they're more prone, so to speak, of having a symptomatic intracerebral hemorrhage. So, what you're saying is, from the data we have, there's really no signal in favor of withholding pre-thrombectomy lytics in this population. So, it's important to know this. Bruce, what should be our final takeaway message from this study? Dr. Bruce Campbell:       I tend to agree with the recent European Stroke Organization and ESMINT guideline that for now, patients should receive lytic as early as possible and in parallel with the decision to perform thrombectomy such that neither treatment delays the other. I think if we can identify a subgroup that benefits from direct thrombectomy, and that's confirmed in the individual patient data and meta-analysis, and we can identify them without disadvantaging the majority of patients, and also that the ongoing improvements in IV lytic strategies don't render the existing trial data obsolete, then we may, in future, skip lytic for some patients, but we are not there yet. Dr. Negar Asdaghi:         So, that's amazing, Bruce. We look forward to reviewing the paper and individual data meta-analysis and interviewing you, hopefully at a better hour your time, on that. Thank you very much for joining us on the podcast today. Dr. Bruce Campbell:       Thanks again for the invitation. It's been great talking to you. Dr. Negar Asdaghi:         Thank you. Dr. Negar Asdaghi:         And this concludes our podcast for the June 2022 issue of Stroke. Please be sure to check out this month's table of contents for the full list of publications, including three very interesting images that are presented as part of a new article type, Stroke Images, and a special report in Comments and Opinions section on "Bias in Stroke Evaluation: Rethinking the Cookie Theft Picture." June is the month of Pride, and in spirit of equality, we hope to do our part to reduce all biases in stroke processes of care, diagnosis, and outcomes as we continue to stay alert with Stroke Alert. Dr. Negar Asdaghi:         This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.

This podcast was created and is hosted by Paul Burns, a young survivor of stroke. This podcast series is part of Stroke Foundation's Young Stroke Project. Gustavo Zaera is a Spanish born, multilingual, Norwegian technology entrepreneur who has dealt with many challenges including a brain tumour in 2013. In this episode we chat about his approach to life, dealing with emotions and how his early childhood experiences forged the resilience that helped him deal not only with his diagnosis and treatment but go on to continue to succeed!

For more details, visit the #DrGPCR Podcast Episode #70 page https://www.drgpcr.com/episode-70-with-dr-stephen-ferguson/ ------------------------------------------- About Dr. Stephen Ferguson Dr. Stephen Ferguson is a Professor in the Department of Cellular and Molecular Medicine at the University of Ottawa. He did B.Sc. in biology at McGill University and received his Ph.D. under the mentorship of Dr. Brian Collier in the Department of Pharmacology and Therapeutics at McGill University (1994). He did his postdoctoral training with Dr. Marc G. Caron at Duke University (1994-1997), where he and his colleagues investigated the role of G protein-coupled receptor kinases and beta-arrestin in regulating G protein-coupled receptor endocytosis, trafficking, and signaling. He has held four Canada Research Chairs since 2001 and was previously a Heart and Stroke Foundation of Canada MacDonald Scholar (1998-2003) and Heart and Stroke Foundation of Ontario Career Investigator (2003-2016). He was a recipient of Canada's Top 40 under 40 award in 2004 and received Queen Elizabeth II, Diamond Jubilee Medal, in 2012. He has also received both Junior (2001) and Senior (2005) investigator awards from the Pharmacological Society of Canada. Most recently, in 2021, he was elected as a Fellow of the Canadian Academy of Health Science (FCAHS). His research career has focused on the investigation of the regulation of G protein-coupled receptors signaling mechanisms in health and disease. He currently holds multiple research grants from the Canadian Institutes of Health Research (CIHR) for his research investigating the role of metabotropic glutamate receptor signaling in Huntington's and Alzheimer's disease. Dr. Stephen Ferguson on the web Carlton University Canada Research Chairs Twitter ResearchGate LinkedIn Great Lakes GPCR Retreat on the web 21st Great Lakes GPCR Retreat More about previous GPCR Retreat meetings ------------------------------------------- Are you a #GPCR professional? - Register to become a Virtual Cafe speaker http://www.drgpcr.com/virtual-cafe/ - Subscribe to our Monthly Newsletter http://www.drgpcr.com/newsletter/ - Listen and subscribe to #DrGPCR Podcasts http://www.drgpcr.com/podcast/ - Support #DrGPCR Ecosystem with your Donation. http://www.drgpcr.com/sponsors/ - Reserve your spots for the next #DrGPCR Virtual Cafe http://www.drgpcr.com/virtual-cafe/ - Watch recorded #DRGPCR Virtual Cafe presentations: https://www.youtube.com/channel/UCJvKL3smMEEXBulKdgT_yCw - Share your feedback with us: http://www.drgpcr.com/audience-survey/

For more details, visit the #DrGPCR Podcast Episode #69 page http://www.drgpcr.com/episode-69-history-of-the-gpcr-retreat-with-dr-stephen-ferguson/ ------------------------------------------- About Dr. Stephen Ferguson Dr. Stephen Ferguson is a Professor in the Department of Cellular and Molecular Medicine at the University of Ottawa. He did B.Sc. in biology at McGill University and received his Ph.D. under the mentorship of Dr. Brian Collier in the Department of Pharmacology and Therapeutics at McGill University (1994). He did his postdoctoral training with Dr. Marc G. Caron at Duke University (1994-1997), where he and his colleagues investigated the role of G protein-coupled receptor kinases and beta-arrestin in regulating G protein-coupled receptor endocytosis, trafficking, and signaling. He has held four Canada Research Chairs since 2001 and was previously a Heart and Stroke Foundation of Canada MacDonald Scholar (1998-2003) and Heart and Stroke Foundation of Ontario Career Investigator (2003-2016). He was a recipient of Canada's Top 40 under 40 award in 2004 and received Queen Elizabeth II, Diamond Jubilee Medal, in 2012. He has also received both Junior (2001) and Senior (2005) investigator awards from the Pharmacological Society of Canada. Most recently, in 2021, he was elected as a Fellow of the Canadian Academy of Health Science (FCAHS). His research career has focused on the investigation of the regulation of G protein-coupled receptors signaling mechanisms in health and disease. He currently holds multiple research grants from the Canadian Institutes of Health Research (CIHR) for his research investigating the role of metabotropic glutamate receptor signaling in Huntington's and Alzheimer's disease. ------------------------------------------- Dr. Stephen Ferguson on the web Carlton University Canada Research Chairs Twitter ResearchGate LinkedIn ------------------------------------------- Great Lakes GPCR Retreat on the web 21st Great Lakes GPCR Retreat More about previous GPCR Retreat meetings ------------------------------------------- We aspire to provide opportunities to connect, share, form trusting partnerships, grow, and thrive together. Fill out the Ecosystem waitlist form today to be the first to explore our brand new and improved space! For more details, visit our website http://www.DrGPCR.com/Ecosystem/.

Tuesday and Tim are joined by Dr. Robert Strang, Nova Scotia's Chief Medical Officer of Health, where they discuss the topic on EVERYONE'S MIND these days, COVID (and the Omicron variant!), his personal leadership, and public health. As the one leading the charge of the response to the COVID-19 pandemic in Nova Scotia, how does he continue to hold his centre and what is he learning?About Dr. Robert Strang:Dr. Robert Strang is Chief Medical Officer of Health in Nova Scotia appointed in August 2007. He received his medical degree from University of British Columbia (UBC) and completed Family Practice and Public Health and Preventive Medicine residencies at UBC.As Chief Medical Officer of Health, he has provided leadership around the renewal of the public health system in Nova Scotia as well as raising awareness around the importance of creating policies and environments that support better health for Nova Scotian families and communities.He is passionate about public health and has worked with non-government organizations such as Smoke Free Nova Scotia, Heart and Stroke Foundation and Public Health Association of Nova Scotia.Dr. Strang has an adjunct appointment with Dalhousie University, Department of Community Health and Epidemiology.Resources:Learn more about, and follow, The Outside by visiting and liking all of our channels:Website: www.findtheoutside.comFacebook & Instagram: @findtheoutsideLinkedIn: https://www.linkedin.com/company/findtheoutsideWindhorse Farm transferred to Mi'kmaq in spirit of reconciliationNova Scotia Health See acast.com/privacy for privacy and opt-out information.