Airplane problems post stroke

 Has your competent? doctor addressed ANY of these problems? NO? So. you DON'T have a functioning stroke doctor, do you?

1. Getting my bag or carryon into and out of the upper bin requires help from other passengers.

2. The seat belt loop is only 8 inches long, not long enough, to stay on my lap, with zero use of my left hand clipping the seat belt together one-handed is almost impossible. Complete failure of my doctors and therapists.

3. If we ever have a water landing it would be impossible to clip the waist strap together meaning the life jacket would float off my neck and I'd drown.
4. Oxygen masks have two tightenibg elastic straps needing to be pulled at the same time.
5. Exiting via the slide requires jumping on the slide which is impossible
None of this was addressed by my doctor. Of course my doctor knew nothing about stroke recovery and did nothing. 

Flying failures by my doctors and therapists

 Don't plan on safely flying after the failure of your doctor to get you 100% recovered.

1. The seat belt clip is only 8 inches long, not long enough to stay on my lap, with zero use of my left hand clipping the seat belt together one-handed is almost impossible. Complete failure of my doctors and therapists.
2. If we ever have a water landing it would be impossible to clip the waist strap together meaning the life jacket would float off my neck and I'd drown.
3. Oxygen masks have two tightening elastic straps needing to be pulled at the same time.
None of this was addressed by my doctor or therapists.

Airplane bathroom needs

 As a guy with only one useable hand. In order to pee standing up I have to choose between grabbing the safety bars to keep from swaying or aiming for the toilet. So I try to wedge myself in a corner, the bumpiness of the flight will determine my success.

Airplane food

With luck I didn't spill anything on myself. The jelly packet was squeezed from the bottom directly on the uncut croissant, I can't cut any piece of bread in half, and I can't spread either butter or jam.  The ice cream tub was too big to properly fit between my fingers and it is impossible to fit in my left hand due to the spasticity.  Luckily no one was beside me so my left elbow didn't attack anyone while I was eating. Getting off the foil tops of the food was quite the challenge.

You can almost see the curve of the wrist due to spasticity which is the reason I can't hold any glasses upright. The fingers will never stay straight for long. I have probably passively flexed each one of them at least 500,000 times.  I would like to know EXACTLY how many more times I have to do that before my spasticity goes away.  THAT is what our stroke associations and researchers need to solve.  Useful stuff like that, not the prediction crapola that seems to be common.

Arm rests between airplane seats

If somebody is sitting to my left I absolutely have to have the arm rest lowered. That way I can wedge my elbow in and not have my left arm wandering into my neighbors space due to spasticity. Hopefully a pillow or blanket is provided so I can pad the arm rest and not have it dig into my arm.

Seat belts on airplanes

These almost require two functioning hands. Luckily the short end does reach the top of my leg and I can one-handedly get the clip into the buckle after several tries. I have yet to call a flight attendant for help and I probably never will.

Patients can fly, go to high altitudes with precautions after MI

You'll have to ask your doctor if they know one damn thing about this travel after a stroke.

Patients can fly, go to high altitudes with precautions after MI

Most patients after an MI and other cardiac conditions can return to high altitudes, including air travel, after a few weeks, according to information presented at the American College of Cardiology Scientific Session.

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Once high altitude, defined as over 2,500 meters (8,200 feet), is attained, a patient can experience “fairly significant” physiological changes. Most mountains are high altitude, and airplanes fly around 30,000 to 40,000 feet, but the cabins are pressurized to 2,400 meters.

John P. Higgins

Effect of high altitudes
“Altitude does require more work from the [CV] and respiratory systems,” John P. Higgins, MD, MPhil, MBA, FACC, FACP, FAHA, director of exercise physiology at Memorial Herman Sports Medicine Institute in Houston, chief of cardiology at Lyndon B. Johnson General Hospital in Houston and associate professor of cardiovascular medicine at the University of Texas Medical School in Houston, said in his presentation. “People with mild to moderate stable [CVD] can go with the right precautions and preparation to altitude. However, those that have [instability], high risk or a recent procedure should delay travel and be guided by their provider.”
Higgins said bodies work most efficiently at sea level, where the barometric pressure is around 760 mm Hg. At sea level, the partial pressure of inspired oxygen is 149 mm Hg and in-arterial saturation in blood is 98%. In higher altitudes, the partial pressure of the inspired oxygen decreases. At 8,000 feet, or where airplanes are pressurized, the barometric pressure is an estimated 564 mm Hg, the partial pressure of inspired oxygen is 108 mm Hg and in-arterial blood saturation is 60%.
“A healthy individual should have a saturation of 90% or more and be able to handle that without any problems,” Higgins said.
A short-term effect of going to a higher altitude is hypobaric hypoxia, where the body increases its minute ventilation and tidal volume, which causes hypoxic pulmonary vasoconstriction. The body’s cardiac output is increased to compensate for it, Higgins said.
Waiting periods
Higgins reviewed the recommended amount of time before patients can return to higher altitudes and air travel. Patients with CAD and prior MI who are stable experience angina symptoms at lower workloads. Those who had non–STEMI or STEMI should wait 2 weeks before flying or going to a location of high altitude, but if they had a complicated case of MI, 6 weeks is recommended. Patients with a recent diagnosis of ACS who were not revascularized are recommended to have a maximum stress test prior to air travel, but if they are revascularized with PCI and have no complications, they can wait a couple of days. Patients who recently underwent CABG should wait 10 days for gas to be reabsorbed, he said.

More at link.

On the road again

Now I'm working Mon-Thursday in Chicago. Total time to get here by flying is 6 hours using approved flights. Driving would take 3.5 hours. Have yet to get a coherent answer if there is a limit on travel using your own car. It would probably save 5-600 dollars a trip. Likely to be here for the rest of the year.

TSA and luggage

Flew to Harrisburg, PA today, checked my bag.  Had to get up at 1:30 am to get to the airport on time, managed 1 hour of sleep. In it are my pill containers, blood pressure, statin, aspirin. The TSA agents went rhrough the bag, managing to get all the pill bottles open but leaving tha aspirin without a cap, Had 400+ aspirin scattered throughout the bag, At least they couldn't break the battery in my laptop any worse that they had done last year. Too bad I have no finger dexterity in my left hand, I could have used that as therapy for 1 hour picking individual aspirins. The 3-5 o'clock meeting was hell, couldn't succeed in sleeping with my eyes open and locking my head in an upright position.

Air Evacuation Following Traumatic Brain Injury Worsens Effects on Learning, Memory and Brain Cell Loss

Our stroke teams should be looking at this for air transport to stroke centers. It would be good to know at what altitude they were traveling at. Plane vs. helicopter? 

Air Evacuation Following Traumatic Brain Injury Worsens Effects on Learning, Memory and Brain Cell Loss

A study that simulated the effects of reduced barometic pressure (hypobaria) experienced by patients with traumatic brain injury (TBI) evacuated by air showed that prolonged hypobaria significantly worsened long-term cognitive and neurological outcomes. Maintaining normal oxygen levels did not affect the poorer outcomes after hypobaric exposure, and multiple exposures or use of 100% oxygen further worsened the effects in the rats studied, as described in an article published in Journal of Neurotrauma, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers (http://www.liebertpub.com/). The article is available free to download on the Journal of Neurotrauma (http://online.liebertpub..com/doi/full/10.1089/neu.2015.4189) website until January 2, 2016.
In "Simulated Aeromedical Evacuation Exacerbates Experimental Brain Injury (http://online.liebertpub.com/doi/full/10.1089/neu.2015.4189)," Alan Faden, MD led a team of researchers from the Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, Baltimore, in designing a study that simulated the prolonged hypobaria that a soldier with TBI would experience if evacuated by air from the battlefield. The researchers examined the effects on learning, memory, movement, and depressive-like behaviors in rats with induced TBI exposed to 6 hours of hypobaria 24 hours after injury. Some rats were exposed to a second 10-hour hypobaric period 72 hours after injury.

Based on the results of this study, the authors suggest several approaches to limit the negative effects of hypobaric exposure following TBI, including delaying air transport, increasing cabin pressurization to reduce barometric effects, having specialized enclosures to individualize pressurization, or changing supplemental oxygenation protocols.

In the Editorial "Hidden Perils of the 'Wild Blue Yonder' after Traumatic Brain Injury (http://online.liebertpub.com/doi/full/10.1089/neu.2015.4329)," Patrick M. Kochanek, MD, MCCM and Hülya Bayir, MD, University of Pittsburgh, PA, describe the study as "a valuable and timely exploratory report that takes an early step in addressing a largely unrecognized gap in the pre-clinical and clinical literatures-a gap that is highly relevant to combat casualty care, but also to some cases of civilian trauma." The study authors "appear to have identified a new secondary injury pathway after TBI to add to the list of hypoxemia, hypotension, hyponatremia, hyperthermia, hypertension, hypervolemia, namely, hypobaria that needs to be characterized and prevented to maximize outcomes after TBI-even if patients need to travel into the wild blue yonder."

John T. Povlishock, PhD, Editor-in-Chief of Journal of Neurotrauma and Professor, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, notes that, "the Journal is exceptionally pleased to report this well done and provocative study that probes important questions relevant to the current standard of combat casualty care during aeromedical evacuation. The reported studies conducted in traumatically brain injured rodents illustrate the damaging consequences of sustained hypobaric exposure, while demonstrating the concomitant adverse consequences associated with the use of 100% oxygen. While additional studies are needed to further refine the overall interpretation of this study, the published work raises the important implication that hypobaria should be considered a potential secondary insult in traumatically brain injured patients."
http://online.liebertpub.com/doi/abs/10.1089/neu.2015.4189

Flying challenges

I'm back in New York for the week. My flight from Chicago to NYC was on a B717-200.  Seats on that plane  reclined by pushing the seat forward at the same time as the back tilted.  This made my seating situation even worse since my knees were already  buried into the seat back in front of me.  So I didn't get any sleep at all in the flight from Chicago to NYC.
It was cool on the plane with cool air circulating behind the overhead bins, so I grabbed one of those thin blankets sealed in a plastic bag. It was a very thin blanket and very static filled. One handed opening  the folds was a complete miss. Finally got it in quarters so at least it would cover my upper body. Getting it over both shoulders and keeping it there was damned difficult with one good hand. Then when drinks came by and I had to move my arm the blanket completely slid off. We got in very late so I'll be lucky to get 6 hours of sleep. But then Morgan Stanley has wonderful free coffee, so I'm good.

Flight fun

I was supposed to leave LaGuardia airport at 6:30 pm leaving me an hour layover in Detroit to catch the next flight. 3 of us took a taxi and arrived at 3pm to make sure we didn't get caught in afternoon rush hour traffic. On the way there I got a text that my flight was delayed by 45 minutes meaning that there was no way to get on the final flight on time. Then I got another text telling me I had been rescheduled to a 3:35 flight to Columbus, then Detroit,  then Lansing.  Since this was a totally different flight I now needed to be in a different terminal which the gate agent called on one of the wheelchair service people and I got whisked thru the TSA line in no time. Barely made it to the gate on time to find out it's delayed 15 minutes, then another 15 minutes as the plane needs cooling down.  We board, sit there 10 minutes and have to deplane because the cooler is not working properly. 45 minutes later we board again.  Now I only have 30 minutes to catch my next flight. Land at 7pm in Columbus.  Rush to my gate. The previous flight to Detroit from 4:51 has not left yet. It seems thunderstorms in Detroit have delayed everything. After the storms clear Detroit, lightning at Columbus prevents the ground crew from getting out there. We finally board the plane around 9:30, about the time my flight to Lansing from Detroit is to take off. That final flight is delayed till 11:02 so it may be possible to still make it. But as we are taxiing to the gate in Detroit I can see the gate where the Lansing plane is supposed to be is already empty. So I now have a 10am flight to Lansing in the morning. I'm spending the night at the airport since I'm too cheap to get a hotel and I'm not sure work would pick up the expense. No idea where my luggage is. I'll be flying back to New York on Labor day to work there Tues., Wed., Thu. And I'll be staying in a totally different area at a different hotel. Time to get completely lost multiple more times. Currently 1:49 am Eastern time. Life is good. We had a great plane turbulence drop on the way to Detroit, everyone got excited. One guy thought for sure we were going down.

flying and camels

This is not about airplanes. It's a dream I had Sunday morning prior to leaving for Sacramento once again.
I was with friends in the middle of a farm field with a farm house nearby and a tent set up for a graduation party. I'm sure the tent was because I'm having to miss high school graduations and weddings back in Minnesota.  The wind became ferocious and blew the tent away. I didn't care because the wind was strong enough to have me flying through the air on my back. I was concerned because the field was only a quarter mile long and I had no clue how I was going to land in that short period. I maneuvered down to 3-4 feet and was preparing to land when 4 single humped camels came out of the woods directly into my flight path. I landed safely but was immediately nosed by all the camels.
Flying was a complete blast. I'll have to do it again, lucid dreaming here I come.

Sleep needs post-stroke

It's Friday afternoon and I'm running on empty. On Wednesday night I got 8 hours of sleep. Thursday, due to plane flights I got back to East Lansing at 1am.  I had to meet friends at 5am to go together to the Windsor airport. Since that meant an hour drive I totally skipped sleep on Thursday night. In order to get there by 5am and leaving late at 4:10 am I set the cruise at 88mph. No problems except my friends overslept their alarms and were taking showers when I showed up 5 minutes late. Had numerous cups of heavy duty coffee this morning to get me going for the morning. I'm trying to stop the caffeine since my flight to Rome leaves at 10:40pm and I'm lucky and got a left window seat. Maybe I'll be able to sleep. Toronto airport has lousy signage and it's a good thing I'm quite mobile since I had to walk all over the airport to find the correct terminal and gate.

Airplane seating stroke rehab

Of the 8 legs of flights I had the past two weeks only two had decent seating for me. That is a window seat on the left side. Otherwise I have to spend the whole trip with my left arm pulled over my right leg and forcefully grabbing it with my right hand to stop it from wandering into my neighbor's space. With all that concentration needed I am never able to fall asleep on the plane. Today I'm in the Toronto airport waiting for a flight to Rome, then Barcelona where a seven day Mediterranean cruise starts, Stops at Nice, Corsica, Rome, Sicily, Malta.

Airplane toilette balancing

For men who want to pee standing up, doing it in a flying turbulent airplane should be required therapy.
Making sure to place the grab bar on the affected side to ensure maximum difficulty. I refuse to do it sitting down. The most difficult way should be chosen at all times.

Standing up in an airplane

You'll need to ask your therapist to demonstrate it. Especially with the seat in front of you leaned back.  I basically stumble into the aisle and catch myself there. I have to do massive gyrations in order to get my feet under me and be able to push myself upright with my right arm. Or I grab the seat in front of me and basically pull it almost to the breaking point. It looks totally pathetic.

Relaxation

There is none anymore. It is not possible for me to truly relax anymore. I can't sit in a chair or couch without checking to make sure my left arm is not in the way as I sit down. Then after sitting I have to determine if I want to try to flatten and wedge my fingers under a leg or just go for the easy route and hang the arm down the side, hoping to reduce my spasticity enough so it hangs straight.  Even just sitting in a car requires much thought, watching the scenery is interspersed with checking my arm and working on my hamstring, pulling my foot under me.
No wonder I am mentally fatigued each and every day and all day long. Probably why I love the social events I go to where drinking alcohol is involved. For short periods of time I can just talk and laugh. Although with one usable hand drinking and snacking are not doable at the same time.
Flying is even worse because I have to hold and make sure my left arm isn't intruding into my seatmate or the aisle due to the damnable spasticity.  I can no longer relax enough to fall asleep while flying.

Passengers needing extra time may board now

I appreciated hearing this on boarding my flights. It allowed me to easily get my briefcase into an overhead bin and not have other passengers piling up behind me as I got out my book and neck pillow and attempted to zip the briefcase one-handed.

Can I fly after a stroke?

This is piloting a plane, not riding. You'll have to register to get the complete article.
http://www.aopa.org/info/certified/pilot-protection-services/archives/2013/130204warren-can-i-fly-after-stroke.html?CMP=PPS:Home
The three terms one hears when dealing with a “stroke” are cerebrovascular accident, stroke, and transient ischemic attack (TIA). In a TIA, a person has neurological symptoms lasting for several minutes up to several hours. A stroke is one of the FAA's specifically disqualifying conditions. This means that if you go in for a flight examination and you had a stroke or TIA, the aviation medical examiner may not issue you a medical certificate without obtaining written or verbal permission from an FAA physician. The FAA medical term for this condition is a “transient loss of nervous system function.” This means that you will need to provide medical records, evaluations, and testing for the FAA medical folks to review and determine whether they will grant you a special issuance… To continue reading…