The swallow lady

She carried a notebook and pen, and a bag that contained saltine crackers, some applesauce, and a box of juice. The Swallow Lady. “Are you ready for the tests?” she asked.

“Yes,” I said, ready to show her I could swallow.

She leaned over the bed and placed her fingers gently on my throat. “Try swallowing for me.”

What could be easier? But my mouth was dry and my throat constricted. I couldn’t swallow. The harder I tried, the more my throat tightened up.

“Relax,” she said. “Try moistening your mouth.”

I managed to work up some saliva. Then my chin pushed forward, my neck stretched, and I swallowed.

“Good,” she said. “Everything 
appears to be working.” She scribbled in her notebook, then passed a cracker to my good hand. “Now try eating this, but do it slowly, in little pieces.”

Immediately, I took a good-sized bite. The cracker stuck to the roof of my mouth. I couldn’t chew and only managed to spit it out.

“Nibble,” she said. “Tiny bits.”

I felt like a fool. How could I not swallow? But I did as she suggested, taking a tiny bite of the cracker, and then swallowed.

“Good. Now try this. Sip slowly.” She poured a small amount of juice into a paper cup, and I drank it, forcing myself to concentrate on each stage of swallowing.

it’s unsettling to have your children see you so vulnerable.

The therapist smiled. “You’ve done well. You’ve passed the test. For the first few weeks, your food will be minced or pureed. You must eat and drink slowly and carefully. This is only one of many things you’re going to have to relearn how to do.”

Relearn. That word would become a mantra of my therapist community. Restoring what has been damaged is a very complicated process

Rehab and relearn

My first night in the rehab ward was terrifying. Alone with my thoughts, I no longer felt like I belonged to the human race. My brain kept taking tours into my distant past. I drifted in and out of sleep, and through the night, I wept.

Yet memories, I was convinced, were the one touchstone I shared with my old self. They worked like a metaphor to help establish my new claim on “being.” A part of my brain was damaged, but other parts seemed to be working overtime to compensate for what I had lost.

Thankfully, Pat would not let me feel sorry for myself. Nor was the staff tolerant of any quitting. As I traveled through the halls in my wheelchair in the weeks to come, I heard a chorus of voices raised in a song of healing. Rarely did I hear anger or annoyance escape anyone’s lips but my own.

That first day of rehab, I had an appointment in the gym. “Do you know the way?” one of the nurses asked. I realized they expected me to wheel myself to the gym. Good luck, I thought. I couldn’t begin to go in a straight line. My right arm hung lifeless in my lap, and when I pulled with my left hand, I did doughnuts, spinning in circles.

“Drag your left foot along the ground as you push,” a nurse advised. When I tried, I made it a few yards before I veered right and smashed into the wall. “Perseverance,” she called to me.

I repeated the lurching motion, once again smashing into the wall, then continued down the hall, swerving to my right, almost colliding with an elderly woman. Then, to my surprise, I bolted in a straight line toward the gym.

The next few weeks were a grueling process of relearning and repeating the simplest movements: swallowing, standing, stretching.

To regain movement on my damaged side, I practiced “mirror therapy.” The goal is to fool the brain. A mirror was placed on a table by my right shoulder, my right arm behind the mirror. Then with my good hand I performed several simple exercises, staring in the mirror as hard as I could.

There is nothing smooth about stroke recovery, but there’s also no limit.

I drummed my fingers, formed a fist, flexed the fingers of my left hand. I did this slowly so my brain could take in the movement, pausing and then repeating, for about a half hour.

What I saw, of course, was the reverse image. I thought I was looking at my right hand doing the movements, not my left hand. My brain was being fooled. Or was it? I wasn’t sure. But I was determined to embrace this little deception. I think these exercises helped forge new pathways between the hemispheres of my brain.

One day, after a few weeks, Nicole was sitting opposite me when she jumped to her feet and shouted that my damaged hand had mimicked the movement of my good hand. At first, I didn’t believe her, but then I lifted my paralyzed arm and, much to my amazement, flung it in a circle, hitting the mirror. I let out a whoop. I had movement in my arm for the first time since the day of the stroke

Going home

The week before Christmas, five weeks after my stroke, the rehab doctor came to see me one morning. By then, I was able to stand on my own. I had started to climb the stairs in the gym, hanging on to the railing. I could pedal the stationary bike for 15 minutes. And I was now able to transfer myself to the toilet without assistance.

Sure, I sometimes became morose, but I had taken a vow: to remain positive and happy. And recover.

The doctor said to me, “Would you like to go home for Christmas? Then if things work out, you’d return in the New Year as an outpatient for three months.”

I was both elated and a bit scared. “Who’ll take care of me?” I asked.

“Pat. Your wife? You do remember her, don’t you?” he said, and then he smiled. “We think you’re ready. Pat’s keen to give the idea a go. We’ll supply all your medications and requisitions for the aids you need—wheelchair, walker, anything to make your home more comfortable.”OK, I thought, being home was a good choice. As the doctor turned to leave, he smiled and said, “Merry Christmas.”

I spent most of Christmas Day sleeping. Nicole arrived the next day with her partner, Iain, and their daughter, Flora. As soon as my grand*daughter saw me, she frowned. What happened to Poppa? She was intrigued by my wheelchair. And fearful.

“They’re my legs,” I told her, “until Poppa gets better.”

The sorrow I felt choked me, and 
if my lips had parted, the whole neighborhood would have sworn they’d heard a lone wolf cry in the wilderness. As they were leaving the next morning, Flora said, “Poppa, please get better.”

A year would pass before she felt confident enough to approach me and wrap her arms around my legs. By then I was walking with a cane.

Meanwhile, my weeks of outpatient therapy were monotonous, but the benefits were immeasurable. I pedaled a stationary bike, climbed steps, and did leg lifts, squats, and arm pulls. I was finally able to pronounce a word without confusing the vowels and consonants.

My emotional control was still 
fragile. I would weep when I saw scenes of poverty on TV. The silliest jokes could give me unstoppable giggles.

The author and his wife, Pat, who nursed him through his recovery
Courtesy Peggy New

The author and his wife, Pat, who nursed him through his recovery

I’ve learned that there is nothing smooth or predictable about stroke recovery, but there’s also no limit. The old notion that there is a finite window in which to achieve rehabilitation is simply false. So, like most stroke survivors, 
I expect full recovery. It’s unlikely I’ll return to being the person I once was, physically, mentally, or spiritually. I have both lost and gained things that define who I am as a person. But with the advances in treatment and therapy, I believe I can continue to repair and rebuild, and find a place for myself in my reconfigured world where I feel both valuable and valued.

24 Secrets Pain Doctors Won’t Tell You

Meds are available, but…



istock/kupicoo

Sure, they can give you some meds to dampen the pain. But the best doctors will talk to you about the cause of your pain, whether it’s your lack of activity, your stress level, a condition like arthritis, your mattress

10 Secret Reasons for Your Back Pain



Alyssa Jung




Prone to back pain? Experts share common but surprising reasons for back pain and ways to make your back stop hurting.




You’re stressed out“Emotional outlook is a big predictor of back pain,” says Todd Sinett, a New York City-based chiropractor and author of 3 Weeks To A Better Back. Mental distress manifests itself physiologically, says Sinett. “If you’re uptight for a long period of time, that muscle tension can lead to aches and spasms,” he says. Common areas for stress-triggered back pain include the neck and shoulder region and lower back. Try relaxation techniques like deep breathing (inhale slowly for a count of four, hold the breath for a count of four, exhale for a count of four), a walk, or yoga. Don’t miss these everyday habits that are seriously damaging your spine.

Your heels are too high



wragg/iStock

Your fashionable shoe collection might be bothering your back. “High heels throw off your center of gravity,” says William Suggs, a certified personal trainer and licensed sports nutritionist in New York City. Heels make you lean forward to walk, put extra pressure on the feet, and cause you to not fully extend the calf. This puts more strain and stress on the lower back, which can cause pain, he says. “If you must wear heels for work, invest in a nice pair of walking shoes for the commute and change at the office,” says Suggs. This is what you need to do if you wake up with morning back pain

Your diet is “dirty”

A 2014 study in the Asian Spine Journal found that about 31 percent of women and 25 percent of men who suffered from back pain also had gastrointestinal complaints, such as abdominal pain or food intolerance. The link between nutrition and back pain is all about inflammation; foods high in fat and sugar trigger inflammation throughout the body, including the lower back. When Sinett’s father injured his back, he saw an improvement in back pain symptoms when he cut back on sugar and caffeine. Aim for “clean” whole foods instead of processed ones whenever possible. “Always have a protein like lean meat or beans, a good whole grain like brown rice, and vegetables,” Suggs says. Here are exercises that could relieve back pain.

Your pants are too tight

Skinny jeans could be doing a number on your back. Dr. Kenneth Hansraj, MD, chief of spine surgery at New York Spine Surgery & Rehabilitation Medicine told Shape.com that too-tight outfits constrict the body, which limits your range of motion and can strain your back, neck, and shoulders. The biggest fashion culprits? Skinny jeans and pencil skirts. For clothes that are snug but not skintight, look for fabrics with a bit of stretch to them. Make sure you can easily slip a finger under the waistband.

You sit on your duff all day

“Inactivity is one of the most detrimental things you can do to your body,” says Suggs. “Your muscles get used to being in that seated position, so they tighten up.” To combat sitting-induced muscle stiffness and tightness, stretch your lower posterior muscles (Achilles, calves, hamstrings, and glutes) when you wake up. “When those start to tighten then your lower back starts to feel the brunt of the pain,” says Suggs. He also suggests a quick stretch midday and before bed. “It’s also a good idea to get up and walk around a few times throughout the day, and to make sure your back is supported and not slouched when you are seated, says Suggs. Check out the reasons why your back pain could actually be a warning sign of sciatica.

You still smoke

A recent Northwestern University study found that smokers are three times more likely than nonsmokers to develop chronic back pain. “[Smoking] affects the way the brain responds to back pain and seems to make individuals less resilient to an episode of pain,” the researchers said in a news release. Smokers who quit their nicotine habit during the study period experienced a decrease in chronic pain. Previous studies found that smoking may damage tissue in the lower back by slowing down circulation, which reduces the flow of nutrients to back muscles.

You’ve been skipping ab workouts

A strong core could combat an achy back. “If your abs are weak, your lower back has to work harder, which can lead to back pain,” says Suggs. Try plank, superman, or bird dog exercises, which engage your erector spinae, the muscle that keeps your spine erect and helps maintain correct posture, he says. Pay attention to your midsection throughout the day. “Your core should never be relaxed, whether you’re sitting or walking; that’s when you put yourself at risk for developing pain,” says Suggs

You’re dehydrated

The bones of your spine have discs between them, each partly made up of a jelly-like substance that is 90 percent water. Your body needs a steady stream of fluid coming in to help keep that cushioning intact, according to the Cleveland Clinic Center for Spine Health. When your body lacks hydration, those discs become flatter and less cushiony, which can lead to pain. A good way to know if you’re drinking enough to water is to look in the toilet. Your urine should be clear or light yellow; if it’s dark yellow, grab some H20.

Your hips are uneven

Many people have no idea that their hips are uneven, which means one side of your pelvis is slightly higher than the other, says Suggs. The imbalance can cause lower back pain in your day-to-day life, and often becomes especially apparent while you work out. “It affects how your body responds to certain moves and will be different for everyone,” he says. For example, if your left hip is higher and you do a lunge on the left side, you may feel that hip muscle pull tighter. If you notice persistent back pain during a workout, Suggs suggests seeing your doctor before trying to cure yourself. “Your doctor can evaluate your whole body and detect potential imbalances,” he says. These are the signs of back pain that may be more damaging to your health than you think.

You have a urinary tract infection

Pain in the lower and upper back or sharp pains in the flank (side) can be a sign that a urinary tract infection has spread to the kidneys. If you’ve noticed other classic UTI symptoms like increased urge to urinate or pain during urination, see a doctor immediately for treatment.

5 Clear Signs Your Mystery Back Pain Is Actually Arthritis



Alison Martin




A backache that won’t quit may not just be from shoveling, lifting too-heavy weights, or wearing too-high heels. These telltale signs suggest it could be osteoarthritis, or arthritis of the spine


You wake up to pain

If your back hurts when you first get out of the bed in the morning, the pain may caused by the inflammation characteristic of arthritis. (By the way, here’s what to do if you wake up with back pain.) “When there’s inflammation, it’s not the arthritic changes that bother you, it’s the nerve,” says Mark Mickhael, MD, of the Illinois Bone & Joint Institute. Pain can also be caused by a herniated disc, as it pushes out and hits the nerves in your spinal cord. Herniated discs are common with degenerative disc disease, which often accompanies osteoarthritis, or arthritis of the spine. (Learn about the miracle cure that soothes osteoarthritis while sitting down.) Look out for back pain that lasts for roughly 30 minutes in the morning and then goes away. “With arthritis, the pain tends to get better during the day, but then in the evening it feels a little worse,” says Prakash Jayabalan, MD, of the Rehabilitation Institute of Chicago. Evening pain may not be from arthritis, however, but rather from the stress of daily activities such as sitting at work. Find out how to recover from a day of sitting.

Other body parts hurt, too
When arthritis of the spine advances, wear and tear on the vertebrae can cause a pinching or compressing of the spinal cord and nerves. Since the nerves running down your back connect to different areas of your body, you could end up feeling pain, numbness, tingling, or weakness in your hips, butt, legs, and feet. (Scarily enough, this form of osteoarthritis has doubled in the past 50 years.) “Those nerves go down the muscles of your legs, so that can cause weakness,” Dr. Jayabalan adds.

Your spine feels extra stiff

“Even if you’re not in pain, you may feel stiff in the morning,” Dr. Jayabalan says. In most cases, this stiffness will wear off as you start walking around, but the pain may return at night as the joints are stressed from the day. Bending over and arching your back may be particularly painful, and the pain can migrate—one day affecting a shoulder and the next day affecting your neck, and so on

The pain keeps getting worse

Everyone experiences pain differently, and there’s no right or wrong time to see a doctor. “Some patients come in because of a very new pain,” Dr. Jayabalan says, “and others come after months or even years of suffering a twinge here and a twinge there.” (Learn what you should and shouldn’t do before a doctor appointment.) Dr. Mikhael recommends seeing a doctor if the pain comes and goes for more than four to six weeks. (Find out how to manage chronic pain without medication.) Most pulled muscles and other minor injuries heal over that period of time, so if the pain persists and especially if it gets worse, schedule an appointment. Don’t miss these everyday movements that are wrecking your joints

The pain disrupts your z’s

Back pain that keeps you up at night is a vicious cycle: Pain can worsen if you don’t get enough sleep, but if your pain is already keeping you up at night, there’s no way for it to subside. “If the pain is so significant that it’s impacting your sleep and quality of life, then I would say it’s time to see a physician,” Dr. Jayabalan says. Still tossing and turning?

50 Things Nutritionists Never Eat—So You Shouldn’t Either



Lindsay Tigar




Want to know what the experts avoid? Here’s the list of foods, processed goods, ingredients, and chemicals that nutritionists won’t put on their plates.

Artificial sweeteners



Daniel-S-Edwards/Shutterstock

A grande iced coffee with skim milk and two Splendas, please? Think again—and hold the sweet stuff. “I do not think there is sufficient evidence to prove that most artificial sweeteners are safe for consumers, so I prefer to stay away from them and indulge in the real thing [sugar] occasionally and mindfully. Plus, there’s a plethora of research that shows how consuming diet beverages may counter-intuitively lead to weight gain, which can increase your risk of chronic diseases like diabetes and heart disease,” registered dietitian and nutritionist, Chelsey Amer says. This is what could happen to your body when you stop eating
artificial sweeteners

Microwave popcorn





Love to curl up in front of The Voice with some vino and a buttery bag of popcorn? Resist. “I once ripped open an unpopped microwave popcorn bag and I haven’t eaten it since! There are too many artificial chemicals used in the flavorings inside the microwavable bag and I prefer to avoid overly processed products like this as much as possible,” Amer explains. But if you’re pop-crazy and can’t stop, she suggests making your own with popcorn kernels, a brown paper bag and olive oil with a touch of salt.

Processed deli meats

While it’s super-easy to make a turkey club when you buy deli meats in bulk on Sunday for your meal prep, there may be some dangerous ingredients lurking in those slices. “Processed deli meats can contain a wide variety of additives from nitrates to carrageenan that can increase inflammation in the body and have even been scientifically linked to increased risk in colon cancer,” says Megan Faletra, MS, an integrative dietitian nutritionist, certified yoga Instructor, and founder of The Well Essentials. Opt for organic, nitrate and antibiotic free deli meats from brands that are focused on changing the way meat products are produced in the USA.” Make sure you know the gross ingredients you could be eating.

Reduced-fat peanut butter

You might think you’re doing your body good by getting the low-fat jar; you’d be better off going full fat. “While regular and reduced-fat peanut butter contain roughly the same amount of calories, the reduced fat varieties typically contain more added sugar or artificial sweeteners to improve the taste,” says Faletra. “The fat found in peanut butter is healthy for our bodies, so stick to the natural full-fat peanut butters.”

Margarine

If the dairy-free life isn’t for you—we feel ya—but you’re a waistline watcher, you might be tempted to reach for the “healthier” margarine. Hold that thought: “While many margarine brands are beginning to remove the trans fats from their products in order to comply with FDA regulations by 2018, most margarines rely primarily on highly processed vegetable oils (particularly soybean and palm oil),” Faletra says. “Choosing grass fed organic butter in moderation is a much better option for our health as these butters contain high-levels of heart healthy omega-3 fatty acids.”

Most frozen meals

While nutritionist Ha Nguyen, RD, used to nom on frozen meals as a kid—nearly every day after high school—today, she wouldn’t touch one with a 10-foot pole. Why? She explains, “Most prepackaged frozen meals are overly processed, made with refined flour, high in sodium, and full of additives and preservatives. All things that are not good for your body.” Learn to recognize the most harmful ingredients in processed food.

Pop Tarts

You might remember these commercials when you were in middle or high school—and maybe even argued with your pals over which flavor was the best—Nguyen recommends keeping ’em out of your shopping cart next time you’re at the store. “You mind as well send your kid off to school with a candy bar for breakfast. If you simply look at the first few ingredients they consists of refined sugars including corn syrup, high fructose corn syrup, dextrose, and sugar,”

Cheese in a can

Though arguably super fun to play with when you’re 16, as far as a nutritional value, there’s not much this canned faux-dairy can offer you. “Cheese spread is highly processed with very little actual ‘cheese’ in it,” says registered dietitian and nutritionist Michelle Jaelin, RD. It comes with a laundry list of artificial ingredients and colors that I don’t feel comfortable eating. It is called plastic cheese for a reason! If I want to eat cheese, I eat the real thing,” says

Boutique fruit juices

While that carton might claim to give you the vitamins and minerals you need, registered dietitian and nutritionist Andy De Santis, RD, says fruit juices—even the boutique ones—are a slippery slope. “The alarming trend of expensive juices is concerning. These products are generally packed in calories and they won’t keep you feeling full or provide anywhere near the full nutritional benefit of eating whole fruits and veggies,” he says. “For reference, eating an apple, orange and banana would take me 10 minutes. Drinking them in a juice—maybe 10 seconds?” That’s a lot of calories in less than a minute.

Sausages, hot dogs

Take yourself out to the ball game, but skip the hot dog. You might be better off with a brewski and a bag of peanuts. “Not only are hot dogs high in fat and relatively low in protein, which is the exact combination you don’t want in your meat, but they are generally chock-full of sodium, which none of us need more of,” De Santis says. “The icing on the cake? There is a growing body of evidence that connects eating processed meats with an increased risk of cancer in the digestive tract.” These

Cheese

Say it isn’t so! While everything in moderation is a good rule of thumb for almost anything, De Santis put cheese on the naughty list because there are better ways to get calcium. “Cheese is generally high in calories, saturated fat, and sodium, all of which we need to cut back on. You are better off with a low-fat milk, a soy or almond alternative, or vitamin D-fortified yogurt. Don’t forget that nuts, seeds, legumes and dark leafy greens also contain calcium.”

Spam





You may want to pass on meat that comes from a factory instead of a butcher. “Preservatives, sodium, and uncertainty of the meat’s origin are three things that make me worry,” says registered dietician and nutritionist Gabriella Vetere, RDN. “Choose meat that your body can recognize, not one full of chemicals and preservatives

Ramen noodles





Your penny-pinching, hungover, inner college student may be weeping, but your body will thank you when you avoid this sodium pit. Exercise physiologist and nutritionist Rachel Straub, MS, recommends steering clear of these packaged goods because they’re loaded with salt and very little, if any, nutritional value. Make sure you know the most harmful ingredients in packaged foods.

Lunchables





They might seem like a breeze when you’re in a bind with no time to pack a snack for your kiddo, Straub says to try to refrain. “Since they have processed meats full of nitrates, refined grains, and candy, of course, this just isn’t a healthy choice,” she says.

Blended fruit yogurts




The commercials are catchy—and they may bring back fond memories of snacking as a kid—but when it comes to getting the essential nutrients that yogurt is meant to deliver, most of blended fruit yogurts are a bad idea. As Straub explains, “It is basically dessert for breakfast. Nearly 50 percent of the calories can come from added sugar, so they just aren’t a healthy choice. I would much rather have a plain yogurt with a piece of real fruit or any of these healthy toppings.”

Doughnuts

Your Instagram feed might deliver a different message about these powdered (and sometimes rainbow-colored) haloes of dough, but that dozen you pick up before a Monday morning meeting is doing damage, says personal trainer, author, nutritionist, and health and wellness coach Jamie Logie. “Doughnuts are made of refined (possibly GMO) white flour which is super high glycemic.” That means it causes sudden spikes in your blood sugar. “And they’re deep-fried in artery clogging and cancer causing trans fats and covered in sugar. They won’t fill you up, make you hungrier and are filled with pretty much the worst ingredients out there.” Here are all the nutritionist-approved snacks you can buy anywhere

Fast food burgers


The healthiest part of those kid meals you used to beg your parents for when you were coming home from baseball practice? Probably the plastic toy. Logie says that while making your own patty on the grill at home can be a good nutritional choice, the one from the fast food window is questionable. “One hamburger patty can be made up of dozens of different cows that come from feed-lot, confinement-based living. They are pumped full of hormones, have high levels of inflammation and are raised on some pretty horrific feed,” he says. “You then have a high starch white flour bun and then depending what you have on it can contain inferior bacon and essentially plastic processed cheese

Movie theater popcorn

Like peanut butter and jelly, toast and butter and macaroni and cheese, some things just seem like they were meant for one another. Though it’s second nature to grab a can of buttery-salty goodness while you check out the latest blockbuster, Logie challenges you to resist. Large sizes at theaters can contain over 1000 calories and 40 grams of fat—and that’s without the butter topping, Logie says. For an alternative, pop your own on the stove top with some olive oil and salt, and sneak it into the theater. (We promise not to tell!)

Raw oysters

Though oysters have an aphrodisiac reputation and can really hit the spot with a glass of white wine on a sunny day, nutritionist Jennifer Bowers, PhD, RD shies away from the slimy mollusk for the threat it can pose on your digestive system. “There are so many potential food-borne illnesses are associated with undercooked seafood—hepatitis A and noroviruses, specifically. Oysters commonly carry Vibrio vulnificus and Vibrio parahaemolyticus,” she explains. “Having said that, I think oysters taste horrible (personal opinion!), so it’s certainly not worth the risk for me. If you’re going to eat oysters, switch from raw ‘on the half shell’ variety to cooked to lower your risk of getting sick.”

Regular soda




You probably don’t need us to tell you that even an eight-ounce glass of any soda is bad news for your bod. Just in case you need the reminder, though, Bowers explains just how bad of an idea drinking liquid calories really is. “The sugar load in just one serving is simply not worth the glucose rush, mood issues, headache, and calorie bomb. The huge intake of soda in this country, coupled with a sedentary lifestyle, is strongly associated with the rising obesity epidemic,” she explains. Here are all the reasons to avoid soda—always!

Fat-free packaged foods




Don’t allow yourself to be fooled by fad ‘diet’ foods, says nutritionist Rima Kleiner, MS, RD. Though it might be a smart marketing move on the part of major food corporations, labels like fat free, sugar free, and anything free—are deceptive. “Even after years of research showing us that our bodies need healthful fats, I still hear clients who consider packaged ‘fat free’ foods the pinnacle of healthy eating,” says Kleiner. “But many of these packaged products that should naturally contain fat (think cookies, crackers and bars) replace the fat with sugar, which means you end up with a cookie or other product that contains less fat, maybe a few less calories, but with little to no redeeming nutritional qualities,” she explains. “If I’m craving something sweet, I try to make my own so I can use healthful fats like olive oil, flax seeds and avocadoes, or I will just buy a single-serving brownie or cookie from a good bakery to share with my husband or kids.”