Replies

• Thank you so much John! It was great to meet you. Thank you for your encouragement! Take Care Dr. Tidman
  March 9, 2025

• Very well done format Dr. Tidman. You are a great teacher. I always learn something from others and enjoyed the interaction between different members in the community. Health and Happiness, John
  March 9, 2025

• Arienne continues on her journey with small improvements daily. Thanks so much for your continued support 🤗🤗
  March 7, 2025

• John, thank you so much for your in depth descriptions and explanation of watershed stroke. I understand a lot better now!! Interesting about the medication mentioned starting all of her low blood pressure syndrome prior. I'd not heard about that before. and just another piece to the puzzle of health. Hope this has been another good week of recovery for Arienne!!
  March 7, 2025

• UPDATE: As of March 1st, 2025, Dr. Linda Julian has agreed to take the Quantitative Mentor role. Thank you Dr. Julian! Also, Dr. Laura Buchanan has volunteered to be our Publication Mentor, helping Members to publish research articles! Thank you Dr. Buchanan! We now have a fully staffed Research Mentorship program with Faculty just waiting to help! Please Contact Kelley Sauber to get connected with a Mentor soon! See everyone at this Quarter's Journal Club on Saturday, March 8th at Noon PST/1:00 MST/2:00 CST/3:00 EST. Click on the Journal Club link under Journal at the top of the screen. See you there, Dr. Melanie Tidman, DHSc, MA, OTR/L, MHP SMHP Research Academy Chair
  March 5, 2025

• Have you tried phenotyping her obesity? There are 4 main phenotypes: 1. Hungry Brain, 2. Hungry Gut, 3. Emotional Eater and 4. Low energy. Identifying their predominant phenotype will help you with a more targeted approach.
  March 3, 2025

• Hello Pam, I did figure out a topic but my supervisor dropped me as she did not feel like she would be the best option. So right now, I am not in a program. I am considering pursuing a Masters in Nutrition through a US school and then try the PhD route again in the future.
  March 3, 2025

• Thank you Pam. Yes it is good to keep up with healthy fluid intake as you point out. Arienne is always well hydrated, and not afraid of salt so unlikely to be an issue with her stroke. To answer your question on “watershed infarcts” the brain has incredible blood flow interconnections. At the base of this beautiful organ exists the “Circle of Willis” whereby blood supply from the the anterior (front) carotid arteries circulation and posterior (back) vertebral arteries join helping to provide alternative flow to both sides of the brain should one vessel get occluded or blocked. Now as vessels get smaller and smaller, like a spider’s cobweb spreading out over the multiple surfaces of the brain, there are numerous areas of the brain that have little backup or what we refer to as collateral flow. As for watershed infarcts when large arteries become smaller arterioles, and eventually tiny capillaries the blood pressure (BP) significantly drops in a gradient along the way. If your systemic blood pressure falls below “normal” then the smallest capillaries are starved of oxygen and nutrients. This is a watershed infarct - both superficial and deep areas of the brain where terminal branches of major cerebral vessels meet suffer. So what caused Arienne’s low blood pressure or HYPOtension. Last year my lovely wife took a small dose of a cold medication in hopes of helping her sniffling nose from a recent cold. She dislikes taking any meds if possible. Next time you’re in a pharmacy check out the cold meds and nearly all of them contain phenylephrine, a potent vasoconstrictor of vessels in your nose if applied topically in a nasal spray. Despite multiple studies, and systematic reviews showing oral phenylephrine is NO BETTER than placebo why is it in so many OTC cold, sinus, and flu products. Perhaps it’s a financial decision because it’s cheap and FDA approved from decades ago. A better oral vasoconstrictor is pseudoephedrine but this was moved behind pharmacy counters twenty years ago because novice “home chemists” could easily convert this to methamphetamine. Long story short a small dose of phenylephrine gave Arienne a rare syndrome where her blood pressure skyrocketed giving her reversible cerebral vasoconstriction syndrome (RCVS). To “be on the safe side” physicians advised her to go on a blood pressure medication called an ACE inhibitor to “keep her blood pressure in a normal range — below 120/80. Arienne has struggled with symptomatic LOW blood pressure on the lowest dose possible (perindopril 2 mg/day) for months. If her BP is too low she doesn’t take any meds that day. Less than 24 hours prior to her stroke she took her daily blood pressure reading and asked me if she should take her meds. I said absolutely not because it was ~80/50 but too late as she took the perindopril minutes earlier. She took a lot of salt with her coconut keto coffee but felt dizzy at times despite elevating her legs. Early the next morning at 0400 her blood pressure likely dropped again as she needed to hold onto the wall to get to the bathroom. She never woke me up so I had no idea until I recognized her stroke-in-progress at 0800 later when I woke her up. Therefore LOW BP - induced by medication - was the root cause of her watershed infarctions of which hundreds of areas of her left hemisphere suffered hypoxia and cell death. The brain try’s to stay alive by a mechanism called auto regulation. As neurons and supportive cells die they swell and further diminish oxygen and blood flow so the brain orders up high blood pressure in a desperate attempt to supply dying brain cells. It then becomes a roller coaster akin to higher doses of insulin chasing elevated blood sugars followed by crashes of blood glucose or hypoglycaemia. Similarly reflex treatment for high blood pressure with multiple medications can precipitously drop BP levels leading to more watershed infarctions — a vicious cycle. Standard stroke protocol keeps Arienne on low dose perindopril but we are extremely cautious with multiple blood pressure checks and seriously question the “normal blood pressure of 120/80” for a female close to 80 years-of-age! Arienne really appreciates all the giant hugs and friendly community support. Thank you from the bottom of our hearts to everyone ❤️ ❤️
  March 1, 2025

• Hi! (I'm sorry for some reason I can't see your name on the post for some reason. We're still working on the functionality of these discussions.) I just came across your post, and wanted to check in and follow up! Have you made any progress? or made any decision on the topic you'd like to focus your research project on for your PhD? Also, We'd love it if you would attend next weekend's Journal Club if you would be available next Sat 3/8, and you can discuss with the group during the Q&A session after the presentation. :) A brief announcement was sent out in an email to the group yesterday, and we'll be doing a round of social media posts with the details, and another email next week as reminders on how to log in to access the broadcast, date and time etc :)
  February 28, 2025

• Hi John, as I was just saying in your email with the picture of Arienne walking in -20 weather, and already walking 2 miles. Wow, just wow! She is incredible! She sure is an inspiration! I'm going to get out and walk with her in mind - her strength and stamina and healing! We are so routing for her full recovery and for both of you, as you navigate this journey! I have to look up this 'watershed stroke' and hypotension. I hate that this happened right after the symposium, we all get pretty dehydrated at events, and being in ketosis we need extra hydration. I'm going to look more into this. and sending a reminder to everyone to stay hydrated, if this is what possibly contributed to her low blood pressure? I've also been wanting to look into Nattokinase, and find out more. I'm interested in hearing any perspectives for recovery in post stroke/Mi, but also, especially in, a preventative scenario. (on a personal level, my CIMT is not great on the rt side, much to my chagrin, from my years of 'not knowing' and doing what we were told was 'healthy' in my latter years, and my younger years of abusive eating of junk food addiction ugh, and don't want to have a stroke in the future! My CAC is zero though, which gives me some piece of mind. I might be doing a CTA sometime in the near future if necessary to investigate further.) Final thought, I found it profoundly interesting one of the responses on the twitter thread that Chris Cornell posted from a doctor of PT, I think she was? The many different movement exercises that she was recommending. Even in a mirror, so that the brain could see what the other side was doing, and try to get the stroke effected side to mirror it! The brain is phenomenal! Just functional movement, and standing from a seated position, and arm and leg movements. Great, I hope it ALL helps!! Sending more giant hugs, and thank you for the updates as we travel together on this health/life journey! ~Pam
  February 28, 2025