Recovery After Stroke

Falls Prevention After Stroke: What the Latest Research Reveals About Staying Safe and Mobile

For many stroke survivors, the fear of falling is a constant companion. It’s there when you get up from the couch, when you navigate the kitchen, when you try to walk further than you did yesterday. That fear is rational, falls after a stroke are common, and their consequences can be serious. But according to Associate Professor Kate Scrivener, a stroke rehabilitation researcher at Macquarie University, that fear doesn’t have to define your recovery.

In Episode 409 of the Recovery After Stroke podcast, Kate returns to the show where she first appeared in Episode 257 to discuss her HiWalk walking program and share the results of two major research projects: the published Phase II results of HiWalk, and a new systematic review focused specifically on exercise-based falls prevention after stroke.

Who Is Kate Scrivener?

Associate Professor Kate Scrivener leads stroke rehabilitation research at Macquarie University in Sydney, Australia. Her work sits at the intersection of real-world clinical practice and rigorous research. She doesn’t just study stroke recovery, she designs and tests the programs that can change it. Kate first appeared on this podcast to talk about HiWalk, a high-dose walking intervention designed to push the limits of what long-term stroke survivors can achieve. Now, with the results published, she’s back to talk about what the data actually showed and what it means for survivors who want to reduce their fall risk.

The HiWalk Results: What Happened When 47 Survivors Walked Hard

HiWalk was built on a straightforward but ambitious premise: what happens if stroke survivors, who have been living with their disability for years, are given a truly high-dose walking program? Not a gentle weekly session, but 43 hours of structured walking across just three weeks.

The Phase II randomized trial enrolled 47 participants and produced results worth paying attention to.

Attendance was 91%. Retention was 98%. For a physically demanding trial involving chronic stroke survivors, those numbers are remarkable, and they tell their own story about what survivors are capable of when given a real opportunity.

For participants who were not already in active rehabilitation at the time of the trial, walking speed improved by 0.24 metres per second, a clinically significant gain. Self-efficacy, a measure of how confident participants felt in their own ability to walk and function, also improved significantly.

The overall group walking speed trend was positive but did not reach statistical significance across the full cohort, partly because HiWalk was a Phase II feasibility trial, designed to test whether the program could be delivered safely and whether participants would complete it. It was not powered to detect large group-wide effects. What it demonstrated is that this kind of high-dose program is feasible, achievable, and produces real gains for the right participants.

Why Falls Prevention After Stroke Is Harder Than It Sounds

Falls after stroke are not simply a balance problem. They involve fatigue, reduced sensation, spasticity, cognitive changes, and the interaction between all of those things in the unpredictable terrain of daily life. Most stroke survivors are told to be careful. Very few are given a structured, evidence-based program designed specifically to reduce their risk.

Kate’s systematic review, published in Clinical Rehabilitation in 2026, searched the global literature for exercise-based trials targeting falls prevention in community-dwelling stroke survivors. Only three trials worldwide met the inclusion criteria.

That number alone says something significant. Falls after stroke are widely acknowledged as a major problem. The research base for solving it is thin.

Of the three trials identified, exercise trended toward reducing the rate of falls, but the effect on the total number of people who fell was less clear. The standout result came from the FAST trial, which reduced fall rates by 33%. All three qualifying trials were conducted in Australia, raising important questions about whether these findings can be replicated in different healthcare systems with different levels of access to physiotherapy and structured exercise.

What This Means for Stroke Survivors Right Now

Kate’s research points to two things survivors and their families can act on.

First, walking intensity matters. The HiWalk results suggest that long-term survivors who have plateaued in conventional rehabilitation may have more capacity than they or their clinicians assume. High-dose, structured walking appears to produce gains that lower-intensity programs don’t reach. If you’re a survivor who has been told to keep active but hasn’t been given a specific, progressive program, that’s worth a conversation with your physiotherapist.

Second, exercise for falls prevention works, but it needs to be the right kind, delivered consistently. Gentle movement is valuable. But the evidence base Kate’s review maps out points toward structured, progressive exercise as the mechanism that shifts fall rates meaningfully. The FAST trial’s 33% reduction didn’t come from telling people to be more careful. It came from changing what they were physically capable of doing.

Bill’s book, The Unexpected Way That A Stroke Became The Best Thing That Happened, explores the tools and mindset shifts that underpin a recovery built on action rather than waiting. You can find it at recoveryafterstroke.com/book.

The Gap Between Research and Practice

One of the most important threads in this conversation is the distance between what the research supports and what most survivors actually receive. Kate’s systematic review found only three qualifying trials globally. HiWalk’s feasibility results are published, but the next step, a large-scale Phase III trial, requires funding, time, and institutional will.

For survivors, that gap can feel frustrating. The science is pointing in a clear direction. The programs aren’t yet widely available. Kate’s work is part of closing that distance.

Listen to the Full Conversation

Episode 409 with Associate Professor Kate Scrivener is available on all major podcast platforms, search Recovery After Stroke and on the Recovery After Stroke YouTube channel.

If this show has helped you on your recovery journey, you can support it financially at 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.

The post Walking More, Falling Less – A Researcher’s Mission to Stop Stroke Survivors Hitting the Ground appeared first on Recovery After Stroke.

Lion’s Mane Mushroom and Brain Health: What Four Clinical Trials Actually Found

Many stroke survivors and people managing cognitive decline more broadly eventually ask the same question: Is there anything beyond physiotherapy and medication that can actively support brain healing? Not symptom management. Actual repair.

Lion’s Mane mushroom (Hericium erinaceus) is one compound that has gathered genuine clinical attention. It is not a cure, the human trial evidence is still limited in scale, and it is not a replacement for the fundamentals of brain health. But the mechanism is unusual, the safety profile is consistently good, and for anyone serious about their brain, the research warrants an honest look.

Why Lion’s Mane Is Neurologically Unusual

Most supplements that claim to support brain health cannot cross the blood-brain barrier, the tightly regulated membrane that controls what enters the brain. Without crossing it, any direct effect on brain tissue is limited.

Lion’s Mane contains two families of bioactive compounds found almost nowhere else in nature. Hericenones come from the fruiting body, the visible mushroom. Erinacines come from the mycelium, the root-like underground network. Both stimulate the production of Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF). These are proteins the brain uses to grow new neurons, maintain existing ones, and strengthen the connections between them.

Crucially, erinacine A, one of the key mycelium compounds, has been confirmed in preclinical studies to cross the blood-brain barrier. That is not a trivial distinction. It is one of the reasons researchers have taken this mushroom seriously.

“These are proteins your brain uses to grow new neurons, maintain existing ones, and build and strengthen the connections between them. They are, in a very real sense, your brain’s repair and maintenance crew.” — Bill Gasiamis

What the Human Clinical Trials Found

Four published human clinical trials have examined Lion’s Mane. Here is what each found:

Mori et al. (2009): In a randomised, double-blind, placebo-controlled trial, 30 older adults with mild cognitive impairment (MCI) took Lion’s Mane supplement or placebo for 16 weeks. The Lion’s Mane group showed significantly better cognitive function scores at weeks 8, 12, and 16. When supplementation stopped, scores declined again within four weeks, suggesting the effect was tied to ongoing intake, not a placebo response.

Saitsu et al. (2019): A multicenter RCT tested 12 weeks of oral Lion’s Mane in older adults. Participants in the treatment group showed significant improvement on the Mini-Mental State Examination (MMSE) compared to placebo. No adverse effects were observed.

Nagano et al. (2010): A 4-week RCT using Lion’s Mane-enriched cookies found significant reductions in self-reported depression and anxiety in women compared to placebo, suggesting effects extend beyond cognition to mood and emotional regulation, possibly via the gut-brain axis.

Docherty et al. (2023): A double-blind pilot study from Northumbria University tested 41 healthy young adults aged 18–45. After a single dose, participants performed significantly faster on the Stroop task, a measure of cognitive processing speed and flexibility. After 28 days, there was a trend toward reduced subjective stress. This was a small study, and results should be interpreted cautiously, but it suggests Lion’s Mane effects are not limited to populations already experiencing cognitive decline.

The Stroke-Specific Preclinical Data

For stroke survivors, the preclinical research adds another dimension.

In a 2014 animal study, erinacine A reduced brain infarct volume by 22–44% in ischemic stroke models (depending on dose), and significantly lowered pro-inflammatory cytokines, including IL-1β, IL-6, and TNF-α markers of the neuroinflammatory cascade that follows stroke.

A 2022 study found that erinacine A helps preserve glutamate clearance in the brain after ischemic injury. Excess glutamate is one of the key mechanisms of neuronal death after stroke, so anything that helps regulate it post-injury is clinically relevant.

These are animal studies. They do not translate directly to human outcomes. But they provide a biological rationale that supports why clinical researchers are now investigating Lion’s Mane in neurological recovery contexts.

What the Research Does Not Yet Tell Us

The limitations matter, and any honest assessment must include them.

All four human trials are relatively small, none exceeds 100 participants. We do not yet have large-scale, long-term RCTs in stroke survivor populations specifically. The optimal dose, duration, and form (fruiting body vs mycelium vs dual extract) have not been established in human trials. Direct confirmation that erinacines cross the blood-brain barrier in humans rather than in animal models does not yet exist.

Bill says it directly in the video: “The human trial data is still relatively limited in scale. We need larger, longer trials.”

Practical Questions to Raise with Your Doctor

If you are considering Lion’s Mane supplementation, the following questions are worth raising with your neurologist or GP:

Is it safe alongside my current medications? Theoretical interactions exist with anticoagulants (warfarin, aspirin, clopidogrel) and antidepressants, not confirmed in human trials, but worth disclosing. Anyone on blood thinners following a stroke should have this conversation before starting.

What form should I look for? Products should specify standardised hericenone content (fruiting body extract) or erinacine A content (mycelium extract). Products listed only as “mycelial biomass on grain” typically contain very low levels of active compounds and high levels of starch from the growth substrate. If the label does not specify active compound content, treat that as a quality flag.

Are there any trials I could join? ClinicalTrials.gov lists current recruiting studies for Hericium erinaceus and cognitive function worth checking if you are interested in contributing to the evidence base.

More information: https://recoveryafterstroke.com/book | Support the podcast: https://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.

The post Can a Mushroom Help Your Brain Heal? The Science Says Maybe appeared first on Recovery After Stroke.

Stroke Impact on Family: When the Caregiver Becomes the Patient

There is a particular kind of reckoning that happens when the person who has spent their life caring for others suddenly needs care themselves. For Kathy Cunningham, that moment arrived without warning.

Kathy worked in healthcare for years, a field built on attending to others in their most vulnerable moments. When stroke entered her life, she was confronted with something her training had never quite prepared her for: accepting help. In Episode 408 of Recovery After Stroke, Kathy sits down with her sons Sean and Paul Monahan to talk openly about the stroke’s impact on the family, not as a concept, but as a lived experience shared across three people who navigated it together.

When the Expert Becomes the Patient

Healthcare professionals develop a particular relationship with illness. They understand the biology, know the pathways, and can often anticipate the trajectory of a condition before the patient has fully processed what is happening. That knowledge is a professional asset. In a personal medical crisis, it can also become a barrier.

Kathy’s background meant she understood exactly what a stroke meant and what recovery would require. What it did not prepare her for was being on the receiving end: needing to ask, needing to wait, needing to trust others to do the things she had always done herself.

Her sons Sean and Paul were part of that support system, two adult men who stepped into a caregiving role they had never anticipated, in a household that was already carrying more than most.

A Household Navigating Stroke More Than Once

What makes Kathy’s story particularly complex is the context it unfolded in. Her household had already been touched by stroke before her own diagnosis, meaning Sean and Paul weren’t approaching caregiving as something entirely new. They were deepening an already demanding commitment.

The stroke impact on family is rarely a single event. It accumulates. Each new development shifts the balance of who does what, who needs what, and who is available to give it. For Sean and Paul, supporting their mother meant learning to hold space for her recovery while managing the weight of their own experience alongside it.

That is the part of stroke that rarely makes it into clinical documentation: the sustained psychological and logistical load that falls on the people closest to the survivor, day after day, over months and years.

The Challenge of Accepting Help

One of the most consistent patterns across stroke recovery is the difficulty survivors have in accepting help, and it is amplified, not softened, when the survivor has a background in caring for others. The implicit logic runs: I know how this works. I should be able to manage this.

Kathy speaks to this directly in the episode. The process of allowing her sons to step forward to organise, to accompany, to simply be present and available required a different kind of skill than anything her career had developed. It required recognising that accepting care is not evidence of incapacity. It is its own form of strength.

For families supporting a stroke survivor, this distinction matters. When a survivor resists help, it is not always stubbornness. Often, it is someone navigating an identity that has been fundamentally disrupted by what happened to them.

What the Family Perspective Adds

Sean and Paul’s presence in this conversation shifts something in the usual stroke recovery narrative. Most episode conversations centre on the survivor. This one deliberately includes the view from the other side, the sons who watched, worried, helped, and carried their own weight through it.

What they share is instructive for any family in a similar position. Stroke impact on family plays out differently depending on who is watching, who is helping, and who is still finding their way back to the person they knew before the stroke. Their account is not about burden. It is about recalibration, finding a new way to be a family when every role has shifted.

What Families Can Take From This Conversation

If you are supporting a stroke survivor or a survivor who has struggled with accepting help, three things stand out from this episode.

The first is that a survivor’s professional identity shapes their recovery. Someone who has spent their career as a carer may need more time and explicit permission before they can accept care themselves. Naming this directly with patience, not pressure, opens the door.

The second is that adult children carry more than they show. Sean and Paul’s willingness to speak plainly about their experience is a reminder that caregiving has an interior weight that often goes unspoken. Creating space for that conversation within a family is not weakness. It is what keeps families intact through long recoveries.

The third is that stroke impact on family is not a moment – it is a process. It evolves, shifts, and asks different things of different people at different stages. Families who move through it with honesty tend to find a stronger dynamic on the other side.

If this episode resonates with you, Bill’s book The Unexpected Way That A Stroke Became The Best Thing That Happened explores the tools that have helped stroke survivors and their families navigate the long road back. You can find it at recoveryafterstroke.com/book.

If the show has helped you or someone in your life, you can support it financially at 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.

The Nurse Who Had to Learn to Accept Care | Kathy Cunningham with Sean & Paul Monahan

When the family’s caregiver becomes the patient, everything changes. Kathy Cunningham and sons Sean and Paul Monahan share the unfiltered truth.

Highlights:

00:00 Kathy’s Life Before the Stroke

03:54 Family Reactions and Hospital Experience

12:31 Coping with the Aftermath

15:33 Stroke Impact on Family

21:24 Reflections on Control and Independence

28:33 Facing Mortality: A Son’s Perspective

35:19 Navigating Family Dynamics During Crisis

45:28 Understanding the Impact of Stroke on Relationships

53:21 Finding a New Normal After Recovery

01:04:58 Reflections on Healing and Future Aspirations

Transcript:

Kathy’s Life Before the Stroke

BIll Gasiamis (00:00)

Welcome to Recovery After Stroke. I’m Bill Gasciamas. Today’s episode is one that doesn’t happen often on this show. And I think that’s exactly what makes it worth your full attention.

Today I’m joined by three guests, Kather Cunningham, who is a healthcare professional and who is the person who experienced a stroke. But what makes this conversation different is who’s sitting beside her. Her two sons, Sean Monaghan and Paul Monaghan, who were there through every stage of her recovery. We talk about what stroke does to a family when the person who has always done the caring suddenly needs the care themselves.

We talk about what Sean and Paul experienced on the other side of that, what caregiving looks like when it’s your parent and it’s not a choice, and when your household has already been touched by stroke before. And we talk about the thing that Kathy found hardest, accepting help.

If you’ve been listening to this show for a while, you know that recovery rarely belongs to just one person. It belongs to everyone around them. This episode is for the families.

Before we get into it, if you’re in the middle of your own recovery or supporting someone through theirs, my book, The Unexpected Way That A Stroke Became The Best Thing That Happened, was written for exactly this moment. You can find it at recoveryafterstroke dot com slash book.

And if this show has helped you or someone you care about, you can support it financially at patreon dot com slash recovery after stroke. Every contribution helps keep the podcast running.

BIll Gasiamis (01:30)

Cathy Cunningham, Sean Monahan and Paul Monahan, welcome to the podcast.

Kathy Cunningham, & Sean, son (01:35)

Thank you. Nice to be on. Glad to be here.

Paul (01:36)

Thanks.

BIll Gasiamis (01:38)

So Cathy, can you tell me a little bit about what life was like before the stroke?

Kathy Cunningham, & Sean, son (01:46)

Okay. So I I was working full time as a s s director of health services at a small I mean a medium private school, grades five through twelve. and I was the director of health services, a school nurse. and I had worked there for twenty five years, at Thayer Academy. and so that

Tuesday, the day of the stroke, I had worked as usual, you know, put in my eight to ten ten hours. and I don’t remember until day ten. so Sean it would be better to describe the first the he ’cause he had to manage everything on his own, w with Paul, and so he maybe he could describe what happened.

Family Reactions and Hospital Experience

BIll Gasiamis (02:41)

Yeah, Sean, tell us a little bit about perhaps how you experienced what happened to your mum.

Kathy Cunningham, & Sean, son (02:47)

So she woke me up. I was am still living here. She woke me up around two in the morning saying that she had severe esophageal pain. Yeah. She described as a nine out of ten, ten out ten. and my first instinct was to call an ambulance, but she said, No, no, no, maybe it’ll let up

You know, like another ten, fifteen minutes. And so I was a little bit like, you know, eventually, you know, I I convinced her I to let me drive her to the hospital. And it was there in the ER where she had a stroke. she was you know, had nausea and was vomiting. and when I was like helping

like you know clean up clean it up whatnot I noticed that she wasn’t like responding at all it was just glassy eyed and so I pressed the you know emergency call button because there wasn’t a doctor or nurse in at that time and there it wasn’t somebody who had seen her prior so they weren’t aware of the change at all. So I had to like very

emphatically tell them like, no, I sh this is she wasn’t like this, you know, two minutes ago. and of all the places to have a stroke, not that there is necessarily a good one. an emergency room is a not a bad one. Because they were able to get her into a CT in less than five minutes to determine whether it was a clotting stroke or a hemorrhagic stroke, which is what

BIll Gasiamis (04:31)

Yeah.

Kathy Cunningham, & Sean, son (04:42)

She ended up having.

BIll Gasiamis (04:43)

Did

you drive to the hospital? How long did that drive take? And was the ambulance not an option at that point?

Kathy Cunningham, & Sean, son (04:49)

we’ll

No, the ambulance definitely was an option. and thankfully though the hospital is close. it only took maybe ten, fifteen minutes to get there. No traffic at, you know, three in the morning. and

BIll Gasiamis (05:10)

Probably not a bad call, know, like not a bad call. Obviously what we want is an ambulance there immediately. The instinct of a stroke survivor very often and anyone going through a difficult situation, heart, you you hear about it all the time is the patient is going, no, no, she’ll be right. This is, you know, this is going to pass. It’ll be fine. We’ll get over it. And the initial reaction to call for help

Kathy Cunningham, & Sean, son (05:10)

It was too

Yeah.

BIll Gasiamis (05:38)

is the instinct and then the head gets involved and does, undoes all the good work that the instinct did to call for help because you’re thinking automatically about how much is that going to cost? Does somebody else really need an ambulance? Am I just overplaying it? Like you do all this weird stuff in your head and then what happens is, you know, somebody else has to take drastic action on your behalf because as a good son,

daughter, parent, sibling, you listen to what the person is telling you and then they convince you to go against your own instincts. It is happening all over the planet, every culture, everywhere you’ve ever heard of somebody being unwell. So now you two guys are in hospital. Paul, when is the first time you find out about it?

Paul (06:31)

Okay, Sean called me. I want to say maybe a couple hours ago. I don’t know how long you guys were at the hospital before it happened and before you figured out because ultimately she was moved from one hospital, which was kind of local, more local to where she lives and then into kind of the major city nearby for where they have obviously more care. But I was, you know,

waking up early to just get ready for work. I think Sean called me and kind of explained the situation in short order of, hey, I’m at the hospital with mom. think she’s having a stroke. They’re talking about moving her into into Boston and, you know, don’t yet know when or, you know, who’s going to move her, how this is all going to happen. I just obviously had to react to that in a kind of a dazed early, early morning.

stupor of like, what’s going on? Okay, definitely not going to work. Where do I need to be? And so it just kind of unfolded then from there. So it was pretty unsettling as of getting a phone call early in the morning and waking up to that sort of a message.

BIll Gasiamis (07:51)

Are you at home with your family and you’re attending to the regular routine that you usually have to go through and then kind of put that on pause and what did you head down to the hospital? do you manage that?

Paul (07:54)

Yeah.

Yeah,

exactly. It’s kind of the, you know, wake up my spouse and explain what’s going on. You know, quickly negotiate. can you take care of things at the house while I zoom off to go figure out and help my brother navigate this? And so ultimately, I think by the time I had put on clothes, got my car keys and was headed out the door.

Sean had told me that they were headed into Boston. And so instead of driving to the local hospital, I just met them then in the emergency room in Boston at the hospital. And so, yeah, met Sean in effectively the emergency room lobby and then walked me back into the actual room that she was on, on a bed in there.

She was still, you know, alert. would say semi aware of what was going on. Obviously, there was kind of this look of concern, but some level of comfort. was weird as it is to say on your face, mom, that you were recognized where you were, but understood it was grave, you know, felt settled that we were there and helping, you know.

Kathy Cunningham, & Sean, son (09:21)

Yeah, and I don’t

Paul (09:30)

that you had good care obviously from the hospital and that we were there to help as well. So yeah.

BIll Gasiamis (09:34)

Hmm.

Do you remember any of that part, that very early part?

Kathy Cunningham, & Sean, son (09:39)

No, I didn’t

not for the first ten days. I I didn’t I don’t the very first memory I had was in the middle of the night when I was at Beth Israel in Boston, the the major hospital, when I was being wheeled out of surgery and I had this paranoid feeling that I was being kidnapped and I I in and out of consciousness that I was aware I be became a aware of the

the familiar voices of my siblings were comforting for me and I I worked out that I like I then I was reassured that my that I wasn’t re wasn’t being kidnapped. So

BIll Gasiamis (10:23)

Do remember

the esophageal discomfort?

Kathy Cunningham, & Sean, son (10:26)

No, I don’t. And it was it’s a common a ver ver familiar pain that I’ve had since childhood and but but I had increasing severity and and associated symptoms of the nausea and vomiting. and it that that that was newer for me and but I don’t remember this particular episode at all.

BIll Gasiamis (10:51)

Sean, did you start noticing your mother dipping?

Kathy Cunningham, & Sean, son (10:57)

well, so the at first it was like a sudden just like glassy eyed no awareness. I’m not sure if it’s because of they they gave you hyper hypertonic or a salient solution basically to try to reduce the swelling. And so while she was at the you know, Beth Israel, the main hospital, there was like a little bit of improvement that, you know, gave us all hope, like, okay, she’s coming out of it. Maybe it was like, you know, healing up, you know.

BIll Gasiamis (11:13)

Mm-hmm.

Kathy Cunningham, & Sean, son (11:27)

she got treatment fast, so and but then it quickly, you know, her awareness declined and then you know we had to start talking about like what the next plans of treatment were.

BIll Gasiamis (11:47)

So how did they manage that? So your mom’s kind of declining. They’ve, they’ve discovered that she has a hemorrhage. And then what’s the next step? What do they do next?

Coping with the Aftermath

Kathy Cunningham, & Sean, son (11:55)

Yeah.

So based on well as soon as they had a spot available, they moved shirt to the ICU, the neur the neuro ICU, they had a sp specifically for neuro problems. One second. And and as I as I was as they told me later that the decision was that that they would wait a little bit and pressure once the pressure got to ten millimeters.

which I don’t know what that means. I I’m a nurse. Yeah. So the they gauge the severity by how much laterally the midline of the brain hemispheres is deviated from the center. and so the cutoff to where like, we need to take in invasive action, you know, is ten millimeters. And thankfully Paul and I and my

And our stepdad, who was in California at the time, he was able to fly back, you know, and get involved with the discussion of planet care, and that we were all on board even before the ten millimeters hit, that like if if that comes to that point, you know, we’re on board with doing what’s called a craniotomy. so

Which is pretty scary to think about and but it no it was it was I we didn’t we didn’t push back at all on the timeline. It was basically it would it was discussed and we were on board with it so that when it hit the point where it’s like we need to do it, we were all just like, okay, good to go. Well, yeah. Yeah.

BIll Gasiamis (13:29)

Was it avoided?

so to speak.

Kathy Cunningham, & Sean, son (13:55)

and and I think Paul and I and Bill were not only on board with each other, but importantly we were all on board with what we thought she would want to be done in terms of, you know, plan of a the plan of attack or treatment.

Paul (14:14)

interventions

BIll Gasiamis (14:14)

Yeah,

Paul (14:15)

and treatments and whatnot.

BIll Gasiamis (14:16)

Paul, I imagine you guys weren’t as nonchalant as your brother said. Yeah, all good.

Paul (14:22)

Yeah.

Kathy Cunningham, & Sean, son (14:22)

Yeah.

Sounds good to me, you know.

BIll Gasiamis (14:25)

I imagine it was a little bit more dramatic than that. tell me a little bit about that part, Paul. Like how do you kind of manage and deal with the knowledge that there’s a possibility that in a few moments, your mom could be missing part of a skull.

Stroke Impact on Family

Paul (14:40)

Yeah, it was definitely stressful and not necessarily nonchalant. And I think part of it too was the acute nature, obviously, of the initial stroke event in the local hospital ER to then being transferred and seeing our mother’s kind of state of health decline. There was…

because it was a hemorrhagic stroke, the primary intervention was kind of a wait and see, right? A monitor of status of inflammation and her health, all the blood pressure and whatnot. once there seemed to be some level of stability approaching where it was no longer a strong acute phase, we were kind of in a wait and see moment. So it wasn’t like a, know,

within a six hour period, we were forced with making a decision. It did take a day or two, I think, where she ultimately stabilized and it was now monitoring that midline shift and her other health measures and whatnot. So we had a little bit of breathing room, if you will, to discuss amongst the three of us about what do we think is the right call? What do we think Cathy wants?

for her interventions in terms of quality of life on the other side. We were able to have good conversation with the doctors and the care staff about what are the options, what are the implications. And I felt like they did a good job of educating us about the risks. So we could then be on that same page of, yes, we’re okay with trying to use some of the saline and other interventions in the interim to try to continue stabilizing and hopefully come out of that. But then,

We’re all also on the same page of when the call needed to be made about, hey, surgical intervention is the right thing to do. there wasn’t any hesitation there. It did, you know, come again in the middle of the night. given kind of how, how acutely all this stuff came on. Yeah. Certainly very grateful for my spouse to be able to be at home, take care of things at the house. I actually ended up staying, you know, at

my mother’s house, sleeping on the couch to just be with Sean if there were to be a call. And that did happen relative to the surgical intervention with the craniotomy where we got the call at like two in the morning or three in the morning and said, hey, we’re at the point where we were recommending we’re calling to get confirmation that we can proceed. so thankfully we didn’t have to have that discussion in a groggy state.

like the first call I’d gotten from Sean was. that there was some level of reassurance there that we felt like we were making the best decision we could.

BIll Gasiamis (17:36)

Hmm.

with regards to making the best decision you could often in these situations. And it’s great to have multiple family members in on this call is you, you get conflicting opinions between family members and often you get, what I would like to see for me. So some people feel icky about perhaps a craniotomy and go, no, no, we can’t take our mom’s

head off, know, or we have to shave her head, you know, like there’s a whole bunch of other things that come into it. People make it about themselves. And it’s not purposeful. Like they don’t do it to be nasty mean. It’s just a difficult situation to deal with. They’ve never had to deal with it before. And they’re putting, they’re trying to put themselves into the shoes of that person. And they’re not considering the nature, serious nature of the situation they find themselves in. Perhaps they’re just considering like,

superficially what it might mean if I have to interact with somebody who’s missing part of this goal. You know, so that’s very interesting. How did you guys become only was only because of proximity and who got the phone call first and who was with mom that you guys became the people who managed this with Bill or like how does

Paul (18:43)

Mm-hmm.

BIll Gasiamis (19:06)

How does that happen? How does in a big family, you two guys become the main people to drive this forward with Bill?

Kathy Cunningham, & Sean, son (19:13)

Well, so one one thing that I would suggest just generally, I’m not sure how it works in Australia, but here in Massachusetts, she didn’t have what’s known as a healthcare proxy on file. So there was no officially declared by her, like this is the person I want to be in charge of making the decisions about plans of treatment. which

Thankfully, though, the fact that the, you know, my brother and I and Bill were all on board on the same we were all in agreement, so there was no ambiguity or conflict there from the any sort of disagreement. And I think it defaults to the spouse in that case, but it was a challenge too, because he was in California at the time. So then he’s flying back, and but

one of those this isn’t directly related to that question, but on the topic of the considering like the impacts of like, it’s icky, like whatnot. But one of the concerns I had, and that I was really grateful to be able to ask the surgeon ahead of time as part of the because it wasn’t like an urgent, like we need to make this call right right now.

I was able, or we were all able to talk to the surgeon ahead of time. And one of the concerns I had was understanding what is the potential changes on the other side, you know, like is she gonna be alive, but you know, it’s the brain. The brain is very important. And the surgeon was very reassured reassuring given that the location of the bleed that the

effects would be mostly with language and potentially some changes in impulse control and regulation, emotional regulation. But I’m incredibly grateful that you know on the other side it still feels like it’s my mom. and

BIll Gasiamis (21:31)

Got it.

Reflections on Control and Independence

I love that you had time because often in these situations people don’t have time. So being able to address those concerns, it’s still valid even though I sort of suggested that it might be a bit strange that somebody is concerned about how their mom’s hair might look. But it’s still valid. And if a surgeon has the opportunity to ease your concerns, then that makes the decision much easier. I like that. Now, my spidey sensors picked up

something that I need to go towards, which was Kathy’s response when you mentioned about impulse control. Tell me a little bit about that.

Kathy Cunningham, & Sean, son (22:13)

Yeah. so i I wasn’t aware when when I finally became conscious, I realized I was slowly coming to understand that I had had some emergency, but I didn’t really understand the extent of it.

I didn’t understand that I had a s a a a hemorrhagic stroke. I didn’t even understand w what that meant. Like I just r realized I couldn’t move my right hand, I couldn’t right move my right side, but it was and then I was also had the difficulty in speaking, communicating my needs. And so I

I’m having difficulty even trying to phrase it. Yeah. but Sean noticed that I I would because I I I just don’t want to be able to say anyway, so I I But like as as an example or very early on.

the nurses and caretakers at the at the recovery, the what is it called? Recovery room. No, but the Spauldings rehab center. Yeah. We’re you know very clear on the limitations that she had and the instructions about like, you know, you cannot get out of bed. You need to remain in bed. If you need something, press the call button and wait for somebody to come help you.

BIll Gasiamis (23:40)

Rehabilitation.

Kathy Cunningham, & Sean, son (23:57)

And you were recounting having gotten yourself stuck in in the wheelchair. She had managed to because I what did you even want to get? I I would sit in bed and I would just repeatedly go like view the the clutter on the couch. I could think rationally and but I couldn’t communicate that. And I I was seeing I just over and over I’d say, well it’s easy enough that we could just get things organized.

and move this here and move that there and I was when I went to do it myself they helped me in the wheelchair and w just because I I I couldn’t navigate the space myself and even even just one sided wheeling th that it was I got stuck that I couldn’t you know stuck in in in a place b you you were

Paul (24:56)

You’ve managed to wheel yourself into a corner effectively and you’re like unable to navigate out of it.

Kathy Cunningham, & Sean, son (24:59)

Yeah. Yes. When

like they had they helped you into the wheelchair and said they said like just stay here. Yeah, well I I was just trying to sneak, you know, because of my lack of impulse control that I I just wanted to do it and and not let them find me out it because I felt like i it’s something I can just do and and I didn’t realize how quickly I I got myself stuck.

BIll Gasiamis (25:27)

and

your intention was to tidy up the couch or clean up, what was it?

Kathy Cunningham, & Sean, son (25:30)

Yes,

because it was driving me crazy. because I I I needed to have I need to have my my environment to be neat and I couldn’t hand I couldn’t stand the the how how n unsettled I I was feeling with the exterior. But

BIll Gasiamis (25:49)

It’s probably a little bit of like control, taking a little bit of control back. There’s so much you’ve given over to the hospital staff, the nurses, the rehabilitation. Everything gets given over and what you want is a little bit of control. Now I’m not a clean guy, as in like, I’m not doing the cleaning or the rearranging or the redecorating. But one of the things that I took control of was what I ate and where I ate it.

Kathy Cunningham, & Sean, son (25:53)

Well

BIll Gasiamis (26:17)

Let me tell you, if things were out of line, I didn’t eat that particular food. didn’t eat it. know, mom and dad had to bring me food. What else was I in control of? Like little things like that. You know, I used to kind of make the rules about how my rehabilitation would go and I’d have to negotiate. Cause if I wasn’t capable of doing something, they would have to convince me you’re not capable yet. But they, they realized they had a negotiator, you know, on their hands.

So that we needed to go through this whole process for me to get over the line with what they intended the day to be like. So I get it. It’s a little bit of control, a little bit of also being, yeah, autonomy, being independent again. And even if you have to wheel yourself with one arm, you have to do it, like whatever. I was in hospital, I think maybe a day or two after surgery before I went to rehab.

Paul (26:54)

you

autonomy.

BIll Gasiamis (27:15)

and they had given me laxatives because I hadn’t been to the toilet like they’d like you to go after surgery. And eventually they’ve worked and I was pressing the button and I couldn’t walk. My left side was completely offline and I couldn’t walk and I was pressing the button for the nurses to come. They wouldn’t come. And then it was like, OK, I am not letting these people clean up after me in my bed. I’m going to get to the toilet and I’m going to.

drag myself off the bed, pretty much throw myself into the wheelchair and then find a way to wheel through the door, which was closed. It was a sliding door of the toilet. And then somehow I was going to get up on the toilet, which was way higher than normal toilets for some reason. And I didn’t know how I was gonna do it, but I was gonna do it. And then I got caught halfway in the middle of the doorway. Thank God they got there on time.

Paul (27:50)

Mm.

Facing Mortality: A Son’s Perspective

You

BIll Gasiamis (28:12)

because then they helped me on the toilet, but then they refused to get out of the toilet and they wanted to be in there while I had to go and do my thing. And then I had to negotiate with them to get them out and it took some time. What seemed like an eternity, but eventually I got to have the toilet to myself and I had the nurse on the other side of the closed door waiting for me in case I needed help. So like I get it totally utterly get it, but from a

Paul (28:12)

Mm.

Yeah.

Yeah.

BIll Gasiamis (28:42)

family perspective, the kids are probably thinking, just do what they say, don’t do anything silly because…

Kathy Cunningham, & Sean, son (28:50)

Yeah, well don’t

jeopardize your your care. Like they’re telling you. But baseline, I I’m in the caregiver role that’s most comfortable for me. And so one of the things I I I’m I’m working on writing a book right now. I I and I was coming from the focus of being it being a positive, you know, like your title of your book is what made the

BIll Gasiamis (28:53)

You’re unwell! Yeah.

Paul (28:53)

You have no idea.

Kathy Cunningham, & Sean, son (29:20)

the stroke is the unexpected yeah. but I realized that I want to try to come from the different slant. Pride met my match in stroke because it was not a comfortable position for me to be in as the care needer, you know, and I had to quickly adjust

BIll Gasiamis (29:20)

the unexpected way that a stroke became the best thing that happened.

Hmm.

Mmm.

Kathy Cunningham, & Sean, son (29:43)

and go through a process of of leaning into surrendering to the fact that and I see that this was a necessary thing and I’m I’m I wanna just make sure that I make note of the fact that I see the positive benefits of the stroke. It it i I wouldn’t have made the decision to leave work. I I was I I they brought up the decision for me to retire and

And I had to accept it and but I would not have been able to make the I had was wor at Thayer Academy for twenty five years and and and even working long hours through the pandemic, et cetera. but I realized my nature by nature I I’m more comfortable with control and so

Paul (30:37)

Yeah, your default nature has always been like kind of that strong independent personality and prided yourself on being able to do things yourself and not necessarily rely or have to rely on other people even if you did get help at times. that was both a benefit in your recovery but also a source of growth and challenge for you in accepting help.

BIll Gasiamis (31:06)

Also, Paul, what’s it like to be on the other side as as a son and

I’m assuming having the first experience of getting a phone call that your mother is at risk of not being around, like, and things are pretty dire. How do you kind of, like, how do you receive that type of news and then deal with it later on, learning perhaps for the first time that your mom is not immortal?

Paul (31:40)

Yeah, yeah, it definitely, you know, definitely takes time really for that to to process that and accept that, you know, you’re you kind of get slapped in the face when you get a call like that of, you know, holy smokes, what’s going on? And, you know, so I’m so grateful that that Sean was there to deal with the initial, you know, challenges and.

And so there was less immediate stress of having to feel like I needed to jump in and control something or, you know, do something. I could just ask the question of like, okay, how do I help? Because obviously we’re dealing with something very emergent. And then, you know, those, those handful of days, those first days of just watching your, your mother’s health and

and alertness and whatnot decline slowly. was very hard, just all that uncertainty and trying to process what is a future that looks like without my mother is obviously very.

very hard to think about, let alone accept. And obviously now at this stage, even getting out of the surgery decision and then navigating the, where does she go to rehab? And the idea of transitioning from rehab to somewhere else or to home.

It’s, I don’t know, it’s, it’s, it is a hard thing to accept. but certainly obviously life changing for her and life changing for me and for Sean in terms of our relationship with her too is, is not the same as what it was, you know, growing up and, seeing her, your mom as this like strong, you know, independent person who is trying to

instill those things into us as kids and now seeing the fragility of life and engaging with her on a deeper level now, right, of what life has to offer and what it means to be alive and have a family and engage with the broader community and stuff.

BIll Gasiamis (34:16)

Hmm. My parents immigrated from Greece to Australia in the sixties and I, and I never lived with my grandparents. Never met any of my grandparents unless it wasn’t a family trip back once or twice in, in my lifetime. Maybe I met my grandparents, three of my grandparents I met twice and

And I never got to witness the generational thing that happens, know, one generation helps the other generation, et cetera. So, you know, my parents, as far as I know, have always been up and about. They’ve always been strong and steady and they’ve always, you know, steered the ship. And then they’re starting to do that old switcheroo, you know, which is now you need care from me. What are you talking about? What do you mean you need care from me? They’re in their eighties and they’re pretty…

Paul (35:09)

Yeah.

Navigating Family Dynamics During Crisis

BIll Gasiamis (35:14)

up and about there quite well, but they’ve had a few medical issues as people do as they sort of become octogenarians. And then it’s like, hmm, okay. And then I put myself in that sort of role. And so there’s my brother, but then they also had to look after me, their son who ended up in hospital with three brain hemorrhages, brain surgery, had to learn how to walk again. And I did that to them as well. And it’s kind of interesting to

Paul (35:21)

Hmm.

BIll Gasiamis (35:44)

have that experience from a patient perspective and how I, even though I recognized I was mortal, even though I went through all the emotional and mental and physical trauma, I was still a little bit less concerned about me than my parents would have been. But I’m very concerned about my parents way more than I was about myself. And

the dynamics of how relationships change are very interesting. My dad, when I got diagnosed on the first time, he’s a very soft, he’s a big giant bloke, but he’s really soft and mushy, There’s nothing. Yeah. And he collapsed at home the day he was told, your son’s in hospital and we need to go to the hospital.

Kathy Cunningham, & Sean, son (36:33)

Any America. Big old time.

BIll Gasiamis (36:44)

And he came to hospital in an ambulance, the same hospital I was in. And when my mum came to visit me, I said to her, where’s dad? And she said, well, he’s in emergency, he collapsed. And I had to go down with a brain hemorrhage to see my dad in emergency and get him like, wait, what are you doing? What’s going on here? So there’s a whole bunch of crazy things that happened that kind of make me feel like, my dad is actually a facade. All of this stuff.

that is always done has always been a facade and is put on a brave face and he’s just pushed on. And then I think about my brother being on the phone and almost badgering my wife to get information updates because he wasn’t the decision maker and he doesn’t, he lives near us, but it doesn’t live next to us and trying to get updates and information and all that kind of stuff. And then my wife kind of having to manage her experience with what’s happening. And then my brother’s experience from afar.

It’s such a weird and crazy dynamic that we never had any of that happen. Before we go to Sean, Paul, I just want to ask you, what’s it like to be a little bit further away than where Sean is, especially in the early days when, you know, things are still a little bit unstable and, you know, we’re still concerned about mom’s health.

Paul (37:53)

Yeah.

Hmm.

Yeah. Yeah, that it was very hard to, as I’ve got learned in both genetically and nurture for my mom to be, you know, independent and, wanting to, to give and care for others, not being able to be there the same way that Sean was to care for and help and advocate for her in that immediate time of need was very hard.

hard to accept, hard to lean into and be direct or just honest with myself and honest with Sean about like, hey, I can’t help X, and Z way, or I can’t be there at that time. That was just really frustrating on a personal level. But we had to rise to the occasion and

you know, talk with Sean, talk with Bill and the three of us, you know, try to figure out what made sense. Cause I, you know, I still, lived like, you know, 45, 15 minutes away. So it wasn’t like, it was just easy to just pop over to mom’s house or whatever. And so I had to make a choice of, I, you know, stay at my mom’s house? Cause I’m going to go into the hospital with Sean the next day, or do I have to go home? How do I balance work? Like it just,

It was very hard.

BIll Gasiamis (39:35)

Life goes on, right? Life doesn’t go to pause when something ridiculously sort of unhealthy happens to somebody. It continues and you have to actually go, I actually can’t go there. I have to attend to this other matter that is related to my life that is not maybe the most important thing in the world, but it’s important in the scheme of things and I’ve got to do it. Work is one of them. Attending to your own family is another thing. Sean.

Paul (39:38)

Yeah.

BIll Gasiamis (40:02)

On the other side of that, what’s it like being the closest to your mom with Bill? So perhaps you guys were able to support each other as well, but then to have to deal with all of the challenges that came when mom came home.

Kathy Cunningham, & Sean, son (40:19)

earlier. the doctors and care caregivers overall were so amazing and so professional to a f to a point where it was kind of almost frustrating because they were so factual and calm. It was it was like I I don’t know how how s how serious is this? I like I wanna see something, I want some feedback to like, you know.

BIll Gasiamis (40:42)

You wanna see them

losing their shit?

Kathy Cunningham, & Sean, son (40:45)

Yeah. They’re like talking about, you know, brain surgery like it’s like not like matter of fact, but that it’s like, you know, they’re very calmly explaining, you know, which are Yeah. Which for a neurosurgeon maybe, you know.

Paul (40:55)

It’s like reading the morning paper with a cup of coffee. just I’ll do brain servers. It’s fine.

BIll Gasiamis (41:02)

Drug survivors sometimes say, you know you hear that saying in life, it’s not brain surgery, but now it is. it is brain surgery. Okay, it is serious. Like I know what you mean.

Kathy Cunningham, & Sean, son (41:09)

Yeah. Sometimes

Paul (41:10)

Yeah, now it is.

Kathy Cunningham, & Sean, son (41:19)

Yeah. the sorry. Okay, no go ahead. in terms of being closer in the day to day assistance of my mom’s care, it was I’m proud of the fact that like Paul and I both stepped up to the plate and in a way prove you wrong.

Yeah, I used to say all the time, like, Who’s gonna take care of me? My husband is thirteen years older than me, and then my two sons, you know, I don’t have any daughters and and I thought, Who’s gonna take care of me? And they it was just such a beautiful thing that they sh proved me wrong and they they came through with so I’m such so grateful and loving and caring and kind for they were for to me and

patient. so it is it is just I have a whole new perspective on what life what really matters in life and and I realized really this you know the phrase no don’t sweat the small stuff and it’s all small stuff after all. And and such an appreciation for i it just worked out I I have Sean is not working currently but I had such

physical needs to go to many doctors appointment after the stroke and I needed depended on him to not only drive but to actually help me into the doctor’s offices and and I was so grateful that it it that he was available to help me with that. So But

Paul (43:05)

Yeah. It went from,

it went from the two of you being able to cover things for the house. Cause you know, Bill is unable to drive, uh, to then just Sean being, you know, available to help both mom and bill get to appointments and do things day to day errands or whatever. I think that transition though, uh, I thought was most interesting. talked about mom, kind of independence and stubbornness in a way, you know,

Kathy Cunningham, & Sean, son (43:16)

Yeah.

Paul (43:34)

early days where, you know, mom, you don’t remember those those details, but, you know, Sean and Bill and I were talking about your recovery progression and fortunate for you to go to Spalding because there was kind of uncertainty about where the hospital is going to just say, you know, she’s out of the acute phase time to discharge somewhere. So we’re fortunate for you to go to Spalding. And then the question was, you know, are Sean and Bill prepared to help you at home? And the two of them are feeling uneasy about like.

I’m not really sure. And we wanted to talk about putting you into like a like a step down recovery space for for yes. So you rehab and and you know, in that period of time, you became much more conscious and alert and able to understand and comprehend verbal, even if you were still working through your own speaking and communication that you eventually put your foot down and like,

Kathy Cunningham, & Sean, son (44:06)

Well part

Sell a few after the recovery. Yeah.

Paul (44:33)

I’m not sleeping in somebody else’s bed any longer. I want to go home. And that was the time in which like Sean, you know, having to navigate that transition and be a primary source, I think was a, you know, a big challenge initially, but obviously Sean, you know, stepped up, figured it out.

Kathy Cunningham, & Sean, son (44:53)

Well

Understanding the Impact of Stroke on Relationships

no, I I think we all we all Paul and Bill and I like we all did what we were able to do and with the reality of you know Paul’s working he lives elsewhere he has his own family like but he’s able to handle certain aspects as he can and

It it also like the when you mentioned Bill the the flip the flipping back and forth of the caregiver caretaker that the

It it it’s been a weird like realization of, you know, that my mom is a person. Like I I don’t even know how to describe it, but that she’s not just like the this parent, you know

BIll Gasiamis (45:46)

I know exactly what you mean. Yeah. Yeah. She,

she’s a, she’s a vulnerable human being who, you know, has, has sort of stopped being the role that she was. And now she’s being this other role and you’ve got to change the role that you were being. And now you’re going to be this role. And it’s a challenging thing to, navigate. saw that in my in-laws, particularly my father-in-law who passed away a few years ago.

who became totally dependent on his daughters to look after him because he was in a wheelchair and he couldn’t use his limbs firstly, but also because then his decision-making was not in his best interests. So that was the hardest part because they had to go against his perceived wishes and then argue with him about.

the decisions he was making, because they wanted him to be well and healthy and have a good last few years. Whereas some of his decisions were made out of frustration rather than what’s best for him. He was in his mid to late eighties and he had been disabled for many, many years and he had a lot of issues and he was over it. But the girls weren’t over it, over him.

Paul (47:11)

Mm-hmm.

BIll Gasiamis (47:12)

You know what I mean? They still wanted to make sure he was going to be around and okay, so that they can help him and interact with him. so I know what you’re saying, Sean, it’s like, how do you know, how do you in a really difficult time, you’re also navigating the complexity of relationship shifting and changing. And it’s been thrust upon you. You don’t have time to ease into it and go, you know, I’m going to now,

do one errand for my mom for the next one year and then I’m going to be doing two errands for my mom. And you’re living with another stroke survivor. Bill is another stroke survivor.

As a spouse, Cathy, becoming a stroke survivor, did you then kind of have this different understanding of what it was like for Bill to be in the hot seat

Kathy Cunningham, & Sean, son (48:05)

Yeah. I

I didn’t actually because he didn’t have any visual or physical d deficits, I he only has a a visual he lost his lost his left peripheral field of vision and and therefore it impaired his ability to drive and he just made the decision that he couldn’t drive safely. And so because I didn’t

see his deficits. I didn’t really give credence to it. Like I I I I realized how insensitive I was to his you know struggles and shifting in his capacities. but I I d my siblings called me Lazarus because they thought I was dying and

that that I I it had such a miraculous recovery from the stroke and I had many, many complications, including a D V T and a a pulmonary embolus which is a blood clot and it’s treated differently than you’re concerned for bleeding and you have to give anticoagulation for a blood clot. And so I I had that when I was in at Spaulding.

And then I had a frozen shoulder because of not being able to move my right side and and then had developed four months later seizures which Sean witnessed and when when I had a seizure. Again, Bill wasn’t home because he was visiting his daughters in California. but so

i it it the the cumulative of effect of all those things that multiplied my medical needs and and and just added to the fact that I was clearly a a miracle r recovery. but anyways, I I forget where I was gonna go with that.

BIll Gasiamis (50:16)

No,

you went well. You did really well with that. Thank you. and I was just marveling modern medicine, like its ability to deal with all of that complication, at the same time is just phenomenal. And I am in awe of all the help and the, professionalism that I received as well in all the years that I needed the, the medical system. I remember my, one of my nurses who was in the,

Paul (50:37)

you

BIll Gasiamis (50:47)

who was in my recovery area after the surgery. So I think he was looking after me in the evening. He was so on top of everything and he noticed that my temperature was really high and he was just scrambling of that entire. I get emotional thinking about it the entire night to make sure that my temperature didn’t go too high and it didn’t become further unwell. He notified everybody. He got ice packs out. He undressed me. He dressed me.

Paul (51:09)

Mm.

BIll Gasiamis (51:16)

He did all these things. I just, you know, it’s like, get, kind of get being that committed to somebody else, but then to experience it, it’s just a completely different thing. So I love that you guys have been able to get through all of the challenges that you’ve got through so far and that you’ve joined me on the podcast as a family that is brilliant.

Paul (51:31)

Mm.

you

Kathy Cunningham, & Sean, son (51:45)

Mm.

BIll Gasiamis (51:47)

because very rarely do we get to put out the broader picture of what stroke does to people. And I know that ill health, another, know, take stroke out and put in heart attack or take, in cancer or whatever. Like it’s the same impact. It’s not just the one individual that gets impacted by everybody around that individual gets impacted by it. And I think as a society, we’re unskilled.

We’re unskilled these days because we don’t live in villages to have, um, to be able to manage that because we don’t see the previous generation. Like I missed my grandparents. We don’t see the previous generation caring for their gen, their previous generation to them. And we, we, we, we missed the learning. We miss what it’s like. And then it’s a big deal. It happens all of a sudden. It’s like, Oh, old people get unwell and then they die. What do mean? Like I never saw that before.

Paul (52:26)

this.

Finding a New Normal After Recovery

Kathy Cunningham, & Sean, son (52:45)

No, it it I lived around there

and and realized that what a wonderful gift for my boys when they b when boys that we as a subunit, the me and the two boys lived with my mother and because she has several, I mean a children, that there was plenty of people in and out of her house. But I’m just so grateful for them having had the experience of living with their nanny.

and and having witnessed that and had that experience of just seeing how families can function in the larger aspect. But but I said to Sean when we were preparing for this meeting that the gift of large families is that there’s always such large numbers like 20, 30 people that had taken over the waiting room, you know.

And there was such a just a a a comfortable pool of people to keep the visitors coming and and encouraging in encouraging me, motivation and such, and but without taxing any individual too too much. Like it it it it it is I’m sure Paul and Sean felt the the lightness of of realizing that they weren’t alone with

the the the work of having to be my sole supporter and and i even Bill i it is my husband. so anyways th they can speak to that w when I had visitors that Sean gets emotional when seeing the

Paul (54:31)

you

Yeah.

Kathy Cunningham, & Sean, son (54:39)

the the excitement on my face with a familiar cousin, you know, that I I was just clearly when I was still wasn’t able to speak, but he could see the joy in my face and and he recalls that tenderly, you know. So

BIll Gasiamis (54:54)

Yeah, that’s the relief, you know, that you that you still have a recognition of things, people, etc. And yeah, it’s a real moment for a family member to go, okay, that part’s still there. I see that.

Paul (54:59)

Yeah.

Kathy Cunningham, & Sean, son (55:07)

Yeah. Yeah. It it was incredibly

Paul (55:07)

Yeah.

Kathy Cunningham, & Sean, son (55:09)

reassuring. She hadn’t spoken a single word yet at that point, since the stroke. But to see her immediately smile, well, half smile as she could at the time, when she saw, you know, her cousin walk in the door was just it it was reassuring and it was reassuring that like clearly, you know.

Even if she can’t talk, even if she’s having trouble physically and communicating like that, it she’s still in there, like, okay, you know, it’s gonna take work to try to figure out how to, you know, communicate and and collaborate with it, but it just

Paul (56:00)

I do totally, totally recognize and agree with that observation you shared, right? About the idea of, you know, with any, any event that’s significant, like a health, you know, health scare, health event where somebody, an individual is impacted, but obviously then by extension, the immediate family and any spouses and, uh, you know, it kind of has a ripple effect outward.

for everyone that it impacts. in today’s day and age, we’re partially forced through COVID and how we all adapted to more remote interactions, right? We talking to somebody on the other side of the world, right, it is a beautiful thing. It’s really cool to be able to exchange information and talk, but it is also not the same as having kind of a local community that you physically interact with.

when it comes to managing just the immediate, you know, fortunate to have, you know, my wife to be able to take care of things here, but having neighbors that we have gotten to know and gotten close with that we can also lean on them for myself and my wife to be able to say, Hey, we’re going to be out of the house. Can you take care of the dog? or, know, people stepping in to make a meal or something, just to, to alleviate that sort of burden on the rest of the family.

It’s obviously not, you we’re not the ones experiencing the medical hardship, but it does, it does help with, you know, mom’s recovery when we also are being cared for by that, that larger community.

Kathy Cunningham, & Sean, son (57:40)

Yeah.

The importance of like the carers also being cared for and taking care of themselves too. One thing very early on that I appreciated about the hospital is that you were not allowed to stay overnight. It was like even though it’s the ICU, you know, and Paul and I and Bill would have loved like would have just parked ourselves there and slept on the couch, like the the waiting lobby. No, they said

10 p.m. or 9 p.m., like you have to go home. Like, you can’t be here overnight. And it was like, you know, the recovery, physical recovery of the person having to do things that they don’t really want to do, but is good for them. Like it we couldn’t have helped nearly as much if we weren’t sleeping and eating and

Taking care of ourselves because you can’t help other people well if you’re not taking care of yourself to give yourself a baseline.

BIll Gasiamis (58:49)

It’s such a difficult thing, right? So my dad, he collapsed and then he needed to be looked after and they needed to get him right. then, you know, he had a high blood pressure episode or he had a fainting episode, you know, he couldn’t deal with the news that he heard. And that’s basically what happened. My wife, when I had brain surgery, also the week before we buried her mum and she

You can imagine I was having kind of mini seizures and different episodes before the surgery. And a week or two before the surgery, had a brain hemorrhage. And then a week or two, a week and a half after that brain hemorrhage, her mom died, we buried her. And then I had to go to surgery. So you can imagine the state of my wife trying to keep it together.

while dealing with all of the things that she has to deal with. So when it came to the surgery, it was a really hot day and she had been out and about on a walk, trying to get out of the hospital, waiting for news. And I think it was the day after when she came to visit me, she had gone on a walk and she hadn’t taken any water with her and she hadn’t been eating properly. And then I’m in bed and my wife sitting next to me,

And she’s fainting off of the chair. And I, and I had to call the nurse and say, can you take my wife to emergency, get a doctor to look after her? There’s something wrong with my wife. So I can’t walk. I’ve got a scar on my head and my wife’s fainting at the end of my bed. And, and they take her, they wheel her down, they get her into emergency, they admit her and they.

Paul (1:00:32)

Wow.

BIll Gasiamis (1:00:44)

I put her in one of the daybeds or whatever it’s called. And I turn up down there, I get one of the nurses to wheel me down and she’s connected to all the machines, a drip and everything. And I’m like, what the hell is going on? And then the surgeon, one of the surgeons who was on my, on the team that did the operation on me came past. And you know, when people just walk past and then they doubled, they do one of those. Yeah.

Paul (1:00:58)

you

Kathy Cunningham, & Sean, son (1:01:11)

Yeah, like wait, what what do you

BIll Gasiamis (1:01:14)

He almost lost his head in that double take, because he saw me in the wheelchair at the side of my wife’s bed with her all connected. And it’s exactly that thing. It’s that in the time of crisis, entire energy is going into, I want to make sure my husband’s well. I can’t go through what I went through with my mom a week after.

Paul (1:01:22)

my gosh.

Kathy Cunningham, & Sean, son (1:01:43)

Right.

Yeah.

BIll Gasiamis (1:01:44)

with my husband, right? And she just forgets about everything else. And then she becomes unwell. And now my family potentially has to now think about another person in the family who’s unwell within that period of time, like, it’s not on that should not be happening. And, and it’s one of the biggest points I tried to make with my sisters, sorry, with my sister in laws and my wife when they were trying to care for their dad.

because the three of them are exactly the same. And I was saying to them, guys, your dad is unwell. We cannot have four people unwell at the same time in the family. You all need to look after yourselves. But caregivers are neglected by society in general in that underappreciated. They’re missed in the whole scheme of things because clearly

Paul (1:02:22)

Ha

Kathy Cunningham, & Sean, son (1:02:32)

Underappreciated

BIll Gasiamis (1:02:40)

At that time, they’re not the injured person, the unwell person. They might become that later, but they’re not at that time. So they get overlooked.

Kathy Cunningham, & Sean, son (1:02:50)

I want to give a shout out to Nadia Paul’s wife who solved the problem of communication, streamlining communication. And she had start a caring village, which is an online p portal for communicating about patients. And and it was just tr truly a gift that for for

BIll Gasiamis (1:02:50)

Yeah.

Paul (1:03:08)

platform.

Kathy Cunningham, & Sean, son (1:03:17)

probably for best for pawn Paul and Sean, that it would be communicating daily updates and photos and videos and such that people could individually log in and get their own update, you know, at their own convenient time. So they weren’t having to be taxed, also trying to repeat the same story over and over and over again. So that helped.

BIll Gasiamis (1:03:42)

That’s very important. how’s, as we come to the end and wrap up, how has sort of things settled now, Paul, for you?

Reflections on Healing and Future Aspirations

Paul (1:03:52)

Yeah, yeah, things, I mean, right with with my mom’s, you know, recovery back to, you know, her independence, being able to drive and, and obviously, it was a stressful time of navigating of, you know, is she going to go back to work or not? That was a that was a hard kind of period of, of will she doesn’t make sense, you know, what’s the right decision and, and, you know, so we’ve we’ve fell into a new

a new normal, new kind of baseline of back to work. I’m not worried about getting a phone call at two in the morning again, you know, because there’s always that kind of lingering anxiety of what’s going to happen next coming out of that kind of medical crisis. so, you know, we have our new way of kind of managing things like I can help out.

you know, even though I live a little bit away, we’re pretty regular making sure we’re doing video calls and, catching up and, and, you know, providing any additional support to mom and Sean and Bill that I can, without, you know, totally jeopardizing and throwing my life into this array, right. Of, my responsibilities. So, it’s, it is definitely a relief to be back to a, what feels like a normal,

kind of cadence of life and relationship with my mom and my brother and friends and family. So it’s definitely a relief.

BIll Gasiamis (1:05:27)

And Sean, what’s it like for you now?

Kathy Cunningham, & Sean, son (1:05:31)

it has definitely it’s not totally gone away, the like anxiety about, you know, if I if I sent like give her a phone call and she doesn’t pick up and doesn’t pick up on repeated ones, my mind still does go to like, gosh, is is she okay? Like, because of the, you know, numerous instances of that with the seeing her have the seizure too and

whatnot. But with time it’s gotten much less severe. That anxiety crops up much less and less. And it’s been one a big challenge for me is trying to figure out moving forward for myself what the

For the past several years it had been like my purpose was to help her recover. And as she’s, you know, regained so much, you know, she’s not back. It it it’s been tough to figure out now that we’re well past the acute stage, like

Where does the flip-flopping go from here? Not the flip-flopping, but the yeah.

BIll Gasiamis (1:06:52)

Yeah. Switcheroo.

Yeah. Back to your purpose, meaning you’re doing you. Yeah. That’s a really good thing to ponder and work out over the next few weeks, months, years. Definitely you need to do that. That’s important that your identity is not, sort of commingled with somebody else’s identity because of a role that you played once that you may have to play again, but

Kathy Cunningham, & Sean, son (1:07:00)

Yeah.

BIll Gasiamis (1:07:21)

temporary role that you played once. Now you’ve got to get back to you for sure. And Cathy, where are you with the book? When can we expect it?

Kathy Cunningham, & Sean, son (1:07:37)

so I’m about ninety percent physically recovered. and cognitively and I I find that my language difficulties is and my energy level is I still need a three hour nap midday each day. and I met with the neurologist to try to get him to agree to

For me to reduce my Kepra, which is an anti-seizure med that I have determined is probably contributing to my fatigue. But so I I wanna give myself a deadline. You know, I wanna say six to twelve months from this day, you know, that I would have that that book completed. And and so just what I wanna leave it as that the

Potential of returning to work was such a an important motivation for me that I really pushed forward to that. I had to have neuropsychaval. I it it did have three three ones, and I finally passed the third one. and I thought I would be returning to work. but I I have come to accept that that it wasn’t the time for me to return to that

pretty stressful even even it takes me longer to get ready in the morning. but but I get easily overloaded and I have seen that though I had less hard lessons to learn and there were t certain times that I really didn’t like what I was going through, but but I tried to always choose gratitude.

that I s would start each day with with you know the reflecting on positive things that Sean would be available and that that I was feeling good in the certain ways that I was feeling. And and it it really set the tone for the day that I would focus on the positive things that was in my life.

But it it’s been a journey and I I’m happy to say that I’m I I’m almost there. But but I don’t I don’t see it as you know like a linear not a linear process, but but that it’s life is a journey and there’s lessons to learn.

BIll Gasiamis (1:10:21)

Well, everybody, thank you so much for joining me on the podcast. It’s been a pleasure getting to know you and hear your stories and your different version of how you experienced Kathy’s stroke. And I wish you all well in your journey from here on.

Kathy Cunningham, & Sean, son (1:10:38)

Thank you. Thank you very much for having us.

Paul (1:10:39)

Thank you, Bill.

BIll Gasiamis (1:10:41)

That was Kathy Cunningham, Sean Monahan, and Paul Monahan. And a genuine thank you to all three for joining me on the podcast today. What stays with me from this conversation is the idea that accepting help is not a passive thing. For Kathy, someone whose entire professional identity was built on giving care, learning to receive it was one of the hardest parts of recovery.

Sean and Paul also showed that caregiving, real caregiving, asks something of you that doesn’t go away when the crisis does. If this podcast brought something up for you, share it with someone who needs to hear it.

You don’t have to leave a review, just send it to one person. That’s the thing that keeps this show in front of the people who need it most. My book, The Unexpected Way That a Stroke Became, the best thing that happened, is at recoveryafterstroke.com/book. If you’re in the middle of your own recovery or helping someone through theirs, it was written for you. And if this show has helped you, you can support it financially at Patreon.

dot com slash recovery after stroke. I’m Bill Gessiamas. Thank you for listening to Recovery After Stroke. I’ll see you in the next episode.

The post The Nurse Who Had to Learn to Accept Care | Kathy Cunningham with Sean & Paul Monahan appeared first on Recovery After Stroke.

EWOT for Stroke Recovery: The Affordable Alternative to Hyperbaric Oxygen Therapy

Brad Pitzele did not set out to become an oxygen therapy equipment maker. He set out to survive. After years of battling significant health challenges, conventional medicine had given him answers that kept failing him. He tried around 200 treatments. Some helped. Many did not. Then he found EWOT Exercise With Oxygen Therapy, and something finally shifted.

Brad’s journey is not the same as a stroke. But what he discovered about oxygen, inflammation, and cellular energy maps directly onto one of the most stubborn obstacles stroke survivors face: the feeling that the brain has gone offline, that the body is running on empty, and that the path back is either impossibly expensive or simply does not exist.

In Episode 407 of the Recovery After Stroke podcast, Brad shares what EWOT is, why it works, and why he now makes affordable EWOT systems through his company, One Thousand Roads, specifically so survivors do not have to remortgage their homes to access oxygen-driven recovery.

What Is EWOT?

EWOT stands for Exercise With Oxygen Therapy. The concept is straightforward: you breathe high-concentration oxygen through a mask while exercising even lightly, and that combination pushes oxygen into parts of the body that normal breathing cannot reliably reach.

Most people assume oxygen therapy means a hyperbaric chamber: a pressurized tube, a clinic, a course of treatments costing tens of thousands of dollars. Hyperbaric oxygen therapy (HBOT) is effective. Brad describes it as “a heroic treatment.” But it is also inaccessible for most survivors, financially and logistically.

EWOT operates on a related principle without the chamber. The key mechanism is not about oxygenating red blood cells; they are already carrying close to their maximum load under normal breathing. The target is the blood plasma. Plasma does not carry oxygen efficiently under resting conditions, but during exercise, even light exercise, blood pressure and circulation increase enough to force dissolved oxygen into the plasma. That plasma can then reach the micro-capillaries, the tiny vessels that feed tissues deep in the body, including areas of the brain that become inflamed and oxygen-starved after a stroke.

The Post-Stroke Energy Problem

One of the most commonly reported and least-explained symptoms after stroke is fatigue that does not go away, no matter how much a survivor rests. Most survivors are told that is just part of it. Brad’s framework centres on mitochondrial dysfunction.

Mitochondria are the energy-producing structures inside cells. After stroke, the cells in and around the affected area are often not dead; they are in a kind of low-power state. Brad describes it as a “brownout”: the lights are on, but dimly. The mitochondria are not producing energy at full capacity, and one significant reason for that is insufficient oxygen supply to the tissue.

“The cells that are offline after a stroke are not all dead. Some of them are just starving. Oxygen is part of what feeds them back.” — Brad Pitzele, Episode 407

When EWOT increases plasma oxygen during exercise, it can reach those inflamed, under-oxygenated micro-capillaries that larger vessels cannot access. The result, for some survivors, is a gradual improvement in energy, cognition, and physical capacity, not because the therapy is miraculous, but because it addresses a specific physiological deficit that conventional post-stroke care often does not target.

EWOT vs. Hyperbaric: What’s the Real Difference?

The honest answer is that EWOT and hyperbaric oxygen therapy are not equivalent. HBOT delivers oxygen under pressure, which drives it into tissue more forcefully. For certain conditions, particularly in acute or severe cases, hyperbaric oxygen has a stronger evidence base. 

But for many stroke survivors in the subacute or chronic phase of recovery, access is the defining variable, not theoretical ceiling. A home-based hyperbaric unit costs $50,000 to $75,000. A clinical course can run to $60,000 or more. EWOT systems are available for under $2,000. 

The question Brad puts to survivors is not “which is better in a lab?” It is: “Which one can you actually do, consistently, at home, over the months and years that brain recovery requires?” Consistency matters more than peak intensity in long-term neurological recovery. 

Starting EWOT With Deficits

EWOT does not require running on a treadmill. The exercise component can be a stationary bike, a recumbent bike, or simple seated leg movements with one limb strapped in. The goal is to raise circulation enough to push oxygen into the plasma, not to hit a cardiovascular fitness target.

For survivors exploring this option, Brad’s team has built a specific resource at onethousandroads.com/stroke-recovery with a listener discount of $100 to $500, depending on the package. There is also a broader introduction to EWOT at onethousandroads.com/pages/exercise-with-oxygen-therapy.

Recovery Is Possible — And It Does Not Have to Be Expensive

If this episode resonated with you or if you want to explore more conversations about recovery options that do not require a second mortgage, Bill’s book, The Unexpected Way That A Stroke Became The Best Thing That Happened, is available at recoveryafterstroke.com/book.

And if the Recovery After Stroke podcast has been useful to you, you can support it financially at patreon.com/recoveryafterstroke. Every contribution helps keep the show going and these conversations accessible to survivors around the world.

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.

EWOT for Stroke Recovery: The Affordable Alternative to Hyperbaric Oxygen Therapy

Why pay $60,000 for hyperbaric oxygen? EWOT brings oxygen therapy into your living room — and could help the brain cells that are only offline.

One Thousands Roads

Exercise With Oxygen Therapy (EWOT)

YouTube Channel

Highlights:

00:00 Introduction and Background

05:37 Challenges in Stroke Recovery and Treatment Options

13:45 Understanding Oxygen Therapy and Its Mechanism

15:51 Oxygen Toxicity Explained

19:24 The Importance of Oxygenating Blood Plasma

24:53 Oxygen and Mitochondrial Function

31:16 Adapting Exercise for Stroke Survivors

38:27 Cost and Accessibility of Oxygen Therapy Devices

Transcript:

Introduction – EWOT for Stroke Recovery

Brad Pitzele (00:00)

like many of your listeners, when you have a medical issue that isn’t treated by traditional medicine and you’re desperate to get your life back, you’ll try just about anything. You, the lens it goes through is like, Well, how bad can this hurt me?

BIll Gasiamis (00:15)

Welcome back to Recovery After Stroke. I’m your host, Bill Gassiamas. Today’s guest is Brad Pitzele, founder of 1000 Roads, who overcame significant health challenges of his own and along the way discovered the science behind exercise with oxygen therapy. In this conversation, we get into how increasing oxygen saturation in the blood, specifically in the blood plasma, can help reach the inflamed microcapillaries.

That are blocking oxygen delivery to cells in the recovering brain. We talk about mitochondrial dysfunction, post-stroke fatigue, and why Ewatt is worth understanding as an accessible alternative to hyperbaric oxygen therapy. Before we get into it, if you’ve found value in this podcast and want to support it financially, you can do that at patreon.com/slash recovery after stroke.

And if you haven’t yet read my book, The Unexpected Way That a Stroke Became the Best Thing That Happened, it is available at recovery after stroke dot com slash book. Here’s my conversation with Brad.

BIll Gasiamis (01:19)

Brad Pitsley, welcome to the podcast.

Brad Pitzele (01:22)

Thank you so much.

BIll Gasiamis (01:24)

Thanks for reaching

out and ⁓ connecting with me to educate me on another thing that I can bring to stroke survivors that could potentially help them in the rehabilitation side of their brain. The the thumbnail that people found on YouTube is probably gonna have E W O T on it somewhere. E what. And it sounds something like something out of that ⁓ space war out of out of what is it?

Brad Pitzele (01:53)

Star

Wars. Star Wars.

BIll Gasiamis (01:54)

Star Wars.

Like the Ewok, right? And it doesn’t really mean anything to me. But before we descri tell people what Ewok is, ⁓ tell me a little bit about your background, the work that you do and how it is you came to be on the podcast today is for s for for the specific discussion that we’re gonna have.

Brad Pitzele (01:58)

Yep.

Sure. ⁓ yeah, so I ⁓ I I’m an e recovering engineer. I like to joke. I spent my first decade of my life engineering. later on in life, I left engineering and went into different pursuits and I became chronically ill, had a variety of medical issues, ⁓ cancer, autoimmunity, and eventually Lyme disease.

And I was in really bad shape. And a doctor recommended I look into either hyperbaric oxygen or this exercise with oxygen therapy, EWAT, that almost no one had heard of, and I’d never heard of it. ⁓ I I I had tried like everything to get better at this point. I was many years in special diets, ⁓ all sorts of supplements and ⁓ all sorts of modalities and things. And

nothing really worked. There was nothing in a matter of fact, some of the medications I took actually gave me cancer. So it kind of forced me on this road to try something different. ⁓ and eventually I found my way back to health through exercise with oxygen when so many things weren’t working. ⁓ and actually later paired that with ⁓ red light therapy. ⁓ and along the way I started because I’m an engineer and I’m inquisitive, I like

It was Lyme disease is kind of a do-it-yourself disease. ⁓ so I started digging in and pouring into research, not just on Lyme disease, but autoimmunity, ⁓ chronic illness, ⁓ trying to figure out what the heck was going on with me. And so ⁓ what I found about exercise oxygen therapy along the way was really fascinating to me. and about a year into using it, I went back to that same doctor and he was kind of shocked.

At my turnaround, and he was like, What did you use? Did you do oxygen? And I said, I did. And he was like, Who’d you buy it from? I want to tell my patients about it. And I said, I didn’t buy it, Doc. I actually ended up making my own. And he was kind of surprised by that for obvious reasons. And then he said, Well, gosh, would you consider making it for my patient? And so, my patients, and so

that’s how we got into this business back in two thousand eighteen. We launched one thousand roads to kinda make exercise with oxygen therapy accessible to people who are dealing with chronic health conditions.

BIll Gasiamis (04:39)

Okay. And it stems from science, right? There’s scientific data that backs up this exercise with oxygen therapy. Before you go into that a little bit, we don’t have to go deep into it, but we can just ⁓ chat about it. ⁓ when I talk to stroke survivors, they get stuck always with what should I do? What should I do? What should I do? They want the

The blue pill, take that one, everything gets fixed. I mean, stroke is not like that, right? And it’s and it’s stroke is also a you’re on your own kind of thing. Because once you get out of the acute phase, once you get sent home, the ⁓ follow up and the medical fraternity doesn’t have a system to kind of say to you, we can’t help you. Speak to that guy. ⁓ that guy might not be able to help you, but but there’s a guy over there.

Brad Pitzele (05:09)

Yeah.

Challenges in Stroke Recovery and Treatment Options

BIll Gasiamis (05:33)

Like there’s none of that. And stroke survivors need podcasts. They need ⁓ people selling all sorts of crazy stuff that they will almost try almost all the time. They’ll try everything. And then they’ll pick and finally stumble into one that helps and gets them a result. But before we talk about all of that, what I want to do is also go back to what you said about ⁓ a year later, you went to your doctor, he was stunned at the result.

We can’t put that down just to eat what? We can’t put that down just to exercise with oxygen therapy. Give me the brief steps on the other things that you also attended to because people miss that.

Brad Pitzele (06:15)

Yes.

Yeah.

I well, here’s what I’ll tell you. I started I started to get arthritis in my hands in like 2010 or eleven. and then I started taking traditional drugs for it. And one of the side effects of the drugs is higher risk of cancer and specifically melanoma, which I developed in two thousand thirteen, I wanna say, maybe two thousand fourteen.

And that kicked me off the traditional medical path. ⁓ to your point, you don’t you don’t in the stroke recovery, there’s not a traditional path. There it was a traditional path, but it was clear that it was a you know it was a choice between cancer and autoimmunity, and neither one seemed great to me. ⁓ from there I tried so many things, Bill. I did s I actually made a list recently and looked at it because I had it like just off the top of my head, I came up with 200 different things I did try. We’re talking special diets.

Eating all sorts of weird, strange things, all sorts of supplements, antibiotics, because it’s Lyme disease, herbal protocols, ⁓ ozone treatments, sa various different types of saunas, ozone sauna, infrared sauna, ⁓ heat steam saunas, ⁓ colonics, coffee enemas, ⁓ weird stuff, you know, you’d never think you’d do. I mean

BIll Gasiamis (07:39)

You are committed

Brad Pitzele (07:42)

‘Cause

like many of your listeners, when you have a medical issue that isn’t treated by traditional medicine and you’re desperate to get your life back, you will you’ll try just about anything. You the the lens it goes through is like, Well, how bad can this hurt me?

Like like ’cause I know where I’m going right now. For me at least it was a I was just like this gradual step down.

It was like I knew like I I couldn’t do this. I had a young family. so, you know, that doctor, I remember him saying, like, look, Brad, we’re trying all these things, we’re gonna get you on thyroid medications and get that right, and we’re gonna do this. ⁓ there on that list of 200, there were about eight things that gave me any kind of benefit that I could identify. ⁓

But I remember he’s like, Brad, we’re gonna take out the big dog. We’re gonna do this ozone treatment. And it’s a special kind where we remove the blood from your body, we inject ozone, put it through UV light, and put it back into your blood. And this helps everyone. Like if nothing else works, this helps, but it’s really expensive. So we’re saving it, kind of. So he he did it. He’s like, do a course of three of them. And he’s like, You might feel bad after it the next day because it kills a bunch of stuff and might you might feel toxic. Or you might feel better. We’re not sure.

And give it a few days. And like I did all three of them, I never noticed a difference. And it was ⁓ the most depressing, scary part was like going through that. So when he said go do oxygen, I was like, Okay, like I’ve done everything else. I’m just gonna check the box so the doctor knows that’s not gonna work, so we can go try to find something else. ⁓

And I didn’t believe it was gonna work. I I you know, I didn’t jump on the the bandwagon gung-ho. I was, you know, kind of kicking and screaming. And that was part of the reason I built my own, is because at the time they were so expensive and the they were five to twenty-five thousand dollars. And I was like, I just can’t spend, you know, ten thousand dollars on an experiment. I just can’t do that. ⁓

And he also suggested maybe hyperbaric and that was like fifty or seventy-five thousand dollars. And I was like, geez, if I knew this was the the blue pill, as you said it, if I knew this was the blue pill, I’d go mortgage the house and I’d go do it because like then I could work full and I could do all the things, I could be present for the family, but ⁓ I couldn’t.

BIll Gasiamis (10:05)

And and and

you know what? And it’s not, and and the reason it’s not for a lot of people is because you need to have penumbras the brain from a stroke survivor perspective that are recoverable and that you can bring back to life that are offline, not dead by ⁓ cell death because of the stroke. And there’s no diagnostic process in the majority of the people I’ve spoken to, you can’t diagnose somebody and then work out whether they’re a candidate, and that really

Brad Pitzele (10:20)

Yeah. Right.

BIll Gasiamis (10:33)

Pisses me off to somebody gonna have to spend 50 grand to find out if they’re gonna get a result, right? The s the guys that who I’ve interviewed about hyperbaric oxygen therapy, ⁓ Viv clinics, ⁓ those guys will do a thorough diagnostic beforehand to determine whether somebody is a candidate. And whatever that costs, even if it’s five grand, I don’t know what it does cost, but even if it’s five grand, at least you can go, you’re not a candidate, don’t spend any more money.

Brad Pitzele (10:38)

Yeah.

Right.

higher yes, you have a higher level of certainty

before you spend the money.

BIll Gasiamis (11:04)

Yeah. And if you do do it, you’re doing it for the other ⁓ non-brain related benefits that you’re gonna get from hyperbaric oxygen therapy. And that’s totally up to you. But it’s not the thing to supposedly fix the arm or the leg that doesn’t work, or to ⁓ repair the damaged cells in your brain. So that part really frustrates me. And if I’m gonna spend that much money, then there’s the opportunity cost as well. It’s like

Brad Pitzele (11:33)

Yes.

BIll Gasiamis (11:34)

Now I

can’t spend that somewhere else.

Brad Pitzele (11:36)

Exactly. That was me too. It was like you you knew you had and I was like, man, if I spend this kind of money on it and it doesn’t work, like nothing’s worked for the last, I don’t know, almost ten years at this point. Like how many of these shots do I have in the cannon, right? Like you you know, now I’m I’m depleted and I’m still sick. And that’s even i and you know this, when you’ve got a chronic health condition, sometimes the psych psychology of it all is just as hard as the condition. And

If you’re like, wow, now I don’t have money. I feel trapped. There’s nothing I can try. Then hope starts to dwindle. And I

say like hope is is like the most potent weapon in recovering from a chronic health condition. It’s a double-edged sword because like you’re s afraid to get hope up because you’ve been let down. But it’s also the thing you need. You ha like when when you start losing hope, and I and I’ve been at that point, it just gets incredibly dark.

⁓ and incredibly scary.

so I I think that was part of it. I just wouldn’t allow it. It was the financial part. I you’re right. You only have so many shots out of the bow. But it was also like if it doesn’t work and I am depleted financially you know, I don’t like that that brings me to a a level of hopelessness I I’m not sure I can confront.

BIll Gasiamis (12:53)

Yeah. And then in order to get back up, you’re getting back up, you’re financially depleted, you’re energetically depleted, your health is depleted. And it’s like, my God, that is a that is like the lowest place that you can find yourself and to get back up is a lot harder. And yet people have still done that, but I know the task is harder. I’ve been in a similar sort of situation.

Brad Pitzele (13:12)

Yeah.

We all love

we all love reading that inspirational story. No one wants to live it if they can avoid it, I’ll tell you.

Understanding Oxygen Therapy and Its Mechanism

BIll Gasiamis (13:23)

Avoid it. Yeah, a

hundred percent. ⁓ so so you’ve tried all this stuff, you’re unwell, and then somebody says to you, try oxygen. Now, what I imagine when I hear oxygen is get a can from the local gas supplier, ⁓ pop pot in a tube, put it on the back of your chair, wheelchair. You know, I’ve seen a lot of older guys who have got it, and then they’ve got oxygen attached to their face and they’re breathing in oxygen. What specifically did

your doctor tell you to get and if you didn’t get what he suggested, like w what did it look like for you?

Brad Pitzele (14:00)

Yeah, so the challenge with bottled oxygen is number one, it’s almost impossible to get. number two is when you exercise, you can take in a massive amount of oxygen, and that’s part of what makes the the therapy really cool. So y you and I sitting here, maybe we’re taking in three liters of oxygen a minute, okay? ⁓ three liters of air a minute, maybe something like that. ⁓

When you’re exercising, you can easily take in 50 or 60 liters. So it’s a massive multiplier. So you need something that’s going to give you a large amount of oxygen. Now, there’s two ways you can get oxygen in your home. One is that bottle you mentioned, and then you’re always refilling it, and you can imagine lugging one of those things around. ⁓ the other way is there’s a device called an oxygen concentrator, and all you do is you plug it into the wall.

And it turns the it purifies the oxygen in the room. So, you know, at sea level, the oxygen in the room has 21% oxygen and it can purify it to 93%.

Now, the challenge with these devices is they put out either five or ten liters of oxygen in a minute. So not enough to exercise with. If you were to try to exercise with it, you would also be sucking in this air at 21% and diluting it. ⁓ and so what you do is you take this device and you fill a large reservoir, it’s about a thousand liters, ⁓ and you fill it up.

using this device and then you hook up a hose with a mask on it and then you breathe through the mask while you do a fifteen minute exercise session.

BIll Gasiamis (15:41)

Okay. A reservoir, ⁓ water tank.

Oxygen Toxicity Explained

Brad Pitzele (15:45)

It well it it’s like it looks like a big pillow. So it’s like six you know, two meters by two meters, sort of ⁓ big pillow, six feet by six feet for us still on Imperial. And you fill it up so a thousand liters and it’s you know it’s it’s thin film and so it’s not a a rigid body of something, and then yeah, it’s a bag.

BIll Gasiamis (16:06)

It’s a bag. Like

a bagpipe, a massive bagpipe.

Brad Pitzele (16:10)

There you go.

BIll Gasiamis (16:12)

Okay. Okay. W I’m sure there’s an image of that, right? We’ll put it on the screen. People can see it while we’re talking about it, trying to work out what it is. Okay. So this thing is something that you accessed and you used specifically for yourself, how many years ago?

Brad Pitzele (16:16)

Yeah. Yeah.

I’ve s I’ve been using it for a decade straight now.

BIll Gasiamis (16:33)

Okay. This stuff’s been around for about a decade. This

Brad Pitzele (16:37)

It’s well, the the research on it goes back to the nineteen sixties and seventies. This it’s really fascinating. actually some of the early research goes back to the turn of the ⁓ twentieth century, the nineteen hundreds. So in the early nineteen hundreds, a gentleman named Otto Warburg won a Nobel Prize for proving that he could turn any cancer or any regular cell into a cancerous cell by depriving it of oxygen.

⁓ and so there’s this really well-established linkage between oxygen and cancer. Even today, a ton of research on that. So in the 1960s and 70s, there was a a German physicist and prolific inventor named Manfred von Arden. Now, and he started to want to do research on Otto’s work, and he he actually started doing research on exercising with oxygen as an anti-cancer protocol.

And some of the research he found was really fascinating. what without getting overly technical, basically it our circulatory system, obviously, this is really relevant to stroke, ⁓ people deal in strokes, is as you get down into the the end runs of your circulatory system, there’s capillaries and they’re like thinner than a human hair. And this is where your nutrients and your oxygen are actually exchanged with the cell.

And what he found is as we age naturally this inflammation builds up on the lining of our capillaries. And it actually causes the capillaries to swell shut so that now none of your red blood cells can get by. Now, I mean, this is how exquisite our body is designed. ⁓ our capillaries are actually thinner than a red blood cell. So under the most healthy of conditions.

A red blood cell actually needs to fold up like a taco to get into our capillaries and deliver that oxygen in the last mile of our circulatory system. So any

swelling in that capillary can cause a blockage. And now all the cells downstream are not getting oxygen and in a sufficient quantity. And so they kind of go into what they what he kind of referred to as like a brownout, right? Like it’s a low energy state. They’re doing anaerobic respiration to get some energy. Maybe some of the smaller red blood cells might squeak by here and there and give a little bit, but they’re not getting the full oxygen they need. And what he found is by doing this procedure,

just a few times he had very elderly people with very inflamed ⁓ capillaries. He was able to re-establish normal blood flow. And the reason is is oxygen is incredibly anti-inflammatory. ⁓ and a lot of research on that we can go into a little bit later.

The Importance of Oxygenating Blood Plasma

So, number one, it causes this anti-inflammatory reaction inside these inflamed capillaries to reopen them. But it also does something really amazing that he discovered is when you’re doing this procedure, ⁓ it causes the oxygen to not just attach to our red blood cells like it always does, but it also saturates our blood plasma, which is this clearish liquid that our red blood cells ride on. And

Our blood plasma is a thousand times thinner than a red blood cell. So if you imagine these blockages, red blood cells are not getting through, but obviously the blood plasma can get through as long as it’s like as thin as water. So as long as there’s any opening there, and it can immediately deliver oxygen downstream, both to cause an anti-inflammatory impact in the capillaries, but also to all those cells that are starving. And so you can obviously, as we’re talking through this, you can kind of

see how this fits folks who are dealing with various different strokes ⁓ and how that can help them as well.

BIll Gasiamis (20:32)

Yeah. Okay. I d before we spoke I did a little bit of research and found ⁓ as well that there’s some there’s a lot of relevant data with regards to oxygen and ⁓ increasing the oxygenation in the blood. you so tell me a little bit about oxygen. I I don’t understand exactly what that is. I’ve heard of people becoming ill.

Because of too much oxygen, ⁓ ill because of not enough oxygen. So what is what what is becoming ill of too much oxygen and why is ninety nine percent saturation not that?

Brad Pitzele (21:18)

Yeah, yeah. ⁓ good question. So oxygen toxicity can occur if you get too much oxygen under certain circumstances. So if you’re in a hyperbaric chamber too long, it can cause oxygen toxicity. And basically that’s when oxygen gets trapped in your bloodstream and it can’t get out. and

You can actually get it without hyperbaric. So hyperbaric is oxygen under pressure. You can get it at normal barracks. So if you were just sitting on the couch breathing oxygen, you could eventually get oxygen toxicity. Now, it would take over twenty-four hours. So if you were breathing just pure oxygen, no exercise, sitting on your couch for 24 plus hours, it starts to get into the risky zone.

When you’re doing exercise with oxygen, that’s actually one of the cool things about it that because of the synergies of exercise and oxygen, it’s impossible to get oxygen toxicity for two reasons. one is that reservoir is only a thousand liters. it’s not a high enough dose that you could get a oxygen toxicity. It is a massive dose, it’s about the same amount of oxygen you take in in a day, and you can take it in in 15 minutes, but it’s not more than.

And the second reason, even if we could make our reservoir 10x, 100x, and you could exercise nonstop, you still couldn’t get oxygen toxicity because when you’re exercising, your body produces a massive amount of carbon dioxide gas.

And that goes into our bloodstream and it increases pressure in our circulatory system. And that actually forces the oxygen out of the circulatory system and into the cells. So it works as a protectant as well from oxygen toxicity. So that’s oxygen toxicity. It’s a real risk. ⁓

Most of the time it’s a very controllable risk. You know, if you’re doing hyperbaric, they’re gonna keep you in there for so long so that you’re not gonna be at risk generally. ⁓ if you’re assigned to do oxygen while you’re stationary at home, they have protocols to make sure you’re not doing it, you know, twenty-eight hours nonstop sort of thing. ⁓ or they have you wear a cannula where where you’re also taking in air and it’s diluting it.

⁓ and in exercised oxygen therapy, it’s not really possible because of the massive amount of carbon dioxide. ⁓ now, not enough oxygen. So if you if you want to measure your oxygen in your blood, the way they normally do it is a device called the pulse oximeter. You can get one for 20 bucks off Amazon. What it does is it looks at how much how many of your red blood cells are saturated with oxygen. And what you’re gonna find in most folks.

Is it’s close to a hundred percent. It’s ninety-eight percent, it’s ninety-six percent, ninety-seven percent. ⁓ there’s not a lot of room in our blood for more oxygen. So that’s why it’s important that ewak can actually oxygenate our blood plasma. The same with hyperbaric does the exact same thing, it oxygenates our blood plasma. So

BIll Gasiamis (24:26)

Okay. I think before you go on,

that’s the key ingredient. It’s oxygenating the plasma as well. Where where previously you’ve got let’s say ninety seven, ninety eight percent saturation of your red blood cells. What we’re doing is adding that little bit of extra oxygen into the space where the plasma is. That’s kind of the key difference.

Brad Pitzele (24:36)

Yes.

And there’s two reasons why it’s important. so normally, just for comparison, you and I sitting here, maybe 2% of all the oxygen in our blood is in our plasma, so it’s not very much. ⁓ but under these conditions of IWAT and hyperbaric, we can saturate that blood plasma. And it’s important for two reasons. One, obviously, it increases the oxygen carrying capacity of the blood, but that’s the more minor one. The more major one is that the blood plasma can get into

let’s just say the nooks and crannies, smaller spaces in our body where inflammation is blocking off access of red blood cells to downstream cells. And so it can deliver a dose of oxygen where it normally is not able to get.

BIll Gasiamis (25:40)

You you’ve spent a lot of time on this topic by the sound of things. ⁓ and that’s really awesome. So before we talk about how to actually use a device, how to get a device, how to how to behave while you’re using a device, I wanna understand like how

Oxygen and Mitochondrial Function

Brad Pitzele (25:52)

Yeah.

BIll Gasiamis (26:02)

How you notice the difference in yourself? Because a lot of people ask me what I did in my own stroke recovery. And Brad’s experience is going to be different from the stroke survivor’s experience. My experience was ⁓ I’ve got nothing from the doctors other than let’s monitor your bleed, let’s give you brain surgery. I mean, that’s not nothing. That’s amazing. Like I’m very

Brad Pitzele (26:05)

Yeah.

Yes.

BIll Gasiamis (26:31)

Grateful for all of that. That removed the the blood vessel that was leaking that was going to potentially kill me. ⁓ so the immediate risk was gone. And then what what I mean I I got nothing is the specialists did their specialty and then I got nothing because they don’t do nutrition, they don’t do exercise, they don’t do meditation, they do brain surgery. And it’s really important for stroke survivors to understand that when you go to a doctor, a neurologist, whoever.

Brad Pitzele (26:55)

Yeah.

BIll Gasiamis (27:00)

They do a specific thing, and once they’ve done it, they can’t do anything else. And you need to get over the fact that you ⁓ might feel disappointment at the at that I don’t know where to go next, and they don’t know where to send you. Okay, they’re not trained and they cannot legally send you elsewhere. That’s why you’re kind of on your own. So I did meditation, I did nutrition, I did all this kind of stuff and

Brad Pitzele (27:16)

Yeah.

BIll Gasiamis (27:27)

Somebody who’s interviewed you is Dave Asprey. I would I’ve been following Dave Asprey and a whole bunch of other guys ⁓ probably since around 2012, 2013. And what I learned was how do I reduce the inflammation in my brain? And I had that one area of inquiry, the one area of inquiry that I could personally impact positively by taking out inflammatory foods from my diet.

And before that it was, you know, ⁓ processed white bread, it was alcohol, it was cigarettes, ⁓ it was all the stuff that you get in a packet that doesn’t really help to nourish the body, right? So I went back to basics. We’ll call it just for the simplicity of the explanation, we’ll call it protein, ⁓ vegetables and basic carbohydrates like rice or potato.

And then what I found was that inflammation decreased, and that was a game changer in how I experienced my brain. And it was a game changer in how quickly I improved neurologically. But just so that people know, it wasn’t the be all end all, it didn’t remove the damaged cells that still are in my head that mean I experienced my the left side of my body in a completely different way than my right side.

I’ve got numbness, proprioception issues. I’ve got ⁓ tingling, I’ve got burning, I’ve got ⁓ spasticity, you know, the muscles are tight. So all that stuff is still there. But I have a better experience of the rest of my body and brain because of the things that I took out. But what I didn’t have was the link between exercise, which I do, light exercise, because I’m a stroke survivor. I can’t.

use the left side of my body like I used to. so I would do exercise ⁓ like riding an electric bike because it’s easier to pedal, like walking and like doing very light weights at the gym. ⁓ but I didn’t have that oxygen part of the the therapy. And that’s kind of why I interviewed the guys about hyperbaric to understand how oxygen supports how

mimicking i a hypoxic brain in the chamber supports ⁓ so how how does like what’s the next part like how does that support the brain to heal let’s give stroke survivors an understanding so that they can kind of grasp that I know we spoke about how oxygen gets into the ⁓ into the red blood cell we spoke about how it gets into the plasma but like

Brad Pitzele (30:15)

Yeah.

BIll Gasiamis (30:20)

Why is that the next step?

Brad Pitzele (30:21)

What’s it too?

Yeah. It’s a good question. I think you’re right. I you know, we don’t I will say we don’t try to go out and pitch like exercise with oxygen therapy is a panacea or it’s everything for everyone. Even the name of our company, ⁓ one thousand roads, is about paying homage to everyone’s own healing journey and recognizing everyone’s unique journey.

So I’ll say that, but

So I’ll say that, but what I found about oxygen was in IWA in particular. What was fascinating to me was for me when I was dealing with Lyme disease, which similar to folks who are dealing with the stroke, there’s a variety of different symptoms and s from different causes. And I was trying to treat all these things with different protocols, different supplements that and I found that when I started digging into oxygen, I was shocked at how many of them came back to it. So when you have

A stroke, often there’s a lot of ⁓ emerging research about mitochondrial dysfunction. And this is interestingly, mitochondrial dysfunction. Now ten years ago when I was researching it, no one heard of it or cared about it. And it’s really burst onto the scene because you’re gonna find it

⁓ At the heart of so many chronic health conditions, right? ⁓ you’re gonna it’s actually they’re looking at it in cancers, ⁓ chronic illnesses of all sorts, Alzheimer’s, all sorts of cognitive and ⁓ autoimmune conditions, etc., etc. So ⁓ you have this disrupted mitochondria, right? So there was a period of time when your cells were not getting enough energy, whether it was a hemorrhagic stroke and

Blood wasn’t being delivered to those cells, so no nutrients, no oxygen, or an ischemic stroke where they were just cut off ⁓ because of a clot or whatnot. And so they were not getting nutrients. In each of these cases, what happens immediately when the cell runs out of oxygen, like I was talking about that brownout, it goes from aerobic respiration to anaerobic respiration. And anaerobic respiration, ⁓ it’s

It only can produce 5% of the energy as aerobic. So the cell is in a low energy state, which is the first problem, which means it doesn’t have energy to repair, it doesn’t have energy to take out the trash, detoxify. so it’s kind of stuck. But also ⁓ it creates a lot of metabolic waste. So it creates lactic acid, it creates free radicals, all these things produce more inflammation, like you were talking about. So

Now we’ve got these mitochondria, which are dysfunctional. They don’t have the energy to repair. They don’t have the energy to take out all these dead cells or ⁓ you know, all these other byproducts of the immune system and the natural kind of response to this damage, which then leaves more of it hanging around to produce more damage, and they’re producing more damage themselves. So it’s kind of like this swirl, and it’s ⁓ you know, it’s a downward swirl, if you will. ⁓ so

When you can re-oxygenate the mitochondria, the first thing you’re doing is you’re giving them the energy to do whatever it is they need to do. ⁓ and that can be the immediate like feeling sharper, like, ⁓ I feel like I can get my thoughts together quicker. ⁓ it can be, ⁓ I feel like I’m more in control of my emotions. And I I don’t feel like sometimes I have a disproportionate emotional response to something. It can be I I don’t have that brain fog.

⁓ you know, that sort of thing. Or I literally have energy. So our brain actually consumes like 20% of all the oxygen in our body. And it’s only like two percent of the mass. So it’s like punching 10x its weight, right? So when your body starts running low on oxygen, it starts conserving. And the one of the things it tells you to do is like cool it, like stop using your muscles. You’re tired. You need to just sit there and veg out.

BIll Gasiamis (34:06)

Mm-hmm.

Brad Pitzele (34:27)

while our mitochondria try to catch up. And so that’s often that chronic fatigue that folks with a variety of health conditions, including stroke, feel, which is their bodies like, stop using energy, we don’t have enough. We need to redeploy it for something else more pressing. And so

When you can reestablish normal oxygenation, it improves energy. ⁓ it improves sleep, it improves memory. and the the cells have energy to start repairing and detoxifying. ⁓ and then obviously I always think it’s cool because we’re pairing it with oc with exercise. And there’s so much research on the benefits of exercise. You mentioned it was so important, Bill, in in your healing journey.

And you know, we know how important exercise is for a stroke survivor.

Well, now we’re pairing it with oxygen and we’re using that exercise to catapult more of that oxygen around the body through the circulatory system while your blood vessels are dilated and opening up. So if you’re still dealing with blockages in your microcirculation, which most stroke survivors are.

You’re opening them as wide as they they naturally can at that moment, and that’s when we’re feeding more oxygen to them. So it works it kind of hand in hand in that respect.

BIll Gasiamis (35:48)

All right. Now one glitch. Stroke survivors often are struggling to get into the physical recovery, right? Because the body goes offline, one of the legs doesn’t work, one of the arms doesn’t work. It’s a real challenge, right? So how how can we benefit from that even though we are at just after the acute phase where there is not a lot of capability for

Brad Pitzele (36:00)

Yes.

It’s perfect.

Yeah.

BIll Gasiamis (36:17)

physicality and I I say that so that the stroke survivors listening know that what I’m leading to is that early on it’s probably harder to do ⁓ physical therapy, exercise, et cetera. But again, with time and hope, all of those things can improve. Right. So I I wanna put that out there for stroke survivors, but also like it’s a can it’s a it’s a constraint.

Brad Pitzele (36:48)

Yeah. And you know, because a lot of our customers are dealing with chronic illness, this is a question that’s not uncommon is like, yeah, but I can’t I’m not out here to run a mile, Brad. I’m like eighty years old and I’m sick or whatever it is. The really ⁓ the really cool thing about ⁓ Ewatt is that it will meet you where you are at. So there is something all of us can do. The goal is to increase your heart rate and your circulation.

Cost and Accessibility of Oxygen Therapy Devices

and breathe the oxygen. So there’s a few ways you can do it. you know, it doesn’t have to be banging it out on a treadmill trying to get your seven minute mile. ⁓ you don’t need to do that. We have folks, you know, depending on where they are, you can start with slow walking on a treadmill. You can start with calisthenics. You can start with stretching.

⁓ gentle aerobics in your living room. You can start by, you know, lifting weights. You could be sitting and lifting weights with the the hand that’s not. We have folks, and this is probably not so much for ⁓ stroke survivors, but maybe jumping on a ⁓ a rebounder, like a little trampoline if you’ve got the balance one with the handle. ⁓ we have people using under-the-desk pedal bikes, the ones you can get for $49 on Amazon while you’re sitting.

BIll Gasiamis (38:03)

Beautiful.

Brad Pitzele (38:04)

while you’re sitting in a chair. And then for the folks who can’t do any of that, we have we even have them doing what I call passive Ewatt, which is they will breathe the oxygen while they get in like a an infrared ⁓ sauna blanket. So infrared sauna will increase your heart rate. And so you will get some benefit out of it. And what normally happens, the the really cool thing about exercising with oxygen is

The first thing folks notice, the very first benefit most folks notice when they start doing is the exercise is easier. So I always describe this like if you were ⁓ jogging on a treadmill at, I don’t know, pick a number, you know, four miles an hour and you put the mask on, you wouldn’t feel like you were getting the same exercise at four miles an hour. You you crank it up to four and a half, and then later you crank it up more. And

Your endurance actually improves much more quickly than if you were just doing exercise alone. ⁓ and there’s a ton of actually research on you know Olympic athletes using it for performance enhancement, which is not what we’re using for in this, but it’s kind of a nice little side effect. So we have folks who come to us who who are out of condition. We’re not talking about the physical disabilities, but out of condition, we’re like, I couldn’t do.

And they’re shocked at what they’re doing and they come back and tell us in three months, look what I’m doing, sort of thing. ⁓

But it will meet you where you’re at. So if you want to do passive Ewatt, you can do that for a while as you’re working and as you start to feel better. Then maybe you’re using the under desk pedal bike. And as you’re getting your balance back and feeling better, maybe it’s a a real stationary bike later or walking on a treadmill and so on and so forth. ⁓ the goal isn’t to bust hump and like try to, you know, get a new record. As a matter of fact, I find that for most folks that sets you back. You wanna kind of you wanna

do within an envelope that you’re comfortable with because

If we work out too hard, also we set ourselves back because in most chronic health conditions and in stroke, additionally, we talked about this fatigue that’s due to an energy deficit. So if you go out there and overwork, you’re just putting your body in more of a deficit and potentially putting it in more of an inflammatory environment. And we’re trying to do this at a level that’s in you know anti-inflammatory and helping you recover.

BIll Gasiamis (40:30)

I love that. I love your whole explanation. So in my what I was hoping was you were gonna say that I could just sit there and almost do nothing ⁓ as a stroke survivor, where I’m completely in in just, you know, like week three of the acute after the acute phase, and fatigue is a massive issue and energy is a massive issue, and I’m barely able to stay awake, ⁓ and all of that stuff. And then ⁓ you could do just I hope you I was hoping you were gonna say,

But you said the equivalent of ⁓ chair yoga, you know, where all I had to do was just move an arm or move a leg and do something just to get me physically going and then it would benefit. That’s what I love about it. The under-the-leg pedal bike, ⁓ under-the-desk pedal bike is one of the best things because you can strap in your leg with the deficits if you have a leg that has deficits, and you can do all the or the majority of the pedaling with the other leg, which is strapped in.

Brad Pitzele (41:07)

Mm.

BIll Gasiamis (41:29)

And you don’t you’re not gonna fall over ’cause you sit in in a chair. ⁓ probably you’re doing it inside your house so the the temperature, the weather is always perfect and ⁓ and you don’t have to door for long, right? You only have to door for a few minutes to start with.

Brad Pitzele (41:45)

And you’re pulling that other leg around and it’s starting to fire inside here and rebuild those connections. And and as you know, exercise increases ⁓ brain drive neurotrophic factor, which is a growth factor in our brain for

BIll Gasiamis (41:51)

Mm.

Brad Pitzele (42:00)

neuroplasticity. So you’re getting you’re getting all of these benefits. So you to your point, for someone who’s if it’s my right leg’s not working and I’m strapped in and my left leg’s doing it, my right leg is firing and it’s firing those neurons at the exact time you have that B D N F as it’s called. So

BIll Gasiamis (42:17)

BDNF’s amazing. And I also interviewed ⁓ recently a gentleman who ⁓ had spoken about ⁓ Jack Clifford on episode 402 who spoke about kind of ⁓ a protocol that enables you to regenerate blood vessels around the area that’s injured ⁓ to increase the oxygenation and the blood flow ⁓ to potentially those areas where

⁓ brain is offline, not dead. ⁓ so all of these things, ⁓ the previous episode that I recorded with Jack, your episode right now, like all are things that you can do that support brain health, brain recovery, ⁓ overcoming all the some of the challenges that stroke causes. And what I love about this specifically is that you can do it from your house.

and you don’t have to go anywhere, but there is a cost. So let’s talk about the cost a little bit because I I want to mention it because of the massive difference to hyperbaric, which can cost up to sixty grand if you go on the right protocol. And ⁓ that’s unattainable for most people, let alone a stroke survivor who just lost their ability to earn ⁓ and may not have sixty grand to splash.

Brad Pitzele (43:48)

Yeah.

BIll Gasiamis (43:48)

⁓

so what is the cost of getting a machine, setting it up and putting it in your house?

Brad Pitzele (43:54)

Yeah. So we sell two different machines. ⁓ we have one machine that’s eighteen hundred and ninety-nine dollars and the other one that’s twenty-four ninety-nine. ⁓ that’s everything you need to get going other than the exercise equipment. and the machines last a long, long time. I think I

You know, I think we actually we’ve been in business since 2018 and we had our first customer come back and tell us they wore out their machine like this year. So I have to stop saying we’ve never had one wore wear out yet. So we’ve had one. ⁓ so it it’s one of I think that’s one of the things that’s great about it is it’s something you can do in your house. It’s something that doesn’t take a lot of time. When I was dealing with my chronic health issue, I was

joke around about the ceremonies of counting pills and doing this modality and doing that. And they all in stroke survivors, I think, recognize the same thing. It starts to crowd out your life. And then eventually you kind of throw your hands up. You’re like, I it might be helping, but I just don’t have four hours a day for all this stuff. Like I just I need to go on and and live my life too. So it’s something that ⁓ it’s 15 minutes. You do it three to five times a week in your home.

⁓ it’s a one time expense and then it’s you know, it’s something you’ll have for many, many years.

BIll Gasiamis (45:12)

I love it. Where are you located?

Brad Pitzele (45:15)

We’re in a Dallas, Texas area.

BIll Gasiamis (45:17)

Okay. And are these things easy to get and distribute throughout the United States and other places in the world? I don’t know I’ve never heard of it before. So are there other people around who who sell a product that’s similar or can you access them easily?

Brad Pitzele (45:35)

Well, we do ship worldwide. ⁓ we ship with US power, so people get a power converter we’ve sold to the UK, to Australia, to all over Europe, Asia, ⁓ South America, ⁓ and of course across North America as well. So ⁓ they’re readily accessible. Kind of our mission was

You know, when the doctor asked me if I’d make him first patients, I I I I thought about what you were saying about how like spending sixty grand to find out if something’s gonna work. And I felt like I was taking advantage a lot when I was very ill. So we wanted to make something that was accessible to people who are chronically ill. They might not have the ability to earn money. They’re on a fixed in like I

have a I guess a deep personal experience and empathy there sort of thing. So ⁓ that’s yeah. So we ship worldwide.

BIll Gasiamis (46:27)

Yeah. If somebody wanted to reach out to you just to get more information, to have a chat with you, to look at your website, where would they go?

Brad Pitzele (46:35)

They would go to 1000roads.com slash stroke recovery. We do. And you can find it at the bottom of that webpage, but it’s 1000 Roads HQ.

BIll Gasiamis (46:42)

And you have a YouTube channel.

Okay. What kind of ⁓ things can people find on the YouTube channel?

Brad Pitzele (46:56)

you can find everything about protocols, benefits, ⁓ how to use it. ⁓ we hit have some customer testimonials and parts of that. ⁓ just talking about the science of it, people’s experience with it, et cetera, et cetera, different use reasons people use it.

BIll Gasiamis (47:17)

I think it’s very important to bring information like this to stroke survivors so that they can access things in their own home that’s going to make their life better. I wrote a book, The Unexpected Way That a Stroke Became the Best Thing That Happened, for the explicit reason to give people like a

path forward, a journey forward as to how to ⁓ s how to kind of obtain the silver lining in stroke recovery. And when I wrote it ⁓ in 2018, when I started writing it, something like that, 2018, 2019, I was lacking a lot of the extra pieces that I could put into ⁓ the mindset chapter, for example, or the exercise chapter, or, you know, the nutrition chapter. And

In the last five or six years, I’ve been picking up those pieces to sort of attach to those chapters because they’re really relevant. And with the exercise chapter, I think this protocol was the one thing that was missing because I made the point of how important exercise was. I didn’t make the point of how you can exercise and get more bang for your buck during that exercise by

Increasing the amount of oxygen that you were getting into your ⁓ bloodstream. How would I have known that if I hadn’t come across the science, which I hadn’t? Plus, there’s only so much you can put in each chapter, but this is the perfect addition. Like, and I love it. So I can go on and on about how much I think this is amazing. Brad, I really ⁓ want to thank you for reaching out and joining me on the podcast.

Thanks for the work that you do. I’m glad that you’ve been able to get your health back and now you’re helping other people.

Brad Pitzele (49:06)

Thank you so much, Bill. I appreciate you having me on.

BIll Gasiamis (49:08)

Well, that’s it for another episode of the Recovery After Stroke podcast. I hope you enjoyed this episode. Might be worth listening to it again. The science here is worth sitting with, oxygenating the blood plasma, reopening inflamed microcapillaries, giving mitochondria what they need to shift out of that low energy state. And the fact that it can be done at home at a fraction of the cost of hyperbaric oxygen therapy makes it worth knowing about. If you want to learn more,

or explore the equipment, head to 1000Roads.com Stroke Recovery. Brad has arranged a discount for listeners of this show of between one and 500 dollars, depending on the package you choose. This episode pairs well with the episode 402 with Jack Clifford, which covers a protocol for regenerating blood vessels around the injured area of the brain.

The two conversations complement each other. Worth going back to if you haven’t heard it yet. Now, if this episode was useful, please share it with someone who could benefit. And my book, The Unexpected Way That a Stroke Became, the Best Thing That Happened, is available at recoveryafterstroke dot com slash book. And if you’d like to support the show financially, I would love it if you could. You can go and do that via patreon.com/slash recovery after stroke. I’m Bill Garciamas.

Thanks for listening. See you on the next episode.

The post Brad Pitzele – How Exercise With Oxygen Therapy Brings Hyperbaric-Style Benefits Home appeared first on Recovery After Stroke.

Microplastics and Stroke Risk: What a Landmark 2024 Study Found Inside Human Arteries

In 2024, a team of Italian researchers published a study in the New England Journal of Medicine that stopped the cardiovascular science community in its tracks. They found microplastics, tiny synthetic fragments embedded inside the carotid artery plaque of more than half the patients they examined. And the patients who had them faced more than four and a half times the risk of a serious cardiovascular event compared to those who didn’t.

This isn’t a distant, theoretical risk. These are living people who had already been identified as having carotid artery disease, and plastics were found inside their arterial walls. For stroke survivors and those at elevated risk of stroke, this study raises important questions that the medical system has not yet caught up with.

What the Research Found

The study by Marfella et al., published in the New England Journal of Medicine (2024), enrolled 304 patients who were undergoing carotid endarterectomy, a surgical procedure to remove plaque from the carotid arteries. Researchers analysed the excised plaque for the presence of microplastics and nanoplastics.

Their findings:

58% of patients had detectable levels of polyethylene, polyvinyl chloride (PVC), or polystyrene in their arterial plaque. This was not contamination from the surgical procedure; it was already there.

Over a 34-month follow-up period, patients with microplastics in their plaque had a 4.53 times higher risk of a combined endpoint: non-fatal myocardial infarction, non-fatal stroke, or death from any cause.

Inflammatory markers were significantly elevated in the microplastics-positive group. IL-18 and TNF-alpha proteins associated with systemic vascular inflammation were markedly higher in plaque samples that contained plastics. This suggests the mechanism is not simply physical obstruction, but an inflammatory cascade triggered by the presence of synthetic material in arterial tissue.

What This Means for Stroke Survivors

The carotid arteries are the primary conduits supplying oxygenated blood to the brain. Plaque accumulation in these vessels is one of the leading causes of ischaemic stroke, and carotid artery disease is a condition many stroke survivors are already living with.

“The patients with microplastics in their plaque had a 4.53 times higher risk of stroke, heart attack, or death over the 34-month follow-up. That’s not a marginal finding. That’s a signal the research community needed to take seriously.”

The NEJM study doesn’t yet tell us whether removing microplastic exposure after the fact reduces risk. It doesn’t confirm that healthy individuals with no existing carotid disease are accumulating plastics at the same rate. And it cannot tell us which plastic sources are most responsible because we’re exposed to microplastics through drinking water, food packaging, air, and a dozen other vectors simultaneously.

But what it does tell us clearly and with high statistical significance is that microplastics in arterial plaque are associated with dramatically worse cardiovascular outcomes.

What the Research Does Not Yet Tell Us

Science at the frontier moves in one direction at a time. This study establishes association, not causation. It cannot yet answer:

Whether people without existing carotid disease are accumulating microplastics at comparable rates. Whether reducing exposure actively reverses or slows plaque-associated risk. Which types of microplastics are most biologically harmful? Whether there will be a clinical screening tool for this in the near future.

These are the questions the next generation of research will need to answer. In the meantime, it’s reasonable to act on what we do know.

Practical Steps to Reduce Exposure

No clinical screening currently exists for microplastics in arterial plaque. There is no blood test, no imaging, no biomarker that your GP can order today. What you can do is reduce your ongoing exposure, particularly through food and water contact with plastics.

Evidence-informed steps worth discussing with your treating team:

Use glass, stainless steel, or ceramic containers rather than plastic for food and drink storage. Avoid microwaving food in plastic containers; heat accelerates the leaching of plastic particles. Filter your drinking water; some filters (carbon block and reverse osmosis) reduce microplastic levels significantly. Reduce consumption of highly processed foods in plastic packaging. Bring this study to your vascular neurologist, cardiologist, or GP and ask whether it’s relevant to your personal risk profile.

This is not a recommendation to take a supplement or start a treatment. It’s an invitation to have an informed conversation with the people responsible for your care using the best available evidence.

If you found this useful, my book walks through the science of stroke recovery in the same evidence-first, no-hype way. Find it at recoveryafterstroke.com/book.

Want to go deeper and support the channel? Join the community at patreon.com/recoveryafterstroke.

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