stroke

Losing My Voice

by Paul Strikwerda in Articles, Personal 28 Comments

At speech therapy wearing a TENS device

The facts are sobering.

Every forty seconds, someone is struck with a stroke. It is the fifth leading cause of death in the U.S. Most people will never make a full recovery, and more than two-thirds of survivors have some kind of disability associated with the attack.

Those are the statistics.

It’s a good thing I don’t believe in numbers. I believe in proving them wrong. The history of the world is filled with people who were told “It can’t be done,” and yet they persisted and succeeded. Against all odds.

I believe that people don’t equal statistics.

Going by the stats, it seems reasonable to believe that I would never fully recover from the stroke that struck me six months ago. But I chose to be unreasonable.

Last week I wrote about my road to recovery, and I promised you to open up about the one thing that terrified me most. It was something I didn’t want my colleagues or clients to know, because it could ruin my career.

HOW IT STARTED

Let me take you back to March 26th, 2018, the day I woke up on the floor of my voice-over studio wondering what the heck was going on. In hindsight I had the classic signs of a stroke: a sudden and pounding headache, loss of coordination, and blurry vision. One side of my body was paralyzed, my face was drooping, and I had trouble speaking.

That last symptom manifested itself in two ways: I had difficulty speaking sentences that made sense, and my speech was slurred. This usually means that the part of the brain that controls language is not getting the blood supply it needs. It was in fact dying.

As I was being transported to the hospital in a helicopter, my wife got a phone call from the surgeon who was on standby to operate on me. “When Paul comes in, I probably won’t have time to introduce myself,” he said, “so I want to take a moment to speak with you now. I’ll be totally honest. Everything we do will depend on the results of Paul’s CT scan, which will show us what parts of his brain are still intact when he arrives. Timing is crucial.”

He continued: “Be prepared that he might not make it, or that he’ll end up being severely handicapped and dependent on others for the rest of his life. If the scan looks good, we can do a thrombectomy to remove the blood clot from his brain, and take it from there.”

Since you’re reading these words, you already know the outcome. I guess it wasn’t my time to go, and I beat the statistics. Annually, out of the 1600 stroke patients that arrive in the hospital I was admitted to, only 80 are eligible for a thrombectomy.

THE RECOVERY BEGINS

So, my surgery was a success, but this did not mean that all was well between my ears. The scans showed a black area on the right side of my brain where cells had died. Those cells do not grow back. In order to compensate for the loss, the brain has to rewire itself and have other parts take over the function of the cells that are lost. To make that happen I needed at least five things: a positive attitude, a solid support system, plenty of rest, healthy nutrition, and therapy.

Even though I no longer sounded like a drunkard, clear articulation wasn’t my forte in the first few months after my stroke. I suffered from dysarthria. That’s a fancy word for unclear speech caused by brain damage. It’s a weakness or lack of coordination of the muscles of the tongue, lips, palate, jaw, and larynx. On top of that I had word-finding issues, indicative of memory loss.

By far the weirdest symptom of my post-stroke condition was the fact that I didn’t sound like me. My speech had become rather robotic and monotonal. It came in little bursts of language, just like the thoughts in my head. In the weeks to come, I discovered that I had the hardest time infusing my words with emotion.

No matter the subject, I sounded as passionate as a concrete wall. After I came home, I tried my hand at a few voice-over scripts for existing clients. It took countless retakes before I was somewhat satisfied with the result, but clients were noticing that something was off. The feedback I consistently received boiled down to this: “Once more, with feeling, please.”

The problem was that I had no idea how to access those right brain feelings. No matter how hard I tried, I seemed incapable of translating instructions like “confident,” “warm,” or “excited” into sound, whether in my studio, or in ordinary conversations. This was infuriatingly frustrating. I felt like a soccer player unable to handle the ball, or a painter who can’t hold a brush to add color to his canvas.

Would I ever be able to reach these emotions again, or were they part of the right brain that was destroyed by the stroke? What would this mean for my voice-over career?

Twice a week I went to speech therapy to learn how to improve my articulation. With my therapist, I also worked on regaining memory, and on sharpening my information processing skills. Very soon I realized that all of this wasn’t going to be as easy as flipping some internal switch. It needed time, energy, and lots of practice at home.

Speaking of home, on top of her busy schedule my wife became my designated driver, my patient advocate, my caregiver, my personal chef, and my hero. She made sure I got to all my appointments, that I took all my medications, and that my recovery would be pretty much stress-free. Her delicious meals were almost always based on fresh, locally sourced and unprocessed ingredients. You can’t have a healthy mind without a healthy body.

MORE TROUBLE

In the weeks after my hospitalization there was something else about my voice that concerned me. For some reason I was hoarse all the time, and I had no vocal stamina for long conversations and even longer scripts. I was tired, and I sounded like it. Something told me that if I didn’t take care of this, my career as a professional speaker would be over.

In May I went to see an otorhinolaryngologist who specializes in working with actors, singers, and public speakers. She performed a flexible fiberoptic laryngoscopy whereby a small endoscope is inserted through one nostril and guided through the nose to the back of the throat. It’s a funny feeling.

This revealed a slight laryngeal tremor. That’s an involuntary tremor of the vocal folds that causes changes in the voice. My ENT also concluded I had laryngopharyngeal reflux (LPR), a.k.a. “silent reflux.” Why silent? Because it doesn’t necessarily trigger the usual symptoms of acid reflux, such as heartburn. It does lead to hoarseness, coughing, and throat clearing because stomach fluid travels back through the food pipe to reach the back of the throat.

It is likely that the laryngeal tremor was caused by the stroke. Perhaps it will go away over time. Perhaps it won’t. I’m treating my LPR in several ways. I avoid spicy and acidic foods. I limit my intake of chocolate, coffee, alcohol, citrus fruits, mints and tomato-based products. I’ve stopped snacking before bedtime, and I’ve lost about twenty pounds. I’m also taking omeprazole which decreases the amount of acid the stomach makes. A new wedge pillow raises my head in bed, and keeps the acid down where it belongs.

Experts estimate that forty percent of the population may have undiagnosed LPR. If you’re experiencing hoarseness, a need to clear your throat, a sore throat, difficulty swallowing, or a red, swollen, or irritated voice box, please see an ENT to get to the root of the problem.

POSITIVE RESULTS

The good news is that after months of speech therapy my articulation and ability to focus has greatly improved, and the robot voice is gone. Only when I get really tired, it becomes more monotonal. I’m relieved that my speech has become more expressive, allowing me to continue to work as a voice talent. I’m also back to doing four-hour shifts as one of the announcers at the Easton Farmers’ Market.

Twice a week I work on strengthening my vocal folds and building my endurance with my speech therapists. I’m not yet where I want to be, but I’ve started recording longer scripts again.

RECOVERY CONTINUES

It takes a positive attitude, plenty of rest, healthy nutrition, and therapy to recover from a stroke. Add to that a support system; a network of caring people who provide you with practical and emotional support. Reading and responding to your comments on last week’s blog post, I realize how lucky I am to have such a supportive group of friends and colleagues!

Thank you for your kind words, good thoughts, and prayers. Your positive vibes revitalize me, and give me energy to keep on beating the odds. The process of healing goes on, which means that I have to be careful not to do too much, too quickly. So, if you don’t hear from me within 24 hours, and you don’t see me on social media, rest assured that I’m doing everything I can to take care of myself.

I hope you will do the same.

Paul ©nethervoice

Important: the information presented here does not substitute for medical consultation or examination, nor is it intended to provide advice on the medical treatment appropriate to any specific circumstances.

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Why I Have Disappeared

by Paul Strikwerda in Articles, Personal 53 Comments

Six months ago I was on top of the world. And then my world collapsed.

I remember being in Carnegie Hall on Thursday, March 22nd to hear Itzak Perlman and Pinchas Zuckerman play. During the intermission, I checked my phone to see if one of my agents had news about an audition. Seconds later I learned that I had landed a national spot for IHOP. The recording session was the very next day.

That night my wife and our companions went home without me, while I stayed at our friend Peggy’s, an oboist who shares a small apartment in the city with her cat Boston. The next morning I took the subway to Heard City at 16 W 22nd Street, a boutique audio post production facility. After two intense hours of takes and retakes the job was done, and I felt fantastic!

Very soon this obscure Dutchman, who came to the States with no contacts and no career, would be selling Hawaiian French toast all over America. Life was sweet! Little did I know that in three days time, I would be toast, as doctors were fighting for my life.

I’ve documented the story of my stroke in “I’m Still Here.” It starts with me, waking up half-paralyzed on the floor of my voice-over studio, a rescue by friends followed by a bumpy helicopter ride, a thrombectomy, and a two-week stay in the hospital.

But that was just the beginning.

CHANGING MY LIFE

From the moment I came out of the ER, it was clear that from now on two things would be crucial. I had to Rest and Recover. Anything else was secondary. This may sound easy, but for a busy bee like me it required a disruptive but essential change in lifestyle and in attitude. For me, the hardest part was this: Being okay with being incapacitated.

I’ll be honest with you: I was anything but okay with that concept. For years and years I had gone full speed ahead, sitting in the driver’s seat of my life, frantically holding on to the wheel. I couldn’t stand that after the stroke I felt weighed down by an overwhelming fatigue, unlike anything I’d ever experienced.

Trapped in my lethargic body, and held back by persistent brain fog, I observed myself becoming dependent on the help and kindness of others to heal from this stroke of misfortune. My prospects for recovery were unclear.

One neurologist casually informed me that the dead brain cells would not regenerate. “What you’ve lost will never come back,” he said. “You just have to learn to live with it.” I hate it when people use the word “just” in that way, don’t you?

Another doctor told me to trust the amazing ability of the brain to reorganize itself and form new connections between cells. It’s called neuroplasticity. As long as I did my part, the grey matter between my prominent ears would do the rest. Now, there’s a concept I could embrace!

SIDE EFFECTS

Apart from feeling tired and overwhelmed all the time, there were other signs that the stroke had done a number on my body and my mind. I’ll mention a few, but please note that these “side effects” are by no means typical. It all depends on which parts of the brain are affected by the stroke, and to what extent. That’s why they say: “Different strokes for different folks,” I guess.

My stroke had wiped out a part of my right brain, which affected the left side of my body. At times that side felt rather uncooperative and weak. If you and I were to go for a stroll, you’d see my left foot dragging, and my left arm refusing to swing. After six months, I still have an interesting time picking things up with my left hand.

Surprisingly, my eyesight was also impacted. For the first time in my life I couldn’t read all the letters on the ophthalmologist’s chart, which is why I now permanently sport a pair of stylish bifocals. As it turned out, my brain was also ignoring part of the left side of my field of vision, which requires bi-weekly vision therapy. Driving a car was out of the question.

Overall, I found it hard to focus in other ways too, especially in an environment with lots of things going on at the same time. My brain would quickly reach stimulus overload and tune out. Supermarkets and department stores were places to avoid, as well a large gatherings of people.

Social situations became particularly awkward for me. I can’t explain why, but instead of taking part in a conversation, I found myself becoming a disengaged observer. It was as if my brain had trouble connecting and downloading the information. Should you and I meet and strike up a conversation, please don’t think I’m bored as my eyes start drifting away and I stop responding. It simply means it’s challenging for me to process the information and the environment, and my wheels are churning.

Anyway, I don’t want this to be a litany of complaints, so, before I talk about how my stroke affected my voice and my career as a professional speaker, I’ll tell you how I approached my recovery.

GETTING BACK ON MY FEET

From the moment I landed in the hospital, I knew I had one job and one job only: to heal my body and my mind. Everything I do and not do, has to serve that purpose. I use present tense, because the process is ongoing.

One of the first things I had to wrap my brain around is that it is okay to be unproductive. Healing from a stroke requires rest. Lots of it. In the first few months, I spent hours and hours in bed. At night and during the day. Even though my body told me to take it easy, my mind felt terribly guilty for not doing my share and pulling my weight. Talking to a neuropsychologist made me realize this was unhelpful, to say the least.

I learned to listen to my body, and accept that I was (temporarily) unable to contribute much to the household. I learned to accept that other people would pick up the slack. Daily afternoon naps are now part of the program. I also learned to avoid things that would drain my energy.

On any given day, you and I spend a lot of time worrying about things that happened in the past, or things that might happen in the future. As a result, we’re barely in the moment. It’s like going out to dinner in a fancy restaurant. During the main course we’re still evaluating the appetizer, or we’re already wondering about dessert. Meanwhile, we ignore what’s on our plate and in our mouth.

The truth is: the only reality is the here and the now. The rest is imagination. Yes, even memories are figments of our imagination because they’re nothing but personal interpretations of what we believe has happened in the past.

Recovering from a stroke is teaching me to be here now; to savor the moment, and not let worries about what may or may not happen suck the life blood out of me.

STAYING FOCUSED

Next, I had to decide how to deal with distractions. To me, a distraction was anything that would keep me from my main goal: to rest and recover. This meant putting my voice-over career on a back burner, and (temporarily) disengage from my community. So, no more Instagram or Twitter, and very limited time on Facebook. I’d stay out of discussions about the state of our industry, and I stopped writing a new blog post every week. In short, I practically disappeared from the radar screen, and I have to tell you: it was bliss!

If you’re active on social media, you know that it can be quite stressful to have to produce new content for the world to see. It’s a monster that’s always hungry for more. On top of that you have to keep up with all the content produced by others on a daily basis. The trick is to control “it” before it controls you.

As I’m taking a social media break, I am reevaluating to what extent I should maintain my presence. Is it a good use of my time? Does it keep me healthy and sane? And most importantly, does it make me and others happy? Having a stroke reemphasized that our time on earth is by no means guaranteed, and certainly not unlimited. It’s what you do with it that matters.

Work wise, I took a long and beneficial break from doing auditions. I only record for existing clients, and for jobs that land in my lap. It’s all I have time and energy for. But don’t think I spend most of my days in a horizontal position. It’s amazing how much time goes into doctor’s visits, medical tests, endless follow-up appointments, and therapy sessions. Getting well has become my day job, and my night time activity.

Every time I go to rehab and see other stroke patients, I realize how lucky I am. I’m not in a wheelchair. I can communicate. My brain still works, and I have a wife and friends who are there for me, every step of the way. Every week caring colleagues check in with me, wanting to know how I am doing. And when I meet people that haven’t seen me for a while, they are surprised how well I seem to be doing.

However, there’s one thing I haven’t told you about: how the stroke has affected my voice. I’ve kept this quiet because I didn’t want my clients to know and look elsewhere for talent. But since I’m on the mend, I’m ready to share that story with you next week!

Paul ©nethervoice

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I’m Still Here!

by Paul Strikwerda in Articles, Personal, Studio 80 Comments

There’s not much I remember of Monday, March 26th, but it’s a day I will never forget. 

In the late afternoon while at work in my studio, I suddenly and inexplicably began to feel light-headed. My legs became weak like rubber, unable to support the body they held up. Then I blacked out for who knows how long. It felt like minutes, but it could have been for hours. When I regained consciousness, I found myself on the floor, painfully twisted like a pretzel, gasping for air. I tried to get up on both knees but couldn’t. It was as if my brain’s messages didn’t reach my muscles. I’d never experienced anything like it in my life. 

The phone rang several times. My arms reached to the desk above, hoping to grab it. No matter how hard I tried to lift myself up, I had no strength to do it. It was infuriating and terrifying at the same time. After a while a text message came in, and I desperately wanted to answer it. I grabbed my desk chair, hoping to climb up on it, but it rolled away from me. 

Something told me that whatever was happening to me, was serious, and I needed to contact the outside world without delay. Then I remembered that I could simply ask Siri to call my wife by shouting instructions at my iPhone. But when I attempted to form words, I noticed something very alarming. My tongue felt swollen and useless. My slurred speech sounded like a drunken sailor. What the heck was going on? 

While I was lying on the floor, I noticed that my breathing had become very shallow. I had no idea for how long I had been down. The lightheadedness got worse by the minute, and suddenly it dawned upon me that I was using up all the oxygen in my seven by seven, hermetically sealed, and unventilated voice-over studio. I clearly needed help, but who could possibly rescue me? 

My wife was at a borough council meeting that night, and she wasn’t scheduled to come home early. Screaming to alert the neighbors was pointless, since I was in a solid soundproofed space I had designed myself. I remember trying to open the heavy studio door, which under normal circumstances takes a lot of strength. An industrial metal door closer keeps it firmly shut, and to make matters worse, my unresponsive body was leaning against it. 

I felt trapped, and it quickly dawned upon me that if no one came to liberate me, I would soon use up all the oxygen, and suffocate in my own studio. 

At borough council, my wife was concerned that I didn’t show up for the meeting I’d said I would attend, and that I did not answer my phone. A few weeks earlier she had found me face down on the kitchen floor after I had thrown out my back and was unable to move. Six hours later an ambulance crew had to pick me up off the floor and take me to the nearest hospital. With that in mind she called our friends who lived nearby and had a house key, asking them to check in on me. Since this was a council meeting, the police and fire chiefs were present, and they promised to send a few guys over for a welfare check. 

Knowing that crying out for help would be futile, I began to bang a loud SOS on the walls of my recording space in the hopes somebody would hear me. It took all the strength I had, but suddenly and miraculously, the back door opened, and I heard voices. Neighbors Scott and Danny had arrived, but they had no idea what had happened and where to find me. In one final attempt I pounded the loudest SOS on the studio door and it worked. My friends came running down to the basement where my studio is located. 

At first they couldn’t open the door because I was lying against it, so I had to roll myself away from it. As the fresh air was flowing in once the door opened, I took the deepest breath I had ever taken in my life. I remember Danny, who is a trained nurse, bending over me, saying: “The left side of his face is drooping and he’s unresponsive. He might have a stroke!” At that point police officers and firemen came in, ready to get me out of my miserable situation. 

What happened next, I don’t remember very well. They got me out of the house and to the nearest hospital to stabilize me, and find out what was going on. A quick scan confirmed that I had indeed suffered a stroke caused by a blood clot in the right side of my brain. To avoid further brain damage and possible paralyzation, it was imperative to get me to a stroke center as quickly as possible. That’s when the medevac team was contacted. 

A helicopter landed on the helipad at a nearby high school, and within minutes I was airlifted in a cacophony of engine rumble and intense vibration. At the stroke center a specialized team was anxiously awaiting my arrival, ready to physically remove the blood clot using a procedure called mechanical thrombectomy. Doctors threaded a catheter through an artery in my groin up to the blocked vessel in the brain. A stent opened and grabbed the clot, allowing doctors to then remove the stent with the trapped clot. 

Get this. During the operation I actually woke up out of my sedation, and I felt the stent going in, grabbing something inside my head. As I stared at my smiling surgeon’s face, there was a moment of sharp pain, followed by intense relief as I drifted away. The next thing I remember is waking up in the ICU, being welcomed back into the world by my wife. For the next two weeks, I would be attached to a network of tubes leading to beeping equipment measuring any type of vital sign. 

I was weak, I was dizzy, but I was alive. Thank goodness I was alive!

What happened next was even more miraculous. As soon as I shared my hospitalization on Facebook, hundreds of people started reaching out to me. Every day I received encouraging, heartwarming messages from all over the world from friends, colleagues, and family members. Some mornings, the nurses caught me using WhatsApp to talk to my sister in the Netherlands, Facebook Messenger to connect with a colleague in Spain, and email to let a client know I couldn’t narrate a script just yet. 

While new medications were slowly stabilizing my situation, I want to tell you that there’s nothing like the positive power of kind, caring people healing what was broken. I felt strengthened, supported, uplifted, and energized. Soon I would be walking the hospital halls in my yellow slipper clogs to the amusement of staff members. I began climbing stairs, regaining my balance, and finding my bearings. Paul Stefano, Trish Basanyi, Uncle Roy Yokelson, and Mike Harrison came to visit, bringing good cheer and yummy treats. 

Friends started cooking for my wife who spent most of her time by my side, keeping track of all the information and advice from neurologists, cardiologists, and other health care experts involved in my treatment. She was the one I leaned on, literally and figuratively, and I count my lucky stars to have her love in my life. 

So, how am I feeling now, a little over two weeks after I had my stroke?

Right now, the biggest challenge to my recovery is… me. I want to get back on my feet as soon as possible, doing all the things I’m so used to doing, even though I might not have the energy and coordination to do them. I have to learn to pace myself and say no. I also have to come to terms with how I handle stress caused by pressure I put on myself, and pressure from others. But based on what has happened, people are surprised to see me in such good shape. I attribute that to two things. The day after my operation the doctor told me: “It’s important to keep a positive outlook. He’s absolutely right. I truly know that being negative is a luxury I can’t afford. 

The second thing is the importance of having a support system. That’s precisely where you came in, and I am so grateful for that. To you, it might have seemed like a few kind words on social media, or a card with an encouraging message. To me, it made all the difference, and I can’t thank you enough for that!

The consequence is that you’ll be stuck with snarky, lucky me for a while, using this blog to dish out my weekly commentary on the wonderful world of voice-overs and life as a freelancer.

Are you sure you can handle that?

Really?

I know I can, because I’m Still Here, and I’m not going anywhere!

Paul Strikwerda ©nethervoice

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