Sunday, October 25, 2015

Sunday Stroke Survival: The Effacy of Botox and the Autumnal Slump

Tis the season...for Botox semi failure. For two years in a row the autumn series of Botox only has limited effect. In talking to therapists and other stroke survivors who receive autumnal injections, they stated I'm not alone in this. Although there are no studies that document this effect, alas, it appears to be fairly common.

I'm left wondering why this is. Is it weather factors? It is chillier. For us down south it's a damp chilliness. The kind that seeps into your bones. Is the arthritis flares that make us perceive an ineffective results of the shots. It's a possibility. It could also be an age factor affecting the injections. But why only autumn? Why not other times of the year?

All I know is that this Botox series is a bust. The spasticity in my leg and arm have had little response to the Botox. So I can expect no improvement or recovery of the spastic muscles. It means no forward progress and I strongly dislike this. I always strive for progress, don't we all? While my arm no longer draws up into my chest like it did before the dry needling, the wrist is cocked at greater than  90 degrees. The best I've managed to straighten the wrist is 45 degrees. The hand is also in a light fist and the fingers will extend to 45 degrees, but it's a constant battle to fight the spasticity.

I should count my blessing though. While my muscles contort into these extreme positions it is only mildly uncomfortable now because of the dry needling once or twice a week. I do have to admit that skipping two weeks of therapy will cause the spasticity to get progressively worse. Three weeks between sessions my arm will slowly rise and lock into my chest. So dry needling has a hold over affect that is lengthening with treatments like I first read.

My dry needling buddy, who I've talked about before, has almost a two-month carry over effect between sessions now. He is now Botox free. I know I'll get there too. Considering how bad my spasticity is, I'm lucky to have any hold over effect at all. To have a two-week hold over is better than the 1-6 hour carry over that I had in the beginning. There are less and less active trigger points which causes problems which is excellent. For example, my bicep has almost no trigger points to hit so we are now working on the forearm, hand and deltoids. My traps are still a problem but getting better. They are no longer my steel traps, but more like lead (tough but malleable). Considering both of us have been in this study for post stroke spasticity for less than a year, we remain hopeful of ending this cycle permanently. I would honestly consider our response as positive results.

 By narrowing my view of what success is, I can maintain hope. Small strides or baby steps. When I look at the big picture, I could make myself seriously depressed. Small blessings focus has been my saving grace. Each blessing, no matter how small, is a stride forward. So in the autumnal slump of the Botox series the blessing of not being in the agonizing pain of full fledged spasticity is a greater blessing to focus on. Judging by last year, my winter series should have me on the track of positive, forward gains again. Three months to wait isn't long compared to the almost three years of no progress. I can take heart in that.

Nothing is impossible.


  1. I am so impressed by your progress. As a stroke survivor I know how frustrating slow progress can be. As an OT I am excited by you achieving results that many would say is impossible.

  2. Hope *is* the big picture, isn't it?

  3. I wonder also if the shortening hours of daylight have something to do with it. My sister has SAD (Seasonal Affective Disorder) and gets depressed every fall. A light box helps her tremendously. Don't know if it would have any effect for you.

  4. Hope the needling starts to work and you don't need to even think about the Botox.


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