It was in the hallway of the Acute Rehabilitation Unit at Evergreen Health Medical Center, a week after my stroke. Dr. Kim, my physiatrist, was talking to me and my physical therapist, Caroline.
“Yutao, in the following few weeks, you will be stuck here for a while. Caroline and her team will make sure to kick your butt and get you out of the door as soon as possible,” said Dr. Kim jokingly.
What he said was for sure funny. As a serious person of myself (at least for most of the time), I usually would just give it a polite, acknowledging, and subtle smile.
But for some reason at that moment, I found a strange, unexplainable sensation. It was like an unbearable itch in my heart (or belly? I couldn’t really tell). The subtle smile suddenly turned into hearty laughter. Embarrassingly, I apologized for that. But that itchy sensation wouldn’t go away, and I had to bite my lips to hold it. It didn’t work at all! I burst into laughter again, and again!
On that day, I learned from Dr. Kim what I had over there is called Pseudobulbar Affect (PBA), a fancy name for an odd side effect after a stroke: uncontrollable bursts of laughter or crying that don’t always match how we’re feeling inside. For me, it’s mostly laughter – random, unstoppable, and sometimes wildly out of place. Think of it as brain’s way of hitting the “LOL” button at the strangest times.
Dr. Kim prescribed me a medication called Escitalopram (Lexapro), which increases levels of serotonin, a neurotransmitter that helps regulate mood, emotion, and sleep. By preventing serotonin reabsorption in the brain, it helps improve communication between nerve cells and stabilize mood.
I had taken that medication for a few weeks after being discharged from Evergreen. Then I started to have a second thought.
First of all, in general I don’t like taking any medications unless it is absolutely necessary. I always believe any medication could have side effects. There is a Chinese saying 是药三分毒 – If it’s medicine, it has three parts poison (All medicine carries some degree of toxicity).
Secondly, I am lucky my symptoms are on the laughter side of the mood spectrum versus the other end. Laughing can generally make me feel happy. Here is another Chinese saying 笑一笑十年少 (A smile makes you ten years younger).
Besides, I was taking extended disability leave from work, which meant I would be mostly staying at home for some time. I was hoping my family would not mind some silly laughter from me!
So, I said to myself, “Let it be,” and stopped taking Lexapro.
PBA has caused quite a few small incidents since then.
It was a session with Margaret, my speech therapist. She was demonstrating some vocal exercises to me. All was going well at the beginning. Then for reasons I cannot exactly remember, something triggered me, and I started giggling. I tried to calm myself down. But whenever I opened my mouth to repeat what she just taught me – “Aaaaah,” I immediately lost it. As Margaret suggested, I drank a bit of water. That didn’t help. I took some rest. No luck. We chatted about something else then came back again. I still cracked up. The whole thing continued for several minutes until both she and I decided to give it a pass. Even though Margaret showed extreme professionalism and patience, I could still tell she was trying so hard, refraining herself from laughing and didn’t want to make me feel bad. I felt truly grateful for that.
Mishaps were also happening when I returned to work a few months later. I recall once I couldn’t help laughing when one coworker was discussing some bugs in my office. I apologized, explained my situation, and told him that there was nothing funny about what he just said. Jokingly, he replied, “Yeah, it’s actually a funny situation when our product is sitting in the background doing nothing but having a memory leak”!
These kinds of situations come up regularly, whether in person or online. When in person or when my camera is on for online meetings, I have to bite my lips so hard to hold my laughter. Now I learned to always turn off my camera before joining a meeting.
Outside of work, this also happens quite often. It occurs on all kinds of random occasions – riding a bus, walking in a cafeteria or grocery store, or even when I am crossing the street. For many times, I would try pretending that I was laughing at something I saw on my phone, hoping people around me wouldn’t think I was laughing at them and felt offended.
At home, it is less embarrassing because my wife and daughter know what is really happening to me. Although things might get messy sometimes especially when I am eating or drinking. But most of the time, it is a rather pleasant experience. I remember laughing together with my daughter for some remotely funny internet memes or cat videos. Seeing my silly laughter, she sometimes would also totally lose it and literally ROFL (Rolling On the Floor Laughing). That, unfortunately, would put me into an even wilder place. I would laugh for minutes, and it hurts my belly so much.
Joy or challenge, PBA is something I need to cope with daily. I find one thing that seems to be useful for me to ease that “itchy” sensation before losing it, is what Margaret taught me – trying to change the body posture slightly, as simple as just turning my head to another side. It works most of the time and the urge to crack up seems to be able to immediately go away. But sometimes it just comes so quickly before I can pick up this trick! If you are a fellow stroke survivor with PBA, please give it a try and see if it helps you as well.
So here I am, laughing into my post-stroke recovery. Living with PBA has been a wild ride, full of funny, frustrating, and unexpectedly heartwarming moments. If you’re struggling with this, know you’re not alone and your journey can be filled with connection and joy, too. I’d love to hear your stories: moments you laughed, cried, or just rolled with it. Drop a comment or reach out. After all, we’re in this together, and sometimes, laughter really is the best medicine.
P.S. here are a few techniques I read from Stroke.org to regain control during a PBA episode:
- Let others know you have PBA to avoid confusion during episodes
- Use distraction techniques, such as counting objects in the room
- Relax tense muscles
- Take slow, deep breaths to regain control
- Change your body position or adjust your posture
- Talk to your health care team about treatment