My Stroke (Part I)

Of all the afflictions that I feared might eventually lay me low, (or lay me down under), stroke wasn’t even on the list. Topping my list were the two biggies: cancer and heart attack.  Likewise, I imagined that it was just a matter of time before my doctor called me on the phone (You never want the your actual doctor calling you direct!) and announcing, “Thomas, I’m looking at your third consecutive glucose reading above 120, so why don’t you stop by, sooner rather than later, so we can put together a game plan for how you and your adult-onset diabetes can co-exist in a way that best facilitates you staying alive.”

Conversely, I tended to associate “stroke” as some sort of coup de gras, converting very elderly infirm, unfortunate bastards into human vegetables until someone has the compassion to pull the plug. I was aware that that strokes were very bad for the brain but I hadn’t a clue regarding the etiology of a stroke or its prevalence within the human population.

Having suffered two, possibly three strokes, I now realize in hindsight that I had experienced several transient ischemic attacks ( popularly known as “mini strokes”) prior to my first “real stroke” A transient ischemic attack blocks blood (and hence, oxygen) from reaching the brain for a fleeting few moments, but not long enough to destroy brain tissue. A sufferer of a TIA may or may not feel symptoms. In my case, I recall several instances of being seized with the sudden feeling that my left arm and leg had gone weak and numb. The sensation was as if the ground I was walking or standing on had suddenly tilted. In a couple of instances, I found my self groping for something to hang onto lest I Iose my balance.

gr3

This MRI image of my brain taken in April, 2010, after my first stroke, shows area of destruction to my parietal lobe. Surrounding undamaged neurons in the vicinity would “pick up the added load,” and allow me a full recovery, my neurologist reassured me.

Now, wouldn’t you think if something that weird happened to your body, you’d want to get it checked out, like immediately? But I simply did not equate those events with stroke. In fact, I didn’t even think I was having a stroke when I finally had a stroke. It was Easter Sunday, right after 11:00 a.m. mass, and I, along with Suzanne and youngest son Kevin, was enroute to the Davis Street CTA train station to pick up Suzanne’s friend, Pat, who would be celebrating Easter with us.  I distinctly recall approaching a red light and then, as if caught in some of sci-fi time warp, suddenly finding myself driving merrily along a half-block beyond the intersection.

“You just ran a red light!” Suzanne, announced in a remarkably restrained tone of voice.

“How strange was that?” I thought to myself. But I took a quick inventory of my faculties, and concluded that whatever just happened was some sort of anomaly, some momentary neurological crossed signal.

I insisted I was okay, and in fact, I picked up Pat and drove her back to the house, all the while making small talk. It was all quite uneventful until I parked in front of the house and then tried to get out of the car.  I swung out my left leg, planted my foot on the pavement, and then, just as I had thousands of times before, proceeded to ease myself out of the driver’s seat and assume a standing position. The problem was, my entire leg seemed to have deactivated. “Uh, I need a hand.” I muttered to no one in particular.

Suzanne had hopped out of the passenger side and now stood in front of me.

“That’s it. I’m calling 9-1-1,” she insisted.

“Just help me out of the car,” I replied. Again, absent any pain, I assumed I had just experienced something weird but fleeting, akin to what I experienced when I ran the red light minutes earlier.

With Kevin’s help, Suzanne eased me out of the car. I had regained enough mobility in my left leg to limp to the porch and to maneuver up the five porch steps. I insisted on entering the house unassisted, which I did, albeit with a limp. I turned the corner from the hall to the living room, and there was the couch, which suddenly seemed like exactly the right place to be. I pivoted to sit on it, and next thing I knew, I was sitting on the floor. “I’m fine!” I again insisted as I managed to heave myself on the couch.

“Look up stroke symptoms on the computer,” I heard Pat tell Suzanne. Admittedly, I was starting to be concerned myself, but I could smell the baked ham on slow cook and it was making me hungry. My oldest son and his wife, along with his wife’s mother and sister, would be coming over in less than an hour. Suzanne had set the table before we had left for church. A large basket overflowing with Easter candy served as the centerpiece. My mind, which still seemed perfectly intact, could not wrap itself around a scenario in which I would trade a visit to the hospital for food, drink and family.
“The warning signs of a stroke are a sudden numbness or weakness of the face, arm or leg, especially on one side of the body,” Pat intoned loudly and slowly from the adjoining office room. “Also, sudden confusion, trouble speaking, understanding, walking or dizziness.”

And then, with an annoying extra measure of loudness and emphasis, she delivered what I’m sure she thought was the capper. “Sudden   loss   of   balance   or   CO-OR-DIN-A-TION!”

Pat wasn’t done yet. “If you’re with someone who may be having stroke symptoms, immediately call 9-1-1 or the EMS. Expect the person to protest — denial is common. Don’t take “no” for an answer. Insist on taking prompt action.”

“Does it really say that?” I asked.

“Yes, it really says that,” Suzanne responded.

But, even as I continued churlishly discounting the information Pat and Suzanne were relaying to me,  I was already reconciling myself to the realization that I was going to be spending my Easter Sunday in the hospital.

I worked out a compromise. If Suzanne would forego dialing 9-1-1, I would allow her and Pat to drive me to the emergency room. Through the course of the 15-minute trip, I cracked jokes about growing old, offered a critique of President Obama’s first year in office, and riffed on the rewards and frustrations of fly fishing (I was still counting on going fishing two weeks hence. However, I was no longer in denial regarding my need to go to the hospital. My goal at that point was to be pleasant to the two women accompanying me. After all, I realized, both of them also were giving up their Easter Sunday.

Here’s the deal when you check into an emergency room with suspected stroke: Things start happening very fast. A nurse helped me onto a gurney and wheeled me to radiology, where, within ten minutes, i was administered a computerized axial tomograph (CAT scan. During this interval various medical personnel asked me who I was,what day of the year was it, and why I was in the ER, while others would ask me to squeeze their hand, lift an arm, follow the arc of a penlight — all designed, I later learned, to roughly gauge the extent of damage wrought by my stroke.
It took only about twenty minutes or so for the attending neurologist, Richard M (see note at conclusion of this post), to inform me that, based on the images developed from the CAT scan I had very likely suffered a dissection stroke.

As Dr. Mexplained to me, a tear had developed on my right carotid artery. In the aftermath, most of my blood continued flowing unimpeded to my brain, but a small quantity of blood begin pooling inside a pouch, or flap, what Dr. M termed a “false lumen.” This accumulated blood then formed clots. It was just a matter of time before one or more of those clots broke loose, traveled upstream and clogged one of the smaller arteries coursing through my brain, specifically, the artery supplying blood to my right parietal lobe.

The damage impeded my ability to locate parts of my body in space, as well as elicit response from my limbs. This explained the sudden onrush of symptoms that compelled my trip to the emergency room –sudden paralysis of my left leg, arm and hand, as well as a pronounced  droop of the left side of my face.

“There’s encouraging news in all this,” Dr. M reassured me. “You suffered a moderate stroke, but you’re young  (I was 57), and the area of damage is relatively small. I see no reason why you shouldn’t anticipate a complete, or at least, near complete recovery.”

He then delivered even better news. “Based on the data regarding dissection strokes, the odds of you suffering a second stroke is remote. This is why I am recommending a protocol of primary stroke prevention, as opposed to secondary stroke prevention, which I would usually  recommend to my stroke patients. In other words, your chances of another stroke are the same as for the general population of men in your age group with similar risk factors. Of course, you want to keep your blood pressure and chlorestoral in check, and maintain a regimen of moderate exercise. Other than that, you’re pretty much good to go.”

He did opt to put my on Warfarin, a potent blood thinner for three months, which likely would be followed by a regimen of daily aspirin therapy, assuming a follow-up Magnetic resonance angiogram (MRA) of my carotid artery indicated nothing of consequence.

DSCN0239

June, 2012, just two days before my second (or third) stroke. I am posing with my three sons and Suzanne in Savannah, Georgia, where Chris had just graduated from the Savannah College of Art & Design. (Note the facial droop.)

I was released from the hospital three days later. Remarkably, I appeared to have incurred no deficits of any kind. As an outpatient, I performed so well on my physical, occupational and cognitive evaluations, that additional outpatient therapy was deemed unnecessary. I was back at work the following week.

Sounds like I really dodged a bullet, doesn’t it? ARE YOU KIDDING? Stay tuned for part II (Spoiler alert! The picture of me in this posting will totally let the cat out of the bag!

Note: I was determined to identify my former neurologist by name because, notwithstanding the occasional “fibs,” “stretchers,” “re-imaginings,” or “reality enhancements” that pepper my postings, I intend this blog to be an unblinking, thoroughly credible (hopefully) series of vignettes detailing the life of a stroke survivor who loves to teach, fish and write (in that order).

Despite the best of intentions (not to mention a formidable depth and range of expertise), Dr. M  played a pivotal role in withholding critical treatment strategies that may have prevented the “big stroke,” with its nasty smorgesbord of deficits from which I will never recover.  I was persuaded to adopt a pseudonym only by a trustworthy, longtime friend whose understanding of the medical profession gar exceeds mine.

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