Knowing My 'Normal' Saved My Life
I was in the hospital Wednesday (2/15) mid day until today (Friday, 2/17) mid-day. I suffered a small stroke. I was instructed to take it easy for the next week (no driving, no lifting, etc.) and take my time building back up to my previous activity level. We literally didn't know what had happened until about 2 hours before I was released. The small stroke was identified on an MRI taken the night of 2/16 that was reviewed early the following morning in detail.
The MRI report says:
"There is small focal area of restricted diffusion in the right inferior lateral temporal lobe with subtle gyriform area of restricted diffusion seen in the right insular cortex. There is no corresponding T2/flair signal abnormality. No susceptibility artifact on GRE sequence. The findings are consistent with an acute infarct.
The ventricles are midline, without mass effect, hydrocephalus or shift of midline structures. There is no extra axial-fluid collection. The flow voids are maintained in the major intracranial vessels at the skull base. The sella and cranial vertebral junction appear unremarkable. Globes, orbits and mastoid air cells are clear. Mild ethmoid sinus mucosal thickening.
**IMPRESSION**
MR findings consistent with an acute infarct in the right temporal lobe. No findings to indicate hemorrhage."
While walking Fred on the morning of Wednesday the 15th, I experienced chest pain and a shoulder/neck pain I'd been experiencing for a week off and on became constant. So I bribed Fred to come home early from the walk by holding Zuke's treats in front of him to get him to move forward. Once home I knocked on Karl's office door and told him to get dressed and ready to go because I thought I was having a heart attack and was going to call 911. I sat in my office chair by the front door, called 911 and told the dispatcher I thought I was having a heart attack. EMS arrived soon after, started oxygen, asked me tons of questions, and determined I needed to go to the hospital.
On the way out the front door, my left side went completely numb and I lost the ability to speak properly. As I collapsed into the arms of the firefighter behind me, I remember the paramedic looking up at my face and saying "Looks like she's stroking." The firefighters picked me up and put me on the gurney, did a stroke assessment test and then lifted me into the ambulance. Karl followed by car. Fred stayed home.
Karl knows more about what happened in the ER. Inside my head I could form thoughts perfectly and I was frustrated that I couldn't make the words come out. Nurses, doctors, lots of concerned faces, I got a bit confused, they took me to CT. I was so cold and shivering so uncontrollably on the way to CT that the nurse thought I was having a seizure as we exited the elevator and the transport tech rushed my gurney to the CT lab. There was a frenzy of activity with 2 nurses hooking me up to monitors and 2 techs wrapping me in warm blankets. They got me still, transferred me to the CT machine. As Ike, the CT tech was arranging me on the machine - he was gently aligning my head, neck and spine - I was suddenly speaking and the nurse, Danuta, hollered "YAY! She is too young for this." I laughed, everyone laughed and they got on with the scan.
On the way back to the ER, Danuta kept asking me questions and encouraging me to talk by asking me questions and telling me I was getting better, sounding clearer. When we turned the corner to go back into the exam room, I heard her say to several people "She is talking. It's a miracle. She is talking better." It was a development that proved to be a game changer as the ER team had been preparing to administer TPA, the FDA approved stroke intervention drug that works best within 3 hours of the onset of symptoms. Since I was talking and 'coming back' they cancelled that plan, administered aspirin and admitted me for 24 to 48 hours of observation with evaluation.
I was admitted to the Cardiac Monitoring Unit where the nurse handling my care focused on the neck, shoulder and chest pain. Three rounds of nitroglyceride and that stuff finally went away. My blood work was all negative for a cardiac event and she was trying to play it safe. These are the symptoms of anxiety and extreme anxiety is a precursor to stroke. Since Karl had arranged for our friends Tom & Lori to take care of Fred, Karl stayed with me to watch Survivor.
Two days of blood work, stroke assessment screenings by every specialty, an MRI and a treadmill stress test all resulted in a diagnosis of minor stroke. The objective assessment tools used by the occupational therapist determined that my left side is at 80 to 85% of the right side with regards to strength, coordination, etc. There is a good chance that it will return to 100% if all goes well.
Once home I began by walking 300 yards and increasing the distance walked by a factor of 1.5 to 2 until I was back up to an hour long walk with Fred on the 26th. Normal speech processing is restored. The minor foot drop on the left is mostly resolved. No hearing or vision loss.
At my first follow-up appointment on 2/23, things went great from my perspective as I'm cleared to be alone (no more babysitters) and clear to ride the bus (freedom). No driving for 2 to 4 weeks depending on the next round of blood work - coagulation tests. Blood pressure was 111/60 this morning. No problems with the Zocor yet. My doctor is concerned about how it will affect my liver and plans to order more frequent liver panels to track that. The low dose aspirin is going on also at 2 x 81 mg per day. They doubled my prilosec to 2 x day to tolerate that and are hoping for the best on the GERD situation. The doctor told me today that my BMI is normal and that I need to ramp back up on the PT exercise routine. He said I am at my maximum weight range and should be careful to stay below that. I will continue with acupuncture to help the healing and continue to manage my pain. The doctor and I agreed today that I'm 'practically' 100% back to normal.
I'll have more follow-up doctor appointments, a 30 day heart monitor and blood work over the next couple of months. I passed the first milestone of 48 hours without recurrence. The next milestone is 90 days. I'll be on daily aspirin and cholesterol lowering medications for the rest of my life.
It is like a complicated math word problem; After a minor stroke like this there is a 60% chance of recurrence within 90 days. Use of a statin drug is said to reduce the risk of a stroke recurrence by 70%. Women who experienced extreme hot flashes during menopause are at a higher risk of stroke. Migraneurs are at increased risk of stroke. Ehlers-Danlos syndrome increases the risk of stroke, particularly in the vascular type. Stroke risk is minimized by a low fat diet full of fruits and vegetables. Low cholesterol readings usually indicate a decreased stroke risk. What is the likelihood that Maggie will suffer another stroke? Hoping the answer is close to zero.
