Monday 6 December 2010

The Story of My Stroke

Every person’s life has a story to share. My life is no exception... neither is yours. Here is the how the "stroke chapter" of my story begins:

Funny how we never know what is around the next corner. The family calendar was full, my relationships were complicated, my commitments list was long and I had settled into a new job. It was Tuesday, September 7, 2010. I remember that it was the first day at school for my three sons. In my mind’s eye I can picture the new backpacks, lunch bags, and “indoor” shoes for at school. They were excited and keyed up to get back to school and friends and classrooms.

My day sped by at the usual, intense pace. At about in the afternoon I made it home at an unusually early time. I called the caregiver and told her I was home. I asked her to please send the kids back to me (she lives around the corner so they walked home). Yay!

At about they barrelled in the front door. I remember having a very intense headache – terribly intense. That said, the reality is I don’t remember any of the rest of this day except for a couple of the moments I am about to share.

The older two sons (grade three and grade five) went and flopped onto the couch in the family room. The youngest (grade one) settled immediately onto the floor to dig into his schoolbag and retrieve the notes for me. At some point around this time, my headache had turned into a stroke. The boys tell me I kept asking them how was their first day, then I would look to the right and ask the exact same question again. They said they stopped trying to answer me but I kept asking (like a record skipping). Then I fell to the floor, landing on top of my youngest son, and was unconscious. They tell me that I was “shaking” and was “blowing bubbles” and some blood from my mouth.

The youngest got out from under me and the older two came over to see what was happening to Mommy. Immediately, my eldest son found the phone and called their Daddy’s cell phone number. My husband was in a grocery store at that moment picking up some items I had earlier called and asked him for. Unfortunately, he missed that call.

The boys were not convinced that it was alright to call 911 and were afraid they would get in trouble. While the eldest and youngest started to discuss who they should call for help, the middle son tells me he decided someone should be with me and despite feeling scared he came over to me and held my hand on the floor. He says my hand was very hot and sweaty but he held it until the seizure stopped. [Note: since this event, we have talked to them about the fact that they are allowed to call 911 and that there are many local family members, friends, and neighbours that they can call if they need help but I firmly believe things happen the way they were meant to. I might have missed my hero surgeon if I had gotten in on someone else’s shift.]

After about a half hour (according to the boys), my seizure had stopped and I regained consciousness and I got up off the floor and walked to a seat in the family room. I have a vague recollection of feeling dizzy and that unbearable headache was still raging. The kids came over to me in the family room. They were crying and asked me if I was okay and what was wrong with me. My answer was that I was “fine” and that I “just had a headache.” Of course, they were not convinced that I was fine at all... and I wasn't!

About an hour later, Daddy arrived home and the boys descended upon him in tears saying how glad they were that he was home – something is really wrong with Mommy. They tried to describe to him what had happened. He came right over to see me. In response to his question I told him too that I was fine and that I just had a very bad headache. By this time, I was also somewhat confused and I was dizzy. In retrospect, I obviously had no idea what was happening in those moments deep inside my head. But see?!?! My body was trying to warn me about what was coming... like I said, I had 4/5 symptoms! sigh... back to the story.

My husband asked if I would have supper with them once it was cooked. I said yes but felt absolutely disinterested in eating anything at all. Then he asked me if I had taken a painkiller. I recall feeling confused and not knowing what painkillers we might have, where the painkillers were or if I had taken one. This was not like me. I excused myself to go downstairs and lie down. Moving around, I felt totally uncoordinated and felt almost like I was drunk and lost.

Some time later, he arrived downstairs to see if I would come up for dinner. I said yes and made it up the basement stairs but had no interest to even sit at the kitchen table, certainly not eat. I weaved into the adjoined family room and sat back in the chair. The kitchen was silent as everyone was aware that something was terribly wrong with Mommy.

The kids picked at their dinners and glanced at me periodically. I recall that my husband got up and came into the family room. He asked if I was going to eat – I said “no.” He said that I should at least drink water to avoid dehydration. I felt annoyed by his comments because it was hard to follow his conversation and I felt like I was just exhausted and wanted to sleep. My head was still raging with a headache that I just can’t describe. I thought I just needed to rest until the headache passed. I didn’t want to talk and I found his questions confusing. He suggested that I get into the bathtub to relax (one of my favourites). I accepted.

He assisted me to walk upstairs (by now I could not walk by myself) and I lay down on the master bed as he filled the bathtub for me. By the time it was full, he came to get me but I was not responsive on the bed and I had another seizure lying face down. He dialled 911.

Within minutes my seizure had stopped. The firefighters responded and were up in the bedroom with my husband and me. Soon after, the paramedics were on site and there was quite a crowd in the bedroom. The boys were settled quietly in the family room to watch TV as the commotion unfolded around them in the house. Such wonderful and brave little men!

The emergency responders had a ton of questions but by this time I was delirious and was not able to understand or respond. Fortunately, my husband was able to answer many of the questions and assist in their information gathering. It wasn’t long before they carried me out of the house and into an ambulance.

I am told it was a rainy evening – that there were neighbours gathered around on the street watching the commotion at our house. In retrospect, I know that this was one of my last moments outside in almost a month.

I am told that I was taken to the Monfort Hospital in the ambulance. My husband took the boys to his parents’ house and then drove himself to the hospital. I was evaluated there and also had a CT done.

At that time, they were knew that I was suffering a hemorrhagic stroke. I was very delirious, confused and unsure of where I was and why I couldn’t go home. My language skills were fading more and more by the minute. By now, I could speak but I could not easily understand others. My husband tells me that everyone would speak to me very loudly and attempt to ask me questions – needless to say that was no good. I wasn’t deaf… I was having a stroke… my husband was the best hope for answers to questions.

Very soon the emergency room staff decided that I needed to move to another Ottawa hospital – one with a significant medical team focused on the neurology specialty. They put me on a gurney and fastened me as a precaution for safety during the trip. Before we left the hospital, I had a third seizure. My husband describes it as the most violent of my seizures and that he was reassured by the medical team that although there was nothing they could do, I was restrained and would therefore not likely hurt myself. He describes how difficult it was to watch me in a serious seizure frothing at the mouth and biting my tongue. When the seizure finished they began the process to move me. He was cautioned about driving safely to the Civic Hospital so that he didn’t have an accident en route.

He tells me about the busy night in the Civic Hospital Emergency Room and that it took a long time before the ambulance could get me admitted to the ER. He was seated patiently in the waiting room and eventually was advised on how to find me in an inspection area.

I was happy to see him and I vaguely recall that – that is my last little bit of memory from this experience (I don’t remember very much about the experience). Likely, recognizing him was almost my only reassurance as I still did not understand what was happening or where I was. At this hospital I had further tests (MRI and another CT) and IVs in my arm – some more successful than others. I was not fully dressed and my husband tells me that I would kick my legs in the air and leave myself exposed (I was wearing only a hospital robe that I had on from the Montfort). Eventually he found a sheet to hold over me. At some point someone advised him that kicking my legs around was a common action among stroke patients. I rolled over toward him and was trying to sleep, my arm folded protectively over my chest. This caused problems with the IV and it bled onto my robe. The next nurse who appeared asked my husband where all the blood was from. He explained that I had bent my arm and the IV must be bleeding. What chaos. I can hardly believe any of this although I know it is true. I have absolutely no memory of this at all.

The on-call neurology surgeon came to talk to my husband (and me?) in the early hours of the morning on September 8, 2010. He explained what they had learned from the tests performed on me and that it was important that they quickly performed surgery to remove some of the blood that had amassed in and around my brain. My situation could easily be fatal so really there were not many choices. Dr, Sinclair and a couple interns sought my husband’s consent for the surgery and explained the risks of the operation. My husband – who is fortunately calm in emergency situations – listened to the explanation and signed the required permission forms.

At , my surgery began. If you are not strong-stomached, you may want to skip the next few paragraphs… (look for the line of asterisks to know when the surgery details have finished).

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My husband walked along with my procession toward the surgery area but he was stopped at the doors into surgery. He was told that he could come no further but that someone would come to advise him when there was news from my procedure. There are many moments as a stroke patient that you walk your path alone. This, too, was another part of my journey that mine … and mine alone.

To prepare me for surgery, my head was fastened into a device using a tool called a “halo.” It is a large, metal, circular device that prevents any movement of your head at all as the operation happens. Brain surgery is, of course, all about precision. The most minor movement could have terrible results so the halo ensured that I could not move during surgery. At this point, an incision plan was prepared on the left side of my head (above and around my left ear) and a path for the incision was shaved into my long hair (mercifully, they picked a path that spared most of my long blonde hair). The area was sterilized and the incision was made. There are several layers between the scalp and your brain. The first layers were incised with a scalpel and my skull was revealed as they moved aside my skin and layers underneath.

The next step requires a drill to make a series of holes in my skull which were connected (like dot-to-dot) with a saw. The piece of my skull removed, it was kept in a container with sterile water to ensure that the piece of bone stayed healthy.

The actual work on my brain was to remove the quantity of blood that had hemorrhaged on the left side of my brain (yes, this means at least one doctor touched my brain). He described the haemorrhaged blood as somewhat gelatinous; I guess my blood was attempting to clot. He then cut away a portion of my brain on my left hemisphere – he had to remove the part that had been deprived of oxygen during the stroke and was no longer viable. He also described having to use a drill to make a hole in my brain to allow some of the blood inside my brain to drain and thereby reduce the internal pressure of the blood. He also knew that some of the blood had pooled at the back of my brain but that would be reabsorbed by the body after surgery.



A CT scan of the left side of my head.
My titanium plates and screws holding my skull together
(I think it's beautiful and looks like snowflakes)
P.S. the dark spot beneath is my left ear ;)
 
After this work was done, they replaced the piece of my skull. They reconnected that piece with titanium screws and several titanium pieces that are used to span the gap between my intact skull and the removed piece. Finally, they closed the layers of my head and scalp. There was a series of sutures underneath that were done with dissolving stitch thread and the top layer (my scalp) was fastened shut with staples.

The surgery preparation started at , the first incision was at about and the surgery was completed at some time close to .

After surgery I imagine I would have been cleaned up to some degree, the “halo” removed, and I was wheeled into the Intensive Care Unit (ICU).

I was intubated both for breathing (via my mouth) and also for feeding (via my nose). I was also sedated to keep me unconscious after my operation. The medical team expected my head to swell (after all, it’s our body’s only trick to try and protect itself from trauma).

*******************

The surgeon explained to my husband how the surgery went and what the results may be. He was clear that it was too early to speculate on my recovery but he cautioned my husband that I may never again be verbal as the area affected on my brain was the area of the left hemisphere that had language ability. He also commented that there may be physical disability that may be serious but that the results would become clear over time.

I am told that in the early days after surgery, still sedated, my head became so swelled on the left side, I looked deformed and my left eye was swollen shut. In addition, my right arm swelled up and they worried that maybe there was a second clot in my arm (first one was in my head and had caused the stroke in my brain). Very soon, a technician arrived and did a whole body ultrasound which revealed no clot in the right arm but discovered a second clot in my right leg.

It’s hard to believe that all of this happened to me. I am very lucky about how I recovered and although I am certainly better than most of the medical team expect, I am disabled.

So this was the story of my stroke and how it ended (and BEGAN a series of recovery and coping chapters). In the coming days, I will talk about how I am disabled, how my sons have made out, how my husband fared.

Oh, and by they way, I have decided to take the weekends off from blogging (it’s very hard to write but I am loving the process – it’s only that on the weekend my boys are home so blogging then is only going to drain energy that I would prefer to give to them).

Happy birthday to my youngest this weekend – he turned 6 on December 4th!

Friday 3 December 2010

5 Warning Signs of a Stroke

[this was supposed to be posted yesterday... sorry...]

The material offered below is best written by the pros (the Canadian Heart and Stroke Foundation). Take a minute to read this - it may make a big difference for you or someone you love.

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The five signs
Stroke can be treated. That's why it is so important to recognize and respond to the warning signs.

Weakness - Sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary.


Trouble speaking - Sudden difficulty speaking or understanding or sudden confusion, even if temporary.


Vision problems - Sudden trouble with vision, even if temporary.


Headache - Sudden severe and unusual headache.



Dizziness - Sudden loss of balance, especially with any of the above signs.



Stroke is a medical emergency. Recognizing and responding immediately to the warning signs of stroke by calling 9-1-1 or your local emergency number can significantly improve survival and recovery. If a person is diagnosed with a stroke caused by a blood clot, doctors can administer a clot-busting drug available only at a hospital, and only within a few crucial hours after symptoms begin.* That’s why it is very important to be able to recognize the 5 warning signs of stroke and immediately call 9-1-1 or your local emergency number.

*Health Canada has approved the clot-busting drug called tPA to be used within 3 hours from the time symptoms begin. However, emerging science is now showing that tPA could be effective up to 4 ½ hours afterward. As a result, the Canadian Stroke Strategy has issued new Canadian Best Practices Recommendations for Stroke Care, which have included this new treatment time. Still, it will be up to the attending emergency doctors to determine when tPA may be administered or if it is appropriate to the situation.
For more information on stroke warning signs, please read our brochure Emergency signs, signals, actions - for life and Emergency wallet card for heart attacks and strokes.


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For the record, I did it ALL WRONG and I had 4/5 symptoms... if I had responded to my body's signals (which it was SHOUTING by the way), I might have avoided having a hemorrhage and having them saw their way into my head to save my life.

See you tomorrow!

A card to me from my middle son
Jen

My Stroke

So I told you that I would take a moment to tell you about how I fared in the stroke world. What follows is a short bit from information that they shared with me and then a long summary that had been documented on a form by one of my rehabilitation doctors.

The survival rates cited in my Dec 1 post are not bad but what I have been told is that the survival rates are attributed mostly to the Ischemic strokes (the ones that involve "only" a clot). Sometimes, if treated fast enough, a drug can be given to dissolve the clot - that is a very good thing.

Interestingly, I was not in the 80% who have that kind of stroke... I was in the 20% who have a hemorrhage stroke. The survival rates for that type of stroke are very low. This is part of the reason that I feel SO fortunate. I have been given a second chance at life. ...Sighing and staring at the screen as I take a moment to absorb that again...

I will, in the near future, tell you about the actual beginning of my stroke and paint you a picture to understand what that was like (home alone with my three little boys at that time). For now, I will share with you a copy of the medical description of my illness [my comments are offered in square parentheses throughout the medical summary below]. The doctors' part of the story begins after my husband found me non-responsive, unconscious and then having a seizure. He called 9-1-1 on the early evening of September 7, 2010. Firefighters and Paramedics arrived and the medical system kicked in to save my life..

If you can't cope with the medical text that is coming next, scroll to the bottom where you see the text in bold ;) .

Here we go:

"HISTORY OF PRESENT ILLNESS

"The patient was taken to the Montfort Hospital where she had a CT scan that diagnosed her left temporal intracranial hemorrhage. She was also noted to have a seizure [this was a "grand mal seizure" and was the third I experienced - the one and only "extreme" seizure I had in the presence of the medical professionals] and was treated with Dilantin and Ativan. She was then transferred to the Ottawa Civic Hospital under the care of Neurosurgery. The patient does not recall any descriptions of her seizure. On [the early morning of] September 8, 2010, she had a CT angiogram which showed a left temporal intracranial hemorrhage of 36 x 55 mm associated with vasogenic adema, partial left supraseller cistern and left lateral vetricle effacement, as well as a 2 mm left to right subfalcine shift. Her left posterior cerebral artery was noted to be hypoplastic. The vetebral arteries, right posterior cerebral artery (PCA) and anterior cerebral artery (ACA) were patent. There was also an incident of aneurysm noted involving the opthalmic segment of the right internal carotid artery measuring 1.7 x 1.7 x 3 mm. The left transverse and sigmoid sinuses were hypoplastic. A limited examination of the left internal carotid artery cerebral angiogram was performed and showed no arteriovenous malformation, no arteriovenous (AV) fistula, aneurysm, or vessel irregularities. The patient was then taken for a left craniotomy and hematoma evacuation [I was unconscious by that time and my husband gave consent in early morning and I had surgery starting at 11:36 AM]. Intra-operatively, there was some suspicion of a venous sinus thrombosis. Subsequent MRI and magnectic resonance venography (MRV) on September 9, 2010, documented absent filling of the left transverse and sigmoid sinuses.

My CT scan on October 25, 2010
"Postoperatively, the patient was sent to the Intensive Care Unit, was sedated and ventilated. She was also started on intravenous (IV) heparin for treatment of her venous sinus thrombosis. September 10, 2010, Doppler ultrasounds of the legs showed superficial and deep venous thrombosis of the left leg, which was not occlusive. Thrombosis was involved and advised on anticoagulation which was eventually switched to oral Coumadin for long term management. It was noted in her discharge summary from the Neurosurgical service that the hypercoagulable workup by thrombosis was negative. Howerver, a follow-up has been arranged with them [that was an appointment with my hero, Dr. Sinclair, on October 25 - I will go back to them again sometime between March and June 2011. He teaches at UOttawa and here is his bio and a photo about halfway down this linked page].

"During her hospital stay, Jennifer also experienced visual hallucinations involving seeing insects and dots or spots in her visual fields as well as abnormal colours or shadows, which were considered to be seizures occuring while on Dilantin. For this reason, the patient was switched to Keppra and has a followup arranged with Dr. Sharma in three months' time with MRI of the brain [appointment is December 20 and here is an interesting interview and picture of my doctor from Oct 29, 2010].


The Left Side of a Brain
 "The patient's overall diagnosis was left temporal intracranial hemorrhage secondary to venous sinus thrombosis, for which the patient was considered at higher risk given her age [36] and use of oral contraceptives [yep, the birth control pill; the estrogen one... be cautious ladies].

"The patient denies having had recent dental work prior to her stroke. She also denies any recent illness. However, she did mention that four months preceding her stroke she developed an incessant headache for which she took Motrin as needed and was scheduled to see her Family Physician on September 9, 2010."

CHEAT NOTES: I had a hemorrhage stroke in my brain. I had brain surgery (yes, they opened my head and did incredible things to my brain). They found a clot in my left leg. And I had visual hallucinations which were due to the damage to my brain - the hallucinations have subsided since late September. 

I know that was a pretty long and meaty piece of information but I offer it so that you now know (medically about my case) about as much as I know. Well... except what it is like to actually live through this. But over the course of time, perhaps you will see that part too...

See you Dec 3 when I share some information about when you need to get yourself to a doctor as quickly as possible.

A card to me from my eldest son

Wednesday 1 December 2010

Facts about strokes in Canada

If you had asked me about strokes a couple months ago I would have likely been fairly obvious in terms of how little I know about strokes and our precious brain. I would have told you that strokes are a blood clot that paralyzes senior citizens. If I handed in that quiz I would have failed.

Let me share a bit of information...

...by the way, tomorrow I will share where I fit in to this statistical picture (hint: I did not die)...

Types
  • About 80% of strokes are called "ischemic" which is caused by the interruption of blood flow to the brain due to a blood clot.
  • About 20% of strokes are called "hemorrhagic" which are situations of uncontrolled bleeding in the brain

Deaths
  • Stroke is the third leading cause of death in Canada. Six percent of all deaths in Canada are due to stroke.
  • Each year, nearly 14,000 Canadians die from stroke.
  • Each year, more women than men die from stroke.

Prevalence
  • There are over 50,000 strokes in Canada each year. That’s one stroke every 10 minutes.
  • For every 100,000 Canadian children under the age of 19, there are 6.7 strokes.
  • About 300,000 Canadians are living with the effects of stroke.2
  • After age 55, the risk of stroke doubles every 10 years.
  • A stroke survivor has a 20% chance of having another stroke within 2 years.

Effects

Of every 100 people who have a stroke:
  • 15 die (15%)
  • 10 recover completely (10%)
  • 25 recover with a minor impairment or disability (25%)
  • 40 are left with a moderate to severe impairment (40%)
  • 10 are so severely disabled they require long-term care (10%)

For every minute delay in treating a stroke, the average patient loses 1.9 million brain cells, 13.8 billion synapses, and 12 km of axonal fibres.

Each hour in which treatment does not occur, the brain loses as many neurons as it does in almost 3.6 years of normal aging.

Costs
  • Stroke costs the Canadian economy $3.6 billion a year in physician services, hospital costs, lost wages, and decreased productivity (2000 statistic).
  • Canadians spend a total of 3 million days in hospital because of stroke.

So this is a serious situation and the reality is that in the stroke survivor community I have met a lot of people who were closer to my age than you might want to hear (I'm not too shy to tell you I'm 36)... so please take your fingers out of your ears and stop pretending I'm not talking to you. I am looking you right in the eye and telling you the truth. When you started reading this blog it meant that you may encounter some painful truths, but they might help you to avoid encountering an even more painful life-changing experience.

Besides, the worst possible thing you can do is to remain unaware of the situation.

See you tomorrow when I share some of the technical jargon that applies to what happened to my brain...