Culture

My 'Stroke' of Good Luck

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Readers may recall my description of aortic valve replacement last year and a warning of the importance of treating heart disease seriously. Here’s another lesson from medical misadventure: if you are going to have a stroke, it is best to have it on an operating room table. And best of all, avoid strokes if at all possible.  As miserable and expensive as last year’s surgery and recovery was, I think I would make that trade.

This started as the classic symptoms of a heart attack on the evening of August 2: chest pain, pressure, left-arm pain, a sense of confusion. So I had my wife drive me to an urgent care facility, where they decided that I was beyond the level that they could treat other than giving me aspirin and nitroglycerin, and calling the Ada County Paramedics to transport me to St. Alphonsus hospital. In retrospect, my wife could have driven me there directly in less time, and saved the insurance company $1300.

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When we reached the ER, I had my first good luck: the cardiologist on call was my cardiologist.  He immediately scheduled a cardiac angiogram, where they snake a tube from the groin up to the heart, to  see which arteries are blocked, by releasing dye and watching it on a fluoroscope. In my case, my LAD (left anterior descending artery) was blocked.  This is not surprising; previously my EKG had shown a right bundle blockage which means that the electrical signal that tells the different parts of the heart when to pump blood isn’t propagating normally, and the LAD feeds blood to the interventricular septum, which feeds the conductors.  I suspect the LAD has been partially blocked for some time. There’s a reason a blockage of the LAD is also known as the widowmaker: it is critical to far too many components of the heart.  Once my cardiologist identified where the blockage was, he used a small wire to clear it, then put a stent in place, a wire mesh that prevents future blockage of the artery.

It turns out that as dramatic as running tubes from groin to heart sounds, the procedure is normally done under either local anesthesia only or a hypnotic sedative that leaves you conscious but you have few or no memories of it.  I am quite sure that my knowledge that the LAD was blocked derived from overhearing my cardiologist talking to his assistants.  Another part of my good luck is that because I was conscious, my cardiologist immediately recognized from my slurred speech that clearing the artery had caused one of the dangers of doing Roto-Rooter in an artery: calcium deposits broken loose can go for a swim to the brain, where they clot an artery and become a stroke.

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What is a stroke and why do you want to avoid one? It is almost a month now, and I am still in the hospital recovering. And I was lucky.  A stroke is either a clot in an artery on the brain or a sudden rupture of a blood vessel in the brain. The symptoms include face drooping or an uneven smile, or numb arm, slurred speech or inability to clearly repeat a simple sentence.  If you or someone else has these symptoms, it’s time to call 911.  The faster that doctors start treatment with anticlotting agents, the less likely you are to die or be permanently brain damaged. Among the books that I have been reading while recovering is Mike Medberry’s On the Dark Side of the Moon, a memoir of his recovery from a stroke suffered while backpacking in Craters of the Moon National Monument. It was almost a day from his stroke to reaching a hospital.  Reading his description of his attempts to recover his language skills makes me appreciate how lucky I was.

Immediately after the stroke, my right side was paralyzed.  Two weeks later, my right leg moves, and so do my right toes. My right arm is still largely inoperable, with only gross muscle motion working.  I can move my wrist and with luck my fingers will start working in the next day or two.  Considering that I used to touch-type 100 words per minute, this is the greatest disability of all.  My slurred speech is slowly clearing, but I am not sure when I will next be up to public speaking. 

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What can you do to reduce your risk of spending weeks in the hospital re-learning to walk, talk, and wipe your own butt? Some risk factors are inborn defects you can’t identify but some you can identify and correct: high blood pressure, smoking, high cholesterol, diabetes, obesity, and insufficient exercise. If you are black, you are genetically at higher risk of multiple vascular diseases, so be especially concerned.

How important is stroke? In 2008, stroke was the fourth most common cause of mortality in the U.S.,  and a leading cause of severe disability. “Care for stroke survivors cost an estimated $18.8 billion in the United States during 2008, and lost productivity and premature mortality cost an additional $15.5 billion.”