My
Stroke Story
The year 2014 was a difficult year
for me. I experienced two strokes. Doctors said they were 'mild' but
that term is strictly relative when you're on the receiving end of one.
Tucked in between the two strokes I endured a total thyroidectomy for
thyroid cancer. In this story, I have attempted to capture many of the
details of my ordeal in the hope that it will enlighten and encourage others
who at risk of a stroke or in the process of recovering from
one.
Background
I turned 67 years of age on November
1, 2014. For several years prior, I had experienced elevated blood
pressure levels. Whenever I went to the doctor, and my BP was a little
high, I vowed to use diet and exercise to rein it in and achieve safer
levels. For a period of time I would achieve my BP goals, but get lazy
and fall back into old habits. Pounds went back on, exercise was
neglected and BP levels went up again. During a trip to Charleston, SC
in the Fall of October 2012, I was in a grocery store with my sister
and another friend. The store pharmacy had a BP machine in the area, so
I decided to check it. My best recollection is it was about 220/98. I
was somewhat shocked, and later jokingly told my sister that I was a
stroke waiting to happen. I had no idea how prophetic that statement was.
In February of 2013, I bought a
NutriBullet machine for health and nutritional reasons. My weight at
the time was 226. I began making healthy 'nutriblasts' once or twice a
day, bought some resistance bands for strength exercise and started
walking with some regularity. By the Summer of 2013, I had dropped to
195 pounds, achieved excellent BP levels and enhanced my strength and
stamina. But as the Fall came along, I got lazy, slacked up on my
routines and put some weight back on. I kept canceling my scheduled
Doctor's appointments to avoid accountability for my dereliction. In
addition, I suffered from Type 2 diabetes and my blood sugars were a
little out of control. I was playing a dangerous game but didn't take
things as seriously as I should have.
First Stroke
On Thursday, February 27, 2014 my
wife and I were at home. Our daughter and two grandchildren had stopped
by for a visit. It was mid-morning when I got an unexpected case of
hiccups combined with a bit of slurred speech. The stroke was taking
place, but I didn't know what it was at the time or get alarmed. The
next day, Friday, February 28, I noticed a little difficulty in
walking. My wife and I went to our favorite Chinese buffet for lunch. I
found it difficult to get in and out of our booth as well as walk to
and from the buffet. I told my wife Barbara that I felt weak. She also
noticed I was having a problem. So after we got home, I was having
trouble with balance. So she insisted we head to the
Emergency Room at Williamson Medical Center in Franklin, TN to get
checked out.
The person in Admitting took my
medical information, checked my grip, etc. They eventually
escorted me back to an ER room, and all the tests began. My
BP was through the roof with a systolic above 200. They ran an EKG and
heart monogram to check out my cardiac function. All
turned
out well there. They brought in a laptop computer that had a doctor on
video conference. He had me do several drills with my arms and legs to
check for functionality and stroke symptoms. Based on certain deficits,
he concluded I had experienced a mild stroke. They took me in for a
brain CatScan and MRI. The stroke was confirmed. It was what the
doctors called 'mild' and had affected my left side – arm and leg – and
mildly affected my speech.
After lying in the ER for a few
hours, they transported me to the 6th floor CCU for observation. There
I was, at age 66, in a hospital for the first time in my adult life. At
that point, my symptoms were not that severe. I felt that after a few
days, I would be released and sent home with maybe some outpatient
therapy to help me recover. I was still able to use my left hand to
open various items on my food tray. I knew I had a problem, but was
confident that I could make good progress in short order. I know now
that the medical staff, where stroke victims are concerned, triy to
keep BP systolic between 150 and 170 to keep blood flowing through the
affected areas of the brain. They achieved
that goal until supper on Saturday.
I was out of bed, sitting up in a
chair and eating my meal. All of a sudden my left side (arm and leg)
went totally numb and my right side (arm and leg) began to tingle.
Paralysis was setting in. Fortunately, the red call button was adjacent to my right hand. I pushed
the buttton and alerted the nurses' desk. I told her I thought I was
having another stroke. Within seconds there were 5 or 6 people in the
room to assist me. I was rapidly losing coherence and could not move.
It took 4 people to get me back in my bed. My BP, as I found out later,
had dropped to normal levels, inhibiting blood flow to the affected
part of the brain. I honestly felt I was going to die. Within minutes,
however, the staff administered medications to re-elevate my BP.
Feeling began to come back to my left side, but not to the extent it
was prior to that episode. It's my opinion that the drop in BP worsened
my stroke, extended my hospital stay and time I spent in
rehab. At
the time my body began to shut down and paralysis was setting in, I
sensed the Lord's presence and began to silently sing this chorus:
"Give thanks with a grateful heart, Give thanks to the Holy One, Give
thanks because he's given Jesus Christ his Son." It was like God was
saying: "I've got you, son!" To this day, I cannot hear that praise
chorus without weeping.
I remained in CCU until Wednesday,
March 5. During that time, I had visits from both physical and
occupational therapists. They encouraged me, and gave me certain
exercises to do. On Tuesday, March 4, a physical therapist had me out
of bed and walking around my room with a cane. It's hard to put into
words the joy one feels when abilities begin to return, even if slow.
The staff physician told me later on Tuesday that I'd be moving to a
hospital room the next day. Early Wednesday, the nurse came in with a
wheelchair ready to transport me. That was progress. As my nurse
(Buddy) was leaving the room, he paused, turned
around and said, “Don't give up!” I assured him that I wouldn't, told him I appreciated his encouraging words.
Wednesday was a routine day in my new
hospital surroundings. There were the typical hospital staff visits for
BP checks and vitals, blood sugar readings, medications, weight checks,
blood specimens for labs, etc. The food was decent. In fact, I was
pleasantly surprised with the menus. Thursday, March 6, was my first
full day waking up in my hospital room. It was also my wife and my 43rd
anniversary. Another routine day with good meals. I remember commenting
to one of the nurses that on Thursday I had three of the best meals I
had eaten back-to-back in a long time.
The last meal on Thursday was meat
loaf. As the night went on, I began to feel ill, sick to my stomach and
nauseated. I developed a bad case of diarrhea. In the middle of the
night I was on the portable potty. The next day, Friday, March 7, I
experienced projectile vomit while laying in bed. The doctor told me I
had caught a stomach bug, that my transfer to a rehab facility would be
delayed until the danger of infecting others was past. They kept me
through the weekend. On Monday, March 10, an ambulance took me to NHC
Place, Cool Springs, TN to begin rehab. I remember being so
excited I was able to dress myself and tie my own shoes before the
ambulance got there. When they arrived at 2 P.M., I was ready to go.
On Tuesday, March 11, two therapists
came to my room to evaluate me. They check for everything by way of
physical deficits. Their assessment took about an hour. They said they
were confident that a full recovery was probable. On Wednesday, March
12, I began my therapy, both physical and occupational. From 8-9 A.M.
each day, I had physical therapy with a young lady named Amanda. From
9-10 A.M. and 1-2 P.M., I had occupational therapy with Meandria.
Progress was steady.
After two weeks (April 24), I was
able to walk (with my walker) down to the gym by myself to meet Amanda
for physical therapy. Prior to that, she had come to my room to escort
me down with a safety belt. It was that same week I took my first
steps using a cane, then without a walker or cane. I cannot put into
words the joy of walking again. The right side was still strong and the
left side was progressing rapidly.
On Tuesday, March 25, my therapists,
my wife, the insurance coordinator and I met in a conference
room to discuss my progress and potential go-home date. I wanted to
go home that Saturday, but the consensus was an extra week would
work to my benefit. As much as I wanted to go home, I agreed that an
extra week of therapy would be a good thing. So Saturday, April 5,
became the magic day. I continued to work hard and make progress. As
that Saturday morning dawned, I looked forward to my last meal
(breakfast) at NHC Cool Springs and final check out.
On the way home, we stopped at CVS
Pharmacy to pick up my medications, then at Publix to pick up some
basic provisions. I walked through the store with my walker, went
through checkout and out to the car. It felt good to be heading home.
The Monday after I got home, I folded up my walker and put it away. I
had progressed beyond being a fall risk. I was also able to function in
the kitchen, bath and dress myself. Home therapy was unnecessary. On
Monday, April 7, my wife took me out for a test drive in my pickup
truck. I passed with flying colors, and began driving by myself from
that time forward. The stroke was a setback, to be sure. But it was now
in the rear-view mirror. I had the option of outpatient therapy to
continue healing, but refused it because I was doing so well. In
hindsight, that was a mistake. It would have done me a world of good to
stay with the program and do outpatient therapy a few more
months.
Thyroidectomy
The week after my release from Rehab,
I saw my Primary Care Physician. During that visit, my Doctor shared
with me some notes the Emergency Room medical staff had placed in my
record. It had to do with a “Non-Emergic” anomaly in my
thyroid gland.
I took “Non-Emergic” to mean no big deal. But my wife Barbara insisted
we follow through with an endocrinologist to determine the true nature
of the anomaly. After an ultrasound that revealed several nodules on my
thyroid and subsequent biopsies on the three largest ones, the
report came back as “suspicious for carcinoma” for one of them. It was
determined that my thyroid must come out.
We scheduled an appointment with a
thyroid surgeon, Dr. Sinard at Vanderbilt Hospital, who explained the procedure and what I could expect.
Surgery was scheduled for Monday, August 11 for a total thyroidectomy.
After four hours, I woke up in the recovery room.
After an hour or two of observation, I was taken to a regular hospital
room to spend the night. The next morning I took my first dose of
Levothyroxine, had my swallowing checked and took a short walk to
verify my readiness to go home. In addition to the thyroid replacement
drug, the surgeon placed me on a calcium protocol, which
tapered off and ended after three weeks. This is important to the story
in that one of the symptoms of a calcium deficit is tingling in the
extremities. I received paperwork explaining this possibility and what
to do about if it occurred.
The surgeon and his assistant came by
my room about 7 AM to check that all was well. At that time, he
informed me that the surgery had traumatized my left vocal chord nerve,
that it would be paralyzed temporarily with the result I would
experience some hoarseness. He discharged me at about 9 AM. I went
home and continued to recoup, taking my calcium dosages regularly as
prescribed. All seemed to be going well until Thursday, August
21.
Second Stroke
Thursday, August 21, was a routine
day. I had written out a few bills and headed to the Post Office late
morning to mail them. As I was getting out of my truck, I noticed a
tingling and weakness in my right hand and arm. My first thought was
“calcium deficit.” As I
was walking in, I found it difficult to walk, struggling to get to the
main entrance. I got back to our PO Box, and whispered to
myself,
“I've got a real problem.” I managed to get back to my truck and headed
home. Upon arriving, I took an extra dose of calcium as a remedy for
the weakness and tingling, thinking that would do the trick. It seemed
to work.
Other than a little weakness, which I
attributed to calcium issues, I continued to function through the
weekend and drove my truck to church. On Monday, August 25 (four days
after the first symptoms at the Post Office), I went out to run some
errands. My last stop was at Kroger before coming home. As I got back
to my truck, offloading some 12-pack soda cartons into my truck bed, I
noticed weakness in my right arm. At the same time, I felt a need to
urinate. Tried as I might, I could not control my bladder, and
wet myself right there in the parking lot. It was yet another telltale
symptom that things were not right. As I got in my truck, my right leg
showed noticeable weakness. It reminded me of my first stroke when my
left leg was hammered.
I drove back to the house, exited my
truck and headed for the front door. I was staggering like a drunk man.
I remember praying, “Lord, just let me get into the house!” I was
having difficulty with the one step up I had to take. But I got in and
chilled the rest of the day. In fact, I pretty much stayed in the house
for the rest of the week, managing to get around and perform most
tasks. The one thing I noticed was my ring finger on my right
hand while typing. I could not control it. It was drooping and dragging
the mouse pad on my laptop, moving the cursor around. It was an
aggravation and yet another evidence that I had a serious problem.
On Thursday, August 28, I had a
doctor's appointment with my Endocrinologist for a thyroid followup. It
was about a 40-mile drive from our home in Spring Hill to Nashville's
West End. I stopped at my wife's place of employment (Cool Springs) to
pick her up and proceeded to drive up I-65. I was not able to get a
parking place close to the main building, so we had to walk fifty or so
yards through the parking garage. Again, I noticed weakness in my
right side
and struggled traversing the parking garage. As my
Endocrinologist
and I were talking, I told her that perhaps I had experienced a TIA or
something. She actually made a note of that in her records (my
electronic chart).
We concluded the visit and headed
home, stopping at Cool Springs to drop off my wife at work. I came
south on I-65, exited onto Saturn Parkway and then onto Port Royal.
As I rolled up the exit ramp, I put my right hand on the steering
wheel. I felt at that time a significant right arm deficit and
weakness. It had been a full week since my initial symptoms.
Finally there was an indication to me that perhaps I had had a second
stroke. I got home and chilled the rest of the day. Inside my house, I
was still able to walk (not a fall risk).
I went to bed that night as usual.
About 4 AM Friday morning, August 29, I woke to use the bathroom. As
I got in front of the toilet, I reached out my right hand to grab the
handicapped bar that was installed from my first stroke. The ring
finger on my right hand was curled under (I was not able to extend it).
Instead of gripping the bar to stabilize myself, my right ring finger
deflected my hand. I lost my balance, and in less than a second tumbled into the bathtub, slamming my head against the
enclosure. I couldn't believe the noise didn't wake up my wife. So
there I was, sitting in the bathtub, in the midst of another stroke event.
It took me a half-hour to extricate
myself from the bathtub. I managed to crawl back into bed about 4:30
AM. I laid there for a few minutes, and concluded my best course of
action would be to get out of bed, get my walker out and speak to my
wife when she got up about 5:30 AM to prepare for work. She
was a
little surprised to see me sitting on the couch. I told her what had
happened. But because I didn't look to be in too bad shape, she went on
to work and told me to be careful. She got halfway to work and turned
around. Upon returning to the house, we headed once again
to Williamson
Medical Center ER in Franklin, TN to get checked out. After a full
battery of tests (MRI, CatScan, Ultra Sound et al), the medical staff
determined that I had experienced a stroke, this time in the brain
stem. At the time, I didn't realize how serious that was. But I would
soon learn that my situation was critical and potentially
fatal.
While I was in the ER, my Neurologist, Dr. Mendez,
showed up. He had me get up, walk around and assessed my condition. He
also took me off aspirin and started me on Plavix (blood thinner). I
was thinking that if I could maintain what I had (i.e., got no worse
than I was in the ER), I could go home and rehab there. After all, I
had the tools I needed from my first stroke (therabands, dumbbells
and ankle weights), a battery of exercises and a walker. I was
somewhat
disappointed when the attending physician came in to tell us that I
needed to stay in the hospital overnight for observation. It was Friday
morning of Labor Day weekend. A while later, a nurse came in to take me
to the CCU. One of the doctors in the CCU joked that since they had to
work the entire weekend, I might as well stay the whole weekend as
well. I didn't think it was funny. I was ready to go home.
On Saturday morning, August 30, the
head nurse came in to monitor my status. The doctor on duty was there
as well. The doctor was talking about a better blood pressure medicine,
and mentioned how her mother benefited from one particular drug.
Remember how I mentioned that the medical staff for my first stroke
tried to keep the blood pressure elevated (150-170 systolic) to keep
blood flowing through the affected areas of the brain? Well, this
doctor was taking the opposite approach. Looking back, I think this
doctor was wrong. Like the average patient, I thought the doctor knew
best. I took the medication.
One of the questions that bugged me
was how my second stroke could have happened. I mean, I took all my
medications, ate pretty well and monitored my blood pressure three or
more times a day. The answer to that question came when the head nurse
mentioned that BP medications should ALWAYS be taken in the early
morning
so they can work throughout the day. That's when the light came on in
my brain. I was taking my medications, but haphazardly.
Sometimes I would take them in the AM, sometimes at Noon and
sometimes early afternoon. The day I had the first symptoms of my
second stroke, I had not yet taken my medications for that day.
Among the reasons for the nurse being
there was to validate my ability to walk. So I got out of bed by
myself, took my walker and made a loop around the CCU without incident.
I did well enough that the nurse gave me the OK to go home. The doctor
did as well. Within a few hours, they processed the paperwork for my
release. They took me down in a wheelchair, my wife drove the car
around, and off to the house we went. I felt pretty good, as well as
one can feel after a stroke. I had my walker and all my tools. For me,
a second round of rehab had officially begun. I remember posting on
Facebook that I had had another minor stroke, and solicited the prayers
of friends. I remember doing a few dumbbell exercises and taking my new
medications as prescribed.
As I went to bed Saturday night, my
wife placed a sauce pan and lid next to the bed for clanging purposes,
to alarm her if I encountered any problems. Sure enough, about 4 A.M. I
had to use the restroom. But when I tried to get up as I normally did,
my right arm was so weak it could not support me. My legs were over the
edge of the bed, but I could not raise myself up. I was stuck. So after
ten minutes or so of struggling, I rotated my body and took a
controlled descent to the floor. I then clanged the sauce pan. My wife
came to my bedroom in response. My legs and right side were so weak I
was unable to sit up or get into a chair, much less stand. My wife was
unable to lift me. So there I was on the floor, a helpless
basket
case. When my wife checked my blood pressure, it was nearly normal. The
new medication the doctor had given me had worsened my
condition.
My wife called 911 for assistance.
Two EMT's showed up before too long. They managed to get me up into a
chair, and eventually got me into our car. We headed back to the
Williamson Medical Center ER. It would be a month and a half before I
saw home again. After a few more hours in the ER and another CatScan, I
was admitted, placed in a hospital room. It was Sunday, August 31. I
stayed in the hospital through Wednesday, September 3. During those
three days, my symptoms got progressively worse. The brain stem stroke
affected my swallowing and my diaphragm (breathing) in addition to
pronounced right-side deficits.
A severe complication came with my
previously paralyzed left vocal chord. Since my swallowing had been
affected, it opened up the new possibility for aspiration of food since
my lungs now had little to no defense against it. So as I took meals in
the hospital or drank liquids, it would result in severe coughing
episodes as my lungs tried to reject the leakage. I was now at risk for
pneumonia due to aspiration. Every coughing spell left me absolutely
exhausted.
After my first stroke, my symptoms
were as bad as they were going to get after two days. But it took
nearly two weeks with my second stroke for deficits to reach a
pinnacle. I attribute this disparity to (1) my failure to see the first
symptoms as stroke-related, thereby keeping me from going to the ER,
and (2) a well-intentioned doctor who gave me a medication I
should have never taken.
On Wednesday, September 3, my wife
transported me to NHC Cool Springs to begin my second round of
rehab.
Meandria Davis, my Occupational Therapist for my first rehab, was once
again assigned to me. (I think she assigned herself.) My Physical
Therapists this time were Andrea Hollis and a young lady named Monica.
Both were outstanding in their ability to work me and
encourage me!
Because of swallowing tests conducted while at the hospital, I was
prescribed
a diet of pureed food. At lunchtime on Friday, September 5, the speech
therapy staff, including Anna Soph, Head Speech
Therapist, was there in my
room to observe me eating. I had a severe coughing spell due
to aspiration that turned me red in the face.
They were alarmed, and recommended I cease eating anything by mouth as
a health
precaution. Instead they would insert a feeding tube through my left
nostril and feed me with bottled food through a metering
device. Friday
afternoon the Director of Nurses came in and inserted the tube. After
X-rays confirmed proper positioning of the tube in my stomach,
the
feeding bottle was hooked up. It was definitely uncomfortable.
But I was
assured it would only be for a few weeks. That
Friday night as I laid in bed, wondering about the road ahead and why I
was in the shape I was in, the Lord brought this scripture to my mind:
"Though he were a Son, yet learned he obedience by the things which he
suffered" (Hebrews 5:8). At first I began to ponder how the Creator of
the universe, the sinless Son of God, had to learn obedience. That was
a profound thought to me. In short order, the Lord showed me that my
suffering was to teach me obedience. That was important because it gave
purpose to my suffering. The question then was no longer "Why am I
suffering?" but "What matters of obedience is the Lord going to teach
me in my suffering?" That was a precious truth for me at the time!
On Monday, September 8, I was reading my Bible and came
across Pslam 27:13: "I had fainted, unless I had believed to see the
goodness of the Lord in the land of the living." I latched on to that
truth like a drowning man grasping a life preserver. I had to
believe...and DID believe...that, in spite of my troubles, there would
be goodness from God's hand in my future. I remember the first time I
was able to walk to the gym for PT using my walker instead of going in
a wheel chair. Goodness! Every little bit of progress was a
measure of God's goodness. By the first of the year, I put my
walker away...again. Goodness! ! Well, that two-week feeding tube estimate turned into
five weeks. Two weeks into the feeding tube regimen, Speech Therapy
conducted a swallowing test, hoping that my swallowing had improved
enough to allow for feeding tube removal. But the test showed that
swallowing was still significantly impaired with my left vocal chord
still paralyzed. So the tube stayed in for
another three weeks. On Monday, October 6, the feeding tube got
clogged. The Director of Nurses came to my room and explained that he
could remove the tube and insert another one. I told him that he was
NOT going to insert another feeding tube UNLESS Speech
Therapy said it's absolutely necessary. Speech
Therapy conducted another
swallowing test, and determined my swallowing had improved enough to
OK a 'mechanical
soft'
diet. That meant the feeding tube was gone. I went to the
dining hall that evening for the first time since arriving at rehab. I
told the nurses and techs that there was a party going on in my
stomach.
I continued my daily therapy sessions
and mechanical soft diet. Anna Soph and her Speech Therapy Team had
taught me some critical
swallowing techniques that I sought to follow diligently. With the
feeding tube removed, I was finally untethered from the feeding machine
and free to cruise around the rehab facility in my wheel chair (which
I referred to as "my little speed wagon"). That
freedom was immensely therapeutic. My progress rapidly improved in the
next two weeks. On Saturday, October 18, I was released from rehab and
went home. I continued working out with my dumb bells, ankle weights
and therabands. By Christmas I was driving again. I'm still working out
and trying to recover what the strokes took away. But it's going to be
a long process. My left vocal chord is still paralyzed.
Lessons
Learned
In conclusion, there are a few
lessons I learned along the way that I'll now pass on to you:
(1) If you're on any medications for
blood pressure, be
diligent to take those medications per your Primary Care Physician
(PCP). If you're supposed to take your meds in the morning, do so
religiously. Blood pressure meds are usually taken in the morning so
they can work throughout the day. Failure to follow that
regimen brought
on my second stroke. Ask your PCP if you have any questions about your
meds.
(2) If you have any symptoms that are
not normal, like tingling or numbness in your extremities, like arms or
weakness in your legs, head to an Emergency Room as soon as possible.
Better to be safe than sorry! Hospitals have techniques and medications
they can administer within
three hours of symptom onset that can mitigate or even reverse the
effects of a stroke.
(3) If you're on any medications,
prepare ahead of time and print out two copies of your medications to
take with you to the hospital. You will provide the ER staff with one
copy and give one to the CCU or ICU staff once admitted. Do NOT expect
the various care units within the hospital to communicate with each
other. Make sure YOU make communication happen.
(4) Make sure you have a ADVOCATE,
whether spouse or close friend, to question everything the medical
staff does and plead your cause when necessary. Even though hospital
staffs may be well-intentioned, they are NOT infallible.
(5) Remember that you are under NO
obligation to take a medication or undergo a procedure that your
Primary Care Physician (PCP) or Specialist (such as a Neurologist,
Cardiologist) does not approve first. Physicians are in the business of
'practicing' medicine. Just be sure you do NOT become one of their
tackling dummies when they want to try out a new drug on you. (6)
Don't allow yourself to become discouraged! I have discovered first
hand the frustration of being an able-bodied guy who lost many of those
abilities. My first stroke saw fairly rapid recovery. But my second
stroke was far more serious. I've had some dark moments with a recovery
that is more painstaking. But I keep reminding myself that every
workpout, no matter how brief, is a building block. If you keep
building faithfully, the body will give what it will give. You should
greet progress, no matter how slow or small, with a certain joy of
fulfillment. Your stroke is what it is. Deal with it accordingly. (7)
Don't allow yourself to become bitter! Sometimes life deals us a bad
hand. Unfortunately, it's not a hand we can fold. We have to play.
So keep looking forward, one day at a time. Don't get caught up
in second-guessing what could or would have been if you had done this
or that. It's even possible that a stroke could save your life. My
first stroke enabled medical staff to discover my thyroid cancer. If it
had gone undetected, there's no telling what damage it would have done.
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