This is the story of my particular stroke. I know that everyone is different, and the outcomes vary from minimal to dead, so some or all of this story may not relate to you.
First, a little history
In the spring of 1995, my dad suffered a heart attack. It was a pretty minor one, and they scheduled him for angioplasty later on that summer. What was supposed to be a day-patient procedure turned out to be a marathon. The stents they installed in his heart kept clotting, and he ended up having open heart surgery and several bypasses. After this, he suffered some post-surgery infection, and ended up back in the hospital to fight that.
Following this drama, I took a long look at my own health, and the fact that both my grandfather (at age 66) and father (at age 60) had heart attacks - so perhaps there was some genetic predisposition for this. I changed my life radically. I became a vegetarian, and started vigorous exercise several days a week. I would regularly run 10km, and would hike up steep mountains for fun. I actually felt pretty good. Lost a lot of weight, too. So, going into this health fiasco, I was in really good shape, was a healthy eater, had good blood pressure, and monitored my cholesterol.
The Precursors
There were some signs that something was amiss long ago ... and in hind-site you can connect the dots. These are the dots - any one of them looked at in isolation isn't a big deal, but put together they form a pattern.
- For the last several years, I would experience light-headedness (is that a word?) periodically. I would chock it up to hydration, because if I had water during one of these episodes, the feeling would go away.
- In 2006, I experience some exercise-induced angina when I would trail-run up steep hills. I thought to go and get myself checked out, and they found a build up of plaque around a particularly strategic part of my heart. They also found that my cholesterol was relatively high (I had monitored it for years, but in the matter of a few months it had escalated). The original solution was to place a stent in the heart, but the location was such that they couldn't do it - so I ended up having open heart surgery in July of 2006 - a double bypass (one major plaque location, and another minor one). The whole long-winded story is told in mypersonal blog. After this experience, I started calling myself "Doug 2.0".
- In early 2007, months after the heart surgery, I was in Calgary for a while and had a "dizzy" spell that lasted most of one day. No balance, room spinning, nausea. The only relief was closing my eyes and lying down.
- I started work again in May of 2007, and in June of that year I woke up in the middle of the night extremely dizzy, vomiting and unable to stand. They took me by ambulance to the hospital and I really thought that "this is the end". I was there for the weekend (it happened on a Friday night), and they diagnosed it as "vertigo". I had no CAT scan, and no further investigation. I was unbalanced on my feet for about two weeks after this little episode.
- Then nothing for another year, but on July 1st 2008 I was doing a hike with friends and felt a "weakness" or "rubbery feeling" on my right side. It went away after a few hours, but the next day I found that I was making all kinds of errors typing, and my writing was nothing more than chicken scratch. My family doctor, who saw me almost immediately, referred me to the Vancouver General Hospital's Stroke Prevention Clinic. They saw me in a couple of days - during which time I had greatly improved. But when they did a full work up, they could see that I still had some residual weakness on my right side. After a CAT scan with these people, they could see an "old stroke". At the time, I thought that I had experience a stroke, but that it had healed sufficiently to look old. I now think that there was an old stroke during one of my previous episodes, and that this one was a TIA. Nevertheless, I was given a full workup, which involved a lot of my blood and some uncomfortable tests, including something they call a TEE. At the end of it all, they found no reason for the TIA/stroke. I'm a relatively young man (48 at the time) that isn't overweight, a vegetarian, and in good shape. Nothing added up.
The Main Event
So that's the pre-story to the main event. On the morning of Tuesday, October 5th, 2009, I got up as I normally do, did some stuff around the house, and went to get a hair cut. When I got back from the barber, I complained to my wife and my son that the dog hadn't been walked yet, and so they went off to do that.
I wasn't feeling quite myself, and lay down on the couch. Call this spooky, but I thought to myself at the time "I'll check myself in half an hour to see if I've had (or am having) a stroke". Well, half an hour passed, and as I sat myself up on the couch, I could feel the right side of my body starting to become paralyzed - almost like a wave of numbness. Fortunately, I could still talk and someone had left the phone on the coffee table in front of the couch. I called 911 and told the operator that I was having a stroke - she called the ambulance right away.
There are a number of interesting coincidences around this event. First, my son always locks the front door when he takes the dog for a walk. My wife doesn't if somebody is home. She was the last one out the door when they went for the stroll, so the front door wasn't locked (for the ambulance guys). Next, as they were wheeling me out of the house, a neighbor that worked at the school down the street was coming home for lunch. She saw me (and the ambulance) and was able to tell Laura and Dave when they got back what had happened and where I was taken. Otherwise there would have just been an mess of plastic gloves and syringes on the living room floor when they got home. The other coincidence is that the phone, which normally would be in it's cradle several feet from the coffee table, was right in front of me. The only thing I could move was my left arm, so it was within reach to make the call.
Royal Columbian
So I was taken to the Royal Columbian Hospital - one of British Columbia's stroke centres, and was met there (another coincidence) by a neurologist who just happened to be doing rounds in the ER (they work at several different hospitals - so this was a case of the right guy, in the right place, at the right time). This event would normally be handled by an attending ER physician - I happened to get a specialist. They got me to tell them what happened, and I was starting to get some motion back in my right arm when they got me to perform some simple tasks (see the section on Stroke Basics, and look for the NIH Stroke Assessment). I signed a waver for the administration of the clot-busting drug, TPA, which didn't seem to do much at the time.
I was moved into ER for a couple of days, and everything more or less stabilized. After those couple of days I was moved up into the neurology ward, and even had the folks from physio get me up walking (if you could call it walking at that point). I was strong and stable enough during these days to hold on to a handrail in the shower, and stand well enough to have Laura give me a washing. It felt good to be clean!
Eagle Ridge
The actual timing of all the rest is a bit vague, but I was at RCH for about a week before they moved me to our local hospital, Eagle Ridge, that just happened to reopen it's rehab wing the previous year. I was put into the rehab program there, and they started the long process of teaching me how to walk again.
Things were progressing quite well at this point, and my mobility in a wheel chair was quite good. My daughter, Kathryn, returned home from her job in Turkey, and she joined her mom and brother and we went to see a movie and had a "walk" the first weekend I was in rehab (they would encourage either "day passes" or, once you were a little more established in the program, "weekend passes"). By week two I was getting into a routine of regular progress, but that was where I had a major setback.
One of my sailing buddies, Andrew, stopped in at the hospital to buy me lunch. While having lunch in the hospital cafeteria, I found myself unable to chew or swallow my grilled cheese sandwich. I asked Andrew to take me back to the ward, and they quickly checked me out and sent me upstairs to an intensive care unit. I was there for a couple of days before they sent me back to rehab - it seemed the new "event" had partially affected my speech - it was getting worse - but everything else seemed normal.
Back Slide
While trying to go to the washroom one evening shortly after, I passed out - seconds after I pulled the "emergency cord" installed for just this situation. This event seemed to trigger a downward cascade of my health. Back upstairs I went (ICU) where I was unable to drink or talk at all. I couldn't swallow at will, and I really was worried that this was the end of it for me. I had a suction hose at my bedside to remove all the saliva building up in my mouth, and an IV running to provide me with some fluids. After a few more tense days in ICU they sent me off to a general ward where I slowly started to improve. I used an embossed letter board to communicate with, and after a while I could speak a few words - a very haltingly one per breath. I still couldn't swallow thin fluids, though, so I had to get all my liquids through the food I would eat - they were really anxious to remove that feeding IV. Eventually, after a couple of weeks on the general ward, they found me another bed back in rehab (I had to give my original one up, as I was off the ward for such an extended period of time). Downstairs I traveled again.
This time, rehab stuck, and I had no further back-steps. I had the additional challenge of speech therapy this time around, as I couldn't say more than a few words at one time. My emotions had been affected this time as well, as I would laugh or cry without any control. This was also the time where serious, chronic insomnia would take a hold in my life. Not the 4-5 hour of sleep per night kind of insomnia, it was the kind where I'd lie awakeevery night and stare at the ceiling. It seemed I never slept.
Every weekday, I would have a schedule of speech therapy, occupational therapy, and a couple of physio therapy sessions. I found that the speech and occupational therapy sessions were of little value to me - it seemed that progress was organic in these areas and recovery was more a time based thing than a therapy based idea. Physio, however, was a whole different story.
Physio
I had all kinds of problems with walking at first. My right foot wanted to walk on the outside of the solet all the time. I had uncontrollable shaking in both legs. I had no balance. I could barely make it from sitting in a wheelchair to sitting on a bench.
Over several weeks, things gradually improved. I had the benefit of a veteran physical therapist - she had seen it all before, and got me walking in about six weeks. By the time I left the hospital, on January 3rd 2010, 93 days after the stroke, I could walk about a block and climb a couple of flights of stairs.
Recovery
Over the course of the last nineteen months, the progress across all fronts has been slow but steady. I was initially told that most recovery happens spontaneously over the course of one year. After that, it levels off and you're stuck with what you have. My experience has been that if you constantly stretch for more, it will eventually come.
I can now go on short hikes - 5km or so, on hilly terrain. Bike riding is the same as it ever was. Driving a car is no problem. Still can't run, and I discovered about a year ago (first time I tried) that I can't swim anymore. I think these issues will resolve themselves with time and perseverance as well.
The insomnia thing was a huge struggle for me, but it's gotten appreciably better during the last month or so. I have a whole separate section of this blog for that topic!
So now it's time to get on with my life. I'm no longer fatalistic, but realistic. There will be a return to normal, but it will be different - the "new normal" as it's called. I wish there is something I can do to guarantee that this will never happen to me again, but life isn't about guaranteeing anything .. so from now on I have to relish the time I have (we all have) and start doing all the things I want to do.
