I had a stroke

As part of my continuing efforts to “walk point ”medically for readers my age and younger, I had a stroke Saturday. Well, not quite  a stroke. It was a Transient Ischemic Attack (TIA). Close enough. I call it a “free sample of a stroke.”

I had the symptoms of a stroke. I got a security guard at the mall to call 911. I spent 24 hours in a hospital getting the various tests. It was a “free sample” because I suffered no brain damage.

But having a TIA means you are more likely to have a full-blown stroke thereafter.

I previously wrote extensively about my experience with prostate cancer and colonoscopy—in the interest of maybe saving your life. To find those articles, type “prostate’ and “colonoscopy” into the blue search box at the top right of all my web pages.

Am I again trying to save your life? A stroke can instantly kill you. In fact, if you gotta go, that’s one of the best ways. No fuss, no muss. No relatives and friends coming to the hospital and showing by their facial expression how bad you look. 

But consider this exchange I had with the emergency room doctor.

“What is the probability of another attack in the first 24 hours after my TIA?”

“You have a 4.25% chance of a catastrophic attack in the first 24 hours.”

“Like I’m dead?”

“No. Worse than that.”

Think about that.

A stroke that does damage may kill you right then. Or it may kill part of you, unfortunately the part it kills is brain cells. And that does not totally kill the part of your body controlled by those dead brain cells, but it renders that body part inoperable. In other words, the stroke may make you blind or deaf or unable to speak or unable to communicate or paralyze you or or make half your face hang useless or multiple combinations of those.

Is that worse that death? I am not certain. I suspect it varies according to what no longer works and how you and your relatives think about it and deal with it.

So what I’m trying to do with this article is tell you:

• how to decrease your chances of having a stroke
• the symptoms of a stroke
• how to react to those symptoms

There is also rehab after you have one, but I have no expertise in that and have not researched it.

Strokes are caused by a diminution of blood flow to the brain, usually caused by a clot, or blood in the brain not being where it is supposed to be—inside the veins. I apparently had a temporary partial clot.

Window of possible cure

Medical treatment of a stroke can be almost totally curative—if you get to a hospital that can perform an endovascular thrombectomy fast. That procedure is for large vessel strokes. If you are not having a large vessel stroke, no harm done. That hospital can treat all types. But if you are having a large vessel stroke and you do not go to the hospital that can perform the endovascular thrombectomy they will have to transfer you to the better hospital and time is of the essence. The sooner you get the endovascular thrombectomy if you need, the better the result. Basically whatever hospital you go to will assess whether you can benefit from the endovascular thrombectomy—a minority of cases.

The doctors want you to note the time at which you had the stroke. Because the window where the doctors can help you lessen the effects of the stroke is about five hours total. For example, Tissue Plasminogen Activator (tPA) works in more cases than endovascular thrombectomies, but must be administered within a few hours. So you do not want to delay getting to a hospital that has tPA—all of them—in order to go to one that does endovascular thrombectomies.

Once your stroke is maybe twenty or thirty minutes long, your brain cells start to die and cannot be brought back to life. After around five hours, there are none left to save in the brain region where the problem is. And the stroke victim in question will probably be severely disabled.

You’ve heard the phrases “time is money” and “time is of the essence?” In a stroke, time is disability. The less time you take, the less disability you will suffer. And time is never as much of the essence as when you suffer a golden-hour injury or illness: stroke, heart attack, substantial bleeding.

I am not a doctor so I may be garbling this a bit. I have doctor readers and I expect one or more of them will point out errors if I have any.  But I guarantee you that all the stroke literature for laymen constantly emphasizes call 911 FAST!

“Time lost is brain lost,” says the Kaiser hospital brochure on stroke.

Stroke is a misnomer

I think the word stroke is a misnomer. I’ll bet it was named that by laymen back in the day, not doctors.

The word stroke implies instant and it’s over.  Better names for the two types of stroke would be intracranial bleeding (15% of strokes) and blood clot in the brain (85%).

That’s better because people understand that bleeding is extremely dangerous and that one needs to stop it ASAP. And that is the understanding stroke victims and the people who are with them need to recognize what needs to be done: call 911 immediately. And if you can get there as fast as to a non-endovascular thrombectomy one, go to an endovascular thrombectomy hospital. If however the “non’ is closer and let them decide on whether you stay there or go to the more specialized one.

Take Uber

When I had my stroke Saturday, February 24, 2018, the mall security called 911. I think it took about 45 minutes for the ambulance to arrive. This at Westfield mall in downtown San Francisco on Market Street across from the Powell Street Cable Car turnaround!

In retrospect, I should have taken Uber after the ambulance took more that 10 minutes—and gone to the hospital the ambulance took me to.

That 45-minute wait for the ambulance—then about 15 minutes more to the hospital without the endovascular capability—could have killed or totally disabled me.

Symptoms

You must recognize the symptoms and act instantly. Mine were distinct. My left leg was weak and wobbly. Then I noticed my left hand was also weak and wobbly. Two left side body parts being that way made me think, “That means I’m having a stroke in the right side of my brain!” They could also be numbness or paralysis on one side.

A Kaiser brochure lists five symptoms. Each begins with the underlined word “Sudden.”

It also lists:

• Sudden trouble seeing
• Sudden problems speaking or understanding 
• Sudden dizziness or loss of balance
• Sudden severe headache with no apparent cause

I must say that mine was not sudden. I noticed I needed to catch my balance repeatedly. And I was listing to the left and drifting to the left as I walked as if I were on a ship that was rocking back and forth. I kept brushing my left shoulder against people I thought I was just going to walk past. They looked at me as if to say, “What’s wrong with him?”

My left foot was landing on the floor before it should then sliding to the spot where it should have landed. It was as if my right leg was on a normal floor but my left leg was in two feet of water or in sand. It took extra force to make it do as the right one was doing.

I had intended to get in line at Lobster Me to order lunch, but I finally decided I needed to just find a chair and sit down. I kind of plopped into one hard. I wonder if that plop caused the clot to break up. I’ll ask my neurologist.

911

After taking inventory for five or ten minutes, I decided I need an ambulance because various anti-stroke commercials said you need to call 911 immediately. I got a mall security guard to call 911.

Kaiser always uses the word “Sudden.” My symptoms were not sudden. My sense of what happened after researching strokes is that a blood clot started to diminish blood flow to the left-side muscle control part of my right brain. My leg and hand started to get weaker gradually. The weakness became greater the way a person struggling against being strangled puts up gradually less resistance the longer the oxygen deprivation goes on.

What may have been sudden was the clot breaking up and my left-side strength being rapidly restored.

My vision problem

I had trouble seeing out of my left eye during our recent cruise. I saw the doctor on the cruise ship—an internist—and a Kaiser opthalmologist when I got back. She seemed to think my retina was slightly burned by the sun off the ocean and healed itself. I told the neurologist about that. He did not suggest it was another stroke. My left-eye problem came and went for a couple of days. I don’t think strokes fade in and out.

Other symptoms

Problems speaking or understanding are obviously brain related.

Dizziness and loss of balance, however, happen a lot, at least momentarily. Given the nature of strokes, I surmise that the dizziness and loss of balance in a stroke are prolonged.

I expect we have all had severe headaches at times, and they were not strokes.

So here is what makes sense to me. If one side of your body gets weak, numb, or paralyzed, you are having a stroke. Same with difficulty speaking, understanding, or prolonged dizziness or loss of balance. Call 911 immediately. 

Severe headache may or may not be a stroke, but you should assume it is a stroke until a doctor says it’s not. Again, call 911 immediately.

Furthermore, if an endovascular  hospital is as close as a non-endovascular one, you should assume your stroke is in a large blood vessel and therefore fixable by way of an endovascular thrombectomy. So you tell the ambulance or Uber or whomever you are riding with to take you to your local hospital that can do that procedure unless it is farther away than a regular stroke hospital.

Which hospitals?

I think the hospitals who can do the endovascular thrombectomy are in this list. But I am not sure. Check around to confirm that this is the correct and complete. I assume additional hospitals are acquiring this capability by the month. It is apparently easy for doctors to learn. They get it right  on the first or second attempt. I do not know if it requires new equipment.

http://www.lifeextension.com/Lpages/2015/Stroke/index

What if there is none in your area? You may need to fly there in order to get there fast enough to be inside the window during which the doctors can lessen your disability. Ask around of your doctors how to do that if necessary. Again, you are more likely to need tPA than endo, and you need tPA fast. Do not delay getting tPA to get to an endo hospital.

This is not written about as much as it should be, but living out on the boondocks can kill you if you suddenly need medical care that is only available too far away for you. My two brothers live in Fort Collins, CO. The only hospital in CO on the above list are in Aurora, Lakewood, and Englewood, CO—three south of Denver suburbs over an hour away by car.

I have some travels planned to the East Coast and Europe. I will travel with a list of hospitals that can do endovascular thrombectomies and other stroke center hospitals where I change planes and in my destination areas. My wife knows a couple where the husband suffered a stroke while in Cambodia. He suffered permanent damage. I do not know if he would have done better had it happened when he was closer to modern hospitals.

My wife and I went on a cruise through the Panama Canal recently. I do not know if I want to be that far from modern hospitals in the future now that this has happened to me.

Prevention of strokes

Prevention just seems to be basic good health practices:

• Low-salt diet
• Low-fat diet
• High-fiber diet
• Avoid being overweight
• Avoid diabetes
• Low cholesterol
• Exercise
• Daily aspirin
• Daily Lipitor or other statin
• Avoid falls
• No smoking
• Minimal alcohol consumption
• No cocaine or amphetamines or methamphetamines

The keys are a disciplined healthy lifestyle, knowing the symptoms, calling 911 the moment you even suspect you are having a stroke, assume you have the large vessel thrombus that benefits from endovascular thrombectomy and go to a hospital that can do that if you have such a hospital as close as the closest non-endo-stroke center hospital.