Tag: The Anatomy Of A Stroke

I get messages most days asking about my dad. I generally reply saying things are progressing well, but slowly, and had intended to make this generalised update over the weekend – exactly two months after suffering his stroke [19th December].

But, suddenly, in a moment, everything changes…

Last week one of dad’s physio sessions decamped to the local golf driving range; a new experience for both girls supporting him, whose first job, after placing the basket under the wrong delivery chute, was to roll around scrabbling to pick up the 50 balls now randomly bouncing around the hard-stone-floor corridor. Considerable hilarity ensued. I wish I’d witnessed that. And to highlight my dad’s often twisted perspective, he later bemoaned his apparent loss of form without a shred of irony!

Other than that, the last few weeks have mainly been characterised by the inching forward in hand mobility and walking distance; the sheer tiredness associated with the mental and physical effort; and the small tremor in his hand, which the support staff believe is likely to be a combination of working it so hard, coupled with his own sense of anxiety and frustration.

Everything changes…

Early yesterday afternoon my step-mum was set to go to the supermarket and dad happily decides he’s fit and well enough to go, too. His first return to routine mundanity; now a genuine challenge.

Apparently he tired quite quickly. My step-mum told him to go and sit down. He wouldn’t. Eventually, at the checkout, he admitted to feeling quite unwell. They got back to the car with him ‘wobbling all over the place’. Now a little concerned, my step-mum returned to the shop and asked if there were any first-aiders present. No less than four of them swiftly descended on the car and immediately called the emergency services.

The rapid-response paramedic arrived. ‘He was the strangest colour. His lips looked almost blue and he said he couldn’t see anything.’ The problem wasn’t obvious, but she wasn’t happy with the ECG trace, so an ambulance was called and off they went to A&E.

Time dragged on. Five hours later, amidst a hectic A&E with people on beds in corridors, and the ECG monitoring had revealed nothing. Dad was feeling better – though exhausted – and asked to go home. He was disconnected from all the wires and traces, slowly got dressed, and was pulling on his coat as the doctor approached, “I’m sorry. You’re not going anywhere…” The blood tests showed some abnormal results which suggest a problem with his heart.

24 hours later and the cardiologist still isn’t entirely sure what the problem is. Three men are next to each other in beds at the end of the ward, currently grouped together as ‘Mystery’. He’ll definitely be there all weekend now, with little further investigation likely before Monday.

I think he’s beginning to crave much less drama and mystery and considerably more mundanity. We all are.

No turning back now.

Dad went to meet the consultant who will perform the operation tomorrow [Day 25]. Thankfully, he presented the necessity for the operation [carotid endarterectomy] clearly, concisely and compassionately. And, while being realistic about its inherent dangers, left dad reassured and acceptingly philosophical over the choice.

Having witnessed such remarkable progress to this point, it seems almost counter intuitive to return to the hospital and willingly plunge yourself into the vagaries of chance again so soon; the temptation to simply go with how you’re currently feeling. But the only virtual guarantee without the operation is another stroke: next year… next month… next week… tomorrow… And that, realistically, is an impossible thing to live with. “It would be like walking around with a time bomb waiting to go off in my head.” A time bomb that would now likely kill or permanently paralyse. Essentially, the very epitome of Hobson’s choice.

So, tomorrow will inevitably feel like the longest day. Dad’s being picked up at 7:00am. Operation will be late morning and lasting 2-3 hours. Given his age/condition, it will be an overnight stay, but home on Friday without complications. And then… get on with the rest of your life [and, of course, the ongoing torture of the daily physio visits and his ultimate measurement of recovery and motivational aim: to play golf again. Which is usually a bloody long walk! Even the way he played it before the stroke! : )].

I took this photo about an hour after he came home from hospital today. His 79th birthday. All things considered, an extremely welcome present.

Within 5 minutes of getting home my wife somewhat incredulously caught him half way up a step ladder into the loft, “There’s another walking stick up here somewhere…” Yeah, well, we’ll be sure to get it down for you and put it on the stretcher when they take off in another ambulance after you’ve broken your neck! Unbelievable.

Dad continued to make steady physical progress throughout the first week of 2012, but it seems clear that the autonomic rewiring has finished and now it will be down to the daily visits of the physiotherapists [for 6 weeks] and his own motivation to reinforce and strengthen those newly constructed neural pathways.

Here you can see how his left hand is attempting match his right but, despite immense effort on his part, stubbornly refuses to comply; the arm and hand tiring quickly as the tension of the movement slowly evaporates. The index finger is working much more effectively now, in tandem with his thumb, but the second, third and fourth fingers currently remain ‘mostly asleep’. Dad often reports the sensation of holding something which isn’t there. [Er, like a step ladder?!]

During the week he had another scan of his neck which showed severe stenosis of his right carotid artery. On the plus side, this is virtually guaranteed as the cause of his stroke, but with his rating at 70-75%, means he will need to return to hospital on Wednesday for a carotid endarterectomy. Think: your drains need rodding to clear a blockage, then apply that image to the artery in your neck.

Obviously, as with any operation, there’s a risk – of death and/or of a second stroke [between 1-5%] – but it will reduce the likelihood of a second stroke occurring within three years, essentially a daily living form of Russian roulette, by 33%. So, it’s a bit of a, umm, no-brainer.

Psychologically, dad’s currently dealing with the idea of the operation, but is otherwise in good spirits and very happy to be out of the acute ward. Two guys sadly died during the week and, as we were leaving, another is now on permanent oxygen and fading. When we take a look around us, the reality of dad’s progress in less than three weeks since admission is truly blessed and remarkable.