We don't know the reason for the stroke that I had in 2011.
It could be high blood pressure: my blood pressure is high, but not very high. Blood pressure is responsible for a third of strokes, and may be caused by excess dietary salt. I've been trying to reduce my salt intake, and I'm also taking Ramipril daily.
My blood pressure has come down somewhat, but it's hard to get consistently accurate measurements.
It could be a Patent Foramen Ovale (PFO) - a hole in the heart that's supposed to close at birth. In about 25% of people, it doesn't close properly. However, 50% of people who have an early stroke have a PFO. It's possible that a clot forms in the hole, then escapes and lodges in the brain, for example.
PFO closure is a simple, day operation. Imagine pushing a tiny cocktail umbrella through the hole, then opening it up: but it's a more sophisticated bit of kit than that! It can be inserted through a large vein in the leg. It's a very safe operation, and there's some evidence that it really can reduce recurrence of Transient Ischemic Attacks (mini strokes, whose effects last only a very short time).
There are three studies that show a reduction in adverse events in the five years after the operation. None have shown a statistically significant effect, but adverse events turn out to be very rare, so larger studies may be needed. It may be that aggregating the statistics from the three studies would demonstrate a statistically significant result. Anyway, having declined the operation after the first study was published, I've now decided to go ahead with it.
I was very pleased to be given a choice of dates for the operation. I turned down May 1 (the day before the County Council Elections) and May 8th, the annual meeting of Lewes District Council. Instead I've elected to have the operation on May 15th. They only do it on Wednesdays, it seems.
I still have the altered sensation in my left side: often pain, but generally hypersensitivity to cold, heat, pressure, and so on. I think it's probably going to be permanent.
Edited to add: Yesterday (16 April), I got a phone call to say that the 15th May date isn't actually available. I had a choice of 1 May, or to go back on the waiting list. I chose to go for 1 May. Also, my wife and I watched a Holby City staff member (Tara Lo) die on the operating table, which is discouraging, even if entirely irrelevant! The letter that I got from the hospital says that my consultant has performed this procedure 260 times, and not had serious adverse affects. Tara's operation, in contrast, was (a) a high risk procedure, (b) on a brain tumour, and (c) fictional.
Showing posts with label stroke. Show all posts
Showing posts with label stroke. Show all posts
Wednesday, 10 April 2013
Sunday, 6 November 2011
Stroke update
I want to describe the symptoms that I'm feeling, and how they've changed since I had my stroke on 17th October - almost three weeks ago. I've definitely improved in some ways, having recovered much touch sensation, but I'm also feeling more pain and cold.
My stroke (for which I'm still awaiting a definite diagnosis, by the way) was a pure sensory stroke. It hasn't affected my mobility or cognition in any way. That is, apart from a slight lack of confidence when using my left hand. Fortunately, I'm right handed.
In my face, I feel like I have a black eye and cauliflower ear, and am a bit numb on the chin. The ear is constantly slightly painful, as if someone had punched me there quite hard a few hours ago. The eye sometimes feels a bit dry, and I use optrex eye drops a few times a week. I don't know if it really is dry, but the eye drops do seem to help.
My neck feels stiff, which is a symptom that has come on in the past few days. Lifting heavy shopping bags hurts my shoulder more than it should. The upper arm feels constantly as if I have a blood pressure monitor inflated on it, but isn't painful. The lower arm including part of my hand (but only the little finger) feels like it's slightly sunburned. When I'm tired, or cold, the pain extends right up my arm, and becomes quite serious. I haven't resorted to pain killers yet, and have no idea if they would work, but this does keep me awake at night somewhat.
My side, over my ribs, feels like it's ballooned up. When I wear a heavy coat, it feels like I'm carrying a few phone directories under my arm. That's the most peculiar of all the sensations, since it feels like my arm should be sticking out almost horizontally. And yet, there's no apparent motion impairment. Between my rib cage and my waist is numb, but I'm please that the chafing sensation at the waist has subsided now.
When I sit down, it feels slightly uncomfortable. It always feels as if someone has left a wooden ruler on my chair, so I always have to check that there's not actually anything there. My thigh also feels constricted, just like the upper arm. Also like the upper arm, it can become painful when cold, but not to the same extent. From the knee down, I feel relatively normal!
Also, on that first day, I was walking very tentatively because I could not feel the weight on my foot, so I wasn't sure of my balance. In fact, I was walking independently and quite well, but I had to look down to be sure of myself. The next day, though, I was walking normally, and my wife still complains that I walk too fast!
The strangest sensation on that first day came when I need to remove ear-plugs after an MRI scan. MRI scans are very noisy, and the radiographer had inserted ear-plugs for me. After the scan, though, I was left to remove them myself.
I took the right one out first. Then, I raised my left hand, and touched something, but what? It had to be my ear, but neither my hand nor my ear was giving me any clues. It was simply impossible to remove the plug with my left hand. So, I reached around with the right. It was still tricky. Of course, I couldn't see, so I had to grope around to find the plug in what felt like someone else's ear. A week later, when I went for a repeat scan, I had no problem inserting and removing an ear plug with my left hand.
From what I've read, there's a good chance that things will improve, but it could take a few months and may not be a complete recovery. Exercising the affected areas might help - apparently recovery in the arm is more common than in the leg, and that may be because the arm gets more exercise just in daily activity.
Finally, on the Thursday after the stroke, my wife printed out some diagrams of a body, and we compared how a simultaneous light touch on both sides (for example, on both elbows) felt. At each point, I rated the sensation on the left compared with the sensation on the right. At many points, I could only just sense something on the left, and at some points not at all. At other points, I was super-sensitive. We repeated this exercise a week later, and there was a dramatic improvement almost everywhere. However, there are many other types of sensitivity - to heat, to sharp pricks, to cold and so on, and we've not measured any of those.
My stroke (for which I'm still awaiting a definite diagnosis, by the way) was a pure sensory stroke. It hasn't affected my mobility or cognition in any way. That is, apart from a slight lack of confidence when using my left hand. Fortunately, I'm right handed.
Half Michelin manCurrently, I'm feeling the following symptoms pretty much all the time, but all only on the left side. In short, I feel like my left side has been blown up like a balloon, but the sensation is different in different parts.
In my face, I feel like I have a black eye and cauliflower ear, and am a bit numb on the chin. The ear is constantly slightly painful, as if someone had punched me there quite hard a few hours ago. The eye sometimes feels a bit dry, and I use optrex eye drops a few times a week. I don't know if it really is dry, but the eye drops do seem to help.
My neck feels stiff, which is a symptom that has come on in the past few days. Lifting heavy shopping bags hurts my shoulder more than it should. The upper arm feels constantly as if I have a blood pressure monitor inflated on it, but isn't painful. The lower arm including part of my hand (but only the little finger) feels like it's slightly sunburned. When I'm tired, or cold, the pain extends right up my arm, and becomes quite serious. I haven't resorted to pain killers yet, and have no idea if they would work, but this does keep me awake at night somewhat.
My side, over my ribs, feels like it's ballooned up. When I wear a heavy coat, it feels like I'm carrying a few phone directories under my arm. That's the most peculiar of all the sensations, since it feels like my arm should be sticking out almost horizontally. And yet, there's no apparent motion impairment. Between my rib cage and my waist is numb, but I'm please that the chafing sensation at the waist has subsided now.
When I sit down, it feels slightly uncomfortable. It always feels as if someone has left a wooden ruler on my chair, so I always have to check that there's not actually anything there. My thigh also feels constricted, just like the upper arm. Also like the upper arm, it can become painful when cold, but not to the same extent. From the knee down, I feel relatively normal!
Signs of improvementThere have been changes, particularly over the first few days, and I'll try to describe them. On the day of my stroke, I was sitting in an armchair and tried but failed to lift my arm. Looking down, I realised my arm had slipped off the arm of the chair, and was trapped between my side and the chair arm. Within a day or so, I'd recovered enough sensation in my arm that that wasn't possible.
Also, on that first day, I was walking very tentatively because I could not feel the weight on my foot, so I wasn't sure of my balance. In fact, I was walking independently and quite well, but I had to look down to be sure of myself. The next day, though, I was walking normally, and my wife still complains that I walk too fast!
The strangest sensation on that first day came when I need to remove ear-plugs after an MRI scan. MRI scans are very noisy, and the radiographer had inserted ear-plugs for me. After the scan, though, I was left to remove them myself.
I took the right one out first. Then, I raised my left hand, and touched something, but what? It had to be my ear, but neither my hand nor my ear was giving me any clues. It was simply impossible to remove the plug with my left hand. So, I reached around with the right. It was still tricky. Of course, I couldn't see, so I had to grope around to find the plug in what felt like someone else's ear. A week later, when I went for a repeat scan, I had no problem inserting and removing an ear plug with my left hand.
Pain managementI mentioned that I've not been using pain killers. That's partly because the pain isn't severe, and partly because I'm concerned about how pain killers might interact with my other medication - which included aspirin for the first two weeks. The best way to deal with the pain is just to get on with life, and take my mind off it. Staying warm helps, too.
From what I've read, there's a good chance that things will improve, but it could take a few months and may not be a complete recovery. Exercising the affected areas might help - apparently recovery in the arm is more common than in the leg, and that may be because the arm gets more exercise just in daily activity.
Finally, on the Thursday after the stroke, my wife printed out some diagrams of a body, and we compared how a simultaneous light touch on both sides (for example, on both elbows) felt. At each point, I rated the sensation on the left compared with the sensation on the right. At many points, I could only just sense something on the left, and at some points not at all. At other points, I was super-sensitive. We repeated this exercise a week later, and there was a dramatic improvement almost everywhere. However, there are many other types of sensitivity - to heat, to sharp pricks, to cold and so on, and we've not measured any of those.
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