My Mini Strokes Symptoms (TIA) (Transient Ischemic Attack) Journal

My first TIA happened while I was sitting at work in 1969, studying some paperwork. As I was reading, my right arm began to tingle, and I started rubbing it to encourage blood circulation. After I finally got the tingling stopped, I again picked up the sheet of typed text and was startled to see that I could not read it.

What I saw appeared to be a huge, donut shaped blank area on the page, with text on the 4 corners and on the center of the page, in the donut hole. When I looked closer, I saw letters swimming into and out of the blank area. The next move was for my phone index to call my doctor. Luckily he was at the nurses station, between patients.

After I related the above information, his first words were, :"Calm down, it is not a heart attack, it is affecting the wrong arm."

I guess that was intended to be good news, but I had not even thought in that direction. He then said that, "It is probably a micro-stroke and people have them all the time, usually when they are asleep, and never notice them. If this symptom does not go away in 30 minutes, call me back. If it does, make an appointment for a routine check up." This was 1969 advice and is certainly not valid today. Be sure to read on and do not follow it currently

True to his prediction, all symptoms disappeared and I kept the appointment a few days hence, per his suggestion

The second TIA, a few months after the first, interrupted my enjoyment of a performance of a Ringling Brothers circus. Again I felt tingling in my right arm and noticed very tunnel vision. I just sat quietly and waited for it to pass. In a few minutes. it also cleared up with no apparent after effects. Ho-Hum. Been there, done that.

Again a few months elapsed. This time I was driving on the freeway. I suddenly realized that I could not form a sentence. I did not seem to have access to my vocabulary. I knew what thought I wanted to express, but I could not seem to figure out the words to use. While I was struggling with this problem, my lady turned and asked where we were going. I had no trouble with the answer, "Why?"

She replied that I was 3 exits past the one for home!

I took the next exit and took surface streets home. By this time, the symptoms were again gone.

Shortly after the third event, I was discussing health issues with a friend and she advised that if my doctor was not interested in these "micro-strokes" that I should check with her father's doctor. Her father was participating in a clinical trial of a method of Life Extension. The results were published in a book of the same name in 1982. The next subject heading includes a link to Amazon.com to look over this book. His doctor was the doctor that was monitoring the trial.

I took her advice and consulted the suggested doctor, and subsequently switched doctors to get access to some of the drugs being used in the trial. Some of them were simply vitamin and mineral supplements, but a few were prescription.

I stayed with that doctor for many years, even continuing with his partner after he retired.

Decades passed. Fast forward to late 2005. By this time, I have bought a house, my wife died, I have a new partner, I have retired, and I have changed to VA medical care, in that order. And there were no TIA's. At this time, I feel that I should acknowledge the apparently good advice I got from my friend that caused me to change doctors.

Unfortunately, she was better at giving sound medical advice than following it. In spite of being more than 20 years my junior, she died about the turn of the century.. She was one of the generation that lived fast and died young. I miss her knowledge base and free spirit outlook on life. She was a good friend.

One evening, after a very tiring day, I crawled into bed and was feeling a little disorganized. A TIA never crossed my mind. If it was one, I missed the signs. I just went to sleep almost before my head hit the pillow. It could easily have been my last night, if it was a bleeding type stroke. I thought no more of it, until after number 5.

As I climbed into bed one night in April of 2006, it was a little more difficult than usual. Our mattress is about 6 inches more off of the floor than is usual. I just thought I was more tired than usual. I made a few comments and Deb asked if I was ok; that I was not making sense. I replied I was ok and she said if I did not stop talking like that she was going to take me to the hospital. So I did. Stop talking, that is. I went to sleep.

I felt a little strange the next morning, but not much.

Being Saturday, we ran a couple of errands and went to lunch. After lunch I still felt a little weird, so I asked her to take me to my local VA hospital. I went to the ER and told them that suspected that I had had a small stroke.

They hustled me off to a bed and had a Dr. check me. They then put me into the standard backless gown and started the standard tests. blood, x-rays, CT-scan, EKG. heart monitor, oxygen monitor, etc. A neurology Resident showed up and said that I definitely had had a TIA and that there was no bleeding into the brain, so they were going to admit me and were starting blood thinner therapy to allow whatever clot was causing the problem to disolve. By this time a series of 4 doctors had read the riot act to me for not checking in sooner. I should have gone immediately to the ER when Deb noticed that I was speaking "funny" the night before.

The fact that only minor damage was done was in spite of my negligence.

During the afternoon, the Dietition stopped by to ask the doctors what food I was allowed and then discussed what I liked, disliked, and was alergic to. Anything i really detest went on the "alergic to" list. Most of the afternoon was spent doing all of those tests; and waiting for a bed to empty for me. When one did not, I was put on the cardiac wing instead of the stroke wing.

I found out later that I was assigned to a Heart Intensive Care Unit. Or HICU. When Deb returned after dinner, she did not find me in ER, so she called me. I did not know my room number, I only saw HICU as they wheeled me in on the gurney. So I told her that I had been assigned to write poetry. I was in the HICU room and did not know the number. She did not understand the humor so she was worried that I was a lot worse. She had to call hospital information to find out my room number. When she arrived, she saw that my room number was on a white board on the wall behind my head.

While waiting for the clot to dissolve, the damage continued thru the night. I was defimitely confined to bed.

Morning arrives very early in the hospital. 5:45 to be exact. It does not matter that it is Sunday and that nothing much routine happen on Sunday. No rounds, no appointments in clinics, no routine tests. There are still meals to be served, rooms to be cleaned, and records to be updated. The duty interns and duty residents check on their assigned patients and insure that no emergency is developing. Routine stuff can be put off until Rounds and students arrive on Monday.

I was closely watched to see how much damage had been done and how fast the brain was rewiring itself. Sunday morning I needed to use the bed rails to roll over. I could not push myself off of the mattress to do that. By evening, I was recovering that capability. It is utterly amazing how fast the brain begins recovery.

I have a good friend that I met on a plane on the way to the hospital after her father had had a serious stroke. I kept in contact with her as her father progressed thru his recovery, so I knew that significant recovery is possible. That hope kept me calm during my worst hours. That and the knowledge that there was no bleeding into the brain. The big surprise was how fast this recovery progressed.

Unlike the typical hospital patient, I found the food good and more than adequate quantities. But my inputs to the dietitian in the ER may have had a bit to do with that.

The first thing I learn prior to 6 AM is that I am assigned to three services for monitoring; Cardiac, Neurology, and Stroke teams. This means that I will be on "rounds" conducted by all three teams, and interns from each of those services will be assigned to re-examine me during the day. They need the practice! But it also means that I will be under almost constant surveillance during the day. I learned, a week later as I reviewed the hospital records, that when the team members were not there, the nurses recorded every move I made. I guess that is what "intensive care" means.

The first team to arrive was the Cardiac rounds. They were thorough with their exam, reviewing the most recent EKG results and doing all of the routine heart exams. They immediately looked at my most recent blood work and assured me that the enzymes that indicate a heart attack were not present. I guess that was good news, but, again, that possibility had never occurred to me. I guess I am a slow learner, As they left, they assigned 2 interns to re-examine me during the day. Each to visit me twice.

The second team was the neurology team. By this time Debbie had arrived and for the first time in my life, I realized after each answer I gave, they looked to her for confirmation that my answer was correct. At this point they were not sure that they could trust either my memory or observation ability. And after a stroke, this would seem justified. I was glad that she was there to assure them. I seemed to be at least minimally passing their tests. All except the curette scraping my foot sole. When asked if I felt that, I replied it tickled. The right answer was that it hurt. No biggie, the important thing at that point was that I could at least feel it. Again, as they left, 2 of the interns were to repeat the tests that day. During this exam, I saw the stroke team rounds group waiting their turn in the hall. After a short pause, they moved on to another patient.

After a short break in activity, the stroke team returned. Now the most intensive exam began. Everything from speech, to touch sensitivity, to facial muscle control, to grip strength, to limb movements, to balance while attempting to walk were tested and compared, right side to left side of the body. The professor did most of the talking, and explained that the more weight the muscle worked against, the faster the capability would return. Therefore the left leg would recover faster than the left hand and arm. He said that if we walked on our hands, the reverse would be true.

I soon learned that the more trouble you are having with balance, the wider the stance needs to be to walk. Again, 2 interns were to recheck me during the day.

Now let's review the schedule for the day. I had been thru exams by the three heads of service and their entourages. I had 2 interns tasked with repeating those exams twice each. 3 services X 2 interns each X 2 exams each = 12 exams during the rest of the day, plus the 3 already done makes 15 exams for the day. Plus a repeat CT scan to confirm no bleeding in the skull. I trust nothing will get past them. It was a very busy day.

By the afternoon my walking was good enough to earn my release from bed rest status. It was nice to earn bathroom privileges again. By the end of the day, the interns were beginning to talk about the possibility of my release the next day, if I continued to recover over night. I was certainly ready to sleep after a large dinner.

During rounds today, the period was focused on what was necessary to insure that I had recovered enough to allow me to go home. To insure this, appointments were made with the swallowing clinic and the Speech Therapist. Physical Therapy people came by and checked my ability to walk and climb stairs, step into a bath tub, and sit and stand easily.

After I passed those tests, I met my appointment at the swallowing clinic. The testing device there seated me in a very narrow space to restrict my movements as much as possible. I was given various types of liquids and food to swallow. Everything from water to soft bread to dry cheese crackers. As I swallowed, the action of the epiglottis was video taped by some sort of x-ray-like device that can record the action of soft tissue. It was fascinating to view that motion as it blocks the entry of food into the larynx.

The final hurdle to clear to get released was Speech Therapy. I was ushered into a small office and seated at a very small conference table. Perhaps 48" by 18". The technician was a beautiful young lady, blond, blue eyed, and about mid twenties. Her first question was, "Do you know why you are here?"

I replied, "I think so, but I would like to here your version."

She said, "It is my job to determine how well you can use your lips and tongue"

Well, that answer stunned me. I swallowed and finally said, "You do understand how obscene that sounds?"

She laughed and thanked me for my politely phrased answer. She said, "Some answers are much more crude. To this day, I do not know whether that was an ice breaker comment, or an attempt to see how well I could talk when my attention was no longer focused on carefully forming my words. Either way, it was very effective.

She proceeded to have me read a paragraph and a few tongue twisters and also eat crackers and drink liquids. I guess she agreed that it was ok to send me home, because by the time I got back to the HICU, my release papers were in order.

I was to do occupational therapy and physical therapy in that order. I protested that I was retired and did not need an occupation. The therapist promptly told me that recovery and returning to a full life was now my full time occupation.

Balance:

I have to pay more than normal attention to balance. A special class in Tai Chi that was offered in Rehabilitation by the Veterans Administration Medical Center helped a lot. Learning to stay on balance at all times when walking or moving in any direction is very important for those with balance problems. Also, learning about how to fall at advanced age with minimum damage to your fragile frame.

Build up of saliva in the mouth:

There seems to be a partial loss of the trigger to automatically swallow as needed. When distracted, sometimes it leaks from a corner of the mouth. Sort of like a precursor to a drool, but noticeable immediately on the face. Sometimes instead, it runs down the throat without a swallow, occasionally causing choking.

Speech:

I have to speak slower and more deliberately to speak clearly. It probably would have been better to speak more slowly all of my life, to insure that the brain was engaged before the mouth said things I regretted.

Brain speed?

Sometimes I have to advise rapid speaking people that I cannot listen that fast! This may also simply be due to advancing age.. Or perhaps a return to the Southern speech patterns of my early years.