Thursday, December 27, 2012

Abandoning drug treatment...

On my drug abandonment cold turkey experiment, I felt convinced to resume the Verapamil today. Everyone has expressed concern about my blood pressure, and today it was what they characterize as "seriously elevated". I had a long discussion with the Home Health supervision, Jeremy Osmond, and yes it does just happen to be true that he is Donny's son. Anyway, Jeremy convinced me that it would be safer to resume the primary hypertension control drug to keep the blood pressure down. I conceded. I also further reasoned that calcium channel blockers are one of the oldest, most proven of the drugs I had been using. It was not likely to be causing unknown problems.

Verapamil is also used intra-arterially to treat cerebral vasospasms, like the basilar migraine syncope I have experienced. 

I was talking to Jeremy today about my continuing Home Health service, and after he took my blood pressure, finding it to be rather high, we veered off into discussing strokes and after-effects.

For no particular reason, I remembered that at the very end of my first meeting with Dr Digre, we were talking about something to do with migraines and damage to my brain stem, from the strokes. She looked rather pensive and said, kind of as an aside to herself, "...if it WAS a stroke."


The implications of that question did not strike me until long afterwards, and I have never followed up at all.

The question elaborates into, what if the brain damage was not caused by a stroke at all?

Remembering, I recalled that I was confused at one point by the inconsistent results of the cerebral angiogram they performed at the U hospital. They preferred that I stay awake for the catheterization, so we could interact if I felt anything unusual, while they were snaking a long thin wire up my left femoral artery, through my heart, and into my brain.

Seeing nothing unreasonable about their recommendation, I consented. I lay in an unusual bed that was designed to facilitate the procedure. Shaped like a crucifix, so that I lay with arms extended, and with short metal side walls all around me. it was built over a turntable that the operator could rotate to rearrange the position of my body, in order to facilitate directing the catheter to the right place.

I don't know the reason for the peculiar arrangement, and did not think to inquire, as I was lightly sedated at the time.

As the procedure commenced, I heard a great deal of excited chatter coming from the doctors witnessing it. The U is a teaching hospital, so I was not surprised.    I thought maybe they were passing around popcorn, and even imagined I could smell it. The catheter was snaked up into the right position, and a puff of xray opaque dye was injected. An xray exposure at that moment would illuminate the 
vascularization local to that artery, and then they would manipulate again to see the next subsystem. As they proceeded I overheard remarks like, "slick as a whistle!" or, "looks good!". When they neared the brain stem, the area damaged, everyone grew very quiet. No one said anything that I managed to catch for a long while. Appeared to be a somber mood that ruled the crowd from that moment.



Afterwards, the radiologist told me that in the area of the damaged brain stem, they observed a type of vascularization he characterized as "tortuous". This apparently means that the pipes resemble a plumbers nightmare.

Okay, so this is the typical appearance of the whole mess following a stroke. Or is it?

I recollect the diagnosis that Dr Digre made, also included her evaluation of my self-described "shark attacks". It seemed to say something meaningful to her, and her eventual identification was something she called "basilar migraine syncope". Apparently the theory is that periodic convulsions of the basilar artery in the brain stem interrupt blood flow, and results in episodes of spasming of the entire vascular system. This suggestion suddenly seemed very neat to me, since it might explain both the shark attacks and the strokes.

Then I described the first attack features in detail. In the sequence, I was out working with Ricky in the desert, and I was feeling somewhat ill and uneasy all day. I thought I would feel better after some hiking, to get the blood pumping or something, so I took a short hike up the bed of Paradise Creek. It was quite beautiful but surrounded on all sides by the charred remains of a huge wildfire that had destroyed most of the trees on the mountain the year before.

While I was walking up Paradise Creek, Ricky was surveying across from me on the shoulder of Paradise Mountain. We met in the middle, eventually.

We headed back to camp because rain was threatening. Just as we arrived a tremendous storm broke. My tent door was left open, so my bed got soaked. I went to sleep on the wet bed because there was nowhere else to sleep out of the rain, and I spent a restless night tossing and turning while lightning boomed. I still felt uneasy and sick, to which I added cold and wet through the long night.
The next day the sun broke on a landscape devastated by the storm. There were flooded areas in the bottom of every canyon. Ricky and I decided we couldn't work any more, and after breakfast we started packing up.

Our four wheelers and utility trailer were configured such that the bikes fit better crosswise, so we were in the habit of just picking them up bodily and swinging them across the width of the trailer, where they made a very tight fit. Anyway, I'd loaded my own bike like this many times over the past three months, but was unable to do so this time. I tried to lift it, but my right arm was suddenly not strong enough to pick up the machine, and Ricky had to do it. I thought no more about it at the time, but the weakness stuck in my memory.

On the trip home, Ricky had to drive, because I was still feeling too sick. Long drive home, and the trip was disturbing because I felt so ill. We had to travel slowly out of the Paradise Mountain area, because many places the road was washed out in the storm of the night before. We finally got home safely. I don't recall anything unusual about the rest of the day, except that I still felt queasy and sick.

After a nights sleep on a dry bed, I expected to awake feeling better, but I still felt sick when I got up. I thought maybe I would chop some firewood, and maybe the work would do me good.

I was swinging the heavy maul, breaking up big rounds of wood into chunks for firewood size. Suddenly someone hit me on the back of the head with a two by four. Or so it seemed. I even looked around behind me, to see if anyone was there. I fell down from the weakness and pain. Accompanying the tremendous shock of pain, it seemed like I heard a loud boom at that moment, but I knew I hadn't really heard anything, but inside my head.

My legs immediately turned rubbery from the shock, and I started to make my way to sit in the shade before I fell down again.

I made it to sit down on the porch, but staggered like a drunk to get there. My dad was sitting there in the rocking char, and I tried to tell him, my legs are unhinged. My speech was slurred like that of a very drunk man, and I had trouble getting the words out.

My dad called my mom to come out from the house and see if she could tell what was wrong. She figured it was heat stroke, because it was a very hot day, and I had been working very hard.
  I recovered quickly enough, and later that evening drove us all down to Wheelers for a hamburger. I actually felt better than I had most of the day, and I enjoyed a bacon cheeseburger. Stroke food.

The next day I woke up paralyzed all over my right
side. The doctors term for it is "total paresis".  I couldn't talk properly, because the right side of my mouth sagged open and flaccid.   My right arm seemed to stay crooked, as though I was holding it across my midsection, and I could not move my arm at all. My hand would still flex, but very weak and feeble.

Of course the suspicion for stroke was obvious at that point. In spite of feeling terrible, with a little help I made it into the truck, and we went off to the hospital.

 We arrived at the hospital and I immediately was interrogated about everything. I tried to describe the spasm I had experienced. But the ER attendants ignored me.

Next instalment:   Coronary Artery Bypass Grafting

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