pevco

My Brain

Posted on October 26th, 2006 by GregPC.
Categories: Uncategorized.

The Saturday before Labor Day I was sitting and reading and talking with Wendy and my brother Dave. My lips started to go numb, then my gums, teeth and tongue - all on the left side. Then my left hand started to go numb and tingly. All of this happened very quickly and didn’t seem normal at all so Wendy drove me to the emergency room at Metro West Medical Center in Natick.

While Wendy was parking, I went in and told them that I thought might be having a stroke. Everyone there was great. They got me into a room, hooked me up to any number of monitors and whatnot and began poking and prodding and testing and talking all at once. I had an EKG,an ultrasound of my carotid artery, a CT scan and some tests on my precious bodily fluids. After several hours of waiting, they told me that there was nothing outstanding in the tests and let me head home with advice to take aspirin, see my doctor and arrange to see a neurologist.

When I saw my doctor, she was reassuring. It was very unlikely that I’d had a stroke (which was good). What was more possible was that I’d had a migraine phenomenon without headache. Now that was at least somewhat more comforting. Sure, it’s still brain related but it didn’t sound as ominous as a stroke. She said I needed to see a neurologist though and told me to have the various test results sent over the the doctor to whom she was referring me.

A few weeks later, I met with Dr. Abend. He’d received and reviewed the materials and the two of us spent an hour together - he asking questions, me answering them as best I could. Toward the end of the appointment, he said he had to check something in my records and stepped out for a few minutes. I tested my reflexes a few times and waited.

When he came back he was prepared to tell me what he thought had happened. It was possible that it had been some kind of migraine phenomena, but he didn’t think that was the most likely explanation. More likely it was what he referred to as a “warning stoke” (I’ve since looked it up and understand it’s also called a Transient Ischemic Attack). He talked about why it might be that and why it might not be. None of it was especially reassuring but I was glad for the information.

He referred me on for a whole bevy of additional tests - blood tests and an MRI and a halter and an EKG and who knows what else. From time to time this all worries me; but most of the time I am able to fall back on the argument that “such is life.” I guess I will have to reserve judgment until all of the various tests are complete.

10.12

In Wellesley, waiting to have various MRIs and MRAs. I have to be honest, I don’t know what an MRA even is but I guess I’ll find out soon enough. It’s freaking me out a little to be here today. This is a very quiet and antiseptic place and it makes me feel pretty alone and disconnected from my world and life.The technicians who helped me were very friendly. I think they thought it was a little weird that I asked them to take pictures of me but they were willing to do it. I was in the tube for at least an hour. Regular scans on my brain and then scans of the blood vessels in my brain and neck. (Those were the MRAs, which stands for magnetic resonance angiography.)

On to the the EKG on Friday . . .

10.13

Today I went to the cardiologists office for an EKG. I walked from Kenmore and my heart was racing. I never have a problem walking like that; but as is the case with the numbness, I am convinced that I can feel all kinds of issues with my heart. This whole thing has taken a bit of a toll on me. Aside from the fact that I interpret every sensation as a potential clue to my health, I also find myself worrying what would happen to Wendy and the kids if something were to happen to me. That makes my heart ache in a different way.

The appointment was tougher than it ought to have been. It started easily enough with some simple ultrasounds of my heart. It was really weird watching my heart pumping away on a screen. In the grainy grey image on the screen, my valves looked like the gills or legs or a triop or sea monkey; or some fast fluttering wings.

Unfortunately, there was another part of the test no one had mentioned. This involved doing the tests again, but with the addition of “agitated saline.” The point of the test was to see if there was any “communication” between the sides of my heart. Getting the saline required an IV.

First they tried putting the IV in my right arm. The needle went in but somehow the vein wasn’t playing its part. Next they tried my right hand. Once again, the needle went in but the blood just wasn’t flowing. The nurse thought that if she tried really hard in might work. Instead, it really hurt and I got a big bruise on my hand. Next she tried my arm again, just in case. It didn’t work the second time either. The nurse then went and found someone else to lend a hand. She tried my left arm and managed to get the IV in there. This whole process took half an hour or so and pretty much sucked the whole time.

Once the saline was in and I was agitating it, the last tests took only a few minutes. I was cold and tuckered out but and still had to go back to work. I don’t recommend having these tests unless you really need to.

10.16

Today I went to get a holter monitor. I wasn’t that familiar with these things but here’s the scoop. They are about the size of one of the old Motorola pagers and hang around your neck. Five electrode things are pasted onto your body and connect to the pager thing. For 24 hours this thing records every beat of your heart.

When I got to the lab to be kitted out, the first step was to draw some blood. I was told not to eat on the day of the test and even though I don’t eat much, I was hungry by the afternoon. The woman who drew my blood is someone I’ve seen there before. In the past she was often joking around with people but today she was all business.

I sat down, rolled up my sleeve and noticed that there were four or five tubes for collecting my blood. I pointed out that it seemed like a lot to me but she said it wasn’t and stuck me. Now I like this woman. As I said, in the past she’s seemed pretty nice and all; but today I kind of wished she’d been a little nicer than she was. This whole experience is making me think about the role of the patient. I realize that for her I am just another arm that needs to have blood withdrawn; but to me, I am a guy who is confused and a bit freaked out by the whole situation. A kind word would go a long way.

When she was done she sent me along to get the holter. They sent me to wait in the pediatric phlebotomy chamber. After a few minutes Debra came in to help me. She explained things in excessive detail and narrated everything she was doing. “I’m writing your name on this form.” “Whoops, I wrote your name in the wrong place, now I need to cross it out.” “This is a sticker.”

Once she’d exhausted the paperwork, it was time to get down to brass tacks. I took of my shirt and tie and t-shirt. Debra, consulting a diagram, noted where she would be sticking the monitors. She next proceeded to shave patches of hair off my chest because the tape they use is just so sticky. Eventually, everything was connected, taped down and declared fit for use and so I was sent on my way. Tomorrow I need to go back in again to have the super sticky tape ripped from by freshly shaven chest. It’s something to look forward to I guess. I also arranged to meet with Dr. Abend late next week. I’m interested to hear what he has to say. And a bit nervous too.

10.17

This holter this is pretty annoying. It’s stuck on very well and so when I move it tugs and pulls at me. And even though it feels light, having it hanging around my neck has started to make my neck sore. According to the little read out on the front of the thing I will be able to take it off in 8h31m03s.

My doctor’s office just called. They have preliminary results from some of the tests. The MRI was normal - that’s a relief; but they did identify a “communication” or hole between the sides of my heart. They told be not to worry about it but guess what, I am anyway.

When they gave me the holter yesterday the nurse made a big deal about how much it was going to hurt to take off the tape. She shaved my chest here and there to try to make it less painful to remove it. I got to the doctor’s office early so I could try to get the tape off myself. It really wasn’t that bad. Here I am getting ready to pull the tape off myself.

10.18

I wish I could say that this was the first time my brain played a little prank like this on me; but that isn’t the case. In 2004 I was traveling in Asia for business. My colleague Betty and I were conducting media training sessions for Hitachi Data Systems executives across the region. On our flight from Hong Kong to Singapore, as I was sitting and watching “Master and Commander: Far Side of the World,” I had a seizure.

I don’t remember much about the seizure itself. I suddenly found myself the center of much attention. People were offering me water, damp towels and a larger seat. I accepted the first two but turned down the third as I didn’t feel very steady on my feet. By the time we landed, I was feeling OK and was happy to be back on solid ground.

At first I thought I would just ignore what had happened. Betty and I took a cab to the hotel, checked in and went out for dinner. By the time I got back to my room it was quite late and I fell straight to sleep. The next day - Thursday I think - we had to work. We finished late in the afternoon and were free until we were due to leave for Sydney in a few days.

That night I didn’t sleep as well. I woke up at 2:00 in the morning, worrying about what had happened. I called my doctor back in America and was told I needed to go to an emergency room immediately. At around 3:00 I called to Betty’s room to ask her to come with me. In the interim I had called the embassy to try to find a hospital and spoke to a Marine guard who was very helpful.

We got to the ER quickly and after a few quick tests were told to return the next day (or later that day) to meet with a neurologist. That appointment was in the late morning and was not very heartening. He told me that for someone my age to have a first-time seizure was most likely due to bleeding in the brain or a tumor. Not really explanations one wants to hear when thousands of miles from home. To make matters worse, the tests he was recommending - an MRI and and EEG - couldn’t be done until Monday.

I remember being just stunned. I walked out of his office into a bright and humid Singaporean afternoon. I sat on a low wall and called my wife Wendy to tell her what was happening. All kinds of worst-case scenarios were going through my head: was I in some immediate risk of death? Would I be allowed to travel? Would I have to stay her in Singapore for the rest of my potentially shortened life? It was pretty overwhelming.

Next I called my boss Greg to tell him that I might not be able to finish the trip as planned. I’d know Greg for 12 years at that point and he dismissed the work stuff and just wanted to know how he could help.

When I felt ready, Betty and I took a cab back to the hotel. Outside, the streets and sidewalks were so alive and inviting. As we drove, I began to rationalize things for myself. There was nothing I could do about what was happening, at least not at the moment, and here I was in a really great city. “Such is life,” I thought, and I decided to enjoy my time in Singapore.

As it happens, I had a great weekend. Singapore is a terrific place. The people are great, the food is good and it’s just a lot of fun. Hours were spent at the hotel’s poolside bar, walking the streets, shopping, etc.; but all the time, in the back of my mind, I was aware of my brain.

When we went back for the tests on Monday, I was feeling OK. The MRI was mysterious and the EEG was kind of funny in a weird way - just stting in a dark and quiet room with sensors on my gel-covered head. We had a few hours to kill waiting fro the results so Betty and I walked through the Singapore Botanical Gardens and had lunch. It was very pleasant.

As we walked back to the hospital and made our way upstairs to the doctor’s office, I was as anxious as I’ve ever been. Waiting for him, my mouth got dry and the world felt so far away. When we met with him he said that there was nothing wrong. That all of the tests were normal and that I shouldn’t worry. It was such a great relief! When I got over the initial shock I just laughed.

Back in America I went to see my doctor with all of the various test results and she decided that it had probably been a vegal nerve thing and that since it hadn’t happened before I oughtn’t worry. So until that Saturday of Labor Day weekend, I didn’t.

Technorati Tags: Brain, TIA, EKG, MRI, heart, holter

10.27.06

Today I go back to see the Dr. Abend. He has all of the test results now and the plan is for him to let me know what happened/is happening and to come up with a prognosis/treatment. I’ve known for a while that I would be meeting with him today but I’ve done a good job of pushing it out of my mind. So many other things have been happening that it’s been easy.

I can’t ignore it anymore. Already I can feel tension in my heart. Already, hours before the appointment, I am distracted and anxious. The appointment is in five hours and they will pass very, very slowly.

10.30.06

Dr. Abend’s office called late in the morning to see if I could come later in the day.  I agreed, but only to a point and told them I would come and wait for the earliest opportunity to meet with him (clearly I wasn’t too anxious . . .).

I saw him at 3:30 and spent probably 45 with him.  We went through the various test in those cases where the results warranted discussion.  (The one exception being the MRI which he let me know showed nothing unusual.)

My blood work showed a lower than expect homocysteine level.  He explained it to me but to be honest I can’t remember what it even means.  The level was close to normal and in any event vitamins are apparently the treatment.  I will be better about taking my vitamins.

My cholesterol was on the high side. He and my doctor met to discuss what this might mean and whether I ought to do anything about it and both agreed probably not.  I will try to eat less fat of my steak (even though it is super tasty).

The big news (which I already knew thanks to a call the week before) was that there is a communication in my heart, a “hole” if you will.  He explained that about 20 percent of people have some form of a communication and that it isn’t a very big deal.  He mentioned a number of treatment paths I could consider - continue to take a lose dose of aspirin every day, begin taking an anticoagulant or have the hole repaired.  For the moment, I am picking option one but I will also be arranging to see a cardiologist.

The hole is apparently an interaterial shunt.  I’d convinced myself it was the PAO variety (don’t ask me what either means, I just know that excessive coughing can cause the PAO kind and I cough a lot).

At the end of the appointment, he wanted to know if I was scared by this news and just not letting on.  I told him I was not; but that I’d hoped to have something a little more definitive after all of the tests.  Here’s what I found out instead: It likely was a TIA (but not certain).  All of the tests looked normal or good (except the ones that weren’t).  There is nothing more I can do than I already am (which isn’t much). And if it happens again I should go to the ER (like I wouldn’t).

Such is life.

Technorati Tags: Brain, TIA, EKG, MRI, heart, holter

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