Stroke

Stroke is the third leading cause of death in Canada states the Canadian heart and stroke, foundation, going on,

“Although strokes can occur at any age, most strokes occur in people over 65.”

I was 69 when I had mine.  It  happened while I was  unconscious on an operating table, having open heart surgery, specifically,  a quadruple coronary bypass, performed by  BC vascular  and chest surgeon Dr Lynn Fedoruk (right).

A stroke, also known as a cerebrovascular accident (CVA), is the rapid loss of brain function(s) due to disturbance in the blood supply to the brain,” says the Wikipedia. “This can be due to ischemia [lack of blood flow] caused by blockage [thrombosis, arterial embolism), or a hemorrhage (leakage of blood]. As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.”

And one in six people will eventually have a stroke.

On the night of March 25, 2011, I was lying in bed, getting ready to go to sleep when I noticed a dull, heavy ache just under my left shoulder blade.

I’d had similar spasms before, although not quite as strong as these: I wasn’t overly concerned.  But the ache kept me awake that night and when it came on again the  following evening, my wife, Liz, insisted I go to the nearby hospital.

She and I live in Lake Cowichan, a small town about an hour’s drive north of Victoria on Vancouver Island, and the hospital nearest to us is the Cowichan District Hospital in Duncan. There, on March 26, despite my protestations that it was probably only heartburn, or something, as soon as we’d  related my symptoms to the admittance clerk at the emergency department, I was taken to an examination cubicle and told to lay down while an ER nurse drew blood from my arm.

Soon after, a doctor parted the curtains and told me I’d had not one, but two, heart attacks.

I was quickly moved upstairs to the intensive care ward where I spent the weekend before being sent by ambulance to the Royal Jubilee Hospital in Victoria for an angiogram, a high-tech diagnostic tool used by doctors to get real-time, moving images of someone’s internal structures and organs.

Myocardial infarctions

Most of us fool ourselves into believing heart attacks — myocardial infarctions, as they’re called in the trade – only happen to other people. But the undeniable truth is: they can  hit anyone, anywhere, any time, young, or old. And usually, they arrive completely out of the blue.

Neither of mine was particularly impressive. In fact, I didn’t even know I’d had them. I didn’t fall on the ground, clutching my chest, writhing in agony, or anything like that. But nonetheless I’d  suffered at least two heart attacks.

Angiogram

For an angiogram, a special non-toxic dye is injected slowly into your bloodstream. As it’s going in, you feel a not unpleasant warming sensation flowing throughout your body.

A fluorescent screen hooked up to a monitor lets doctors see exactly what’s happening in and around whatever body systems are being examined. And they see it as it’s actually happening.

The angiogram  often shows the exact  locations of obstructions,  and if that’s the case, another  method called angioplasty is  sometimes used to get  clear  the blockages.

In my case, it revealed major problems with the supply of blood to my heart. An artery was 70% to 80% blocked over a long stretch, another was 98% blocked, and one was jammed up by a small wedge of calcium which would go on to cause serious trouble in my brain.

That same afternoon, Fedoruk had shown me the diagram  on the right,   telling me I  was a candidate for a cardiac bypass because the angiogram had clearly shown the blockages in my arteries were  significant  and couldn’t be  fixed by angioplasty.

Under it, “An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres, says the Wikipedia, adding,),

“The balloon crushes the fatty deposits, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn. A stent may or may not be inserted at the time of ballooning to ensure the vessel remains open.

I don’t remember anything about the angiogram procedure  or, for that matter, the ensuing operation. But I knew exactly what was going to happen because years ago, I’d watched an identical operation  as it was being carried out.

In the 70s and 80s I’d written a series of columns for the Toronto Star on common surgical procedures. The articles were meant to give readers an idea of operations they might one day have themselves.

The first had described – you guessed it – a coronary bypass. Now, more than 30 years later, I was on the receiving end, having the same surgery as former Canadian prime Minister Jean Chretien and ex-US president Bill Clinton.

Stroke

It’s estimated that six percent of all deaths in Canada are caused by a stroke with more than 50,000 recorded in Canada every year. That’s one every 10 minutes, say heart and stroke foundation statistics.

Fedoruk said the chances of my experiencing a ‘cerebrovascular accident’ were small; between 2 % and 4%.  Although I was leery — I knew the operation involved having my sternum split  down the middle, not an attractive prospect . But at those odds, I figured I’d be a fool to refuse  it having already survived at least two, and possibly three, myocardial infarctions, so deciding whether or not to undergo a relatively common operation at the hands of one of Canada’s most practised cardiac surgeons, or risk death from another potentially fatal MI, didn’t take much thought.

Open heart surgery

According to the Wikipedia, the first surgery on a living, beating heart, was carried out by Norwegian doctor Axel Cappelen, on September 4, 1895, at the Rikshospitalet in Kristiania, now Oslo.In the 21st-century, open heart surgery is fairly common, but it’s never routine.

In most cases, open heart patients have only their healing to deal with. But while I was on the operating table, I’d also had a stroke which presented, and continues to present, very definite recovery problems of its own.

Hospitals are dangerous places

To make things worse, I’d also somehow picked up an infection in the incision in my chest. It was later described by one of the doctors looking after me as “catastrophic,” and I had to have a third  equally invasive  operation to fix it.

Additionally,  I was hooked up to an  intravenous antibiotic  pump for six weeks  which  meant being constantly woken up  in the wee small hours  to have the drip changed.

Meanwhile, the after-effects of a stroke can be many and varied, creating unpleasant cognitive ‘deficits’.

The damage to the part of my brain which deals with sequencing, meant, for example, I had (and to  an extent still have)  trouble telling time with an analogue watch, although digital time-pieces present no difficulty. And I’m always having to ask my wife what day or month it is. On top of that, I have a minor type of apraxia, “[which] is characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements. It is a disorder of motor planning,” says the Wikipedia, going on, it affects one’s] ability to  “carry out learned complex tasks in the proper order, such as putting on socks before putting on shoes”.

For five or six weeks, while I was still at the Victoria General Hospital for neurological and physical rehabilitation, every time I left my room I’d get  hopelessly lost. Quite literally.

It reached a point where the nurses had to inflate a blue rubber surgical glove and tape it outside my door so I could find my room. But often, even that didn’t work and I’d  roam the corridors like a phantom, looking for the right door.

As I write this, just about a year  after my heart attacks,  I now find my way around  without any trouble, l but my apraxia could definitely do  with improvement 🙂 My brain still  sometimes confuses my left with my right hand,  but this has its advantages;  it’s the perfect excuse  for broken dishes during washing up 🙂

But one-off the most most bizarre of the problems following, and resulting from, the stroke was/is the distinct idea – feeling, really — that a new   person now occupies the mental space I’d thought of exclusively as ‘me,’ or I should say ‘us,’ ‘us’ the community of cells which make up our ‘selves.’

It was a frightening realisation. To all intents and purposes, the trio comprising Me, Myself and I had died on the operating table. ‘We’ no longer existed.

This also dramatically affected, and continues to affect, my wife and my daughter Emma, who are doing their best to put up with the sudden outbursts of temper, depressions and moodiness which characterise the new Jon, as well as all the other things associated with recovering from two heart attacks and major surgery, and a stroke.

For myself, I’m grappling with fundamental questions such as who is this person, this interloper who’s squatting in my brain? Will he evolve into an entirely new ‘Jon’ with new perceptions and thoughts? Or will he be a mere shadow of ‘ his’ former self? for 3 or 4 weeks,  I’d get lost  every time I went to the dining area,  or for therapy session,  or anything else.

Will  there be a positive side?  Will I  now be able to do things I’ve never been able to do before?

So far,  there’s no sign of  me developing any extraordinary new skills,  but I’m still hopeful 🙂

Certainly, there already are major changes. For example, the stroke also resulted in a condition called “left in neglect,” which means although I perceive things on my left, sometimes they don’t register in my brain, which leads to obvious difficulties such as collisions with tables and chairs – and people,  and a tendency to take out  door ways.

I now have a collapsible white cane,  which I occasionally use in crowded places, not so much for finding my way around, but more so people will see me coming.

In his wonderful book,The Telltale Brain, neuroscientist VS Ramachandran  puts it like this:

 […  ] “the parietal lobes  are primarily involved in processing touch, muscle and joint information from the body and combining it with vision, hearing, and balance  to give you a rich ‘multimedia’ understanding of your corporeal self and the world around it. Damage to the right parietal lobe commonly results in  a phenomenon  called hemispatial neglect: the patient loses awareness of the left half of visual space.” 

And speaking of ‘leftness’I sometimes  my left arm or leg  will touch something  and I have to  look  because  there’s a  feeling of vacant space  instead of actual sensation,  if you can make any  sense of that.

On the brain’s  amazing ability to  quite literally rewire itself, [… Starting in the 1990s,  this static view of the brain was steadily supplanted by a much more dynamic picture.  The brain’s so-called modules don’t do their jobs in isolation; there is a great deal of back-and-forth interaction between them, far more than previously suspected. Changes in the operation of one module — say, from damage, or for maturation, or from learning and life experience — can lead to significant changes in the operations of many other modules to which it is connected. 

To a surprising extent, one module and even take over the functions of another.  Far from being wired up to rigid, prenatal genetic blueprints, the brain’s wiring is highly  malleable — and not just in infants and young children, but throughout every adult lifetime.”

 But there’s a second,  for me, far worse problem.

There’s an unusual condition in which my central vision in both eyes is partially obscured by a patch of brightly coloured lights/shapes superimposed over whatever I’m looking at at any given moment.

Although I noticed and mentioned these visual obstructions early on whilst undergoing neural rehabilitation at the Victoria General, the condition is still undiagnosed, so I did a little research of my own and discovered it’s probably something called “scintillating scotoma”. Sometimes it’s known as the “fortification spectra” because, as Dr Gordon T Plant points out, very often it also bears a remarkable  similarity to ancient fortifications in the Dutch town of Naarden.

Moreover, while it’s often confused with ocular migraines, which present  the same visual obstructions, the crucial difference is that ocular, or retinal, migraines  typically only involve one eye.

I’ve had so-called ‘ocular migraines’ for years but what I experience now is something totally different: ocular migraines generally end in about a half-an-hou  whereas my pretty pictures are,, permanent fixtures which are with me day and night.

As I’ve mentioned earlier, there’s no firm diagnosis yet and I’m still awaiting the results of a recent MRI scan of my brain.

Neuro-plasticity

Doctors, scientists and other professionals until fairly recently believed once the brain was imprinted it couldn’t be changed.But they were wrong. Our brains are frequently compared to computers and this comparison is accurate in more ways than one.

A computer memory comprises a hard drive on which data are  written and stored, Our brain is our body’s hard drive and, like a computer’s  parts of it it can be overwritten.

This is known as neuroplasticity, short form for the process by which the brain quite literally modifies itself, or creates new  routes ort pathways  for lost functions or abilities. And it’s an  absolutely essential part in my recovery.

However,neuroplasticity  has only fairly recently  been generally accepted as a healing and transformative force. It has important implications  for recovery,  in many fields such as addictions.

Problems, problems

Recovering from any kind of major operation requires significant withdrawals from your body’s reserves. And when you’re also trying to deal with a stroke, you can double that.

I used to run p2pnet.net, a well-known Canadian freedom of speech advocacy site, relying on advertising for income. But, in late 2009, when the economic downturn took hold in the US where many of my advertisers were, I lost  practically all of that income and Liz and I had to quickly find another way of making a living.

We decided to turn to something we’d already dabbled at a few years before and in February 2010, we launched a small business making gourmet hot sauces which, initially, we sold at local farmers’ markets. But it didn’t take long for Dad’s Westcoast Wildfire Awesome Sauce, as we’d called it, to catch on and soon retail outlets on Vancouver Island the were carrying it.

Just before I first went into hospital, we’d reached a critical point in developing our venture, where we had to make a major marketing push to get our business to the next level. It  but it would’ve had taken the two of us to do it.

For the ten weeks I was in hospital, my wife had the burden of running our start-up  by herself, bottling, capping, labelling, printing labels, driving an hour each way to and from the hospital, driving to Victoria’s open-air markets, looking after our teenaged daughter, Emma, and dealing with a number of other issues, all without help.

She had to do everything to keep the business from collapsing. And while all this was happening, instead of helping her, I was worrying myself even sicker in hospital, fretting about how things were going.

This combination meant I was a very bad patient.

For the first while, my left arm and leg were paralysed, but thanks to the miracle of neuro-plasticity  and the unstinting efforts  of the rehabilitation stuff, it wasn’t long before I regained most of the functions on my left side.

Other problems from my stroke are slowly getting resolved and now I’m left with my as yet undiagnosed vision difficulties which have yet to be sorted out.

There are still plenty of hurdles to overcome as part of my recovery,

However, as a recovering drug addict and alcoholic, I try to always remember  one day at a time  and that none of us has any more than the one single minute of time that’s our life – the’ instant’ we all live in.

Knowing that, we can survive and overcome anything.

Having said that,  how are things today,  and weeks and months  after surgery?

Physically, they couldn’t be better.  Once again,  I’m able to help Liz   with our embryo business — lift cases, and so on.

But I’m still struggling with  difficulties  relating directly  to the stroke.

However,  looking back  I didn’t expect to be  able to do the things I can do now  (for example,  I used to play guitar  but  for long time long time,  I completely lost interest not only in it,  but in music generally.

Now  I’m slowly  relearning  guitar,  and my enjoyment  of music  has returned  in full.

So,  things could definitely be worse.

I could, for example,  be dead 🙂

[Follow me on Twitter @jonnewton8, and/ or identi.ca]

 

 

 

 

One thought on “Stroke

  1. Thanks for sharing your story Marie: I’ll respond in more detail in an email. But for the moment, don’t do what I started to do yesterday, which was leave my cane at home because I somehow felt like a fake or phony for using it when in fact I’m not blind in the traditional sense of the word.

    It was a dumb thing to do. We both need to let people know we’re visually handicapped.

    I know exactly what you mean when you say you’re afraid of bumping into people with hot coffee or young babies. And neglect also means life can be dangerous for us. I’ve twice nearly been run down by motorcyclists turning into my space, once recently (yesterday in fact) and once quite a while back.

    Also, coming out of alleyways can be intimidating.

    Anyway Marie, I’ll email you separately and don’t give up. One of the reasons I stopped using my cane was because of the neuroplasticity phenomenon; I figured if I stopped using my stick, my brain would eventually compensate; perhaps it has and perhaps it will, but it isn’t happening fast enough for to be meaningful for me.

    We don’t see with our eyes; we see with our brains

    So for now, cheers and all the best … Jon

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