Wednesday, November 21, 2012
Missed It by That Much
That's just under half an inch. And apparently that was the difference between me making a full recovery and me blinking my way through life.
I went to see my neurologist today, a very capable, humorous, and accessible man named Dr. Silver. I felt very comfortable in his presence. He examined me, by giving me an abbreviated version of the NIH stroke scale, which I told him I knew all about. He asked me how I knew so much about the diagnostic process, and in response I told him, "I know a thing or two about a thing or two," which is one of my favorite lines. He was warm and funny, and quite thorough. I'm glad he's my neurologist.
One of the things he did was show me the CAT scans associated with my stroke. He pointed out where the bleed took place, which was more like in the exact middle of my brain at the very top of the brainstem, instead of towards more of the back of the neck, where I thought it was. The bleed was 11 mm in size. But that's not the 11 mm that I was talking about earlier.
You see, if the bleed was just a little bit bigger, say 22 mm instead of 11 mm, it would've encroached upon an area of my brain that is associated with "locked-in" syndrome. 11 mm — .43 of an inch – separated my more or less full recovery and disaster.
I have to say, that rattled me pretty good. He told me quite matter-of-factly that if the bleed was 11 mm posterior to where it was, I wouldn't be in the office today. I'd be were I would always be, in a hospital bed, there to stay for the rest of my life.
Locked in syndrome, by the way, is when you're completely paralyzed, completely unresponsive in every way, with the only thing you can do of your own free will is blink. There is a famous book and movie about it, both titled "The Diving Bell and the Butterfly," where somebody with locked in syndrome dictated an entire book to his caregiver who, letter by letter, would go through the alphabet and the guy would blink when the right letter was gotten to. That redefines "painstaking."
I knew I was lucky, even though I put a lot of hard work in to facilitate my recovery, that I had a chance to do so, instead of sustaining permanent damage. But I had no idea how close I came to a nightmare existence of complete musculoskeletal unresponsiveness. I can't even imagine a more or less intact brain inside a body that offered no ability to express itself. I really don't know how long my will to live would have sustained me, and most of my effort would have been taken up with me painstakingly blinking a request to end my life. Instead of glibly trading bon mots with the doctor, I could have been, to use a cynical expression, a potato.
That gave new meaning to the term "perspective."
I also learned some things about the nature of hemorrhagic stroke. Before, I had counted myself lucky that my stroke was the result of the bleed as opposed to that of a blood clot. As it turns out, though, you're better off getting an ischemic stroke than a hemorrhagic one, because doctors can give you medicine that dissolves a blood clot almost instantaneously — but they can't do squat for a bleed. Best they can do is hope that the pressure caused by the bleed closes the blood vessel before any significant damage is done, and then try and work with what is left. Funny little sideline – if they think you have a blood clot when you really have a bleeder and they give you the anti-clot drug, it will just keep the open blood vessel bleeding and you will end up with a good case of death. That's why, even though time is such a factor, they got to give you a CAT scan before they give you the drug.
But the visit wasn't all jarring news. For example, in response to my request, and after he examined me ("you're giving me the NIH stroke scale! How quaint."), He pronounced me fit to drive, and authorized same. Yay! A quick call to AAA to have them inflate a tire that has gone flat, and I'll be back to being a menace on the road. I can't wait.
I had to walk from the front entrance of the hospital to the doctor's office, a distance of approximately 275 miles, after which funny enough I found my gait to be markedly improved. It seemed a lot more natural, without me having to think about it. And navigating my way to the parking lot where the car was involved a lot of curbs, rough surfaces, inclines and declines, and just to round things out, a set of stairs – all of which I navigated completely naturally without any troubles. Hosanna in the highest. Don't get me wrong: my career as an international ballet star is over. But I can get from point A to point B without having to worry about taking a digger into a mud puddle.
I got some encouraging news about my overall recovery. My doctor indicated that the window for me to recover coordination that I have lost is far from closed, and that I had the better part of a year to improve my condition. It's time I have no intention of wasting.
This NIH stroke scale that I keep talking about, by the way, is a standardized series of tests to determine consciousness, cognition, limb control, speech clarity, and sensation. Each individual test is scored with your aggregate score representing roughly how severe your stroke is. The lower the score, the better. Someone who had a major stroke, for example, who was severely aphasic (aphasia is roughly defined as the inability speak properly or to comprehend speech), paralyzed on both sides of the body, and unable to feel stimuli such as a pin prick might score as high as 25 on the stroke scale. Me, I scored an eight, which was pretty damn low.
I bring this up because one of the questions I asked the doctor was, was he surprised at the degree to which I made a more or less full recovery. He told me no; my low stroke scale score was a decent predictor of my ability to get back what I had lost, though he was glad that I put in the work and got the job done.
Well, you now probably know more about strokes than you ever cared to, but I hope it's at least interesting. If you've nodded off by now it might be an indicator that YOU need a stroke scale test. Can you tell me what month it is? Do you know where you are right now? Hello? Hello?
Thanks for paying attention. Go see a doctor if you haven't done so recently.