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The Irish Stroke...

posted in JoMo's Musings by Last Ditch Racing


For some reason, I feel like I need to recount the tale of my recent brush with the emergency room and mid-life health crisis. Partly so I don't forget what happened, and perhaps so that others might be a bit more informed in case something similar occurs for them.

About a week ago, I was doing bills at home, and was planning on meeting my oldest son for sushi-one of our favorite meals-that evening. I had some time in between, so I reluctantly prodded myself into doing a TRX workout at home. I had just installed the TRX and really had no excuse to not give it a go. My good friend/trainer, Scott, had recently sent a couple of workouts over via email, so I decided to go with the one with the least reps-don't tell him! ;-)

The workout seemed harder than usual, and I fatigued pretty quickly, having to adjust my angle on the TRX to finish the sets. I was sweating quite a bit more than usual, and had to make a couple trips inside to towel off during the workout. After I was done, I reflected that the workout was perhaps deceptively harder than it appeared on paper and perhaps even cursed Scott under my breath. I went to fix my usual post workout protein drink and headed upstairs for a shower.

The perspiration didn't stop. As I got to the bathroom and turned the shower on, I realized that my head hurt. It really hurt. I hung onto the bathroom counter and looked at my eyes in the mirror. Everything looked ok. I hung my head down, thinking that perhaps I had pulled something in my neck. Bad idea. Pain was worse.

Being a medical professional, and a student of mid-life fitness for some time, I realized that I wasn't ok. The question wasn't if something was going on, but what?! I thought I might have done something to one of the couple bulging discs in my neck. My arms and hands were tingling, but equally. Vision was ok. Everything seemed to move ok. Headache was really bad. Some nausea. Perhaps some dizziness. Could it be some sort or arrhythmia, elevated blood pressure or something vascular going on in my head?

Whatever it was, it wasn't ok....FML

I got in the shower, thinking that I could perhaps help any blood pressure issues out with some cool water. I also was sweaty and thinking that I should soap up before heading to the ER, which now seemed an eventuality.

I felt worse in the shower, and decided to sit on the floor-it's stone and I didn't want to fall/pass out, adding injury to my existing condition. Once sitting down, I realized that didn't feel any better, so I decided to lay down and elevate my legs. Even worse. Great. Now with my ass blocking the drain and realizing I had a long way up to become upright again, I started to move slowly towards the stone seat in the shower, hoping not to slip. As I ran through the differential diagnosis while sitting in the shower, looking out my window, I figured that if it were an aneurysm causing my issues, I'd had likely not made it far enough to reflect on a differential diagnosis...

I had considered taking my phone into the shower with me in case I needed to call for help, but figured I'd give it some time. Bad choice.

Pain and nausea persisted. Needed to move bowels, which was unexpected. Managed that, but the increase in pain was terrific. Figuring I'd multi-task, I texted a friend for, "a tide to the ER." Auto-correct could've been worse, I suppose.

I managed to get somewhat cleaned and dressed and made my way downstairs just as my ER ride arrived. Made it to the hospital and the front desk staff asked what I thought was going on. "I think I'm having a vascular accident and need you to fire up the scanner."

"Have a seat and we'll be with you when we can." I was having issues with my temperature. Sweats, hot, freezing, shivering. When I got in to see the triage nurse, they were unable to get a temperature on me. The look on the nurse's face wasn't reassuring, but I think my look seemed to say, "I told you so...."

The ER was packed. Of course. The staff were great, but most of the specialists work at the larger hospital across town. This one was closest and seemed the most prudent to go to. The provider came in and I asked for something for pain. Anything. Just give me anything. I knew this was a difficult request without a diagnosis, but some morphine was on it's way which helped, along with some nausea med.

A couple IV's were started and, after what seemed like a long time, likely about 45 minutes. I was in the CT. Once back in the ER, the word was that I had a bleed around the bottom of my brain. Neurosurgeon was consulted by phone and a CT-angiogram was ordered. Wonderful contrast solution that makes you feel like you've pee'd your pants when they inject it.

Yup, there was a bleed. "Substantial amount of blood," was the word from the neurosurgeon. Some hydrocephalus, which is swelling of the cavities in the brain due to the cerebral spinal fluid not being able to circulate as it should. More morphine.

Everything was a bit surreal through the ER visit. Lots of voices. Lots of rolling down halls. Talks of helicopter flights to Portland or perhaps a ride across town to the other facility. The concern was whether there was an aneurysm causing the bleed that couldn't be seen through all the blood. Luckily, I've had a few head scans over the past couple of years. The neurosurgeon could look back at these and see that the vascular structures all looked good. She consulted with at least two other surgeons, who both agreed that they didn't think there was an aneurysm present.

As I was laying in the hallway, waiting for some sort of disposition, a wave of increased pain shot through my head. It was likely the most unbearable pain I've experienced in my life. All I could think about was that bad things were happening that were out of my control. There wasn't much about that day that was in my control.

Once it was determined that the likelihood of an aneurysm was low, I was transferred to the Critical Care Unit. Neuro checks every hour through the night and a steady cocktail of morphine and dexamethasone were given IV. Temperature regulation continued to be an issue and my blood pressure was high. No doubt due to the pain.

By the next day, I was feeling quite a bit better(relatively), and was transferred to a medical floor, followed by discharge to home the next day.

The questions I'm getting now are the normal: "What happened?" "What did they say caused it?" "Will it happen again?" "Are you going to be ok?" I think what people are really asking by that last one is will I be somewhat more normal than my pre-event status. ;-)

I'll have a followup with the neurosurgeon in another week, with a repeat CT-angiogram prior. The official diagnosis is, "peri-mesencephalic sub-arrachnoid hemorrhage." This is thought to be a bleed from the venous side of the circulation near the brainstem and not arterial. Most sub-arrachnoid hemorrhages are caused by Berry aneurysms or arterio-venous malformations, requiring surgical correction.

The change of recurrence for my type of bleed is <1% by some counts and life expectancy seems to be normal, with most folks enjoying a full recovery. The psychosocial effects of an event like this are perhaps a bit more concerning and there hasn't been a lot of research on it.

So, what now? Well, no work for at least a month. My instructions are to watch the grass grow. Sleep is terrible. Headache is terrible at times and not really helped by meds. I'm sensitive to light and sound. I'm fatigued easily and have a general sense of disconnect from the world around me. Very strange. The blood in the brain and spinal cord eventually gets reabsorbed, and the irritation from it being there(where it shouldn't) are what cause a lot of pain in the low back and hips, as well as the headache.

Of course, side effects from the pain meds and steroids are hard to tease out, and they can be significant.

I'm calling what happened to me, "The Irish Stroke," because I feel like I have a horseshoe stuck up my ass. To be essentially neurologically intact, able to walk, talk, type and do everything, amazes me and is a testament to the body's ability to tolerate great injury-especially something so fragile as the central nervous system.

While in the hospital, many of the staff shared with me stories of colleagues, friends and family members who were far less fortunate than I.

The cause? Almost forgot. 15% of cases of PMSAH have no identifiable cause and it seems that it's been studied only since about 1985. The neurosurgeon is quite sure that a rise in blood pressure during my workout was what caused the bleed. My poor exercise tolerance over the couple of weeks leading up to the ER visit could've been related. Or not.

Because it requires no surgical intervention, the specialists have deemed this to be a, "benign," type of hemorrhage. Although the mortality rate from PMSAH is less than SAH due to aneuysm, I'm not sure that any brain hemorrhage can be classified as, "benign."

I'll likely get a baseline neuro-rehab consult and make sure there are no deficits that I'm not picking up on. Slowly increase activity and eventually start driving again.

Rally racing? Let's just say I'm happy to be able to sit here and make my fingers work and have my neurons fire at the moment. The risk assessment skills I developed over years of racing allowed me to run through a physical checklist during this crisis, and I thank racing for that. Prioritizing and thinking rationally under pressure is a good skill to have.

So I'll end with some advice. Pretty standard stuff. Eat well, be well, exercise, see your medical provider regularly. Even if you're healthy-I certainly look good on paper-doesn't mean you're immune from catastrophe.

If you're brain is sending you warning signals, LISTEN TO THEM! I can't emphasize that enough. We all have a built in DEFCON 3 warning system that us in the medical establishment call, "a sense of dread." Seems to be hardwired, and an antidote, to that that thought-"I'm sure it's nothing-I'll be fine." Listen to your gut and stay safe.

A huge thank you to all the nurses, technologists, specialists that cared for me in the hospital. Thanks to my family, friends and the LDR team for being there in my time of need. You all hold a very special place in my heart.

Cheers! JoMo

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