Well: My Stroke of Luck

Twenty-two months ago, I interrupted my nonstop reporting about paths toward a sustainable future for our species to focus on sustaining myself. The hiatus was not by choice, but was?mandated by a stroke ? the out-of-the-blue variant, the rare kind of ?brain attack? (the term preferred by some neurologists) that is most often seen in otherwise healthy, youngish middle-aged people.

It?s Fourth of July weekend, 2011 ? a beautiful, if hot, morning for a run in the Hudson Valley woods with my son Daniel, back from brief service in the Israeli army. I?m eager to be pushed hard. I?m not even a?lapsed?middle-aged athlete; I?m truly negligent when it comes to exercise.

We?re jogging up a steep path, and my breathing gets deeper and faster. At a particularly tough turn, I pause, hands on knees.

?Come on, keep it up, Dad.?

I?m panting but don?t want to disappoint. We press on. But I stop again, this time insisting that Daniel run ahead. I rest in the mottled shade and sunlight of the woods until he returns. Then I realize that through my left eye, the world appears paisley ? as if I were looking through a patterned curtain. Something is really wrong.

We make it back to the car. Daniel takes the wheel. Back home, I take a shower, thinking that cooling off will help.

For the first time, a thought flickers. Could this be a stroke? Almost unconsciously, I take half a dozen baby aspirin. I know enough about aspirin?s blood-thinning properties to think this can?t hurt.

I call my doctor?s office and the receptionist says I should go to the emergency room.

We head to the hospital. Although it?s a designated stroke center, there is no stroke neurologist around on this holiday weekend. A CT scan shows nothing. Vitals are normal. But I realize something is still wrong when I get an eye test in a hallway. I can see the letters on the eye chart, but not the?hand?of the nurse pointing to a particular row.

Also, my pupils are different sizes, a condition that I later learn is called?Horner syndrome and can presage a stroke.

Nonetheless, the hospital plans to release me. I push back, recalling that months earlier my doctor, as a midlife precaution, had recommended ultrasound scans of my carotid arteries to be sure there wasn?t any buildup of plaque. Maybe they should try this?

Preparations are made for an ultrasound of my arteries. But the technician holding a gel-covered probe against my neck has a puzzled look. She can?t find my left internal carotid artery. She asks for a second opinion.

I vividly recall hearing the words, ?There?s no flow in your carotid artery.?

My first reaction: How can that be the case while I?m sitting here conscious and listening to you?

I would later learn that my left internal carotid artery had no flow because of what is known as a ?spontaneous dissection.? The artery lining had peeled away and blocked the vessel.

This kind of injury can result from certain?yoga moves, painting the ceiling, tipping your head back?for that soothing shampoo at a salon, possibly a?chiropractor visit (research is equivocal), even a coughing fit. Or, evidently, a tough run on a hot day.

In hindsight, all I can think about is the doctors? mantra about stroke: ?Time is brain.? More accurately: Time wasted is brain lost. It seems to me the hospital staff ramped down their concern about my case just when they should have been swinging into high gear. The ultrasound, at least, confirms there is a serious problem.

The doctors arrange a transfer to a bigger regional hospital. My wife, who had been at a job interview, has caught up with me, and we have an ambulance-and-Prius parade to Westchester Medical Center.

I haven?t had a stroke yet; stroke is loss of brain function. But it is coming. At the hospital, there are more tests and tubes. Finally, I get intravenous heparin to prevent blood clots, but probably too late.

Seeing the Damage

I?m sent to the neurology ward, which is a deeply unsettling experience from the start. The man in the bed next to mine, an actor with an aneurysm, alternates between saying he?s dying and calling nurses to insist that he needs to leave to get to the set of ?Boardwalk Empire.? Late that night, I fall asleep to the moaning and howling of an unseen old woman down the hall.

If you can avoid the neurology ward, do so.

Sometime that night, blood clots break away from the damaged artery lining and flow up the middle cerebral artery into my brain. I awake to a bad headache, a throbbing left eye socket and the realization that three fingers of my right hand aren?t working.

Now M.R.I. scans do show damage. I?ve had a stroke. I learn I have to remain in the hospital for a week as I?m put on warfarin, a blood thinner also used as rat poison.

A week in the hospital. What to do?

Blog, of course. I hunt and peck, writing a post for my blog, Dot Earth, on the need to sustain your health if your broader goal is sustaining the a thriving planet. I also get focused on building stroke awareness on Twitter.

Tapping on my laptop with unfamiliar fingers, I learn that stroke?kills 130,000 Americans a year?and is the leading cause of disability. Horner syndrome, I find, is often the first sign of carotid dissection. Recent studies have found the mean age of stroke occurrence is declining, with 19 percent of strokes in people younger than 55. Some stroke specialists who have studied misdiagnosis in stroke victims younger than 50 have proposed a push for ?young stroke awareness? in staff in hospital emergency departments. The American Academy of Neurology has created a task force on stroke in young adults.

And I learn of a solution for hospitals, like the one in my suburb, when they have no stroke specialists on duty: telemedicine.

Through something like Skype on steroids, any stroke specialist could provide virtual care in any emergency room. The technology is most developed in places like Arizona, where it connects big urban teaching hospitals to dispersed rural health care centers that will never have a stroke neurologist. Most of the signs of stroke are visual, meaning an expert diagnosis and swift application of the right medication are possible without laying on hands.

I interview Dr. Yulun Wang twice, first using his technology ? with me at a Long Island hospital and Wang in Santa Barbara ? and them when I visit his company,?InTouch Health, a few months later. Here?s Dr. Wang describing these tools and the hurdles to wider adoption of the technology:

The merits of telemedicine seem utterly obvious, but I learn that Medicare and insurers don?t reimburse for this sort of care, with a few exceptions, because the doctor is not physically at the bedside.

Well, there was no living, breathing stroke specialist at my bedside to bill in those first vital hours. Give me a virtual doctor any day.

There are other impediments to what?s called telestroke technology, including licensing roadblocks preventing doctors from practicing across state borders.

You can learn more about research showing the cost-effectiveness of telemedicine for stroke and the hurdles to its adoption in?my Skype chat with Dr. Bart Demaerschalk, the director of the Mayo Clinic Telestroke Program in Arizona and an author of an important 2012?paper on telestroke cost-effectiveness.

New Chance, New Vows

After my week in the hospital, I dive into my physical and occupational therapy. I also make lots of vows.

? I vow to write a hard-hitting print article about stroke care.

? My wife gives me a card for a personal trainer. I start working out.

? In the interest of not torturing my neck, I vow no more red-eye flights.

? I?ve played guitar since I was 17, but never with much discipline. I start doing scales.

So how am I doing? I?ve stuck with almost none of those commitments.

Run-ins with the reaper cut in two directions. Part of you swears to slow down, to smell the roses, to get closer to loved ones. But part of you ? me, anyway ? says life is short and tenuous. Get everything done now!

I posted 322 times to Dot Earth in 2012. The flow of news on my beat pushed my stroke article to the far back burner. My workout routine and guitar scales faded. I?ve taken several red-eyes, with more coming. I?m on the run, in many ways, more than ever.

But I am humbled by one thing that I learned. I was pretty smug, once I recovered, about having scarfed down those aspirin early on. Experts tell me that act probably did mitigate the effects of my stroke. (My fingers and vision are fine.)

In my later research, however, I realized that if I?d had a bleeding stroke, the kind that almost killed?Jill Bolte Taylor ? the neuroscientist who wrote ?My Stroke of Insight? ? the aspirin might?ve killed me. Roughly 1 in 10 strokes are of the bleeding variety.

So yes, this was my stroke of luck. As it turns out, luck played a bigger role in my being here today than I?d like to admit.

Source: http://well.blogs.nytimes.com/2013/05/13/my-stroke-of-luck/?partner=rss&emc=rss

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