On Strokes and (Personal) Sustainability

I have a long list of backlogged posts but am taking a brief break from tracking global sustainability to check my personal operating systems.* A stroke will do that to you.

I summarized one moral of the story below in this Tweet:

Don’t stress your carotid arteries if you like your brain & the things it does for you.

There are other lessons here, one being that stroke is not restricted to what you might call “the usual suspects.” Here’s what happened. After I took a marvelous, although stressful, run with my older son up our Chimney trail, one of my eyes started giving me Peter Max-style input when the world is not Pop Art. The root of my problem was damage to the lining of my left internal carotid artery. The vision problem presaged a stroke. [I forgot to include what could be an important detail; after my son drove me home, and before we headed to the hospital, the first thing I did, on instinct, really, was to down 5 or 6 baby aspirin.]

Read the following updates from the bottom up for the chronological view (my health-blogging colleague Tara Parker-Pope noted that my initial post had some — not surprisingly — confusing elements*):

Here’s one of my occupational therapy tasks, in which I focus on grasping and manipulating small objects with the two fingers that lagged most following my stroke:

As my typing improves, I still can’t get over seeing the damage to the left side of my brain in this MRI image following my carotid dissection and “minor” stroke. I feel beyond lucky given what I’ve learned of others’ experiences. Karin Nystrom, a close family friend who’s a stroke nurse, gave this sobering deconstruction of the image:

Your stroke “picked off” the corona radiata – an area of white matter underneath the cortex (the cortico-spinal tracts run through it from the motor cortex on down), which explains why you had the symptoms you did.

We also call these strokes “watershed” – very much indicative of bits of thrombus from the carotid travelling up through the middle cerebral artery (MCA) and then out to the branches.

Watershed, indeed.

All’s basically well as I collect my various hospital records, watch my vitamin K veggies to be sure I’m not interfering with my blood thinning medication, and work on regaining my keyboard and fretboard dexterity.

One weird issue, which I’ve noted has popped up for others is a pulse-timed whoosh in my left ear, presumably related to the resumed, but restricted, flow in the damaged left interior carotid artery. It’s called “pulsatile tinnitus.”

It’s been quite a week since I joined me elder son in run up a wooded trail and my left eye started sending scrambled signals to my brain.

After a quick stop at the closest hospital, where an ultrasound and then a CT scan revealed no flow in my left carotid artery, I was shuttled to Westchester Medical Center, joining the steady stream of stroke and similar cases funneling past Dr. Michael F. Stiefel, Dr. Ramandeep Sahni and the rest of the medical and support team there. I’d like to thank them all, from the doctors to the ambulance drivers, the radiologists to the nurses and phlebotomists, the cooks to the counselors and cleaning crews.

I’m slated to head home this evening if my Coumadin anticoagulant function comes in as expected. Then there’s monitoring and therapy so my fingers on my right hand can once make the keystrokes my brain is seeking – not to mention the right guitar chords.

This Twitter exchange is worth highlighting as a reminder (one of many I’ve received about less lucky victims of strokes from carotid dissections) of how lucky I am to have deficits as negligible as typing trouble:

From Alex Wise, a musician and the host of Sea Change Radio, who Tweets as @SweetAl:

Thx for sharing details of your stroke w/the world, Andy. My mom died of a dissection of carotid artery on her 52nd b-day. Be well!”

My reply @revkin:

Terrible about your mom. I feel lucky with each mis=typed keybaord stroke. (Those typos are not a joke.)”

As I hunt and peck this post-stroke note, I’m exasperated by the inadequately realized potential of “Telestroke” technology to speed treatment in the first critical hours of care. Here’s one example of how it works. The five-foot-tall robot-style attending neurologist looks goofy, but this is important stuff.

This is a fantastic manifestation of how the human capacities for specialization, communication and technological innovation lead to rational optimism — although the pace of adoption has been achingly slow in the stroke field, as I’ll be writing soon.

I’ve begun some preliminary physical therapy:

Here’s what appears to be the most comprehensive paper on the condition I experienced on Friday: Painful Horner Syndrome as a Harbinger of Silent Carotid Dissection. (Hat tip to Karin Nystrom!)

Turns out I seem to have had a “dissection” of my left internal carotid artery (dissection in this case meaning a separate of two layers of the arterial wall, which can lead to clotting and reduced blood flow). Here’s an interesting instructional cartoon on one of the main visual clues, Horner’s Syndrome:

This kind of occlusion of a carotid artery, which can be the result of things ranging from blunt trauma to heavy exertion, appears to be the prime source of strokes in youngish middle-aged people — i.e. people like me.

Here’s the entry on Stroke Secondary to Carotid Dissection from The New York Times Health Guide and Gina Kolata’s article on the importance of prompt diagnosis and treatment for stroke.

Here’s the lay of the land, as illustrated for The Times health guide entry on stroke from carotid dissection:

[*I’ve made some small changes to the original text. Also, the section archived below has been moved from the top:

Let’s all take a break to check this communication system, too. I think Dot Earth, and perhaps the blogosphere more generally, feels a bit stuck in some ways. One thing I’d love to see renewed here is people posting YouTube greetings and comments to humanize their Web presence. Use this post as a means of expressing your views on how to harness the Web to help shape the human enterprise in ways that lead to the fewest regrets.]