Stroke: TIA Transient Ischaemic Attack

10 September 2024. I had a mild stroke TIA, Transient Ischaemic Attack. Here follows my TIA stroke, hospitalization & some rehabilitation:

Background information: A week before my TIA stroke I did a training walk of 17km as I was getting fit again for South Canterbury mountain tramps during summer. From my Pleasant Point home I walked the following roads over rolling hills, a circular walk: Afghan St, Manse Rd, Smart Munro Rd, Doake Rd (steep hill), Levels Valley Rd, Driscoll Rd (another steep hill), SH8 back home. I considered myself fit & healthy. (I'd twice run Comrades Marathon between Durban & Pietermaritzburg in my youth). A recent blood-check & ECG by my Geraldine clinic GP showed I had low blood cholesterol & normal ECG. Post-Covid vaccinations & pandemic, I was concerned I had Long-Covid as I had intermittent heart palpitations over the years. From Timaru Hospital, I wore a heart-monitor holter for a day to monitor my heart beat.

Three years prior to my TIA stroke, aged 70, I had Cochlear Implant surgery at St Georges Hospital, Christchurch, as I was profoundly deaf. Prior to my CI surgery I had to have a meningitis vaccination & ensure that my Covid-19 booster vaccination was done. There were no cholesterol, blood pressure, heart, allergy problems in the lead-up for my Cochlear Implant surgery. Subsequent audiology rehab at St Georges Hospital enabled hugely improved communication. But the external processor of the Cochlear Implant was badly designed, its microphone was aimed backwards causing background-noise interference, e.g. kitchen noises, LOUD TV ads when trying to converse simultaneously, cafe music, etc. That caused intense irritation & "flight-or fight" adrenalin spurts increasing my blood pressure as I resisted annoying background noises!

I never used Cochlear speech exercises touted by Cochlear firm in a boring manual nor listening exercises touted by rehabilitationists. I went my own unconventional way paying Spotify premiums & listening to lots of music & podcasts. My Cochlear Implant hearing soon improved.

7 September 2024. I drove with wife Leah from Pleasant Point to Ashburton. Cheesecake treat at a local nursery cafe.

8 September 2024. I mowed our garden lawn & verge using our electric mower, a two hour gardening job.

9 September 2024. I hand-raked our lawns to make compost. I tidied our garden after the previous day's mowing. In our garden shed I wire-brushed dirt off our firewood.

TIA Stroke. Day 1. Tuesday 10 September 2024. Hospital admission. At my Pleasant Point home, soon after midnight I was doing word puzzles & watching Al Jazeera TV news when I had my TIA stroke. I didn't know it was a stroke then. I thought it was vertigo caused by my profound deafness (Menieres Disease). I felt dizzy, nauseous, unable to walk properly. Left-handed, my handwriting degraded while I tried to do word puzzles. My speech was slurry. I did eye-excercises to EMDR-control my vertigo, to no avail. EMDR eye excercise & bed rest usually sorted my vertigo.

I had a disturbed night, tossing & turning in bed, still not knowing I had a stroke!

After breakfast, (hand-control of cutlery & crockery wonky) I wobbled out to our garden shed for more firewood wire-brushing. Unstable, I carried firewood to our lounge fireplace. I rested in our lounge, watching TV & reading. After a wobbly lunch I did Pilates exercises on our bed. (Leah attended weekly Pilates classes). I vomited! I did a Google search, finding I had stroke symptoms: slurred speech, limb movement affected on my left side. A search described carotid artery stenosis, narrowing of the carotid arteries due to plaque! That caused blockage of blood-flow in an artery starving my brain of nutrients & oxygen. In Timaru Hospital I later learned the medical jargon TIA: Transient Ischaemic Attack! My deafness vertigo & stroke weakened mobility left me with walking problems: I walked like a drunkard, feet wide apart for "balance". My left leg intermittently buckled at the knee...

Late afternoon, Leah drove me to Geraldine clinic. By then I needed my mountain tramping-stick to stop me falling when "walking". Clinic staff took one look at me & sent us to Timaru Hospital. Leah drove me there. We hadn't considered a hospital stay, so I didn't arrive with pyjamas, change of clothes, toothbrush, etc.

EMERGENCY Department, Timaru hospital: While waiting for two hours, I copied some of the Emergency wall-posters into my puzzle notebook. My handwriting was an illegible scawl. An Admissions nurse questioned me for hospital computer input. She placed a plastic name-tag on my right wrist. (In the following days nurses would ask my name & birthday!) She stuck a large needle into the back of my left hand, the first of many needle stickings over the next few days. She took blood samples from my arm.

While I was seated upright, a doctor questioned & tested me: "Smile! Stick your tongue out! Raise your eyebrows! Raise your arms! Press your hands against mine! Clap your hands while revolving your wrists! Close your eyes & touch your nose with your index finger! Press your feet against my hands! Stand up! Walk heel-toe in a straight line! Stand with feet together!" I fell to my left against a bed. "Fail!" said the doctor. "You've earned a stay In hospital. Lie on the bed!" I asked Leah to bring me a change of clothes, toothbrush, books, a pack of cards & battery recharger for my cell phone & Cochlear Implant processor.

While I clutched my trusty tramping stick, a male orderly wheel-chaired me in a lift up to the Medical & Surgery ward on the 5th floor where I would "sleep" 3 nights. First night I slept in a ghastly gown, open at the back, but attached with strings on my shoulders & down my back. I kept my pants on! I got little sleep due to nurses flitting past my bed at night. My bed was by the ward door near the toilet / shower room shared by three more men patients. I hobbled to the toilet using my walking stick. The toilet had a wheel-chair with a poop-hole on top of the standard toilet-bowl. The shower & toilet had stainless-steel bars attached to walls for support, preventing falls. The shower also had plastic curtains & a chair.

Nurses regularly took my blood pressure, pulse & temperature recordings on their wheeled-in machines. During the day, doctors with hangers-on did their noisy rounds, drawing curtains round patient beds & muttering... Not conducive to my peaceful convalescent sleep! A night-nurse woke me every few hours by prodding my arm to take her measurements. Day-nurses did the same measurements periodically, as well as asking whether I had urinated & had a bowell movement & showered! Nurses shone a torch in my eyes to check my retinas. Like blood pressure checks, temperature checks & pulse checks, retina checks were done frequently. Whenever I was woken at night, I searched in my bedside locker to fish out my Cochlear Implant processor & battery & install them over my CI above my ear before decent communication. Tiresome! A nurse even asked me if I wanted to see a priest. No thanks!

TIA Stroke. Day 2. Wednesday 11 September 2024. Breakfast & future meals: I ordered my meals from a daily tick-box page left on my bed-table with a jug of fresh water. Meals were efficiently provided by catering staff: soft, easily swallowed food, like porridge, boiled beans, mashed potato, ice cream...

A day-nurse stuck heart-monitor electrodes on my bare chest. Electrodes & the boxy heart-monitor, caused uncomfortable sleep. Next day she changed the battery of the heart-monitor before monitor removal. Another nurse stuck another needle in the crook of my elbow, taking more blood samples! The stuck needle prevented my sleep. As it was loose, I pulled it out, throwing the needle & plaster in a bedside bin! Dr R visited, questioned me & opined about my blood pressure & vertigo. She insisted I would feel "spinning." Balderdash! I had vertigo so far for four decades & never experienced spinning. I experienced dizziness, wobbly gait, scintillating scotoma & nausea when having a vertigo attack. Dr B visited, questioned me about my family history regarding stroke. He lectured me about smoking & boozing & on cholesterol production in the liver & plaque blockage of my carotid arteries. He suggested I get enduring power of attorney!

A Speech & Language therapist visited, giving me a slice of bread to eat, testing my swallowing. She questioned me about my work history & gave me a worksheet to rehab my slurry speech. Regarding my stroke she said: "Don't be hard on yourself. You got off lightly." The speech exercises were like oral exercises I did 50 years prior as a teacher student at Durban Teachers Training College & as a Speech & Drama student at Natal University: diaphragmatic breathing, enunciation, "Moo-Mo-More-Mah-May-Me..." I taught that oral stuff when I directed school plays in SA.

A Social worker gave me four pamphlets recommending I buy a hazard-button in case I fell or injured myself at home. The hazard-button Leah & I liked would call an ambulance but costed $30 / week service-charge! My house-perimeter-area would also need technical-vamping to enable the hazard-button to work. Hard-sell, as the Social worker needed a doctor's signature for me to get NZ govt funding. Commercial rip-off while I was vulnerable! I could get the same ambulance-call / cop-call service for free if I pressed my cell-phone emergency call-button! I was also questioned by doctors & physiotherapists about hand-rails for steps at my home. They were worried about me falling due to my poor balance & weakened limbs! I told them my front & back porch steps had hand-rails & there was also a wheel-chair ramp by another door.

A psychologist(?) visited, checking my cognition & memory: "Do you know where you are? What day is it today? What's today's date? Remember this word... I'll ask you for it later. Count backwards in threes from 100?!..." I asked the psychologist(?) if I was in an all-male ward. She carefully explained that the hospital had mixed-gender wards. A male orderly wheel-chaired me to the Radiology department for my brain CT scan. My CT scan would be interpreted by another Dr at Christchurch Hospital before my Timaru Drs could proceed. What a waste of time! Leah visited with my requested supplies. I dumped the gown!

TIA Stroke. Day 3. Thursday 12 September 2024. A nurse looked at my bare arm & whined: "How must I take your blood?" She jabbed a new needle into my elbow-crook for more blood samples! My blood pressure was elevated, over 200 systolic pressure! Could cause another stroke! Nurses encouraged me to get out of bed & sit on my chair. I wore my clothes & listened to Spotify music via my cell phone & Cochlear Implant. I listened to as many TIA stroke podcasts I could find to catch-up on medical jargon. I learned fast.

Dr R visited again, opining again on my "spinning" vertigo & that my elevated BP must be reduced. I guessed the medications I was fed by nurses each morning in little cardboard cups were lowering my BP. Dr B visited again & lectured some more. A physiotherapist visited, made me walk along a corridor to her physio-gym to do some tests, similar to what the admissions doctor did on my arrival at the Emergency dept. I was unbalanced, battling to walk properly. Later I wobbled to the toilet / shower room without using my stick. Leah visited. In addition to her work driving, she did daily 50km return trips when visiting me.

TIA Stroke. Day 4. Friday 13 September 2024. Lower Blood Pressure. The male orderly wheel-chaired me again to the Radiology department, this time for an ultra-sound scan of my carotid arteries. My carotids were approx 70% blocked by plaque! The Speech & Language therapist wheel-chaired me to the Assessment Treatment & Rehabilitation ward (AT & R).

A nurse weighed me on a weigh-chair. I'd lost 2 kgs in 2 days! I had a new ward-room to myself, natty shower & toilet room. Lovely sea views.

Settling into the A T & R ward, I scan-read my books. Nothing wrong with my reading, memory, thinking. I did word puzzles in my notebook. My hand-writing improved with practise. I asked a nurse to remove the admission needle from my left hand. It had not been used since admission!

I walked to the lounge, played Patience, watched TV with other patients. A truck-driver was legless in a wheel-chair. He did rowing excercises in the physio-gym. A retired Pareora freezing-worker plodded with his Zimmer-frame & noisily chattered, revving up nurses by sneakily smoking his hidden cigarettes. (Forbidden!) A Rasta-haired bloke pushed his tall walking-frame along corridors trying to walk properly. Most ward rooms had male & female patients. Leah visited with our youngest son who'd driven from Christchurch. We played Patience & Scrabble in the lounge. I walked with them to the hospital foyer door, my longest walk so far. I was determined to drop my walking stick.

A physiotherapist gave me 3 physio exercises to do over the weekend:

1. Stengthen my left arm & hand-grip by moving a yellow plastic-band (exercise resistance-band) tied to my chair. I had to stay seated & move the resistance-band away from my body then back across my body. Repeat as many times as I wanted.

2. Strengthen my hand-eye coordination & left arm / hand movements by building a tower of tapered plastic cups on my table, akin to kids' building blocks. Deconstruct the tower by restacking the cups one-by-one without the tower falling. Repeat. A nurse was amused at my clumsy efforts, saying I knocked down the tower like a kid.

3. Balance exercise as I was wonky: Stand up from my chair without using my hands & chair arm-rests for support. Push up with my stroke-weakened left leg. Then sideways crab-walk to my bed, turn & sit on my bed. Stand up from my bed using weakened left leg as push-up, turn, & crab-walk sideways to my chair & sit. Repeat.

The physiotherapist gave me cell-phone pics of me doing the exercises, so I got exercises right. Physio exercises should form new brain pathways replacing those destroyed by my TIA. i.e. Neuroplasticity. For the last 3 years, I'd already proved my neuroplasticity by playing Spotify music & podcasts into my brain with my Cochlear Implant.

TIA stroke. Days 5-6, Weekend. 14-15 September 2024. Not a physiotherapist nor doctor in sight. New offices empty, no staff meetings. Nurses, catering staff & cleaning staff ran the hospital! I checked out the wall-displayed pamphlets. I did my physio exercises. I relaxed: reading, Patience, TV viewing. Leah & son visited. He drove back to Christchurch

My hassles: swallowing & peeing. I vomited my curry & rice lunch! A nurse said it was caused by the shape of rice-grains. What a mess, I vomited a cup-full of mucous. I peed my pants! Couldn't "walk" to the toilet in time. My brain was healing slooooowly. Leah washed my dirty clothes & brought fresh clothes. Hospital saved money on laundry costs! Meanwhile an old lady was admitted to my ward-room. I think she'd had a heart attack. She was quiet, dozing behind her bed curtain. Her stream of visitors were noisy. No privacy!

TIA stroke. Day 7. Monday 16 September 2024. Using a faulty blood pressure cuff, a nurse caused bruising on my left hand & wrist. She repeated the test using another BP apparatus. A nurse stripped my pants off me & placed sticky electrodes on my upper thighs & lower abdomen for another test. She placed my breakfast-bib on my gonads for privacy. I was tired of all the testing! A nurse jabbed another needle into the back of my right hand, this time for another CT scan requiring blue dye to be injected into my vascular system to get a better view of my TIA brain damage. The dye injection & CT scan was done by another Dr. Timaru Hospital staff consisted of locals & others from all over the world. Dr B visited with a young Dr in tow, learning the ropes.

I had an assessment in the physio-gym done by 2 physiotherapists: Chair-sitting exercise to see if I could rise from a chair without falling. Physios tied a nylon-strap around my waist so they could catch me if I fell. I was asked to lean over & lean to my sides to see if my balance was OK. I was asked to walk in a straight line with a physio barking "Look left!...Look right!" while I walked. I laughed as the exercise reminded me of my conscripted soldier days in SA. A physio placed plastic cones on the floor & ordered me to stride-weave round the cones so she could stop-watch time my mobility. I did the exercise quickly. At a table, I was also timed taking little wooden pegs from a bottle then placing the pegs in rows in a wooden block & removing the pegs back to the bottle. I took that toy to my ward room, to accompany my plastic cup stacking. The physio made an appointment for me in the physio-gym for the next day.

TIA stroke. Day 8. Tuesday 16 September 2024. Dr B visited again saying I needed endarterectomy surgery at Christchurch Hospital to remove the plaque from my right carotid artery. When I asked if he would do the surgery he gave an embarrassed smile & declined. There was obviously no vascular surgeon available at Timaru Hospital.

I cancelled my appointment with the physio & returned her physio toys. Ambulances were in short supply (WHY?!) The chief nurse was in a transport bind, so Leah offered to drive me to Christchurch Hospital, a 3 hour journey. Two Social workers came to my ward offering to arrange Christchurch accommodation for Leah, but Leah had already booked accommodation at the old YMCA now called Give Hotel, Hereford St. We'd lived & worked in Christchurch for 19 years, including quake years, so knew our way around the city.

Leah drove us to Pleasant Point for me to dispose of my dirty washing & fetch a change of clothes. She drove me to Christchurch Hospital. Vascular dept, 8th floor, night-nurses were expecting me. I had a ward room to myself, overlooking Hagley Park & the CBD. A nurse gave me sandwiches for my late supper. Thereafter I ate nothing more & had a shower. Mr K visited & explained endarterectomy surgery on my right carotid artery. I signed consent forms for my neck surgery & donating urine & plaque for Canterbury University research. I played Patience & slept well. No noisy patients & visitors in my room.

TIA stroke. Surgery. Day 9. Wednesday 17 September 2024. The consultant surgeon visited & said I needed to shave my beard. I did, chivvied by 2 nurses. I peed a urine sample. A nurse pushed me & my bed to the surgery prep ward downstairs. Two more nurses prepped me for the surgery, chatting & covering my wedding ring with elastoplast. Two more needles in my left hand & wrist! Two anaesthetists prepped me & fussed. One worried about my Cochlear Implant electronics interfering with surgery machines. No problem after phoning my St Georges Hospital surgeon. My bed was pushed into the operation theatre. Vultures circled...

Approx three hours later I woke up in the recovery ward, a nurse checking I was OK. Mr K & an anaesthetist checked I was OK. Later a male orderly pushed me & my bed back to the 8th floor vascular ward recovery room. My Cochlear Implant processor was returned intact. My voice was croaky as a tube was shoved down my trachea to help my breathing during surgery. I was stuck in my bed, 3 plastic tubes sticking out of me: a drip tube in my left arm, a catheter in my penis for urine, a drain tube for gunge from my cauterised neck wound. A thick dressing covered my neck wound. My lower legs had socks intermittently constricting to stop blood clots. Leah, sons & their girlfriends visited.

That night I didn't eat supper plonked on my bed-table. I couldn't sleep, my throat was sore & I was swallowing mucous brought up from my trachea. I asked for a bed-pan, I needed a crap. A male nurse groaned & shoved a ridiculously small bed-pan under my bare butt while I lay tube- trapped in bed. I didn't use the bed-pan. I would've lain in my own shit!

TIA stroke. Day 10. Thursday 18 September 2024. Hospital discharge. Hangers-on & consultant surgeon visited: "Do you have swallowing difficulties?" Affirmative. "Stick your tongue out!". My tongue deviated to my right indicating successful surgery. If it had deviated to my non surgery side, it meant I had another stroke during surgery. Thankfully not.

A nurse removed my socks, & detached plastic tubes from my graunched body. Catheter removal: "Deep breath!..." She left a needle in my left hand which was bruised down to my wrist! My neck was bruised down to my clavicle! I removed the hospital's grotty gown. (A nurse had removed my pants while I was unconscious prior to catheter insertion & surgery). I dressed in my clothes. My eldest son visited & watched a physio in her physio-gym checking my walking & balance prior to my hospital discharge. Back in the vascular ward I removed the errant needle from my left hand. Blood everywhere on my hand, shoes & floor. I forgot I was on blood thinner medication. I surreptiously cleaned-up using a box of tissues.

A stroke-nurse farewelled me with 3 pamphlets: Medication. Driving. Fatigue. Legally I was forbidden driving for a month. I would need to take tablets for the rest of my life to manage my cholesterol, blood pressure & platelets! Brain fatigue would slow me down.

While Leah got my tablets from a Memorial Ave pharmacist, I disposed of my last needle & bloody tissues! Leah drove me back to Pleasant Point. As a NZ citizen & taxpayer & as my hospital stays & surgery were at public hospitals, I didn't pay a cent for hospitalisation & future medication.

THANKS NZ.

In both Timaru & Christchurch hospitals I was never visited by an Occupational Therapist.

Aftermath:

A week later, a Geraldine clinic nurse changed my neck dressing. A week after that my clinic GP increased my blood pressure medication as my BP was still dangerously high! We paid the clinic nurse & GP.

When reading my Amlodipine & Quinapril blood pressure tablets' pamphlets I found that both drugs caused fatigue side-effect, disguised with euphemisms like: "feeling very tired". Atorvastatin & Clopidogrel drugs for my cholesterol & platelet management respectively could also cause fatigue. Neither my GP, nor pharmacist, nor hospital staff informed me that all my scripted drugs could cause fatigue!

Meanwhile, a Timaru outpatient physiotherapist contacted us wanting to come to our home! No thanks! After an appointment at her Timaru physio-gym / office, she emailed me some physio-exercises designed to strengthen my mid core & hips. I'd learned that conventional physio guff 50 years prior during movement classes at Natal Uni, Durban. Martha Graham type movement exercises. Thanks, but no thanks! Some video-exercises were harmful so soon after my neck surgery: Lying on my back, raising my hips, moving my legs increased pounding blood-flow in my neck! I loathed gyms of any description, reminded me of school PT. Exercise fatigue was incompatible with my brain fatigue caused by TIA. Physio exercises would waste my limited energy needed for everyday activities like housework, gardening, walking. During 2 hospital stints I was fatigued by bossy physios. They needed me more than I needed them.

My own unconventional rehab was domestic chores, gardening, walking, word puzzles, reading, watching TV, Netflix, blogging, Patience, driving. Leah gave me hand-eye coordination puzzles to do. She was Resource Teacher Literacy, South Canterbury. She knew a local physiotherapist if I needed to consult. My home activities & my neuroplasticity did most of my brain & limb repair work, not gym exercises.

I changed my diet, consuming a breakfast including rolled oats, grapes, raisins, prunes, milk. I drank a milk & vanilla-essence egg-flip. Drank coffee with breakfast too. Laxative prunes countered constipation side-effect of my scripted meds. I drank black tea the rest of the day, no milk, no sugar. Early recovery lunches while Leah was at work, I avoided pies & coffee at Temuka Bakery, but went back to them as other cafes were either too expensive or their stodgy / buttery / oily fare was crap! I avoided bread, pasta, sucrose & junk food. Thankfully my oldest son is a chef & Leah is an excellent cook for balanced suppers. I still drank an ocasional beer, reward for gardening days. No-one at the hospitals, nor my GP, nor clinic nurse advised on what I should eat during stroke recovery!

For 2 sleep-disturbed nights I had Restless Leg Syndrome as I was seated too long writing this blog post. I solved my RLS by a late night walk.

After I left hospital, Leah pointed out that although my speech was OK, my word-alignment was sometimes wrong! I sometimes substituted a wrong word in place of a similar word. e.g. I mixed up colours when describing something: Look at those "red flowers" when indicating "orange flowers". Sometimes I would substitute a wrong but similar word. My stroke had scrambled my speech's word-selection. That wasn't noticed by the Speech & Language therapist at Timaru Hospital. I had no difficulty in talking, but sometimes the words I uttered were inexact slip-of-the-lips, like "race-track" instead of "railway-track", or "door" instead of "window", or "today" instead of "tomorrow", or "sound-effects" instead of "side-effects", or "tomato plant" instead of "lemon tree" etc. The similar words were stored in my brain, but my stroke caused them to come out wrong! I'm working on it by correcting my speech when I'm aware of wrong word-choice in my speech. A Google search generalises speech difficulties as "aphasia", listing several forms of aphasia, but not mine.

I have two overlapping rehabs, my unconventional stroke rehab, my conventional CI rehab where I still annually visit St Georges Hospital audiologist for my CI mapping. I stay in contact with CI rehab persons & Southern Cochlear Implant Programme (SCIP) Facebook page for advice about CI. I look at Facebook stroke pages for support info. I'm still profoundly deaf, have daily tinnitus, have deafness related imbalance, vertigo & scintillating scotoma. To me, deafness vertigo & stroke vertigo are inseparable. I'm still irritated by loud background noises like kitchen noises, TV ads, cafe noises, traffic, birds chirping... I have to fiddle with my CI volume-control on my cell phone to lessen overwhelming noises. I listen to "Recovery After Stroke" podcasts by Bill Gasiamis for stroke info & for my CI rehab.

South Canterbury mountains still call. It will take me a while to get tramping fit again, but I will start on easy Mt John overlooking Lake Tekapo. Then there's Mt Gerald...

Coda:

21 November 2024. The Timaru Courier STANDING AGAINST HOSPITAL CHANGES reported a proposal to "see Timaru Hospital brought under the umbrella of the Dunedin-based Southern District Council.." What a stupid proposal! Govt Bean-counters expected stroke patients like myself to travel from Timaru to Christchurch or Dunedin for surgery. Those Bean-counters should drive their own cars from Timaru to Christchurch or Dunedin to see what death-traps they proposed for patients! Planning by Bean-counters to move vulnerable patients from Timaru Hospital hundreds of kilometers away to Dunedin or Christchurch is wrong. I speak from experience! As strokes are common, Bean-counters must employ vascular surgeons for South Canterbury. Bean-counters will save money on inter-city ambulance & helicopter transport fees. Never mind transport & accommodation costs for families displaced by hospital-displaced stroke patients .

Copyright Mark JS Esslemont.