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 info: 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. 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 halter for a day to monitor my heart beat. The hospital called me back for another test. I declined as I felt I was being over-tested. Three years prior to my TIA stroke, aged 70, I had cochlear implant surgery at St Georges Hospital, Christchurch, as I was profoundly deaf. There were no blood pressure, cholesterol, heart problems in the lead-up for my cochlear implant surgery. Subsequent audiology rehab at St Georges Hospital enabled hugely improved communication.

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 job. In our garden shed I wire-brushed dirt off our firewood.

TIA Stroke. Day 1. Tuesday 10 September 2024. 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 realizing I was having 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 some 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, showing I had a right hemisphere stroke! A search described carotid artery stenosis, narrowing of the carotid arteries due to plaque! That caused a blockage in the arteries starving my brain of food & oxygen. In Timaru hospital I later learned the medical jargon TIA: Transient Ischaemic Attack!

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 & 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! Press your hands against mine! Clap your hands while revolving your wrists! Press your feet against my hands! Stand up, 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.

With 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. 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 went 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! Shone a torch in my eyes to check my retinas. Like Blood pressure checks, temperature checks & pulse checks, retina checks were done frequently. Problem: Every time I was woken at night, I had to search in my bedside locker drawer to fish out my cochlear implant processor & battery & install them over my implant above my ear before communication could take place Tiresome!

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. A day-nurse stuck heart-monitor stickers on my bare chest, attached to octopus strings & the boxy heart-monitor, causing 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 came loose, I pulled it out, throwing the needle & plaster in a bedside bin! Dr R visited, questioned me & opined about my blood pressure. Dr B visited, questioned me & lectured me on cholesterol & possible blockage of my carotid arteries. He suggested I get enduring power of attorney!

A Speech & Language therapist visited, questioned me about my work history & gave me a worksheet to rehab my slurry speech. 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 blah, blah, blah!

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 weakened left 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: "What day is it today? What's today's date? 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 & ablution rooms! A male orderly pushed me in a wheel-chair for my brain CT scan at the Radiology department. 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 grotty 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. Great. I could wear my clothes, listen to Spotify podcasts & music via my 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 that my elevated BP must be reduced. I guessed the medications I was fed each morning in little paper 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. I showered! 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 pushed me in a wheel-chair again to the Radiology department, this time for an ultra-sound scan of my carotid arteries. Dr J found my carotids were approx 70% blocked by plaque! A nurse said: "You will leave our ward & go downstairs to the AT & R ward. (Assessment Treatment & Rehabilitation ward). The Speech & Language therapist arrived with a wheel-chair to push me to the AT & R ward. I offered to walk. "Not on my watch!" she said.

AT & R ward was new: new doctors-rooms, new ward-rooms, new physio-gym, new lounge & TV. New equipment throughout. A nurse weighed me on a weigh-chair. I'd lost 2 kgs in 2 days! I even had a new ward-room to myself, natty shower & toilet room. Lovely sea views.

Settled into the A T & R ward, scan-read my books. Nothing wrong with my reading, memory, thinking. I did word puzzles in my notebook. Hand-writing slowly improving. I asked a nurse to remove the admission needle from my left hand. It had not been used! She did so & fashioned a fingerless glove from a bandage for me to wear.

I walked to the lounge, played Patience, watched TV with other patients. A truck-driver was legless in a wheel-chair. I watched him doing rowing excercises in the physio-gym. He went to school at Pleasant Point. A retired Pareora freezing-worker plodded with his Zimmer-frame & noisily chattered, revving up nurses by sneakily smoking his hidden cigarettes. (Forbidden!) A tall, Rasta-haired bloke pushed his tall walking-frame along corridors trying to walk properly. Most ward rooms had male & female patients, many in bed. Leah visited with son Luke who drove from Christchurch. Good son, he did odd-jobs at our home. We played Patience & Scrabble in the lounge. I walked with them to the hospital foyer door, my longest walk so far.

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 & connect neurons to replace those destroyed by my TIA. i.e. Brain plasticity. I'd already proved my brain plasticity by playing lots of Spotify music direct into my brain with my cochlear implant.

TIA stroke. Days 5-6, Weekend. 14-15 September 2024. Routine recovery days. 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-installed pamphlets. I did my physio exercises. I relaxed: reading, Patience, TV viewing. Leah & Luke visited. Luke drove back to Christchurch. Only hassles: my swallowing & peeing difficulties. I vomited my curry & rice lunch! A nurse said it was caused by the shape of the 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 had to clean my dirty clothes & bring 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 privacy curtain. Her stream of visitors were noisy. No privacy for me.

TIA stroke. Day 7. Monday 16 September 2024. Using a faulty blood pressure cuff, a nurse caused bruising on my left arm & 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 over. 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 placing little wooden pegs in a wooden block & removing the pegs. 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. I cancelled my appointment with the physio & returned her physio toys. Ambulances were in short supply, the chief nurse was in a 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 18 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. Dr K visited & explained my neck surgery. I signed consent forms for my 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 off. I did, chivvied up 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 he phoned my St Georges Hospital surgeon. My bed was pushed into the operation theatre...

Approx 2 hours later I woke up in the recovery ward, a nurse checking I was OK. Later a male orderly pushed me & my bed back to the 8th floor vascular ward recovery room. 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 neck wound. A thick dressing covered my wound. My lower legs had socks intermittently constricting to stop blood clots. Leah, sons & their girlfriends visited. Nice to have family support.

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.

To be continued...

Copyright Mark JS Esslemont