On February 14, I went to a nearby grocery store to pick up a grocery order and decided to treat myself to Caribou. When I pulled up to the drive-thru and she asked what she could help me with, I tried to ask for a small vanilla chai with almond milk. But even though I knew exactly what I wanted, I couldn't seem to make my mouth form the words. The memory of starting and stopping three different times is cemented in my head. Finally, after what seemed like HOURS, I blurted out my order, pulled forward and paid for my coffee (thanks to the gal at Caribou for her patience). At that point all I could think about was getting home, thinking it must be the start of a migraine. I didn't have any pain but it was a super sunny day and I remember thinking it was overwhelmingly bright. I got home and immediately laid down and napped for an hour or so on the couch, then went downstairs and napped for awhile longer. I woke up around 9pm to have a bite to eat and even talked with Mark. Still no pain and my speech seemed to be back to normal, so I concluded (with the help of Web MD) that it must have been a hemiplegic migraine of sorts. I had a normal night of sleep, waking the next morning to the kids hopping up on the bed and no sooner had I tried to tell them good morning but I stumbled over my words. I knew then that it was probably time to head to the clinic even if all they did was confirm what I had self-diagnosed.
The week before, my childhood home in River Falls went up for sale and I couldn't resist setting up a walk-through with the realtor which was scheduled for 1pm. I decided I wanted to proceed, so off to RF we went. It was an amazing experience and I couldn't see cancelling not knowing if the opportunity would still be there later on. Mom and both my sisters came as well, and we talked here and there as we walked through the rooms reminiscing. I stumbled over my words occasionally but it didn't seem to be anything too extreme until we went to leave, and I tried to say my goodbyes. I knew exactly what I wanted to say but again couldn't seem to make my mouth form the words. After establishing a plan for the kids, all I could think was that I wanted to get to the clinic as quickly as possible (https://www.stroke.org/en/about-the-american-stroke-association/american-stroke-month/community-resources-english/2019-fast-infographic).
Experiencing any stroke-related symptoms is a good way to get VIP medical care so the receptionist immediately took us back to a room and it wasn't long before I was with a doctor. After explaining the situation, he did a quick physical exam and ran me through several assessments including walking in a straight line, touching my nose, memory and standard arithmetic (I did have to make the disclaimer that there is a reason I majored in journalism and not math, especially when he asked me to count backward by sevens, but I digress). I did really well except for my speech. He told me that judging by my performance, I was likely experiencing a migraine but it couldn't technically rule out something neurologic without imaging. I was deemed stable enough to be taken to my choice of hospital by private transport. Off to United it was (with a stop for a quick burger along the way just in case there was a going to be a long wait). My head was pretty good at that point- more pressure than pain, really.
We arrived there about 7pm and were immediately sent back to an emergency bay. After explaining the situation for what felt like the hundredth time, the doc agreed the best course of action was an MRI. I changed into a gown and was given two injections; one ironically for pain (though still minimal) and another as a sedative (I'm a tad claustrophobic). It wasn't long until I was taken back to the imaging area and I made it about halfway through the scan before I hardcore panicked. It is all kind of a blur; I tried to return to the scan but pressed the emergency button and eventually was wheeled to a tiny room to calm down. I'd like to say that worked but not even close. I do remember hyperventilating, insisting I wanted to go home, and pleading to be done. My nurse from the ER (God bless her) came down to give me another sedative injection but unfortunately I was so amped up on adrenaline that I didn't feel a thing. At this point, though I was unaware, the nurse told Mark they were seeing enough of an abnormality on the scan that it was imperative they convince me to finish. Eventually I managed to go back in and let them finish the scan (on some level I knew it was important we needed get the full picture despite my anxiety).
We were sent back to our little bay in the ER, me awfully proud of myself at this point, finally feeling a bit of the medicine kick in, and expecting it wouldn't be long before they let me go home. When the ER doc came in, sat on the stool, and rolled up next to my bed, the last thing I expected was exactly what he said: "Unfortunately we see something on the MRI that we honestly didn't expect to see. You appear to have had a stroke and we can see bleeding in your brain. You will need to be admitted to the hospital for a few days for more testing in order to figure out the cause."
As the news sunk in, I remember seeing the sympathetic look on the faces around me and feeling a sense of dread. I know I cried a little once the doctor left, but between the sedatives and crash in adrenaline, I was mostly in shock. The rest of that night was a blur. I was given a more permanent IV and wheeled up to Neuro ICU where they completed my admission paperwork while we called family to give them the news.
The next four days sort of melted together. Docs and nurses came in and out of my room consistently as I tried to snag a few moments of sleep in between; my vitals were monitored constantly and blood was taken in tandem with neuro assessments every couple hours. I underwent a COVID nasal swab (negative) as well as another MRI and CT the first night, followed by an angiogram, ECG and lumbar puncture the next day, and then a transesophageal echocardiogram (basically a long tube down my throat to look at my heart) the day after (for those not familiar with the type or purpose of these tests, a summary is below). At one point they took 14 vials of blood at once to test a myriad of factors from my thyroid function to blood sugar levels.
- Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).
- Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography or magnetic resonance venography).
- Cerebral angiogram. In this uncommonly used test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.
- Lumbar puncture. LP aka spinal tap is the procedure of taking fluid from the spine in the lower back through a hollow needle, usually done for diagnostic purposes.
- Transesophageal echocardiogram. TEE is a special type of echocardiogram. It is usually done when your doctor wants to look more closely at your heart to see if it could be producing blood clots. Like an echocardiogram, the TEE uses high-frequency sound waves (ultrasound) to examine the structures of the heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke.
I was examined by the neurointensivist (a physician who cares for patients in the Neurological ICU) on duty and eventually assigned to the care of a neurologist. Mark started a Facebook page to keep close family and friends updated, and I'll be sharing a lot of the photos and recordings from there over the next weeks as I continue to update this page.
I was assessed by a speech therapist the first day, who confirmed that I was experiencing speech aphasia, a language disorder most often caused by stroke(s) in the left side of the brain (which controls speech and language). She said she was impressed at my ability to work around my difficulties to still communicate efficiently, which felt encouraging. I found that if I slowed down and took time to form each word, I faltered less. But more people in the room increased the pressure I felt, which aggravated the difficulty. I was also assessed by folks in occupational therapy and physical therapy, who were in agreement that my motor skills hadn't seen any negative effects (thank God). The consensus was that my symptoms were confined to my ability to communicate rather than my cognition, which I found somewhat comforting (more on that later).
On Wednesday the nurse told me they were considering transferring me out of ICU and into a regular bed, which gave me something to look forward to. The next morning, to my surprise and surprise of everyone around me, I woke up and it was like a switch had flipped - my speech was completely back to normal. Before I even had time to fully absorb turning that corner, they told me that instead of transferring me, they would be sending me home! Before I knew it, they had given me a prescription for levetiracetam (anti-seizure meds due to the location of the bleed) and discharge instructions to set up appointments to follow up with my primary doctor in a week and additional imaging in a month. More on my return home and the weeks leading up to additional imaging in a bit. My scans were done two days ago and as I wait for results, I wanted to get down as much as I can for context.
If you stayed with me this far, thanks for reading. I am equal parts anxious and excited to see if the bleeding has dissipated enough to reveal anything (even if it's nothing)! I am hoping for some answers soon.