Oh No, Back in the Hospital

These strokes are capricious things...they sneak up on you, often without warning. On the other hand, sometimes there is ample warning...and that's what happened this time.

For the last several weeks, there have been warning signs that another stroke is possibly looming in the future:

• A couple of episodes of double vision.
• About five episodes of numbness of the left arm from shoulder to finger tips, lasting a minute or two.
• A persistent headache just behind the right eye, sometimes lasting for more than a day at a time.
• On Sunday a large island of numbness in the right side of the face.

During a visit with Bettie's nutrition counselor on Tuesday, these symptoms were all discussed and he said it was time to see just what was going on...NOW. So off to the emergency room once again, this time at Valley Medical Center. We choose VMC for a couple of reasons:

1. They are a little better equipped for this kind of stuff than Auburn.
2. They have all my medical records.

That's right, MY records. You didn't think this was about Bettie did you? She's coming along OK, this time it is my issue.

Being male and basically invincible, I've been noticing the issues mentioned above and, because none of them (except the headache) last for more than a minute or so, pretty much ignoring them. But when the facial numbness occurred on Sunday, I realized that this could be pretty serious. Since I was scheduled for a visit with Bettie's nutrition coach on Tuesday for my own issues, I mentioned everything to him.

So here I am, blogging from a hospital bed at VMC while they poke, prod, scan, and otherwise make like doctors. I had to stay the night Tuesday and may have to Wednesday as well, simply because of the number of tests they want to do.

Meanwhile, Bettie is being cared for by our son Rick.

It is nice that I have access to the web from bed here, but it is very difficult logistically. The monitor is across the room and the controls to type and edit are unfamiliar. I'll post this now, and then edit it tomorrow when I get home, assuming nothing serious is found that precludes it. (Talk about serious...a few minutes ago the nurse came in and said I had flat-lined...she quickly discovered that one of my heart monitor cords had unplugged. Whew, that was close.)

__________ Update __________

I did, in fact stay both Tuesday and Wednesday nights and had a good going over. I had my head in a scanner three different times...you'd think they could find something in there with all of that, wouldn't you. Also had blood work and a echo analysis of my heart for half an hour. I'll revisit some of the specialists soon to get the fine details. But for the most part, everything checked OK. I need to be taking asprin every day as a cheap, effective blood thinner, and of course, no more having secret issues that I keep to myself. It turns out that I am not invincible...imagine that.

To the ER...but Home Again

Today we "celebrated" the clot being gone by making a 4-hour visit to the Auburn Medical Center ER, where this whole thing began nearly seven weeks ago.

The gall bladder pain, described in the previous post, got to the point where it hurt her, even when she was lying down. That was the signal that Dr. Spens' nurse said should trigger a trip to the ER. (Of course the issue of pain is complicated by the fact that Bettie cannot accurately relate to us the severity of it.) Better to err on the conservative side, since we can't be sure. That's what we did.

In the ER, Dr. Spens visited us and told us the strategy: "We'll scan the gall bladder and be sure it is OK and the drain is properly in place. If all is OK, we'll assume that the pain is from the drain itself. After all, it is a piece of plastic rubbing on her insides and that is bound to cause some irritation. I'll prescribe a pain killer to help, as the drain needs to stay in for another two weeks."

And that's how it turned out. She's resting comfortably in the family room as I write, looking forward to Friday night pizza. Me too.

The Clot is :-) The Gall Bladder is :-(

Big news today: the clot is gone, I saw the evidence today!

We had our second appointment at Dr. Heide's clinic. First we spent nearly an hour with the dietitian, learning how to feed her to get her weight back up and keep her blood consistency stable. After that, we spent the better part of the next hour having her head examined, quite literally.

In a typical clinic exam room, she lay on the table with a crown-like gadget on her head, to which were attached two ultrasound probes, a left and a right. The technician aimed one probe at the vein where the original clot lodged in her left brain hemisphere, and the other at the corresponding vein in the right hemisphere (for comparison).

When he turned it on, we could watch, on a computer monitor, electronic depictions of the sound waves, picking up the blood flow through each vein. A sound amplifier and speaker completed the information flow.

The device ran for just over half an hour, displaying nearly identical pictures of flow through both veins, side by side. The flow sounded the same on each side, and the digital readout of volume was just very slightly better in the right (non-clot) side than the left. I asked the tech if he could tell how long the clot had been gone, but he could only guess that it was probably breaking up fairly soon after it first lodged there. No way to know. Many clots never break up.

Clear flow of blood, means that whatever cells in the clot area survived, should be able to return to good function. It also means good flow to facilitate retraining of adjacent cells. I may not be describing it in good doctor-talk, but any way you say it, it is good news.

-----------------------

On the not-so-good side of things is this: For the last couple of days, by afternoon Bettie has been way more comfortable lying down that any other position. So you're thinking: "Well duh, who isn't?" But this is different.

Her gall bladder area seems to be giving her trouble each time she gets up, at least later in the day. I've talked to the nurse at Dr. Spens' (the doctor who is handling Bettie's gall bladder issue) office both yesterday and today. We decided to move Bettie's follow-up visit up by a week. She'll see Dr. Spens on Monday. Until then, she may be down more than she's up.

Comparing the two issues: No Clot vs (maybe) No Gall Bladder ... well, its a no brainer, isn't it?

A Date with "New" Bettie

Several times in the week before coming home I asked Bettie if she would like to go to church next week. Each time she quite adamantly said: "No", with an expression that said: "How could you ask such a thing." I'm not sure just what the issue is, but she clearly is not ready. I went alone again.

Speaking of church, a couple of weeks ago, Art Palecek, the Associate Pastor, announced to the congregation that Bettie's clot had dissolved. I was unsuccessful in getting his attention to correct him...the doctor didn't say that. In fact the doctor said the clot is likely a permanent fixture. Blood is flowing around it, but it is still there. However, if you read the post: A Follow Up With Dr. Heide you know that there is a good chance that Pastor Art was right after all. We'll find out more this week (on Wednesday and Thursday) when more definitive scans are performed. Where do you suppose Pastor Art is getting his information. Hmmm.

When I arrived home, I found Bettie with Veronica and Jordan on the front deck having lunch at the big table under the awning. Later, we took a nap and then, about 4:00 o'clock, I coaxed a "Yes" out of her to have a dinner date with me.

I had received a $50 dinning card for The Cheesecake Factory for Fathers Day, so off we went to cash-in. Though she was a little apprehensive about it at first, she did just fine.

Soon, a couple took the table next to ours. The gentleman was Captain Mike McCoy, with Tukwila Fire Dept. I asked him if he was a 911 responder. He confirmed that he was. I thanked him for his service, and told him that it was people like him that took care of Bettie that fateful morning (June 23rd), and that I have a great respect for people that do what he does. He seemed pleased and, I hope, honored...that's what I intended: "Honor to whom honor is due".

All in all, it was a lovely evening...my first date with the New Bettie.

A Follow-up with Dr. Heide

If you have read this blog from the beginning, you will recognize Dr. Heide as a key player in this whole drama. I first met him via video hookup while Bettie was in the ER, the day it happened. Over the course of the last five and a half weeks, we have come to know, trust, and be thankful for this man.

Today was the Bettie's first follow-up visit after discharge. It took place at his facility, in Renton, near Valley General Hospital. It began with a new scan of Bettie's head, so that a comparison could be made with Day One. Then Bettie was weighed (104.2 lbs... down about 20 pounds from five weeks ago) and finally we saw our friend, Dr. Heide.

He showed us the scan on his computer screen, blown up to reveal startling detail (if you know what you are looking for). He pointed out that the original scan clearly (at least to him) showed the clot, right where speech and communication are processed.

Today's scan, did not show a clot there at all! Now before we get too excited, he wants to do a different kind of scan next week that will show different detail to confirm that the clot is, in fact, gone. If it is, that will considerably improve her prognosis.

Part of the doctor's routine involves asking Bettie her name. I don't think she has ever been able to answer that question for me ... but then I'm not a doctor. But for him, she says "Bettie Aitkins", like "Well duh". Seems like this happens too often to be a coincidence. Oh well.

An interesting part of the conversation with the doctor was about music. You may remember that my son Steve, suggested that we put headphones on Bettie and play her old but familiar music (See the post titled: The Sound of Music). She responded dramatically, singing along before she could speak or put other sentences together. Evidently, that idea of Steve's had not been explored by the medical community before. Dr. Heide says we are exploring new ground here and he is very interested in discovering the potential for communication with stroke patients via music.

He wants me to continue singing to, and with, Bettie. I told him I know a lot of songs, since I sing in a men's chorus (Northwest Sound). Unfortunately, I sing bass, so if Bettie starts croaking in a deep voice, blame me.

Before we left Dr. Heide's office and went out to set up the follow-on visits with his nutrition expert and others on his staff, he told me this: "After Bettie's stroke, I had a number of other patients with the same type of stroke. I have directed them to the Bettie's Challenge blog for help with dealing with the situation, and it has been very helpful. Very helpful."

I have to tell you, that gives me a big lump in the throat. We have known all through this that the Biblical promise (Rom. 8:28) that "... all things work together for good ... " is true. Dr. Heide's comment demonstrated one way that it is happening (and there are undoubtedly others as well). Very humbling.

If you are one of those refereed here by Dr. Heide because you too are traveling this road, know that you are not alone. Feel free to contact me directly if there is any way I could be of help, I'd be honored. Contact info is on the Profile page.

A final, but very important, point from the doctor. I asked him how he was coming on procuring a very expensive but promising piece of new technology that could be helpful in regenerating brain tissue. He said that, with the federal government proposing to take over the health care industry, it is currently impossible for any doctor to make a sensible business case for major equipment expenditures. Our elected officials in the executive and legislative branches of government are already having a negative effect on the medical profession, and they are only talking about what they want to do.

This blog is not about politics, but about the care of a stroke patient, my wife. My recommendation concerning the issue is this: ask your doctor what he/she thinks about the issue, then write or phone your representative and tell them your personal concerns, based on what you have learned. Would it be asking too much of your representative to insist that they read and understand the bill, at a minimum, before voting on it?

The Doctor's Prognosis

It's kind of a shock to walk into your wife's hospital room and find someone else in "her" bed. You can imagine the initial reaction when you are dealing with stuff that is sometimes terminal. To my relief though, she had only been moved. Whew!

So, if you visit, you will now find her in the "Cedar" wing of Highline Medical Center, room 526. Take a left out of the elevator, then a right after passing over the cafeteria, to find her room. It is a nice single bed room with a view of the SeaTac Airport. (Hmm...SeaTac Airport. Did I tell you that that is where we met? She worked in Northwest Airlines reservation center, in the upstairs of the big Northwest hanger, and I worked on the planes, down on the maintenance floor, as an A & P mechanic.)

Sweetie was awake and responsive for most of the 2 1/2 hours I spent with her this morning. The most impressive response, and it was not actually a response to anything, she simply asked me at one point: "Do you know what time it is?". Now she didn't actually want to know the time, though I told her ... and the day and date too. It is encouraging to see that a seven-word phrase can be put together and spoken, even thought it is not related to anything else.

I was very grateful to have Doctor Heide appear at 10 a.m. for his daily check-in with her. I asked him: "Don't you ever get a day off?" "No" he replied, "but I'm coping". What a professional.

Anyway, after not seeing him for two days, I was full of questions. So here's his opinion of where we go from here, based on his 16 years of dealing with stroke and his current caseload of more than 1,000 patients:

• She is past the critical stage, brain swelling is going down.
• The clot is not diminishing as I previously stated, but some blood is flowing past it. It will likely be permanent.
• She is expected to walk again, maybe with a limp or needing a cane.
• Her right hand and arm may have very limited, if any function.
• She will have difficulty communicating, but family will eventually get acquainted with her expressions and cope fairly well.
• She could possibly be ready to come home in three to six months.
• She will not have amnesia.

These are the high points of his prognosis. We all realize that each stroke case is different. As they say in the investment world: "Past experience is not indicative of future returns."

Oh, one other thing you should know. Dr. Heide is attempting to acquire a new state-of-the-art device that uses magnetism to stimulate brain tissue growth. He will be one of the first in the country to use the device, but the $50,000 price tag may delay it's acquisition. Let's pray that deal comes together.

After the doctor left, we had a nice long quiet time together, we both even fell asleep at one point. Finally, about 11:30 a.m. friends arrived to be with Bettie so I left her in their company.

On the way home, I stopped to have lunch and visit with dear old friends. What a joy to be hosted, loved, encouraged, accepted, and listened to by people of quality.

The Day it Happened

As best we can determine, Bettie's challenge began on Tuesday, June 23, a few minutes after 9 a.m.

(A little personal background here may help: I am employed at iShip, Inc. a subsidiary of UPS, the shipping company. I work in their offices every Tuesday, Wednesday, and Thursday; I work from home on Fridays, using the company intranet. Being something of an insomniac, I awaken one or more times throughout the night. When it's a work night, I just get up and go into the office. So I'm often there in the wee hours of the morning, but seldom past noon. It's kind of crazy, but it works for me, and the wonderful people I work with are very accommodating. My usual habit on work days has been to give Bettie a brief check-in call between 8 and 9 a.m.)

I first called Bettie at about 8:40 that morning. I got no answer, but that occasionally happens if she is in the bathroom or something. I called again just a few minutes after nine. She answered, in a normal sounding voice, with "You're late". Not saying "Hello" was a little unusual, but maybe everything was normal to that point.

After those first two words, our world changed.

What I heard sounded like she was crying at first. (That has happened before ... she called me at work years ago to give me the news that my grandmother had died. When I answered that call she couldn't speak for a minute or so, so I thought it was something like that.) I gave her a few moments to compose herself, but it didn't happen. It sounded like she was muttering or something.

We knew she was at risk for stroke, due to a heart condition called atrial fibrillation that she had been dealing with for about six months, but realizing that I was actually hearing one happen took a minute or so to sink in. I finally said something like: "Honey, I'm going to call 911 ... Do you want me to call 911?"

I made out "911" in her garbled response, but that was all. My head was spinning, this was the real thing!

I hung up and punched in 911. Since I was at iShip's Factoria office, I got the Bellevue police response center but they quickly connected me to Auburn and I gave them the required details. Paramedics were there in minutes and found Bettie in bed and mostly unresponsive.

I locked up my computer, told a co-worker: "I'm leaving; I think my wife may have had a stroke", and took off for home. I'm not careful to always have my cell phone with me and have it on, but that day I did.

Ten minutes into the trip, my son Tim called me and put one of the emergency team guys on the phone. (Tim, his wife Veronica, and their two children live with us. Being self employed, he might leave for work anytime between 7 a.m. and 10. This day, he happened to still be home.) The emergency team guy told me they were taking her to Auburn Regional Medical Center, so that was where I headed.

On arrival I provided the registration desk some quick information, then I found Bettie in ER room #1. I suppose the initial reaction one has in a situation like that is akin to what you might feel when the sheet is pulled back in the morgue and you realize that, yes it's her.

The doctor was busy determining the extent of her condition, asking her all kinds of questions, poking, prodding, touching, all with speed and precision. He did his best to fill me in on what he was finding as he proceeded.

Though her eyes were about half open, there did not appear to be much going on in there. It was then that he first used the word "Stroke". Though not a surprise, given her history of atrial fibrillation, hearing that word came down heavy, like hearing a jury foreman saying, "Your honor, we find the defendant guilty of all charges."

They soon whisked her off for a CAT scan of her head to actually see what was going on.

Upon return, the doctor detailed it for me: "She has a very large clot on the left side of her brain, in the area where speech is centered. It is very serious and there are some very high risk issues you are going to have to decide right now." They wheeled in a cart with a flat-screen TV monitor and a camera on it. I was quickly introduced via video to Dr Aaron Heide, a stroke specialist who handles cases like Bettie's for a number of area hospitals. He explained that we had two high risk scenarios here: doing nothing, and doing something.

The something he proposed was to transport her to Highline Medical Center, in Burien, where another specialist, Dr. Wiess, could attempt to break up and/or remove the clot via a catheter inserted into her groin and directed all the way up to her brain using some very new, very high-tech imaging. While it offered the prospect of giving her a greater chance for some recovery than doing nothing, it also could create bleeding and ultimately be terminal. The doing nothing at all choice also had the risk of death, but with less chance for recovery.

By this time my son Tim had arrived at the Auburn emergency room, so at least I wasn't faced with this decision alone. Together we concluded that we would rather try the procedure than not ... so off we went to Highline.

Just before the procedure, which they said could take from one half hour to four hours, I met Dr Wiess. He's an intense, fast-talking professional who gives the impression that, even though he's talking about high-risk stuff, everything will be OK. I asked him if I could see Bettie before he began. He said no, that hospital procedure forbade that. He then, without a word, took me by the hand and led me to her side in the procedure room. He muttered something like "this didn't happen" and left me there with her for a moment.

I can't describe that moment without seriously soiling my keyboard with tears and drool, but it was intense.

In the waiting area I was joined by Tim and his wife Veronica, my daughter Kim and her husband Mike, Art Palecek, our associate pastor, and his wife, Maureen. Later, our previous associate pastor Steve Ambros joined us for an hour or so. We prayed and talked and ate lunch and waited and waited. "Wait" is not the right word for this kind of wait. "Wait" is something you do in check-out lines and at traffic lights. When the life of your beloved hangs in the balance it is something else. I'll think about that another time.

After about three hours, Dr. Weiss came in. He said he had good news and bad news. First the bad: because of the unusual amount of twists and turns in Bettie's veins, he was not able to get the catheter close enough to grab the clot nor inject it with a dissolving agent. It was close he said, very close. However the good news was that there appears to be some blood flowing around the clot so the damage is not as severe as it could easily have been. That bodes well for future recovery.

Bettie spent the rest of that day and night in intensive care. The gaggle of family and friends eventually thinned until I was left alone with her. Next to our wedding night, perhaps the most memorable of our nights together.

I talked to her, not knowing if she could understand. At one point she said "I'm too hot." I took that as a good sign, putting three words together. Another time she began saying the word "take". She must have said it twenty times or more. Finally she got out "care". She wanted me to "take care" of her. God, I love this woman.