Stroke: May 2013 Archives

Recovery.

Recovery is where you spend all the time. For me the stroke was maybe 15 to 20 minutes, then a day of barfing.

Then recovery.

So there's my stroke. On the cerebellum, right near the centerline. The way my neurologist explained it to me, functions in the cerebellum mimic the body: the further to the outside, the further from the body core they are. My damage was all core, and it is confined to my balance.

The first part of recovery was working on simple lying-down exercises to re-teach my brain about balance. Turning my eyes side to side, up and down. Turning my head the same way -- still makes me dizzy, but it's important to do it to teach my brain not to be dizzy.

Walking. The first walk was intensely disorienting. I felt detached from my body. Things didn't just work the way I was used to. I was having to catch myself from falling.

And mind you, by then I had walked into the bathroom a few times. But longer than that, in a straight line, was harder.

The amount of work involved in walking increased by quite a bit. I've always been quite a walker, able to keep going, albeit slowly, for hours. Now walking a couple blocks is real effort. Not aerobic effort, but thinking effort. I'm having to consciously hold myself upright and not swerve around. The best comparison is to being a little drunk all the time.

Most of my physical therapists, occupational therapists, and frankly many other people are surprised at how well I am getting around. This is not common, though I was, as I mentioned, incredibly lucky and my stroke was very small and fortunately confined. And I was already an active person which is kind of half the battle for those poor PT and OT people, trying to push somebody to move who isn't interested in moving.

And the pain. Nobody ever seems to mention the pain when they talk about stroke recovery.

OK, maybe they are focussed on recovering more motor functions and mental capabilities, but let me tell you about the pain. I started out with 100mg of gabapentin three times a day -- that's the generic of Neurontin and an anti-seizure drug (they're very cautious about seizures after a stroke) that helps with nerve pain as well -- and 650mg of acetaminophen every 4 hours. That was fine up to a point, but once I really got exercising and moving around again, the pain got much worse.

You see how the blood vessels are just kind of not there or all small and hard to see on this scan? Those blood vessels are surrounded by nerves, and the nerves are freaking the heck out. They don't know what is happening, and so they are sending signals to the brain and the brain doesn't know what the heck to do with that so, well, default to pain. Thanks, brain.

The gabapentin is the reason I'm not (always) curled up in a ball in pain. On Friday morning I woke up at 3am in hideous pain, the kind of pain that radiates out all over your body.

Doctors ask you to rate your pain on a 1-10 scale with 10 being the worst pain you can imagine.

My scale:

radiating pain = level 8

radiating pain plus barfing or severe nausea = 9

radiating pain plus blacking out = 10.

I have experienced all of these. Level 10 sucks really hard, by the way. Though to be honest I have a pretty good imagination and I think that having a limb cut off while in level 10 would be like a 15 or so. When I say things like that to doctors they never seem to know what to say, but I read this horrifying book once on the history of surgery and I think those early patients really knew what a level 10 really was. In comparison, I am a total wimp.

So, well, on MY scale on Friday I spent the hours between 3am and 11am at a level 8 or 9.

The thing was, it was the morning the housekeepers were coming, and having the house cleaned is very important, so we had to get us and the dogs out of the house.

I'd woken up at 3am in intense pain, and the acetaminophen didn't touch it (I've actually pretty much never found acetaminophen very effective, and its toxicity keeps me from keeping it around the house in general, but NSAIDS like ibuprofen are verboten when you are on blood thinners). You can't just take more -- the stuff is very very toxic to your liver.

Noel called the 24-hour nurse and they were useless, didn't do any of the followup they said they would do. Finally after a few phone calls, we called the neurologist and she told me to up the gabapentin to 300mg.

I did that and was almost immediately not in so much pain any more. The gabapentin is messing with my vision (everything is blurry) and it makes me so sad I want to cry all the time (maybe not such a great drug for somebody who is chronically depressed), but it is saving my life in terms of pain relief.

The pain ebbs and flows. Tonight I spent an hour on the treadmill just walking because my left shoulder felt stiff and achy and sometimes a little exercise helps with that kind of thing, but it just got worse. I've been riding busses to work and around town because it's still not a good idea for me to drive (and also because I don't normally drive to work), and that can either be agony or just fine. Usually the pain is on the right side of my head and neck; today it shifted to the left, though I think that is more of a tension headache thing.

One doctor tells me the pain might start to go away in a week or so. I like that idea. In the meantime my neurologist gave me a gabapentin routine that should help manage the pain without having to take acetaminophen every four hours (which really messes with the sleep schedule). I slept through the night last night, which was very nice.

And just to end this post on a high note, this is one of my brain scans that looks all freaky and weird. We have a lot of empty space in our heads. Also, check out my weird ears.

The food. Oh, god, the food.

Look, I am not a picky eater. My parents raised me to at least try everything. There are some foods I don't like, but if you place them in front of me I will eat them because that is polite. There are some foods I don't eat because they make me stop breathing (conventionally raised poultry, and oddly, melons). But I'll give just about anything a go.

Well, OK, almost anything.

This is basically what every meal at the hospital was like. I was on a diet called "Mechanical Ground" which meant every meal was chopped up. That's fine -- because of the two IVs I couldn't use my left hand at all for eating, so it was OK to have food I could eat basically with a spoon.

But this.

Ground up mystery meat -- presumably some unspeakable part of a cow -- "gravy" in a little plastic container. The potatoes were starchy and bland, but I actually ate all of those. They gave me a dinner roll, too, but it was stale and dry and not really very easy to eat.

I had many discussions with the dietitian and occupational therapist (who was there to make sure I could eat larger chunks of food without choking to death) about my food and why I wasn't eating. The best was one in which I tried to explain that I don't drink hot liquids of any kind -- no tea, no coffee. This was very confusing.

"None?"

"No."

"Herbal tea?"

"None."

"I could give you Sprite."

"I really don't drink sodas, either."

"How about milk?"

"I don't drink milk, either. I usually only drink water."

"We can give you bottled water."

"OK, but I'm fine with tap water."

This conversation resulted in my getting put on a no-dairy diet. And since I just don't eat margarine (the oily texture bothers me), that meant I couldn't eat half of what was on my plate, oh, yay.

I was inordinately excited by the day when blueberry pancakes were on the menu. Until I took one bite:

Regular pancake rolled around blueberry pie filling. Yes, this was actually passed off as food. That was as much as I could eat of that breakfast.

There were a few things I knew I could eat: any juice, the fruit cups (a little too sweet, but I was hardly eating anything so a bowl of sugar was fine), the vegetables on the plate. They started giving me extra juice. I tried to explain to them multiple times that I just don't eat like this at all at home and I didn't know how to cope with it. The meat thing always smelled like poop or vomit to me. I already had limited appetite, but I had real struggles with this food.

My real relief was breakfast, when they invariably brought me scrambled eggs (and dry toast! Because no dairy!). I tried their margarine for a couple days but it still kind of grossed me out, especially on white bread. There was one day we had a waffle and that was pretty exciting; I finally gave up trying to eat like an adult and ate it with my hand. It was not inedible.

It took two days to correct the "no dairy diet" mistake on my chart. Two days of me trying and trying to explain that no, I eat dairy just fine, I just don't drink milk as a liquid because all I drink is water. I think they thought I must be a space alien.

The last day I was there, they switched me from the Mechanical Ground diet to a normal diet, to see if that would help (it did not; the meat still smelled inedible, though I valiantly gave it a try every time). And look! They gave me real butter! That was pretty nice.

The last couple days they also added on a diet shake from Ensure that would fill in calories. It was pretty horrible, like drinking fruity cold chicken soup, but I drank it because I could make it stay down.

The last day I was there they said I hadn't thrown up in days and they almost had my TP/INR levels (blood thinner) where they wanted them, and they were trying to get permission to release me. I'd had a couple days of "maybe you'll go home today!" disappointments already, so I was very motivated. Then they brought me my lunch and I felt the horrible urge to throw up like I hadn't for days. I have never before in my life been able to stop that urge, but sheer willpower and the knowledge that dinner would be just as bad were strong motivators. I made it.

I lost three pounds in the hospital. I stuffed myself stupid the first couple days of being home, I was so hungry. When we walked into the house I was torn between wanting to eat ANYTHING FOOD and wanting a shower desperately. A little food won out.

Feeding patients like this cannot be good for patient outcomes. We are right in the middle of the best food culture in the country. Fresh, delicious produce is available year-round. There is no need to feed patients reheated ground meat patties, except that of course cutting back budgets in the kitchen is easy to do, and who's going to notice? The insurance companies don't care -- though they should, since I think I stayed in the hospital extra days because of the food -- and the patients aren't usually paying, so they get no say.

My food was limited because I wasn't eating, so they didn't want me eating outside food and confusing things. But I wasn't eating because I literally could not eat that food. And I am not, as mentioned, a picky eater. I tried to eat everything. Every day I would eat as many mouthfuls of that horrible meat concoction as possible. When your patients are having to live on dietary supplement shakes, you really need to fix your hospital meal program.

The first few days in the hospital were kind of the same: every couple of hours they came to take my vital signs (again: blood pressure, blood oxygen, temperature). Every four hours they came to take blood to test various levels (I haven't gotten those records yet). They initially said they would be testing my blood sugars but they stopped that pretty fast since I don't have diabetes and am not pre-diabetic even though it seems like everybody thinks I should be.

The room was grim. I really understood why the modern patient rooms every new hospital I've worked on were so important. Looking up at this TV every day (I really don't watch TV, so I only once accidentally turned it on), it was depressing. As if I needed that.

What I needed to do was get up and walk and sit upright.

Walking was interesting because it was as if I were super super drunk, but with all my usual cognitive skills (quite unlike being actually drunk). The first time I walked down the hallway, I was being very careful about wobbling and we only went as far as the end of the corridor (about 20 feet). That time the nurse was holding the back of my gown closed with her hand and honestly? I wanted to shorten the walk because I found that too embarrassing. I could easily have walked much further.

The second time I went for a walk, the next day, they gave me a second gown to cover up my behind. By that point I had asked Noel to bring me some pajama pants (he'd already brought me some blessed changes of underpants). They arrived shortly after that walk and then I felt like I could go anywhere. I wanted to try running, actually. Even at my schlumpiest I try to fit in a brisk 20-minute walk every day.

From my room, right outside the nurses' station, I heard all the status reports and patient gossip. Nobody believed I'd had a stroke. I was in such good shape. In contrast, a 21-year-old came in with a massive stroke on my third day and was essentially immobile. Most of my fellow ward occupants were lying still in their beds. I was sitting up most of the day, awake and aware. The therapists told me a couple times that the more I sat up the better I would do, so I made a very serious effort at it.

I had my ebook reader with me (Noel brought me that the first day), but I found it hard to read because of the spinning room. I felt mildly carsick from reading, so I didn't get as much reading done as I would have liked. I had less patience for bad writing because it felt like reading was more precious.

Most of the nurses were great. They really cared about taking care of people and they wanted to help me stay clean and get around. I was really dependent on the nurses because I was attached to this IV pump full of Heparin, a blood thinner, and also because when I was lying down I was supposed to be wearing this leg compression system that prevents blood clots in your legs.

The alternating pressure of the leg system was actually very comforting. It felt a lot like Goldie lying on my legs at night, and I missed the animals intensely, so it helped. However, if I needed to go to the bathroom I had to be disconnected from that leg squeezy, my pump had to be unplugged, and I had to roll into the bathroom.

I was allowed to use the toilet in privacy (the very first day they discussed having me on a bedpan but all concerned decided that sucked and I had one bedside toilet experience). They were measuring and examining my pee, so I had to pee into something they called a "hat" -- a little plastic pan. I learned that I pee about 500 ml at a time. Useful to know, I guess?

Night and day kind of blended together. I slept when I could, which was mostly in the mornings when the morning nurse came on. I had one nurse, one horrible, horrible nurse, who actually ignored my use of the call button all night. I don't know what he was doing or where he was, but eventually I decided to just disconnect my leg thing and unplug Mr Pumpy all on my own, and go to the bathroom.

In the morning of that day the morning nurse got upset at me, and then really, really angry at the night nurse when I told her I waited an hour to be taken to the bathroom and I really could not hold it any longer. Twice.

But for the most part, people were wonderful to me. I just really really wanted to go home.

Throughout my stay, we have problems with my IV pump. I called him Mr Pumpy, and he did a lot of yelling. He had one beep he did when his battery was bad -- my first pump was replaced with another because the battery just could not hold a charge, which was an issue when I needed to go to the bathroom or for a walk. He had another, longer and more complicated beep that he did when the IV bag was low. Or when he thought it was low. Somebody had to come and reassure him or whatever you do to make the beeping stop.

And look, I understand. I was easily the least critical patient on the ward and I'd rather the nurses were taking care of the guy who can't breathe next door, or dealing with the respirator problems for the lady down the hall. I don't demand prompt service or snappy responses, but Mr Pumpy would start beeping at 2 or 3am every day, and sometimes I would lie there in the dark listening to him for an hour or so, not able to sleep because the beeping was so loud and right next to me.

So mostly I slept in the mornings, and mostly the morning nurse was trying to get me to wake up and get moving because up and moving is good for recovery, and she didn't realize I'd been awake most of the night between sitting up in bed needing to pee and lying in bed listening to Mr Pumpy sing the song of his people.

In my next installment: the food. And how I learned to control my gag reflex for survival.

Let me tell you about my grandfather.

My grandfather was a violinist and trombonist. He was in the band in World War II, which is how badass a musician he was. I'm not sure whether we actually sent musicians in against Hitler but it seems like it would be pretty effective, given my experience of one year living near a marching band practise field. He worked as a carpenter and built violins in his spare time at a little table in the basement.

When my grandfather was 52, he was driving along the street and suddenly veered off the road, driving into the side of a drug store. The guy behind him stopped to see if he was OK and my grandfather was already dead; he'd had a stroke. This was the year before I was born.

Having a stroke is a lot about luck. You should know the symptoms. If you get any of these, you should call 911.

Common stroke symptoms seen in both men and women:

• Sudden numbness or weakness of face, arm or leg -- especially on one side of the body


• Sudden confusion, trouble speaking or understanding


• Sudden trouble seeing in one or both eyes


• Sudden trouble walking, dizziness, loss of balance or coordination


• Sudden severe headache with no known cause

Women may report unique stroke symptoms:

• sudden face and limb pain


• sudden hiccups


• sudden nausea


• sudden general weakness


• sudden chest pain


• sudden shortness of breath


• sudden palpitations

(This list and a lot of other information are available at the National Stroke Association web site.)

Sometimes it's hard to tell if they really are what you think it might be, but having any two of these symptoms is a definite 911 situation.

But it's luck. The morning of my stroke I felt lightheaded, but that was easily explained because I hadn't eaten before working out. I felt weakness, but that was also obviously because of not having worked out for a while. I didn't feel the one-sided weakness that would have twigged me to a stroke. When the dizziness and nausea came on, I connected them more with the migraines my friends have than a stroke. I was even briefly worried that I'd developed a sudden severe allergy to banana bread (I adore banana bread and this would have been worse than a stroke, and I am not exaggerating).

Luck is that Noel was home and was an impartial judge who decided we should go to the ER. Luck is that I realized that an ER might have strong drugs for a migraine so I went along with it. Luck is that the really bad part of things happened while I was under observation. Time is brain cells in a stroke, and the response to my stroke took under five minutes.

One of the things that has been most interesting to me about this stroke is how people react to it.

Everybody wants to know WHY it happened, what I did that made it happen. What it was about me that made this horrible thing happen.

This is what caused my stroke: chance. Probably genetics.

By chance I had the kind of arteries that delaminate spontaneously. There's no evidence that I did anything to cause this; I don't do extreme sports or get chiropractic work or try to lift heavy things with my head, ever. Those are the risk factors for my type of stroke, and none of them fit me.

(As a side note, don't ever let a chiropractor touch your neck. I'm not joking when I say that EVERY doctor told me this could result in instant death if you have my kind of arteries, and you cannot know if you do or not.)

I don't smoke, I'm not diabetic. The classic young woman stroke is from smoking and taking birth control pills, but that doesn't quite fit me, either (I do take birth control pills).

There's a minor additional risk of stroke from taking thyroid medications (which I have taken for almost seven years now since I got Hashimoto's Thyroiditis in 2006) and birth control pills. My GP and I had a serious conversation about why I take those pills and what we can do to remove that risk factor, but nobody thinks that caused the stroke. The stroke was caused by just having been built slightly wrong. Lots of people are built like this. It may run in my family.

My grandfather had a stroke on the same artery, on the same part of the brain. I never knew him, but his death was part of my life; my middle name is from him, my brother's name is from him. I have on my bookcase a violin he was making when he died, and his bow. And now we have had the same stroke. He was unlucky, I was lucky. In the years between our strokes, medical understanding and treatment of the condition changed completely. Had he survived, he would probably have had major deficits; I'm walking and talking and everything works except my balance.

It is sometimes hard to come to grips with random chance. I learned all about that when I got Hashimoto's and I wanted to know WHY WHY WHY. There is no why. The why is that we are human beings who are all put together in a certain way and sometimes things go wrong. We get sick, things fall on us, we trip and fall into deep holes. Some of those things might have been preventable. Sometimes hindsight is amazing -- ask me how I'm feeling about not pushing for an MRI of my shoulder a year ago.

But things happen, things happen to us when we aren't expecting them, sometimes they are unusual and confusing.

Can you avoid a stroke? Don't smoke, especially not if you take birth control pills. Exercise as much as possible. If you're diabetic be a good patient. Don't eat non-food edible items like fast food or packaged processed food items that play havoc with your cholesterol and blood pressure. You still might get a stroke. I'm not saying doing these preventative things aren't worth it -- they are basically how I live my life (well, except I'm not diabetic even though it seems to have plowed through my family with impunity). What I'm saying is that you can do your best and still have bad luck.

My mother and I talked about my grandfather's death, 43 years ago. She thought that if he'd survived his stroke and lost his ability to play music -- and he had a cerebellar stroke so that was a possibility -- he would have died inside. Stroke care was very different back then, and in many cases you might have been better off just dying. Now I'm looking at going back to work, part time, two weeks after my stroke.

Sometimes you get unlucky and have a stroke. Sometimes you get incredibly lucky.

So on Day One, I basically set a personal record for barfing. Yay me. My goal when I started the day on Day Two was to not throw up at all. Not throwing up was one of the two steps they gave me to leaving the hospital, and I wanted to leave pretty much as soon as I realized there would be no more showers.

In the morning my roommate was moved to another unit -- her condition had improved enough. That was good because not only did her family stay with her until really late (around 2am), but she spent most of the night crying. I spent most of the night having my vitals (blood pressure, blood oxygen, and temperature) taken, and giving up regular vials of blood as well. Neither of us slept very well.

I had a decent breakfast of scrambled eggs and toast. It felt like a minor victory to eat, and the eggs were not great but they were fine. I didn't feel sick at all. A little later a physical therapist came by and had me sit up in bed, then, in an extremely revealing moment, had me walk down the hallway. Revealing because I was wearing an IV gown and a cardiac monitor and pretty much the whole thing wanted to slip off of me, and there was not that much underneath. This was a little inhibiting for me, I admit. I took it as a sign that I was getting better that I was a little embarrassed at flashing half the ward.

They want to get you moving as soon as possible so the natural plasticity in the brain will take over and start rebuilding connections and relearning old skills. Anything that you consciously or unconsciously decide you "lost" and don't try to regain, that is lost to you forever, and that can include things like pooping, so it makes sense to get up and about as soon as possible. There's no lying in bed just resting up after a stroke, unless that's the level of activity you're aspiring to.

Anyway, we took a quick turn down the hallway about 20 feet, which was the third most disorienting walk of my life (first was ER room to bathroom, second was trying to get down the hallway to the kitchen; I keep these neatly ranked in my head because that kind of order helps me).

That was about all I was up for, but they suggested I try sitting up as much as possible that day; I had been lying down which helps keep the world from spinning but again, training early and often was key.

I also was to turn my head from side to side and up and down as much as possible. At first this was horrifying and disorienting, but it did get better.

Just around noon my neurologist sailed in. She's amazing. First of all, I love doctors who talk to you like you're smart, and she did. She explained what had happened in my stroke super clearly, and helped me understand it.

I'll talk later about risk factors and that sort of thing. Right now let me tell you what she told me.

So here's your torso. I left out all the crazy internal organs that get in everybody's way so you can see that there's a spine that runs up to the brain, and the heart is kind of right in front of that. You need all these parts. None are strictly speaking optional.

I think we all know that.

Where the spine ends is a part of the brain called the cerebellum. This controls our most basic functions like walking, breathing, swallowing, and probably making the middle finger at taxi drivers although that has not been medically confirmed.

We lay people call that the brain stem because we like to think brains are like plants. Or something. Hey, look how good an ear I drew on the right side there. I did that freehand in Photoshop.

There are two blood vessels that go from the heart right up the spine (actually wrapped inside of the edge bits of the spine) to feed the cerebellum. One on the right, one on the left. These are called the vertebral arteries and are pretty small compared to the more famous neck blood vessels like the carotid or the jugular. Not pictured for clarity because nobody needs to know any more about those guys.

Anyway, working around this system are obviously a bunch of blood vessels that carry blood everywhere and help things work out. Your brain needs blood all the time but the catch is not TOO much blood, like if a huge pile of blood gets in your brain it does not care for that at all.

There are basically two kinds of strokes: a blood clot gets lodged in the brain and cuts off blood to part of the brain that dies from that, OR a blood vessel bursts and floods the brain with blood and the brain dies from that.

This goes to show that we were either designed by an idiot or a lot of this sort of thing evolved over time and with the help of pure dumb luck and it's kind of surprising anybody can do anything at all.

Anyway.

Neither of these is exactly what happened with my stroke. I had an arterial dissection -- that's when the inner lining of the artery delaminates from the outer "skin" of the artery.

This is that a normal artery kind of looks like, with a lot of creative license. There's a kind of skin part, then a lining called the lumen that's where doctors give you shit about eating bacon because it may cause buildup in arterial plaque. Normal people have a lumen, healthy people have one, it's part of the whole having blood vessels thing. If you've ever done any plumbing work you know pipes get a lumen, too, and it's only a problem when the lumen gets so thick that it clogs the pipes.

Or, well, if this happens.

Some people, maybe some people we know who are writing this post, have bad arteries that can delaminate from the lumen. In my case the lumen delaminated from near my heart all the way to the end of the vertebral artery on the right side of my body. This was actually working kind of OK because the left side had picked up the slack and was pumping more blood in there. Lucky me, number one.

Based on my medical history, this delamination had probably been going on for 1-2 years. I had this pain in my left shoulder. I saw doctors and physical therapists about it and everybody agreed it was my excessive mousing and I should cut that out. I even used a couple little pieces of software to remind myself to take breaks and stretch my shoulder out, but it kept coming back.

Turns out, stretching and warm compresses do not help with arterial delamination all that much. And the weights I was using to try to get the shoulder stronger were accelerating the process.

So, by the time I hit the emergency room on the 13th, this artery was fully delaminated and probably mostly occluded (blocked).

Then I had a teeny tiny stroke when a blood clot formed behind the smushed-up lumen and popped right into my cerebellum. Boom, stroke. Luckily for me, that happened while I was in the ER.

The cerebellum, you remember that, right? Basic motor functions? When I was learning brain parts in high school I thought of it as anything a lizard could do that I could also do. So breathing, swallowing, so on. After I was admitted they spent a whole day checking me for these basic motor functions because a stroke in the cerebellum could mess you right up.

Have I mentioned how lucky I was?

Anyway, the stroke didn't affect any other part of my brain. But I think, given that most people don't know how very specific strokes can be, that any future forgetfulness or stupid thing I do I'm going to blame on this stroke. Even though the only thing I can really blame on the stroke is that I walk like a drunk now.

So, end of part 2.

(My version.)

(I started writing this as one post but it's super long and I'm hardly there, so I'm going to break it up. You can't even comment here anyway so I won't know if you hate it.)

So. On Monday, May 13, yes, Monday the 13th like some kind of horrible ancient Garfield joke, I went to my morning workout at Lake Merritt with my awesome Boot Camp group. I felt a little lightheaded and weak through the workout, but I attributed that to a month off the workout and stuffing myself silly in Turkey. Time to get real and get back to work.

I was also less able to keep my balance, nearly falling over a couple times doing thigh stretches, which is unusual for me. I'm naturally a little clumsy, but I usually have good balance and I've been doing stretching yoga since I was a teenager.

My heart rate stayed in the normal ranges. I had to put down my weights for some of the workout -- I didn't feel exhausted but I felt unnaturally weak. That's OK, I thought, I will go slow and do bodyweight work until I'm back into the thing. Slow and steady. Don't push it and injure myself as I did when I was younger, over and over.

In the car on the way home I felt weird. Lightheaded. I should have had an energy bar with me, I thought; it almost feels like it should be illegal for me to drive like this.

I got home, had some breakfast (I can't eat before my workout because my thyroid meds need to be taken on an empty stomach an hour before eating, and honestly I can get up at 4:30am but not at 3:30am). I took a hot shower which was really nice. I still felt lightheaded.

I got dressed, had a brief conversation with Noel about something work related, then walked downstairs.

At the bottom of the stairs, the entire world spun around me as if a giant hand had lifted me and spun me around. I staggered down the hall to the kitchen. I could barely stand up straight. A wave of nausea hit me -- I absolutely cannot stand spinning -- and I made it to the bathroom to throw up.

In the kitchen again, I tried to put my head between my knees to calm the spinning. Henry jumped up on my back and started purring, and he got to join me for my second bout of nausea.

At that point I realized I was too sick to go to work and sent email to my boss and the project managers I've been working with. That's the kind of person I am: thinking about work responsibilities when I should have been thinking about why I might not be able to stand up straight.

Noel came downstairs. I was sick again. He got me the blood pressure machine and we saw that my blood pressure was incredibly high for me (129/96; my typical pressure is 90/70). He gave me a quick stroke check and I passed it, but we decided I should go to the emergency room anyway. I was thinking I was having a bad migraine and they might have good meds for me; as we left the house the visual migraine symptoms I sometimes get showed up which seemed to confirm it for me.

In the emergency room they gave me a neurological check, which I passed. "It's probably an inner ear thing; we'll give you some medication and keep you under observation." I took the medication. Time passed. They let Noel come in and see me, and we were talking about whether Noel should go to his own scheduled doctor appointment and risk having me have to take a cab home, when suddenly the right side of my body went numb, like a massive novocain shot. I knew exactly what that was and exactly what had to happen. I said so.

Noel got the doctor and I massively failed the neurological test. They stuck an IV in me; I think that was Heparin. I lost all sense of time and place. Noel went for his appointment: I thought it was important that he do that rather than just sit and worry and wait for me while they did all kinds of tests. They gave me a shot of Phenargan for nausea -- it is an antihistamine with all kinds of other uses. I guess it sort of works? It was very disorienting. I somehow ended up in a wheelchair covered in some delightfully warm blankets. Hospitals have blanket warmers, did you know? I did not. This sounds like a terrific idea for home appliances. I should look into this.

At Alameda Hospital the MRI is a mobile unit that sits in the parking lot, so they wheeled me out there and helped me get my earrings off (my wedding ring, made of platinum, was OK). For the next hour I alternately lay in the machine enjoying the very calming feeling of the padding holding my head secure, and sat up vomiting over and over. I think I threw up four times, enough that I didn't have anything to throw up in the end. The MRI techs were great, real champs about holding cool compresses to my face and neck and letting me barf it all out. A nurse arrived and gave me another injection of Phenargan to try to keep the nausea down, which did not much help but made it hard to carry on any kind of intelligent conversation like "I feel better now let's give it another go."

The MRI confirmed the stroke: I had a dissected vertebral artery on the right side of my head, fully occluded (that means no blood flow was going through the vessel at all). If you look at pictures of this artery you will see that it runs along the back of the neck on the side and through the spine. Interestingly, it also showed that the artery on the other side that serves the same area was enlarged, so my body had already adapted. This probably kept the stroke from being as bad as it could have been. I was unbelievably lucky.

After the MRI they brought me back to the ER and gave me an X-ray. I managed not to throw up for that one. Then they added another IV port at my elbow and sent me to have a CTA. This showed that the extent of the damage was pretty severe: the artery had dissected from below my shoulder to the very end inside my skull. I was having severe symptoms by then and had trouble keeping still for the imaging. But I did learn that I'm not as allergic to iodine as I thought I was, which is good because they injected it into me and I might have died if I were. I'm still not going to use iodine rinses on my skin, but good news for contrast imaging needs.

Also, when you get the contrast material injected in you, it makes you feel warm all over and especially, mysteriously, in the groin, where you feel like you just peed yourself. Weird.

Anyway, after that, I really needed to use the bathroom, though god knows why since I'd pretty much puked up everything I'd had to eat or drink ever. Back in the ER the nurse helped me stagger down the hallway (I could barely make it) to the bathroom. I managed that part OK, washed my hands, got out the door, and the nurse was not there. I couldn't get any further; I was clutching the walls to stay upright. Then the urge to throw up came over me and I staggered back into the bathroom.

The was the first time anybody has ever gotten angry at me for barfing in a toilet. I'm not sure where she expected me to do it: all over the floor seemed like a bad idea for many reasons. I got back to the bed in ER and they gave me another shot of Phenargan and 2.5 mg of Valium. I'm not sure how effective taking anything in pill form was at this point given the incessant vomiting, but maybe Valium gets absorbed really really quickly.

I don't remember the next few hours. I knocked out from the Phenargan and possibly also from the Valium. Noel came back and sat with me in the ER and I guess read all the stuff about my illness that I had to discover later.

Eventually I woke up right before they moved me to a room in the DOU (Determinate Observation Unit, a step down from Critical Care, but we shared the same nurses). At this point I'd totally lost track and thank god Noel was there to make sure they had my clothes and everything. I gave him my wallet and my work phone (I kept my personal phone with me in case I needed it -- for the foreseeable future I am going nowhere without my phone close at hand). The world was spinning. I think I threw up another couple times. I kind of lost track.

When I got settled in my bed, I felt better right away. They leaned my head back and I could rest against the pillow. Noel had called my parents while I was knocked out in the ER, so we called them again so they could speak to me in person and be reassured. Everybody was telling me how lucky I was. Every nurse and doctor gave me a neuro check and marveled at my swift recovery. My only real loss, by the end of the day Monday, was my balance center.

Some friends came by to see me, which was awfully nice. We hung out and talked and marveled over my roommate, who had arrived shortly after me and turned on the TV immediately. Through the curtains I saw her family had brought her a pile of junk food like chips and oreos. I was not hungry really at all, even though I had not eaten all day and had thrown up everything I had for breakfast. I was so sick that while I was overjoyed to pass my swallow test (to make sure I hadn't lost that ability in the stroke), I was not able to eat more than a single cup of applesauce. They brought me a tray of dinner that smelled horrible, and I didn't eat anything on it.

After everybody left, I barfed that up, too. Including, mysteriously, a large pill I took on Sunday night. I don't even know where that was that I could still throw it up. Gross.

They had to change all my sheets and my gown and everything, but there are no showers in the rooms and you can't wash the IV connections at all, so what I got was a wipe-off with wetnaps. For the record, this sucks. For the rest of the week I kept smelling old applesauce vomit on and off. I'd really just gotten over my aversion to applesauce from having to take ground-up prednisone tablets in it when I was 7 and got poison ivy down my throat thanks to some idiot burning weeds. No more applesauce for me, I guess, if it takes 35 years between aversive episodes.

Anyway. That was the having a stroke part. The next several days were about having had a stroke.