WHAT DOES A STROKE LOOK LIKE?

Stroke is the most common cause of adult injury and can be very difficult to self-diagnose. The symptoms vary widely from patient to patient, so it’s hard to see it coming.

I think it’s important to share unusual medical happenings and to be transparent about my own health in hopes of helping someone else, which leads me to share the story of my own brush with a stroke, which happened this last Wednesday, January 17.

First of all, with tongue in cheek, I want y’all to know that playing horse turd ice hockey, which I shared pics and video of on social media just the day before, is NOT the reason for my injury, BUT I AM LUCKY that playing hockey didn’t end with me having a stroke.

Sunday, a few days before playing hockey, I came in from the morning feeding of the wood stove, kicked off my snow boots and shucked off my layers, sat down and cuddled up with Cale in my recliner.

I was coughing a lot because of the transition to the warm dry air of the house from the -2 cold snowy air outside. Every morning, it was taking about 15 minutes for my lungs to calm down and for the coughing to cease after coming inside. I’ve been using peppermint oil a lot and drinking soothing tea and honey, but my congestion was just awful and difficult to manage.

We had some sort of flu right at New Years, and I had the worst congestion of the three of us. My body is still getting rid of it, and on that day when I opened the wood stove, the stove’s fan was running, so as soon as I opened the stove door, an open flame perked up and smoke came out the door. It’s normal, and the opening in the roof of the wood shed funnels most of the smoke up and out, but with the residual congestion, it really irritated my lungs and I was coughing up phlegm while feeding the stove.

I had cut down a really nice dead hedge tree in the days after recovering from the flu but before the cold snap arrived. Hedge burns hot and long, and while the tree was a prize, some of the pieces are really big, so I was coughing while feeding a 60-pound chunk of hedge and some smaller but heavy pieces of oak into the stove. That amount of weight is really not a lot for me. Combined with the coughing, though, the damage done would present itself very soon, but I didn’t recognize the danger.

Sitting inside reading a book with Cale afterward, my teeth were throbbing in rhythm with my pulse, and my jaw and neck hurt. These were my first symptoms, but I chalked them up to breathing the insanely cold air in through my mouth because breathing through my nose was painful because I had been blowing my nose so much, my sinuses were raw, and breathing through the nose set my sinuses on fire. I spent some time with Mom at the studio the next day, Monday, and I remarked to her that it felt like I’d been grinding my teeth at night, something I do only rarely. My jaw was really sore. My teeth still hurt.

Tuesday we finished school work, got ice broken for the horses, fed the stove, cleaned the house and treated ourselves to horse turd hockey on the north pond at the Forsts’ place. There were about 20 kids and 5 adults. It was a blast, and we were exhausted after 3 hours on the ice. I fell a few times, but didn’t feel a thing, as the adrenaline was rushing and I was wearing lots of soft layers.

On Wednesday, we were doing chores and getting things rounded up to go to the studio for the afternoon and evening. It was warmer than it had been, the sun was shining and there was a stiff south wind melting the snow, but it was still only about 25 degrees.

Creek and I were breaking ice and scooping it out of the horse tank when my right hand wouldn’t grip the shovel handle.

I stopped, looked at my hand, tried to make a fist, and my fingers didn’t do what I told them to. There was this bizarre disconnect, a 2-second delay between me telling my fingers to move and them actually moving. “My hand isn’t working right.”

“Mom, you’re just cold. Take your glove off and put your hand under Rusty’s blanket.”

The sorrel gelding, my regular ride, was standing nearby, and I worked on bending my fingers as I walked over to him. I touched my face, and while not especially warm, my hand wasn’t cold either, and the sensation of warmth from my face took a couple seconds to register in my brain. I could feel the touch on my cheek but not on my fingertips.

I said “My hand’s not cold. Something else is happening,” and as I slid my hand along Rusty’s neck and under his blanket, my thumb caught and bent slightly backward, and while this should most likely hurt like hell, I didn’t feel a thing. I pulled my hand away from the horse’s warmth and headed for the gate.

Whatever was going on, I didn’t want to end up prostrate 50 yards from the house, on the other side of the fence, in 25° weather, my only rescuer my 13-year-old daughter. She’s stout, but not drag-Mom-to-the-house stout.

“I’m going inside, I better sit down. Stay here and finish filling the tank.”

“Ok, are you ok??”

“I’m not sure, but I don’t want you to have to drag me to the house if I do down. Fill the tank and come right in.”

I got inside and headed for my recliner. I sat down and removed my left glove. I made a fist, then wiggled my fingertips in a wave at myself. It worked perfectly. I tried touching my left and right fingertips together in a church steeple, and while the movement was true and I touched them together, the sensation of them touching was immediate on the left side, but an echo on the right, an afterthought, further muted by my own confusion.

Cale had just poured boiling water over a scoop of beet pulp for the horses’ feed and was waiting on it to soak. She stopped at my side and watched me for a few seconds. “What are you doing?”

“My right hand isn’t working right. It isn’t doing what I want it to. I’m hoping I can warm up my hands and cool down my body and figure out what’s going on.” I had been sweating out there chopping ice, which splashed water on my jacket and face, which froze within seconds in the wind, and a few minutes inside was melting my shell.

I was sitting still, my body was cooling down, and the exertion outside in the cold air and the transition to inside had irritated my lungs, so I coughed up a wad of junk. Flashing lights began arcing around the right side of my vision, which is normally a sign I’m going to have a headache soon.

This time it was insane and more distracting than usual because in addition to the normal half-moon arc of flashing triangles, there were swordlike lines of the flashing triangles stabbing through the outer arc and stretching right into the center of my vision.

Cale was talking to me about mixing the feed, and suddenly it was like she was in a tunnel. I have no idea what she was saying to me but I got next-level concerned real quick.

I got up and walked to the bar. “Cale, I need your help.”

She was immediately concerned, and followed me to the bar, where I sat down on a stool, looked at her, and said “Go get the tank.”

“What?” she asked. “Are you ok Mom?”

I knew what was happening now, and I said “Go get my sister.” Her eyes got real big, like she thought I actually expected her to run to Iowa real quick and drag my sister back. I clamped my hands over my temples and shook my head. I concentrated really hard and said “Get Creek. At the tank.”

She was out the door like a shot, and I pulled my phone from my pocket. I used both hands to dial Mom. I was able to use my right hand to hold the phone and dial, but I had to concentrate really hard again to be able to tell Mom “I need your help. I think I’m having a stroke.” She said my speech was clear, not garbled, but she could tell I was having trouble getting my point across.

She hustled to shut off the lights at the studio, lock the door and get in her truck while keeping me on the phone, talking the whole time. “Are you inside the house?” My communication began to improve markedly. I was able to answer her questions without a struggle to find my words. “Where are the girls?” Creek and Cale had just come back inside and were listening. We hung up and Mom called Creek’s phone so she could talk and listen to us, and I called my doctor’s office at Carthage, where they instructed me to get to the ER as soon as possible.

Mom was still about 5 minutes away, and I began rifling through the mail for my new insurance card, which had just come recently and I hadn’t opened it and put it in my wallet yet. My right fingers were a bit slow as I flipped through the stack of mail, but they worked. I used my right pointer finger to peel open the envelope containing the ID card. It was slow work, but my fingers worked. As soon as Mom got here I met her at the truck, hugged and kissed the girls, told them to fill the second water tank and feed the horses, and we headed to Mercy Carthage.

After checking in, it was only a couple minutes of waiting and a young man came to get me. I walked to my bed in the ER, gowned up and had my vitals taken and explained my symptoms.

I saw the ER doctor, who heard my symptoms and left to deliver orders.

It was at this point a nurse gave me stroke-prevention meds, Plavix and aspirin, and left us to wait. Plavix makes the inside of the blood vessels slick, preventing a clot from sticking and building and blocking. The aspirin thins the blood, preventing clots from forming in the dissection.

Before long, a camera on a stand next to where Mom was sitting began swiveling around. A doctor appeared on the screen below the camera. He asked me about my symptoms, and a nurse came in during our conversation and he had her do some testing. She had me follow her finger with my eyes, touch my nose, smile really big, hold up my arms, hold up my legs, squeeze her fingers. I did everything just fine. The Telehealth doctor said he thought I had had a “migraine with complications,” but was going to order some testing for me.

It wasn’t long and I was taken for a CT scan. They took pictures, then injected dye in my IV and took more pictures. It took about 10 minutes.

Shortly after returning to the ER from CT, I was taken for an MRI. It took about 30 minutes. I was surprised when the technician told me we were going directly from there to get me an echocardiogram. The tech also said the word on the street is they were keeping me overnight. I was like “Are you serious?” She said “Yep, that’s what I was told.”

She took me directly to get an echo. I have been diagnosed with mitral valve prolapse (a heart murmur) in my past, so they wanted to check and see if I had any holes in my heart.

After I got back to the ER, it was only a few minutes before the ER doctor came in and said “you’ve been quite the adventure today, but we have a diagnosis. You have a dissection of the left internal carotid artery.”

Explanation: The artery runs on the left side of the neck to the brain beside vertebra C1-C4. The insides of arteries have a lining, or lumen. The lumen inside my artery is torn for about a 3” stretch, and instead of flowing through only one channel, my blood is flowing through two. The torn lumen is just flapping around in there. A piece of it could break off, clog an artery in my brain and cause an ischemic stroke, which is a stoppage of blood flow that results in part of the brain being deprived of blood flow (oxygen).

When I had lost control of my hand and when I lost my words, I was having a TIA, or transient ischemic attack, which is “when blood flow to a part of your brain is blocked for a short time. A TIA causes stroke symptoms that can last for at least a few minutes. Stroke symptoms include sudden weakness or loss of movement in a part of your body, confusion, vision changes, trouble speaking and trouble walking or balancing. Unlike a stroke, a TIA doesn’t cause lasting brain damage.”

The ER doctor said they planned to transfer me somewhere, though he wasn’t sure where yet…either Joplin or Springfield Mercy. He said the specialist at Springfield thought they could manage the dissection medically instead of doing surgery, but the Carthage doctor wanted them to look at me and then tell me that.

I asked if I could have headache meds and if I could eat, which he affirmed. We had Aunt Sandy go over to my house to be with the girls, and we relayed the diagnosis and had them gather up some things for me, which Sandy delivered to Carthage. Mom went out to get us some dinner, and we settled in to wait on transport.

This was around 6:00. A bed became available in Springfield around 10 or so, but miscommunication between the ER and the dispatcher delayed the transfer vehicle, which arrived at about 12:45 am. They unloaded me at Mercy Springfield around 2am. After entering my chart information, the nurses let me get some rest.

A doctor came in at 4am and woke me to tell me that the specialist said after viewing my scans that they would not do surgery, but would medically manage the issue and we would work to mitigate risk factors in my environment.

After I woke up around 9am, my nurse talked with me about how dissection of an artery can happen.

As she talked about examples of it from her career, I was able to narrow things down to what I was doing when my tooth, jaw and neck pain began, which was after feeding the wood stove on Sunday.

One example was of coughing too hard. I said bingo on that one; I’d been coughing ever since we had the flu, and it was improving slowly but my lungs weren’t completely clear yet. She nodded and said there was some variant of respiratory flu going around that wasn’t flu and wasn’t COVID, they didn’t know what it was, but it was nasty and the congestion was long-lived.

Another cause of dissection was chiropractic adjustment. My last adjustment was over a month ago, and I hadn’t had any pain afterward, so I said that option was out.

A further example was lifting too much weight. I said I lift heavy stuff and do physical work every day and I’m smart about it; however, combined with that insufferable cough, I think that may be what caused my teeth and jaw to hurt, as well as my neck.

The nurse said “Why didn’t you call your doctor about that?”

“For tooth pain?” I explained to her again that I figured it was from breathing in the cold air through my mouth, and aches and pains are part of life in the country, so a little crick in my neck is par for the course. These symptoms didn’t scream “stroke” at me. When I couldn’t control my hand, THAT told me I was having a stroke. When I couldn’t say the words I was thinking, THAT told me I was having a stroke. The only course of preventing what happened was for me to self-diagnose the dissection, because I’m pretty sure I would have been either laughed out of the doctor’s office for coming in for tooth pain, or sent directly to the dentist and then back home.

Caption: The pain in my face and neck was an indicator of the dissection of the internal carotid artery. This graphic is probably the most valuable piece of information I can possibly share to help others in the same situation. Carotid artery dissection is the most common cause of stroke in adults under age 45, so this info is also the only thing that could’ve helped me BEFORE I had stroke symptoms. My pain was exactly where this graphic says it should be.

The nurse and I reasoned that the intense exertion from breaking ice on Wednesday probably knocked loose a little flapping piece of the dissection, causing the first symptoms of the TIA while I was outside. Further, we reasoned that after I came inside and coughed some more, that knocked some more of it loose, which caused the flashing lights and impaired speech, further symptoms of TIA. I was lucky that none of those ‘floaters’ got caught in my brain and caused an actual stroke.

I would venture to guess that I didn’t stroke out playing hockey the day before because I was drinking at the time, which thins the blood. I hadn’t had anything alcoholic in over 2 weeks, since the last time I was around friends, and what better time for a drink than with my friends while playing reindeer games on a 20-degree day? It gives you a false sense of warmth, which was a total bonus.

The nurse soon brought in a stack of test findings and went over them with me. My blood labs came back excellent. She said there was nothing abnormal that would cause a stroke. My BMI is elevated but I’m very healthy despite that. My A1C is at a healthy level below the pre-diabetic threshold. We reviewed the info that the CT with contrast revealed the dissection of the left internal carotid artery. The MRI revealed that I have degenerative disc disease and narrowing of the spinal cord opening in several vertebra. They didn’t have results of the echo yet, but I can get that report at my doctor’s office next week since they would be discharging me within the next couple hours.

“Really?” I figured I was there for another night since they brought me towels and let me take a shower that morning.

She went through the mitigation measures with me: blood thinners for up to six months, 10-lb weight limit, don’t cough. Follow up with my PCP within 5 days, then meet with the arterial specialist in Springfield in a month, who will do an ultrasound on the artery to see if it’s healed.

She didn’t have to tell me twice. I wanted my own bed, my kids, my recliner, my dogs. As soon as she left, I ditched the gown and the heart monitor and got my own clothes on.

She said it would be an hour or two, but she returned within 20 minutes with my discharge orders, and she let me walk out.

I’m so happy to be home. When I first arrived in Springfield, I was of the opinion that “they need to fix this before I leave,” but I’m actually happy now that I can heal without surgery, which would keep me down plenty long itself.

In regards to the degenerative disc disease…my dad has the same issues, so this is not unfamiliar to me, and I figured I had inherited them because I have had to manage my own chronic pain for nearly 7 years through regular exercise and daily consumption of natural supplements that include inflammation controls.

Why am I overweight if I’m so active? It’s all in my belly, which is the area you see weight gain from overproduction of the stress hormone cortisol, especially in women, because let’s face it: us ladies worry for everyone in our family and then some. Casey’s aneurysm, the possibility of him dying, the hospital bill, his recovery, my PTSD, restarting my business after it ground to a halt, selling the farm, my divorce, finding my groove living as a single parent again, these things have all played into my stress for the last 3 years. I’ve been working on simplifying, letting go of the idea of the junk art dynasty that I dreamed of, and niching down into a smaller corner of the art world, all of which have been instrumental in reducing stress.

I find it hard to eliminate bread and dairy from my diet, a first step in dropping that weight, but maybe soon I’ll get it kicked. I did intermittent fasting last summer and dropped about 15 lbs, then I stopped the IF while we were at Silver Dollar City and while I haven’t gained it back, I haven’t begun again yet to drop more.

Right now, there are still stroke warning bells that I must heed and keep myself sedentary to a point. I have some residual tingling and pain in my jaw and in my left cheek, and a headache sometimes seems to just threaten in my left temple. I have pain in my neck that sometimes stretches down to my shoulder. If I bend over, I feel the pressure on the artery. It’s kinda crazy and pretty scary.

It’s difficult to sleep comfortably because I can’t sleep flat right now. I have to keep my chest and head elevated or I’ll cough up junk. I can’t sleep comfortably for an extended period on my back, so it’s challenging finding a comfortable position on my side that keeps my head elevated, but it helps eliminate the coughing, so I turn back and forth a lot trying to sleep.

My back hurts from the inactivity. I’m a physical person. I’m overweight, yeah, but don’t let it fool you. I LOVE a workout. I don’t dread cutting firewood because I love the exercise. I love tearing down barns and salvaging materials because essentially, it’s getting paid to go to the gym instead of the other way around. I loved the physical side of farming, and I love landscaping and gardening because besides scratching my botany itch, they are great exercise too. If you’ve got a hard job to do, set me up, because I’m addicted to the adrenaline of going balls to the wall until the job is done.

It’s interesting to me that none of my ‘health quirks’ truly caused my dissection. The ER doctor at Carthage, when I asked him what caused this, he shrugged and said “Bad luck.” I found that irritatingly nonchalant and hard to believe, but then later we narrowed it down to when my teeth began hurting and put two and two together that I was coughing my head off and shoving huge chunks of wood in the stove at the same time, and it really WAS bad luck, getting injured doing something I do every day.

I’ll probably invest in a splitter after this. Then we don’t pick up ANY big pieces, period. Take the splitter to the woods, cut the tree down, split it, load it, haul it, stack it at a more manageable weight. I’m 44, so maybe it’s time to act a little older and “Mitigate the risk factors.”

As interesting as the cause is, I find it more interesting what I learned firsthand about my own mortality and that you can die from just plain bad luck. It makes me want to love on the girls harder, be softer on them when they need a lecture, reduce stress in my life more and become a better version of myself. While I’ve been working on that for awhile now, it’s apparent that it never ends until you’re gone.

What also never ends is the love and support from my people. I was scheduled to cut firewood again on Thursday, but then I was in the hospital and ordered to rest, so Julie Forst went to the saw mill and picked up a dump trailer full of firewood to us that should last us quite awhile, and talk about bad luck, she blew two trailer tires on the trip to my house. Ugh, I feel so bad about that! Leonard Forst brought me some firewood too, and while I was sleeping at the time and didn’t get to hug him for it, I’ll drop in to see him soon and leave him a gift in his beer fridge. My neighbor Bradley Morgan checked on the place and got my Ford going (it had gelled up on me on Monday, even after I treated the fuel tank), and although the sun had already thawed out the fuel filters and it fired right up, I sure appreciated that he took the time to knock it off the list of stuff I was worried about. I’ll have to see if I can make cookies as good as his wife’s and deliver them soon. So many have texted, called, prayed and probably done stuff I don’t even know about yet. I’m much obliged to all of y’all!

If there’s any advice I’d like to share about all this, it’s to take extra care of yourself in this ridiculous cold. The frigid temps are hard on a body. Allow plenty of time for tasks. If you’re congested, take care to use cough drops or cough syrup so that you don’t put a lot of continuous pressure on your blood vessels and brain. If you’re over the hill, like me, realize that we can’t do what we’ve always done forever. Make a point to make things easier for yourself. Last, if there is any change to the status quo, be curious and get it checked out. My teeth and jaw hurt for three days and I didn’t get it checked out until I had stroke symptoms. Don’t explain it away! In my research, I found that “Due to a lack of specific signs, the diagnosis (of arterial dissection) often goes unrecognized for some time.”

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