Act F.A.S.T.

The headaches started on Wednesday, October 5th. I had just returned from the post office after mailing the first full draft of my dissertation to my advisor. I was pretty proud of myself for meeting that deadline and was going to reward myself with a day of doing nothing taxing and catching up on TV shows. After almost a year of data analysis, no one had to convince me that I deserved this break. Even better, I would have the house to myself since my aunt Nancy was going to be out of town. By the time I settled into the couch though, my head was pounding. I took two Advils, wrapped myself in a comforter, and turned the TV on. This headache was not going to interfere with my agenda!

...oh, but it did. Since the images on the TV had become unbearable to watch, I moved to my bedroom. The headache lasted for hours, then days. The pain got worse. Much worse. My head felt like it was on fire. At one point, I jumped into the shower with my clothes on (I didn't realize they were on) just so I could cool my head/scalp with very cold water. I laid in bed until Saturday. My head felt  heavy and it was very difficult and painful to move my neck. I couldn't stand the light coming from my bedroom window so I pulled the blinds down and found comfort in darkness. I ignored phone calls and resorted to humming. For some reason, humming made me feel better. The Advils were not working. When I tried to stand up, I felt dizzy and unbalanced. After 12 hours or so, I finally mustered up the courage and energy and made my way to the basement, then to my car. The drive to the pharmacy that usually takes me 3-5 minutes took me almost 30 minutes. It was past about 2am. When I finally go to Walgreens and made my way inside, it was too bright to keep my eyes open. I collapsed on the floor and the attendant rushed to my side.

     "Ma'am, are you OK? Ma'am??"

     "Please.call.the.pharmacist."

     "The pharmacy is right there, can I walk you over?"

     "Please.call.the.pharmacist."

     "But ma'am, I can't have you lying on the floor. Could you at least get up?"

     "Please.call.the.pharmacist."

Finally, the attendant paged him :). The pharmacist towered over me and asked what the matter was. I told him that I had had a headache since Wednesday and that the pain was now unbearable. He asked a few other questions that I can't really remember now. He suggested that I get medicine for tension headaches and some Ensure since I hadn't had any solid food for some days. He asked if I wanted him to call an ambulance, but I declined. The drive back to the house was also slow and the automatic humming continued. Once home, I took the tension headache medicines. No change. Sunday morning, no change. Nancy got back on Sunday afternoon only to find me in pain. Because there was still no change on Monday morning (the 10th), Nancy insisted that we go to the ER. I had to cover my eyes since the sunlight made the headache worse. Three hours later, the ER doctor explained that I exhibited symptoms of a migraine. That also explained my sensitivity to light, the doctor said.

     "But I've never had a migraine in my life."

     "Well, migraines can happen for any reason. Your aunt tells me you are a graduate student and writing your dissertation. Stress can cause migraines."

The doctor prescribed migraine medication, but cautioned that everyone reacted differently and that it was a matter of finding the right one for me.

October 10th, 11th, 12th. That medicine was not working. The ER doctor asked me to go see my primary physician. I didn't have one, so I looked in the Cornell University out-of-network directory and picked the first Ghanaian-sounding name I found. 'Dr. A.' had just recently set up an office in Framingham, right next to the hospital where I had been to the emergency room. My visit to 'Dr. A.' on the 13th exposed other problems when he checked my blood pressure. The expression on his face was not encouraging at all. He immediately prescribed medication to regulate the blood pressure and explained: "for now, it's not about changing your lifestyle with exercise. You will do that when you get better. For now we need to keep this pressure under control." He asked how long I had had the migraine for. "Almost a week now, but the medicine they gave me at the ER didn't work". He confirmed what the ER doctor had said about the medicine reacting differently with everyone. 'Dr. A.' prescribed another migraine medicine (Fioricet) which affected my coordination and sense of depth perception even more. Although the pain was more pronounced on the right side of my head, the headaches were not as bad as before.

Five days later (the 18th), I woke up with what I thought were 'pins and needles' in my left leg and arm. I wiggled my toes. Well, I tried to wiggle my toes, but only felt numbness. With much difficulty, I got out of bed and tried to squeeze the fingers on my left hand. Also numb. I caught a glimpse of my face in the mirror and the left side looked different. I took a closer look and saw that my left side was droopy. What in the.....was going on??? I started to panic.

I don't know where this moment of clarity came from, but I quickly remembered the contents of an email that was forwarded to me some 6 years ago, describing the signs of a stroke (a droopy face being one of them). I raised my arms, but the left one didn't budge. Then I spoke out "it's a sunny day today", which sounded more like "beh beh beh beh beh". "Oh my God, was I having a stroke? At 31 years? How was this possible?" I thought to myself. I tried to grab my phone to call 'Dr. A.', but couldn't hold it in my left hand (it didn't occur to me use my right hand). I inched closer to Nancy's room, knocked on her door using my right hand and laid there, waiting... Nancy, who was not in her room at the time, almost had a heart attack when she found me sprawled on the floor, visibly ill. There was really not much to ask or say so Nancy ran to get the car, came back to carry me, and we headed to the ER (again). This time we drove directly to where the ambulance pulls up.

On the way there (3-minute ride), I had a very interesting experience. Because of the numbness on the left side, my body slumped to the left, with most of my weight resting on the seat belt. While Nancy uttered very comforting words to me and drove as fast as she could, I thought: "I don't remember the last thing I said to my mother / My room is not clean / I will not finish what I set out to accomplish in life / Nancy has been like a mother to me / Daddy died 4 days before his 51st birthday and so am I."

I snapped back to my reality when I was lifted onto the stretcher and taken to one of the ER rooms. Different machines were instantly hooked up to me and a medical team formed around me almost immediately. Nancy explained that I had been there 8 days ago and was told it was a migraine. "Dela, can you smile for me please?" one nurse asked. I tried. Although she didn't say it out loud, I watched her lips as she nodded to the doctor saying "stroke signs." 

      "When is your birthday, Dela?"

      "10.22.79" 

      "Oh, that's a couple of days from now!" 

Yes it is, lady. Don't remind me. Please don't remind me.

A CT scan, two unsuccessful and very painful spinal taps, and a very uncomfortable MRI later (six hours), 'Dr. T.' walks to my bedside and says: "Dela, we did find some abnormalities in your MRI. Looks like you have three large blood clots in your brain, on the sagittal vein, which goes along here (she showed me). That explains the severe headaches you have been having and  the mild stroke you suffered this morning. It's known as cerebral venous sinus thrombosis."

Blood what? You see, my mother had suffered a pulmonary embolism in September 2008 that nearly took her life and gave me the greatest scare of my life (indeed, I am still recovering from that traumatic experience). Blood clot in the brain? How does a clot form there and why? I had a thousand questions. Nancy and I were dumbfounded. As we tried to understand what was happening, doses of heparin (blood thinners) were injected into my stomach. 

The neurologist on call recommended that I be transferred to a dedicated neurology unit. There were no beds at Tufts, so the other option was UMass Medical in Worcester. Both are about 35 minutes from Framingham, in opposite directions. Off I was, strapped in a stretcher, sirens blaring. "How did I manage to end up in another ambulance? Was the broken ankle that required surgery in 2008 not enough excitement? Or was it going to be one major event per decade?" I tried to find humor where there was none.

About 15 minutes after I got to the UMass ER, the doctor said "Hi, I'm 'Dr. X.' I hear you suffered a stroke today. Don't worry about anything. We are going to take care of you. And no, you will not die." How comforting! A neurology resident came to ask a million questions, including the date, what state we were in, and the name of the current President: "I hope it's still Obama!", I said. "When is your birthday, Dela?" "10.22.79." "Oh! That's soon!"
I know..............

Some four hours later, I was wheeled upstairs to the Neurology Wing. The next morning, I felt the numbness again. When the nurse saw my face drooping, she screamed "get Dr. S. now!!" I couldn't believe it. Another stroke? And to have the nurse's eyes open so widely, I thought "this is not good." 'Dr. S.' and her team of residents made it in time and performed a series of balance and coordination tests. 'Dr. S' (a neurology surgeon) also took the opportunity to ask about language and intonation in West Africa as well as my Ghanaian background, American-sounding accent, and dissertation topic. Since my life was in Dr. S's hands, I obliged!

The inter cranial pressure persisted, but not with the same intensity. 'Dr. S' recommended that I take the next two months off to recuperate and warned that it might take longer to get back into the groove of things. I would be taught to self-inject heparin in the stomach area for about a week or two, while I started on coumadin (pill form of blood thinners that is essentially low doses of rat poison). The hematologist, 'Dr. T', recommended that we start a 6-month coumadin regimen, then see whether we would need to increase it to a year.... Being on coumadin requires a lot of changes in one's diet, including watching one's intake of Vitamin K (increases coagulation) very carefully. 

I came back home on October 21. The next day, I celebrated my 32nd birthday, filled with  gratitude. Four days prior, I didn't think I would see that house again. The next two months were characterized by visits -- every 3 days -- to the Anti-Coagulation Clinic in Worcester, to check my blood level. I then started going once a week. In early December, another MRI was done. I was experiencing chest pains, which prompted the hematologist to request a full body CT scan, in case the clots were breaking up into small pieces and traveling into my lungs (which could cause a pulmonary embolism). Another MRI was done in early December, confirming diminishing clot sizes. However, the neurologist ('Dr. H.') disagreed with the conclusions that the hematologist drew from the MRI and requested an MRV instead. Let's just say that he overspecialization of medicine in the US has its disadvantages.

The clots had disappeared by February, but I stayed on coumadin for two more months. I happily took my last coumadin pill at the end of April. To manage the dull pain in the head, the 'Dr. H.' prescribed amitriptyline, which has worked wonders. 


I won't go into how and where I found the strength to get back to the 14-hour/day schedule it took to write, defend, revise, and get final approval of the dissertation (January to August). I just want to take the opportunity to thank you all, my family and friends, old and new. I would not be here without your support, care, and love.

So why this long story? Well, you can imagine that during my recovery period, I had a lot of time to learn about the causes of a stroke. My aunt recommended that I read My Stroke of Insight by Dr. Jill Bolte Taylor, a neuroanatomist who suffered a stroke and wrote a memoir about her experiences as both a patient and a brain scientist. 

I also found out that October 29 is World Stroke Day and that 1 in 6 people will have a stroke it their lifetime. The email that I read years ago about stroke signs proved very useful. Allow me to use this opportunity to remind you all of some simple ways to help determine if  someone is experiencing a stroke:

• Act F.A.S.T:

(F) Face Drooping. Does one side of the face droop or is it numb? Ask the person to smile.

(A) Arm Weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

(S) Speech Difficulty. Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like "the sky is blue." Is the sentence repeated correctly?

(T) Time to call 911/get to the hospital. If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

• Ask the person to Smile, Talk, and Raise Both Arms (representing the first three letters of the word STROKE).

There are numerous resources online, some of which I have linked in this post. Please take the time to learn more about strokes, their causes, how they can be identified, and how they can be prevented. Your knowledge could save a life, if not your own.

Thank you for reading. The next post will be cover much less somber topics. That is a promise!