17) A New Wrinkle in Time

July 28, 2021
Wednesday

Following a new strand: For a number of months I have had what I called 'hand tremors' in my right hand when I write client notes, calendar entries, my signature, etc.  It got progressively worse and spread to my difficulty holding cups of coffee while walking up the stairs, or carrying two vessels of liquid at the same time anywhere. Another concern was my "fuzzy brain" and forgetfulness about certain specific names (authors, Thomas Hart Benton (the other day), TV personalities and musicians (Jim Morrison), and colleagues (except you of course!).

Referral to a Neurologist: During my last conversation with my nephrologist (Dr. Baru) we talked about my getting a Neurological exam and he referred me to Dr. Manchanda, who may have saved my life! On July 8th, Liz and I visited with Dr. Manchanda's nurse who did some basic physical and cognitive assessments with me and proclaimed me "almost adequate" (MY assessment). During the visit with Dr. Manchanda, we discussed my medical history, substance history, timeframes related to fuzzy brain and the tremors.  He thought the cognitive issue could be connected to the ammonia levels (due to liver function) so he scheduled liver level labs and an MRI.

I got the blood work done at Path Labs on Brodie; my new favorite. I was able to get in for an MRI at Austin Radiological at 9 p.m. on July 23rd.

On Sunday morning, July 25th, at about 10 a.m. Dr. Manchanda called and directed me to get to an ER immediately (St. David's S. Austin Community Hospital) and tell them I had had a stroke.  Telling hospital ER staff you've had a 'stroke' is a great way to bypass everyone waiting for services! By the time Liz had parked the car, I was in a treatment room with two nurses checking my vitals.

July 25,2021
Later Sunday ~ St. David's S. Austin Hospital ER: We were in an ER exam room for about 6 hours having bloodwork, several careful MOCA assessments by the ER Doc and each specialist that came by. The ER Doc said they'd be keeping me overnight and had a lot of tests to run on Monday. We were moved over to another exam room while waiting for staff to clean a room on the 5th floor. At about 6 p.m. I was moved up to the stroke floor and the floor nurse was waiting for me to explain the safety concerns, routines (they'll be coming in every two hours to 1) check vitals; 2) draw blood if needed; and 3) see if I looked the same as two hours ago. The charge nurse explained that I cannot walk around or go to the bathroom without a physical support nurse with me at all times because they didn't have data on how I was navigating: I just call them and they come right away. I wasn't too happy with having to call for "help" to go to the toilet but I did understand their concern, and I settled in for the night. About midnight I was awakened by the Nurse, who had me sit up, hands out straight (5 seconds), push against Nurse, push back when she pushed against me, arms out sideways, push push; leg lift right, push push; right leg lift push push, etc. 

Watch my finger.  Touch your nose and then touch my finger... squeeze my fingers... take down your mask and give me a big smile...

The regimen was the same about every two hours: in the Pictures/Names portion my favorite was this picture that I told a different story about each time .

The Speech Pathologist stopped by, talked to me, and gave graham crackers and applesauce (to see if I can eat and talk at the same time, or maybe if I was raised well as a child). 

July 26,2021
Monday~ St. David's South, 5th Floor  

I had finished my breakfast by the time Liz arrived and found fruit I had saved her from breakfast. The Physical Therapist led my MOCA assessment and then got me up out of bed, wrapped a wide rubber belt around me like I was a refrigerator, and took me on a walk down the hall. Off we went for a little stroll around the floor, which, of course, I hadn't seen yet. She had me close my eyes and walk (Trust walk? I hardly knew her) and then walk backwards with closed eyes.  She was testing my balance and gait and the surprise result was... she gave me the 'okay' to get out of bed on my own and walk to the bathroom to pee without a chaperone 👍🏽!  

This day was full of testing: ultrasound of arms and legs looking for clots, an ECHO Cardiogram, ultrasound of my neck, etc. (meaning I didn't remember or take notes). Liz went to the re-decorated cafeteria to call immediate family, who we hadn't called because we really didn't KNOW anything. I was out for another test when Katie came to visit. What a surprise to see her when I was rolled back in. She stayed for an hour or so waiting to hear something about my status and through a couple of MOCA sessions, and a lab draw. We had a great talk about everything that is going on with this new wrinkle in my time and with her being

 a "mom". I was still waiting for the CAT Scan when Liz left a little after 8. Staff came to get me (wake me up) for that around 2:30 a.m. The red headed CAT technician said, "we get really busy...."for that around 2:30 am, Tuesday morning. Red headed CAT operator told me they "get really busy"

July 27, 2021
Tuesday ~ St. David's South, 5th Floor

For breakfast I ordered scrambled eggs with wheat toast and 

plasti-pac picante sauce, which came without the sauce. I called down to the cafeteria and the sauce was delivered forthwith, getting to my room before Liz arrived with sauce from home. As usual, I saved my breakfast fruit bowl for Lizzie for our third day of tests and assessments and hopefully a discharge summary and plan.  

Many of the important players came by to visit and inform us of their thoughts.  Dr. Middough, the stand in as my "attending physician" popped in to talk a little about the testing results and in the midst of his little report, Dr. Hoak, the consultant Neurologist showed up with a more detailed review of his thoughts (Both Liz and I liked his report a great deal!). He is still waiting to see the CAT scan from early this morning. For the time being what I recall him saying was 1) it seems like the stroke did not happen months ago (and therefore be related to my hand tremor history; 2)  small residue that may have come from a little clot somewhere that filtered up and into my Cerebellum (My fuzzy brain tells me, but maybe it wasn't Dr. Hoak); 3) this probably was NOT related to HHT (although I plan to send their results to Dr. Battaile at the HHT Center at Southwestern in Dallas anyway), and 4) Hoak will report on CAT as soon as he looks at it. 

My own thoughts, based on my non-medical diagnosis AND my personal need to name things to think I understand them, is that the stroke might possibly be a "transient ischemic attack" (TIA), having a ICD-10  diagnosic code # G45.9.  While Dr. Hoak was there discussing my situation with us, Dr. Baru (my nephrologist) stopped by to check on me as well and I think he heard some of Dr. Hoak's thoughts. After this meeting, it was not too long before the nursing staff told me I could be discharged with the plan of getting an appointment within four days with Dr. Wozniak for a heart monitor to collect more cardiac data. The actual checking out at the discharge station was futile as far as being beneficial, but a much more conversational woman who knew how to answer my page of questions called me at home, and many of the things I wanted to know were covered in that call. 

I got home and fell asleep watching TV by mid afternoon: happy to be back home after our 3-day crisis that is evolving into a new wrinkle in time.