Reflections on My Strokes
Bart Binning, Ed.D.
Have you ever been in a situation where you get sick or hurt your self, and then say something like
“I don’t need to see a doctor, I will be Fine, I just need some rest.”
I confess, I am that kind of guy. And for some things that may be ok. But not for strokes.
For those who have not heard, I managed to upstage last Thursday’s Makeup Breakfast speaker, Leonard Sullivan, by having my second stroke in the past two or so years. After signing the breakfast’s attendance sheet, my left leg stopped working, and I slid down to the floor. After Blair Naifeh asked about all the commotion on the other side of the room, I told him I thought I was having a stroke.
Everyone should regularly attend Dr. Richard Smith’s lectures on the symptoms of stroke. He is scheduled to speak at our Rotary lunch on March 12. Dr. Smith is affiliated with the Neuroscience Institute at Mercy Hospital. Mercy Hospital has achieved Advanced Certification for Comprehensive Stroke Centers [https://www.mercy.net/practice/mercy-neuroscience-institute/]
I am doing fine now and since it is my turn for a Reflections Article, I thought I would share my experience and make some observations. I am not a doctor, so if you have any questions, come to Dr. Smith’s talk on March 12.
- I have attended Dr. Smiths stroke lectures at least four times and each time came away with something new. While each of my strokes were unique, what I learned from Dr. Smith was that if you feel anything out of the ordinary related to your brain or it’s function, do not assume it will go away on its own.
- Because about 85% of damage from strokes result from diminished blood supply to the brain, Time is of the Essence. The longer it takes you to get to a hospital (and with a stroke you will eventually need to go to a hospital) the more permanent the damage that will be done.
- The fastest way to a hospital and treatment is in an ambulance, which is an extension of the hospital’s emergency room. With my first stroke, since I was about a mile from Mercy Hospital, I decided I would “speed things up” and not wait for an ambulance. I drove myself to the ER (not a smart thing to do). However, once I said the word “stroke” I was surrounded by Mercy’s ER stroke team and I was fast tracked to treatment before I was officially admitted, much to my brothers chagrin because he could not find me when he went to the hospital to check on me.
With my second stroke, since my left leg stopped working I waited for an ambulance. This time my treatment started when the ambulance arrived. They took my vitals, my contact & insurance information, gave me an EKG, and poked IVs into my arms. When going to a hospital in an ambulance, because the ambulance is an extension of the emergency room, one can bypass standard in-hospital emergency-room admitting procedures (these were done in the ambulance) and go directly to your ER room. (In case you could not tell, this was my first ambulance ride in something that did not look like a station wagon with lights and a siren.)
- With a stroke, aneurysm, or other brain trauma, if at all possible, go to a hospital with a Neurological ER team and a Neurological ICU. Because the Neurological ER team uses specialized protocols, one can also significantly cut the Door-to-Needle time. The injection of anticoagulant is often the “cure” for a stroke.
- I had an Ischemia Stroke, which is caused by a restriction in the blood supply to the brain. The cause of the restriction is usually the breaking away of plaque or a blood clot that that becomes lodged in one of the brains arteries.
- Within an hour of arriving at Mercy, I was evaluated and then began the process of receiving an injection of a Tissue Plasminogen Activator (tPA), often called a “clot buster”. tPA is a class of manufactured enzyme, using recombinant biotechnology techniques, that is specifically designed to break down clots. In general, tPA needs to be administered within three hours of the first onset of symptoms, which is why Door-to-Needle time is so important. If you have been administered an tPA drug, which is a process that may take up to 30 minutes, count on being bedridden long enough for the drug to leave your system, about 24 hours. tPAs are powerful anticoagulants, if you accidentally bruise yourself (for example, stubbing your toe on the way to the bathroom), you could bleed out.
- It turns out that this was my fourth stroke (two within the last 3 years, and two that occurred sometime before). I asked my neurologist Why? He said that Diabetes is an insidious disease and should be my first focus. He went on to to say that one “cures” Type II Diabetes by becoming a vegetarian. Because of pancreases issues I am already avoiding beef, pork, and lamb. I have found that many restaurants have vegetarian options, but I do miss my Whataburger. 😟
He went on to note that Atrial Fibrillation (A-fib) is a significant source of blood clots that can cause strokes. A-fib is an irregular, unsynchronized, and rapid heart rate that commonly causes poor blood flow because the heart starts churning rather than pumping blood. Blood clots can then form in the heart’s chambers and explode into fragments when entering either the lungs or the brain. This link between the heart and blood clots is why many large hospitals are starting to have linkages between specialty cardiac and neurological ICUs.
- An example of why Time is of the Essence: My first indication of a possible stroke was my lower left leg not working. By the time we reached the hospital, about 30 minutes later, I had limited use of my left Leg and my left arm, and I was slurring my speech, indications of a major event (a potential 10 to 15 on a scale of 40). During the process of administering the tAP, a process that can take 30 minutes, my leg started working. The MRI taken about 27 hours later showed a small grey spot in the area of motor control; the Neurologist estimated the stroke, after the tAP did its job, about 2 on the scale of 40.
- There are about four different tPA drugs on the market, with price ranges of between $20k and $120k per dose (only one dose is needed). For my stroke two years ago I listened to one side of a conversation between my doctor and the insurance company, balking at the price of the drug. Considering the life-cycle cost of not using the drug (the cost of rehabilitation and institutional housing), it would seem that using the drug is the less expensive alternative.
In the spirit of the Oscars, I have several Rotarians to thank (Apologies to some because things are still a bit fuzzy on who did what):
- Ron Rocke and Joe Fleckinger for helping me off the floor and into a chair at the entrance to the meeting room, and then washing the spilled coffee from the loose change collection basket.
- Blair Naifeh for setting the mood by calling across the room, What’s Wrong? and then calmly continued to finish breakfast when it appeared everything was being handled
- Bud Oehlert for taking control of the situation by instructing the call to 911
- Leonard Sullivan for bringing to my ER room the notes of his talk
- Keith Oehlert for coming to the hospital to make sure my car, dogs, and cat were not abandoned
- Chris Griswold and Tim Strange for dropping by the hospital to make sure I was in good spirits.
Bart, an excellent letter. I could not believe you responded to my text late in the afternoon when I learned you had definitely had a stroke. Blair really was concerned as I spoke with him after you responded you were doing well. The texts on the following days assured me you were continuing to recuperate and wanting to head home. Many prayers were said for you during the critical period. Thank God they were answered.
Not for your “episode,” but for the reminder, I thank you!
It’s been about 7 years since my carotid artery gave me a trip to the ER and appropriate follow up.
You get complacent!