9:00 AM- my Neurologist, from the ER last night, came to see me in the ICU, I think I was sleeping. After checking my neuro status, he reported that my NIH stroke score was down from 20 to 16. I still could not verbalize very well, or even say my name. “J” sounds were extremely hard for some reason. I had difficulty following commands. I could hold my right arm and leg, up against gravity for no more than 5 seconds. He was ordering Speech Therapy for me today. Also Physical Therapy and Occupational therapy as well. He explained that I had a rather large clot, most likely caused by my chronic atrial fibrillation. He will also order a Cardiology consult. Until that time, I had not realized how bad my stroke had been. I mean I knew I could move my arms and legs right now, how bad could it have been?
But I had received the wondrous tPA drug-Tissue Plasminogen Activator. I had made it to the ER in time. In order for tPA to be effective in ischemic stroke, it must be administered as early as possible after the onset of a stroke. Protocol guidelines require its use via IV withing the first three hours up to 4.5 hours after a stroke has occurred. After that time the risk begins to outweigh the benefits of using the drug, in fact, there is more chance then of a severe brain bleed. In the US, due to this narrow time factor, only about 3% of patients actually receive tPA, as most people do not seek medical help quickly enough! It’s true!
As therapists, my wife and I have met patients, some of whom have lost their speech and they didn’t go to the ER. It is hard for us to fathom this, tPA is not a new drug regime, it was discovered in 1982! But we also understand that most people don’t want to go to the ER unless they absolutely have no choice. It’s that ability we have to deny that something is really wrong with us. Or very tragically, something happens at night, while sleeping, when no one knows until the morning that a stroke has occurred. And you must be able to pinpoint the time as accurately as possible when the stroke started! So thanks to my love of the Television, and both my wife and I watching our favorite show, “Blindspot,” which started at 10 p.m., she was able to tell them when my stroke occurred.
Breakfast came a bit after the Neurologist left. I was on thickened liquids and foods were pureed until the Speech Therapist would come and evaluate my ability to swallow. I seemed to be ok with swallowing soft foods, but I could not really taste anything much, except for the thickened cranberry juice. Speech Therapy came early in the afternoon, she was very good. She checked out my swallowing abilities with some different textured foods and allowed me to have soft foods, but my liquids would still have to be thickened. She worked with me on making sounds with my tongue and sounds from my throat. It was still so very hard to say much of anything, mostly grunting sounds! She gave me a placard with written words on it and the alphabet, pictures of objects like the TV, bathroom, so I could at least point to things and communicate a bit.
