Sunday Stroke Survival: Gone Under the Knife Again

On Friday, I was scheduled for my TCAR procedure. SIGH! So much for staying out of the hospital in 2020. It just couldn't be scheduled any sooner. At least it was only an overnight hospital stay. Seeing how they catheterized two major (carotid and femoral) arteries, they wanted to be sure the bleeding was stopped before releasing me. I really couldn't begrudge them for being cautious. I would be dead in under an hour if one of the internal closing sutures gave way.

With as much heparin (heavy duty blood thinner) that was given during the procedure, my clotting factor was similar to a hemophiliac, or nonexistent. I tolerated the weight on my right thigh/groin well. It was no different than one of my numerous heart caths in the past. What bothered me was the weight they placed on my left clavicle. Having torn that ligament and had torn my rotator cuff in the past... 2012 and 2013 respectively. Both tears had been immobilized and allowed to heal naturally so no surgically intervention took place to repair these tendons. Just how poorly they healed, was directly proportional to the added weight and pain level increases I felt.

Silk Road Medical

Never heard of a TCAR? Neither had I. It was first performed in 2018 so it's relatively new. But it reduces the risk of stroke and other complications to almost nil versus the old cut down, open endarterectomy and the healing time is much quicker.  Currently, TCAR is only offered to patients who have increased risk factors against an endarterectomy, such as me whose heart stops under general anesthetic, history of strokes, and other heart issues. In this case, being the queen of Abby Normal worked for me rather than against me.

In my pre-op discussion with my vascular surgeon, I asked if I could be shown

Filter contents blood clots and plaque

what the filter caught. I was shocked when I saw the strokes that had been circumvented by doing the TCAR. Each one of red dots showing in the left picture was a possible stroke stopped by the filter attachment. Talk about relief! Since I could not move to see it, my surgeon took a picture of it with his phone or actually a tech did it for him to show me. My surgeon had seemed shocked that I'd asked him, but complied. I was only given relaxation drugs for the procedure so I was awake during it. It's not a choice normal people would ask to see, but as I've already said, "I ain't normal!" I have an innate curiosity about the human body especially when my body is trying to kill me.

I'm still moving a bit stiffly. I'm bruised from my belly button to my knee on the right side. Which is my normal reaction to heart characterizations and from left ear to mid chest line on the left side. Which I'm assuming is normal for this type of procedure or so I've read. No fever and no other side effects that they told me to expect. So I guess I came through with flying colors. I do know that some of my brain's fogginess has cleared. I actually have more energy than before the procedure. The vertigo and headaches I had have lessened. I'm gathering that they mostly been caused by the blockages. Now, I just have to heal my bruises and the stitches to achieve a new normalcy. It couldn't come at a more opportune time. Spring planting is just around the corner.

Nothing is impossible.

This Must Be A Red Letter Week~ Sore

There will be four blogs for this week. You haven't seen four? Just wait they are coming. That's the most I've blogged since October when I had my second stroke and my husband was put of hospice services. With all this putting words together and correcting it before I hit publish, I must be gearing up for something. <slaps my forehead> Oh, that's right. I'm a writer! Doh!

This morning I awoke at 3AM. I tried to get out of bed but had a real hard time doing it. Yes the spasticity is a factor, but it was all the stuff that went along with the Botox injections yesterday. Had you ever been stuck multiple times by someone who is drawing blood, or by someone who is trying to root around with an IV needle to catch a vein, or had an EMG done? Then maybe you can relate to the soreness I feel today.

An EMG (electromyography) has a needle like probe that sends signals to a machine that measures the activity. It is done to measure the nerve input to various muscles.

With Botox, it's an EMG guided needle and syringe filled with Botox. You push the needle into the muscle and move it around (digging) for the most activity...in this case, it's the strongest muscle spasm. It may mean going deeper or shallower, to the left or right and various points in between. Like I said yesterday this procedure lasted two hours for the 300 CCs worth of Botox to be injected.

I was heavy into my Lamaze breathing at times. It's really yoga breathing techniques, but I always called it Lamaze breathing.  I use it several times a day for various pain issues. It's basically focused breathing to over ride pain. I've used this technique for over 35 years in dealing with pain. Just like I've used various yoga positions to deal with pain also. Amy Shissler is heavy into a certain type of yoga for stroke rehab.

Before you poo-pah it, try it. You might just be surprised how well it works. But I digress.

Notice it doesn't say Cosmetic

We decided before the insurance denied the extra 100 mg of Botox for my leg that we (the neurologist and myself) that the main focus for the injection sites would be the arm. My pectoral (chest) muscles were badly affected by my stroke. Nobody ever thinks of those muscles. You gotta love a good working relationship with a neurologist. I've heard and had a few horror stories with bad ones over the years.

An EMG driven needle procedure is more expensive than just standard shots but it pinpoints the shot accurately. When you consider each vial is $365 or more, I prefer the accuracy for the most bang for my buck. When the warble sound and the monitor show high almost straight up and down movement in rapid sequence, you know you've hit the right spot. Yeah, I can feel it also. Then comes the injection. The muscle is tense already, but now you are trying to push fluid in the space too. I definitely can feel that.

I'm not the squeamish type when it comes to procedures. I watch with great interest even if it's my own body. I have been since I was a child. That's why I chose medical career in the first place. I'm a nerd. I admit it.

All fifteen injections were done this way. Since I couldn't extend my forearm for injections, I rolled on my side and held the arm out so the doctor would have better access. In my mind, the better access the sooner we'd be done. The sooner we were done, the sooner I'd have relief in a week or two.

Not me but close

Now, I'm not flat chested so when it comes to pectoral muscles I have to hold my girl twins in check and out of the way so that the doctor can reach the muscle. The Hooter girls have nothing on me even after a breast reduction. I used to say my twins were identical twins until a second partial mastectomy because of cancer. So now they are fraternal twins. No, I did not have reconstructive surgery after the last time either. One double surgery was enough for me. A rolled up sock works wonders to fill in the gap in a bra under clothes.

Which poses an interesting question...you shouldn't take a blood pressure on the stroke affected side and you shouldn't take a blood pressure on the side with a mastectomy, but I only have two arms. Most nurses are dumbfounded when I tell them. Only one yesterday was quick to say take it in the leg. Ding, ding, ding...we have a winner finally. I've only been asking nurses since I had my stroke in May 2012! Honestly most cannot be bothered. I can understand this.

So I'm waiting and expecting the shots I had yesterday to take effect.