Stroke Class of 2023

[Dantheman]

"Let me tell you about the time I got stabbed in the neck in prison...."

[pfluffenmeister]

Holy Christ man!!!


Post-op season pass pick-up!
Nice.

[old goat]

Yeah, next time have em put in the A line after you're out.
And find a surgeon with a better mortality rate for CEA than 5% (I'm guessing his personal stats are no where near that bad, quoting a literature figure but it's still higher than the doc needs to quote. The literature figure for death for my operation--replace ascending aorta, aortic valve, and 3 coronary bypasses was 2%) Glad the number didn't scare you away from surgery.

[bodywhomper]

I hope BobMc is stable and good.

TL/DR: My pop’s (78yo) going through a thing. Getting old sucks. There’s medical tech that’s gotten pretty amazing. Treating elderly in the hospital is tricky because the medical team often does not have a good baseline of their patient or the education level of their family.

He was in fairly good physical, mental (functioning/working SME engineer), and emotional condition before Nov except for a bad knee that was affecting some mobility and was scheduled for replacement. Had TKR in early Nov (biggest knee issues related to skiing most of his adult life), had initial stroke symptoms at end of Nov, spent 1.5 wks in hospital in Dec dealing with strokes.

Prior to stroke symptoms, his surgery recovery was going really well, and he was back to work. He was admitted to the hospital in early Dec barely functional, physically or cognitively. MRI when admitted showed no evidence of recent stroke.

It took the hospital team over a week to diagnosis what was up. They almost discharged him at day 5 (basically as a near vegetable) because he was “stable,” starting to show signs of minor improvement, and they were not seeing any reason for the stroke symptoms. It seemed to take a lot of advocating by me and coaching my mom to advocate more for him, especially advocating about his previous level of functionality, to get them to take one last look. At that point, my mom was nearly freaking out about how to deal (they have a two-story house) and bl wife and I were starting the conversation of me staying at their home for several more weeks.

The neurologist ordered one more mri (“just to be sure”), and they saw lots of small clots throughout the brain. They then did a bunch of new tests, finding a PFO (hole between heart atriums) that had never been previously diagnosed. The PFO can allow clots to go directly to the brain rather than the lungs. They found a DVT in both legs. They went through the process of dissolving the clots, kept him there for a few more days to stabilize, and discharged him.

He showed rapid physical and cognitive improvement by the time of discharge and no longer qualified for speech therapy, OT, or PT (except for PT related to his TKR). He also gained a cardiologist with appts to deal with the hole in his heart.

That was an exhausting week+. I bailed on work and managing a couple $M in projects, with leadership support (I still haven’t caught up with those projects). I helped initiate the process for ramping down his biz and handing over his role on an NGO board along with helping my mom deal with everything new.

Yesterday, he had a TEE, where they send a “camera” down the esophagus to look at the heart and gain info for confirm the surgery for plugging the heart hole. Last night he had complications as a result of the TEE and was taken to ER. He now has a tear in the back of his throat that needs to be closed (by an ENT) and a CT to look for fluids in his chest cavity to possibly be followed by an evac of fluids, if accumulated. A new MRI this morning indicated new small clots in his brain but currently has no outward symptoms from those clots.

Currently unclear how/when/if the heart will be plugged and/or clots dissolved. He’s off all rx for clots because of the planned surgeries. My mom’s well informed and mentally sharp and seems on it in terms of advocating and getting a good understanding of the treatment plan.

With my folks’ age, it’s sometimes been tricky for the doctors and hospital staff to understand how to speak-to and approach my folks or to understand my father’s general baseline. Apparently, there was one surgeon today (who came and left the scene) that was treating my mother like she was a feeble old lady. Fortunately, they now have some neuros and a cardiologist that have met them a few times under better circumstances.

There’s a virus in my household so I’m not traveling to help/advocate.

[PB]

Holy crap - sounds like a multi front shit show. I don't know where to begin ..... but I'll start with the staggering amount of personnel screw ups. And then start ranting about not listening to you and your mother. Granted, a lot of people think they know more than the medical staff but are badly informed, however they should NEVER disregard input from immediate family - as you say, it's the best baseline data available.

Torn esophagus?!? I've had numerous upper GI laparoscopic exams, and that sounds almost impossible - the worst I ever had was a bruised tonsil. I wonder if there's an underlying condition that made his esophagus more prone to tearing; seems hard to really screw that up once your past the upper throat, but .......

This lands close to home, as I'm only 5 years younger than your Dad.

Hang in there.

[old goat]

bodywhomper--what an ordeal for your dad. One of the downsides of having hospitalist specialists is that they don't know what the patients were like before they got sick. At my hospital one of the family docs would see his own clinic patients when they were in the hospital--unofficially, but most of the primary care docs didn't. No one was paying them to come in early before clinic started.

Re the PFO--normally the higher pressure in the left side of the heart (left atrium) keeps blood and clots from crossing the PFO, so people can go their whole lives never knowing they have it or having problems from it. A PFO acts like a one way flap valve. But when someone starts having blood clots in their legs going to their lungs, the pressures in the right atrium rise as blood backs up behind the clots and when the pressure in the RA is higher than the LA then blood and clots can cross and go out into the general circulation. "Parodoxical embolism"

This is a tough management problem for your dad's docs and of course a real tough problem for your dad and your family. I wish him the best.

[old goat]

bodywhomper--what an ordeal for your dad. One of the downsides of having hospitalist specialists is that they don't know what the patients were like before they got sick. At my hospital one of the family docs would see his own clinic patients when they were in the hospital--unofficially, but most of the primary care docs didn't. No one was paying them to come in early before clinic started.

Re the PFO--normally the higher pressure in the left side of the heart (left atrium) keeps blood and clots from crossing the PFO, so people can go their whole lives never knowing they have it or having problems from it. A PFO acts like a one way flap valve. But when someone starts having blood clots in their legs going to their lungs, the pressures in the right atrium rise as blood backs up behind the clots and when the pressure in the RA is higher than the LA then blood and clots can cross and go out into the general circulation. "Parodoxical embolism"

This is a tough management problem for your dad's docs and of course a real tough problem for your dad and your family. I wish him the best.

[bodywhomper]

Thanks, guys.

Old goat, thanks for explaining the PVO stuff. There’s still a plan in place for plugging it.

Turns out the tear from the TEE was in the back of the throat. He was transferred to a different hospital system and had emergency throat surgery. Spent a total of 17 hrs intubated. Apparently, is recovering fairly well from the drug-induced coma. Discharge is likely in a few days. Then back to the other hospital system closer to home for the PVO repair. Apparently, DVT clots have resolved for now.

I can totally understand the challenge for hospital docs to understand previous, pre-incident patient baseline or level of education of family. My moms been struggling with that a bit at the new place.

[PB]

Sounds reassuring; fingers crossed for continued progress!

[BobMc]

Damn, sorry to hear all that. Hopefully things turn out ok. I'm pretty much no worse for the wear, I've got a bitching neck scar and can't see to the left of me but other than that...

[Meadow Skipper]

…can't see to the left of me but other than that...

Sort of like you were a snowboarder, regular foot.

I know, I know…my sincere apologies to the boarders here.

[old goat]

Thanks, guys.

Old goat, thanks for explaining the PVO stuff. There’s still a plan in place for plugging it.

Turns out the tear from the TEE was in the back of the throat. He was transferred to a different hospital system and had emergency throat surgery. Spent a total of 17 hrs intubated. Apparently, is recovering fairly well from the drug-induced coma. Discharge is likely in a few days. Then back to the other hospital system closer to home for the PVO repair. Apparently, DVT clots have resolved for now.

I can totally understand the challenge for hospital docs to understand previous, pre-incident patient baseline or level of education of family. My moms been struggling with that a bit at the new place.

Sounds like a hell of a tear. Glad he's doing OK.
As far as level of education IME the higher the level of education the harder it is to explain stuff. Educated people think they know more than they do--like doctors who think they know about home remodeling.

[bodywhomper]

“Level of education” was the wrong term. Maybe “good critical thinking skills” is more appropriate.

She’s still actively teaching and mentoring teachers. It’s more about the condescending attitude of “don’t worry little old lady, we’ll take good care of him and only use acronyms and big words without explanation when we went you need to give consent.” Most of the docs aren’t doing that and are very good and empathetic communicators, but I encountered one when I was there that was being a POS (or having a bad day) and she’s run across two at the new hospital.

My uncle used to do that when he was a young surgeon. One of the doctors that was overseeing my dad yesterday actually knew my uncle. Uncle was chief resident surgeon when the doctor was a junior resident.

Bob, glad your recovery is going well! Do you expect to get mobility back in your neck?

[old goat]

In your mom's case sounds like maybe standard condescion towards older people. We get used to it.

Speaking of old people and neck mobility, backup cameras and blind spot detection are the greatest things sinced sliced bread.