The Story of my Stroke

How it all started

Stroke is Singapore’s third leading cause of death and the number of deaths and admissions to Singapore hospitals for stroke has been rising. I am one of those who survived stroke and this is my story. 

It was Sunday, 18th September 2011. It was a run that I was looking forward to after my cruise to Thailand, it was my last 'organised' run before my enlistment on 8th November 2011. 

The weather was warm and welcoming. The sun was rising and the rays penetrated the soft fluffy white clouds. Well, I was late. I couldn't get any sleep the night before and what felt like when I just could head to sleep, I had to wake up and rush to reach the north eastern part of Singapore for the run. I guess you could say that I wasn't really prepared for my run. I wish I could have been!
My last recorded jog was on the 6th of September 2011, the last morning of my cruise trip. 

After that, all I got to finish doing was short hikes! I initially planned to do a super long walk from Tuas to Changi but that was not going to happen because I started feeling this painful pulse that went through my left side of my head, so I only managed to hike from Tuas to Joo Koon. After a night of rest though, everything went back to normal. It felt like an ordinary migraine attack.
Back to running, I was obviously not ready to clock the fastest personal time for my 10KM run. I did my usual warm up before starting a slow jog when I reached the starting line. 

After a while, I found that I wasn’t feeling the best. I couldn’t push my legs and my feeble lungs. I decided that my head was ailing me so I decided to slow down my jog into a walk prematurely, having cleared half of my run distance already.

 I walked-jogged and took a rest, it felt bad. I completed the run, feeling glad that I could finally head home for a good rest. My head started having the migraine feeling at night and it was difficult sleeping with the pain let alone the loud snoring from my brother.

I continued my part time work at the Singapore Heart Foundation along with head pressure pains as I got up quickly or squatted and four nights passed since Sunday and the pain started getting progressively worst and it seemed to magnify the snoring in the night even though I had put on earplugs. In the train, I staggered and lost my balance while standing because my head felt so heavy. Still I scoffed at the idea of seeing a doctor because I thought that they would just diagnose me with a migraine attack and give me a painkillers.

Progression

By the end of the week, I did not have 3 nights of sleep. Every night, I would be tossing and turning in pain because the pain came at night and early in the morning. It felt bad, like, if I could give a description, someone using a jack hammer and drilling specifically to the left back side of my brain inside my skull. I was so annoyed that I assumed it was the snoring.

I felt a bit dozy while conversing with my family and friends and was slow in my thinking and conversation, but I didn’t make an issue of it. My thoughts became awry and I even started forgetting where I put things and got impatient and angry over little minute things. I blamed it on the lack of sleep I was having.

On Friday morning, I was awoken around two hours after lying in bed and I took out my sheets and went out to sleep on the couch and two hours later, I woke up in pain and my clothes were soaked in perspiration. 

I had my breakfast and I felt like vomiting. I headed down to work and felt like I was going to pass out. I decided to ask for leave and go to a polyclinic. My father thought otherwise and instead sent me to the Accident and Emergency (A&E) in Tan Tock Seng Hospital. 

The waiting time for the A&E was around 2 hours and I was thinking of the explanation to the doctor of how I felt. The time came to see the doctor and I really thank God for the wisdom and the words just came out from my mouth. It felt good because the words matched exactly what I wanted to say. He concluded that he needed to check with his senior doctor on the proceedings and I was alone by myself seated by the table, thinking how serious it could be.
They sent me for a Computed tomography (CT) scan and while waiting for the results, by then, I was thinking of the worst possible scenario and thinking of the possibility of a brain tumor. My parents were there with me and though they did not show it, I think deep down inside, I sensed that they were afraid and so I prayed. I was ready for any possible trial that was going to be thrown into my way; No, actually I was afraid of my wits too. But the presence of my parents and the warmth of God comforted me and I felt the calm assurance that He was in control. 

The results came out and they showed me the results in front of us and they tried explaining the different patterns of my skull were but all I knew was that there was just a tiny spec of bulge on the left hemisphere compared to the opposite side of my brain. This showed some possible trouble brewing over my cerebral venous sinus. They concluded that I would be admitted for a Magnetic Resonance Imaging (MRI) to make sure that the suspected bulge was not swelling of my brain. 

Then Things Started To Get Messy.
My parents left to do paper work with the hospital for documentation. They placed me on a hospital bed and pushed me into some RESUS centre and there I waited for at least another 2 hours. It felt like ages just lying on the darn bed watching nurses and doctors running around and answering phone calls.

By 8pm, I was taken to the MRI scanner to establish whether I had a blockage or a bleed, and pinpoint the exact location. It was of utmost importance to establish which type it was in order to give the correct treatment. I could have fallen asleep in the MRI. The whole day of waiting made me feel so fatigued. The room was cold and all I had was a thin towel that was laid across my legs. I was warned that it was going to be loud so I put on the earplugs and a headset which was playing a classical piece, was snapped on my head the wrong way by the MRI assistant, leaving only one ear with the music. It took ages! The whole process of the MRI scan was the epitome of boredom. Thankfully, I survived and was back at my ward shortly after.

I dosed off and I was woken up at midnight by a Neurologist and it turned out that I had suffered a Cerebral Venous Sinus Thrombosis (CVST) which is a rare form of stroke that results from thrombosis (a blood clot) of the dural venous sinuses, which drain blood from the brain.

Blockages that cause strokes are the result of the breaking off of pieces of plaque built up on the artery walls. Fifty percent of these blockages originate in the soft plaque that has built up on the walls of the carotid arteries. That was so in my case, I assume. After which, less than three hours had passed since getting admitted, a valuable clot-thinning treatment called heparin could be started intravenously. An anti-coagulant treatment called Warfarin was also started orally after which, once it started working, the heparin was stopped. I was to be on an 'experimental' dosage of Warfarin till they could find out the proper dosage to stabilise the International Normalised Ratio (INR) of my blood, which 1 is assigned to the time is takes for normal blood to clot.

Meanwhile, nurses drew blood for testing and this would continue every two hours for the next 3 days until they extended it to 4 hours and then to 6 hours towards the end of my stay in the hospital.

I was placed in a  class B  6-bed orthopedic ward. These could be patients suffering from traumatic brain injury, stroke, orthopedic injury, amputation and other neurological conditions or brain injuries. The ward was not conditioned and I was thankful for it because I had my very own personal hanging fan right above me.

That night, I spent without any form of technology or communication device with me because it ran out of battery and my parents took it home to charge it. I felt a little more handicapped than what I suffered from the stroke. I spent my night questioning God and praying for my planned hiking trip to Nepal not to be cancelled. It was somehow, a demand that I knew deep in my heart would never be fulfilled given the sheer circumstances of the situation I was in.

It was a night of God-given rest, even when my bedside neighbors were awake and discussing about horse betting, I slept through it all. The heparin drip that I was on, was aiding me. I didn't feel as much pressure and pain as I felt the previous nights before. It felt good and relaxing, if I could give it a description, it felt like drinking a little wine before bed time, smoothing. I felt that I was very, very lucky to be in hospital, admitted through A&E. I believe God had preserved my life through many ways, on my runs and on my hikes.

I woke up in the morning to see the neurologist that woke me the previous night as well as student nurses scurrying around serving breakfast to the patients. She wanted to check and inform me about a team of neurologists including their professor going to visit me later after breakfast.

The first breakfast was a Chinese breakfast and it included gruel, it was watery and blend. Unknown to me, I did not know that patients could actually choose what cuisine they wanted their meals to be! The default diet was a varied but not particularly targeted dietary meal. The good thing though, was that I had the choice to have any meal I wanted, which included McDonald's and a nice sub, of course, my parents were kind enough to offer their services. For the next few meals in the hospital, I opted for the nicer looking cuisines simply because the food looked better on the menu.

Nurses floated around ensuring everyone who needed to be fed. There were forms to fill in to order from a menu for the next meal. The variety of drugs one was on was mostly given out during meal times. 

I was confined to the bed and warned not to get out, meaning that I could not get out to the washroom to shower, pee or walk around. I had to do it all by the bedside! I felt so handicapped though I felt that I could do all those! My muscles were wasting away! The doctors were concerned that as my INR was still unstable, and with blood-thinning drugs in my system, it was not a good idea to risk me getting out of bed and injuring myself as patients with blood-thinning drugs in their blood tend to bleed and bruise easily if they get injured.

I concluded that there was nothing for it but to trust God and instead have a positive attitude because I was there to be repaired. Despite that, it was hard keeping up my spirits as I was tired, and easily fatigued. I tried smiling but I knew inside I was little down. Every time I felt that, I would pray and continue trying. I did not really sleep long hours, though sleep was supposed to be part of the recovery, but I had restful sleep.

The neurologist team came up and it was like a study and I was the guinea pig. They started telling me of the procedure of how the treatment went and mentioned briefly to me about this blood thinning medicine called Heparin and Warfarin. They questioned me and tried to find out the cause of the stroke but to no avail. I tried suggesting different things I did that could have caused it, like a soccer injury that I suffered in late April.

It was a soccer match against Kebun Baru United in ESPZEN Sunday League Season 15.
There was a through ball and I made the decision to get it and there was a 1-on-1 opportunity. I made a clean catch and got the ball and held on for a good second, but the striker got me, he swiped his foot and kicked my head. I blacked out. The next thing I realised that I was lying on my back on the ground and my hands were on my head and it was feeling really badly shaken. There was a laceration on the left side of my tongue. My second premolar had chipped, my neck sore, bruised and I had a laceration on my tongue. I felt a little groggy but with the adrenaline masking my pain.  After the bus ride home, I felt like vomiting . When I got home, I could not turn my neck or apply a slightest bit of pressure either to my left side of my neck or my head.
I tried to rest but couldn't because of the extreme pain. My mind kept flashing pictures of people  whom I knew and events in the past: Secondary School teachers, friends that I thought I forgotten. It was really quite an experience! My brain was crazy, the air-condition was on and the fan blowing directly into me but yet at times I felt cold and after I thought I felt cold, my brain would tell me that I was feeling hot and I would start breaking into sweat. I couldn't really lift my my left arm above my neck, let alone turn my head. The next particular night just before I went to sleep, there was a deep throbbing pain in my head. Soon though, I was back to normal, the pain cleared up.

This didn't convince the doctors though! They said it was too long ago from April to September and that usually the gap was about 2 weeks before the patient suffers a stroke. I even told them about the long distance hiking as well as running. But they weren't too convinced about that as well! So my case was classified under 'cause unknown'. They spoke to me about switching wards from the Orthopedic ward to the Neuro ward so they could monitor me easily along with other Neuro patients in the same ward once there was a bed available.

The pharmacist came in the evening and started explaining about Warfarin. I knew quite a bit about it already because the doctors explained that to me in the morning. After a few days, I became terribly aware of the routine. It was predictable: Drawing of blood, taking of blood pressure, breakfast, drawing of blood, visitors, lunch, snacks, drawing of blood, taking of blood pressure, visitors, dinner. The doctors came every morning to get my psycho-motor skills and check the strength of my limbs and the brownness of my beautiful pair of God-given eyes; No, they were checking on the dilation of my pupils.

My bed and ward however, remained the same till the end of day 3. The Neuro team found me a bed in the Neuro ward. I loved the new ward. It was because I wasn't confined to lying down on the four corners of my bed; instead, I could walk myself to the restroom because they attached my Heparin drip with a movable metal roller. I had to be very careful; the needle feeding the Heparin in my blood was quite uncomfortable. It felt like having a foreign body in the veins and if I bent my wrist too much, it would hurt.

Though I could not have a good full body shower, my hygiene was well taken care of when I was confined. I would get a 'wipe down' with wet wipes; it was also something extra the hospital could charge us with. Brushing of my teeth was also done in bed. The only thing I was disgusted with was that I couldn't wash my hair. It was oily and it made my hair shine!

The beds were made by the time one got back from using the restroom after breakfast.  There were early morning probes every 3 days to sample bodies for infections that might invade the wards like Vancomycin-Resistant Enterococcus(VRE) or Beta Lactamase-producing Bacteria(ESBL), both usually carried in the bowel and fatal if they crossed into the bloodstream.

There were two doctors every morning. At these visits one doctor would interview the patient and consult records, questions were asked and decisions were made then and there about one’s treatment for the next day or more. My blood was taken a few times a day to monitor the level of Warfarin which was required to be kept within a narrow range of 2-3.

Being a little free and bored, I went exploring in the ward and found myself a weighing machine. I took a peek, I weighed 74kg amidst all the eating of food! The last few years have seen my weight rise to 79kg with food and exercise, 4 kg over my ideal weight. My ideal weight is 75kg for my 172cm frame my total cholesterol was Lo, including the bad Low-Density-Lipoprotein cholesterol(LDL)

The Days Went On. 

The next major highlight of my hospital stay was day 6, which started at 4.30am when I woke up with a sharp pain in my left side of my brain. It felt like the clot was making its way through my sinus of my brain, it felt like someone slicing the brain with a knife, it was even more painful than all the previous nights before I was hospitalised. It went on for hours, I took Paracetamol and it didn't work so they gave me 50mg of painkillers. It didn't work because the pain lasted till 9am before the pain subsided. The doctor sent me for a CT scan just to be safe. The results came back and there were more promising results compared to the previous CT scan; the little bulge of pressure in my skull was gone.

Day 6 was also the day that I could have a full body shower! It was the freshest I felt in ages. Yes! I felt spanking clean!

By the end of the 6th day, I had met most of my secondary school friends, polytechnic mates, my previous church members and seniors, ex-colleagues, church members, family and other church youths from other churches who came to visit me. I seemed to cope well by then, they were my pillars of support through my stay in hospital. It was sad that I had to meet them this way. I would have rather met them in gatherings than meeting them confined in the 4 walls of the hospital.

Homecoming.

 I had now spent a week in hospital; the doctor came in the morning and told me I could be released today if my INR levels are balanced up and in the therapeutic levels. And after the blood results came back, they told me I was going to be discharged! I was elated and really happy that I didn't have to walk around with that metal roller thing containing my Heparin drip anymore. I was so elated in fact, that when I got off bed to walk, my reaction was to go and push the rollers! The nurses all laughed and I felt sheepish. I can’t say enough about the care and attention I received at Tan Tock Seng Hospital. The doctors, staff and student nurses were at all times professional and friendly. Without the friendly nurses and staff that cracked hilarious jokes, I think I just might have died of boredom.

I just thank God that I happen to live in Singapore and not some other countries where I may not have received any treatment at all.

The wait to be discharged felt equal to the wait to be admitted. I had waited for at least 4 hours before the pharmacist came and checked through the medicine quantity three times before leaving and she nearly sold me on a few hundred tablets of painkillers I didn't need. On the day of my discharge, 4th October, I was given a Discharge Report, and my medication. I had to return to the National Neuroscience Institute weekly for a month to keep in contact with the pharmacist and hospital in order to monitor my Warfarin levels through blood tests. This went on till they could be sure that my INR was kept from 2-3. Then they met me biweekly, monthly, and so forth for further blood tests.

My uncle gave me a lift back home that day and I was very glad! I could walk and do my normal daily activities just that I could not head out and exercise.  I took a while to be able to walk properly, because I did not walk much in hospital, the muscles in my legs were wasted and the first few steps felt like baby steps again; unstable. But after a while, I got the hang of it and could do longer distances as the days went by. This was the start of the rehabilitation process!