Friday, March 16, 2012

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!

Tuesday, October 4, 2011

Day 7 - Out of Here!

Today I had a good restful sleep! They took my blood 3.30am and 8.30am. I got up at 9am feeling super well rested & brushed up before having breakfast!

9 plus the doctor told me I could be released today if my INR levels are balanced up and in the therapeutic levels. And the blood results came back! They told me I was going to be discharged!!!

Super happy I didn't have to walk around with that roller thing anymore and my first habit getting off the bed was to go and push that! Super funny :P the nurses all laughed hahaha.

Had a great shower and changed back to my clothes.

Waited till around 12 and Adam from Act's baptist came! He stayed for quite a bit till around 2? Mum and dad came around 2. The pharmacist checked trough the medicine 3 times before leaving and she nearly sold me on a few hundred tablets of painkillers I didn't need, afterall, strong men don't need painkillers...or do they? Haha

I checked out at 2.30pm and uncle Jason came to pick us up. I felt sad leaving the hospital and the friends I made. I found some of the student nurses on Facebook though. And I felt sad that I was leaving my super ultra comfortable bed that could rise up so high and contort to a comfortable rocket seat position HAHAH!

Was home and I did not do much! Showered and did almost the same mundane things. Aunty Corinna, Raymond & Kevin came to visit our family. Good chat and I let them play my simulator heeeheee.



Monday, October 3, 2011

Day 6 - Sharp Pain + CT Again

Day 6

The day started at 3.30am when they drew my blood. 4.30am I woke up with a sharp pain in my front left of my brain. It went on for hours till at about 5 I took paracetermol and it didn't work so they gave me 50mg of painkillers. It kind of didn't work because the pain lasted till around 9 plus before I felt better.

Doctors woke me up at 8am and I told them about my pain before they said they will send me to a CT scan to check it out. I feel like a Guinea pig undergoing tests haha. Oh well another $300 flying away!

Had some marshmallows and had a great full body shower! What a Luxury! Managed to clean myself and I felt really fresh! :))

Went for CT scan and mum and dad came. Mum left and I had lunch that she cooked.

MY cousins Geraldine, Chek chin, Tiffany came too.

My colleagues Denise, Chloe, Ally, Gerrard, Stephanie, jerry came to visit me :)

Uncle William & dorothy , Michael and Ivan from BA came! They prayed for me.

Marianne, Uncle Jason & Daniel came. She left and Daniel and Uncle Jason prayed for me.

Dad came down again with McDonald's. Terrence and Jtaime my poly mates came down to visit. Before aunty Rebecca came. Mum came shortly after with another round of mcdonald's :) foodcoma!!!

Bro came with avocado juice ! Yummy but I couldn't drink much ;) was full!

After that I just washed up and pretty much got ready to...watch Who's Line is it anyway! Haha spent an hour and a half watching a few episodes and let the food digest before heading to sleep! :)

11:02pm

Sunday, October 2, 2011

Day 5 - blood takes and long breaks

I only remember being woken up at 3am and 7.30am for blood taking. The doctor came and woke me up after 7.30am to do checks and update me on my status. Currently my INR is 1.5. The desired level is 2-3.

Breakfast was solid today. It was like sticky porridge with fried onions. Gobbled it all up. Tasty!

1032 finally managed to be unplugged and went to wash up n clean up :)) feel so fresh !

Took my weight and I weigh 74kg! Drop from 79. Must be from muscle loss

Uncle Russ and aunty chew Peng came. Followed by my mum. Explained to them the story I explained a million times and when my dad came they left. Bro came shortly after.

All left and uncle Patrick came and missed mum and dad by 10minutes. Chat a bit and I went to rest after. Zanna and her friend Nadira came to visit.

Rested for a bit till Clement came! He stayed for a while till my mum came.

Aunty Jan came with lots of food and Kamy came with food too! Mushroom soup and angle hair spaghetti with Portobello.

Aunty Jan brought olive rice with chicken. Yummy! :))

Clement left quite late about 6 plus! Before sister came up. And Ah Yi's family came! So sweet. They prayed for me and stayed for a while before they left.

Mum came back and I did my toilet washup and poohping before she left and I went back to watching who's line and laughing off :P

Saturday, October 1, 2011

Day 4 - Headache is Back

Day 4





Had multiple needles stuck to take blood and a anti biotic needle stuck on my right hand which hurt like crazy.

When I got up at around 7.30am I went to brush my teeth and wash my face and shampoo my hair. Before having breakfast. It was like mee Siam with Milo.

Doctor came to check on me after I finished the noodles and I went to watch ironman for 40 minutes before headache set in. I took a nap and 2 doctors came. 1 was the same doctor that checked on me earlier.

They tried finding causes but couldn't conclude.

They lowered my drip from 15ml/ h to 14ml/ h. And say I'm stabilizing. Let's pray I am stablising.

Managed to be the middleman to get my dad to purchase the tickets for my friends to go USS because MasterCard was having an offer & I was supposed to go tomorrow.

Mum dad came. Liyi n jason came. Monica n her mum. Vimi and Jolynn came.

Kamy came. Zahir came. Melvin & wei jun came. Shaun came.

So sweet liyi & Jason got me a gift. Kamy got me flowers. Vimi & Jolynn got me a crossword booklet & a plushie. I got so many gifts lol might need my parents to bring em back haha.

Good chats with my friends ! ;)

Weijun and Melvin came and Shaun from NP came.

They left & Mum came back. Heng Zhu and Amirrul arrived! After they left I took a short nap.

Jonadab, Corinne, wing Kit came.

Emmanuel, samuel, Linda & Michelle came. A pastor from another church came over & prayed for me. He looked really young!

Rebecca & weijie came.

Today has been a blessed day. I felt like a hamster :=P napping like after a visitor left and waking up again. Because of the headache that arose throughout the day. But all is well! My Mum and dad are awesome!!!

Good night ! 9:45pm







Friday, September 30, 2011

Day Three in TTSH

Had an ok sleep. Got up at 7.30 to take my Blood Pressure then back to sleep till 8am. A nurse got me up to tell me I have to eat at 9.30am due to done blood taking.

9.40am took my blood and I could eat! Muslim food! Bee hoon with like tomato sauce with cucumber. Quite tasty I finished all of it yum yum.

Had my sponge and it was back to lying in bed.

3 neurologists came to do checks and check up on me. When she was doing the lights on my eyes I said:NICE BROWN EYES lol

My colleague Ryo came around lunch time 11.30 unfortunately my other colleague couldn't make it die to visiting hours. He shared cost to buy a balloon & a basket of goodies with my other colleague. Dad came shortly after With my laptop. Ryo left & serene & Charlie came and it was a quiet surprise! They brought a bag of apples.

Ahma & uncle Dave came for a bit to visit.

Serene & Charlie left and dad left for work.

Ahma went off for lunch shortly after.

Mum came after her work! Plus a surprise visit from one of the clients from SHF!

The nurse from neuro came to explain about my diagnosis.
Marianne came shorty after one of the neuro MO came down.

Then a prayer support group came & they prayed for me. Before my sister came with a book.

Brother n Monica came after & I was going to be transferred to level 10, the neuro wards. Aunty Jane caught me before I left. & when I got transferred, aunty Janet came. I received Lots of goodies!

I finally got to take a crap when I transferred. Previously they wouldn't allow me to get out of bed. Now I can push around my drip ;)

Monica n bro went down then up before leaving last!

I have my laptop and a cupboard lock! Woo


Spent my time laughing off who's line is it anyway before heading to sleep at 11.30 pm plus.

Thursday, September 29, 2011

BBBBBoring. Day 2 of Boredom

Got awoken up a few times in the night to take blood samples(4 hourly) and got awoken at 8.30 for breakfast. Porridge and bread & Milo.

Had to sloth and lie in bed for an hour before my dad came with my iPhone.

The doc came & talked to me before they sent the team of neurologists to talk to me.

Uncle Jason and uncle Dave popped by during lunch. Aunty Jane cam by after they left and during her lunch hour. Dad left at 2 to leave for work. Had rice, bitter gourd soup and and salted egg for lunch. Thankfully dad bought subway. Ate half of the footlong he bought.

Waited till around 3 pm. Waiting for my mum.

Hung Yong came too he brought a huge box of strawberries. Real sweet !! As in juicy sweet.

Waited till around 5.30? Shu and tian came followed by my sister. They left around 6pm. Nice company ! My sister brought bubble tea along with a hippo for painting. Shu & tian brought loads of snacks and goodies for me to eat. Tian even brought monopoly deal haha!

Thus pharmacist came while they were there and started explaining about WARFARIN. The blood thinning drug.

Had dinner and it was eerrryucks. Ate half of it before giving up!

Shu n tian left at 6.05pm. Mum and sister about 6.15pm.

Rested for a while before Kamy popped by at 7.30pm before mum came again to pass me earphones and just to see me before she left for the night. Brother arrived later at 8 plus.

Had a good talk with Kamy and my bro. She left like 9 plus and my bro left at 10 plus.