@Nate_Pearson Sorry to hear about your wife’s stroke but happy to hear her symptoms improved. Thank you for your discussion and education on stroke. I help run a stroke service at a hospital in Boston. I’m happy to answer any further questions regarding the topic.
For general education, there are two types of ‘stroke’, hemorrhagic and ischemic. A hemorrhagic stroke is one with bleeding into the brain which can be due to trauma, aneurysm, high blood pressure, or other reasons of old age. An ischemic stroke is generally thought to be a clot that can block an artery to brain tissue although there are other types of ischemic stroke (for ex. small vessel disease.)
‘Time is brain’ is an essential notion. Acting quickly saves neurons (work horses of the brain). To identify a stroke, we teach BEFAST to our patients which stands for Balance-Eyes-Face-Arms-Speech-Time (BEFAST). Basically if any of these are off, for example, imbalanced, double vision, facial droop, weak arm, then 911 should be called. As I mentioned, time is an important factor for treatment.
TPA is the clot buster Nate spoke about. If one arrives within 4.5 hours, this can be given as long as you meet the criteria. Certain academic centers in Australia (where research has been done on this) are testing extended TPA windows up to 9 hours. This can be done at most hospitals.
What has really revolutionized stroke care is the advent of thrombectomies/intra-arterial therapy/clot retrieval. In the last couple of years, multiples studies have found that ‘pulling the clot out’ of a large vessel in the brain, for example, the middle cerebral artery (MCA), helps treat large strokes within 24 hours of symptom onset. These can only be done for large vessel occlusion so basically what would be a very large stroke. It’s pretty incredible to watch these patients improve in seconds. Again, time is brain, so outcomes are better in those arriving sooner. This is usually only done at large institutions which are designated stroke centers. Most ambulance/EMT/Paramedic crews will triage to the stroke center if they recognize symptoms of a large stroke.
Anyways just some thoughts off the top of my head. Happy to discuss stroke mechanisms, treatment etc. further.
I think the remote format worked really well! The video lagged but I didn’t have an problem with the audio quality. I love the podcast in general and as a female listener it’s great to get Amber’s perspective.
I’m going to be using this opportunity as a time to get into my “race weight”. I really enjoyed Matt Fitzgerald’s Racing Weight book and I grabbed the Racing Weight Quick Start for $10 on Amazon yesterday to use this period without races as my “kick start”.
Racing weight has been something I’ve always struggled with achieving because I’ve always been in a training period or a 2-3 week off season for the past couple of years. I’ve been too focused on my training to focus on weight loss too and didn’t want to sacrifice too much for the last 10-15 lbs I’ve been carrying.
A 6-8 week “Racing Weight” diet plan with some good strength training seems like a great personal method for me to “Train without events”. Setting some new goals and feeling a little bit happier than I was before with all this chaos going on
That’s what my wife had! She was totally paralyzed on one side. They called it a “massive stroke”. She could move a finger like an hour later, and was doing a workout 2 days later. Crazy!!
She said when the busted the clot it felt like her brain was on fire.
The crazier part is that her first neurologist on call said “There’s nothing we can do for her” and that she would be paralyzed for the rest of her life.
Then the nursing team called another neurologist who was on the other side of the country and he took over her case in like minutes and had that procedure you mentioned above done on her.
You might have heard me say that not all doctors are created equal and this is an example of it!
My Wife had an Ischemic stroke. She was off work and recovering from having her gallbladder removed the prior day, I woke up at my normal 5 am and made coffee, she had slept on the couch as she didn’t want me to accidentally bump her lapro. incisions. She woke up and was completely normal at this point, asked if she wanted some coffee and then we sat down and started talking. Like a light switch she had no clue about what we were talking about and seemed confused about where she was. As fast as it happened, I thought she was messing with me. At this point a stroke didn’t cross my mind at all, She’s 33 for crying out loud! Healthy 33 year old’s don’t have strokes, atleast that was my mindset prior. I had her get up and she was able to walk halfway to our bedroom before needing to use the wall to stay upright. By the time she made it to our bathroom she had lost complete control over the left side of her body. At this point I was thinking, these are the things that happen to people that have strokes but she can’t be having a stroke. I knew I needed to call 911. We live in a small rural town(~2k people) with a volunteer FD/EMS, I swear we had the entire department in our driveway. The entire time she kept tell me that she was ok, To this day she isn’t allowed to answer “how are you doing” with O.K. The EMS transported her to our regional hospital about 15 minutes away in a town of ~60k. After a frantic phone call to the neighbor to watch our 6 year old who slept through then entire EMS ordeal I tore off to the hospital. By the time I got there they had already done a CT to confirm it was Ischemic. The nearest Neurosurgeon was at a hospital ~90 minutes away. I still remember the hospital staff saying that they needed to take her by ambulance as the Med-Flight pilot refused the transport due to weather. Meanwhile we were well within the time window for TPA, but due to her gallbladder surgery they were hesitant to administer it. After consulting with the Neurosurgeon at the hospital we would be headed to(and him telling them ‘You don’t have a choice, you need to give her the TPA’ They hung the IV bag of it and then loaded her in the Ambulance and they took off. I followed shortly after, doing everything I could to not speed and put myself or others in danger. I arrived at the new hospital and found the room my Wife was in. I walked in expecting the worse. What I was greeted with was a wave from her left hand and almost no speech issues. She had to spend the next 48 hours completely flat due to the TPA and gallbladder surgery, and what seemed like 2 MRI’s each day. All told she spent 4 days in the Neuroscience ICU at the UIHC and at this point the only lingering effects seem to be some cognitive load and fatigue. I totally agree with you that TIme is Brain, I am so thankful for how fast we were able to respond and get her the treatment she needed.
Wow @Nate_Pearson scary to hear your experience with the first neurologist. Unfortunately as you say, not all doctors/providers are created equal although at the same time, those folks might also not be supported well from administrators, etc. Nonetheless, they should have known to activate thrombectomy pathway which EMS can actually do from the field. It’s similar to when someone is having an MI (heart attack) but this is relatively new procedure compared to what interventional cardiologist have been doing for years. Again, time is brain so minimizing all non-essential stops is important.
It sounds like you had a tele-stroke consult which is common for hospitals that don’t have a dedicated stroke team. Tele-stroke is increasing more and more and with COVID, all of outpatient medicine has moved to tele-health.
@Cory.Rood Thanks for sharing your similar experience and so glad you’re wife was treated. I hear these stories everyday but it’s always important as a provider to put myself in the patients shoes and imagine what it would be like if it were my wife which you described well. It’s a very scary experience even when it goes well and obviously terrible when it doesn’t go well.
Thanks for sharing your stories, folks! When I was 30, I’ve had a case of Bells Palsy, which as I found out later has very similar symptoms. I woke up in the morning and half of my face felt a bit numb. Once in the office, my manager mentioned that half of my face appears to have “fallen down” and when I tried to talk, I could only mumble.
Went to the GP who had immediately sent me off to the emergency room, where I’ve had a brain scan done, which confirmed that it wasn’t a stroke. It took about 2 weeks before the face started taking its normal shape, but with that I started having an awful pain right behind the right ear. That went for another 9 month. Now, 14 years later I still get that pain whenever I am tired or stressed.
From my limited research and anecdotes given by other people, it appears that these types of strokes and cases of bells palsy tend to affect people in their early 30s or mid-50s. Also, a lot of those are either teachers or tend to do a lot of public speaking.
They had a stroke team but their main doctor was speaking at a conference, that’s who they called. This was almost exactly 10 years ago and apparently it was a new procedure.
The neurologist who was on call was from the university and I don’t think she was familiar with the procedure because it was new.
@Nate_Pearson If this was 10 years ago they were way ahead of the curve at that point! Most of the studies were negative then except highly selected patients so you guys were really lucky to have that care. Kudos to that stroke team!
@SomeCallMeTim Tim, thanks for sharing. I just wanted to clear something up for the forum from your story. Bell’s palsy is damage or inflammation of the VII (facial) cranial nerve. This is not due to a stroke but is generally thought to be due to a virus effecting the nerve. We usually will not figure out which virus is involved however. Bell’s palsy does present with facial weakness so it’s important to get checked out quickly but what’s different about bell’s palsy is that it will cause weakness to the whole face due to the lower motor neurons in the facial nerve being effected whereas a stroke effects the upper motor neurons in the corticobulbar tract causing only lower facial weakness. Your symptoms are very common for Bell’s palsy (pain behind the ear). Some patients will never improve although the majority will so I’m glad you got better. Take care! Will
Thanks very much for clarification, Will. @Rondeaunotrondo What I was trying to convey is that it is very important to get checked out ASAP as the initial symptoms can look very similar.
So my events are canceled but I’m trying to look at as an opportunity to improve even more. I started indoor training in December and have increased from 1.75w/kg to 2.3w/kg by dropping forty pounds and riding 100 plus miles per week. I don’t know how much more weight I can drop and keep off. What can I do to increase another 50-80 watts of FTP to get above that 3w/kg threshold by early June? I’m a mountain biker and most plans seam geared to high cadences where I am very comfortable at 60rpm.
Since you guys asked - I like the format better because I could see your faces. You guys have better chemistry in person however, and the laughs are better. Gotta admit, it’s always refreshing to have Amber in the line up. Women’s racing is (was?) blowing up and there just aren’t many experienced women’s voices out there to speak to women’s specific challenges. Good job all around guys!
And holy shit Nate! Way to drop that bomb! So glad your wife is getting better!
Great podcast episode! I’m a new subscriber to TrainerRoad - just starting my recovery week from SSBMV1 - thanks largely to listening to this amazing podcast!
Thanks for rolling with the changing world and forging ahead with the remote podcast. Awesome to be able to bring in perspectives from those not local to Reno - Amber as well as others in the future! The remote recording worked great, in my opinion, and any decrease in audio quality was more than made up for by having a new podcast to listen to despite social distancing. Thumbs up!
@Nate_Pearson I would totally subscribe, and listen, to a podcast in which you would talk about business, culture, product management, and relevant topics. I think that when it comes to growing a “kick-ass bootstrapped outfit” you are at world-tour level
I only know about it because my wife has it and a couple of her sisters inherited the defective gene, too. I believe people of Swedish descent are at an increase risk of it. Just throwing it out there as a possible reason. Like I said I am no doctor just married to someone with the blood clotting disorder.
