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January 6, 2011

Update on Elise
Posted by Patrick at 04:07 PM * 74 comments

Having read the previous post and its comment thread, and having confirmed with Elise that she doesn’t mind having her medical stuff discussed on Making Light, Elise’s attending physician Dr. Salman Azhar has asked that we note two points of fact.

First, it really was a stroke, not a TIA.

Second, the fact that they were able to administer the anti-clotting TPA so soon after it happened was critical to the fact that, so far, the tests have shown practically no permanent damage.

This has been a public service announcement. Learn to recognize stroke in yourself and others.

(Elise wishes to report that in the throes of the actual event, she was tempted to just lie down and see if the symptoms would go away, but as she put it, “I then realized that Soren would kill me.”)

Teresa adds:

Elise may not have realized it, but just lying down was not an option. By the time she was mumbling about “Soren will kill me,” I’d already phoned 911, and the EMTs were on their way.

The episode started with her telling me that she was seeing differently out of each eye. If that had been all, I might have been persuaded that she just had a migraine coming on. But right after that she got mumbly, her sentences got shorter and lost their cunning, her ideation went flat, and she repeated three or four times that something was happening and she Didn’t Like It.

Diagnosis is easy when people can self-diagnose. When they can’t, they may still be aware that something isn’t right. Elise is normally a clear and forceful speaker. If something’s bothering her, she calls it by name, often in colorful detail. Yet here she was, repeatedly saying a thing that was vague and without force but somehow still troubled-sounding. That made my ears prick up. When she added a minute or two later that she was feeling “prickly” on one side of her body, boom, I was on the phone calling 911. And when the dispatcher asked how old Elise was, and Elise couldn’t remember the answer, I knew I’d been right to call.

Dr. Azhar’s message is still giving me the post-emergency shakes: my god, it really and truly was a stroke.

Comments on Update on Elise:
#1 ::: xeger ::: (view all by) ::: January 06, 2011, 04:46 PM:

Woo! Stroke-- Caught in time to do (nearly) no damage++

#2 ::: TomB ::: (view all by) ::: January 06, 2011, 04:50 PM:

Dr. Azhar read the previous post? That is just great. Bedside manners for the twenty-first century. And yay for TPA and the fast response.

#3 ::: abi ::: (view all by) ::: January 06, 2011, 04:54 PM:

Thank you, Dr Azhar, for your good care both of Elise and of all of us (in bringing up the importance of early treatment of stroke). Very much appreciated.

#4 ::: John Chu ::: (view all by) ::: January 06, 2011, 05:02 PM:

Glad to hear that she can look forward to practically a full recovery. So happy that you all recognized the signs of stroke right away and she got the right care so quickly.

#5 ::: Ken Houghton ::: (view all by) ::: January 06, 2011, 05:10 PM:

Sad to have been wrong about TIA (though only because I've been told by TIA victims that they are easier to deal with going forward), but very happy with the results and that all bodes well for the future.

And thrilled she got a doctor who is clearly paying attention to her and her wishes.

Repeating best wishes for a full recovery.

#6 ::: dcb ::: (view all by) ::: January 06, 2011, 05:13 PM:

Thanks for the update. Really glad to hear it was caught & treated in time to minimise the permanent damage.

Lesson heard and understood. Going to re-read the stroke spotting guide now.

#7 ::: Michael I ::: (view all by) ::: January 06, 2011, 06:04 PM:

Glad to hear chances look good for a full recovery.

#8 ::: Bruce Cohen (Speaker to Managers) ::: (view all by) ::: January 06, 2011, 06:05 PM:

Sounds like the best possible outcome short of "It was a false alarm". Thanks for the update, Patrick, and please thank Dr. Azhar for the good work. Elise, if you have to be afraid of Soren, so be it; I'll take the results.

#9 ::: Barb Moermond ::: (view all by) ::: January 06, 2011, 06:15 PM:

thank heavens for 21st c medicine!!!
thank you dr azhar!!!

elise, glad your fear of soren made you do the smart thing - go you!

#10 ::: Madeleine Robins ::: (view all by) ::: January 06, 2011, 06:37 PM:

You know, having Soren deSelby strike fear in your heart is not a bad thing. Not with these results, anyway.

I'm glad the damage seems really minimal. I will be happier when The Lioness is out and ranging around, all healthy-like.

#11 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: January 06, 2011, 06:40 PM:

“I then realized that Soren would kill me.”

Damn straight!

(Having Soren as your conscience is not a bad thing, O choir. Can I get an A-men?)

#12 ::: Lila ::: (view all by) ::: January 06, 2011, 06:49 PM:

TPA FTW. Recognizing signs of a stroke in time to administer TPA: priceless.

#13 ::: Mary Aileen ::: (view all by) ::: January 06, 2011, 07:28 PM:

Good to hear!

#14 ::: Stefan Jones ::: (view all by) ::: January 06, 2011, 07:35 PM:

Coincidinkiditty, there was a PSA about recognizing strokes on NPR this morning.

I'd heard it before, but never really payed attention.

#16 ::: Xopher ::: (view all by) ::: January 06, 2011, 08:09 PM:

It's great that Dr. Azhar read that whole comment thread! Now THAT's a bedside manner.

Thank you, Dr. Azhar, for taking good care of our friend.

#17 ::: Fragano Ledgister ::: (view all by) ::: January 06, 2011, 08:09 PM:

I'm glad it was caught in time.

#18 ::: Fragano Ledgister ::: (view all by) ::: January 06, 2011, 08:13 PM:

I should add that my best friend at university, Paul Davis, died of a stroke at 23. It was an extraordinarily traumatic experience, one that has caused me occasional nightmares in the years since.

#19 ::: Paula Helm Murray ::: (view all by) ::: January 06, 2011, 08:32 PM:

Adding to the Yaays for Elise's recovery. And glad she didn't just try to 'let it pass.'

#20 ::: Fred ::: (view all by) ::: January 06, 2011, 09:00 PM:

WHEW.

#21 ::: Mary K ::: (view all by) ::: January 06, 2011, 09:23 PM:

I'm so glad to hear that things are as good as they are. Please tell Elise I'm thinking of her. (And making necklaces...)

Mary Kay

#22 ::: edward oleander ::: (view all by) ::: January 06, 2011, 09:26 PM:

This should go into a textbook as the ideal way to react and respond to a suspected stroke, from beginning to (hopefully) end, complete with a picture of the Lioness with a thought balloon containing Sparks frowning in admonishment...

#23 ::: Mary Dell ::: (view all by) ::: January 06, 2011, 09:30 PM:

Fragano @#18: I'm sorry about your friend. I lost my best graduate school friend when I was 24 and that experience will always be with me. Fortunately I feel my friend is always with me, too.

My sister was fortunate to survive the strokes she had at 19, back before modern protocols. Many people still think, unfortunately, that strokes only happen to elderly folks. I'm so glad Elise and Teresa spotted this one right away.

#24 ::: Patrick Nielsen Hayden ::: (view all by) ::: January 06, 2011, 10:57 PM:

edward oleander #22: "Sparks"?

#25 ::: Patrick Nielsen Hayden ::: (view all by) ::: January 06, 2011, 11:03 PM:

I would be even more impressed with the staff at Lutheran Medical Center in Brooklyn if it didn't take a gigantic effort by THE PATIENT (you know, the sick one? the one lying down on the bed?) to make sure she was allowed to take all of her regular medications -- a printed list of which she provided them with two fracking days ago.

This kind of nonsense is why people tend to regard hospitals as places where sick people go to get sicker.

#26 ::: P J Evans ::: (view all by) ::: January 06, 2011, 11:12 PM:

Patrick, I heard about a woman who was wearing a Medic Alert bracelet telling them she was allergic to some drug (don't recall what) and the hospital staff were going to give the drug to her anyway. Fortunately she had a family member who was there at the time and was able to stop them.

But yeah, I don't think they pay much attention to what the patients (or the people with them) know or need. Certainly not as much as they should.

#27 ::: Steve C. ::: (view all by) ::: January 06, 2011, 11:29 PM:

Hospitals are essentially $10,000/day hotel rooms, only you get an IV stuck in your arm and the food is worse.

#28 ::: Mary Dell ::: (view all by) ::: January 06, 2011, 11:33 PM:

PNH@ #24: an anagram of Skraps, obviously.

#29 ::: Rikibeth ::: (view all by) ::: January 06, 2011, 11:53 PM:

Hooray for prompt response and lack of permanent damage!

very scary, but at least the best possible outcome in the situation.

#30 ::: B. Durbin ::: (view all by) ::: January 07, 2011, 12:30 AM:

Okay, what is it with 2011 and medical problems? (Not mine, FWIW, but right now we're praying that a family member only has ONE form of cancer.)

Get well, Elise. Glad you got to the hospital in a timely fashion.

#31 ::: Terry Karney ::: (view all by) ::: January 07, 2011, 12:41 AM:

I got to the last thread on the subject late, and didn't know quite what to say.

I am pleased as punch the diagnosis is solid, and the prognosis favorable.

#32 ::: heresiarch ::: (view all by) ::: January 07, 2011, 01:49 AM:

Thank goodness.

#33 ::: Fragano Ledgister ::: (view all by) ::: January 07, 2011, 07:32 AM:

PNH #25: I second that, having very nearly been taken for a completely unnecessary operation while recovering from the very necessary one I had in August. Were it not for the vigilance of Gail who knows what might have happened.

#34 ::: Fragano Ledgister ::: (view all by) ::: January 07, 2011, 07:41 AM:

Mary Dell #23: I'm glad too.

When it comes to stroke matters today are a quite a bit better than they were a generation ago.

#35 ::: ebear ::: (view all by) ::: January 07, 2011, 08:18 AM:

A large sigh of relief and a lot of love from slightly north.

#36 ::: fidelio ::: (view all by) ::: January 07, 2011, 08:28 AM:

W00t! Go, Elise! ANd W00t! for Dr. Azhar and the ER staff.

Sometimes a wonder drug really is a wonder drug.

#37 ::: Ginger ::: (view all by) ::: January 07, 2011, 08:38 AM:

Applause for all, including Dr. Azhar.

#38 ::: Dichroic ::: (view all by) ::: January 07, 2011, 08:55 AM:

Very, very glad to hear it.

#39 ::: Serge ::: (view all by) ::: January 07, 2011, 10:13 AM:

Für Elise on electric guitars.

#40 ::: ddb ::: (view all by) ::: January 07, 2011, 11:06 AM:

Dr. Azhar sounds both professionally good, and "our kind of people", compatible social styles. That's a nice bonus! Thanks, Dr. Azhar, if you're still reading.

Thanks, TNH, for spotting the symptoms and reacting quickly. The transition to taking over and forcing action on the patient (clearly necessary and appropriate in this situation) is a step I expect I will have trouble with if I ever need to make it.

People have talked about the good prognosis; I haven't seen any specific reason to feel good in this area myself (beyond the benefits of prompt treatment, and the benefits of having your stroke now rather than 20 years ago). If there's additional reason to feel particularly good on this front, I'd be happy to participate.

Hey Elise! Keep getting well!

#41 ::: Scraps ::: (view all by) ::: January 07, 2011, 11:09 AM:

It's very bemusing to hear Elise saying the fear of me motivated her to go to the hospital. But good. If anything good came from my stroke, it was as alarm-bringer.

#42 ::: Starshadow ::: (view all by) ::: January 07, 2011, 11:44 AM:

@41 I look at my stroke (which was much, much less severe than yours) the same way. If my experience gets women to explore other options of birth control other than hormones, if it educates people that no, it's not just the elderly that can suffer a stroke... then while I can't say "it was worth it" then at least I can say that it's doing some good.

#43 ::: Margaret Organ-Kean ::: (view all by) ::: January 07, 2011, 11:53 AM:

Glad to hear the Elise is doing well. Glad she had good friends with her when it happened, too.

#44 ::: Tom Whitmore ::: (view all by) ::: January 07, 2011, 11:58 AM:

T -- on post-emergency shakes, make sure you really let yourself feel them, and remember that you reacted correctly. Far better to have shakes after than during. Been there, on both. And far better to have done the right thing, especially since the result was good. Again, from experience -- it's much more difficult to remember that if the result isn't good.

You Done Good. Thank You. And I'm glad to hear that you're doing well, and continuing to do good. As I said upthread, if I were in a hospital I can't think of anyone I'd want more as an advocate than you and Patrick. Some folks might do as well, but I sincerely doubt they'd do better.

#45 ::: sdn ::: (view all by) ::: January 07, 2011, 11:59 AM:

Thank you so much for the update. What a terrific doctor. And what terrific friends you are, NHs.

#46 ::: Velma ::: (view all by) ::: January 07, 2011, 12:03 PM:

"...Soren would kill me." No, Soren wouldn't: he's mellowed out a lot in the past two years. However, should anyone reading this have a similar crisis, you may assume that now Elise and Soren will shake their canes at you, and I will kill you.

And even if the staff at Lutheran had difficulty dealing with the list of medications, I heartily recommend that anyone who is taking meds regularly keep a typed list of what they take accessible, and give one to close friends/family/housemates, so that in an emergency, you're not staring at pill bottles.

Let us have a peaceful weekend, okay?

#47 ::: Kelly McCullough ::: (view all by) ::: January 07, 2011, 12:29 PM:

Eek, been mostly offline lately and missed that last post until now. Glad to hear that she's doing so well, and absolutely delighted that if she had to have a stroke it happened where she could and would get help so fast. I'll keep a couple of fingers crossed for speedy recovery.

Get well soonest, Elise.

#48 ::: albatross ::: (view all by) ::: January 07, 2011, 01:17 PM:

Best wishes, Elise!

#49 ::: Evan Goer ::: (view all by) ::: January 07, 2011, 01:36 PM:

I've been on a self-imposed slowdown/break from the Internet, so I'm just reading this now. Elise, I am just so happy you are okay. And Patrick and Teresa, THANK YOU for taking such good care of Elise. Any one of us would be lucky to have such alert, capable friends.

#50 ::: Christopher Davis ::: (view all by) ::: January 07, 2011, 02:24 PM:

Thank you, Teresa, for knowing what needed doing and doing it.

Thank you, Dr. Azhar, for practicing 21st century medicine that includes using modern technology to learn about, and communicate with, your patient's community.

Thank you, 21st century medicine, for having things like TPA.

#51 ::: Julia S. ::: (view all by) ::: January 07, 2011, 02:34 PM:

Thank you (and thank Elise) for sharing this. Both the good news, and the wise words about taking these events seriously. Best wishes to Elise for a good recovery.

#52 ::: Jane H ::: (view all by) ::: January 07, 2011, 02:40 PM:

Get well wishes from Minneapolis, and much gratitude to Theresa & Patrick for not only being brilliant, but brilliantly competent. It's a rare combination. Feeling strangely blessed by how good the bad news has turned out to be . . . and looking forward to 4th Street!

#53 ::: Nadine ::: (view all by) ::: January 07, 2011, 02:59 PM:

Thank you Teresa, from the bottom of my heart. Love to Elise.

#54 ::: Terry Garey ::: (view all by) ::: January 07, 2011, 04:12 PM:

Good job Teresa and Patrick! Let's hope it continues to go well.

#55 ::: Rob Hansen ::: (view all by) ::: January 07, 2011, 06:13 PM:

Yowza! Only just now seen this. Elise was incredibly fortunate to be with you guys when this happened to her. Not everyone would've recognized what was going on or the importance of Acting Right Now.

#56 ::: Amysue ::: (view all by) ::: January 07, 2011, 06:22 PM:

Hoping for refuah shlema for Elise and yay for TPA given in time!

#25 I am diabetic and always bring my own jnsulins, meters etc with me when in the hospital. They always, always, always mess up my numbers by forgetting to bolus or insisting I take more or less than I need etc. I basically tell them, I'm in charge of this stuff and leave it at that.

I am also a fierce advocate for, well, advocacy. Patients, no matter how well informed need someone with them to advocate on their behalf and to filter a lot of the nonsense that happens in today's hospitals. It shouldn't have to be that way but it is and people end up sicker for longer often because of it ( and often the biggest issue is getting ones daily meds, whatever they are, administered.).

#57 ::: Jo Walton ::: (view all by) ::: January 07, 2011, 09:22 PM:

T, you were probably the best possible person to be with her when it happened.

Who is the patron saint of serendipity?

#58 ::: Brad Roberts ::: (view all by) ::: January 08, 2011, 12:40 AM:

@57 I'm pretty sure it's Malcom Reynolds.

#59 ::: James D. Macdonald ::: (view all by) ::: January 08, 2011, 12:57 AM:

#56 Amysue I am also a fierce advocate for, well, advocacy. Patients, no matter how well informed need someone with them to advocate on their behalf and to filter a lot of the nonsense that happens in today's hospitals.

The only people in the heathcare system on the treatment side whose formal job description includes "patient advocate" are the EMTs.

#60 ::: Bruce Cohen (Speaker to Managers) ::: (view all by) ::: January 08, 2011, 01:31 AM:

James D. Macdonald @ 59:

Astoundingly, there is another class of people now who advocate for patients, but they're highly specialized. Eva had radiation therapy for a Stage 0 breast cancer last summer. When she went in to arrange the treatment schedule, she was given the name and phone number of a case worker who would follow her treatment. She didn't have to call the case worker; she was contacted almost immediately, and the case worker kept in contact throughout the 6 weeks of treatment and afterward. Several times she called the radiologist to make sure that he knew about Eva's concerns about the side effects of the treatment.

#61 ::: Xopher ::: (view all by) ::: January 08, 2011, 03:14 AM:

When I went into the hospital for my hip surgery, I was explicitly told not to bring any of my medication, that they'd supply anything I needed from the hospital pharmacy.

Only oops, they didn't have my ADHD drug, for which there was no generic. So I had to rely on sedation to keep me from climbing the walls.

#62 ::: David Goldfarb ::: (view all by) ::: January 08, 2011, 05:11 AM:

Brad Roberts@58: Are you sure you're not thinking of serenity rather than serendipity?

#63 ::: Katya ::: (view all by) ::: January 08, 2011, 10:45 AM:

Thanks for the update, so glad Elise is OK and so grateful that you were there to support her!

Is it possible to visit?

K

#64 ::: Jacque ::: (view all by) ::: January 08, 2011, 01:15 PM:

Yay, P & T, Elise, and Dr. Azhar! WHEW!!

#65 ::: Jacque ::: (view all by) ::: January 08, 2011, 01:17 PM:

Oh yeah, and: Yay Soren!

#66 ::: edward oleander ::: (view all by) ::: January 08, 2011, 01:58 PM:

@Mary #28 - As much as I'd like to claim that it was the clever riddle you suggested (which I wouldn't have thought of on a good day... kudos!), it was just a total brain fart, resulting from working the night before, then not sleeping that day...

Sorry, Soren :-(

#67 ::: Linkmeister ::: (view all by) ::: January 08, 2011, 02:47 PM:

Xopher @ #61 they'd supply anything I needed from the hospital pharmacy

(Puts on bitterly cynical hat)

At the usual outrageous hospital markup, no doubt.

(Removes hat)

#68 ::: edward oleander ::: (view all by) ::: January 08, 2011, 03:21 PM:

Teresa's addition to the update points out an incredibly valuable tool that she used without even thinking about it:

Noticing/determining the raw fact that Something Was Different (! ! !)

With someone you know well, even small difference(s) can be striking, but this works even with strangers. Often you can cut through some of the fog by asking the person having the pain (or other symptoms), "Is this normal for you? Has it happened before?" If they say "No" or cannot decide, then you know to proceed with a more detailed assessment, including possible neurological deficits from conditions like a CVA, or a closed head injury. If they say, "Yes," that also helps narrow down your next set of questions, but the "No/I don't know" answers are the ones that prick your ears up and lead to that boom moment.

Thanks for adding that info to the post, Teresa, it brought out a very valuable point.

#69 ::: Angiportus ::: (view all by) ::: January 08, 2011, 07:11 PM:

Thanks for the lessons, all, and hope that Elise and the rest of you get and stay well.
2 weeks after an operation in '92, I got a sudden nasty fever and my doctor said it was an infection from the hospital. I don't know if that's true because I had been home for 10 days, but it gives one pause. [Fortunately the doctor gave me something that set things right.] This and a few other incidents give me not a whole lot of trust in the system--and let's not even get started on insurance.

#70 ::: Brad Roberts ::: (view all by) ::: January 08, 2011, 09:59 PM:

@62 David. Yes, I know. But playing with similar words is a bit of a habit of mine. And, you know, any chance to remind myself of the awesomeness of that cast.

#71 ::: Teresa Nielsen Hayden ::: (view all by) ::: January 09, 2011, 01:50 AM:

Velma @46: For the record, I told Elise that you were the one she should worry about.

Edward Oleander @68: Many years ago, I was impressed by a doctor's observation that if you wanted to know what was wrong with a patient, try asking them -- they'll often tell you.

(One of my personal disciplines is to try to always bear in mind the possibility that what someone is telling me is the literal truth as they perceive it. The trouble with using approximate language is that it encourages the user to view all language as approximate, and automatically reassign ambiguous or unfamiliar statements to the nearest common meaning. In the majority of cases they'll be right, and save a great deal of time and effort; but it limits their ability to process nonstandard statements, especially ones that are similar to but not identical with some frequently conveyed meaning.)

One of Jim Macdonald's proverbs is that you should never ignore a warning, including ones you don't understand.

When I read your comment, I saw immediately that "Is this normal for you?" is a powerful question. Thank you for passing it on. I promise it will get used.

#72 ::: Lin D ::: (view all by) ::: January 10, 2011, 04:09 PM:

Elise: boo for stroke, yay for treatment and recovery.

Besides the thanks to TnP for everything they've done, thanks to Jim and the Fluorosphere for sharing not simply knowledge but wisdom (how to apply knowledge).

With regards to medication and hospitals, I have a medication from a compounding pharmacy. The nursing staff ruled that since they couldn't match it, I couldn't take it. Or, well, maybe I could. Or... not. I told them I was taking it, period. I got waffled at by the nursing staff, the doctor who came in once a day never mentioned it past my telling her my meds list, and I had someone bring my personal meds daily. Nothing for anybody to take away, nor block.

An advocate/speaker-for-the-ill is a useful thing, even when brain function isn't directly damaged. My last ER visit involved lots of swearing and vomiting from pain. Communication was not always relevant or coherent.

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Another spam wave. I'm tagging this one specifically @73 because of the human-seeming name.

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