Friday, November 16, 2012

My stroke recovery: A visit to the neurologist

I received my third botox treatment for muscle spasticity this week. My visit to my neurologist also included a comprehensive discussion of my April 22, 2011, hemorrhagic stroke. Although more than 18 months seems a long wait for details, I think the information arrived right on time and in language I could absorb--mostly. The inevitable inaccuracies are all my own.

I have been seeing a neurologist for about nine months. In response to my request in a previous office visit, he went into teaching mode during this appointment. We examined two cat scans: one made soon after the stroke and the second near the end of my 27-day stint in an in-patient rehab center. My neuro doc also gave me guided tours of the MRI I had several weeks ago plus dozens of images pulled up through Google, of other stroke-affected brains.

The basics I came away with were twofold: first, most strokes like mine occur in one of three areas. Of those three, the general area mine occurred in is usually the least severe. But secondly, and this is a big “but,” my stroke was in the worst place in that region of the brain, right on the “internal capsule.”

That internal capsule is a structure where a large number of motor and sensory fibers are bundled together and lead to the spinal cord. I borrowed the image below from Stanford School of Medicine’s “Stanford 25” Website.

If my stroke had been even a little bit to one side or the other, the internal capsule would have escaped the degree of damage I experienced. Likely in that case I would already have recovered more range of movement in my shoulder and arm, at least some function in my elbow, wrist, fingers and thumb and maybe even some sensory input on my left side.

The speculations about what might have been are all from my own inference from what my doctor said and from what I gleaned via Google. Although I have a long way to go before my left hand and arm are contributing substantially to tasks of daily living, the fact that they are contributing at all is improvement.

Rather than despair at learning the specifics of the damage to my brain, I find it interesting. This knowledge is part of my journey. And I am buoyed up by the improvement that has occurred in my condition. I know that function can be regained because I am regaining function, slowly and in minute increments, but it is happening.

I am not sure what my reaction would have been if I had learned all the details earlier in my recovery. Looking back on those early days of inpatient rehab, I realize that sometimes what I heard from therapists and physicians was not what they were actually saying. A long-haul recovery wasn’t on my horizon. I think I just assumed everything would be back to normal shortly and processed everything to fit that assumption.

Now I am in the long haul, and I am thankful for all the folks who are hanging in there with me.

A Google note: Googling “internal capsule” launched me into a brief exploration of the Stanford 25. That has been an adventure in itself. I appreciated evidence of the Stanford School of Medicine’s common-sense emphasis on mastery of hands-on, bedside examination as a crucial element of accurate diagnosis.

And I appreciate even more my neurologist. He did a year’s fellowship with the reigning leader in the use of botox to treat muscle spasticity like mine. The field is so new that techniques are not readily available in books or papers. At this stage, my neurologist explained, the treatment is a combination of art and science.

With completion of my third set of botox injections, I have observed that combination in action in his treatments. And I am alsoconvinced that he could probably make it in stand-up comedy. His stories are hilarious. But it was no laughing matter when I walked out of that office and could immediately see that my elbow was straighter. And that was without the usual monumental effort from me to force it straight.


  1. amaze me! You really do! I am so thankful to God that He is healing you, and that you are showing signs of improvement. You have such a great attitude...and I applaud you! I know some days must be rough...but you are a trouper...and I love how you have such determination.

    May God Bless You Greatly!

    Love, Linda @ Truthful Tidbits

  2. Oh Linda, what a wonderful progress report. You are in it for the long haul and I am right there with you to cheer you on.
    The Lord has been faithful and good to show you the right information at the right time.
    Appreciate you letting us be a part of your journey.

  3. Praise the Lord for progress! Hang in there :)

  4. I think your neurologist is wonderful. I wish someone had explained all this too me.

    I thought your stroke must have been worse than mine as I recovered much more rapidly. I attribute that to the quick response of my office mates who aclled 911. Dianne

    PS, i love the larger darker type you used in this post. I can see it.

  5. Wonderful info. I do think swift response is critical in this situation. With only me at home, who would call 911 if I had a stroke?

  6. Bravo to both you and your neuro doc.....says another stroke victim. I'm amazed at all you do with limitations. My stroke was diagnosed years after it happened, and there's little that can be done now. I too can see the type easier.

    RYN: I volunteer two days a week at the American Cancer Society's Discovery Shop here in Point Loma, San Diego. These shops are in the western part of the US, and are considered "upscale" thrift stores. We who volunteer try and get as many goodies out onto the floor, and the manager takes them off the floor if they are less than perfect. I'm the booklady on Wednesdays and a donation Sorter on Fridays.

  7. You truly do amaze me. This information is quite fascinating, but I am just reading it, I don't have to live it. You not only are able to process this information for your own understanding, but you have helped me understand what happened to you.

    I know you are into this recovery for the long haul. It is good that we don't have too much information at the beginning of the journey, isn't it? Keep on keeping on. I'm also happy to read that the botox shot helped so much.

  8. Glad the Botox is helping you. Generally, doctors and therapists realize that patients are absorbing so much information in the beginning that we must use care in just how much and how soon to explain specifics.

    One reason for care in sharing information is due to what you said: "I realize that sometimes what I heard from therapists and physicians was not what they were actually saying."

    You also expressed what is typically thought by stroke patients: "I think I just assumed everything would be back to normal shortly and processed everything to fit that assumption."

    Your reference source is excellent with the picture graphic -- reminds me of our neurological studies when I was in training as a Speech-Language Pathologist.

    Keep doing what you're doing!