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.