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“He Took Aspirin.” Stroke and Aspirin

June 24th, 2019 my husband had a stroke. It started with a funny headache around his left eye. He also had ringing in the ears and pain in his upper molar. He decided it was eye strain and took a nap to try to shake it. When he awoke an hour or so later, he was having trouble with his arm and he felt “funny”. The headache, while not bad, was different from anything he had experienced before.

Normally I recommend ibuprofen for a headache. I get periodic headaches with aura that last about three days. Aspirin and Tylenol don’t do a thing for those but 200mg of ibuprofen works like magic. For some reason, a little alarm bell went off in my head and I told him to take two regular aspirin. (325mg each meaning 650mg total.) It was while he was pouring the water to swallow the aspirin that I could clearly see his arm wasn’t working properly. He was overshooting and knocking stuff over. As he swallowed the aspirin I first began thinking maybe we should go to the hospital because it might be a stroke.

The drive to our nearest local hospital is typically one hour and fifteen minutes. I made it in under fifty. I was speeding. At the hospital, they said I should have called 911 and waited for an ambulance. If I had done that, the paramedics could have started the stroke protocol immediately and my husband could have been in a CT machine about an hour and fifteen minutes after paramedics arrived on scene. I felt horrible. I felt crushed. However, talking to the local folks here since we got home, many have told me that paramedics take at minimum forty minutes to arrive at our small rural town. And that forty minutes is on a good day with nice weather and only if the nearest ambulance is not busy with another call. Sometimes in an urgent emergency like a stroke of heart attack, it can take an hour and half to two hours for the nearest ambulance to arrive. They would also have had to then make the same drive I did.

It is possible we would not have had to go through the one hour delay to CT involved in a transfer from the small hospital I went to first. That hospital had no CT machine. They had to arrange the transfer to the large teaching hospital for the CT. There are two local smaller community hospitals that have CTs. They are slightly further than the one I went to in different directions. They usually have staff on hand to do a CT. However neither one are equipped for acute care beyond contacting a neurologist at the major centre, administering clot busting drugs and then transferring to the large teaching hospital we ended up at anyway.

The neurologist told me to stop fretting about it. It does no good to blame myself. I did the right thing and the outcome was excellent. He told us that since my husband’s symptoms were resolving on their own and had largely resolved by the time he had the CT and the symptoms were so very mild, he would not have been eligible for the clot buster drug anyway. The clot busting drug is high risk resulting in 6% of patients dying. Compared to a catastrophic brain injury its well worth the risk but that was not what we were dealing with. His kind words took a huge load off my mind and eased my conscious considerably. Analysis of events to improve future response is one thing. Second guessing and regret is another and it is a waste.

In retrospect, I should have called 911 and then took off and met an ambulance somewhere on the trip in to one of the hospitals. The 911 people would have known where the nearest hospital open to do a CT was. Also when we arrived at the local hospital, my husband’s systolic blood pressure was over 220. They treated that while arranging the CT and transfer. The paramedics could have started that treatment sooner. Given their travel time, however, that meant only ten minutes sooner. I risked him having a major medical crash after a catastrophic stroke affecting his breathing and heart during those extra ten minutes. They would have been better equipped to handle that event.

The symptoms of arm weakness and headache my husband was experiencing dropped to about half by the time we hit the first town near us, a 38km (23miles) drive away. It was twenty minutes after he took the aspirin. While he was in the CT machine, the last of the symptoms went away. His arm was still a bit weak but it was working properly and the head ache was gone. The diagnosis was inner carotid artery dissection clearly visible on CT. At that point they weren’t sure if he’d had a full stroke or a transient ischaemic attack (TIA). They had not yet determined if he had thrown a clot that had traveled and lodged somewhere deeper in the brain or if the relatively small area of carotid artery had partial closed due to the dissection and reopened. Later, the neurologist would tell us it was a mild but full stroke and a clot had traveled and lodged in the area of the brain that controls arm movement and it has done a small amount of damage. (That damage will remain but the slight weakness should disappear as the brain heals and rewires itself around the stroke site.)

We went through four days in hospital of careful monitoring, 24 hour heparin drip, a barrage of drugs and lots of fighting his blood pressure. (It needs to be up to get blood into compromised areas but not high enough to encourage another clot of break off and travel. The doctors fretted and administered drugs every time the systolic number went over 180.) Students came and went along with the many doctors and one thing I kept hearing over and over again was how lucky my husband was and how mild the event was. This was invariably followed by a lowering of the voice, heads coming closer and then in a near awe-struck tone someone would say, “He took aspirin.” This would be followed by knowledgable head nods and as if that explained it all. At the time it made no sense to me. I fretted that maybe I had made things worse by telling him to take two aspirin instead of an ibuprofen. I even asked if the aspirin made it worse. “Oh no, not at all,” everyone assured me. No one mentioned it might have been absolutely best thing to do.

I have since put things together in my mind. In ScienceDaily, 18 May 2016, there was commentary on how taking aspirin as soon as you have symptoms of a stroke, especially if you are far from medical help, reduced the chances of a major stroke by 70-80%.

The authors concluded ‘Our findings confirm the effectiveness of urgent treatment after TIA and minor stroke — and show that aspirin is the most important component. Immediate treatment with aspirin can substantially reduce the risk and severity of early recurrent stroke. This finding has implications for doctors, who should give aspirin immediately if a TIA or minor stroke is suspected, rather than waiting for specialist assessment and investigations.’

Furthermore: ‘The findings suggest that anyone who has stroke symptoms, which are improving while they are awaiting urgent medical attention can, if they are able, take one dose of 300 mg aspirin.’ [Note I gave him 625mg which may have been too much but then again….]

I am an avid follower and reader of science news consolidators such as Science Daily. I often then go back and read the entire article they reference. In retrospect, I think I must have read that article about stroke and aspirin and it sat in my subconscious. I now also think the dramatic improvement we saw in twenty minutes was due to the aspirin starting to dissolve the clot. The fact that the symptoms pretty much vanished even as he had the CT was when the clot was fully dissolved. All the other stuff the doctors did, like keeping his blood pressure in a range that allowed more blood to get to the brain but not so much as to cause the delicate healing process of the carotid artery dissection to break open, those anti-inflammatory drugs to stop the brain from overreacting to the damage, and the blood thinners, all prevented something much worse from coming afterward.

Am I recommending taking an aspirin if you have symptoms of stroke? I can’t do that. I am not a doctor. There are two kinds of stroke. One kind (about 30%) is caused by blood vessels rupturing and bleeding into the brain causing damage. The other kind, the 70% kind like the one my husband had, is due to a blockage, usually but not always by a clot. Aspirin could make the bleeding kind worse. That’s why doctors don’t just give you clot busters if they think you are having a stroke. They do the CT first to make sure they don’t make a bleeder worse. I also don’t know if it will help all kinds of blockage. There are also people who should not take aspirin because of other reasons. So no, I can’t recommend you take aspirin if you are having stroke symptoms.

I recommend instead that everyone read up on the symptoms of stroke so you know if it happens to you or someone you love. Understand your best options for getting to medical care quickly before you need it. Talk to your own doctor about it and read up on taking aspirin. Weigh the risks. Make your own decision once you are fully informed and do it before you need to deal with an emergency. If you live next door to a major teaching hospital you can afford to wait to treat. If you live 250km from the nearest hospital, like we do, you have to play different odds. Aspirin might be your answer. Maybe.

We got lucky. As Louis Pasteur said, “Luck favours the prepared mind.” We were also prepared with knowledge even though I did not recall from where during the emergency. We had aspirin on hand. I distinctly remember buying that aspirin even though we never use it, in order to have it in the house, just in case. [My husband has been on the low dose aspirin for decades which he takes with a multivitamin which is why we don’t use it randomly for other things.] I don’t recall just in case of what. The aspirin bottle has an expiration date of this year. That means I likely bought it around the time I read that article in 2016. It doesn’t have the vinegar smell of spoiled aspirin and aspirin lasts a lot longer than the three years or so written on the bottle. Even so, I will be buying a new bottle next trip to town. I might even buy a half dozen or so and keep aspirin in my truck, my RV and a couple in my purse.

We got lucky. Luck favours the prepared mind. Be prepared.

 

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Solar Water Heater for Pool

After the Alonsa tornado the beach got full of wood bits and broken glass. We’re a bit hesitant about swimming there. I have always wanted a pool in my yard but never felt I should waste the money when we had a perfectly good beach 12km away. This year I did it! I bought myself a pool.

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Okay, it’s not exactly an Olympic pool but I am delighted by it. I also ordered a water test kit and some chlorine stabilizer and several bottles of household bleach. I now have the chlorine and stabilizer in the water and the test kit shows the level of chlorine and the pH are perfect. The big problem is temperature. The water came out of the well at 6C (43F) and it was COLD in that pool. It’s been cool at night so the temperature is now up to 19C (66F) which is a lot better than the heart stopping cold of the initial fill but still not what I consider good for a casual dip.

In order to more quickly raise the temperature I cobbled together a solar water heater using some stuff we had laying about. I stapled a black mat onto some plywood and then wound 50 feet of black hose in a loop. I purchased a submersible pond pump and attached it.

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The pump sits on the bottom of the pool where the water is coldest. It pumps the water up to the looped hose. The cord was long enough to easily have the plug outside but I will have to remove it if we’re using the pool because it is in a spot it could get wet and deliver a nasty shock.

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The result? Well in full sun water goes in and then comes out a full 2C (3.6F) higher. The pump is strong enough that the water is going out at a good pace. Given it took 16 hours to fill, it will take 8 hours for each degree it goes up. However we are going into a stretch of nice hot weather with daily highs predicted to be 27C (80F). I regard 24C (76F) as perfect swimming pool temperature so we’re on the road to that. The pump is also working well enough I plan to buy some more black hose and add another 50 ft.

I look forward to taking a swim in my pool shortly.

DUMBER …

Spot on. I could not have written this any better myself.

Regie's Blog

A lot of people have pretty much had enough. And I get it.

Actor Jeff Daniels said, this week, that one more term of Donald Trump would end Democracy as we know it. Okay, there cowboy. Settle down. Hitler couldn’t do that. The Civil War couldn’t do that. Nixon couldn’t do that. No, Obama couldn’t do that. FDR couldn’t do that (although he and Lincoln got the closest), even the Soviet Union couldn’t do that. I get it. You hate the guy. But ending Democracy as we know it is simply not happening. It’ll be here long after the Donald is replaced.

But then he said something that simply makes my blood boil. He said other than not wanting to pay taxes, the only reason he could see for people voting for Trump was racism. My eyes rolled so far back in my head I could see that phone number…

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Falling Waters State Park, Florida

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We left our friends behind in Florida and began our long slow migration north. In previous years we have taken 4-5 weeks to get home and our plans was to do the same. Our first step was therefore only a short distance away at Falling Waters State Park. The park was badly damaged by Hurricane Michael and had only just reopened after months of clean up. As we expected the park still showed a lot of damage from the hurricane. While the campsite itself was mostly clear, there were a lot of places still piled high with windblown debris. Several stretches of the hiking trails had major detours and one large boardwalk trail was still closed. However the main attraction, the creek flowing down and falling 72 feet into a large sinkhole, was open. It was running fairly quickly that first visit on our arrival day.

We stayed two nights and very much enjoyed ourselves. The campground is very busy and the sites are highly variable in quality. I strongly recommend reservations. Ours was a tight fit and we had to unhitch. It was beside an area still uncleared from the hurricane so we had to deal with things like mounds of overhanging and tangled vines with big spikes. The washrooms were in clean and excellent shape and the hosts were wonderful. There is a small artificial lake and swimming hole with a sandy beach that would have been very attractive except for the alligator dangers signs. We didn’t go swimming. 

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The second day we spent walking the trails that were open. Many of the trails were long boardwalks and they had lots of sections with brand new wood. There were also crews busy repairing and cleaning so all day long we heard the sound of small tractors and chainsaws. Even so it was really lovely The spring flowers were all in bloom. There were many beautiful ferns and mosses. It had rained a lot overnight and so the creek leading to the waterfall was running vigorously and we got really lovely display. 

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Overall it was well worth the stop and I’m glad we visited the highest point in Florida and saw Florida’s biggest waterfall. Next stop on our long migration home for 2019 was Isaac Creek, Alabama.

That Canada Goose Problem

When I was a little girl, the Canada Goose was in danger of extinction. I explicitly recall a great event when I was perhaps four or five years old. There was an uproar in the neighbourhood and my father grabbed me to run outside and see something wonderful. All up and down the street were neighbours pointing at the sky and hold up their children in great excitement. My mother clapped her hands and shouted “Spring is coming at last!”

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As we all watched a flock of about fifty Canada geese flew over honking and calling, me on my father’s board shoulders. I remember thinking it was pretty neat. I had never seen such a bird before.

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My father then went on to tell me the great birds had once filled the skies but they were now in danger of going extinct because of the greed and stupidity of humanity who had over hunted the glorious bird. I was really sad that the day might come that these majestic birds with their haunting call might vanish from the earth. If things don’t change, my father said, my children would not get to see a migrating goose. I was sad. It was the start of my interest in being an environmentalist.

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Flash forward five decades (okay five decades plus a few years) and not only has that Canada Goose not gone extinct, it has become a right bloody nuisance. There is currently a Canada Goose hiding out in a Winnipeg car wash trying to survive the winter in the cold. It is far too canny for anyone to catch. The reason geese are thriving is because they have adapted to us and like our golf courses, suburbs and even our car washes. All I can say (after a muttered curse when I have goose poop on my shoes again) is I wish every species in danger of going extinct could have such a resurgence. On the other hand, I should be careful what I wish for.

Update” That silly goose was finally rescued.

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Migration South Day 7-9 – South Kansas

We left Fort Kearney and it was freezing cold. As the day progressed and we moved south it got warmer. Our original plan was to try to get to a KOA just north of Oklahoma City. It was a long trip. Dick checked our KOA campground book and discovered there was another year round KOA near Wellington Kansas about twenty miles (32 km) or so from the border with Oklahoma. That shaved some two hours of driving so we diverted there. We settled into the Wellington KOA and signed up for two days.IMG_4273

We had been driving in above zero weather for about four hours and temperature was a balmy (compared to what we had been dealing with) 7C (45F). To my great relief, as soon as we hooked up to the sewer and I pulled the valves, they opened easily and the trailer drained. More important, they closed perfectly afterward. Letting your plumbing freeze up is a bad thing to do. When it freezes you can damage things. This time we got lucky.

There were a few things we really needed to do. Most important, we both needed a good hot shower. We had a big pile of laundry to do the next day. We also had tracked mud all over the trailer and it was in sore need of a good cleaning and there was a lot of stuff to sort and put away. This is why we like to check into a “proper” campground every so often. KOAs are rarely beautiful on lakesides with gorgeous views although that can happen. They are almost uniformly solid and reliable when it comes to whether the WIFI works, the cable connects, and full hookups with water and sewer are available. They are also pretty uniformly clean and well run. We have rarely been disappointed. The Wellington KOA was a better run KOA with a cheerful fellow who greeted us nicely. We settled in for a day of cleaning and catch up. The weather was lovely and we took a long walk the second afternoon. We found some neat things like a windmill and lots and lots of hedge apples and glorious junipers taller the us and magnificent cedars.

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The weather reports were turning ominous though. Our area was supposed to be hit by severe weather Friday night. We did what we usually did. We changed our path to go a bit west out of the yellow hatched danger zone on the NOAA map. There was a promising state park near Enid, out of the danger zone. It was called the Great Salt Plains State Park. The drive was only 72 miles (116km) an easy hop skip and jump, so we decided to take it. We slept in, we said goodbye to the Kansas, and the very nice KOA just before check out, and by 2:00pm we were comfortably settled in a wonderful spot on the river in full view of a beautiful spillway that looked like a big two tier waterfall. Lovely!

Preparations to Head South Again

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We are in preparation mode as we get ready to head south again. It’s cold in Manitoba and the snow is here to stay. We had some friends over for supper last night and they left with hugs and wishes for safe travels. I fell asleep considering what lies ahead.

We had replied to an invitation to visit West Texas but our potential host meanwhile went on her own trip during this time frame, so we have no specific destination and no specific plans. Last year we returned to Panacea, Florida by following the coastline and we stopped at several lovely seashore campgrounds along the panhandle. We had tentatively decided to do that again but many of our favourite spots were horrifically damaged by Hurricane Michael and won’t be open. Our special favourite St Joseph Peninsula State Park is just plain gone. The camping spot we enjoyed so much is now part of an island. Falling Waters State Park was on our to do list but you can’t get to the waterfall so we’ll wait. I’m not sure I want to take that coast road and see the region I loved so much in its mortally wounded state. All our plans are up in the air, except of course Gulf Specimen Marine Lab which was injured but was back up and running in a week having gotten only the edge of Michael.

This trip represents our nineth trip south. Some of our best experiences have been found by just winging it as we travel wandering about with no special plans. Part of me is delighted with the prospect. Another part of me is looking forward to going back to some of our favourite discoveries from past trips and another part of me wants to go looking for new wonders. Last year we finally got to Utah and it was as wonderful as I expected it would be. I kind of have a hankering to finally get to the Corpus Cristi area which is the winter home of so many snowbirds. There are a couple of iconic places like San Padre Island I would like to see. I loved Galveston and I kind of want to go back there. On our trip to visit a colleague in Beaumont we passed a few intriguing looking campground in a barren area cleared by Hurricane Ike that are tempting. Then again, there are all those lovely Army Corps of Engineer campgrounds across the middle of Alabama and Mississippi the we loved so much and would love to camp in again.

Right now our only firm plans are to get to the year round Sioux City North KOA in South Dakota, the first place we can hit with full hookups. Unless of course we decide to go south via Minot which might happen yet. Which way go will depend on the weather, what strikes our fancy, and what calls to us. We’ll see.