Stroke or Brain Attack

PREQUEL

The cause of my stroke was atrial fibrillation, an erratic rhythm in the heartbeat, which can cause the creation of a blood clot which can then travel to the brain causing a stroke.

I had been under treatment for high blood pressure (hypertension) since 1988 and my average reading was in the order of 155/90 when ideally it should be more like 120/80. My treatment for this has been a string of drugs to widen blood vessels, slow my heart and reduce my fluid retention. Some of these drugs have had unpleasant side effects and the “water tablets” have been a real inconvenience, no pun intended, to me in my operation of a tour business.

My work over the years has occasionally been very stressful, having to crisis manage a failing company during the dreadful recession of 1990 then starting a new business from scratch with no resources. Then designing and running a large tourist attraction in the Highlands only to find that the monks who owned it were planning to abandon it, causing me to have to make fifty people redundant on their behalf. Stressful is not a sufficiently strong word. Then setting up another new business which came up against ruthless competition just as it was achieving success.

That, however, was the end of the stress. I sold up and established yet another new business providing exclusive tours. The stress was minimal, the work fascinating and the income growing above projection. Everything seemed perfect.

Yes I was working long hours, not unusually fifteen hour days, but the anxiety of the bus operation I had, was gone. All was now set to keep my working life on track and I was learning more about the nature of my customers and their requirements. This would have enabled me to cherry-pick tours in 2008 to reduce the length of the working week, but when you are trying to establish a business, absolute commitment is essential.

So, with things looking up, in the spring I decided to get my health back on track. My weight had increased steadily since I gave up smoking in 1987 and I had not weighed myself for some time, despite having scales in the bathroom. I was staggered to discover that I now weighed 17 stone and 6 pounds[1]!

On 2^nd May I discussed this with my doctor and although I said I was not eating very much, he said that it must be the number of calories I was taking which was causing the weight gain.

He asked me to write down absolutely everything I ate and drank over the next seven days or so, and I promised to be religious in so doing.

On 11^th May a second appointment saw an analysis of my consumption.

“What about these M&Ms?”, I was asked. I said that I had only had one small pack over the entire period.

“And these crisps on Tuesday?” But again it was just one pack in the week.

He picked on several other items which I considered minor.

Perhaps I ought to explain that my normal diet involved a couple of poached or boiled eggs for breakfast with two slices of toast or bread. Lunch most days, when I was taking a tour, was two rounds of sandwiches – four slices of bread with cheese and tomato, chicken, salmon, tuna or whatever. I may, every three or four days, supplement this with one of those illicit bags of M&Ms, Snickers or packet of crisps. I might have a bag of French fries at the Armadale ferry terminal on the odd day I would be there with visitors! In the evening I would have a good meal with a glass or three of wine, followed occasionally with some desert or small bowl of cereal, or perhaps some cheese and biscuits. Looking back on this paragraph today it seems shockingly excessive, but at the time I thought I was eating healthily. After all it wasn’t pizzas and burgers all the time, never a deep fried Mars bar and I didn’t sink pints of beer!

My doctor spelled it out. I was taking in maybe a hundred calories (a deliberate underestimate I think) too many every day and what I needed to do was reduce this so that I was eating a hundred calories fewer than I needed each day.

I went away from his office for the first time with a real understanding of why my weight had been growing. It is so easy to ignore all of those snacks, the odd biscuit or Danish pastry and live in denial. I was determined to get back to a sensible weight.

I started a strict regime of a banana[2] for breakfast; two rounds of bread in my lunchtime sandwiches and only a main course for dinner. Yes I added an occasional small pudding about once a week and never gave up my rare bag of French fries at Armadale, but I was extremely careful otherwise.

The weight fell off and after just four months I had lost 34 pounds[3].

As coincidence would have it, my doctor had sent me for a coronary check up in 2006 and I was called back on 14^th June to have a Holter Meter[4] fitted to monitor my heart over a twenty-four hour period.

On July 20^th my doctor called me in to discuss the results and he explained that I have atrial fibrillation. As said previously, but it bears repeating here, this is an erratic heart beat caused by the upper chamber of the heart not always performing normally and starving the lower chamber of blood. This is often followed by a heavy beat of the lower ventricle as it pumps to send more blood around the body. This can cause a clot to form which can then lead to stroke.

I pointed out to my doctor that I had reported, for around fourteen years, that I had these flutterings in my chest and occasional sudden thumping and that these usually occurred just after I went to bed at night. I also reminded him that I had told him that my blood pressure monitor had regularly made erratic beeps when I took a pre-sleep reading.

He said that he remembered this, but that when he had done ECGs in the surgery they had shown nothing out of the ordinary. The Holter metre, however, had found the irregularities.

My doctor told me the advice was that I be given Atenolol, a beta blocker to steady my heartbeat. He put me on 25mg immediately and asked me to return after a month to assess the effect. He removed the Doxazosin I had been taking previously just for the hypertension, as the Atenolol was expected to have the same effect.

Obviously I discussed all of this with Wendy and I took much more notice of how my heart was behaving over the following weeks.

My next appointment to review the situation was on 3^rd September when I reported to my doctor that I was still getting a lot of erratic beats at night. He increased the dose to 50mg of the Atenolol.

Just eleven days later I had my stroke attack.

[1] 244 pounds or 110.9 kilos.

[2] I have had a low potassium problem in the past which I did not want to recur.

[3] 15.45 kilos.

[4] Portable ECG device.