Impractical Paradise

 After talking things over, my doctor and I decided on a change in my cholesterol reducing agent from atorvastatin to something called rosuvastatin, along with a decrease in the dosage. I'm hoping that this will be at least somewhat more tolerable. More tolerable then the nightly near death experience of atorvastatin, I mean.

In the meantime, I have discovered that I have become super sensitive to tropical heat. This of course is unfortunate, given that I live in the tropics. So if anyone out there has a little place in Alaska for instance, or maybe North Dakota, that they can rent me for about $300 a month, I'm willing. A little snow just now sounds like heaven.

It's such a strange thing to have happened. Among the many strange things that appear to come along with stroke. I remember a time when I used to go to the beach here everyday, no matter the temperature, and swim in the ocean, and lie on the beach, and think nothing of it at all. 

Ah, the good old days.

As it is, paradise has become pretty damn impractical. Guess I'd better change the blog name.

The Smoker's Paradox

 Smoking induces cytochrome P450 1A2 (CYP1A2), a hepatic enzyme involved in the metabolism of clopidogrel. Clopidogrel shows better inhibition of platelet aggregation in smokers than nonsmokers,⁸⁾ and smokers are less likely to be hyporesponders than nonsmokers.

In plain language, this means that clopidogrel, the blood thinning drug typically used after a stroke, works more effectively in smokers than in non-smokers. Thus we call this the smoker's paradox, in that we all know that something that is bad for you cannot be good for you and yet in this case the thing that is bad for you is good for you, while still being bad for you. Got it?

Well I'm learning all sorts of fun facts as I study up on medicine, having become aware that the doctors here certainly aren't going to do it for me. Good thing we have the internet these days.

Another thing I have discovered is that the main odious symptoms I am suffering come not after all from the effects of medication but from the effects of the stroke itself. Severe headache, dizziness, vertigo, mild nausea. This is due to damage in the cerebellum, the area of the brain responsible for regulating senses such as sight and hearing, along with balance and so on. Even though I am using voice typing on my phone, it is still necessary to look at the screen and read the text and this has instantly given me a bloody bad headache. So I'm going to call it a night, and give it another shot tomorrow.

Facing It

 Having a stroke is a real drag. I do not recommend it. It's one of those things that shows you, much to your surprise, that ultimately you are not in control of your own body, you are not in control of your own life. Suddenly your body decides to do its own thing. One eye stops seeing, for example. Both eyes go blurry. One leg becomes paralyzed. Suddenly your neck freezes and you feel as if you're going to pass out and you experience a temporary incontinence of bladder. You did not plan this and there's nothing you can do about this. You are at the mercy of your own body. When I lie down at night, or indeed increasingly in the middle of the day, I can feel my own brain trying and failing to think. I can feel my brain being stuck in place, not being able to move forward with whatever thought I might have intended. It's very hard to describe, and it is very unpleasant. It seems that the longer I take this medicine the doctors have put me on--the high cholesterol agent and the blood thinner--the worse I feel, and the farther away I am from being well. It's depressing. And so one begins to face some things. Such as the fact that one is no longer young. In 2 months I will be 70. What time, after all, have I in which to recover? And what would recovery even look like at this age? Yes, one begins to face some things. Like it or not. There is no choice.

It Sucks and So Do I

For a while now, I've been using voice type instead of typing with my fingers in the normal manner, which is because my fingers don't really work properly anymore, especially those on the right hand. Hard to imagine now that I used to play Mozart and Debussey and Chopin with these fingers of mine. Oh well, Time Marches On.

For the first time in some 20 years I smoked less than 20 cigarettes in a day. In fact I smoked less than one. Yes, today I smoked not a single cigarette. Although I missed it like hell, I also sure as hell don't want to have another stroke, and if that means, in part, stopping smoking, I intend to do so. I had not been aware in the past (for who looks into the various causes of stroke except for people studying to be doctors) that smoking causes cholesterol to be especially sticky, making it even more problematic as a clogger of arteries and thus a causation of stroke. As a replacement, I have been sucking air through a straw cut down to be the size of a cigarette. Lol. Not quite the same thing. I thought of purchasing some nicotine gum online, but the fact is I have done that in the past and I know that one tends to end up both chewing the gum and smoking cigarettes anyway.

I started smoking when I was 18 years old, just after entering college. For a period of time during the 1990s, I stopped smoking. And then after the divorce from my second wife, I began again. I had stopped for perhaps 9 years, although I do remember sneaking a cigarette here and there. The thing is, aside from the addiction to the nicotine, smoking becomes wrapped up in so many activities that one does. It becomes, for instance, a part of reading a book. It becomes a part of writing. It becomes a part of thinking or working. It becomes what one does on a break from work. It becomes a part of one's life.

In short, it is very difficult indeed to stop. But at the same time, it is very unpleasant indeed to suffer from a stroke.

I have felt today, for the first time since the stroke event, almost human again, and as if I might actually recover. I managed to go most of the day without a severe headache, and for part of the day without any headache at all, which has certainly been a relief. So I am hoping that things will march on in a positive direction for the next month until I see the doctor again and we can take a look at my blood check and cholesterol levels and whatever else doctors look at. In any case, I will keep my fingers crossed, and keep sucking on my straw.

MRI Part II

 The story of My Life, or rather of my general ill health, is moving faster these days then I can keep up with on this blog.

Let's see now, where were we ...

Ah yes, the MRI ordered by Dr Yoanes at Kasih Ibu Hospital. Predictably enough, this showed multiple small lacunar strokes over a period of time. With great brevity, the doctor pointed out these highlights on the MRI picture, wrote a prescription for three medications, and said goodbye. His next patient was waiting.

These meds were 1) atorvastatin, to lower my cholesterol, 2) clopidogrel, to thin my blood and 3) Xanax, for fun, I guess. Well that's not true. The Xanax is to interrupt the severe headaches I am having and allow me to sleep.

So in brief, I was feeling like shit when I went to the doctor and after I left him I felt even more like shit.

I spent the next day wondering about all of the things that the doctor did not have time to speak with me about. Such as how long will I feel like shit? How long is the recovery period from these strokes? To what extent will I recover?

As I have said all along, Dr Yoanes is competent in his field, as far as knowledge goes, but I'll be damned if he ain't the worst I've ever seen at doctor/patient communication. And remember, I worked for 25 years in an American Hospital.

So after stewing about this for some time and scanning around on the internet trying to get my own information, I talked to my girlfriend and she insisted that I try a different doctor at a different hospital. Smart girl. She looked up some numbers for me and put me in touch with a number for the international wing at Sanglah Hospital. And boy am I glad she did.

Dr. Angga, a young Indian fellow, could not be more different from Dr. Yoanes. He led me patiently through a thorough explanation of the MRI, exactly what it showed, where the problems were located. He proceeded to answer each and every question of mine, again with patience and thoroughness, and even good humor. He told me that he knows Dr. Yoanes and that he considers him quite able and intelligent. But when I mentioned the doctor's lack of communication skills, Dr. Angga just smiled and kept politely quiet. 

So anyway I came away with the same medications that Yoanes had prescribed plus two additional medications, both intended to address the headaches, which may, according to the good doctor, be caused by the atorvastatin. I will see him again in about a month after getting another blood panel. To be certain, I still feel like shit, but a little better sort of shit now.

MRI

 So yesterday I finally got around to going to see the doctor. I made an appointment with my usual neurologist at the hospital and showed up early in the morning with only one patient in line before me. That patient, happily for me, did not appear for his or her appointment and so I went in first.

The doctor seemed more communicative this time around. Maybe he found my complaints, of which there were three, more interesting than usual.

The first, as I have earlier mentioned, was losing the sight in my right eye temporarily on two occasions. The second was the near fainting incident and the painful stiff leg that went along with it while I was having a coffee sometime last week.

A third, which I don't think I've mentioned here, has been a 3 week long headache, sometimes quite severe, along with a tense feeling of pressure in my forehead and behind my eyes and nose.

In any case, the doctor seemed to take these complaints seriously and felt that an MRI would be necessary and perhaps and echocardiogram as well. Not good news for me, because of course these things cost money. Nonetheless, these recent troubles had kind of spooked me so I thought I'd better agree to the tests and see if anything serious is going on, other than old age I mean.

Therefore, I returned to the hospital the next morning to have my MRI. As far as I can recollect, it has been perhaps 10 years since I last had an MRI. It turns out that they are just as annoying and uncomfortable as ever they were. So now this MRI must be sent to the doctor and then I will see the doctor once again. Apparently the MRI scans are sent to an outside facility and so I have to wait for 2 days.

In the meantime, my headache went away for about 3 hours today, which was purely wonderful! It's back now, but it was nice to briefly feel human again.

This Last Week's 'Entertainments'

Another delightful week with Evelyn has come to an end here in Bali, but the heat wave has not, nor have my weird health problems.

In the latest incident, just yesterday, I was sitting at The Daily Baguette cafe, enjoying my usual cappuccino and slice of banana bread while reading a book, when suddenly I felt very light-headed, lost visual focus, and experienced a painful paralysis of my left leg, especially the thigh. I felt myself involuntarily leaning to the left while reaching to the left with a hand that did not seem to be functioning normally. My great fear at that moment was that I was having some kind of seizure and would soon pass out and tumble from my chair onto the ground. This would have been greatly embarrassing, so I struggled to stay conscious and began to massage my upper thigh. My vision cleared within 30 seconds or so, I would estimate, but the muscular pain continued for some time longer.

After this, I was unable to return to reading for fear that the symptoms would recur.

So what the hell was that all about? A small stroke? A small seizure? Who knows? I thought about rushing out to the hospital, but then I remembered how fruitless my last visit there had been just a week before. So I just gave up on the banana bread and the coffee and drove myself back home, or rather to Louis' Villa where I have been staying again while she is on vacation.

Although I have not had any further notable disturbances since that time, which was only yesterday, I have continued to feel very tired and vaguely unwell since. If nothing else, I have learned that it is unwise to venture out as long as this heat wave persists. So, I'm spending a rather boring time here, with Etta the dog, until the 12th, when I will return home to my own little house in Sanur. If I live that long.

In fact, the extreme heat kept me and Evelyn in the house most of the time she was here (unlike me, she is smart enough to know better than to go outside in this sort of heat and humidity). During the day, we watched movies and cooked meals, and then sometimes ventured out in the evening when the temperatures had cooled somewhat.

I suppose that eventually I will go back to the hospital and report these occurrences (and who knows, maybe new ones by the time I act). Or in any case, I suppose that I should.