My Right Vertebral Artery Turned into a Little Stump.

I seemed to have caused "My own Sroke"

If you wish to read about a "Very Uncommon Stroke" that has puzzled many doctors, then please read on.

A piece of "WARNING",it is "VERY LONG".

However if you continue it means that you care to find out and that will please me immensely.

I Think I -" Stroked "- "Myself" !!!!!!

I have thought about my habits over the last 54 years and realise that I have caused my own injury and health problems. As a youngster (8 year old) I suffered from very serious Whooping Cough and was wrongly treated by a so called "TB" expert for TB for six months.I used to get two injections a day and empty promises from my mother to buy me a "top" the next day. She kept the bait dangling so that I would not make a fuss for the next injection. Thank God it was not TB as diagnosed.

During this period I found relief from my cough when I slept on my TUMMY. I recovered from the cough but the habit of sleeping on my tummy continued well into the eighties even after my marriage. What happens to your neck when you sleep on your tummy?. You have to turn the neck one side or the other. In my case I turned it towards my left shoulder. The right vertebral artery as a consequence got stretched and flattened in the process.(Cerebral Angio shows that the left vertebral is very large and dominant while the right is very thin comparatively.)

All my health problems started because of this reduced flow in the vertebral artery during my sleep.(Who knew there was a so called vertebral artery ? ) I was accused all my life,of being lazy and sleeping all the time like a log. Nothing would wake me up, not a lightning or even an earthquake. As soon as my head hit the sack, I was dead to the world. The fact was, during my sleeping hours, I was not getting enough oxygen to that part of the brain supplied by the right vertebral artery. This would explain all my Health Problems encountered in my adult stage. All kinds of weird symptoms follow

• I have always suffered from a right sided sinus (blocked nose) and have been addicted to Otrivin (Nasal Drops) for as long as I know.
• I have a right sided deafness and tinnitus (which I now understand is linked to vertebral artery problems.)
• I have always had problem swallowing tablets and used to choke on them.
• In 1989 this reduced blood flow in my right vertebral probably caused hypertension as not enough flow was going through this artery. (My cholestrol level has never exceeded 4.0 and I am not FAT)
• This was again followed by sleep apnea which was diagnosed about the same time.(I wonder about this diagnosis now as the lack of oxygen to the brain could have been due to the restricted flow in this artery rather than a breathing problem. We will never know.I seriously believe there is a link between Sleep Apnea and blood flow in Vertebral arteries.)
• I then get into an accident, when a six tonner slams my car from behind and I suffer a whip lash. Like a "Rambo" I get out of the car and tell the cops that I am fine. Little did I know that I must have injured this vertebral artery further. Honestly never ever knew there was something called a vertebral artery. Heard of the CAROTID ARTERY -Yes, VERTEBRAL ARTERY -NO.
• I then injure my back and go for back manupulations and the chiro IN GOOD FAITH also manipulates my neck (probably adding to the damage )
• Because of my sinus, back and breathing problems (I have worn a CPAP mask for ten years now) I get into the habit of sleeping with two or more pillows. Good feeling when you start, however you slip down and end up with chin to chest and wake up with a severe neck pain or sprained & stiff neck.

• After a few days you rush for a massage and manupulation to get some relief.

Then in years that folowed, all sorts of weird symptoms started to surface:

• Loss of taste for a week in 1995 that no one could explain.(Linked to VAD)
• Extreme shortness of breath (Linked to VAD),I blamed my ticker for it, for lack of a better understanding. Everyone told me that I was unfit and overweight and needed more exercise. This was not true as I could walk from 6am to 11pm during our holidays in the US , with no complaints, while ny wife and son would give up.
• I used to get severe pain in my feet every morning when I got out of bed. People said I probably suffered from gout ( I hardly drink any Beer.)
• Then I had this serious problem with my mouth getting DRY and BURNING day and night. It was blamed on Reflux and Hiatus Hernia and I was on Losec and drank milk, buttermilk,ice water and Mylanta by the bottle.(little did I know then that it was a nerve in the neck causing it.)
• 8th Dec 1999- 9.30pm . I am watching TV. My wife and son are asleep. I get this severe spasm round my neck. I check my BP. Cannot measure it as it has gone "out of the allowable range" for my little Omron BP gadget. I get up drink some water and calm myself. The pain eases and the BP comes down to 140/95. I wake my wife up and we see a late night GP. ECG is clear but she frightens me saying it could be an indication of "MS".

Severe "TIA" followed buy a Stroke- "Lateral Medulary Infarct caused by the Dissection of the Right Vertebral Artery"

I ring my GP friend and tell him about possible "MS" and he calls me a Hypocondriac. So I give him the flick.

• In March 2000, soon after my mum passed away and I was down in the dumps, I start experiencing "Visual Disturbances" on the right side only. Starts as a small ZIG ZAG pattern, bright orange and keeps growing until you can't read or see well any more, followed by a mild headache. Sometimes there used to be these "Droplets" that appeared at random and if I was reading a document on the computer screen, I would see the letters inside the droplets magnified. Was I having a Retinal detachment ??? Who Knows ??
• I get to see a new GP, a Lady Doctor this time who starts investigations earnestly. She says she is baffled with all my diseases and symptoms and does not know where to start. Sends me for Blood Test, and refers me to an Opthalmologist, Cardiologist, Respiratory Specialist, Neurologist and suggests a Gastroenterologist and Haematologist aswell as the platelet count is marginally high and flagged as "mild thrombocytosis."
• I am cleared by the cardiologist.(Top Guy)
• The neuro after CT Scan and Doppler decides there is nothing to worry about. It is Migraine Hemiplegia and starts me on Sandomigran. I ask him the chances of this leading to a stroke or being onset of MS. He assures me it is not and I brag to my colleagues that I am safe. It is only migraine.
• A week later I experience my first TIA (Transient Ischemic Attack),when I was at at the cardiologists reception waiting for a stress test,watching an over head TV show (Springfield) My neck was sore so I exercised my neck by turning it to the extreme left and right.
• BINGO. I had triggered a "TIA".... My entire right hand side of the body was tingling (electrical sensation ),eyes went blurred, speech was slurred and had severe nausea & vomiting. BP however remained normal.

"I HAD DONE IT THIS TIME FOR SURE"

I had stopped flow completely for a few seconds or milli seconds, causing the TIA.( I did not have a clue then as to what was happening).I was rushed by the doctor himself to RPAH emergency.

• Emergency staff at RPAH failed me by not investigating the TIA properly and not calling a neurologist to see me. It was not even late at night. It was at 2.00pm in the afternoon.

They packed me off home after four hours, when I came good, diagnosing the attack a Migraine Hemiplegia based on the previous neuro's notes..

• An immediate diagnosis by an alert doctor and administration of Heparin could have saved me from the stroke.
• That saturday I rang my new lady GP to tell her about my attending the emergency and she also implied that I was a "hypocondriac." I have forgiven her since, for she has apologised and had phoned me in the hospital several times when I was admitted with a stroke. She is a very caring and good doctor. Poor lady, I had presented her with too many problems (Hypertension, Hiatus Hernia,Peptic Ulcers,Sleep Apnea, Shortness of Breath,Tinnitus, Sinus, Visual Aura,Head Aches, Burning Mouth and Tongue etc. etc., and I do not blame her for thinking I was nuts. She was relying on the specialists to come up with a diagnosis.
• Exactly a week later I suffered a "Lateral Medullary Infarct" in the early hours of 13th April, 2000,(A DAY I CAN NEVER FORGET -as I was watching Jonty Rhodes of South Africa,hammering our Aussie Bowlers), diagnosed to be caused by the dissection of the right vertebral artery, and "Boy I thought I was a gonner."
• Tough that I am I fought like mad, did double of what my physio and speech therapist wanted me to do every day, and pushed myself to walk and talk and eat.I was like a Baby trying to show every friend who visited me that I could walk ten feet without support. What I hated most was Hiccups that lasted all day for three weeks. I was scared that if the stroke did not KILL me the Hickups would. It was that bad.

The Stroke symptoms were standard as documented in any textbook:

• Numbness and Burning on the right side of the face and left side of the trunk and left leg.
• Hiccups
• Nausea and Vomiting
• Diminished taste
• Difficulty swallowing
• Loss of control and weakness of Right hand and left leg.
• Double Vision
• Slurred speech
• Dizziness
• Loss of balance

I survived the stroke and then came home after three weeks at RPAH and two weeks at "Alwyn" Rehab facility in Strathfield. The carers at Alwyn were really great. The physio's and the occupational therapist were extremely nice.

After a couple of nights< realised that I was triggering some symptoms that mimicked the stroke but only lasted for short durations. Was my left vertebral also packing up ? I froze with FEAR that if my other vertebral artery was also damaged, I had no choice but to say "GOOD BYE"

I saw several neurologists and neuro surgeons in the following nine months and told them that "I strongly believed, that my attacks were linked to my head movements and position". IT FELL ON DEAF EARS.

So I see a neuro surgeon, who after a cerebral angiogram suggests a "PICA BYPASS SURGERY" in the Brain.He is a talenred and clever surgeon but he had never done one before and it has never been done at Prince of Wales Hospital for the last 15 to 20 years I was told. Another Neuro at Royal North Shore Hospital and a stroke specialist at Prince of Wales, endorse my surgeon's diagnosis for a PICA bypass.(They were not independent opinions as my surgeon brought them on board).I am told the risk is as high as 80% of having another stroke within a year.My case is presented to all involved in Neurology at POW and the registrar told me confidentially that the verdict was duvided. Most neurologists said it was Migraine while the surgeons recommended PICA Bypass.

At that time even I was convinced by the surgery proposal.

I beg my neurosurgeon for a Trans Cranial Doppler Test-based on what I have researched on the net.

He declined saying, you should stop believing everything you read on the internet as there is a lot of rubish floating around. Cerebral Angio is the "Gold Standard for Diagnosing VAD" This may have been so before the advent of the MRI,MRA and the Trans Cranial Dopplers. He gets an expensive "SPECT" done instead as he is focussed only on the bypass surgery.

I consult many more neuro people in Australia and in USA and UK via the internet. I gain no support for the proposed PICA Bypass. It is all thumbs down from all neurologists in Australia as well as neuro surgeons, all over the world. Yet no one seems to be able to explain my attacks, 4-5 each day, that seemed to knock me out.

Do I accept the Bypass or Do I take a risk and wait ?

Every one who sees me says "Ram you are looking Great" This was getting to annoy me as if implying that I should get off my but and get on with life" . I was tired of explaining that I felt good until I had an attack. It is like fits. You look and feel good until it strikes.

I travel to India to pick the brains of the top neuros there but come up with a blank. They all agree that the problem is in the neck but have no solution to offer .They confuse the issue further by saying that "I do not have a PICA" , but have a very dominant "AICA" (the reason for my miraculous survival and very quick recovery). They were in fact disputing the diagnosis of the POW neuro radiologist. Hence no PICA Bypass was possible. They recommend the use of a collar. Some suggest a soft collar and the others hard one.I had both made and discarded them both promptly as they triggered more attacks.

I had a go at "Indian Ayurvedic Treatment". It cost me a fortune and has fixed some of my lumbar spine problems, but no luck with my cerebral attacks which continued.

I land in Singapore to spend a few days with my in-laws. Never had any intentions of seeing a doctor there, as they cost a fortune and HCF won't cover this overseas medical expense. I let a few days pass and my favourite Sister-In-Law talks me into seeing the neuro who saved her husband in 1989.

I took her advice and said what the heck it was only money.I had nothing to lose, especially that I was now returning to Sydney where the surgeon would gloat and say "I said So". "Please book yourself in for a PICA Bypass" and let me "Experiment on your Brain."

The Neurologist,I consulted in Singapore to me is a God Send as well as a genius. He personally performed "Transcranial Doppler" tests on me twice and established that my attacks were not linked to blood flow (Hypoperfusion of PICA as had been postulated in Sydney ), but were nerve related called the "Neck Tongue & the Neck Eye Syndrome"

Ironically this was first postulated and written about by none other than the first neurologist I consulted, Prof.Lance, Migraine specialist at POW. I will be going back to see him again soon.

My attacks continue, but I am now conviced that I will not stroke out in a hurry - my neuro has assured me this and I can now sleep every night in peace. The medications prescribed by my neurologist in Singapore mask the symptoms arising from the attacks and I am able to sit and type this long document at a stretch, despite having a few attacks on the way. God bless him.

Details of diagnosis is as per extract below:

This is an extract from the Book Migraine and Other Head Aches by Prof.Jim Lance, of Prince of Wales Hospital, NSW.

This is my story. The stroke was diagnosed correctly immediately after it occurred but it has taken me a good twelve months to find a reason for multiple attacks (4-5) each day.The neuros in Sydney disappointed me as they were not willing to listen to the patient like the doctors in India and Singapore did. Call it Ego or Arrogance or Ignorance what you will.

My attacks still continue and I have no clue what the long term issues are.

I have turned out to be a "PAIN IN THE NECK" for the neuros in Sydney .

Thanks for reading my story with such patience.

Ram