The Neurologist

Last week Dad saw Dr. Hajjar, the neurologist. While I knew he had been seen by neurologists in the hospital and Stillwater, this was the first appointment I took him to and the first visit he’s had since he’s been home. As we slowly followed Dr. Hajjar into the office she asked Dad, “I remember you Rudolf from the emergency room, do you remember me?” He didn’t. He doesn’t remember much about the stroke itself and that’s a good thing. I; however, remembered her. Dr. Hajjar was called in for a consult the morning Dad had his stroke. She carried with her a plastic flip book listing different criteria for determining the acuteness of a stroke in patients, questions to ask, things to notice etc. To be honest, it’s so long ago I forgot where Dad was on the scale of stroke severity that morning. All I remember is thinking there was still hope. Neither of it is here nor there now, but seeing her brought back that morning in the emergency room with such vivid clarity that save for the time of year, I would have sworn I was back there watching Dad spastically try to get off the table they had him lying on, while she tried to talk to him.

The good news is (for there is always good news) Dad’s latest CT scan revealed nothing new, which I had been anticipating. It’s nice when things out of your control work out in your favor. She emphasized to Dad how he didn’t just have a “little stroke”, but rather such a really massive stroke, he was lucky to be alive. It reminded me of the pulmonologist in Portland who played bad cop, telling us Dad wasn’t going to improve beyond the way he was in intensive care. Everyone has been right and wrong with much of what’s happened. She also mentioned that the type of stroke Dad had was unusual because, as I like to say it, it’s more a young person’s stroke, affecting people around 35-45 years old. I guess Dad is young at heart, no pun intended. She couldn’t give an opinion on the cause of Dad’s stroke, just the damage that had been done. And the damage was pretty extensive. Dissections, like the one he had, are either traumatic or spontaneous.

Traumatic dissection is the result of either external mechanical injury, such as a penetrating or blunt trauma, or trivial trauma that is related to a movement or abrupt change in head position. Examples of such movements include rapid turning of the head, flexion or extension of the head and neck, and strenuous physical exertion.

Spontaneous dissections are those in which no definitive precipitating factor is recognized. However, spontaneous dissections may be associated with predisposing factors, such as connective tissue disorders, systemic hypertension, smoking, diabetes mellitus, a history of cerebral infarction, hyperlipidemia, cerebral and abdominal aortic aneurysms, use of oral contraceptives, and a family history of arterial dissection.

At the end of the appointment she ok'd Dad to go back on blood thinners because of his Afib. We are working with his PCP Dr. Biswas to determine when that is to take place. What I like about Dad's PCP is he isn't looking to rush into anything and prefers Dad not take any medication. His philosophy is if you don't have to take a pill, then why would you? I like that about him.  

And we continue on...