So Much To Be Thankful For

It's Thanksgiving Week, and in these days I have so much to be thankful for!! I have continued to improve day by day, and I definitely credit my quick recovery to all of my amazing family and friends continual prayers for me. God has been so faithful to me, and I give him the glory for where I am now!

Here are some updated praises and prayer requests in the different areas of my life that have been affected by the vertebral artery dissection (tear) and stroke. I again apologize for the length, but God has been doing a lot of great things! Thank you again for all your prayers and support. They have meant the world to me during this time!

Headaches:

• At the time of my last blog entry, I had started taking Aleve each night to see if that would help me not wake up with headaches each morning. That was definitely a great suggestion by my primary care doctor, and since starting that medication at night, I am no longer waking up with headaches!!
• Thankfully, also, I am rarely having headaches at all any time of the day!
• A few days after being headache free on the Aleve, I gradually moved from the recliner (which was helping my headaches too) into my bed with no increase in my headaches. I am now sleeping well in my bed every night!
• I am now taking Aleve every other night and hope to wean off of it soon! Thankfully, I have not seen any adverse effects from being on a full Aspirin everyday and one Aleve at night, but I don't want to continue that for an extended period of time because that can cause problems.

Right Hand Dexterity/Strength:

• Even before going to my hand PT appointment last Monday, I had seen a significant improvement in the dexterity and strength in my right hand. I take notes every Sunday at church and in just one week there was a significant visual improvement in my handwriting!! (I was able to write after the stroke, but it was harder to write and my handwriting was not my own.) It was so encouraging to have a visual example of the quick work the Lord was doing with my recovery.
• When I went to my hand PT appointment, she evaluated me and determined that while my fine motor skills weren't perfect, my overall strength was were it should be and I would not need any further physical therapy for my hand!! She told me to take up a hobby that would exercise my fine motor skills, so my friend is going to teach me to crochet and let me borrow her crochet materials and some beading materials that she has!! 
• I have noticed since meeting with her that when I am more tired or do too much with my right arm/hand that my right arm/hand gets more tired and feels fatigued easily. The hand PT said that I could follow-up with her if I needed to and so I plan to talk to her this week as well as my doctor. Please pray that this is normal and that I will figure out the best way to not overdo it while also exercising my hand appropriately.

Equilibrium:

• The first big praise for my equilibrium issues is that I was able to get into physical therapy for this 5 days sooner than I had expected! I originally didn't have this appointment until today, but the office manager at the physical therapy office I am going to remembered that I had wanted to get in sooner and called me when they had a cancellation last Wednesday!!
• As with my hand, I have noticed a spontaneous improvement in my equilibrium issues. From not being able to walk without help during the stroke, to being able to walk alone with the feeling of "motion sickness" when I was discharged from the hospital, when I went to PT for my equilibrium I was only feeling the "motion sickness" with specific head movements or trying to move around too fast while walking. 
• The physical therapist evaluated me and does want to continue to see me once a week until I get closer to 100%. She sent me home with some daily exercises. 
• Physical therapy for equilibrium is tricky because the exercises are not that straight forward and my improvement and how I am doing is subjective to how I describe that I am feeling. Since my symptoms are so slight, I have a hard time explaining them. Pray that I will be disciplined with doing the exercises even if I can't tell how they are helping and that I can communicate well with my physical therapist about how I am doing. 

Driving:

• I was hoping to be cleared to drive last week after seeing the equilibrium physical therapist, and while she did feel that I am ready to drive, my primary care doctor doesn't want me driving until I see him tomorrow. I am hopeful that there won't be any reason why he can't clear me tomorrow.
• In the mean time, I have been so blessed to have so many friends and coworkers that have gone out of their way to pick me up for appointments and just to get me out of the house. Thank you to everyone who has given me a ride and been on call for giving me rides!!
• I will never cease to be amazed at how God uses every little detail in our lives to teach us and to prepare us for what is ahead of us (James 1:2-4). I went 4 weeks in Cambodia with not having as much to do as I am used to and also not having my own transportation, and I knew while I was there that He was teaching me something, I just didn't realize that "something" would happen so soon! 

Overall Energy Level:

• While I have definitely been feeling better day by day, I have noticed that my energy level and ability to "go" like I used to is not the same as it used to be. Unfortunately, as the headaches went away and my deficits were spontaneously improved, I think that I got the false sense that since those things were better that I must be almost back to my normal self. 
• I am realizing that I can't do as much with my days as I am used to, and that is a struggle for me. The other evening I had to cancel going to a friend's birthday celebration, and for those that know me well, you know that is a very big deal to me. 
• Again, this goes back to the lessons that God is teaching me about being still and not as busy. Please pray that I will be good about pacing myself and not pushing too hard, but also that my energy will increase day by day so that I will be back to "myself" as soon as God provides. 

Long Term Restrictions/Working:

• Most of the above issues have to do with the minor stroke that I had, and they will hopefully be completely resolved quickly (I don't want to put a time on it, but at the rate things are going I would hope within the end of the year).
• However, the vertebral artery dissection (tear) that clotted and caused the stroke will be healing over the next six months. As long as the headaches stay away and the aspirin does its job in preventing the tear from clotting again, I shouldn't have any physical issues with the tear as it heals, but I am under a strict lifting restriction while it heals (as well as a restriction on crazy sports like skiing and roller coasters and such). 
• No matter how well I am doing otherwise, my neurosurgeon will not clear me to lift more than 10 lbs until May 1. This means that I will be on disability from my job at CHOP until then. Thankfully, I have disability pay and my manager is committed to bringing me back into a position as soon as she can in May. 
• Over the last 3 weeks, I have been reminded of what I have always known. I am an extreme extrovert and need interaction with people for energy and general well-being. While it is nice to have a break from my job at the craziest time of year for us and take some time be a little quieter with life, I have realized that I am definitely going to have to find either consistent volunteer work or some type of part-time job (which would help with finances) once the holidays are over and I am back to myself energy wise. Please be praying that God will lead me to what he wants me to be doing with my time and finances while I am on disability.

Because God has ultimately provided for me through sending his Son, Jesus, to die the death that I should die, and to make a way for me, a sinner, to become a child of God, I know that he will provide for me during these days that he has formed for me.

"What, then, shall we say in response to this? If God is for us, who can be against us? He who did not spare his own Son, but gave him up for us all—how will he not also, along with him, graciously give us all things?" Romans 8:31-32

So, I had a stroke...

When I started this blog, "the days that were formed for me" included a 4-week trip to Cambodia to do medical missions. The title came from wanting to possibly continue the blog past my trip but not knowing what I would ultimately blog about because only the Lord knows what lies ahead for each one of us. Little did I know that the next season of "days" would include recovering from a vertebral artery dissection and a minor stroke. Below is the (long) story of how this all unfolded, how God has protected me, and what lies before me in recovery.

On Friday, October 28th, I had a very minor headache that I didn't think much of. I took Tylenol and Motrin for it and went about my day as normal, working and volunteering at my church's Autumn Fest. The next morning, I woke up with the headache and decided that it was probably the start of a sinus thing and took some Tylenol and Sudafed. I was going to be taking my friends, Amanda and Keith, to the airport, so I drove to their house to pick them up. I had the headache as I was driving, but felt totally fine. After getting out of the car at their house, I immediately got very dizzy and had some visual disturbances in my left eye. It was unlike any dizziness that I had ever experienced in my life. It definitely concerned me, and I told Amanda that I was really sorry but I didn't think I would be able to drive them to the airport. That was a big deal for me because I knew that I was making them miss their flight. They were very gracious and drove me home. On our way home, I had a moment when I thought I should go to the ER, but I talked with a medical friend and we decide that it was probably just an intense sinus headache and I should give it some time.

By the time I got home, I was having a hard time focusing on things and was feeling a lot of pressure in my head. Because of the focusing issue, it was hard for me to walk on my own. Looking back on it now, I probably should have gone to the ER then, but as an ER nurse, you never want to go to the ER prematurely or for something that ends up being nothing. Oh yeah, I was also having numbness in my right hand (I wasn't focusing on that, yet it should have been the most concerning factor!). Finally, a couple hours later, after calling my on-call primary doctor, we decided it was time to go the the ER. At this point, I knew it probably was something that would keep me in the ER for a while, so I had my roommate and good friend, Tiffany, pack up all the things I knew I would need to survive an ER visit!

Around 4pm on Saturday, Tiffany drove me, through the SNOW, to Bryn Mawr's (a local hospital) ER. The whole thing was the most surreal experience I've had in a while. It's snowing, in October, and I'm the one presenting to an ER. The whole time I was being triaged, I kept thinking, "I'm the one that's supposed to be asking these questions!" The anticipation of knowing exactly what they were going to do and then them doing it (because of the severity of my symptoms) was too much for me to handle emotionally (on top of not being able to see straight or walk without help), and so I pretty much cried with each new doctor or nurse that I met. I'm pretty sure I wouldn't have appreciated having me as a patient! But, I knew that something was wrong, and so crying was my way of dealing with it.

They immediately ordered blood work and a head CT. I knew that the waiting process would then begin. I waited to be transported to CT, waited at CT as a "STAT" patient got their CT in front of me, and waited for the results...always anticipating each of these waiting periods. I would have been shocked if it had happened any faster. Knowing what to expect in an ER is a blessing and a curse. About when I expected, the ER attending physician came in with my CT results. My CT was negative, but he was very concerned about my neurological symptoms and wanted to transfer me to Jefferson University Hospital (a big hospital in Philly) to figure out was was causing them. It was the first time anyone used any scary words (the ones I was trying not to think about the whole day) like stroke, aneurysm, or tumor. Another waiting period began...waiting on transport...again, not surprising to me. Thankfully, at that point, my ER room was filled with some of the closest members of my "Philly" fam (longtime friends from my church), who were a great emotional support, and also an entertaining distraction from the gravity of the situation. When I was being loaded onto the gurney to be transferred via ambulance to Jefferson, I found out that I wasn't being transferred to their ER like I had assumed, but I was being directly admitted to their Neuro ICU. I assumed this would be a good thing, since I wouldn't have to sit through all the waiting games at another ER. I was proved wrong.

After arriving in the ICU around 10:30pm, the nurses quickly admitted me and threw in another (very large and uncomfortable) IV. My nurse then told me that I would be getting another head CT. This didn't surprise me, but I really didn't think that I needed another CT. I knew that it probably wouldn't show anything and that what I really needed was a MRI. I refused the CT until I could talk to a doctor. "Ok, but that might be a while, we have a lot of sick patients here tonight." Ughh...I know that line all too well...not sure how many hundreds of times I've said it to my patients. I was glad not to be their sickest patient, but I knew that something was definitely wrong with me and I was getting quite tired of not knowing what it was. I was also very stressed out on behalf of my parents who were 1000 miles away and very worried about me to say the least. I was quite surprised to find out that the Neuro ICU I had been transferred to, in order to get a much needed MRI, only had one neurosurgeon resident (who was spread way too thin) covering the unit and no MRI tech currently in the hospital. I had a few moments of wishing I had asked more questions before I was transferred, and also a moment of wishing I was a child and could be at my own hospital where I knew there would be people who would advocate for me to get what I needed right away. But, I was where I was, and so after giving the resident a pretty good earful about what I knew I needed and basically making my nurse put a smaller IV in a more comfortable spot on my forearm, I settled into a night of waiting on the MRI. I was so, so thankful to have my close friend, Liz, stay with me, in a very uncomfortable straight backed chair, that whole night.

I finally went down to MRI about 6 hours after arriving at Jefferson. The MRI actually wasn't that bad to sit through, and by 6:30am, I was back in the ICU and a neurosurgeon resident immediately came in and told me that I had suffered two small strokes in the pons of my brainstem and one small stoke near my cerebellum. With that diagnosis, the worst of my emotional stress was over. I had been mainly praying that it wasn't cancer or an aneurysm, so I was actually thankful for that diagnosis. I was thankfully able to catch my mom on the phone before she took off to fly to Philly, and I know she was also thankful to finally have the results. Very soon after, I was also told that they had found a left vertebral artery dissection (VAD), a tear in an artery in my neck. This was the cause of my stroke. It had clotted off and then the clot blew off and caused the small strokes. They grilled me on the common causes of VADs...have you been skydiving...had chiropractic manipulation of your neck...do you play the trumpet...have you been sneezing a lot...lifting weights? I couldn't think of anything weird involving my neck that had happened recently. After all the grilling, they said that many times they never pinpoint the cause. Arterial dissections are the most common cause of strokes in young people, so even though it was obviously crazy for this to happen to me, it's not unheard of. They also said that this had nothing to do with my travel to Cambodia. Because it seemed to happen basically randomly, I am so, so thankful that I was in this country when it happened. If it had happened just 2 weeks prior, I would have had an experience with the Cambodian healthcare system that I hadn't gone there looking for!

Well, this "summary" has gotten really long, so I'm going to try to be more brief from here out. The rest of my hospital stay was filled with visits from doctors (not as many as you would think), lots and lots of visits from family, friends, and coworkers. My parents and my 2nd parents, The Bishops, made their way to me very quickly. I was discharged 3 days later. My stroke symptoms had resolved so much with each half day that I was there. We determined that my (thankfully, very minor) deficits include some right hand dexterity issues, very, very mild right leg weakness, and mild equilibrium issues with walking and looking around quickly. I will be getting PT/OT for these deficits and given how fast I have been moving back to baseline, the therapy shouldn't take too long. Thankfully to look at me, and even when the doctors examine me, you would never know I had a stroke. Also, I was told that I would probably have headaches for a "while". I didn't think much of this because my headaches in the hospital hadn't been that bad. Unfortunately, my first few days at home I had some pretty intense headaches that wouldn't go away with the meds they sent me home on. It has become clear that this will possibly be an ongoing issue for a least a few weeks. I tend to go to sleep fine, wake up with a headache that varies in intensity, and then as long as I push through it, it's gone by the afternoon. I have thankfully just started taking a med at night that has so far been improving how I feel in the morning.

There was one thing that I was told on discharge that will affect me for a longer period of time than any of the rest of these issues. The vertebral artery dissection is still there and will heal over the next six months. I have to be on a full aspirin daily to decrease the risk of it clotting again (and that is a risk...I could have another stroke). Also, because it is healing, I am not allowed to lift more than 10 lbs for six months. When I heard this, I no longer worried how long it would take me to retrain my hand to place IVs. I knew this meant that I would be out of my job as a nurse in the ER for those six months. I will thankfully have short-term and long-term disability to cover a percentage of my salary, but my position will be filled after 3 months. I have an amazing manager who is so supportive and will bring me back into my position as soon as my weight restriction is cleared and she has a position available.

I have been humbled and overwhelmed by the outpouring of thoughts, prayers, calls, visits, messages, cards, and flowers from my family and friends from every aspect of my life. Thank you so, so much for everything and continuing to follow up to see how I am doing. It is so encouraging and helpful for my recovery. I am so blessed that this was not more serious and am truly trusting God that these are "the days that were formed for me" (see Psalm 139:16) and that he knows what lies ahead of me during this time. Here is how you can be thanking the Lord and praying with me as I take this season day by day:

Praise:

• That I was not out of the country when this happened.
• That my vertebral artery dissection was not more severe.
• That the clots were small and the neurologic deficits are minor.
• That I had great doctors and nurses who were able to diagnose and care for me.
• That my stroke deficits have been fading fast and that I will have a full recovery.
• For my "Philly" fam, especially Tiffany and Liz, who stayed with me before my parents arrived.
• For my mom and dad and their support despite dealing with my ailing grandfather in Atlanta at the same time. Especially to my mom who hasn't been home for two weeks and has been doing more than I could have ever asked for me here at home.
• For all of my amazing family and friends who are supporting me during this time.

Prayer

• That I will continue to take things day by day and not be frustrated by "bad" days.
• That my Physical Therapists will be knowledgeable of my deficits and know the best plan to get me back to 100%.
• That I will be disciplined in my physical therapy.
• That while I can't drive, I will be patient and not get frustrated with feeling cooped up.
• That my morning headaches will continue to subside and that I will be able to sleep in my bed again (I've been sleeping in a recliner to keep my head more elevated).
• That my vertebral artery dissection will not clot again and cause another stroke.
• That the Lord will lead me with what to do with my time and finances during my six month leave from work.

Thanks again! Giving God the Glory!