The Terrible “S”s

I don’t know what “The Terrible ‘S’s” made you think of, but for me it means Strokes and Seizures. We are so lucky in the Pilat family tree that we had both—Pop had strokes and Mom has seizures.

A quick reminder: My parents were the healthiest people you could find—very few medications, no smoking or drinking, great family histories of long-living people. 

I mention this because both of the Terrible S’s can hit your loved ones as easily as they hit mine. There are no early warning signs for these bitches.

Stroke Basics

One day, Pop came out of his bedroom and bounced off a wall. He apologized to the wall, sat down at the table and asked for “tacks and nails” for breakfast. His confusion, dizziness and odd facial expression took us to the emergency room, where they diagnosed a TIA…because they couldn’t find anything else. 

A “brain attack” occurs when the blood circulation to the brain fails through being blocked by a clot or when the clot itself ruptures. There are four different types of strokes, and they can have devastating effects up to and including death. Perhaps worse, strokes can leave their patients with very limited abilities and paralysis. 

There are risk factors you should know, to see if you or your loved one is at a higher risk. Some of these signs include age (generally between 55 and 85) and gender (men are more likely to have strokes). (https://www.ninds.nih.gov/health-information/patient-caregiver-education/brain-basics-preventing-stroke) The biggest risk factor is family history, so it is important to make sure that you are aware of everything from the generations above you. This is one area I had very limited information on, which has been frustrating for me.

Warning signs

Strokes are really, really weird. They don’t hurt. There is no pain. That is just crazy!!! There are, however, specific symptoms and warning signs you need to look out for with your loved one. Weakness in the extremities is quite common, including a drooping or “melting” of the facial features on one side. This can cause slurred speech, as well as difficulty walking or balancing. 

TSAs

Trans-Ischemic Attacks is what Pop suffered from, and this is commonly called “mini-strokes”. Pop had a number of them in the last years, and they are a very frustrating type of occurrence, because they can’t actually be diagnosed. They are often quite small with little in the way of lingering effects. The first few, by the time we got Pop to the regular doctor, the lingering confusion and dizziness was completely gone, so they could only diagnose through anecdotal information. Since a stroke is diagnosed most commonly through a CT scan, a TIA wouldn’t show anything on the CT scan, so we were sent home with a “potential” diagnosis of TIA, and a suggestion to rest. 

As happy as I am that Pop’s brush with strokes was so mild, it was like having a ticking time bomb in our house, because TIA’s usually are a precursor for a larger, often fatal, stroke. 

Full-blown strokes

The most common type of stroke in adults is an Ischemic stroke, which is when a blood clot actually blocks a blood vessel going to the brain. Research shows that eight out of ten strokes are this type (https://uihc.org/health-topics/stroke-know-basics), yet this is NOT the most deadly type of stroke. A Hemorrhagic stroke occurs when an artery in the break leaks or ruptures. This less common type is usually more deadly, as the leaked blood damages all blood cells. 

Recovery from a stroke could include surgery, but always includes physical and occupational therapy to regain any mobility and strength lost from the attack. The most important thing following a survived stroke is to minimize whatever risk factors you can so that another stroke does not happen.  

Seizure Basics

When my kids turned 21, the best part of their birthday was that Granma would take them to Bingo for the first time. For My Oldest and Sweet Stevie, they both won money, had a nice cocktail, and a fantastic memory with their beloved Granma. Robber Baron turned 21, went to Bingo with Granma, only to see her have her first seizure right in the Bingo room, which required an ambulance to take her to the hospital. He also didn’t win. Mom had no symptoms or warning signs that something was brewing in her head…it just happened.

Similar to a stroke, a seizure indicates a problem with the brain. Unlike a stroke, a seizure is caused by an electrical overload in brain cells. Seizures, like strokes, tend to return once you have had one, so the first seizure is not only scary, it could be the beginning of a new and very frightening trend. Seizures, like strokes, can come in a wide variety of impacts, but generally do not carry with them the ongoing and permanent effects you can get after a major stroke. While it took Mom a few days to recover, she had absolutely no memory of the event, nor did she suffer any permanent problems.  

Symptoms

When you say “seizure”, people imagine the uncontrollable, jerking type motions we see in Hollywood. While this absolutely is the most common symptom of a seizure, it isn’t the only one (https://www.cedars-sinai.org/blog/differences-between-stroke-seizure.html). Mom, for example, froze like a stone for a few seconds, then vomited and fell from her chair. Afterwards, she had the confusion and agitation common in seizures, in addition to the inability to speak clearly, loss of balance and memory loss.  

Frequency

The first stroke—at Bingo with Robber Baron—was shocking and frightening and threw us into a panic. Would this be a regular thing? Should we medicate her? How do we treat this? She was hospitalized for tests for a few days, but we decided not to medicate her unless she had another seizure of this level. 

Ongoing seizures might lead to the diagnosis of epilepsy, which could be treated with medication. This would have been our course of treatment, had Mom been younger, or exhibited seizures on a more regular basis. Unlike stroke, seizures can happen at any age.

Level of disability

Mom had no lingering effects from her first (and ultimately her second and last) seizure. The second seizure occurred at home, and did not even take us to the hospital, since we knew and understood exactly what we were dealing with. However, people who are prone to seizures do “run a higher risk of untimely death” particularly because of the timing of the seizure (https://www.cedars-sinai.org/blog/differences-between-stroke-seizure.html). A seizure while driving or walking up stairs could prove fatal. 

This was the end of Mom driving, that’s for sure. 

Recovery Is Similar

It’s interesting that the recovery for both strokes and seizures is relatively the same. Minimizing risk factors, like smoking, is important, but nothing is more important than rest and a return to as much mobility and activity as possible. For both Mom and Pop, we had physical and occupational therapy come to the house to access them, and work with them to make sure they had no lingering loss of coordination and balance. 

Choosing A Neurologist

We’ve talked in the blog about how to build your team around you, and now you need to add another component to the team—the neurologist. I remind you of several things we have discussed in the past that are true for every single professional on your team:

1. You are in charge. You are interviewing them.
2. Choose an office that is convenient for you.
3. Make sure their office staff is efficient and professional in their dealings with you.
4. Read as much as your own brain can handle about the neurological effects of the disease you are fighting.

Be On Guard Constantly

Cancer never scared me. Dementia doesn’t scare me. The Terrible S’s—they scared me. I had no weapons in my arsenal to fight them. They just lay in wait in my parents’ brains…building and plotting to ruin their lives—and mine. Both of the main killers I’m dealing with—cancer and dementia—have predictable cycles and build slowly to the crescendo of debilitation and death. Strokes and seizures, however, can smack you in the face with absolutely no warning and no time to prepare. 

I only did what I could, what I recommend to you every day you are on The Job:

Enjoy every good day.

And prepare, as best you can, prepare for what’s coming…

THANK YOU FOR READING THIS FAR

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