Dissecting Aneurysm - Quite a bolt from the blue !

Going by the posts on this page, it’s apparent that this has been used by me pretty much like the iconic tag line of the Hero Honda Ad in the 90s ... Fill it Shut it Forget it ! Not literally the case but guess this is a reflection of how little I tend to pause n put words to my thoughts n events happening around me on a daily basis. This space has largely been used to document specific events at very infrequent intervals , changes that have come about in life and to capture few lines that I believed that could pass off as poetry in what seems now to be a previous life ! 

Taking the former to be true and in order to continue documenting the new event in my life currently, I could not NOT write this piece on what has been arguably the biggest change in my life ! Something that came about quiet unexpectedly and the magnitude of which, is still to yet to sink in fully. So this is about the events that took place during the week starting from the 5th Nov 22, a day that started off pretty much just like any other but surely had gone about changing my life like none other ! 

Just another typical start to the Saturday, with a quick breakfast and off to play a few games of badminton at the local club where I’d become a regular this year and was having a wonderful time doing the same. Played few games and unlike most other days had a decent start winning the first couple of games pretty well and was feeling all good about myself! Decided to rest out the 3rd game and sitting courtside somehow seemed to be right in line of the sun rays peering in through the glass window at the ceiling.  During the next match I played, somehow the left eye seemed to have a bit of a haziness and I just dismissed that as the result of sun rays hitting earlier. Took a break in between to wash off my eye but nothing much changed. Continued the match though, played the next one as well ... losing both pretty tamely. Thought of calling it a day and drove back home after this and then daddy duties started. Kiddo were up and my daughter had to be taken to her badminton class now. Dropped her to the academy and as against the usual practice of sitting courtside and watching her session, decided to go back home n surprise my lil nursery kiddo to take him n wife to school for the parent teacher day. All the running around meant that there was a fair deal of fatigue setting in but given that it meant some more time riding on my new Enfield and the fact there was no inclination of what was about to happen just about 30 mins later, I went about the chore as usual!! 

Dropped the lil one and wife to school and was about to go back to my daughter's badminton academy to pick her up, when something happened and a sudden jolt t'was for sure. Was about to take a U-turn on the busy road when like a flash, felt the world around me moving in circles. Sudden bout of giddiness with quite a bit of heavy headed ness and disorientation. Call it luck, awareness, divine hand, will never know the reason for sure, had the presence of mind to quickly bring the bike to the side and park it, even though the parking happened to be right in front of the 'No Parking' board. Keeping up the luck factor was the presence of an auto standing right in front where I'd parked the bike and he was happy to take me home. That short 15 minute auto ride had 3 bouts of uncontrolled vomitting across the auto seat, floor, on the road - everywhere! Somehow reached home and never having an experience even remotely close to this, meant that I knew this was something BIG ! Barely had the energy to puke out once more and somehow plonk myself on the bed once I reached home. Fortunately a doctor from the building came pretty soon and checked all vitals and declared that all seems fine, probably a BP n Gastro issue and was put on  medication to address those with an advise to be on complete bed rest for couple of days. The weekend went past, with me firmly stationed on the bed with an odd vomitting bout and largely on liquid diet. Monday morning meant stepping out to meet a Senior Dr who advised to take an MRI and along with few other tests. That was taken promptly and the results were available within couple of hours. The result was shared with the doc and the prompt callback by the doc changed the scene quite a bit at home ! Seeing the MRI result, the condition was categorized as a 'Minor stroke' with a urgent advise to immediately report to the Accident and Emergency desk at one of the largest hospitals in town - Kokilaben Ambani. The next couple of hours were a blur. We reached the hospital at the earliest we could and had a queue of Junior docs from the neurology department examining me, doing multiple tests and assessments. After couple of hours at the Accident & Emergency centre, was shifted to ICU with my case being tagged as a young stroke patient. All this while, I was at a loss to identify exactly what the problem was. Absolutely no giddiness / vomitting prevailed and apart from minor fatigue I felt perfectly fine. All the assessments and doc checks went without any findings and I became the talk of the floor for the docs to identify the root cause of this stroke case. This resulted in multiple docs coming up and putting me through various tests ... heart, liver, Kidney all got assessed thoroughly and the success rate for all of these seemed to be far better than most of the academic successes of their owner! 

Was scheduled to be discharged on the 11th and as a last assessment by my neuro was recommended to take a DSA - Digital Substraction Angiography of the brain as my Doc was still a bit stumped as to the reason for the ordeal I went through and his view was that for my age and my vitals there had to be some specific reason behind the 'Acute Ischemic Stroke' and could not be just dismissed as lifestyle/ age etc. Though was very bugged with the suggestion to start as I was looking forward to get back home after few days at the hospital, that test turned out to be quite a blessing indeed. Since the procedure involved minimum intervention my case was handed over to the interventional neurology team and was explain what this procedure will be and was informed that this is the gold standard of diagnostics for such cases and post the same we will be able to definitively pin point the reason behind the whole episode. The procedure was for about 60 mins though there was a good deal of waiting at the Cath Lab prior to the same and sure enough the result did clear the air quite a bit.  Post the procedure my case was diagnosed as a condition called ' Dissecting Aneurysm' which basically meant cuts in the walls of the artery that fed the brain. This meant that there was a impact in the blood flow to the brain and that had led to a ballooning which, if left untreated, ran the risk of eruption in which case there would be impacts to various parts of the body given that the nervous system would be the part taking the bulk of the harm. This was explained descriptively to me by the Head of Interventional Neurology at the hospital and was informed that while the condition is perfectly clear, this meant that the corrective surgery required is imperative and is required to be done at the earliest possible. Given that this involved a neurological surgery and a mighty precision one at that, obviously the cost involved was going be like none other and criticality of the same meant that the procedure was required to be completed urgently. Fortunately, we were able to seek multiple independent opinions to validate the diagnosis and post the same we were clear that this corrective action can be taken up and completed the very next day. After a brief stage of anger and dismay on why this has come up all of a sudden now, I was comfortable to the idea of the surgery and the timeline primarily on account of the 3 reasons -

 1) not having much of an alternative and the fact that multiple independent opinions including family members who happened to be neuro surgeons backed the diagnosis and the treatment required 

2) confidence in the doctors handling the case and a general positivity always about things being in control and lastly 

3) Support of the family and long conversations with wifey, Anu who was very upright and clear headed throughout the whole saga though she would have been a nervous wreck internally, but much to her credit never let that cloud her thought process. Parents had come down from kerala earlier in the week and they were right there for support and taking decisions! 

The procedure required involved a Keyhole surgery where there would be a puncture ( small hole) made in the thigh where the main artery of the body would be accessed and through a catheter ( a small tube) a 4 cm length flow diverter would be pushed in and placed in the brain artery, right about behind the left ear area. This surgery was done under the able hands of Dr. Manish Shrivastava and that was one experience that unfortunately I can write nothing about as I just remember being asked about my name and other basic details while lying down on the operation table. The next thing I know was waking up 2 hours later post the anesthesia effect wearing off. The Flow diverter and a stent was placed on the artery successfully in order to ensure the blood flow remained uninterrupted thereby removing the risk of any further complications. We were shown multiple pics and CDs showing the before and after photos of the artery which clearly displayed the corrections done and the impacted area cleared being addressed through the procedure. The next couple of days post surgery went without any major issues. Movements were restricted for 24 h given the procedure process and there were some level of discomfort in the vision. However post the 24h period, everything was largely fine and could do all activities on my own. Was shifted to a ward from the ICU post the same. ICU observation remained for couple of days more and then on 15th was discharged from hospital with a big list of medicines and dietary restrictions to be followed at home. 

Been a month now, and in between the one hundred thousand pieces of advice received from all across, its been a slow journey back to resumption of BAU mode. Getting used to the restrictions and getting comfortable to the reality of not playing sports ( Badminton, volleyball maybe never!!)  - , not picking up the kiddo and jumping around with them and generally getting used to heightened level of consciousness of all at home so as to accept the new life as it were, has been an interesting experience. Looking forward to using this sudden speed breaker as an excuse to clean up the system and take the steps required to ensure the wheels keep churning without too many such speed breakers ahead ! :) 

Been an experience that has jolted us quite a bit, but as indicated earlier there have been a number of unexplained good fortunes that came along the way ensuring that there was minimal damage, no impacts to other parts of the body, quick actions taken in terms of treatment and corrective measures as well as minimal drain on financial resources thanks to an increased insurance cover that I'd voluntarily opted for a while back. Along with all this, there's been substantial support from immediate family and close friends all through, rallying behind myself, and with each other ensuring right decisions were taken at the right moment and maintaining their calm always. Wife has remained a rock all through and been right with me throughout to egg me on, shout at me and encourage me at all times to ensure that there is no physical or mental damage in all these days. Handling 2 little kids along with an adult who'd also become a kid given the circumstance along with the Sr citizen parents single handedly takes a lot out of self and she'd managed the same wonderfully well throughout the days. Family members always close n willing to help making multiple visits to the hospital, braving / thwarting the hospital rules with regards to meeting time and spending their evenings with us helping to light up the mood and lend support throughout the time and after !! Kiddos were largely unaffected and went about their daily school and playtime all through the time thanks to wonderful support from in laws and parents. Their joy in having me back apparent from the lil cake cutting that we did on the day I returned from the hospital with them jumping with joy as always ! :) 

Looking forward for the times ahead, couple of minor follow-ups done and all the assessments seems to be perfectly fine. The exact root cause of the event is yet to be clearly ascertained. there is a degree of inherent weakness in the arterial walls that is is all probability caused the same and this would require a reasonable level of precaution being maintained always along with the medications and follow-ups required to be done at the recommended frequencies as mandated by the docs. Normal work day with WFH has resumed for couple of weeks now with travel being restricted for the moment but in the coming week, will be travelling to work as earlier, though probably the Enfield joyride will need to wait for a while- a lil over a month more I guess ( much to my and more so my 4 yr old son's frustration!! ). Will have an MRI after 4-5 months and further assessments done then. Till then the same precautionary restrictions would continue along with the recommended medicines. 

Blessed and geared up for the days Ahead !!