Tag Archives: Subarachnoid Haemorrhage

An improved prognosis

This is a follow-up to my post from two years ago, “Dealt a Blow“.

So, having had the subarachnoid haemorrhage in 2011 and a number of follow-up interventions in 2012 and 2013, it’s time for me to bring you up to date with what the hell is going on inside my skull.

My previous post got as far as me not looking forward to a further angiogram after the one in March 2013 showed that there was still some blood flowing inside my coiled aneurysm after having two coilings in 2011 and 2012.

Well, I flew back to London to get a further MRA in September 2013, and towards the end of the year got the results which said that I would have to have ANOTHER coiling via angiogram (my third), since the aneurysm wasn’t sufficiently blocked off. So I jetted off to London again in January 2014 (this time with girlfriend in tow) and underwent the coiling process via angiogram (under general anaesthetic) at what was becoming my regular haunt, the National Hospital for Neurology and Neurosurgery in Bloomsbury.

Before, during and after a coiling of an aneurysm

It was around this time that I looked back to all the medical interventions I had since my original haemorrhage, wondering why it was proving so difficult to block the aneurysm completely. I reluctantly decided that I simply couldn’t risk training in the gym any more, no matter how light the regime. It seemed entirely possible that too much training was raising my blood pressure and preventing the total blocking-off of the aneurysm.

After I got home I learned that I would no longer be able to have follow-up MRA scans in the UK, I would have to have them in Malta. No problem, I thought, and called Malta’s national hospital to arrange one. Three weeks of complex negotiations, phone-call hopscotch and red tape cutting later, I finally got myself onto the patient list of a Maltese neurological consultant and had my first consultation in February 2014. They scheduled an MRA for July to review the most recent coiling.

This MRA in July 2014 was, believe it or not, the first time I had treatment in Malta since the original haemorrhage back in 2011. The results came through quite quickly (quicker than in the UK), and this time, FINALLY, it was good news. When I met my consultant in August 2014 she said that the aneurysm appeared to be totally blocked off, though they would need to send the images to the NHNN in London to get a second opinion.

This was done and in March 2015 I received my first ever official ‘All Clear’. The NHNN agreed that the MRA showed there was no blood flow in the aneurysm – the blood flow in the vessels of my brain were bypassing it completely. I would need annual MRAs to check all was still good, but no more angiograms would be on the immediate horizon.

You can imagine the level of relief I felt. Since 2011 during my initial recovery, the aneurysm had felt like a huge shadow stalking my every step through life, and now that has been lifted.

I still bear the invisible scars of the subarachnoid haemorrhage, like a lot of SAH survivors. My eyes get tired and vision gets blurry much more frequently, and I have a much harder time with bright lights and glare. My medium and long term memory is nowhere near as good as it used to be. I get dizzy spells. Once in a while I suffer a day or two of extreme physical fatigue when I can hardly support my own head. And of course I have to avoid heavy lifting and anything which is likely to increase my blood pressure. But I’m still here, and with this prognosis I’m likely to be still here for some time to come. That’s what’s important.

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Dealt a blow

Sometimes a piece of news, while seemingly small, can rock your world – and not in a good way.

I’d better backtrack a bit, since there’s one big life event that I haven’t posted about here yet. This could get quite long…

In the summer of 2011, I had just returned home from an excellent holiday in central Italy, and was settling back into my normal routine of working at the office, training at the gym, relaxing with TV, etc. At one of my gym sessions I was using a multigym-style machine to do chest presses, and, smart cookie that I am, I decided to up the weight a little (from 35kg to 40kg) to see how I coped. Well, I didn’t. About 3 presses in, I suddenly felt what I can only describe as a silent “snap” somewhere inside my head; immediately I felt faint, dizzy and nauseous, and swirling colours were dancing in front of my eyes. And the pain…

I stumbled outside to the parking area, with my personal trainer anxiously following me, and collapsed in a heap on the ground, vomiting and clutching my head, trying to stop what felt like an army of elephants quick-stepping through my brain. Eventually I felt stable enough to be driven home, and home is where I stayed for 4 days, figuring it was simply the worst migraine I had ever experienced. A friend bought me painkillers and tried to get me to eat though I had no appetite.

In the end I realised that something major was wrong, and got myself driven to the local hospital, where, after eliminating meningitis via a spinal tap and other tests, an MRI finally confirmed that I had a subarachnoid haemorrhage (SAH) – a bleed in my brain, where an aneurysm (a long-standing weak-walled bulging blood vessel) had burst when I tried those ill-advised chest presses.

Unfortunately Malta’s hospitals lack staff with the right skills and specialisms to fix subarachnoid heamorrhages, and so I was booked on a flight to London, where I would be taken to the National Hospital for Neurology & Neurosurgery (NHNN) to be treated. However I had to wait 3 days for the flight, and those three days were the most agonising and depressing of my life. Each dose of morphine or codeine eased the pain in my head for about 20 minutes, before it returned as strong as ever. I couldn’t eat without throwing up – in fact I couldn’t even sit up straight. I lost about 8 kilos. Friends and colleagues came to visit but to be honest I can’t even remember everyone who stopped by. I think my brain has blurred those memories so that the memory of the pain is also softened. But I remember being aware that I wasn’t expected to survive and that efforts were being made to contact my family.

The flight was interesting – I was lying on a stretcher bolted above 3 rows of seats, with a doctor and a nurse sitting next to me with bags of gear to try and keep me alive if I needed it. I also have one distinctive memory of my doctor escort telling me how lucky I was, as I was being transferred to an ambulance at Heathrow airport. I remember not feeling very lucky at that point.

At the NHNN in central London, I underwent a procedure called “coiling”, which involved the surgical team sending a catheter into my brain via my femoral artery and aorta (this process is called an angiogram), and then pushing tiny coils of platinum or tungsten wire (I’m still not sure which) into the aneurysm, to force the blood to clot and block off the bleed. It was successful, and I then spent two weeks on a ward, gradually regaining some strength. After that, I had another two weeks convalescence at my sister’s home, before I was strong enough to fly back home to Malta.

The months following the operation were frustrating – I had memory recall problems, trouble with puzzles of any kind, frequent blurred vision, periods of severe depression – all of which, apparently, are standard fare for someone recovering from a SAH. And to this day I have intermittent loss of sensation in my legs and feet – also something to be expected apparently. But eventually I gained enough strength to go back to work, part time at first, then eventually full time about 6 months after the op. During this period I relied heavily on sessions with a counsellor to keep my fears and depressive episodes under control and to simply adapt to a post-SAH life.

Round Two

Nine months after my injury, an angiogram at the NHNN to check me out revealed that there was still a small part of the aneurysm which had blood flowing in it, and I was therefore still at risk of having a second SAH. So I was booked in for a third procedure in the summer of 2012, during which the angio team placed a small metal mesh stent (tube) across where the aneurysm met the blood vessel, which would seal it off totally once blood clotted in the mesh. They did this again via angiogram, thus again avoiding the need to make a hole in my skull.

When I woke up I was told it had gone perfectly, and I should have a final check in six months. In the end, six became nine and I was checked out again, with an MRA this time, in March 2013.

Round Three?

Which brings us pretty much to the present day. A few days ago I was finally emailed the results of the MRA I had in London in March. The letter was terse and to the point – they could see a small recurrence of the aneurysm, and wanted to check me again in a further six months. In the meantime I should try to stay fit and healthy but avoid lifting heavy weights.

You can imagine that this is bitterly disappointing news, however, for some reason it has hit me even harder than I expected. I had really thought that I was risk-free, and that my days of repeated shuttling to London and back were over. I have reached a point in my life where I am actually very happy with almost every aspect of it – I live (by choice) on a sunny island in the Mediterranean, I have a great job, a loving girlfriend, a lifestyle that I love, a nice place to live, enough money to be comfortable, the list goes on. And now the threat of mortality is back, complete with scythe and hood in my mind’s eye.

Frankly, I’m scared. I know that I have to keep my blood pressure down to reduce the risk of a further SAH. Luckily my blood pressure tends to be below average. However, I love coffee (but hate decaff), and I still haven’t managed to entirely kick a 25 year smoking habit, though I have cut down somewhat and only smoke tiny roll-ups. Still, both caffeine and nicotine tend to increase blood pressure, as does stress, which creates a vicious circle. The more I’m scared, the more stressed I feel, the more I want to smoke, the more my blood pressure will rise. At least I no longer use alcohol, I guess.

I need to find a way to cultivate a more “zen” attitude to the whole thing, but that’s not easy. Roll on October, when they’ll MRA me again and we’ll see if the aneurysm has grown at all in the meantime.

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