Results Still TBD, But TIA?

In my last post, I had planned on reporting on a visit to the cardiologist’s office, but sad news of my primary care physician’s sudden death (the same person who had given me a referral to the cardiologist) sent my post in a different direction.   Here, I’m going to describe what happened that day, once I saw the cardiologist.

The title of this post sums up my status pretty well:

But here’s the unabridged story:  The doc was quite pleasant, seemed very knowledgeable.  When asked why I was there, I told him about the incident I had while biking 2 weeks earlier, in which my chest felt tight, I had difficulty breathing, and the center of my chest ached.  Given these “heart attack-like” symptoms, combined with my family’s rather poor track record in keeping their hearts beating to some respectable age,  I expressed my concern that perhaps I was beginning to see signs that my own heart was coming up on its shelf life. He looked at the results of the EKG that had been performed before he had entered the room, declared me to have a very healthy heart, and stated that we could definitely rule out a heart attack as being what happened that day on the bike.  Whew!

The cardio then proceeded to ask more questions about me and my family history.  He looked at the list of medicines/supplements that I was taking, and asked ‘What is Copaxone for?” (Wow!  Another refreshingly humble doctor, to admit he doesn’t know everything!)  I described what this drug is, and of course the probable/possible MS diagnosis. We talked for a while longer, and he seemed to be wrapping things up.

I then remembered something important:  my weak arm.  I started with the usual caveats:  “Doc, I’m not sure if this information is relevant or not, but I’ve been dealing with an unusually weak right arm for a couple of months now“.  There was a noticeable change in his demeanor.  He said that although the EKG would have detected any heart damage caused by a heart attack, the EKG results would not eliminate the possibility that I had a stroke, and that “stroke” is the first thing that came to his mind when I was describing my arm.

But of course, as nearly everything associated with me, the situation is not a “textbook case”.  Usually, a stroke victim has high blood pressure, and high cholesterol.  My blood pressure tends to run low (usually something like 105/50-something.  Sometimes the top number is only in the 90’s!).  My cholesterol is a tad over the “good” range (it measured 202 when I last had it tested), but the good-to-bad cholesterol is off-the-charts — it is in the absolute “lowest-risk” category. Not what would be expected of a stroke victim.

When I explained to him that my arm didn’t just get weak during that one biking trip and then get better, but rather has a baseline weakness all the time, that it gets worse when I use it a lot, and that in bike rides I’ve had since this incident, my arm goes so weak during the ride that I can’t even lift it off the handle bars, he got a Sherlock Holmes  look on his face as he was contemplating all the clues, and said “weird” out loud several times.

His working theory:  that the incident I experienced during that one bike ride was a TIA, and that there is residual blockage in the carotid artery (refer to above figure — the carotid is the main artery going up the neck into the brain) that is causing the continued weakness.  He said that if this theory turns out to be the correct one, then fix is super-easy:  a stent, and then I’m back to business as usual.  The concern is that the gunk in the artery could break loose, resulting in a full-on stroke — if blockage is indeed the problem, it needs to be dealt with asap.

I went in for an echo-cardiogram last week (provides more information about heart health that an EKG would not be able to measure), and I am scheduled for a carotid ultrasound this week.  The results of these 2 tests should be able to determine if a partially-blocked carotid (and/or a heart abnormality such as a bad valve) is the root of my problem.  I’ll have an answer in 2 weeks.

I can’t help but wonder if a heart abnormality or artery blockage is perhaps what has always been wrong with me.  What if those handful of spots on my brain are the result of oxygen deprivation (vascular/heart-related) rather than demyelination (MS-related)?  I’m running out of my last few packages of Copaxone, but I am tempted to see where this new wrinkle of life leads before ordering a new supply of painful skin-jabbers…

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4 thoughts on “Results Still TBD, But TIA?

  1. So…your story continues to sound very familiar to me. My neurologist has been focused on the “possible MS” diagnosis for some time now, and I admit that the medications seem to be helping a lot of the symptoms. But I had an “ah ha” moment when I learned that my mother has a mitral valve prolapse, which makes her extremely tired and gives her palpitations and a feeling of a strong heartbeat in her chest. In some of my “episodes” with the arm and leg, I also have a strong heartbeat and some palpitations. My fist visit to the ER included an EKG which was completely normal. Not a heart attack. I didn’t really pay attention to my mom’s issues in relation to my diagnosis process, because she does not any of the symptoms in her arms and legs like I do, nor does she have the migraines or headaches. But I convinced my neurologist that it was at least worth exploring. I am in the process of scheduling an echocardiogram as a first step. Like you, my blood pressure is normal, and I have moderately high cholesterol, but also have very high HDL levels in relation to LDL, to put me squarely in the normal category. Good luck, and keep me posted!

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    • TIAs need to have a complete workup including EKG, surface echocardiogram (TTE) and transesophageal echocardiogram (TEE), event monitor, and carotid ultrasound. Many patients see a primary doc and say TIAs “just happen”. This cannot be further from the truth. See a cardiologist or a good neurologist after any “mini stroke” (TIAs). Full a comprehensive, patient directed site on cardiac procedures visit http://www.myheartprocedure.com

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  2. I had to google “mitral valve prolapse” to know what it is. Interesting, I believe that this condition is one that a colleague of mine recently discovered that he had, and was the underlying reason for his recent stroke (the blood that leaked around the valve formed a clot that went to his brain). He completely recovered from the incident, but could have had a future stroke, had this problem not been identified. I hope that you get answers soon!

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