Wednesday, April 22, 2009

TIA?

Wednesday, March 11, 2009

TIA

I think it was a Transient Ischemic Attack, known in the doctoring trade as a TIA. Whatever it was, it was one of the damnedest experiences I've ever had, with or without the influences of strange medical, commercial, or recreational drugs. It only lasted about twenty minutes, which was long enough, and I do not care to repeat the experience.

There isn't any residual effect as far as I can tell. I can remember my children's names, my address and phone number, and I can look on my wrist to see what day it is. (Wikipedia has an article about TIA.) The experience, for me, was almost entirely visual. I was working on Rene's computer when I lost the ability to look to the left of center, I would have to turn my head to look to the left. I checked, and it was the same with either eye closed. As it progressed, I became locked in, visually, on the close box in the upper right corner of a window. I couldn't look away at anything else for more than an instant, and then my focus snapped back to that little 'X' in the corner. Again, it was the same with either eye closed, which told me that something was probably occurring in the brain, not the eye or optic nerve.

During all this I was able to clearly describe the sensations I was experiencing to Rene'. About five minutes after it started, I was able to start moving my eyes off the little 'X' and look to the right of me. I realized I was sweating profusely and slipped off my jacket. Then Rene' suggested I go to the living room and sit in a reclining chair. I was light-headed, and there was a very loud but inaudible buzzing going on in my head, but I was able to stand and walk about 20' into the next room and sit down in a chair.

After sitting for a while I finally stopped sweating and my vision cleared up. I wasn't dead, and didn't feel like I was dying, so I got up, went out to my car, and drove home. That was a mistake. I didn't run over any dogs or children, but my wife was not happy with me. She thought I should have called her to pick me up. Hell, I figured out I was invincible when I was a teenager, so there was nothing to worry about.

After much insistence by my spouse, I ended up in the emergency room about ten hours after the attack. Becky, the nurse who took care of me there, looked a lot like Julia Roberts, only younger, so it wasn't a bad experience at all. The doc, though, decided I needed to stay in the hospital for a few days. While there I was poked, prodded, scanned, and screwed around, but nothing particularly painful was done.

The main problem was the food. I would rather eat stewed possum than most hospital food. No salt, no fats, and all vegetables boiled for at least an hour before being well cooled and served. Red beans and brown rice would have been a lot more edible.

The admission process was very interesting, especially the part where they tried to compile a list of my current medications. I keep a spreadsheet with my current meds on www.GeezerNet.com. Anybody should have been able to fire up their web browser, point it at GeezerNet, enter the username and password I give them, and navigate straight to my current medications page.

I run GeezerNet, both .com and .US, on a very old server I own that sits in a laundry room in the back of an old building next to the library in Oskaloosa. It is not an ideal setting for a server, nor is the server reliable. The general unreliability of the whole setup became apparent when I went into the hospital, and discovered that www.GeezerNet.com was not available.

With no written record of my current medications available, it was Friday evening and both my primary physician's office and the cardiologist's officer were closed, nor could the ER at Lawrence memorial search access the data sets except by a telephone request from human to human, so it became their duty to somehow extract from me a complete and accurate list of my current medications. Remember, I'm in there because something went wrong in my brain.

The staff was courteous, pleasant, and professional, and I estimated that the average cost for their time was about $150 per hour (that is cost, not pay rate). If that is a valid assumption, then the approximately 90 minutes spent by three nurses, two pharmacists, and two physicians in determining my current medications, cost all of us $225. That $225 never appears on any bill or report, because it is just ordinary overhead, so it is never noticed as an incredible waste of money.

GeezerNet could be hosted on a commercial hosting site for less than $60 per year, so I could have had it in a secure and reliable environment for three years for less money than it cost the health care system to find my current medications. If I couldn't have given them the password to my health records, the primary care physician I see has it, and so does my wife, who was with me.

There is no reason I can see, other than mass organizational myopia, for the records of the hospital, the physicians' offices, and the pharmacies, to not be available to each other and the ER of every hospital. Our health care system does not have a IT infrastructure. By clinging to the same narrow visions of information technology that characterized the decline of the mainframe computer, the health care system has severely inhibited it's ability to develop an information infrastructure. And that is costing all of us money that doesn't need to be spent.

And that was what I was thinking about most of the time I was in the hospital, being examined because something went wrong in my brain.

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Massive Learning Attack

At about age 25 we undergo a process called myelization, during which we grow a protective layer around our neural dendrites. After that, they say, learning is achieved by pruning existing neural connections, not growing new ones. So, I figure that having a stroke, a process that achieves rapid pruning of a bunch of neural connections, could be considered as a massive learning attack, or MLA.
MLA's are tricky rascals. This last one did something to me, but I can't put my finger on exactly what has changed. I think there might be some small gross motor impairment of some sort, but I've always been clumsy. I may be lazier, but I've always been lazy.
It has given me the opportunity to spend a bit of time with some interesting new physicians, a Neurologist and a Vascular Surgeon. Physicians and dairy farmers are generally nuts, I think. Who wants to work that hard, that long, and that carefully? These two guys, the Neurologist and the Vascular Surgeon, seemed to be very bright, very competent physicians, which is generally the kind of people you want whether dealing with MLA or hemorrhoids.
As has been my experience throughout this excursion into the world of MLA patient, the new physicians do not have patient information systems capable of communicating with other systems. Mainframe mindset. Why do all those physicians and staff members put up with non-communicating systems? I might be experiencing a mild stroke, but I am not so vegetative I would put up with their systems.
I have started reading My Stroke of Insight by Jill Bolte Taylor, Ph.D., a neurophysiologist who had a massive stroke. I've seen her presentation on the Ted Talks, and was impressed at the time.

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