My Stroke Story Chapter 4

Cork day is coming up on 26FEB16

The Treatment Plan

At the hospital there was a lot of discussion about what the best treatment plan would be. The options boiled down to 2 basic approaches, based on the mechanics of a stroke.  For a stroke to occur, two conditions are necessary:

1. There must be a blood clot AND
2. The clot must be in the brain

It follows then that a stroke can be prevented by:

1. Preventing blood clots from forming OR
2. Keeping blood clots out of the brain

The first approach is to prevent clots from forming by medically lowering the body’s ability to form clots, i.e. taking blood thinners. Of course the body needs some ability to clot in the case of cuts and nose bleeds, so doctors must find a balance that prevents their patient from bleeding to death or clotting to death.  Patients on blood thinners will bruise more easily and will bleed longer when they get cut. In most cases patients will alter their lifestyles to minimize their cut, fall, and bruise risk. My wife says I would have to cut back on power tools. :(

The second approach is to to keep clots out of the brain.  Our bodies naturally produce and dissolve clots on a regular basis. We don’t care as long as they dissolve before they cause a problem. In my case there is a shortcut from my venous system through the hole in my heart, and directly to the brain. By closing that hole, that path is removed, and the probability of a clot making it to the brain is reduced.

I should point out that having this particular hole in the heart is not itself a risk for a stroke. A very small (about 1%) fraction of people with this condition ever have the issues I have had. And it is not clear what coexisting condition makes the hole become an issue. It is clear that a statistically significant proportion of people that have otherwise unexplained strokes have this heart defect.

In a recent study, the CLOSURE Study, they found that treated medically or surgically, there was about a 3-4% reoccurrence of a stroke. Statistically the benefits are about the same. The consensus among the doctors providing my care is that I would be better off having the surgery and avoiding blood thinners given my young age, and the need to beat up my children on a regular basis.

We have decided to take that advice and have scheduled non-invasive surgery for Friday, the 26th AKA Cork Day. On that day, I will swallow a small robot which will swim to my heart and place a small cork in the hole.

Okay, not really. Actually, a catheter will be inserted into the vein in my leg all the way up into my heart. The doctor will use tools and a closure device delivered through the catheter to close the hole. Once the closure device is in place, flesh will grow and eventually completely cover the device, sealing the hole forever. Here is a video by my doctor showing the surgery. The device in the video is made of Nitinol, a shape memory alloy made of nickel and titanium, and is covered with polyester. These materials are encourage flesh growth.

Here are the details for Cork Day:

I will be at Medstar Washington Hospital Center.

The surgery will be on 26FEB at 1200 and I will depart the next day.

The surgeons are very experienced, and will actually have multiple surgeons watching them to learn the technique.

I will appreciate your prayers for a successful and safe surgery on Cork Day. Specifically pray that I have a complete closure, as 15% of these surgeries result in an incomplete closure of the hole.