Carotid Artery Dissection, a Ticking Time Bomb
Live-Giving Blood Supply
See those beautiful red tubes running up the neck and into the brain? Those are the carotid arteries. These two large arteries bring the blood supply to the brain, and if the supply is interrupted, we may only have minutes before damage is done. One event that can disrupt this precious blood supply is a dissection, or a tear, inside the inner lining of the blood vessel.
The 3 Layers Inside Your Arteries
Carotid Arteries and the Brain
What Happens When Your Carotid Artery Tears?
We've probably all heard the word aneurysm, but I had never heard about dissection before this happened. We were told that our arteries have 3 layers, and the inside layer sometimes tears.
Once there is a small tear, blood sneaks through that hole and pools between the outer and middle layer. Of course, the body tries to heal itself, and so clotting begins to occur. Now you have a bulging bubble of blood and clots, and that can only lead to serious trouble. Stroke can occur when the clots let loose and move into the brain. Some people get bad headaches, and many are misdiagnosed until they actual present with the stroke. We were lucky. My husband had a rare side effect that helped us to catch the dissection before the stroke occurred.
Something Is Wrong: Follow Your Instincts
My husband woke up one Sunday morning, the last Sunday in 2013, and his eye looked puffy. We both thought it was from his sinus/upper respiratory infection. He'd started antibiotics the day before, so no big deal, right?
Thankfully, I decided to call the doctor to ask if we should be concerned, and then opened my trusty laptop. Always Google medical conditions so you can find out the full list of crazy things you might have. No, I'm kidding. But I do like to Google medical things to be sure I am informed and knowledgeable, and because I love medical stuff. Good thing.
One site said it could be from blood clots, but I didn't think it was that. It said, check the pupils in the eyes. OK. So I told my hubby to let me check. BOOM! Life changing moment. One pupil was tiny and barely responsive. It wouldn't open right. That was the eye that looked puffy. Time for a trip to the emergency room!
So, I tell my husband his pupil is wonky and we need to get to the emergency room. However, he is only 47, and he's a very strong, healthy man.
He says, "No, let's wait to see what the doctor says."
Me, "Um, NO. We are leaving now!"
I love my big strong man, and I understand his reluctance, but some things aren't up for negotiation. On the way to the hospital, my phone rang and he answered it. It was the doctor's office calling to be sure we were on our way to the emergency room.
Everyone we met after that took one look, listened to the story, and then hurried to find out what was wrong. We have a few funny stories on the way. First, the triage nurse asked a bunch of questions, in a quiet, bored manner. He finally looked up and said, you are on antibiotics, so why are you here?
"His eye," I say emphatically.
After an eye test and flashlight in his face, the nurse says, "Wait outside until we call you." He then turns, before we leave the room, and slides open a small window. He calls out to the next room, "Where is the full arrest cart? Make sure we have it ready."
My husband turns to me and tells me he doesn't like the sound of that. I tell him it isn't about him. Silly worrier. Huh. He was right. We were quickly taken to a room, seen by a doctor, and he was sent for a CT scan. Definitely not the usual slow process I've experienced in emergency rooms before. Then they moved him out of his room, into a small side area, and ten minutes later they wheeled him into a bigger room.
Hubby sees the sign saying Trauma Room and asks the nurse, "Why am I in the Trauma room?"
Nurse, "Oh, they just name the rooms. That's just the name for this one."
Right. Then the doctor comes in an stammers a bit. He stops and says, "Let me start over. You have a carotid artery dissection."
As he goes on to explain what it means, the nurses are rushing to start two IVs, one in each arm. One nurse says, "Sorry, we have to put a big needle on this side in case we need to get meds in you fast. This will hurt."
Once the heparin (blood thinner) is started, they rush Roger up to ICU. They are talking about surgery, and sending him to a bigger hospital an hour away. It takes less than an hour to hear from the Vascular Surgeon. His dissection is too dangerous to consider operating on at this time. We get to stay in our hometown, and hope the doctors can fix this with medicine.
He is checked constantly in ICU, and the next morning we begin to see doctors. He ends up with four on the case. His General doctor, the vascular surgeon, a neurologist, and a cardiologist. They are all amazed and intrigued by his case. He is one in a million. The doctor in charge of the E.R. for the night comes to tell us he's never seen a case like Roger's, and he probably never will again. Roger has a rare condition called Horner's Syndrome, and it probably saved him from a stroke, or worse.
Horner's is the name of the syndrome that comes when the nerves to the eye are damaged and the pupil stops responding, the eye droops, and there is intense pain and pressure. If we hadn't noticed that, he would have gone on to the next step, and probably had a stroke. Horner's can be caused by a few different things,and one is when the carotid artery dissects, and then the bulge pushes on the nerves to the face. He is now in pain from that, but his brain is intact.
Why does the dissection happen? That is a good question, and one that hasn't been completely answered. There are two different kinds. One is from trauma, like in a car accident, and the other is called spontaneous dissection. My husband's was the second one, though they think a rather violent sneeze caused the tear. My kids are now afraid to sneeze, but there were other factors involved.
First, the condition of the artery is considered. As we age, and depending on our lifestyle, our arteries can become less elastic. Smoking, high cholesterol, and high blood pressure all take a toll on our vascular system. My husband had smoked for over 10 years, and his blood pressure had recently been crawling higher and higher. It was only a few months, and the doctors were at a point where, if his pressure didn't go down, they were going to prescribe medicine for that.
For some unknown reason, a good percentage of people who have had a carotid artery dissection, or CAD, have had an upper respiratory infection just previous to the event. My husband was quite sick with a bad cough and was on antibiotics and over-the-counter cold medicine. This may have raised his blood pressure even more. If there is a tear, and the blood is forcefully pushing through the artery, the lining will rip even farther. His tear starts low on his neck and goes all the way up into his skull.
Our neurologist said to picture a rug, and when a piece rips and is then pushed by a flood of water, it can roll right up as it goes. Or picture a fruit roll up. Either way, the flap of tissue that tore rolled up and blocked (occluded) his artery 90%. They aren't sure if that will get better as it heals. It may stay blocked, or it may open up some. Only time will tell.
So now, he is not supposed to stress, lift his arms up over his shoulders, lift more than 10 lbs, stretch, twist, cough, sneeze, or strain. You get the idea. Plus he is in pain from the nerve damage and possibly the healing process. It is a long recovery, and chances are good that he will never go back to his construction job. He'd worked his way up to a well respected position, and a decent career. Now we have no income, and his life has changed...but don't stress.
This will be a learning experience from here on out. Learning how to start over in middle age. Learning how to lower stress in our lives. Learning to appreciate family and the good friends that have been there to help us through this. Learning to take better care of ourselves. The wonderful part is that we still have Roger with us. The rest we can deal with. One thing that has helped is finding a group on Facebook of other CAD survivors. If there are more of you out there, please comment so we can get in touch. You know how important that can be as he is healing.
Enjoy each day, and don't let the little things ruin the good in life. We are thankful for each day we have together to continue learning and loving.
Eating Healthy Is Now a Priority
Eating to promote a healthy heart has become a new way of life in our family. We used to alternate between eating healthy and then opting for faster, cheaper alternatives when things got busy. We no longer have that luxury.
Since Roger must keep his blood pressure low, a low-salt diet is essential. That means no processed food. In addition, we are upping the fresh fruit containing vitamin C for healthy blood vessels. We have also reduced the amount of red meat and fat in our diets.
We have discovered some great new recipes, and I will work to share them on another article soon. Take care, and hug your loved ones today.