Stroke Symptoms: Think You Know Them All?

Thanks to effective public awareness campaigns, many of us are familiar with the common signs of stroke. Think of the television ads that show us what to look for if we think someone is having a stroke.  The mnemonic “F-A-S-T” reminds us to look at the Face (is it drooping?), Arms (can you raise both?), and Speech (is it slurred?), and to waste no Time in getting help.

This checklist is a potential lifesaver because when it comes to strokes time is of the essence. But there’s more to the story. That’s because there’s more to the anatomy of our brains than what can be incorporated into a simple memory jogger of stroke symptoms. I learned this the hard way.

I’ve written elsewhere about the fascinating system that feeds blood into the human brain. More on that very soon. (By the way, everything I write on medical matters is in layman’s terms.) In brief, there are two main sets of arteries, the carotids and the vertebrals. These arteries are found in the front and back of the neck, respectively.

The carotids are the workhorses, accounting for about 80 percent of the total blood flow to the brain. And these are the arteries that, if they get blocked or damaged, can result in the symptoms noted above.

In 2017, I began to experience symptoms that didn’t fall into the handy, F-A-S-T category. Over a period of two months, I had several episodes of vertigo. I saw strange artifacts in my field of vision. I had a sensation that my body had become disconnected from my brain.

Then, one morning in July 2017, I woke up feeling odd. The first things I did were look in the mirror (to see if my Face was drooping) and talk (to see if my Speech was slurred). They weren’t. I could move my arms and legs, although they felt strangely heavy and lethargic. Naturally, I concluded I wasn’t having a stroke.

The scans done later that day in the ER said otherwise.

It turns out I had developed a blockage in my left vertebral artery. These arteries, left and right, run from a point about the level of your collarbones at the back of the neck. They join up to form the basilar artery, which feeds blood to the back of the brain. The vertebrals account for about 20 percent of the blood flow to the brain, and when they are blocked, functions like balance and coordination, including visual and hearing coordination, are affected.

The blockage in my vertebral artery had probably been there for some time before it started to cause symptoms. Until my situation was eventually brought under control, after a lengthy stay in the Foothills Medical Centre stroke ward, I experienced a wide range of symptoms. I had my eyes and ears go out of sync, as if someone had gotten hold of the control knobs in my brain and started twisting them randomly. My tongue turned into a frozen lump. My arms went into jerky spasms. It was not pleasant.

The reason I’m explaining all this is to share what I’ve learned. While catchwords are helpful, they don’t tell the whole story. If you, or someone you care about, is having any of the above symptoms or a long list of others[1], get it checked out immediately. Symptoms that are caused by a blockage in the vertebral arteries can be deadly serious, just like those in the carotid arteries.

By the way, when I did some research into the F-A-S-T mnemonic, I found some recommendations that it be modified to BE FAST. Why? The B and E would include Balance and Eye trouble in the checklist of stroke symptoms. This version of the mnemonic certainly would have helped me.

[1] Other potential symptoms of “vertebral artery stenosis” include sudden falls, severe headaches, breathing problems, confusion, trouble understanding speech, incontinence, and more.

An Ideal Photo Run

Today’s photo run was perfect.

The weather in Calgary has taken a turn. I was about to write “for the worse” but since this is a blog about running, I’ll leave that comment off. Let’s say that we have seen a change, from something approaching “too hot” to “good running weather”.

Cool temperatures and drizzle often have a way of dampening (pun intended) my enthusiasm for a run. But one thing I’ve learned is that I need to look beyond those feelings and get myself out the door. Today was no exception.

After a block or two, I knew I had made the right call. The Elbow River pathway was quiet, and the river was looking fine. The sun was trying its best to make an appearance. I knew the light would be good for photographs, so I brought along my trusty Ricoh GR III.

One spot I’ve gone by a thousand times but have had trouble capturing is the small garden on Elbow Drive at 30 Avenue SW. It’s an attractive little spot but I’ve always found something challenging about the composition. Today, though, the combination of the soft lighting, misty conditions, and the new foliage was magical. I stopped and grabbed a couple of shots without a second thought. Later, I tried Lightroom’s infrared preset and got a result that I think was very cool. I hope you’ll agree

Almost back home, and content with the run (and the photos), I passed a leafy corner and noticed two eyes peeking out from between the hedges. Closer inspection revealed that it was, in fact, the headlights of a Triumph TR3 sportscar. At least I think it was a TR3. Maybe a car expert reading this piece can confirm its pedigree. In any case, it was a scene that made me smile, and a fitting way to end my run.

Enjoy.

A Different Perspective on Sustainability

I just picked up my 1954 Leica M3 from a routine but overdue service. I couldn’t wait to get it home and load it with film. Yes, 1954. Yes, film.

Holding this remarkable machine in my hands, feeling the impressive weight of its all-metal construction, is an experience. But looking through its now clean and perfectly clear rangefinder to compose a picture and pressing its silky-smooth shutter is something else entirely. And don’t get me started on the feel of its double-stroke film advance. I hope I haven’t lost anyone yet.

Some would suggest that my nearly seven-decade-old camera, totally manual and without any kind of exposure metering, is the best camera ever made. Others might take one look and scoff at it as a worthless anachronism.

It got me thinking about how much we have lost, in our seemingly endless quest for the latest gadget. When did we get on this treadmill? The more relevant question is, why?

There are other examples of devices that seem to have reached a point of perfection, before sliding down a slippery slope on the back of consumerism. Italian racing bicycles are a good example. There are few things more suited to their purpose than steel-framed bicycles from Bianchi or Colnago, especially when kitted out with high-end components from manufacturers like Campagnolo. Just like my camera, they are perfectly suited to one job, and they were built to last.

The curious thing is that the apex for many such devices was reached at about the same time. The mid-to-late 1970s seem to have been a watershed period. After that time, something changed. An endless push for profit ensured ever-decreasing quality. Offshoring of production and substitution of parts with (usually) plasticky alternatives sealed the fate of manufacturers who had built their reputation by designing equipment that could last indefinitely.

From the consumer point of view, we came to accept this trend, because rapidly changing tastes made it less likely we would want to hold onto one product for a lifetime anyway. Fashion, which has always been at the forefront of the throwaway mindset, became a model for how other goods were marketed.

No one stops to ask if there is an alternative to the mania that accompanies each new release of the latest iPhone or the newest gee-whiz electronic gadget. To my mind, it does nothing but ensure that we will be putting a lot of material in landfills, as last year’s devices are cast aside just before they fail.

All of this makes it more satisfying that I can still pick up a camera that is older than I am and take pictures that are every bit as impactful as those coming out of the latest high-resolution, high-frame speed digital monster. Maybe more so, in fact.

Posing for her portrait, Leica M3 and Ilford Delta 100 film, 2022

When I travel with my M3, I don’t have to worry about chargers or SD cards. When I estimate the exposure with my brain, and when I get it right, there is no feeling that can compare. Sure, not all my shots are keepers, but that’s the quest that makes it worthwhile. Even the wait for my film to be processed seems to enhance the experience.

And when I’m done, I will be able to pass this wonderful machine onto my sons, knowing that with a bit of care it will serve them well for their lifetime too. How’s that for sustainability?

Running and Thermodynamics

In his book, “Running with the Pack”, philosopher Mark Rowlands makes some interesting observations about evolution. His essay, “The Serpent of Eden” starts by explaining the first and second laws of thermodynamics. While this immediately caught my attention as a chemical engineer, it may not resonate with everyone.

Basically, the preposition of the first law is that energy can neither be created nor destroyed; it can only be converted from one form into another. The second law states that any closed system (like the universe, or like us as entities within it) tends towards maximum disorder.

So, what does this have to do with running?

Well, Rowlands makes a rather neat argument that can be paraphrased as follows: because we evolved as creatures in a world where our stores of energy rely on us converting it from another source, there is a predisposition for us, as conscious beings, to focus on the competitive forces that allow us to continue living. Human beings are highly complex, closed systems, and for us to survive (that is, to avoid maximum disorder) we must compete for energy. And to do that, we must get it from another source.

Said another way, we tend to focus on those things that affect our ability to continue the competition… to stay alive. This is nothing more than the natural result of our evolutionary makeup. (Of course, the end game is predetermined, but let’s put that aside for a minute.)

Think about this. When you are running, and things are going especially well, what do you notice? Are you conscious of your heart and lungs and legs all doing their job efficiently, just as they were designed to do? No, of course not. They just get on with their job, and you enjoy the intrinsic benefits without even thinking about it.

Instead, what we tend to notice, as conscious, competitive beings, are the things that aren’t going so well. That niggling pain in your knee, or the stitch in your side, or any number of other ailments is what gets your attention. You do notice these things because, as Rowlands suggests, our brains have evolved to notice when things aren’t going well.

Rowlands gives further depth to his argument, with reference to the work of the great philosopher, Schopenhauer. And frankly, some of his observations are a bit depressing. Schopenhauer observes that because we are so highly evolved, with cognitive abilities like memory and anticipation, abilities that other creatures don’t possess, we are especially sensitive to our place in the grand thermodynamic scheme of things.

If the universe is destined to end up with maximum disorder, we might rightly ask ourselves why we bother. After all, what’s the point if we will all end up as worm food?

That’s where the Rowlands piece shines. He points out that as human beings, we have evolved as social creatures precisely because that improves our odds in the unrelenting competition for energy. The bonds that keep us together… mutual recognition, affection, love… can be seen as small bits of defiance against overwhelming odds, in a universe where the rules of the game are stacked firmly against us.

My advice is that the next time you are out running, you should spare a thought for the amazing confluence of conditions that had to go well for you to even be out there at all. The very fact that you exist is in defiance of the laws of thermodynamics, at least for the time being.

And the next time you are out running with your gang, give some consideration to them, as what Schopenhauer referred to as, “my fellow sufferers”. Since we are all in this together, it is only right that we should have some tolerance and patience with each other. As Rowlands says, “Every act of kindness we show to someone or something is a defiance of the spirit of the laws that made us”. Defiance may be futile, but it is still valuable.

Four Ways Running Has Changed

  1. Technology

These days, most runners take for granted that they will have a permanent record of every kilometre they run. Some obsess over it. But the availability of all this information and more is a relatively recent phenomenon. For much of my time in the sport, that is to say, the last half-century, there was almost no information available on pace or distance, let alone heart rate, recovery time or anything else.

I used to check the time on the kitchen clock before I left my house for a run, so I could have some idea of how long I had been running when I got back. Pace? Forget about it. That started to change when GPS watches came into the market. Of course, they are now ubiquitous.

I still think of my Timex Ironman watch as something special. This reminds me, there is something liberating about setting off for a run with no watch of any kind. Try it sometime.

2. Gear

As I plodded through fresh, wet snow on a 16k run yesterday, I thought about how fortunate we are to have tights, high-tech base layers, and Gore-Tex jackets to get us through the worst of our Canadian winter weather. We finished with slightly wet feet, but otherwise we were warm and comfortable. And in the summer, breathable fabrics magically shed water to keep us dry.

Am I the only one that remembers Adidas tracksuits from the 1970s? You know, the gymnast-style pants with the loops that went under your foot? They were made of some strange synthetic fibre whose only attribute was to guarantee to chafe. Or how about cotton T-shirts and sweatpants, which held water like a sponge? Then there were the cringeworthy Dolfin running shorts from the early 1980s. Richard Simmons had nothing on me. Some things are best forgotten – forever.

3. Races

This is probably the category where I’ve seen the biggest changes. Some are good and some are not. I’m thrilled to see so many more races on the calendar than we ever had in the early days. Not only that, races are almost always well-organized now, with proper timing and accurate course measurement. Gone are the days of haphazard planning and poor execution by well-meaning but inexperienced race directors.

But I have to say, there are downsides. I object to shelling out $75 for a race that is, frankly, a pretty minor event. I don’t need a technical T-shirt and a finisher’s medal from each race I run. Sometimes, I’m just there for a quicker pace run, or to get a bit of competition. I’d much rather have the choice of whether to buy the shirt, and I really could do without the medal. Maybe that sentiment underlies the growing Parkrun trend, where runners can show up and run/race, without all the trappings.

4. Participation

For years, the only participants in road races were gaunt, sinewy veterans of the circuit. Even the big races were sparsely attended, and the runners who did show up were all of a certain demographic. Many races went through an existential crisis in the late 1970s, when it became clear that small fields of young adult males didn’t bode particularly well for the future of the sport.

It was the salvation of the sport that running became mainstream starting in the 1980s and 1990s. Frank Shorter is often given credit for enticing a whole generation of new runners to put on a pair of newfangled Nike Waffle Trainers and give it a try. (I think there was more to it, but that’s fine.) Whatever the reason, we should all be thankful, because we are now enjoying the benefits. The starting grid for just about any road race is a healthy cross-section of society, including people of all ages. We’re all better off for it.

It’s Collateral

By any reasonable measure, I shouldn’t be writing this. I shouldn’t be able to do much of anything. And yet, here I sit, thinking and typing. My typing is certainly no worse than it was five years ago. That was before my first running life abruptly ended.

Over the last month, I’ve had an opportunity to push against the limits of my compromised vertebral artery system. Vertebral arteries – “verts” – are the second major set of arteries that supply blood to the brain; the back of the brain to be precise. The verts account for about 20 percent of the total blood supply to the brain. When they are blocked, like mine were, the result is an ischemic stroke.

In 2017, I had a number of transient ischemic attacks, or TIAs, which are often called mini-strokes. The strokes were due to a blockage in my left vertebral artery. The result was a long stay in the Foothills stroke ward in Calgary.

I’ll repeat what I’ve said many times since then: the doctors that deal with stroke patients every day are heroes. I know this firsthand because the Foothills heroes stabilized me and saved my life.

The blockage in my left vertebral artery remains untreated. This is only possible because my body has made a rather ingenious adaptation to the blockage, by building secondary arterial connections to keep blood flowing to my brain. We were able to watch this in real time, on a video taken from an angiogram procedure. It makes for fascinating viewing.

As I pushed through a 16k run in the snow yesterday, or a 20k run in fine weather the Sunday before, I realized that I am a real-life experiment. While I am apparently able to cover these distances without too much trouble, it has not been a straight-line recovery. Just after my hospital stay, I had trouble walking around the block. Slowly but surely, I put my life back together. As you’ll gather from the title of this blog, I call it my second running life.

I barely managed a 500m walk/jog a month after my last TIA. A year later I finished a 5k race side-by-side with my wife. Last year we ran the First Half Half Marathon in Vancouver.  

Now I’m at what I think is my upper limit. I can get through 20k, but not without discomfort. I know I’m at my threshold because my neck/shoulder are generally screaming for me to stop by the end.

Curiously, this is the same symptom I experienced before my strokes, when I was training at a much higher level. The pain was most severe during marathon buildups, and I’m certain that it was the first warning sign of the arterial problems I would have a few years later.

It occurred to me that I could perhaps use these pre- and post-stroke data points to estimate the change (if not the absolute amount) in blood flow to my brain. My assumption is that by comparing the usual measure of maximum oxygen uptake – the “VDOT” – I could arrive at an estimate of the amount of damage done to my vascular system by the strokes.

Before my hospitalization, I was training at a VDOT of between 50-52, based on my being able to run 1:25 to 1:30 for the half marathon. Last year, my wife and I completed a half marathon in 2:06, which suggests a VDOT of about 35. In both circumstances, I would consider myself to have been at my oxygen uptake limit.

Based on these empirical results, it would seem that I’ve experienced a reduction of between 30-35 percent in my ability to process oxygen in competitive running situations.

I’m not sure these estimates would have any value in a clinical setting, or whether it would be useful information in determining the next (if any) course of medical action. But it does make some sense, when you consider that I cannot come close to the kinds of performances I could manage five years ago. Even so, the fact that I can get through a strenuous run or race at all validates what I’ve come to see as the silver lining from this whole episode: I’ve been given a second chance, thanks to the remarkable machine that is my body. I know I mustn’t waste it.