After waiting a few minutes to make sure she was really asleep, Casey picked up the research and continued to read. “How atherosclerosis and clot formation cause transient ischemic attack–It can make arteries in the neck a lot more narrow, allowing little or no blood flow through these arteries. A blood clot or piece of plaque can block an artery and halt blood flow entirely, or a blood clot can break off and make its way to another place and block the blood supply there. Blood clots can form when cells in the blood named platelets clump together. Very often blood clots are brought about by atherosclerosis, however they can also be caused by certain heart conditions. Blood clots can form anywhere in the body, including inside the arteries and on the vales in the heart. The majority of blood clots causing TIAs originate from the carotid arteries in the neck (fifty to sixty percent). About twenty-five percent originate in the heart, and the remainder of them originate in arteries in other parts of the body. When a TIA happens, the plaque or blood clot breaks up and clears away on its own. Little or no brain damage happens, and the symptoms go away without any treatment. If brain cells are deprived of their blood supply for a longer period of time, some cells will die, resulting in a stroke. Damage to a particular part of the brain affects the function controlled by that part of the brain. For example, damage to the speech region of the brain may lead to challenges talking. TIAs may not cause obvious lasting effects but are a significant warning sign of risk of stroke or more TIAs.”
“This is definitely a good refresher for me. I’d forgotten a lot of this stuff. Besides that, I’m saving Nikki the trouble of having to read all this on her own. I’ll be able to answer questions she has too. ” Casey murmured before she continued. “Recognizing TIAs and Stroke–Should I be concerned if I’ve had a TIA–A TIA’s a really serious warning sign that something’s wrong with the blood flow to your brain. If you’ve had a TIA, you’re at an increased risk of having a stroke. The most significant risk is in the immediate period after the TIA and up to the first year. The good news is that because a TIA warns you that you’re at risk for a stroke, you can take steps to prevent it. Individuals who’ve had a TIA are five times more likely to have a stroke over the next two years compared to the general population. Lots of individuals who’ve have a stroke had one or more TIAs prior to their stroke.”
“Why I need to get medical attention quickly if I think I’m having a TIA or stroke–Arriving at the hospital quickly is critical to getting the best treatment. Over the past few years, significant advances in stroke treatment have been made. The new treatments must begin within a few hours of the onset of symptoms in order to be affective. Doctors need to carefully investigate to find out what caused your symptoms so you can get the correct treatment.”
“That’s probably why they’re taking so long to come and talk to us. They need to find out what kind of stroke it is, if he even had a stroke.” Casey murmured before continuing.
“Never try and figure out on your own what’s causing your symptoms and don’t wait for them to go away. Get to a hospital as fast as you can. Even if your symptoms go away on the way there, being seen by a doctor is critical in identifying the underlying cause of your symptoms. Recognizing TIA and stroke warning signs as soon as they appear and getting immediate medical treatment gives you the best opportunity of a good outcome. If you have any symptoms of a TIA or stroke, call 9-1-1 or your medical emergency number right away.”
“Stroke–Something to think about… Seven percent of all deaths in Canada are caused by stroke. It’s the fourth most common cause of death in Canada. Stroke’s the leading cause of adult neurological disability in Canada. Approximately fifty-thousand strokes happen in Canada per year. Sixty percent of stroke survivors will be left with a disability.”
“I was hoping it would be a little less with the new advances.” Casey murmured sombrely.
“Between two-hundred-thousand and three-hundred-thousand Canadians are stroke survivors.”
“That’s something encouraging.” Casey tried to sound optimistic.
Awhile later, as Nikki and Casey sat in the waiting room discussing how best to tell Nick and Victoria what was going on, Victoria rushed in.
“Mom, what happened? Where’s Dad?”
“Victoria. I thought you’d be here later on.”
“Hi Aunt Casey. The way I drove, I’m lucky there weren’t any police officers out on the roads tonight. “What’s going on with Dad, what happened? Mom, what’s going on?”
“Let’s just wait for your brother, alright?”
“It’s bad, isn’t it?”
“Victoria, let’s just wait for Nicholas, okay?”
“What? Mom, come on, you’ve got to tell me something, I’m going crazy here! Tell me what’s going on?”
“Mom, what happened?” Nick asked as he raced into the waiting room.
Hoping to compose herself enough to be able to tell them what had happened, Nikki took a deep breath before beginning, “I found your father at the office.”
“We figured that out.” Nick studied her closely, trying his best to figure out what was going on.
“You should both sit down.”
“Mom, just tell us what’s going on! Stop trying to soften the blow and tell us!”
“Victoria, this is hard enough for your mother. Just be patient!” Casey told her, effectively silencing both her and Nicholas.
Swallowing hard and taking another deep breath, Nikki finally told them, “Your father had a heart attack.”
“What?” Nick asked in disbelief. “You’re kidding right? Dad had a heart attack? When, how? Why? What do the doctors know? What are they doing for him?” Unable to comprehend, let alone believe what he’d just heard, he peppered his aunt and mother with questions.
Victoria, on the other hand, was strangely quiet.
“Victoria? Sweetheart? Are you alright? How are you holding up?” Nikki whispered softly as she took her daughter’s hand.
“What aren’t you telling us?” Vicki asked suspicious, strangely detached. “This can’t be happening! I just saw Dad before I left and he was fine! What happened? What the hell happened?! If Bradley had anything to do with this there’ll be hell to pay! He’ll rue the day he ever decided to try and insinuate himself into my family again!’ Victoria thought to herself, quickly growing both suspicious and furious at his growing audacity!
“Sit down, both of you.”
“We’re fine, Mom, just tell us what’s going on.” Nick wouldn’t give up. ‘She’s nervous, terrified even, what the hell’s going on? What could’ve happened here?’ he thought to himself, getting irritated.
“Mom, just come out with it! What’s going on? What’s wrong?” Vicki snapped impatiently, angrily.
Taking a deep breath, Nikki replied, unable to look her children in the eye at first, “After that, your father had a stroke.”
“What? What happened? What the hell happened?” Nick asked completely shocked.
“You’re kidding, right? Please tell me you’re kidding!” Victoria exclaimed as her jaw dropped and her blood ran ice cold.
“I wish I were. You have no idea how much I wish I were.”
“What the hell happened? What happened? Haven’t the doctors told you anything for heaven’s sake?” Victoria continued, completely flabbergasted by what she was hearing. “They must know something by now! What caused the heart attack and the stroke? How much damage was done? What can they do to fix it? When can he come home?” Vicki peppered her mother with questions, determined to get whatever answers she could.
“Victoria, we don’t know what damage was done, or the extent of it. We won’t know anything until your father wakes up. All we know for now is that it was caused by a blood clot.”Nikki replied apologetically, as she silently vowed determinedly, ‘And he will wake up. There is no way we’re going to lose him now!’ “Aside from that, the only thing we do know is that, at this point, is that the only thing left for the doctors to do is a heart transplant. But, he’s still too weak for that.” She finished, watching her children’s faces as the shock faded, only to be replaced by immense fear, total disbelief and fury.
“A transplant? This is a nightmare! What are they doing about this? Why haven’t the doctors told you anything?” Vicki demanded hotly, impatiently, as she tried but failed to keep the fear running through her at bay.
“Vicki, come on, just take it easy. They’ll tell us as soon as they find out anything.” Nick reasoned calmly, although he was equally upset. “I know how you feel, but we can’t do anything for now. All we can do is sit and wait.”
“Nicholas is right, the best thing we can do now is just let the doctors do their work. We need to just sit and wait for them to find the answers we’re looking for.” Nikki reasoned, much calmer than anyone expected.
“You’re kidding me! What are we supposed to do in the meantime, just sit and wait? Wait for what?” Vicki shot back angrily, fearfully.
“Damn it, Vicki, you don’t think I hate this? You don’t think I want to believe it’s just some kind of horrible mistake? I’ve got news for you, I do! So, excuse me if I’m not telling you what you want to hear! That’s not my job! And, don’t start this! Don’t you start this garbage with me! I’m just as upset as you are so don’t go giving me a hard time alright!”
“Oh yeah, could’ve fooled me! You’re sitting here calm as can be, you act like Mom just told you Dad broke his leg for God’s sake! Don’t you tell me what to do! Back off Nicholas, I’m warning you!”
“What are you gonna do, huh? What are you gonna do?”
“That’s enough!” Nikki half yelled, making Victoria and Nicholas turn to her, shocked at the sudden outburst. “I know you’re both angry and upset, I know you’re scared too. But this is the last thing your father needs and it’s absolutely the last thing I need! Now, if you’re going to continue this, go do it somewhere else! Clear?”
“What does everyone expect me to do, sit here and pretend everything’s just fine? Is that it?” Vicki asked angrily.
“No, Victoria, nobody wants or expects you to do that.” Nikki sighed as she sat beside her daughter. “All I’m saying is that we don’t need to go pushing any panic buttons yet.”
As tears welled up in her eyes, Vicki paced to the window and stared out it blankly.
His voice matching his ice cold eyes, as he glared at Vicki Nick said, “I’m going to get some coffee.” Then turning to Casey, he asked, “Can I get you anything?”
“No thanks, honey, I’m fine.”
“No, I’m fine, sweetheart.”
“Victoria, I know how you feel right now, but what you did to Nicholas just now wasn’t right.”
As Vicki stood there with her arms wrapped around herself protectively, she thought to herself furious, ‘You have no idea how I feel right now! You have no idea, so just quit wasting your time trying to make me think you do!’
“Victoria, nobody’s giving up on your father. Nobody’s ready to let him go. The doctors are doing everything they can to make sure he’s okay and they’ll keep doing it. He needs you to be strong for him.” Casey explained, hoping that, on some level she’d get through to her niece.
“It doesn’t make this any easier, it probably should, but it doesn’t,” Vicki whispered with her back still turned towards her mother and aunt.
“I think I’ll give you two some time alone.”
“Victoria.” Nikki whispered her name softly as she walked up to her and put a hand on her shoulder.
Nikki got only a brief glimpse of the tears pouring down her cheeks and the overwhelming pain tearing at her soul as Victoria quickly wrapped her arms around her mother. Her voice was a mere whisper as, clinging to her mother, she said, “Mom, why is this happening? Why is this happening? I don’t want to lose him, Mom, I don’t want to lose him. I can’t lose him!”
Unable to find the words she needed to comfort her daughter at a time when she needed it most, Nikki wordlessly wrapped her arms around her daughter as she let her own terrified, angry and bitter tears fall.
Slowly pulling back and wiping stubbornly at her tears, Vicki asked, “What’s with the binders Mom?”
“Research on what?” Vicki asked a little confused, a little intrigued.
“Heart attack and stroke.” Nikki answered plainly.
“That makes sense.” Vicki answered quietly before hesitantly asking, “Mind if I take a look?”
Surprised to hear her ask, Nikki said, “No, go ahead.”
Quietly clearing her throat, Vicki began. “Risk Factors for TIA and Stroke. What’s a TIA?”
“It stands for Transient Ischemic Attack, basically it’s a mini stroke that acts as a warning sign that another more serious stroke may be coming.”
“Oh.” Vicki answered quietly before continuing. “What are the risk factors for stroke– A risk factor’s something in an individual’s physical condition or health habits that increases the chance of developing a medical condition like a stroke. Once you’ve had a TIA it’s imperative that you do all you can to decrease your risk factors of stroke. Some risk factors are there at birth, some are because of normal changes like aging and some are because of lifestyle. Risk factors you can’t change are: Age, Gender, Ethnic background and Family history of stroke or TIA. The closer the family member, for example a parent who’s diagnosed as having had a heart attack or stroke, the higher your risk. You can’t do anything about these risk factors. But, if you’ve got one or more of them, you should take extra steps to make healthy lifestyle choices to prevent stroke. Risk factors you can change are: High blood pressure, Smoking/Being smoke free, and limiting alcohol use. If The above methods aren’t effective. Medications may be prescribed. For it to be effective, it needs to be taken regularly. Never stop taking blood pressure medication without talking to your doctor first. If you’ve got any questions or feel any unpleasant side-effects, talk to your doctor. There are often alternatives. High blood pressure has been called the “silent killer” because often there aren’t any symptoms. The only way to know if you’ve got high blood pressure is to have it taken by a health care professional at least once every two years.”
“Who got you all this research?” she asked curious.
“Your Aunt Casey.”
“Oh. Mom, are you sure it’s a good idea to be reading all this stuff? You look exhausted and it can’t be good for the twins.” Victoria told her mother wisely, trying not to upset her.
“Yes, Victoria, I’m sure.” Nikki told her, trying to keep her temper under control, although that was very quickly becoming nearly impossible.
“Okay.” Vicki reluctantly relented before continuing.
“More on Risk Factors: Become smoke-free–Smoking’s the most preventable cause of disease and death in Canada. Despite what most individuals think, smoking causes almost as many deaths from stroke or heart attack as it does from cancer. It affects the circulatory system in many ways. It adds to the buildup of plaque in your arteries. Nicotine raises your blood pressure. The carbon monoxide in cigarette smoke cuts down on the amount of oxygen your blood carries to your brain. Cigarette smoke makes the blood thicker and more likely to clot. Individuals who become smoke free can quickly cut down their risk for stroke to that of non-smokers. Non-smokers can reduce their risk by avoiding environmental tobacco smoke.”
Turning to her mother, Vicki wondered aloud, “With all the junk they put in and side- effects, it’s pretty hard to understand why people would want to start smoking in the first place! What makes it so appealing?”
“I don’t know.” Nikki snapped at her her grumpily, tiredly.
“Sorry, I guess I’m not helping much.”
“No, it’s not that. I’m just getting really frustrated. Nobody will tell me anything!”
“Why don’t we go for a walk, it might help.”
“No, keep going. I need to hear this.”
“Okay, but I don’t know if it’s such a good idea.” Then, seeing the look in her mother’s eyes, she continued reading her the research.
“Physical inactivity–Over half of Canadians don’t get enough physical activity to prevent heart disease and stroke. Regular physical activity raises the level of ‘good cholesterol’ (HDL) in the body. It also makes muscles more efficient and aids circulation. To reduce your risk of stroke, you should be physically active for thirty minutes a day most days of a week. How much exercise you need to do depends on how hard you’re exercising–for example, a short run can provide you with the same benefits of a long walk. You can get the same benefit from breaking you physical activity into shorter sessions, like three ten minute sessions per day. Remember to talk to your doctor before starting a fitness plan.”
“I guess all that exercising he did just wasn’t enough.” Vicki murmured half to herself before she continued.
“Heart disease–Coronary artery disease, heart valve defects, an enlarged heart, or an irregular heartbeat can make blood clots form in the heart that can break loose and block arteries supplying blood to the brain. The doctor may prescribe medicine to help prevent clots forming. Because it makes clots that can break loose and travel to the brain, arterial fibrillation, a kind of irregular heart rhythm, is strongly linked to a higher risk of stroke. If you’ve got arterial fibrillation, make sure to ask your doctor about anticoagulant medicine.”
“What’s anticoagulant medicine?”
“Medicine that makes it harder for blood clots to form, I think. I’m sure it’s in there somewhere.” Nikki told her
“Mom, when was the last time you ate?”
“I don’t know, but I’m not hungry.” Nikki told her firmly, letting her know in no uncertain terms that she wasn’t in the mood to discuss anything but what was going on with her husband.
Picking up on her mother’s unstated warning, Victoria nervously continued. “Diabetes– Diabetes mellitus is a condition where the body doesn’t make or use insulin right. It often leads to high blood pressure and high levels of cholesterol in the blood. Individuals with diabetes are at much greater risk for stroke compared to the general population, and women with diabetes are especially at risk. Risk of stroke also starts at a much younger age for individuals with diabetes. If you have diabetes, you should eat a healthy diet, exercise daily, maintain a healthy body weight, and take the medicines prescribed by your doctor to regulate blood sugar levels and reduce your risk of stroke. Good control of your diabetes is the best way to minimize your risk.”
Turning to her mother, Victoria asked hesitantly, “Do you think Dad developed diabetes? Is that what happened? Did they just not catch it in time?”