Dr. Giannotto’s Stroke

It has been a while since I posted on the Giannotto Clinic Facebook Page of our blog. This clinic has undergone a large move to a new space and for the last six weeks I have become a patient in the medical system. I have always attempted to explain the benefits of proper lifestyle in taking control of one’s health and have literally adhered to the principles that I have defended. Healthy eating, daily exercise and proper supplementation have all been a major part of my life, and in the end, are probably, according to my physicians, what saved me. I wish to explain what happened to me, why it happened and my thoughts about lifestyle changes bringing a positive ending or beginning to the story.

It was February 19, 2016 and we were in the middle of an extremely stressful move. By the end of the day on February 20, I was exhausted and went to bed early. I did not sleep well as I was constantly thinking of the move, the ensuing problems and my staff. I awoke on February 21 feeling extremely fatigued and went through my Sunday morning routine of reading the papers and enjoying a cup of coffee. I decided to try and shake my fatigue by going to the gym and do some interval training on the elliptical cross trainer. I felt good while on the trainer, worked up a sweat and finished the 40- minute routine without incident, or so I thought. I walked home, entered the building and went to speak to the concierge about an impending delivery. I knew exactly what I wanted to say but the words would not come out. As my mind raced, I thought to myself that this dysphagia (inability to speak) was a sign of a stroke happening at that very moment. In about thirty seconds, the episode ended and I could speak normally. I noticed that I became frustrated and tired. I went up to the condo, laid down and woke up an hour later feeling refreshed. I thought nothing more of the incident that day. Having spoken to several friends, including one in the medical profession, I was urged to seek immediate care. Being the stubborn doctor that I am, I chose not to go to the emergency room and to be treated by the medical student or doctor on call and to instead call a neurologist that I knew Monday morning.

Monday, February 22 came and I had slept well and felt great. I did another elliptical workout combined with weight training successfully. I went into the office to oversee the move. I had one of my assistants take my blood pressure and it was elevated at 165/100. I put a call into the neurologist and was waiting for a reply. Now my blood pressure had always been borderline and I was on two drugs for the control of the hypertension. Between the medication, the exercise and my healthy diet, the blood pressure was mostly controlled, or so I thought. I had not heard back from the neurologist by closing time and left the office to have dinner with Dylan, my office manager. And as we were sitting quietly enjoying our meal, I experienced a second episode of dysphagia which lasted about 2 minutes. I was speaking to Dylan and was on the phone with my sister at the time I lost control of my speech. I began to cry. I could not control my speech and was frustrated as hell! And then in a matter of minutes, I felt normal. Both Dylan and my sister urged me to get care that night but I refused again. Dylan was so upset, he did not leave the front of my condo for an hour and debated calling 911 despite me. In the end, I fell asleep and felt great the next morning.

The neurologist squeezed me in to his schedule on February 24. Dylan accompanied me and with good reason. He was present during the second episode and could describe it more accurately than I. The neurologist put me at ease. My blood pressure remained elevated, but then again, I was stressed beyond what I was used to. And I was frightened and anxious about my prognosis. He concluded that I had experienced either a TIA or transient ischemic attack( aka a minor stroke), or perhaps a seizure. Blood tests, scans, and an EEG for the brain were scheduled and I was to return in several weeks for the results. I was told to continue to exercise but to tone it down a bit, and continue my Mediterranean type diet.

That night I thought long and hard about my lifestyle choices and the role that my genetics were playing in this situation. My father had died of a stroke in his eighties and my mother had died of severe coronary artery disease. My younger brother had a myocardial infarction (heart attack) resulting in a stent procedure. I was anxious to find out what was happening to me. I assumed that adhering to the lifestyle choices that I made would protect me but now I was doubting everything that I preached. But I soon discovered that I was wrong. I had tunnel vision.

I made the decision then and there that I would intensify my lifestyle choices. I decided to eliminate most animal protein from my diet and rely on a mainly plant based diet. Yes I became a vegetarian, with the exception of some dairy on the weekends. I decided that I was not going to become maniacal about it and that occasionally I would enjoy some fish or chicken. But for the most part I followed a course of nutrition espoused by Joel Fuhrman, MD which can reverse heart disease, atherosclerosis and cancer. I have previously written about this in a post last year. I was determined to do everything I could to reverse or negate my genetics. I decided to switch m workouts from weight lifting to cardio and yoga in the hope that I would calm down and lower my blood pressure. I admit that I am impulsive and these decisions were sudden, especially since I had no test results at the time. But I was not ready to give up and I wanted to do something positive immediately.

Within the next ten days, I had MRI of the brain, an MRA with dye of the brain and carotid arteries (the major blood supply of the neck and brain), blood studies, and EKG and consultation with a new primary care physician. The role of a patient in the maze of medical offices, hospitals and insurance companies is not an easy one and I can see how a patient could easily get sidetracked into unwarranted testing and unreasonable scheduling. Being the physician that I am, I would not put myself in the situation of being told when or where to go. I constantly questioned the system and usually avoided unnecessary and duplicate testing. I did request an echocardiogram to assess heart function and my request was accepted.

The night of the dye test on my brain and carotid arteries I received a phone call from a doctor on call for the neurology group. She had the radiologist’s report which showed an 80-90% obstruction of the left carotid artery and a 60-70% obstruction on the right side. In light of my history she urged me to check into an emergency room immediately so that further work up could be completed in hospital. I found this upsetting as I was having no symptoms. I know the doctor was trying to cover herself and her medical group, but her request had the effect of elevating my blood pressure and anxiety to the point that I had a minor breakdown. The next morning, I called the neurologist and complained about the way I was treated. The nurse made an appointment that afternoon with a vascular surgeon and agreed that following my gut feeling was probably correct. How are most patients supposed to know this? Patients are taught to believe in the system. I feel that it needs to be questioned every step of the way.

I met Dr.Dipankar Mukherjee in his office and he immediately calmed me down. Dylan was there as was Matt Cissell, a PA with INOVA Hospital System who was a former surgical assistant of mine. The doctor put me at ease by telling me that the dye studies often exaggerated the extent of the pathology at hand and then made the observation that my blood vessels were strong, like that of a nineteen -year old and did not reflect my sixty four years at all. Ah, I thought, positive lifestyle changes are at work here. I was encouraged.

He then performed Doppler aka ultrasound studies of the blood vessels in question. The left carotid was 80% occluded and the right between 40 and 50% occluded. I needed a left carotid endarterectomy. In this procedure the artery is clamped, opened and the plaque is removed. Then a patch is placed upon the artery and closed tight. This would be done under local anesthesia and I would remain in the hospital overnight for observation. He wanted the small stroke area of the brain to heal a bit before this. I was to continue my diet and exercise plans. The procedure was scheduled for March 24.

Part two will be posted next Tuesday, April 19th at 11:00am. Stay tuned.

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