STOPBANG - 3 yes. Tiredess, stop breathing and male.
That said I have a very low respiration rate as a result of abnormally large lungs - always need 2 plates when I get them x-rayed 
And I do wonder how many other people will find evidence of stroke damage if they have MRIs after covid.
There is no urgency to get a sleep study done but it would be advised to get one moving forwards. You score 3 out of the 8 risk factors, but will be 4 out of 8 soon (with age being 50 happening soon for you). That still keeps you at intermediate risk but only adding one more puts you at high risk (and it would be interesting to see whether they are wanting to give you any antihypertensive medications).
Re the MRIs and what we find post COVID-I think this has been really well shown in other areas that there is a lot of asymptomatic stuff which has been found further down the track.
Out of interest-did you attend a dedicated āstroke unitā hospital? The city where I live and work there are dedicated stroke units which have fast tracked ambulance protocols and immediate imaging and interventional neuroradiology to clear clots etc. My wife (who is a GP) came across another GP collapsed in a bathroom at the University prior to sitting an exam, it was about 1km from the stroke unit. They were transferred there immediately and straight into the interventional radiology unit for targeted thrombolysis.
Out of interest-did you attend a dedicated āstroke unitā hospital? .
I was fast tracked into the ED as the ambulance called a stroke code NIHSS score =2 and so on arrival then got instant care and almost immediately sent for a CT. However, as it was overnight there was no in hospital person to review the scans and so it was sent over to a site in Australia which took a couple of hours and then it didnāt show anything. So they just gave me some asprin and clopidogril. I went to be at 8:30, woke with the paralysis at 1:30 so they decided that the āeventā was 11:00pm and so couldnāt give me the clot buster stuff (4.5hr max) even if the CT had shown anything.
But, I did go into an Acute stroke unit (within the Health in Ageing ward). Was funny, the other 3 beds had a 96year old, a gut that was in his late 80s and a lady late 60s/early 70s. Where I live (Tauranga) healthcare system is set up more to deal with the significant elderly population. It is changing a bit in last 10 years, but when I moved here in 2010 someone described the City as a series of retirement homes connected by motorways.
Out of interest-did you attend a dedicated āstroke unitā hospital? .
I was fast tracked into the ED as the ambulance called a stroke code NIHSS score =2 and so on arrival then got instant care and almost immediately sent for a CT. However, as it was overnight there was no in hospital person to review the scans and so it was sent over to a site in Australia which took a couple of hours and then it didnāt show anything. So they just gave me some asprin and clopidogril. I went to be at 8:30, woke with the paralysis at 1:30 so they decided that the āeventā was 11:00pm and so couldnāt give me the clot buster stuff (4.5hr max) even if the CT had shown anything.
But, I did go into an Acute stroke unit (within the Health in Ageing ward). Was funny, the other 3 beds had a 96year old, a gut that was in his late 80s and a lady late 60s/early 70s. Where I live (Tauranga) healthcare system is set up more to deal with the significant elderly population. It is changing a bit in last 10 years, but when I moved here in 2010 someone described the City as a series of retirement homes connected by motorways.
When I left NZ (Waikato) for Australia in 2006 Tauranga was already had that retirement vibe about it!
I donāt think there are many units in NZ that do quite the same work that we have here, but this is really big city stuff for those exact reasons in terms of all the support structures you need in place to be able to provide that care in a timely fashion. Will post a link below to a newspaper article about what they do etc-the clot retrieval stuff is the next level stuff that you need the more highly trained and skilled teams to do.
Medical wards always had a rather lovely vibe (and smell) about them!!
Well another week on. I managed to get back to swim squad a couple of times this week. And in farness in yesterdays session then I was swimming almost as well as before. My legs are sinking a bit, but Iām going to have a technique session (or 2) with my coach to try to get on top of that. Also, finding my strength to climb out pool is better too.
And today I learned to ride my (mtb) around the garden. Wasnāt perfect, but gave me hope I will be able to ride on the road in the future.
I also had the rehab physio round in the week and she ran through some tests - walking, walk backwards, skipping, and even a run. Run was dreadful, and I canāt walk 10m on my tiptoes as my right just ends up collapsing. But this was +3weeks, and even a horrendous jerky mechanical ārunā is progress. And now am up to 3hours of rehab a day. Not sure where the time to go back to work is going to come from
Cardiologist trip was a non event, just confirmed the TEU for next few weeks.
But, this week Iāve really noticed/found some things that I was overlooking as impacted. Iād focussed on the big stuff of can I move arm, or leg. Thatās now coming on well, but more Iām noticing my vision has been impacted, my right foot isnāt āliftingā, my small two fingers on my right hand I canāt control (so writing and holding things is hard) and I struggle to think when more than thing is happening (in a shop when trying to pay and someone is talking to me, making a sandwich and a drink at same time).
I still realise just how luck Iāve been. And Iām still making good progress with a lot of hard work in rehab. But equally, I am getting my head around the likelihood that no matter how hard I work then in this case that wonāt be enough and I will have some permanent disabilities. Now that just means to me I need to adapt how I do some things, a few pivots. I met a guy a few years ago who has been to 3 paralympics, climbed Kilimanjaro, broken land speed records and more, all after having both his legs amputated aged 7. He said that without legs there were quite a few things he was never going to do - play winger for the all blacks for example. But out of the hundreds and thousands of things in the world, a few hundred he needed his legs to do, and most of those he wasnāt likely to do even with legs. So donāt focus on what you canāt do, but on how to achieve what you can do.
Mixed week this week, generally felt tired and seemed to be busy all the time.
However, have managed to return and do all my squad swims this week, and I did a technique session with my coach. Iām not kicking and that was why I was struggling a bit. Itās my right knee Iām letting go with, and not keeping it straight and kicking from the hip as I normally would have. That matches with when Iām walking too - but over the week both of these have made progress.
And got the GP approval to start driving again. He also said I can go back to work, but only 2-4 hours a week, 2 or 3 non-consecutive days a week for next month. So mixed feelings, on one had happy to be going back, but also am now seeing some of the cognitive symptoms alongside the physical control side.
In the first few weeks I needed to mentally have the mindset that I can work through all the rehab, and get back to 100%. In this last 2 weeks Iāve benefitted from a āpragmaticā mindset of aiming for 90% and accepting some things will be different.
Iāve tried a few ārunsā either with my PT or when trying to catch a bus;-) Best way of describing that is ājerkyā. And a lot of this is that my right foot / achilles / ankle isnāt really doing anything in a controlled way. I can do 3 or 4 heel raises but then it doesnāt move, and Iāve no precioception of what the ankle is doing.
But Iām up to 1hour of 220w of zwift (not today, was toast after 45mins).
GP was very surprised at the 80mg of atorvastatin the hospital consultant put me on, especially as I was only just above the 2.0mmol target. But he said he wanted to wait for the 3 month bloods before reducing. Iām hoping then he will bring me down to a low dose and that will also result in a reduction of the breathlessness and shoulder ache.
Bit of a gap since last update, but lots been happening.
Iāve been back at work over last 3 weeks, albeit only 2hrs every other day. And thatās been really hard. I canāt believe the fatigue. And Iāve found by trial (and mostly) error that if I empty the tank then it takes several days to recover. So Iām needing to behave like an EV - lots of little journey and quick top ups, donāt let the battery get to less than 20%.
And this has meant Iāve had to pull back my aerobic (ie zwift) as I was just too tired from work, the cognitive retraining, and the travel. But with the now less frequent zwift then the cadence (co-ordination) is back and Iām holding 90+ and peaking at over 100 which is way better.
Did ride the MTB outside, did a 40min ride, was exhausted then fell off as when I unclipped I had no control of my right leg. Sigh. Nothing broken just pride and hip a bit bruised.
But big news is that heart scan yesterday (TOE) showed I do have a PFO (basically leak between the sides of the heart) and so in next few weeks will get a dynaplug stuck in there (via femoral artery, overnight stay) which is fantastic news as this shows the WHY I had a stroke and also addresses the future risk. As far as I can tell then a few weeks taking it easy post procedure and then its green light.
So I can see a way forward, but also way way more realistic about the degree of impact the stroke has had on me. Still hoping this is mostly temporary and I can get most thing close to prestroke, but that is going to take months, not weeks.
Good luck. I just rode my 1st TT since crosswind blew me off the road at high spd and separated my right c-bone from my sternum last summer. Very lucky. Best wishes and ride on!
-U
Urgh, that sounds awful and Iām trying to put that thought out of mind for now. Wishing you well though, and hopefully if you are Northern Hemisphere then just in time for summer. At least Iām heading into trainer season anyway.
Slight update, got the full results of scan and referral and seems the PFO is fairly significant. ā>.5cm and >30 bubbles in <3 beatsā. So High risk. Be interesting to see if after all this then Iām actually better than before this little fun.
Thank you for the updates. Hopefully, now they found the issue, they can fix it. Best wishes.
Recovery progresses, but itās a journey with ups and downs, not a straight line. After trying to be back at work (limited hours) from week 5 then Iāve been signed off now until August. The fatigue is the big issue for me at the moment, and itās a strange debilatating thing unlike any ānormalā feeling of tiredeness. Iām 8 weeks in now and still needing naps in middle of day and then am sleeping 10+hours. If I try doing stuff for more than 90mins without a 15min ātimeoutā then I get really drowsy
Getting back to a run is still a distant dream - it will happen, but a lot of stages of physio rehab to go before then. For now itās focusing on heel raises and āfallingā from a step and learning to bend my knee to absorb the shock.
But then I did a 3.7km squad swim this morning. Got wobbly after an hour where I was starting to nod off as I was swimming, but thankfully someone else was leading the lane and counting And Iām back into group pilates classes rather than 1:1 rehab which is a bit of a milestone. Really helping with relearning control of my right side.
And for all those worried about tubeless tyres, what brand of sock will save you the most watts, etc. Just be grateful thatās your stress and not dealing with insurance companies who are doing their best to get my heart rate up more than a zwift crit race.
But through all this, I know the fitness/strength pre stroke has helped me get back to the point I can get by on a day to day basis. And Iāve been very very fortunate compared to the majority of people that get a stroke later in life.
I would imagine that the recovery and fatigue and drowsiness is a lot worse than a major concussion. Thanks for the update. My concussion docs told me to focus on month over month progress. I had around twenty things that I would score from 1-10.on average during the last week of a month this way I was not getting trapped into day to day up and down swings and associated euphoria or depression. Day to day can be a bit of an illusion in these things. Tue to Thu averages this week versus 4 or 8 weeks ago may be a better way of claiming victories because you always need victories in these rehab processes when it comes to brain stuffā¦hang in there
Been a while, but Iāve just been focusing on making some progress on a few things. Some admin stuff dealing with insurance companies that hasnāt exactly been āpro recoveryā, but such is life.
Big progress today though was taking the road bike out for a ride and not falling off. Was first roadie, and was only 40mins but did include a fairly steep climb back home (I live half way up the route of the local cycle club hill climb course). Out the saddle riding wasnāt good at all, so practice needed there with balance and timing.
And 9 July Iām getting my PFO (heart) sorted. Does mean 4 weeks of absolute zero exercise which is frustrating but this is a watershed moment that means I can move on with life from here.
My cholesterol just been retested and is now 2.1mmol/L total and 1.1mmol/L LDL. So my expectation is after the heart op then Iāll be off the statins which I am looking forward to as well.
Iāve not done any running yet, thatās still a way away, but I have started some stair reps (thereās a 320 step āwalkā to a lookout by my house) and tomorrow will do a 3 lapper. Also being working hard on some skills ladder drills - hopping, bounding, simple stepping. Hardest thing is actually crabbing sideways, but thatās just as itās not a movement Iāve āre-learntā yet. And right foot is still numb from second toe outwards and all along the outsole. Dorsiflexion not really too good and so thatās the main concern for future running.
Fatigue is still the major issue. Wednesday I did a bit to much and still feeling it today. Both last couple of days Iāve been doing something and then suddenly been hit with the urgent need to go to sleep. Still thatās why there are car parks so that people can get 40min naps in the middle of the day And whilst Iām OK in the morning, as I tire and as the day goes on the weakness increases and the control of my right limbs gets (literally) a bit shaky.
But today was a good day as I can see that I will be able to ride outside again which after the first attempted ride where I ended up sprawled on the floor in the park, made me worried. I can now spend the 4 weeks forced rest with a positive mindset and then once the two stroke engine has been tuned then itās a case of getting the fitness back.
Bit of a delayed update but a few key milestones. Last week my PFO surgery got postponed by a week and so I took that opportunity to do a real outdoor ride on my roadbike and then try a ārunā. The bike went ok, but climbing out the saddle was really bad - no timing so chain kept going slack then catching. But I got back up the hill and home without much damage.
In fact I did 2 runs, first was 3x2min run with 3min walk, and the second was 7 reps. First rep felt awful - trying to think how to actually run is bloody hard. But as the reps went on then it got āeasierā but was bloody tiring. Same with the second, but whilst not thinking about pace when out there, was good to see I was doing 4:45/km for the 400m I was doing. Which is psychologically a real boost as that means that I can control my legs at a pace that if I can build the endurance will be called a ārunā in a race.
So Iām now 2 days post PFO operation and into my 6 week of no-exercise restriction post operation. This is way longer than the general recovery procedure, but when they went in to put the discs in my heart then they found Iāve an anomoly in that my coronary artery isnāt in the right place, it comes off the wrong side and that complicated the operation, and necessitated a smaller device that is more prone to dislodge whilst healing. So nothing but gentle walking, nothing that uses the core and causes changes to breath (ie lifting, pilates, swimming, etc).
But also good news, Iām off the statins. Will need to keep checking on that but the cameras they used for the surgery showed zero deposits and so Iām hoping that in the coming days the fatigue and a few aches Iāve had will go.
Bit sore at the moment on my groin and wrist where they went in for the operation, but genuinely the worst pain Iāve got is from my little finger than somehow got caught in something when I was sleeping after the operation and seems bruised. Way worse than the incision sites
No real issues with odd heart beats yet, although my RHR has dropped from what has been 46 recently to 42 and 41 overnight post surgery.
So Iām feeling positive about getting back into things in September, frustrated at all the rehab work to build strength in the last 3 months will be gone by the time I start again, but it should hopefully come quickly.
Had a bit of eventful week.
Understatement of the year.
Good luck with your recovery! 6 weeks of no elevated heart rate sounds tougher than an actual ironman, but I know you can do it.
I think youāve got a great outlook on this whole event that will definitely speed your recovery back into the the sport, hopefully the fatigue will edge away with time and youāll be right back to where you were prior.
Also may have to steal your ānot afraid of dying ā¦ā quote - its golden
Saw this article on my reading feed today. Thought it may be of interest to you and others.
Thanks DJM, interesting. And the āgo hardā was the advice I got when I was discharged. They said the more you do the better it is for recovery, and between their comments and my reasoning I guessed that the more bloodflow through the brain, the faster the healing. That said, this needed to be balanced against the (severe) fatigue and the need to get lots of sleep.
Of course as above, the challenge is with ischemic strokes (the clot ones, not the brain bleed ones) in young (hey, I counted as young at 49 ) is that PFO is a common ācauseā. And in that case, as above, that normally leads to a PFO closure 2 months later and a 6 week ban on exercise.
In that stroke to PFO period I did include HITT, albeit I was mindful of going to 100% with the PFO, probably capped at 180ish rather than my prestroke max 195bpm for things like zwift intervals of vomit ,
And of course I am also wondering if there is any chance that what on slowtwitch we think of as HITT in prefference to Moderate longer exercise we may be envisioning something slightly different to the 40-80 gen popln of stroke survivors. I am wondering if the paper defines moderate endurance as 30-60mins of gentle cycling or brisk walking, not a 4.5hour 100mile ride or 25km run at marathon pace.
So back into some training over the last week. First thing was an hour zwift, which was medium hard work and at an astounding 127w average 
For reference my FTP immediately before the stroke was about 290w, and when race ready 320w.
Next up was swim squad. Sadly bad luck meant it was a kick heavy set. Did about 1h15 before I was cooked, and later saw HR peaked in the 180s. Felt awful all the next day, really tired. This week zwift 2 was 150w average and felt way better, so ust need to shake a few cobwebs off. Same with squad this morning, felt a lot better even if still 15-20s/100 slower than 7 weeks ago. Itās come, just need to keep pushing.
Wife is about to have spine surgery and rehab for her will be twice daily walks of 5mins increasing to 1 hour. So sorted out a hire treadmill for 3 months as safety for her, and will use that for some of my initial run rehab after Iāve built some muscle strength. Normally I hate treadmill running, but I think for safety / confidence itās a sensible way to build that base.
My HRV is still through the floor. I wonder when and where it will stop and settle but until then Iāll just carry on and ignore garmin telling me to stay in bed every day.
Hey there, just found this forum after looking for some IM Maryland info and stumbled upon this thread. It seems like your recovery is going well, but somewhat frustratingly slow. Had a similar event happened to me and wanted to share some encouraging news and perspective.
I had an ischemic stroke in July 2023 due to a PFO. I was only 34 at the time and had literally ran 9 miles before it happened. My plan to do State College 70.3 in three days was obviously gone as was IM MD in a few weeks.
After getting the PFO closed, my doctor told me to gradually ease back into things over the next 3-4 weeks. Most importantly, I needed to listen to my body and rest when necessary.
Fast forward to February 2024 when my cardiologist and neurologist both gave me the green light to start training again for the current season. They were both marathoners and knew what I was getting into; they didnāt have an objections since the primary cause of my stroke, the PFO, was fully addressed.
Iāve since done State College 70.3 back in June and will be doing IM MD in about 2 weeks. So it took me the better part of a full year to get back to where I was before everything. Amazingly, my swim/bike/run benchmarks have gone up between 10-15% post-stroke (likely due to the PFO closure). Even more amazingly, I did a battery of testing the week before my stroke and have a great comparison to where I was before and after.
All that to say, strokes can be a severe setback, but you can make it through the other side. Best of luck with the recovery and let me know if you have any questions.
Awesome to hear your story and congratulations on the level you are back at. Iām hoping for that post PFO improvement but not counting on it. Age not on my side either 
But also really good to hear about that 1 year period. I suspect many that would stumble on this thread are biased towards the personalities that think we can recover in 12 hours/weeks if left to our own planning. And 5 months in I tend to agree. I do have a half in January, but Iām not aiming to PB/podium, I am literally looking to get to the finish line. Itās local and is more to be able to demonstrate the hard work of my physios, coach and wife. May even be jogging the run with a bucket/QR code for the stroke association, not sure.
One observation for anyone that follows is that in the period between the stroke and the PFO closure itās important to work on building strength as much as the fatigue allows, or at least the loss of the muscle during the post PFO rest period has been really impacting my day to day to the point itās back to about week 3 levels of ability to walk. Itāll come back, but I dread to think what it would be like if Iād not done all that work pre-op.