Subarachnoid haemorrhage: my journey, by Kevin Toach

Tuesday, March 23rd, 2010

The day started as any other normal working day. I was training a group of work colleagues on a first aid at work course, and had arrived early to set up the room and prepare the equipment and course material needed for the day.

I had just started the course and was about 15 minutes in when I had a numb / tingly sensation across the top of my head and both ears went muffled for about twenty seconds. I then had a headache and stiffness and pain down the back of my neck. At the time I wondered what could that have been, was I having a stroke? But as I had no other signs or symptoms I thought it was just a bad migraine.

After about an hour my head was starting to hurt a bit more so I took some pain relief tablets to ease it but vomited shortly after taking them. Having vomited I felt a lot better and continued with the course for the rest of the day. I now know these were classic subarachnoid haemorrhage symptoms, but at the time was not aware of this.

Over the next few days I managed to control the headaches with pain killers, finished the training course, continued to drive a car, ride a motor scooter, and do activities with my son, including climbing and swinging from climbing apparatus. Had I known the full extent of what had happened inside my brain things would have been a lot different.

Monday, March 29th, 2010

The headache had still not cleared so I visited my GP. I was diagnosed with a tension headache and given some medication to relieve the symptoms and it was expected that I should be back to normal within the next few days.

Tuesday, March 30th, 2010

The medication I had been prescribed was having little effect. I phoned my GP and spoke to another of the doctors at the practice to ask if there was any other medication I could take together with the original prescribed tablets. I was told I could take cocodamol as well but was asked to go back to the surgery as he was a little concerned and wanted to check me over.

I was given a very thorough neurological examination where my legs and arms were checked for strength, my eyes were examined and my balance and coordination were tested. Having passed all these I was given another prescription for a different type of medication.

Thursday, April 1st, 2010

The headache had still not fully subsided so I again visited my GP. He was more concerned this time and decided he wanted a second opinion and asked me to sit in the waiting room whilst he made some phone enquiries. He later came to the waiting room and told me to go to one of the local hospitals for some more checks but not to go before 21:30 as they were very busy.

On arrival I was taken to a bed and eventually seen by one of the doctors. He examined me and asked me to do all the neurological tests that my GP had already done. It was decided that I needed a CT scan just to be safe.

Friday, April 2nd, 2010 (Good Friday)

In the early hours of the morning I was taken in a wheel chair, by one of the porters, through the deserted corridors of the hospital to have the scan. This took only a few minutes and it wasn’t long before I was back on the ward. At around 6:00 I was seen by the registrar who agreed with the doctor, who was dealing with my case, that having looked at the CT scan there was no evidence of any abnormal activity to my brain, and that I would be discharged with a tension headache that should clear within 24 hours. I was given some paracetamol tablets and left the hospital at about 10:30.

Later that evening, around 21:30, I was not feeling too well so I went upstairs to bed leaving my wife downstairs watching the television. I had just finished in the bathroom when suddenly my head started to hurt considerably and the pain was going down my neck again. I went straight into the bedroom and lay on the bed, and so as not to disturb my son in the next room I banged my foot on the floor to alert my wife.

When she came upstairs and saw me she realised I did not look well and asked if I needed an ambulance. I of course said yes and she proceeded to call for one. I was taken to the A&E unit of a different hospital from the one I had been discharged from earlier in the day. I was given all the same tests as before and asked numerous questions. They were a little surprised that the other hospital hadn’t given me a lumbar puncture and said that I needed another CT scan, possibly followed by a lumbar puncture if the scan was inconclusive.

Saturday, April 3rd, 2010

In the early hours of the morning, once the CT scan had been checked, things started to happen rather fast. I was wheeled into the resuscitation area and told that I was not to worry but I had suffered a burst aneurysm in my brain and that it was the second time it had happened as the first bleed was clearly visible on the previous CT scan, and had been missed by the first hospital. I was relieved that the doctors had found a reason for the headaches but apprehensive about what was going to happen to me from now on.

A drip was hastily put into my arm, the angle of my bed was reduced to 10 degrees and I was taken by ambulance to another hospital 30 miles away. The journey was rather bumpy and I had to hold on to the drip line because it was whipping about quite a bit and I thought it might be pulled out of my arm if I didn’t hold on to it. We were on blues and twos and our speed reached 100 miles per hour over some of the journey.

I was wheeled through deserted corridors onto the ward and immediately told that I should be laying flat and that everything I did from now on had to be done in this position. During the day I was given all the neurological tests again and taken for another CT scan followed by a CTA scan which involved dye being injected into a vein to allow an image of the blood vessels in my neck and brain to be produced for the radiologist to use. I was seen by the main consultant and a neurological radiologist (who hopefully would be performing a coiling operation to the aneurysm sometime over the next two days).

I was concerned that I had already had two bleeds and asked if it would be possible for the operation to be performed on Sunday. I was suffering from very bad headaches by this time and though I was regularly receiving pain killers it did not always provide efficient relief. I was offered some morphine to combat the pain but was warned that there was a possibility that it would make me feel sick. I decided to have some and sure enough I vomited very soon after taking it.

I was having checks on my blood pressure, heart rate, respiratory rate and oxygen levels every few hours and later found out that at one point my pulse rate dropped to 35 beats per minute.

Sunday, April 4th, 2010

I was visited by the consultant at about 11:00 and told that they were going to perform the coiling operation later in the day. I was told all the things that could go wrong and that there was always a possibility that I could die during the procedure, but the risks were small compared to what could happen if the aneurysm was not treated. I asked him to telephone my wife to let her know what was to happen as I knew he could answer any of her questions better than I could.

At 15:00 I was taken to the operating theatre and put under general anaesthetic. The procedure involved a small incision in my groin where a catheter was fed into my femoral artery. This was then guided through my body to my neck and then into my brain. Using a guide wire platinum coils were then inserted into the aneurysm.

Three hours later I awoke from the anaesthetic as I was being wheeled into the recovery room. This was the start of the regular neurological observations that involved answering some simple questions, tests on my arm and leg strength, shining a light in my eyes and also checking blood pressure, heart rate, respiratory rate and oxygen levels.

After about an hour I was taken back to the ward and as I was being wheeled back into the bay of the ward I looked up and saw my wife and son standing by the window. I remember waving to them, as I was wheeled in, and thinking how wonderful it was that they were there. From then on things began to improve daily.

I wore pressure stockings to help prevent blood clots forming in my legs. I had a urinary catheter, which was removed the next day, because I needed complete bed rest immediately after the operation. I was on 29 tablets a day which consisted of the following:

1x Aspirin in the morning,
2x Nimodipine every four hours (to reduce the risk of stroke),
2x Paracetamol four times a day (for pain relief),
2x Tramadol four times a day (for pain relief).

I was also given an injection of Enoxoparin each night to reduce the risk of blood clots in my legs. I needed to drink three litres of fluid every day.

Every four hours I was visited by a nurse to complete all the neurological tests and to administer the drugs I needed. I was allowed out of bed the day after the operation and after a shaky start began to wander further each day. I was discharged from the hospital on Friday, April 9th, 2010, five days after the procedure.

Saturday, April 10th, 2010

A doctor, followed by a district nurse had to visit me at home because I had a very compacted bowel. I was given an enema but because I could not push very hard for fear of damaging the coil, this had little effect, and after two hours an ambulance was called to take me back to a local hospital. I was refused a bed on the ward because they had given the bed to another patient and had to go back to A&E to have any chance of being seen. They thought that I would need another enema but after sitting around for more than three hours relief finally came.

Back at home it took some weeks for my brain to settle down after the procedure. I felt more tired after simple daily activities and needed to drink two to three litres of fluid a day. I had to set the alarm to wake myself at 02:00am and 06:00am to take the Nimodipine tablets, which needed to be taken every four hours, to finish the thirty day course. I only needed to take a few of the pain relief tablets. I now do all the things I did prior to the haemorrhage and apart from the odd sensation every now and then things are fine.

I returned to work on reduced hours on Monday, June 7th, 2010, nine weeks after the operation, and started full hours four weeks later. My driving license was returned on 15th June, 2010, after my doctor had deemed me to be clinically recovered, because the DVLA had requested that I surrender it following the operation.

Thinking back I now realise that throughout everything my wife and son have probably suffered more than I have because they had no idea how I actually felt, other than what I had told them. They were the ones that left me at the hospital night after night and had to go through the trauma of thinking what effect all of this would have on our lives and would I be the same after it was all over. It was easier for me because I had all the feelings and sensations.

Yes, it was scary to think that someone was going to carry out an operation inside my brain, and the pain was very intense, but I had complete confidence in the medical team that were looking after me. I was blessed that I did not have a craniotomy operation (a trap door cut into the skull to reveal the brain underneath) and the trauma that goes with it, and it still amazes me and anyone I speak to that the procedure was carried out via a small incision in my groin. I can only wonder at the advances in medical science and owe a lot to the medical team that looked after me so well.

Further information

If you have any questions about subarachnoid haemorrhage or any other neurological topic, call the Brain and Spine Helpline on 0808 808 1000 or email helpline@brainandspine.org.uk.

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