Sunday, May 23, 2021

2,972,120

So, here's a final post about my time at the hospital, and about how I see things playing out in the near future. According to my boss, the amount I ended up paying was the net figure after insurance was taken out. That figure was 2,972,120 won. Seems like a lot, but I'm sure I would have paid a lot more in the States. It all went on my credit card, which now sets me back about two months in terms of paying the credit card down. I guess you could say it's better to be inconvenienced than to be dead.

I was at Samseong Hospital a total of seven days plus a few hours: almost a whole day in the ER followed by nearly seven days as an inpatient. For much of that time, I did little more than lie in bed except when I got tested or sent to therapy.  Over the final three days, I started walking around just to punctuate the tedium and start myself on the road to recovery. This was better than just lying in my bed depressed. 

Over the course of eight days, I underwent a battery of tests: a chest X-ray, an MRI, two CT scans, eye tests, and God-knows-how-many blood-pressure tests and blood-sugar tests. I was passive and patient through it all, accepting this as my fate. It wasn't until the hospital staff wanted me to stay beyond Friday for my heart that I finally put my foot down and refused further treatment. My heart might not be fine, but it's carried me this far.

There were repeat visits from doctors who said overlapping things about my health: the need to follow a better diet, to exercise, to take the meds they were going to send me off with. Two doctors struck me as rude; the rest were fine. One seemed almost flirtatious. 

While I learned plenty from my physical-therapy session, I now realize it took a lot out of me. Just today, I tried walking to a nearby medical-supply store that was barely a kilometer away, and I was pooped. Took a cab back. Before the stroke, I could eat twenty kilometers for breakfast, but I guess things are different now. Part of the problem may also have to do with spending a week in bed. I doubt that that helped my muscle tone. 

On the final day, I was billed; I got a last round of advice about the meds I was to take, and I got the meds themselves. My boss, serving as my guardian, was there to help me through that final process and then drive me home. Felt good to be out of the hospital and back in fresh air. The small of my back appreciated the chance to sit in a normal posture. The boss promised to take my fan back to my desk at the office; I, meanwhile, shuffled back to my apartment. 

I don't normally refer to my apartment as "home," even though I consider Korea a second home. Before I began working for this company, I used to stay at any given job no longer than maybe three years. With such a transitory lifestyle, what's the point of calling anyplace home? But Friday, when I flopped into my bed, it felt like coming home.

Took a shower after trying and failing to poop. The shower felt good. I'd worn my hospital gown for a week, and despite showering twice during that time, the gown still felt stinky and gross. It was good to scrub off a week's worth of hospital grunge. I had gone to the ER on a Friday, which meant I was at the end of a laundry cycle, i.e., there wasn't much for me to wear when I got back. Luckily, I had a spare shirt plus extra socks and underwear. 

Weighing myself was a revelation. I had apparently lost 9 kilograms in the hospital. I was down to 119 kg. Maybe I should stroke out more often, right? Still fat, of course, but now, there's a little less of me to love. Or as my boss joked, a little less to hate.

So the hospital gave me homework. I have three weeks' worth of meds and an appointment to go back on June 10th. I'm supposed to take the meds faithfully, exercise minimally, and keep a diary of my blood pressure and blood sugar. To that end, I have to buy a BP monitor and blood-sugar equipment, which includes the little strips that go in the machine as well as the finger-prick thingie, which I came to hate in the hospital. Getting stabbed, even a little bit, four or five times a day was no picnic. 

I tried walking out to the med-supply store late today, but they were already closed. Figures. All that damn effort for nothing. I'll try them Monday morning 

So what's going to happen over the next few months? I should probably start by writing about where I am. I'd say I have about 80% functionality of my right side. I have balance issues when I walk, and I walk slowly. I have trouble opening those little foil-covered, bubble-shaped pill containers. Based on today's walk, I'd say I'm walking a bit less than 2 mph, i.e., less than 3 kph. No way I'm making it down to Busan in a timely manner at that speed. I can otherwise function on my own: dress myself, wipe my ass, feed myself.  I haven't tried cooking yet, but I bet I can do that, too, albeit slowly. My right side is weak. I say 80% mostly based on the neuro tests I was constantly doing, but the actual number may be a bit less than that.  And before we go any further, I guess I should explain a "neuro test." This is from a text to a friend:

They ask you your name. Sometimes they also ask the date. They flash a light in your eyes. They make you go "Eee" and then stick out your tongue. They make you touch your nose and their fingertip with both of your fingertips (one at a time). They ask you to grip their fingers to test your grip strength. You have to lift your legs for five seconds, then they tell you to resist as they try to push your legs down. They ask you to take your right heel and touch your left knee, then run your right heel down your left shin to your ankle and back. [You then do this with the opposite leg.] Sometimes they ask whether you've gone to the bathroom.

For the most part, that's the neuro check. Also for the most part, the docs all thought I'd done a fine job, although at least one worried about the balance issues when he did an extended neuro check, making me walk in the hallway. Overall, though, they seemed fine with my going home, and they never suggested that I come back for more physical therapy.

So now you know my baseline. I have trouble with some minor stuff (including typing), but I'm functional. So let's talk about where we go from here.

Here's where I'd like to be: as I told my buddy Tom, I still want to do my east-coast walk later this year. Specifically, this means being able to walk 30 km a day at a rate of about 4.8 kph. That's actually faster than my average rate in the past, but it's a worthy goal. I'd also like to be able to talk normally. As my boss noted, I sound better than I did when I was stroking out, but I also sound out of breath when I talk now, and I also sound a bit as if I have a speech impediment. Not good.

Along with those goals, I have other goals, all of which I wrote up during my long hours of free time in the hospital. Here are my strength goals by the end of the year (Dec 31): (1) 50 legitimate pushups, (2) planks at 2 minutes per side, (3) two legitimate pullups. Keep it simple, right? Here are my health goals by year's end: (1) blood sugar averaging 90, (2) resting heart rate at 70, (3) diabetes gone, (4) insulin managed, (5) blood pressure at classic 120/80, (6) waist-to-hip ratio of 0.9. My cardio goals: (1) 30 km of walking at 4.8 kph by Sep 1, (2) stairs (in my building) 3 times (up, not down). My weight goal: down 10% to 110 kg by Aug 1; down further later. I also want to keep doing some version of the exercises I learned during my physical-therapy sessions, but those are more a matter of continuing my therapy and not about reaching a given goal (unless that goal is total rehabilitation). 

How to accomplish these goals? Well, I need to chart that out, so I'll be buying some graph paper and working on that over the next few days. My friend Neil linked me do a "get rid of diabetes" program by a British scientist named Roy Taylor. I know my Korean docs won't agree with it because it's too cutting edge, but I'll be doing it, anyway. Taylor's program dovetails in many ways with that of Dr. Jason Fung; both recommend rapid weight loss and adherence to a low-carb regime. I'll be following Taylor's program initially, then switching to Fung's for what I assume will be the rest of my life. While on Fung's program, however, I will allow myself two cheat days per month so as not to go totally insane. Taylor's program won't allow me any cheat days, but it's only for two months. (There's a maintenance phase after the initial phase, but I prefer Fung's way of handling that.)

Near as I can figure, the docs say these are my conditions:

• diabetes (too much sugar in the body for liver and pancreas to handle)
• atherosclerosis (hardened arteries)
• hyperlipidemia (fat/bad cholesterol in the blood)
• high blood pressure
• weak heart (ejection fraction, per Bill Keezer, i.e. the heart's ability to pump blood)

Pills, diet, and exercise ought to take care of most of that. I'm hoping that, by following Dr. Taylor's and Dr. Fung's programs, I might even wean myself off some or all of the drugs. We'll see. Korean docs seem about twenty years behind Western docs, so they might not want to admit I've gotten rid of, say, my diabetes. But again, we'll see.

So there's plenty to do, and the prospect of death is a great motivator. Plenty of people, in ways both polite and rude, have told me I'm statistically too young to have had a stroke, but as I wrote a few days ago, I saw people of all ages in the stroke ward. My emphasis right now is on thinking positively, living in a goal-oriented way, and doing what I can to avoid having a second stroke, which can occur with some stroke victims.

Stroke recovery is something I read about while lying in bed at the hospital. (As I've said, I had plenty of free time.) Apparently, for most stroke victims, the bulk of the recovery happens within the first three months after the stroke, which doesn't leave me much time. Important concepts for stroke recovery are neuroplasticity and myelination.  Neuroplasticity is the brain's ability to rewire itself after an injury, and an ischemic stroke, which leaves dead brain tissue, definitely qualifies as an injury. With dead brain tissue becoming scar tissue inside my head, I have to rely on neuroplasticity to help me heal. A part of the brain not normally associated with the functions that need to be relearned can wire itself to become competent in the needed skill. Myelination, meanwhile, has to do with the formation of neural pathways that are coated with myelin, a fatty substance that aids in the transmission of neural impulses. Habit-formation aids myelination, so repetitive activities, like typing and walking, help the brain to relearn anything it might have lost. As neural pathways myelinate, things become easier to do. This process carries no guarantees and isn't necessarily a path to a total cure, but myelination obviously helps with neuroplasticity. I have to be an active participant in my own recovery; passivity is not the way to go during the recovery period.

This brings us to an interesting issue. Some stroke victims work around their injuries and disabilities by finding new ways to perform old activities, like buttoning their shirts. While there's a practical dimension to doing this, it isn't always the right choice, especially for us stroke victims who have suffered only minor strokes. If the goal is to aid myelination and neuroplasticity, then we sufferers of minor strokes need to do what we can to perform normal activities normally. That's a demanding order, but not impossible, and it's necessary to train our brains and promote healing. In my case, I can say that a brain rewired to do everything differently would be useless to me. This obviously doesn't apply to people who have suffered severe strokes and who have little choice. So as much as possible, I'll be buttoning shirts, walking, typing, and wiping my ass as normally as possible to retrain my brain.

I think that covers everything I wanted to say for now. Future blog posts will focus more on goals and my progress toward those goals. I can see that my blog numbers have generally gone up since the stroke, possibly because having a stroke makes you a Suddenly Interesting Person. I certainly don't mean to be cynical about the attention and kind support I've received from friends, coworkers, and family. To those people, I am nothing but grateful, but one has to wonder. Those of you who think analytically will doubtless have tracked the length and complexity of my recent blog posts as a way to gauge my mental state; as I'm sure you realize, my marbles are all in place, but physically, I've got work to do. I've been blogging, texting, and writing emails in English, French, and Korean this entire time, so I'm pretty sure my brain's language centers were unhurt by the stroke. 

Anyway, that's all for the moment. More later. Thanks, as always, for reading.



6 comments:

John Mac said...

Wow. I learned a lot from this post. It sounds like you have charted the right course of action, and anyone who has the fortitude to walk from Incheon to Busan multiple times shouldn't have a problem with implementation and goal achievement.

It seems odd to tell a stroke victim they are lucky, but in your case at least you are lucky it wasn't worse. I was wondering about recovery options and was happy to learn that neuroplasticity and myelination are potentially the tickets to a return to normalcy. I wasn't surprised about your age at having a stroke, it just seemed contrary to your relatively healthy lifestyle. Everyone I've known with a stroke was a heavy smoker and/or drinker who rarely exercised. If anything, this happening to you is a wake-up call for the rest of us.

I'm curious how your condition will affect your work. You plan on taking more time off or jumping right back in?

Here's hoping that the old cliche about "what doesn't kill you makes you stronger" proves true as you implement your new lifestyle goals and objectives. Good luck! You've got this.

Kevin Kim said...

Jumping right back in on Monday. Thanks for the comment.

Horace Jeffery Hodges said...

Also, write that novel!

Jeffery Hodges

* * *

Kevin Kim said...

Well, Jeff, I do have some book projects in the works. Not novels, per se, but books.

Charles said...

I don't what exactly the Fung program consists of, but one of the reviews mentioned intermittent fasting. As you know, I am an intermittent faster myself, and I would definitely recommend it. It has helped me regulate my blood sugar in terms of not experiencing crashes, at least, and I imagine it just keeps me on an even keel in general. I also do HIIT, which I think helps as well.

Good luck on the road to recovery. I don't doubt you have the determination to do it!

Daniel said...

Where to start? First, I can only imagine the time and effort it took to keep us updated here. Respect for typing out the long-awaited post.

Had never heard of neuroplasticity or myelination before. Fascinating concepts that sound like the key to getting back on track. Most importantly, for both your sanity and employability, there was no damage to the part of the brain that processes language.

I remember watching a documentary (forgot the title) about Dr. Fung's program a while ago (as my own weight loss goals gained momentum before sputtering to a halt because of the pandemic). If memory serves, several of the people interviewed reported getting off of some or all of their (diabetes) meds.

Those are some pretty impressive exercise and health goals! My gut (which is admittedly large and flabby) tells me that the health goals (saying goodbye to diabetes, high BP and the extra pounds) will be a lot easier to achieve than the exercise goals. Wouldn't rush any anything either way. Getting there is half the fun (or in the case of pullups, half the pain).

On the topic of sounding out of breath and like you have a slight speech impediment, I heard on a podcast that there are now mobile apps that can help stroke victims work on diction and all the other factors that combine to create a single utterance. Sorry I don't know anything more, but might be worth looking into.

You can double check the portion of the medical bill covered by NHIC (Korean national insurance) on the hospital receipt under the "공단부담" column if you're curious.