Blessed by the Potato

And the winner of our ultimate cause of Horner’s is… vascular!

I figured once the CT report came back that I had a soft tissue thickening around my carotid artery that it was indeed a carotid dissection causing the Horner’s syndrome. I got to spend two nights in the hospital hooked up to monitors to catch if I had a transient ischemic attack (TIA, in other words a mini-stroke, which a dissection puts you at risk for) while they started me on anti-platelet drugs, and also as a way to expedite getting an MRI.

Then things took a turn for the weird: the MRI did not look like a dissection. There was a thickening there (it’s still the carotid as the culprit behind my Horner’s), but there wasn’t a little pocket of deoxygenated blood trapped in the wall of the artery like you’d expect with a dissection. The radiologist suggested vasculitis instead.

So they did a bunch of blood work looking for the immune markers of vasculitis… and nothing. There’s a few super-rare ones we’re still waiting on the lab to process, but after a lot of head-scratching they let me go with basically a shrug on the exact diagnosis.

I had a bad round of covid about a month before all this started (two months ago now), so the leading theory is basically “covid can do weird and bad things to blood vessels so I guess that’s it.” Maybe it’s a small dissection (which could have been caused by the extreme coughing I had), and maybe I’ve already mostly healed it by now which is why it didn’t have the characteristic appearance on MRI. Maybe it’s an inflammation from the covid itself.

Which leaves me with a bunch of shrugs from a bunch of doctors. We now know I don’t have a brain tumour, but I do have something funky going on in my carotid artery, and that’s causing my Horner’s syndrome. We don’t know exactly what’s happening in that carotid, or what caused it.

Will it get better? shrug.

Will it get worse? shrug.

Will my Horner’s go away? shrug.

They stopped the anti-platelet meds because now there’s no telling if those would help or harm. I’m back home and told to go back to regular life and just be a little extra vigilant for signs of stroke.

The one thing I do know is that this year I’m dressing up as a Zebra for Halloween.

Aside: Hospitals are Hell

I technically work in a hospital (though nowhere near patients), and have ever since I started grad school. I have a great deal of respect for the work that gets done there, the pressures the staff are under and have to juggle (patient comfort, safety, efficiency, etc.), and the limitations of funding and ancient buildings. I don’t mind being prodded, poked, imaged, treated, whatever has to happen there.

But it is impossible to sleep there. The beeps, the lights, the talking, the other patients (snoring, screaming, moaning, watching TV, talking on the phone), and in my case the shining a flashlight in my eyes to check my pupils and taking blood pressure every 2 hours. The first night was annoying but fine — I’ve pulled many an all-nighter, one more sleepless night was nothing I couldn’t handle. But the second night of not being able to sleep was torture.

There’s only so much we can do: while it would be great to build enough hospitals that are large enough for every patient that has to stay overnight to have a private room with a door that can close, that would be a huge investment and not anyone’s top priority for our limited healthcare dollars. However, I believe if I change the trajectory of my life to become an advocate with a single-minded mission to take all the fucking unnecessary beeps off every future piece of medical equipment, we could at least make it so that the wards get quieter as the various monitors get turned over. Indeed, alarm fatigue is a thing so it’s also bad for healthcare quality and safety.

I looked at myself in the bathroom mirror, and my pupils were different sizes. That’s gonna need a trip to the doctor, I figured, but it went away when I turned on the big light to get a better look, and again in the morning things seemed fine.

I stayed up late to see the lunar eclipse, and couldn’t focus both eyes on the moon at the same time. Took a few days until I figured out that one eye wasn’t dilating in the dark, but in well lit settings everything seemed more or less fine.

So I finally scheduled that doctor visit.

I wasn’t sure whether this was a GP issue or optometrist issue, so started with GP. She gave me reqs for a bunch of tests and suggested I see the eye doctor, who was able to identify it as Horner’s Syndrome — a collection of symptoms from an interruption in the sympathetic nerve on that side of the face. He asked if I also wasn’t sweating there, which sounded crazy, but I hadn’t been feeling well enough to work up enough sweat to notice. Sure enough, I hopped on the exercise bike afterward and only sweat on one side of my face, which somehow is even more viscerally freaky-deaky than mismatched pupils in the mirror.

Now the syndrome points to a common proximal cause for those symptoms — that sympathetic nerve block. But the ultimate cause of that block could be a dozen things… Most of them bad.

Tumours (brain, spine, neck, lung), vascular complications (esp. carotid dissection), MS (already an S-tier fear for me), or perhaps an upper lobe lung infection or abscess in the jaw or sinuses can all potentially be the cause.

Never thought I’d be rooting for the bacteria.

An MRI will go a long way to figuring out the culprit driving this, and nothing to do now but wait and try not to worry until I get one (it’s in the works).

I don’t know what’s been going on with the last few versions of WordPress, but my sites have been going down a lot. I had barely had things up and running, then a new update, and down again. I’ve disabled every plugin except Woocommerce (for the direct sales over at VoS) and now another update got pushed today and it’s down again (though BbtP seems to be up now, it was down yesterday).

I don’t know what is going on over there, but knock it off! I have a hundred productive things on my to-do list, I can’t keep trying to give CPR to my sites.