Health Issues and Travel

Health Issues – Vertigo?

As many of you have read in my posts, I have mentioned a few times that I have suffered from health issues related to vertigo-like symptoms since about 2015. After chasing the root cause over several years, it was determined not to be vertigo. In 2019 my ENT ruled out vertigo; I was referred to a neurologist, who ordered an MRI, MRA, and CT scans. He was leaning towards vestibular migraines initially but wanted to be sure it wasn’t more.

The doctor reading the scans initially called me directly as my neurologist couldn’t be reached after hours. They found a dissection in an artery feeding my brain. She asked if someone could drive me to the ER or whether she should call 911 as I was at risk of having a stroke.  Luckily, my wife was home and drove me to the ER. They were not able to do a CTA that night due to the MRA dye still being in my system from earlier in the day and my shellfish reactions ruling out iodine.  They prescribed Plavix that night to prevent clotting. A few weeks later I had my CTA and it was not just a restricted blood flow as he originally thought; during the initial tests, it was determined that it was a 100% blockage of my right vertebral artery.

Vertigo or Stroke?

Therefore, it is believed that the several hundred vertigo episodes I encountered over almost 5 years were most likely mini-strokes. It is scary to think of all the places I have visited in the last 5 years and that I could have had a fatal stroke at any time. My neurologist stated it was inoperable due to the location. I was not willing to take that as a final answer. Therefore, I scheduled an appointment with a top vascular surgeon in Atlanta. Sadly, he agreed it was riskier to perform the surgery than to treat the symptoms. This is from a surgeon who has performed hundreds of these surgeries.

Going Forward in 2020

The surgeon stated that he would only consider the surgery if I had a fall-down stroke. Luckily, since October 2019 I have been on an anticoagulant and have not had another episode. My neurologist has wanted me to have an MRI scan since February 2020. Due to now being in the high-risk category for COVID-19 and the scan not being a required procedure, this has been temporarily put on hold.

Unfortunately, this could have been caught much earlier. I have been to the doctor multiple times over the past 5 years and they never thought to test for neurological or vascular issues. A previous CT scan showed nothing wrong. It had been treated as an ear infection most of the time. My great ENT was able to rule out my ears on the first visit.

My Vertigo Symptoms

I experienced vertigo-like symptoms that involved balance issues, spinning vision, nausea, and a stiff neck. The damage to the artery is most likely due to the stiff neck I have experienced since around 1988 which had worsened over time. I would pop my neck as it felt like I had fallen asleep on a plane and had a stiff neck after waking up.

The doctors asked if I had any chiropractic work done as that could cause a tear in the artery that would restrict the blood flow.  I hadn’t, so it must be due to my DIY chiropractic work of popping my neck. My vision was like a kaleidoscope with spinning around the edges and a clear area in the middle. If you are having intermittent vertigo issues with similar symptoms, get a neurologist to perform an MRA and CTA to rule out a blockage. I wish I had known earlier.

Vertigo Episode in South Africa

During our trip to South Africa in 2019, I experienced a serious episode at the wedding reception. I had a few drinks before I started to feel bad. It was assumed by all that I was under the influence. In fact, I was having a mini-stroke most likely. Below is what I looked like at the time as people thought it was funny to see a drunk guy that early in the evening. My response is quite visible to the person taking the picture. After a few hours, I recovered and was the designated driver. I never thought that it was a mini-stroke at the time, just another annoying vertigo episode. If I had been drunk, this would have been an embarrassing photo.

Will I Travel Again?

Yes, I look forward to the COVID-19 travel bans being lifted once it is safe to travel again. At that time we will continue to see the world and complete the trip we had to cancel due to COVID-19. However, I plan to buy travel insurance from now on. This is due to my health issues, and the potential for COVID or other infections is a large concern.

Why Did I Write About This on my Travel Blog?

This is to be an FYI of sorts. Don’t ignore vertigo symptoms or assume they are always related to your ears. After finding the source of the issue, a little research showed it is quite common to be misdiagnosed. Some people were not lucky enough to have it diagnosed correctly before a fatal stroke occurred. The possibility of a stroke scares me as my father passed away at 48 after having a stroke 2 years earlier.

In October 2019 I took about a month off work to handle the doctor appointments and to reduce stress.  Upon my return to work in November, I asked to be converted to a part-time employee or to have reduced hours as a contractor.  After 4 months, I had not received a response and decided to leave my job to reduce stress.  My last day was in February, just before the world went crazy with the COVID-19 outbreak.

UPDATE August 16, 2020:

Due to changing insurance after leaving my job in February, it has been an uphill battle with the new insurance over the needed MRI. They had a peer-to-peer review with my neurologist. The insurance company wanted me to do 4 weeks of physical therapy for my neck issues. I went for a couple of sessions and realized that it would be more cost-effective and faster for me to pay for the MRI out of pocket. The MRI was $525, 8 sessions of PT would have been $800. I had the MRI last week and I am awaiting the results.

When I last saw my neurologist, he asked if I had any TIA (transient ischemic attack) events since he last saw me. Luckily, I have been TIA-free since starting the medication in October 2019. However, I did have a couple of very mild episodes where I had blurred vision. None of the other symptoms that I previously encountered were present though.

UPDATE September 2, 2020:

I had an appointment with my Neurologist yesterday and received the results of my MRI. The MRI shows that I have degenerative disk disease in 3 places on my neck. Luckily, there is no sign of spinal damage. This is similar to bone spurs that fill the void after my vertebrae shifting due to the excessive neck popping over the years. At the moment, there is not much that can be done other than possibly physical therapy.  My Neurologist is scheduling another CTA in the coming months to see if there are any further issues from a vascular standpoint.

UPDATE January 12, 2021:

I had my CTA at the end of October. During my follow-up appointment with my Neurologist, I learned that the blockage had not increased. However, the other vessels in the affected area have recovered about 10% of the blood flow. This does not mean that they can recover all of the flow, they are only providing some of the needed blood. Due to this, the issue will still be with me for the rest of my life. I need to continue with the Plavix to prevent any future blockage.

I Didn’t See That Coming

UPDATE July 6, 2022:

My eyesight had been getting worse over the past few years and I needed to use reading glasses occasionally. I thought, hey I am getting older, this happens. In recent months, it has deteriorated to a point where even the reading glasses didn’t help much. It felt like I was looking through a dirty glass.

So, I decided to have my eyes tested. My right eye seemed to be worse than my left. Well, that is where the fun started. I had an eye stroke as it is called. A clot in my right eye caused blood to look for another path and that was covering my retina. This is called a Central Retinal Vein Occlusion with Macular Edema. My left eye is 20/20 and my right eye is 20/200. There are a couple of options going forward, a laser which is not recommended as it also causes some damage, and injections directly into the eye every month. I elected for the injections and they start in a week.  If there are any typos, I can’t see well enough to notice them.  Hopefully, this changes, and I can get back to writing and editing videos again soon.

UPDATE November 2022

I have received 4 injections so far. The first 3 went well, the last one hit a blood vessel and caused some bleeding. It looked like I was in a fight, you should see the other guy. When the needle went in I heard a pop sound similar to popping one of the inflatable plastic packs you get in shipments. I am sure it was louder for me and not heard by anyone else.  That was different, but not painful and I just felt the normal pressure on the eye.

As far as the injections, the first two were with a low-cost drug, the last two were the more expensive ones. I believe the first two cost about $900 including the doctor’s fees before insurance. For the last two doses, I almost needed to a cardiologist when I received the bill of nearly $9500 ($8900 was the drug portion) per injection. Luckily insurance reduced the cost down to about $1900 on the first one with the pharmaceutical company picking up all but about $150. The second one was covered by my insurance as the deductible was met.

Due to the vision in my right eye still not getting back to semi-normal, I have to use reading glasses for computer work and reading menus at restaurants (if I remember to take them with me). Driving is fine during the day, but at night car lights can cause a glare/reflection with the blood in my retina area.

UPDATE December 2022

My last injection went fine, except for an annoying floater in my eye that looked like Mickey Mouse’s head. The ears would float away and then come back. Imagine the floating bubbles in a lava lamp, but in your eye that would move around in your eye when you turn your head. Luckily, this only lasted for a few days. It was fun trying to put the ears back on Mickey’s head though.

UPDATE May 2023

My vision seems to be improving on my eye tests. Reading is still a problem, but getting better and I am using reading glasses more now. The doctor said that the outer vision would clear up before the inner/main. My vision is now about 20/40ish in my right eye, which is better than the 20/200 it was a year ago. Also, there is a new version of the injection available in late June 2023 that will allow me to go 5 months between injections, it is a quadruple dose. Since the regular dose is about $9k, this is probably $35-40k an injection. Even without the new injection, I should only have a few more to go before my vision is back to the new normal, or about 95%. Of course, I will have to get regular follow-up visits to make sure it is not returning or other issues.

UPDATE July 2023

My vision is still improving somewhat. However, in June the doctor suggested taking a month off from the injections to see if it will worsen, improve, or stay the same. During my July appointment, my vision had worsened and some bleeding near my retina was still occurring. Therefore, another injection was needed. I am hoping that we will be able to get this under control before the end of 2023 or at least to a point where it is consistent and I can get prescription glasses to correct the issue. As long as there is still bleeding, glasses are not a valid option as my vision will fluctuate too much.

UPDATE March 2024

I am continuing to get the eye injections approximately every 4-6 weeks. My vision has good and bad days due to the blood still blocking some of my field of view.  Since we are planning to travel more in 2024, I looked at options to receive the injections while in Turkey. In the US the doctor invoices our insurance company just under $9500 per injection. I received a quote from an eye doctor in Antalya, Turkey for the same procedure it is $650 including meds, injection, examination, etc. That is almost $9000 cheaper. In the US, our insurance company negotiates the price to about $2000 and the pharmaceutical company covers the first $15000 a year in costs after insurance. So, the total out-of-pocket cost is higher in Turkey, but the cost difference is staggering.

This eye doctor is not working behind a dumpster or anything like that, he is a member of the American and European Ophthalmologist Associations and spent a couple of years working in San Francisco at the University of California.  He speaks perfect English and responded personally to my initial communications over the weekend via WhatsApp. He has great reviews on Google and one of the reviews is from someone who is also on the Senior Nomads group on Facebook that I have communicated with previously.

UPDATE June 2024

The eye doctor in Turkiye wanted to do an angiography to see how bad the issue was. This is an injection with a dye and they watch it pass through your eye to see where any blood leakage is happening. The injection is in the arm, not the eye. I read that it may make you nauseous and you should have something small to eat before the procedure. About 10 seconds after the injection started, I could feel the nausea starting. My wife was in the waiting room and could hear me getting sick. You only have a couple of minutes to get a good look at the dye in the eye, so I had to hold back any further violent vomiting.

Fast forward a couple of weeks. I received an injection in Turkiye, it was done differently than my US doctor. There was no pain from the injection itself, it was all the sterilization liquids. My eye was on fire and they had to hold me down to complete the injection.  This was not a fun experience, if it was the normal process I would probably not continue with the injections. The procedure was extremely stressful and I just wanted to sleep after taking painkillers. I was physically exhausted after the injection. In the US, I drive myself home after the injection.  The environment was very sterile and I feel that the extra prep is justified, but it was not the experience I want every month. At least I know now to ask what procedure the doctor will use, no more assuming.

UPDATE October 2024

My Neurologist in Atlanta has decided to retire at the end of November. During my recent appointment with him in September he seemed less interested in seeing patients, now I know why. I have been trying to find a replacement since I was notified. Unfortunately, most Neurologists in Atlanta are not scheduling new patients for at least 5 months or more. Luckily, I found one with “decent” (above 4.0 on Google) reviews that can see me in December. Hopefully, he is better than just decent. At least I will be able to get my prescriptions filled if nothing else. I am probably due for MRI/MRA and CT scans to see if anything has changed in my blockage.

I will continue to update this post as more info is available.