AIBU to not mention that I think my dad has had a stroke?

[vivariumvivariumsvivaria]

Proud man, retired semi-pro footballer. Had 2 stents about 10 years ago so is on medication for that and his BP - is very fit for his age (79) and has a big case of Peter Pan Syndrome.

During lockdown he had a bad fall. Broken ribs, smashed up face, big mess - took a week to persuade him to see GP for painkillers. I'm not local so only saw him 3 times in lockdown from the garden and once since restrictions eased in the house - seemed fine.

This morning, though, we went for a walk in the forest. His left side is just slightly clumsy, his arm doesn't swing as he steps, and his balance is easily lost. He didn't fall, but he is definitely not steady and for the first time I thought he needed a stick. There is no chance he'll use a stick, he is an athlete, remember?

He is using his left arm fine, no facial weakness, speech is fine and he is as sharp mentally as ever. He doesn't limp or trip in the house, he's a bit slow and steady on the stairs, takes them one at a time, but, he is ok.

Am I right in thinking that his heart medication will reduce his stroke risk anyway? His GP is great, but I don't think there is much to be gained from a scan - he is, after all, ok if a bit clumsy, so it would be an expensive scan to find "oh look, you've had a little stroke, I wonder if that is what caused that fall?"

If I tell him he'll be upset, he doesn't see himself as old, and he would deny there is a problem because he is unaware of the loss of balance (old football injury to my knee) and he is very fit and active for his age.

WWYD? Just keep an eye on him, or ring the GP and say "I think he's had a stroke" or tell him and have the argument?

Is him being blissfully unaware better than finding out whether he's had a stroke seeing as how he's already on cardiovascular medication?

Of course you’re being unreasonable. If he’s had one stroke there’s a high risk he’ll have more and eventually one of them will be bad enough that he won’t be able to function independently any more. Be honest with your Dad and tell him you think he’s had a stroke so he can get help!

My dad thought he was invincible, didn't take any meds advised by doc until too late. Had a life changing stroke. It was a long arduous 'recovery' which not only affected him physically but also mentally. Please urge your dad to get checked out.

You are, of course, right.

I just really don't want to be the person to say "you are not invincible" to him. He likes being the hero, he likes being the Big Man, he will not enjoy having his daughter tell him that actually, he's getting older.

He is not going to enjoy it, but, I'll go back and have the difficult conversation with him. It's not a chat for the phone.

I'm just sad about it. I like they hype of him being a bit invincible as well, if I'm honest.

Oh, and, for clarity - this could have happened at any point in the last year, and he's been on blood thinners for a decade since he had his stent. So, that's why I hoped there wasn't a need for urgency, but I do agree, his risk is higher.

I really don't want to have the chat with him, but he isn't going to see it on his own. Big girl pants time.

My dad was the same age as yours when he had a number of mini-strokes, over a period of weeks, but did nothing about it, because he didn't want to bother the GP.
He then had a massive stroke from which he never recovered. Visiting him when he was unable to move or speak was a terrible experience.
He spent 2 months in a hospice and then died.
I'm sorry to be blunt, but it is really important to try to get across to him how serious the situation is.
If he is a proud man, he would really not want to end up paralysed or worse. Good luck with talking to him!

OP being on blood thinners is a massive risk factor for anyone who has had any sort of neurological event. A ‘stroke’ can be caused by a clot OR a bleed in the brain. A bleed which can be catastrophic in someone on blood thinners. He NEEDS to be assessed by a GP urgently.

It seems sensible for him to get checked out. I hope he'll agree. His change in gait and mobility issues could be unrelated to a stroke though. He's getting on and it's inevitable that he won't be as sprightly. My dad played a lot of football and had a physical job and now in his late seventies, he's got arthritis in his joints and a lot of wear and tear on his body.
A bad fall can also really affect an older person's confidence and make them more cautious on their feet ( taking the stairs slowly for example).

Good luck with your chat, maybe frame it as asking him to get checked for you, because you love him and want him to stay as active and independent as he is now? It's difficult, he doesn't want to be pitied or "babied" as such. My dad's the same, he still wants his daughters to look up to him if that makes sense, rather than be a frail person that needs help.

Hope it goes well.

After my dads TIA the dr put him on blood thinners without a scan... she just assumed the mini stroke was caused by a clot rather than a bleed as he has a heart murmur which can cause clots.

But the lack of a scan does worry me.
OP if your dad can get a scan then encourage him to have one.

I take it that strokes can be seen on a scan even if they were several months ago?

Yes they will be able to see the damage caused by the stroke. My Ddad had a TIA on holiday and didn't realise until he was getting dressed for work and realised he couldn't tie his tie. He is on medication to try to prevent anymore and was given exercises to improve his hand eye coordination.

Call it a possible TIA rather than a stroke, when you talk to him. But remind him that a TIA can lead to a stroke if it's not investigated.

@vivariumvivariumsvivaria

I take it that strokes can be seen on a scan even if they were several months ago?

Yes. You can see new and old damage on CT or MRI of the brain. It looks different.

Series of small strokes can indicate a massive one is coming without intervention. It could also point to multi infarct dementia etc.

I would encourage your Dad to go for a scan I would imagine if he has lasting damage this would show up. There is a huge risk of further strokes if he has had one and is not on the proper medication. FWIW I had a stroke at 29 (and strokes among younger people are actually way more common than you think) so if he gets defensive about his age explain that people can have strokes at any age!

I think it’s very likely that your dad had a trans-ischemic attack as PP have mentioned, called a TIA, which is often referred to as a mini-stroke. You really can’t recover from a “full” stroke without the hospital, physical therapy, medication, etc., and even sometimes that’s not enough. Which is why it’s so important that you talk to him as soon as possible. While unfortunately it’s a difficult conversation, a TIA puts him at MUCH higher risk of a hemorrhagic stroke soon (what we think of as a full stroke that causes paralysis, difficulty talking, and often kills) - the odds are 1 in 5 within a year of the TIA ( www.ncbi.nlm.nih.gov/pmc/articles/PMC3134717/ ). He needs to have preventative treatment now to try to stop one of these from happening.

You need to get him checked over, Strokes can either be caused by a clot or a bleed, please get an ambulance if he displays any signs of a stroke.

@RightYesButNo

Erm I had a stroke! Sure my recovery isn't yet 100% but after 4 days in hospital to check for heart issues and loads of scans etc I was discharged with statins and blood thinners.

A few months on strangers would never know I'd had one. My main issue is memory retention and concentration. My limb doesn't have proper sensation but works normally just feels like that sensation before pins and needles start.

Everyone recovers differently or brains are amazingly plastic and "normal" life is possible for some.

@RandomMess Right, I wonder if this is related to there being two kinds of strokes? (Maybe you already know this so apologies if you do). There are ischemic strokes and hemorrhagic strokes. I meant to say ischemic strokes in my post, as they account for 87% of strokes and generally follow TIAs. They are also the type of strokes where there is a clot stopping blood from reaching part of your brain. This results in death of part of the brain - an ischemic stroke happens over roughly 10 hours and in that time, a person will lose 2 million brain cells and age the equivalent of roughly 35 years.

Then there is a hemorrhagic stroke which is when a blood vessel bursts in the brain and there is bleeding. This is sometimes accompanied by a sudden horrific headache, which some people may have heard of, described as a thunderclap headache or “the worst headache of your life.” While people still need to be hospitalized for these strokes, they often don’t require treatment besides watchful waiting.

So as you say they were just scanning you and weren’t pumping you full of drugs whilst in hospital, I’m wondering if maybe you had a hemorrhagic stroke?

Now, with that said, yes, you’re absolutely right; younger people who have either type of strokes can recover quite well (by younger, I’m referring to anyone under the age of about 60) and people in extremely good physical shape before an ischemic stroke can have “miraculous” recoveries (I know a man who had a stroke at age 47. He swam and jogged several kilometers every day so had a lot of muscle tone that helped him compensate, and as a result, he physically recovered very quickly from a stroke that might have taken another man’s ability to walk). But that can also be luck of the draw. Some people in extremely good shape, at any age, might have an ischemic stroke that isn’t treated quickly enough and suffer very severe symptoms.

When you say he has been on blood thinners, do you mean an anticoagulant such as Warfarin, Rivaroxaban, Apixaban etc? I’m just checking as some people wrongly believe that drugs such as Aspirin or Clopidogrel are blood thinners.

He needs medical assessment, just to echo the previous posters. For example he could have undiagnosed atrial fibrillation or a severe carotid artery blockage that would be suitable for surgical intervention - it would be awful to miss this, especially as he is otherwise fit and well.

I had an ischemic stroke and thrombolytic treatment in A&E.

Beyond that no other drugs I was just very lucky. Lots of scans to investigate what caused it (sticky blood coinciding with a migraine).

I know how very lucky I am, ambulance came quickly and they managed to get initial investigations done so I could have treatment just within the 4 hours.

Stay on strike ward in Covid times desperately sad and distressing

My friend also had ischemic stroke but didn't seek treatment. Sure her life is normal now but her sight will never fully recover, can't feel limbs properly although moved completely normal. All because she delayed seeking help.

I think he's on both aspirin and rivoroxaban. GP Pharmacist recently reviewed his meds on the phone, so, presumably it's all up to date.

I'm going to go down to see him rather than do it over the phone. I think I'll need to get him to try and lift something with his left arm and stand on his left leg to show him that they aren't doing the same thing as his right. If it's just the phone he'll say I'm being overly worried and that he's fine.

Which he is. But, i'td be nice if he stayed that way. Left sided stroke is the one where you can lose speech, isn't it? That must be AWFUL for people. Just awful.

Good luck OP, it's never easy having these sorts of conversations with a parent

I understand what you are saying but it seems you have decided to raise the subject now which is the right thing to do. Good luck.

My father, an angry and difficult man at the best of times, is becoming increasingly so as his health deteriorates. It’s bloody hard.

I think you are doing the right thing and hope you are successful in getting your dad to visit the GP.

He may well be on anticoagulants for his heart, but he might not be taking them or he may just be on a daily 75mg aspirin by now, and if he did have a stroke while taking them he's at risk of another stroke. Or a PE, or DVT. Alternatively seeing as he is an athlete he might benefit from seeing the GP about some physio for that dodgy knee.

Sorry, I think you need to bite the bullet. If he falls and breaks his hip or if he has a bigger stroke you'd feel awful wouldn't you?

Yes, Any I think this is training ground for the future - it'll be me who has to tell him that he needs to think about giving up driving, that he needs help in the house, that he needs to move closer to us...

I love my dad, but, he is difficult. Well, single minded. And thinks of me as a silly little girl!