TIA two weeks ago, what should I do?

Hi Cindy, a TIA is urgent, as after having a TIA he is at greater risk of a more severe stroke. I would see another doctor and get tests done on blood pressure and other risk factors. With investigation and treatment, the risk of stroke following a TIA can be reduced by up to 80 percent. For more information click the following link: TIA 

Thank you Vanessa.  I will be calling a neurologist today and if I can't get an appt. there within the next few days we just may go to the ER.  

My father had a check up a week before his TIA.  His BP, which has never been a problem, is fine.  His cholesterol is fine.  He is extremely active.  Not overweight, not diabetic.  He doesn't seem to have any of the risk factors for a stroke and maybe that is why his GP is taking the possible TIA so lightly.  

I've read that only 40% of people that have TIA symptoms actually did have a TIA.  But my father is 84 and if it wasn't a TIA I need to find out why he lost the sight in one eye for 15 seconds!  

I just can't believe there is nothing anywhere on the internet that addresses the question of what to do once a week or two has passed!  

Thanks for your input!

Hi Cindy Loo,

Whether the TIA has occurred in the last couple of days, or weeks, medical review is essential. A TIA is a warning sign that should never be ignored, and 000 should be called immediately, even if signs go away.

Thank you Vanessa for sharing the link to Transient ischaemic attack (TIA) webpage – there is information on signs and tests here.

It’s good to hear your father has already seen a doctor. If you have ongoing concerns or questions, return to the doctor or seek a second opinion. A specialist would also further investigate the neurological symptoms, so arranging an appointment is certainly important.

If you have any further queries about stroke prevention, treatment, recovery and support, please call StrokeLine on 1800 787 653.  

Regards,

Kirsty

(StrokeLine) 

Thank you Kirsty.  From everything I've learned about TIAs and strokes this past week, I do feel like a person should have a complete TIA workup done ASAP after the suspected event. 

As I understand it, a TIA is caused by an abnormality that will not resolve on its own.  So the sooner you identify whatever caused the first incident, the sooner something can be done to lower your future risk.  

I've read that you have a 10% chance of having a stroke within 90 days after a TIA. 

When the person from my father's GP called to give me the CAT scan results I asked her what the next step would be, since a CAT scan was not likely to show a TIA anyway.  She said, "Well, it's been two weeks, so whatever damage was done it is already done."   Of course that is true, but it seems to miss the point that one TIA/stroke is a good indication there will be another at some point!

I can't think of any good reason for failing to investigate the incident until we can reach a conclusion.  I find it alarming that any Dr. would suggest waiting to see if the symptoms return!  Your post validates my concern and I need that.  I am going to push for a full TIA workup immediately!  I will come back and report the outcome for any future readers.

Since i had mine you find yourself in conversation with lots of people sharing their experiences or others they know. Its a bit scary when you hear about when things didn't go quite right or better actions would have helped. Between the public system and my GP I feel like everything couldn't have gone better but I have also heard stories about bad calls by medical professionals or things missed - I guess nobody is perfect. I know with my 90yo mum that she is of a generation that it seems wrong to get second opinions, like she is cheating on her doctor - she is the same with the hairdresser! But with my dad (deceased for some 10 yrs), a second opinion and change in doctor saved his life, being treated for some time for something he didn't have, while missing the real reason. Having a good GP was important for me and i wouldn't have hesitated to change, but mine was great. You sound like you are on the right track though now and hopefully your dad with a bit more knowledge is also keen to look for the reasons. My uncle ignored a TIA and then spent 6 years in a bed being fed through a tube. It was absolute torture for him and all those that loved him. You mentioned BP, cholesterol and blood sugar but i am sure you know there are other things they can check for... Arterial fibrillation, ultrasound of arteries and looking for a hole in the heart which 25% of people have (including me!) were all relatively easy tests and I found it very comforting to know exactly what was going on. They had me on Aspirin straight away and said i would be on it the rest of my life - I couldn't help wondering if your Dad was on some sort of blood thinner because my understanding was that this will greatly reduce clots, but I am no expert, just what crossed my mind.  I reckon he is lucky to have you looking out for him.

Hi Craig and thank you for your post.  You have raised some important issues.  I spent the first nine months of 2017 caring for my 83 year old mother.  She spent the first six months of that year in two different hospitals and three different rehabs.  She had the best possible private medical care (I'm in the U.S.).  I were to write out all of the medical errors that occurred it would take you over an hour to read my post!  

I  realized after several important mistakes were made in my mother's care, that even under the best of circumstances, errors are bound to occur.  Some of those errors can have devastating consequences.  If the patient has an advocate that is willing to supervise EVERYTHING, it can be a huge help, but errors will still occur.  

I thoroughly educated myself about my mother's case, her meds, suggested treatments, etc.  Since I spent every day with her anyway, I used that time to review her med list, speak to all of the nursing staff, and get a report from each of her Dr.s EVERY DAY.   

I also discovered that it is very important, especially in the case of an elderly patient, for someone that is familiar with the patient to be on hand as much as possible when a patient is institutionalized.  The medical staff don't know the patient well enough to recognize subtle changes that should alert them to a problem. I can't count the number of times I walked in to the hospital or rehab to immediately recognize that my mother was in a condition that required intervention (extremely low blood sugar, dehydration, etc.), but the staff had failed to take notice.    It seems to me that if a patient is over age 70, the staff  sees an "old" person and they  think that as long as the patient is breathing they are fine.  

My extreme supervision and fairly constant presence definitely prevented some serious errors and I was often able to solve some of my mother's problems.  And I was certainly able to keep my mother much more comfortable than she would have been without me there.  But in the end, I STILL overlooked (as did her entire team of specialists) a couple of major things that I believe caused her to die a year or two earlier than she should have!

I don't  blame the medical community for providing less than perfect care.  Medical science has progressed to the point where almost any condition  can be fixed/controlled etc.  The problem is that no mere human Dr. can take the time to apply everything he/she has learned, to every single patient.  And while a dedicated lay advocate may have the time, they lack the education to catch everything. 
 
What I've learned is that every patient needs all the help he/she can get!  I am so sorry for all of the patients that don't have anyone to advocate for them.  Those people will not receive the very best care that medical science has to offer, and most of them will never even know "what could have been".   

Btw, the same level of errors occur in the U.S. legal community, for the same exact reasons.  A person that leaves an important matter entirely in a lawyer's hands, does so at his own peril!  

Also, I agree with you that a person should be sure to have an excellent GP.  I spoke with my own GP about my father yesterday.  She immediately said that any indication of a TIA warrants a full work up, no matter how much time passed since the incident. 

Last year, I had my father change GPs, for several reasons.  I chose the new GP because he was highly recommended by others in the medical community.  But this is the second time in a year that I have been concerned with his lack of action.   I do intend to ask my father's GP why he was satisfied with nothing more than an inconclusive CAT scan.  Maybe he knows something I don't know and he has a reasonable explanation.  If not we will make some changes.  There is no sense continuing with a GP if you are less than confident about his advice.

"My uncle ignored a TIA and then spent 6 years in a bed being fed through a tube."

Thank you for sharing that.  It is the kind of account that will help me reinforce the seriousness of the TIA with my father and others.

My father does not have Afib because he has a pacemaker.  I did know about the need for an ultrasound of the carodid artery and it was the first thing my own GP mentioned. It's such a simple test I don't understand his GPs failure to order it. 

I had no idea that 25% of people have a hole in their heart!!!   I assume they would catch that with an Echo, which is the other "must do" test following a TIA.  Geez, now I want to have an Echo done on myself!   

 "I found it very comforting to know exactly what was going on."

Exactly.  My father was happily oblivious of the seriousness of his incident, but I have been worrying to death.  I jokingly told him that if he didn't get the workup done I was going to have him declared incompetent! 

My father already takes Aspirin every day.  All things considered, I think the most likely culprit if he had a TIA was the carotid artery situation. 

As I said, I will report back after the tests are done.  Good chatting with you and I do hope your own situation has been thoroughly resolved!
  

I strongly agree with your comments. I am an ecologist and did a lot of work with land managers in our arid centre of Australia - big area, not many people, extremely variable climatic conditions from one year to the next. The team i managed got themselves into no end of trouble before me by sending out grads with arrogance that they thought they knew best because they went to Uni. I would always emphasize the point that their challenge was to understand this highly variable landscape and use every resource available to them. These land managers were there all the time, they have observed what you want to know about and if you are smart you will listen hard and try and interpret whatever they say. The land manager may not fully understand reasons behind their observations but together you can come up with great resolutions but you have to create this environment where they feel respected and willing to be open and share information. So like your legal analogy, there are basic principles that apply across the board. My example certainly doesn't apply to all my medical situations across the years with medical professionals keen to listen and interpret your observations - an allergy specialist for my son I remember in quite disrespectful tones instructing my wife to stop looking at the internet!

But i think your comments are important for us all to take that interest in our own situations. I said about my Dad changing GP's and saving his life, but even with the new GP at some point I noticed my Dad going downhill rapidly quite some time after the operation. Dad had seen him but no action taken. I was a bit lost what to do and at some point i decided to write to the GP outlining my observations and the decline. It took days and then i got a phone call from the doctor that was a bit of a 'lecture' of how poor my dad's heart was and i had to prepare myself that he didn't have long, many people wouldn't have survived what dad had been through but he had this incredible will to live. I then relayed my observations of progress and that i thought it really was only days to go by the sound of things and that I would take time off work. I don't know what his trigger was and if from what i said but he agreed to call in and see him on the way home. Once there he was immediately calling an ambulance...... result was his meds were wrong and from memory basically his liver was being poisoned. I remember them mixing up this solution for him to swallow in Emergency..... few days of observation and he went home and lived for years after that. Just another example of the same thing!

But sounds like you have it all covered now. Yes the heart thing is surprising but with 25% of people with that hole (or failure to close off these 'flaps' in the heart that is to do with circulation from the mother closing off after not needed once born) - 25% don't die from the effects of it and why it is often not treated even if known about and it presents its own risks of operating on it that can be greater than the risk of living with it. My 'flaps' were a bit deformed, plus the stroke and otherwise perfect health and so the decision was to do it. Yes i had an echo that showed the hole but then an esophageal echo that gave them a closer look and confirmed this deformity.

Anyway, good to chat and all the best!