I actually slept well that night, and things seemed to be getting better. However, by the time I got downstairs in the morning, the pain was back and worse. What worried my wife most was that we needed to be out the door in 15 minutes and I had crawled back into bed. We had a plane to catch, so I slapped on an ice pack and loaded up the car, and we were out the door. About 10 minutes into the car ride, my wife noticed that I had my seat completely reclined, and we both came to the realization that getting on the plane probably wasn’t a great move. She got off the freeway, and we decided to swing by my emergency department to get told everything was fine, and then we’d be on our way.

Emergency Department Workup

At the emergency department, I had a normal exam, and everyone agreed that this was muscular. My colleague even found a nice trigger point that exacerbated my symptoms. He suggested a trigger point injection, which I was agreeable to on the condition that I would get a CT angiogram of my neck if it didn’t help. Deal. I got the injection; it didn’t help. I got the CT angiogram, and about 30 minutes later, I was in an ambulance to our neuro tertiary-care center for my long-segment VAD. No Hawaii for me.

The overnight stay in the neuro ICU was pretty uneventful. I got a little morphine, more for the cough than the pain. I was started on Plavix and aspirin. My MRI of the brain was normal. Transcranial Doppler showed no emboli. I puked up a dose of Norco, but otherwise, the night was uneventful. After seeing the intensivist, neurologist, and neurosurgeon, it was decided that I would lay low for six weeks, continue the antiplatelets, and start lisinopril and Lipitor.

Little did we know that the day I left the hospital was the first day of boating season in Seattle, and our route home was from one side of Lake Washington to the other. After about an hour in the car (for a 10-mile drive), I was carsick and made it to within a half mile of my house before I vomited. This led to a marked increase in the headache that was not improved with position, ice, Zofran, or tramadol. Of course, my wife thought I was doing fine, so she popped over next door to chat with the neighbors. When she got home, apparently I looked like death, so back to the emergency department we went. I guess the nurses agreed with my wife’s assessment; they put me in a resuscitation room. Now my blood pressure was 230/120, and I was dripping in sweat. Fortunately, a repeat CT angiogram showed no change in the dissection, and I did not have a subarachnoid hemorrhage. After about eight hours in a room, two liters of fluid, IV Dilaudid, Zofran, Compazine, Benadryl, and Ativan, I was as good as new.

Long Road to Resolution

Sadly, I spent the next three weeks on my back, needing narcotics and benzos to control the pain. I finally went in to see the neurosurgeon, who wasn’t thrilled that I was incapable of sitting upright in the waiting room. He promptly got the neurointerventionalist from next door, who sent me down to interventional radiology and performed a diagnostic angiogram, which showed a pretty ragged artery with lots of thrombus. The options were: 1) stay on Plavix and hope for the best, or 2) sacrifice the artery that I really didn’t need anyway. I chatted with a few people, but it was pretty clear that the second choice was the best option. The next day, I had a second angiogram and had six platinum coils placed. As an aside, it was noted that I had some extravasation of blood into the soft tissue. I went home that evening with a Medrol dose pack, and by the next morning, I was nearly pain free and have been so since.