Surviving and Thriving: A Stroke Victim's Inspiring Journey

Imagine being at the height of your career, and suddenly, life throws you a curveball. This is exactly what our guest, Ewan Ramsey, a 49-year-old business man, experienced. With his wife Liz ( a physiotherapist) by his side, Ewan (Puggy) opens up to Dr Gavin Nimon about his personal journey, the sudden onset of the stroke, the challenges he faced, and the lifestyle changes he had to adopt. Puggy's story is not just about survival, it's about resilience, determination, and an unyielding spirit to live life to the fullest, even in the face of adversity.

From struggling with speech impairments to the distress it caused to his family, from enduring intensive tests and treatments to his remarkable progress, Puggy's journey to recovery is nothing short of inspiring. His story is a testament to the power of hope, positivity, and support networks, all of which played a crucial role in his recovery. Listen in as we explore not only Puggy's challenges and triumphs but also delve into the overlooked challenges faced by stroke survivors. We also look forward to the next part of our series where we will be joined by Dr. Michael Waters, an interventional neurologist, who will shed light on the diagnosis and treatment of acute strokes.

Aussie Med Ed is sponsored by OPC Health, an Australian supplier of prosthetics, orthotics, clinic equipment, compression garments, and more. Rehabilitation devices for doctors, physiotherapists, orthotists, podiatrists, and hand therapists. If you'd like to know what OPC Health offers.

Visit opchealth. com. au and view their range online.

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Transcript

Gavin: 0:21

Imagine driving your daughter one Friday afternoon, sunny. Your entire world changes in an instant when you suffer a stroke. 39,000 people in Australia suffer a stroke each year. That's a hundred a day. 10 percent of those are under the age of 50. Whether you're a medico, a relative or a stroke survivor, this episode promises a deep dive into the personal journey of a stroke survivor, shedding light on the challenges often overlooked in our clinical settings. Stay tuned for an eye opening conversation you won't want to miss. This episode is a part of a two part series. The second part, we get to interview Dr. Michael Waters, an interventional neurologist about the diagnosis and the treatment of acute strokes. G'day and welcome to Aussie Med Ed, the Australian medical education podcast, designed with a pragmatic approach to medical conditions by interviewing specialists in the medical field. I'm Gavin Nimon, I'm an orthopaedic surgeon and I'm based in Adelaide and we're broadcasting on from Kaurna land. I'd like to acknowledge the traditional owners of the land on which this podcast is being produced, the Kaurna people, and pay my respects to the elders, both past, present and emerging. I'd like to remind you that if you enjoy this podcast. Please subscribe, or leave a review, or give us a thumbs up, because it really helps this channel grow. I'd also like to remind you that also, this is now a video podcast as well, so you can actually find us on YouTube. It's my pleasure now to introduce you and Ramsey and his wife Liz. Puggy, as I know him, is a close friend of ours and at the age of 49, at the height of his business career, he suffered a hemorrhagic stroke which put him in hospital and he's now had to go through four years of rehabilitation to get where he is. His inspirational story is amazing will shed light on what the challenges are for someone who suffers a stroke in this scenario puggy, perhaps you can just start off and tell us what your life was like prior to all this.

Liz and Ewan (Puggy): 1:58

Um,

Puggy (Ewan): 1:59

uh, I were working all over the world and I do, uh, basketball in America and I traveled the world up Inverness and in lots of places, and I always also play, uh, so sorry. I also play down in

Liz: 2:24

new,

Puggy (Ewan): 2:26

new, uh, New, uh, Malawi, um, as well. And it was really good. Um, the next, uh, uh,

Liz: 2:41

You were full on, weren't you? I did. You were full on, really,

Puggy (Ewan): 2:43

really busy. It is. And it was, was, uh, in the, in the morning of, Fourteen years ago, I've got a headache.

Liz: 2:55

No, no, that's not right. No. Not fourteen years

Puggy (Ewan): 2:58

ago. Four years ago, it was, I woke up and it was really sore in my head. And I don't know what was wrong. It was just a, um, something's wrong. And it was annoying me. And then I, I picked up my youngest. Uh, Ellie, and driving her on, and then I just, oh, sugar. And Ellie was saying, are you okay? And I said, I couldn't speak. And I'd drive another two, three hundred yards, and it was Liz, uh, Ellie, she said, oh, are you alright? Please, are you alright? And then I was, that was it. I couldn't speak and I was in hospital for six months. It was a nightmare.

Gavin: 4:06

Wow, I believe, I believe you've not had it, you had maybe had some headaches for a few days prior to that as well and up to it, but it was really this particular day that really triggered it off.

Puggy (Ewan): 4:17

yeah, I'd had a few headaches that were quite sore about three, four, five months ago and really was awful. And I took a pill. And they, we will get better. So,

Liz: 4:34

Do you mean months or days? Months. So over the three to five months? Yes. Before you'd had headaches? Yes. Ah. Yeah, yeah. And you'd also, you know, you'd also um, you know, been treated for high blood pressure because you had. Yes. had had high blood pressure, um, before. Yeah. Yes.

Gavin: 4:57

We had a history of high blood pressure and your medications for it and you obviously were very busy at work. I believe you're running left, right and center at work and doing many other activities.

Puggy (Ewan): 5:09

I think, I look it back, I was really busy working seven days a week and um, I would say, I would always, Liz would say, Are you okay? And I said, yes, I'm busy, but I'm fine. And that was my...

Liz: 5:29

I think the hard thing is that you really loved what you were doing. Yes. So, you know, it wasn't that it was hard work for him as such. Um, but he loved it and so, you know, it was almost like you couldn't stop him doing what he wanted. You know, it sounded frantic sometimes because he would be travelling to Inverness very early in the morning and then maybe he'd drive down later to Glasgow and then he'd maybe come back round home that evening. So it was quite a lot of mileage he was covering, quite a lot of activities he was doing. And then he was flying off to, It was a particularly really busy spell, the sort of few weeks leading up to the stroke. He had reported having a sort of heavy nosebleed on one of the flights. Yes., and

Puggy (Ewan): 6:24

that prompted... That was about two

Liz: 6:24

months ago. No, it wasn't two months before, it was about two weeks before your stroke. Oh, right, okay. And I, that prompted a few discussions.

Gavin: 6:35

Yeah, I think you were saying previously you have a blood pressure check at some stage and you didn't get a chance to get around to it. Is that correct, Puggy?

Puggy (Ewan): 6:41

Yes, because you never ever have blood pressure, you go, Ah, that's alright, I will be fine.

Liz: 6:50

Yeah, I think, and we talked the morning off it. We talked the morning off his stroke and said, This is ridiculous. You know, you are blasting about everywhere. You must be due your blood pressure test, check. And, um, yeah, didn't happen.

Gavin: 7:10

And with the exception of being, having high blood pressure, and, uh, did you have any other history or any other factors that made you at risk of a stroke? Do you, have you smoked in the past or do you have high cholesterol or any other factors?

Puggy (Ewan): 7:22

I smoked about until 26 and then I quit and I haven't had a really, really strong fag or anything sort for 26 years ago.

Liz: 7:40

I think we'd really engaged with the high blood pressure because he was on sort of medication for it and we'd talked about lifestyle factors so we were watching diet and we were watching exercise and one of the things that We were doing together, actually it was every Sunday, we were going to a yoga class together. And we were loving that, and we'd done that for about a year. So, at his previous blood pressure checks. They had reduced his medication and, um, yeah, so I mean, and he was down to sort of six monthly checks. It wasn't like he was on regular checks by that point. So at the beginning stages, he was getting regularly checked a few years before, but. We felt, felt that we were on the right part of things with that sort of lifestyle, relaxation, yoga, stretching, we'd incorporated quite a lot of it. Mm-hmm.. Yeah. Um, I, yeah, I think it was the frantic nature of that stage. Yeah. Mm-hmm.

Gavin: 8:53

So actually on the day when you had the stroke. you remember much about, about it after the car? Do you remember going into hospital and the experience and casualty at that time?

Puggy (Ewan): 9:02

I, I referred, I remember my, my. Liz, no, Ellie saying, are you okay? And then I, that's the last time I was able to speak and then I went into the hospital and I just, I couldn't really speak anything until I remember I would own dinners and stuff like that. And the hospital didn't get me to try and drink about three days ago.

Gavin: 9:46

Do you remember everything people were saying to you and just couldn't speak back or you just don't remember much about that at the time?

Puggy (Ewan): 9:51

I must I, I don't remember. I don't

Gavin: 9:55

And Liz, what do you remember about the experience? What do you remember happened at the time?

Liz: 10:00

well, I just remember it being very stressful. I remember well, um, I, you're probably aware that I wa I was on a flight to the south of France and um, so I didn't get any of the messages until I arrived in France. Ewan was supposedly, um, coming home to be with our three daughters while I was away, so, um, there was nobody really here, so it was quite a stressful situation when I arrived in France, and, um, yeah, so I had to find myself back, and so I really wasn't involved in the situation until the next day, when I managed to get back to the UK, and I saw Ewan about Oh, well that happened about five o'clock on the Friday night, I saw you round about midday on the Saturday, and by that stage he had... been transferred from emergency services into the specialist, um, sort of neurosurgery unit at the Western General and was heavily sedated and, um, was in intensive care at that time. So he was very heavily sedated and...

Puggy (Ewan): 11:21

And I don't remember anything. Yeah, he doesn't really remember anything. Yeah. Yeah,

Gavin: 11:27

Liz, do you remember whether you had some sort of investigation right at the start

Liz: 11:31

he did at the beginning. Um, and, um, because I was air born, um, the scans were discussed with my daughter and um, which is actually our eldest daughter, Ellie, and she was only 18 at the time. And she did a FaceTime call to my sister who was actually in Toronto at the time and my brother in law and because they've got a medical background they were able to support her at that stage with trying to sort of process what was happening. And trying to, obviously, sort out about trying to get me back home, so, yeah.

Gavin: 12:17

It must have been absolutely frantic at the time that your flight must have been hell coming back, worrying about Puggy, what was happening at the time.

Liz: 12:25

It was really, really stressful. It was really, really... I was asleep. Ewan was fast asleep, and I knew he, I knew that he was sedated, but I didn't know what I was coming back to. And, um, yeah, I think it was the worry because I'd left the two younger ones in the house. And so they would have been, oh, twelve and fifteen at the time. And I'd left them alone and there was nobody because my sister was away in Toronto as well. So there was nobody at the house, so friends certainly came and did their job here. Um, but yeah, it was really stressful and I didn't know. Whether it was coming, what I was coming back to, yeah.

Gavin: 13:09

When they started waking you up Puggy, what did you notice? I mean, you know, what were your, what were your deficits initially and how have they changed since then?

Puggy (Ewan): 13:17

I know that my right hand was all the way down and, uh, my leg was also down. And, um, I, I, I to speak, I wanted to speak properly, but I couldn't get her out my mouth. So I would say hello and a doctor or something turned round and said yes and then I speak or I thought I was speaking but I was making no sense and I think oh this is a nightmare.

Liz: 13:59

Yeah, yeah, it was really, really difficult because you could see that you were just getting quite distressed with not being able to speak. And, um.

Puggy (Ewan): 14:11

And it stayed for that, for the, of all of my time up in the Astley Ainslie, and if you really want to. It probably took me six months, no, one year and a half a year ago. That was, I couldn't speak really at all.

Liz: 15:03

I think, I think the early stages you were very random in your words. I think the thing that was most upsetting for family, especially our daughters, was that you couldn't... You couldn't, um, see who they were. You would mix up names, which you still do, but, um, but that's, yeah, but it was quite distressing for everybody around because you just couldn't identify, you knew who people were, but you just couldn't communicate and that you, because there's social media and you're an avid social media person, he was sending messages. to family and friends and nobody really understood what those messages were, nobody could... And it was

Puggy (Ewan): 15:58

appalling, it was

Liz: 15:59

awful. Yeah, we couldn't, so we, we chose to... Um, just respond to them, but just give some pieces of information at the same time. Um, and, but it was distressing because you didn't really know what you were trying to make the point about. You didn't really know what you were trying to say. And, yeah, it was really, yeah, thinking back, it was painful. Really painful.

Gavin: 16:32

And, and during the, apart from the initial investigations with a CT or an MRI. What other treatment did you have initially? And I'll just explain to the listener. Western Hospital, Western General is the Neurosurgical Unit or Neurological Unit and the Astley Ainslie is the Rehab Facility. So how long were you in the Western General and what other treatment did you have there? And then when, how long were you in Astley Ainslie for?

Puggy (Ewan): 16:54

I was in the Astley Ainslie.

Liz: 16:56

You were in the Western. So initially you were in the Western for about three weeks. Yes. Until they had a rehabilitation space for him. Um, in the Astley Ainslie and then he was in the Astley Ainslie for six months. Um,

Puggy (Ewan): 17:13

and only that I had to push, push, push and say I want out of here. Because it wasn't, it was uh, for a, It was cause, it was all going to lockdown.

Liz: 17:27

Yeah, no, I mean, the, the, as far as investigative tests. They chose, I can't remember what you call it, Gavin, but they chose to do, um, a test where they check all the blood vessels up in the brain, but use a dye or do a sort of, like a, uh, but they waited, they waited quite a period of time for that. So he was still in Astley Ainslie when he had that test. One of the reasons they waited is because at Astley Ainslie. He developed a blood clot in his leg as well. So within a week or two of him being in the ass lanes, he developed a high femoral, um, blood clot. Um, and so there was all sorts of other health aspects that sort of held him back. So, yeah, it was just like one thing after the other.

Gavin: 18:26

That would have been particularly hard if you've had a bleed in the brain but also they want to give you an anticoagulant for blood clot is actually a catch 22. Astley Ainslie obviously is a Rehab Facility What was the thing that brought you along most of all Puggy? And you actually, I think about to say to you is actually this all happened during COVID as well. So was all during 2020, you were having a rehab. So it made it extra hard for you too.

Puggy (Ewan): 18:49

Yes, I was, I enjoy doing the bike because I got through to the physiotherapy and I was doing the bike but I didn't really make any because I wanted to do something

Liz: 19:09

worth it. I think the way that the Astley Ainslie, they work is that they have Obviously, you've got to consider the fatigue element of the stroke, um, and, um, you had your, sort of, your physio most days, and you had your speech therapy most days, and you saw a neuropsychologist. Some occasionally. Mm-hmm.. Um, but the main focus was on speech and physiotherapy and it was very sort of much gym-based mobility, sort of progressing some sort of strength work as well. I think you're just impatient. I think you just felt that you should be at B and actually you were still only at level A level and, um, You were constantly frustrated, and I think that frustration was driven by you're just, all these faculties being taken away. You know, you're not being able to speak, not being able to communicate, not knowing what was happening with his work, not knowing what was happening, you know, about all the work that he'd really worked really hard on that he was juggling for months. And also, it was that desperation, you just couldn't quite let it go, and that was what was really difficult at the time. Controlling your expectations. Yeah. Really

Gavin: 20:43

so you went through a lot of rehabilitation and you've now, you're now walking. In fact, you just recently have done a, I think it was an eight kilometre walk up, up Arthur's Seat, which is an incredibly big hill in Edinburgh. which you did. It's a very, very impressive feat to do it such, so quickly., where does it go from there? Is there any further treatment or investigations they have to do to check you out and see, make sure nothing like this happens again, or?

Liz: 21:06

hmm. Not really. No, um, no. Puggy was discharged from hospital just as COVID came in. And then we did a lot of the sort of rehab and things at home. So you did some of it on a screen. But you still, you've not really been in for rehab. You've had a lot more speech therapy and things like that. No, I think so. been stopped. Um, and so it's really down to time and me. Um, and yeah, so there's not really anything else that we're waiting for. No further tests. They've explained this as just that high burst of blood, high blood pressure at that time. There's no weaknesses there in the blood vessels, they're happy with them, there's no treatment that needed to take place as a result of that, and the main thing is managing your blood pressure, which has been absolutely fine, there hasn't been another episode of high blood pressure at all. Um, since that event. Mm.

Puggy (Ewan): 22:19

And I, I got to try and go to Malawi in 2024.

Liz: 22:26

Well, the drive's still there, Gavin. The push is, push is

Puggy (Ewan): 22:30

still there. That's, that is going to happen.

Gavin: 22:34

So you're keen to get back on as much of your normal life as possible, so.

Liz: 22:38

Yes. Yes.

Gavin: 22:41

There's a hell of a, hell of a toll to take, um, going through all this. When I was speaking to you earlier this year, We're talking about the importance of perhaps needing support groups to be had. Is that the thoughts you still have or do you feel like it's heading, things are settling down?

Liz: 22:54

Mm.

Puggy (Ewan): 22:56

The only one that I really thank you for was down in Peebles, because it was Fiona McFarland. She was

Liz: 23:08

excellent. Very supportive

Puggy (Ewan): 23:10

for you. Yes, she started for three years. Didn't she? And it was, she stayed every week, and for once a week, and it was really, really good.

Liz: 23:23

I think that there is weaknesses in the system, and one of those weaknesses is the early stages, because for us as a family, our whole world had turned upside down, so there was no specific support mechanism for our children, for myself, for... because the only mechanism of support was through family and this uncertainty, we didn't know what was... where were we going to get to with Puggy, what level he was going to achieve and we still don't because that's still slowly slowly progressing. And it's only because I have that knowledge, that, and you, you have your drive as well, that you've probably reached the level that you've reached. Whereas I do reflect and think, there must be so many people out there that really don't know that there is a massive potential for themselves, and that I find quite distressing because... We're strong enough in ourselves, but actually it would be nice to know that you were getting and we were all getting that. Maybe six monthly support or review or, you know, just something that just kinda you could call on if you needed it. And that doesn't really exist. It's not there and you just have to have faith in yourselves really and yeah, I think there's just so many people I think that must not be achieving their potential. And that's, that's really, really difficult. Whereas, you know, one of the things that I can say is, you know, you've now traveled up to and you've been in your own and done these things now. And I think that's because we have belief and we have this, um, it was one of the most difficult things I've ever done, which is putting him on a train. It felt like I was putting my 10 year old on a train. And I was so anxious about the whole thing, and he was going to be away for a night, and he'd never done anything like that before. And that was a year ago. And, you know, where he is now, a year later, four years after his brain haemorrhage, you know, he goes up now, and he can spend a week up there. So, you know, it's, it's changed. It's still progressing. And I think that's the thing. It doesn't end. Our brains still continue to form and re change and re shape and develop. And because we have that knowledge, or I have that knowledge and drive, and you've got the massive drive. Mm hmm. Yeah. Um, and also I've got the contacts you've achieved. Mm hmm. Yeah. A lot more possibly than a lot of others could have achieved. And, uh, that's because we know that we've got the knowledge, I think. I think that's what it is.

Gavin: 26:39

Well that's the take home message for the people listening who might have had family going through this is that things keep improving all the time and to be aware of

Liz: 26:46

yeah, yeah. But it's slow. It's slow and really subtle. And you, you know, you can't, it's really difficult to describe because your speech today isn't fantastic but actually there's some days it's amazing and you can have really amazing conversations and then, you know, there's other times it's not quite so good so there's inconsistencies in it as well. Yeah,

Puggy (Ewan): 27:12

and that's really annoying me and it annoys me so much.

Liz: 27:18

Yeah.

Gavin: 27:18

probably made it a bit harder for you today too. I'll explain to the listener. We had a few technical issues at the start, which has probably put us all under stress since the start of this. So,

Liz: 27:26

Yeah.

Gavin: 27:26

that doesn't help too. I'm sure when you're, any or all of us are under stress, we, we have trouble with our speech.

PUGGY interview- Gav-1: 27:31

So I do think the, the other thing you told me, Puggy, was the importance of your, your other goal, apart from traveling to Malawi, was also your hope to get back and play on a game of golf as well and hit a few golf balls. So,

Puggy (Ewan): 27:44

Yes, I do. That's, that's one thing I try. I take my time and I hit a golf, golf ball. So, that's. You've tried?

Liz: 27:56

Yes. You've tried? And so, in the summer, um, so just about a month or so ago, six weeks Alyth. Yeah, to the driving range, and, um, he managed about 60 yards, I think. Yeah, Yeah, yeah,

Gavin: 28:14

that's

Liz: 28:14

Um, so it's alright, so it was a good start, and, um, it's just trying to find the right position, and which direction to go, so how to hold the club, um, and we've got some friends, um, actually one who's, uh, golf pro, so they're going to try and help support us a little bit with that as well, so. Yeah. Yeah, we're really lucky with the people that we have and the support network, um, that we have got. And the hope is that you can get back to doing some things like that again.

Puggy (Ewan): 28:50

Yeah, I can get and go and watch the football.

Liz: 28:54

Yeah. And stuff like that. So, yeah, so he goes out and he does things with others and goes to sort of the football and things. So, big love there. Yeah. Yeah.

Gavin: 29:07

Look, it's been fantastic hearing your story. You know, we, we all put ourselves in your situation and it's just impossible to try and understand how hard it would have been to going through those few days particularly, but also the next four years. But it's brilliant. And, uh, hopefully the listener will get a bit out of it. Final thing, is there anything you think that would be important for young doctors to know about for treating patients who have suffered a stroke and what, what you think it's worth telling them?

Liz: 29:34

I think a lot about, um, hope and... Um, what would I say, probably. I think the main thing is, is to ensure that the people that are supporting the individual with the stroke and the individual with the stroke knows that there's lots of potential. It doesn't need to be just like it was. It's not the end of the world. There is scope out there, there's change, the brain develops, the brain changes, it re forms, it re shapes. I think that's the important message right from the very beginning that, um, needs to be followed through more regularly. And, um, if they can, you know, I think the rehab services Um, fall through a bit because they only really cover, they only, they only do sort of the first six months. And we've not really had any sort of regular rehab as such. You've had some support because you go when you get... The other thing that he does get Gavin is he gets Botox injections every sort of four months or so into his arm or his calf or whatever. So you do still keep connected in some ways but there's no Yeah, there's no review of, of his limbs and his movement and, you know, seeing if there's times where it may be just a little bit of extra rehab would be really valuable. And so that's the, that's the bit that's missing and I guess it's more to do with funding rather than anything else. But I think it's about the positivity rather than, I mean the consultant said to me when I arrived, um, He was very, very... Um, obviously I'd done all that travelling, and I'd had all that worry, and the first thing he said to me, and I just saw him in a corridor. So being mindful of, of the situation as well would be really helpful, because I'd just arrived back from France, and he just sneaked out of theatre, spoke to me in a corridor, and said, The damage is all done now. It's all done. So, it's whatever you can make out of it from here. And... That resonates with me, and I suppose that's the bit that, yes, he was right. I probably needed to hear that, but that was quite a difficult time to hear that.

Puggy (Ewan): 32:21

But, if you have one thing, it's things that get better and better and better. So, if you keep on trying, you will make sure that something's doing well

Liz: 32:35

for you. I think, yeah, it's about maintaining your positivity, isn't it? And, Yeah,

Gavin: 32:43

that's just, I

Liz: 32:44

and we need to.

Gavin: 32:47

Puggy you've just, it's just a fantastic, fantastic way to finish the interview is that, that sentence is just brilliant, is what you've said the whole time and, it's been fantastic speaking to you, and thank you very much.

Puggy (Ewan): 33:00

Okay. Thank you.

Gavin NImon: 33:02

Thank you very much for listening to our podcast today. I'd like to remind you that the information provided is just general advice and may vary depending on the region in which you are practicing or being treated. If you have any concerns or questions about what we've discussed, you should seek advice from your General Practitioner. I'd like to thank you very much for listening to our podcast, and please subscribe to the podcast for the next episode. Until then, please stay safe.