TIA and Minor Stroke
Getting a diagnosis of transient ischaemic attack (TIA)
An good blood supply is vital for the brain to function. The blood supply carries oxygen, glucose and other nutrients and removes waste products such as carbon dioxide. Four large blood vessels carry oxygenated blood up into the head – two either side of the windpipe at the front of the neck (carotid arteries) and two along the top of the spine (vertebral arteries). If a blood clot or other debris clogs one of these blood vessels (or one of their smaller branch vessels), the blood to the nearby brain cells may be disrupted. If the disruption is only temporary (causing symptoms that last up to 24 hours) it will be diagnosed as a Transient Ischaemic Attack (TIA), whereas if symptoms are more permanent, it is diagnosed as a Stroke. Sometimes a TIA occurs when a blood clot from a blood vessel in another part of the body, or from the heart, moves upwards into one of the brain’s arteries. This is called an embolism. Very rarely, symptoms of a TIA are due to bleeding (haemorrhage) in the brain (see the Resources page for more information)
Once help was sought most of the people we interviewed had had it explained that the symptoms they were experiencing were typical of a TIA or stroke – slurred speech, weakness in limbs or visual disturbance (see ‘Symptoms’), and in most cases people were told to take aspirin straight away if a TIA was suspected. In some cases the suspected diagnosis was given by the ambulance crew or paramedics who attended the patient following a 999 call.
Enid rang the doctor as soon as she realised that Geoff was unwell...
Enid rang the doctor as soon as she realised that Geoff was unwell...
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Geoff' Early Friday morning I was in bed, about to get up and now I just sat up in bed and I just lost all consciousness. And the next thing I realised I was being put in a, in a little chair to be taken in an ambulance. And then the next thing I, I know I was, had, had the medical examination in [local hospital].
So can, maybe Enid can fill in some gaps there, what happened? What did you know to …?
Enid' Well, he woke me up by making a funny noise. And I said, “Geoff are you all right?” And he said, “No.” So I got out of bed and ran around the bed and I said, “What’s to do?” He said, “I don’t know.” But he wasn’t sat up. He was on his back. And he said, “I’m going, I think I’m going to be sick.” So I said, “Well, if you’re going to be sick, you’ll either have to sit up or get on your side or else you’re going to choke.”
Geoff' No, I don’t remember any, any of that.
Enid' Now he said, “I can’t.” So I realised then he was paralysed.
Geoff' So, I got me….
So, you then…?
Enid' …I rang the doctor first and then she sent an ambulance. And they rushed him to the hospital. They were very, very good actually the paramedics that came.
So, Geoff, perhaps you could carry on with your story now?
Geoff' So when, I came round after being examined in hospital and there was just wait, they were, the. It was a doctor, was it?
Enid' I think you were about two hours before you came round.
Geoff' They were trying to find me, find a place to take me, weren’t they?
Enid' They asked you some questions before that. And asked you if you knew where you were and if you knew what had happened. And you just said, “I’ve had a funny do.” And they said, “Where are you?” He said, “[local hospital].” That’s the hospital in [town] because we used to live in [town].
Enid' So they said, “Where are you?” And he said, “I’m in hospital in …
Geoff' “I’m in hospital.”
So he knew what was going on at that point?
Enid' He knew what going on then. Yes.
Yeah.
Enid' But I bet it was about two hours before he actually came round.
Geoff' Yeah I don’t, I don’t remember anything.
Enid' Because I don’t remember them doing like they do on your knee you know to see if you have any reaction.
Geoff' Yeah.
Enid' But when you spoke they said that was a good sign.
OK. So then what?
Geoff' So that.
When, when you did start remembering, what, what was, what can you remember now?
Geoff' I remember taking, me, taking me out of the emergency department and…
Enid' Took you to another ward.
Geoff' They took me down to put me on a ward, which was down the road and out of the, the building where we were, and across and into another building. And they put me into bed there.
And that’s where I stayed.
Enid: Until he came home.
Geoff: How long was I in?
Enid: Nearly a fortnight. Well, it happened on the 27th of July and it was the beginning of August when you came out.
And that’s where I stayed.
Enid: Until he came home.
Geoff: How long was I in?
Enid: Nearly a fortnight. Well, it happened on the 27th of July and it was the beginning of August when you came out.
Clare was taken ill at work and an ambulance was called by one of her colleagues. In the...
Clare was taken ill at work and an ambulance was called by one of her colleagues. In the...
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So then the ambulance men came in and my colleague was sat next to me and I didn’t know what he was doing but unbeknown to me I was paralysed down my left side but I didn’t realise, I had no idea whatsoever. And he was holding me up. And then they got me into the ambulance and they set me up with an IV drip and everything [coughs] and I can remember one of the bosses sort of like coming to the front of the ambulance, the back of the ambulance and saying, you know, “Take care.” And I went to wave at him and do that with my left hand and it was like my brain was saying, “Move,” and it wasn’t moving. And then I said to the ambulance man, “What’s the matter with me?” And he said, “You’ve had a stroke.” But I think I’d guessed, the fact that the holding of the hands and I was weak down the left side. But the one thing that was so handy was they’d done a spate of those commercials for the Stroke Association and I think that had so much bearing on the speed my sort of care, because it was just shortly after all these commercials and the commercial had a tremendous impact, because a lot of people have said, “Oh you were exactly like the commercial.”
Phillip's wife said she thought he should see the GP, so he made an appointment the next day and...
Phillip's wife said she thought he should see the GP, so he made an appointment the next day and...
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My wife came home from work and, you know, she’d seen this in the morning and I explained I still had a little bit. And she sort of worried and said, “Look, you need to go and see your GP.” So the next morning I went to see my GP and I explained what this was. And it’s a tribute to the National Health Service that you can actually do this. I mean I can call them up in the morning and say, “Look, I think I’ve had this episode” and they say, “Come right in.”
And she, she said she thought I’d had a stroke. And I was very fortunate because the practice I go to is a part of the [name] stroke study. And so she called up the [hospital] and they arranged for me to come and visit them at 2 o’clock in, 2 o’clock that afternoon. And so at 2 o’clock I went over there. And by now the symptoms had essentially vanished. I might have had some, but it just might have been, you know, you keep thinking about this, and when you think about things you think they’re there anyway.
Yvonne's GP referred her to a TIA clinic, but as she'd never heard the term before she didn't...
Yvonne's GP referred her to a TIA clinic, but as she'd never heard the term before she didn't...
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Had a doctor’s appointment on the Monday so I thought I won’t bother the doctor, I’ll just mention it, you know, when I go in on Monday.
Mentioned it to her eventually [laughs] and she said, “Ohh, I think I need to refer you to the TIA clinic.” I said, “Yeah, OK fine.” Not knowing what TIA clinic meant and kind of not asking really. And I came home. It was about half past seven in the evening as it was a late appointment. Came home. Phone rings at nine o’clock the next morning to say, “Can you come in tomorrow?” I got, “Sorry? What’s, you know, what’s the rush?” And eventually I said, “No, I’m on annual leave at the moment my first day back at work tomorrow, so can I come in on Thursday?” And they said, “Oh, OK.”
So I went in on Thursday, spoke to the specialist who at the hospital who was very good, very reassuring and said, “No, I don’t think it I think, don’t think you’ve had a stroke, I think you’ve had an episode.” And that’s the first time I’d kind of heard the word stroke, which was a bit of a shock.
Michelle's symptoms weren't diagnosed as indicating a TIA until several months later when she...
Michelle's symptoms weren't diagnosed as indicating a TIA until several months later when she...
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Because we live too far away to the hospital, they couldn’t actually get an ambulance up the mountain where we live, so I had to get or my mum did, sorry, the next, next door neighbour from where we live to take us to the hospital. And it was a weekend because it was an out of hours and we got there [sighs] and he did examination, blood pressure and he checked my ears and he said I had viral infection. And just to go to see my normal GP in the week, the next week. So we did. And, and from there I was having, I don’t really, funny sensations. The doctor thought it was neuralgia, anxiety.
What sort of funny sensations?
It was more in my face like, not like pins and needles, it’s not like that or, like something running on your skin. Kind of like that. But it would go numb and then come back and, but it was, it was more on my face than anywhere else on my body. And a lot of the doctors thought it was a severe anxiety problem and they was giving me medication to treat anxiety which in one way prolonged the stroke but didn’t really investigate TIA, the possibility of TIA at all, the lead up to a stroke.
When was that first mentioned then? TIA?
TIA was after I’d had the big stroke.
Oh really?
Which was five months later.
Ok, so you hadn’t realised that you’d had a mini-stroke?
No, nobody said it was a TIA or anything until I had the big stroke and they’d seen in my notes what had happened five months previous and said, “Oh, that was a TIA, somebody should have, you know, picked up on it.” So that’s when we first got told it was, these were mini ones leading up to the big one.
So you went for five months just feeling intermittently …
Yeah, having constant like mini TIAs. Some could last minutes, some could last days, hours.
Ken was told he had had a minor stroke and given a brief explanation of what that meant
Ken was told he had had a minor stroke and given a brief explanation of what that meant
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I started querying he said, when they started wondering, because then they mentioned sort of what I would say were two types i.e. the sort of blood clot or the, you know, bleeding in the brain. And he considered it, it was, it was a sort of temporary blood clot had got there and that I could expect that you know, certainly some, some of the symptoms would go away and I would, you know, improve.
As opposed to the bleeding in the brain when he was saying this is much more serious.
I found there that the, the you know, they didn’t, quite honestly they didn’t go into it too much. They just said, “You’ve had a minor stroke.” You know, “You’ve got the symptoms, you know what the symptoms are. We, you know, you can expect this or that or anything else and you’ve obviously had these you’ve had a minor stroke.” And that’s what he said, and that’s it.
And did, did that feel enough for you? Did that feel …?
Yeah.
Susan is convinced she has had a series of TIAs but doctors disagree and say she hasn't
Susan is convinced she has had a series of TIAs but doctors disagree and say she hasn't
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I was made redundant and then I went into sheltered housing where I had an accident and injured my spine. It went to court but because my father was dying of cancer I gave up with all of that. And I had illness. And ME came in and fibromyalgia and a lot of other medical conditions. And I’ve switched to many doctors but I was diagnosed I would say about nine years ago I felt that I wasn’t right so I went to my GP and I was, and had hospital tests, lots of hospital tests because they tried to rule out MS. I’ve had a battery of tests, feeling unwell. And then I was put on 75mg aspirin, one a day and from that I’ve gone downhill to the point of having carers, being on Medic Alert and on Lifeline. Lots of vagueness and just really out of it. And because of the stress that I’ve undergone which is very long and complicated I know I’ve had a lot more.
So I’ve had a lot of drugs for different conditions, including the ME and CFS and the spinal injury. And then got very frustrated with all the tests at the hospital, kept collapsing and I kept arguing that I’d had more TIAs. Continually at the hospital and then they said that “You haven’t had any.” And I said, “Yes, I have.” So I went and got my medical notes out, challenged the consultant that I was seeing, had lots and lots more hospital appointments and challenged them to the point that I’d had a lot more. And I’m still fighting to this day.
So how many would you say you’ve had then, the TIAs?
Well, I consider that I’ve had about six. But because I’ve changed doctors and I’ve had collapses and I’ve had a lot of things ongoing, one’s saying I haven’t, one’s saying I have.
And how does that feel for you having this ongoing argument with medical professionals?
Well, I’ve really, that’s caused me more stress. And because I keep a lot of my forms and I check things through, because I’m that sort of person they just kept putting it down to stress. They didn’t deny I’d had the first one but I said I’m having a lot of other things that are happening and I know I’m not well. And I’ve challenged them and I’ve put in complaints to different places. But you just, it’s the system.
Brian's consultant said he'd had a 'small stroke' which he thinks means the same thing as a mini...
Brian's consultant said he'd had a 'small stroke' which he thinks means the same thing as a mini...
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Who actually told you it was TIA? Was it the ambulance staff, or was it in the hospital?
Brian' In actual fact the consultant at the hospital told me it was a small stroke [laughs]. So it was actually the research staff. I mean, a small stroke can mean anything, the same as a mini-stroke, or a TIA.
Rosemary' In actual fact that paper that come with you out of the hospital had got a “query TIA/ or stroke. It had got a question mark.
Brian' Yeah.
So basically the research team kind of changed the diagnosis when they came to see you?
Brian' Yeah.
Mm, interesting.
Brian' Yeah, I mean, all three terms were used when I was actually in hospital overnight. Small stroke, TIA, and syncope. So, you know, you take your pick [laughs].
Does that worry you, not - that sort of lack of …?
Brian' No.
No? OK.
Brian' No. Because I know it’s nothing serious, then, let’s put it that way. In my own mind it’s, it’s just an inconvenience at that time, sort of thing. But to some people it could be extremely frightening.
David was told by the consultant that he'd had a TIA. But the term mini-stroke was also used. He...
David was told by the consultant that he'd had a TIA. But the term mini-stroke was also used. He...
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At what point did they mention that it was a TIA? When did you get told what it was?
I think it was the following day. Somebody did come in and, one of the nurse practitioners came in that day into A and E and said that they thought I’d had a mini-stroke.
OK.
Which I found to be extremely frightening. The next day a doctor came. Nice, approachable young fellow and I asked him exactly what had gone on and he said, “Oh, you’ve had a, a TIA.” And I said, “Well, what in hell is a TIA?” And he said, “Well, it’s a mini-stroke.” He said, “But we are going to call it an actual stroke because it has left you with certain things. You’re still, you know, if it was a, if it had been just a TIA it would have just of gone straight through and you would have had nothing left of it now. But because you’re still having slight difficulty with some of the words and, you know, emotions, we are going to call it a mini-stroke.”
And how, how long after the event was that, that you had that conversation with the doctor? Was it the next day? Did you say?
Yes it was the next day. It, it was probably about 12 hours after it happened. No, sorry, 24 hours after it happened.
So what he was talking about the duration of your symptoms and …
Yes.
.. relating that to …
Yes.
...the diagnosis that he gave?
Yes, well I still, I was talking then, I was talking OK but I, on occasions I lost the words this time, I just couldn’t, I knew exactly what I wanted to say and I knew where the word was but I just couldn’t put it in line.
Did you get any bet, any further explanation of what a TIA or mini-stroke actually is or do you know that now? Or …?
Not really. I think the nurses did sort of say did give some information but even to this day, I mean, I know what a mini-stroke is obviously now [laughs] but even to this day I haven’t got, I wasn’t given that much information. I don’t think anybody actually sat down and said, “This is what happens and these are is, these are the results and this is what is likely to happen and this is how you are likely to end up.”
Clare was told it was a TIA because the symptoms subsided within 24 hours, but she has been left...
Clare was told it was a TIA because the symptoms subsided within 24 hours, but she has been left...
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Was it called a stroke or a mini-stroke or TIA? How was it …?
It was a TIA. But the thing is that I was left with brain damage so that was where it was sort of like, because I did recover very well …
But I was left with a small patch of brain damage to which I was extremely, I took very, very badly. You know.
And what’s the outcome of that then in terms of the future for, is that something that’s going to improve or that’s permanent?
I feel that, I mean, it’s permanent damage because it’s brain damage but I feel that other parts of my brain have compensated because how I was then to how I am now… I said to friends on the weekend that I was doing this interview with yourself and the fact that, you know, I felt that I, the way I was before I had come back if you like.
And do you remember how, what the doctors or whoever it was that gave you the diagnosis, I mean, how did they distinguish between a TIA and a full blown stroke?
Because they, because it had happened within a certain amount of time.
Right.
And because it had happened within 24, I’d recovered within 24 hours they put it down to a transient ischemic attack.
Jennifer was admitted to a stroke unit where she had tests and scans and was then told that she...
Jennifer was admitted to a stroke unit where she had tests and scans and was then told that she...
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I was taken, taken into [hospital] into a, a stroke unit and was given all the tests. I had weakness in both my leg and in my hand and arm for 24 hours to 48 hours after taking ill. My speech was slightly slurred but there was no drooping of the mouth or anything like that. They, they gave me a scan and they also, they tested my veins and my arteries just to see if there was any clogging or anything like that. And they then diagnosed as best they could that I’d had a TIA.
They told me at that time that, that you can have a TIA but it cannot be diagnosed as definitely be, because there are no signs after you’ve had a TIA. And they told me it was a mini-stroke, a trans, transient ischemic attack. Which I knew anyway because I’m a trained nurse.
Peg was told that it probably wasn't a TIA she had experienced but she is waiting for further...
Peg was told that it probably wasn't a TIA she had experienced but she is waiting for further...
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And then I got into the hospital, and I was all wired up for scans and what have you. And then I went for an x-ray, a chest x-ray, and then I was admitted to a ward about twelve o’clock that night. And then the next day I had [tut] a head scan, and then the doctor came that afternoon and saw me, and I said, you know, what the symptoms were and I said they weren’t quite as bad as, you know, they had been the day before. And I said it was just like getting a migraine without the symptoms, the other symptoms, like the flashing lights and the bad headache. Because I expected, at that point, to have a whammy of a headache. Anyway, the scan was okay, apparently, my head scan, but then she sent me for a neck scan for the vascular veins and what have you, and that was okay. But I mean the attention I got was just wonderful, sort of thing. You know.
So they told you they thought it wasn’t, hadn’t been a TIA?
It hadn’t, it wasn’t a TIA, definitely not. But they were going to, I’ve got to go in for an MRI scan and to see a neurologist, which they’ve arranged both the appointments and I’ve got the appointment through for the MRI scan
Gilly was told initially in A&E that her symptoms looked like a TIA, but she is still waiting for...
Gilly was told initially in A&E that her symptoms looked like a TIA, but she is still waiting for...
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I thought I knew what the next steps were for when people had TIAs because although I’ve never worked in a stroke ward, I have worked as an NA in hospitals and I do kind of know a little bit which is probably dangerous. And my understanding was if you had a TIA, you had a scan and you’re seen by a stroke specialist within a week. Certainly in a city. And I think everywhere else as well.
So when that didn’t happen and when he said, “Well what we do here is, we put you through this other clinic, so you’ll be seen and you’ll be seen quite soon.” And I presumed that ‘you’ll be seen quite soon’ meant you’ll be seen quite soon. It never crossed my mind it would be two months. And that was with a lot of pushing.
And when the triage nurse mentioned the neurologist then it was at that point that you kind of, was it at that point that you felt, ah, at last I’m going to get some help?
I really felt that we had now reached something that was going to be trying to explain what had happened. I knew that something had happened although I couldn’t talk a bit and now I was fine I knew that all the things that had happened from the following day on had happened suddenly overnight. Very quick fast change. And when things happen with our bodies suddenly then there’s a very swift, big change overnight I know I only know a bit but I know that’s dangerous. And I know it has to be followed up. So I was just, I am, I remain very pleased that they’ve done that and that they have referred me.
And have you been to see the neurologist yet?
No. Two weeks after being to the clinic we still don’t, my referral letter was still on the doctor’s desk yesterday, so it had been sat on his desk, for administrative reasons, that’s out of their control a bit. But it’s, still that my referral letter is sat on the doctor’s desk two weeks later, so I’m in the process of chasing that up.
Clare was told her Doppler scan showed an occluded carotid artery which seemed to be the result...
Clare was told her Doppler scan showed an occluded carotid artery which seemed to be the result...
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I think then when I had a Doppler scan my neck he said to me, “Had, have you had a trauma?” And I was quite taken aback and I said, “No.” And he was like, “Are you sure?” And I said, “Yes.” And then I was trying to think back as to have I had a trauma, no. And he said, “Because your carotid artery is damaged, is completely occluded.” So I can remember thinking, “Why? Why is that? You know, I’ve had no trauma to the neck.” And then the only think I could think of was going back, because he said it was in the last week he thought this trauma was. But about a few months prior I was in the shower and I’d had a bit to, too much to drink, I was a little bit inebriated, and I went to get out of the shower and I slipped and I fell and as I fell I brought the curtain pole down on top of me and across my neck. And I can remember calling out for my husband and him coming and saying to him afterwards, “I’m surprised I’ve done such little damage to myself in view of the fall.” And then weeks after that I started to sort of experience headaches and also I lost the vision on my left side. But I, it, it was really strange because it happened so quickly. I just kept putting it down to tiredness.
So I feel that I did have clues that something was going on, that I was having a, you know, there were symptoms prior to my stroke …
Yeah.
But I kept putting them down to tiredness, to this, to that but, when in actual fact I wish now, because I can remember, I had like almost like an electric shock in my brain and I can remember thinking I should write this down because I’d lost my vision temporarily. It was all very, very odd. And I just thought, “Well I’m over tired,” you know. “Work’s quite, you know, heavy at the moment.” And so I didn’t really think any more of it. But then it was when I’d had my stroke and I started to think back and eventually the consultant said to me that it was a biological accident. And they never did find out why I had a stroke.
Martyn feels lucky that nothing more serious happened to him and sees the TIA as a warning sign
Martyn feels lucky that nothing more serious happened to him and sees the TIA as a warning sign
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I think I was very lucky. I look upon it as a sort of warning sign really. And as the doctor said at the time, “You were very lucky Martin [own surname] it was just a sort of an episode, two episodes but fairly minor and it could have been far, far worse. And now you know what to do to you’re taking medicines etc, medication to prevent anything nasty in the future”. So I think I was very, very lucky indeed.
Michelle had a stroke following several incidents that were later diagnosed as TIAs, but the...
Michelle had a stroke following several incidents that were later diagnosed as TIAs, but the...
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I mean, what, when, when you, you heard the word stroke and that, told that’s what’s happened, what did you feel?
I was really shocked to be honest because the, it wasn’t even the doctor that told me, it was my dad. As I came out from the CT scanner there was no doctors there and I could see by my dad’s face. And I said, “What’s wrong?” And he said, “You’ve had a stroke.”
How did he know?
I don’t know.
Oh.
I presume the doctor must have been in the room when I was being scanned and he’s come out and told my dad I’d, I don’t know.
Phillip felt unprepared for what had happened and said 'one knows these things happen even though...
Phillip felt unprepared for what had happened and said 'one knows these things happen even though...
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After my wife had told me, “Look, Phillip, you really have to go and see your GP, because you might have had a stroke” I thought to myself, “Wow.” But you know, one knows these things do happen even though you don’t believe you’ll have one yourself. So by the time I’d cycled up to the surgery, which is only about a mile away, I was sort of thinking to myself, “Yeah, maybe, maybe that’s correct, maybe I have had a stroke. That’s rather terrifying. I’m still alive but I guess right now I’m suddenly in a situation where I am contemplating serious change.” And so when I talked to my GP and she explained that that sounded like it was a stroke, it’s called a TIA, a transient ischaemic attack - I’m still not totally sure what ischaemic means - and that the, she was a part of a study and that I should be heading up to the study in [city], I kind of accepted the fact that this absolutely unprecedented and completely unexpected event had occurred, which I was totally unprepared for. And so I was sort of a bit like Livingstone and Speke, wandering around the African jungles. I was just completely in a no-man’s-land, this was going to be... And so I decided that I would look at this as an adventure, because otherwise how else can you look at it? This was a thing that was going to happen to me, and it was going to happen to me willy-nilly and so I’d better just sort of in a sense, “Okay, find out - this is, this is terrifying, but this is exciting” you know.
And I, that’s... So that moment of trying to come to grips with what’s happened, I think it would be very important to try and avoid saying to yourself, “No, this is not happening.” Because if this is happening and you’re just denying it, this is certainly the worst thing you can do. And if you’re saying to yourself, “This is happening” and it turns out this is not happening, well, that’s fine. You have gone through a learning cycle, you’ve learnt about this, and if it should happen in the future - and I think these things are rather likely as we, as our age expectancy increases and we expect to get to 102 - I think that you’ve learnt something and that would be very important. So I think that this learning cycle is that as soon as you feel that you have something like this, you have to say, “Yes.” And when you wake up in the morning, and now that I’m older and wiser and know more, when I woke up and this wasn’t working right, my first thought should have been not, “I’ve been lying on my arm”, but my first thought should have been, “Have I had a stroke?”
Last reviewed June 2017.
Last updated June 2017.
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