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I Had a Stroke at 33 (buzzfeed.com)
603 points by Thevet on Sept 21, 2014 | hide | past | web | favorite | 151 comments



What a beautiful article.

My girlfriend had three strokes, in succession, two years ago (when she was 22). The night before these strokes occurred, she had a transient ischemic attack (TIA). She began speaking gibberish to her friends. She texted me later that night explaining what happened. Her friends had laughed about it because they thought she was just acting like a goofball. I had no idea these were signs of a TIA, but I told her that if it happened again she needed to go to the doctor immediately.

The next day, the right side of her body went numb. This time, she was around people who noticed something was wrong, and she was immediately rushed to the emergency room. By the next day, I had flown a thousand miles (from the location of my new job) to be with her. She couldn't remember many words. She couldn't read a clock. She did not know the answer to 3 + 0.

It turned out that, similar to the author of this article, clots had traveled through the hole in her heart and up to her brain. Luckily, she recovered fully and was back to her old self within about a month. She had surgery to fix the PFO a couple months later. The neurologist told her that nine times out of ten, the clot travels a different path, and the victim is left dead or braindead. I am so lucky. Writing about this has me in big tears.

I am going to stop writing and go hug her now.


I'm the writer of the story--thank you so much for reading. I'm glad to know that my experience helps people gain further understanding of strokes/brain injuries. I hope your girlfriend is in a better place, now.


> I'm glad to know that my experience helps people gain further understanding of strokes/brain injuries.

After my severe traumatic brain injury, I'm trying to do the same thing. Brain injuries are so broad and so complex and dangerously invisible. I would guess this is the one unifying thread between us.

This is a solid A-level piece. Good job on both the writing and content.


I've only had a mild traumatic brain injury, but it's been about 1 3/4 years and I still have some symptoms. I could emphasize with a lot of what was written in the article. You're right in saying that these injures are complex and invisible... and I would say that that is true as much for the people around you as it is for the person experiencing the injury.

Even for someone who understands the symptoms conceptually, it's a completely different matter to actually experience what it's like to be unable to speak the name of a person that you see constantly, or to experience real pain from light, or to be around people and then be utterly exhausted afterwards. It took time for my family and friends to grasp the extent of my injury, especially since it didn't occur in any dramatic or obviously horrible way.

If you are like me, you'll have moments in which you feel completely frustrated and hopeless. Be patient and merciful with yourself. Last year I wondered if I'd ever be able to have a job that required serious mental thought -- but this year I've successfully switched careers to become a full time programmer.

I apologize if this is unsolicited advice, but I guess I'm saying what I wish I would have known when I first got my concussion. And for others who read this: if you get a concussion, see and listen to your doctor -- and if your doctor doesn't take you seriously, find someone who does (especially if you have a clinic nearby that specializes in concussion / brain injury). I can't know for sure, but I think my life over the past two years would have been a lot different had I simply _rested_ in the period afterwards, instead of staying up late studying.


> I've only had a mild traumatic brain injury

"only". All brain injuries are incredibly frustrating.

Adding on the advice, if you have others close around you, please listen to them and take their advice even if it's painful. This was positive for me and I'm glad I did it... but man it was painful. I felt powerless and helpless and couldn't grasp the full details of the situation. When everyone around you is saying the same thing, they're saying it for a good reason.

The largest lesson I've learned is that there's nothing fundamentally wrong with someone who has a brain injury. They manage their deficits like any sane person would. Yes, their deficits will show through but that doesn't speak to who they are. That's their injury showing itself and they're doing their best to control it.


Thanks for writing the article - it was well written. One item to point out to any fellow migraine w/ aura sufferers that are worried right now they're going to have a stroke...

http://www.mayoclinic.org/diseases-conditions/patent-foramen...

Generally, a patent foramen ovale doesn't cause complications. But, some studies have found the disorder is more common in individuals with certain conditions, such as unexplained stroke and migraine with aura. In most cases, there are other reasons for these conditions, and it's just a coincidence the person also has a patent foramen ovale...The possible link between patent foramen ovale and stroke or migraine is controversial and research studies are ongoing.

I'm 42 and have had migraines with aura (mostly blindness) since I was 15. My father is 72, my oldest sister is 51 and my youngest sister is 45 and they have all had migraine with aura since a young age with no strokes reported yet.


A migrainous infarct is a rare complication of migraines with aura, and you should probably not worry too much about it.

But make sure you'll NEVER take vasoconstrictors during the aura... Migraines with aura have two phases :

- first vasoconstriction, which cause the aura. Should not last more than 30-60 minutes. Take NO anti-migraine vasoconstrictor at this point.

- next comes vasodilatation which causes the pain. That's when vasoconstrictors can be used.

Find my comment bellow to learn more.


The two phases you detailed of "Migraines with aura" match my experience precisely. Dark spots in vision are typically the first sign at which point I have about 30 minutes before tunnel vision and blindness kick in. Then I gradually get my vision back with an equal measure of pain in my head.

Interestingly, I have literally never taken prescription migraine medication. I don't have severe ones often enough to warrant needing it. The only thing I take - and I take it at the first sign of aura - is two Excedrin. The active ingredients in Excedrin (aspirin, tylenol, caffeine) are identical to the active ingredients in Excedrin Migraine so I generally take either. It seems to lessen the severity and duration of the headache.

As a neurologist once told me - there is no medication you can take that will reduce or eliminate an aura. So to your advice that it is dangerous to do so, apparently it's not effective either. So there is no upside and apparently plenty of downside to taking vasoconstrictors during aura.


Actually, I had that stroke the first time I tried anti-migraine treatment (eletriptan). I have no medical proof that there was it was a cause though.

Before that, I was usually taking 1000mg of aspirin too.

My advice if your migraines occur in high stress times (mine did): learn auto-hypnosis or find anything to lower that stress level...


This is extraordinary writing! Gripping to the end. I'm very _very_ curious to know how you are doing now? I hope you've recovered well.


Hi. It took about 2 years to recover (I went to occupational therapy, and stumbled through 18 months), and then I was able to have a very high functioning life. I can exercise to full exertion, I had a very normal pregnancy, and am overall doing physically well. I'm very very very lucky.

There are still gaps in memory. My friends, since this essay was published, have told me how they visited in the weeks and months following my stroke, and I am floored by how I don't recall their visits, whatsoever. Like, nada. But I know I felt their love, so there is that.

Again--thank you all for the amazing response to my essay. I am overwhelmed in the best way. We writers don't get a lot of kudos, so when the love does come around, it matters very very much. I know it holds me through the darkness and keeps me going. So, thank you for keeping me going!


Thank you for sharing your story. I enjoyed reading it. I had a stroke at 35 also caused by a PFO.


Thank you for writing it down. Especially the "hugging" part.


Thanks for this.

Are you in the US? If so, how much did the ordeal cost?


Yes, we are in the US. Her situation was unique in many respects. She was on her father's health insurance plan (Blue Cross and Blue Shield) and also had secondary health insurance from being a student athlete at our university. (The first of the three strokes occurred during a meet! The other two occurred within a day after being transported to the hospital.) Everything would have cost well over $100,000 had she not had insurance, but thankfully all visits/procedures were completely paid for.

I'm unsure how much it would have cost (uninsured) had it been a more straightforward path toward treatment. However, I left many details out of the story. Doctors were unsure if the stroke was simply caused by a PFO; they thought she may have had a more serious heart defect. Thus, she was airlifted to a better hospital for a more thorough diagnosis and later ended up having robotically-assisted heart surgery (i.e., not the simple, cheaper PFO closure procedure described in this article).

Another thing: her father was very persistent with the insurance companies throughout this entire ordeal. Had he not paid attention to the way things were being billed (i.e., between primary and secondary insurance), some costs may have been pushed onto her family.


>Had he not paid attention to the way things were being billed (i.e., between primary and secondary insurance), some costs may have been pushed onto her family.

How does one pay attention to this in a time of crisis? Is there a good guide to navigating it somewhere?

Last summer I woke up with a monster headache and suddenly stopped being able to put words to thoughts. Tried calling a taxi, couldn't say where I wanted to go, so he called 911. On the way to the hospital in the ambulance I was just praying I was making the right decisions. The paramedics couldn't understand me and that frustrated them. They asked me what hospital, being an intern and totally new to the city I wouldn't know what to tell them even if I could. I was worried they'd treat me like I was on some kind of drug.

Turns out I had contracted a meningitis. The ambulance ride was $1000.


Did you get a bill after the fact? You could call them up and negotiate. If you have two insurance plans, then it's mostly talking with a particular office/section that deals with coordination of benefits.

Until my family members and I individually ended up switching to insurance with nice low flat rates for services, I used to negotiate everything from office visits to ER bills. Before service if you can (especially for elective/outpatient type things), otherwise they really like cash in full. They tend to prefer working outside of insurance too, since it means more money for them even if they're halving your bill.

I'm sure there are services, and occasionally you'll find more tips on places like reddit (/r/frugal comes to mind). I have no immediate suggestions for how to do this in a time of crisis - it mostly depends on someone that knows you well giving enough of a shit, and when they'll try to bill you for services. :(

Why this is a thing is beyond me, but while it's the case...


>> Did you get a bill after the fact? You could call them up and negotiate.

IMHO negotiation is one of the problems causing high health care costs. Prices are crazy high by default, but insurance companies are able to negotiate lower prices from providers. This means the uninsured are billed higher by default. It turns out that individuals can negotiate lower prices too - sometimes. I advocate that a given service provider should be forced to charge the same price for the same service to all patients. This might result in competition and lower prices, but in the mean time it should lower costs for the uninsured.


There are services which offer medical bill review for patients, usually via nurses or others with clinical and medical billing knowledge.

I know of these largely through news coverage, and cannot speak to how effective they are (or what the costs are).

The stories I've heard, though, of the absolute complete and total nightmare that is the US healthcare scam, are heartbreaking.

I'm looking for online references but cannot find any at the moment, maybe others here have more information.


This is my question as well. I'm not only afraid of something like this happening but that I'd be ruined financially if it did (and it really doesn't have to be something this big. Simply going to the emergency room would cost me thousands).


Is health insurance not an option?


There will be things that your insurance plan will just randomly decide not to cover or worse, you just don't have the right kind of insurance for what you need.

Both my parents have suffered strokes. My father had to go to a step down unit which requires Long Term Care Insurance, something that I'm willing to bet most people aren't familiar with. Even that, due to changing regulations, your LTCI that you purchased decades ago most likely no longer covers today's prices. Unfortunately you just can't prepare for everything.


I do have health insurance but it only covers around 47% of my medical costs (at least when I go for a primary care visit, I suspect they might even cover less for a more expensive procedure).

I understand that my coverage is not all that common, although most providers do an 80/20 split. So for a procedure costing $100k (an ambulance ride and a few nights in the hospital would easily run this high) you'd have to pay $20k out of pocket.


> I do have health insurance but it only covers around 47% of my medical costs (at least when I go for a primary care visit, I suspect they might even cover less for a more expensive procedure).

Actually, it's the opposite. For the vast majority of insurance plans, there's an annual limit to your copay.

To be honest, if there weren't that limit there would be no purpose to insurance at all.


A few years ago there was no annual limit on my plan. Not with co-pays, just co-insurance. I ended up needing outpatient treatment almost every day for over a month. Each day was a $25 co-pay. I then moved on to a once a week treatment for close to the next year. I could afford that, many people cannot. I was also lucky to be able to collect my pay while I was getting treated because my employer provided me disability. The cost just skyrocketed beyond belief and while I already maxed out my co-insurance my treatment was billed like an office visit so co-pays are treated differently.


Do you mean the insurance company has a limit for what they pay? [1]? I can't find a source for the limited co-pay that I think you're suggesting.

1.http://www.hhs.gov/healthcare/rights/limits/


It's called "out of pocket limit". After you meet your deductible the insurance company will pay for every covered cost except for the copay and coinsurance. Once you've met your out of pocket max they will pay for every dollar of every covered cost.


Except prescription drugs. I am not fully informed on how the ACA affected this, but it used to be that insurance plans could exclude certain classes of prescription drugs from out of pocket max.

This is how many people are financially ruined by long-term chronic illnesses. For some less common diseases, medications can easily cost >$10,000 per month – which might not be covered by your health insurance for various reasons or only partially covered. Read the fine print.


Many health insurance plans have a yearly cap on how much you pay out of pocket. So you might pay 20% up to a few thousand dollars, and then get 100% coverage after that.


Actually, with the passage of the ACA, the limit is a requirement for all health insurance plans (a few were grandfathered in, but they will disappear over the next few years).

It goes up each year (adjusted for inflation), but as an individual, your maximum out of pocket (includes everything: deductible, co-pays, co-insurance, etc) is ~$6,750.



I'll never forget the year I had laproscopic surgery to remove my gallbladder, not because of the experience (although being asked for $3000, in cash, before they'd let me into the OR, was interesting, but welcome to America), but because I ended up hitting my $5000 or so out-of-pocket maximum, between that and co-pays for a few other visits. For the remaining 6 months of the year, I joked that I was living it up Canadian style, and actually visited the doctor to get regular exams and to get medicated for influenza, you know, the things everyone should do, but a large double-digit percentage of Americans can't. Ahh, the good life...


Don't "suspect," know. Your insurance will have an extensive description of their coverage. You should go read it, and if you find it to be inadequate, you should go shopping for new stuff. This is really important and not something to ignore.


you just have to step in the wrong hospital to break the agreement and end up with massive bill


Any vaguely decent insurance will cover emergency procedures in any hospital.


About 15 years ago my father had a stroke at our house. I was about 12 years old and at home at the time along with my grandmother. We didn't know what was happening. At one second he was okay and in another he was on the floor. It was almost impossible to put him back at the bed even with the help of one of our tenants.

We called my mother at work and the funny thing is that before she came home to take him to the ER he was able to ask for coffee (and drink it) and also to smoke a cigarette.

Moving 15 years forward he's still with us (62 years old) with no movement at all on the left side of his body. Had a heart attack with major surgery, is on more than 15 different medications, has diabetes and a bunch of other "minor problems".

My mother gave up her life to take care of him and everyday is a struggle because of the existing problems prior to the stroke and the ones that came after he became bitter and really mean to those who love and take care of him.

I'm not sure why I wrote about this but I felt like sharing. It's not easy when people don't recover, but for some reason I believe we have to take care of them and do our part.


Thanks for sharing.


I was 32 when I had a stroke (March 4th, 2003). It was a different kind of stroke, affecting a different part of my brain, essentially related to vision. I was half blind, but I only realized something was "strange" when I saw myself in the mirror: I had only one eye. My brain knew I should have two: I was half blind.

The first diagnosis was migraine with aura (blindness in my case). But the aura should have lasted no more than an hour. Two days later, the aura (blindness) was still there (a sign of infarct but my doctor didn't know it).

I spent 2 days alone in the dark. I forgot to eat but I knew I had to call a taxi to take me to the hospital. I wasn't scared, I though it was just a migraine. It really looked and felt like my usual migraines. So my doctor had me take anti-migraine pills, which are vasoconstrictors. That might have caused the actual stroke: extreme vasoconstriction. Never take anti-migraine treatment during the aura. Never.

It took 2 days before I was diagnosed at the hospital, but they just told me "I see a shadow on the CT scan"... so I spent the next 2 days wondering what kind of shadow? stroke or cancer? And no, I didn't think about asking.

It took one week to be hospitalized for 10 days (my mother called the hospital, harassed them until she could talk to a doctor, who said it was an emergency... one week after the stroke).

It took 15 days before I woke up in the morning and thought "Wow! WOW! I'm back now!". Before that, I spent most of my time sleeping, reading half a page between two naps. I was sleeping more than I was awake.

It took 3 months before I could look at everything I wanted. Before that, looking at trees (and other complex objects) was "painful", and watching movies was too exhausting (especially action movies). During these 3 months, I recovered from blindness, but not completely. I still have a blind spot in my field of view today.

It took 6 months before my mood was really restored. Before that, I needed a daily nap, lots of soothing music, and no pressure at all.

I took aspirin daily for 3 years, after which my neurologist told me I could stop.

I had a few migraines after that, and even ended under oxygen at the hospital once, but I always recovered within 15 days.

It was 10 years ago, and it changed my life. I quit my job as a developer, spent 2 years wondering what to do next, then became a wedding photographer. In february this year, almost 10 years after, I got a new job as a developer.

I'm back on rails (node.js to be precise :-)


> It was a different kind of stroke, affecting a different part of my brain, essentially related to vision. I was half blind, but I only realized something was "strange" when I saw myself in the mirror: I had only one eye. My brain knew I should have two: I was half blind.

There's something going on here beyond just loss of raw visual input. If you lose an eyeball, or hold your eye closed, and look in the mirror, your one good eye will still show you that you have two eyes (or, as the case may be, sockets / sets of eyelids). Perceiving yourself as having one has to involve a loss of brain function, not just a loss of eye function.


My eyes were just fine: it's the brain that was the cause here. When it occurs, I can close one eye then the other and still not see in half of my FoV.

Part of my brain was not irrigated and did not function properly...

There was nothing in /var/logs: I couldn't perceive that I was half blind. syslogd crashed :-)


Is this always one half of your field of view? Or is it one half of certain objects (e.g. your face)?

If it's the first, then it sounds like damage to one visual pathway. The visual input from each eye is divided into left and right fields, and they're processed independently. Here's a good illustration:

http://commons.wikimedia.org/wiki/File:Constudeyepath.gif#me...

After the optic chiasma, the two pathways diverge. Damage any time after there, such as to the occipital lobe of one hemisphere, could result in blindness to one half of the field of view.


It's really one side of my field of view.

It've talked about the face because I did not perceive that half my field of view was missing, but when looking at myself in the mirror, I saw one eye was missing... But it really was half of my field of view.


There's a similar phenomenon called contralateral neglect (or one of various other names), where after brain damage to one hemisphere of their brain, a person tends to ignore things on the opposite side. The effect is sometimes in retinal coordinates (e.g. only scan objects in one half of the field of view), sometimes in object coordinates (e.g. eat only one half of a plate of food), and sometimes in egocentric coordinates (e.g. not shave one half of their face).

This seems to be similar, but different condition. Contralateral neglect is a problem of attention: they can see the things they ignore, they just won't spontaneously pay attention to them. This is a problem of perception, where they tried to pay attention to their eye, but perceived it as not being there.

I don't have an easy explanation for how this effect occurs.


> Before that, looking at trees (and other complex objects) was "painful"

You are the only other person I have ever heard describe looking at complex objects as sometimes painful. This happens to me sometimes, mostly with very complex and disfigured cartoon faces. Very strange. I have never had someone understand what I'm talking about when I try and describe it. Do you have any idea what causes this effect?


As a layman who has read up a bit on how the brain processes stimuli such as visual data (my mom has severe migraines and I'm afraid someday I will be told this information by a doctor on her behalf), what I understand is that if the part of the brain that would normally process these images is damaged, the brain has to be rewired to use another part for this activity. So it's "painful" because that part of the brain isn't used to processing this data, so it's inefficient at it. Looking at a static image is easy, looking at something with a complex physics system such as a lot of individually moving leaves would require more processing power. The more sprites/polygons on screen, the harder it is to render, to use computing examples.

I might be wrong, and I would love to be educated further if my understanding is incorrect. I hope I never need to use this information in my life.


Wow, your doctors suck.


It was a mix of bad luck and bad luck:

- happened just before the week end

- began exactly as a migraine (I had them in the past) making the diagnosis more complex

- doctor had never seen a migrainous infarct (it's very rare)

- hospital didn't have a neurology department

- the medicine resident called a neurologist to get advice

All in all, I was lucky it wasn't more severe...


Thanks for sharing, awesome write-up (your doctor sucks).


wow. you usually hear how the usa is a litigious place and that make doctors scared of new treatments and what not... but that's just negligence. anyway you look at it. probably from several professionals you talked to during those first days.


it happened in France, where the health industry is supposedly very proud of itself...


>I wandered outside the boundaries of telemetry. They lost my heartbeat. When I returned, they scolded me.

The audacity of health care industry workers (those who should know what a certain disease entails) who place blame on their patients for acting normally is infuriating.

I had kidney stones once at a young age. I remember barely walking into the emergency room one night after they became too painful.

As soon as I arrived, white as a sheet of paper, they asked me a few questions... doped me up on morphine... and managed to "lose" me on a gurney in a hallway somewhere for a few hours until my girlfriend at the time came and found me.

They took xrays I believe and I was free to go with some more painkillers in hand.

Apparently the hospital told me that I was supposed to call them by X date if I wanted any more painkillers.

I called them back about a week after that date had passed, asked for a refill, and was scolded like I was some drug addict just looking for a fix. I think they even hung up on me. How could I be so stupid as to have forgotten a date they told me when I was high as a kite by their own doing? Right.

I ended up passing them without any painkillers which as many of you have probably heard is unbelievably painful.

I understand that it can get monotonous working in a hospital, but with the amount of money they're paid to work there you would hope that they would be required to operate with a little compassion. Considering the fact that many people in a hospital are leaving this world.

What if the author's last memory was that of a person she didn't know berating her for something she wasn't sure she even did?


> ...was scolded like I was some drug addict just looking for a fix...

It's tough dealing with drugs and potential abuse. You know if you're really in need or not, but they deal with people wanting them for any reason just because, and so the skepticism starts to show. There's the default assumption at hospitals/pharmacies of just locking everything down so the healthcare providers themselves can't abuse them too.

My father was in the ER the other month for severe abdominal pain. He got morphine _after_ it was discovered that his blood pressure was through the roof and he wouldn't tolerate even a light touch in the area. Then multiple people were required for disposal and documentation of whatever was left over - after someone had to go get it from an automated dispensing cabinet and _then_ scan both the drugs and his bracelet QR code to verify the order (+allergies+other things). It was impressively thorough.

In comparison, my neurologist and doctor are really freehanded with nerve pain meds for my legs. Can't really recreationally abuse anticonvulsants or antidepressants or lidocaine patches, I guess. Also on the pain front, having something that can be directly tested goes a far way for the disbelief/skepticism that might otherwise be a problem. :(


I am not allowed to have a prescription that has refills (I assume due to law? Maybe office policy though). So when I need a refill I have to call and leave a voicemail message. It takes up to 72 business hours then I get a phonecall my prescription is ready. I have to physically go there and sign two forms saying I picked it up AND get my ID photocopied. Then I have to go to the pharmacy and show my ID AGAIN. I hate being treated like I'm a criminal!!


>I hate being treated like I'm a criminal!!

That's exactly how I felt when I called in for a refill of my pain medication after just having met with multiple doctors in the ER just a few weeks prior.

Do they really think I intentionally got kidney stones (which they saw themselves on xray) just to get an extra refill of pain meds a few weeks later?

No, the lady on the phone probably got intense amount of pleasure by telling me off verbally and hanging up. At least that's one of the only reasons I can think she didn't even bother to listen to me.

I was upset and confused, but too proud to call back and have myself humiliated again. So I just grinned and bore it and screamed like a baby when the stones actually passed a few days later.

A funny side note to this story... I can laugh at it all now seeing as it's ten years in the past. In my long walk to the hospital (I was a poor student at the time, unable to even afford the bus) me and my girlfriend passed a band of elderly ladies who took one look at me and within seconds said "Oh no, look at him. You must have stones, don't you laddy?".

I wasn't sure what was wrong with me at the time and I just replied something like "haha, I hope that's it!" and continued on to the hospital.

6 hours and an xray later... the doctors confirmed the very same thing.


I was debating if I should mention it in my original comment but...

I have ADHD and I've been on almost all stimulant options available, most often Adderall and lately Vyvanse. Those are Schedule II drugs in the US, where you can't get refills on a prescription and there's a whole huge thing about auditing and verifying that you can't abuse it.

I feel like your doctor's office is a little ridiculously strict if that's the case for you too as none of my psychiatrists have ever required that kind of sign-off on picking up prescriptions, but in my experience, yeah... it sucks. I've been treated like a criminal at the pharmacy, many times. Also ask me how many times I've had insurance/pharmacy deny a prescription because I am picking it up literally a day too early. Requiring ID is ridiculous too. I just recently changed my name, but the name change for my insurance hasn't been going anywhere, so I'm surprised I haven't triggered any kind of problem when signing off on picking up these drugs. I don't know what I'd do if I lost a prescription (doctors can write up to 3 separate ones dated appropriately) or if I lost a bottle. :(


This is another reason for drug legalization. The paranoia around opiates has to end. Lack of access to pain medication is a huge problem globally. Every time there is a natural disaster doctors are arrested for carrying pain meds without waiting for formal permissions. After the Haitian earthquake many people had limbs amputated without pain medication.


>The paranoia around opiates has to end. Lack of access to pain medication is a huge problem globally.

I agree 100%.

I passed kidney stones without any pain medication because the "care workers" thought I was a junkie looking for a fix... Even though I had been into their ER a few weeks earlier and was white as a sheet due to incredible pain.

You can't even fake that type of pain afaik.


Remember this -

  You have FOUR HOURS to get a person with a stroke to the emergency. 
If you do, their chances of survival are dramatically higher.


I think many people that haven't personally faced what a stroke is in one way or another don't realize how dangerous and life changing the disease is. Also, they don't understand how to detect it.

I have seen it several times. The first time it happened to my grandfather, nobody in the family realised what's wrong only that he seemingly was losing memory and repeating things he just said. Several hours passed until we thought we should perhaps call the medics - stroke was immediatelly recognized by the doctor and the emergency saved my grandfather only with very mild consequences afterwards. The second time my grandfather got a stroke, he started stuttering and had difficulty speaking. Again, we did not believe it could be stroke, because, you know, he might just be feeling bad. And again, the emergency saved him within a few hours. During the third and final stroke that we know of family was already aware and he was taken to the hospital early but he was released just a couple hours later with instructions to stay in bed and rest. Overall, about 6 to 8 hours passed until he got the required medical care. After that stroke he spent almost five years doing nothing, just existing - with almost completely blank mind. If only the doctors were professionals and we, the family, would have paid better attention, he would have been saved.

TL;DR: pay attention to the people you know. If something is slightly off and the person himself does not seem aware of it, this is definitely a strong signal that it might be a stroke.


Problem is, there are tons of other diseases that look like stroke. Migranes, epilepsia, etc. IF you have one of those, going to ER every time you have something weird going on will suck you dry of money and your doctor will probably start treating you like an hypochondriac. There is no subsystem in US health care to handle this. Your primary care physician probably sucks and not available when you need them the most. ER does not care, prone to misdiagnosis and like to dope people on drugs before figuring out what's wrong. Been there, seen that, and it makes me really angry.


>> "Problem is, there are tons of other diseases that look like stroke. Migranes, epilepsia, etc. IF you have one of those, going to ER every time you have something weird going on will suck you dry of money and your doctor will probably start treating you like an hypochondriac."

But shouldn't the doctors have though, "Ok, this man has had two strokes. These symptoms could be of something much more mundane but as he has had two strokes we will take very precaution"? I don't want to start the free health care debate but is that a problem? We have free health care and doctors seem to be willing to admit you for a night even if there is a very high likely hood you're fine. Do finances come into it more in the US and actually effect patient care?


My understanding is that early presentation to hospital with ischaemic stroke does not improve survival [1]. The reason for early presentation is that if thrombolysis with clot busting drugs is administered early then long term neurological outcome is better. Survival alone is not improved however.

As discussed in another comment, the earlier the better. The idea is for as little time as possible to have elapsed between blocking off the blood supply and opening it up again. The reason for this is that when part of the brain becomes ischaemic, a central core dies instantly but around this there is a halo or penumbra that is not dead but at risk. This penumbra of tissue dies off over time, and can be saved if the blood supply is reconstituted. The penumbra can be visualised using quite clever MRI [2]. Having said that, trials that have tried implementing this kind of imaging to guide thrombolysis have not been positive, as compared to just thrombolysing everyone.

[1] http://www.ncbi.nlm.nih.gov/pubmed/23791822 [2] http://en.wikipedia.org/wiki/Perfusion_scanning#MR_Perfusion


My dad had a cerebral stroke a few years ago. As everyone else was trying to arrange an emergency ambulance, his doctor was on the phone with him asking him to stay awake. Apparently, he said "if you fall asleep, you'll die." Fighting to stay awake for those few hours was one of the hardest things he's ever had to do.


This advice to not fall asleep is pretty prevalent (at least on TV). Is there a basis for it?


Not sure about strokes, but it used to be believed that a person with a concussion must be kept awake, but it turns out not to make a difference. It's still a fairly common trope in movies and on tv, though.

One source on that: http://www.uamshealth.com/?id=10724


It's useful to detect problems not prevent them. One of the symptoms of interracial pressure, a significant risk with head injury, is drowsiness. But, other symptoms are also fairly easy to detect in a responsive patent. However, in cases of significant head injury this can be directly monitored allowing the patent to sleep.

http://www.nlm.nih.gov/medlineplus/ency/article/000793.htm

PS: From you link "If the person who is injured is awake and holding a conversation, you can let him or her fall asleep as long as they are not developing any other symptoms such as dilated pupils or issues with walking. "


The most important thing about staying awake is that a more complete neurological exam can be performed. There's always ways to wake someone up, but the unfortunate part is that any treatment may alter the results of neuro tests


Would love to know this too. I have always thought it might have to do with being able to communicate with the medical staff to get a better assessment.


The only equation that matters is

Time = Brain

every second a stupendously large number of neurons die. at 4 hours the damage is complete, there will be total wipe-out of the infarcted area. you really want to get to emergency within half an hour.

Note, this is for an ischaemic stroke. If you have a haemorragic stroke (usually in the elderly and in those with ruptured aneurysms) there will be little that is possible except supportive care


As someone who had two grandparents have strokes absolutely this, prompt medical attention significantly reduced both the damage and the recovery/rehabilitation time.

If you think even remotely it's a stroke then straight to the hospital you go.

https://www.youtube.com/watch?v=yXONEHmupy0 (UK National Health Service Advert about strokes)


Thrombolysis works only for ischemic strokes. The much worse hemorrhagic stroke doesn't even have that window. Fortunately, it is somehow rarer.


Gatsky addresses this in more technical terms [1], but this is more an issue of long term outcomes if they survive than of survival. Not that this is less important (some people would say it is more important!) -- just different.

[1] https://news.ycombinator.com/item?id=8348741


So, time for a quick Throne of Thunder raid, then.


My mother had a stroke. The fallout is very, very hard for the patient and their family.

Diet and exercise are, apparently, the easiest levers you have to control for stroke risk. Trust me: this is the best of all possible reasons to care about those. You do not want to go through it and you do not want your family to go through it. Specifics elided for privacy but suffice it to say that it combined elements of a heart attack, advanced Alzheimer's, and a profound war injury in a compact package that arrived on a normal sunny Tuesday.


Diet and exercise should really be taken care of by everybody. Lowers the risk of strokes and heart attacks considerably. In most of these young patients the reasons are due to other (most often undetected) issues like PFO though. That's also why i really have issues with health care in the US, as many people avoid checks to save costs. In germany, whenever you feel something is really wrong, you can just walk into ER and costs will be covered, no matter what.


If you want to do something nice for your family, look after your own health.


Strokes can present in truly any number of ways. The Cincinnati Stroke Scale, often seen in public health campaigns as "FAST", provides three simple, quick assessments that can reliably delineate a majority of strokes. It is the standard for basic EMTs as well. More advanced providers should perform a more comprehensive exam, testing all the cranial nerves (actually usually just II through XII). A more formalized, advanced stroke scale is the NIH stroke scale: http://stroke.nih.gov/documents/NIH_Stroke_Scale.pdf

While there are often some kind of neurologic deficit associated with a stroke, the goal standard is, of course, a CT or CTA that should be administered immediately upon arrival in the ED of a suspected stroke (depending on the presentation of symptoms an exam by a neurologist may occur first).

The symptoms described in this story would absolutely make me think this person was having a stroke if she had verbalized them to someone with my training.

It's also worthwhile to point out that the person having a stroke may not realize they are having a stroke. People may have the obvious symptoms - slurred speech and hemiparesis - and refuse to acknowledge that these problems exist, because, in their mind, they don't.

If you think someone is having a stroke, record the time you first noticed symptoms and call 911 immediately.


Great article.

I had a stroke one night in my 20's. When I woke up, my right side was numb (I thought I just slept on my arm), I spoke gibberish and was unable to write but I felt fine and I thought I spoke perfectly fine. I finally figured out that something was not right when I tried to write a message to my mom on the back of an envelope to tell her that I was fine and I just drew a straight line instead of letters. That's when she called an ambulance.

Luckily I was back to normal within a month, but I struggled for some time to to find the right words when talking.


I had a TIA when I was 28 (over 10 years ago) and under heavy stress (high blood pressure; they did not find any other causes; I was healthy as I could be, just extreme stress from my own business at that time); I swore after that to never be stressed again (and took measures to make sure that is possible, like living in southern Spain for large parts of the year) and haven't been since. I even forgot how it felt. My life is so much better that I now thank this TIA. Stress is pure hell and whatever business people think they get out of it; it's bullshit IMHO; I have had way more business success than ever without stress than I had with.


I can relate to this.

At 28 I had to deliver a project with a very tight schedule and ended up working 70 hours a week. It was fine for about two weeks, then started to have a permanent headache, then chest pain, then collapsed in the gym. After a doctor check up it turned out I had a 24h average blood pressure of 190.

It all went to normal again after taking forced holidays.

I swore to never put anything before my health.

Don't overwork guys, it's just not worth it. Screw the rat race. Your health comes first, it's your most valuable possession.

Stress is always there even if you don't see it, and by the time you do and symptoms arise it's almost always too late.


Four weeks ago my girlfriend, 32 yo, had a brain stroke because a deep venous thrombosis at her left side of the head. It was intense to see how much she deteriorated in the course of just a few hours, starting with a seizure and some very acute headaches she had together with vomiting the previous days. We were in intensive care around 10 days, and then 3 days more in hospitalization. The investigation of her tendency to hypercoagulate yielded as main culprit sedentarism and the previous uninterrupted usage of oral contraceptives (mercilon) for almost ten years. We were fortunate in some sense as the cause was easy to point out and also as we discarded autoinmuse diaseases (my biggest concern) and now she is under low molecular weight heparin, hoping that the clot is reabsorbed in two or three months.

As part of the recovery, I'm reading to her My Stroke of Hindsight, of Jill Bolte Taylor, and her symptoms and the description of the episode of the acute phase match largely: speech loss, paralysys of her right part of the body and rational disconnect with external stimuli.

This article highlights also how sensible we are to the changes of what we are at the end: physicochemical interactions. I was worried my girlfriend would lose her essence, but thanks to God her recovery has been amazing so far.


I am not sure if you are the OP or know her, but this story touched my heart. It is beautiful. I am only imagine how strong she has to be, and the people around her must be to get through this. My sister and her husband are going through the very same thing -- He was progressing very well in his career and they just had their first child when he suffered his from the same reason - a hole in the heart. All the best. You and all the stroke victims have my prayers tonight.


All the stories I know and heard of stroke victims in their 30's or 40's make me think and ask: is there really a way to prevent or predict a stroke?

Would the "controversial routine full body scan" help? Specially to people who have a parent being an early stroke victim?

These things are scary as hell...


Most common symptoms of PFO are described in the article: "migraine headaches, or have altitude sickness at 5,000 feet instead of 10,000 feet, or find yourself panting while doing a slow jog, no matter how often you train." Also should be noted that there are much many other subtle syndromes that can lead to sudden cardiac death, many are detected accidentally when testing something else (going to the ER because of a car accident) There's no math formula to detect how and when each of us will die one day.


Remember FAST: http://en.wikipedia.org/wiki/FAST_(stroke)

First 3 minutes of the house episode Fetal Position (S3 E17) demonstrate it.


The author points out that she didn't display any of those symptoms.


Though she says her speech wasn't slurred, you can tell from the story she had speech and comprehension difficulties. Regarding face drooping and arm drift, it could be that she just doesn't remember/didn't notice, again she says herself her memory was failing. I'm sure a doctor would have recognised the symptoms immediately.


She was sitting with her husband and friends for hours and they obviously felt extreme guilt about not realizing she was having a stroke. I'm sure they've all played that party back and forth in their minds for days wondering if there was something they should have noticed. That day would have been analyzed in agonizing detail by all of them. And it sounds like the writer had this conversation, as she had to re-piece so much together.


I can guarantee if she had voiced any of the things she wrote here it would've immediately been recognized by any competent medical practitioner


The NHS run a great advertising campaign on this. Here's one of their adverts: https://www.youtube.com/watch?v=9KG_2OEH8UM&list=UUoFX8yfaEw...


Her memory experience was already reminding me of Leonard in Memento and then she writes, "it's time for my shot." That hit me unreasonably hard.


I just saw Memento last night (for the first time), so reading the article felt like an incredible coincidence.


Two years ago this October I was homeless. I would wander around all night for fear of attacks[1] and try to sleep during the day at the university while sitting on a bench or chair. In October the winter shelters had not yet opened here, and it was so cold I feared I would freeze to death. I wandered into ER on a pretext: there was a swelling in my leg, spider bite maybe?

I overheard the intake person talking with someone: "I'm worried about that guy in #68." Why? "He thinks he's got a spider bite, but he's got blood clot written all over him."

I felt pretty good about that; it meant I'd have a place to sleep for a whole night. Then I was suddenly surrounded by 5 or 6 people.

Symptoms, sir?

Sometimes slurred speech, tingling in the extremities, can't spell anymore, confused by the way people talk so _fast_, confused by simple things, excessively paranoid, feels like there's an Ace bandage wrapped around my chest.

You're a junkie. No. You're exclusively vegetarian. No. You're diabetic. No, I've been tested for that. Well, we'll take a blood draw.

I got an ultrasound over my legs -- and they discovered a DVT. Next thing I knew, they'd slapped me in hospital for eight days. I was put on no less than eight medications, the scariest of which was Coumadin (same as Warfarin, I think?) -- scary because they made me watch a video describing it, by which I mean "You follow these instructions to the letter or you gonna die, son." At least that's what it felt like. And I had to sign all kinds of waivers, or something. Two of the residents (very young women) told me that they had had DVT's themselves... possibly as a result of being exclusively vegetarian?

The diagnosis was: Pernicious Anemia. My understanding (which is not to be trusted) is that the myelin sheathing around my nerves has been dissolving for years. Apparently the communicating tissue between the axons in my brain had been going away for quite some time.

I liked this diagnosis because: it's easily treatable; it explains my increasingly weird behavior; I'm not dead from it.

The treatment is: Take B12 every day for the rest of my life.

The highly-abbreviated coda to the story is: My Doctor told I'd had this disease for at least ten years(!); hospital got me a case manager, who got me Disability, Homed, and a Laptop. But it took 2 years or so.

TLDR: Being exclusively vegetarian can cause DVT's

[1]http://www.youtube.com/watch?v=lM6WrqLMJrQ


>The treatment is: Take B12 every day for the rest of my life.

Every human being on earth that I know of needs this. It's not just vegetarians.

What foods were you eating while homeless?

I imagine it's fairly tough to come by nutritional yeast and other B-complex rich foods whilst living on the street.

My girlfriend is a strict vegetarian, gets her blood checked regularly, and is apparently fine. We assume because she supplements all of the necessary nutrients that she lacks in her food. Mainly iron and the b complex vitamins I believe.


> Each night, I took the box of Lovenox syringes and carried it to my husband, sobbing. “It’s time for my shot,” I said, tears streaming down my face.

> Each night, he pinched skin on my belly as I screamed like a toddler and he injected the medicine.

Her husband sounds like an awesome guy - taking care of her in that state sounds incredibly difficult.

> My husband and I decided to get a divorce.

> “I think in hindsight, it was your stroke that changed everything for me,” he said.

> I thought it was the affair he’d had. But maybe he had a point. “Maybe that was the year,” I said.

Dang.


I actually found this to be the most interesting/least covered aspect of the article. I wanted to know more about the husband, and how he dealt with (or didn't) the ordeal.


Also this:

> People have asked if anyone around me could tell I was having a stroke. “Weren’t you acting weird?” they’d ask, and my husband’s mouth would turn into a thin line, and my friends who joined us for New Year’s would lower their eyes.

How long would that be hanging in the back of his head, eating at him about what he could have done differently?


Well, I just popped an Aspirin for no reason.


Please discuss it with a doctor first if you're considering continuing to do so.

My father ended up in the hospital with internal bleeding after he decided to start taking low dose aspirin on a whim because "it's good for heart health". I just straight up don't have it in my home because the last time I did, it predictably didn't work well because I was on prednisone and checking every little interaction gets tedious. Taking more than you need to of most things is kind of pointless.

Outside of this particular cause, you can live a healthy lifestyle to help prevent/control hypertension, diabetes, high cholesterol, and other problems that can increase your risk for stroke. There's a lot of ways to get sick or die - no point in stressing too much about one particular problem that is otherwise out of your control.


Aspirin indeed often has a blood-thinning effect. As such it may help reduce the risk of blood clots. That's the best case scenario, and even then it merely treats the symptoms, not the root cause of blood clots.

Blood clots and cerebral hemorrhage are the two sides of the coin. By popping an aspirin you shift the odds from blood clots to hemorrhage.

If I had to choose one of them, I'd take the blood clot.


just don't do to much of it, one dude killed himself with couple dozen taken within a day in the 90-ies (or at least that's what the then Russian media reported; aspirin UPSA was heavily advertised back then)


I really hope the above was not downvoted due to you guys taking mentioned amounts of aspirin every day :)


Will smartwatches with heart rate/other health sensors be able to detect strokes right when they happen? Or maybe even slightly before they do?


One similar thing I really want is a smartwatch that will call 911 if my heart stops. Nowadays with hypothermia-assisted CPR [1], a person can be resuscitated up to 15 minutes after their heart stops!

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3389464/


A smartwatch with a pulse sensor could easily detect an arrhythmic pulse, which can be a symptom of atrial fibrillation, one of the most common causes of strokes. You couldn't diagnose a stroke itself just from heart rate and blood pressure, though. There's way too many other factors that can cause variations in those.


I don't see how a clot in the brain would be detectable through heart rate at all.


Not sure, but maybe at a preventative level? E.g. if your heart rate behaves a certain way after exercise or during sleep, maybe it indicates a stronger likelihood of having a blood clot.

Well I don't know, I'm not a doctor- that's why I'm asking the question, hoping that someone knowledgeable will answer with a concrete reasoning.

Your comment in its present form is quite pointless.


I had a couple of ECGs recently. I'm not sure if they could get anything approaching the same graph through a watch some distance from the heart (the ECG has 8 or so contact points around the chest) but I did notice that a good portion of the cardiologists judgement came from inspecting the graph rather than anything more complex.


This is an amazing article and incredible blog

Among many interesting and inspiring themes, of interest to the HN community may be the disassociation of vision and objects. All of the deep learning models succeeding in classification emulate one side of the brain, while perspectives like this present life outside the constraint of rational thinking.


I was terrified after reading this. Reminded me that I should live a bit healthier, not drink more coffee then water, got to sleep earlier, wake up earlier, maybe even exercise. But more important, it got me thinking. The non-routine kind of thinking. Read some old diary entries. Wrote a new one, after almost a year.


My wife had a stroke at the age of 30, seven years ago. It happened in the hospital during an embolization procedure. She was unconscious for 5 days. This event has obviously changed her life, but I wasn't prepared for the ways it would change mine. Thank you for sharing this.



Profound. Thank you for sharing this. It pains me to read though that you had years of abnormal symptoms (severe shortness of breath, migraines, etc) and the medical system was unable to detect the issue early. This seems like the sort of issue that early detection could provide tremendous quality of life / survivability improvements at little risk. If the existing tests are too difficult, then we need more tests.


This was on buzzfeed?? Crazy. Didn't think those soul-less bottom-feeders would turn to quality long-form essays.


This is the best piece I have read in a while. It is amazing how something so small could affect our life. We are so delicate. Do you actually see objects as shapes and colors (as in, was the part of the brain that translates the signal into images lost) or was that you can not figure out what it is that you are looking at?


There is a similar TED Talk worth watching:

Jill Bolte Taylor: My stroke of insight

http://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke... (18:19 min, Feb 2008)


Such a well written article. I loved the details with which the incident was described.


I wish Buzzfeed only had articles like this.


BuzzFeed is reportedly profitable and growing quickly...if it were to just publish massive, obviously-valuable stories...well, the first thing from a software development perspective, they would've never had the highly-refined production process and CMS they have now...which, among other things, allows them to efficiently distribute to many eyeballs stories big and small.

And of course, the second consequence of being only a "reputable" publisher...they would've never even had a known name. I wish I could name all the many other news/story startups that have promised "just the good stuff" but have failed (Byliner comes to mind)...except they all quit so quickly that it's hard to even remember them.

I appreciate BuzzFeed's strategy as a content-provider and a technology company. And when it comes to actually reading their site, I have an easy tip: The more boring the headline, the better the content.


Why, people enjoy the other types of articles - why should they not cater to them as well?


Because we associate BuzzFeed with bullshit clickbait spam. It makes it difficult for an article to reach the right audience when you have such a large amount of negative association with a particular brand. It'd be like if the supermarket tabloids starting include well-written and legitimate content. It's going to take a substantial amount of work to win over the millions of people who view them exclusively as a tabloid, which is exactly how we view BuzzFeed today.


Exactly.

I don't even know how you'd find this article on Buzzfeed - the homepage is so obnoxiously cluttered with vapidness ("21 Hashtags All Curvy Girls Really Need") I only lasted about five seconds. It's like a parody of everything that's awful, only it's real.


If you want a parody of the parody then clickhole.com is awesome - it's the sibling site to The Onion.


Just an FYI: Currently, this article is on the front page of buzzfeed. Perhaps, for a brief time, we've made a genuinely good and interesting article bubble up their internal rankings?


There are countless efforts to reach people with this sort of information. Official medical sources, highbrow papers, trashy sites. What's to say that this isn't the best option to reach a certain segment and that, as a bonus, it reached beyond that?

Buzzfeed may well be a Trojan to get better content to those typically reading vapid junk? Or, more likely, a way of building a financially-secure publication from trashy beginnings.


Do you really believe this?

If Buzzfeed can achieve financial security by creating an audience who enjoy feeble drivel ("54 Things You Probably Didn't Know About 'Gossip Girl'"), surely if they then start replacing that material with long-form, well-written, thought-provoking content (like this article), they run the risk of losing that audience? It seems to me that the people who want to see 27 pictures of Beyoncé with staccato-sentenced captions - and haven't grown sick of this type of content yet - probably don't ever want to read a long article about something more important than Paris Kardashian.


Yes, I really believe what I said:

That rather than just vapid trash, I'd prefer seeing something occasionally informative in there for that market.

That monetising first through listicles in order to fundraise for more serious efforts could well be a valid strategy.

If you're Buzzfeed, and you're offering a bit of both, you can't really lose. You have the daily visitors reading their listicles and occasionally stumbling across something premium, and you have other markets who don't enter via the front page, but follow viral links from aggregators like HN or Reddit. Unless a front page is saturated with "ugh boring!!1" content, I don't know that there'd be a risk with their existing market.

One side of the fence gets slightly more educational content. The other gets more quality content, propped up by tabloid junk.


BuzzFeed is a content farm that steals other people's work and reposts it without permission or credit. At least that's what I've heard. Here's a random example - http://www.slate.com/articles/technology/culturebox/2013/09/...


Good thing we have HN to filter the trash out for us.


It seems like http://www.buzzfeed.com/ideas does a pretty good job of it too (I'm new to the site but was inspired by the "easy tip" above to search out some good content)


Not sure what this has got to do with programming?


Intellectually interesting stories on all topics have been welcome here ever since PG changed the site name from "Startup News" in 2007:

https://news.ycombinator.com/hackernews.html

By the way, if anybody wants a hit of meta, it's astonishing how precisely the last five paragraphs there still apply.


> The focus of Hacker News is going to be anything that good hackers would find interesting

How are we defining "good hacker" ?

> It doesn't include most stories about politics, or crime, or sports, unless they're evidence of some interesting new phenomenon.

Can a "good hacker" be curious and intellectually satisfied by political stories even if they don't include new phenomenon?

Don't get me wrong, I enjoyed the article. However, if we're saying, "this is on topic for HN" or "this is off topic for HN" it seems weird to have a definition that is 100% dependent on one's lived experiences and what they individually find interesting. Maybe someone really really likes cat pictures because of the color or makeup of the fur, or the instincts of felines. Maybe someone finds geopolitical discussions about surveillance states to be intellectually uninteresting because they feel helpless to affect reform. Or they feel most startups are void of substance and rely too much on VC funding and thus are not intellectually interesting.

I guess I'm looking for a bit more of an enumerated "this is acceptable" and "this is not" as opposed to "you'll know it when you see it."

Thoughts? Thanks!


I don't think "defining" captures what we can do about these things. "Meandering around" is more like it. But here are a couple observations.

A semi-objective thing about most of the uninteresting, non-HN-appropriate stories is how predictable they are, i.e. how repetitive of previous instances of the type. The more predictable a story is, the less information it adds and the less interesting it is.

There's a reason we say "intellectually interesting" to describe the stories HN wants. There are different kinds of interesting. For example, we all have an interest in the things we're personally invested in or identify with, but that is not intellectual interest.

Similarly, as humans we're highly interested in what other humans are up to, but that—think gossip and celebrity news—is not intellectual interest either. So a story can be interesting without being a good fit for HN, quite apart from not all having intellectual interests in common.

Maybe this explains why upvotes alone don't work for a site like HN. We upvote the things that excite our interest. It's too much work to pause and ask ourselves what kind of interest we're experiencing. And the non-intellectual kinds have the advantage—they require less attention to get excited. (For one thing, they rely on recognition, while intellectual interest relies on curiosity, which is an absence of recognition.) This is compounded on the internet, where attention is fleeting and fragmentary.


Oh absolutely, this is a really neat conversation that I was hoping could happen. You mention how predictable stories are, and we all have those moments on social media sites where we're all rolling our eyes. I think it might be interesting to look at HN from something like Google Trends, wherein tracking the topics that are upvoted/downvoted. Maybe do some penalties for topics that have a large front-page success rate and upvote/downvote ratio (and throw in comment # too, same with comment length) and you could start to probably see trends for circlejerk material. We'll always have people flagging stories for duplicates or the like, but certain topics always get through by virtue of many people submitting about that topic.

The advantage to so something like Reddit is if a topic is talked about too much or not at all, you can just add a channel and grassroots it. On HN, you only have a single timeline and front-page (yes, there's searching, but people are lazy). News sites have channels but editors which controls the stream (and most restrict who can edit). I think a more algorithmic approach to provisioning up and down channels for specific topics could be neat. Not really sure where I'm ultimately going with this, kind of free-forming based off issues I've seen with internet discussions and IRL discussions and recent controversies as of late. I think it's important to look at how HN does it's news/info vs. reddit vs. twitter etc, to me it doesn't feel like we've really 'optimized' it yet for user distributed news ... or maybe I'm not hip with the latest app.


>Maybe someone really really likes cat pictures because of the color or makeup of the fur, or the instincts of felines.

If someone posted an article that went into depth about the make up of color and fur and the development on instincts of felines, I don't think the community would object to such an article.

Just posting a picture however, is just lazy.


I feel like this should be "stickied" at the top navbar.


Try creating a new accout and posting - all the guidelines are pretty heavily pushed at new users.


From the guidelines:

What to Submit

On-Topic: Anything that good hackers would find interesting. That includes more than hacking and startups. If you had to reduce it to a sentence, the answer might be: anything that gratifies one's intellectual curiosity.


It has to do with wetware (biological computers).


Ha. I like this.


It's BuzzFeed. They want HN eyeballs.


They want a lot more eyeballs than that.


> As a result, my left brain, the expert at numbers and language and logic and reasoning, a part of it suffocated and died. My right brain, the specialist with regard to color, music, creativity, intuition, and emotions, therefore could not talk to my left brain.

This popular myth of broad specialization of the hemispheres needs to die. The author lost credibility there.


There were a thousand ways to convey this information. You could have pointed at articles, you could have enlightened the reading audience. You chose the one with the highest insult to information ratio. And you did this when the target of the insult is someone who went through a tough ordeal.

Humanity never ceases to amaze me, on both ends of the spectrum.


My first draft was actually more harsh, mostly because I do not consider this essay well written in several aspects. I did not insult the author; I just did not sugarcoat my criticism, as US American culture of insincere friendliness may demand.


I'm not North American. Your post has a high insult/information ratio in any culture.


You still have not pointed out my alleged insult (as in personal attack). The only insult I see here is your passive-aggressive one: "Humanity never ceases to amaze me, on both ends of the spectrum." As for your questioning why I did not reference external sources, the invalidity of this popular myth is far from arcane knowledge, especially on the Internet where it is just one web search away, and I do not reward lazy ignorance.


After you read it, is this all you have to say?

Lost credibility? The author is telling her story, she is not writing a scientific paper.


I have to admit that I finally stopped reading after "My heart freaked out. My heart didn’t want to be closed. It didn’t want to be touched."


That really irked me as well, which is an absolute shame because the rest of the article was very well written.




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