The Hidden Risk Factors for Stroke
My stroke hit out of the blue at 7:30 on an ordinary Wednesday workday morning — January 30, 2002.
I was in alone in the house mentally reviewing the "to do" list for my public relations business: revise notes for client meeting, finish draft press release, don't forget gym workout at 6.
My right arm went numb — just fell asleep, I figured. Probably nothing serious. I wasn't in pain.
But it wasn't getting better and I couldn't seem to think straight. Should I call someone? I couldn't remember how to reach my husband.
Then it dawned on me — I couldn't quite think of his name.
I stared at the phone: What's the number for emergency? How many digits? Letters or numbers? All I could do was press "O."
The operator's voice was crisp. I wanted to explain: my arm seems out of control and I can't think what to do. But when I opened my mouth, the sounds were unintelligible. "H-H-He." "H-He-H-He." I could hear myself.
"Ma'am, do you need something?" the operator asked again.
Panic. Oh, no. She's going to hang up. She'll think I'm a kid playing with the phone, or a crank or a drunk. Please, please don't hang up, I tried to say, but only gibberish came out. "D-De-He-He-D-D-Don-Don-Ha."
"Can you tell me where you are?" The operator was still on the line.
I couldn't think.
"Is there an envelope nearby with your address?"
Still nothing. What's wrong with me?
"That's all right," the operator said, "I can trace the call." The ambulance pulled up a few minutes later.
"We think you are having a stroke," the paramedic told me.
A stroke, I thought. That's preposterous! I'm only 48, healthy weight, I work out, don't smoke, great blood pressure. Perfectly healthy women don't wake up feeling fine and have strokes!
But sometimes they do, at least women who think they're perfectly healthy.
The next day, in the hospital, tests confirmed that I'd had a moderately severe stroke caused by a blood clot on the left side of my brain. The stroke wiped out all sensation and muscle control from my right hand. I couldn't hold a fork, tie a shoe, sign my name.
The stroke also damaged my brain's language center. I knew what I wanted to say, but I couldn't find the words or negotiate the alphabet. Like my two-year-old granddaughter, I struggled with the sounds.
Frustration followed me home from the hospital. Life became a training camp — a single-minded focus on rehabilitation, a race to re-lay ruined brain connections.
I was fortunate to have help: from doctors; speech and occupational and therapists; from my family and friends who cheered me on. But only I could do the work. And, I was the one who had to live - every day - with my own incompetence.
Every sentence was a struggle: to remember names, to find words — ordinary words for ordinary objects like car or bookshelf or school.
A simple question from my sister. "Want to get out this afternoon?"
I did. "Let's go park — no stop — no shop, yes shop."
I never saw it coming.
Until January 30, 2002, I would have guessed that most strokes happen to the elderly or to smokers or people with high blood pressure or cholesterol or heart disease.
I would have been right. Those are the "big" risk factors. I had none of them. I never dreamed I could be at risk for stroke.
But there are other risks - risks especially important for women under 55. Risks that aren't well known. Factors like migraine headaches. Taking estrogen either for birth control or hormone replacement. And autoimmune disorders such as lupus, arthritis, diabetes or clotting disorders.
I'd had three of these "hidden risks":
- I'd taken estrogen birth control pills for almost 20 years.
- I'd suffered mild migraines for almost as long.
- And, my most serious risk was a clotting disorder that I never knew I had.
But I might have known, if I'd known what to look for.
A month after my stroke, doctors told me I'd had subtle signals of a clotting disorder since my 20s:
- I'd had two false positives on the test for syphilis required for a marriage license.
- I'd had pregnancy problems including a miscarriage and a tubal pregnancy.
- And, my knees often looked purplish and mottled especially when I got chilled.
Based on medical knowledge of the times — the '70s and '80s — my doctors thought nothing of it. Nor did I. I just didn't like to wear shorts! But the false positives, the miscarriage, the mottled knees all were signs of a clotting disorder.
Even later, I might have dodged the stroke... if I'd known what to look for.
In the year before my stroke, I'd been increasingly forgetful and distracted. My friends and I just chalked it up to approaching menopause. We made jokes about '"senior moments." I was having more frequent migraines, but they were mild and my doctors had never worried about them before. And, I'd noticed strange "rhyming" mistakes in my writing: 'height' was written as 'right.' 'Core' was written as 'bore'&endash;mistakes that didn't come from a missed finger on the keyboard. I didn't know it, but the forgetfulness, the increasing pace of migraines, the "rhyming" mistakes &endash; all were signs that my brain might not be getting enough oxygen.
If I'd reported these to my doctor... If my doctor had connected the dots... he might have ordered simple blood tests that could have identified the clotting disorder. He would have advised me not to take estrogen. He might also have prescribed low-dose aspirin to reduce my stroke risk.
I'm lucky. I've recovered much of what I lost. I worked hard at speech therapy and hand therapy. Fortunately, many brain cells were able to heal. My recovery isn't perfect. On bad days I forget how to spell "lousy." I put face cream on my toothbrush, stick orange juice in the microwave.
But two years after my stroke, I'm working part-time, I'm traveling — to China, to Africa. Best of all, I'm writing so that other women can learn about the hidden risk factors for stoke.