The Time My Family Acted FAST and Saved My Life (again)

When celebrities die, the world seems to suddenly become more aware of the many maladies that kill humans. I think that’s probably a good thing, because we need the occasional reminder of our mortality to keep us centered, but also because following the death of a famous person we get a series of reminders of what we need to look out for regarding our own health. Famous deaths, in a strange way, have a secondary effect of making us healthier.

Actor Luke Perry, who died on March 4 following a stroke.

While we don’t know yet exactly what killed actor Luke Perry, we do know it was due to complications from a stroke. The buzz around his death is that most people think stroke is a disease that old people get, but unfortunately that’s just not true. There was a good article in the New York Times this week about how stroke effects younger people.

In my work I meet a lot of young stroke survivors including some in their 20s and 30s. While it’s not too common, it does happen. The article calls out undetected birth defects, blood clots, and aneurysm as reasons for stroke in young people, and there have also been some high profile drug interaction causes like in the case of the oral contraceptives Yaz, Yasmin, and Ocella which were not found to cause stroke but which were taken off the market because of side effects that may have led to stroke in some women.

And then there is the dreaded spontaneous arterial dissection, something that I learned far more than I would have liked when in 2017 at age 50 I suffered a stroke as a result of a dissection of my carotid artery. Because you probably have no idea what a dissection is, here’s a definition:

“An arterial dissection is a tear in the lining of an artery. When a tear occurs in a major artery in the head and neck — the carotid or vertebral arteries — that transmit blood to the brain, this is called a cerebral arterial dissection.”

— University of California San Francisco

In layman’s terms, for various reasons an artery can tear without warning and as a result blood flow can be cutoff to the brain or a clot can travel to the brain causing a stroke. Fun, huh?

In my case, I was in Tucson helping my parents move on a lovely April day and unbeknownst to me I began slurring my words. When I say unbeknownst to me that’s because I honestly have no recollection of it. I continued to move items from the truck into the apartment, and apparently my niece thought I was joking around and slurring my words on purpose in an attempt to make fun of someone. Unfortunately, that wouldn’t be abnormal behavior for me. A few minutes later, back at the truck, my brother in law responded much more dramatically. He noticed that the entire left side of my face had dropped, and he yelled for my wife.

Moments later I do remember being back in the apartment and telling my wife I was fine. In fact, I insisted I was fine. But my wife was by my side six years earlier when I had a heart attack and tried to play it off so she was having none of it. She also knew about FAST.

  • Face Drooping
  • Arm Weakness
  • Speech
  • Time to Call 9-1-1

I had the F and the S covered, and she took care of the T. Within minutes, the paramedics arrived and while my symptoms had gone I got a ride to the hospital to be safe (I was a heart patient after all). Because the stroke was short-lived, doctors figured it was a Transient Ischemic Attack (TIA), often called a mini-stroke. These are fairly innocuous, but could be a warning sign of something worse to come. But tests confirmed I had a full-on stroke, and nobody could tell me why.

I don’t want to minimize my stroke, but I got lucky. Unlike Perry, my stroke was small, came and went quickly, and in the end I have had no noticeable deficits. My face and speech returned to normal, I experienced no arm or leg weakness — hell I didn’t even have a headache. In 2011 I had a nearly 100 percent blocked widow maker artery and my heart has pretty much bounced back. I had a stroke and have had no lasting effects. I am clearly a lucky dude.

Perry, however, was not so lucky. As we learn more about his stroke I suspect the reason for its size and devastation will become more clear. For my part, it took five days in the hospital, three specialist followups back home in Phoenix, and multiple invasive tests to diagnose with some certainty (not complete certainty) that my stroke was a result of a dissected carotid artery.

Honestly, we still don’t know exactly. The hospital doctors couldn’t determine why following the stroke my carotid artery was 100 percent blocked. Neither could my cardiologist. She sent me to an electrophysiologist to see if it was due to a clot from atrial fibrillation (AFib) or another heart rhythm issue. He ran some tests and those came back normal. I then went to a vascular surgeon, who said that because of the shape of the blockage in my carotid artery it was likely a dissection, but he couldn’t be sure. Oh, he also said there was no way to fix my carotid artery because it was too dangerous to try to open the blockage so I would simply have to live the rest of my life relying on the other arteries delivering enough blood to my brain. (This is cool, but apparently the body learns to compensate and even creates new arteries to get around the blockage).

Because of my heart history, the biggest worry for me was that the carotid blockage was caused by the same thing that caused my heart attack — calcium buildup from fat and cholesterol in my blood. This was infuriating to me, and really scary, because since my heart attack I had changed my lifestyle and been working hard to maintain good cholesterol. If my efforts had been fruitless I may have been fighting a losing battle all these years.

Strangely, the possibility that the stroke was due to plaque buildup put me into a major funk. I had beat the heart attack in 2011, but if I could still drop dead any second from a stroke or another heart attack despite all that I had done to negate this possibility, I was a lost cause. After my heart attack I was oddly calm. I got lucky, and I moved on. I really didn’t overthink how close I came to dying. But the stroke knocked me for a loop.

I started to dwell on death. I began researching cemeteries because I wanted all those details to be taken care of before I croaked so my wife and family wouldn’t have to worry about it all. I went as far as to research various alternatives to burial like burial at sea and natural or green burial. I found out I could be cremated and planted with a tree, or turned into a diamond (although asking one’s spouse to wear your dead ashes around their neck after your gone is a bit selfish). I even dragged my wife to visit a few cemeteries in the area, but in the end the cemeteries in Arizona were depressing as hell and I eventually changed my mind altogether and decided I wanted to be cremated and have my ashes spread at Powerhouse Park in Del Mar, Calif. (my favorite spot on earth). So I got that going for me.

The possibility of the stroke being caused by more plaque buildup led to me having an angiogram to check inside my heart and arteries. So it was back to the hospital to have a camera inserted through my groin and up into my cardiovascular system, and the good news was that my arteries were all very clear. All the work I had been doing to keep my cholesterol down had been working.

That was sweet relief, but it didn’t provide an explanation for the stroke. Next stop was a neurologist, and more scans, and then something really odd happened. The new scans, taken just a few months following my stroke, showed that my once fully blocked carotid artery was now flowing nicely. It had spontaneously cleared on it own. This phenomena all but convinced my neurologist that I did indeed suffer a dissection, since many dissections spontaneously heal on their own. The body once again outsmarted medicine.

This all leaves me with no clear answer as to what caused the dissection, as I did not experience any trauma like an accident or a roller coaster snapping my neck too forcefully. And while I ended up having a good outcome (just like I did with my heart attack), it still left me a little uneasy about how delicate our bodies can be. But hey, what can you do?

These days I don’t think about the stroke much. When I meet stroke survivors who have been left with deficiencies, I feel a little guilty in the same way I feel guilty when I meet heart attack survivors who had to get cracked open for a bypass. And, as this blog post might suggest, I am always taken back to that day in April 2017 when someone famous has a stroke.

The bottom line here is that I am probably still alive thanks to luck, and the quick thinking and persistence of a smart spouse. So I suppose the lesson is to know the signs of stroke and heart attacks and be vigilant. If you suspect you are having a stroke or heart attack, get thee to a hospital post haste even if you aren’t sure. The life you save just might be your own.

And RIP Dylan McKay!

American Stroke Association

I Was the Last to Know I Was Having a Stroke

Last spring I had a stroke. It feels weird writing these words, because truth be told I haven’t really shared this with too many people. When I had a heart attack in 2011 I shouted the news from the virtual mountaintop that is social media, but for some reason I’ve kept the stroke news closer to the vest. I think maybe I’ve been reluctant to share the stroke story because I’m still in denial about it and frankly it scared me more than I’d like to admit. More than the heart attack. I’ll tell you why.

My stroke occurred more than five years post heart attack, and in those five years I’d been doing everything in my power to take good care of my cardiovascular system. I had been eating right, taking my medications, exercising regularly, and keeping my cholesterol in check. I’d been going to the cardiologist every six months and having all the appropriate tests — stress tests, echo-cardiograms, blood work. I was in as good a condition as any heart attack survivor could expect. I let my guard down. So the last thing I expected last April 30 was a stroke.

I was helping my parents move into a new apartment in Tucson when it happened, but I didn’t know anything was wrong. I was moving boxes and clothes between the rental truck and the apartment when apparently I began slurring my words. My niece said later she thought I was being silly. My mother said she thought I was making fun of someone. My brother-in-law, however, was the first to notice something was not right. He was handing me a box from the back of the truck and evidently he yelled for my wife to come quickly.

My wife took one look at me and called 9–1–1. I was telling her to relax and that I was fine while she was on the phone with the 9–1–1 operator telling her that I was slurring my word and that the entire left side of my face had fallen. I assured her I was fine. The look on her face was of pure terror. She told me to sit down and be quiet.

The paramedics arrived within minutes and I guess by then the symptoms had already gone away. I listened to my family tell them what had happened and I honestly thought they were nuts. I was fine. They took my blood pressure and asked a few more questions, then let me know they’d be taking me to the hospital to be safe. I then got my second ambulance ride in the past five years.

At the hospital they ran some more tests and surmised I’d had what’s called a transient ischemic attack, or TIA. Basically a TIA is a temporary blockage of blood flow to the brain. A TIA is like a stroke, producing similar symptoms, but it usually lasts only a few minutes and causes no permanent damage. Unfortunately, after a few more tests, including an MRI of my brain, the truth was I did indeed suffer a stroke. A small stroke, but a stroke nonetheless. Additionally, one of my carotid arteries was 100 percent blocked. And despite my insistence that I was fine and more than well enough to fly to London in two days for a long-planned European vacation, I would not be going home for a few days and I would not be seeing Big Ben anytime soon.

Without going into too much detail, the next several weeks included more tests, a visit to my cardiologist back home in Phoenix, a visit to a vascular surgeon to confirm the carotid artery blockage, a visit to an electrophysiologist to rule out that the stroke was caused by a clot as a result of atrial fibrillation (AFib), and a trip to the cath lab to see if I had any other new blocked arteries.

None of these doctors could fully explain why I’d had a stroke. The vascular surgeon thought the stroke was likely caused by a spontaneous dissection of my carotid artery, meaning the blockage was the result of a random tear in my artery. The electrical guy pretty much ruled out AFib. The cardiologist who did my cath said my heart and surrounding arteries were clear and it was unlikely that the stroke was caused by a clot emanating from my heart.

All of this was good news actually, because the biggest concern for me was that despite all the work I’d been doing to keep my arteries clear (i.e. diet, exercise, medications) I was still producing sticky artery-blocking plaque. I was terrified that all my hard work was to be for naught, and in fact that fact alone caused me to fall into a pretty serious funk in the weeks following the stroke. I was sure my body was a plaque-making machine and that I was doomed to die an early death. I’m not typically a doom and gloom guy, but I actually started looking into burial plans so in case I kicked the bucket my wife wouldn’t have to worry about the details. Morbid I know, but that’s where my head was. And by the way, when you reach a certain age it’s actually a good idea to discuss your death wishes with your loved one, but that’s a story for another blog post.

The last specialist I saw was a neurologist, and his assessment was that the vascular guy was probably right — I’d had a dissection. And a few weeks later when another MRI showed that my carotid artery was no longer fully blocked but in fact mostly open, we all agreed that I did indeed have a dissection. In layman’s terms, this means I had a stroke because for some unknown reason my carotid artery decided to tear and as a result a small clot traveled to my brain and cut off the blood supply long enough to cause slurred speech and face droop. Yep, it was a freak accident and probably had nothing to do with my heart disease history aside from the possibility that my carotid artery may have been a little weaker due to plaque build up. Basically, there was nothing I could have done to prevent it, but it wasn’t likely to ever happen again.

Boy did I feel…lucky? I’d cheated death for the second time in five years. Let’s hope the third time is not the charm.

So why share this now, after nine months? Well, this week many of the best medical minds in the world are gathering in Los Angeles for the International Stroke Conference, the world’s largest meeting dedicated to the science and treatment of cerebrovascular disease. Yet I bet you had no idea stroke is the fifth leading cause of death in America.

I don’t think many of us think about stroke, or even really know what a stroke is. There are various kinds of strokes with different causes, and you can learn a lot on the American Stroke Association website. But really what I’d like to get across is that 80 percent of strokes are preventable through diet and exercise as well as by keeping an eye on the warning signs like high blood pressure, elevated cholesterol, obesity, diabetes and more.

I’d also like to spread the word about the warning signs of stroke — the things my wife and family noticed about me that lead them to call 9–1–1. The warning signs of stroke are: face drooping, arm weakness, and speech difficulty. One or all of these symptoms means it’s time to call 9–1–1. Knowing these signs can save a life.