I Had a Stroke at 27 While on Hormonal Birth Control (And How To Know If You're At Risk)
Reassembling memories of parts of your own life is a weird feeling. That said, I may never again experience anything as weird as feeling part of my brain actively die.
I don’t really remember why I decided to harvest all of the thyme I’d grown that summer. Just a huge amount and for no good reason; all the people I know who use seasonings wouldn’t have used that much in the next year. I went back inside with this laughably huge harvest and my husband and a friend who was over made terrible and predictable tired puns involving old songs and bottles of thyme, but not so loud as to wake the toddler upstairs. I forgave them magnanimously for implying that I should plant parsley, sage, and rosemary and a short while later our friend left to head back home, tossing me funny little worried looks. I checked email one last time, wrote an oddly worded blog entry, took my hormonal birth control pill as near-religiously as I usually did, and dropped off to sleep.
I woke up in the middle of the night unable to tell my husband that something was wrong.
A transient ischemic attack (TIA) is often called a “mini stroke.” That’s a stupid term designed to avoid panic in patients and families. Take no crap on this; it’s a stroke. A blood clot in your brain’s vasculature cuts off downstream circulation and for a bit that part of your brain gets no oxygen. No tissue dies and generally there are no lasting effects. It’s only that in silence you’ve become much more likely to have a(nother) vascular brain injury than ever before.
Recently a friend posted some photos from a gathering in the year preceding that overenthusiastic thyme harvest. My then-fiancé and I attended but I was late because I was exhausted and slightly confused. I’d woken up in the middle of the night for no reason; my tongue felt fat and I couldn’t think. I said thickly to my fiancé “I feel weird,” but dropped back off to sleep. I woke up exhausted, drove to the gathering and on the way drove the front passenger tire off the road into a ditch.
Today that day and a few days after are hard-to-impossible to access in my memories. There’s just a hole. I only remember feeling completely sleepy and thickheaded. I don’t remember the pictures, but there I am.
In the last few years, various official bodies have updated guidelines for prescribing hormonal birth control. Patients who should be excluded include smokers, illegal drug users, and those with a history of strokes in their own or genetic family members’ history. The update included people who’ve had certain kinds of migraines which have visual effects. I’d had a couple in college. This update would come out after Night of the Terrible Thyme Puns.
I also had a family history but didn’t know it. At that time my family didn’t tell “the kids” about “stuff like that.” I am the oldest grandchild in my generation and at 27 still subconsciously a kid to older family members. There was time enough, surely, and also the vague thought that Someone had possibly said something at some vague time. To one of us. Right? Surely.
I woke up and knew in a muzzy, dazed state that I needed help. It took me forever to wake my husband, partly because I couldn’t really form words. He did what we all do when loved ones wake up needing something in the middle of the night but don’t quite seem to be awake and got me a glass of water. I sputtered and choked on it immediately, water running down my chin and shirt front while I coughed it out of my airway. I think I muttered some things that were totally unhelpful. After a minor eternity he decided to call my mother, a licensed practical nurse. We spoke briefly and then she told him to take me to the ER. I sounded “shocky” she said.
Not to give away any secrets of the art of nursing, but that is Momma’s nurse-speak for “I have to stay calm but oh holy hell, something is wrong, get the doctor.” No argument from me because finally someone seemed to be freaking out appropriately outside the suddenly-closed borders of my own brain. My husband got visibly more worried when he had to tie my shoes for me. I couldn’t reassure him.
Going to an exam room from the ER waiting room, I suddenly could not walk in a straight line. With a new speech impediment, I apologized to the intern for swerving around. He put on the face that my husband had worn for an hour and slowed to offer his arm. I don’t remember anything from then until sitting in front of my husband, the intern, and the doctor as the left half of my face felt like it was trying to melt off and my left hand and arm clawed up of their own accord in the exam room. Tears fell though I felt no intent or need to weep and said as much. Then to my horror I found myself droning on in completely pointless ways about nothing useful and watched from behind my face as the doctor blinked slowly and visibly wrote me off as another Saturday night drug seeker or possible psych patient.
Had I taken any drugs? No, just my birth control, and I have never indulged in illegal stuff or been a smoker. Had I drunk any alcohol? I’d drunk most of a hard cider about two weeks before. The ER doctor diagnosed me with a panic attack and ordered Ativan and some imagery just to cover bases. Ativan hit my bloodstream and I certainly didn’t feel anxious at all after that.
Later the Ativan wore off a bit and my husband agreed with me that I had not been taken seriously. We got into our GP’s office where my doctor performed some simple physical tests that had been skipped in the ER. He made worried faces and said he needed to see results of the imagery he’d just ordered before he’d say anything else. I went home and slept some more. Later that day a phone call made it official: I’d had a stroke about 30 years before I should expect one.
Very quickly I learned a lot of new words.
My stroke had affected my left basal nuclei, which signal-wise lie sort of downstream of the hippocampus, the seat of hunger and motivation, and which also plays a role in depression. I was completely exhausted as my brain rebuilt itself but my familial hyperlipidemia was useful as the surplus of otherwise bad cholesterol in my blood was used to rebuild and rewire part of my brain. Neural plasticity refers to the fact that your brain is still fairly willing to rewire itself -- the younger you are, the more plastic your brain. The dysphagia ended and I could swallow normally within a day. In the same time, the mild aphasia faded completely and I was able to express everything in my head again. The left-sided hemiparalysis within a week became something that only happened when I was tired, then changed to a tendency to trip in certain shoes when tired or distracted.
Stroke patients are told they’ll either develop memory issues or depression. It’s much more like somewhere in between where you get an amount of both. Middle-term memory was a non- and then semi-functional mess for about three months wherein I tried to pay the same bills multiple times. The depression was thankfully subclinical and equally thankfully ended along with the memory issues but there were some really bad days. That experience changed my view of depression as a disease. It’s real and calls for real treatment when at a clinical level.
Some things remain unrepaired: My left hand’s agility is largely back, but I will never play violin again. I have had some personality shift as well, but being more Type A can be a boon in a pre-med. I occasionally have to remind my husband that I am not made of spun sugar. We still compulsively although sincerely tell each other that we love the other before parting company.
Young people represent an increasing percentage of stroke patients but are often misdiagnosed, as in my case, because we’re just not supposed to be old enough to have strokes.
Primary risk factors for stroke in women under the usual, near-retirement age range appear to be smoking, uncontrolled diabetes, uncontrolled hypertension (high blood pressure), uncontrolled high cholesterol, and using any form of hormonal contraception with a list of risk factors I can't possibly add here, so talk to your doctor. Be honest with them so they know about your risk factors.
If you think you're having a stroke: Most often a stroke is very confusing for the patient. You won't necessarily understand what is happening to you though, like me, you may have an idea that you need help. If you're alone and think you've had a stroke, seek out a neighbor or coworker to communicate your need for help to emergency services. In many areas, dialing 911 can get you help even if you can't speak properly. I can't say it firmly enough: Do not try to drive yourself.
If you think someone you know is having a stroke: Loved ones, friends, and coworkers are most likely to notice major changes that come on suddenly. A patient will usually notice and mention sudden-onset chest pain or difficulty breathing, but you can see the sudden inability to hold something like a glass with normal ability in the hand on the affected side. You may notice the patient's face suddenly becoming flaccid or droopy on one side, or that they have speech or thinking impairments. You should call 911 immediately and if possible not leave the person you think is having a stroke until trained help arrives.