Kelly tried calling her supervisor to say she wasn’t feeling well, but she struggled to type her password into her cellphone and got locked out. She went back to bed, telling herself she was just having a bad morning and that all would be fine when she woke up later. When Kelly didn’t show up for work, however, her supervisor called her parents, who contacted her roommate. When the roommate entered the room to try and rouse her, she realized something was amiss. “Are you okay?” she asked Kelly, who couldn’t respond. The roommate called 911. Kelly was admitted to the hospital’s neuro intensive care unit, where an MRI showed she had had a stroke. “It took me two days to realize I had a stroke because the doctors and nurses didn’t tell me and neither did my family,” Kelly says. Stroke is more common in people over 65, according to the American Heart Association, but it can happen to anyone, even someone fit, young, and healthy like Kelly. Roughly 10 to 15 percent of all strokes occur in adults ages 18 to 50, according to a review article published in March 2020 in Stroke. Another study, published in Stroke in September 2020, found that more young women have strokes compared to young men, suggesting that stroke risk may be sex linked. Blood tests revealed the cause of Kelly’s stroke: She had two copies of the factor 5 Leiden thrombophilia gene mutation, a genetic blood clotting disorder. Factor 5 Leiden is the name of a gene mutation on the F5 gene that causes the blood to form clots abnormally. In addition, she had been taking oral contraceptives, which further increased her blood clotting risk. “The hormones in my birth control pills reacted with my factor 5 Leiden, which is why I had a stroke,” she says. To reduce the risk of a second stroke, Kelly stopped taking oral contraceptives and was immediately put on blood thinner medication. But that was only the beginning of her long road to recovery.
Recovery Is a Physical and Emotional Process
After a week in the hospital, Kelly spent three weeks at Spalding Rehabilitation Hospital in Boston, where she began to relearn how to walk and talk before being sent home to recover with her parents. “The first thing I could say was, ‘Oh my God, Mom!’ My mom loves to tease me about that now,” she says. A month after the stroke, Kelly could also say her name, “How are you?” and “I love you.” To continue with her rehabilitation, Kelly began speech therapy three times per week, music therapy twice a week, and occupational therapy once a week. But what proved to be more challenging than physically recovering from a stroke was recovering emotionally, she says. “My friends, family, and doctors kept saying: ‘You’re so inspiring. You’re so strong. You’re getting your speech back and your strength back.’ I didn’t want to let them know I was sad and depressed, so I pushed every emotion down,” Kelly says. In addition to major depressive disorder characterized by fatigue, depressed mood, and insomnia, the research community is recognizing that post-traumatic stress disorder (PTSD), characterized by reexperienced intrusive memories, avoidance of trauma triggers, and longer term impact on mood and hypervigilance, is also common after stroke, affecting as many as 1 out of every 4 patients, according to a review published in February 2017 in Stroke. “I cried in the shower and in my speech therapy sessions,” Kelly says. “No one focused on my mental and emotional recovery at all." To help herself feel better, Kelly did CrossFit daily. The endorphin rush from the high-intensity workouts helped to an extent. But her health suffered. “I was fatigued and having nightmares about the day of my stroke that would wake me up and that wasn’t good because sleep is important for brain health,” Kelly says. Emotional changes are not uncommon after a stroke because it is a traumatizing and disorienting experience. “Having a stroke is like trying to put a puzzle together, but instead pouring the puzzle out on the table and assembling the border first, the pieces remain jumbled,” says Catherine Atkins, PhD, supervisor of the Cardiac–Medically Complex Psychology Service at NYU Langone Health in New York City. “You are not the person you once were.” Brain damage from stroke can cause changes in mood and thinking. Talk therapy can help stroke survivors process the experience and understand the after effects. Knowing, for example, that crying is typical after a stroke because of brain damage can help you feel more in control of a chaotic situation. “In a clinical interview, I try to get a good sense of who the person is and what I can do to help them become grounded, remember who they are and recollect their parts and put them back together in a meaningful way,” Dr. Atkins says. “Psychotherapy provides the glue to put the pieces back together.” Luckily, Kelly’s sister and her speech therapist pushed Kelly to see a psychotherapist. “I didn’t want to go because I didn’t want to relive the day of my stroke, which was the worst day of my life,” Kelly says. But Kelly gave psychotherapy a try. She now meets with her therapist once a week to address her mental health. “The more I talked about my stroke, the better I felt,” Kelly says. “You can’t be physically strong unless you’re mentally that much stronger. Surviving a stroke is hard and it’s okay not to be okay. It’s okay to be sad and depressed. But you need to talk about it,” she says. Other forms of therapy that can help individuals with post-stroke PTSD symptoms (with or without anti-depressant medication), include:
Cognitive behavioral therapy (CBT)Problem-solving therapyArt therapy
Take Steps to Reduce Your Risk of Stroke — No Matter What Your Age
As the fourth leading cause of death for women, stroke kills more women than men, according to the American Heart Association (AHA). During the “brain attack,” a blood clot travels to the brain (ischemic stroke) or a blood vessel in the brain bursts (hemorrhagic stroke), impacting blood flow in the brain causing nerve cells to die, which could lead to disability and death. To reduce your risk of stroke, know your numbers, including your blood pressure, cholesterol, and blood sugar, and avoid smoking. Also, ask your doctor about genetic testing for factor 5 Leiden, especially if you’re considering taking oral contraceptives or another drug that could increase your risk of blood clots, or you have a personal or family history of deep vein thrombosis, a condition in which a dangerous blood clot forms deep in the vein, which can break off and travel to the lungs. Deep vein thrombosis is the most common type of blood clot associated with factor 5 Leiden thrombophilia. Pregnancy may also predict your future risk of stroke. According to the AHA’s Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women, women with a history of preeclampsia — high blood pressure during pregnancy with protein in the urine after 20 weeks gestation — have double the risk of heart disease, stroke, and blood clots over the next 5 to 15 years after pregnancy, compared with women who don’t develop preeclampsia. “Pregnancy is like a stress test. If you develop one of these stroke risk factors during pregnancy — preeclampsia, high blood pressure, gestational diabetes, or preterm birth — tighten up on controlling all the conventional risk factors for stroke, such as controlling your blood pressure, eating a heart-healthy diet, exercising regularly,” says Bharti Manwani, MD, PhD, assistant professor of neurology at the University of Texas Health Science Center in Houston.
Kelly’s Lifesaving Mission
This year, Kelly was named one of the American Heart Association’s 2022 Class of Real Women. She uses her title and experience to talk to other young women about heart health and knowing the risk factors of a stroke. She also made sure that her entire family was tested for the factor 5 Leiden gene mutation, and discovered that each of her parents has one copy of the gene mutation, as does one of her three sisters. Another sister, like Kelly, has inherited two copies of the gene mutation. (Genetic testing for factor 5 Leiden is covered by many insurance plans.) Kelly is working hard at her rehabilitation and hopes to return to her job as a pediatric nurse. “If I can have a stroke, so can you,” Kelly says. “Stroke does not discriminate. Act fast because time lost is brain lost.”
