JACKSONVILLE, Fla. — A stroke can happen at any age. It can happen when you're two months old or 99 years old, but it's definitely something I never expected to happen to my husband. While we still don't know when he had a stroke, we now know what likely caused it. The path to answers started with a freak accident.
Last year, my husband, Michael, hit his head as he was getting out of his truck. A few days later, with signs of a concussion, he went to the Emergency Room where they took a scan of his brain.
"The ER doctor came back and said have you had a stroke? I said no I have no idea what you are talking about," recalled Michael.
Confused and scared we went to Dr. Ricardo Hanel, an endovascular neurosurgeon.
"Clearly there was a stroke on right parietal area of the brain," said Dr. Hanel.
Dr. Hanel, the Director of Baptist Neurological Institute, told us Michael had suffered a silent stroke.
"You can see people with worsening of short term memory and trouble controlling bladder," said Dr. Hanel. "If someone has a small stroke in that area they might not even realize they had a stroke."
Just 40 years old, and the father of our two young children, Michael was sent for a series of tests to figure out why he had a stroke, so it wouldn't happen again.
"I think it's very important to question your physician, am I doing all the tests that needs to be done for a stroke in the young?" said Dr. Hanel. "Is my blood too thick, do I have any heart defect that makes me more predisposed for a stroke?"
All the tests came back negative until cardiologist Dr. Pamela Rama guided a probe down his throat to get an up close look up at his heart. It's a procedure known as a TEE, a Transesophageal Echocardiogram.
"Because of my age and lack of risk factors they did a specialized form of echocardiogram called a TEE,” said Michael. “And it picked up that I had a hole in my heart, a PFO."
"In my opinion it should be done for every young person who has a stroke because through the chest echocardiogram can miss those little holes there," said Dr. Hanel.
The hole in Michael's heart was congenital, and despite numerous echocardiograms over his life, it had never been discovered.
"There was always something going with my heart that didn't make sense,” Michael said. “I knew it in my gut but they all missed it."
We were sent to interventional cardiologist Dr. Ruby Satpathy at Baptist Heart Specialists. She is the director of the Structural Heart Program at Baptist Health. She shared with us just how common it is to have a hole in your heart.
"If we have four people in the room, one will have a PFO. We don't need to close all PFOs,” Satpathy said.
“We usually don't look for a PFO until you have symptoms. The symptoms we know are a stroke and a migraine,” said Dr. Satpathy. “We are more worried when somebody is a scuba diver because when the pressure changes there is more risk for having a stroke.”
In Michael's case, doctors believe the hole in his heart allowed a blood clot to travel to his brain. He was at high risk of having another stroke. He had two options. He could either take a blood thinner and aspirin for the rest of his life or have surgery to close it. Dr. Satpathy said new research shows in cases, like Michael's, the risk of a stroke would decrease significantly by closing the hole versus taking medicine.
"There are two options. One is open heart surgery by closing the hole, like putting a patch on it, which we have done historically for 30 years. It's a big major surgery. The other option is closing with a catheter which is what I do," said Dr. Satpathy. "I think it's important for people to be aware there are different options available and again most physicians are aware of the options, open heart or catheter approach, but sometimes they may not be because these are relatively new technologies."
We opted for a minimally invasive, hour-long procedure that required only one night in the hospital. Early in the morning in late March we arrived at the hospital for his procedure. I waited anxiously for Dr. Satpathy to walk into the waiting room and tell me the procedure had been a success. It took a little longer than expected because she ended up finding not one, but three holes in his heart.
By using a catheter and going through his groin, she implanted a small mesh device in his heart to close all three holes. While the procedure has been used on children for several years, Michael was only the second adult to have it performed at Baptist Medical Center Jacksonville. Just hours after the procedure he was sitting up and eating, and the next day he was able to walk out of the hospital and go home.
"I'm lucky to be alive. I have to keep thinking about that in my mind, but I will forever wonder what is me versus what is the stroke," said Michael. “There are so many people in this position that have some mysterious disease that they complain about symptoms and that people blow them off that they're crazy or a hypochondriac, but now I'm living proof. There were some pretty significant things going on and somehow those were overlooked."
Dr. Satpathy and the Structural Heart Team at Baptist Health are performing a number of procedures using a catheter, giving patients an alternative to open heart surgery. Dr. Satpathy leads The Valve Clinic, which includes a team of interventional cardiologists and cardiothoracic surgeons who specialize in minimally invasive techniques. You can learn more here.
Are you at risk for a stroke? Take a quick quiz here and you can also learn more about clinical trials going on right now at Baptist Health to expand hope for stroke patients.