I was thrilled to be featured in a recent story by the Calgary Health Foundation. You can read their piece here. And don’t pass up the opportunity to read some of the other motivational stories on the CHF website.
In our interview, Ashley and I talked about my running adventures and my recovery from a series of strokes in the summer of 2017. I shared my experience as a patient at the Foothills Stroke Unit, and what prompted me to write a book about it.
While I’m writing, I will say thanks to those who purchased a copy of my book, Stroke of Luck: My Life in Amateur Athletics. It’s worth reminding my readers of my main messages:
The importance of an active lifestyle
Awareness of the full range of stroke symptoms… remember, “BE FAST”
Support for world-class stroke care at the Foothills Medical Centre
If you haven’t already picked up a copy of Stroke of Luck, it isn’t too late. The book is available directly from me (if you live in the Calgary area), on Amazon, or at any independent bookstore. Speaking of which, let me give a shout-out to Owl’s Nest Books in Calgary!
I’ve been very gratified by the response to Stroke of Luck. Many families are affected by strokes, so my story is one we can all relate to. And don’t forget, funds raised from sales of the book are going directly to support the work of the Foothills Stroke Unit, through the Calgary Health Foundation. It’s a win-win situation!
In this, Heart Health Month, it was a great pleasure to sit down with Christa Abbott, Director of Marketing & Communications for Earl Grey Golf Club in Calgary. (I’m quite sure it used to be called Heart and Stroke Month, so I should be okay borrowing the older designation!)
I’ve been a member of Earl Grey for many years, although admittedly golf has taken second place behind running for most of that time.
Christa and I talked about my stroke journey… the medical one, not the golf one… about the role that running played in getting me through that ordeal, and about the process of writing my book, Stroke of Luck.
I was really pleased with the piece that Christa wrote, and in particular how she incorporated one of my main messages… the importance of knowing ALL the symptoms of stroke… into the graphic for her article. Here it is:
Splash screen from Earl Grey Member Profile (Christa Abbott, 2024)
You can find the post on the club’s Instagram page here.
Christa neatly highlighted the phrase “BE FAST” as a reminder of the full range of stroke symptoms. You can read my post on this potentially life-saving topic here. I’ve included the information below, for quick reference.
And the picture of me that Christa used?
It was taken at about the 8k mark in the Calgary 10k race, in May 2017. I’ll be the first to admit it isn’t the best picture that’s ever been taken of me during a race. That said, when I do show this picture, I point out that I had just suffered a vertebral artery stroke a few minutes before it was taken!
For me, this is a stark reminder that strokes can affect any of us, at any time.
You can read the full story in Stroke of Luck: My Life in Amateur Athletics, available online at Amazon, or at independent bookstores, like our great local store, Owl’s Nest Books.
Thanks to all my friends at Earl Grey, and everyone else who has supported me in this initiative. Oh, that reminds me, there is one thing I plan to do in this next phase of my life (My Second Running Life)… suck a little less at golf!
I recently wrote a piece about the common symptoms of stroke, and how public awareness campaigns, as effective as they are, can leave a gap in the number of strokes they help to detect.
I’ve been doing more reading on this subject, and turning up some interesting results.
For years, the mnemonic F-A-S-T has been used to trigger us to recognize when someone may be having a stroke. Using this word, we should check the Face (is it drooping?), Arms (can you raise both?), and Speech (is it slurred?). “T” is for Time, as in don’t waste any before getting help.
Sounds good. But is it?
I mentioned in my previous piece that there’s more to the story. Why? Because F-A-S-T refers to ischemic strokes that occur in the carotid arteries. (There are two types of stroke: ischemic strokes, which occur when blood clots block flow in the arteries; and hemorrhagic strokes, which are associated with a rupture in a blood vessel.)
As a reminder, the carotids are the large arteries at the front of the neck. They account for about 80 percent of the total blood flow to the brain. In neurological terms, the carotids are the workhorses. And these are the arteries that, if they get blocked or damaged, can result in the symptoms noted above.
The balance of the blood flow to the brain is delivered in the vertebral/basilar artery system at the back of the neck. These arteries are smaller and they deliver blood to different parts of the brain. Not surprisingly, blockages in this network of arteries produce different symptoms. When vertebral blood flow is restricted, problems with balance and coordination of the eyes and the limbs can occur.
It has been recognized that a modified mnemonic would help detect strokes that occur in the vertebral arteries. BE FAST is already being recommended by some healthcare agencies as a more comprehensive trigger. Here, “B” is for Balance, and “E” is for Eyes (or ears). That makes sense to me, especially as I was having precisely those symptoms for weeks before I acted on it.
A study done by the University of Kentucky Stroke Center suggested that 14 percent of stroke patients were not identified using FAST. When BE FAST was applied, the proportion of identified strokes that were missed dropped to 4 percent.
In other words, more strokes could be caught if a wider screen were in use. Coincidentally, but maybe not, the number of strokes missed by FAST more or less matches the proportion of blood flow to the brain that originates in the smaller, but still important, vertebral arteries.
Another article I read recently on CNN Health addressed the different presentation of strokes between men and women. Interestingly, women may experience other stroke symptoms, beyond the parameters of even the broader, BE FAST, mnemonic.
Research summarized in the CNN article has shown that women may present with atypical stroke symptoms or symptoms that are more subtle and vague. In some cases, symptoms such as severe headache, generalized weakness, generalized fatigue, shortness of breath and chest pains, nausea and vomiting, brain fog, and even hiccups, may occur instead of or in addition to the symptoms noted above.
As to the reason why men and women experience stroke differently, scientists have come up with different theories. First, it’s about hormones. Age is another factor. There are other possible explanations too. I recommend reading the article to get the whole story.
It goes without saying that any symptoms that suggest a neurological problem should be acted upon immediately. No one ever needs to apologize for flagging a problem that may turn out to be nothing. It really is a case of being better safe than sorry.
As a final point, I’ve been spreading the word about stroke symptom cues when I speak to my running friends. There’s something appropriate about advising runners to BE FAST. After all, this should be an easy phrase for them to remember… it’s what they’re trying to do already!
I’m pleased to announce that my memoir, Stroke of Luck: My Life in Amateur Athletics, was recently published. The book is available now on Amazon (in either print or e-book format) or through independent bookstores. For those in Calgary, you can reach out to me directly for a copy. You’ll find details about the book on the dedicated page on this site. Click here.
Writing and publishing the book has been a personal journey of discovery. I hope you will enjoy reading about my lifelong connection with distance running, and the process of recovering from a number of strokes in 2017.
To my readers, and to those of you following me on the blog or on Instagram, I appreciate your interest and support. I look forward to sharing more stories and photographs with you.
Steve
Stroke of Luck: My Life in Amateur Athletics – order your copy today!
Two main sets of arteries feed blood to the human brain. At the front of the neck are the left and right common carotid arteries. The common carotids divide into the external and internal carotids. The carotid arteries are big, as far as arteries go, at about six millimetres in diameter for the average adult, and they account for about eighty percent of the total blood supply to our brains.
At the back of the neck, we find the left and right vertebral arteries—the verts. These major arteries run from a point behind the collarbones, up and through the vertebrae in our neck, and into the back of the brain. The verts originate from a junction with the subclavian arteries, another pair of large arteries that deliver blood into the arms. The verts are smaller than the subclavians, at about three millimetres in most adults.
As I’ve mentioned before, I look at medical subjects from a strictly layman’s perspective. One aspect of the arterial system feeding the brain that I find fascinating is the amount of redundancy that is built into it. In most people, the left and right vertebrals do the same job. The two separate arteries meet up in the back of the skull to form the larger basilar artery. It is the basilar artery that supplies the remainder of the blood to the brain, about twenty percent of the total.
Redundancy extends further than just between the left and right vertebrals. It also includes connectivity between the two sets of arteries feeding the brain, the carotids and the vertebrals. At the base of the brain, where the various arteries come together, there is a circle of connections between the carotid and vertebral arteries. This arrangement of communicating arteries is called the Circle of Willis, named for Thomas Willis, an English doctor who discovered it in the seventeenth century. Several other arteries meet up in the Circle of Willis and then take blood away to other parts of the brain.
The reason for the Circle of Willis is quite simple and elegant. If any of the main arteries is blocked, or occluded, then the parts of the brain that depend on the blocked artery can still get blood supply. In other words, blood can flow around the circle to get to its destination by another route.
Not the Circle of Willis
There can be differences in each person’s arterial connections, and many people have an arrangement other than a textbook Circle of Willis. This is what a neurologist would refer to as an “incomplete Circle of Willis”. It doesn’t seem that having an incomplete Circle of Willis is necessarily a problem. Besides, there is no option to fix it, given the complexities involved. In other words, an incomplete Circle of Willis is likely something that would only ever be discovered in an autopsy.
So, why am I even writing about this?
I know from personal experience that having an incomplete Circle of Willis can lead to higher risks of stroke or other neurological problems.
Even if that weren’t the case, I look at this system from a chemical engineer’s perspective. And when I do, I can’t help but be fascinated by the perfection of the design for this most essential system.
Thanks to effective public awareness campaigns, many of us are familiar with the common signs of stroke. Think of the television ads that show us what to look for if we think someone is having a stroke. The mnemonic “F-A-S-T” reminds us to look at the Face (is it drooping?), Arms (can you raise both?), and Speech (is it slurred?), and to waste no Time in getting help.
This checklist is a potential lifesaver because when it comes to strokes time is of the essence. But there’s more to the story. That’s because there’s more to the anatomy of our brains than what can be incorporated into a simple memory jogger of stroke symptoms. I learned this the hard way.
I’ve written elsewhere about the fascinating system that feeds blood into the human brain. More on that very soon. (By the way, everything I write on medical matters is in layman’s terms.) In brief, there are two main sets of arteries, the carotids and the vertebrals. These arteries are found in the front and back of the neck, respectively.
The carotids are the workhorses, accounting for about 80 percent of the total blood flow to the brain. And these are the arteries that, if they get blocked or damaged, can result in the symptoms noted above.
In 2017, I began to experience symptoms that didn’t fall into the handy, F-A-S-T category. Over a period of two months, I had several episodes of vertigo. I saw strange artifacts in my field of vision. I had a sensation that my body had become disconnected from my brain.
Then, one morning in July 2017, I woke up feeling odd. The first things I did were look in the mirror (to see if my Face was drooping) and talk (to see if my Speech was slurred). They weren’t. I could move my arms and legs, although they felt strangely heavy and lethargic. Naturally, I concluded I wasn’t having a stroke.
The scans done later that day in the ER said otherwise.
It turns out I had developed a blockage in my left vertebral artery. These arteries, left and right, run from a point about the level of your collarbones at the back of the neck. They join up to form the basilar artery, which feeds blood to the back of the brain. The vertebrals account for about 20 percent of the blood flow to the brain, and when they are blocked, functions like balance and coordination, including visual and hearing coordination, are affected.
The blockage in my vertebral artery had probably been there for some time before it started to cause symptoms. Until my situation was eventually brought under control, after a lengthy stay in the Foothills Medical Centre stroke ward, I experienced a wide range of symptoms. I had my eyes and ears go out of sync, as if someone had gotten hold of the control knobs in my brain and started twisting them randomly. My tongue turned into a frozen lump. My arms went into jerky spasms. It was not pleasant.
The reason I’m explaining all this is to share what I’ve learned. While catchwords are helpful, they don’t tell the whole story. If you, or someone you care about, is having any of the above symptoms or a long list of others[1], get it checked out immediately. Symptoms that are caused by a blockage in the vertebral arteries can be deadly serious, just like those in the carotid arteries.
By the way, when I did some research into the F-A-S-T mnemonic, I found some recommendations that it be modified to BE FAST. Why? The B and E would include Balance and Eye trouble in the checklist of stroke symptoms. This version of the mnemonic certainly would have helped me.
[1] Other potential symptoms of “vertebral artery stenosis” include sudden falls, severe headaches, breathing problems, confusion, trouble understanding speech, incontinence, and more.
By any reasonable measure, I shouldn’t be writing this. I shouldn’t be able to do much of anything. And yet, here I sit, thinking and typing. My typing is certainly no worse than it was five years ago. That was before my first running life abruptly ended.
Over the last month, I’ve had an opportunity to push against the limits of my compromised vertebral artery system. Vertebral arteries – “verts” – are the second major set of arteries that supply blood to the brain; the back of the brain to be precise. The verts account for about 20 percent of the total blood supply to the brain. When they are blocked, like mine were, the result is an ischemic stroke.
In 2017, I had a number of transient ischemic attacks, or TIAs, which are often called mini-strokes. The strokes were due to a blockage in my left vertebral artery. The result was a long stay in the Foothills stroke ward in Calgary.
I’ll repeat what I’ve said many times since then: the doctors that deal with stroke patients every day are heroes. I know this firsthand because the Foothills heroes stabilized me and saved my life.
The blockage in my left vertebral artery remains untreated. This is only possible because my body has made a rather ingenious adaptation to the blockage, by building secondary arterial connections to keep blood flowing to my brain. We were able to watch this in real time, on a video taken from an angiogram procedure. It makes for fascinating viewing.
As I pushed through a 16k run in the snow yesterday, or a 20k run in fine weather the Sunday before, I realized that I am a real-life experiment. While I am apparently able to cover these distances without too much trouble, it has not been a straight-line recovery. Just after my hospital stay, I had trouble walking around the block. Slowly but surely, I put my life back together. As you’ll gather from the title of this blog, I call it my second running life.
I barely managed a 500m walk/jog a month after my last TIA. A year later I finished a 5k race side-by-side with my wife. Last year we ran the First Half Half Marathon in Vancouver.
Now I’m at what I think is my upper limit. I can get through 20k, but not without discomfort. I know I’m at my threshold because my neck/shoulder are generally screaming for me to stop by the end.
Curiously, this is the same symptom I experienced before my strokes, when I was training at a much higher level. The pain was most severe during marathon buildups, and I’m certain that it was the first warning sign of the arterial problems I would have a few years later.
It occurred to me that I could perhaps use these pre- and post-stroke data points to estimate the change (if not the absolute amount) in blood flow to my brain. My assumption is that by comparing the usual measure of maximum oxygen uptake – the “VDOT” – I could arrive at an estimate of the amount of damage done to my vascular system by the strokes.
Before my hospitalization, I was training at a VDOT of between 50-52, based on my being able to run 1:25 to 1:30 for the half marathon. Last year, my wife and I completed a half marathon in 2:06, which suggests a VDOT of about 35. In both circumstances, I would consider myself to have been at my oxygen uptake limit.
Based on these empirical results, it would seem that I’ve experienced a reduction of between 30-35 percent in my ability to process oxygen in competitive running situations.
I’m not sure these estimates would have any value in a clinical setting, or whether it would be useful information in determining the next (if any) course of medical action. But it does make some sense, when you consider that I cannot come close to the kinds of performances I could manage five years ago. Even so, the fact that I can get through a strenuous run or race at all validates what I’ve come to see as the silver lining from this whole episode: I’ve been given a second chance, thanks to the remarkable machine that is my body. I know I mustn’t waste it.
My Second Running Life 