I had stroke at 41 years old. It was preventable. So is yours.
My name is Michael Riviello and I survived a high blood pressure stroke.
At 41 years old I had a stroke. To be honest, I didn’t even know that was possible. I always thought strokes were something that happened in your 70s or 80s. But strokes don’t discriminate; they happen at all ages. In fact, every 40 seconds someone in the United States has a stroke and every 4 minutes someone dies of a stroke.
The good news is that the CDC estimates 80% of strokes are preventable. Let’s stop there for a moment. Eighty percent of strokes don’t have to happen! I’m in that group. I didn’t have to have a stroke. I share my story in hopes that it will help you or someone you love to prevent a life altering stroke.
LIKE A SHOT OF NOVOCAIN
It was about 10 a.m. on Friday, October 18, 2019 when I felt a sudden and strong tingling sensation in the left corner of my mouth. It came out of nowhere and felt as if my left upper lip had been given a huge shot of Novocain. The right side of my mouth was completely normal, but it was as if my left side had disappeared.
My immediate thought was that I was having some weird allergic reaction. Moments later the exact sensation began in my left thumb. This freaked me out and motivated me seek medical attention. I don’t know that I have ever been so quick to see a doctor, but the peculiar nature of this situation could not be ignored. So, I grabbed my keys and headed to Urgent Care. (Yeah, I know you are questioning why I drove but that’s a story for another day.)
ANYTHING BUT A STROKE
During the five-mile trip to Urgent Care, I felt no real physical change. My mental state was a different story. I began feeling intense anxiety. Dark thoughts started to creep into my mind. Did I just leave my house for the last time? Will I ever see my family and friends again? Is today the day I die? I was definitely freaking out.
I decided to push those thoughts aside and calm down. Panicking never makes anything better. I took a few deep breathes, composed myself, and walked into Urgent Care. Once at the desk, I calmly shared my symptoms with the friendly front desk agent. I also shared with her that both of my parents have had Bell’s palsy.
If you are unfamiliar, Bell’s palsy is a condition that causes temporary paralysis of the muscles in one half of the face. As I think back on it now, sharing Bell’s palsy was probably my feeble attempt to will a non-fatal diagnosis into reality. My instincts told me what was happening was bad.
This same wishful thinking was probably why I went to Urgent Care instead of the Emergency Room; subconsciously I wanted to have an issue that could be fixed at Urgent Care without ER intervention.
RELAX MICHAEL. YOU ARE IN THE RIGHT PLACE
Straightaway, I was escorted to an exam room and told to take a seat while I wait for the nurse. The room was cold and quiet. The only sound was that of paper crunching under me as I nervously shifted on the exam bed.
As soon as the nurse entered, she began taking my vitals. Like any good nurse she could tell I was nervous. She paused a moment to reassure me by looking me in the eye and saying, “Relax Michael. You are in the right place. You are surrounded by people who can help you.”
After that she happily returned to her work. She informed me that my temperature was normal: 97.4 degrees. Just then the mechanical blood pressure cuff released. The nurse glanced down to see the reading. Immediately the look on her face told me something was wrong. Very wrong.
254 over 150.
If you are unfamiliar with blood pressure readings, 254/150 is dangerously high. Medically speaking it is called a hypertensive crisis. The mood in the room immediately changed. I could sense that the formerly cheery nurse now possessed a heightened sense of concern.
The Family Nurse Practitioner (FNP) entered the room and began his exam. I was asked to smile, which evidently showed a small facial droop on the left side. My arms and legs appeared to be functioning normally. I shared with the FNP that I felt like I was having to work hard to speak; like it was extra effort to choose my words.
The FNP asked the nurse to retake my blood pressure. The new reading had lowered to 192/143. While things were moving in the right direction, my number was still much higher than a normal blood pressure reading of 120/80.
I was told I didn’t appear to present with Bell’s palsy because my left eyebrow was spared from the paralysis. (Apparently Bell’s is an all or nothing thing, so being able to move my eyebrow brought my wishful thinking to an end.) The FNP voiced his concern that given the numbness in my face and thumb this could be a cerebrovascular accident (CA). In other words, a stroke. I was told I needed to go to the Emergency Room for evaluation and scans.
As I walked up to the ER, I caught my reflection in the sliding glass doors. There was a huge disconnect between what I saw in the glass door and how I felt. My left arm was dangling lifelessly. I looked like it was completely disconnected from my body. I also appeared to be walking like Frankenstein with a pronounced limp affecting my left leg.
As soon as I walked in the door the staff put me in a wheelchair, wheeled me down the hall, and parked me outside a room. The intercom loudly proclaimed, “Code Stroke Room 3. Code Stroke Room 3.” I glanced up and saw a Room 3 sign. Damn it. That call was for me. I was the Code Stroke.
Just then my shoe fell off my left foot. I began to move my foot toward my shoe. The effort was much like a child’s first attempt to walk: horribly uncoordinated but full of effort. The healthcare worker standing next to me said, “I can help you.” To which I politely responded, “Thanks, but I can do it.” He put his hand on my shoulder and quietly stated, “No you can’t bud. You can’t control your leg and that’s ok. Let me help.” I was gutted.
SCANNING AND WAITING
A few moments later I was inside Room 3 having a CT scan. My recollection gets a bit fuzzy at this point, but the next thing I clearly remember is sitting on a bed in the ER.
A nurse wheeled a tall pole next to my bed that had a tv and video camera attached to it. She told me “the doctor will join us shortly to explain the results of your CT scan.” I asked, “The doctor? Is the doctor a computer?”
The nurse then told me about the hospital’s teleneurology program. Basically, there’s a neurologist on-call 24 hours a day whose sole duty to review emergency CT scans. This shortens the time from arrival to treatment, which is essential when dealing with potential strokes. Time is life and the faster the treatment, the better the prognosis.
I HAD A HEMORRHAGIC STROKE
The television’s blank screen popped to life with the image of a doctor. The neurologist introduced himself and got down to business by saying, “Michael you’ve had a hemorrhagic stroke.” All I could say in response was, “Oh shit.” I didn’t know much about strokes but the little knowledge I had wasn’t exactly uplifting.
In layman terms, I had a high blood pressure stroke. The neurologist said I was admitted with extremely high blood pressure (aka hypertension). My high blood pressure had been applying great force to an artery wall in my brain, over time that force weakened the wall and this morning the wall broke. He called it an intracerebral hemorrhage – bleeding inside the brain. The teleneurologist added that the location of my bleed was in a classic location for hypertensive patients.
After the videoconference an Emergency Medicine Physician (EMP) joined me and explained she was giving me a powerful medication to drive down my blood pressure. The goal was to lower the pressure because less pressure means less blood spilling into my brain, and less blood means less brain damage. By this point numbness had engulfed the entire left side of my face. Both left limbs felt as if they were encased in concrete and were nearly impossible to move. The EMP explained that the bleeding was in the right side of my brain which is why my left side was being affected.
I was now being prepped for transport to the main hospital downtown where I would be admitted to the Neurological Intensive Care Unit.
WELCOME TO THE NEUROLOGICAL ICU
The nurses’ first task upon bringing you into the ICU is to strip you down and wipe you head to toe with alcohol wipes. The ICU houses the most compromised patients; thus, they must sterilize you. So here I am standing naked with one nurse sanitizing me while the other nurse helps me balance. By this point in the day, my high blood pressure stroke had made standing without support was impossible.
It is difficult to fully articulate the feeling of that experience. I felt feeble, vulnerable, and helpless. It was in this moment where reality became a bit overwhelming. I began to wonder if needing help to stand was a glimpse of my future.
After being wiped down, I was placed in a bed and the nurses put an IV port in each arm. They put a blood pressure cuff on my right arm to take my BP every 15 minutes. The nurses told me it would beep if the top number (systolic pressure) went above 140. They weren’t kidding. The alarm went off numerous times during my stay.
My family and friends started showing up as did the doctors. My friends and family were a welcome distraction from the current situation. The doctors were less distraction and more frustration. That’s not to say they weren’t friendly and intelligent individuals; they were those things and more. But each doctor visit included the same test to assess my physical condition. A physical condition that was frustrating me.
I was asked to raise my arms and hold for 10 seconds. My left arm would go up but then it would drift erratically. I simply couldn’t hold it still. I then lifted my legs and held for10 seconds. My left leg cooperated better than my left arm, but that wasn’t exactly a high bar to reach.
Finally, the doctor would run two fingers across my forehead and ask me to describe what I felt. I could feel it on the right side of my head but when they crossed the midpoint, I could no longer feel it. My frustration and concern grew as I lacked control of my body.
A REFLECTIVE OVERNIGHT
After my last visitors departed shortly before midnight, it was time to try to get some sleep.
I struggled to sleep that first night. Maybe it was trying to sleep sitting up while being attached to machines. I know that is not the reason…although it certainly didn’t help. For the first time I was alone and able to reflect on the events of the day.
What started as a normal day took a life-threatening turn. Today could have been game over for me. According to Harvard Medical, between 30 and 60% of people that experience an intracerebral hemorrhage die. Many of those deaths occur before ever reaching an Emergency Room.
I started to reflect on my life, the mistakes I’ve made and the countless fun times I’ve had. I’ve lived an amazing life and I certainly wasn’t ready for it to end. My attention to turned to the things I’ve wanted to do but have yet to accomplish.
Why haven’t I done certain things?
What is holding me back from doing what I want to do?
Why do I put things off for a future day?
It was about one o’clock in the morning and my room was illuminated solely by the overnight glow of the city outside my window. The weight of the day was bearing down on me, and I began to cry. I’ve never been one to tear up easily, but the emotion of the day was overwhelming. To be sure, there were many happy tears as memories of people and events came to mind. But there were also tears of fear regarding my future.
One question kept coming up: What would life be like going forward?
MY HOSPITAL STAY
I was in the ICU for two days before being downgraded to a regular room for another three. All my days were fairly similar: amazing care from rock star nurses and a parade of doctors performing physical evaluations.
I was surrounded non-stop by family and friends; in-person visits and Facetime calls were a constant. From sunrise to well past sunset, I was rarely alone which was a great comfort. One of the nurses joked that it was like a party in my room and suggested that I share the wealth with other patients who didn’t have visitors. It was in that moment I realized how lucky I was to not be alone. Never undervalue the people around you.
When I was finally discharged from the hospital, I walked out with the help of a walker. In that moment, I felt like an old man and was embarrassed that I needed such support. Today I look back and see an amazing accomplishment that, at the time, I could not fully appreciate. I now know the extent of what my body went through and how lucky I am. The truth is things could have been a whole lot worse. I would later learn of a guy, two years older than me, who had a stroke the same day as me. He was released to a live-in rehab facility wondering if he would ever walk again. Suddenly having to use a walker for a few weeks didn’t seem so bad.
HIGH BLOOD PRESSURE: THE SILENT KILLER
People ask me if I had any symptoms of my high blood pressure. The answer is no. The first physical symptom of my hypertension was my stroke.
High blood pressure is “the silent killer” because usually there are no symptoms until after it has done significant damage to your arteries, brain, and heart. It is a stealth ninja; you have no idea of its presence.
I hear people say, “I feel my blood pressure going up.” This is simply not true. You can’t feel your blood pressure. People who make that claim are probably experiencing an elevated pulse rate mixed with a rush of adrenaline. Just because your heart is beating faster doesn’t mean you have high blood pressure.
The only true way to know your blood pressure is to have it measured by a health care professional.
LEARN FROM MY MISTAKE
I went to the doctor when I felt sick. In my 30s that was rare and in my 20s visits were even more infrequent. As a result, I wasn’t able to catch my hypertension at an earlier stage. That was my biggest blunder.
At a post-hospital follow up appointment, I asked a neurologist to assess my chances of having a second high blood pressure stroke. She said, “if you didn’t have high blood pressure, you may never have had the first stroke”. The doctor wasn’t trying to shame me. She was trying to educate me. In other words, keep my blood pressure in a normal range and avoid another stroke.
Now let’s apply that logic to you: no high blood pressure, no first stroke. 108 million American adults have hypertension and a large amount of them have no idea.
If you have high blood pressure, it is not a death sentence. Many people can maintain a healthy blood pressure through diet and exercise. For others, you may need medicine. If this is you, don’t worry. I currently take five pills (down from six!) every day and it’s the easiest thing I do all day. The choice is simple: take the pills and stay alive or don’t take them and risk death. Trust me, it is an easy decision.
KNOW IF HIGH BLOOD PRESSURE RUNS IN YOUR FAMILY
The other mistake I made was failing to fully comprehend my family’s medical history.
I was “sort of” aware of that hypertension ran in my family but never took the time to truly understand the history and the risk it posed to me. The facts are that my maternal grandfather had a high blood pressure stroke, his mother had a high blood pressure stroke as did his sister. All three of his children – including my mother – take high blood pressure medication.
That’s a pretty strong family line of hypertension. So know your family history! Ask questions and share those answers with your doctor. That data will help you make wise decisions about your medical care.
ROAD TO RECOVERY
Today, anyone would be hard-pressed to look at me and guess that I had a stroke. For that I am beyond grateful. My biggest post-stroke struggle is invisible: numbness in my face and hand. I still can’t feel much of the left side of my face and the fingertips of my left hand remain numb. The face thing is more of a nuisance than anything else. It doesn’t negatively impact speech and only slightly hinders chewing. (Although it does occasionally cause some minor drooling out the left side of my mouth.) Not having full sensation in my fingertips, however, makes typing tough, buttoning a shirt difficult, and tying a shoe impossible.
I do wrestle with one issue that impedes my movement: muscle spasticity. After a stroke muscles may become stiff, tighten, and resist stretching. In my case, my left arm contracts up and in toward my body. I notice this particularly if I’m stressed or cold; situations that would naturally make a body tense up.
My stroke has left me with a heightened sense of emotion. Remember earlier when I said I’m not one to tear up easily? Well, the happy tears come a bit easier these days. And you know what? It doesn’t bother me at all.
I take joy in the little things and I walk through life with humble appreciation. I realize I’m lucky to be alive and live independently; I can drive, cook, and bathe myself. Unfortunately not all high blood pressure stroke survivors can say that. Strokes not only kill but they take away personal independence. Some survivors need a wheelchair, others struggle to speak.
I share my story as a cautionary tale of what can happen if you don’t know your blood pressure. I ask for your help in spreading the word. Please share my story with your circle. You might save the life of someone you love. The danger of hypertension is real, but the solution is easy: know your blood pressure. And if you have high blood pressure, do something about it. My stroke didn’t have to happen and neither does yours.