IT had been a perfectly normal morning in April 2013 — right up to the point Kay Howley turned to say something to her colleague, who’d just come back from a coffee break.
“She didn’t hear me, but suddenly I realised my words sounded weird, slurred. I went into the back office where we had a mirror. I looked fine. I repeated the exact same words, but they didn’t come out right.”
Her heart racing, Kay — who’d celebrated her 40th birthday three months earlier — ran to her manager. “I tried to explain to Mary something was wrong, but it was obvious it was.” By now, the TV ad for FAST — the acronym to help detect signs of stroke — had come into Kay’s mind. Then a receptionist at the Irish Examiner, her husband, Paul, also worked there in circulation.
“Mary called Paul and also the first aid team. Brian Lougheed, who knows a lot about first aid, was getting me to do all sorts of things: raise my arms, push against him, say funny sentences. Little did I know I’d be repeating those tests all day, every day, over the next few days.”
At the emergency department, attempting to explain what had happened, it was very clear something wasn’t right with Kay’s speech. While colleagues had speculated she might have Bell’s palsy, the first doctor she met said he’d assume it was stroke, unless tests proved otherwise.
“He must have known,” recalls Kay, whose only other symptom was slight facial tingling. Consultant neurologist at CUH Dr Áine Merwick says one in five women will suffer stroke in their lifetime. “The majority of stroke in either gender is in later age,” she says.
Over the next hours, Kay had several tests, ECGs, bloods.
“It was all new to me — I’d only ever been in hospital to have my three children. I was also perfectly healthy, I wasn’t overweight. Did I have a stressful lifestyle? No more than any working mum of young kids. Doctors asked about alcohol. Well, I didn’t have a hectic social life — a bottle of wine could last me three weekend nights.”
Scary as the day was, there were light moments, recalls Kay.
“They put a gown on me, and I asked to go to the ladies’, and the nurses were laughing at me walking down the corridor in a gown with high heels.”
After some hours, her speech returned to normal, though she had a bad headache. “I put it down to stress. I was feeling fine and — seeing the manic A&E department — I actually wanted to help out and answer the phone.”
Kay was taken aback that evening when, in addition to regular medication for underactive thyroid — a condition she’d had for 10 years and which was well-managed — she was given a cholesterol tablet. “I argued about that. I didn’t have a cholesterol problem, but they insisted, so I just went with it.”
Next day, her consultant neurologist said he suspected she’d had a TIA — a transient ischemic attack or mini-stroke, which occurs when part of the brain experiences a temporary lack of blood flow. He said once an MRI returned clear, she could go home.
“I was relieved, delighted at the prospect of going home.”
But the following afternoon came the shocking news: the MRI showed she’d had a stroke.
“I was hysterical. It was like my whole world had fallen apart. I was so young, I’d been so healthy. I thought of my kids — Ciarán, Laura, and Orlaith were aged 11, seven, and four at the time.
“Things fly through your head. Will I be able to care for them? Is something worse going to happen,” says Kay, who later discovered Ciarán thought the whole thing was his fault.
“Because he’d been acting up the morning I had the stroke — and Laura thought I was in a hotel.”
She was kept in hospital for more tests, including a Holter monitor (to measure heart activity) and an echocardiogram, the latter showing that she had a PFO (patent foramen ovale) — a hole in the heart that did not close as it should after birth. “They believed it probably contributed to my stroke.”
Discharged home with a prescription for Aspirin plus a cholesterol tablet (“my cholesterol came back at 5.2 — not very high, but because I’d had stroke it’d have to be kept considerably lower for the rest of my life”), Kay felt very fearful.
“I was shaken. I questioned everything. Could I trust my own capability? I lacked confidence I could do things I’d normally taken for granted.
“In hospital, I’d felt my hand tingling one night. I told myself it was my imagination, but I got very upset. I called the nurse and the night doctor did the tests again that had been done that first day in the office. Of course, it was just my imagination.
“But going home, not having the security of hospital was nerve-racking. Going to sleep — what if I didn’t wake up? What about driving the car? What about being home alone? I’d been job-sharing, so I was used to being home alone several mornings a week.
“Friends said I’d been lucky to be at work the morning it happened — things could have been worse if I hadn’t been treated so quickly.
“A month to the day after the stroke, Laura made her First Communion. It’s a bit of a blur — I don’t know how we managed to have it at home as planned. First Communion can be emotional on the best of days — a group of eight-year-olds singing gets me every time. I remember sitting in the church, thinking how lucky I was to be there — all the what ifs.”
Kay continued to have tests, which showed up an irregular heartbeat — this, with PFO, created ongoing stroke risk. “I was prescribed a new oral blood thinner called Pradaxa, which I was grateful didn’t require the monitoring associated with something like Warfarin.”
Transferred to the care of a specialist in young stroke, he talked to Kay about the risks another pregnancy would pose. “Paul and I had decided three [children] was our number anyway, but this put the writing on the wall.
“It was very black-and-white, very final, and — just like when you say ‘no’ to a child and they automatically want the thing — it would put thoughts in your head. I suppose it was just Paul and I hadn’t had that final conversation before the stroke hit.”
It’s estimated one in four stroke sufferers in Ireland are younger than 65. The IHF/HSE National Stroke Audit 2015 showed a 26% rise in the rate of younger stroke since the 2008 audit.
As the months progressed, Kay had mixed emotions. “I looked so normal and healthy. Everyone assumed I was, and it really annoyed me when they’d say: ‘It’s great to see you back to normal’. To me, there was nothing normal about having a stroke at 40, about taking a handful of tablets morning and evening. But I’m grateful now for those meds — they’re what keep me ticking over, a small price to pay for being healthy and being able to do normal things.”
For a while afterwards, Kay withdrew into herself. “It was just easier to stay at home. I didn’t want to go on a night out unless Paul was with me. I guess I was just afraid.”
But time was a healer. The fearful feelings passed, and now she credits the stroke with changing her perspective on life.
“I left the job. I felt I’d been doing it for the sake of it. After 21 years I called it a day. It was sad, but it wasn’t heartbreak.”
It was, she says, the first big step in a total life change. At the time, the family lived in Glanmire, Cork, but now began wondering about re-locating. “Could we do it? Would we do it? Would we be brave enough? We felt the children were still at an age where we could make a new home for them and we thought if we’re going to do this, now’s the time. So we found the courage to go with our gut.”
Since 2017, they’ve been living in the Maharees on the northern side of the Dingle Peninsula.
“We’re surrounded by beaches and mountains. The pace of life is much slower here. The sunsets — the sunrises too — are spectacular. I stop and appreciate all of this. And certainly, in the most recent lockdown we couldn’t have asked to be in a better place,” says Kay, who feels she’s ready now to look for another job.
“Moving away from Glanmire and not having family backup, I didn’t look for anything initially. Now the kids are older and Paul’s working from home, I’m freer and I feel a need to pick up my life again.”
Above all, Kay feels grateful. “If the stroke happened in 20 years’ time, I mightn’t be so lucky — I’d probably end up with life-limiting restrictions. It happened when my body was able to cope with it. It was mild, and I’m on medication to mind me. I’m lucky that it was what it was, and that it has opened my eyes.
“I believe everything happens for a reason, though we mightn’t always know why, and — for me — life actually did begin at 40.”
With about 10,000 people in Ireland having a stroke-related event annually, around 5,000 of these are women.
“Women have as many strokes as men,” says consultant neurologist at CUH Dr Áine Merwick.
She points, however, to UK studies that find more women than men aged between 45-54 having strokes (age when women are peri-menopausal).
“There’s uncertainty as to whether hormones are protective for women. Oestrogen can be protective against cholesterol – but can pre-dispose towards clot. Certain kinds of contraception can increase risk of clot – and the vast majority of stroke is due to clot,” says Dr Merwick, who advises “very careful discussion with the GP” if a woman’s overweight, smokes, has high blood pressure/diabetes and is wondering about contraception.
An estimated five to 10 out of 100,000 women get stroke during pregnancy. “It’s relatively rare but it’s a recognised risk compared to non-pregnancy. In the case of most young women we see, pregnancy isn’t a factor – rather it’s other factors like diabetes or high blood pressure. The few who have stroke in pregnancy tend to have some other risk factor like high blood pressure,” confirms Dr Merwick.
She recommends any woman with family history of stroke, who’s overweight or has high blood pressure and is planning a pregnancy, to discuss their vascular risk factors with their GP and have them treated. “Don’t ignore high blood pressure with talk of being very busy. High blood pressure needs treatment, not excuses about why it’s so high.”
Dr Merwick says currently two big studies are looking into whether women with pre-eclampsia during pregnancy are at increased risk of stroke in later life.
- See: exa.mn/StrokeWomen