Discovering my PFO
I was recovering well and exercising again. But one big question remained unanswered: why had I suffered a stroke at 44? Finding a possible answer meant more tests, long-term heart monitoring and one investigation I definitely wouldn't rush to repeat.
I still wanted to know why
As life began returning to something approaching normal, the cause of my stroke remained uncertain.
I had been 44, active and apparently healthy. I'd never really been ill before.
I'd recovered quickly from many of the immediate effects of the stroke and gradually returned to exercise, but that didn't answer the question that mattered to me.
Why had it happened in the first place?
Then came a lot of tests
The investigations didn't stop when I left hospital.
I underwent a number of tests looking at my heart and heart rhythm as doctors tried to identify anything that could help explain the stroke.
Echocardiogram
My heart was examined using ultrasound as part of the investigation into its structure and function.
Bubble test
I underwent further testing designed to help identify whether there was an abnormal route for blood to pass through the heart.
Long-term monitoring
A loop recorder was implanted so that my heart rhythm could be monitored over a much longer period.
A monitor under my skin
One part of the investigation involved having a loop recorder implanted.
Rather than relying on a short ECG taken during a hospital appointment, the device could monitor my heart rhythm over a much longer period.
At that stage, the doctors were still looking for clues.
I carried on with life and exercise while the investigations continued in the background.
Looking for something intermittent
If an abnormal heart rhythm only happened occasionally, there was always the possibility that a normal ECG performed at one particular moment wouldn't capture it.
The loop recorder allowed monitoring to continue over a much longer period.
The test I remember most
Of all the investigations I went through, there is one I remember particularly well.
It involved passing a probe down my throat so that doctors could get detailed images of my heart.
Before starting, the doctor gave me a warning that was both funny and slightly worrying.
He wasn't wrong.
He was right
I certainly didn't enjoy that particular test.
But by then I wanted answers.
After having a stroke without an obvious explanation, there was a reason behind all these investigations. The doctors were trying to find something that might explain what had happened and potentially reduce the risk of it happening again.
Eventually, they did find something.
They found a small hole in my heart
I was told that I had a patent foramen ovale, usually shortened to PFO.
I remember it being described to me as a small hole in my heart.
It wasn't something I had known about. I'd lived for more than four decades, exercised regularly and considered myself healthy without having any idea it was there.
The PFO was considered as a potential explanation for my stroke.
What is a PFO?
A patent foramen ovale is an opening between the two upper chambers of the heart.
Everyone has this opening before birth, but it normally closes afterwards. In some people it remains open.
Many people with a PFO never know they have one.
Was this why I'd had my stroke?
Finding the PFO finally gave the investigation something tangible.
But I think it's important when telling my story not to rewrite what happened with the benefit of hindsight.
I can't simply say that the PFO definitely caused my stroke.
It was identified as a potential route by which a clot could have travelled to the brain, and it became an important part of the medical discussion around my stroke.
Then I waited
I remember being told that the hole was small and that I would be placed on a waiting list to have it closed.
My recollection is that I waited roughly a year before the procedure eventually took place.
In the meantime, I continued living my life.
I exercised to a good level and continued trying to look after my health while waiting for the next stage.
Eventually I was called to Leeds
The procedure eventually took place in Leeds during the Covid period.
By then I'd had plenty of time to think about it.
I knew why the procedure was being recommended and I wanted the PFO dealt with.
But there is a difference between knowing you want a procedure and actually arriving at hospital to have it done.
Then came the consent form
One of the things I remember before the procedure was signing the consent paperwork.
Like any medical procedure, there were possible complications that had to be explained to me.
Seeing those risks written down made me nervous.
Until that point, I'd been thinking mainly about having the PFO closed and moving forward.
Reading through what could potentially go wrong made the procedure suddenly feel much more real.
My PFO was closed
I went ahead with the procedure and the PFO was closed.
After everything that had happened since January 2018, this felt like another major milestone.
I'd had the stroke, recovered my speech, returned to work and exercise, gone through numerous investigations and eventually been given a possible explanation.
Now that potential route had been closed.
Naturally, I wanted to run again
Exercise had been a major part of my recovery from the beginning.
So once I was able to start getting back to it after the procedure, running was something I wanted to return to.
I'd already rebuilt my confidence after the stroke and had been exercising to a good level.
I expected to continue moving forward.
But on my first run after the PFO procedure, I noticed something.
Something felt different
Running uphill was suddenly much harder than I remembered.
My exercise tolerance didn't feel the same.
I thought one problem had been dealt with
I'd gone into the PFO procedure believing that a potential problem had been identified and was now being addressed.
So noticing that I could no longer run uphill normally was unexpected.
At first, I didn't know what it meant.
But eventually my heart rhythm became another focus of investigation.
And strangely, the loop recorder that had spent so long monitoring my heart without providing the answer to my stroke would eventually record something significant.
Looking back at the search for an answer
One of the things I learned was that investigating a stroke doesn't necessarily end when you leave the stroke ward.
In my case, the search continued through numerous cardiac tests, monitoring and specialist investigations.
The PFO gave my doctors a possible explanation and eventually led to closure.
But my health story didn't end there.
A PFO is common and discovering one does not mean it caused a person's stroke or that it necessarily needs to be closed. Those decisions require individual assessment by appropriate medical specialists.
Then running exposed another problem
My PFO had been closed and I was looking forward to putting another part of the stroke journey behind me. But when I returned to running, hills suddenly became a problem. Further investigation would eventually turn my attention towards atrial fibrillation and flutter.
BACK TO MY STROKE JOURNEY