Amy Buford occasionally looks at a photo of her father helping her walk.
Not a baby photo as you might think, though her father Bob raised her alone from the time she was a little girl. He's always been her rock, and that's reflected in the photo from five years ago, taken when Amy was 26.
"I like this picture of my dad holding me because it reminds me of how far I've come," said Amy, now 31.
At 26, Amy felt she had answered most of life's questions. She had been in a career she loved for five years, helping at-risk preschoolers as a special education teacher. During her master's degree, she volunteered as a court-appointed advocate for children. She played club volleyball in the evenings and on the weekends, also very competitive. And she was engaged to be married.
"She had the whole world after her," Bob said.
But all that changed when Amy had one.massive stroke, leaving them with an altered reality. She had new questions to answer. Would she ever go again? Would she be able to teach again? Could she ever be a mother?
"It was terrifying," Amy said. "I was wondering what I was going to do and how I was going to move on with my life because a lot of people told me at the time what I could and couldn't do. I didn't like that. I wanted to show if I could do something or not, and that's not always it was easy".
Stroke in young adults is rare, but it is on the rise. So health experts are working on it.raise awareness of them. Amy's doctors had to save her life first. Then they would learn more about the probable cause of her stroke.
three days before christmas
On December 22, 2013, a blood clot became lodged in Amy's middle cerebral artery, one of the main arteries supplying blood to the brain. Amy's then-fiancé, a military medic, immediately realized that she was having a stroke and called 911.
Know the signs, thinkFAST.
Uneven or drooping smile.
One arm is weak.
Slurred or slurred speech.
TIME FOR A CALL
Call 911 if you suspect any symptoms.]
The paramedics rushed AmyHospital Poudre Valley de UCHealthin Fort Collins, where a CT scan confirmed the clot. Doctors gave her tPA, a drug used to dissolve blood clots, and then flew her there by helicopter.University of Colorado UCHealth Hospital.
Bob was in Denver when he heard the news. He ran north to Colorado, then turned around when he found out his daughter's stroke was so bad he had to go to Aurora.
While Poudre Valley Hospital is a Certified Primary Stroke Centerable to provide stroke careLike tPA, the University of Colorado Hospital is aComprehensive Center for Cerebrovascular Accidents, where doctors can provide more complex services.
Bob had just arrived at the hospital when the helicopter landed. Amy's best friend, Valerie, joined him.
"One of the nurses came and grabbed us," Bob said. "She told me to run and follow her. I was there when Amy was pulled off the roof. It was pretty grim. We were afraid she wouldn't make it through the night.
"And so the long process began."
Work against all odds
A brain scan showed that the stroke had affected two-thirds of Amy's right hemisphere, Amy's neurologist said.Dra. Sharon Poisson, co-medical director of the Certified Comprehensive Stroke Center and inassistant professor of neurologyIn itUniversity of Colorado School of Medicine.
Bob credits Poisson and his team with saving his daughter's life, twice.
The extensive damage caused Amy's brain to swell significantly, prompting doctors to perform a hemicraniectomy. Because she had part of her skull removed, the swelling in her brain did not put lethal pressure on other areas of her brain. (Doctors then reattach her skull once the swelling subsides, which in Amy's case was several months later.)
But Amy's brain started bleeding again.
"They realized what was going on and saved his life again," Bob said. "I have nothing but praise and admiration for these people."
battle against the brain
Because the right side of Amy's brain was so damaged, the left side of her body was completely paralyzed.
"I remember they asked me to move my left arm," Amy said. “I extended my right arm and picked it up. They wanted to know if she could really move her arm. I thought they just wanted it out of the way."
Amy's stroke left her with what's known as left-sided neglect, which is more than just not being able to use one side of her body. Amy's brain literally didn't recognize that she had a left side. People with unilateral negligence may leave food on half their plate or put on a single glove or shoe. Amy's doctors, friends and family had to leave her looking to improve her disability.
"My dad could be sitting next to me and I wouldn't know it if he didn't get my attention more directly," she explained.
The stroke also affected his memory. She can remember some of the time he was in the hospital, but most of her memories of him since the stroke are marked by seasons or major events, not actual dates.
Remember New Year's Eve when your friends decorated your room for their favorite party. And he remembers many of those days having Valerie by his side, bringing a bit of normalcy to his life.
"He took me on a wheelchair trip and we laughed and laughed at all the things we saw in the hallways," Amy said. “He often stayed overnight. She was there for everything."
After about a month, Amy was able to leave the hospital and start rehab. She was unbearable.
Don't tell me what I can or can't do
"I've had this new normal, but there's nothing normal about being 26 and in a wheelchair when I was used to being active," Amy said.
Still, she didn't want to give up. At one point, her caretakers told her that she might never be able to walk again. He made her angry, and he made it clear to her therapists.
"Then don't work with me if you don't get me to where I've been," he told them. "I'm a special education teacher. Don't tell me I can't."
Poisson said Amy's drive is inspiring. Amy said that Poisson gave her strength.
"Young adults who have a stroke are a different population than most," Poisson said. “Not only are you struggling with stroke deficits, but you were a healthy 26-year-old yesterday. It is a sudden realization that you are now a different person. It changes the way people define themselves."
who am i now
Being able to use her left side was Amy's biggest challenge, but she was determined to get out of rehab, and this spring she did.
"She had a cane and my arm, but she went through all the nurses, physical therapists and occupational therapists - all the people who helped her in rehab lined up in the hallway to the car. Everyone cried and clapped and we went home," she said. Amy's father.
"We've been there ever since," he said. "Now I live with Amy and she's probably my best friend."
Amy struggles with daily chores and being close to her father helps her cope. She wears an ankle foot orthosis (AFO), a brace that helps her raise her left foot to walk, since she can't move those toes. Her left arm also has limited range of motion and she can grab onto things but she has trouble letting go.
"Here I was, 26, asking my dad to fasten my bra," she said with a laugh. "It was my best friends who told me about the front clasps (of the bra), it was a game changer."
Amy said she spent a lot of time Googling self-care tips. She can't do what is essential for most young women: curl her hair or tie it in a ponytail.
"I had to stop worrying about these things," Amy said. "That's me now."
It focused more on functionality than glamour.
"I'll never wear stilettos... and shopping for shoes is a pain," she explained. "I have to bring my father because I have to adjust the shoe and the orthosis."
She mourns her limitations. Even little things like seeing another young woman in flip flops can make her angry. She gets frustrated when she has to multitask and can't. She also organizes small celebrations, as she did recently when she found sandals to walk on.
"Not only do I have to break the physical barriers, I also have to break the mental barriers," he said. “There are moments when I walk into the store and the sidewalk seems strange to me. I'm freezing and I can't get on the sidewalk."
He finds inspiration in a poster showing a horse tied to a small plastic saddle. It's been said, "Sometimes what's holding you back is only in your head."
However, her father is impressed by her strength. Amy returned to teaching high-risk preschoolers after suffering a fall following a stroke.
The lessons from his stroke give him empathy for his students.
“I can only focus on one thing right now. Sometimes I have to force myself to take a deep breath and slow down. I know I'll make it, but if I want this quality of work, I have to make the time to do it," Amy explained. "I see my students are just as frustrated. Maybe they'll be challenged by a riddle. I let them take a breath. deep, I tell them to step away from that for a minute and come back. I was in a situation where a puzzle was really hard for me."
stroke in young adults
At the University of Colorado School of Medicine, Poisson studies stroke in young adults. Although she has seen an overall decline in strokes over the past two decades, there has been an increase in strokes among people ages 20 to 40.
One possible explanation is that risk factors such as high blood pressure, obesity, and diabetes are becoming more common in young adults and may not be addressed early enough.
But that was not the case for Amy. She did not have these risk factors, but she did have a patent foramen ovale, or PFO, commonly known as a persistent "hole" in her heart.
Foramen oval permeable o PFO
In the womb, each fetus has a foramen ovale, an open valve in the wall between the left and right atria of the heart. This opening allows most of the blood to flow from the right atrium into the left atrium and not into the lungs. When a baby is born and takes its first deep breath, more blood immediately enters the lungs, and the "valve" in the foramen ovale closes. It seals completely and permanently in most people within a few years.
But in25 percent of the population, the valve does not fuse, and this opening between the right and left atria can come and go intermittently, called a patent foramen ovale (PFO). For the vast majority of these people, there are health problems related to their PFO.
researchers like itDr. Juan Carrol, an interventional cardiologist at UCH and professor at the CU Faculty of Medicine, wondered if there was oneLink Between PFO and Strokes, as 50 to 60 percent of young and middle-aged people have been diagnosed with PFO with no apparent stroke cause, he said.
Potentially, a PFO could allow a small blood clot originating in a vein to travel to the arteries leading to the brain. In most people, such a clot would pass through the vast network of branching arteries in the lungs, where it would filter out harmlessly. But even a small clot of two to three millimeters could pass through a PFO and reduce blood flow to the brain and cause a stroke, Carroll said.
It would be difficult to design a study to determine if this was really the case, he added. But onelarge clinical research studyLed by Carroll, there was a clear finding that PFO occlusion with an inserted medical device was more effective than medication in preventing a second stroke.
Once Amy was healthy enough, Carroll performed a transcatheter PFO closure on Amy.
Five years later
Amy continues to attend physical and occupational therapy once or twice a week. And she's trying new things instead of focusing on limitations. She said that she uses her stroke as an excuse to "be a little selfish".
"I feel like I owe it to myself to reach my goals and follow the dreams I had before my stroke," she said. "I focus on myself."
You've been taking a spin class and hope to try a new kind of exercise from time to time. Then comes Pilates. She has returned to hiking and has not stopped teaching. She works hard every day to gain more independence.
"I have to look at things for my own personal growth, to prove to myself that I'm still an adult and capable of great things," she said.
Her father couldn't be more proud and his love is evident in his aspirations for her.
"She fulfills her own destiny every day," Bob said. "I would like to see her have a life that is independent of me. At 32 (which she will be filming on June 3), she totally deserves it. She is just an amazing person. She sets goals and implements them. And when she fails, she sets a more achievable goal, achieves it, and then sets it back to a higher goal. She's an amazing kid."
Amy said she couldn't have done it without her dad.
"I wouldn't be where I am right now without him," he says. "My father is my rock."
She has a photo to prove it.
Care for adults over the age of 65Ankle Foot OrthosisComprehensive Center for Cerebrovascular AccidentsFaculty of Medicine from CUemergency carehemicraniectomyNeurologyunilateral negligencepatent foramen ovaleprimary carePrimary Stroke Centerstroke carethrombetomyHospital Poudre Valley de UCHealthUniversity of Colorado UCHealth Hospitalemergency carewoman care