Here are some things young women should learn from Hailey Bieber’s “Mini Stroke”

Hailey Bieber, 25, said to her 43 million Instagram followers, “It’s difficult for me to tell the story, but it was important for us to share this,” in a video recently that described her recent health scare. The model was able to recover quickly and didn’t experience any long-term consequences, as evidenced by her attendance this week at the Met Gala. After a blood clot had traveled to her brain, she was taken to the ER and suffered a “ministroke.”

According to the CDC, strokes are most often caused by blood clots, also known as venous thromboembolism or VTE. An estimated 900,000 Americans are affected each year. Although strokes and heart attacks are often thought of as affecting older people, Bieber’s experiences has shown that they can affect anyone at any age.

Many young women are left wondering how and why this happened. They also have questions about their birth control pills. We spoke with leading stroke experts to get the details.

What is a “ministroke”? And how common are they among young people?

Bieber describes how she was sitting at breakfast on a Thursday morning when suddenly felt “this really strange sensation that traveled down the length of my arm, from my shoulder down to my fingertips.” Her right side began to droop for 30 seconds. When she tried to speak, she could not. They recognized the signs of stroke and called for help. However, when she was asked some routine questions, she couldn’t form sentences.

Bieber said that her speech began to improve as she waited for an ambulance. By the time she reached the ER, she was feeling almost back to normal. The stroke checklist gave her a zero, meaning that her attack subsided in the same time it occurred. This is also known as a Transient Ischemic Attack or a “mini stroke”. TIA, which is a temporary blockage in blood flow to the brain, doesn’t cause any permanent damage but could signal a full-blown attack.

Despite being less common in young people, recent studies suggest that strokes are rising in younger age groups, even though strokes overall are decreasing. According to a 2020 study in Stroke, between 10 and 15% of strokes happen in people aged 18-50.

One reason could be that risk factors closely associated with older people are now more common in young people, says Chi-Joan How M.D. Associate Physician at Brigham and Women’s Hospital and Professor in Medicine at Harvard Medical School.

Young people are more at risk than women, as estrogen increases the chance of a blood clot and women have higher estrogen levels than men. Nicolas Gendron, Ph.D. is a cardiovascular researcher for Georges Pompidou Hospital, Paris. Her message is especially important because Bieber’s audience consists mainly of young women.

What does it mean to have a “hole” in your heart?

Bieber’s doctors performed extensive testing at UCLA and in the ER to check for any pre-existing conditions such as autoimmune diseases or clotting disorders. These can lead to strokes. She also shared that they wanted to check for a possible “hole in the hearts” or PFO. This is a congenital defect that causes blood to flow between the upper chambers. The highest grade PFO was grade 5.

This revealed the truth: a blood clot can travel into the heart and is normally filtered to the lungs. However, because Bieber was wearing a large PFO, the clot traveled to her brain through the heart-opening.

Although they are not a cause of stroke, PFOs can be a route for blood clots to reach the brain. They also pose a risk to young people, Amy Guzik M.D. is a vascular neuroologist and Director at Atrium Health Wake Forest Baptist Medical Center’s Comprehensive Stroke Center. These are common and not something to be concerned about. However, she recommends screenings for those who have higher stroke risk factors such as high blood pressure, diabetes or high cholesterol.

Bieber had to have a PFO procedure. She’s now “really well” and “really fast” and says she’s “relieved that I can move on from this frightening situation and live my own life.”

Is there a way to increase blood clot risk by using birth control?

Bieber claims her doctors concluded that her blood clot was caused by a “perfect storm of coincidental factors.” However, hormonal birth control may have been a contributing factor. Hormonal birth control can increase the likelihood of blood clots. Bieber states that she just started birth control pills, which was a mistake as she has suffered from migraines. And I didn’t talk to my doctor.”

Research has shown a link between blood blots, oral contraceptives containing estrogen and myocardial injury. Although researchers are still trying to determine the exact correlation and the optimal dosage of birth control pills, there have been positive developments. We now have progestin only birth control methods. Even traditional estrogen-containing birth control methods have had their doses reduced from 150 mg to 50 mg in the 1970s to 50 to 20 mg in modern times.

Hailey Bieber experienced something very frightening. Amy Roskin M.D., Favor’s Chief Medical Officer and ob-gyn, reminds us that there is a small chance of suffering a stroke while using hormonal birth control.

Dr. Roskin says that it is important to give medical professionals a full overview of your medical history when considering birth control options. This includes any pre-existing clotting disorders, family history of early strokes, and frequent migraines. You should be aware of any discomfort, pain, swelling, redness or other symptoms after starting hormonal birth control. This could indicate that you are not getting the right medication.

Dr. Roskin can help you determine the best contraceptive method if you are at high risk of strokes or blood clots. Dr. Roskin suggests that you talk to your doctor if you have had a stroke, blood clot or other medical issues.

What does Covid and long flights have to do?

Bieber was informed that there could have been other contributing factors, such as the fact that she had just flown from Paris to Paris in a very short time and slept through both flights without moving. The CDC suggests that long-haul flight passengers walk up and down the aisle at least once every hour to prevent blood clots from forming. Experts say that the longer you stay in the same place without moving, the higher your risk of developing blood clots. Therefore, it is important to break up long flights with movement and stretching.

Another factor is? Bieber’s recent treatment for Covid-19. In fact, doctors initially reported that Bieber’s medical emergency was COVID-related when she arrived at the ER. Both her husband and she had tested positive for COVID in recent weeks.

Although we are still learning about Covid’s effects, Dr. Guzik said that we know one thing: it can increase clot risk — not only during the infection, but also for a few weeks afterwards.

Dr. How explained that this is due to inflammation from the viral infection which activates our coagulation systems. Dr. Gendron says that Covid-19 is known for its tendency to cause blood clots (also called thrombophilia). Blood-thinning medication is frequently prescribed to Covid patients. Following her TIA, Hailey Bieber was prescribed blood thinners and aspirin.

Patients who are hospitalized have a higher risk of developing blood clots, particularly if they are in intensive care units. This is because patients with more severe illnesses tend to have an increased inflammatory response. Dr. Guzik advises that you keep in touch with your doctor for at least a month to monitor for any new weakness, numbness or imbalance. Also, be alert for speech changes and vision loss. If this happens, it is important to get to the ER immediately. She says that even if the symptoms are brief, they can indicate something more serious in the days and weeks ahead. To prevent additional risk, it is important to get vaccinated.

Takeaway from Hailey Bieber’s experience

It is important to know your body so you can avoid life-threatening situations. In the event of an attack the most important thing is to remain calm and get to the doctor as quickly as possible. Bieber, who has anxiety, said that her symptoms were affected by the attack. “I noticed that my anxiety would strike me as soon as it hit me. It would make my speech feel funny. And when I felt really scared and anxious, it made things worse.”

Bieber says, “I feel very fortunate to have had the health resources and support from my family to be able deal with this as quickly.” “If you know of anyone who has been through similar experiences, but don’t know why, I encourage you to speak to a doctor.”