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Medical mystery: Toledo mother recalls stroke while riding her horse

It would be the first of many episodes for Kate Sippel. She had no idea she was battling a rare condition she'd been born with.

CLEVELAND — Kate Sippel of Toledo started riding horses at age 2, and it led to her veterinary career. She's been competitive horse jumping since 2014 and, last March, added "mom" to her titles.

Two months after John David's arrival, Kate and her horse, Norwin, went back to the ring. A great ride, until a terrifying moment.

"All of a sudden it felt like somebody punched me in the face," Kate recalls. "I was headed right towards a jump and lost all kind of movement or feeling of the left side of my body."

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Norwin kept going for three more jumps, and then as suddenly as it started, it was over.

"It was gone," Sippel says, "and I was kind of back to how I felt before."

Kate figured she was out of shape because she stopped riding during pregnancy. At first, it was easy to blame time away from the ring, until the episodes kept happening and getting worse.

"I hit the ground and I couldn't get back up," she says of another incident. "I tried to push myself up, but I couldn't, and that lasted probably 30 seconds."

The day after that episode, it happened again, this time in front of Sippel's husband Fred while they were in the car.

"I went completely paralyzed on the left side of my body," Kate rememebered, "and I lost my ability to talk."

Fred thought his wife was having a stroke and rushed her straight to the emergency room. This was in the midst of COVID, and he couldn’t be with her in the hospital. 

The ER doctors told Kate the episodes were likely related to stress from being a new mother and then sent her on her way. She was confused by that diagnosis, and as she stood in the parking lot of the hospital waiting for Fred to pick her up, it happened again. Four more times. 

As a veterinarian, Sippel didn’t need human medical training to tell her something was way off. She called her primary doctor right away.

"She said, 'You're 100% right,'" she says her doctor told her. "'This is scary. Something's not right.' and she got me into a neuro consultation."

The neurologist diagnosed mini strokes called transient ischemic attacks, or TIAs. Kate also learned she had a condition called moyamoya disease.

According to the National Institute on Neurological Disorders and Stroke, moyamoya is a rare but progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The term "moyamoya" is Japanese, meaning "puff of smoke," and describes how the tangle of blood vessels look to compensate for the blockage.

Sippel's neurologist prescribed blood thinners, but even on the medication, she continued to have nearly 15 TIAs a day, and she feared for her baby.

"Who was going to take care of this little guy, and who was going to raise him to do all the things that I wanted him to do?" Kate remembered thinking, holding back tears all these months later. "I just laid in the hospital bed in tears. I wrote John David a letter just in case I couldn't be there."

In general, TIAs do not cause brain damage and they typically resolve in about 24 hours. However, they are a huge red flag: About 20% of patients have a massive stroke within a week to 90 days. 

Kate's doctors told her it was okay to have two or three TIAs a day and they would check on her in six months. That plan did not sit well with her.

"If I let this continue, I'm going to have physical or mental deficits and won't be able to do any of this again," she thought, "or I'm going to be dead."

So she jumped on the internet and started looking for an expert second opinion. She didn’t have to look far: Cleveland Clinic was just a couple of hours away from Toledo.

"We see dozens and dozens of patients per year with this condition," Dr. Andrew Russman, head of the stroke program and medical director of the Comprehensive Stroke Center at the Clinic, told us. "Many of them will go on to surgery; some of them don't need surgery."

Kate, though, would need surgery. Cleveland Clinic surgeons took her temporal artery and connected it to another artery in her brain, bypassing the dwindling carotid and saving her life.

"Moyamoya vasculopathy is a rare vascular condition that develops, typically, in childhood or early adulthood," Russman explained. "It involves a thickening that occurs within the carotid arteries that are inside the brain, eventually causing complete blockage of these arteries.

"We understand what happens to the blood vessels, but what we don’t know is how to prevent this from happening."

But Kate knew how to prevent herself from becoming a statistic, becoming her own best health advocate and taking back the reigns on her own life. The 38-year-old is now healthy, happy, and stable, and ready to glide over many more jumps in the ring with Norwin.

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