Running Man: An Unlikely Stroke

Posted on 31 August 2017

By Ami Kapilevich

A stroke can come out of nowhere and happen to anyone. Just ask super fit ultra-runner AJ Calitz – or, to get the full story, ask his wife.

“I struggle to think of myself as a stroke survivor,” says AJ Calitz. Which is understandable because anyone who has met him would do the same. Energetic, lean, eyes like knives – AJ radiates not just good health but sheer indestructability.

AJ is one of the most talented and successful ultra-athletes in the world. Ultra-running is the most physically daunting and technically difficult form of long-distance running, involving distances of over 50km, frequently on mountain trails or hikes.

“It’s mountain hiking for the family man,” grins AJ. “If you’re going to do the Boland Trail, that’s a week away from your family. But you can run it in a day and a half and be back at work on Monday.” He is only half-joking.

But one day in April, this mental strength turned into a weakness when he refused to acknowledge the seriousness of what was happening to him. Like it or not, this elite athlete was having a stroke.

Going the distance

AJ has been a long distance runner since primary school but he only ran
his first ultra-marathon, the Hout Bay Triple Trouble, in 2010. Two things captivated him immediately: the first was the freedom. Where most road races are strictly officiated and crowded, ultra-marathons are more solitary and some don’t even have martials. The second was that he was not as good at it as he could be. This – the lure of self-improvement – is irresistible to AJ Calitz. He was hooked: attracted to the challenge, fell in love with the freedom, and married the discipline.

AJ’s many achievements include the world record for most metres ascended on foot in 12 hours, when he climbed Table Mountain’s Platteklip Gorge 15 times to rack up 10 257 metres. (Previous record holders ran up air-conditioned skyscraper staircases.) He also boasts the best known time for the highly technical Fish River Canyon Ultra, completing the five-day hiking route in six-and-a-half hours.

As part of his training regimen, AJ cycles 23km (one way) to work every day, and runs up to six hours at a time, depending on the race he is preparing for.

So how does this happen? How does a man who sprints up mountains and trains up to 25 hours a week suffer a stroke?

The unexpected

On Sunday 9 April 2017, AJ Calitz had just cruised to victory in the Impi Elite, a popular but gruelling obstacle course race, and was at home jumping on the trampoline with his two-year-old daughter Emily, when his vision doubled. In fact, his eyes had drifted in opposite directions.

“I’m feeling a bit woozy,” AJ told his wife, Paulette. “I’m just going to have a little nap.”

When Paulette woke him up 45 minutes later, he was not looking any better. She phoned a doctor friend who advised them to go to hospital immediately. Despite AJ’s protestations that he was fine, Paulette could see him quickly deteriorating on the way to the ER. His speech was becoming slurred and he was losing feeling in his right side.

Even as he was being wheeled into hospital in a wheelchair, the incredibly headstrong AJ was still insisting everyone was overreacting and that he could sleep it off. But by 7pm his entire right side was paralysed and he was incoherent.

Initial test results were vague but eventually, Paulette recalls, “The doctors sat me down and told me he was having a stroke. They said they didn’t know what caused it, and they didn’t know if the damage would be permanent.”

Into the unknown

Perhaps one of the most frightening aspects about a stroke is the number of variables and unknowns. Technically, a stroke occurs when the brain is deprived of blood and therefore oxygen. This results in damage to the brain and leads to symptoms, such as disorientation, slurred speech and partial paralysis.

But there are two types of stroke, which differ in cause and severity.
An ischaemic stroke is the most common, occurring when a blood  clot travels up one of the arteries that leads to the brain until it gets lodged  in a narrow blood vessel, blocking it and depriving that part of the brain  of blood and oxygen.

A haemorrhagic stroke is more rare but much more dangerous, and occurs when a blood vessel in or leading to the brain bursts.

This lack of blood to the brain is compounded by internal bleeding that causes pressure and distension.

When the Calitzes called on a neurologist friend for an opinion, Dr Pierre van der Merwe surmised that AJ had suffered an internal tear – called a dissection. This is not a haemorrhagic stroke because the tear is not all the way through, and the outside wall of the artery is intact. But a blood clot that had formed to heal the damaged artery had become dislodged while he was jumping on the trampoline, and had caused an ischaemic stroke.

The good news is that the clots formed by dissections are fresher and softer than the older clots that become dislodged in the arteries of older people. For ischaemic stroke patients, this means the clots are easily dissolved by blood-thinning medicine.

In retrospect, it all makes sense.
AJ is incredibly fit, but his training routine involves running and cycling. The Impi presented an unfamiliar type of physical exertion and contortions: moving his head under obstacles, and carrying a 50kg sack of salt on the back of his neck.

AJ has few recollections of the immediate effects, but he does remember lying in the CT scanner, wondering if he’d ever play with his daughter again, or be a provider for his family, or run, or surf …

Fighting fit

Chances of a full recovery after a stroke depend on the type and location of the stroke, as well as the physical condition of the patient and how quickly he receives medical attention. Overall, however, says Dr Alex Landmann of Mediclinic Sandton, “roughly a third of all stroke patients will have a full recovery, another third will have a deficit but still be functional, and the rest will have a severe deficit – or not survive the stroke.”

AJ is in great shape and the softness of the clot meant it could be dissolved quickly. However, his denial of any problem meant it was several hours before he arrived in hospital. The location of the stroke – an area where critical blood vessels and nerve endings converge – also meant serious damage.

Nevertheless, AJ’s recovery was swift. The stroke happened on a Sunday. By the Tuesday he was sitting up in bed as feeling gradually came back to his fingers and toes. On Wednesday he was discharged. But that is where the hard work began.

He took walks in his garden, gradually increasing the time and speed until, he says, “it began to feel like exercise again”. He also worked on his coordination, juggling and doing balancing exercises. But telling AJ Calitz to take it easy is like locking a thoroughbred horse in a stable.

“After about three weeks I felt like I was going insane,” says AJ. So he went for a run on the beach, under strict instructions to keep his heart rate down. Two weeks after that he did his first run up Lion’s Head. Still, the big question loomed: could he run competitively again?

Before the stroke, AJ had bought a plane ticket and entry to the Fisherman’s Friend StrongmanRun race, in Germany. “I can’t get my money back,” AJ told his coach and physiotherapist, Christo Smit. “I may as well go and try.”

“Don’t compete,” replied Christo. “Just participate.” The race had 15 000 entrants. If anything, it would be a good indicator of his rate of progress and level of recovery.

AJ won.

Back to the future

“The good news is there is always some plasticity in the brain, at any age,” says Dr Landmann. “Some of the function that has been lost through a stroke can be taken over by surrounding brain areas, but that process can take up to two years.”

In a cruel twist of fate, the part of AJ’s brain that was most affected included the thalamus, which is particularly necessary when trail running. AJ has to concentrate on every obstacle in his way. As he gestures to illustrate his point, his palms are grazed from falls. “My brain is having to form new neural pathways,” he says. “It’s frustrating because I know what I was capable of, and now I need to re-learn those skills.”

So there is a certain poetry to the drama: AJ Calitz started trail running because it was something he wanted to improve in. He has done it before.
He will do it again.

The Heart and Stroke Foundation warns you may be having a stroke if you suddenly experience one or more of these symptoms:

  • Sudden numbness or weakness on one side of your body
  • Sudden loss of speech, trouble speaking or understanding language
  • Sudden loss of vision, trouble seeing in one or both eyes, or double vision
  • Sudden trouble walking, loss of balance or dizziness
  • Sudden severe headache with no cause

Act FAST

What to do if someone you know suffers a stroke.

Face

  • Is it drooping?
  • Ask the person to show their teeth or smile.

Warning sign:
One side of the face droops more than the other.

Arms

  • Can you raise both of them?
  • Ask them to lift both arms and keep them there.

Warning sign: They can’t move one arm, or it drops while they’re trying to keep it up.

Speech

  • Is it slurred or jumbled?
  • Ask them to repeat a short, simple sentence.

Warning sign: They can’t use the correct words without slurring.

Time

  • To call ER24
    on 084 124.
Published in Magazine

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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