A healthy 17-year-old had a stroke. Doctors think vaping was the cause.
Just moments before Ella Blinco suffered a stroke, she had been her normal, perfectly healthy 17-year-old self.
She had woken up, vaped some nicotine and headed to the bathroom to prepare for an Ivy Tech Community College class later that January day. As she sat on the toilet, scrolling through her phone, she dropped the device. She went to reach for it and fell.
She tried to sit up but had no strength and fell to one side, hitting her head against the wall and heard her neck pop. She struggled once more, to no avail. Ella called for her dad Todd Blinco, who was downstairs, and when he opened the door, he saw one side of her face was drooping. He called 911.
“It was really hard to comprehend, like where I was and what I was doing,” the Fishers, Indiana, teen said about four months after the incident. “It felt like I knew what I was doing, I just couldn’t move if that makes sense. Like there were weights on my arms or something.”
The ambulance whisked her to Ascension St. Vincent hospital, where doctors diagnosed a stroke and performed an interventional procedure to reverse the stroke’s effects.
Next came answering the question of what had caused this stroke, so rare for someone of Ella’s age.
Her doctors still don’t know for sure but they have a suspicion: a combination of vaping THC and nicotine and smoking cigarettes and birth control.
“There’s definitely a link between smoking and stroke. I don’t know that there’s a one-to-one relationship,” said Dr. Krishna Amuluru, an interventional radiologist with Goodman Campbell Brain and Spine, who treated Ella. “Certainly they are risky behaviors, and these risky behaviors act in synergy.”
While studies show a clear link between traditional smoking and stroke that increases further in people who use oral contraceptives, the link to vaping nicotine or THC is "a little more nebulous," Amuluru said. In part, that's because vaping has only been around for about 15 years in the United States and is a far less controlled substance than traditional cigarettes, making it more difficult to study. Still, he's making an educated guess about why Ella experienced a medical event so rare for a teenager.
Shocked by the doctor's opinion, Ella wants to share her story, to warn other teens that although what happened to her is rare, it could happen to other young women, ones who like her feel invincible because of their age.
The Food and Drug Administration estimates that one in 10 middle and high school students vaped last year — a total of 2.5 million. A Columbia University study last year found that cannabis vaping among teens increased over the course of two years from 2.1% to 5.4% in 2017 to 2019. Yes, Ella had heard the warning about the risk of blood clots and stroke from oral contraceptives when she first starting taking the pills a few years ago, but she knew plenty of people who had similar habits and no problems.
Besides, she had only been smoking and vaping for a few years, she figured.
“I never really thought that it would catch up to me like that,” she said. “I never thought it would really happen to me.”
Pediatric strokes quite rare
Ella took up cigarettes in her sophomore year of high school after her therapist warned her that with vaping one can never know what’s in the oils. Traditional cigarettes, the therapist said, were safer. After a few months of traditional cigarettes, though, Ella missed the flavors and went back to vaping, though she kept smoking a few cigarettes a day. In addition, she’d go through a disposable vape every week or so. She maintained this pattern until her stroke in January.
At some points over the past two years, she asked her parents to help her get help to shake the addiction to vaping and nicotine. At other times, she said, she would say she was old enough to make her own choices.
But she never realized the potential consequences of those choices until Jan. 19, the day of her stroke. Other than the paralyzed side of her body, she had no symptoms, no headache, no dizziness, no pain, she said.
Ella’s diagnosis might have been missed at another hospital or at least taken longer to arrive at, Amuluru said.
Young patients do not often have strokes, especially without any underlying health conditions. Most pediatric strokes that do occur involve inflammation of the blood vessel, not the type of stroke that Ella had.
Ascension St. Vincent, however, has ample experience with stroke, treating between 1,000 to 1,200 patients a year, more than any other hospital in Indiana, Amuluru said. When Ella arrived, doctors gave her a medicine to try to break up the stroke but when they scanned her brain, the images that greeted them suggested that Ella’s condition would require more intervention. Scans showed that so far no part of her brain had been permanently damaged. But the scans also revealed a clot in a large vessel blocking blood from flowing to a large portion of her brain, which could lead to extensive damage if not corrected, Amuluru said. He likes to use the analogy of a village with a dam on one side that blocks the villagers from the water. Those on the wrong side are thirsty but still alive; if the dam doesn’t open soon, however, they will die from dehydration.
Medicine helps a stroke like this less than 10% of the time, so doctors knew Ella’s best bet would be to undergo a procedure called a thrombectomy. This entails breaking up the clot to allow blood to restart flowing, or in Amuluru’s analogy, to bring water to the villagers once more. St. Vincent performs about 300 of these procedures a year.
Amuluru and his colleagues placed a tiny catheter in an artery in Ella’s leg and threaded it up through the aorta and carotid arteries and dispersed the clot. Time, he knew, was of the essence. Every minute that a blood vessel is blocked, about 2 million of the brain’s approximately 86 billion neurons die.
“So in someone like her, getting that vessel open, that is the highest prognosticator of a good result, apart from a patient’s underlying health status,” Amuluru said.
Within 12 minutes of Ella’s arrival in the interventional radiology procedure room, the doctors had opened up the blocked vessel. The thirsty villagers had water.
Life after stroke
Ella awoke and felt fine. She could move all her limbs with no trouble. The only slight change she noticed was that when playing cards with her father, her mind didn’t seem as nimble as before the stroke.
While Ella has had an amazing recovery, she’s now at risk for future stroke. She needs to watch her blood pressure and cholesterol and curtail her risky behaviors. She’s still on a blood thinner and has switched her birth control prescription to one that puts her at a lower risk of blood clots, she said.
Recovery, however, has not been easy for Ella, who graduated in December from Fishers High School. After her stroke, she tried to cut back on vaping THC and smoking but that led her to return to drinking, from which she had been clean for eight months after running into trouble with alcohol the previous year.
“I had just like almost come really close to death and I was like nicotine is not worth having another stroke,” she said. “Right after my stroke, I was like, 'Well, if I can't smoke, then I'll just drink.'”
But a month after her stroke, she ended up back in St. Vincent with alcohol poisoning after a night of over-indulging. In March, she spent three weeks in rehab to help her manage all her addictions. Nicotine has been the hardest substance to quit, she said.
Equally difficult has been navigating relationships with some of her friends who don’t take her experience that seriously. Ella often serves as driver for her friends and some of them just scoff when she asks them not to smoke in her car. Others have sobered up in solidarity with her.
"I've been in that same spot before where it's like, if your friends aren't smoking, you just feel like they're not as fun to hang around with," she said. "It definitely showed me I guess who my true friends really were."
Contact IndyStar reporter Shari Rudavsky at shari.rudavsky@indystar.com. Follow her on Twitter @srudavsky.