Twenty days before she would take a shot at the Olympic Marathon Trials qualifying time of 2:43 at the Eugene Marathon on May 9, Tia Accetta, then 39, of Tucson, Arizona, was feeling good.

She had just run about 21 miles with friends Lucas Tyler and John Chamberlain. She had averaged close to 6:00 pace for 10 miles of the run, with the last four at sub-6:00 pace.

It was a hard run for Accetta, a 2:48 marathoner, but that was the point.

“It felt like I dug deeper because I was really practicing trying to do that—to hold on even when I felt like I was done, to see if there was a little more left in the tank,” Accetta told Runner’s World. “I felt like I had accomplished something and had a little breakthrough.”

Instead, she was about to be tested in a way that would leave her competitive career in doubt.

After the run, Accetta stood around a parking lot, chatting with Tyler and Chamberlain. She had plans to meet her husband, Randy, and their two children at a racquet club with a swimming pool about half a mile away. She began jogging over to meet them, but about a minute into her run, she had to stop due to dizziness.

“[Everything] kept spinning, so I just went down on my hands and knees and waited for a while,” Accetta said. “I thought, ‘This is weird, I’ve never had this happen before.’ I was kind of confused. And then I stood up and waited for a minute. I wasn’t dizzy anymore, but I had absolutely no feeling in my left leg. It was like it wasn’t even there.”

She assumed what she was experiencing was a result of the hard run she had just finished.

“I didn’t really get scared by it. I thought, ‘Oh man, I must have tweaked a nerve or something,’” Accetta said.

She made her way back to the parking lot and asked Tyler and Chamberlain to give her a ride. When she sat down in the car, she began losing feeling in her left arm, and her left cheek was tingling.

“I remember thinking at that point, ‘Oh my gosh, is this a stroke?’” said Accetta, but she let the thought pass quickly.

Tyler offered to take her to the emergency room, but she declined. Shortly after, the symptoms passed.

Accetta ate a granola bar, because she thought maybe food would make her feel better. But after meeting her family at the pool, she continued to feel dizzy and nauseated. She told herself she’d have to be more careful about hydrating next time.

After a two-hour nap, Accetta woke with neck pain. She threw up, and then felt much better. The following morning, she felt worn out, but still figured she had just had a bad case of dehydration.

But at around 10:00 a.m., she had an episode similar to the one she’d had the previous day, though not as severe. She decided to drive herself to urgent care.

After doing an EKG, the nurse practitioner sent Accetta to the emergency room. After doing an MRI, doctors determined that there were two small damaged areas in her cerebellum, and that Accetta had had two small strokes.

Because of the irregular EKG, doctors ran more tests and discovered that, like up to 25 percent of the population, Accetta has a hole in her heart, a patent foramen ovale (PFO), which is usually asymptomatic, but can become problematic when blood clots form.

Accetta’s doctors initially thought that her stroke had happened as a result of a blood clot traveling through the PFO and to her brain, but after doing more tests, they ruled out that explanation.

Doctors have been unable to come up with a concrete explanation. They believe the birth control pills she took for many years may have caused her blood to clot, and that dehydration could have also caused the clotting. They don’t think Accetta’s hard long run caused her stroke.

Accetta wonders what genetic factors might be at play, because she recently learned her mother, who is 69, may have had an undiagnosed stroke when she was in her 40s.

Accetta’s recovery, which the Arizona Daily Star has chronicled, has been challenging. At first, she had intense vertigo, which prevented her from walking across the street to pick up her children, ages 6 and 8, from school. After a month, she could walk around the block twice. Some days her neck and head hurt, but other days they’re fine.

Following her doctor’s orders, Accetta took three months off from running, but did some low-impact exercise during that time. Her first run back lasted 10 minutes. She tried 15 minutes the following day.

Accetta is now doing no more than 20-25 miles a week, a far cry from the 90-95 miles per week she was averaging leading up to the Eugene Marathon, or the 70 miles per week she used to run when she wasn’t marathon training.

As a coach herself, Accetta is trying to follow the advice she would give someone else in a similar position.

“I think I could do more, I don’t think it would be wise,” Accetta said. “I’m sort of intentionally keeping it low for now because I know once I get into doing more and more and more, it’s hard to stop. I’m purposefully trying to focus on just getting stronger before I start back into the grind of training.”

Accetta’s neurologist has told her there’s little chance she will have a repeat episode. Still, fear of another stroke lingers.

“I think it’s always going to be in the back of my mind now, and I can’t tell how that will affect me. So far, I haven’t really pushed myself too hard. I was pretty scared to go on my first run, obviously, but I got through that and everything’s fine,” Accetta said.

“I think that over time, and I do more and more and things are fine, then that fear gets pushed back farther and farther. But for now, it’s up front in my mind with everything I do.”

Accetta made a deal with herself that she will take the remainder of 2015 easy, and not think about setting goals until 2016.

She imagines that she will eventually get back to setting ambitious running goals, but she doesn’t know if she will focus on the marathon and continue to pursue her dream of qualifying for the Olympic Marathon Trials. She says that focusing on the 10K, half marathon, and trail running are all options she’s considered. Having turned 40 since her stroke, Accetta is excited to enter masters competition.

Accetta says she can imagine getting to a point a few years down the road when she tries to run a fast marathon again. She doesn’t know if that will mean taking a shot at the Olympic Trials qualifying time, but with a personal best of 2:48:05 from 2013, she feels she has unfinished business with the distance.

“I feel like I definitely could qualify on the perfect day on the perfect course, but who knows if that will ever happen or when it will happen,” Accetta said.

Though Accetta was likely in the best shape of her life when she had her stroke, she’s not confident she would have qualified for the Trials at Eugene. She notes that only one woman ran under the Trials standard that day, and that some of the non-qualifiers were in great shape.

“It [may have] saved me from having a heartbreaking race. But I definitely would have rather gone and tanked than had a stroke,” Accetta said.

Since her stroke, Accetta has been devoting more time to her work as an event coordinator and coach for Run Tucson, the company she and Randy, a 1996 Olympic Marathon Trials qualifier and director of coaching education for the Road Runners Club of America, co-founded. She also volunteer coaches the cross country and track teams at her children’s elementary school.

As Accetta reflects on her experience, her biggest takeaway is to encourage others to know the symptoms of a stroke and to get help immediately when experiencing them. She believes that, with the stroke occurring so soon after a long run, she didn’t take her symptoms as seriously as she otherwise would have.

“If I had just gotten up out of bed and had been making my coffee and that had happened, I for sure would have been way more alarmed than after a run when you are kind of expecting to feel twinges and aches and pains,” Accetta said.

“If ever your one side feels different than the other side, or if your face starts to droop a little, no matter how healthy you are, just go to the hospital.”

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