How Not to Have a Stroke: The discussion you should have with your doctor


Sean Maloney’s remarkable stroke recovery and subsequent creation of the Heart Across America bike ride have raised awareness nationwide for people wanting prevent strokes and heart attacks.  As Sean’s mission is that no family should have to go through what he went through,  we touched base with some leading medical experts on some key points of this topic.

Introducing Dr. Neil Schwartz & and Dr. Nicholas Leeper, Stanford School of Medicine.

Q:  Tell us about “the scan” and is this something that people should request from their doctors?

Dr. S: There are two scans, the Carotid Artery Scan which looks for clots in the arteries that feed the brain, and the Coronary Artery Scan which looks for blockage in the arteries that lead to the heart.  That being said, the scan is not the most important thing to ask your doctor about.  

While there is a certain population (less than 10% of adults) that have the Class I symptoms  or a family history that would indicate a scan should be performed, it has been determined that potential harms associated with routine screening in asymptomatic adults are likely to exceed benefıts.  

However, one test that is useful and can be easily performed while at your doctor’s office is referred to as the Bruit.  This refers to the sound heard over an artery or vascular channel, reflecting turbulence of flow. Most commonly, a bruit is caused by abnormal narrowing of an artery. Listening for a bruit in the neck with a stethoscope is a simple way to screen for narrowing (stenosis) of the carotid artery, which can be a result of cholesterol plaque accumulation.

Dr. L:  If we could ask patients to do one thing when they talk with their doctor, it would that they go through the Framingham Risk Score (FRS), which can help identify high-risk asymptomatic adults who may benefıt from preventive treatments.   

Going through this exercise with your doctor will provide an estimate of the probability that a person will develop cardiovascular disease within a specified amount of time, usually 10 to 30 years.  Because they give an indication of the risk of developing cardiovascular disease, they also indicate who is most likely to benefit from prevention. 

Cardiovascular risk scores are used to determine who should be offered preventive drugs such as drugs to lower blood pressure and drugs to lower cholesterol levels. For example, nearly 30% of CHD events in both men and women were singularly attributable to blood pressure levels that exceeded high normal (≥130/85), and this can be easily treated with a variety of non surgical treatments.

I think Sean’s example has inspired a lot of people which is great!  In particular, it can help to motivate the people “in great shape*” to push their doctor to look for ways to lower risk.  The truth is that fewer than 2% of the population is at optimal health if you look closely at all the risk factors.

Knowledge is Power - and if Sean has motivated you to look for answers to optimize your/your family's’ health, we hope that you will use the resources mentioned above and be proactive with your doctor. So ask about a bruit, getting your Framingham Risk Score (FRS), and if you are concerned about the stroke or heart attack ask about the scan. Take charge of your health now and start planning your healthiest future.

(*author’s note:  I fall into this category, for though I exercise regularly and eat well, my German ancestors have blessed me with a family history of very high cholesterol which my very wise parents manage with statins and I likely will too!


How Sean Trained for Ride Across America: As Told by George Mount


Thousands of people ride across the USA each year.  Its a big deal, a life changing adventure, and incredibly challenging no matter who you are.  But for the survivor of a recent stroke which robbed you of your right side body movement and speech - how can it be at all possible?

If you’re reading this blog you know that it is.  Though a crash after leaving San Diego ended his participation on the ride, Sean was trained and ready.  His training included the best help, support, advice and coaching possible.  One of his advisors, former Olympic cyclist George Mount shares what it was like to be part of “Team Sean” preparation. 

How and when did you decide to become an advisor for this endeavor?

I was invited in by David Fisch who is leading the ride  -- he asked me to speak with Sean, go on some rides with him, and evaluate his riding skills. David had already worked up a good fitness program; so we wanted to focus on all of the other skills needed to ride.

What were issues or concern from working with a stroke survivor?

Once you meet Sean you know very little will stop him, but we did find out some interesting things about his recovery. For one, it’s not over, he is still recovering and rebuilding. For example, he has trouble with not feeling thirst which is an incredibly important thing to be aware of in sport where you spend hours on the bike in all kinds of weather.  

What issues/advantage did Sean have as he began this focus to become cycle ready?

Before his stroke, Sean was a very serious rower, used to shorter duration events, using but a single “gear”. As he began cycle training, this would lead him to go very hard to a point of exhaustion too early on a ride. Fortunately Sean is a born athlete, very methodical and learns quickly. Spending my life around world class athletes has prepared me for dealing with type A personalities and I could see how Sean needed to do things.  

Despite the accident that sidelined him on this tour, I have no doubt he’ll be back in the saddle as soon as the doctors let him so he’ll be ready to go for next year.

How would you advise a newcomer to cycling to approach it for maximum satisfaction?  

For anyone starting on a bike, the first thing to do is go and do some organized rides with some local touring clubs. You can usually find groups in the larger clubs that match your skill level and move up through the groups as your skill increases.  

Cycling skills take time to become 2nd nature, it doesn’t happen overnight.  A good local bike shop can steer you in the right direction to a club and if they can’t you are in the wrong shop.  No need to hurry to ride with the local hammerhead rides and racer boys.  Make sure you train safely and appropriately for your experience level.

What do you hope will be the result of the Heart Across America campaign?

This campaign touches everyone I know. My first coach had a stroke around the time the ride started and former pro riders I knew in Europe, younger than I, have passed away from strokes recently. The riders looked fit so they were ignored by the medical establishment.  

I’d like to see this campaign get doctors to stop using devices invented in the early 1800s to diagnose issues when they can use modern technology to more accurately find issues before they become killers.


How Sean Recovered as told by Margaret


If you’re reading this, odds are you know former senior Intel exec Sean Maloney had a devastating stroke, but achieved a nearly full recovery from this stroke and was able to train for a ride across America.  (Pretty inspiring, right?)  But you may not know how. Sean’s wife Margaret shares her recollections of this recovery.

Sensory Stimulation from Things Beloved

One of the most challenging thing for the stroke survivor is that while the body and brain have changed, with its ability to communicate and act, the mind and soul are still the same and deeply crave stimulation and satisfaction.  Key things that worked for us to keep connected to Sean during the early days were bringing him music he loved, wonderful smelling and tasting food, and interesting news and information (news from Intel and the industry). And of course, the sight, feel and smell of our family, especially our sweet baby girls.

It was music and a technique called Melodic Intonation that first helped Sean communicate by singing/tapping “I Love You” to me.  As he began therapy to regain speech, it was reading and discussing the Wall Street Journal with his colleagues that gave him the spark to push through challenging exercises.  (The rote exercises on material that did not have inherent interest was very frustrating and not as effective!)

It was his beloved rowing that motivated his physical rehabilitation.  But rowing on a machine didn’t give the same feedback for balance and coordination that a live boat did, so he found support and encouragement to make that a part of his routine.  

Spiritual Support and Hope

Sean and I are blessed with a very broad network of people who care deeply for us.  The Intel family was there for us, and even when most tired and overwhelmed, we welcomed every visit, ever offer of help.  Our worldwide network included people of many faith backgrounds; people prayed for Sean in churches, synagogues and mosques around the world.  I was given instructions on meditation by the great Deepak Chopra which greatly helped me to take in all this goodness.

Even though Sean doesn’t follow a specific spiritual tradition, we know that all of this was instrumental in the recovery.  Another person I want to call out as giving us a very specific sort of hope...  Dr. Marion Buckwalter, who shared a great outcome based upon the unexpected recovery of one of her previous patients - a type A personality CEO who was able to get back in the saddle despite the severity of her stroke.  Being able to envision this was very helpful to Sean. 

A Goal - And a Calling

As mentioned above, Sean felt that rowing was something that he could reconnect with to guide his body’s recovery. To keep focused and motivated, he chose a goal - being able to row The Head of the Charles.  He also had a very clear and present goal;  to Intel and carry out the unfulfilled promise there was deeply motivating for recovering speech.

But he also discovered a new calling.  He believed he could prevent other people and families from going through this experience - and this is what has led him to today; leading the Silicon Valley branch of the American Heart Association and creating Heart Across America.

If you feel a calling in this area, please join us.  The website has resources on stroke recovery, ways to support the current Heart Across America biking, and of course, an invitation to stay connected with us via our email list or social media.  Your actions matter!


The Man Behind SCAN


OK, as you read that title, do you anticipate learning some top secret, spy worthy tidbits from behind the scene at Heart Across America?  Well, while we don’t have “Q” (ala “James Bond” fame) or secret lairs or lasers, we do have insights and updates from Dr. Maarten Lansberg from the Stroke Collaborative Action Network (SCAN) - a cross disciplinary group out of Stanford University looking to find new and better ways to detect strokes and to heal better and more rapidly.

Tell us about your work with Sean and family; leading him through his recovery

As you know, Sean is an extraordinary individual; blessed with drive and determination, an incredible family and circle of support; and with very clear goals to motivate his recovery.

Because Sean was so motivated and well supported, he had great success with very specific therapies in recovering his speech and motor skills on the right side of his body.  The melodic intonation therapy was very successful for his speech recovery, and it is my observation that his early attention to aerobic exercise (rowing) along with traditional physical therapy, was instrumental in his physical recovery.

Share with us recent research in stroke prevention and treatment

Well, there has been a lot of discussion recently about the results of the AVERT study (A very early rehabilitation trial) where they looked at the effect of starting rehabilitation as soon as possible after the stroke.  Common sense would tell you that it could be useful in reducing complications and lead to better outcomes, but after the evidence was compiled it showed that the hypothesis did not hold up.

Tell us about SCAN

There is so much that we don’t know about how stroke recovery is best achieved.   To move forward as effectively as possible, we’ve created the Stroke Collaborative Action Network where we bring together colleagues from 14 different disciplines from across Stanford.  The network will strive to support the individual genius of its investigators and together create solutions that could not be achieved separately.

Current studies span a wide spectrum of stroke research including:  haptic devices, brain-machine interfaces, novel MRI techniques, brain stimulation to rewire circuits, mechanisms of post-stroke seizures and synaptogenesis, neuroinflammatory consequences of stroke, blood-brain-barrier manipulation, acute stroke therapies, pediatric stroke, and many others.
Similar to other targeted initiatives (the most famous being the space program) we expect that along the way our efforts will not only generate practical solutions for stroke survivors but also uncover basic truths about the brain and generate new engineering solutions with applications to other neuroscience problems.

How can stroke survivors and their families take part in this?

All of our activities and information are available at our website, and for those who want to take part personally, we invite participation from both stroke survivors and healthy adults.

I would also hope that people affected by strokes would be following and supporting the Heart Across America campaign.  Each individual donation, ride and sharing makes a difference in the fight against strokes and heart attack.


Halfway there


A cross-country ride is to many people, a pipedream. I was very fortunate that in this campaign, I was given an opportunity to take a trip of a lifetime and all for a great cause. As the Heart Across America ride passes its halfway point, let me share my personal highs and lows.

California Dreaming…  

The kickoff at Palo Alto was spectacular. More than 800 people rallied together to spread the word about stroke and heart disease prevention, and to see us off as we ride began our ride. Friends, old and new, came to bid us goodbye and to say they look forward to seeing me again after I had completed this tour.  
After the kickoff, we first went along the Pacific coast. We saw the breathtaking views from Big Sur, saw Gordon Ramsay, kicked off the National Walking Day in LA, and spent a number of days in stunning Del Mar as we kicked off Qualcomm’s Health Month. As we left to go east from San Diego, I ceremonially dipped the rear wheel of my bike in the Pacific, looking forward to June when I’ll be able to dip my front wheel in the Atlantic….

A Crashing Change to the Narrative…. 

We expected April 5 to be an easy day. I say that relatively, because the day before we rode 75 miles with 7,200 ft of elevation. As the saying goes, “what goes up must go down”- the following day would be a downhill ride. 7 minutes into the ride, we encountered poorly maintained roads. It was this, and a more-than-brisk downhill pace that led to me being thrown off my bike. I suffered from 3 broken ribs, a fractured shoulder, and a fractured hip socket.  740 miles and *then* a crash.  Really.
I was airlifted to Sharp Memorial Hospital where I was to stay for the next two weeks. The surgery for my hip socket required more than 29 pins and cadaver bone just to reconstruct my hip.  Fortunately, I was not alone as friends from all over came to visit, and for those who didn’t, sent their regards by every way imaginable. A few days after surgery I was sent immediately to rehab where, much like I had to relearn how to speak before, I had to learn how to walk again. Sharp’s most competent therapists made sure that my recovery was swift, and in a week’s time, I was able to fly back home to rest before rejoining the tour.

An Amazing Man...

I met Don Brennen not more than 6 months ago. He was an avid biker, Dave Fisch’s brother-in-law, and the father of my campaign manager, Amy. As we were planning how the cycling support during the ride would look like, Don without hesitation volunteered to take care of preparing a vehicle and being our driver and bike mechanic on the road.   The care he put into the work that he did was something I’ve never seen before. He was creative, hard working, patient and most importantly, very skilled at what he did. On a 5,000 mile ride, the importance of a good bike mechanic cannot be overstated.

When I had my crash and we were thinking of postponing the ride, Don without missing a beat volunteered to ride in my stead. He continued on with Dave and rode through California, Arizona, New Mexico and Texas. To anybody who spoke to him during this time, his feelings were clear. In his own words - he was having the time of his life.

Nothing could have prepared us for April 25, the day the tour was scheduled to ride into Dallas. Don was found in his bed in the morning, having passed away peacefully in his sleep the night before.
Don was an extraordinary person with the kindest of hearts and we will remember him every day. He is survived by his wife Andrea and his daughter Amy, both of whom express that Don would have wanted the ride to go on. This ride is about heart disease and stroke and we will ride on, knowing that Don is with us.

The support and encouragement we’ve found...

We have had amazing encounters along the way, from individuals stories, to encountering whole groups at AHA events, as well as corporate events at Intel, Samsung, Qualcomm. In Texas its been a whirlwind of activity, we even rode with Michael Dell and had rode a bike for the first time since my accident (a handcycle!).  We followed this with wonderful events in Houston; a health and wellness event at HP and a dinner with the Houston Aphasia Recovery Center. (more in these in future postings.)

Your involvement matters...

It has been an honor to reach deep with myself in service to this cause.  And I can’t tell you what it means to have people come out to ride, to post photos on our social media, to share it with their friends, and donate towards the cause.  I personally invite you to do what you can to join us.

Receive our Newsletter
Sign up to ride
Send us a photo of you riding


A Road Bump: Hard to Cross America


Two weeks into the ride, the daily updates seem to have followed a pattern - the team takes on a big challenge which they then overcome by the end of the day effortlessly. 

In a way, this is not one of those days.

This past Sunday, April 6, Sean set off from Boulevard, California heading east. Not far from the starting point, the road was rough and had a steep decline. As he cycled through this part, he hit a major bump and was thrown off of his bike. Among other things, Sean fractured three ribs, hip bones, and an acetabulum socket. 


He was immediately airlifted 100 miles from the scene to be treated at Sharp Memorial Hospital in San Diego, where he will be resting and awaiting surgery. It is a challenge, but hardly the toughest that Sean has faced. He is not going to let this sideline him for long and most definitely will not get in the way of spreading his message.

The ride will continue as planned. Sean has passed the torch onto David Fisch and Don Brennen, his riding companions who will carry on with the ride. Sean will fly into subsequent city stops to talk about his story and recovery starting in Dallas. 


What can you do? More than ever, Sean can use your help to spread the word.

  1. Ride for Sean - ride along as the ride continues, and/or post a picture of your ride for Sean (see below)
  2. Engage with our Facebook page - leave a message, like the page and invite all your FB friends to do the same
  3. Share Sean's story - share with your friends and loved ones 
  4. Fundraise for the cause - consider making a donation, create a fundraising page, or create a fundraising team for your company, local team or cycling group

Anybody can ride - you don’t have to ride along the route to ride for Sean. Dedicate one of your rides by taking a picture at the end holding up a sign, “I rode X miles for Sean #bike4heart” and sharing it on your Facebook and Twitter. Make sure to tag Heart Across America's Facebook page and @heartacross as well!


This is a minor setback. The campaign will go on, and Sean will remain an integral part of it, but this is bigger than him. It is about the 1.5M heart attacks and strokes every year. It is about the 800,000 who die from heart attacks and strokes, while 80% are preventable. 

He’s not giving up his campaign to reduce heart attacks and strokes, and neither should you. So, let’s keep riding!