Gubernatorial challenger Walt Maddox’s introductory television ad aimed to convey crucial details to voters. He described rebuilding tornado-ravaged Tuscaloosa as the city’s mayor and called his politics “pro-life and pro Second Amendment.” He also emphasized his age.

“I’m Walt Maddox. I’m 45 years old,” Maddox said at the ad’s start.

In Alabama’s race for governor, the issue of age and health has awkwardly rippled as an undercurrent as the 74-year-old incumbent Gov. Kay Ivey faces the 45-year-old Democrat. In the GOP primary, Ivey’s younger male opponents challenged each other to release their medical records and said the state needed a governor with energy and stamina while simultaneously maintaining that they weren’t directly questioning Ivey’s health.

The undercurrent—and along with it accusations of secrecy and malfeasance—burst to the surface Tuesday. The state’s former top law enforcement officer came forward with claims that Ivey was hospitalized for stroke-like symptoms during a state trip three years ago and that her office directed the trooper not to tell superiors. Ivey adamantly denied the accusations, saying she had altitude sickness and releasing a letter from her doctor.

Spencer Collier, who served as the state’s top law enforcement officer at the time, told The Associated Press Tuesday that the trooper traveling with then-Lt. Gov. Ivey reported to his commanding officer that Ivey developed stroke-like symptoms during the trip and had a transient ischemic attack.

“The trooper noticed that she was incoherent and made the decision to transport her to the emergency room,” Collier said. “Initially, I was told when they brought her to the hospital it was stroke-like symptoms. In the following days we were briefed it was a TIA,” Collier said.

TIA is shorthand for transient ischemic attack. According to the American Stroke Association, a transient ischemic attack is a temporary blockage of blood to the brain, caused by a clot or blockage and is sometimes referred to as a mini-stroke or warning stroke.

During the 2015 incident, Collier said the trooper also reported that Ivey’s chief of staff, Steve Pelham, had directed him “not to tell anyone, including his chain of command.” Collier said Ivey also later asked to have the trooper reassigned.

Collier said he was not attacking Ivey’s health, noting he himself had health problems. He said he was more concerned about the instructions to the trooper to hide the matter.

“Don’t take it lightly when you instruct troopers not to tell the truth,” Collier said. Pelham now serves as Ivey’s chief of staff in the governor’s office.

Ivey told reporters Tuesday evening that she had “altitude illness” and released a letter from her doctor.

“The letter I released today from my doctor clearly confirms what I’ve been saying all along that I’m in good health,” Ivey said.

Dr. Brian Elrod said he was aware of the hospitalization and examined her a day after her discharge.

“During my examination I saw no evidence of a transient ischemic attack and learned that the extensive work-up done at the Denver hospital, including an MRI, a carotid ultrasound and labs were all negative,” Elrod wrote.

The letter did not say how long she was in the hospital. Elrod said he could not confirm what condition led to the hospitalization, but said he considers Ivey to be low risk for a cardiovascular event.

Ivey spokesman Daniel Sparkman disputed the claim that the trooper was told not to tell his superiors.

“The answer is: No… Besides, there was nothing to cover up,” Sparkman wrote in a text message.

Collier said he would be willing to take a polygraph to show he is telling the truth. He said the matter was also reported to the division chief over dignitary protection and then-Gov. Robert Bentley. Bentley did not respond to a message seeking comment. Efforts to reach the division chief and trooper were unsuccessful.

The two campaigns took swipes at each other.

“Like most Alabamians we were shocked to learn that Governor Ivey possibly had a stroke and attempted to cover it up. We are examining all the available information and Walt will have more to say very soon,” the Maddox campaign said in a statement issued Wednesday.

Ivey on Tuesday blamed the Maddox campaign for the Collier accusation.

“It’s plum sad that Mayor Maddox’ campaign is pushing this issue out just three weeks before an election,” Ivey said. “It makes me have to assume Mayor Maddox is desperate because his liberal record is not connecting with Alabamians,” Ivey said.

Throughout the primary, Ivey has alternately bristled to questions about her health or responded with folksy humor that age brings wisdom. In a speech at the University of Alabama’s football stadium, she suggested her experience was a good thing.

“The state of Alabama is looking for a head coach. I’m the only person applying for the job who has actual experience coaching at this level,” Ivey said, adding “who would ever consider somebody who’s never coached a single game at this level to be head coach,”

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