Monday, May 31, 2010

Could you be at risk for a stroke?

Immediate treatment can mean the difference between life and death

It happened recently to Beau Biden, the 41-year-old son of Vice President Joe Biden. And to 47-year-old Bret Michaels of the band Poison and winner of the most recent round of “Celebrity Apprentice.”
It struck a former Miss America, Jackie Mayer — the closing speaker at this year’s Junior League Town Hall Series — at the age of 28. It can befall teens, twentysomethings and the elderly. It can strike a fetus in utero.
And it can happen to you.
May is National Stroke Awareness Month, an ideal time to learn about the nation’s No. 3 cause of death and No. 1 cause of disability. The good news is 80 percent of strokes are preventable and that huge strides have been made in diagnosis and treatment in the past decade.
What experts find discouraging is that too few of us make the healthy lifestyle choices necessary to avoid them: controlling high blood pressure, not smoking, eating a low-fat, low-cholesterol diet, being physically active, maintaining a healthy body weight, drinking moderately or not at all and managing diabetes. And when symptoms do occur, they are either not recognized or ignored.
Life changing events
The idea that our lives can change dramatically in an instant leaving us with cognitive, emotional, or physical disability is hard for those who haven’t experienced it to imagine. Victims of stroke know it too well.
“It was really hard not being able to talk at all because I couldn’t tell anybody what I wanted,” says Christan Hyde of New Bremen, who suffered a stroke at age 26 after experiencing “a huge headache” and realizing “what I was saying didn’t make sense to me.”
Steve McCullough, an engineer at Wright-Patterson Air Force Base, was lifting weights in his basement when he felt a “pop” in his neck last June at the age of 39.
“It can happen to anyone if the circumstances are right,” says the Beavercreek man.
Those “circumstances” can lead to a sudden death of brain cells — either as a result of a blood clot that’s blocking an artery or a blood vessel that bursts.
Drug saves lives
What concerns many in the medical community is that only three percent of potentially eligible patients get the clot-busting drug, TPA, approved for acute treatment of strokes since 1997. The life-saving drug must be administered within four-and-a-half hours of the stroke in order to be effective.
“This drug could mean the difference between being in a nursing home and going back to your family,” says Dr. Olajide Williams, a New York neurologist and author of “Stroke Diaries: A Guide for Survivors and their Families.”
While the medication isn’t appropriate for all strokes, it can be used for approximately 80 percent of them — those caused by clogged arteries from blood clots. “Anyone who receives the medication in a timely manner has a 33 percent chance of having zero to minimal disabilities,” Williams adds.
Steve McCullough swears by the new drug.
“It saved my life and probably prevented a lot of brain damage,” he says. “I’m now fully recovered and back to normal.”
In addition to the clot-buster therapy, Dr. Williams says there are now corkscrew devices which can be inserted through the artery in the groin up into the brain to remove blood clots.
Recognizing symptoms is key
So why aren’t more people benefiting from these important medical advances?
The biggest reason, says Jeanne Robinson, stroke coordinator at Kettering and Sycamore Hospitals and the stroke team nurse, is that people don’t recognize the symptoms, don’t realize there is treatment and don’t go to a certified stroke center that can give the TPA.
In the Miami Valley, stroke center certification has been given to Kettering Medical Center, Good Samaritan Hospital, Miami Valley Hospital, Grandview Hospital and The Atrium Medical Center in Middletown. Williams says many states now have laws in place that require ambulances to divert patients away from non-certified stroke centers and get them immediately to the certified centers. Ohio does not yet have such a law.
The problem is often denial, believes Beth Anspach, spokeswoman for the Miami Valley Division of the American Stroke Association. “They insist it’s not really happening to me.”
Anspach says most of the time you’ll know if it’s a stroke.
Bret Michaels told Oprah his brain hemorrhage felt “like a migraine times ten.”
“If you’re speaking to someone and they don’t understand what you’re saying, or if they have pain on the side of their face or their arm feels numb, those symptoms shouldn’t be ignored,” cautions Anspach.
“We say time lost is brain lost,” says Jeri Braunlin, clinical stroke program manager at Miami Valley Hospital, who says 911 should be called immediately when a stroke is a possibility.
It’s better to be taken to the hospital in an ambulance, she says, because paramedics can evaluate the situation and alert the hospital’s stroke team.
Williams says he and his colleagues are seeing more and more strokes within younger age groups.
“My personal opinion is that with the explosion of obesity comes many risk factors and we’re seeing obesity in very young people,” he says. “That means more diabetes, higher blood pressure — it’s all pushing stroke further and further down the age ladder.”
Once a stroke has been diagnosed and treatment is under way, the road to recovery can be difficult and frustrating. It may involve relearning everything from speaking and eating to walking and even swallowing. Advances in rehabilitation also continue to be made.
“There’s now a trend toward early physical and rehabilitation therapy at a high dose,” Williams says. “Those who are more motivated do better, and support group therapy is also critical.”
Those affected by strokes agree.
“When I couldn’t talk my sister made cards for me that said things like “I’m cold!” remembers Hyde, now 28, who married her fiance when he returned from Iraq after her stroke. Today she works as a teacher’s aide.
Ginger and Ken Evers of Riverside urge stroke victims and their caregivers to take advantage of free local organizations such as the Montgomery County Stroke Support Group that meets monthly at Miami Valley Hospital.
In 2004, Ken suffered a stroke in the middle of the night that initially left him unable to walk, talk, read or write and left his left side paralyzed. He’s gained back 85 percent to 90 percent capacity.
“Two things I learned from the group were the importance of exercise and a positive attitude,” he says. His wife greatly appreciates the free advice from occupational, physical and speech therapists who attend. She says being with others who “get it” is wonderful.
“I remember I was worried about a strong medication my husband would have to take,” she says. “When I saw how well someone in the group was doing who’d been on that same medication for 16 years, it was very reassuring.”
Their group encourages others to show up for stroke victims and try to help them feel normal. They say it’s important not to stare, to visit but not stay too long at first, and to support the primary caregiver.
Former Miss America Jackie Mayer travels the nation bringing messages of inspiration to those who’ve been hit with unexpected and difficult life events such as strokes. Her stroke, attributed to birth control pills, affected her speech and caused right side paralysis.
“The message is to take life one day at a time, one moment at a time,” says Mayer, who has been left with only minor paralysis. “Believe in yourself and always think positively. Turn those problems into challenges.”

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