This story is based on a Sept. 20 lecture at Cayuga Wellness last month. The lecture will be presented again at the YMCA of Ithaca and Tompkins County on Nov. 8, at 6 p.m.
Approximately 800,000 people have a stroke every year in the United States, though only three percent of them are under 65 years old. However, that doesn’t mean that education in stroke prevention, as well as how to recognize and manage one, isn’t relevant to those that are at a much lower risk. ?
The medical definition of a stroke is a deprivation of oxygen as a result of either a blood vessel being blocked by a clot, and restricting blood flow, or bursting, and bleeding within the brain ensuing. Both of these scenarios then cause brain cells to die. Stroke symptoms include numbness, weakness, and loss of vision, balance, or coordination
There are three main types of strokes: an ischemic stroke, a hemorrhagic stroke, and a transient ischemic attack (TIA). An ischemic stroke is the most common, occurring in approximately 87 percent of all stroke cases, and involves a blockage in an artery. A hemorrhagic stroke, which takes place when a blood vessel is ruptured due to either high blood pressure or an aneurysm, is much less frequent, comprising only around 13 percent of all stroke cases. However, it much more likely than an ischemic stroke to result in a fatality. Finally, a transient ischemic attack, also referred to as a “mini stroke,” is a temporary blockage of an artery, and produces stroke-like symptoms for a short period of time (anywhere from an hour to a day or two) that then resolve quickly. Nevertheless, it is still important for an individual experiencing a TIA to seek an immediate medical assessment, as up to 40 percent of cases later result in a full stroke soon after. Thus, Jen Johnson, RN at Cayuga Medical Center (CMC) prefers to refer to a TIA as a “warning stroke.”
The risk factors for a stroke, both controllable and uncontrollable, include: high cholesterol intake, poorly-managed diabetes, alcohol abuse, smoking (which doubles one’s risk), obesity, irregular heart rhythms, hereditary background, race, gender, and age. Says Johnson, “We really believe that four out of five strokes are preventable, meaning that if people were educated and remembered the things that we talked about, and get rapid treatment, or do preventative things ahead of time, we could probably prevent a fair number of those strokes . . . We really need to get the word out to as many people as we can.”
But it’s not just important that people that are at risk of a stroke are informed on the issue.
“The person who’s going to identify that a stroke is happening more likely to be the person who’s with the person who is having the stroke, which is why we like to educate across the whole range of ages,” says Johnson, who even stresses the need for youth to be able to identify strokes when around older relatives.
A common acronym associated with identifying strokes is F.A.S.T. (face, arms, speech, time). The face is a common indicator if one is having a stroke, as one side usually appears droopy. The individual’s arms would also feel weak, and would have difficulty lifting one up. Another common sign is speech—in particular the inability to form complete sentences.
The last—but most crucial—part of the acronym is time. Although strokes happen to be more subtle than the nation’s leading cause of death, a heart attack, they require rapid treatment the exact same way as a heart attack, according to Johnson.Whether or not one is truly having a stroke, it is critical to act swiftly, and receive treatment at a designated stroke center like CMC. “It’s important to act fast,” Johnson advises. “That’s the educational challenge that we have: getting people to appreciate the fact that you need to get to the hospital quickly even when you think there’s a slight chance you or someone you’re with is having a stroke, because it’s just as important to treat quickly for a stroke as it is for a heart attack.” In addition, calling an ambulance should always be the first priority, as it allows for the hospital to be prepared for the patient, and ensures a safe transport.
Once the patient arrives to the hospital, the first thing the team at CMC does is a CTC scan to determine what treatment is needed. “If you’re bleeding in your brain, your treatment is going to be entirely different than if your stroke is caused by a blood clot,” says Johnson. The time that the stroke occurred also affects how the situation is handled. “The first thing we need to know when someone comes in is when the symptoms started,” she says. This is because TPA (tissue plasminogen activator), a clot-busting drug that opens the blood vessel and restores blood flow to the brain, has a three-hour window to be administered and work effectively. If given after three hours has elapsed, the drug can cause internal bleeding throughout the patient’s body. TPA will not be administered if the time that the stroke began isn’t definite. “Research has shown very clearly that beyond three hours, the risks of giving the drug start to outweigh very quickly the benefits of giving the drug.”
While there are some restrictions for administering TPA, such as if a patient is on a blood thinner, or has had recent surgery, when it is able to be used, TPA can be near miraculous, says Johnson. “I have seen people come into the hospital not being able to form words—nevermind a sentence—and within a five to six hours after getting the TPA, are speaking in full sentences again. And that’s how dramatic it can be.”
While strokes are just the fifth leading cause of death in the United States, they are the number one source of serious long-term disability, and according to the World Health organization, cost the United States $73 billion for direct and indirect care spending. Rehabilitation from a stroke can involve lengthy rehab, the earlier the treatment for a stroke, the better the recovery. After a patient has been stabilized, they are sent to an inpatient rehab hospital that provides a variety of physical, occupational, and speech therapy, as well as round-the-clock nurse care, and visits from doctors. This goal of this, explains Johnson, is “getting back to enjoying your life, and even if you have a stroke, regaining function.”
Once the patient’s condition has improved even further, and they are able to return home, and begin appointments with an outpatient physical therapist, such as John Mayer, a PT at CMC.
“Anything the brain does can be messed with by a stroke,” says Mayer. “After a stroke, the brain adapts to what it doesn’t have.” Recovery from a stroke through physical therapy typically requires a comprehensive recovery program that adapts to the patient’s need over time, and structures a patient-centered training regimen that incorporates a variety of interventions, functional task practice, as well as muscle strengthening and cardiovascular exercise. Says Mayer, “The goal for physical therapy is to help the patient return to their role in their home, their community, to work.”
And it’s also about averting a future stroke. According to the American Stroke Association, about 80 percent of strokes can be prevented. “You want to make sure that you are progressing,” says Mayer. “I advocate for my patients to do preventative stroke activities, like being more active, diet, and lifestyle changes.” Exercise is the most key component, though. While many doctors on commercials advertise pills, Mayer maintains that “one of the best pills you can do is just get up and move.”
Follow Austin Lamb on Twitter @AustinCLamb