http://www.ithaca.com/living/think-it-might-be-a-stroke-better-act-fast-doctors/article_fd65420e-a928-11e7-a014-f3e679fcfa0a.html
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.”
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