Different Strokes

Whether ischemic or hemorrhagic, it’s important to recognize the signs so you can take swift action. Here’s what you need to know.

Lynn Toth, stroke center coordinator at Beebe Medical Center in Lewes, says if you don’t care for your body, “You’re a sitting duck for problems with your brain and heart—a double whammy.”  Photograph by Jared CastaldiBruce Casale thought popping a few aspirin would cure what the overworked salesman from Bear thought was a bad headache. That headache turned out to be two strokes, which robbed him of the ability to “walk, read, write or speak for two years”—an awful situation, but one that he wants to talk about now to encourage people to avoid strokes in the first place, recognize the symptoms of strokes and get help fast.

Margie Goodier of Odessa knew more about bodily malfunctions than many because of her daughter’s brain injury, but she shunted aside “the most horrible headache” of her life for a few days before she sought care. “I’m thin, walk two miles a day, don’t smoke,” she says. “I didn’t fit the stereotype, but I had a ministroke.”

“We do not pay attention to the signs,” says Dawn Fowler, head of the stroke center at Bayhealth Medical Center. “People say ‘I’m tired and dizzy, so I’ll just lay down.’ You’d be surprised about the people who come in dizzy, confused and weak. And they’ve been feeling like this for three weeks.”

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That is very disheartening. The sooner a stroke is acknowledged, the better chance for treatment and rehabilitation. At least that was the case for Attorney General Beau Biden, who was fit and just 41 years old when he had a stroke in May.

There are some frightening statistics: Strokes killed more than 137,000 people in 2006, making it the nation’s third-largest cause of death, ranking behind diseases of the heart and all forms of cancer. About 795,000 people in the United States suffer a new or recurrent stroke each year. It is the leading cause of serious, long-term disability in the United States.

And there are scary correlations. Strokes can be traced to heredity factors, though some can be controlled, says Lynn N. Toth, the stroke center coordinator at Beebe Medical Center in Lewes: hypertension, elevated low-density cholesterol, inactivity, obesity, smoking, alcohol use and illegal drug use.

If you don’t care for your body, “You’re a sitting duck for problems with your brain and heart,” she says, “a double whammy.”

“Everybody can say they know the risk factors, but then they put the Whopper in their mouth. They need to take responsibility for what they can control,” says Diane M. Gutierrez, leader of the Delaware Stroke Initiative. She also raises a red flag on hoagies, pizza, sodas, super-sized fast food, and restaurant items that are heavy on fat, salt and sugar. “We have to address this as a society.”

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A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is blocked. Strokes are ischemic if they are caused by a clot, hemorrhagic if they’re caused by a rupturing blood vessel. The effects depend mainly on the location of the obstruction and the extent of brain tissue affected. Strokes can produce numbness or paralysis, especially on one side of the body, and sudden trouble speaking, understanding, seeing or walking.

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Unfortunately, not enough people recognize the symptoms quickly and call 911. “It’s frustrating,” says Dr. Anthony E. Munson, director of the Christiana Care Health System stroke program. A neurologist, Munson suggests that people may avoid seeking treatment because they fear getting the diagnosis and confronting the potential long-term problems of a stroke.

In one study, people blamed headaches, vertigo and intoxication for problems that were caused by strokes. Even when they do know the symptoms, “People do not realize that all the signs do not occur,” says Toth, a registered nurse. “They may have just one and stay home. It takes just one. People look for a reason not to go. Denial is not just a river in Egypt.”

Mary Ciechanowski, stroke coordinator at Christiana, wonders what symptoms people are waiting for. Any of them would scare her. All five of Delaware’s hospital systems—Bayhealth, Beebe, Christiana, Nanticoke Memorial Hospital and St. Francis Hospital—have stroke coordinators and have or are developing stroke centers.

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Stroke centers are intended to improve patient outcomes, decrease mortality rates and shorten hospital stays, which now average about six days nationwide. They also connect several groups within the hospital to improve diagnosis and treatment. Bayhealth, which runs hospitals in Dover and Milford, began its stroke center on January 1 as a virtual unit of nine departments. The goal is to unite patients in one space.

Among the more prominent participants are three types of therapists: occupational therapists who instruct patients in the demands of daily living, speech therapists and physical therapists, who are concerned about patients’ mobility. Depending on what part and how severely the brain is damaged, “A stroke patient could forget what a tree is,” Fowler says, recalling a case involving what she called a “51-year-old child.”

Stroke center staffers also warn patients—and the public at large—about things that they can control to reduce their chances of strokes. At the top of the list, for its significant correlation, is blood pressure. At the top of Munson’s list for things people can do most easily is to quit smoking.

As for recovery, Casale feels that “getting better is a mindset.” He emphasizes the power of positive thinking, in addition to the dietary changes, work with therapists and computer exercises he used to retrain his brain.

Munson agrees. Studies have found that 40 percent to 70 percent of stroke patients have clinical depression in the first two months after their strokes, which hinders their rehabilitation. “People who want to do well are those who do well,” he says.

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One of the acronyms for stroke awareness is FAST, for face, arms and speech—where stroke symptoms are most obvious—and time, for the limited window in which medical professional and medications may reduce symptoms. For example, a clot-busting medication called tissue plasminogen activator can reduce long-term disability for ischemic strokes, the most common type, but only if it administered within a few hours of the onset of symptoms.

According to the American Stroke Association, a stroke is suspected if there is:

  • sudden numbness or weakness of the face, arm or leg, especially all on one side of the body. Can the person smile? Raise both arms and keep them there?
  • sudden confusion, trouble speaking or understanding.
  • sudden trouble seeing in one or both eyes.
  • sudden trouble walking, dizziness, loss of balance or coordination.
  • sudden, severe headache with no known cause.

Risk factors

  • The chance of having a stroke doubles for each decade of life after age 55.
  • African-Americans have a much higher risk of death from a stroke, partly because they have higher risks of high blood pressure, diabetes and obesity.
  • More men get strokes, but women are more likely to die from them. Use of birth control pills and pregnancy pose special stroke risks for women.
  • People who have had strokes or transient ischemic attacks (warning strokes that produce stroke-like symptoms but no lasting damage) are almost 10 times more likely to have a stroke than someone of the same age and sex who hasn’t.
  • People with heart problems have a higher risk of stroke. Atrial fibrillation—a condition in which the heart’s upper chambers quiver instead of beating effectively—can cause the blood pool and clot. Those clots can dislodge and be carried to blood vessels in the brain, where they can cause a stroke,
  • People with plaque build-up in their arteries or “sickled” red blood cells, which can stick to blood vessel walls, have greater risks of blockage.

Prevent a Stroke

  • Reduce your blood pressure. High blood pressure is the leading cause of stroke. A pressure of 110/70 is a good goal. People on maintenance medication for their blood pressure should continue with it, not stop it when they feel better.
  • Get at least 30 minutes of physical activity on most or all days.
  • Improve your diet. Reduce your intake of saturated fat, trans fats and cholesterol. Lower your intake of sodium, which can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. Eating five or more servings of fruits and vegetables per day may help.
  • Stop smoking. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways.
  • Work to improve your cholesterol. People with high blood cholesterol have a higher risk for stroke, and it appears that low HDL cholesterol, the “good” cholesterol, is a risk factor for stroke in men.
  • Don’t abuse alcohol, which can lead to severral medical complications, including stroke. No more than two drinks per day for men and no more than one drink per day for nonpregnant women is generally recommended.
  • Don’t use illegal drugs—including cocaine, amphetamines and heroin—which have been associated with an increased risk of stroke. Strokes caused by drug abuse are often seen in a younger population.
  • Take extra precautions if a parent, grandparent or sibling has had a stroke. Some factors are hereditary.

Source: American Stroke Association

Find Out More

People interested in learning more about strokes can use these resources:

  • The Delaware Stroke Initiative (www.udel.edu/destroke) focuses on prevention, risk assessment and recovery for all Delawareans, especially low-income and minority residents. The coalition will hold its annual stroke conference October 9 at Christiana Care.
  • The American Stroke Association, a division of the American Heart Association, maintains a thorough website (www.strokeassociation.org) with tips on the warning signs, risk factors and life after a stroke. A companion site (www.powertoendstroke.org) covers factors associated with African-Americans. If you’re offline and not in an emergency, call (888) 4-STROKE. The association publishes Stroke Connection Magazine every two months. It is free to stroke survivors and their families.

All five of Delaware’s hospital systems have stroke coordinators:

  • Dawn Fowler at Bayhealth Medical Center, 744-6584
  • Lynn N. Toth at Beebe Medical Center, 645-3100, ext. 5592
  • Mary Ciechanowski at Christiana Care Health System, 733-4231
  • Annedreea Webber at Nanticoke Memorial Hospital, 629-6611, ext. 1806
  • Kathleen Gibson at St. Francis Hospital, 421-4273.


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