On Target with Stroke Awareness Month
To the ancient Greeks, the archer god Apollo was the god of music, healing, and sudden death. Those struck down by Apollo’s arrows died instantly, or if they survived, were robbed of motion, speech, and vision.
Thankfully, today this ancient attempt to explain the sudden onset and potential long-term consequences of a stroke has been replaced by targeted stroke awareness education programs and progressively modern and effective health care.
Stroke Awareness Month
Every year, according to the Centers for Disease Control and Prevention (CDC), around 800,000 people in the U.S. suffer from a stroke – 600,000 of which are first attacks and 185,000 recurrent. In America, stroke is not only the fifth leading cause of death, according to CDC figures, but is also the leading cause of serious long-term adult disability.
Despite these grim statistics, many Americans remain unaware of both the symptoms of and treatment for stroke. However, this is something health providers are fighting to change.
Michael A. Puente, M.D., is the Director of the West Jefferson Medical Center (WJMC) Stroke Unit and Neurologist at the Culicchia Neurological Clinic.
“The medical term for stroke is cerebral vascular accident,” explained Dr. Puente. “There are two types of strokes – ischemic strokes (IS) and hemorrhagic strokes (HS.) Ischemic strokes are due to some kind of arterial blockage in the brain, and hemorrhagic strokes are caused by bleeding into the brain due to some kind of rupture.”
According to the American Stroke Association (ASA), ischemic strokes account for 87 percent of all stroke cases. Hemorrhagic strokes (HS) occur when, for various reasons, a blood vessel in the brain bursts. Two types of weakened blood vessels usually associated with HS are aneurysms and arteriovenous malformations (AVMs.)
The brain can be viewed as both the most important and the most fragile organ in the human body. As the command center for the human nervous system, the brain consists of specialized areas that work together to exert centralized control over both the body’s organs and its physical functions.
The human brain is an energy-hungry organ. Typically weighing in at less than three pounds, it uses up more than 20 percent of the body’s total daily energy intake and 25 percent of the oxygen. If the blood flow carrying those all-important supplies is interrupted, as in the case of stroke, brain cells begin to die almost immediately.
Ischemic strokes and hemorrhagic strokes have different causes, but the effects of both can be devastating. Raising public awareness of stroke symptoms and encouraging immediacy of seeking medical care can make all the difference when it comes to effectively treating stroke and minimizing its long-term and possibly extremely debilitating effects, said Dr. Puente.
“When it comes to treating stokes, time is absolutely of the essence,” said Dr. Puente. “Time is brain cells. Once they are lost, they are not coming back; they are gone for good.”
Like Apollo’s legendary arrows, stroke symptoms often appear out of the blue and include sudden confusion; trouble with vision in one or both eyes; difficulty talking; headache; numbness of the face, arm or leg; difficulty walking; dizziness; paralysis; and lack of coordination. Other, less well-known, symptoms include bladder or bowel control problems, persistent pain in the hands or feet, or even trouble controlling or expressing emotion.
“When stroke hits, it hits all at once,” explained Dr. Puente. “What some people refer to as partial strokes, we call TIAs, or transient ischemic attacks. This is what happens when people experience symptoms of stroke that come and then go away. Often people will ignore TIAs, but they are actually big-time warnings. Anyone who experiences any symptoms of stroke, even temporary symptoms, should seek medical attention as soon as possible.”
Many common medical conditions increase risk of stroke. Non-modifiable risk factors include things like age, gender, sickle cell disease, race, and heredity, while modifiable risk factors include high blood pressure, high cholesterol, heart disease, diabetes, unhealthy diet, physical inactivity, obesity, and alcohol and tobacco abuse.
While many modifiable risks may be improved by early detection and treatment, according to ASA figures, after the age of 55, the risk of stroke approximately doubles every ten years. While women show a higher incidence of stroke and a higher mortality rate than men, the risk of stroke is higher in stroke survivors of both sexes.
The Stroke Belt
According to various studies, geographical location also seems to add to risk of stroke. The adjoining states of Mississippi, Tennessee, Kentucky, Georgia, North and South Carolina, Alabama, Arkansas, Indiana, Virginia and Louisiana make up what is collectively known as The Stroke Belt. According to figures quoted by the Heart Attack and Stroke Prevention Center (HASPC), stroke incidence rates in this belt are between 18 and 35 percent higher than the national average.
“The Stroke Belt is basically the whole of the Deep South,” said Dr. Puente. “Part of the problem is probably socioeconomic – poorer people’s diets tend to be less healthy, with a lot of fatty and fried food, and they have less access to health care. But we also have high rates of obesity and diabetes here, and all of those factors go together.”
Effectively treating stroke depends on the type of stroke, how much time has passed since symptoms began, and the involvement of other medical conditions.
If caught within approximately four hours, ischemic strokes may be treated using tPA (tissue plasminogen activator), which “busts” blood clots apart, or by an endovascular procedure called a mechanical thrombectomy, which removes blood clots by mechanical means and opens up the artery using a stent.
Treating hemorrhagic strokes involves quickly identifying and stopping the source of the bleeding; stabilizing vital functions, especially blood pressure; and reducing pressure on the brain. If bleeding is caused by ruptured aneurysms, or AVMs, emergency surgery may be necessary.
Long-Term Care versus Damage Control
While the first priority in treating acute stroke is to minimize any potential damage, at WJMC, this is only the first step in caring for stroke victims.
“At West Jefferson, we can handle all types of stroke, from stroke onset all the way through the recovery and after the patients are discharged,” said Dr. Puente. “Stroke treatment begins in the ambulance, but our care doesn’t end when patients leave the hospital. We work hard to ensure our patients have the very best ongoing care as they regain their health.”
And the WJMC is well equipped to meet this promise. In 2006, it became Louisiana’s first Advanced Primary Stroke Center. Since then, WJMC has added an inpatient stroke unit manned by National Institutes of Health (NIH) Stroke-Certified Nurses. With an extensive EMS service area reach, WJMC also utilizes Louisiana Emergency Response (LERN) Stroke Protocols, and is the only CARF stroke-accredited inpatient rehabilitation facility on the West Bank, offering monthly stroke survivor and family support groups, acute rehabilitative care by therapists and social workers who specialize in stroke rehabilitation and individualized treatment plans for stroke survivors and their families.
Dr. Michael A. Puente at West Jeff Medical Center
Experience is often called the best educator, and for WJMC’s Stroke Program Coordinator, Lisa B. Plauche, personal experience as a stroke survivor forms her passion for patient care and stroke-related education. Use of the mnemonic F.A.S.T. (Face, Arms, Speech, Time) to recognize the most common symptoms of stroke is a useful tool for raising awareness, said Plauche.
“A lot of people ignore their symptoms,” she said. “But I would advise against second-guessing. Do not wait. Seek medical help as soon as possible. Remember to always act F.A.S.T.”
Soldiering on while experiencing symptoms of stroke is something with which 59-year-old Jay Gould, Director of Planned Operations at the St. Charles Surgical Hospital, is familiar. In 2015, while training for New Orleans’ Man Up Triathlon, Gould abruptly lost peripheral vision in both eyes. Shrugging it off, he went to work.
“I knew something was going on neurologically,” said Gould. “But I never thought it was stroke.”
Gould was diagnosed at WJMC with ischemic stroke, the underlying cause of which, he later discovered, was undiagnosed atrial fibrillation, AFib. In AFib, the heart’s upper chambers do not pump properly, causing blood in the heart to form clots. One such clot had lodged in Gould’s brain.
After being treated with tPA, Gould’s vision improved almost immediately. He is now taking medication for his AFib, and has resumed physical training.
“I knew I had an irregular heartbeat,” said Gould. “But I never connected that to a risk of stroke. I don’t know what might have happened if the doctors at WJMC hadn’t acted as quickly as they did, but I do know it wouldn’t have been good. I would advise anyone who thinks that they might be having a stroke to go straight to West Jefferson.”
Triumphing Over Stroke
During September 2007, the then 29-year-old ballerina, Sarah Abrusley, was anticipating performing at the first post-Katrina overture to the Cultural Season Gala at the New Orleans Museum of Art (NOMA.) Her dream was shattered when she suffered a hemorrhagic stroke on the morning before the performance, resulting in complete left side paralysis.
After being rushed to the E.R., she received an emergency CT scan, which revealed a larger bleed in her brain. At WJMC, Abrusley had a tangle of blood vessels surgically removed from her brain.
“I was aware of everything,” said Abrusley. “I remember my husband telling me that he loved me, but I couldn’t answer him because at that point, I was slipping into a coma. It turns out that I was born with an AVM. Prior to the stroke, I had no symptoms at all that might have told me I had this little ticking time bomb in my head.”
Abrusley has since undergone a number of CT scans, none of which have revealed any other AVMs. She dedicated herself to recovery, and eight years out, with the help of WJMC’s physical rehabilitation specialists, has almost completely recovered from her paralysis. Her road back to health was a long, hard fight, said Abrusley, but in winning that fight, she remains grateful to the doctors, therapists and staff of WJMC, who honored her individual health needs and rehabilitation goals.
“There is nothing lacking in my life,” said Abrusley. “I feel that I am blessed, and in some ways, I feel my life was spared to inspire others.”