Sunday, August 28, 2016

Hidden Stroke Victims: The Young

The following article comes from kaizer health news (KHN): khn.org/news

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.


By Anna Gorman Photos by Heidi de Marco August 24, 2016

Jamie Hancock, 38, at her house in Rocklin, Calif., in June 2016. Six years ago, Hancock suffered a stroke caused by a tear in her artery. (Heidi de Marco/KHN)

ROCKLIN, Calif. — The headaches were excruciating and wouldn’t go away. Her doctor said they were migraines. Then, one morning a few weeks later, Jamie Hancock stood up from the couch and discovered she couldn’t move the right side of her body. When she spoke, her speech was slurred.

At the hospital, doctors told her she was having a stroke. The 32-year-old Hancock, whose children were just 1 and 3, had a sobering epiphany: “My whole life is changed forever.”

Now, six years later, no one would know she is a stroke survivor. A lifelong dancer, she is fit and muscular. She speaks clearly and walks quickly as she shuttles her kids around, runs errands and teaches dance classes.

But the effects — for her and other young stroke victims — linger just below the surface. They are there when she gets mad at her family, when she can’t remember what she needs at the grocery store, when she tires after working for a few hours. The noise and light can be unbearable, forcing her to escape to a dark room.

Some days Hancock tries to be the energetic and sociable working mom she was before the stroke. Then she crashes.

“I sort of forget I have a disability and I think I can do everything anyone else my age can do,” she said. “But I can’t.”

***
Hancock is among a growing number of younger adults who’ve had strokes, which occur when blood flow to the brain is blocked or a vessel in the brain bursts. Because strokes are most often associated with old age, symptoms in younger adults may be overlooked, according to patients, advocates and physicians. And their need for rehabilitation — to return to active lives as parents and employees, for instance — can be underestimated.

“The American public is still very locked on stroke being an [affliction] of the elderly,” said Amy Edmunds, who started a nationwide advocacy and support organization called YoungStroke. “But we are an emerging population … and we really need to be recognized.”

The rate of hospitalization for strokes dropped nationwide by 8 percent between 2000 and 2010 (from 250 to 204 per 100,000), but in those same ten years it increased almost 44 percent for people ages 25 to 44, though from a much smaller base (from 16 to 23 per 100,000), according to research published in May in the Journal of the American Heart Association.

Hancock serves lunch to her children Blythe, 9, and Andrew, 7. Hancock said she lost the cognitive ability to do certain tasks which made it difficult to keep her full-time, office job. (Heidi de Marco/KHN)


The reasons for the rising prevalence among young people are not clear, but physicians believe that growing risk factors such as hypertension, smoking and obesity contribute. And because younger patients aren’t as aware that they can get strokes, they may not be proactive about controlling those risk factors. Older patients, by contrast, may be more inclined to exercise, eat healthy and take preventive medications.

“Older people are educated and understand they need to take care of themselves and are doing all the things to prevent strokes,” said Lisa Yanase, a stroke neurologist at Providence Health & Services in Oregon. “Young adults … think they are bulletproof. They haven’t had the realization that these things can actually be bad for them.”

Some young people also may have strokes because of drug abuse, and others because of undiagnosed genetic conditions. Hancock’s stroke was caused by a tear in the artery.

Strokes are still more common among older adults though. People ages 18 to 50 years old account for only about 10 percent of the 795,000 strokes that occur each year, according to the American Heart Association.

When their patients are younger, doctors don’t always immediately recognize strokes, said Lucas Ramirez, a physician at Keck Hospital of USC and one of the co-authors of the journal article. Young adults may also be unaware they are having a stroke, jeopardizing their chances of receiving critical, time-sensitive treatment.

Common symptoms, for all ages, include sudden confusion or numbness, slurred speech or severe headache.

Hancock said she had no idea of the warning signs. “I had heard about strokes, but I thought they were for the elderly,” she said.

***

Years had passed since the stroke, and now the Fourth of July was just a few days away. Hancock had promised her children they could buy fireworks. Blythe, 9, and Andrew, 7, selected several sets. But when the clerk handed the bag to the kids, one of Andrew’s wasn’t inside.

“Mom, where’s my rocket man?” he asked.

Hancock told her son to stop. But he asked again — and again.

“Hold on!” she yelled. “I’m trying to focus on paying. You know I have a hard time with focusing.”



Hancock and her children get ready for a shopping trip to the grocery store in June 2016. Hancock said her stroke made her forgetful, so Blythe has to help her keep track of things around the house. (Heidi de Marco/KHN)

Hancock said she never used to be that way. Now, she has trouble multitasking and gets angry about minor things — her daughter playing music too loud, her son bouncing the ball inside the house. “My family pays the price,” she lamented.

Both children say they’ve learned what to do when their mom gets stressed. Andrew gives her hugs. Blythe helps her take deep breaths. “Sometimes she has really good days and sometimes she has horrible days,” Blythe said.

In addition to the emotional roller coaster, Hancock said she has lost the cognitive ability to do some things, such as handling the family finances.

There is less money to go around, too. Just a few months after the stroke, Hancock returned to her job as an executive assistant at the California Restaurant Association. But she had trouble concentrating, couldn’t manage her time or meet deadlines — and she eventually left. She later got fired from a subsequent job.

“I would get distracted really, really easily,” she said. “I still do.”

Hancock said she spiraled into depression, which therapists later told her was likely a symptom of the stroke. She also became addicted to a painkiller prescribed to treat her headaches. She said it helped her get through the day without feeling exhausted.

With the assistance of Suboxone, a medication to treat opiate addiction, Hancock got sober. But that didn’t stop her mood swings. There were times when she slammed cabinets so hard they fell off their hinges.

Her husband, Ken Hancock, said the stroke and its aftermath nearly tore their family apart. At first, he just felt scared. For a while, his wife couldn’t wash her own hair or pick up their children. When she cooked, one of her hands shook.


A meditation book sits on Hancock’s living room table. After her stroke, she said she needs to find ways to calm herself down during stressful moments. (Heidi de Marco/KHN)


He concentrated on getting his wife to appointments and taking care of her and their children. But as she got better physically, he said, she became worse emotionally. The addiction didn’t help, and they argued frequently. “It was a terrible, terrible cycle,” he said. “It took a long time to realize better things were around the corner.”

Now, the family is in a better place, he said. Jamie Hancock sees a therapist and takes medication that is normally used to treat schizophrenia. The volatility has subsided.

Ken Hancock said his wife’s brain injury isn’t visible, but it’s there. “She is still trying to recover, and we are sort of in the same boat with her,” he said.

***

On a June afternoon, Hancock sat in her living room with another young stroke survivor, Jen Ruzicka Lee, an ER nurse and longtime runner who was stricken last year at age 43. Lee returned to nursing part-time in April, but she still stutters and uses a walker.

They laughed and nearly cried as they talked about the impact of different medications, becoming intimate with their husbands again and the daily guilt they felt about the effect of the strokes on their children.

Both women said they had attended a few stroke support groups but couldn’t relate to the older participants. “They would say, ‘You need to nap,” Hancock recounted. “That’s great, but I can’t. I have kids.”

Support groups and rehabilitation programs are typically designed for older adults, said Edmunds, the YoungStroke founder, who was hit by the disease at age 45. Many young stroke survivors have to figure out how to continue raising children and working while dealing with the effects of a stroke.

Hancock says she feels guilty about the stress her children have to endure due to the side effects of her stroke. (Heidi de Marco/KHN)


“It’s a different landscape for younger adults,” Edmunds said. “We need skills to help us get on with our lives post-stroke, which could conceivably be as long as pre-stroke.”

Hancock and Lee, along with two other women, have become an informal support network. They text often and meet for coffee when they can. This month, they had a family barbecue.

Being a young stroke survivor, Hancock said, “is a whole different ballgame.”

***

Hancock tried to return to dancing soon after her stroke. She couldn’t do a single turn on the floor, and walked out in tears.

“I had to learn to walk again so I don’t know why I thought in my brain I could take an advanced dance class,” she said.

Over time, Hancock regained her strength. She said she doesn’t think her brain will ever be able to handle a 40-hour work week. Teaching dance part-time can even be too tiring some days.

On this evening, however, Hancock energetically stepped into a brightly lit dance studio. She and five young students warmed up to music. Hancock instructed them to run through the dance routine they had practiced the previous night.

“Let’s see what you remember,” she said.

Then she smiled. “Let’s see what I remember, too.”


KHN’s coverage in California is funded in part by Blue Shield of California Foundation.


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Monday, August 22, 2016

Developing Resilience: A Mother's Perspective

The following article is taken from an article posted on an American Heart Association website. I encourage you to visit their site, news.heart.org, and the site strokeconnection.strokeassociation.org where this article written by Carol Dow Richards was first published. 


Carol Dow Richards

“Your child has had a stroke.” Those words are hard to fathom — and just the beginning of a long road to recovery. It requires entire families to adjust to many challenges — and not just those faced by their child.

In 1995 when my son David had a stroke at 10, my first thought was one of denial. Surely, we’d be out of the hospital in no time and he would be back to normal. Didn’t modern-day doctors “fix” these things?

I learned, as time passed, that we were not to be out of the hospital for nearly three months. And David never returned to the “old David.” We now had the “new David” — a 10-year-old who could no longer read or speak, as he now had significant aphasia. He was in a wheelchair. His arm was limp.

He’d been in the gifted program — and now moved to special education. His heart — and mine — had been broken. Hopes and dreams changed on that dreadful day.

That was nearly 20 years ago. David navigated the course of puberty, depression, school challenges. Our family learned to manage on one income. His brother had to grow up fast — as I was rarely home for nearly three years — as we navigated David through intense rehabilitation. In some ways my husband lost his wife, as I was 100 percent a mom on a mission: Help my son. David went to therapy for the next 15 years.

Today, David and I volunteer at a nonprofit we started, The Aphasia Recovery Connection. We connect families dealing with the devastation of aphasia. We also have several Facebook group sites, including one just for kids with stroke and aphasia, ARC Kids with Aphasia (0-18), where we connect families, offer tips, and help others navigate the journey.
As I look back over those difficult years, I think there are three main pieces of advice I would offer parents.


First, learn the rights of students in the educational system. Students are afforded a free and appropriate public education in the United States. What was appropriate prestroke may not be now. David’s aphasia was so significant that by high school, he needed to attend a boarding school with significant therapy services for his aphasia. Had I not known the laws, I would not have known how to advocate for my son. Parents need to advocate for their child.




David’s recovery is a testament to his mother’s dedication. Today, both Carol and David are devoted advocates for stroke awareness.
Second, maintaining self-esteem and hope is so important. Kids at school can be cruel — and it is easy for these kids to fall into depression and loneliness. Every night as David fell asleep, I would whisper in his ear, “I am getting stronger, I am improving. I will improve day by day. I’m still smart.” He needed to believe that. I often felt that maintaining David’s self esteem was really my biggest job.

Lastly, take care of yourself. I remember one day at the hospital looking into a mirror. Who was that woman? I thought as I realized I had stopped taking care of me. I was pale and lifeless. It was at that moment that I reached into my purse and added some color to my lips — and tried so desperately to put a bounce back into my step. This challenges you to your core — but you have to believe in resiliency. And believe that yes, you CAN do this.

Deep inside each of us, we are resilient. Children are resilient. Parents are resilient. And we can indeed adjust to the new “normal.” It may be painful, horrific at times, but each day, we need to lead. With strength. And courage. And set the example for our children. No matter what life brings.

This information is provided as a resource to our readers. The tips, products or resources listed have not been reviewed or endorsed by the American Stroke Association.

Copyright is owned or held by the American Heart Association,Inc., and all rights are reserved. Permission is granted, at no cost and without need for further request, to link to, quote, excerpt or reprint from these stories in any medium as long as no text is altered and proper attribution is made to the American Heart Association News. See full terms of use.
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Sunday, August 14, 2016

Part 2 - History of Stroke

The following is a re-post from the stroknet newsletter http://www.strokenet.info. The original post can be found on http://www.healthline.com/health/stroke/history-of-stroke

There are several links to more information included in this article. If you click on any words in red or blue they will take you to more detail.

Written by Rachel Nall, RN, BSN, CCRN
Medically Reviewed by University of Illinois-Chicago, College of Medicine on March 21, 2016
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Advancements in Stroke Treatments
TPA is the preferred treatment method for ischemic strokes. However, an emerging treatment for these types of strokes is the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) retriever. This device can physically remove a blood clot in someone having an ischemic stroke. Since its first use in 2001, the MERCI retriever has treated approximately 10,000 people. However, the drawback is that many surgeons still need to be trained in its use, and hospitals need to purchase the equipment, which can be very expensive. While TPA is still the most commonly used treatment for ischemic strokes, the MERCI retriever may increase in popularity as more surgeons become trained in its use.

Hemorrhagic stroke treatments have also come a long way. If the effects of a hemorrhagic stroke affect a large portion of the brain, doctors may recommend surgery in an attempt to reduce long-term damage and relieve pressure on the brain. Surgical treatments for hemorrhagic stroke include: 

Surgical clipping: This operation involves placing a clip to the base of the area causing the bleeding. The clip stops the blood flow and helps prevent the area from bleeding again. 

Coiling: This procedure involves guiding a wire through the groin and up to the brain while inserting small coils to fill areas of weakness and bleeding. This can potentially stop any bleeding. 

Surgical removal: If the area of bleeding can’t be repaired through other methods, a surgeon may move a small section of the damaged area. However, this surgery is often a last resort because it is considered very high risk and can’t be performed on many areas of the brain.


Other treatments may be required, depending on the location and severity of the bleeding.

Advancements in Stroke Prevention
While stroke continues to be a leading cause of disability, approximately 80 percent of strokes are preventable. Thanks to recent research and advancements in treatment, doctors can now recommend prevention strategies for those who are at risk of having a stroke. Known risk factors for stroke include: 

being over age 75

having atrial fibrillation
having congestive heart failure
having diabetes
having high blood pressure
having a history of stroke or transient ischemic attack

People who have these risk factors should talk to their doctor about how they can lower their risk for stroke. Doctors often recommend taking the following preventive measures:
quitting smoking
taking anticoagulant medications to prevent blood clotting
taking medications to control high blood pressure or diabetes
eating a healthy diet low in sodium and rich in fruits and vegetables
exercising three to four days a week for at least 40 minutes a day

While a stroke can’t always be prevented, taking these steps can help to minimize your risk as much as possible.

The Takeaway
A stroke is a life-threatening medical event that can cause lasting brain damage and long-term disabilities. Seeking treatment immediately can increase the likelihood that you or a loved one receive one of the innovative treatments used to treat stroke and minimize complications.
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Sunday, August 7, 2016

Part 1 - History of Stroke

The following is a re-post from the stroknet newsletter http://www.strokenet.info. The original post can be found on http://www.healthline.com/health/stroke/history-of-stroke#1

Written by Rachel Nall, RN, BSN, CCRN
Medically Reviewed by University of Illinois-Chicago, College of Medicine on March 21, 2016
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A stroke can be a devastating medical occurrence. It happens when blood flow to a portion the brain is impaired due to a blood clot or broken blood vessel. Much like a heart attack, the lack of oxygen-rich blood can lead to tissue death. When brain cells begin to die as a result of the reduced blood flow, symptoms occur in the parts of the body that those brain cells control. These symptoms can include sudden weakness, paralysis, and numbness of the face or limbs. As a result, people who experience a stroke may have difficulty thinking, moving, and even breathing.

Though doctors now know the causes and implications of a stroke, the condition hasn’t always been well-understood. Hippocrates, the “father of medicine,” first recognized stroke more than 2,400 years ago. He called the condition apoplexy, which is a Greek term that stands for “struck down by violence.” While the name described the sudden changes that can occur with a stroke, it didn’t necessarily convey what is actually happening in the brain.

Centuries later, in the 1600s, a doctor named Jacob Wepfer discovered that something disrupted the blood supply in the brains of people who died from apoplexy. In some of these cases, there was massive bleeding into the brain. In others, the arteries were blocked.

In the decades that followed, medical science continued to make advances concerning the causes, symptoms, and treatment of apoplexy. One result of these advancements was the division of apoplexy into categories based on the cause of the condition. After this, apoplexy became known by such terms as stroke and cerebral vascular accident (CVA).

Today, doctors know that two types of stroke exist: an ischemic and a hemorrhagic stroke. An ischemic stroke, which is more common, occurs when a blood clot lodges in the brain. This blocks blood flow to various areas of the brain. A hemorrhagic stroke, on the other hand, happens when an artery in the brain breaks open. This causes blood to accumulate in the brain. The severity of the stroke is often related to the location in the brain and to the number of brain cells affected.

According to the National Stroke Association, stroke is the 5th-leading cause of death in the United States. However, an estimated 7 million people in America have survived a stroke. Thanks to advancements in treatment methods, millions of people who’ve experienced a stroke can now live with fewer complications.
History of Stroke Treatments


History of Stroke Treatments
One of the earliest known stroke treatments occurred in the 1800s, when surgeons began performing surgery on the carotid arteries. These are the arteries that supply much of the blood flow to the brain. Clots that develop in the carotid arteries are often responsible for causing a stroke. Surgeons began operating on the carotid arteries to reduce cholesterol buildup and remove blockages that could then lead to a stroke. The first documented carotid artery surgery in the United States was in 1807. Dr. Amos Twitchell performed the surgery in New Hampshire. Today, the procedure is known as a carotid endarterectomy.

While carotid artery surgeries certainly helped to prevent stroke, there were few treatments available to actually treat a stroke and reduce its effects. Most treatments were more focused on helping people manage any difficulties after a stroke, such as speech impairments, eating problems, or lasting weakness on one side of the body. It wasn’t until 1996 that a more effective treatment was implemented. During that year, the United States Food & Drug Administration (FDA) approved the use of tissue plasminogen activator (TPA), a medication that breaks up the blood clots that cause ischemic strokes.

Though TPA can be effective in treating ischemic strokes, it must be administered within 4.5 hours after symptoms begin. As a result, receiving prompt medical attention for a stroke is vital to reducing and reversing its symptoms. If someone you know is experiencing symptoms of a stroke, such as sudden confusion and weakness or numbness on one side of the body, take them to the hospital or call 911 immediately.
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Next week I will continue this article in Part 2 with advancements in treatment and prevention.
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