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Strokes are the third-leading cause of death in the U.S., but with some lifestyle adjustments and education, many are preventable.
Bill Collins watched his mother suffer through several strokes before passing away at age 82, so the thought of going through the same experience himself was always on his mind. Then the unthinkable happened: In December 2009, Collins, 70, woke one morning with extreme head pain.
“It was the most violent shaking of my head I’d ever experienced. I laid back in my bed,” says Collins, who works in the security department at Metro Christian Academy.
His wife gave him aspirin and called 911. A CT scan did not show a stroke, but his doctors at St. John Medical Center knew he had suffered one.
“I was blessed I didn’t have paralysis,” he says, but he still had to undergo extensive physical therapy to relearn how to do basic activities such as walking and standing up.
“At 70, it (retraining the body) is difficult to do,” he adds.
As the third-leading cause of death in the United States each year — behind heart attacks and cancer — strokes kill more than 100,000 Americans, and like heart attacks, most strokes are preventable.
There are two types of strokes: ischemic, which accounts for 85 percent of all strokes, and hemorrhagic.
In an ischemic stroke, blood supply to part of the brain is cut off, leading to brain dysfunction, according to Dr. Wayne Leimbach, invasive cardiologist at Oklahoma Heart Institute. As in a heart attack, an iscehmic stroke plugs up a blood vessel.
“The difference between a heart attack and a stroke is that in a stroke you plug up the vessel to the brain, and in a heart attack you plug up the vessel to the heart,” Leimbach says, which leads to heart failure or death. “So if you plug up a vessel that involved vision, you go blind. If you plug up a vessel that goes to your brain that controls your right arm, you become paralyzed.”
A hemorrhagic stroke, the more deadly of the two, involves a blood vessel in the brain rupturing and bleeding into the brain, which damages the brain cells.
“Those are much more serious because there is no room in the skull for brain tissue and the blood, so it tends to really produce very devastating strokes,” Leimbach says.
Strokes that are caused by the building up of blockages in the brain are preventable, the cardiologist says.
Risk factors for strokes can be divided into modifiable — elements people can change — and unmodifiable — elements people can’t change. Modifiable risk factors include high blood pressure, high cholesterol, diabetes, tobacco use and obesity.
Another controllable risk factor affecting about 15 percent of stroke patients is atrial filbrillation (AF), also known as an irregular heartbeat. Most Americans over age 40 are at risk for AF, but it can be treated.
Uncontrollable risk factors include age, gender, race, family history, previous stroke, a hole in the heart, or arteries that fail to develop properly.
People as young as 20 can have strokes, and as one ages, the chance increases. For every decade over age 50, the chance of getting a stroke doubles, Leimbach says.
Time is crucial
The National Stroke Association has developed an acronym, FAST, to help people determine whether a stroke has occurred.
Face: When the person smiles, does half of the face droop?
Arm: When both arms are raised, does one drop down?
Speech: When repeating a phrase, are the words slurred? Are the sentences repeated correctly?
Time: Every second brain cells die. Call 911 immediately.
Many people fail to realize the importance of getting to a hospital as soon as signs and symptoms of a stroke occur, Leimbach says.
“Unlike heart attacks, where people know they need to get to a hospital right away, people deny when they’re having a stroke,” he says. “People hope their arm will start to move again, or they hope their speech will come back. Sometimes it does and sometimes it doesn’t. But if you wait to prove it’ll come back, it may be too late. If you get into a hospital very quickly, we can often interrupt strokes just like we can heart attacks.”
Within three hours of a stroke occurring, doctors can give patients tissue plasminogen activator (tPA), a drug approved by the Food and Drug Administration to treat blood clots, says Anna Wanahita, director of St. John Stroke Center. Within eight hours, doctors can try to remove the clot.
Far too often, however, patients wait too long to come to the hospital, adds James Rooks, director of inpatient medical services at the Stroke Center at St. John.
“Patients come in after three days, and at that point, it’s simply too late to treat the acute stroke and instead we must change the modifiable risk factors, treat the other risk factors and start rehab,” he says.
Patients typically begin rehab within a few days, says Dr. Rodney Myers, medical director at Hillcrest Medical Center’s Kaiser Rehabilitation Center. Rehabilitation usually lasts two to four weeks, says Myers, who is also a neurologist at the Utica Park Clinic.
“What we do is we try to get patients to emulate normal walking and normal activities as much as possible, even though they may be weak on one side,” he says. “We try to get them to use that side as much as possible because, in so doing, it helps the rewiring in that part of the brain that occurs after a stroke.”
