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July 26, 2011 > Your Role in the War Against Stroke

Your Role in the War Against Stroke

Seminar Covers Acute Management of Stroke and Making Gains During Rehab

The stroke specialists at Washington Hospital need your help to turn the tide against stroke, a potentially deadly condition that represents the No. 1 cause of long-term disability in this country.

On average, every 40 seconds, someone in the United States has a stroke, according to statistics compiled for the Heart Disease and Stroke Statistics - 2011 Update report published in Circulation, the Journal of the American Heart Association (AHA).

And, on average, every four minutes, someone dies of a stroke.


Stroke symptoms? Don't delay

"Acute management of stroke can help save lives and mitigate long-term disability," according to Ash Jain, M.D., medical director of Washington Hospital's Stroke Program. "However, we find people are still arriving in the ER later than we would like. Recognizing the symptoms is important, but ideally we also would like them to know enough about stroke to prevent it in the first place."

Next Tuesday, Aug. 2, from 6 to 8 p.m., members of Washington Hospital's Stroke Program will give community members a chance to learn more about stroke during the latest seminar in the Free Stroke Education Series: "Acute Management of Stroke/Chronic Care and Stroke Rehabilitation."

According to Dr. Jain, when it comes to effective treatment of stroke, timing matters. But he says one of the primary issues preventing people from getting to the emergency room quickly enough is the fact that many people still do not recognize stroke symptoms - or the urgency behind them.

"The community needs to learn and recognize the risk factors and symptoms of stroke," he says. "They need to communicate with their physicians for a complete evaluation for risks of stroke if they have had blockages in their hearts or legs or other arteries in the body. A blockage in one part of the body means that there is a 50 percent chance that they have a blockage in the neck or the brain that could cause strokes. There are easy ways of determining these blockages."

According to Circulation's report, a study of patients who have had a stroke found that only 60.5 percent were able to accurately identify one stroke risk factor, and that 55.3 percent were able to identify one stroke symptom.

Furthermore, patients' median delay time from onset of symptoms to admission in the emergency department was 16 hours, and only 31.6 percent accessed an emergency department in less than two hours, the report said.

This is devastating when even small delays can cause a life-altering disaster that Dr. Jain says is reported as worse than death by some people who have had a serious stroke.

"If the patient comes in within four hours of suffering a stroke, we can get good results with administering tissue plasminogen activator (tPA) intravenously," he explains. "If the patient comes in between three and six hours after the stroke, we would inject the drug directly into the brain and still get fairly good results."

After six hours, though, patients are no longer good candidates for clot-dissolving medications, according to Dr. Jain. In spite of this, the Stroke Team at Washington Hospital can still treat strokes for up to eight hours by inserting a catheter through the groin into the brain to remove the clot.

"It's a riskier procedure and the results are not as good, but we are still able to preserve a fair amount of brain function. After eight hours, most of the damage to the brain has been done, and we generally are not able to attempt acute treatment."

The lesson, Dr. Jain says, is to become familiar with the symptoms of stroke - and not to hesitate if you or family member is showing any signs of stroke.

"The patient's role - and that of all community members - is very important in acute stroke care," he concludes. "The more quickly people can recognize stroke and call 9-1-1, the better chances we have of improving our patients' outcomes.

The community is fortunate to have a certified Primary Stroke Center right here at Washington Hospital, but people need to make that first step and call 9-1-1."


The caregiver-survivor relationship

Doug Van Houten, R.N., the Stroke Program's coordinator, will discuss the stages that follow acute management of stroke: rehabilitation and chronic care.

"Patients come into the ER for acute treatment of stroke, then they often go to the ICU, then the nursing floor and, after that, acute rehab," Van Houten explains. "And then, at some point, they get sent home. From here, you don't necessarily have more visits with the rehab specialists, but you have to keep this momentum going to improve."

He points out that approximately 80 percent of stroke survivors do in fact go home after a stroke, something he says this is mostly due to two factors: effective rehabilitation and a dedicated caregiver, most often a spouse.

"The spouse who becomes the stroke survivor's primary caregiver is statistically in his or her fifth, sixth or seventh decade of life, and these people are automatically expected - with no experience or formal training - to be able to help keep the rehab process moving forward," Van Houten says. "Surprisingly, despite these challenges, these caregivers do pretty well."

He says he thinks of caregivers as an extension of rehabilitation and nursing care.

"On top of this, we expect them to do it without training, and there are fewer and fewer resources out there," he reflects. "On the other hand, we're telling people all about stroke during this series, including how to care for stroke survivors, as well as inviting them to talk with other people in the same situation during our monthly stroke support group."

"During each meeting, they can learn from other stroke survivors and caregivers, and a social worker is there to help them get access to various resources. I think there is help out there if you look for it, and I'm encouraging people to take advantage of that."

Van Houten points out that depression can be a common side effect of stroke for both the survivor and the primary caregiver. This is where maintaining a positive outlook can make a significant difference, he says.

"These things happen in life, like stroke," he says. "So, what happens when life throws you this curve? Do you say, 'Time to die' or do you say, 'I wouldn't have chosen this, but I'm going to make this work'?"

"You wouldn't choose this, but you find something new to keep you occupied, interested and happy. Some people will take the problem of stroke and won't adapt, and others will take it and adapt and overcome. You can still have a satisfying life that way and it's the same thing with caregivers."

Van Houten says he always talks about the caregivers' role in stroke care because they are often sharing the same issues as the survivor, only from a different perspective.

"They mirror each other in a way," he says. "Both of their lives are different now, not in the same way, but mirrored - the person with the deficits and the person helping them live with them."

To learn more about acute management of stroke and rehabilitation and chronic care, join Dr. Jain and Van Houten on Tuesday, Aug. 2, from 6 to 8 p.m. in the Conrad E. Anderson, M.D. Auditorium, located at 2500 Mowry Avenue (Washington West) in Fremont.

To register for the seminar, call (800) 963-7070 or visit www.whhs.com and click on "Register Online for Upcoming Seminars."

To learn more about the Stroke Program at Washington Hospital, visit www.whhs.com/stroke

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