Three hours made all the difference in a Fairchance woman’s recovery from stroke
The average life expectancy in America is 78.8 years, or more than 690,000 hours, according to government statistics.
But when it comes to stroke, three hours are all that matter.
For Carolyn Hoover, those three critical hours occurred the day after Thanksgiving: Nov. 23, 2012. That evening, the Fairchance woman (then age 47) and her husband, Jon, had just finished dinner and were washing the dishes when Carolyn suddenly had to sit down.
She couldn’t speak. She couldn’t see. She was unresponsive.
“She was just sitting at the table, wringing her hands, and when I looked at her, she just had this blank look on her face,” Jon recalls. “I didn’t have a clue what was going on until the ambulance got there. The paramedics said she was having a stroke and that if she got treatment within three hours it could reduce some of the effects or reverse them.”
With stroke, time is brain. Every second a stroke persists hastens the death of brain cells and the loss of physical functioning that accompanies this process. So it’s critical to recognize stroke symptoms and seek immediate medical attention, as the Hoovers did.
Sadly, though, many people ignore the signs of a stroke, opting instead to wait and hope that the symptoms will pass. By that time, their treatment window may have closed and the damage from the stroke is irreversible.
No time to lose
The most common type of stroke–comprising 87 percent of all stroke cases–is ischemic stroke, caused by a blood clot in the brain. The clot may develop at the site of a clogged cerebral artery, or it may occur elsewhere and travel to the brain until it reaches blood vessels too narrow to let it pass. (Another type of stroke, hemorrhagic stroke, occurs when a weakened blood vessel ruptures, and the resulting blood accumulation compresses nearby brain tissue.)
Strokes cause a loss of blood flow to one or more areas of the brain, and the tissue deprived of this nourishing blood supply rapidly begins to die.
“We have 2 billion neurons [nerve cells] in our brain,” says Lori Matthews, stroke coordinator at Uniontown Hospital. “We lose brain cells all the time, but with stroke it’s 1.9 million per minute because you’re not getting the blood flow. They just don’t come back, and brain tissue is rapidly lost as the stroke progresses.”
If a particular area of the brain is affected by stroke, the body functions controlled by that brain region are impaired. One side of the brain controls functions on the opposite side of the face and body. A stroke in the right brain can cause paralysis on the left side of the body, vision problems, memory loss and quick, inquisitive behavior, according to the American Stroke Association (ASA). Conversely, a left-brain stroke can cause right-side paralysis, speech or language problems, memory loss and slow, cautious behavior, the ASA notes.
Stroke can cause a wide array of symptoms (see chart), varying from person to person but similar in their suddenness. Carolyn Hoover’s stroke manifested as sudden disorientation and a loss of speech and vision.
“It was scary,” she recalls. “The ambulance driver was in my face, and I heard her say, ‘She’s having a stroke,’ but I couldn’t see her. It was so scary.”
In some instances, stroke symptoms are non-specific, so people experiencing them either don’t recognize them or don’t take them seriously enough, says Dr. Lawrence Wechsler, founding director of the University of Pittsburgh Medical Center Stroke Institute. If you or someone with you experiences stroke symptoms, call 911 immediately, he urges.
“The battle we have with stroke compared to heart attack is that heart attacks hurt. People are in pain, so they know to call for help,” Wechsler explains. “With a stroke, they get a little weak or a little numb, they have some trouble with speech, and they say let’s just hold on and see if it goes away. That’s the wrong thing to do, because they could miss their opportunity for help.”
Time for treatment
When Wechsler began his stroke training in 1983, little to nothing could be done for stroke patients arriving at a hospital emergency room. Given the lack of effective treatments, medical personnel were in no rush to care for these patients, Wechsler recalls. Understandably, the prognosis for many patients was dire, and many were left with permanent deficits in motor function, speech, vision and memory.
Today, that situation has changed dramatically–for the better. That transformation is due largely to the use of “clot-busting” drugs known as tissue plasminogen activators, or tPA. The intravenous therapy works by dissolving blood clots to improve and restore blood flow to stroke-affected areas of the brain. The drug has been shown to improve significantly the chances of recovering from a stroke.
“So if a patient comes to the emergency room with a stroke today, it is an emergency. They are rushed in, the staff converge on them, and everything is done very emergently,” Wechsler says. “The idea that we can intervene in the midst of a stroke and reverse the effects of a stroke–honestly, 20 years ago that wasn’t even considered. So, as far as I’m concerned, it’s really something of a miracle what we can do today.”
The limitation of tPA is that it must be administered within three hours of the onset of stroke symptoms to be most effective, although that treatment window may be extended to up to 4½ hours for certain eligible patients.
Regardless, the sooner tPA is administered, the better a stroke patient’s chances of recovery, suggests research published Saturday in the journal The Lancet. The review of nine randomized trials found that patients given the tPA drug alteplase within three hours and within three to 4½ hours of symptom onset were 10 percent and 5 percent more likely, respectively, to be free of significant disability three to six months later, compared to those receiving no treatment.
“Today, we get a significant number of patients coming in within this time window, and we’re able to treat them,” Wechsler says. “But you have to recognize the symptoms, and you have to know that you have to get to the emergency room, because it’s an emergency.”
Some stroke patients–specifically those with a persistent arterial blockage despite tPA therapy or those beyond the three- to 4½-hour window for tPA–may require an endovascular procedure, in which a catheter inserted through an artery in the leg is fed to the site of the blood clot in the brain. Once there, the physician may administer tPA directly into the blood clot or attempt to remove the clot. New studies are showing promising results for this interventional therapy.
In 2013, Uniontown Hospital was certified as a primary stroke center, the only one of its kind in Fayette or Greene counties. The certification is awarded to hospitals that follow the best practices for optimal stroke care. (Several UPMC hospitals, Washington Hospital and Ruby Memorial Hospital, in Morgantown, also have earned this accreditation.)
Uniontown Hospital also has partnered with UPMC’s Telestroke Program, which connects emergency room physicians with Wechsler and other specialists at the UPMC Stroke Institute 24 hours a day, seven days a week. Through video conferencing, the UPMC physicians can assess Uniontown stroke patients and communicate with them, their family and the emergency room doctors in real time. They also can review CT scans and consult on the use of tPA and other treatments.
“It’s been an excellent addition to our armamentarium,” Wechsler says. “It’s allowed us to bring our stroke expertise to the rural areas. I’m at a meeting on the South Side of Pittsburgh, and if a patient came in to Uniontown’s ER right now, I’m sitting here with my iPad and I could just turn it on and be right there with the Uniontown emergency room.”
Sadly, many stroke patients fail to take advantage of the improved stroke care at Uniontown Hospital and other centers, and the consequences can be life altering, Matthews says. She recalls a male patient who had laid down for an hour after his stroke symptoms started. When he awoke, he couldn’t get out of bed and couldn’t speak, and by the time he reached the emergency room, he was well beyond the tPA treatment window. Afterward, he was so disabled by his stroke that when he was asked to pick up a ball from a table and throw it, all he could manage to do was roll it across the table, Matthews says.
“If he would have said something and his wife would have called 911 at 6 a.m. instead of 9 a.m., things would have been different,” she says. “Unfortunately, I have seen people who have waited too long and just haven’t been able to get that treatment. I look at them and think, if you would have gotten here one or two hours sooner, you would be so much better.”
Time for recovery
Carolyn Hoover required six weeks of occupational and physical therapy and six months of speech therapy after her stroke. For the first week or two, her vocabulary was limited to three or four words–yes, no and damn it–she jokes.
Jon Hoover took off work for five months to help his wife recover. The couple spent hours each day retraining Carolyn’s brain with flash cards and activity books. Through the whole process, Jon became somewhat of an expert on stroke and stroke recovery, and for his wife, “It was like going to school again,” Jon says.
A few weeks after her stroke, Carolyn had a new photo taken for her driver’s license. In the picture, she bears a slight facial droop, a stroke remnant that has since disappeared. Still, for another two years, until she needs a new license, she’ll have that photo as a reminder of where she was then and how far she’s come.
Carolyn’s right side was affected by the stroke, and, as a consequence, her right hand remains hypersensitive. Like many stroke patients, she battled (and overcame) depression, frustrated by the deficits her stroke caused. She admits that the stroke has shaken her confidence in certain areas of her life, such as driving or walking alone outside the house without some fear of falling.
And although her speech has improved and she continues to rebuild her vocabulary, she still has aphasia, a language disorder that affects her ability to communicate. She laughs as she shows off a card that her speech therapist gave to her to help her explain her communication impairment to other people. The card reads, “My intelligence is intact. I am not drunk or mentally unstable.”
Otherwise Carolyn, now age 49, and Jon, 54, have worked to regain the life they had before her stroke, and they regularly get out and enjoy the things they’ve always liked to do.
“My outlook on life is greater,” Carolyn says. “I want to do more because you never know. Tomorrow is not promised. I want to live life and get in as much as I can.”
Jon continues to help his wife in her recovery, and he urges anyone experiencing stroke symptoms to “get checked as quickly as possible.”
“Just three hours and your life changes,” Matthews adds. “I’m sure that instead of calling the ambulance and getting the help Carolyn needed, if Jon would have said, ‘Lie down and see if you feel better,’ Carolyn wouldn’t be sitting here today.”
Identify the signs of stroke
The American Stroke Association recommends using the FAST acronym to help identify the signs of stroke:
Face droop: Does one side of the face droop or is it numb? Is the person’s smile uneven?
Arm weakness: Is one arm weak or numb? If the person raises both arms, does one arm drift downward?
Speech difficulty: Is the person’s speech slurred? Is the person unable to speak or difficult to understand? See if the person is able to repeat a simple sentence, such as, “The sky is blue.”
Time to call 911: If a person exhibits any of these symptoms, even if the symptoms wane, call 911 and get him or her to a hospital immediately. Note the time so you’ll know when the symptoms began.
Also call 911 immediately if you experience these other stroke warning signs:
? Sudden, severe headache
? Sudden vision problems in one or both eyes
? Sudden confusion, trouble speaking or understanding
? Sudden numbness or weakness in the face, arm or leg, especially on one side of the body
? Sudden trouble walking; loss of coordination
Source: American Stroke Association