On July 4, 2012, Robert Wheelan went kayaking. He had “one or two drinks. Nothing extravagant.” The next morning, he woke up to the feeling of a hangover, just “not feeling right.”
“I was disoriented,” he recalls. “I had a headache.”
For two days, the downward spiral continued. The trained guitarist found he couldn’t pick a note. He endured sobbing fits and bouts of uncontrollable laughter. Finally taken to a hospital, Wheelan learned the diagnosis. He had experienced a stroke. Every stroke and every patient is different, doctors say. But no matter what, fast action and a positive attitude are the keys to surviving and thriving.
1. Know the signs
There are two kinds of strokes. The more common ischemic strokes come from blood clots that block blood and oxygen from the brain. Hemorrhagic strokes fill parts of the brain with blood.
Symptoms vary, but to recognize and react to most strokes, go through the acronym FAST. That’s F for facial droop, A for arm droop, S for slurred speech, and T for time, because immediate help can minimize damage.
2. Get help quickly
Ischemic stroke victims may be candidates for tPA, a blood-clot diffuser, but it must be administered within three to four-and-a-half hours.“You should recognize stroke and act fast,
because time is brain,” says Dr. Parul Aneja, neurologist with PinnacleHealth, Harrisburg (www.pinnaclehealth.org).
Those with bleeding on the brain or who take blood thinners aren’t good candidates for clot busters, so doctors might try a clot-removal procedure, or they might work to control blood pressure.
In many hospitals, ERs are also Primary Stroke Centers, with teams trained in reaching diagnosis and administering treatment within the critical window of time. Patients who call 911 do better than those who drive to the hospital because ambulance personnel are trained to recognize the signs and mobilize ER stroke teams so they are, ready to go when patients wheel through the door.
“The quicker we get the clot buster in place, the more likely the recovery,” says Dr. Heather D. Harle, neurologist with Lancaster General Health (www.lancastergeneralhealth.org). “It is so important for patients to go to Primary Stroke Centers. It’s like a well-oiled machine.”
Lancaster General Hospital, which is a Joint Commission-accredited Primary Stroke Center, also runs a Stroke Program offering neuro-specialty critical care and multidisciplinary teams that prepare stroke patients for re-entry into the community. Services include stroke rehabilitation during hospitalization and a partnership with Lancaster Rehabilitation Hospital and its
outpatient neuro rehab team for seamless transitions.
3. Identify the cause
Causes can’t be found in about one-third of strokes, but doctors still search for the triggers that help determine treatment. Perhaps a blood thinner level was incorrect. Maybe high cholesterol clogged the carotid artery that delivers blood to the brain. Diabetes, high blood pressure, and smoking are all major risk factors, as are alcoholism and drug abuse. Treatment aims to control risk factors, toward the critical goal of preventing future strokes.
“The more strokes you have, the more likelihood that you’re not going to have a good recovery,” says Harle. “Once you’ve had a stroke, that tissue is dead, and other areas of the brain have to learn how to do what the dead tissues used to do.”
4. Commit to recovery
Stroke patients typically spend two to four days in the hospital, where physical, cognitive, and speech-related disabilities are identified, says Aneja. Discharged patients might go to nursing homes or rehab facilities, or they could go home. All undergo physical, occupational, and speech therapy tailored to their injuries.
Wheelan remembers that when he tried to move his arm, his brain simply wouldn’t signal the body to function—a consequence of dead tissue that wasn’t functioning anymore. His Lancaster General Health therapists used fun routines such as kickball to encourage his brain to create new pathways for directing movement. “You’re retraining yourself,” he says.
Recovery typically takes from six months to a year, says Aneja. Skills that haven’t been recovered by then will probably “be left behind.”
A positive attitude and a strong support network are essential to recovery, doctors say. Wheelan sometimes “wanted to have a pity party and wanted to get angry and curse everybody out.” He got through those days by reminding himself that he was going through a process of healing. And even though the support of family, friends, and his wife, Terri Givens, never wavered, he learned to turn down help, knowing that he needed to relearn for himself such simple tasks as getting a drink from the refrigerator.
Many stroke patients endure periods of depression, regardless of the extent of their injuries, says Dr. Stefan P. Kruszewski, of Stefan P. Kruszewski, M.D. & Associates, Harrisburg (www.spkmd.com). Treatment with anti-depressants or other medications is “absolutely critical” to successful recovery, he says. “People who recover–and most people can recover, especially if they’re treated right away–need to be motivated and not depressed to be active participants in their care. You have to believe, and you have to feel like you can overcome some of the obstacles.”
5. Lower your risk
Prevention is “the best thing” to avoid the devastation of stroke, says Kruszewski. Keep blood pressure and weight in reasonable ranges. Treat diabetes “relatively aggressively, and keep blood sugars from going too high or too low.” Don’t smoke cigarettes or use illicit drugs, and manage cholesterol and triglyceride levels. Minimize stress, get plenty of sleep, eat a healthy diet, and exercise regularly. Even walking three times a week “can significantly reduce heart attack and stroke,” he notes.
6. Stay positive
After his stroke, Robert Wheelan gradually returned to work. He’s golfing and skiing again. He enjoys yoga and, with his wife’s help, eats healthier, except for “the occasional cheeseburger.” Givens draws inspiration from her husband’s upbeat attitude. Wheelan says he has learned “not to take life so seriously.”
“Life is short,” he says. “Might as well enjoy the things you have.”
