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Responding Quickly to Stroke Symptoms Aids Recovery

By Joan Morris CONTRA COSTA TIMES

Frank Cooper's first clue that his whole life was about to turn upside down came as he was eating an apple.

About a year ago, Cooper, 63, choked on the apple he was munching for breakfast. He realized he was having trouble swallowing. Then his vision blurred and doubled, and he developed a sudden, dull headache. But before he could get worried, the symptoms subsided, and he talked himself into ignoring it.

The next day, however, the worry returned when Cooper and his wife, Andrea, headed to Napa. Andrea was driving and Frank was navigating, only nothing was making sense. He could see the map, read the street names, see the roads, but he just couldn't put it together. He not only didn't know whether they should turn left or right, but he also couldn't understand what direction left and right were.

By the time he'd talked with a doctor and been admitted to a hospital, 72 hours had elapsed, and doctors were unable to prevent what was coming: a massive stroke that left Frank paralyzed on one side, unable to see out of one eye, and forever grateful he came out of it with his life.

Frank had made the one mistake that stroke victims can't afford to make: He waited to get help. Immediate care has always been essential, but approved treatments for strokes must be administered within hours to lessen the damage strokes can cause and prevent future brain attacks.

The need for speed is a message doctors and emergency care workers are trying to impress upon the public. We've been taught that sudden chest pains may be a harbinger of a heart attack and that we should get to the nearest emergency room as quickly as possible. But when it comes to the signs of stroke, most of us try to shrug them off and hope we'll be better in the morning.

Advances in stroke treatment, however, can make an amazing difference in a patient's outcome following a stroke -- if they are administered soon after the onset of symptoms. Once the window of time closes, there's not much doctors can do but use standard treatments that may or may not bring about the hoped-for results.

John Muir/Mt. Diablo Health System has created designated stroke centers to get patients the immediate and appropriate care they need. The centers recently were certified as Primary Stroke Centers by the Joint Commission on Accreditation of Healthcare Organizations. John Muir and Mt. Diablo are the first in Contra Costa and Alameda counties to achieve the certification, and are among only 148 other hospitals nationwide to have the centers, which are designed to quickly diagnose stroke and start treatment.

Cynthia Miller, neurosciences clinical coordinator, says the centers rely on a team of doctors, nurses, emergency technicians in the field and occupational and physical therapists. They ensure that every patient gets the same standard of care, and that the standard is based on guidelines established by the American Stroke Association.

That means, Miller says, when patients are brought in, they are evaluated for stroke, and a series of tests are immediately administered. Then a medical team determines the appropriate treatments, and as soon as possible, therapists are brought in to begin working with the patients to recover lost motor and verbal skills.

Dr. Ray Stephens, a neurologist who also serves as director of the stroke program, says not every case brings the result they'd like to see, but the program gives them their best chance for recovery.

"We can't advocate that we have a cure for stroke, because we don't," Stephens says. "What we have is a consistent state-of-the-art approach to treating every patient, rapidly accessing whether a patient is a candidate for intervention, and then identifying and preventing future stroke."

The most powerful tool in the stroke-fighting arsenal is the clot-busting drug TPA -- tissue plasminogen activator. Originally developed for dissolving clots that cause heart attacks, the drug has proven extremely valuable in treating strokes. But it must be administered through an IV within three hours of the onset of symptoms.

The drug can also be administered directly to the clot via a catheter, keeping the window open for a bit longer.

In some cases, doctors can use a clot retrieval device that is directed through the main arteries to the clot. A corkscrew device then plucks out the blockage.

Researchers are working on other drugs and treatments to dissolve clots and prevent the loss of brain tissue, Stephens says.

Patients also now begin to receive physical therapy immediately after their stroke, which Stephens says also helps improve chances for recovery.

While there are more ways of treating stroke these days, it still remains a condition that causes a number of problems for the patient. Many are left with disabilities; some are minor, others are devastating.

Cooper, who considers himself lucky to have survived, is still working on finding his way back. He has residual weakness on his left side, although he now is able to walk unassisted. The stroke also robbed him of vision in his left eye -- there is nothing physically wrong with his eye, but the brain does not comprehend the messages sent to it -- and the blindness prevents him from driving.

Andrea Cooper decided to retire so she can care for her husband; she doesn't like leaving him alone. The couple, who lived 17 years in Danville, now live in Incline Village.

David Lamm, a 41-year-old Walnut Creek man, credits the emergency care and his age in helping him survive and recover from a stroke he suffered in June. Still, it took him almost four months to regain his full health.

Lamm, who had none of the known risks for stroke, awoke one day with dizziness, slurred speech and a problem with his balance. He convinced himself he was suffering from some sort of virus, but his wife talked him into going to John Muir's emergency department.

From there, he was sent to the stroke center, where doctors quickly diagnosed a blood clot in his brain.

Lamm wasn't a candidate for TPA -- it had been almost seven hours from when he first noticed symptoms. And by the time doctors saw him, the clot was dissolving on its own.

He suffered some physical disability and cognitive loss, but doctors started him on rehabilitation almost immediately. Lamm says he expected to be back to work by July, but wasn't able to return until early October.

"This is something I'll live with forever," Lamm says.

Stella Dempsey of Pittsburg also considers herself fortunate to have survived two strokes that occurred about 16 years apart.

In 1989, Dempsey was working in Oakland when she was suffered a stroke. It felt like someone hit her in the back of the head with a frying pan, Dempsey says. She could hardly see, but she walked six blocks to the hospital, where doctors diagnosed a massive stroke.

Even though she got to an emergency room soon after her stroke, there was little that could be done for her. She suffered extensive weakness on her left side and after two weeks in the hospital, she was sent to a rehabilitation hospital, where she was told not to expect too much.

Unable to return to work, Dempsey retired. Over time, she had regained some of what she lost, walking with a cane. Then last year, while on the way to visit her daughter, she began experiencing weakness and feared she was having another stroke.

Dempsey was taken to Mt. Diablo Medical Center in Concord, where she was treated at the stroke center.

"I'm blessed, I really am," Dempsey says. "The people at Mt. Diablo are just marvelous. They are very encouraging, and that's what you need when something is going wrong with your body."

Dempsey, 68, still is recovering from her stroke, but she's almost back to where she was.

Both Dempsey and Cooper say if they could offer any advice to folks, it would be to pay attention to the symptoms of stroke and seek help immediately.

(Posted October 26, 2005)