When strokes strike
By Shannon Harsh, The Review, Published February 13, 2013
When it comes to strokes, time is of the essence.
This was one of the key points made by Dr. Karen Gade-Pulido during an educational lecture called "Brain Attack: Life After a Stroke" held Friday at Alliance Community Hospital.
To stress how crucial time is, Gade-Pulido said doctors are referring to strokes as brain attacks. "The reason we do that is because we want to emphasize the importance of getting care immediately. We all think about that with a heart attack. Well, a brain attack is equally, if not more, important," she explained.
Gade-Pulido, the medical director of ACH's Physical Medicine and Rehabilitation Unit, said almost 800,000 Americans suffer from a stroke each year, meaning there is an average of one stroke every 40 seconds. She said strokes are now the fourth leading cause of death in U.S., but are becoming the primary cause of death in developing countries. On average, she said, someone dies from a stroke every four minutes.
"It can happen to anyone at any time at any age. Children can have strokes, elderly can have strokes -- everyone can have them," she said, adding it is important to know that stroke is preventable.
Gade-Pulido said risk factors include being overweight; having diabetes, high cholesterol, blood pressure over 120/80 (with or without medication), heart disease; smoking or having exposure to secondhand smoke on a regular basis; having a family history of stroke; getting physical activity of less than 30 minutes most days; and being a man over age 45 or woman over age 55.
She said some risk factors are controllable, and thus can help make stroke avoidable.
"We can't do anything about our genetics. I can't do anything about the fact that my grandmother had a stroke, but what I can do is watch what I eat," she explained. "Am I eating a healthy diet? Am I eating a diet that's low in fat, high in nutrition -- vegetables and proteins? Am I getting enough physical activity?"
Gade-Pulido stressed the importance of getting at least a half hour of exercise each day, which she said helps with many of the other risk factors and issues. She said it is also important to keep things under control, whether it be blood pressure or blood sugar.
According to Gade-Pulido, stroke involves a loss of blood flow to an area of the brain. She explained the difference between the types of stroke, including the most common type, ischemic stroke (when a clot leads to a blockage in an artery), intracerebral hemorrhage (when there is a sudden rupture of an artery that causes blood to leak into the brain tissue) and subarachnoid hemorrhage (when there is a sudden rupture of an artery that causes blood to surround the brain).
Gade-Pulido said if you suspect a stroke, you should act FAST, which is an acronym for the important things to remember:
Face -- Ask the person to smile. If they have a droop on one side, it suggests they may have had a stroke.
Arms -- Can they raise both their arms up? If they are having trouble raising one, they may have had a stroke.
Speech -- Ask them to repeat a simple phrase. If they can't say it, their speech is slurred or they can't repeat what you're asking them to repeat, they may have had a stroke.
Time -- Remember time is of the essence. Brain tissue is being affected every second.
After a patient is stabilized, medically or surgically, Gade-Pulido said rehabilitation and recovery is possible. "Just because someone has had a stroke doesn't mean it's the end of the world. It may seem like it because it's a huge, life-altering event, but it's not the end of the world," she said.
Gade-Pulido said stroke is the leading cause of long-term disability in the U.S. She said stroke causes impairments and disabilities that may lead to handicaps, but in the Physical Medicine and Rehabilitation Unit, she said the focus is on "addressing impairments, dealing with disabilities and preventing handicaps."
The impairments caused by stroke can vary, depending on which part of the brain is affected. Gade-Pulido explained the different parts of the brain and what functions they are connected to, which can be anything from balance, speech and language or hearing and vision to memories and personality.
"We focus on restoration of function, so that's physical, mental and emotional," Gade-Pulido said. "We're trying to look at the whole individual. This is a patient-centered approach to care. You have to consider every impact that this stroke's had on this individual and on their function, on their day-to-day life."
To help restore as much independence as possible and get patients back to their home environment, Gade-Pulido said they use a health care team that includes a physician, physical therapist, occupational therapist, speech therapist, rehabilitation nurses, dietician, social worker and psychologist or counselor. Once home, they use a combination of any adaptive equipment, visual aids, adaptive diet, memory and language aids (such as memory notebook), medications/injections and home modifications needed to help them function as well as they can.
Gade-Pulido said they try to help people return to important leisure activities, and many can often return to work.
She noted that the patients who do the best in recovery and rehabilitation are those who have a good support system. "Establishing a support system is key for those who've had strokes," she added. "They need to know that even if they're different, they're still loved and they're still supported."