<p>This was sent to me via email. We’re all of that age now, not just for our parents but for ourselves, spouses and friends:</p>
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<p>Thanks so much for posting this, Wyogal. I find it really interesting because a couple of weeks ago I was talking to my 79 year old mother who lives in Florida on the phone (I’m in CA) and she didn’t sound quite right. Nothing really obvious, she was just kind of groggy and she said she felt a little out of it. She insisted she was O.K. but I called my brother who lives nearby my mother to ask him to drive over to see if she was O.K. because I was afraid she might have had a stroke. My brother called her and called me back saying he thought she sounded O.K. But when they got together for Thanksgiving, my sister noticed that my mother’s mouth seemed to droop on one side. So I do think that she might have had a small stroke so now I understand the reason for asking the individual to smile.</p>
<p>Thanks again for posting this…it’s something we all should know.</p>
<p>Great post. However, even the best doctors/surgeons in the world cannot reverse the effects of all strokes, particularily Hemorrhagic
strokes.</p>
<p>This is a very valuable post. My mother suffered a devastating stroke in 1992, robbing a vibrant 74 year old of speech and any movement on her right side. I am not sure that there is any more tragic life, than life after a stroke that is so severe that no recovery is possible. My mom lived another 9 years, but never spoke another word (other than hoarse “yes” or “no”), and never was able to stand or walk again. The grief still washes over me at times.</p>
<p>The truly horrible thing is that in retrospect, she had had two episodes that were probably small strokes, that we chalked up to food poisoning or stomach flu. Another little known symptom of stroke is nausea and vomiting, which is what had happened to my mom. If only, if only, we had known that, we could possibly have gotten her surgery and help before the horrible event that changed her life, and all of ours. </p>
<p>I am so sorry for your friend and his loss.</p>
<p>cheers makes an important point. There are 2 main different types of strokes, and a huge range of severity, from barely noticeable to total paralysis and death. I have become an instant expert since my mother had a stroke 2 weeks ago. She was very fortunate in that she recognized that she had a stroke and went to a hospital and received treatment within that all-important 3 hour time period. Stroke victims can be given the drug t-PA which dissolves the blood clot which caused the stroke. It is critical that the drug be administered within 3 hours of the stroke, so from the post above - recognizing the symptoms and getting treatment promptly are extremely important and worth mentioning. I am not sure I can totally accept the claim that "if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke…totally. " My morther is in rehab and doing very well.</p>
<p>Here is an explanation from another website:
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<p>patient, I would like to extend the knowing hand of sympathy to you and your family. I have had precisely the same experience with my mother as you have, except her debilitating stroke occured in 1990 and she is still alive, although with essentially no functions she can control and nothing I would consider “quality of life”. She has been able to silently watch her grandsons grow up, but also never spoke or walked again. She, too, had TIAs that could have been recognized and possibly treated had we only known. I miss her every day.</p>
<p>Thank you for the reminders, wyogal and everyone. Stroke can change so much so fast, and comes close to so many of us.</p>
<p>This is so important!!!</p>
<p>I was going to jump in, and say that there was a little hyperbole about totally reversing the effects, but the general concept is very true, and the diagnostic actions are easy to remember - want to add a couple of thoughts.</p>
<p>With busy, overworked ERs, it is very difficult to meet that narrow time window on the hospital’s end, those accompanying the victim should make it clear that we think he’s having a stroke - because often the patient will poo-poo the symptoms, and the symptoms can be vague and non-specific - not as dramatica as chest pain.</p>
<p>As someone else said the other big category of stroke is hemorraghic stroke, which is not treated by blood thinners, but by drugs that reduce vasospasm, and possibly surgery. This is the disease that often kills 20 year olds in their sleep, as well as older people with untreated hypertension. The measures here are first, have your blood pressure checked regularly. Then if someone complains of headache, particularly if the person rarely has headaches, ask them if “Is this the worst headache you’ve ever had?” - if the answer is yes, they need to be seen by a doctor, preferably someone conversant with neurology and headache. Many people with aneurysms have sentinel bleeds - tiny leaks from the swollen vessel - if they can be diagnosed and can have surgery, devastating consequences can be avoided. My Dad had this - a changed man at 54, I was worried about aneurysm, but didn’t insist that he be seen, he was eventually seen, but the neurosurgeon was reluctant to do an angiogram (which in those days had a real risk of mortality), and so he had the big bleed, spent 5 months in the neuro ICU, and was never the same again. Now they can be diagnosed often on MRI, and the more invasive angiogram done to prepare for surgery.</p>
<p>Ach, this is bringing back many sad memories, and thoughts of “If only we’d known”…but if it can save someone else, that will be good. Mootmom, my heart goes out to you too. It is heartbreakingly sad to watch someone who in many ways still knows what is going on, but cannot express it to the world. </p>
<p>There was an article by Oliver Sacks in the The New Yorker in the last couple of months, about a woman with a similarly impairing stroke and how she has managed to function. I’ve tried searching online and will continue to try to find the link–it may give some help.</p>
<p>At the time my mom had her stroke, she was living nearby but my dad was out of town on business, planning to return on Friday evening. I spoke to her at 8:30 on a Thursday night and she was in great spirits. The police called from her apartment the next afternoon around 3 p.m. to report that she had been found by the housekeeper when she came to do the weekly cleaning. She was way outside the 3 hour window at that point (at that time the treatment was experimental but was being given to appropriate patients at the hospital where she was taken), although I am not sure that we ever knew what time she had suffered the stroke. I guess that is a testament to the idea that people should not live alone, because it was clearly an overwhelming event that left her unable to call for help. Perhaps an emergency lifeline device might have helped. All questions for those with elderly parents.</p>
<p>many communities now have designated “stroke centers” with a much higher level of imaging and neuro capabilities. (same principle as having a regional trauma center). Find out if that’s the case in your own community. Going to the “wrong” hospital ED and having to get transferred will eat up as much as 2 hours.</p>
<p>The original story is meant to be illustrative and was probably written by a non-medical person. The Ingrid in the story would not have been given tPA based on a stumble. There is a real risk of death or hemorrhagic stroke from tPA itself, so it is only given when symptoms are severe and do not appear to be improving. Ingrid would not have been a candidate. Now, she might have been admitted for a TIA (ministroke) work-up if she had gone to the ED immediately after the stumble. That would have had the advantage of the second, apparently massive stroke occuring while she was at a medical facility. But still, it starts to get conjectural to assume she would have been fine.</p>
<p>My mother had a stroke last December. Thankfully, she is up and about daily, doing great. Being a single mom of one son, I moved back in with her, (I am her only child). I never really thought about the effect that strokes have on families until it happened to me. Good Advice, OP.</p>
<p>Quo</p>
<p>In 2005, my FIL was a board meeting when the right side of his face fell. He was immediately taken to a hospital with exprienced neurosurgeons where he had four hours of neurosurgery and all the drugs. They saved his life but the damage was huge.</p>
<p>He can say a few things and has limited mobility. He is a shadow of his former self. We miss him terribly. Funny how that routine “Hello!” over the phone becomes a treasured memory when it’s gone.</p>
<p>A further warning to men out there…my FIL was super fit and lean at 65 but he had high blood pressure. He decided against the most potent medications because they cause impotence.</p>
<p>It was too high a price to pay…</p>
<p>I have to agree with some of the above…being a neuro nurse, not all strokes are reversible, no matter the time frame involved. Hemorrhagic strokes and people with extensive other medical issues may not be good candidates for interventions. hemorrhagic strokes are a completely different story, since some can be operated on and some cannot. for embolic strokes, patient’s must meet criteria for receiving those interventions, and if they are taking certain drugs, such as aspirin, coumadin, other blood thinners they might not be able to receive the tpa. also a thrombus in another area such as the heart would preclude them receiving this measure. but the topic is great to bring up, because there ARE strokes that can be intervened on and reversed if they are within that 3 hour time frame. Hospitals that are accredited by JCAHO must adhere to those time frames of getting a CT of the head within an hour of arrival if a stroke is the diagnosis, and proper usage of tpa or other thrombolytics within 3 hours if indicated. another problem though is that initial ct of the head usually does not show the stroke, it typically takes a follow up ct in 24 hours to show the damage. you need an experienced neurologist to take the lead, which is why many hospitals have stroke alerts now. It is crucially important when you feel somebody is having a stroke, (or heart attack), to get them to the hospital asap, and make a lot of noise to get these things done quickly if the hospital is not moving quickly enough. time is muscle and brain, be it the heart or the head.</p>
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<p>This isn’t quite right. JCAHO is the accreditation agency for all hospitals, even the ones that have no chance at all of getting a CT within an hour (even if a hospital is accredited, the tech or the radiologist may have to come in from home. Or the hospital may not even have a scanner). That’s why it is important to go to the right hospital in your community, not just the nearest or most familiar one. The best thing is just to call EMS. They will know which hospital(s) have stroke capabilities, and will also ensure that the patient doesn’t waste time in triage or registration.</p>
<p>Thanks all, for the comments. I do want to make clear that this story is not my personal experience, but was emailed to me from a friend. I do have a friend, though, who suffered a stroke at age 35, and want to add that the younger the victim the more they will protest and the more important it is to insist they be evaluated.</p>
<p>I agree that there is never any guarantee for any treatment, and that there are big differences between bleeding and clot - caused strokes. But I think the important part is the urgency.</p>
<p>The other thing about treatments like TPA is that long-term studies are rarely done to show efficacy, nor are they done when the administration of the drug was outside of guidelines. My husband had a heart attack at age 41, and there was unacceptable delay at the hospital. They administered TPA anyway at 8+ hours from onset. He is now 55 and tests almost completely normal. The point is the same–no guarantees, but you never know, you might be lucky.</p>
<p>Good point about the fitness of the patient. My mom was tiny/thin–weighed at most 100 pounds, and at 74 was still “running” around her very large apartment complex, swimming a little, and exercising at home. But, she (and I) have a hereditary predisposition toward high cholesterol, and she started taking statins way too late in life (in fact, not too long before the stroke). I will start much earlier. But one risk factor is enough to cause a horrific event. Watch your cholesterol count and all the LDL/HDL measures.</p>
<p>the worst thing you can have is regrets. be it strokes or heart attacks or anything else. my brother, my mother and I are nurses. when my father was brought into our very large, level 1 trauma center a few months ago where we have stroke and MI alert protocols, nobody called one on my father. He had been very sick, but was improving and was in no way ready to “pack it in” as he said in a moment of lucidity. we asked and asked where is the neurologist, where is the stroke alert. we heard one called and thought it was for my dad. we were wrong. nobody listened to us, and nothing was done for my father except to let him die, because 3 years previous he had been very ill. I should have gone out in the middle of the emergency room and screamed, called doctors on my own, made a huge fuss. but I maintained myself because this is my place of employment, we expected people to do their jobs appropriately as we do, we trusted our colleagues. I don’t know if tpa could have helped my dad, or if he still would have died because his stroke was big and bad, (but did not show up on the first ct scan, I only had my experience as a neuro nurse to point out that he was inappropriate, had neglect on his one side, wasn’t moving his arm properly, but I’m just a nurse). but I will never know, and we were not given the chance to make a choice. that is the worst part. so that is my advice. yes, get to the right hospital, but speak up, speak up loud, yell and scream, call supervisors and doctors directly if nobody listens. trust nobody. my dad is now gone and I don’t know if he should be.</p>
<p>amith - I am so sorry for the loss of your father. Please try not to second guess either yourself or the medical staff where you work. I have worked in an emergency room for the past 20+ years, including all of the years since tPA was introduced. There are so many contra-indications to tPA that it is actually rarely given. The strokes that can be helped with surgery are also very limited. Everything is rush, rush when a stroke patient arrives. But as soon as it is established that the patient is not a candidate for tPA or surgery, everything just slows down because it is going to be a matter of simply waiting and hoping for the best, not treating. The neurologist does not usually come in urgently at that point, at least at the hospitals where I have worked (stroke patients are admitted to internists and the neurologists consult). Something like that may have happened with your dad.</p>
<p>thanks texas 137, that is the most consolation I have gotten thus far regarding my questioning of stroke protocols and why we were given no options. as my brother says though, to question why a stroke alert wasn’t called on my dad might prevent the same error with a 45 year old who could benefit. my dad’s words haunt me, “I’m not ready to pack it in”. He said that once before when he had fungemia, SMA clot and an open belly. he recovered and had a huge garden, back to hunting and fishing, driving, driving my mom nuts. as a neuro nurse, I know he probably had no chance from this stroke, large mca, but as his daughter I just know protocols weren’t followed, and no options given. It makes me sad that I work here now, knowing they did not do their jobs.</p>
<p>Oh Amith, my heart aches for you - because I have a similar story with my Dad - I was a resident and 800 miles away at the time, but if I had just insisted that he have an angiogram with possible surgery. But, but, but - in those days angiograms had an appreciable mortality risk for a diagnostic test, and then he could have died from the surgery - too many what ifs.</p>
<p>I’m not sure non-medical people understand all the problems with medical folks being the “family” or the “patient” - I feel for you.</p>
<p>I’m grateful for a couple of posts from Amith (#12) and MootMom (#6). I lost my Dad earlier this year to what was, in essence, a stroke caused by bleeding on the brain…sounds like the hemorrhagic stroke…caused by a fall in the bathroom at our home. At the time he said he was fine and symptoms didn’t show up until three days later…when he was back at our place and started losing track of nouns, had to point at items on lunch menu. </p>
<p>He was diabetic, on coumadin, and other stuff, and was generally a mess. I’m so glad that my sister in-law and her mother brought him back up from San Diego instead of just putting him on a train for his home the next county north…who knows when he might have been discovered, by who, in what condition, where, etc. and what kind of treatment he received.</p>
<p>Unfortunately, the symptoms had been accumulating for days while he was down in San Diego but nobody realized them and even after he was having the speech problem nobody immediately thought stroke. His speech wasn’t slurred but just…odd. E.g., he couldn’t summon the word “charger” for his cell phone but “reinforcer” instead.</p>
<p>It was only a couple of hours later when talking to my Mom (they were divorced) that I called the paramedics and they took him to UCLA/Santa Monica hospital and after four hours in the ER there…that’s when X-rays showed the bleeding on the brain…they transferred him to UCLA. </p>
<p>He seemed “fine”, all things considered, but it took nearly 24 hours for an ICU bed in one of the two neurological wards to open up. They put him into a chemically induced coma when the monitors showed he was having a series of seizures. Apparently at least one of the seizures was very bad, based on ensuing read-outs. </p>
<p>The doctor told us that we could hang on and try to “save” him but, under questioning, he said that my Dad would never participate in a meaningful conversation again. The three of us–me and his two biological kids–deciding to “pull the plug” on the ventilator was one of the hardest things I’ve ever had to do. At least we were all of one mind, thank God.</p>
<p>In some ways I wonder if my Dad’s body was doing him a favor by his lights. The reason he was going down to San Diego was that he was checking out an assisted living facility with my brother and I think in heart of hearts he just absolutely hated…not just disliked, but hated…the very thought of losing his independence. He was cantankerous, stubborn, and irrascible…and he took horrid care of himself: diet, blood pressure, the whole megillah. We laughed later when we found that while filling out the preliminary paperwork at the assisted living facility he had checked the box for “Good” health, despite the fact that he needed a wheel chair to finish the tour. But we knew that he had increasing difficulties living alone, everything from washing dishes to paying bills to the dents accumulating in the car…if we knew just how bad his driving had become, we’d have had his license yanked.</p>
<p>Amith, thank you for the medical detail and MootMom thank you for showing me the scenario that likely would have played out at best if we had tried to “save” him.</p>
<p>And sympathies back to all of you who have experienced losses due to stroke/bleeding. We all have to go some time, some how, but this would not be high on my list. Though at least it was fast and it possibly saved my Dad from eventually becoming a dialysis patient…his kidney function was down to 29 percent. </p>
<p>I think I need to get back to doing my morning walks.</p>