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Publication Date: Friday, May 11, 2001
(May 11, 2001) With delays in treatment still common and minimal education efforts in place, stroke remains the leading cause of disability in the United States
By Diana Reynolds Roome
When Laura Oku felt dizzy in the supermarket one morning, she didn't pay much heed. She was more concerned about making sure her elderly mother held firm to her shopping cart. Instead, her mother pushed the cart towards her and said, "I think you need this more than I do."
It was true. Oku's legs were wobbly, and driving back to her Mountain View home, she narrowly missed the center divide. Later, when she started to slice sausage for lunch, it kept slipping from her grasp.
Her son asked if she was playing games, but then wondered out loud if she was having a stroke. Now Oku thought he was joking. Though she felt terrible, she assumed it was a reaction to a root canal operation she'd had the day before, or to the antibiotics she was taking. Consequently, it was several days before she went to a doctor, and almost a week before CAT and MRI scans at El Camino Hospital confirmed that she had indeed had a stroke.
Had Oku known the warning signs, she would have wasted no time in getting to the emergency room. Instead her husband David gave her aspirin, which happened to be the right thing for ischemic stroke like hers (the commonest kind). But aspirin was not enough. By next day Oku's left hand was barely functioning and she had to drag her foot up the stairs. Her speech was so slurred that she sounded drugged. It was only when she started seeing two Davids that they decided it was time to get treatment.
Stroke is the leading cause of disability in the United States. Its effects range from paralysis to difficulties speaking, remembering and organizing simple tasks. It's also the third leading cause of death (19,000 every year in California alone). Over four million people nationwide are coping with the physical, emotional and financial devastation stroke brings.
Until recently, there were no known remedies. Recovery depended on the severity of the stroke, access to therapy, determination, and a large dash of luck. But today, for anyone at risk for stroke, Santa Clara County is now one of the best places to live. The area is one of 24 sites targeted by the American Stroke Association (a division of the American Heart Association) to improve recognition of stroke by both the general public and the medical community, and encourage fast action in treating it.
"Stroke is now preventable," says Dr Greg Albers, chairman of ASA's Operation Stroke, Santa Clara, and director of the Stroke Center at Stanford Hospital, a pioneer in stroke treatment. For a malady that had no known remedies and was often considered an act of God or even the fairies, this is an immense advance. "Yet,"adds Albers, "very few people are receiving appropriate emergency therapy in time."
The reasons are mostly to do with education - or lack of it. In 1996 a powerful clot-busting drug, reserved in the past for heart attack, was approved by the FDA for use with most stroke patients. Tissue plasminogen activator (tPA) can reverse the paralyzing and sometimes fatal effects of stroke. To be effective, it must be administered within the three-hour window of the onset of symptoms. Because most people do not recognize the signs of stroke, they fail to reach the emergency room in time to benefit from the drug. So despite the dramatic success of the treatment, fewer than 5 percent of people who come in to the hospital with stroke symptoms currently receive it.
"Signs of stroke are often ignored," says Anne Jacobs, PhD, PT, the executive director of the Peninsula Stroke Association, an organization that offers education about stroke prevention, as well as support and for stroke survivors and caregivers. "Our aim is that everyone should recognize stroke as readily as they recognize heart attack."
Stroke symptoms include sudden numbness, weakness or tingling, especially on one side of the body, severe headache, blurred vision, loss of balance or dizziness, and unusual confusion or trouble speaking. A recent study from the American Heart Association found that barely half the respondents could recognize even one symptom. By contrast, 80 percent knew the signals of heart attack.
Patients, family or colleagues can misinterpret warning signs, which often mimic other conditions such as migraine, eye trouble, muscle strain, or stress. Recognition of stroke symptoms can be difficult, and even physicians do not always agree. Precious time can be wasted in doctors' offices or even emergency rooms when staff do not understand that "time is brain."
Dr. Chien-Ye Liu, staff neurologist at El Camino Hospital advises anyone who thinks he or she may be experiencing signs of stroke to call 911 and get to the emergency room as quickly as possible.
"If in doubt, seek medical evaluation without delay," says Liu. "It's critical to get to the hospital in time." In deciding whether a person might be having a stroke, he says the critical signs to look out for are "any sort of deficit on half the body and not the other half. If you've had weakness in a leg for 15 years and one evening it feels worse, that's probably not a stroke."
One the other hand, even if symptoms last for a very short time, it is still important not to ignore them, says Jacobs, as they could indicate a transient ischemic attack or mini-stroke. According to the ASA, often the patient seems normal by the time he or she is seen by the physician. But recent research shows that a full-blown stroke follows more than 12 percent of TIAs within a year, sometimes much sooner.
Though risks increase with age, stroke can happen to healthy people at any age. The ASA is extending the messages of prevention and fast action to local companies, while the PSA regularly holds talks at community and senior centers. Jacobs would like to get the message through in schools, too.
"It could be a child or grandchild who recognizes the symptoms and calls 911," she says. "Not just the elderly are at risk. Stroke can happen at any age, and whatever the age, it profoundly impacts whole families."
Monthly PSA meetings at the Veterans Administration Hospital in Palo Alto provide support for those recovering from stroke, their families and caregivers, as well as education on the latest research, ways to cope with immobility, aphasia, loss of work and social life. For Oku, such support, as well as therapy, and constant mental and physical effort have helped her regain much of her former life.
"I exercise, sew, knit, arrange flowers, do math problems," says Oku. "I won't let a moment go by without doing something." Recently she went on her first vacation since her stroke two years ago and managed to walk two miles on the island of Oahu. She is determined to return to jogging, tennis and skiing.
Like many who have experienced stroke, she has banished the word "can't" from her vocabulary. But even better than making a great recovery from stroke is preventing it from happening in the first place. Learning and heeding the warning signs is the first step.
For more information on stroke and upcoming events, call the Peninsula Stroke Association at (650) 565-8485 or visit the organization's Web site, www.psastroke.org.