Search for tag: "stroke"

Interviewer: We all know that a stroke is a serious and potentially life-threatening situation, but it might surprise you that it impacts women more than men. According to the CDC, stroke is the fifth leading cause of death for women in the U.S., and as many as one in five women between the ages of 55 and 75 will have a stroke.

To help us better understand why women face an increased risk of stroke, were joined by Dr. Jana Wold, an associate professor of neurology and a stroke specialist at University of Utah Health.

Dr. Wold, let's start out with why are women at more risk of stroke than men?

Dr. Wold: So the best way to understand it is because women live longer than men and because stroke risk increases with age. So because we have a larger proportion of the population in this older age group, the greater-than-85-years-old age group that are women, and also that's when your stroke risk really ramps up, overall more women have strokes than men.

Interviewer: So I'm hearing that more older women might have strokes than men. What about younger women?

Dr. Wold: Unfortunately, there is a risk of stroke in pregnancy. So, at a younger age, there also is a brief period of time when women are of childbearing age that their stroke risk could be higher than some men.

Interviewer: Yeah. And that is very unique, childbearing, to women obviously. What are some other risk factors that are very unique to women versus men?

Dr. Wold: Yeah. So women take oral contraceptives. Not all women, but some women do. And those medications, unfortunately, do carry a small risk of stroke. So in the wide scheme of things, it's a very small risk.

And women who take oral contraceptives tend to be women younger than the age of 50, so their overall risk of stroke is low, but if you are taking oral contraceptives, that can double your stroke risk. And if you are smoking while you are taking your oral contraceptives, that can dramatically increase your stroke risk.

Also, in speaking of oral contraceptives, oral contraceptives should not be given to women who have migraine with aura because that also increases your stroke risk, because migraine with aura independently increases your stroke risk.

Hormone replacement therapy. So if you are taking hormone replacement therapy for a long period of time, this also can increase your risk of stroke. There was a time many years ago when we thought maybe taking hormone replacement could actually decrease your risk of stroke, and that is not true.

The other important thing that I haven't mentioned yet — atrial fibrillation. So atrial fibrillation carries a high risk of stroke. It is uncommon in the younger population, but as you age, your risk for atrial fibrillation increases. And it's actually riskier for women to have atrial fibrillation than it is for men when you consider their stroke risk. So atrial fibrillation, you can be screened for this in your doctor's office when you are above the age of 75.

Interviewer: So if a woman's listening and she recognized some of these increased risk factors, does that mean that perhaps hormone therapy is not a great idea, birth control is not a great idea? How can a woman weigh the risk versus the benefits of those things?

Dr. Wold: Yes, absolutely. So this is where your primary care doctor comes into play. Everyone should have a primary care doctor whether or not you're a woman or a man, and you need to discuss this with your primary care doctor.

So, for example, if you are a young woman and you're considering going on oral contraceptives, you need to make sure that your physician is aware if you suffer from migraine with aura or if you are a current smoker or if you have high blood pressure. So you need to be in good communication with your primary care physician to make sure that they are also considering your overall risk of stroke.

When it comes to hormone replacement therapy, again, I would have a conversation with your primary care physician or whichever physician would be prescribing this treatment for you. And you would just need to understand the risks and the benefits, because it's going to be different for different women.

Interviewer: And I understand that women sometimes don't experience the standard stroke symptoms. What are those standard symptoms?

Dr. Wold: Yeah. So the standard stroke symptoms, the way we like to remember them is an acronym known as FAST. This stands for face, arm, speech, time.

Face is for that facial asymmetry that you were speaking of before. So if your face is droopy on one side, that can be a symptom of stroke.

Also, if you have one arm that is weak, that can be a symptom of stroke.

And then if you have a change in your speech, that can be a symptom of stroke as well.

The T is for time, because if you notice any of those symptoms, you need to immediately call 911 and go to the emergency room to be evaluated.

Interviewer: And those standard symptoms, those aren't necessarily always the way women experience stroke symptoms. Can you expand on that?

Dr. Wold: Not necessarily. There are some studies showing that women are more likely to have atypical symptoms of stroke, but it's not clearly defined what those would be. So, overall, I would say when you experience any sort of acute change in your vision or your speech or your strength or your walking, that's when you need to consider stroke.

Interviewer: And are there other risk factors that women would want to keep in mind?

Dr. Wold: I would just consider changes in those areas. And a lot of women, also men, like to call their neighbor, call their son, call their daughter. I would encourage you to call 911 when you notice those symptoms.

Interviewer: Right. Because the tricky thing about stroke is it can kind of trick you, can't it?

Dr. Wold: It can. And the medications that we can provide in the emergency room, there's one medication and it's time sensitive, so you need to get to the emergency room very quickly.

Interviewer: Dr. Wold, in your experience, what are some of the misconceptions that you find that people have when it comes to women and stroke?

Dr. Wold: I think a misconception can be that there's nothing that you can do about your risk for stroke, and because the risk of stroke increases as you age, that it sort of is just inevitable, and that once you have a stroke, then you need to try to prevent the second one. But we as stroke physicians would certainly like people to be interested in preventing that first stroke, which you certainly can do.

Interviewer: If there's a woman listening and she might be worried now about her risk of stroke, what takeaway message would you give to them?

Dr. Wold: The takeaway message would be to know what your independent risk is for stroke, and so to consider if you have high blood pressure. If you have high blood pressure, you need to be under the care of a physician. You need to have it properly treated. And if you are a smoker, you should consider stopping smoking.

The other thing that you can do as far as lifestyle measures are concerned is to exercise regularly, and we mean cardiovascular exercise, and also keep a healthy diet that is high in fruits and vegetables.

Interviewer: For patients that have survived a stroke, there could be some worry that they might be at risk for a second stroke.

Dr. Steven Edgley is the Director of Stroke Rehabilitation at University of Utah Health. Dr. Edgley, what can people who have suffered a stroke do to minimize their chances of having another one?

Dr. Edgley: The most robust way to prevent another stroke or heart disease is to control hypertension. If we put these three things into three buckets, controlling hypertension, its own bucket. It's so important. The second bucket is controlling things like cholesterol or diabetes or if you have AFib, which is an abnormal heart rhythm. So these are other medical factors that lead to an increased risk of stroke and heart disease. And so I mentioned three, the three major factors, but everyone should go to their own and primary care physician to outline and identify their personal risk factors.

The third bucket is lifestyle factors. And we can break those into diet, exercise, and what I would call avoidance of smoking, drugs, controlling your alcohol intake, things like that. So lifestyle factors, away from the doctor's office, things that you would do at home.

Interviewer: How do you best control hypertension? Let's go back to that first bucket. Is that diet and exercise? Is that usually some sort of medication?

Dr. Edgley: Both. Usually, medication works best. But diet and exercise play a role in controlling high blood pressure.

Interviewer: Generally, does a stroke, a person who's had their first stroke, do they have the hypertension that would more likely need medications to control as opposed to lifestyle?

Dr. Edgley: Both are truly important. So, certainly, if you have had a stroke due to hypertension, you need to be on some medication for that.

Interviewer: And then the second bucket, cholesterol, diabetes, AFib, or other medical factors you'd be discussing with your primary care physician. Again, is that medication generally to help control those things, or we do know that diet and exercise, again, can control those factors as well?

Dr. Edgley: Yes. So I'm talking about going to your primary care physician and getting on the appropriate medications. And I think of that third bucket, so it does influence a lot of risk factors. But I think of it as its own bucket, diet, exercise, and avoidance of harmful behaviors and substances.

Interviewer: So when we get to that third bucket with lifestyle behaviors, is it more difficult for somebody who's had a stroke to manage and control their diet and exercise? Is that a little bit more of a challenge?

Dr. Edgley: It is. They may have physical impairments that make exercise really difficult. And they may have physical mobility issues that make activity more difficult and leading to the problem of obesity. And so every one of us is on either an upward spiral or a downward spiral. And it's very, very important to, if you are on a downward spiral, to break that cycle. And a downward spiral means, you know, inactivity, leads to overweight, leads to poor muscle strength, leads to more inactivity and down and down we go. And patients can break that cycle, but it's got to be a conscious choice and an active choice.

Interviewer: So in a lot of ways, what you do, which is help stroke survivors with physical rehabilitation, is really important in breaking that downward spiral. I mean, I can speak from my experience, as somebody who has not had a stroke, I know it all comes out of exercise for me. If I'm exercising, then I tend to eat better. I tend to sleep better. I tend to do all those things. And I don't know if that's the case for everybody, but I would imagine that that physical activity component is pretty important.

Dr. Edgley: Yes. And that's true. And what we really try to do, we can't be everywhere for everyone, but we can set them out on a positive course. And so the most important thing is to be on the right uphill track and not a downward track.

Interviewer: Harnessing the power of physical therapy for stroke recovery, Dr. Steven Edgley is the stroke rehabilitation medical director at University of Utah Health.

Dr. Edgley, just first off, what is the importance of physical therapy for stroke recovery?

Dr. Edgley: The reason why physical therapy is so important, and walking specifically, is that physical therapy will facilitate better walking. Better walking will facilitate better function in the home and the community, and better function will facilitate a better quality of life. And that's what we're really after. It's very important to the individual patient to regain walking and moving around capabilities.

Interviewer: Dr. Edgley, in the past few years, from what I understand, the technology or the ways that you help people recovering from a stroke start to walk again has actually changed quite a bit and improved. Tell me more about that.

Dr. Edgley: Over 15 years ago, so many stroke patients did not get the therapy they needed because it was too labor-intensive. Now we are able to use advanced techniques like bodyweight-supported harnesses.

Interviewer: Tell me what that harness does.

Dr. Edgley: Early on in the recovery process, we used to use three and four therapists. Now we can use one, maybe two therapists with the bodyweight-supported training.

We actually have in the new Neilsen Rehab Hospital have the longest what's called the ZeroG track in the world. Also possible is unweighting the body through using a pool therapy, and we now have a treadmill on the bottom of a pool that partially unweights the body. And that is actually going along with the same concept of partially unweighting of the body for increased reps and practice.

Interviewer: What I'm hearing is walking is just that important. That should be your goal, just to get out and do it. It might not necessarily be pretty at first. You've just got to go through the motions. And if you go through the motions, it will get better and your recovery will get better. Is that a fair assessment?

Dr. Edgley: To be able to effectively walk, you typically need to compile a lot of repetitions. And typically, starting from square zero, a lot of people don't really get out of bed and stay in bed for months to years. And so we find it's critically important to ambulate early and often use these advanced techniques to help in the process.

Interviewer: Dr. Edgley, if an individual recovering from a stroke doesn't have access to a ZeroG track or the treadmill that's underwater like you talked about to help them get in those reps necessary for regaining their ability to walk, what would you recommend for that individual?

Dr. Edgley: Everyone should have access to a physical therapy gym or location. Encourage your therapists to actually walk with you. And it may be that you have to have four hands on deck to fully walk safely at first, but that is what it sometimes takes.

Interviewer: I feel like if there is just one thing that somebody should take away from this is just if you've had a stroke, you've just got to start walking and figure out how to make that happen. And if you have access to great technology like the ZeroG track at University of Utah Health . . . and by all means, if you can take advantage of that, great. If not, have those people help you walk on the treadmill that has the sidebars. You've just got to get those legs moving to get that brain muscle reconnection going again and those repetitions. That's what really matters.

Do you have a story that illustrates just how important walking is, getting those repetitions in is, to stroke recovery?

Dr. Edgley: I'm thinking of one young stroke patient who was despondent and discouraged, so discouraged that she really did not walk and put forward the effort that is necessary for recovery. And that went on for months. Couple of years actually.

And when she started to be more receptive to these therapy techniques, her whole life changed as she began to be more able to walk, more able to get outdoors, and more socially active. And now she is married and chasing a toddler around. So it can have very, very wide-ranging impacts.

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Scot: Many people take fish oil for a lot of different reasons. Some of the benefits, well, there's a lot of mays in front of these benefits. May support heart health, may help treat certain medical conditions, may aid in weight loss and the list goes on and on. However, we might be able to take the may off of one of those. Dr. Tom Miller is an internal medicine doctor here at University of Utah Health.

What might we possibly be able to remove the may from, as to what fish oil helps with?

Dr. Miller: Well, it's interesting. Let's start with a little bit of history. Some time ago, probably back in the '60s, maybe '50s, we understood that the native population up above the Arctic Circle, Innuits had low rates of heart disease, and it was postulated that perhaps their high diet in fish contributed to this.

Now, Arctic fish have high levels of omega-3. The idea was that if you took omega-3s, you might have less heart disease, lower incidents of stroke. This went on for a number of years, in fact a couple of decades, and it was never really very clear whether omega-3 supplements actually made a difference.

But in the last year there have been a couple of landmark studies that have employed the large number of patients required to sort this out. And it does appear for people who have high triglyceride levels and have some type of event, like heart attacks or they have coronary artery disease or they might have had a stroke, that omega-3s supplemented to their diet will prevent and lower the risk of a second event.

The exact number that they came out with in this trial is 25% reduction if you were to take four grams a day. Now that's a higher dose than most people take. Most people take one to two grams a day as a supplement. I think what needs to be determined going forward is what would be the adequate dose for those who have had an event versus those who've never had that event. Should they just take a one gram, standard daily dose, or should it be more? We don't quite know that yet.

And then, secondly, there seems to be less evidence that's it beneficial in people who have never had an event.

So it does appear for the first time that we have some pretty reliable evidence, especially in people who have had cardiovascular events and high triglycerides, that the addition of omega-3 to the diet can lower the risk of a second event.

Scot: If they take a four gram dose. Dosage is important. That was the question.

Dr. Miller: That was the study that was done on four grams. Is that the optimal dose? I don't think we know just yet, but at least we have signposts that tell us that this is going to be beneficial.

Scot: Is this something you should talk to your physician about, or if you know that you fall into this category, should you just go ahead and start taking a four gram dose?

Dr. Miller: I think it would be wise to talk to your physician, because you also want to have the rest of your metabolic profile tuned up. So you want to make sure your other cholesterol subgroups are taken care of. And that's why people are on statins for preventing secondary events of coronary disease. And then, if you high triglycerides, which statins don't treat, then it might be wise for you to start omega-3.

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Announcer: Is it bad enough to go to the emergency room or isn't it? You are listening to "ER or Not" on The Scope.

Interviewer: All right. It's time to play along. Dr. Troy Madsen is going to give us the answer to our scenario here today of whether or not you should go into the ER for this particular condition or situation. Today, dizziness. So once again, not caused by anything else, just seemingly out of nowhere, all of a sudden I feel pretty dizzy. I have to sit down, ER or not?

Dr. Madsen: So this one depends a lot on how high a risk you have for a stroke and this is what I think about with dizziness. So young person, otherwise healthy, they feel dizzy, probably not a big deal. If you're 65, you've got high blood pressure, high cholesterol, maybe you've had a previous heart attack or a previous stroke, someone like that comes in and says to me, "I just feel dizzy. I feel like the room is spinning. I can't walk in a straight line," I get really concerned about a stroke.

So there are some blood vessels that feed the brain, the back part of the brain. That's what controls your balance. So if you get a stroke there, people will often describe a feeling like the room is spinning, they say they can't walk in a straight line, they're falling to one side. So that's when I get really concerned and I say, "Well, let's get our neurologist down here right now. We may need to give you a clot busting medication to treat the stroke." So really it's a time dependent thing if you're in that category.

Interviewer: All right. And does that usually come with the other stroke symptoms, slurred speech, facial droop?

Dr. Madsen: Sometimes but sometimes not.

Interviewer: It can just come isolated?

Dr. Madsen: That's the tough part of it. I mean, typically, it will come with balance issues. That's the big thing we see, persons falling to one side or they just say they cannot walk in a straight line. But oftentimes with these types of strokes, they don't have a facial droop. They don't say, "My arm's weak." They don't say, "I'm having trouble speaking," because it's a different part of the brain. So that's why I get really concerned when I hear that, and that's why we kind of jump right on top of it in terms of getting them treatment if they're within that window where we can treat them.

Interviewer: If it's a younger healthier person that you don't believe that it's a stroke, then what do you tell them?

Dr. Madsen: So if someone comes in the ER and they say, "I feel dizzy," you know, we'll typically do some tests like an EKG to look at their heart. Certainly full physical exam, neurologic exam. Say, "Is anything else going on?" But quite often what this ends up being is what's called benign positional vertigo. So you've got like these canals in your ear that help you keep your balance and these little stones. And if one of these little stones gets out of place, it feels like the room is spinning and anyone who's been through this knows how miserable that feeling is.

You know, most cases it's going to go away after a week or so. We can give medication to kind of calm that sensation down and there are actually repositioning maneuvers you can do to try and get this little stone back in the right place. You know, it sounds kind of funny but it's . . . Yeah, it's one of the more common things we see in younger people, otherwise healthy people, who come in with this symptom.

Interviewer: And for that person, no immediate danger. Would they be able to just go to their regular physician to get some of these things that would offer them relief for that two-week period while they're recovering?

Dr. Madsen: Exactly. I think most of these cases, you know, if you're otherwise healthy you can probably wait, get in to see your doctor. One medication that can help in the short term is meclizine. It's an anti seasickness, anti motion sickness medication. It's kind of the non drowsy form of Dramamine. You'll see it right there next to Dramamine. I recommend taking it if you have that. It can help out with some of those symptoms.

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Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question on The Scope.

Interviewer: All right, it is time for our listener question. Today, the listener question is from Renee. Her dad just had a stroke and he's going through physical therapy, and she wants to be sure that she's doing the right things to help him recover. She understands how important physical therapy is and she wants to know what to do, how to help. So we brought in an expert, Randy Carson. He is a new neuro clinical specialist in physical therapy. What can she do to help her dad?

Randy: One of the first things that we talk to people about, families especially, is to actually take care of themselves because they definitely need to be in a position where they could be helpful. So after somebody's had a stroke, they may need help with things like walking around the house, getting in a bed, and doing things like that. And while they're in rehab with us, they're in good care. So this would be the time for them to do things like get their house in order, make sure they've got the time when their dad goes home so that they can actually be in a good position to be helpful.

We do a lot of training with families right before somebody goes home to show them really great body mechanics and things like that so they don't get injured, a lot of good safety things that we teach them about how to assist, in her case her father, so that he wouldn't have a fall or put himself in more harm's way, and definitely, a lot of education on prevention of secondary risk factors so that you don't end up back in the hospital too.

Interviewer: Yeah. That surprised me a little bit. I guess I didn't see that answer coming. I thought your answer is going to be more along the lines of, "While he's doing his exercises, you can do this, this, and this."

Randy: People make tremendous progress while they're in the hospital. So if they're involved a lot and really early on, for one, they usually burn out by the end of the stay if they're there three or four weeks, because that's a long time to be on you're A-game the whole time. And then, the other thing is they're overwhelmed because who they see on the first day in rehab is going to be dramatically different on the person that they take home.

So we don't do a lot of training in the beginning, because that's when they're at their worst. They might need a lot of lifting assistance, they might be a super high risk for fall, and that's the best time to let us take care of them and try to improve them to a point where they can be very manageable to take home.

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Dr. Majersik: Hi, I'm Dr. Jennifer Majersik. I'm a stroke neurologist at the University of Utah Health Care and the Director of the Stroke Center. My guest today is Dr. Alex Terrill. She's a rehabilitation psychologist in the Division of Occupational Therapy at the University of Utah Health Care. So, Alex, I've been very excited about this topic since I take care of stroke patients and when patients come in, I find we talk all about their high blood pressure and whether they're taking aspirin.

But actually, it's difficult for us to talk about the partnership between the two of them and I can see, although I'm not experienced to this, I can see that there's maybe difficulties between them, but I don't always know how to deal with that with the partners. What have you seen that are some of the problems that happen between couples?

Dr. Terrill: They follow and there are some different broader categories. I'm going to focus more on the psychology or emotion-based problems because that's my area of expertise. But one of the big changes for a certain are changes in mood. So post-stroke depression or apathy is extremely common. It occurs in about a third of stroke survivors. But it's also extremely common and some suggest that it's actually more common in caregivers, up to about 50% of caregivers who experienced depression after stroke. And so these changes in mood, they not only affect the individual but it's been shown that there's a reciprocal effect.

So it's very interconnected. When one person isn't doing well emotionally, the other person isn't doing as well either. And so, for example, if you have a caregiver who is depressed, they will have a harder time doing some of the caregiving, having hard taking care of themselves on their own needs and this can actually increase the likelihood that the person who had the stroke will be hospitalized.

Dr. Majersik: I've also seen data saying that the caregivers health themselves is compromised and I somewhat assume that this is because they stopped going to appointments for a breast cancer screening or to get their own cholesterol checked and they're not out socializing as much.

Dr. Terrill: Yes.

Dr. Majersik: Sometimes, I do talk to my patients' spouses about that. "Are you taking care of yourself?" because I worry and I can tell that they probably aren't.

Dr. Terrill: That's great, yeah. We see that all the time and it's something that the message that we are trying to spread is that, again, the caregiver kind of . . . everything focuses on the patient and, of course, they are too and they want to help. Sometimes they don't know what to do, but it's exhausting and they often neglect their own needs in terms of taking care of their health. Just socializing, getting some social support and we believe that that also contributes to depression is that their social circle shrinks because they're not able to get out or will not get out.

Dr. Majersik: So if a spouse is looking for more help in trying to understand his or her new role, where should they go? Should they go to the usual caregiving sources of support or is there something else that they should do?

Dr. Terrill: That's a good question and I think it's very individually based. I mean, certainly, getting resources for caregivers in general could help with some of the more general issues that come up. How do you find time to do some stress management or take care of yourself? And there are some resources out there. There are caregiver support groups specifically. But there's relatively little that's out there for stroke caregivers, per se, and one of the things that is unique or there are actually several things that are very unique to caregivers for stroke survivors that might not be the case in other things like old-timers or spinal cord injury, for example, along with maybe some physical changes that might happen after stroke.

You do have kind of that emotional piece, the emotional component, changes in cognitions. So the way that you're thinking changes the way that you communicate. And if you think about couples talking to each other, and if one of those partners in the couple isn't able to communicate effectively, how difficult that is. And that's a fairly unique thing, I would say, to partners of stroke survivors.

The other thing is that it does happen very suddenly and, often times, I would argue that practically no one is prepared for something like that when it does happen. And so you have that sudden transition to where you're taking on that role and whereas initially, you might have people rallying in helping you, social support at the hospital, once you're back out there, there's few and far between. Things drop off and it's good to know where to go.

Dr. Majersik: What are you doing now to try to help the situation? It sounds like an area that you're obviously very interested in and I'm hoping we're going to learn more in the next few years about how to help spouses and caregivers.

Dr. Terrill: Yes, so one of the things that I'm working on is actually creating an intervention that is done by both partners in the couple. And rather than just focusing on kind of educational pieces for a caregiver, which is something that's more traditionally done, we actually have them both participating in activities on their own and the activities that they do together. So we like for them to have that shared experience and we have them do positive psychology-based activity. So things like expressing gratitude, working on relationships, acts of kindness, savoring. I mean there are all kinds of things that they can work on. And it really kind of helps to give that structure to ways that they can interact and share some positive moments, make that time.

And that's something that we're hearing quite a bit is that after stroke happens, you kind of flail. You just survive and you want to help each other, but you don't know how and you stop interacting altogether. So and that's really a shame because your partner can be one of your biggest sources of strength and resilience and that's mutual, for both the person who have the stroke and the caregiver.

updated: July 29, 2020
originally published: January 20, 2016

Interviewer: Somebody you know or love is having a stroke, you need to call 9-1-1 immediately. We'll tell you exactly why, coming up next on The Scope.

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Interviewer: Dr. Jennifer Majersik is the director of the University of Utah Stroke Center and a stroke specialist. And this is the message that I hear you say all the time, "If you think you or somebody you know is having a stroke, call 9-1-1 immediately." Why is it so important that you call 9-1-1 so immediately?

Dr. Majersik: Yes, this is the heart of what I do is to try to get patients to understand just how important it is. In this country, there are about 800,000 strokes a year. And about 650,000 of them are ischemic strokes, maybe a few more, and only maybe 5% of them get acute treatment for stroke. The other 95% do not. And the vast majority do not because they do not get to the hospital fast enough. So we have two major types of treatment now that we can give quickly. One is intravenous, so via an IV, as it's usually called, it's a medicine called TPA and we can give that out to about three hours, sometimes four and a half hours.

Interviewer: And it makes a huge difference in the person's life afterwards.

Dr. Majersik: Yeah, it reduces disability, it makes patients walk again, talk again, go back to their lives, work, play, etc., all the things that are important. Some of the patients who are having a really severe stroke, so the kind that will land you in a nursing home if it doesn't get better or perhaps hurt you to the point of not surviving, those strokes we now have very effective treatment for as well.

2014 and '15 were landmark years for new trials that came out showing the efficacy, so the ability to work, for large-artery strokes, so these are the big ones. Nowadays we have physicians who are known as neuro-interventionalists and they can take a catheter and go into your leg and go on up to the brain and be able to pull clot out and, again, give you back that function so that the stroke is no longer affecting you like it was.

Interviewer: So it seems like a no-brainer, bad pun not intended but it just kind of came out. Why don't people call 9-1-1 after a stroke then?

Dr. Majersik: They are afraid. Some people think that the ambulance will come, will embarrass them. They don't want their neighbors knowing about it. To that fear, I usually say, "Call 9-1-1 anyway, it doesn't matter what the neighbors think, and if you're really that concerned, tell them to not run their sirens and nobody will know."

Interviewer: And this is stuff actual people have told you after they've come in for stroke that blows my mind.

Dr. Majersik: Absolutely people tell me that. Also, there's been studies on it, people-- we've asked, "Why didn't you call 9-1-1 or why wouldn't you call 9-1-1 in this situation?" And these are the kinds of things people tell us. So they're afraid of embarrassment. They're also afraid of being wrong, so what if I'm not actually having a stroke, I'm whatever, having a migraine or Bell's Palsy. And I think it's really hard as a layperson, and sometimes even as a physician, to sort those out. And so I don't think it's worth the risk. I think our lives are too important to be worrying about those kinds of fears. And I think we should do the best thing, which is to call 9-1-1 and get to the hospital and let the professionals sort it out.

And then the last thing. But it's just that people don't even recognize that they're having a stroke. Which we've talked about before, but again goes back to recognizing the signs and symptoms of a stroke.

Interviewer: And sometimes it's not like a heart attack where somebody grabs their head like, "Oh, I'm having a stroke," it's a very quiet thing with very subtle signs that I think all of us, as humans, should know because time is brain.

Dr. Majersik: Right. So the stroke patient doesn't call out, they don't say they're in pain, they just lose function. So the function that they lose could be vision, or it could be arm strength, or face strength, leg strength, sensory, or balance, or speech. I almost forgot speech, the most important one, perhaps.

Interviewer: And the acronym you use is FAST.

Dr. Majersik: Right, so we always use FAST. "F" for face, "A" for arm, "S" for speech. And so if the face is drooping, or the arm won't hold up when you ask someone to hold it up, or speech, if they can't make or understand speech. And all of these should start suddenly. These aren't signs or symptoms that come on slowly, they should come on over just a couple of minutes.

Interviewer: So of all the medical conditions, if you believe that you're having any sort of symptom of a stroke, don't go to the computer and Google and figure it out, don't waste any time whatsoever. The first, and only, thing you should do is dial 9-1-1. And what happens if the person's wrong?

Dr. Majersik: If the person's wrong, they'll come and find out they're having a migraine, perhaps, and hopefully they'll feel better and we'll send them home. Or maybe something else is going on, but I think it's still the most appropriate thing to do. We certainly, on the physician end or the nursing end, we're not upset that you came to the ER. We're not annoyed by extra patients. This is what we do every day and we really enjoy our job. And so whether someone's having a stroke, or if they're not having a stroke I have the joy of telling them, "You're going to be okay."

Interviewer: I guess, you know, we go to the ER for a broken arm, so the repercussions are a lot less worse than the potential repercussions of a stroke, so why would you hesitate?

Dr. Majersik: Right. Absolutely.

Interviewer: What's your takeaway? What's the final thought here?

Dr. Majersik: I think the final thought is that stroke used to be a field that we thought there were no treatments. And I think that still pervades in our communities, that if you're having a stroke just curl up and don't worry about it. But we actually have great treatments now. You just have to get to the hospital fast to receive them.

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Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Amy: From stretcher to skiing, for a podcast focusing on some physical challenge patients may encounter when recovering from a stroke. This is a topic I am all too familiar with after suffering a stroke on New Years Eve of 2012. So, the first question I have for you, Stacy, is what advice do you give stroke patients on setting realistic physical therapy goals?

Stacey: I think it's really important to individualize the care for each patient and really tap into what motivates them in getting back to their new lives.

Amy: How important is it for the physical therapist and stroke patient to work together?

Stacey: I truly believe it's the only way to have a successful therapy outcome and a successful relationship with your patient. I think that making goals together and individualizing their care and getting them back up on their feet is what makes the rehab process really important and very fun and unique as a therapist.

Amy: What are realistic goals for someone who has had a stroke?

Stacey: That's a huge question, but I think it depends on the person's age. It depends on what they enjoyed doing beforehand. If they want to lie on the couch, we can definitely get you back to lying on the couch. If you want to ski, we can get you back to skiing. So, it's really important to make sure that you're taking your patient's needs and wants and desires into your plan of care and adjusting those as needed.

Amy: I want to return to a previous question. When it comes to physical therapy after someone has had a stroke, I'm thinking one shoe does not fit all.

Stacey: Correct.

Amy: So how do you individualize a patient's plan of care?

Stacey: Again, I think it's vital to their participation. I use family members if communication is a barrier at first. I say, "What makes Amy, Amy? What makes her tick?" And trying to pull those pieces into their rehab is really important. And it's a team approach. We have an occupational therapist. We have a speech therapist that work with our people who are recovering from a stroke. We work together to make sure you're able to get out into the community, because that's a huge, scary barrier for someone who has suffered a stroke. It's something that's very important to us as a team to get everybody on the same page, especially with the patient's goals being the center of the focus.

Amy: Many stroke patients have uncovered either major or minor setbacks. And what words of wisdom do you give them on coping with that setback?

Stacey: I think it's very individualized, but I think, it sounds clichÈ, but keep going. Just keep swimming. Just keep doing. Don't stop moving. Motion is life. Find what motivates you. It's going to look different than it did before quite possibly, but trying to find some peace and some enjoyment in what your new activity is or what the new adaptation is. Or really just trying to cope with what the difference is that you're now facing after you've recovered from your stroke or recovering from your stroke.

Amy: Speaking of noticing a huge difference, I recently this winter went skiing at Alta.

Stacey: That's amazing.

Amy: And that was quite challenging, but I was amazed at how naturally it came back to me. I still, favored my right side, but it was amazing how naturally it came back.

Stacey: I think that's why we do our job, is to hear stories like that. In in-patient rehab, we don't get to see you get out on the slopes, but we get to give you a little push and hope that one day, that's the story that we're hearing is, "I'm getting back to skiing, I'm getting back to biking, I'm getting back to walking, I'm getting back to..." whatever it is that, again, makes Amy, Amy. That's the true joy of being a physical therapist.

Amy: And one final question, what advice do you give stroke patients on their first day in the rehab unit.

Stacey: It's going to be a long day. It's going to get easier every day from here on out. You're going to keep getting stronger. You're going to keep seeing improvements but you're going to do this, and we're here with you to help you do the best that you can.

Amy: And so, in ICU and acute care both, I was worried if I would be able to go for hikes, swim laps, or ride my bike again. All that changed when I met you, Stacey, in the rehab unit. I will be forever grateful for your patience, encouragement, and saying, "You can do this." But most importantly, I am thankful to you for your friendship.

Stacey: Thank you, Amy. You've been a true gem to work with, and I'm honored to watch you go from stretcher to skiing. It's amazing.

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Interviewer: When you're a younger stroke victim it presents a whole different set of challenges than if you are older and have a stroke. Amy Steinbrech doesn't consider herself just a stroke survivor she considers herself a stroke thriver. We're going to talk to her next to find out what it was like when the stroke hit, when she realized her life was going to change forever, plus advice for other young stroke victims coming up next, on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're talking with Amy Steinbrech. She's a stroke survivor here on The Scope Health Sciences Radio. Amy thank you for taking time to join us today.

Amy: You're welcome. Thank you for inviting me.

Interviewer: So tell me, when did your stroke happen, how many years ago now?

Amy: It happened 22 months ago. It happened...

Interviewer: Twenty-two months, wow.

Amy: Yeah.

Interviewer: How exactly did it come on? Did anybody know when it was happening? Tell me about that.

Amy: Well it happened when I went out to the car to start my car. And I realized kind of a dÈj‡ vu feeling, that only lasted a split second. So I didn't think much about it. But was in the left side, when a stroke occurs on your right side, the left side of your brain is impacted. So I went back inside and watched a movie with my family. And then went back home to my sisters house in Lander, Wyoming. And went to bed and then I woke up in the middle of the night to use the restroom. And I went to turn the light switch off and my mind didn't register where on the wall the light switch was. So at that point I was still able to walk. So I walked back to the bedroom and drifted in and out of consciousness.

And about 8:00 that morning my sisters, they wondered why I wasn't up because I'm usually an early riser. So they came to check on me and what they found when they opened the door terrified them. I was barely conscious, not able to walk, talk or anything.

Interviewer: And from your own experience, the only indication that something was weird was that momentary bit of dÈj‡ vu and then the fact that you recognized your brain wasn't quiet computing where the light switch was.

Amy: Exactly.

Interviewer: And that was it. Is that common for most people? Is that the only sign you get?

Amy: Yeah, well sometimes there can be more common signs, like a headache. But mine was just that split second when the stroke must have happened.

Interviewer: How would a person even know? Because we all experience dÈj‡ vu, right? So why would you even think that that was... Obviously you didn't.

Amy: Yeah, I didn't, exactly.

Interviewer: Oh wow. So they find you, they take you to the hospital. What happened at that point?

Amy: Well I was brought to the hospital in Lander, Wyoming where my family is. And then the doctors at Lander Hospital immediately recognized that I had a stroke. So they immediately gave me the choices of to life flight me to Denver or University of Utah. Obviously I live here so University of Utah was a no brainer. So they flew me to the University of Utah and what I remember about the life flight was kind of in and out of consciousness, but I remember the air medic. My sister rode with me in the air medic and the air medic had the nicest smile I remember. He was just comforting and so reassuring, "You're going to be okay. We're going to get you taken care of."

Interviewer: Did you realize at this point that you'd had a stroke? I mean at this point you knew.

Amy: Yeah, I realized that it was something.

Interviewer: Because people told you?

Amy: Yeah, well I wasn't able... I didn't register, my mind didn't register what people were saying. But internally I knew that this was a big deal, typical more than minor accident.

Interviewer: Were you able to realize you couldn't move fingers or feet or legs or?

Amy: Yeah, exactly. And then we arrive at the airport in Salt Lake. They get me there and stabilize me at the University of Utah. And they run all the tests and do everything and get me stable. And then they immediately bring me up to the ICU room. And I was in and out of consciousness. But for a good day or so I don't have any memory of what happened.

Interviewer: And then what was your next memory?

Amy: My next memory was a couple days later I remember my mom reading to me, trying to get me to respond to things and I wasn't even able to talk or walk or anything. So that was her first attempt to get me to talk and my niece and nephew made a memory board for me. The speech therapist must have mentioned that a memory board would be helpful in recognizing the name and faces of family members.

So I remember the memory board very well in the acute care after the ICU. And constantly me pointing to a picture of my sister and saying, that's "Vicky or that's Sonia," and pointing to a picture of mom. And just to be able to recognize my family members.

Interviewer: Did it register with you at that point? Was there any sort of mental connection that that was mom and what that meant?

Amy: Yeah, yeah it did.

Interviewer: Oh okay. What was going through your mind at that point when you came to then?

Amy: Well, it was a long process. I was in the hospital for a total of six weeks. And basically in the ICU it was just a big blur. In acute care, a few things started to stick with me. And then the rehab unit is where my recovery really started earnest with Dr. Edgley.

Interviewer: When you when was the moment that you realized my life has really significantly changed?

Amy: Right from the ICU, right from the ICU a couple days after the stroke I knew I had a long road ahead of me to haul. But I wasn't going to give up and I was a determined person, a determined personality and I was up for the challenge.

Interviewer: How do you do that? In that same situation, I don't know that I could do that. I mean, how did you get yourself to that point? Or is that just inherently who you think you are?

Amy: Well to be any other way never really crossed my mind.

Interviewer: Yeah.

Amy: I get a lot of that stubbornness from my dad. And he never settled for anything, always pushed himself. Even after a heart attack and a brain aneurysm.

Interviewer: So it runs in the family. You've seen it.

Amy: Yep.

Interviewer: Because I think for a lot of people it'd be easy to go, "I don't know if I could overcome this." But that wasn't even a question. That's incredible.

Amy: Right.

Interviewer: So tell me about going through rehab then and what that process was like for you.

Amy: Well in the rehab unit I had speech, physical therapy, and occupational therapy. The three therapies. And I was in therapy for seven hours a day, six days a week. I guess usually they only have three or four hours of therapy. But I was constantly wanting more therapy, constantly wanting to push myself. And I was always up for extra time on the treadmill in between therapy sessions. Just to break for lunch, from 8 until 4, I was in therapy. And so therapy was hard. It was hard. I remember my speech therapist holding up a pencil and asking me to identify it. And it's like I looked at her and said, "Your guess is as good as mine."

Interviewer: You just didn't know what that was.

Amy: I didn't know what that was.

Interviewer: Wow. Did that happen with a lot of objects?

Amy: Yeah.

Interviewer: And a lot of things?

Amy: Yeah. Eraser, a pencil, a cup.

Interviewer: So you had to relearn a lot of that kind of stuff. Did that come easy? Were the connections made fairly easily and quickly after somebody held that up and said what it was or did it take time?

Amy: Well they were made quickly. I noticed the most dramatic improvement in physical therapy. From being guided along the guide post on the wall. To actually to graduating to a cane, to a gate belt, to today being able to go on seven mile hikes.

Interviewer: Wow. There are a lot of healthy people that have never had strokes that can't do that.

Amy: Yeah and speech continues to be my most challenging. I still go to speech therapy once a week and work with my speech therapist here at the University of Utah. They have a great graduate speech therapy program where graduate students work with you and I've been really blessed to get into that program. And this'll be my sixth semester there and just little things that still need a little bit of fine tuning I'm finding. They have deductive puzzles and advanced level things they have me working on.

Interviewer: Yeah.

Amy: And occupational therapy was, it progressed nicely. I still don't have total use of my right arm. And I'm constantly reminded by my mom that says, do you have a right arm?

Interviewer: Yeah.

Amy: In that way that moms only can say.

Interviewer: Oh and she's doing it because really you need to challenge yourself to use it in order to get the usage back.

Amy: Yeah and my fingers are a little bit stiff, so I have a problem typing. It's slow, but I still use both hands.

Interviewer: Gotcha. I want to step back here for a second. So after you got up and you started to try to walk for the first time and go through physical therapy. What's that experience like when your limbs aren't doing what you would expect them to do or your mouth's not doing what you want it to do?

Amy: It can be frustrating.

Interviewer: Yeah.

Amy: But I was very patient with myself. There was always the next hour of therapy or something that I couldn't do one hour, I could literally do the next hour. My therapy progressed that rapidly.

Interviewer: So that was fortunate.

Amy: That was very fortunate that it progressed that rapidly.

Interviewer: So you mentioned some of the ongoing things that you still go to speech therapy and you got to work on that right arm as your mom reminds you. What are some of the ongoing things? Is there ever an end when you're done?

Amy: I don't think. I feel like I'm about 95%, but there's that last 5% is obviously the hardest to come back. And I'm working hard, remaining very physically active and remembering to use my right arm. And just working hard in speech therapy. But I don't think you ever fully recover from a stroke. You can get about 99% but...

Interviewer: Yeah. What is it that you hope for in the future now?

Amy: Well I'm currently looking for employment. Yeah, that's my next obstacle to overcome.

Interviewer: And what kind of challenges are you facing there?

Amy: I haven't really been looking that hard yet. Doing volunteer stuff with the American Heart and Stroke Association and writing some freelance articles has kept me pretty busy. But if the right job comes up. I would ideally like to work for the health care system up here.

Interviewer: And why is that?

Amy: So I figured I'd be a banner client, in the public affairs department working for the University of Utah. I think I have a lot to offer.

Interviewer: Did your experience lead you to want to work in health care you think? Your stroke.

Amy: Yes, yes exactly. And just writing articles. I'm exploring options for writing articles for health related magazines and everything.

Interviewer: What was it about your experience that made you want to do that?

Amy: I think it gives me a unique insight to be able to share with other people and other stroke survivors and their families. I think it puts me in a unique position to give back in a unique way.

Interviewer: What advice would you give somebody who has gone through the same thing that you have, has had a stroke. And they're going through the same thing you did or you are currently going through.

Amy: I have two bits of advice. Is to never give up on yourself. You have to believe in yourself. And also to surround yourself with only positive people. No Debbie Downers allowed in my support network group. And a positive attitude. Positive attitude can truly work miracles and I'm a shining example of that.

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