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.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Who Cares About Men’s Health listener Ryan is an educator in Salt Lake. He’s in his mid-forties and in pretty good health. He’s not the typical stroke patient, by any means, but he was surprised to find himself in the hospital undergoing surgery to save his life. The fascinating thing about Ryan’s experience, his stroke symptoms manifested in a very strange way.

A week or so prior to the event, Ryan had been experiencing an earache that just wouldn’t go away. He had gone to his primary care doctor to try and figure out what was causing the earache. No matter what they tried the pain in his ear wouldn’t go away. Ryan had just seen his doctor for a followup visit just two days before he had his stroke.

The symptoms became worse after his anniversary dinner with his wife. Ryan left the restaurant feeling nauseous and dizzy. He rationalized that the symptoms were nothing more than indigestion or a bout of food poisoning.

The next day Ryan’s symptoms only became worse. He woke up feeling really sick. His nausea was so bad he couldn’t keep food or water down. He was extremely dizzy and couldn’t stay standing for long bouts of time.

But he was also starting to experience symptoms that are not common of a stomach bug. He started experiencing severe vertigo and double vision that wouldn’t seem to go away. When he tried to walk it was as if he “had a flat tire on his left side.” He would continually tilt to the left. His balance was extremely off.

After a full day of extreme symptoms - and the urging of his wife - Ryan could no longer rationalize that his symptoms were nothing more than severe stomach flu or related to his earache. After a call to his primary care doctor, he went to the emergency room.

Once in the ER, the physicians did an MRI and found not only a serious aneurysm on the lower back portion of Ryan’s brain but a pretty serious dissection as well.

Ryan spent 14 days in the hospital after surgery. It was a relatively long road to recovery and he still struggles with occasional vertigo. But according to Ryan, the stroke could have been a lot worse. He came away without any particularly debilitating cognitive issues.

Getting to the hospital on time saved his life and his brain. There are More Signs of Stroke Than Just FAST

Time is of the essence when it comes to a stroke. The sooner you can receive treatment, the more likely you are to minimize damage to the brain. As such, it’s important to know the signs of a stroke so you can respond quickly.

The Scope Radio has been talking about the acronym F.A.S.T. for years. It’s a helpful way to remind people of the major signs of a stroke:

• F - Facial Drooping
• A - Arm weakness
• S - Speech difficulties (including slurring, trouble finding words, confusion)
• T - Time is of the essence to get help

But Ryan’s symptoms didn’t fit the FAST acronym. He was experiencing dizziness, nausea, and having vision issues. There are several different ways a stroke can form and impact a person. Not all strokes are caused by deep vein thrombosis. Some can be caused by injury to the head directly. According to Troy, he will often see these injury-related strokes in young people. They will experience trauma from whiplash injuries, sports injuries, falling while skiing or snowboarding, etc.

While we don’t often think of this type of stroke, they can be quite serious. As such, there are additional symptoms you should be on the lookout for beside face drooping, arm weakness, and slurred speech. These include?

• Leg weakness
• Balance Issues
• Vertigo
• Double Vision
• Other vision issues
• Trouble walking
• Severe Headache

If you have a suspicion that you or someone you know may be suffering from a stroke, don’t wait to see if the symptoms will go away. Get to the ER immediately. Call 911 and get an ambulance if you need to. Time is crucial for stroke treatment, so don’t delay. You Should Probably Read that Genetics Test Terms of Service

We’ve all been guilty of quickly scrolling through one of those long irritating user agreements you are forced to scroll through when you install a piece of software on your computer. But when it comes to the Terms of Service Agreement you sign when you take an at-home genetics test, it may be worth taking the time to actually read it.

Scot is still considering whether or not he wants to take a genetics test, so he and the Who Cares guys read through the Terms of Service from one of these testing companies. He found some of the strange, concerning, and occasionally downright terrifying implications that are inside the fine print.

They include concerns about what you may learn about yourself, your identity, the health issues you may face, as well as the legal ramifications you should consider before taking a test.

The guys discuss their thoughts and feelings on the issue. And if you’re still interested in entering to win the genetics test, be sure to enter. Housekeeping - Welcome to the Community

We want to take a moment to welcome all of our new podcast listeners and people who have joined the movement on our Facebook page. We’ve seen a significant increase in both the likes on our Facebook page and listeners of the podcast.

We’re quite excited to have more people joining us on our mission to get men caring about their health. Stay tuned on our social channels. There will be much more community involvement with the show moving forward. Help us come up with ideas and participate in future shows.

If you haven’t liked our Facebook yet, be sure to join. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Scot learns a new trick to improve his bathroom habits. In other news, Troy enjoyed the Sundance film festival and gives a recommendation for the film Boys State. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Announcer: Health information from experts, supported by research. From University of Utah Health, this is thescoperadio.com.

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.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Recently, Who Cares producer Mitch Sears went to the ER with what he believed were stroke like symptoms. It started in the morning with a mild twitch in his left eye that he assumed was caused by eye strain. That afternoon while eating lunch, a spoonful of soup suddenly slipped out of the side of his mouth. He ran into the bathroom to see what was the matter and was shocked to see the left side of his face had begun to droop down. In the course of just a few minutes, Mitch had an unresponsive face and difficulty speaking.

With panic setting in, was Mitch having a stroke? What is a Stroke?

Before getting any further into Mitch's story, the symptoms of stroke are:

• Facial weakness/drooping
• Difficulty speaking
• Problems with coordination
• Tingling or numbness
• Muscular weakness on one side of the body

If you or a loved one are having any of these symptoms, seek treatment immediately. Time is of the essence for treating a stroke. Clot-busting medications and clot removal surgeries are available to minimize or reduce the effects of a stroke, but they are time sensitive. A stroke victim typically only has a window of three to four hours to receive treatment. So seek treatment immediately. The Brain Attack Protocol

After arriving at the emergency room, Mitch was brought back to be seen immediately. Doctors began running tests on his ability to speak and think as well as his strength and sensitivity. The physicians were concerned enough to start the "Brain Attack Protocol."

A brain attack is a lot less scary than it sounds. At University of Utah Health, "brain attack" is what they call a stroke. If a doctor suspects a patient may be having a stroke, a neurologist is brought in immediately to help diagnose the patient.

The "brain attack protocol" helps doctors and patients receive faster care and jump the lines for CT and MRI imaging. It helps make sure that stroke patients are identified and treated immediately rather than waste time in the waiting room. Remember, the window for treatment of a stroke is three to four hours, so it's important to get diagnosed and treated ASAP.

After starting the brain attack protocol Mitch was taken immediately to imaging. After a quick CT scan and spending an hour in an MRI listening to Marilyn Manson, he had his diagnosis.

It wasn't a stroke. It was Bell's Palsy. So What's Bell's Palsy?

Bell's Palsy occurs when the nerve running from your spinal column to one side of your face becomes inflamed. The inflammation can occur after an injury or - in most cases - a viral infection. There are many viruses that can cause Bell's palsy, including cold-sore causing herpes, dormant chicken pox, or even influenza.

This increased pressure on the nerve causes muscle paralysis on one side of a person's face. This facial drooping can sometimes be confused with the symptoms of a stroke, but the condition, while irritating, is not life threatening and often temporary.

Treatment of Bell's Palsy typically includes an anti-inflammatory medication and a round of antiviral drugs. Unfortunately for patients, even with medications, recovery can take anywhere from 10 days to 6 months depending on severity. After a round of medications, patients just have to wait to regain control of their face.

"Bell's Palsy just happens," says Troy, "and I don't think anyone knows why." The condition can affect anyone of any age and there are no known increased risk factors. The Stress of Not Functioning

"At least it wasn't a stroke," jokes Mitch. It's been a week since his incident, but he's still not able to move his face completely. While Bell's Palsy isn't as life-threatening as a stroke, a loss of functionality can be stressful on anyone.

Mitch found his quality of life to immediately change. "Suddenly not being able to speak correctly. Suddenly not being able to eat very easily. There were a lot of things that were killing me," he says, "I loved my smile."

The disruption to his life has been difficult. Symptoms kept getting worse throughout the first week. He was unable to blink so he had to use eye drops and tape his eye closed every night. He explains that there's a lot of stress that comes with waking up every morning knowing that all you can do is wait for the symptoms to subside.

"I know it's nothing super serious to my health, but it's a big deal."

Luckily, as of today, Mitch is beginning to see vast improvements very quickly. He blinked for the first time since the incident. It's small, but a good sign he's on the road to recovery. How One Trainer Helps Celebs Get Movie Ready

Scot recently found an article about a personal trainer's approach to fitness he just had to share. Jason Walsh is personal trainer to the stars. He's worked with celebrities like Matt Damon and Jennifer Aniston. He's the trainer that helped Bradley Cooper gain 40 pounds of muscle in 3 months for his role in American Sniper and helped Emily Blunt get strong enough to carry around a 70 pound exoskeleton in Edge of Tomorrow. He seems to know what he's doing to help people get fit.

Scot was struck by the sensible approach Walsh brings to fitness. Rather than putting a person on a high protein diet with a high intensity workout routine, Walsh focuses on a more holistic strategy to getting his clients in shape. He also works to help his clients improve their overall nutrition, sleep, and mental health.

Before beginning any workout routine, Jason Walsh first works to get his clients a "clean bill of movement." This means that he works with the actors to get all of their nagging physical issues under control. Whether it be a weak knee, a problematic back, a bad shoulder, Walsh works with physical therapists to get a person's body moving correctly. Those issues need to be fixed before anyone can get on track to get the body they want.

Sounds a lot like this podcast's Core Four strategy.

For more information on Jason Walsh and his fitness strategy click here.

How a Celebrity Trainer Got Matt Damon, Jennifer Aniston & More in Shape

How a Celebrity Trainer Gets Actors in Shape for Movies ER or Not: Seizure

Seizures can be scary. A person suddenly begins shaking and convulsing. It sounds serious. But is it serious enough to go to the ER?

According to Dr. Madsen, if the person has never had a seizure before, it's an emergency. Call 911 and get to the ER immediately. Doctor's need to see what's causing the seizure and make sure it isn't anything life threatening. Some seizures can be caused by brain bleeds and tumors, so it's important to get a scan done quickly to diagnose and treat these serious conditions.

Alternatively, there are many people who have a seizure disorder. These conditions can cause a person to regularly have seizure episodes. Sometimes these seizures occur daily. Doctors will treat these conditions with anti-seizure medication, but sometimes episodes still occur. For patients like these, there is no reason to take them to the emergency room unless there are any new symptoms. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Troy learns all about the differences between left and right handed people - and animals; and Scot can't resist those sweet treats sitting in the break room. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

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.

Announcer: Have a question? Ask it. Send your listener question to hello@thescoperadio.com.

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: Your ability to recognize strokes symptoms can make all the difference if a loved one has a stroke, especially for their quality life afterward. We'll talk about that next, on The Scope.

You know, there are some things that everybody should be able to do, CPR, first aid and recognizing signs of a stroke. Dr. Jennifer Majersik is the Director of the University of Utah Stroke Center and a stroke specialist. And unlike the other conditions, the faster you realize that somebody has a stroke and the faster you get them help, really affects the rest of their life in a way that like no other disease really does.

Dr. Majersik: That's right because stroke has such a powerful impact on our lives both from a disability perspective and a quality of life perspective. And we actually have treatment. If you can treat a stroke early then you're less likely to have disability later.

Interviewer: I've heard time is brain.

Dr. Majersik: Right. I think that was coined about two decades ago right around the time that TPA was introduced which is the medicine for acute stroke. And if you are one of the very few people in the United States who receives TPA, you have 30% better chance or higher chance of having a better outcome. And that better outcome really matters. It's like walking out of the hospital going back to work, taking care of your family, not just wiggling your pinky or something that may not just critical to you, but things that really affect how you are able to take care of yourself and to live a full life.

Interviewer: So really as humans and members of the human race, all of us should be able to recognize when somebody we know or love is having a stroke because it really, truly could make you a super hero.

Dr. Majersik: That's what I call my patients who do recognize the signs of stroke or their family members. I've had numerous patients who they themselves didn't even know they are having a stroke, but their child or their neighbor, or their co-worker, even people at the gym, grocery store people, any passerby recognizes that someone is having a stroke and they make that decision to call 911. I've numerous times told me patients, "Please go back and find that person and thank them because they really made a difference."

Interviewer: Do people know a stroke when they see it?

Dr. Majersik: Sometimes and sometimes not.

Interviewer: Yeah, it's not like a rattle snake rattle where you hear that, you know.

Dr. Majersik: No.

Interviewer: Okay.

Dr. Majersik: So that most common signs of stroke, we use the acronym FAST. So FAST stands for face, arm, speech, and time, so the F is for face. So we ask people to smile and you see if their face is dripping on one side or the other.

Interviewer: So droopy face is a sure sign of a stroke?

Dr. Majersik: Well, not always. That's the trouble with anything neurologic.

Interviewer: This is tricky.

Dr. Majersik: It could be Bell's palsy. So I see a lot of patients who are coming in with, "My face is drooping. Is it Bell's palsy or stroke?" But the truth is that they should come in anyway.

Interviewer: If the face is drooping, call 911.

Dr. Majersik: You are not going to figure it out at home.

Interviewer: Okay. All right.

Dr. Majersik: It's going to take a specialist. Arms, we have people raise both arms and see if one doesn't raise or doesn't raise as high or drifts down after it goes up.

Interviewer: Okay.

Dr. Majersik: And then the last is speech. Speech is the most prominent symptom. So you look for someone who can't make speech or can't understand speech. So the speech could be slurred as if someone is drunk, but they aren't drunk. Or it could be misusing words or missing words up, they're backward. Sometimes it truly sounds like someone just took a whole bunch of words like confetti and threw them into the air and just randomly grabbed them out. They just don't make any sense at all. I've tried to imitate it for my medical students and I actually can't.

Interviewer: Okay.

Dr. Majersik: And the last is you talk to them or ask them to do something and they don't understand you. They can't make any sense of what you're saying. Their reception, their ability to receive speech is altered.

Interviewer: So let's pretend here for a moment we are sitting here and you have a stroke. Are you going to convulse, are you going to shake? What am I looking for? I know you told me FAST acronym.

Dr. Majersik: So unlike heart attack, which hurts in most people, particularly men but most people, stroke doesn't hurt and it doesn't look no one shakes and people typically don't call out as if having a seizure. It's very quiet. So you could be in a meeting and have a stroke and someone wouldn't notice except that they notice that you're not using your arm or maybe you notice you're not using your arm. I think for that reason, it's a bit of a quiet disease so it is very sudden onset, but it's not noisy and no one clutches their chest in pain. So they may say, "My arm feels funny. It's not moving right," but they're not going to be someone that everyone would notice on the street corner.

Interviewer: I understand that sometimes after a person has a stroke, they don't really know that they had a stroke or they don't even think they had a stroke. Explain how that's possible.

Dr. Majersik: There are some stroke syndromes, particularly in the right side of the brain, that involve recognition of your own body and of the disease processes that are going on. And so when your right side of your brain is having a stroke, you may be in complete denial that anything is wrong. I've had patients in the ER who can't move their left side and they are telling me they're going to go home. And I say, "You can't. You can't move your left side." And they say, "I'm still going home." They just don't get it. Patients who have a stroke on the other side of the brain typically do recognize it. So it just depends on which side that is hit because the brain is so specialized in all of its functions and locations.

Interviewer: Are there some common things that you hear your patients or family members say when they come to the hospital? Like, for example, "I thought it would just go away. I didn't actually think I was having a stroke. I just laid down for a second."

Dr. Majersik: Yeah, it's the bane of my existence really.

Interviewer: Yeah.

Dr. Majersik: So many, many patients ignore their symptoms. So the most common thing I hear is, "I just thought I'd take a nap. My arm was numb so I thought I'd take a nap." Or, "I was having slurred speech," or, "I couldn't see out the right side, but I kept driving because I had a really important appointment."

Interviewer: So those things, under no circumstances, are normal?

Dr. Majersik: It's not normal to not be able to see out of one side of your vision.

Interviewer: And you should do something about them immediately.

Dr. Majersik: Yeah. The best thing to do it to call 911. So, first of all, you shouldn't be operating a vehicle. I know that seems really obvious, but just in clinic yesterday, I had a guy tell how he just kept driving. It, again, kind of goes to that element of people not really recognizing how really serious something is. But if you call 911, the advantage rather than driving yourself, for example, is that ambulance, A, can keep you safe while you are in route. So they make sure your oxygen is okay and your blood pressure because a lot is going on when you're having a stroke.

And, second, they call the hospital ahead of time and they take you to a stroke center. They won't just take you to an ER that isn't just ready to take care of a stroke. They will take you to one that is ready. And they will call the hospital ahead of time and get the stroke team there in place. We were talking earlier about how time is brain. We only have three hours from the beginning of the stroke to the time when I'm no longer allowed to give that medicine, that TPA. And that includes from the very beginning of the stroke so it takes us a while in the hospital, up to an hour to get your head imaging, your labs and all that stuff. So you don't have a lot of time to waste. So we really want people to come via ambulance if at all possible.

Interviewer: Tell me if I'm right. The take away here is if you're experiencing any symptom of a stroke, which is you feel your face or somebody notices your face is dripping, if you can't raise your arm or put your arm up and it starts to drift down or your speech is slurred or jumbled words are coming out of your mouth, call 911 immediately.

Dr. Majersik: You got it.

Interviewer: Don't hesitate.

Dr. Majersik: You passed the test.

Interviewer: I passed the test. And the other thing I think that's important to take away is that strokes don't cause pain and there's no real other physical manifestation of it.

Dr. Majersik: That's right. It's a silent killer.

Dr. Majersik: There are other additional signs of stroke that aren't in the FAST acronym, such as the vision loss or having trouble walking, being off-balance. And we focus on those main three, face, arm and speech because they're so common. But sometimes I've actually had people say, "Well, I've had those other symptoms, but I wasn't sure if they were related." Anything where you've lost function in your body suddenly, sudden onset, be concerned.

Interviewer: For no apparent reason, yeah.

Dr. Majersik: Right. So, if something has been very slow over the years or weeks or months, that's a little different. But if something was normal one minute and five minutes later it's abnormal that's when you should be concerned and be calling 911.

updated: September 29, 2021
originally published: August 19, 2015

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.

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: 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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Amy: This is Amy Steinbreck talking with Dr. Steven Edgely, the director of stroke rehabilitation at the University of Utah Health. What do you think is helpful to promote a helpful recovery with a stroke victim?

Dr. Edgley: A lot of recovery happens, initially, without the patient doing that much. We try to facilitate optimal recovery in the first couple of months. Those brain circuits come back to function.

Amy: So, the first couple of months are the most important, in a stroke victim's recovery, would you say Dr. Edgely?

Dr. Edgley: I would not say that.

Amy: Okay.

Dr. Edgley: Because stroke recovery can happen even years down the road. But the rate of improvement typically is fastest at the early months.

Amy: Okay.

Dr. Edgley: That's due to a number of factors, specific to what's going on in the brain and [retraining] the brain cells to function. After about three to six months, it becomes somewhat more difficult to see those marked improvements, but the potential for recovery is still present. It takes the patient to challenge him/herself to do things in a way that's comfortable for them, in a way that's still challenging to them. Simple tasks around the home, using their hands or arms for simple tasks. In time, the brain will change slowly to accommodate for those new tasks and ease of movement.

Amy: It's all part of the brain, reworking those connections and reforming those connections, I assume?

Dr. Edgley: Yes, that's exactly right, and, with time, the brain will be able to lay down new connections, new circuits, and be able to find an effective work around. The main point is the patient has to keep challenging themselves, to do more and go slightly beyond their comfort zone to facilitate those changes in the brain.

Amy: Do a lot of patients find that frustrating? I know, Dr. Edgley, that I sure found that frustrating.

Dr. Edgley: It's frustrating at times, but I like to promote people training for a triathlon. Not necessarily frustrated, just challenged. Training need not be frustrating. Frustrating things are mostly a product of their own emotions. The patients are less frustrated when they see progress towards goals that are meaningful to them.

Amy: I remember in the hospital when I was just learning to walk and they had me in the wheelchair, with the railing, you know, the guided walking path.

Dr. Edgley: Yep.

Amy: I found that very frustrating. But eventually, I was able to walk with a cane, then a gait belt, and now look at me, you know?

Dr. Edgley: Yeah.

Amy: Twenty-four months later.

Dr. Edgley: Yes.

Amy: Yeah.

Dr. Edgley: Yeah so, your situation was not unique.

Amy: So, Dr. Edgley, what factors do you think in the young stroke patient, are optimal influencers on promoting a strong prognosis for a recovery?

Dr. Edgley: Setting long term goals, and those goals should be something that the patient has to reach a great deal for, like 6 to 12 months, or beyond. Then teaming up with a group of people that can help you on the process.

Amy: I would say from a personal experience, a strong support network of family and friends to push you to your limit is important.

Dr. Edgley: Yes, so, pushing people to their limits is good to a point. Sometimes people, all people just need a break in knowing what your limits are, is also important. One of the unique things about changes in the brain, in improvements is, for example, if you played the piano and worked for hundreds of hours to perfect a piece, you don't sense necessarily the brain changing to make it easier to perform the task of being able to play that piece perfectly. You may perceive the completion of that perfect piece, but the brain does not have this building, built in system to signal when you're improving. So, you actually have to look at milestones, recognize the milestones, because it's not natural to do so and give yourself credit.

Amy: The self recognition, and giving yourself a pat on the back.

Dr. Edgley: Yes.

Amy: Is often important.

Dr. Edgley: Yep.

Amy: And recognizing that the milestones and the path people will take are all different. There is different milestones and different paths.

Dr. Edgley: Absolutely. Absolutely.

updated: November 3, 2021
originally published: May 6, 2015

Amy: This is Amy Steinbrech talking with Dr. Steven Edgley, the director of stroke rehabilitation at the University of Utah Health Care.

Dr. Edgley, thank you for joining me so much in studio for a podcast on stroke recovery.

Dr. Edgley: My pleasure.

Amy: Every year, more than 795,000 people in the United States suffer a stroke. Strokes are becoming more common among young adults in the prime of their life. I'm wondering if you could tell me a little bit about stroke recovery process in the young stroke survivor.

Dr. Edgley: It's true that about 10% of stroke patients are under the age of 50. This population represents a special population in terms of the unique challenges they face that are generally in the crux of their career and raising families, and this life event is very hard for most people. I find that all stroke patients who have a loss of function, they go through certain stages of mourning or loss.
We talk about the Kubler-Ross stages of mourning, which entails denial, bargaining, things like anger, and, ultimately, acceptance. I find that especially in the young stroke patient, meaning younger than, say, 50, these patients need to be guided towards things that will improve their chances for recovery before they reach the level of acceptance. Oftentimes stroke patients don't fully realize their own potential.

Amy: So this is somewhat pushing the stroke patient to their potential and making them realize their potential?

Dr. Edgley: Exactly. It takes a lot of guidance and someone actually, a whole team of people to guide them through the barriers that they encounter, medical, physical, emotional, everything.

Amy: Right. So I guess one way to look at a stroke is it's a process from beginning to end. Stroke recovery is truly a process.

Dr. Edgley: That's exactly right. A process that takes a lot of support. For many people that are young, they have the potential to get back to high level things like driving, or returning to work. They just need a little guidance and the resources and a team of people to help them along.

Amy: Young adults are often faced with this different set of circumstances than elderly stroke patients. They have a long life expectancy in front of them.

Dr. Edgley: I think it's critical to set the patient on the right course for their next future decades. And getting them set up with the things that will truly provide quality of life, like being able to access the community, like being able to recreate and like being able to form meaningful relationships with friends and family. And for some people, like being able to return to their former employment, or at least do some service, activities, which is helpful to their overall quality of life.

Amy: Remaining engaged with community and family I'm sure is a big part of that.

Dr. Edgley: Yes. Yes.

Amy: How do young patients sell themselves short oftentimes?

Dr. Edgley: You know, when patients have a stroke, it's a really traumatic life event. They probably don't see their friends and family going through and succeeding without the process of recovery. They don't know what to expect. They don't know how to get themselves out of this black pit. I think many patients come to a certain level of comfort and realize that things will be okay in their life in terms of their basic needs, but don't really have an idea what to reach for. Many times the limits of people are limits that they put on themselves.

Amy: Self imposed. Yeah.

Dr. Edgley: Now, that's not to say that every stroke patient has the potential to get that back to 100%, the way their life was in the past. Certainly reaching and striving to get as much quality of life, and be as independent in the community is really important.

Amy: Recognizing your potential.

Dr. Edgley: Yes.

Amy: Have you experienced other people putting limits on stroke patients?

Dr. Edgley: I do see occasionally some people around the stroke patient who, based on misinformation, have some assumptions what the stroke patient's potential is. We commonly deal with this in therapy. For example, the patient's family member tries to do everything for the patient without giving them the chance to learn how to do the activities themselves. That's a common occurrence, and a simple matter of just educating the family members to let's try to promote as much independence as possible. And the way to do that is you learn by doing.

Amy: Right. Most often finding that balance, that perfect balance between independence and dependence.

Dr. Edgley: Yes.

Amy: What are some of the barriers, Dr. Edgley, do young stroke patients face in recognizing their potential?

Dr. Edgley: I would say, again, a stroke is a major life event and it requires a major life adjustment. Some people are able to adjust better than others on their own.

Amy: Right.

Dr. Edgley: Most people are able to adjust more effectively with a broad network of support, including family, friends, and rehab specialists. With time we like to promote higher level goals, like return to work if possible. For that to occur, you have generally got to have a supportive employer who is willing to take a chance. Stroke patients have the potential to be superb employees.

Amy: Dr. Edgley, what advice or tips do you have for the young stroke patient?

Dr. Edgley: Accept yourself and where you are. But don't accept the limitations that you perceive or that other people put on you.

updated: April 7, 2021
originally published: December 10, 2014