Sodbuster - Brain Attack - Jennifer Crown

BRAIN ATTACK !
© 1998 Jennifer Crown

As some of you know, my father had a right-brain stroke on February 1st of this year. He spent 1½ months at Madonna Rehabilitation Hospital in Lincoln, Nebraska and now is recuperating at home. I'd like to share with you some of the things we learned throughout this situation. Much of it is fascinating, but my main hope is that it will prove useful to readers who are susceptible to having a stroke.

When we think of strokes, most of us think of the elderly. One of the first things that really startled me when we got to Madonna was the age range of people on my father's floor. I was shocked to see that one sweet young lady had already suffered two strokes in her brief lifetime of 29 years. Several others were in their late 30's to 50's. It was quickly apparent to me that a person of any age could be at risk for a stroke (cerebrovascular accident [CVA]). Your risk does increase with age, though. Peggy Jo Donahue states in her book, How to Prevent a Stroke (p. 31):

The incidence of stroke doubles in each decade after you turn 55 years old, although almost 30 percent of those who suffer strokes are younger than 65.

A stroke is caused by a change in the blood supply to the brain. That causes a lack of oxygen and, thus, damage or death to brain cells. A clot (stationary or traveling) or a hemorrhage (blood vessel in the brain bursts) can produce the blood supply change. Generally, when the stroke damages the left side of the brain, the right side of the body is weakened or paralyzed. If the right side of the brain is attacked, the body's left side is effected. Damage to the back of the brain usually causes visual and other physical problems. Since my father had a right brain stroke, his left arm and leg are paralyzed and the left side of his face is weakened. He also has a "field cut" (one-sided neglect where he is unaware of objects near or actual parts of the damaged side of the body).

Some of my father's fellow "inmates" (as he calls all of the patients in any hospital) had some problems I had not realized a stroke could cause. Not all after-effects occur to each person. Every stroke is an individual experience with different problems plaguing each patient. I was surprised by the various kinds of hurdles a stroke could present and had not realized the residual speech defects that were possible.

When the 29-year-old (I mentioned her earlier) first got to Madonna, she could say only one word -- "no." So, the nurses were careful to ask only questions requiring a "yes" or "no" response. If she meant "no," she would simply say it and do nothing else. If she meant "yes," she would say, "no," but would nod her head in the "yes" motion.

As one patient explained (after he'd conquered many of his communication challenges): "you are in this body that won't cooperate. You know in your head what you want to say and have the words all formed; but when they come out of your mouth, they are just garbled and no one understands you. It is very frustrating." A lively 50ish fellow, who was sitting nearby, tapped the one who had just spoken and nodded emphatically. He could not speak a word, but had come up with his own sign language to express his wishes. In one move, everyone in the room understood his empathy. Getting together with those who have "been there" is good medicine.

Speech is only one of the possible complications. At the current time, my father has swallowing difficulties and needs his liquids thickened in order to avoid choking. The muscle structures in his throat were weakened; so, when thin liquids reach his throat too quickly, his muscles do not have time to react and close off the openings to his lungs. This can cause choking, but also increases his risk for pneumonia because water can easily slip undetected into his lungs. One day (while we were still at Madonna), a nurse came to the patient dining area and sat close to my father. She had a large glass of ice-cold water and was periodically gulping from it. Dad watched her for a while, then whispered to me: "You know, a person sure takes a lot of things for granted until some abilities are lost. She doesn't realize how wonderful it is just to be able to take a good, healthy swig of clean, cool water. Then, too, she WALKED into here. I'd give every dollar I had just to be able to walk from my bed to the bathroom. A person doesn't realize what he has until it is gone."

As I mentioned, I've learned a lot (medically) about strokes, but it is has been an eye-opening experience (philosophically), too. Every time I enjoy a sip of cool water, I think of all the things for which I can be thankful on a daily basis. I look forward to the day when Dad will recuperate enough to enjoy a tall glass of unthickened lemonade on a hot, summer afternoon.

STROKE FACTS TO PONDER

** It is important to know the warning signs of an impending stroke and to get medical help IMMEDIATELY. There is medication (t-PA) now available that, if administered within the first few hours after the stroke's onset, can greatly reduce further damage or even prevent permanent damage. However, since the medication acts to quickly break up clots, it can be dangerous for people who are not definitely having a clot-related stroke, especially those with high blood pressure or hemorrhaging.

See:

http://www.worldhealth.net/search/archive/strokes.html

http://spruce.flint.umich.edu/~sblatt/res/cva/cq1st5.htm

http://www.advocatehealth.com/magazine/spring97/magazine/mag2.html

http://jfp.msu.edu/jclub/jc0596a.htm

Know the warning signs of a stroke:

Headache (probably will start quickly and without cause).
Sudden paralysis or weakness (especially of one arm, leg, or side of the face).
Changes in:
- Vision (blurred or decreased in one or both eyes).
- Feeling (numbness of arm, face, and/or leg).
- Behavior (changes in memory and/or judgment).
- Consciousness (hard to wake; may be groggy).
Problems swallowing (or drooling; coughing).
Ringing in the ears (or decrease/loss of hearing).
Transient Ischemic Attack (TIA) or "ministroke." If any of the above signs last for only a few minutes or hours then go away, that is a ministroke. Ministrokes are easily ignored because they don't last long. You should get medical help, though, for they are precursors to a major stroke. My father had a series of ministrokes for about 4 months before the "big one."

Possible effects from a stroke:

Jumbled, slurred, or lack of speech.
Difficulty comprehending spoken or written language.
Paralysis (imprisonment in your own body).
Inability to problem-solve and apply solutions.
Impulsiveness.
Spatial-perceptual changes.
Personality changes.
Lost ability to control emotions (laughs or cries at inappropriate times).
Memory loss.
One-sided neglect (unaware of things on the damaged side of the body [aforementioned "field-cut"]).
Swallowing difficulties.
Vision problems (tunnel, double, or blurred vision).
Impaired cognitive skills (doing simple math, recognition of objects/faces, organizing thoughts, understanding passage of time).
Denial of any disabilities (can be dangerous if the patient does not call for help and tries to do something he/she is not currently capable of doing [getting out of bed, for example]).

What increases your risk of stroke:

Your risk increases with age.
Men have a 30% higher risk than women do.
Afro-Americans have a higher risk than other ethnic groups.
People who have already had a stroke are at a higher risk to have another.
A family history of high blood pressure, diabetes, stroke, or heart disease.
High blood pressure.
Presence of problems such as rheumatic heart disease, diabetes, or atrial fibrillation.
Hardening of the arteries.
Increased number of red blood cells.
High blood cholesterol.
Stress.
Taking birth control pills.
Smoking.
Obesity.
Inactivity.
Excessive alcohol intake.

Most stroke victims make some gradual improvement because the brain heals. There are ideas of how this happens:

Idea #1: Better blood flow may help damaged brain cells to recover.

Blood vessels surrounding the damaged area may start bringing blood to the weak spots.
After a stroke, the brain swells. As swelling decreases, blood flow to the damaged area increases.

Idea #2: Previously unused brain cells may begin work, taking over the work of the damaged cells.

Idea #3: Patterning. Undamaged parts of the brain learn how to do the things the damaged parts used to do by being exposed to repetitive activity. Some of the physical therapy after a stroke involves repeated motions in hopes that the brain will "relearn" how to make the body do "normal" things.

A speaker came to Madonna and told an enlightening story I'd like to share. She described a man who had suffered a stroke. At first, he could not talk, walk, eat, or perform necessary bodily functions for himself for several months. The only thing he could move (slowly and haphazardly) was one arm. He gradually got to the place where he could eat and talk, but he could not move one arm or either leg for almost two years. However, he did recover. Today, he takes regular walks and is back in the business world. No one would know he had had a stroke unless he told them.

If you recognize yourself as "at risk" for a stroke, consider making changes to put yourself at less risk (to lower your blood cholesterol, for instance) and know the warning signs. If you've already had a stroke and are recuperating, keep plugging away -- there's hope. If you are recovered from a stroke, welcome back.

OTHER GOOD SITES:

HealthGuide Online

National Stroke Organization

American Heart Association (on strokes)