When It Comes to Stroke Treatment, Timing Matters
Free Seminar Focuses on Acute Care, How to Improve Function Following Stroke
As medical director of the Stroke Program at Washington Hospital, cardiologist Dr. Ash Jain is used to looking at stroke from a number of different angles-from prevention to acute treatment. Each month, during the Stroke Community Education Series-free to the community-he shares research, his insights, and what community members should know about stroke.
Next Tuesday, April 3, Dr. Jain will discuss acute management of stroke inside the hospital. Doug Van Houten, R.N., the program's clinical coordinator, will discuss issues surrounding stroke rehabilitation and chronic care following stroke.
"Due to the comprehensive nature of our program, stroke intervention begins the moment a patient or family member calls 9-1-1," Dr. Jain says. "Emergency medical responders are trained to identify stroke and ideally bring patients to the nearest Primary Stroke Center such as Washington Hospital where they will receive expert care."
When it comes to effective treatment of stroke, according to Dr. Jain, timing matters. Unfortunately, one of the primary issues preventing people from getting to the emergency room quickly enough is the fact that many people still do not recognize stroke symptoms. Additionally, they may not understand the urgency behind them.
"Acute management of stroke can help save lives and mitigate long-term disability, but patients and family members first need to recognize the signs and symptoms and call 9-1-1 immediately," he says.
It's very important to take stroke seriously, because even small delays can have heavy costs, according to Dr. Jain.
"If the patient comes in within three hours of suffering a stroke, we can get good results with administering tissue plasminogen activator (tPA) intravenously," he explains. "If the patient comes in between three and six hours after the stroke, we would inject the drug directly into the brain and still get fairly good results."
Treatment interventions like tPA, also known as a clot-busting medication, are only helpful if patients arrive in the ER soon enough. After six hours, patients are no longer good candidates for clot-dissolving medications, Dr. Jain says. However, the Stroke Team at Washington Hospital can still treat strokes for up to eight hours by inserting a catheter through the groin into the brain to remove the clot.
"It's a riskier procedure, and the results are not as good, but we are still able to preserve a fair amount of brain function. After eight hours, most of the damage to the brain has been done, and we generally are not able to attempt acute treatment.
"The best option is to prevent stroke in the first place by identifying your risk factors-like high blood pressure and atrial fibrillation-and seeing the doctor about how to treat or manage them effectively. The next best thing is to know the signs and symptoms and make sure to get to the hospital right away so we can treat stroke."
Minimizing disability, finding satisfaction
After acute management of stroke inside the hospital comes a very important phase, according to Doug Van Houten, R.N. First, the stroke team makes sure that patients' risk factors have been identified and are being properly managed.
"Stroke isn't like measles-you get them once and you're done," he explains. "If you've got all the risk factors in place for stroke, you can keep having strokes after the first one. Risk of future strokes is one of the strongest reasons for being admitted following stroke-to check the carotid artery for blockages, identify diabetes, and measure cholesterol and blood pressure to make sure those things are under control."
Strokes and the impairment they can cause vary from person to person. In very mild cases, people may recover with very little deficit at all. However, stroke remains the No. 1 cause of long-term disability, which means that most people will go on to acute rehabilitation to help them regain lost function, such as mobility, speech, and activities of daily living.
"This whole talk is about disability, first how to minimize the disability through acute rehab, and also how you can cope and find satisfaction in life following stroke," according to Van Houten.
One of the most important steps stroke survivors need to take is reorienting themselves to their new reality following stroke, he adds.
"You have to find a way to move forward and say, 'Yeah, I sort of planned to have everything one way, and now things are going to be different.' You wouldn't have chosen to have a stroke, but there's no turning back. Now you've got to find a way to live with this."
"There are things that can be positive. You have to find the good. It can lead a married couple to spend more time together, or maybe it teaches them and offers them new opportunities."
Van Houten points out that the caregiver's role is an important one, but one that often falls to someone with no patient care experience. In fact, most caregivers are spouses who 'learn on the job,' and may be completely new to helping someone walk or brush his or her teeth. Ultimately, recovery from stroke means people have to be open-minded and clever and to take opportunities and be creative in finding ways to get around the disability.
"You treat stroke-related disabilities with rehab, and you get around them with perseverance," he says.
To learn more about acute management of stroke, as well as rehabilitation and chronic care following stroke, make sure to attend the upcoming free Stroke Education Series seminar next Tuesday, April 3, from 6 to 8 p.m. in the Conrad E. Anderson, M.D. Auditorium, Rooms A and B, located at 2500 Mowry Avenue (Washington West) in Fremont.
To register for the upcoming seminar, call (800) 963-7070 or visit www.whhs.com and click on Upcoming Health Seminars.
For more information about the Stroke Program at Washington Hospital, visit www.whhs.com/stroke.