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Improving Stroke Outcomes Takes Teamwork, Community Awareness

November 18, 2013

Seminar Addresses Acute Management of Stroke, Chronic Pain After Stroke

Stroke Care and Prevention

Do you know what stroke is? Better yet, would you recognize signs of stroke if someone close to you were suffering one?

If you don’t have all the answers about stroke, then it’s a good idea to attend Washington Hospital’s monthly Free Stroke Education Series, which helps people better understand stroke, including when to seek emergency medical attention.

Next Tuesday, Dec. 3, Dr. Ash Jain, M.D., medical director of Washington Hospital’s Stroke Program, will talk about acute stroke management, and Doug Van Houten, R.N., Assistant Chief Nursing Officer and clinical coordinator of Washington Hospital’s Stroke Program, will discuss the acute rehabilitation and chronic care phase of stroke recovery.

Acute management of stroke requires community awareness

“In many cases, stroke is highly manageable if patients arrive in the ER as soon as possible following stroke,” Dr. Jain says. “Community members need to be aware that there is cutting edge stroke care available locally. Furthermore, by acting quickly and calling 9-1-1, they can make the difference between minimal damage and long-term disability or death.”

Fortunately for residents of Washington Township Health Care District, the Stroke Program at Washington Hospital is a Primary Stroke Center certified by The Joint Commission and the American Heart Association/American Stroke Association.

“The moment 9-1-1 is called for a suspected stroke, it initiates a protocol intended to maximize outcomes for each patient who is brought to Washington Hospital for a stroke,” Dr. Jain says.
Once a patient arrives in the hospital, Dr. Jain and his team of health care professionals—from neurologists to nurses to interventionists who specialize in stroke care—have numerous tools at their disposal to achieve the best results possible.

“If a patient comes in within four hours of suffering a stroke, at this point, we can get good results with administering tPA—also known as clot-busting medication—intravenously,” he explains. “After that, if the patient comes in between four and eight hours after the stroke, we would inject the drug directly into the brain and still get fairly good results.”

The goal, in all cases, is to preserve as much brain function as possible, according to Dr. Jain. Still, achieving this goal requires immediate action—because after eight hours most of the damage to the brain has been done, and the window for acute treatment has usually closed.

“Beyond eights hours there is still a subset of patients that can benefit from aggressive management, and we at Washington Hospital aggressively look for this subset, so as to give them a chance to recover from the damage caused by the stroke,” he says.

In addition to expert care by the team at Washington Hospital, effective management of stroke requires community awareness and knowledge of stroke that can be gained through educational seminars like the one Dr. Jain will be presenting.

“With the latest research and best tools at our disposal, we save lives and help to reduce the chances of long-term disability from stroke,” Dr. Jain says. “At the same time, we rely on members of the community to take the initiative and learn more about stroke so that they know when to seek emergency care for themselves or a family member.”

If you suspect someone is having a stroke, don’t hesitate, Dr. Jain says. Call 9-1-1.

“Even small delays can have heavy costs, and research has shown that outcomes are better when people can properly identify signs of stroke and they know to seek help immediately.”

What a pain

“When we hear about chronic care after stroke, how many of us think about pain as a major problem?” asks Doug Van Houten, R.N. “It turns out that this is reality. Chronic, consistent pain is becoming more frequently identified in association with stroke.”

Following stroke, changes in the brain can lead to a perceived pain response from harmless stimuli—like touch or temperature changes—that wouldn’t typically cause pain. Other types of pain associated with stroke include:

  • Peripheral neuropathy, which usually occurs in legs and is frequently associated with diabetes
  • Spasticity, or spastic paralysis, which occurs when the muscles become so tight that it causes pain
  • Shoulder separation pain, which occurs when the shoulder falls out of joint, resulting in the muscles around it atrophying and causing pain

“When a stroke survivor has chronic pain, it can lead to more depression, and they may not want to be involved in rehab—which makes it that much harder to get better,” Van Houten points out. “In many cases, people are suffering in ways that they may not be able to describe, and traditional pain medications—like Tylenol, ibuprofen, and Vicodin—may not be effective in relieving this type of neuropathic pain.”

He adds that a good neurologist has the expertise to prescribe appropriate prescription pain medications—gabapentin (Neurontin), for instance—which is why it’s important to discuss pain symptoms with a professional.

“Pain management following stroke is complex, because not everybody is the same and not every pain problem is the same,” Van Houten says. “If a patient is having an unusual type of pain, it may be hard for them to express. I’m looking forward to talking to audience members to find out—has this been a problem, and if so, how did you deal with it?”

Attacking stroke with knowledge

To learn more about acute management of stroke, as well as how to address pain symptoms during stroke recovery, plan to attend the Free Stroke Education Series seminar next Tuesday, Dec. 3, from 6 to 8 p.m. in the Conrad E. Anderson, M.D. Auditorium, (Washington West building) located at 2500 Mowry Avenue in Fremont.

To register, visit or call (800) 963-7070.