Education, Support

Tackling The Most Common Complication Of Stroke

If suffering a stroke weren’t difficult enough, survivors often face physical complications such as pneumonia, bed sores, falls and blood clots in the extremities. You may be surprised that none of these examples are even the most common complication of stroke. What is you may ask? Depression. Some sources report the incidence of post-stroke depression as high as 30-40%. At least one out of three survivors! As a society we often say, times are tough and things will get better; keep your chin up; or it’s just the blues, it will go away with time. But what about when it doesn’t?

The social stigma of mental illness in our world is a huge barrier to psychiatric care. The National Alliance on Mental Illness reports that of the 450 million people who suffer from mental illnesses globally, almost 60% do not obtain care. For a stroke survivor this not only affects psychological well-being, but also physical and cognitive recovery from stroke. Despite global efforts by the World Health Organization that stress the importance of mental wellness, post-stroke depression often goes untreated. It is crucial for the individual, the caregiver and others involved in the stroke survivor’s recovery to advocate for management if symptoms arise.

What are the symptoms of depression?
Persistent sadness
Pessimism, hopelessness, guilt, worthlessness
Loss of pleasure or interest in activities that were once enjoyed
Decreased energy, slowed activity
Restlessness of irritability
Difficulty concentrating, remembering or making decisions
Inability to sleep or oversleeping
Appetite or weight changes
Thoughts of death or suicide

The general rule is if five or more of these symptoms exist for greater than two weeks, they may be caused by depression. Depression after stroke is commonly attributed to losses associated with the stroke. However, there also may be biochemical changes in the brain that increase the chances of this happening. For this reason some people require medical treatment of their depression. Don’t tackle it on your own. Symptoms of depression are serious and need to be discussed with a physician to prevent setbacks in physical and cognitive recovery from stroke.

For more information visit:

American Stroke Association

National Stroke Association

Education, News, Support

Support Group Guest Speaker From Albany Medical Center

This month’s stroke support group was joined by guest speaker, Dr. Laura Risley. Dr. Risley is a Vascular Neurology Fellow at Albany Medical Center, meaning she has completed her residency in the field of Neurology, and has specialized in stroke for her last year of medical training. Dr. Risley graciously volunteered her time to come discuss stroke diagnosis and treatment as well as answer questions for stroke survivors and their families. We would like to highlight the main content of this information session in hopes that it may benefit those who were unable to attend.


 

The main message Dr. Risley wanted to convey was–in the event of any stroke symptom or concern, call 911 right away! Do NOT wait. If you think that you may be having a stroke, that is cause enough to seek treatment. EMS will start IVs and check blood pressure and heart rate/rhythm on the way to the hospital. These steps reduce the amount of time needed at the hospital to provide life saving treatment. Request to go to your nearest hospital that provides tPA to get the “drip and ship” process rolling. From there you can be transferred to a stroke center such as Albany Medical Center to receive further care. (We’ll discuss tPA in further detail later in this post).

Dr. Risley explained that the majority of strokes (87%) are ischemic strokes, or caused by a clot or restriction of blood flow causing loss of oxygen to brain tissue. These clots most frequently come from cholesterol plaques that build up in the carotid arteries (the large vessels in your neck). Over time these plaques become bumpy and small pieces break off and travel to vessels within the brain. Medications such as aspirin and plavix (clopidogrel) help to prevent sticky cells called platelets from clumping up around these plaques and restricting blood flow.

For some who have heart conditions such as atrial fibrillation (AFib) clots can form in the heart by a pooling of blood in the upper chambers when they fibrillate, or twitch, rather than pump effectively. This also happens with congestive heart failure (CHF) when the heart muscle is weakened and unable to pump thoroughly. Dr. Risley compared this to paint thickening, or congealing, in the roller tray after time. These conditions are treated with anticoagulants, or “blood thinners”, such as warfarin, pradaxa or xarelto. These medications prevent the thickening and clotting of the blood in order to prevent heart attack and stroke. Some individuals have both carotid artery disease and heart conditions such as AFib and CHF and may need to take both aspirin and an anticoagulant.

Anticoagulants decrease risk of a secondary stroke by 67%. Those that have a history of ischemic stroke should be on anticoagulation to prevent a recurrent stroke, although some people may have other medical conditions that make these medications too dangerous.

Tissue Plasminogen Activator (tPA) was a prime topic of discussion. TPA is a clot busting drug that can be given within a three hour window after the first signs of stroke begin. The brain is very sensitive to injury and as soon as these cells start to lose blood flow, symptoms begin to occur. Over a million brain cells die each minute of a stroke. Death of brain cells cannot be reversed, however the area of injury surrounding the dead cells can often be saved with tPA and/or surgical clot removal. Certain conditions can prevent an individual from receiving tPA. A history of bleeding on the brain, and recent history of heart attack or surgery are a few such conditions. Use of newer anticoagulants such as pradaxa or xarelto prevent treatment with tPA as the bleeding times can’t be monitored or reversed with these types of medications. Treatment with tPA in these cases would have too high a risk of uncontrolled bleeding. Warfarin, however, can be monitored by an INR. If the INR is low enough, the decision may be made to treat with tPA to stop the progression of brain cell death associated with stroke.

For those patients that are not eligible for tPA, surgical removal of the clot may be possible in some cases by threading a catheter from the large artery in the groin up to the artery within the brain where the clot is located. For a general idea of the Penumbra device used click here. For the general idea of the Solitaire device used click here. The time frame for this procedure is longer than that of tPA, previously up to 6-8 hours after first sign of stroke. More recently however, certain cases have had successful outcomes when performed past this time period.

Stroke can also be caused by a bleeding of blood vessels, primarily caused by high blood pressure. These hemorrhagic strokes often occur deeper within the brain and account for the other 13% of strokes. Treatment for these strokes is limited, and consist mainly of controlling blood pressure and allowing the body itself to stop the bleeding on its own. For patients on the anticoagulant warfarin, correcting increased bleeding times is important as well. In severe cases, where bleeding causes a large mass of pooled blood on the brain, a surgeon can remove the blood to reduce pressure and restore brain function.

Another important topic of discussion was the recovery period. Stroke recovery takes on average 9-12 months. Although recovery can extend past the one year mark in some cases, the return of function is mostly limited to this period. Although the original area of brain that was damaged by the stroke will never heal, different areas of the brain can take over, building new connections to accomplish the same task. Although these new connections are not as effective as the original ones, with consistent therapy some degree of function can be returned.

If you missed Monday’s meeting, we encourage you to keep an eye on our Facebook page as Dr. Risley has offered to return later this spring or summer for another question and answer session. The expertise she shared was truly invaluable to the group. We hope this summary is beneficial to you in your recovery.

Support

Caregiver Resources

We review the articles to get you the information you need!


Caregiver assistance and support during the rehabilitation period is essential for the stroke survivor for both physical and emotional recovery. This role can be very difficult to take on in addition to previous family roles and responsibilities. A common challenge many face is learning how to be an effective caregiver while remaining able to care for yourself.

The immediate period after your loved one suffers a stroke is a stressful time, however take every opportunity to gain whatever bits of knowledge you can. Learn about your loved one’s condition and the likely course of their recovery. Be sure to find out the specifics of your insurance coverage. Case managers are excellent resources to help navigate the insurance world and understand coverage for inpatient and outpatient rehabilitation.

Learn about the plan for rehabilitation from the physical, occupational and speech therapists that are working with your loved one. Be present for therapy sessions and have therapists show you how you can assist with exercises to improve strength and coordination. Don’t be afraid to ask questions! The inpatient and outpatient care teams are there for not only the patient, but the family care unit as well.

After stroke, emotional changes are common in the stroke survivor and caregiver. Loss of function and independence leads to frustration and grief, however, some types of stroke can put your loved one at a higher risk of depression. Talk to a doctor if your loved one experiences symptoms of depression such as extended periods of sadness, anger, and loss of interest in things they once loved.

There are many caregiver obligations but you don’t have to do it all yourself. Reach out for support! Ask for family, friends or neighbors to help with grocery shopping, cleaning or respite care. Take time for yourself to rest, relax and refresh.  Join your local stroke support group to talk to others who share similar caregiver challenges and learn what resources are available to you.

 

Summary of “Stroke Recovery: Tips for Caregivers”                                                                     by Brenda Conaway, reviewed by Michael W. Smith M.D.

Click here for full article

Events, Support

Support Group

STROKE SUPPORT GROUP

Join us for monthly support group meetings to meet survivors and families who have walked in your shoes! This group provides an opportunity to share your experiences, concerns, information and ideas with other loved ones in a welcoming, safe and supporting place.

Meetings are scheduled for the last Monday of every month except for holidays from 4:30-5:30pm. Meetings are a service of the Glens Falls Hospital Rehabilitation Center. For more information you may call the hospital directly at (518) 926-2000 or feel free to call us at (518) 744-0649. Hope to see you there!