If you’ve ever watched a show on Discovery or National Geographic about great white sharks, you likely know how suddenly and explosively they can strike. Jumping eight feet or more out of the water, they attack their prey with massive jaws, unprecedented force, and awesome ferocity. They are a force of nature, uncompromising and unyielding.
In my own life, I experienced a similar display of such power. It’s a power that doesn’t sleep, never eats, and destroys without mercy. This year, that power will take more than 140,000 of our loved ones away from us. For some, it will be an almost instant death. For others, it will be a lingering existence and a quality of life that deteriorates over time. For those who haven’t guessed yet, I’m talking about stroke.
Stroke is the fifth leading cause of death and the leading cause of disability in the United States. A stroke occurs when there is an interruption of blood supply to the brain. As a result, nerve cells in the affected area of the brain are deprived of oxygen and die rapidly. When nerve cells die, the areas of the body controlled by these cells are unable to function. Anyone can experience a stroke, but risk factors include family history, obesity, high blood pressure, a history of smoking, and diabetes.
When my 75-year old grandmother– someone with relatively few health concerns– suffered a stroke, I was shocked. When I arrived at the ER, a hurricane of emotions swirled around me and my family. Jean Luciano, MSN, RN, CNRN, SCRN, CRNP, co-director of Penn’s Comprehensive Stroke Center, explains this is a common reaction.
“Immediately after a stroke, family members experience a large spectrum of reactions,” Luciano said. “They are often grief stricken, sad, angry, or depressed. Some have all of these reactions at different intervals in the trajectory of the stroke.”
In addition to the swell of emotions, there can also be the stress of uncertainty. It can take weeks to uncover just how severe a stroke has been and what “recovery” will look like, and not knowing the actual physical or mental condition of a stroke survivor can be difficult to cope with, both for the patient and their loved ones.
“We see the majority of the recovery at approximately 90 days and often they will plateau,” Luciano said. “Stroke severity is evaluated initially upon arrival at the hospital and then at intervals. That being said, some stroke survivors will see some recovery go on for months, or even years– particularly if they're continuing therapy. I have seen individuals with cognitive and speech deficits continue to show recovery for years.”
Once a stroke survivor begins the process of recovery, family and friends will often take on the title of “caregiver.” Hundreds of thousands of individuals are impacted annually when they become caregivers for stroke victims, often spending months, and even years, supporting them on the path to recovery, a journey that can include physical, speech and occupational therapy, as well as services related to other complications. Luciano has walked that path herself. “Being the child of a stroke survivor, after my mother died, my siblings and I had to add the caregiver role to our lives that were already busy with jobs, spouses, children, and grandchildren,” she recalls. “We all loved my dad and took very good care of him, but we were exhausted. Young caregivers often compromise job responsibilities and promotions as well as their personal lives to take on the caregiver role.”
According to a study on management of depression in elderly stroke patients published in Neuropsychiatric Disease and Treatment, “Poststroke depression (PSD) in elderly patients has been considered the most common neuropsychiatric consequence of stroke up to 6–24 months after stroke onset.” Even more worrisome, the American Stroke Association found that 30 to 33 percent of caregivers for stroke survivors suffer from depression in one form or another. This represents a rate of depression higher that those who actually suffered the stroke and underscores the reality that it’s a condition that strikes a whole family.
Being mindful of one’s own mental and physical health is vitally important when caring for a stroke victim. “Don't forget to take care of yourself and get some respite from being a caregiver,” Luciano advises. “It's not unusual for a caregiver to neglect their own heath and emotional needs when they are focused on caring for someone else.”
Knowing how devastating a stroke can be, what can the average person do to avoid suffering one? As the old saying goes, “an ounce of prevention is worth a pound of cure.” Luciano recommends having a primary physician who is aggressive in identifying and managing risk factors, including hypertension, diabetes, and cholesterol. “I encourage everyone to go to your primary provider even when you're not sick with a sore throat or cough,” she says. “Go when they can address health maintenance.”
The National Stroke Association encourages everyone to remember the acronym “FAST” – Face, Arms, Speech, Time – which can help identify the symptoms of a stroke. Identifying the symptoms and getting help as quickly as possible opens up the opportunity for medical therapies and interventions that may minimize or reverse the symptoms. “We work diligently to educate our patients and our community about recognizing stroke symptoms and calling 911 so they can get to a hospital – specifically a stroke center – as soon as possible,” Luciano says. “Every minute counts towards increasing the opportunity for a good outcome.”
For those who have been affected by a stroke, Penn Medicine’s Young Adult Stroke Support Group serves as weekly all ages resource for patients and their families. For more information, call 800-789-7366.