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Stroke Part 1

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Written by: Healthysport

Created: 27 November 2023

Last Updated: 27 November 2023

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I am glad for each day I wake up. That means there is another possible 24 hour adventure for me -  a new ending and beginning, another sunrise and sunset, another joyful or challenging existence. It is a gift I am very thankful for. 

My gratitude is more felt as I am settling down at the footing of my 60s. At this age one can only hope and pray for the best of each day. I am very confident about life but I have to accept the truth about Nature. There is a blooming and a wilting, a rising and a falling, a birthing and a dying. Empowerment is matched by decline and that has been the natural law since the beginning of time. 

There is no such thing as a perfect 24 hours. Even I who guard my solitude with utmost care cannot be immunized from the sadness of the world. There are wars. There are political upheavals. There are economic uncertainties. Our engagements with people can take different turns, from good to worse or vice versa. Sometimes the 24 hour day we have becomes an insurmountable crisis. 

Again, that is a permanent feature of the law of Nature.

And then, the real sad news drop from nowhere  - someone we know has gotten sick, a terminal diagnosis is handed down to someone minus sugar coating, someone we love  figured in an accident, a child that now has his own family is diagnosed with something that could destroy his family’s future. And you start to wonder how you can help. There are lots of future scenarios that can only be defined by randomness and inevitability. The tough among us roll with the punches and fight life’s  challenges to rise up victoriously. Others admit defeat without a fight and let the wind blow them in any direction like old leaves in the Fall. 

Despite all my blogs about living a healthy lifestyle in the twilight years, there is always the possibility I myself would end up with sickness and debility and dementia and frailty. I have pre-existing medical  conditions  that slide  me closer to the very same diagnoses that I talk about. And people my age are in the same boat.  All we can do is reduce and minimize the risks - but we cannot completely eradicate their inevitability. They can happen  if they are meant to happen. This blog can only talk about minimizing the inevitable or delaying it. There are things we can do to control the controllable and be strong enough to accept the ones we cannot control. 

Let me talk about the risk of Stroke. 

The Three Hour Window

In my previous life as a clinician, I dealt with strokes like there is no end to them. Someone wakes up with numbness and suddenly falls on the floor the moment he tries to get out of bed. Someone’s speech slurs and another could not utter a single word. Someone is ok but his car keys keep falling from his hands. Another has a sudden blurring of vision. Another becomes confused not knowing the people around him. Another suddenly walks like he is as drunk as a sailor. Someone is suddenly dizzy or is having a headache like he never had before in his entire life. Someone is disoriented in space. There are a variety of symptoms that suggest stroke but a few realize it. A young person who is numb would probably blame the poor way he slept last night. Another whose job is labor intensive would probably blame the lifting he did yesterday as the cause of his left side weakness.  There are indeed many variations of symptoms to see with stroke and it is  most advisable to err on the side of caution by going to the hospital immediately than  end with devastating consequences.

However, we want to simplify matters. There is a likelihood we need to have standards to watch for that may suggest stroke when we see it. There are a few checklists to rule out, to at least  start the diagnosis (it could under or overdiagnose) but no matter, it is your health and your life you are dealing here. So don’t worry too much about being correct. 

1. Is the persons;s speech altered, is it slurring or garbled?
2. Ask the person to raise both hands. Are they equal or one hand struggles to keep up with the other?
3. Ask the person to smile. Is the face equal or is it asymmetrical or one side drooping?
4. Ask the person the date, time, year, the address of the house, names of children. Does he answer correctly?
5. Is the mental state appropriate or is the person confused?
6. Ask the patient to take steps (with you holding him of course). Is his steps normal or one leg dragging or he walks like about to fall?

If these are present or at least majority of them are present, it is time to go to the ER

In my old days as a clinician, the moment a person is seen  as a possible stroke the first question  to my mind was -  Is it due to bleeding or infarct(clot) and how long did the first symptoms appear? I had no role in the medical treatment but I needed to know this information to determine what kind of PT protocol to follow when I see  them after the critical period is over] Time is of essence here in reversing certain strokes. There is a window of opportunity to reverse  an infarct (not hemorrhagic) stroke. But first, a CT scan or MRI is needed to  distinguish the two. A hemorrhagic stroke is due to a burst blood vessel that disrupts the blood supply of a part of the brain. That has its own protocol. An infarct is a blood clot that clogs the blood supply of a part of the brain. This type also has a different protocol. If the clot happened less than 3 hours ago, and after making sure the clot does not deteriorate into a bleeding, tPA is administered.

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Tissue plasminogen activator (tPA) is a drug given through a vein to help break up a blood clot so that blood flow can return to normal. It is used for the emergency treatment of ischemic stroke, which occurs when a blood clot interrupts blood flow to a region of the brain.

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tPA is a clot-breaking-smashing treatment very similar to using Drano in unclogging the clogged pipe of the kitchen sink. Although the comparison is weird and over simplistic, tPA has  consequences that it is carefully evaluated  and its side-effects watched once it is administered. I have no role in determining the criteria for this treatment as this falls in the expertise of Neurologists and other specialists, but because  this blog is  for learning and acquiring a basic  understanding how strokes are handled in their acute and sometimes critical phase, it is worth blogging about. 

Since tPA  is a clot - breaker, pre-existing conditions that render the person susceptible to bleeding due to thinned blood are verified, questioned and determined  exhaustively. So is the person on a blood thinner, did the person recently had brain trauma, are they taking supplements that thins out the blood like Omega 3 or garlic pills or medications like aspirin? Are there any other medical conditions like bleeding ulcer, pregnancy, use of blood-thinning medication, uncontrolled high blood pressure (above 185/110 mmHg), low blood sugar (below 50mg)? These are only a few of the questions that may impact the administration of tPA. Ignoring these  can lead to some side effects and consequences that only Stoke specialists are more qualified to explain. (not me)

On the bright side, if its administration is successful, the stroke is reversed and the patient will demonstrate no residual  deficits, although I will be the first to state this - once a person has a stroke, regardless of  whether he overcomes it or not , his life will no longer be the same again.