The Tribune Democrat, Johnstown, PA

May 26, 2013

Stricken by stroke: Quick care is key to recovery

Randy Griffith
rgriffith@tribdem.com

JEROME — Pat Schafer had been fighting a headache all night.

When the last dinner guest left her Ebensburg home, the 51-year-old office manager took some aspirin and went to bed.

“That’s the last thing I remember for about two weeks,” Schafer said.

She came downstairs the next morning, but was disoriented and did not respond to her husband, Carl. He rushed her to their family doctor, who immediately called for an ambulance.

Doctors at Memorial Medical Center in Johnstown confirmed that Schafer had suffered a stroke and that the location made it extremely dangerous.

“The doctor told my husband I was going to die,” Schafer said.

She was transferred to a Pittsburgh hospital, where surgeons placed a medical implant to control bleeding. It was March 29, 2009.

The swift response has allowed Schafer to resume most of her daily activities, but it took months of rehabilitation. She will never be completely restored.

“On the right side, vision and hearing is gone,” she said. “My depth perception is off.”

She tires easily, can’t hear certain frequencies, and has trouble with numbers and reading comprehension.

“I am not disabled. I have deficits,” Schafer said. “You learn to be normal and keep going. You just keep pushing.”

Schafer’s hemorrhagic stroke represents the least common of the two major stroke categories, neurosurgeon Dr. Alfred Bowles said. Bowles is chairman of neuroscience for Conemaugh Health System.

“A stroke is caused by the interruption of blood flow to the brain, or the interruption of the delivery of oxygen to the brain,” Bowles said.

The two major groups are hemorrhagic and ischemic strokes.

Hemorrhagic strokes occur when a blood vessel that supplies the brain ruptures and bleeds, depriving the brain cells and tissues of oxygen and nutrients. About 13 percent of strokes are hemorrhagic.

Ischemic strokes are caused by blockages in blood vessels in the brain, usually from blood clots or fatty deposits called plaque. About 85 percent of all strokes are ischemic, and often are related to the same vascular disease that causes most heart attacks.

“Devoid of oxygen, brain cells will die in two to three minutes,” Bowles said, explaining that the loss of enough brain cells results in long-term disability and death from strokes.

But the good news is most areas of the brain get oxygen from more than one blood vessel, Bowles said. When the primary supply is interrupted, a number of cells remain viable for several hours.

“That won’t last for long,” Bowles said. “As the brain becomes more swollen, you have secondary neural injury. The blood vessels won’t be able to supply any oxygen to the brain.”

The key to treatment of acute stroke lies in preventing that secondary injury, he said. Studies show the treatment must occur within about three hours to be effective.

In strokes caused by blockages, a clot-busting medicine such as tissue plasminogen activator, or TPA, opens the blood flow to mitigate further damage, Bowles said.

A new telemedicine program at Windber Medical Center helps bring the clot-busting treatment quickly for stroke patients there, leaders say. Windber rolled out the partnership with Danville-based Geisinger Health System earlier this year.

By consulting remotely with doctors treating the patient in Windber’s emergency room, Danville’s experts can order treatment immediately, Geisinger neurologist Dr. Edgar Kenton said.

“Time is brain,” Kenton said. “We can begin treatment as though we were right there in the same room.”

“Being able to get that medicine into them as quickly as possible will save brain cells,” said Mary Lee Dadey, vice president of nursing services at Windber.

For those with dangerous swelling in the brain or hemorrhagic strokes, advances in neurological surgery allow doctors to save more lives and help patients regain function, Bowles said. Many of the new techniques can be completed using minimally invasive procedures. Tiny instruments are fed to the damaged areas to repair vessels without major incisions.

Memorial’s stroke team covers the full gamut of expertise, earning it the Joint Commission on Accreditation of Healthcare Organizations’ Gold Seal of Approval as an advanced primary stroke center.

Studies show that stroke patients who receive care at primary stroke centers have better outcomes, Bowles said.

It has to do with training and protocols proven to preserve as much brain tissue as possible, prevent additional events and begin rehabilitation, said Janet Ashurst, neuroscience clinical coordinator at Altoona Health System, another primary stroke center.

The stroke center’s team extends from the ambulance and emergency medical crews to the emergency department, surgeons, in-patient staff, therapists and follow-up care providers, Ashurst said.

“We work together so when we discharge you, you are in the best place that you can be,” she said.

Altoona recently received the American Heart Association and American Stroke Association Gold Award Plus for its success in following the best-practice guidelines.

Even with the best care, it can be a long road back, Schafer said. The two weeks she spent in Pittsburgh after her surgery are little more than a blur. When she first came around she only recognized her husband and her mother. No other relatives or friends remained in her memory.

It took many more weeks in Conemaugh’s Crichton Rehabilitation Center before she could function well enough to go home. It was two years before she could drive a car.

“I had to learn everything again: Walking, talking – everything,” Schafer said. “It was like going to kindergarten again.”

Now Schafer serves as a volunteer advocate for stroke patients in Memorial Medical Center and at Crichton. She believes her recovery has been an inspiration to many patients.

“I talk to all of them,” Schafer said at Memorial. “I go in and say, ‘I heard you had a stroke. Me too.’ ”

Some become depressed and think about giving up because they see their lives as over, she said.

“I tell them, ‘Only if you let it be,’ ” she said.

Schafer commended the Crichton program for helping patients reach their full potential.

“They push you hard every day, but they get results,” she said. “If you keep working at it and keep pushing, you can pick up most of it.”

Schafer admits her own lingering effects can get her down and she wonders if her devotion to helping others may interfere with her emotional recovery.

“Sometimes I think: How do I completely get over it if I keep talking about it?” she said. “My husband said, ‘You are helping other people to see that you can come from really bad situations and make the best of it.’ ”

Making the best of bad situations has become Schafer’s mantra.

“I’m still here, and I’m still driving people crazy,” she said.

“So life is good.”

 

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