Experiencing severe headache pain for a number of days, Kathy Doyle lay on the couch with icepacks on her forehead for relief. “I chalked it up to stress,” the young mother of three recalls. “Looking back, I knew it wasn’t normal. I just didn’t want to bother anyone.”
In 2009, then 36 years old, the elementary school teacher from Little Egg Harbor, N.J., was on her way home from her third baby’s two-week pediatric appointment. As she waited in the car while her husband ran into a coffee shop, Doyle felt a terrible pain behind her eye. She described her left side as “melting away” with numbness, which caused her to slouch over. The young mother was unable to move or speak. Her husband, a police officer, returned to see his wife’s face drooping and immediately realized she was in trouble.
They rushed to a local hospital where the staff presumed she was having symptoms of a migraine as a result of childbirth. “I remember thinking, ‘I’m just having a bad headache and I need to go home to lie down,’” Doyle tells Real Woman. A computed tomography (CT) scan, however, revealed a clot in the main artery supplying blood to her brain. This young, otherwise healthy woman had experienced a serious stroke.
A stroke occurs when a blood vessel to the brain is blocked or bursts. If deprived of blood, brain cells die. Many people mistakenly believe that strokes are an elderly patient’s disease, but it’s a growing concern among younger adults. Between 1995 and 2008, the Centers for Disease Control and Prevention (CDC) reported that hospitalization rates for ischemic strokes in patients 15 to 44 years old increased by 37 percent. Strokes are especially on the radar of women, who are twice as likely to die from a stroke than breast cancer. One in five females who experience stroke will die from the event, while many others are left significantly disabled as a result of brain cell loss.
These statistics, while frightening, are especially unfortunate since the damage from stroke is largely preventable. Young adults need to be educated about stroke’s signs and symptoms to seek immediate treatment.
Face, arm, or leg numbness or heaviness on one side is an indicator, according to Erol Veznedaroglu, M.D., director of the Capital Institute for Neurosciences and chairman of the Department of Neurosurgery at Capital Health. “The asymmetry with facial drooping is a red flag. And difficulty with speech, such as slurred or garbled words … these are typically noticed by someone else,” he adds. Patients also tend to report vision troubles such as spots or “seeing a black shade coming down.”
Dr. Veznedaroglu, known as “Dr. Vez,” notes that strokes certainly may be caused by non-modifying, or genetic, components. But there are also lifestyle choices that can put people at risk. The incidence of stroke has risen in tandem with obesity and inactivity in recent decades.
“Lack of exercise, sedentary lifestyle, elevated cholesterol, and obesity—particularly belly fat—have a high correlation with stroke,” Dr. Vez says, noting that cigarette smoking is No. 1 among modifiable risk reducers.
Common risk factors for stroke include high blood pressure, high cholesterol, diabetes, and heart disease. Most strokes are ischemic, which means they are caused by an obstruction, or clot, within a blood vessel supplying blood to the brain. Atherosclerosis, or fatty deposits, is often to blame. Hemorrhagic strokes, which account for 13 percent of stroke cases, result from a weakened vessel that ruptures and bleeds into the surrounding brain. Untreated aneurysms, among other causes, can lead to these strokes, Dr. Vez says.
If you consume an unhealthy diet, are physically inactive or overweight, use tobacco or illegal drugs, or drink in excess, you are putting yourself at risk for a stroke. Women are at additional risk if they experience migraines, take birth control pills, or are pregnant or recently pregnant.
Doyle’s stroke, from an occlusive clot in her right middle cerebral artery, may have been caused by pushing during her baby’s delivery two weeks earlier. Once physicians at Southern Ocean Medical Center in Manahawkin, N.J. diagnosed her stroke, her family sought the highest level of specialized stroke care. “My brother asked the ER doc, ‘If this was your family, where would you take her?’” Doyle says. “Without hesitation, he said, ‘Dr. Vez at Capital Health.’”
Dr. Vez and his team were waiting for Doyle to arrive at the Capital Institute for Neurosciences at Capital Health in Trenton, where she went immediately to a sophisticated surgical suite. The standard treatment for ischemic strokes within a three-hour onset window, administration of tissue plasminogen activator (tPA), was not effective since Doyle suffered a large vessel occlusion. Dr. Vez applied the innovative Merci® Retriever technology, a corkscrew device that traps the clot for retrieval and removal to restore blood flow to the brain. More recently, Capital Health has pioneered use of stent retriever technology to quickly and safely restore blood flow and retrieve clots from large intracranial arteries.
Immediately after her procedure, Doyle was moving both sides of her body and speaking clearly. “Kathy is the epitome of what it means to get to treatment early,” Dr. Vez says. “If her husband did not take her to the hospital, she would have been permanently disabled. Today, we have several effective interventions, so it’s critical that people not dismiss the symptoms of stroke and, instead, act quickly.”
Another woman, Ashley Bowes, was admitted to Capital Health after suffering an ischemic stroke as a result of a head injury, which she initially perceived to be a “non-event.” On her family farm in Southampton, N.J., Bowes was head-butted by one of her goats. She continued with her day, but when she went to sleep nine hours later, a clot that had formed from the injury traveled to her brain. Her fiancé, an EMT, called 9-1-1—she was admitted to Virtua Memorial for a CT scan.
Following stroke diagnosis and administration of the “clot buster” tPA, Bowes was transferred to the care of Mandy Binning, M.D., director of the Comprehensive Stroke Center at the Capital Institute for Neurosciences. The injury had caused tears to form in the inner lining of her vertebral artery, which lead to a clot in the basilar artery. “The blood flow stopped [to my brain],
so my body started slowly shutting down,” explains Bowes.
After surgery during which Dr. Binning inserted stents in the back of Bowes’ head, the young woman was admitted to Capital Health’s Neurosurgical Intensive Care Unit for recovery. “The care was awesome,” recalls 28-year-old Bowes, who had been given only a 20 percent chance of survival. “It was a horrible thing to go through, but these people were very supportive of me—and that I was going to get better. Without them, I wouldn’t be here, and I’ll forever be thankful for them.”
Capital Health accepts patients from more than 90 health care facilities in the tri-state area for the treatment of complex strokes, cerebral aneurysms, brain tumors, and other neurologic conditions. Their Comprehensive Stroke Center was awarded advanced certification from the Joint Commission for providing the highest level of stroke care. It is the only Joint Commission Comprehensive Stroke Center in the country to also be named a Joint Commission Top Performer for stroke.
The center offers neuro-intensive care unit beds for complex stroke patients with 24/7 neuro-critical care, advanced imaging capability, coordination of patient’s post-hospital care, and participation in stroke research. Dr. Vez notes that upon admission, the team appoints one person who oversees evaluations by nurses; physicians; physical, speech, and occupational therapists; and social workers. All clinicians work closely with the patient and family, as well as rehabilitation partners, for continuation of care.
Capital Health is also pioneering an innovative pre-hospital alert study. For stroke, outcomes demonstrate that “time is brain.” The organization is training EMS squads all over the region to identify presence of stroke and to call ahead with vital patient information so ER and triage tasks can be bypassed. From the ambulance, a patient undergoes a CT perfusion exam to determine how much brain has been lost and if immediate clot retrieval is the ideal treatment. “We need to think of stroke as a trauma,” Dr. Vez says. “We set up this center solely for this type of disease process so everyone understands: This is an emergency. And there’s no time wasted.”
Thanks to quick, accurate responses by their loved ones and care providers, both Doyle and Bowes have survived to lead fully functioning lives. All are not so lucky. Given the dire implications of delayed medical attention, Dr. Vez believes hospitals and organizations need to do a much better job educating the public about stroke warning signs and symptoms. If you don’t get to an emergency room immediately, the outcomes are very poor, he says. Lasting effects include paralysis; pain; depression; spasticity in limbs; loss of memory, cognition, or language decline; or even death.
Women tend to be especially slow to recognize stroke symptoms, such as numbness or weakness on one side; sudden confusion; difficulty with cognition or language; loss of
vision or balance; trouble walking or coordinating movements; severe headache; or dizziness. They are hesitant to seek medical help, and often attribute symptoms to medication, stress, a pinched nerve, hormones, or other unrelated conditions.
“Don’t take anything for granted or think you’re invincible,” warns Bowes. “I was one of those people who thought nothing would happen to me. I was going about my regular day and then I almost died. When the symptoms of a stroke start, there’s a small window of time [for intervention]. Go get checked out, quick. Because you can get yourself back to where you want to be if you’re treated fast enough.”
Eight months after her stroke, still under the care of Dr. Binning, Bowes found out she was expecting her first child. On May 17, 2013, her son Harry was born. “He’s my reward; my light at the end of the tunnel,” she reflects. “It wasn’t my time. I was supposed to be here to be a mother. The team saved me, and we couldn’t be happier.”
Doyle also feels blessed that her husband acted quickly and he sent her to a center that’s committed to cutting-edge stroke treatment and care. “They were very caring and doting,”
Doyle recalls. “When I open my eyes every morning, I’m so thankful for everything. This has been an amazing journey,” Doyle concludes. “Life is beautiful and precious.”