Stroke still a great danger, despite advances in medicine

Bill Washabaugh, formerly a “Dance Fever” TV show contestant, could dance up a storm, igniting the floor with his graceful and seemingly effortless moves.

Joseph Taglione’s musical instruments were virtually an extension of him, as he played his heart out on the keyboard, bass and guitar.

These two Vero Beach men have exceptional talents in their respective art forms. But both recently suffered strokes, even within 24 hours of dancing and playing, pretty much knocking one off his feet, the other off his beat.

“I can lead a lady around on the dance floor and give her one hell of a time – spin her, dip her, do little tricks like that,” the 65-year-old Washabaugh said from his patient room at HealthSouth Treasure Coast Rehabilitation Hospital in Vero Beach last week.

Washabaugh is using a walker to get around and aid his right side, sagging a bit due to a stroke doctors deemed “mild.” He’s in physical, occupational and speech therapy sessions each day to address the areas that were affected. He said he’s adhering to a healthy diet, which he’ll continue when he returns home; get regular exercise and routinely check his blood pressure in an effort to prevent another stroke.

“I have a good outlook on myself,” he said. “I don’t want to be dependent on somebody. I want to dance again.”

Taglione, 72, is in a wheelchair after a severe stroke in March. He too, hopes to resume an active lifestyle. He is home now and just started physical therapy. Speech and occupational therapies will be added to his regimen.

“A life-changer,” he lamented with slurred speech.

That it is – a life-changer – for the many who suffer stroke, the leading cause of serious, long-term disability and the fourth-leading cause of death in the United States. Some 785,000 people in the United States suffered stroke last year, according to the American Stroke Association.

Symptoms include sudden facial weakness, numbness on one side, weakness in an arm or leg, change in speech, change in vision and dizziness. A stroke happens when the blood supply to part of the brain is blocked or when a blood vessel in the brain bursts. This damages or kills parts of the brain.

Dr. Jimmy Lockhart, medical director at HealthSouth in Vero Beach, who is board-certified in physical medicine and rehabilitation, says in recent years he has noticed an increase in cases of younger people suffering stroke. That is, people in their 30s to 50s.

“You used to discount stroke at age 30,” he said. “Blood pressure is the main thing in younger folks. It’s a silent killer. You don’t realize that your blood pressure is elevated. You just don’t know about it.”

Although stroke risk increases with age, they can occur at any age. In 2009, 34% of people hospitalized for stroke were younger than 65, according to the Centers for Disease Control and Prevention.

May is National Stroke Awareness Month – a time to highlight stroke prevention and the difference that rehabilitation can make in a patient’s recovery. Therapies such as electrical stimulation, the autoambulator – a kind of treadmill that helps patients relearn walking patterns – and physical, occupational and speech therapies can make a huge difference in a person’s rehabilitation, Lockhart said.

A new federal study finds that strokes related to diabetes are plummeting, one bright spot in a still dangerous stroke landscape. Over the last two decades, the rates of strokes and heart attacks among diabetics fell by more than 60 percent, according to research by the CDC. The drop is mainly attributed to better screening, medicines and care. The improvements came even as the number of U.S. adults with diabetes more than tripled in those 20 years.

When asked about these findings, Dr. Taher Husainy, board-certified neurologist who practices in Vero Beach, said greater awareness of risk factors and improved management of the condition have made a sharp difference and not just in cases linked to diabetes.

“The incidence of stroke has gone down substantially due to increased awareness of all the risk factors, and improved management,” he said. “Also, the mortality from strokes went down by more than 50%, due to improved methods treatment and preventing possible complications. I have observed that in my practice, in the last 20-plus years.”

Dr. John Fernandez, emergency medicine physician at Sebastian River Medical Center, noted the advances in stroke medicine in the 25 years he’s been in practice.

Before, he said of patients with acute symptoms, “We’d get them in the hospital, try to do some preventable stuff, but we couldn’t do much.”

Now, by administering clot-busting drugs, they get to the ICU and have better outcomes. “We were helpless to do much with stroke. Now, we can make strokes better.”

The key with the clot-busting drugs is that they are given soon after symptoms of stroke start occurring – within three hours. Not everyone is a candidate for these, but in cases where they can be used, they can produce good outcomes, greatly limiting stroke damage and disability.

“They can return a person from having a major stroke to normal within a day or two of recovering,” he said.

At HealthSouth – an 80-bed inpatient rehabilitation hospital that offers comprehensive inpatient rehabilitation services – Lockhart sees some stroke victims make remarkable strides; others less sizable ones.

According to Lockhart, about 10 percent of stroke survivors will recover completely and 25 percent will have minor impairment. The majority will have moderate to severe impairment, sometimes long-term. Some 70 percent of people who survive strokes will need some sort of rehabilitation involving an interdisciplinary team.

Early detection and treatment are critical. Survival often depends on it. The CDC also says people who arrive at the ER within three hours of their first symptoms tend to have less disability three months after a stroke than those whose care was delayed.

In a 2005 survey, 93% of respondents recognized sudden numbness on one side as a symptom of stroke. But only 38% were aware of all major symptoms and knew to call 911 when someone was having a stroke, the CDC says.

Similarly, physical, occupational and speech therapies are best begun as soon as possible after a stroke.

Strokes can happen anytime. The most severe ones tend to happen in the night.

Washabaugh attended a wedding one recent evening and danced, drove home and started to feel a tingly and numb sensation on the right side of his body. The sensation went away, and he went to bed. In the morning, he awoke and was not able to control his right arm and leg, and his speech was slurred.

“It was incredibly frightening,” he said. “I thought I was having a heart attack.”

”I lay there thinking, ‘I’ve moved into a new phase of my life. I am paralyzed.’”

An MRI showed he had experienced a stroke a week or so earlier. It was the aftereffects that he was aware of.

“A lot of strokes are preventable,” Lockhart said. Detection and management of high blood pressure and diabetes can avoid strokes arising from those conditions. Odds are also improved by avoiding smoking, eating well to maintain a healthy weight and staying physically active.

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