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Speedy Response Key for Stroke Victims

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Jean Wiseman's life changed in the middle of making an angel food cake.

Wiseman and her husband, Sherm, were in the kitchen of their home east of Cheyenne on Oct. 29, 2011, making a cake for their daughter-in-law's birthday.

"I reached for the sugar to put it into the egg whites as he was beating them," she said. "And then I went to the floor."

Her husband held her to protect her head from hitting the floor: "She was like a wet dish towel."

When she tried to speak, he knew what was wrong.

She was having a stroke.

"Her speech was very slurred. You couldn't understand her," he said.

He called 911; emergency crews rushed her to the hospital.

Jean Wiseman had not been sick before her stroke. It took her by surprise.

Her journey to recovery began that day. She has made great progress since, getting therapy at Cheyenne Regional Medical Center, Life Care Center and through Continue Care, a home health-care business.

Wiseman is one of about 795,000 Americans who suffer strokes every year.

More than 137,000 a year die from strokes, making it the fourth-leading cause of death.

In Wyoming, there were 189 deaths from stroke in 2010, down from 217 in 2009, said Joe Grandpre at the state Department of Health.

In 2010, 33 people died from stroke in Laramie County compared to 31 in 2009 and 35 in 2008.

On the mend

Jean Wiseman is proud of her progress since her stroke of a little more than a year ago.

"I've had an awful lot of good trained help," she said, her deep blue eyes shining.

She regained her speech within the first week and talks without difficulty.

Her mind is sharp as evidenced by her keen sense of humor.

But there still is work to do. She does therapy to help regain control and strength of her left side, especially her left arm.

She is in a wheelchair much of the time, but she plans to reduce that through her physical and occupational therapy work.

The Wisemans have been a team throughout their 57 years of marriage. So it's no surprise that they approach Jean's recovery as a team effort too.

Sherm is with her at her sessions at Life Care Center. He created a walking route inside their home and installed grab bars. He urges her to ride her stationary bike at home.

"I'm riding to nowhere again," she said, laughing when she talks about the bicycle that stays put.

Jean was an inpatient for 10 days at CRMC, five of which were in ICU. Her condition was touch and go at first.

She then was at CRMC-East's Acute Rehabilitation Unit for a month. There, she learned how to sit up and walk again.

The rehab unit focuses on getting patients to their previous level of functioning, said Staci Stone, director of the acute rehab and transitional care units.

Physical and occupational therapists and nurses trained in rehab make up the staffing. Its doctor is skilled in working with rehab patients too.

Employees help patients with individual needs, whether it's learning to walk or talk again or to get dressed and eat.

"The sooner people get rehab, the better the outcome," Stone said.

The unit has a room of rehab equipment like parallel bars.

It also has a one that looks like a home. There, patients learn the skills to return to their daily lives.

They also help with community projects like Project Linus: Patients help make blankets for children in need.

The staff also teaches caregivers how to help the patients at home.

Jean spent three months at The Therapy Center at Life Care Center, undergoing several hours of intensive therapy a day. She goes to therapy at Life Care Center now as an outpatient.

What is a stroke?

A stroke occurs when a clot or rupture blocks a blood vessel that carries oxygen and nutrients to the brain. Part of the brain that needs oxygen can't get it, so it dies.

There are two types of stroke.

One is caused by a blood clot in an artery, which decreases blood flow, said Dr. Dan Surdam, medical director of CRMC's emergency department.

The other occurs from bleeding in the brain, caused by the burst of a blood vessel in or leading to the brain.

Education can help prevent stroke or reduce its severity. People who recognize symptoms and get help quickly can help those who suffer from stroke.

But such education is lacking in Wyoming, based on results of a 2011 statewide survey.

Nearly 86 percent said they would call 911 if they saw someone was having a stroke, Grandpre said. But only 45.3 percent were aware of all five warning signs for stroke.

That's unfortunate because prompt medical treatment that's available now can improve the outcomes of stroke.

"We think people know what the signs and symptoms are for heart attack and stroke but they really don't," Grandpre said.

Paralysis is not the only sign. There are other, more subtle cues like sudden dizziness, numbness, trouble talking and confusion.

Treatments for stroke

Many stroke survivors make remarkable improvement with today's therapies and medicines. But such treatment must start quickly, Surdam said.

Doctors gave Jean Wiseman a drug called t-PA, or tissue plasminogen activator. It must be given in the first few hours after a stroke.

"It probably saved her life," Sherm Wiseman said.

On average, about one person a day comes to CRMC's emergency department with stroke-like symptoms, Surdam said.

"We really want to educate people that if they think they are having stroke-like symptoms to come to the emergency room immediately because time is basically brain tissue," Surdam said. "The longer you wait, the less chance you have of meaningful recovery."

Surdam has seen remarkable results with t-PA. Some patients who are paralyzed on one side return to normal on the next day after taking it, he said.

TPA should be given during the first three hours after a stroke. But it can't be given for every stroke.

Patients whose strokes are caused by bleeding in the brain cannot use the medicine. And it isn't for patients on blood thinning medication.

"Over the past decade, there have been tremendous advancements about what we can do (for stroke survivors)," Surdam said.

CRMC established a formal stroke alert system a year ago. The goal is to streamline care so patients can be treated as quickly as possible.

Paramedics with American Medical Response start the alert if patients they treat show signs of strokes that could benefit from t-PA.

Once the stroke alert is activated, CRMC staff prepares the CT scanner to avoid delay when a patient arrives. The CT scanner can detect what type of stroke a patient is having and its severity.

Therapy takes work

On Tuesday, occupational therapist Rebecca Murchie worked with Jean at The Therapy Center at Life Care Center. The aim was to do activities that strengthen her left side.

The pair prepared poppy seed muffins at Life Care Center's therapy kitchen. The facility is equipped with a full-sized kitchen, bathroom and bedroom to help patients practice routine skills.

Murchie directed Jean to use her left hand and arm as much as possible as she mixed the muffins. Jean stirred the batter with a spoon and scooped it into muffin cups with a measuring cup in her left hand.

Therapy assistant Courtney Caswell then helped Jean walk on a parallel bar apparatus.

Caswell stood close by as Jean took careful steps as Sherm Wiseman held his wife's hand to steady her.

"We do a lot of repetition, over and over," Caswell said.

At Life Care Center, the staff first evaluates patients so they can set up a treatment plan. They want to get them back to doing what they did before the stroke, said Sarah Patterson, occupational therapist.

Added Shannon Dunn, a speech therapist there, "We have amazing miracle stories walk out of this place."

Advancements in technology have helped too. Equipment is now available, for example, that strengthens the muscles used to swallow.

Conventional wisdom used to be that a person's recovery level peaked six months after a stroke.

Not so.

"We can see recovery in people two, six, 10 years down the line," Murchie said.

Jean Wiseman will not give up; she has a deep resolve to improve. Her therapists are sure she can do it.

"Grit your teeth and go," she said. "You have to keep working. You've got to work past it.

"I just put it in the Lord's hands. I think he's using me as a testimony to others that you can do these things."

Distributed by MCT Information Services

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