Getting out of bed that Saturday morning in July, I collapsed on the floor and couldn’t get up,” remembers Furlong resident Thomas Blackburn. “My left side was completely paralyzed. I kept telling my wife not to call an ambulance, but I’m a big man and she couldn’t move me. Clearly we needed help.” Tom’s wife had sound instincts. She summoned medical assistance despite her husband’s protests.

Tom is one of 700,000 Americans to suffer a stroke in 2006. Striking someone in the United States every 45 seconds, stroke is a thief that silently steals away independence and mobility. Often painless, stroke signs prompt many to blame a numb arm on stress, dizziness on sports injuries, or trouble speaking on fatigue. According to the National Stroke Association, sufferers typically wait 12 to 24 hours before seeking help – a costly delay that limits treatment options and compromises recovery.

Brain Attacks: Just as Urgent as Heart Attacks
Sometimes called “brain attacks,” strokes occur when a clot blocks blood flow to an area of the brain or when a blood vessel ruptures and leaks blood into surrounding brain tissue. As brain cells begin to die from lack of oxygen, they no longer govern body functions correctly.

The severity of a stroke varies from person to person. A major stroke in the brain stem, which controls basic functions like breathing, may be deadly. Small strokes elsewhere in the brain may trigger only slight arm or leg weakness. TIAs, or transient ischemic attacks, interrupt blood flow only briefly, causing fleeting symptoms and leaving no lingering effects.

About two-thirds of stroke sufferers have lasting disabilities. Strokes affecting the right brain hemisphere often cause movement difficulties on the body’s left side, memory problems, and difficulty judging size, distance, speed, position, or how parts connect to a whole. Left hemisphere strokes often leave behind speech and language troubles, memory deficits. and problems moving the body’s right side. With both right and left hemisphere strokes, people may have difficulty seeing, swallowing, communicating, and performing everyday tasks like feeding themselves, bathing, dressing, and working. Depression and personality changes are also frequent side effects.

Are You a Risk Taker?
Strokes can affect anyone, even children – though this is an exceedingly rare event usually triggered by existing health problems. Most strike older adults who are at risk for the disorder. In Tom’s case, a three-packa- day smoking habit compromised his circulatory health, as did a diet laden with fats. “I liked the fat on my steak too much,” Tom admits.

Regular medical care and lifestyle changes lessen some stroke risks. “Reducing high blood pressure and high cholesterol with medication and diet helps lower risk,” explains Doylestown Hospital neurologist Roy Jackel, MD. ”Diabetes also increases the likelihood of a stroke, so managing the disease carefully is essential.” Obesity, excessive alcohol use, and physical inactivity also predispose a person to the disorder, so losing weight, kicking bad habits, and getting more exercise comprises a three-pronged insurance plan against stroke.

Unfortunately, we can’t change other risk factors. Men who are over 55 and of African-American, Hispanic or Asian/Pacific descent have an increased stroke risk, as do those men and women with a family or personal history of the disorder.

Time is Brain: Faster Help Saves More Brain Cells
For the 500,000 who suffer first strokes and the 200,000 who have recurrent strokes annually, innovative treatments offer hope. Doylestown Hospital administers one of the most promising: t-PA, also known as a “clot-busting” medication. For qualifying patients, t-PA breaks up clots within the brain and can produce rapid and significant improvements. The potential benefits t-PA offers are extra reasons for quick medical attention: it’s only effective within three hours of stroke onset, and some studies suggest that the earlier the drug is given, the greater the potential benefit.

The drug doesn’t help everyone – some patients don’t respond and others can’t have it at all. “Physicians evaluate patients carefully to see what type of stroke they are experiencing,” Jackel explains. “Clot-busting drugs help those whose strokes are caused by clots, but harm those with hemorrhagic strokes – the ones caused by ruptured blood vessels.”

Other treatments dot the research horizon. Some institutions are testing tools that physically retrieve clots and others are treating hemorrhagic strokes with hemophilia medications. Doylestown Hospital recently assessed a medication that may protect brain cells near the stroke area. They also are starting to evaluate a t-PAtype drug that may expand the treatment window from three to six hours.

Getting Back on Your Feet
Stroke treatment extends far beyond emergency room doors. “Rehabilitation begins as soon as we admit a stroke patient from the emergency department,” explains Doylestown Hospital rehab director Thea Semanoff, MD. Physical and occupational therapists position the patient to maintain mobility in affected limbs and initiate early mobility. Speech therapists assess factors such as the patient’s ability to communicate, a critical skill since rehabilitation relies on teaching. They also evaluate swallowing problems – a common stroke side effect – with a state-of-the-art video imaging system. Physiatrists and social service specialists lay the groundwork for appropriate rehab placement or a productive return home. Throughout the entire recovery process, the medical team involves the patient’s most powerful healing resource: the family.

As patients graduate from institutional care, they enter comprehensive outpatient brain injury programs with physical and occupational therapy three to five times weekly for up to four hours at a time. During these sessions, Doylestown Hospital therapists incorporate cutting-edge rehabilitation techniques, including one called “vital stimulation.” Using electrical signals, this process can enhance swallowing or promote function in upper extremities. It helped Tom Blackburn get his smile back. “Before vital stim, I felt like half my face was on the floor and I was kicking it along in front of me,” Tom describes. “Vital stim returned movement and feeling.”

Researchers across the country are testing novel rehabilitation methods. For example, several studies have suggested that restraining a patient’s unaffected arm prompts the affected arm to regain function.

Doylestown Hospital: the “Go To” Stroke Resource
Tom anticipates driving again when his vision improves. As a head plant mechanic accustomed to a 70-hour work week, he itches to return to the job. For now, he focuses on positives like the patient, competent staff he encountered in the hospital’s emergency department, during his hospital stay, and through continuing outpatient rehabilitation. “When they work with me, I feel like I’m the only person in the world,” he says. “They take time and devote all their attention to me and my needs. I can’t say enough about how much they have done for me.”

Dr. Roy Jackel is with the Neurologic Group of Bucks and Montgomery Counties. Dr. Thea Semanoff is with Doylestown-Buxmont Rehab.