stroke

Bob and Lorraine Tamas relax in the garden at their Stratford home.


When a stroke occurs, act FAST

A retired teacher, Lorraine, then 63, was taking care of her six-month-old granddaughter. She dropped off the baby at her daughter’s house and went to Pilates. She got home and had started to make dinner, when her husband Bob Tamas noticed something was wrong.

“When she was chewing, I noticed that something was going on with her left side,” said Bob, her husband of 40 years. “So I called 911.”

By the time the ambulance had arrived, Lorraine “was passed out,” said Bob.

It was June of 2010 when Lorraine suffered a hemorrhagic stroke and was rushed to Bridgeport Hospital. “The bleed was causing so much pressure on her brain, they weren’t sure she was going to make it,” recalled Bob. “But they operated and saved her life, and she is still with us today.”

According to the American Stroke Association, stroke is a disease that affects the arteries leading to and within the brain. It is the number-five cause of death and a leading cause of disability in the United States. On average, someone suffers a stroke every 40 seconds, someone dies of a stroke every four minutes and 795,000 people suffer a new or recurrent stroke each year.

“There are basically two types of strokes, an ischemic stroke, which is usually due to a clot obstructing the flow of blood to the brain, or a hemorrhagic stroke, due to a blood vessel rupture,” explained neurologist and co-director of the Stroke Center at Bridgeport Hospital Philip Barasch, MD.

Causes of stroke

“There are a number of risk factors,” explained Dr. Barasch. “As people get older, the risk gets higher. The most important risk factor is hypertension. Other risk factors include diabetes, smoking, lack of exercise, family history, race, gender, certain cardiac disorders (especially atrial fibrillation), high cholesterol levels and illicit drug use.”

“A good way to identify a stroke is to use the FAST acronym: Facial drooping, Arm numbness or weakness and Slurred speech. Time to the hospital is of the essence, since treatment for a stroke must be started immediately,” said Dr. Barasch.

“FAST can help identify about 80 percent of strokes.” Another health issue that has similar symptoms to a stroke is a TIA or transient ischemic attack.

A TIA can cause the same symptoms as a stroke but will go away after a few minutes or a few hours. “TIAs can be a warning sign of a stroke, so go directly to the emergency room,” said Dr. Barasch. “Any acute neurologic change deserves an evaluation.”

“A person having a TIA or stroke may not realize their symptoms while they are occurring because a stroke may cause problems with perception. In other instances, they may be aware of their symptoms, but unable to communicate effectively because of the stroke itself,” said Lisa Webb, MD, neurologist and physiatrist at Bridgeport Hospital and medical director for Ahlbin Rehabilitation Centers, Bridgeport Hospital’s outpatient rehabilitation arm. “If experiencing or witnessing any of these symptoms, do not assume that the symptoms will improve by resting at home. Call 911 immediately time is brain.”

Stroke treatment at Bridgeport Hospital “Upon their arrival at Bridgeport Hospital, our potential stroke patients are identified and evaluated immediately in one of our designated resuscitation suites,” explained Rockman Ferrigno, MD, associate chief medical officer and chair of Emergency Medicine. “They are examined, have blood drawn and are moved quickly to CT (computed technology) scan, where they receive a head, neck and brain CT. In parallel, their care is partnered with our neurology service.”

If a patient suffers an ischemic stroke, there is a three- to four-hour time frame for treatment with recombinant tissue plasminogen activator — r-tPA — given through an IV in the arm. If a clot is found, Bridgeport Hospital may team with Yale New Haven Hospital to treat the patient with intra-arterial therapy.

Lorraine’s hemorrhagic stroke was caused by a ruptured intracranial vessel due to a cerebral aneurysm and repaired surgically. A ruptured aneurysm or other vascular abnormalities can be the cause of a hemorrhagic stroke.

“You can reduce your risk of having a stroke by living a healthy lifestyle,” said Dr. Ferrigno. “But if you or a loved one is showing signs of a stroke, get to a hospital immediately. Bridgeport Hospital is certified by The Joint Commission as an Advanced Primary Stroke Center and is trained to provide safe, high-quality care to stroke patients.” Life after a stroke

Luckily, Bob called 911 and got Lorraine medical attention quickly. after her surgery and intensive care unit stay, Lorraine received therapies through the full spectrum of rehabilitation settings: acute inpatient rehab at Bridgeport Hospital, subacute rehab at an extended care facility, home based therapy and finally, outpatient rehab.

“After a stroke, if patients are not strong enough to safely care for themselves or be cared for safely in the home setting, it is usually recommended that they first receive inpatient rehab,” said Dr. Webb. “With milder strokes, patients may be deemed safe for discharge directly to their home, but they would usually receive home-based rehab first and then use outpatient rehab.”

When Lorraine had her stroke, the inpatient rehab unit was located at Bridgeport Hospital, but it has since been consolidated into the Yale New Haven Hospital Rehabilitation and Wellness Center, located on the second floor of Milford Hospital. Opened in 2016, this 24-bed multidisciplinary inpatient rehabilitation center provides intensive, three-hours-a-day, one-on-one therapy to help patients regain their functional abilities.

Physical therapists help to improve a patient’s mobility, balance, flexibility, strength, gross motor skills and coordination. Occupational therapists address problems with fine motor skills of the hands and basic activities of daily living such as feeding, grooming, dressing and bathing. Speech therapists instruct patients in oral-motor exercises, strategies for safe eating and swallowing, techniques to improve clarity of speech and overall communication and cognitive retraining.

“The first time I saw her at the inpatient rehab center after her stroke, I had tears in my eyes because there was so little that she could do,” said Bob. “But now she is capable of so much more. She is improving. She is pretty amazing. I am not sure that I would have the stamina to do what she does.”

Lorraine, now 70, remains under the care of Dr. Webb, who administers intramuscular Botox injections and manages a pump that delivers muscle relaxant medication directly into the spinal fluid via a pump system implanted under the skin. These treatments help the excessive muscle tone that developed because of the stroke and can interfere with her mobility and flexibility. Lorraine also uses a lower leg and foot brace, or orthosis, which can help her advance her weak leg when walking.

In addition to these treatments, Lorraine still receives therapy several months per year at the Ahlbin Center.

When it comes to therapy, Dr. Webb believes that you generally get out of it what you put in. “Lorraine is very motivated to get better, works hard and has made tremendous progress,” said Dr. Webb.

Lorraine offers advice to people dealing with the aftereffects of a stroke: “Participate in a support group. Find others to talk to who have also been through a stroke,” said Lorraine. “You don’t have to do it alone.”

Lorraine practices what she preaches. She and Bob attend the monthly stroke support group on Tuesdays at the Ahlbin Center. She also attends a weekly support group at a private residence.

Lorraine and Bob are thankful for the care she received at Bridgeport Hospital. “I really didn’t mind spending my summer at Bridgeport Hospital. They were fun people and so positive,” said Lorraine. “Their uplifting attitudes helped me a lot and my attitude has made a real difference.”

Bob chimed in. “We have maintained friendships with some of the therapists we met through this experience. We are very grateful to Bridgeport Hospital.”

For more information on stroke care at Bridgeport Hospital, visit bridgeporthospital.org/services/stroke.aspx
.