Stroke of Good Luck

April 15, 2015

 

It seems the brain can not only change itself, it can cure itself.

 

This is especially true when you have a stroke. A lot has to do with how fast it’s treated.

As we age, we forget a lot. But one thing we need to remember is these three quick tests for a stroke: Smile, Raise your Arms, Speak a Simple Sentence.

 

If you can’t do that, call 911 right away or get the first person you see to call. The goal is to get to a hospital as fast as you can. For within three hours you have a chance of restoring your mental and physical functions; after three hours, not so much. The longer your brain tissue is deprived of oxygen by virtue of a blood clot in the vessels supplying it, the worse the damage and the more likely irreversible damage will follow.

 

For whatever reason most strokes occur in the early morning. A man tries to get up to go to the bathroom and has trouble standing up. The stumbling around alerts his partner and she asks: “What’s wrong?” There’s mumbling or incoherence in response, and the alarm is up.

 

In the ER, once a CT scan confirms a clot (most strokes are from clots rather than bleeds), doctors will provide a clot-buster drug via an intravenous line. Then wait and see what happens.

 

have a friend who’s an ER doctor. She’s now leading a study that will let EMS teams administer a trial drug in the home if the patients meet the study’s criteria, including how long ago did the stroke begin. This means she carries a pager 24 hours a day in order to be able to take the calls from the EMS people within the first four rings. If she doesn’t answer by then, they get a message back saying to proceed with usual care and transport the patient immediately to the hospital. So she is now a virtual stroke midwife for the ambulance crews. But doctors take this very seriously – as should patients. Early intervention is critical to providing the best outcome in the same way that M.A.S.H. units in the American military proved their worth in saving lives in combat zones.

 

But there are even more promising advances. They come in discovering the brain’s amazing capacity to re-invent its essential functions using new pathways when the old ones are damaged,

 

Some scientists believe the brain can grow new cells, a notion once thought impossible. Dr. Norman Doidge argues this in his new book, The Brain’s Way of Healing. He reviews the conventional wisdom in the fields of chronic pain, Parkinson’s, autism and stroke, and then searches the world for credible practitioners in the new, hard-won arts of healing by redirecting the neural pathways.

 

Let me add my own patients’ experiences to underscore the fact – well, the very strong belief – that our brains aren’t in any way passive in the process of recovery from serious assaults like stroke.

 

Transient Global Amnesia was something I’d never seen in the first 40 years of my practice. Then within two years, two of my patients were diagnosed with this odd and baffling occurrence. It doesn’t last long and seems to have no lasting effects. My first patient was driving her car and realized she had no idea where she was going or why.

Her passenger grew alarmed, and though he didn’t take over the driving, he directed them to the nearest hospital. Everything checked out when she was tested and she was allowed to go home to follow up with me for more extended testing. We learned nothing new. The entire sequence lasted four hours. Nothing else happened, nothing was lost except her memory for a defined period of time.

 

The second patient lost an entire day to Transient Global Amnesia. She had virtually the same circumstance of driving and forgetting, but maybe because her ‘forgetting’ lasted so much longer, she was dubious there wouldn’t be some kind of fallout, like losing her sense of self.

 

Both cases remain a mystery.

 

My own story, 40 years earlier, also remains a mystery.

 

In my early 30s I felt I had it all. I’d scrapped my way into medical school, though I was already considered too old. To go to school again, I’d quit my job as a head nurse at Toronto’s famed Clarke Institute of Psychiatry. I was joyously a student again and 5-months pregnant with my first child.

 

I’m not sure what made me leave the lecture hall early one afternoon. I didn’t usually think the lectures were boring, but for whatever reason I was driven out of the auditorium. I walked the hour or so to the house my husband and I were ‘baby-sitting’, our friends having left the house and their kids in our care. I settled into the kitchen nook with the newspaper when their daughter arrived home from school and dived into the fridge for a snack. I raised my head to say there were cookies. But what emerged from my mouth was garble, even to me.

 

So I turned to the editorial cartoon on the newspaper page. Did I understand what it meant? No. Could I articulate what it ‘said’ in my head? No. Alarmed now, I next turned to the easy cartoons. Could I connect their frames? No.

 

So I did what any self-respecting 30-year-old would do in those circumstances. I went to bed, uttering some gibberish to the puzzled 14-year-old in the kitchen. I slept a few hours and when I woke my words were back and my understanding returned. I told my husband, who’d heard with some alarm from the children about my odd behavior. He accepted my ‘too tired’ version and gratefully made dinner, by which time I felt indeed fully back to myself.

 

But I’ve often wondered about this bizarre incident; my mind settled on hormones or a tiny clot in a critical area.

 

Would I advise such a cavalier attitude for my patients today? Absolutely not.

 

Even allowing for the magic of re-wiring and regeneration, I’m much happier to share the process of trying to figure out what’s really going on with anyone who reaches out with a helping hand along the way.

Dr. Jean

Marmoreo

 

Doctor. Writer. Athlete.

Advocate. Adventurer.