Coping With Stroke

STROKE!

A LEADING cause of death and chronic disability in the Western industrialized world is stroke. The very word "stroke" implies the suddenness with which a "brain attack" occurs. One moment, you may be feeling fine, and the next moment, you feel as if you were hit by a bolt of lightning-a major stroke can abruptly and dramatically change your life. Cruelly maiming and crippling you, it may render you speechless, wreak havoc on your emotions, alter your personality and powers of cognition, and thrust upon you a seemingly endless struggle to regain the normal life you and your family once knew.

Consider Ellen Morgan.* On Wednesday, Ellen was a healthy, active 64-year-old. On Thursday, while shopping with her husband, Ellen suddenly lost her ability to speak, and her face became distorted. Her body weakened, and she lurched as if in a drunken condition. Ellen was suffering a major stroke!

In the aftermath of the stroke, Ellen was so disabled that she could not do the simplest of things, like bathing or dressing herself. Unable to write, knit, or sew, she became plagued with bouts of uncontrollable weeping and overwhelming fatigue. In all of this, Ellen's thought processes were not impaired; however, feelings of embarrassment would arise when she felt that perhaps others looked upon her as a simpleton. Later, Ellen explained: "Few realize how the shock of this sudden change affects one emotionally and psychologically. I almost felt as though it were the end of my existence as a person."

What causes a stroke? Is everyone who has a stroke affected in the same way? How have survivors coped with this disease? How do families of stroke survivors cope? What can all of us do to provide support?

STROKE—Its Cause
THE brain is the most delicate organ of the body," states neurologist Dr. Vladimir Hachinski, of the University of Western Ontario in London, Canada. At only 2 percent of the body's total weight, the brain contains more than ten billion nerve cells, which are in constant communication to produce our every thought, movement, and sensation. Dependent on oxygen and glucose for energy, the brain receives a steady supply via an intricate system of arteries.

However, when any limited part of the brain is deprived of oxygen for even a few seconds, delicate neuron functions are impaired. If this persists for longer than a few minutes, brain damage results, as brain cells begin to die along with the functions they control. This condition is called ischemia, a lack of oxygen mainly caused by artery blockage. Further damage is inflicted on brain tissue as oxygen starvation triggers a deadly cascade of chemical reactions. The result is a stroke. A stroke also occurs when blood vessels rupture, flooding the brain with blood, which cuts off connecting pathways. This disrupts chemical and electrical flows to the muscles and causes injury to brain tissue.

Its Effects

Every stroke is different, and strokes can affect individuals in ways that are almost limitless. Although no one suffers from every possible consequence of a stroke, the effects may range from mild and barely observable to severe and painfully obvious. The area of the brain in which a stroke occurs determines which bodily functions are impaired.

A common affliction is weakness or paralysis of the upper and lower limbs. Generally, this is limited to one side of the body, the side that is opposite the side of the brain where the stroke occurs. Thus, right-brain damage results in left-sided paralysis, and left-brain damage, in right-sided paralysis. Some individuals may retain the use of their arms and legs, only to find that their muscles shake to such an extent that their limbs seem to go off each in its own direction. The victim looks like a novice skater trying to keep his balance. Dr. David Levine, of New York University Medical Center, says: "They have lost the kind of sensation that tells them whether or not their limb is moving and where it is in space."

Upwards of 15 percent of survivors experience seizures, resulting in episodes of uncontrolled movements and, commonly, in periods of unconsciousness. Also, feeling pain as well as changes in sensations is common. A stroke survivor who experiences constant numbness in his hands and feet says: "There are nights when something touches my legs and I wake up because it seems as if I am receiving electric shocks."

Stroke outcome may include double vision and problems with swallowing. If the sensory centers of the mouth and the throat are damaged, further indignities can be suffered by stroke victims, such as drooling. Any of the five senses can be affected, causing disturbances in sight, hearing, smell, taste, and touch.

Communication Problems

Picture yourself being followed down a dimly lit street by two huge strangers. Glancing back, you see them rushing toward you. You try to scream for help, but nothing will come out! Can you imagine the utter frustration you would feel in such a situation? That is what many stroke victims experience when they suddenly lose their ability to speak.

Being unable to communicate thoughts, feelings, hopes, and fears-figuratively being isolated from friends and family-is one of the most devastating consequences of stroke. One stroke survivor described it this way: "Every time I tried to express myself nothing came out. I was forced to remain silent and could not follow either verbal or written commands. Words sounded . . . as though the people around me spoke a foreign tongue. I could neither comprehend nor use language."

Charles, though, understood everything being spoken to him. But about making a reply, he writes: "I would frame the words I wanted to say, but they came out scrambled and garbled. At that point I felt I was trapped inside myself." In his book Stroke: An Owner's Manual, Arthur Josephs explains: "Over one hundred different muscles are controlled and coordinated during speech and each of those muscles is controlled by an average of over one hundred motor units. . . . An astounding 140,000 neuromuscular events [are] required for each second of speech. Is it any wonder an injury to a portion of the brain controlling these muscles may result in garbled speech?"

Many baffling phenomena in the speech area are produced by a stroke. For example, an individual who cannot speak may be able to sing. Another may say words on impulse but not on command or may, on the other hand, talk incessantly. Others repeat words or phrases over and over or use words inappropriately, saying yes when they mean to say no and vice versa. Some know the words they want to use, but the brain cannot prompt the mouth, lips, and tongue to say them. Or they may experience slurred speech because of muscle weakness. Some may punctuate their words with explosive outbursts.

Other stroke damage may be impairment of the portion of the brain that controls emotional tone. The result can be speech that sounds flat. Or there may be difficulty in comprehending the emotional tone of others. Communication barriers like these and those described above can drive a wedge between family members, such as husband and wife. Georg explains: "Because stroke affects facial expressions and gestures, indeed the whole personality, we suddenly did not get on with each other as before. It seemed to me as if I had a totally different wife, someone I had to get to know all over again."

Emotional and Personality Changes

Inappropriate mood swings, outbursts of tears or laughter, extreme anger, unaccustomed feelings of suspicion, and overwhelming sadness are just part of the bewildering emotional and personality disturbances stroke survivors and their families may have to deal with.

A stroke victim named Gilbert relates: "At times, I get emotional, either laughing or crying over the slightest thing. Once in a while, when I laugh, somebody will ask, 'How come you're laughing?' and I really can't tell them." This, coupled with problems with balance and a slight limp, prompted Gilbert to say: "I feel as though I'm in some other body, as though I'm somebody else, not the same person I was before the stroke."

Living with mind- and body-altering impairments, few people if any escape feeling a sense of emotional upheaval. Hiroyuki, whose stroke left him with impaired speech and partial paralysis, comments: "Even with time I just didn't get better. Realizing I would not be able to continue my work as before, I fell into despair. I began blaming things and people and felt as if my emotions would explode. I did not act like a man."

Fear and anxiety are common to stroke victims. Ellen comments: "I have feelings of insecurity when I experience pressure in my head that could warn of a future stroke. I become really fearful if I allow myself to think negatively." Ron explains the anxiety he deals with: "To arrive at correct conclusions is almost impossible at times. Sorting out two or three small problems at once frustrates me. I forget things so quickly that I sometimes cannot remember a decision made a few minutes before. As a result, I make some awful mistakes, and it's embarrassing to me and others. What will I be like in a few years? Will I be unable to converse intelligently or drive a car? Will I become a burden to my wife?"

Family Members Are Victims Too

It can be seen, then, that victims of stroke are not the only ones who must grapple with devastating consequences. Their families also do. In some cases they must cope with the terrible shock of seeing a once articulate, capable individual suddenly deteriorate before their eyes, reduced to a state like that of a dependent infant. Relationships can be disrupted as family members may have to take on unfamiliar roles.

Haruko relates the tragic effects this way: "My husband lost his memory of almost everything important. We suddenly had to get rid of the company he had run and let go of our house and our possessions. What hurt most was no longer being able to talk freely with my husband or turn to him for advice. Confused between night and day, he often removes protective diapers needed at night. Although we knew that the time would come when he would be reduced to this state, it is still hard for us to accept the reality of his condition. Our situation is completely reversed, in that now my daughter and I are my husband's guardians."

"Caring for someone with a stroke-no matter how much you love them-can be overpowering at times," observes Elaine Fantle Shimberg in Strokes: What Families Should Know. "The pressure and responsibility don't let up." In some cases the high level of care some family members provide can take its toll on the caregiver's health, emotions, and spirituality. Maria explains that her mother's stroke had a terrific impact on her life: "I visit her every day and try to build her up spiritually, reading and praying with her, and then lavishing love, hugs, and kisses on her. When I come home, I'm drained emotionally-some days to the extent that I throw up."

The most difficult thing for some caregivers to cope with is the change in behavior. Neuropsychologist Dr. Ronald Calvanio tells Awake!: "When you have a disease that affects higher cortical functions-that is, how a person thinks, conducts his life, his emotional reactions-we are dealing with the very essence of the person, so in certain ways the psychological impairments that occur really change the world of the family in a way that is quite dramatic." Yoshiko relates: "My husband seemed to change completely after his illness, flaring up over the slightest thing. I get truly miserable at those times."

Often, personality changes may not be recognized by those outside the family. Hence, some caregivers feel isolated and carry their burdens alone. Midori explains: "The strokes have left my husband with mental and emotional disabilities. Although he has a great need for encouragement, he will not talk about it with anyone and suffers by himself. So it is left up to me to handle his emotions. Watching my husband's moods each day has made me uneasy and sometimes even afraid."

How have many stroke survivors and their families coped with the changes a stroke brings in their lives? In what ways may each of us support those who suffer from the crippling effects of stroke? Our next article explains.

Coping With Its Effects

LYING in a hospital bed with paralyzed limbs, Gilbert asked his doctor: "Will I ever regain use of my arm and my leg?" Gilbert heard the challenging response: "The harder you work, the more you will get back, and the quicker you will do it." He replied: "I'm ready!" Physical therapy coupled with a positive outlook led him, at age 65, from a wheelchair to a walker, then to a cane and back to work.

"Most of today's poststroke rehabilitation supports the notion that if one area of the brain is damaged, other centers can assume the role of the injured tissue. One purpose of therapy is to both bring out the potential of these uninvolved centers and provide the stimulation to permit the brain to reorganize and adapt," state researchers Weiner, Lee, and Bell. However, recovery is determined by other factors too, such as the site and the severity of the stroke, the general health of the individual, the quality of medical care, and the support of others.

Support of Family and Friends

Erikka engaged in rehabilitative exercises for three years, learning to walk and to use her right hand to compensate for her disabled left hand. She tells what enabled her to cope: "The most important thing was that my husband and my friends remained loyal to me. To know that they loved me gave me strength, and when they encouraged me not to give up, that motivated me."

Family members become partners in the recovery process of their loved ones. They need to ask questions of medical personnel and observe therapies that may need to be continued at home so as not to lose the gains already made. The patience, kindness, understanding, and affection shown by family members and friends provide a secure emotional environment in which to relearn speech, reading, and other skills of daily living.

Striking a balance between pushing and coddling, John worked hard helping his wife Ellen with exercise and therapy. He describes his family's efforts: "We wouldn't let Ellen sink into the depths of self-pity. At times we were hard taskmasters, but we always monitored her limitations and gave assistance. She is more sensitive, so I make an effort not to cause her stress."

As Ellen learned how to speak again with the help of a speech therapist, John assisted her. "Doing things together was a means of encouragement, so we would read the Bible aloud to each other, which helped improve her speech. Also, taking it slowly at first, we engaged in the ministry, as we are Jehovah's Witnesses. In this way Ellen could share with others the hope we have for the future. This was a therapy in itself for Ellen." By the end of three years, Ellen had improved greatly.

The encouragement and strength that friends can impart should never be underestimated, as they can have a tremendous effect on a stroke survivor's recovery. The medical journal Stroke reported that higher "levels of social support were found to be predictive of a more rapid rate of recovery and a greater amount of overall improvement in functioning, even among patients with more severe stroke."

Bernie appreciated very much the support that his friends gave him. He reminds us: "The visits of friends are vital in coping. A sympathetic voice and a caring attitude lift the morale. Though one need not dwell on the person's disability, recognition of any improvement is very encouraging." What might all of us do to lend support to those coping with the aftermath of a stroke? "Take some flowers," suggests Bernie, "or share a Scriptural thought or experience. That was of great help to me."

Melva, an elderly stroke survivor, found it helpful to have one of her spiritual brothers pray with her. Gilbert also recommends this, explaining: "It shows that you really care enough when you pray with someone." Peter, whose stroke left him with impaired vision, appreciates it when others understand his limitations and take the time to read to him.

Assisting one to and from rehabilitation is also a loving gesture. Making sure that the stroke victim's home is a safe place is necessary too. Falling is a constant threat when balance is a problem. Gilbert, for example, appreciated the kindly help of friends who, among other things, installed a grab bar in his shower for safety.
Learning to Render Support

Mood swings and a heightened tendency to cry can be embarrassing for the stroke victim, as well as disconcerting to onlookers who may not know how to respond. However, learning to be supportive, friends can rescue a stroke victim from the isolation that may otherwise result. Usually, crying spells become less frequent. But when tears come, remain calm and stay by the person, saying what you would like to hear if your roles were reversed.

Above all, cultivate godly love for those whose impairments may have changed the personality you once knew. They sense how you feel, and that, in turn, affects their response to you. Erikka comments: "I may never be the same person again. But no one should demand that of a stroke victim. Relatives and friends should learn to love the person as he or she is. If they carefully rummage around in his or her personality, they will discover that the most attractive qualities of the past are still there."

Self-respect dips to a low point when one is unable to talk or be understood. By making the effort to talk with them, friends can affirm the worth of those whose speech is impaired. Takashi states: "What I think and feel at heart has not changed. However, people tend to avoid contact with me because they can't hold a normal conversation with me. It's hard for me to approach people, but when someone comes up to talk to me, it is a tremendous encouragement and makes me very, very happy!"

The following are some guidelines that can help all of us to support and encourage those who suffer speech impairments.

Most strokes do not affect the intellect. Most people who survive a stroke remain mentally alert, even though their speech may be difficult to understand. Never speak down to them or resort to baby talk. Treat them with dignity.

Listen patiently. They may need time to reorganize a thought or finish a word, phrase, or sentence. Remember, the most caring listener is not in a hurry to hear.

Do not pretend to understand if you don't. Kindly admit: "I'm sorry. I just can't seem to understand. Let's try again later."

Speak slowly and clearly in a normal tone of voice.

Use short sentences and familiar words.

Use questions that elicit a yes or a no, and encourage response. Keep in mind that they may be unable to comprehend your words.

Keep background noise down.

Coping, With Jehovah's Loving Support

While it is important to know the cause of your stroke, as that enables you to take action and reduce your risk of future strokes, gaining control of the accompanying fear is also important. Ellen relates: "God's words at Isaiah 41:10 especially comfort me. There he says: 'Do not be afraid, for I am with you. Do not gaze about, for I am your God. I will fortify you. I will really help you. I will really keep fast hold of you with my right hand of righteousness.' Jehovah has become so real to me, making me feel unafraid."

The Bible also helps Anand cope with the despair he feels: "It provides me with extreme support, as it constantly revives and refreshes me." Hiroyuki's problem was how to benefit from the Scriptures, since he could not concentrate. He says: "I found comfort in listening to the Bible books on audiocassettes."

The apostle Paul stated: "When I am weak, then I am powerful." (2 Corinthians 12:10) It was Jehovah's spirit that helped Paul accomplish what he could not do on his own. Those who survive a stroke can also rely upon Jehovah for spiritual strength. Erikka explains: "When we are healthy and do everything in our own strength, we may not give Jehovah much opportunity to help us. But my handicap has enabled me to strengthen my relationship with him in a very special way."
Caregivers Find Support

Caregivers need support in their crucial role. Where can they turn for support? One place is within the family. Each member needs to share the load of caregiving. Yoshiko tells how her sons gave her emotional support: "They would listen to my problems as if they were their own." Family members need to obtain all the information available to them in order to learn how to care for a stroke victim and also how to deal with the changes in their loved one's personality.

Who else might lend support to caregivers? David and his family reached out to their spiritual family within the congregation of Jehovah's Witnesses for help with Victor: "They responded to our need. Taking turns, they at times come and sleep at our place to attend to Victor throughout the night for us."

Every caregiver needs to feel the warm love and support of his spiritual family. But some may find it difficult to ask for help. Haruko explains: "I am often told: 'If there's anything you need help with, don't hesitate to let us know.' But knowing how busy everyone is, I cannot bring myself to ask for help. I would be very grateful if people offered help in specific ways: 'I can help you with cleaning. Which day is best for you?' 'I can do your shopping, so will it be all right if I drop by now?'"

Kenji's wife had a stroke; however, he was able to provide the care she needed. He found that by prayer he could throw his burdens upon Jehovah. Eventually, his wife lost her ability to speak, and with that, Kenji lost a partner to talk to. But he reads the Bible every day. He says: "It reminds me of Jehovah's tender care for those crushed in spirit, and this has prevented me from becoming depressed and lonely."

Relying on Jehovah's spirit can help when it seems that emotions are about to get the best of us. Yoshiko, coping with her husband's personality change and temper flare-ups after his stroke, relates: "Sometimes I've felt driven by an urge to scream at the top of my voice. At those times I would always pray to Jehovah, and his spirit would bring me peace." In appreciation for Jehovah's loyalty to her, she lets nothing interfere with her Christian way of life. She regularly attends Christian meetings, engages in the ministry, and does personal Bible study. "By doing my part," Yoshiko says, "I know that Jehovah will never forsake me."

When anxieties creep in, Jehovah is always there to listen. Midori, whose husband is a stroke survivor, takes comfort in the fact that, figuratively, Jehovah has put all the tears she has shed into his "skin bottle." (Psalm 56:8) She recalls Jesus' words: "Never be anxious about the next day." She says: "I've made up my mind to be patient until the new world comes."—Matthew 6:31-34.
Facing Severe Limitations

It is true that in their rehabilitation some experience significant recovery, but others attain only a small amount of success in regaining prestroke abilities. What can help the latter to face the challenge of accepting their limitations, severe and long-lasting though they may be?

Bernie, who lost much of his mobility because of a stroke, answers: "The joy of my hope of eternal life on a paradise earth to come and prayer to my heavenly Father, Jehovah, helped me accept my limitations with calmness."

That hope helped Erikka and her husband, Georg, accept her limitations and still enjoy life. Georg explains: "We have God's promise of complete healing one day. So we don't concentrate on the disability. Of course, we still do all we can for Erikka's health. But you can learn to live with the imperfect coordination of muscles and concentrate on more positive things."—Isaiah 33:24; 35:5, 6; Revelation 21:4.

In cases where recovery is very limited, the support of family and friends is even more crucial. They can help the victim to cope until it is God's time to remedy all health afflictions.

Knowing that there is a grand future for stroke victims and their families when health will be restored enables them to deal with life one day at a time. They can thus patiently wait for relief from all suffering, in God's new world soon to come. (Jeremiah 29:11; 2 Peter 3:13) In the meantime, all who turn to Jehovah can be confident that even now he will help and support them in coping with the crippling effects of stroke.—Psalm 33:22; 55:22.

Warning Signs

* Sudden weakness, numbness, or paralysis of face, arm, or leg, especially on one side of the body
* Sudden blurred or dimmed vision, especially in one eye; an episode of double vision
* Difficulty speaking or understanding even simple sentences
* Dizziness or loss of balance or coordination, especially when combined with another symptom

Less Common Symptoms

* Sudden, unexplained, and intense headache-often described as "the worst headache ever"
* Sudden nausea and fever-distinguished from a viral illness by the speed of onset (minutes or hours rather than several days)
* Brief loss of consciousness or a period of decreased awareness (fainting, confusion, convulsions, coma)

Do Not Ignore Symptoms

Dr. David Levine urges that when symptoms appear, the patient "go as quickly as possible to a hospital emergency ward. There is evidence that if a stroke is treated in the first few hours, the damage can be minimized."

Sometimes symptoms may appear for a very short period of time and then disappear. These episodes are known as TIAs, or transient ischemic attacks. Do not ignore them, as they may indicate serious stroke risks, and a full stroke may follow. A doctor can treat the causes and help reduce the risk of a future stroke.

Stroke Prevention
"THE best way to deal with stroke is to attempt to prevent it," states Dr. David Levine. And the number one factor associated with most strokes is high blood pressure.

For many people, high blood pressure can be controlled through a diet rich in potassium and low in salt, saturated fat, and cholesterol. Modifying alcohol consumption may be important too. A regular exercise program appropriate for one's age and fitness level can help shed excess pounds, which in turn may reduce blood pressure. Medicine may have to be taken-under a doctor's supervision, as there is a wide range of drugs available.

Carotid artery disease narrows the major blood-supply route to the brain and is a main contributor to stroke. Depending on the degree of blockage, surgery known as carotid endarterectomy to clear the blocked arteries may be indicated. Studies have shown that people who were exhibiting symptoms and whose arteries were severely narrowed benefited from surgery along with medical therapy. However, there can be problems related to the surgery, so it must be considered carefully.

Heart disease can increase the risk of stroke. Atrial fibrillation (irregular heartbeat), which can cause blood clots to form and travel to the brain, can be treated by anticoagulants. Other heart problems may require surgery and medication to reduce stroke risk. Diabetes accounts for a large proportion of stroke occurrences, so controlling it helps prevent stroke.

Transient ischemic attacks, TIAs, are clear warnings that a stroke may occur. Make sure that they are not ignored. See your physician, and deal with the underlying cause, as TIAs increase stroke risk manyfold.

A healthy, moderate life-style can do much to prevent stroke. A balanced diet and regular exercise as well as keeping consumption of alcohol to a minimum and eliminating smoking can help keep arteries healthy and may even promote healthy changes in already damaged ones. Increasing the intake of fresh fruits and vegetables and grains has, according to various studies, helped reduce the risk of stroke.