This week, longtime New York Times reporter and popular “Dot Earth” blogger Andrew Revkin vividly describes his 2011 stroke in the first-person piece “My Lucky Stroke.” He includes these “prime take-home points”: “Take your body seriously. Time (wasted) is brain (lost). Question authority, but not too much. Old habits die hard.”
Dr. Lee Schwamm, chief of Massachusetts General Hospital’s stroke service and medical director of Mass General TeleHealth, would suggest that readers take away some rather different stroke lessons from Andy Revkin’s story. He shares them here.
By Dr. Lee H. Schwamm
I congratulate the journalist and blogger Andy Revkin for courageously sharing the story of his stroke and his subsequent recovery. I also thank him for taking the time to share his personal experience for the benefit of his readers, and for the opportunity it presents to highlight some key learning points for patients, as we dissect his journey through the health-care system.
Mr. Revkin was relatively young and healthy, out for a run with his son, when he experienced stroke symptoms. All too often, when we think of stroke, we envision an older patient clutching their chest and being unable to move or speak. This stereotype is dangerous, both for patients and health-care providers, because it lowers our sensitivity to stroke-like symptoms in patients of any age.
Mr. Revkin and his son were concerned enough about his symptoms that he went home, but they didn’t appreciate the immediate seriousness of his condition and he took a shower, hoping his symptoms would resolve. Watch the video clip above showing a young news reporter having stroke-like symptoms, and ask yourself, would you have called 911 if you’d been present? You should have.
Without treatment to restore the blocked blood flow to the brain, 2 million nerve cells are dying every minute of continued stroke.
Then Mr. Revkin did what generations of doctors have advised us to do for a heart attack; namely, take some aspirin and call your doctor’s office. Unfortunately, when it comes to stroke, there are two types: those caused by blocked arteries (ischemic) and those caused by rupture of blood vessels (hemorrhagic). It’s not possible to tell just from symptoms if a stroke is ischemic or hemorrhagic; only a CAT scan or MRI can distinguish them.
Obviously, you don’t want to take an aspirin if you’re having bleeding in your brain, as it will make the bleeding worse. But it’s also not a great idea to take aspirin if it’s an ischemic stroke, especially not six aspirin, as Mr. Revkin did, because there are powerful clot-busting drugs that can be given to reverse the disability caused by ischemic stroke. These drugs — the main one is known as tPA — are only effective if they are given within the first 4.5 hours after the start of symptoms, and aspirin might increase the risk that the drugs could convert an ischemic stroke into a giant hemorrhage that could be fatal.
It’s also really important to realize, as Mr. Revkin mentions, that “time is brain.” This expression reflects the fact that without treatment to restore the blocked blood flow to the brain, 2 million nerve cells are dying every minute of continued stroke.
So what’s the best way to act fast and to get help fast? First you need to know the warning signs so you can recognize stroke. A simple memory tool is the acronym FAST, which stands for Face, Arm, Speech, Time: Is the Face drooping or uneven? Does one Arm drift down when held outstretched? Is there trouble with Speech or understanding?
If any of these are present, then it’s Time to call 911. The terrific animated public service message below helps reinforce this critical message and has been shown in studies to improve detection and recall of stroke symptoms.
The next issue is how to get help, and many studies have shown that if you arrive by ambulance, your odds of being seen rapidly and getting the right treatment are dramatically increased, because arriving by ambulance already signals this may be an emergency.
When EMS responds to your call for help, they need to decide where to take you, and there are many different methods they might choose to make that decision.
If you can’t breathe, they will take you to the nearest hospital; if your vital signs are stable, in many states they will take you to the nearest stroke center. Different organizations certify these stroke centers and not all stroke centers are alike. In many cities, there may be more than one nearby stroke center. So if you’ve done your homework as detailed below, you may want to weigh in on where you or your loved one is taken.
To see a map of stroke centers near you, click here and enter your zip code. There, you can select centers certified by the Joint Commission, which accredits and certifies American health care facilities, as having the processes in place that lead to quality, or by the American Heart Association Get With the Guidelines Stroke program that have demonstrated high rates of actually providing evidence-based treatments for stroke, including rates of tPA use greater than 85% of all eligible patients.
A recent editorial highlights the differences in these certification programs and explores how the different factors motivating certification might determine the quality of care that can be provided. It’s hard to tell why a center near you has chosen to become a stroke center, but as always, look for the other signs of excellence such as local reputation, service to the community, the presence of their doctors and educators serving as leaders in their fields.
As Mr. Revkin notes, telemedicine-enabled stroke care is revolutionizing the field of stroke, and programs and centers from across the country now provide this service to increase access to care and mitigate disparities in acute stroke care.
A recent survey documents programs across the United States, based at leading academic medical centers like Partners Healthcare and the Mayo Clinic as well as for-profit companies, all working to bring stroke care to the bedside wherever it is needed.
This is critical, since not every hospital has the skills and the staffing to treat acute stroke properly and safely. So look on the map cited above, ask around, and find out why the hospital near you isn’t certified, or if it is certified, why it hasnt won any awards for its care. Be an advocate for having the highest quality of stroke care in your community, since you never know when you or someone you love might need it.
Sadly, Mr. Revkin’s story is all too common, that a patient has to be the one to raise the question of whether stroke might be the diagnosis, and all too often, the chance for treatment has evaporated before the diagnosis is made.
Fortunately, it sounds like he made a substantial recovery. The good news is that most stroke patients experience some recovery, and many have a complete recovery and return to their lives, their homes and their work.
I will end by sharing with you the take-home points I give all my patients: Be prepared. Know the warning signs. Know how to activate EMS and say the word “stroke” when you call. Act FAST if you suspect a stroke. Know where the nearest stroke center is located. And know that getting to the hospital quickly is your best shot at a full recovery.
[Posted by Carey Goldberg]