The victim of the nation's
third largest killer tells what
science and family can
do to return an invalid
to a normal life
ten blamed, really don't have much to do with
causing strokes. In a recent large-scale study at
the New York University-Bellevue Medical Cen
ter, only 3.5 percent of several hundred stroke
victims were stricken under circumstances that
might be described as acute stress. Many of them
were asleep, just as 1 was, when the stroke oc
curred. Typically, over four times as many house
wives had strokes as did professional people.
The word "stroke" has no precise meaning. It's
just a way of indicating the symptoms of cerebro
vascular accident obstruction of the circulation
of the blood to or in the brain by hemorrhage, by
narrowing of an arteriosclerotic blood vessel, or
by clot If the stoppage of blood (which supplies
vital oxygen to brain tissues) lasts even a few
minutes, it is enough to kill the tissues affected
and knock out the things they boss leg or arm
movements, speech, and memory.
If the damaged tissues are on the left side of
the brain, the right side of the body is stricken.
Injury on the right side of the brain knocks out
the left side of the body. The extent of the injury
depends on which and how large a region of the
brain ia affected. Speech is controlled by a dime
size piece of tissue called "Broca's Area." When it
is only lightly damaged, there is just a slurring
of words, which usually clears up in a few days,
aa it did in my case.
Why I Had a Strafe
At the Northern Westchester Hospital in Mt
Kisco, N.Y., where I was taken by ambulance
from my home, specialists determined the cause
of my stroke: the high blood pressure I have had
for years had ruptured a weakened part of an
artery in my brain, causing hemorrhage. Because
I was not unconscious and because my speech,
while Blurred, was not seriously affected, the doc
tors reasoned that the bleeding was not extensive,
that nature itself had already stepped in to start
patching the hole. This was backed up by the lack
of blood in my spinal fluid.
Until just a few years ago, doctors generally
thought that all strokes were caused by blood-vessel
accidents inside the brain itself. But Dr. C.
Miller Fisher of Montreal, among others, was
baffled by consistent autopsy findings on stroke
victims which showed no damage at all to blood
vessels above the neck. In the early 1960s, Dr.
Fisher, studying 432 autopsies, discovered that,
in over a third, one or more of the four neck arter
ies supplying blood to the brain were narrowed or
clotted to such an extent that the tissues in the
brain were cut off from nourishment This was
quickly ruled out as a cause of my stroke by tests
that showed the blood pressure in my neck arter
ies to be normal. But in cases where the neck ar
teries are involved, dramatic new procedures are
now being developed.
Then, shortly after Dr. Fisher's proof that not
all strokes originated in the brain, a nontoxic
radio-opaque dye, which could be injected into
the circulatory system, was perfected. By using
rapid-fire X-ray equipment, it became possible to
follow the dye (injected into either arm or neck
arteries), as it surged up through the neck to
make its three-second trip to the brain. The dye
shows up white on the X-ray film. Where there
is a block, a dark shadow appears.
This new diagnostic tool enabled Baylor Uni
versity's Dr. Michael DeBakey, a noted vascular
surgeon, to develop in 1964 a surgical method
for correction of a clogged neck artery. Work
ing through a small incision in the neck, Dr. De
Bakey clamps off the artery on either side of the
obstruction, installing a temporary "shunt" so
that blood supply to the brain will be maintained
during surgery. He removes the fatty clots which
have narrowed the artery channel, and further
enlarges the passage by means of a Dacron patch.
Since then, Dr. DeBakey and his associates
have performed blocked-artery surgery on several
hundred stroke patients. This surgery is now be
ing performed at 20 major medical centers in an
evaluation study of its benefits in comparison
with "natural" recovery of stroke patients.
The most practical advances in general stroke
treatment and prevention today are the new drugs
those that retard blood clotting and those that
lower and control high blood pressure. A recent
report to the American Heart Association largely
credits these drugs with a 22 percent drop in
death from strokes among white males in the 45
64 age group. The anticoagulants, used to retard
clot formation, boost a stroke patient's chances
for survival by nearly one-third, according to a
five-year study at the New York Hospital-Cornell
and New York University-Bellevue medical cen
ters. In a Mayo Clinic study, the drugs appear to
reduce the incidence of second strokes by as much
as 75 percent
Tha High Priea af Nagtact
Two years ago, when my blood pressure shot
above the 200 mark and I had to be hospitalised
briefly, I was given the new drugs to help lower
and control it They worked fine but left me se
verely depressed. Against my doctor's advice, I
stopped them. My blood pressure shot back sky
ward, and my stroke appears to have been the re
sult Now, I'm taking them again two aspirin
size tablets a day and I am determined to keep
on doing so for the rest of life.
Once you have suffered a stroke, you discover
that rehabilitation is accomplishing near-miracles.
Stroke no longer means the end of a person's
useful life. But rehabilitation must begin early,
whether in a hospital or at home. Exercise of
seemingly useless muscles must begin at once,
since inactivity can be more harmful than the
original damage caused by the stroke. At first
By JAMES WINCHESTER
Perfectly mobile now, Jim visits
daughter Nancy, 9, at day camp.
the muscles and nerves in paralyzed parts of the
body are as good as ever. It is just that their con
trol centers in the brain are damaged.
But deterioration of muscles and nerves sets
in quickly and progresses rapidly when the stroke
victim is bedfast or immobile. Other things hap
pen, too. Circulation slows, calcium leaves the
bones. Moreover, you can quickly acquire the atti
tude that you're an invalid. Dr. Anita Isaac, a
Kansas physician specializing in stroke rehabil
itation, says, "I consider it an injustice to a stroke
victim if he isn't standing within 24 hours, either
alone or supported."
I was sitting up in bed the first day after my
stroke. On the second, I was standing, assisted,
though my leg was completely paralyzed. That
same day, the hospital's physical therapist began
exercising my muscles with gentle massage every
two or three hours although I still couldn't move
them myself. Before the end of the week, with
help, I was getting across to the bathroom. Every
day I sat in a chair while my bed was being made.
Comments Dr. Howard Rusk, who heads the
New York University-Bellevue Institute for Phy
sical Medicine and Rehabilitation in New York
City, where I was transferred for intensive physi
cal therapy just ten days after my attack, "If
simple physical therapy begins within the first
week after a stroke, most victims can be walking
and taking care of themselves in six to eight
weeks, sometimes sooner."
Caring far tha Strata Pattant
The best thing that family members can do
for stroke patients, I think, is not to treat them
as invalids. My wife, bless her, assumes I can do
anything. Somehow or other, though, she always
seems to be around when I'm dressing. It's just
natural when she casually reaches out to help me
with the cuff button on my left sleeve. I don't
feel dependent Believe me, that's important
Recovery for a stroke victim isn't easy for
either the patient or his family. Physically, stroke
victims may look and feel fine. But a part of the
brain AM been destroyed. Only nature and time
can train new tissues to take over. Until they do,
there are bound to be emotional changes. These
should be expected but recognized as temporary.
For example, during their recovery periods,
stroke victims, almost without exception, are ir
ritable and snappish, often over trifles.
When I first started back to work, I'd dictate
letters to my wife, who'd take them down in long
hand. She's not a secretary, and it was laborious
work for her. Often, though, I'd have her in tears
because she made a simple mistake, such as mis
interpreting a word. I would become utterly out
raged. Later, I would be bitterly ashamed.
Another thing that stroke victims frequently
do in the early stages of recovery is cry. You're
not sad. Nothing has upset you. You just start
( Continued on page 15)
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