Before Ann Shuck retired from Raymond James Financial, she had some pretty persistent friends and co-workers. They wouldn't take "no" for an answer. And that's probably why she's alive and very well today, three years after suffering a major stroke.
It was April 2014. She left home for work that morning feeling fine. But shortly after arriving at her desk she noticed her left arm felt like it had gone to sleep. She decided to get up and move around to shake it off and walked into a wall. Something was wrong. Nearby co-workers noticed her struggling to walk. A friend suggested calling 9-1-1. Shuck said no. "I told them to call my husband who would come get me and I could just go home and lie down," she remembers. But her friend insisted they call 9-1-1. "I thought I would just die of embarrassment being wheeled out of the building on a stretcher," Shuck said.
On the phone, the 9-1-1 operator asked if Shuck exhibited any of the warning signs in the FAST acronym, which helps identify people having a stroke: Face drooping, Arm weakness, Speech difficulty, Time to call 9-1-1. Shuck had them all. By the time she reached St. Anthony's Hospital, a designated primary stroke center, she was paralyzed on her left side. After immediate testing to rule out a bleeding stroke, doctors gave Shuck a clot-busting drug. She arrived at the hospital within 30 minutes of the onset of symptoms, making her a candidate for tPA. There's generally a 4.5-hour window of opportunity to use the drug. Within hours of receiving it she could move her left arm and leg again; two days later she went home with no residual effects.
"It was so important to get (to the hospital) quickly," said the now 66-year-old Seminole resident. "I still thank the person who insisted we call 9-1-1. If I had gone home like I wanted to, I would have missed that window of opportunity for treatment and recovery."
That's the message doctors hope to get across on Sunday (Oct. 29), World Stroke Day, a day set aside annually to increase awareness of stroke symptoms and emphasize that these symptoms signify a medical emergency. "People need to know the symptoms so they get care quickly," said Dr. Justin Whisenant, a neurointerventional surgeon at the Northside Neuroscience Institute, a comprehensive stroke center in St. Petersburg. "Time is a great predictor of good outcomes. The sooner they get care, the more likely they will go back to normal."
Also important is knowing about stroke prevention. That means being aware of and controlling your risk factors. Shuck had one of the leading risk factors for stroke, high blood pressure. Although she took medication for it, she admits that she didn't monitor it properly. "I hadn't checked my blood pressure or been to the doctor in months, and the medication wasn't working, wasn't controlling it," she said. The first indication that her blood pressure was uncontrolled was the stroke. Now she owns three home blood pressure monitors and even travels with one.
High blood pressure is considered a risk factor you can control, along with high cholesterol, diabetes, obesity, smoking, inactivity and a poor diet loaded with fat, sodium and empty calories. Drug abuse, in particular cocaine use, and alcohol abuse are also associated with increased stroke risk. There's also evidence that poor sleep and sleep apnea may increase stroke risk.
Then there are the risk factors that you can't control. According to the American Stroke Association, they include advancing age (55+), gender (women have more strokes than men), family history of stroke or TIA (parent, grandparent, sibling), your own prior stroke, TIA or heart attack, and race (African-Americans are at higher risk of death from stroke). Also, some medications and medical conditions increase stroke risk.
Liz Johnson developed a condition called vasculitis, inflammation of the small blood vessels, following treatment for cancer. It causes narrowing of the tiny blood vessels in the body and, in some cases, can reduce blood flow to the brain, increasing the risk for stroke or TIAs, transient ischemic attacks, so called mini strokes.
Johnson had her first TIA in July and another in September. "I never imagined that it would be me," the 40-year-old Tampa resident said. "You think it's going to be somebody else." She's now at risk for a major stroke. "I feel like I'm walking on eggshells now," she said.
For survivors like Johnson, it's all about preventing a future attack by managing those risk factors within her control. But recent research shows few Americans are doing that. A new study in this month's Neurology found that, despite ongoing efforts to educate the public about stroke prevention, risk factors such as high blood pressure, smoking and diabetes actually increased among stroke patients between 2004 and 2014. "What that says it that our prevention efforts haven't succeeded. And most of the people in that study had more than one risk factor," said Whisenant, a specialist who treats acute strokes with clot retrieval devices. He said the findings should serve as a wakeup call for all of us.
"Realize that this can happen to you, to me," he said. "It's a common disease and it makes people disabled and it takes lives. If you don't want it to happen, get healthy, manage your risk factors."
Contact Irene Maher at email@example.com.