The Many Faces of Stroke

The Many Faces of Stroke
​Anyone can experience a stroke, regardless of age, sex, or race. And, as these five survivors attest, recovery is multifaceted too.

​Illustration by Jorge Colombo

Bruce Dettman 
Age at time of stroke: 59
Year of stroke: 2009
What helped: Recognizing signs of stroke
What hurt: Not calling 911
Takeaway: Always call 911 to facilitate diagnosis and treatment.

​Bruce Dettman, 69, says luck and a little bit of knowledge helped him make a full recovery from a stroke 10 years ago. Because he knew the signs of a stroke, he recognized arm weakness as a symptom when he reached for a book on a shelf and couldn't lift his left arm past his belly button. "I knew I was having a stroke but checked online to confirm my worst suspicions. I even attempted a jumping jack, but only my right arm would cooperate."

Luck was on Dettman's side, however. The hospital his wife drove him to was a comprehensive stroke center, a medical facility certified by the American Heart Association/American Stroke Association and the Joint Commission as having the ability to treat the most complex stroke cases. Dettman underwent imaging of his brain, followed by a battery of tests to assess his neurologic function. Based on the results of his tests, he was diagnosed with an acute ischemic stroke—caused when an artery to the brain is suddenly blocked by a blood clot, depriving brain tissue of oxygen and nutrients—on the right side of his brain. A stroke on one side of the brain impacts the opposite side of the body, which accounted for the weakness in Dettman's left arm. After alerting his wife, the two of them drove to the nearest hospital—a serious no-no, he learned later from his neurologists, who said people should always call 911 if they suspect a stroke. That allows paramedics to notify the hospital's emergency department that a possible stroke patient is arriving, says Sarah Song, MD, MPH, FAAN, a stroke specialist at Rush University Medical Center in Chicago. "It speeds up the whole diagnosis and treatment."

Doctors administered intravenous tissue plasminogen activator (tPA), a drug that dissolved the arterial clot, allowing blood to reach the brain. When administered within four and a half hours of a stroke, tPA can reduce long-term disability.

Dettman's prescription for recovery involved twice-weekly physical therapy to regain strength; antiplatelet medication, such as aspirin or clopidogrel (Plavix), and blood-pressure-lowering medications; and regular visits with his neurologist. While Dettman had no lasting speech or physical impairment, he did have temporary weakness on his left side and a hypersensitivity to sound. "Things like china clinking or glassware colliding seemed twice as loud," he recalls. He also adopted healthier habits that he maintains to this day: He walks three miles each morning and eats more fresh fruits, vegetables, poultry, and fish than he used to. The combination helped him shed an extra 20 pounds he was carrying. "I also try not to overstress about things. I survived a pretty difficult stroke and came through it well," Dettman says.

Each year nearly 800,000 Americans experience a stroke, according to a 2017 report published in Circulation, the journal of the American Heart Association. About 87 percent are ischemic strokes, like the one Dettman experienced. The remainder are hemorrhagic—caused when a blood vessel ruptures or tears. Both types produce sudden symptoms such as weakness, numbness, difficulty speaking, sudden vertigo, and vision loss, typically on one side or the other.

Thanks to improved health care and advances in treatment, fewer people are having strokes and those who do are more likely to survive than in the past. Among adults 35 and older, the number of deaths from stroke declined 38 percent from 2000 to 2015, according to September 2017 statistics from the Centers for Disease Control and Prevention (CDC).

The effects of a stroke depend primarily on the location of the damage or obstruction and the extent of brain tissue affected, says Sara K. Rostanski, MD, assistant professor of neurology at NYU Langone Medical Center and medical director of stroke at Bellevue Hospital. How well patients recover depends on many factors, including how quickly they receive treatment for their stroke and whether they go to rehabilitation, says A.M. Barrett, MD, FAAN, director of stroke rehabilitation research at Kessler Foundation in East Hanover, NJ. "The area of the brain damaged makes a difference, as well as people's attitude about the stroke and their recovery. In general, people who are more fit beforehand have a better recovery."
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In recounting their journeys, Dettman and the following four stroke survivors demonstrate the importance of recognizing symptoms, getting help immediately, and accessing ongoing rehabilitation.

​​Gary Gould
Age at time of stroke: 77
Year of stroke: 2018
What helped: Lifestyle and good health
What hurt: Ignoring stroke symptoms for 14 hours
Takeaway: Don't wait to seek help—your symptoms won't get better.

​When Gary Gould woke up at 3 a.m. on July 11, 2018, with no feeling in his right arm, the retired tax preparer thought he'd simply slept wrong. He shrugged it off and went back to sleep. The next morning, some feeling had returned but he struggled to perform routine tasks. "I logged on to the computer and had no control of my right hand on the keyboard," Gould says. "I thought, 'This is really not good, but it'll probably get better and go away.'" It took persistent urging from two close friends to get him to agree to go to the emergency department later that afternoon.

Upon his arrival, Gould underwent CT and MRI scans and was diagnosed with an ischemic stroke. "The doctor showed me a picture of my brain with five little dots on the left side, which he said probably happened when a much larger clot blew apart." Because the blood clot broke into tiny segments, the blockage was less intense and greatly reduced the severity of the stroke, according to Gould's doctor.

Gould's Medicare coverage provided excellent care, including three days in the hospital under close supervision. Several times a day, caregivers took him for short walks to gauge his ambulatory skills. "The neurologist said he believed there wouldn't be any lasting effects and didn't recommend home health care," he says. Within a few weeks of his stroke, Gould had full use of his right arm and was back to his normal routine.

Gould attributes his good fortune to his healthy lifestyle, which includes walking regularly, maintaining his weight, and not drinking or smoking. He also has been taking medication to control high blood pressure and cholesterol since having a heart attack in 1995. Poststroke, Gould was diagnosed with atrial fibrillation and prescribed warfarin, an anticoagulant, to prevent blood clots. He has his blood checked once a month to make sure his clotting time is in the therapeutic range.

Given his age, Gould's stroke was not unusual—about half of all strokes occur in people over 75, according to a report published in the June 27, 2018, issue of Current Gerontology and Geriatrics Research. But his recovery is exceptional: The same report noted that patients in this age group have lower survival rates, poorer functional outcomes, and longer hospital stays. Gould's doctor believes he made a complete recovery because the stroke's severity was lessened due to the fractured blood clot.
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What's equally exceptional is Gould's hobby. The septuagenarian can be found most weekends at a Denver-area club dancing and performing rap songs with his cover band. "You can always tell who is seeing the act for the first time by the number of cellphones that come out to take my picture," he says with a laugh. Ever since his stroke, Gould will tell anyone who listens, "If this happens to you, don't wait, because it won't get better or go away."

​​Kelly Fucheck
Age at time of stroke: 32
Year of stroke: 2011
What helped: Her youth
What hurt: Not calling 911; obesity; smoking; poor diet; Hispanic ethnicity, a risk factor for stroke
Takeaway: Take care of your health—it's never too late.

​One morning eight years ago, Kelly Fucheck woke up feeling awful. Her heart was pounding, the back of her neck was on fire, and her words came out garbled. When she stood up to put on her pants, she nearly fell over. "My husband wanted to take me to the hospital, but I wouldn't let him. I'm Mexican, and we think Tylenol can fix anything," she jokes.

Despite a second bout of vertigo that night, Fucheck waited two days to go to the hospital. MRI and CT scans showed she had sustained a vertebral artery tear that caused a clot and an ischemic stroke in the back of her brain. In young people, swelling around the injury can increase pressure in the skull, which can be life-threatening.
During 10 days in the hospital, Fucheck received IV fluids and blood pressure medication to reduce pooling and pressure on her brain.

Before her stroke, Fucheck was an admitted couch potato who also smoked, ate mostly fast and processed food, and was 70 pounds overweight. After the stroke, her doctor urged her to quit smoking, to exercise, and to rethink her diet. It took her more than a year to make changes. At the suggestion of her doctor, she started walking on a treadmill two minutes a day. The first time was the hardest, she says, but she kept going for the sake of her 3-year-old son. Within six months she was running. She also changed her diet and learned to cook healthier foods.

In 2013, Fucheck gave birth to her second child, Lillian. "I really had a wonderful pregnancy because I ate healthfully and stayed active," she says. Fucheck has run six half-marathons to date and coaches Cross-Fit. She has quit smoking, monitors her blood pressure, and drinks in moderation. The entire family eats healthier and is more active. Her husband also stopped smoking and works out with her five days a week.
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"The stroke changed my life for the better," she says. "I see my survival as a chance to serve others. I want to make the most of my second chance."

​​Mark Moore
Age at time of stroke: 46
Year of stroke: 2007
What helped: Intense ongoing rehabilitation; positive attitude; faith
What hurt: Having two strokes
Takeaway: Recovery is a marathon, not a sprint.

​A month after being admitted to the hospital for a possible stroke, Mark Moore woke up very confused. He knew he was in the hospital, but he didn't recognize the room. He didn't know why he was hooked up to several machines or why his head was heavily bandaged. He also couldn't figure out why he wasn't able to talk or move. Most perplexing was the television newscaster talking about the upcoming Father's Day weekend. "I didn't know what was going on," Moore recalls. "The last thing I remembered was the Monday after Mother's Day."

On that day in May 2007, he'd felt fuzzy-headed and weak on his left side while preparing to coach his son's baseball practice. He tried to shrug it off, but his symptoms grew worse. By the end of practice, he struggled to walk to his car. Finally he called his wife for help. "I asked her to pick up our son and call an ambulance for me," Moore says. At the hospital, after undergoing a battery of tests, Moore was diagnosed with a transient ischemic attack (TIA), a temporary blockage of blood flow to the brain. Often called a mini-stroke, a TIA looks exactly like a stroke and can be a warning sign of a future one. Unlike a stroke, however, symptoms typically disappear, and the patient returns to normal.

Moore was kept in the hospital for observation and three days later experienced another stroke. The second one was much more serious and caused his brain to swell. Surgeons performed an emergency craniectomy, removing part of his skull to allow the swollen brain to expand, and inserted a shunt to drain the fluid from his brain. He spent the next four weeks in a medically induced coma.

Within days of waking from the coma, Moore was transferred to an inpatient facility for physical, speech, and occupational therapy; for two weeks he worked on regaining balance and learning how to move safely from the bed to a chair. He also relearned basics such as grasping objects, brushing his teeth, applying deodorant, and tying his shoes. In the first few weeks after his coma, Moore couldn't go anywhere without a walker, which for a previously healthy, active man was a humbling experience. The day he could walk unaided to the bathroom was a significant milestone, he says. "I am a businessman, a CPA with undergraduate and master's degrees. I started five companies, sold three, and raised $2 billion. But recovering from stroke and brain surgery was the hardest thing I've ever done," he says.

Moore eventually graduated from a walker to a cane and finally to walking unassisted. He also had some vision loss due to his stroke, so reading was difficult. His speech wasn't seriously affected, but he often struggled to come up with the right word. He had trouble swallowing initially, but with speech therapy he was able to eat solid food again. After inpatient therapy, he had six months of outpatient therapy three times a week. He also played word-search games and practiced word-picture association to remember names and faces.

As daily tasks became easier, his confidence increased. Three months into his recovery, Moore was cleared to resume exercise. He started walking, albeit in a wobbly manner, then improved enough to try running. One year later, he participated in the 5K Race for Hope to raise money for brain tumor research. "I was 183 out of 857 men, but I felt like I'd won the gold!"
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Six months after his stroke, Moore returned to work but later chose to sell his share of the business and retire. "I wanted to do something different with my life," he says. These days he advocates for more research about stroke and recovery and shares his story with other survivors. "I talk about stroke prevention, awareness of the symptoms, and the importance of post-stroke rehabilitation. I want people to know that you absolutely can recover," he says. Two years ago he published A Stroke of Faith (FaithWords, 2017), an account of his experience in which he credits hard work, faith, and the support of his wife, family, and friends for his remarkable recovery.

Angie Read Doyal
​Age at time of stroke: 45
Year of stroke: 2015
What helped: Calling 911 and undergoing a procedure to remove clots
What hurt: Not getting immediate help for depression
Takeaway: Be aware of post stroke depression and seek help for it immediately.

​A mom of three and a partner at a global communications firm, Angie Read Doyal initially protested when her husband called 911 one morning four years ago after she was unable to push herself up from the bed. "Nothing on my left side was working," she recalls. She'd kept rocking until she had awakened her husband. He took one look at her face ("He told me the whole left side of my face looked like it was melting") and called an ambulance. At the hospital, surgeons removed two blood clots—one in her neck and the other in her brain—in a procedure known as a mechanical thrombectomy. Using X-ray-guided imaging, they inserted a device called a stent retriever through a catheter into an artery in the groin and up through the neck to reach the clot. The device was then deployed to remove the clot and restore blood flow. Doyal believes this early intervention saved her life. Recently, the window for thrombectomy was expanded to 24 hours for patients whose strokes have specific features, says Dr. Song.

Doyal spent four days in the hospital and had seven weeks of physical, occupational, and speech therapy. Afterward, in many ways she looked and felt like her prestroke self and deemed herself unstoppable. But two months later, everything changed. Although doctors had warned her that she might experience depression, she was not prepared when it happened.

"I couldn't eat or sleep," Doyal recalls. She had little interest in engaging with friends or family and spent much of her time lying around and watching television. The problems spilled into her work, where she couldn't focus enough to handle the organizational and creative tasks she had mastered. About five months after her stroke, she was diagnosed with generalized anxiety and major depressive disorder and hospitalized twice for a total of 15 days.
"There's this antiquated idea that you are depressed because you had a stroke, but it's a physical phenomenon," says Dr. Barrett. "About a third of people who have a stroke experience depression. They have double the risk of depression of someone who hasn't had a stroke."

Things came to a head for Doyal in April 2018 when she ran a red light and caused an accident. At the hospital, an MRI revealed that she'd had a second stroke. Doctors never determined the direct cause of her second stroke. (Subsequent strokes are not uncommon, according to a study published in the Canadian Medical Association Journal in July 2017, which found that in the first year after a stroke, survivors are seven times more likely than the general population to have a stroke.) During her recovery from the second stroke, Doyal had a mental health setback and realized she could no longer manage the pace or cognitive requirements of her job.

Doyal continues to cope with depression and anxiety, but she manages it with medication and weekly therapy sessions. She has also undergone an intensive outpatient program for anxiety. As a volunteer ambassador for the American Heart Association/American Stroke Association, Doyal talks openly about what she calls her "invisible scars" in the hope that she can help others.

3 Ways To Lower Your Risk For StrokeThe American Stroke Association says taking good care of your heart is the best way to prevent stroke. Here's what experts recommend.
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1. Exercise. Aim for at least 150 minutes of moderate-intensity aerobic exercise each week, says Sara K. Rostanski, MD, assistant professor of neurology at NYU Langone Medical Center and medical director of stroke at Bellevue Hospital. Try 30 to 60 minutes five to seven days a week, suggests Sarah Song, MD, FAAN, a stroke specialist at Rush University Medical Center in Chicago. In addition to exercising, avoid sitting for extended periods, says Dr. Rostanski. "Sitting has been called the new smoking," she says. "If a standing desk is impractical, get up for walks during the day."
2. Maintain a normal blood pressure. "Recent studies suggest that a target blood pressure of 120/70 or lower is best for preventing strokes," says Antonio Culebras, MD, FAAN, professor of neurology at SUNY Upstate Medical University in Syracuse. If your blood pressure is high, talk to your doctor about taking medication to lower it.
3. Follow a heart-healthy diet. The Mediterranean diet is a good start, says Dr. Rostanski. "Avoid trans fats and limit red meat and processed and refined foods," she says. Instead, consume more whole grains, vegetables, fruit, nuts and seeds, yogurt, and fish. Dr. Culebras recommends eating a low-sodium diet (less than 2 to 3 grams per day).

Stroke Resources

• American Heart Association/American Stroke Association; 888-4-STROKE (888-478-7653)
• American Stroke Foundation; 913-649-1776
• Brain & Life Stroke Overview and The Basics: Stroke Pamphlet
• National Institute of Neurological Disorders and Stroke; 800-352-9424
• World Stroke Organization

Web ExtraLearn more information about risk factors for stroke.

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