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Episode #2111
Stroke: Life, Love and Recovery
Brown: In a previous program we talked about why it is so important for everyone regardless of age to educate themselves on the warning signs for stroke and how to reduce your risk. Today we will talk more about how to handle life after stroke, whether you are a survivor or a caregiver. That is next on Black Issues Forum.
Voiceover: Funding for this program is made possible in part by UNC-TV members.
Brown: Hello I am Natalie Bullock Brown. Welcome to Black Issues Forum. In a previous edition we talked about the warning signs for stroke and why you should arm yourself with information on what to do if you should experience symptoms so that you can hopefully avoid preventable disability. Well today we will meet someone who was fortunate enough to know what to do when he experienced stroke warning signs. We will also talk about coping with stroke. But first please note that information in the program is for informational purposes and is not intended for use as diagnosis or treatment of a health problem or as a substitute for consulting a licensed healthcare professional for medical advice, instruction, diagnosis, or treatment. If you have specific questions or concerns, please consult your physician or appropriate license healthcare professional.
Right now I would like to introduce our guests. First we have Dr. Johnny G. Hamilton, Jr., a clinical psychologist at Pitt County Memorial Hospital. Also Elizabeth Puckett, former executive director of the Justice Warren Heart Disease and Stroke Prevention Task Force who is currently working independently to continue educating the community on stroke. We also have with us Ronald Pannell, a stroke survivor. Welcome all of you to the program.
Now let's start with Mr. Pannell because your experience is just so compelling. Tell us a little bit about what happened to you.
Pannell: Well I was discussing with a co-worker of mine about 9:00 in the morning, Carolina had just beaten Duke the day before, it was March the 7th was the day that I had the stroke. I began to lose my speech a little and also lose my balance a little. My co-worker noticed it and I noticed it also. I asked him to walk me down the hall to the nurse's office and on the way down there I really lost my balance and was having to hold onto the wall to keep my balance. Of course once I got down there and they got the nurse I sort of had a meltdown and at once taking my blood pressure-I think it was 100 over 70; excuse me, the numbers are probably wrong but it was very high. She immediately called 911 and I heard her say she thought I was having a stroke.
Brown: Wow, and I mean, what you were experiencing sounds like it was pretty obvious to you that something was wrong but Dr. Hamilton, how often do people perhaps have signs like Mr. Pannell did and not respond to them, or at least not respond to them as if it is an emergency?
Hamilton: Frequently that does happen. Many times people want to deny it and because they are feeling that they don't have the time or that it can't happen to them. As we were talking earlier men sometimes want to say I am impervious to these things happening and women sometimes say they have too many things to do, as caregivers they are not going to think about these things. So many times that happens and I see that so much in my practice that people often will have these symptoms such as "I couldn't walk so I decided just to lie down and feel better later on." And it gets worse. But the thing is that over time most people say, "Well I've never had that before but I felt I should lie down" and hope it will go away.
Brown: Well with Mr. Pannell, this happened March 2005, correct?
Pannell: Yes.
Brown: And today anyone looking at you not knowing what you went through would have no idea that you suffered a stroke, but Dr. Hamilton that is-there is-he was very fortunate and why is that?
Hamilton: He was extremely fortunate. He did the things exactly right; he talked to someone and he was able to get to emergency care right away. The nurse called 911, which is extremely important, and we had that three hour window as we talk about and every minute counts. So he was very fortunate, he says that when he feels sick he goes to see the physician, he takes care of it. So he was extremely fortunate and everything worked directly in his best benefit.
Brown: Well for those of you who did not catch our show before which we talked about the three hour window of opportunity for you to receive treatment without having to suffer disability as a result of a stroke, Dr. Hamilton let's talk about that again and why it is so crucial, especially in Mr. Pannell's case that he was able to get to an emergency room and be treated within three hours. Why is that crucial?
Hamilton: Well it is crucial because the medicines that usually they are talking about have a three hour window and what you have to do is decide when that symptom might have occurred and then you start counting from that. So I am talking about just as a psychologist and so this is-but I know not being a physician. But it is very important that people know that they have to get to the emergency room right away. If you kind of said, "Well maybe I'm just feeling kind of bad, you know" or "That's too bad for the Duke fans, I am really feeling your pain." But instead he decided to go and get it taken care of. So that was the best thing that he did. And many times people kind of want to self-diagnose, they want to take their time, they want to wait, and you really did something great and I really applaud you for doing that.
Brown: Absolutely. Ms. Puckett I would like to pull you into this conversation because as someone who consults people on heart disease and stroke prevention, what sort of things do you say and what sort of reception do you receive?
Puckett: Well the last 10 years of my life, until I retired recently, I worked for the North Carolina Division of Public Health, specifically in the area of heart disease and stroke prevention. And North Carolina has made great strides in getting the word out and getting funding to keep doing that. From the state level our interest in public health is to have certainly people who are at risk for stroke to know the warning signs and know what to do. But we actually want everybody to be aware of those warning signs and everybody to take responsibility if they see somebody having those warning signs of a stroke, act on it. Don't wait. Don't just say, "Well, so-and-so is holding out," or "So-and-so has got a terrible headache; the worst ever in their life. They should go lie down and take an aspirin." No. Question: Is this a stroke? Because the person who is experiencing the stroke may not actually be able to speak; that's one of the warning signs. Or their speech may be slurred. You may not understand what they are trying to tell you but if you recognize this is a stroke, know that the thing you must do is call 911 right away; don't wait. Don't try to call your doctor? You may not get through. You need to call 911 and they need to treat it as an emergency.
Brown: And we are going to keep repeating this mantra; we are going to make it a mantra of calling 911. But I want to go back and review the warning signs but let's take a look at these warning signs for stroke: sudden numbness or weakness of the face, arm, or leg, especially on one side of the body, sudden confusion, trouble speaking or understanding, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, sudden severe headache with no known cause. Coming back to you, Ms. Puckett, some of these warning signs can really seem to be something else so how do you distinguish between a headache that you've never felt before and a headache that is maybe just more severe than I've experienced before but maybe I'm getting sick; how does one tell?
Puckett: I think the critical word in that list-and it is there for every symptom-is sudden. A sudden headache of unknown cause. If you are somebody who regularly gets migraine headaches you probably recognize that when it happens to you. But if you suddenly have the worst headache you've ever had in your life you need to be suspicious. And you know it is really important that the community, that everybody, understands and is suspicious, suspects stroke. It doesn't just happen in older people; it can happen in a young person. Sometimes the bystanders will say, "Oh they are too young to have a stroke." But the fact is, that particularly among African-Americans, something like 30%--African-American males-something like 30% of the strokes that occur are in people under the age of 65. That is what we consider a premature stroke.
Brown: Right. And we learned in the last show that 50% of African-American women will I believe die from heart disease or stroke, which is just an incredible number. Let me-I want to get back to Mr. Pannell because I want to talk about coping with stroke. Given the fact that you had a stroke in March and it is now December, tell me how long your recovery took and just what are some of the things you were feeling once you realized what had happened emotionally, psychologically, and so forth?
Pannell: Well it started mainly in the emergency room. I knew something was wrong with me. I had problems trying to speak and with movement on the left side of my body. I was sort of taking my cues from the people around me and I could fully understand everything everyone was saying but I couldn't communicate with them. Since then and having spent three days in the hospital, two of those days were in the intensive care unit, I struggled very hard to get out of the hospital; I didn't want to be there, I didn't like it, I didn't know what was happening to me. But even just leaving it was a great deal-this fight was very hard for me to continue to keep going. Since then I am thankful for every day that I have and now I do exercise, I try to watch what I eat. But it is a continual process, progression. I am still not completely well; you wouldn't know it from looking at me, the way I walk or I don't have a limp or anything but mainly a lot of my memory and short-term memory was affected. As a lot of things that happened that day I don't remember. But I do remember being rolled in. I do remember being-telling my friend that if I were driving I would have pulled over and probably called 911. I knew enough to know at the time that it-like you said it was a sudden onset of all of these things. I didn't have any pain at all. I never hurt during the whole process at all. But I knew I was losing my faculties and my mobility.
Brown: So if you were only in the hospital for three days, is that correct?
Pannell: Yes.
Brown: Once you got home, what was that like? I mean that was the very beginning of your recovery, your march to this point. So I mean, what sort of things were you doing and feeling? Was there someone there to help you?
Pannell: Yes, my wife was there and I have a seven-year-old who was there helping me. I live in a two-story house and my bedroom was upstairs. It was very difficult to go up those 15 steps and I can tell you that was really the beginning of it-walking. Even walking from the hospital to the car, I wanted to walk. And I was about dead it seemed like. I mean it was very difficult. I mean it was a day-to-day progression. Just walking around the house was very difficult. I got so where I could eventually walk in our driveway and I was determined because I wanted to go back to work. That was very important to me; it motivated me. And I got so I could walk in my neighborhood. I mean these are real small things that you take for granted every day of my life. And I really wanted to get back to work but even coming back to work it was just very difficult, hard to get there. And of course driving was a big issue for me. I was afraid and the doctors had cleared me but I was still afraid of driving, just to the office.
Brown: How long did it take for them to clear you for driving?
Pannell: It was probably two months afterward that I could drive. But even then I was-
Brown: Of course you were afraid, and that is understandable, isn't it, Dr. Hamilton?
Hamilton: It certainly is and I think that is very interesting about this whole thing, what you were talking about. When you were in the emergency room and you were talking about just going through the signs and symptoms and how you began to feel and that has kind of brought up a lot of emotions and things like that. What you were talking about and I thought was very important was the whole issue of independence and that is what you had lost in a sense. Before you, my guess is before you had the stroke you didn't know how many stairs you had. But after that stroke you knew exactly that there were 15 steps because every day you might go up two. Well I got two today so that means I've got another 13 to go; and you'd go up another couple. So that whole issue of independence, things that we have taken for granted now become so important. And it is that issue of loss of independence, how you cope with that loss, because that is a change of lifestyle for you because you were doing a lot of things, you were managing people before. And now it is hard for you to manage yourself-head of a family, of a seven-year-old, you have a wife. All of these things began to change with you after having a stroke. And you are handling it very well and I think that is very important that you realize what you are doing and you are able to talk about it. So you are doing great.
Brown: Dr. Hamilton, talk a little bit more about those who, unlike Mr. Pannell may not fare as well with their recovery from stroke. What sort of psychological symptoms would they suffer? Is there any depression and also the caregiver must be going through something.
Hamilton: One of the things that I found that is so interesting is quite frequently the amount of residual after the stroke. It doesn't really have anything to do with the amount of depression or psychological issues that they have. Sometimes people with very few residuals have tremendous problems. Meanwhile a person with a lot of residuals has almost no problems with it. So you can't go just by the amount of residuals. What is important, though, is that whatever problems you have is that you get whatever appropriate treatment might be. And the treatment can range from anything from reading about it to support groups to psychotherapy to medication or a combination of all three. And you call that kind of post-stroke depression. And there is a lot of reasons why it may occur; there are a lot of theories about it. So the thing is to get treatment for it. And sometimes people say, "Well I had a stroke, of course I am depressed." That is fine you are depressed but it is equally fine if you get treated for it and whatever that is. But it is not just depression, other things may also occur. Now you talked about your family. I wanted to tell people that you never stroke alone. When you have a stroke your whole family had that stroke. And so as a family, as the head of the family looking at it, chauvinistic sense, what you are saying is, "Well I've changed; my role has changed." So whatever roles you had in your family, whether it be getting the cars, taking care of the oil or whatever, now fall on your wife. And you say, "Yeah, I had a stroke and everything has piled up on my wife so I've got to get up and get well." Meanwhile your wife as the caregiver is going through a lot because she is saying, "Well I've got to take care of him and I've got to take care of my daughter and all of these things." And then a lot of times these caregivers may have problems equally as well. And so they may need some help. And what I think is important is that you guys work together on that. So there are a lot of issues for caregivers because they wind up burning out. They are just so focused on you as the survivor, they may forget about themselves. One of the things that I always tell people that are caretakers is that-in a flight you've flown that I'm assuming, right? Okay. That a stewardess says that in case of a cabin depressurization the masks will come down and so you put it on yourself first then on someone else. The moral of the story is if you don't take care of yourself you can't take care of anybody else. And that is what I want caregivers to remember.
Brown: Well, Ms. Puckett, what Dr. Hamilton just said seems to be right with public health implications, talk about those.
Puckett: Well, all of it is a major public health problem. And it is a particular problem in North Carolina. Stroke is the third leading cause of death and it is-North Carolina has been the fourth-highest stroke death rate state in the nation for many, many years.
Brown: Do you know why that is?
Puckett: Well I will tell you what we know in a second but I would like to say that the good news is because North Carolina has people in all sectors-the healthcare sector, the stroke survivor sector, the community leader sector, and the mental health sector-working together on this public health problem. And as a result of that collaborative work and the advances that are being made in all of those areas in North Carolina, we've managed to move our ranking effective the death rates for 2002 to seventh in the nation. So we've made a huge improvement in North Carolina compared to the other states. Now the issue of why North Carolina has had this high stroke death rate, this unhealthy leader position for so many decades, is less than clear. There is this phenomenon of the stroke belt which is largely southeastern United States where the stroke death rates are much higher. And there are many theories about that. And then within the stroke belt there are the stroke buckle counties, and those counties are in three states along the coastal plain-North Carolina, South Carolina, and Georgia have the highest stroke death rates in maybe the world but certainly in the United States in those eastern-most counties. And it is not fully explained. We know what many of the risk factors are. Some of them you can modify, like lifestyle issues. You can modify how much exercise you get and what you eat, how much salt you add to your food, and whether you either smoke or are exposed to somebody else who is smoking, which is another risk factor. And you can know your blood pressure and your blood sugar and your cholesterol levels and take steps to control them. Those are all key risk factors. There are things you can't change, one is age and the other is being African-American. Being African-American means that you are at higher risk, which means not that you are destined to have a stroke but that you need to take control of the risk factors you can control, those behaviors and those things like high blood pressure and cholesterol and diabetes. And so in public health our concern is to get the word out and let people know the best way to treat a stroke is to prevent it. And I say this as a former physical therapist; I mean I used to work with people who had had strokes and work to rehabilitate them and I did it in the years before we had TPA, which is-
Brown: Supplemental-
Puckett: That's the medicine which is useful for the 80% of strokes that are caused by a clot. It is the same medicine that they use in your heart if you have a clot that is blocking a vessel in your heart and causing a heart attack, it is a clot buster.
Hamilton: I was going to say something that our move upwards is basically a result of your work. Libby has really been at the forefront of moving North Carolina ahead, educating North Carolinian's, talking about 911, doing a tremendous amount of work to move our state to a better physical status and she has really done a great job. So I want to applaud you for doing that.
Puckett: Dr. Hamilton I thank you for the compliment but I cannot take credit. This credit belongs to everybody. What the State of North Carolina and the folks working in the state program did was to bring people together, but people have responded. And they have responded in all of the segments and they need to please continue this work because it is a scandal and a crime that a state like North Carolina does not do better than we are doing now. We can do better and we will if we can just all pull together and hear from people like Mr. Pannell and Dr. Hamilton and Dr. Chase and Reverend Napper who spoke earlier and-I mean these two panels are very important to getting the message out and they are illustrative of the opportunity that we have when we work together. So thank you but please it is not ever one person.
Hamilton: I will still say you did a great job.
Brown: I would like for Mr. Pannell I will give you the last word and I just want you to respond to anything that has been said, of course, but in particular what sort of things have you changed in your household, have you seen change in your community, even at work, since you I believe have been back and you have shared your story? What has changed?
Pannell: One of the most important things that occurred was I was going to leave the hospital the information that they gave me, all of the things that he was talking about, how it affects your entire family, all of that was in the packet. Before I left they had me go to a meeting before they discharged me. Everything they went over are things that I saw. The information was so important so I wasn't shocked when these things were happening and the way I was feeling, the way my family reacted to me. This is all is a book that was given to me, which is one of the greatest things that they did after giving me the TPA of course. Also at work I think awareness, because I had just turned 50, I had been 30 days-my birthday was February the 7th, this was March the 7th-when I had the stroke. So people around me about my age, I know they were thinking about it. And they watch the way they eat now. We have more people that are out walking instead of smoking they are walking around the campus and everything. So I think that is how things have changed because people look at me, people I play basketball with, people who are my friends, they all realize that it could happen to them. Because we considered stroke as something that was only for people much older than us; we consider ourselves to be very young and active and realize that it can affect you and you are not even aware of it.
Brown: Absolutely. Well I am just so grateful to all three of you, particularly you, Mr. Pannell, for being so kind to share your story with us. Thank you very, very much to all of you. And for additional information about today's guests or stroke visit us online at www.unctv.org/bif. You can also call us on the BIF line at 919-549-7167. Join us each and every Sunday afternoon at 4:30 p.m. For Black Issues Forum, I am Natalie Bullock Brown reminding you to be encouraged no matter what. Have a good one.
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