But the vast majority of stroke victims do survive. Today, there are an estimated 3 million survivors of stroke living in the United States, and they must learn to live, and cope, with varying degrees of disability.
Dr. Bill Bulman of the New York Presbyterian Hospital describes the medical issues that stroke survivors and their families need to be aware of.
A good doctor to go the distance
It's important that people who have suffered a stroke be followed closely by a general medical doctor or neurologist familiar with the care of stroke patients. As a General Internist, I care for a number of patients who have suffered strokes, helping them and their families understand and cope with the consequences. Many have gone on to recover all their lost function, while others struggle with significant disability. In the short term, I can ensure that they get the appropriate type and amount of post-stroke rehabilitation. In the long term, I am responsible for ensuring that they get the day-to-day care and supervision they need. This often involves arranging for home nursing care and teaching family members how to watch for signs of illness and deterioration.
Preventing a secondary stroke
One important goal for both doctor and patient is to prevent a second stroke. Whether the stroke survivor has recovered fully or has serious impairment, identifying the cause of the stroke is a very important first step. Once the cause of the first stroke has been identified, medical therapy can be tailored toward preventing another.
Aspirin or other blood thinning medications may be appropriate to reduce the risk of future blood clots. Control of high blood pressure, usually with one or more medications, is critical. Lowering cholesterol, either through diet or with medications, and quitting smoking, are likely to be beneficial prevention techniques. It's important for first-stroke survivors to speak with their doctors about healthy habits that are known to reduce stroke risk, and begin making some lifestyle changes.
Related medical problems
Survivors of stroke who are left with serious disability can be at risk for other medical problems as well. Bladder problems can make them prone to serious urinary infections. Pneumonia is common, particularly in those who have strokes that result in problems with speaking and swallowing. For people with paralysis who have difficulty moving around independently, bedsores and pressure ulcers can be a devastating complication.
Nurses and home care workers are trained to watch for the subtle signs of these problems and are trained in techniques to prevent them. Family members can be trained as well. For example, careful attention to positioning in a bed or in a chair, with appropriate cushioning for pressure points like the heels, hips, and the base of the spine, combined with frequent changes in position, can help prevent bedsores and pressure ulcers.
Finding the support you need
Support groups exist in most communities for men and women who have survived a stroke, as well as for their family and friends. Most are coordinated through hospitals, rehabilitation facilities, or local community centers. Support groups can be instrumental in helping survivors and their families understand and cope with the issues they face after a stroke. Your doctor or hospital should be able to direct you to meetings in your area. The Internet is also an excellent source for finding local and online support.
Life after stroke can be challenging for survivors and their families. Stroke can redefine relationships and create issues of dependence and independence. Work closely with your doctor and the entire health care team to develop a plan for optimizing independence, for preventing future problems, and for identifying all the resources and support available to you.
