Recovery Limited by Severity of Stroke

Q:  My father had a stroke about four years ago. Now his left side (both his arm and leg) is so weak he cannot walk nor use his left hand. Apparently, he has a blockage in the artery in the neck that "cannot be fixed." The doctors tell us, "There is nothing we can do for him." They have only recommended physical therapy, but advise that the therapy will only strengthen him enough to be able to assist the aids at the nursing home, not allow him to walk. My father does not wish to participate in therapy that will not help him get out of bed and back home.

The reason I am writing is that I just cannot believe that there is truly nothing to be done. There are so many miracles in medicine nowadays (cancer, heart disease, Alzheimer's, the list is endless). Where are the breakthroughs for stroke victims?

Before the stroke diagnosis, my father thought the reason his hand was going numb was because of an old back injury he had gotten at work years before. I understand now there are ways to prevent strokes and treatments to be done at the first warning sign of a stroke, but what can you do for guys like my father who are too stubborn to go to the doctor for small symptoms? He shouldn't have to spend the rest of his life in bed!

A:  Stroke is a common and potentially fatal medical problem: it is the #3 killer in America. But most victims of stroke do not die: 85% survive and these people have variable recovery - from full function to persistent coma. About 20% of survivors require long-term institutional care (like your father) and another one-third to one-half are left with substantial disability.

We expect most of the recovery to occur within 2-4 months of the stroke. In general, there is little improvement once the survivor is 6 months past the stroke.

But you ask why doctors can't force an improvement after stroke. Simply put, we don't know how to make brain tissue grow back. Essentially, an ischemic stroke (the kind of stroke your father had) is a result of poor blood flow to the brain (often because of a blockage in the artery in the neck that supplies the front part of the brain). The severity of the stroke depends on how little blood flows, how long the blood flow is interrupted, and which areas of the brain do not receive blood. When the disruption in blood flow is severe, parts of the brain can be damaged beyond the ability of the brain to repair itself.

There are some breakthroughs in stroke research, although most of the work is to prevent stroke and to treat stroke in the first minutes-to-hours of symptoms. It is at this earliest time when new medications and procedures can help get blood flow to the brain again.

You have given me an opportunity to remind readers of the early warning signs of stroke. Call 911 if you or a loved one has any of these symptoms. Cut this out and post it somewhere you can find easily - every second counts:

• 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

And what can you do for your father at this point? You may wish to explore if he is depressed or needs special support in dealing with his condition. About 25% to 40% of stroke survivors experience depression and there are effective treatments for that. You may also encourage him to do some physical therapy - small gains in strength may allow him independence in some tasks, such as feeding himself.

Finally, you may get involved in helping doctors and scientists make the breakthroughs you are looking for. The American Stroke Association has links for advocacy (such as contacting governmental representatives about issues that affect financing stroke rehabilitation or stroke research programs), for support groups dedicated to stroke survivors and their caregivers, and for donations and planned giving. Locally, the American Stroke Association is housed within the Southeast Wisconsin American Heart Association: call 414-271-9999.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices at the Froedtert & The Medical College of Wisconsin General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.