Stroke Patient Education Guide

The warning signs of a stroke can be easily remembered as BE FAST.

• B is for balance. Signs include:
  • Dizziness.
  • Loss of balance or coordination.
  • Sudden trouble walking.
• E is for eyes. Signs include:
  • A sudden change in vision.
  • Trouble seeing.
• F is for face. Signs include:
  • Sudden weakness or numbness of the face.
  • The face or eyelid drooping to one side.
• A is for arms. Signs include:
  • Sudden weakness or numbness of the arm, usually on one side of the body.
• S is for speech. Signs include:
  • Trouble speaking (aphasia).
  • Trouble understanding.
• T is for time. Time to call 911 immediately.

What do you do if you think you or someone else is having a stroke?

Call 911 right away so an ambulance can be sent. Calling 911 is the fastest way to get lifesaving care. A stroke is an emergency and needs treatment right away.

Do not drive yourself to the hospital. Emergency medical services (EMS) staff can begin treatment when they arrive. When taken by ambulance the EMS staff will alert the hospital you are coming. Then the stroke team will be ready to care for you when you arrive. The stroke team will ask when the last time you or someone else saw you without symptoms. This is known as the “last known well” time. This will help the stroke team decide which treatments are best.

A stroke happens when blood flow to the brain stops. There are two types of strokes: ischemic and hemorrhagic.

• Ischemic stroke is caused when plaque or a clot blocks a blood vessel in your brain or neck.
• Hemorrhagic stroke is caused when a vessel in your brain breaks causing bleeding in the brain.

Ischemic Stroke

Ischemic strokes are the most common type of stroke. They are caused by a blood clot that travels through the bloodstream to the brain. They can also be caused by the build-up of plaque in the arteries of the brain. When the artery is blocked, oxygen rich blood can no longer reach the brain tissue, and it begins to die.

Treatment of ischemic stroke may include:

• Tissue Plasminogen Activator (tPA): medicine given through an IV in the arm that can break up or dissolve blood clots. Alteplase and tenectaplase are tPA medicines. Some or all of the brain tissue may be saved if the blood vessel is reopened soon enough. This may decrease damage from the stroke and may increase the chance of a good outcome. A good outcome is little or no disability from the stroke. In the study done that led to the approval of tPA, the odds of being normal or nearly normal increased when getting tPA.
• Thrombectomy: surgery to remove a blood clot from the brain. A neuroendovascular surgeon guides a catheter through an artery in the groin or wrist up to the blocked artery in the brain. The surgeon uses special devices through the catheter to remove the blood clot.

What are the potential risks of tPA?

• There is a higher risk of bleeding in the brain. This may need surgery.
• Your stroke symptoms could get worse. This may need medicine or surgery.
• You may have a higher risk of disability. You may need rehab in the hospital, at a rehab facility, or at home.
• You may have bleeding in the intestines, kidneys, and other organs. You may need medicine or surgery for this.
• These potential risks can be serious, but they are uncommon. Your care team will monitor you closely for any side effects.

Many people do not arrive to the hospital fast enough to get these treatments. Call 911 at the first sign of a stroke!

Hemorrhagic Stroke

A hemorrhagic stroke is when a weakened blood vessel bursts or leaks blood into the brain. There are two types of hemorrhagic stroke:

• Intracerebral hemorrhage (ICH) is when the blood is in the brain’s tissue.
• Subarachnoid hemorrhage (SAH) is when the blood is around the brain’s surface.

Intracerebral hemorrhage is the most common type of hemorrhagic stroke. This type of stroke happens when a weakened spot on a blood vessel breaks and leaks blood into the surrounding brain tissue. Blood can no longer move through the vessel to supply the brain with oxygen rich blood and the brain tissue begins to die. The most common cause of this type of stroke is high blood pressure.

Subarachnoid hemorrhage is typically caused by a burst aneurysm on the surface of the brain. As an aneurysm grows, the blood vessel wall becomes thinner and weaker, increasing its risk of bursting. If the aneurysm bursts, blood builds up over the surface of the brain and begins to push on the brain tissue. Treatment may include clipping or coiling of the aneurysm. Clipping involves putting a clip on the outside of the vessel to seal off blood flow. Coiling involves going in through the inside of the vessel with a small catheter and placing small coils inside of the aneurysm. This will close it off and stop the bleeding.

Transient Ischemic Attack (TIA)

A TIA (Transient Ischemic Attack) happens when there is a brief blockage of blood flow to the brain. Your symptoms may go away, but you should see a doctor right away. TIA is a warning that a stroke may be coming. Your stroke risk increases once you have had a TIA. Medical attention can help to treat your risk factors and help to prevent a stroke.

Your brain controls many of the functions of your body. The brain is divided into different areas (lobes) that control how the body moves and feels. Symptoms you may have after a stroke are linked to the area of the brain where the stroke occurred.

The frontal lobe controls behavior, personality, and voluntary movement or activity. The parietal lobe is responsible for your temperature, taste, touch and movement. The temporal lobe helps you with hearing and understanding speech. The occipital lobe is mainly responsible for vision. The cerebellum controls coordination of movement and balance.

The left side of the brain controls the movement and feeling of the right side of your body. Survivors of left-sided strokes may have weakness or paralysis of the right side of the body. They may have trouble with talking or understanding written or spoken words. This is called aphasia. Survivors may also have a hard time remembering new information.

The right side of the brain is responsible for movement and sensation on the left side of the body. A right-sided stroke might cause weakness or paralysis on the left side of the body. Survivors of right-sided strokes may have problems judging distances and space, making them more likely to fall or bump into objects.

There are many general symptoms that a stroke survivor may experience. Sometimes survivors will have problems with judgment and impulsiveness. They may not realize that they can no longer safely complete tasks as they did before the stroke. Survivors may forget about the affected side of their body. For example, a stroke survivor with paralysis on one side of the body may believe he or she can get up and walk. This could lead to a fall.

Your stroke team may include the following people:

• You and Your Family
• Neurologists are doctors who specialize in the diagnosis and treatment of diseases of the nervous system, which includes the brain and stroke.
• Neurosurgeons are doctors with specialized training in surgical treatments of the nervous system, which includes the brain and stroke.
• Neuroendovascular surgeons are doctors with special training that diagnose and treat certain conditions for stroke.
• Nurse Practitioners (NPs) and Physician Assistants (PAs) have specialized training in the treatment of diseases of the nervous system that includes the brain and stroke.
• Stroke Nurse Navigator supports stroke patients and their families. They will reach out to patients and families during the hospital stay and after they go home. They help you understand your diagnosis and direct you and your family to community resources. They will help coordinate follow up needs with the neurology team.
• Nurses manage day-to-day care and help make rehab a part of your daily routine.
• Social workers and case managers provide counseling and support services for you and your families. They help coordinate rehab and follow up needs after the stroke survivor leaves the hospital if needed. They also help address lifestyle changes.
• Chaplains help to address your spiritual needs.
• Physical therapists (PT) help you regain strength, coordination, balance, and movement. PT will assist with getting in and out of bed, moving from a bed to a chair, balance, and walking.
• Occupational therapists (OT) help you relearn the skills you need for everyday living. This can include eating, toileting, bathing, and dressing. Occupational therapists may also help you work on ways to improve your safety, memory, and thinking skills. They may also work on any vision problems you have related to your stroke.
• Speech-language pathology (SLP) therapists help with communication, thinking and swallowing skills.
• Dietitians help you set healthy eating goals. They teach how to read food labels, choose dining out options and cooking tips.
• Pharmacists help the team choose the best medicines for you and are available for education and questions about your medicines.
• Physical medicine and rehabilitation doctors have specialized training in rehab and help make an individualized plan that best fits your recovery.

Recovery is a journey. Use this information as a guide to recovery and a tool to prevent a future stroke.

When a patient comes in with symptoms of a stroke or TIA, the stroke team will gather information. They will do tests to help determine the diagnosis and possible causes of the symptoms.

Testing may include:

• Your medical history, symptoms you experienced, and a neurological exam.
• Blood tests.
• CT or “CAT” scan: X-ray that shows the structures of the brain in detail.
• Magnetic Resonance Imaging (MRI): test that looks at inner structures of the brain with magnetic and radio waves.
• Computed Tomography Angiography (CTA): special kind of CT scan that looks at the blood vessels using a dye injected into the vein.
• Carotid Ultrasound: ultrasound test that uses sound waves to see the blood flow through the carotid arteries (arteries in your neck carry blood from the heart to the brain).
• Echocardiogram (ECHO): ultrasound test that uses sound waves to create pictures of heart.
• Transesophageal Echocardiogram (TEE): a type of echocardiogram that uses a long thin tube guided through the mouth and down the throat and esophagus to get pictures of the heart.
• Transcranial Ultrasound (TCD): ultrasound test that uses sound waves to see the blood flow through the large arteries in the head. It can be used to detect stroke caused by blood clots and narrowed areas of blood vessels caused by blood clot, plaque, or vessel spasm.
• Bubble study: air bubbles as a contrast medium used with ECHO or TCD to evaluate for abnormalities in the heart that can cause stroke.
• Telemetry Monitor: Heart monitor worn up to 30 days after discharge from the hospital to identify an irregular heart rhythm such as AFib.

You now know the symptoms of stroke and what to do if you see the symptoms of stroke. You may now consider how you can prevent having one. About 80 percent of strokes can be prevented. Learning how to control your risk factors is one of the best ways you can prevent a stroke. There are risk factors that you can control and risk factors that you cannot control. Each year, about 795,000 people in the United States suffer a stroke. Many of the conditions that place you at higher risk for stroke can be managed with the help of your healthcare team.

Treatable risk factors include:

• Blood pressure levels
• Cholesterol levels
• Diabetes
• AFib

There are also lifestyle choices that can put us at higher risk for stroke. These include:

• Tobacco use or smoking
• Drug abuse
• Heavy alcohol use
• Diet high in saturated fat or sodium
• Physical inactivity

High Blood Pressure

High blood pressure, also known as hypertension, is the number one cause of stroke. Many people who have high blood pressure do not realize it. It is important to know your numbers. Your blood pressure should be 130/80 or less.

Two numbers are used to define blood pressure. The top number is called the systolic blood pressure. This is the pressure in the arteries when the heart squeezes blood out of the heart (contracts). The bottom number is called the diastolic blood pressure. This is the pressure in the arteries when the heart relaxes.

There are 8 main ways to control your blood pressure. They include:

• Eating more fruits and vegetables and limit salt intake.
• Staying physically active.
• Staying at a healthy weight.
• Managing stress.
• Avoiding tobacco products.
• Taking medicines as directed.
• Limiting alcohol.
• Working together with your doctor to control your blood pressure.

High Cholesterol

Cholesterol is a fat-like substance in blood that may lead to narrowing and clogging of your blood vessels. Your body needs some cholesterol to work properly but having too much increases your chance of having a stroke. Lowering your LDL (bad cholesterol) can help prevent a stroke. For many people that have had an ischemic stroke, the LDL goal is 70 or less. If you have certain risk factors, your LDL goal may be below 55. Your healthcare team will work with you to decide the best goal for you. Regular exercise, at least 30 minutes a day for at least 5 days a week, will strengthen your heart and lungs. Choose foods that will benefit your heart such as eating nuts, seeds, lentils, beans, fruits, vegetables, lean cuts of meat, low-fat dairy, and limiting sweets. Medicine may be needed to control your cholesterol levels.

Diabetes

Diabetes may increase your risk for stroke. Over time, increased blood sugar levels can lead to increased fatty deposits or clots on the insides of the blood vessel walls. These clots can narrow or block the blood vessels in the brain or neck, cutting off the blood supply. This stops oxygen from getting to the brain, causing a stroke.

Symptoms of diabetes include:

• Increased thirst
• Increased appetite
• Fatigue
• Increased urination
• Weight loss
• Blurred vision
• Sores that do not heal
• Fruity odor or breath

You can help control diabetes. One way is to limit simple carbohydrates (carbs) in your diet. Simple carbs are found in foods like table sugar, cake, soda, candy and jellies. Eating these foods causes an increase in blood sugar levels. Your dietitian can help you manage what you eat to control your diabetes. One way to help may include keeping a food diary to track what you eat, when you eat, and how it affects your glucose levels. Check your blood sugar two hours after eating to see how your body reacts to various foods.

Atrial Fibrillation (AFib)

AFib is an irregular heartbeat that can lead to blood clots, stroke, heart failure and other heart problems. On average, a person with AFib is 5 times more likely to have a stroke than someone with a regular heartbeat. Over 2.7 million Americans are living with AFib. Sometimes people with AFib do not have symptoms.

Others may have common symptoms which include:

• Rapid and irregular heartbeat
• Fluttering in the chest
• Dizziness
• Shortness of breath and anxiety
• Weakness
• Faintness or confusion
• Fatigue when exercising
• Sweating
• Chest pain or pressure (Call 911 if you have chest pain or pressure)

To learn more, visit the American Heart Association website at www.heart.org/AFib.

Left Atrial Appendage (LAA) Closure

In patients with AFib, blood can sometimes pool in an area in the left upper chamber of the heart called the left atrial appendage. This can cause a clot to form. If it breaks loose it can travel to the brain causing a stroke. Ninety percent of stroke-causing blood clots that come from the heart are formed in the LAA.

As a way to prevent strokes in patients with AFib, blood thinning medicines may be prescribed. Some people cannot take blood thinners. In these cases, LAA closure may be recommended. This procedure places a small implant into the LAA where most blood clots form. The implant is designed to permanently close off the LAA keeping blood clots from escaping. The procedure is minimally invasive. It is designed to permanently close the LAA and prevent stroke without needing long term blood thinning medicines.

Patent Foramen Ovale (PFO)

A patent foramen ovale is a small opening between the upper two chambers of the heart. This opening normally closes during infancy, but for some people it never closes. Most people never require treatment or have symptoms from a PFO.

Sometimes a clot develops and moves through the opening from the right upper chamber to the left. From there it can travel to the brain and cause a stroke. A doctor may recommend treatment of PFO in patients who have had a blood clot or stroke. This treatment may include a procedure to close the PFO.

Carotid Artery Disease

Carotid arteries are the main blood vessels in your neck. Carotid artery disease happens when the blood vessels become clogged with a fatty substance called plaque. As the plaque builds up, the blood vessels begin to narrow blocking the flow of blood to the brain. This increases your risk for TIA or stroke.

Risk factors for carotid artery disease include:

• High blood pressure
• Smoking
• Diabetes
• High Cholesterol
• Age
• Family history of stroke

You may not have any early signs or symptoms of carotid artery disease. The first sign of the disease may be by having a TIA or a stroke. Non-invasive tests are used to know how much blood is flowing through the blood vessels. Treatment options are determined based on your symptoms, the amount of blood flow in your blood vessels going to your brain and your risk factors. Treatment options may include medicines, lifestyle changes or surgery to clear the blockages in the blood vessels.

Uncontrollable Risk Factors

These include things that we cannot control or manage. Although we cannot change these things about ourselves, it is important to know what they are so we can better understand our stroke risk.

• Age: A stroke can happen to anyone, but risk increases with age.
• Race and ethnic background: Black Americans, Hispanic Americans, American Indians and Native Alaskans have a higher stroke risk than other groups. The reasons why these people are at higher risk are not clear.
• Family history: You may be at higher risk of having a stroke if one of your parents or siblings had a stroke or TIA.
• Personal history of stroke or TIA: About 1/3 of people who have a TIA have a stroke within one year. If you have had a stroke, your risk for stroke is higher in the future.
• Children: Stroke in children is uncommon. A child can have an ischemic or hemorrhagic stroke. A child may have similar symptoms as an adult such as one-sided weakness or numbness, sudden change in speech or vision loss. Children may also have other symptoms such as sleepiness, dizziness, severe headache, seizure or vomiting. The most common causes for childhood stroke include blood vessel problems, heart problems, infections and blood disorders. Children who have strokes often recover more fully than adults. This is because a child's brain is still developing.

Knowing what stroke is and what your risk factors are is the first step in decreasing your risk for stroke. Sometimes medicines are needed to help control your risk factors. Work with your doctor to see what medicines are best for you. It’s important that you take your medicines every day as prescribed, even if you feel fine. Talk to your doctor before stopping or changing any of your medicines.

Blood pressure medicines are used to lower your blood pressure when diet and exercise are not enough. There are more than 50 types of these medicines. Each medicine works differently to lower blood pressure. Talk with your doctor about which medicine is best for you. Some things to consider in choosing the right medicine for you are cost, convenience, side effects, and how they work with your other medicines.

Cholesterol-reducing medicines help to lower the amount of cholesterol in your blood stream. This will help to prevent a stroke.

Blood clot prevention medicines help to prevent a stroke by stopping blood clots from forming in the blood stream. There are two types of this medicine. They are called anticoagulants and antiplatelets.

Smoking

Smoking and secondhand smoke has many negative effects on your health. These effects include:

• Lowering HDL levels (good cholesterol)
• Raising blood pressure
• Increasing the chance of blood clotting
• Making exercise more difficult
• Increased buildup of plaque in blood vessels
• Thickening and narrowing of the blood vessels

Smoking doubles your risk of stroke. The day you stop smoking, your risk of stroke also drops. Talk to your provider if you want to quit smoking.

Resources:

• Free Quitline: 1-800-QUIT-NOW
• American Heart Association: 1-800-242-8721 (www.heart.org)
• American Lung Association: 1-800-586-4872 (www.lung.org)
• Centers for Disease Control and Prevention: 1-800-232-4636 (www.cdc.gov/tobacco)
• www.Michigan.gov/tobacco

Drug Abuse

Substances like cocaine, marijuana, amphetamines and heroin can increase your risk for stroke. Cocaine, amphetamines and heroin cause your blood pressure to rise quickly and this increases your chance for a stroke. Marijuana use over time can damage your blood vessels and increase your chance for blood clots. Strokes caused by drug abuse often occur in a younger population. Avoid these substances and see a doctor if you need support.

Alcohol

The American Heart Association recommends limiting alcohol intake to no more than two drinks a day for men and one drink a day for women. Drinking more has many negative effects on your health that may increase your risk for stroke. These effects include:

• Raising blood pressure
• Raising blood sugar levels
• Difficulty maintaining a healthy weight
• Increased risk for irregular heart rhythms (AFib)
• Interacts with medicines such as blood thinners

One drink is equal to:

• 12 ounces of beer
• 5 ounces of wine
• 1.5 ounces of liquor

After a stroke it is important to discuss your alcohol use with your doctor. Do not drink alcohol until cleared by your doctor.

Enjoy Regular Physical Activity

Regular physical activity can decrease your risk for health problems. If you are just starting an exercise program, please talk to your doctor before beginning. A key to getting your daily activity in is to make it something you enjoy doing.

• If you love the outdoors, enjoy a walk or hike.
• If you prefer to be inside and love music, enjoy some tunes while you walk the treadmill.
• Mix up your activity routine to keep you motivated.
• Have a workout buddy to help keep you on track.
• Reward yourself for doing the work to achieve your goals.

The American Heart Association recommends the following:

• Get at least 2 ½ hours of aerobic physical activity per week.
• You can get your activity with 30 minutes a day on at least five days a week.
• Activity should last at least ten minutes, and it should be spread out throughout the week.
• Include stretching exercises.
• Include muscle strengthening at least two days per week.

Manage Stress

Stress has an impact on your body. Your body reacts by releasing stress hormones in the blood. These stress hormones increase your heart rate and constrict your blood vessels, which increases your blood pressure. The increased blood pressure is only temporary and returns to pre-stress levels when the stress is removed.

What can I do to reduce my stress? You can reduce your stress by:

• Enjoying regular physical activity.
• Seeking mental health therapy with a professional.
• Giving yourself enough time to get things done.
• Managing your to do list so that it is reasonable.
• Setting priorities. Do not sweat the small stuff.
• Meditating.
• Getting enough sleep (6-8 hours a day).

Pregnancy

Certain conditions during pregnancy such as pre-eclampsia or eclampsia can result in increased blood pressure and raise risk of stroke. Hormone changes related to pregnancy can increase risk of forming blood clots.

Medicine

Hormone treatments containing estrogen can increase risk of forming blood clots.

Basic Guidelines

• Try to eat more plant-based meals, using beans and soy foods for protein.
• Limit your use of added salt and processed foods.
• Talk to your doctor about use of alcohol.
• Talk with your dietitian or doctor about weight goals.
• After a stroke, some patients have difficulty swallowing. If you do, check with your doctor to see if you need a swallow study with a speech-language pathologist.
• The Mediterranean style of eating can help you reduce risk factors such as obesity, diabetes, high cholesterol and high blood pressure.

Suggested Foods for Your Meal Plan

Fruits and vegetables

• Fresh, plain frozen or canned fruits in water or its own juice.
• Fresh, plain frozen or no-salt added canned vegetables.
• If canned vegetables, rinse prior to using.

Grains

• Choose whole-grain breads, pasta, rice and cereals.
• Use old fashion oatmeal over instant.
• Measure cold cereal.
• Limit products than contain seasoning packets, such as: Rice-A-Roni™, macaroni and cheese and ramen noodles.
• Read label for sodium content of pancakes, waffles, biscuits, cornbread or other foods made with baking mix.

Dairy

• Skim, ½ % or 1 % milk.
• Natural and hard cheeses that are “reduced fat”, “low fat” or “part skim”. Make sure to check sodium content on nutrition facts label.
• Low-fat or non-fat unsweetened yogurt.

Meats, poultry, fish, beans, eggs, and nuts

• Choose lean, fresh or plain frozen meats, poultry, fish and shellfish.
• Choose plant-based proteins such as beans, lentils, tofu, tempeh, seitan.
• Trim all visible fat from meat and poultry.
• Unsalted nuts (one-third cup is equal to 1 ounce of meat).
• Use natural nut butters.
• Bake, grill or roast meat, poultry and fish without added fat.
• Package meals or frozen dinners aim for 600 mg or less of sodium per meal.

Soups

• Use low-sodium or no-salt added soups, broths, or bouillon cubes.
• Try homemade soups made with low sodium ingredients.

Fats, oils, and toppings

• Limit use of mustard, regular ketchup, dips, salad dressings, and relishes.
• Check sodium content in Worcestershire, barbecue, pizza, chili, steak, horseradish, and soy (regular or lite) sauces.
• Use Olive oil over butter and margarine.
• Limit added sugar like syrup, brown or white sugar, and honey.

Other foods

• Try unsalted pretzels, potato chips, corn chips, or popcorn.
• Limit desserts such as cake mixes and pie crust.

Dining Out Guidelines

When eating out, you can still follow your stroke nutrition guidelines by being aware of the foods you order.

When ordering

• Avoid the extras that come before the meal like bread and butter and appetizers.
• Avoid ordering foods that are pickled, smoked or served in sauces or broths.
• Ask your server how menu items are prepared and if they have low sodium options.
• Consider looking up on the internet the sodium content of foods at the restaurant you are going to.
• Ask for food to be prepared without salt or seasoning.
• When ordering, ask for all sauces, gravies and dressings to be placed on the side.
• Try to avoid buffet-style restaurants as it is very difficult to eat the correct portions.

Fast Food Restaurants

• Try to select salads with the dressing on the side.
• Order grilled skinless chicken sandwiches.
• Order single-sized hamburgers.
• Put sauces on the side.
• Ask for no salt added to your food.
• Ask if natural cheese, like Swiss or Mozzarella is available.

Preferred Cooking Methods

• Select foods that have been steamed, broiled, roasted, or poached.

Reading Food Labels

The “Nutrition Facts” on the label lists the amount of nutrients in each serving. Understanding food labels can help you make wise choices.

You may be nervous about being on your own at home after a stroke. Common concerns are:

• A stroke may happen again.
• Adjusting to new challenges.
• Ability to go home.
• Your caregiver may not be prepared to care for you.
• Friends and family will abandon you.

Staying safe and connected

• Write down emergency numbers in large print on index cards and keep them handy.
• Arrange for people to check in with you regularly.
• Accept help with household chores.
• Keep active with your family and friends.
• Participate in your local support group.
• Seek mental health therapy with a professional.
• Consider purchasing a personal emergency alert device.

Returning to work and driving is something that is specific to each stroke survivor.

• Talk with your doctor about when it will be safe for you to resume these activities.

After a stroke, some people are at more risk for falling. There are some things you can do at home to be safe.

At home

• Move furniture out of your path. Place extra furniture next to a wall or in a less used room.
• Clear paths to the bathroom, kitchen, exits, and bedroom.
• Move electrical cords out of the way.
• Wear non-skid shoes.
• Remove loose carpets or throw rugs in hallways and on stairs.
• Install handrails in stairways.
• Use assistive devices (cane, walker, etc.) as directed by your care provider.

In the bathroom

• Install handrails.
• Use grab bars in the tub and shower.
• Put non-slip flooring strips inside and outside the tub.
• Use bathtub benches and toilet chairs.
• Use easy-to-use water faucets.
• Use adjustable or handheld showerhead.
• Use bath supplies that are easy to reach and use.
• Consider lowering the temperature on your hot water heater to less than 120 degrees.
• Elevated toilet seat.

Bedroom safety

• Keep a phone close.
• Have a light switch near your bed.
• Use a nightlight and have a clear path to the toilet.

Getting dressed

• Wear loose fitting clothes.
• Wear clothes that fasten in the front.
• Replace buttons, zippers, and laces with Velcro fasteners.
• Talk with other stroke survivors for ideas and resources.
• Check websites for adaptable clothing.

Staying safe in the kitchen

• Use caution if you need to reach across the burners on your stove to adjust temperature control buttons.
• Put a mirror over the stove to help you see the stovetop if you are seated while cooking.
• Keep a fire extinguisher nearby.
• Keep a clear space near the stove where you can place a hot pot.
• Keep oven mitts nearby.
• Move your most often used items to a place where you can reach them easily.

Many stroke survivors are affected by emotions and mood changes. You may experience sudden laughing or crying spells that may or may not have an explanation. Some things that may help you cope with emotional changes:

• Let people know that you cannot always control your emotions. Explain that the emotions you show on the outside may not reflect how you feel on the inside.
• Distract yourself. If you feel an outburst coming on think of something else. Count backwards or count objects in the room.
• Relaxation techniques may be helpful. Some ideas include deep breathing, changing your posture or relaxing your muscles.

Depression

Many people go through depression after a stroke. You can experience feelings of anger, frustration, fear, anxiety and loss. You may not want to take medicines or perform exercises. You may become irritable with others. These can be signs of depression. This may improve over time.

Anti-depressant medicine may be helpful.

Some things you can do to help cope with depression:

• Stay in contact with other people.
• Find some leisure activities you can enjoy.
• Seek mental health therapy with a professional.
• Stay active in spiritual activities.
• Attend your local stroke support group.
• Take medicines as directed by your doctor.

If you have experienced changes in emotions or mood, or if your family has noticed changes in your mood, please talk to your doctor.

Some people may experience changes in their thinking or concentration after a stroke. The location of the stroke makes a difference in the changes you may have. Talk to your doctor if you are having any of these symptoms:

• Forgetfulness.
• Confusion.
• Difficulty speaking or understanding what is written and spoken.
• Trouble paying attention or following a conversation.
• Difficulty planning and organizing tasks.
• Difficulty with calculations, making simple decisions or solving problems.

Helpful ideas

• Make a routine and stick with it. Do your activities at the same time every day.
• Break down tasks into simple steps.
• Focus on one task at a time.
• When something needs to be done, do it right away or make a note.
• Have a place to put important items so they are easily found.
• Keep a calendar.

A stroke may cause damage to the language center of the brain. Language problems can include both understanding and speaking. Your speech-language pathologist will help you with ideas on how to cope with these challenges. Some coping strategies include:

• Write, draw or use gestures for what you need.
• Speak in short sentences.
• Ask simple yes or no questions.
• Use a word or picture board.

Bed sores can be a serious problem if you spend a lot of time in bed or in a chair. Sores may be found on any area of the skin with extended contact such as the buttocks, heel, back of the head or side of the ankle. You should change your position at least every two hours. Use pillows to support the affected arm or leg. Special mattresses or cushions can reduce pressure and help prevent bed sores. Notify your doctor if you notice any areas of redness or open sores.

A stroke can affect your sexuality. If you are sexually active, part of getting back into a normal routine involves resuming a sex life. Concern of having another stroke during sex is common. It is unlikely that a stroke will happen during sexual activity. Talk with your doctor about resuming safe sexual activity.

Stroke survivors report a decrease in sexual desire and how often they have sexual relations. Stroke patients have reported:

• A decrease in vaginal lubrication and the ability to have an orgasm.
• Weak or failed erections and ejaculations.

Talk with your doctor before using medicines that help or correct these problems. Talking about sex is hard for many people. It is important to talk openly and honestly with your partner about your sexual needs, desires and concerns.

Sleep may be a problem after you have had a stroke. This can get better with time. Having trouble sleeping can be frustrating. This can make you feel tired and irritable. One common cause of sleeping problems is sleep apnea. This is caused by abnormal breathing patterns. Symptoms may include loud snoring, shortness of breath, excessive tiredness during the day, memory troubles, headaches and irritability. Other people you live with may notice these changes. Talk with your doctor if your trouble sleeping does not improve.

You may have pain for many reasons. Normally pain is a way for your brain to tell you that your body has been hurt. This is not always the case after a stroke. Sometimes a normal touch may feel painful. Pain may be felt in your joints or muscles due to tightness or weakness in your affected limb.

Pain after a stroke can be:

• Mild, moderate or severe.
• Constant or on-and-off.
• On part or all of the side of your body affected by the stroke.
• Felt in your face, arm, leg or body.
• Aching, burning, sharp, stabbing or itching.

Treating your pain

To find relief, you must first find the cause of your pain. Pay attention to when it happens and in what part of your body. Does it seem to be caused by something or someone touching you? Tell your doctor about your symptoms. Together you can find the best treatment. Here are some solutions you can try at home.

• Avoid things that can cause pain. Examples include hot baths, tight or easily bunched clothing or putting pressure on the side of your body affected by stroke.
• Only use heat packs if prescribed by your physical or occupational therapist. Never place a heat pack on an area of your body if your ability to feel hot or cold has been affected by your stroke.
• Stay as active as possible using exercises prescribed by your physical or occupational therapist. Not using your muscles may lead to muscle spasm.
• Support a weakened or paralyzed arm on an armrest or pillow to relieve shoulder pain while sitting or lying down. Use a sling while active to reduce shoulder pain. A special sling may be prescribed by your physical or occupational therapist.
• Check the skin under braces often to be sure that sores are not developing.
• Depression is common if you have chronic pain. Discuss with your doctor any feelings of sadness or hopelessness. Counseling and medicine may help.

Spasticity is tightness in the muscles of your arms or legs. This is common after a stroke. It may get better over time or stay the same. Some symptoms are:

• Stiffness in the arms, fingers or legs.
• Painful muscle spasms.
• Uncontrolled movements or jerking.
• Change in your normal posture.

What treatments are available?

Physical and occupational therapists can help you manage spasticity. Some examples may be:

• • Regular stretching.
  • Exercises.
  • Splinting or casting.

• Cooling techniques.
• Medicines.

Mary Free Bed Driver Rehabilitation Program

235 Wealthy St. SE
Grand Rapids, MI 49503
(616) 242-0343 or (800) 528-8989

Talk to your provider to see if a driving rehab program is recommended.

• American Stroke Association (ASA) - A Division of the American Heart Association: www.strokeassociation.org
• National Aphasia Association: www.aphasia.org
• Senior Services of Kalamazoo: http://seniorservices1.org/index.htm

Bronson Stroke Support Group

Meets the third Thursday of the month from 11 a.m. until Noon (there are no meetings in July or August). Meetings are located at the Bronson Gilmore Center for Health Education, 601 John St., in Kalamazoo. Free parking is available in the Jasper Street Parking Ramp.

Virtual Option

We will be streaming live so you can join us virtually.

Registration

To sign up, go to bronsonhealth.com/classes-events and click on Stroke. For more information, call (269) 341-7500.

Brain Injury Support Group

Meets on Thursdays from 1:30 p.m. to 3:30 p.m. Meetings are located at the Disability Network of Southwest Michigan, 517 E. Crosstown Parkway, in Kalamazoo. Option to join online or in-person. For more information call (269) 345-1516 ext.109.

To find a support group in your area visit the American Stroke Association website at www.strokeassociation.org.

Ambulate

to walk

Aneurysm

a weak spot on the wall of the artery that balloons out

Angiography

an X-ray of blood vessels

Antihypertensive

medicines used to lower blood pressure

Antiplatelets/Anticoagulants

medicines used to keep blood clots from forming

Aphasia

trouble speaking and/or understanding spoken or written words

Arrhythmia

an irregular or unpredictable heart beat and/or heart rhythm

Arteriovenous malformation (AVM)

blood vessels that are not correctly connected

Atherosclerosis

plaque buildup that causes “hardening” of arteries

Aspiration

when food or liquid enters into the lungs or wind pipe

Ataxia

uncoordinated movement

Atrial appendage

a pocket like section of the left atrium of the heart.

Atrial Fibrillation (AFib)

an irregular heartbeat. A type of heart arrhythmia.

Brain stem

part of the brain that controls activities like breathing, blood pressure and eye movement

Broca’s aphasia

when stroke survivors can understand what is said and written, but have problems talking or writing

Carotid arteries

arteries in the neck that carry blood from the heart to the brain

Carotid endarterectomy

a surgical procedure to remove plaque from the carotid artery to let blood flow more freely to the brain

Carotid stenosis

narrowing of the carotid arteries caused by a build-up of plaque.

Carotid Ultrasound

ultrasound test that uses sound waves to see the blood flow through the carotid arteries

Cerebellum

part of the brain that controls coordination of movement

Cerebrospinal fluid

fluid in the brain and spinal cord

Cholesterol

soft, waxy fat in the bloodstream and cells

Cognition

process of knowing, including awareness, perception, reasoning, remembering and problem solving

Continence

ability to control body functions, especially bowel and bladder use

Contracture

condition where a muscle becomes tight and resistant to stretching

CT or “CAT” scan

X-ray that shows the structures of the brain in detail

Doppler ultrasound

test that looks at blood flow through arteries and veins

Dysarthria

difficulty speaking due to problems with muscles in the face

Dysphagia

difficulty swallowing

Echocardiogram (ECHO)

ultrasound test that uses sound waves to create pictures of heart

Edema

swelling due to fluid retention

Emotional lability

sudden changes in emotions

Hematoma

bruise in an organ or tissue

Hemianopia

partial vision loss in one or both eyes

Hemiplegia

inability to move one side of the body

Hemorrhagic Stroke

stroke caused by a break in a vessel in the brain causing bleeding in the brain

Hypercoagulable state

increased tendency towards blood clotting

Hypertension

high blood pressure

Hypoxia

low level of oxygen in the body

Infarct

area of dead tissue

Intracerebral hemorrhage

stroke caused by bleeding in the brain

Ischemic Stroke

stroke caused by plaque or clots that block a blood vessel in the brain

Left Hemisphere

left half of the brain that controls the right side of the body

Magnetic Resonance Imaging (MRI)

test that looks at internal structures with magnetic and radio waves

Neglect

lack of attention to objects or actions on one side of the body

Occlusion

blocked blood vessel

Occupational Therapy (OT)

help relearn the skills you need for everyday living. This can include eating, toileting, bathing, and dressing

Patent Foramen Ovale (PFO)

an opening between the atrium, the top two chambers of heart

Penumbra

area of the brain around the stroke that is in danger of dying, but is not permanently damaged

Physical Therapy (PT)

help regain strength, coordination, balance, and movement

Plaque

deposits in the inner lining of the artery

Platelets

blood cell that s stick together to form clots

Pseudobulbar Affect

inappropriate involuntary laughing or crying due to certain neurological conditions or brain injuries

Right hemisphere

right half of the brain that controls the left side of the body

Spasticity

tightness in the muscles of your arms or legs

Sickle cell anemia

an inherited blood disorder that affects the shape of red blood cells

Speech-Language Pathology (SLP)

help with communication, thinking, and swallowing skills

Stenosis

reduction in the size of a blood vessel.

Stroke

The sudden interruption of blood flow to a part of the brain

Subarachnoid hemorrhage

a stroke caused by bleeding under the membrane surrounding the brain.

Thrombolytic Agents

a medicine that works to dissolve stroke-causing clots.

Thromboembolism/Embolic Stroke

a clot that travels through the bloodstream and blocks another vessel

Thrombosis

Blood clot in a blood vessel

Thrombotic Stroke

A stroke caused by a blood clot stopping the blood flow through an artery

Transcranial Ultrasound (TCD)

ultrasound test that uses sound waves to see the blood flow through the large arteries in the head

Transesophageal Echocardiogram (TEE)

a type of echocardiogram that uses a long thin tube guided through the mouth and down the throat and esophagus to get pictures of the heart

Transient ischemic attack (TIA)

a brief interruption of blood flow to the brain. This causes temporary stroke symptoms lasting less than 24 hours.

Vertebrobasilar Arteries

the arteries in the back of the neck that supply blood to the brain stem and cerebellum.