JANUARY | FEBRUARY 2010
STROKECONNECTION
StrokeAssociation.org
A Change of Plans
A bittersweet wedding day
Moving from
Victim to Victor:
Creating a stroke
support group
Life at the Curb:
Hold On, I’m Comin’
Stroke Connection is underwritten in part by Bristol-Myers
Squibb/Sanofi Pharmaceuticals Partnership, makers of Plavix.
Surviving
the Links
Getting back into
the swing of things
after stroke
JANUARY | FEBRUARY 2010
Contents
STROKECONNECTION
STAFF A N D C O N S U LTA N T S :
Stephen Prudhomme
Vice President
American Stroke Association
14
Debi McGill
Editor-in-Chief
Jon Caswell
Lead Editor
Pierce Goetz
Art Director
Lyanne Dupra
Advertising Sales
[email protected]
8
Cover Story
Stroke Connection is underwritten in part by
Bristol-Myers Squibb/Sanofi Pharmaceuticals
Partnership, makers of Plavix.
8 Making Golf Accessible
A golf therapy program offers an
opportunity for survivors to stretch
themselves, expand their worlds and
have some fun.
Features
Allergan, Inc. is a proud sponsor of
Stroke Connection E-zine.
Copyright 2010 American Heart Association
ISSN 1047-014X
Stroke Connection is ­published six times a year
by the American Stroke Association, a division of
the American Heart Association. Material may be
reproduced only with ­appropriate acknowledgment
of the source and written ­per­mission from the
American Heart Association. Please address inquiries
to the Editor-in-Chief.
18
14 A Change of Plans
Departments
Arizona caregiver Nancy Clarke shares
her family’s experience when husband
Clif had a stroke two weeks before their
daughter’s wedding in Canada.
3
4
6
18
20
16 From Victim to Victor
Stroke survivor and veteran support
group facilitator Art Gottlieb offers sage
advice for starting a group in your area.
Letters to the Editor
Stroke Notes
Readers Room
Everyday Survival
Life at the Curb
The information contained in this publication is
provided by the American Stroke Association as a
resource. The services or products listed are not owned
or provided by the American Stroke Association.
Additionally, the products or services have not been
evaluated and their listing or advertising should not
be construed as a recommendation or endorsement
of these products or services.
StrokeAssociation.org
1 - 8 8 8 - 4 S T R O K E
( 1 - 8 8 8 - 4 7 8 - 7 6 5 3 )
No one can predict
a heart attack.
But your stroke may be
your first clue.
If you’ve had a stroke, you may be facing a major risk of having another one.
But did you know you may also be at increased risk of a heart attack?
PLAVIX is the only prescription antiplatelet medicine
that helps protect against a stroke and heart attack.
Once you’ve experienced a stroke, your risk of both a
stroke and a heart attack never goes away. PLAVIX can
help reduce your risk. PLAVIX is proven to help keep clots
from forming, the leading cause of heart attacks and
strokes. So if you’ve recently had a stroke, PLAVIX can
help protect against another stroke or even a heart attack.
Talk to your doctor to find out if PLAVIX is right for you.
IMPORTANT SAFETY INFORMATION: People with
stomach ulcers or other conditions that cause bleeding
should not use PLAVIX. Taking PLAVIX alone or with
some other medicines, including aspirin, may increase
bleeding risk, so tell your doctor when planning
surgery. Certain genetic factors and some medicines,
such as Prilosec, may affect how PLAVIX works.
Tell your doctor all the medicines you take, including
aspirin, especially if you’ve had a stroke. If fever,
unexplained weakness or confusion develops, tell your
doctor promptly. These may be signs of TTP, a rare
but potentially life-threatening condition, reported
sometimes less than 2 weeks after starting PLAVIX.
Other rare but serious side effects may occur.
PLAVIX offers
protection.
PLAVIX is proven
to help keep
PLAVIX helps keep
Blood platelets
blood platelets
can stick together blood platelets from
from sticking
sticking together.
and form clots.
together and
forming clots, which helps keep your blood flowing. Clots
are the leading cause of strokes and heart attacks.
PLAVIX helps you stay protected.
You are encouraged to report negative side effects of
prescription drugs to the FDA. Visit www.fda.gov/medwatch,
or call 1-800-FDA-1088.
Talk to your doctor about PLAVIX.
For more information, visit www.plavix.com
or call 1-800-470-4097.
If you need help paying for prescription
medicines, you may be eligible for assistance.
Call 1-888-4PPA-NOW (1-888-477-2669).
Or go to www.pparx.org.
Please see important product information for PLAVIX on the previous page.
US.CLO.09.11.080 November 2009 Printed in USA 264US09AB44701 11/09 sanofi-aventis U.S. LLC
© 2009 Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership
PLAVIX
Rx Only
(clopidogrel bisulfate) tablet, film coated
WHO IS PLAVIX FOR?
PLAVIX® (clopidogrel bisulfate) is a prescription-only medicine that
helps keep blood platelets from sticking together and forming clots.
PLAVIX is for patients who have:
• had a recent heart attack.
• had a recent stroke.
• poor circulation in their legs (Peripheral Artery Disease).
PLAVIX in combination with aspirin is for patients hospitalized with:
• heart-related chest pain (unstable angina).
• heart attack.
Doctors may refer to these conditions as ACS (Acute Coronary
Syndrome).
Clots can become dangerous when they form inside your arteries.
These clots form when blood platelets stick together, forming a
blockage within your arteries, restricting blood flow to your heart or
brain, causing a heart attack or stroke.
WHO SHOULD NOT TAKE PLAVIX?
You should NOT take PLAVIX if you:
• are allergic to clopidogrel (the active ingredient in PLAVIX).
• have a stomach ulcer.
• have another condition that causes bleeding.
• are pregnant or may become pregnant.
• are breast feeding.
• have certain genetic factors.
WHAT SHOULD I TELL MY DOCTOR BEFORE TAKING
PLAVIX?
Before taking PLAVIX, tell your doctor if you’re pregnant or are
breast feeding, if you are taking any other drugs or if you have any
of the following:
• gastrointestinal ulcer
• stomach ulcer(s)
• liver problems
• kidney problems
• a history of bleeding conditions
WHAT IMPORTANT INFORMATION SHOULD I KNOW ABOUT
PLAVIX?
Genetics: People with a specific genetic makeup may get less
protection against heart attack or stroke with PLAVIX.
Drug interactions: Some medicines, such as Prilosec, may affect
how PLAVIX works. Tell your doctor all the medications you are
taking, including prescription or over-the-counter medications. You
should tell your doctor about any other medications you are taking,
including prescription or over-the-counter Prilosec (omeprazole).
Taking Prilosec with PLAVIX may reduce the effect of PLAVIX.
Antacids and most H2 blockers, except Tagamet (cimetidine), are
not known to interfere with how PLAVIX works.
TTP: A very serious blood condition called TTP (Thrombotic
Thrombocytopenic Purpura) has been rarely reported in people
taking PLAVIX. TTP is a potentially life-threatening condition that
involves low blood platelet and red blood cell levels, and requires
urgent referral to a specialist for prompt treatment once a diagnosis
is suspected. Warning signs of TTP may include fever, unexplained
confusion or weakness (due to a low blood count, what doctors call
anemia). To make an accurate diagnosis, your doctor will need to
order blood tests. TTP has been reported rarely, sometimes in less
than 2 weeks after starting therapy.
Gastrointestinal Bleeding: There is a potential risk of gastrointestinal (stomach and intestine) bleeding when taking PLAVIX. PLAVIX
should be used with caution in patients who have lesions that may
bleed (such as ulcers), along with patients who take drugs that
cause such lesions.
Bleeding: You may bleed more easily and it may take you longer
than usual to stop bleeding when you take PLAVIX alone or in
combination with aspirin. Report any unusual bleeding to your
doctor.
Geriatrics: When taking aspirin with PLAVIX the risk of serious
bleeding increases with age in patients 65 and over.
Stroke Patients: If you have had a recent TIA (also known as a
mini-stroke) or stroke taking aspirin with PLAVIX has not been
shown to be more effective than taking PLAVIX alone, but taking
aspirin with PLAVIX has been shown to increase the risk of
bleeding compared to taking PLAVIX alone.
Surgery: Inform doctors and dentists well in advance of any surgery
that you are taking PLAVIX so they can help you decide whether
or not to discontinue your PLAVIX treatment prior to surgery.
WHAT SHOULD I KNOW ABOUT TAKING OTHER MEDICINES
WITH PLAVIX?
You should only take aspirin with PLAVIX when directed to do so
by your doctor. Certain other medicines should not be taken with
PLAVIX. Be sure to tell your doctor about all of your current
medications (prescription or over-the-counter), especially if you are
taking the following:
• aspirin
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• warfarin
• heparin
• heartburn or stomach ulcer medicines, like Prilosec
Be sure to tell your doctor if you are taking PLAVIX before starting
any new medication.
WHAT ARE THE COMMON SIDE EFFECTS OF PLAVIX?
The most common side effects of PLAVIX include gastrointestinal
events (bleeding, abdominal pain, indigestion, diarrhea, and nausea) and rash. This is not a complete list of side effects associated
with PLAVIX. Ask your doctor or pharmacist for a complete list.
HOW SHOULD I TAKE PLAVIX?
Only take PLAVIX exactly as prescribed by your doctor. Do not
change your dose or stop taking PLAVIX without talking to your
doctor first.
PLAVIX should be taken around the same time every day, and it
can be taken with or without food. If you miss a day, do not double
up on your medication. Just continue your usual dose. If you have
any questions about taking your medications, please consult your
doctor.
OVERDOSAGE
As with any prescription medicine, it is possible to overdose on
PLAVIX. If you think you may have overdosed, immediately call
your doctor or Poison Control Center, or go to the nearest
emergency room.
FOR MORE INFORMATION
For more information on PLAVIX, call 1-800-633-1610 or visit
www.PLAVIX.com. Neither of these resources, nor the information
contained here, can take the place of talking to your doctor. Only
your doctor knows the specifics of your condition and how PLAVIX
fits into your overall therapy. It is therefore important to maintain an
ongoing dialogue with your doctor concerning your condition and
your treatment.
Distributed by:
Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership
Bridgewater, NJ 08807
PLAVIX® is a registered trademark.
CLO-BSC-SA-OCT09
YO U R L E T T E R S | Connecting You to Us
Not a Commercial
Inventing a Salt Substitute
This is not a commercial for Stroke Connection
though it could definitely be misconstrued for just that.
Let me explain. I had a hemorrhagic stroke in October
2006. I had left-sided paralysis for several months after. I was like most stroke survivors, lucky to be alive, but
wondering where or if I would ever fit in society again.
If this was a true endorsement for this magazine, I
would probably say that I read it all the time and got
real inspired and motivated to improve my life and the
rest is history.
But that is not the case. In fact, I was lucky to be
able to read anything more than an e-mail during the
first year, which seemed to last about three years.
Persistence and a burning determination to improve,
along with a strong faith in God, pushed me to where
I am today. The road to recovery was long and hard.
After about a year and a half I was able with the help
of my son Mike to form a stroke support Web site
called StrokesSuck.com.
It was around that time as I was searching for
resources to help others and myself in recovery when I
discovered Stroke Connection.
I find that it is a wonderful place for both survivors
and caregivers for up-to-date strategies on improving
life after stroke. In particular, I love reading the stories
of other survivors. Their stories always inspire me and
encourage me to do as much as I can with whatever
time that I have left on this earth.
I now realize that my stroke was probably meant
to happen for me to become aware of my own spirit
consciousness. My purpose now on this earth is to be
of service to others.
I will always be on the road to recovery and I will
lend a hand whenever I can.
Thank you Stroke Connection.
I had a stroke some years back. I spent about a month
in the hospital and couldn’t talk or walk when I left. They put
me on a low- or no-salt diet. I was a saltaholic and would salt
my food before tasting it. My wife was the food buyer and
couldn’t find any bread that didn’t have a lot of salt in it. I
remembered that I used to make sourdough bread and that salt
was one of the ingredients. I told her that I could do that and
got sourdough starter and started making bread without salt. I
knew that salt was a flavor carrier and substituted anything that
was strong for salt. What I came up with was onion, garlic and
jalapeños. I chop up a whole onion, four jalapeños with seeds
and all, crush four cloves of garlic through a press and put all
that in the sourdough when I start it. I find that it is definitely
startling, but I need something I can taste instead of the salt.
Bob Miller, Survivor
San Diego, California
Robert Jorgenson, Survivor
Via e-mail
WARNING
SIGNS OF STROKE:
KNOW THE
• S udden 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
If you experience some or all of
these warning signs, don’t wait.
Call 9-1-1 right away.
We’d like to
hear from you!
E-MAIL US AT: [email protected]. Or send letters to: Editor-in-Chief, Stroke Connection, 7272
Greenville Avenue, Dallas TX 75231. Letters may be edited for length and scientific integrity. The opinions
presented are those of the individual and do not reflect those of the American Stroke Association.
STROKECONNECTION
January | February 2010
3
S T R O K E N OT E S | Connecting You to the World
Better Living through Therapy
Psychosocial therapy with antidepressants helps depressed stroke patients
sychosocial therapy combined with
medication can effectively improve
depression and recovery in stroke
survivors, according to a new study
reported in Stroke: Journal of the
American Heart Association.
In the first long-term study
of psychosocial/behavioral therapy in combination
with antidepressants, researchers found that adding
psychosocial therapy improved depression scores short
term and those improvements were sustained long term.
At one year: • Depression scores dropped 47 percent in patients
treated with eight weeks of psychosocial/behavioral
therapy and antidepressants.
• Scores dropped 32 percent among those with usual
care, which included taking antidepressants.
The results are clinically and statistically significant,
researchers said. Survivors with improved depression
perceived their recovery as significantly greater and also felt
their physical condition and social participation were better
than those with lesser improvement in depression.
One-third of survivors develop clinical depression,
which makes them less able to recover, worsens cognitive
4
STROKECONNECTION
January | February 2010
functioning, impairs social functioning and is associated with
other adverse consequences.
Researchers studied 101 clinically depressed
nonhospitalized stroke survivors (59 percent men, ages 25 to
88). Each had suffered modest ischemic stroke in the previous
four months. The participants were divided into two groups:
48 received the psychosocial/behavior therapy along with
medication for eight weeks, while 53 received medication
as part of usual care, usually a selective serotonin reuptake
inhibitor such as sertraline (trade name Zoloft).
Research nurses conducted the psychosocial/behavioral
therapy, visiting the patients nine times during eight weeks.
The nurses conducted one-hour sessions, focusing on
education about depression and positive behaviors. The
sessions covered how to increase pleasant events, problem
solving, caregiver support and how to identify and modify
negative thoughts.
At the beginning of the study, all patients had a
moderately severe depression rating on a standard rating
scale. The average scores for both groups were about 20. A
score of 9 or below is desirable.
At nine weeks, the psychosocial/behavioral treatment
group had a reduced depression score of 10, a highly
significant improvement, twice as effective as the rating in
the usual care group.
PAD and Stroke Risk
Simple test may identify survivors at risk of another cardiovascular event
easuring circulation in the ankle
using a device similar to a blood
pressure cuff can help identify
asymptomatic peripheral artery
disease (PAD) in stroke and TIA
survivors. These individuals are at
much higher risk of subsequent strokes, according to a study
in Stroke: Journal of the American Heart Association.
The ankle brachial index (ABI) compares blood flow in
the ankle and the arm to detect poor circulation caused by
fatty plaque buildup in the lower body. Researchers used it
to screen 102 stroke and TIA survivors. The investigators
found that 26 percent of the survivors had asymptomatic
PAD, and those people had three times more subsequent
cardiovascular events — stroke, heart attacks or death —
in the following two years compared to those without PAD.
Fifty percent with asymptomatic PAD suffered subsequent
events, compared with 16 percent of those without the
disease. In addition, PAD was significantly associated with
future vascular events, especially strokes.
PAD occurs when arteries in the extremities become
obstructed by plaque. Leg pain, cramping, weakness and
limping during physical exertion are the primary symptoms,
yet surveys show that up to one-third of patients never tell
their physician about symptoms, and fewer than half of
general physicians routinely ask.
“ABI measurement may be appropriate for screening
stroke/TIA patients who may be at high risk for vascular
events,” said lead researcher Souvik Sen, M.D., M.P.H.,
director of the Stroke Center at the University of North
Carolina, Chapel Hill. “The test is easily performed in less
than 15 minutes at the physician’s office or at bedside in
hospitalized patients.”
PAD management guidelines developed by the American
Heart Association and the American College of Cardiology
recommend screening all high-risk patients.
©2009 Innovative Neurotronics, Inc. All rights reserved. L-50-R1
FOOT DROP
A big challenge.
A simple solution.
WalkAide is the biggest name in the treatment of foot drop. WalkAide can
help you step up your mobility significantly and live life on your terms again. With
its compact, single-unit design, WalkAide leverages functional electrical stimulation
to improve brain reaction and restore mobility. Many health insurers are now
covering the Walkaide. Now is the time to take the big step forward by taking
advantage of a free WalkAide trial. For more information or to request a free patient
kit, call 866-909-WALK (9255) or visit walkaide.com.
08-INR-08649_PatientVersion_StrokeConn.indd 1
STROKECONNECTION
January | February
5
1/28/092010
5:51:31 PM
R E A D E R S R O O M | Connecting You to Others
To the Medical Professionals
Who Support Stroke Survivors
Hope is the thing with feathers,
That perches in the soul,
And sings the tune — without the words,
And never stops at all.
— Emily Dickinson
Any change proceeds through many plateaus, and learning never
needs to stop. Caregiver Mary Towse with husband Brad
he third day after my husband Brad
experienced a serious stroke at age 55,
a neurologist took me aside and told
me that his chances for recovery were
very bleak. Another doctor listening
to the conversation approached after
the neurologist had left and said, “I don’t want you to
think there is no hope. There is hope.” Over the past
three years, as my husband has continued to recover
and regain function, I have learned that nothing is
more important than the gift of hope. For all of you
who work with stroke survivors – doctors, nurses,
therapists – know that you also have the ability to give
this great gift.
H – Honor the healing process in everything
you do and say. Believe that healing does not stop
unless hope is lost. When the early, spontaneous
recovery stops, your encouragement becomes even
more important as progress slows and healing requires
more hard work. Use the word “plateau” carefully
and always make sure that it is communicated as a
temporary situation in which the brain and body are
taking a rest, getting ready for more hard work ahead.
6
STROKECONNECTION
January | February 2010
O – Open your mind to the new thinking about the brain’s
amazing capacity to rewire and form new connections. Read
firsthand accounts of stroke recovery as a way of understanding
the personal side of the process – there are several good books
available written by survivors. Although you may have been taught
that recovery stops after a year or two, find ways of unlearning that
information, which is now known to be false. Challenge that old
thinking in your self and in others.
P – Project optimism in all of your communications to survivors
about the possibilities of recovery. If you are thinking it, they will
perceive it. If you do not believe that progress will continue, that
limiting thought will be projected to the survivor. Understand your
power as the “expert” the survivor is looking to and take that role
seriously. Know that, like the survivor, you will reach plateaus while
working with an individual and may also need a temporary break.
E – Expect recovery. Let it become a self-fulfilling prophecy.
In almost all situations in life, people tend to rise or fall to the
expectations held of them. Make certain your expectations are
those to which patients will rise. Edit your language, eliminating
words such as “never or rarely” when used to convey possibilities.
Consider that most of the negative recovery statistics you learned
were created under the “old” thinking about brain recovery and
may well have been influenced by negative expectations. Treat each
survivor as an “exception to the old rules.”
Finally, thank you all for the hard work you do. Thank you for
choosing to help others. Know how much your dedication means
to those of us on the journey to recovery, both stroke survivors and
those who love them. Keep the faith and God bless.
Mary Towse, Caregiver
Bonner Springs, Kansas On the Boat Again
n years past, Willie Nelson had a fabulous song that
had everyone singing and in the process brought him
increased fame and fortune. We assumed he wrote
and sang it because of his love for being on the road
and entertaining his audiences. I, too, sang this song
a couple of weeks ago, but with a few changes. Prior to my strokes in 1999, my passion was sailing, and
although I have sailed a number of times since my recovery,
I had not been on the water this year. As a result of the pure
happiness being “On the Boat Again,” and to the chagrin of
my fellow sailors, I sang to the seagulls and all others within
listening distance while steering my friend’s 38-foot sailboat
across the Potomac River. For those of you who might enjoy a
similar joy of sailing again, I will share my modified lyrics:
On the boat a-gain,
Just can’t wait to get on the boat a-gain. The life I love is going sailing with my friends,
And I can’t wait to get on the boat a-gain.
The key sentence in this verse is “The life I love is going
sailing with my friends.” The thrill of being on the water
sailing again was overwhelming, but most importantly, I was
one of the guys again. Ten years of disability from my stroke
has created a painful distance between me and my former
sailing buddies. I understand their hesitancy to take me on
board their boats. My limited mobility creates a potential
hazard when I can’t quickly shift my weight to the high side
after tacking. On smaller boats (18–20 feet), weight shifting
to offset the heel from the wind is crucial to keeping the mast
pointing skyward. And that can be the difference between
sailing and swimming. So yes, I understand their reason for not inviting me
aboard, but understanding goes just so far in filling the loss
of the fellowship. Anyone who enjoys going out with friends
for a round of golf, a day on the slopes, or whatever activity,
understands the importance of fellowship in making the day
enjoyable. My advice to other survivors is to work hard to
build the strength that enables you to get out and enjoy some
of those activities you loved prior to stroke. And if you find
that task too challenging, make new friends who accept you
just as you are now. For more fun in life, get “on the boat
again,” especially, if it is the one called “Friend-ship.”
My sincere thanks to Billy and Eric for taking me sailing
and allowing me to be one of their crew and “on the boat
again.” And thank you, Lord, for giving me these new friends. David Layton, Survivor
The Captain — Billy
Gardner
The Survivor — David Layton
The First Mate — Eric Morgan
Summerfield, North Carolina
STROKECONNECTION
January | February 2010
7
C OV E R S TO RY
Making Golf
Accessible
Golf therapy offers an opportunity for
survivors to stretch themselves, expand
their worlds and have some fun.
by Jon Caswell
8
STROKECONNECTION
January | February 2010
he lives of stroke survivors often shrink after their strokes. Activities that
they loved may no longer be available to them. And new activities – other
than adventures in Therapyland – may be out of the realm of possibility.
They may seem to be too much trouble or require assistance the survivor
isn't comfortable asking for. For many survivors, the world they once
worked and played in has become an unfriendly and dangerous place.
Perhaps that is why Saving
The golf portion of Saving
Strokes, a golf therapy program
Strokes is for survivors in all
developed and run by the Western
phases of recovery. There is
States Affiliate of the American
even an adaptive golf cart with
Heart Association/American
a swivel seat for survivors
Stroke Association, has grown so
who can’t stand on their own.
much. It offers an opportunity for
That’s how Bill Dodd, age 67,
survivors to stretch themselves,
participates. Bill had six ischemic
expand their worlds and have
strokes on both sides of his brain
some fun. More than 550
between 1981 and 1992, not to
survivors have been through the
mention “a ton of TIAs,” said
program, and almost 800 more are
his wife Marilyn. (Bill’s speech
expected to participate in events
is limited to single words, so
this year. Whether it is therapy for
Marilyn did the talking for the
the body or therapy for the soul, it
interview.)
Survivor
Claire
Borland
takes
part
in
Saving
Strokes
Sacramento
seems to be good therapy.
“The adaptive golf cart is a
Saving Strokes began in 2001
dream come true for Bill,” Marilyn
in Sacramento with 26 survivors. The half-day program
said. “It allows him to almost stand all the way, enough to let
is offered at 13 sites in California, Nevada and Utah. (See
him have a free swing. Now he even hits balls from his scooter
schedule on p. 12.) The original vision was to offer survivors
in the backyard.”
an opportunity to participate in golf for pleasure as well
Once a regular golfer, Bill didn’t play after his stroke until
as physical rehabilitation. The three- to four-hour program
his first Saving Strokes program in 2007. After his first lesson,
includes a blood pressure assessment, balance evaluation and
he participated in the six-lesson continuation program at Haggin
30 minutes of private coaching with golf pros trained to work Oaks, where survivors have 90-minute lessons once a week for
with stroke survivors. After a personal tutorial, the survivors
six weeks. They learn the fundamentals of the game, and at the
practice chipping and putting.
last session, they put it all together and play a three-hole round
Caregivers can also participate. While the survivors are on
of golf. (Not all Saving Strokes sites offer the continuation
the links, caregivers receive special attention at the “comfort
program.)
green,” where chair massages are offered. In addition, a health
Carl Valdrow, 76, had never golfed before he found
and vendor fair typically includes medical device companies,
Saving Strokes in 2003. Carl survived both ischemic and
massage therapists, adaptive driving companies and services
hemorrhagic strokes in 2001. Completely paralyzed at first, he
for the disabled, including electric company and phone
has gotten back about 80 percent. “Golf has helped my rehab
company discount programs, as well as health and beauty
tremendously,” he said.
products and physical therapy companies. Lunch is provided
Carl, who lives in Davis, Cal., also went through the
for everyone. The program and lunch are free, thanks to the
continuation program, and now he plays golf twice a
support of generous volunteers.
week with a group of survivors at different courses in the
STROKECONNECTION
January | February 2010
9
“It’s important to
remember that it’s
not how you play
the game but that
you play.”
Top: Survivor Bill Dodd uses an adaptive golf cart to tee off
Bottom: A Saving Strokes clinic in Salt Lake City
Sacramento area. “Both Saving Strokes and the continuation
program were great because they got me out with other
people who’ve had strokes,” Carl said. “That gave me
encouragement to keep trying. My first year I was just trying
to hit the ball. If it went 20 yards, I was ecstatic. I got more
control the more I used my muscles. Now I can hit the ball
140–180 yards off the tee with my driver.”
One of Carl’s golfing partners on his bi-weekly golf outings
is John Castiglia, 78, a golfer since age 12. He has left-side
weakness as a result of a hemorrhagic stroke in 2003. “My left
side does what it wants,” he said. He found out about Saving
Strokes from another survivor who was visiting new survivors
in the hospital. He still plays golf with that man.
“Saving Strokes really helped me with my balance,” John
said. “It taught me to swing differently. I already knew the
fundamentals of golf, but they helped me tweak what I knew so
it worked with what I had. But the balance was the key thing.”
John still participates in Saving Strokes and the continuation
program as a mentor. At the Haggin Oaks sessions in
Sacramento, they have two pros and two mentors who work
with the survivors. “We also have a lot of media who come out
to Saving Strokes,” John said. “We always play nine holes with
them, and they have to play with a handicap for three or four
holes. It gives them an appreciation of what the disabled go
through to play golf.”
Of course, people with disabilities have to make some
adaptations, which Saving Strokes provides. “I have to be
careful how I line up,” John said. “And stroke survivors have to
be careful walking on a golf course. The first time I went into a
sand trap from the top, I rolled down it just like I was a ball! I
use a cane to walk, so out on the course, I ride a cart now.”
For Carl, Saving Strokes and the continuation program
were just the beginning of many golf lessons. “I took lessons at
different places on and off for two years,” he said. “In fact, I’m
taking lessons right now because I need improvement. Having
people point things out helps me concentrate. I had fallen into
some bad habits because of poor memory. Putting is my biggest
challenge because I have tremors, so I don’t have as much
control with those short moves. (continued on p. 12)
ADAPTIVE GOLF EQUIPMENT
Many survivors can’t use traditional clubs or
golf carts because of their disabilities. But
survivors who want to golf can find adaptive
equipment that includes swivel seat golf carts
available for those who can’t stand and many
different clubs.
10 S T R O K E C O N N E C T I O N January | February 2010
There are many Web sites that can help
you find equipment that is right for you.
A good place to start is the Resource
Center for People with Disabilities
at the United States Golf Association,
resourcecenter.usga.org.
Do sudden, unpredictable emotional
outbursts disrupt your life?
You are not alone.
You may be one of more than a million Americans suffering from
Pseudobulbar Affect (PBA).
Pseudobulbar Affect can happen when disease or injury damages the area of the brain that controls how you express
your emotions. The result: sudden, unpredictable crying, laughing, or other emotional episodes that can be disruptive
and embarrassing.
But you are not alone. More than a million people diagnosed with neurologic disease or injury also have PBA—
impacting their lives, and the lives of those close to them.
If you or someone you care for experiences these episodes and has been diagnosed with a condition such as multiple
sclerosis (MS), Lou Gehrig’s disease (ALS), Parkinson’s disease, Alzheimer’s disease, stroke, or traumatic brain injury,
it may be due to “short circuits” in brain signaling. It may not be depression. Learn more about how you might begin
to take control.
Pseudobulbar Affect
PBA
To learn more, please visit www.PBAinfo.org
©2009 Avanir Pharmaceuticals.
All rights reserved.
PBA-0910-0002
Speech and Language Recovery
Happy golf campers at a Saving Strokes event in Sacramento
“Having never played before, my stance is different,” Carl
continued. “I have to point my left foot out so my whole body can
rotate when I swing.”
Bill Dodd finds joy in just hitting the ball by visiting the driving
range once a week. “He is always ready to get his clubs in the car
and go to the driving range. If he didn’t have that, life would be
different,” Marilyn said. “It’s good for both of us because it allows
me to go and participate in something that means a lot to him. We
look at it as a great blessing.”
Saving Strokes has also been a blessing for John Castiglia.
“It made me get off the couch and do something,” he said. “I
move better now. I could not use my left hand that well when
I started and now I can.”
Carl Valdrow has similar praise for the program. “I attribute a
good 60 percent of my recovery to golf,” he said.
Both men feel Saving Strokes and golf in general have been a
psychological boon to them. “I have met a lot of nice people, and
I’m inspired by the other survivors, many of whom are worse off
than I am,” John said, “but they still come out and give it a shot.
Those are good people to be around. It’s great camaraderie, plus
we have a lot of fun.”
Carl, who had never played golf before, appreciates the
challenge. “I never did competitive sport before,” Carl said, “but
to some degree this is competitive. I’m competing with myself as
well as with the course and the other people. It keeps me enthused,
and I always go out with the thought that I’m going to do better
than I did last time.”
“I topped every ball I tried to hit after my first lesson,” John
said. “It’s important to remember that it’s not how you play the
game but that you play. If you keep after it, you will improve.”
Every year the American Heart Association receives heartwarming letters from Saving Strokes participants telling how
golf has changed their lives, as well as the lives of their friends
and caregivers. People who believed their days of socializing
outdoors were over are now out in the fresh air making new
friends and getting exercise. This is one activity that expands the
lives of stroke survivors.
12 S T R O K E C O N N E C T I O N January | February 2010
Affordable therapy for
• Aphasia
• Apraxia
• Speech
• Word retrieval
• Reading
• Memory
“Bungalow Software is great.
My husband spends several
hours a day working on it. His
progress was quite evident
in the therapist’s follow-up
evaluation.”
Helen Talley
Caregiver
Unlimited, independent therapy using programs created by speech
therapists. Used in homes and clinics since 1995. Money-back
guarantee. Easy to use. No training needed.
Get your free information kit
1-800-891-9937
www.StrokeSoftware.com
It’s never too late—or too early. Start Today!
Saving Strokes
2010 EVENTS
Thirteen Saving Strokes golf clinics will be held
from March through October. Organizers anticipate that almost 800 survivors will participate.
CALIFORNIA
San Diego – March 31 – Riverview Golf Course
Sacramento – April 14 – Haggin Oaks
San Jose – May 5 – Los Lagos Golf Course
San Francisco – May 12 – Harding Park
Fresno – May 12 – Riverwalk Golf Course
Los Angeles – May 26 – Griffith Park
Napa – June 8 – Napa Golf Course
Oakland – June 20 – Metro Links
Santa Rosa – October – date and location TBD
NEVADA
Las Vegas – May 5 – Angel Park Golf Course
Reno – August 24 – Washoe Golf Course
UTAH
Salt Lake City – June 18 – Nibley Golf Park
Provo – September 22 – location TBD
For more information, contact Jennifer Halldorson
at [email protected]
or (916) 446-6505.
STROKE CHANGES YOUR LIFE.
CHANGE IT AGAIN FOR THE BETTER
NESS H200®
HAND REHABILITATION SYSTEM
Designed to help you open and close your
hand, perform daily activities and reeducate
your muscles.
NESS L300™
FOOT DROP SYSTEM
Designed to stimulate the muscles in your
affected leg, thereby allowing you to lift your
foot while walking.
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Individual results vary. Consult with a qualified physician to determine if these products are right for you.
Contraindications, Adverse Reactions and Precautions are available on-line at www.bioness.com (also available in the NESS H200/L300 User’s Guides).
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009
A Change of Plans
by
N ancy B. C larke , C aregiv er
hen a couple plans a wedding, they don’t count on a
serious illness suddenly sidelining one of the key players.
In June 2006, our daughter Connie, living in Buffalo, N.Y.,
and her Canadian fiancé, Patrick, residing in Toronto, were
in the homestretch of plans for their big event. The marriage
would take place June 17 in Ottawa, Ontario.
My husband Clif and I were prepared as well for the longawaited celebration. Our wedding finery hung in the closet of
our home in Phoenix, Ariz. – my mother-of-the-bride outfit and
his wedding suit, in which he would walk our daughter (the
child of our middle years) down the aisle to begin a new life.
Our excitement grew as the day approached. Then on
Sunday, June 4, just 13 days before the big day, we were
stopped dead in our tracks. Clif, then a 77-year-old retired
electrical engineer, suffered a left-brain ischemic stroke while
waiting in our car for me following our church service. The
stroke robbed him of his speech and left him with an impaired
right arm and leg.
When I found my handsome
husband of 36 years, he was
seated in the driver’s seat
14 S T R O K E C O N N E C T I O N January | February 2010
rocking to and fro. When I spoke his name I got no response.
I raced back into church calling for my friend Betty, a retired
nurse. “Come quick,” I said. “I think Clif’s had a seizure!”
We ran out together, trailed within a couple of minutes by
our pastor and members of the congregation. Someone called
9-1-1, and as we waited for the ambulance we prayed and took
turns offering my wounded spouse words of encouragement.
I sat beside him in the car, speaking softly, hoping he could
understand me. I prayed the Lord’s Prayer aloud knowing it
was his favorite portion of Scripture.
I rode in the ambulance with him, and by the time we got
to a nearby hospital emergency room, I was relieved to see he
was aware and alert. Still, his right arm was flaccid and the
only sounds he made were unintelligible. However, when I
caught his eye amidst the flurry of nurses and doctors in the
ER cubicle, I read his message to me clearly. It said our lives
would change now and that, sadly, he wasn’t going to make it
to Connie’s wedding.
The next day, when the bride-to-be walked through the door
of her father’s ICU room, his spirits leapt. There were tears and
hugs and kisses, and I saw him savor the couple of days Connie
was able to stay. On the heels of Connie’s visit, Clif’s eldest
daughter Sharon flew in from Philadelphia to stay with her dad
while I represented both of us at the wedding.
The wedding was beautiful but bittersweet because Clif wasn’t
there. His brother Jim walked Connie down the aisle and spoke for his
older brother at the reception.
By the time I arrived back from Ottawa, Clif was making progress
in an acute rehab center near the hospital and his attitude was good.
Once he completed two-plus weeks we packed his few things and
headed for home. I must admit that later that day, as Clif slept, I felt
a moment of panic. “What do I do?” I asked myself. “How will I
manage? Can I handle this?” My fears passed quickly, though, and that
afternoon I took my first steps on a daunting journey.
Three years have passed since Clif’s stroke. With the help of
physical, occupational and speech therapy, plus participation in
an aphasia support group and a lively conversation group, he has
continued to make small steps forward. He still struggles to speak,
though. There are good days and bad days, but sometimes he amazes
me. A while ago, as we sat side-by-side on the love seat in our living
room, I confided the stress I felt handling our family finances – once
his job. He turned to me, put his hand over mine and said in a voice as
clear as a church bell, “I can help.” And he has in many ways.
There have been many high points for us. I savor the Easter when
Clif stood before our church congregation less than a year after his
stroke and read the central Scripture verse of the day: “He is not here,”
he said with feeling. “He has risen!” (Mark 16:6). The congregation
cheered, not only for the Easter verse, but for Clif’s effort as well. Two
years ago, we had the joy of welcoming Connie and Patrick’s newborn
daughter, Virginia, into the family.
Clif walks with a cane now, slowly because of nerve-ending pain in
his right leg. His dominant right arm has improved, and he’s learned to
write clearly with his left hand. He waters the flowers outside, fills the
bird baths and brings in the trash bin. In the spring following his stroke,
he actually washed windows and put up the screens on our one-story
house. His comprehension is good and his sense of humor intact.
Coming back from a stroke has been a difficult journey for both of
us. Frustration on both our parts has brought on some dandy shouting
matches, followed by requests for forgiveness. In the beginning it was
a tiring, painful, 24-7 experience for both of us, and the future seemed
cloudy. The clouds still roll in sometimes. But by early spring 2007,
as we began to socialize again and get out into the community, we
recognized that even though Clif might not recover totally from his
deficits, we have a life. And we intend to live it.
Clockwise from upper left: Survivor Clif Clarke
with daughter Connie and granddaughter Virginia;
Clif with devoted wife Nancy; Clif and Nancy with
Connie and her husband Patrick
STROKECONNECTION
January | February 2010
15
From Victim to Victor:
Creating a Stroke
Support Group
by Arthur Gottlieb
knew almost nothing about stroke before I had one. I had
heard the word used to describe something that injured
people when they got very old. Even my doctors, who saved
my life after my stroke, didn’t teach me much about this
cruel, mysterious and dangerous illness. My education began
the day a stroke-survivor friend took me to my first support
group meeting. Looking back, it is incomprehensible to
me how anyone can overcome the psychological and emotional
setbacks of a stroke without the help of a support group. And that
goes for caregivers as well. The forced identity change from loved
one to caregiver can be as stressful as a stroke itself.
If you are looking for information about support groups or
wish to start one, visit strokeassociation.org/successfulgroups
to download our publication, “Successful Stroke Support
Groups.” This is a comprehensive guide to stroke support. It begins
with a discussion of the need for such groups and then guides you
through the start-up process. It is sprinkled with advice from those
who have traveled the same road. As good as the guide is at providing direction, you and
your founding colleagues will likely need dedication and
devotion to sustain you through the difficult formation process.
You will also need some inner strength to carry you beyond
potential disappointments and delays. A good amount of
stubbornness will come in handy, too. In my experience, it takes
hardy individuals to successfully bring together stroke survivors and
join them with experienced, knowledgeable and capable facilitators
who can lead them on the path of recovery.
The attributes I have mentioned are frequently found in people
who work in therapy. Doctors preserve our lives with their capable
surgical hands or their knowledge of medicines. But it is the
therapists who, with their patience and knowledge, empower us
to have a shot at making that life meaningful. In my
experience, it is usually the therapists who create and
conduct stroke support groups.
I have studied at least 50 support groups in the
Southern California area. The smallest group is
composed of four couples who met by chance in a
hospital lobby. Their meetings are social get-togethers
held in their homes on a rotating basis. On occasion
they invite stroke specialists to meet with them.
By contrast, the largest groups are part of city
recreation departments, so public park facilities
are their meeting places. Their goal is to provide
an activity center for survivors. They offer
card playing, drawing, painting and craft work.
Caregivers get a chance for some needed rest while
the survivors participate.
The support group I facilitate has an interesting
history, one that I’m sure is similar to many groups
throughout the country. In my next column, I’ll
share details about how our group, still growing after
30 years, got started and what we do to serve our
membership.
Finding a Group
About the author...
If
Art Gottlieb is the author of
you are interested in joining a stroke support group, start
by calling the American Stroke Association Warmline,
1-888-4-STROKE (1-888-478-7653). The person who answers will
be able to direct you to the nearest of the approximately 1,800
groups listed in the ASA’s stroke group registry. Or you can
access the registry online at strokeassociation.org/strokegroup. 16 S T R O K E C O N N E C T I O N January | February 2010
Stroke, an Owner’s Manual.
For information about ordering,
e-mail: artstrokemanual@
aol.com. For more about Art,
visit StrokeAssociation.org/
strokeconnection.
STROKECONNECTION
January | February 2010
17
E V E RY DAY S U R V I VA L | Connecting You to Helpful Ideas
Personal
Health
Records
by Jon Caswell
or most people, keeping track of
personal health information is a
cumbersome and barely manageable
process. A typical person sees multiple
healthcare providers, undergoes multiple
tests and may even have multiple
insurers. If you’re responsible for
family members’ health information there’s even more to
keep track of. That’s why it’s a good idea to create and
maintain a personal health record — a single document
where you store all your medical and health information.
Thanks to the Internet and small digital-memory devices
like USB thumb drives, it is easy to do.
What is a PHR?
A Personal Health Record (PHR) is a history of
health information about yourself or someone you care
for that’s created and maintained in a safe and secure
electronic environment. The information contained in a
PHR is accessed only by you, your healthcare providers
or anyone else who receives your permission. By keeping
a complete, updated and easily accessible PHR, you
ensure that your healthcare providers have access to the
information they need to make educated decisions about
your and your family’s care. The better you understand
the full picture of your health, the more empowered
you will be to partner with your healthcare provider in
determining your best treatment options. Imagine all those paper records of tests, images,
diagnoses, bills, insurance statements, etc., in one place,
18 S T R O K E C O N N E C T I O N January | February 2010
digitally stored for easy access. If you move and have to
change doctors, he or she will know what your other doctors
were doing – reducing the need to repeat tests or procedures.
If there’s a flood or a fire and your paper records are lost,
your medical history is not. It’s stored in a virtual safety
deposit box, and you have the key.
Tools for getting started
If you (or a loved one) can use a mouse and a keyboard,
you can create a PHR. There are a variety of tools to help.
Here are some things to consider when choosing the tool
that’s best for you:
• Ease-of-use – choose a program that is straightforward
and allows simple updating.
• Accessibility – choose a Web-based program that
can be accessed from any computer connected to the
Internet and ideally, that you can authorize others (e.g.,
specialists) to access as needed.
• Security – select a tool that requires proper user
authentication (i.e., secure ID and password) to access
your records.
• Content – choose a program that will allow you to enter
all of your vital health information.
Before picking out a tool, check with your healthcare
provider, insurer or employer. They may provide PHRs
free of charge and even enter your health information for
you through their system, which will save you a lot of
time and effort!
There are a variety of PHRs out there. To help you figure
out what works for you, take the five-question quiz at our
Web site, americanheart.org/phr.
Choosing a PHR
There are three main types of PHRs: Web-based,
software-based and paper. The quiz at the PHR Resource
Center at americanheart.org/phr can help you determine
which is best for you. In all three categories, there are free
tools as well as tools you can purchase.
While many people prefer to create their own PHR,
in many cases these are also available through healthcare
providers, insurers, employers, commercial suppliers and
other sources. Each supplier has different policies and
practices regarding how they may use data they store
for you. Study these policies carefully to make sure you
understand how your personal health information will be
used and protected. Topics to look for include privacy and
security; the ability of the individual or those they authorize
to access their information; and control over access to your
information by others.
If a PHR includes information provided by a doctor,
it is more useful for tracking than information listed in
insurance forms. For example, while insurance claims may
list general information such as a patient’s diagnosis or
prescribed medications, they may not include key details
that are beneficial to medical decision making (for example,
a patient’s most recent blood pressure readings or specific
medication doses).
An American Stroke Association Resource: Heart360™
eart360 is the American Heart Association/American Stroke
Association’s online cardiovascular wellness center. It provides
you with the tools and resources you need to manage your
condition and overall heart health. Heart360 lets you track and monitor
key “numbers” like blood pressure, cholesterol, blood glucose, diet and
physical activity. It also shows you your recommended ranges for these
numbers and helps you set goals to achieve them.
Best of all, Heart360 is easy to use. Each time you enter health
information in Heart360, the data is stored in Microsoft® Healthvault™,
a secure and private place for storing health records. Healthvault™
also lets you enter health information automatically through devices
(such as a blood pressure monitor) that you connect to your personal
computer. For more information, visit heart360.org.
STROKECONNECTION
January | February 2010
19
L I F E at the C U R B
A Unique Perspective on Survival
by Stroke Survivor and Comedian John Kawie
Hold On, I’m Comin’
he ginkgo trees lining 9th Street were the
color of taxicabs and fire engines. The
clouds raced above the skyscrapers so
fast it looked like time-lapse photography.
In other words, it was a perfect autumn
day to run errands on the streets of Manhattan. After
being cooped up in the hospital for two months, I used
any excuse to get outside. It made me feel part of the
neighborhood again — back with my Greenwich Village
peeps — back in the groove, daddy-o. On my way to the bank a slight
breeze morphed into a miniTasmanian devil tornado. It was
like a scene from the Wizard of Oz.
My plan was to hit the ATM, drop off a DVD of A
Streetcar Named Desire (two enthusiastic thumbs up),
then meet Marilyn at our local Trader Joe’s. Estimated
time: 30 minutes.
On my way to the bank a slight breeze morphed
into a mini-Tasmanian devil tornado of leaves whirling
over a storm drain. Minutes later it was like a scene
from the Wizard of Oz. People started ducking into
stores for shelter. Ducking? I can’t even sneeze without
holding onto something. So it was decision time. Should
I persevere and continue on? Or should I go back? I
did what any self-respecting stroke survivor would do…
became very intimate with brick and mortar. I pressed
my torso up against the bank building like I was an
Egyptian hieroglyph, minus the wig, skirt, necklace and
eyeliner. I inched my way along the wall toward the
entrance on 9th and Broadway.
This particular corner is known for the wind-tunnel
effect, a phenomenon created by all the tall buildings.
Stand behind a 747 jet engine before takeoff and
you’ll get the idea. There I was, undaunted, moving
towards the epicenter of the blast. I reached the door,
but couldn’t open it because of the gusts. The security
guard pushed from the other side, grunting like he was
Learn More
About John...
bench pressing 300 lbs., grabbed my arm and dragged
me in. Whew! With the howling outside I entered my
PIN number, did my thing, then looked out the window.
Oh boy! Was that a Chihuahua that just flew by?
I stepped out the door and wondered how I was
going to make it to the other side of the street to
Blockbuster. The answer was blowin’ in the wind as it
whipped me across like a sailboat. Whoa! Right in front
of the return slot. Cool. By now I looked like a derelict. Even my curly hair,
which a nuclear holocaust couldn’t budge, was blown
straight. I hung on to the building with my unaffected
arm for dear life, like Quasimodo hanging on to the bell
at Notre Dame, with lots of moaning and groaning. I
felt helpless and feeble like Olive Oyl. “HELP. PLEASE.
HELP!” There was no Popeye. But there were New
Yorkers, and they avoided me like I was the H1N1 virus.
I was contemplating the possibility of a sleepover
on the subway grate, when before my watery eyes
appeared a rainbow version of the Hulk, offering me his
full-sleeve tattooed arm like a prom date. (Well, Bruce,
the Hulkmeister, likes to call it “body art.”) Normally
I’d peg someone like this as a lunatic and stay clear,
but under the circumstances I batted my eyelashes,
grabbed onto the fire-breathing dragon that coiled
from his forearm to his bicep, and let him lead the way.
The guy was gigantic. We plowed through five blocks
of shrieking wind with impunity. This experience made
me reevaluate the mythical
independence I thought
I still had. In Streetcar,
Blanche DuBois
drawls, “I-havealways-relied-onthe-kindness-ofstrangers.”… and
sometimes, we
have to. I was safely escorted
into the arms of my loving,
concerned wife. She smiled,
narrowed her eyes, and said,
“Where the hell have you been?”
Read John’s personal stroke story, “Life is at the Curb,” from the September/October 2003 issue
of Stroke Connection at StrokeAssociation.org/strokeconnection, or book his one-man show about
stroke recovery, “Brain Freeze,” by contacting him at [email protected].
20 S T R O K E C O N N E C T I O N January | February 2010
PLAVIX
Rx Only
(clopidogrel bisulfate) tablet, film coated
WHO IS PLAVIX FOR?
PLAVIX® (clopidogrel bisulfate) is a prescription-only medicine that
helps keep blood platelets from sticking together and forming clots.
PLAVIX is for patients who have:
• had a recent heart attack.
• had a recent stroke.
• poor circulation in their legs (Peripheral Artery Disease).
PLAVIX in combination with aspirin is for patients hospitalized with:
• heart-related chest pain (unstable angina).
• heart attack.
Doctors may refer to these conditions as ACS (Acute Coronary
Syndrome).
Clots can become dangerous when they form inside your arteries.
These clots form when blood platelets stick together, forming a
blockage within your arteries, restricting blood flow to your heart or
brain, causing a heart attack or stroke.
WHO SHOULD NOT TAKE PLAVIX?
You should NOT take PLAVIX if you:
• are allergic to clopidogrel (the active ingredient in PLAVIX).
• have a stomach ulcer.
• have another condition that causes bleeding.
• are pregnant or may become pregnant.
• are breast feeding.
• have certain genetic factors.
WHAT SHOULD I TELL MY DOCTOR BEFORE TAKING
PLAVIX?
Before taking PLAVIX, tell your doctor if you’re pregnant or are
breast feeding, if you are taking any other drugs or if you have any
of the following:
• gastrointestinal ulcer
• stomach ulcer(s)
• liver problems
• kidney problems
• a history of bleeding conditions
WHAT IMPORTANT INFORMATION SHOULD I KNOW ABOUT
PLAVIX?
Genetics: People with a specific genetic makeup may get less
protection against heart attack or stroke with PLAVIX.
Drug interactions: Some medicines, such as Prilosec, may affect
how PLAVIX works. Tell your doctor all the medications you are
taking, including prescription or over-the-counter medications. You
should tell your doctor about any other medications you are taking,
including prescription or over-the-counter Prilosec (omeprazole).
Taking Prilosec with PLAVIX may reduce the effect of PLAVIX.
Antacids and most H2 blockers, except Tagamet (cimetidine), are
not known to interfere with how PLAVIX works.
TTP: A very serious blood condition called TTP (Thrombotic
Thrombocytopenic Purpura) has been rarely reported in people
taking PLAVIX. TTP is a potentially life-threatening condition that
involves low blood platelet and red blood cell levels, and requires
urgent referral to a specialist for prompt treatment once a diagnosis
is suspected. Warning signs of TTP may include fever, unexplained
confusion or weakness (due to a low blood count, what doctors call
anemia). To make an accurate diagnosis, your doctor will need to
order blood tests. TTP has been reported rarely, sometimes in less
than 2 weeks after starting therapy.
Gastrointestinal Bleeding: There is a potential risk of gastrointestinal (stomach and intestine) bleeding when taking PLAVIX. PLAVIX
should be used with caution in patients who have lesions that may
bleed (such as ulcers), along with patients who take drugs that
cause such lesions.
Bleeding: You may bleed more easily and it may take you longer
than usual to stop bleeding when you take PLAVIX alone or in
combination with aspirin. Report any unusual bleeding to your
doctor.
Geriatrics: When taking aspirin with PLAVIX the risk of serious
bleeding increases with age in patients 65 and over.
Stroke Patients: If you have had a recent TIA (also known as a
mini-stroke) or stroke taking aspirin with PLAVIX has not been
shown to be more effective than taking PLAVIX alone, but taking
aspirin with PLAVIX has been shown to increase the risk of
bleeding compared to taking PLAVIX alone.
Surgery: Inform doctors and dentists well in advance of any surgery
that you are taking PLAVIX so they can help you decide whether
or not to discontinue your PLAVIX treatment prior to surgery.
WHAT SHOULD I KNOW ABOUT TAKING OTHER MEDICINES
WITH PLAVIX?
You should only take aspirin with PLAVIX when directed to do so
by your doctor. Certain other medicines should not be taken with
PLAVIX. Be sure to tell your doctor about all of your current
medications (prescription or over-the-counter), especially if you are
taking the following:
• aspirin
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• warfarin
• heparin
• heartburn or stomach ulcer medicines, like Prilosec
Be sure to tell your doctor if you are taking PLAVIX before starting
any new medication.
WHAT ARE THE COMMON SIDE EFFECTS OF PLAVIX?
The most common side effects of PLAVIX include gastrointestinal
events (bleeding, abdominal pain, indigestion, diarrhea, and nausea) and rash. This is not a complete list of side effects associated
with PLAVIX. Ask your doctor or pharmacist for a complete list.
HOW SHOULD I TAKE PLAVIX?
Only take PLAVIX exactly as prescribed by your doctor. Do not
change your dose or stop taking PLAVIX without talking to your
doctor first.
PLAVIX should be taken around the same time every day, and it
can be taken with or without food. If you miss a day, do not double
up on your medication. Just continue your usual dose. If you have
any questions about taking your medications, please consult your
doctor.
OVERDOSAGE
As with any prescription medicine, it is possible to overdose on
PLAVIX. If you think you may have overdosed, immediately call
your doctor or Poison Control Center, or go to the nearest
emergency room.
FOR MORE INFORMATION
For more information on PLAVIX, call 1-800-633-1610 or visit
www.PLAVIX.com. Neither of these resources, nor the information
contained here, can take the place of talking to your doctor. Only
your doctor knows the specifics of your condition and how PLAVIX
fits into your overall therapy. It is therefore important to maintain an
ongoing dialogue with your doctor concerning your condition and
your treatment.
Distributed by:
Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership
Bridgewater, NJ 08807
PLAVIX® is a registered trademark.
CLO-BSC-SA-OCT09
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StrokeAssociation.org
No one can predict
a heart attack.
But your stroke may be
your first clue.
If you’ve had a stroke, you may be facing a major risk of having another one.
But did you know you may also be at increased risk of a heart attack?
PLAVIX is the only prescription antiplatelet medicine
that helps protect against a stroke and heart attack.
Once you’ve experienced a stroke, your risk of both a
stroke and a heart attack never goes away. PLAVIX can
help reduce your risk. PLAVIX is proven to help keep clots
from forming, the leading cause of heart attacks and
strokes. So if you’ve recently had a stroke, PLAVIX can
help protect against another stroke or even a heart attack.
Talk to your doctor to find out if PLAVIX is right for you.
IMPORTANT SAFETY INFORMATION: People with
stomach ulcers or other conditions that cause bleeding
should not use PLAVIX. Taking PLAVIX alone or with
some other medicines, including aspirin, may increase
bleeding risk, so tell your doctor when planning
surgery. Certain genetic factors and some medicines,
such as Prilosec, may affect how PLAVIX works.
Tell your doctor all the medicines you take, including
aspirin, especially if you’ve had a stroke. If fever,
unexplained weakness or confusion develops, tell your
doctor promptly. These may be signs of TTP, a rare
but potentially life-threatening condition, reported
sometimes less than 2 weeks after starting PLAVIX.
Other rare but serious side effects may occur.
PLAVIX offers
protection.
PLAVIX is proven
to help keep
PLAVIX helps keep
Blood platelets
blood platelets
can stick together blood platelets from
from sticking
sticking together.
and form clots.
together and
forming clots, which helps keep your blood flowing. Clots
are the leading cause of strokes and heart attacks.
PLAVIX helps you stay protected.
You are encouraged to report negative side effects of
prescription drugs to the FDA. Visit www.fda.gov/medwatch,
or call 1-800-FDA-1088.
Talk to your doctor about PLAVIX.
For more information, visit www.plavix.com
or call 1-800-470-4097.
If you need help paying for prescription
medicines, you may be eligible for assistance.
Call 1-888-4PPA-NOW (1-888-477-2669).
Or go to www.pparx.org.
Please see important product information for PLAVIX on the previous page.
US.CLO.09.11.164 November 2009 Printed in USA 264US09AB46501 11/09 sanofi-aventis U.S. LLC
© 2009 Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership