StrokeAss oc iat io n .o rg
Perseverance
+ Patience
= Peace
A blueprint for recovery
Why Rush?
Understanding
the urgency of stroke
warning signs
Double
Diagnosis
Managing diabetes
and stroke
Stroke Connection is underwritten in part by Bristol-Myers
Squibb/Sanofi Pharmaceuticals Partnership, makers of Plavix.
A Stroke
of Insight
Brain anatomist and stroke
survivor Jill Bolte Taylor
shares her remarkable story
Jill Bolte Taylor with mother G.G. Taylor
JANUARY | FEBRUARY 2009
Contents
S T RO K E C O N N E C T I O N®
14
S TAF F AND CO NSULTA NT S :
Dennis Milne
Vice President
American Stroke Association
Debi McGill
Editor-in-Chief
Jon Caswell
Lead Editor
Pierce Goetz
Art Director
Lyanne Dupra
Advertising Sales
[email protected]
Stroke Connection Magazine is underwritten
in part by Bristol-Myers Squibb/Sanofi
Pharmaceuticals Partnership, makers of Plavix.
10
Cover/studio photos by Kip May
16
Stories
10 Beaming Bright after Stroke
Produced and distributed in cooperation
with Vitality Communications
a division of
Copyright 2009 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.
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
Brain anatomist Jill Bolte Taylor’s
T
stroke gave her remarkable insight
into how the two hemispheres of
our brains work together.
GET HELP!
14 Perseverance +
Patience = Peace
Survivor Kathy Spencer shares how the
right attitude added to the right action
continues to produce the right results.
Departments
16 Why Rush?
When talking about stroke, time is of
the essence. Here are the reasons why
plus a primer on TIA.
19 Diabetes & Stroke
Understanding how to handle
these co-occurring conditions
1 - 8 8 8 - 4 S T R O K E
19
2
6
8
20
Letters to the Editor Stroke Notes
Readers Room
Life at the Curb
( 1 - 8 8 8 - 4 7 8 - 7 6 5 3 )
NEUROREHABILITATION SIMPLIFIED
1 - Alon
on G, et
e a l . J Stro
Strokee and Cee rebrovas
rovascular D i s. 2002;1
;11:99-10
0 6. 2 - Alon G , et al. Ne
NeuroR
R ehabilitation. 2000 3 ;18(3):2155 -225
5 . 3 - Ring H, ett al. J Rehab M ed
ed. 2005; 37:32-33 6.
4 - Haus
usd
s d rff JM
sdorff
JM, et al. Am J Physs Med Reh
ehab. 2008;87(1
(11):4-13. 5 - H ausdorff JM, et a l . J Neurol P hys T her. 2006 Dec 30 (4):209-22.
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After surviving a stroke,
some of the toughest
challenges are the ones
you can’t see.
MAJOR RISK OF
ANOTHER
STROKE
INCREASED RISK OF A
HEART
ATTACK
If you’ve had a stroke, you may be facing a major
risk of having another. You may also be at increased
risk for having a heart attack.
PLAVIX is the only prescription antiplatelet medicine
that helps protect against both. Recovering from a
stroke can be difficult and you’ve worked hard to
make progress. If you’ve recently had a stroke, you
should know PLAVIX can help protect against another
stroke or even a heart attack. PLAVIX may be right for
you. Be sure to talk to your doctor to find out.
IMPORTANT INFORMATION: If you have a stomach
ulcer or other condition that causes bleeding, you
should not use PLAVIX. When taking PLAVIX alone or
with some other medicines including aspirin, the risk
of bleeding may increase, so tell your doctor before
planning surgery. And, always talk to your doctor
before taking aspirin or other medicines with PLAVIX,
especially if you’ve had a stroke. If you develop fever,
unexplained weakness or confusion, tell your doctor
promptly as these may be signs of a rare but
potentially life-threatening condition called TTP,
which has been reported rarely, sometimes in less
than 2 weeks after starting therapy. Other rare but
serious side effects may occur.
PLAVIX offers
protection.
PLAVIX is
proven to
help keep
Blood platelets
PLAVIX helps keep
blood platelets
can stick together blood platelets from
and form clots.
sticking together.
from sticking
together and
forming clots, which helps keep your blood flowing.
Since 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 1-888-761-9659.
Please see important product information
for PLAVIX on the following page.
US.CLO.08.09.059/September 2008
Printed in USA
264US08AB20609-09-08 sanofi-aventis U.S. LLC
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.
© 2008 Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership
Geriatrics: When taking aspirin with PLAVIX the risk of serious
bleeding increases with age in patients 65 and over.
WHO IS PLAVIX FOR?
PLAVIX 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.
WHAT SHOULD I TELL MY DOCTOR BEFORE TAKING PLAVIX?
Before taking PLAVIX, tell your doctor if you’re pregnant or are breast
feeding or 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?
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.
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, especially if you are taking the following:
• aspirin
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• warfarin
• heparin
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
New York, NY 10016
PLAVIX® is a registered trademark of sanofi-aventis.
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0
Putting your house in order
means more than cleaning it.
My sister would always leave
her house spic-and-span
whenever she went away on
a trip – ‘just in case’
something happened.
When she died, the house
was spotless, but her estate
was a mess.
We couldn’t even find her will,
to find out what her wishes were.
Estate planning is critical to your own and
your family’s future. We urge you to send
for our free brochure Planning for Women.
The American Stroke Association hopes
you will find this information helpful in
formulating ideas for your estate plan.
You can also call toll-free 888-227-5242,
visit us at americanheart.org/plannedgiving
or e-mail us at [email protected].
Please send to:
American Stroke Association
Planned Giving Department
7272 Greenville Avenue
Dallas, TX 75231-4596
c
Please send me the free booklet Planning for
Women. (QDA)
(CDA)
c
Please put me in touch with an American Stroke
Association Representative. (QDD)
(CDD)
c
I am considering a gift to the American Stroke
Association through my estate plan. (QDC)
(CDC)
c
I have already included the American Stroke
Association in my will/estate plan. (QDB)
(CDB)
Name
Address
City
State
ZIP
Phone
Birthdate
E-mail
07GPGDA
09GPABA
IAD
IADSC
SC01/09
01/07
©2008, American Heart Association
10/06 KC0080
January | February 2009 S T R O K E C O N N E C T I O N
5
S T R O K E N OT E S | Connecting You to the World
AHA’s Online
Wellness Center
Users can now monitor their
cardiovascular health online
ith the American Heart Association’s
innovative new cardiovascular wellness
center — www.heart360.org — you can
now enter your blood pressure, cholesterol
and glucose numbers, log physical
activities, record your weight, and keep a
diary of the medications you’re taking or used to take.
The entries are stored online in a secure, password-protected
system on Microsoft’s HealthVault platform to be charted,
compared and updated to help you set goals and track your progress
in reducing heart disease risk factors.
“Statistics show millions of people are turning to the Internet
for health information,” said Dr. Tim Gardner, president of the
American Heart Association and medical director of the Center for
Heart and Vascular Health at the Christiana Care Health System in
Delaware. “With Heart360, patients and their families can easily
track their risk factors and get quick access to the most credible
source of online heart and stroke information.”
Some of the unique features of the site include:
• Ability to set personal goals for readings, such as blood
pressure or weight.
• Guidance on recommended ranges for blood pressure,
cholesterol and other types of data. In some cases, a
user will receive links and additional information to
share with their doctor.
Warfarin Is
Under-used
Most high-risk patients in
study not taking blood
thinner before stroke
6
STROKECONNECTION
• Users can manage their families’ health with
several user accounts. This is ideal for parents and/
or caregivers.
• Compatibility with some home blood pressure
monitors. Look for the “Works with HealthVault”
logo. Users can upload their readings and
incorporate them into their Heart360 account or
enter information manually.
• Users will receive a message when their health
inputs are in a range that signals they should
consult with their doctor.
• Users can easily prepare reports on their data.
These reports can be printed and e-mailed.
“In the future Heart360 will expand so healthcare
providers can access a patient’s information and
communicate with patients about their progress,”
Gardner said.
Only 40 percent of ischemic stroke patients with
atrial fibrillation (AF) received the effective anti-clotting drug
warfarin before their stroke, Canadian researchers report in Stroke: Journal of
the American Heart Association.
Furthermore, three-fourths of patients who were taking warfarin weren’t
taking adequate doses to prevent a stroke. The rest were taking other less
effective medications or no medications at all for preventing blood clots and
stroke. Overall, 90 percent of ischemic stroke patients with known AF were not
taking sufficient anti-coagulants at the time of their stroke.
“Sadly, we frequently see patients admitted to a hospital with a devastating
stroke who are known to have AF, yet were either not taking warfarin or were
taking a dose that is not therapeutic. We consider these to be potentially
January | February 2009
• The stroke survivors who used the
treadmill for six months benefited
significantly more than those who used
stretching for a comparable period.
Walking and
Neuroplasticity
Treadmill therapy rewires brain,
helps survivors walk better
readmill exercise may help stroke survivors
regain their ability to walk by rewiring parts of the brain
responsible for controlling balance and motor skills to
compensate for stroke damage, researchers report in
Stroke: Journal of the American Heart Association.
In this study, patients with long-term disability after
stroke who did six months of treadmill exercise training
increased activity in certain parts of their brains by 72 percent on imaging
tests. Brain activity changes did not occur in patients who did stretching
exercises. This study provides the first evidence of increased activation in
cortical and subcortical circuitry produced by treadmill exercise training in
stroke survivors.
Researchers compared 37 patients who performed “progressive task
repetitive treadmill therapy” to 34 patients who did stretching to determine
which could improve walking among stroke survivors with chronic partial
paralysis on one side of the body. They found:
preventable strokes,” said David J. Gladstone, M.D., Ph.D.,
lead researcher of the study and a stroke neurologist at the
University of Toronto.
AF is a risk factor for stroke, because when the heart
beats irregularly, or fibrillates, blood clots can form in the
upper chambers of the heart (atria); the clots can travel to
the brain and block an artery. The blood thinner warfarin
has been available for many years and is the most effective
stroke prevention medication for AF patients, reducing
the risk of stroke by about 67 percent. Strokes caused by
AF tend to be severe, and other studies have shown that
warfarin use is also associated with reduced severity.
The researchers said their findings are “particularly
• The treadmill group increased its peak
treadmill walking velocity by 51 percent
compared to the stretching group’s 11
percent, and it increased its average
over-ground walking velocity during six
minutes by 19 percent compared to the
stretching group’s 8 percent.
• Cardiorespiratory fitness in the
treadmill group increased 18 percent
but decreased 3 percent in the
stretching group.
Researchers compared functional
magnetic resonance images (fMRI) of
participants’ brains while participants did
knee-flexing exercises that mimic walking.
The fMRIs showed increased blood
oxygenation and flow in the brainstem and
cerebellum of the survivors who had used the
treadmill but not in those who did stretching.
Researchers said the increases in
blood oxygenation and flow indicated
that the cerebellum and brainstem had
been “recruited” to replace some of the
walking functions of the cortical brain
that had been damaged by stroke. The
subcortical networks could be where the
brain rewires its circuitry and may explain
why treadmill exercise improves walking
in partially paralyzed survivors even a
decade after the stroke.
troublesome” because patients in the study were all
considered to be at high risk for stroke, were living
independently and considered “ideal” candidates for
warfarin. Drawbacks of warfarin include the inconvenience of
needing regular blood tests to monitor the medication, drug
and food interactions and potential bleeding risks.
“Unfortunately, the fear of bleeding side effects with
warfarin results in many patients not taking effective
therapy that could prevent strokes,” Gladstone said. “We
must always weigh the pros and cons of any medication
for individual patients, but for most high-risk AF patients
the benefits of taking warfarin greatly outweigh the
potential side effects.”
January | February 2009 S T R O K E C O N N E C T I O N
7
R E A D E R S R O O M | Connecting You to Others
A Process of Transformation
The Bernard family (l to r): Keith, Kyle, Sue and Ed
can hardly believe it has been seven years since
I had a massive stroke that left my left side
paralyzed. Returning home, I entered a new
world of chronic disability, a world that included
my then three-year-old son Kyle, who has an
autism-spectrum disorder. My husband Ed and
I had only been married four years, and our
home was geared toward a growing child, not
an impaired mommy. My “new normal” was long in coming,
as I had to reprioritize my world to include not only a lack of
function but also a special-needs child.
I was extremely homesick during rehab, knowing that Kyle
needed me. What I have come to learn in the past seven years is
that it was me who needed him — as a wonderful and inspiring
example of faith and trust as he grows in a world that does not
welcome him unconditionally.
The daily routines of a special-needs child are rigorous, to say
the least. The rituals necessary to keep him healthy — a full 9–10
hours of sleep, eating well and exercise — are also crucial for my
recovery and well-being.
We have streamlined our living to include patience with a
developmentally delayed child and a “gimpy” mommy. We have
all come together in our shared challenges. For instance, Keith,
my teenage son from a previous marriage, took over Kyle’s care
while I was in rehab and continues to be an extremely helpful
“third parent” whenever necessary. He is a real hero to his brother.
Ed and I celebrated 12 years of marriage this past August.
8
STROKECONNECTION
January | February 2009
Despite my lingering impairments, I have found
wonderful ways to make an impact on the universe.
Ed and I are involved with a parent advisory council
for special-needs families, and I write a bimonthly
e-newsletter for special education families in our
town. I have spoken on autism to the local Rotary
Club. I walk at a gym while Ed swims with Kyle, and
I have gotten some movement back in my arm.
My message to other survivors on my seventh
anniversary is that improvements and progress
continue long after the stroke. A positive attitude
helps tremendously. I look forward to growing older
because I see the universe through my inner eyes
and know what it is to be “differently abled.” As I
accentuate my spiritual growth, I see how this journey
was specifically selected for me. I see the quietude of
life as a sacred place where I can enjoy the love of my
family and fathom the “big questions.” I don’t miss
the “captivity of activity.”
Kyle recently attempted ice skating in a Special
Olympics program. Through that, I was welcomed
into the special world of disabled children. They are
full of joy and enthusiasm and are encouraged by
parents who tenderly handle huge challenges in caring
for these angelic children. No wonder I’m filled with
joy and hope — life is beautiful after nearly losing it.
I have been in a process of transformation. There is
never a reason to give up when every second is a step
toward a greater existence. Patience and tolerance are
tremendous gifts. Would I trade what I have now for
what I had before? I really doubt it.
Susan Bernard, Survivor
Cedar Grove, New Jersey
Now Is the Time
kay, it’s time — time to set aside the
destruction caused by a series of strokes
and to really and truly start the recovery
process. It has been four years since my
last stroke, and I consider this time a period
for rebirth and relearning — incomplete
and unfinished as yet, but a viable and
ongoing project. After all, I’m only 64.
I am most grateful to my wife Lynda, who has stood so tall
in my fight while feeling so small in life — she has been and
is a giant. And to my children also, who have been stalwart in
their love. They are
living proof that my
worthiness was not in
the monetary things
I provided, but in the
immaterial values I
imparted. I thank them
for their understanding
and encouragement.
Physically, I think
I’ve recovered pretty
well. I’m not the way
I use to be, but I don’t
think I have anything
to complain about.
Complaining is just
not my thing, anyway.
Spiritually, I am just
thankful. It is so strange
that through all of this
mess
I seem to be more
Survivor Joe Arnold
and better grounded
than ever before. Chapters and verses are gone, but the story of the
Bible has been renewed and confirmed. I am at peace.
Mentally and emotionally is something else — a daily battle
I have to keep reminding myself to fight. It would be so easy to
just give up.
But enough of that, it’s time to move on and see if I can
really get my mental/emotional sides into some semblance of
order and effort. It’s time to attempt to make a contribution
to this parade of life and once again gain some positive
consequences for being alive.
It would be nice if, somehow, I could finish something. I’ve
recovered the planning-process thinking pretty well. I can think
things through but the actual doing process is still faulty — I just
don’t seem to be able to finish. Often, I have to be reminded that I
didn’t finish. However, I am getting better and I improve each day.
These two quotes encourage me at this time:
“ Nothing is worth more than this day.”
— Johann Wolfgang von Goethe
“ It’s never too late to be what you might
have been.” — George Eliot
There, I finished. And aphasia can be overcome,
or at least worked around.
Now, will my sense of taste ever return?
Joe Arnold, Survivor
Ballwin, Missouri
Emilia and
Eric Scanlan
at their son’s
wedding
in Hawaii
Caregiver
Photo courtesy of stanwongphoto.com
Some days are good, some days are bad
Same days are happy, some days are sad
Sometimes I’ll cry, then I’ll let out a big sigh
I seek understanding from all the demanding
Sometimes they say things, unaware of the hurt it brings
Sometimes a little patience will do
To make it through the day with you
You can’t forget that I have feelings too
So you must remember I’m human like you.
They say we’re unsung heroes
Like soldiers in the field
Not knowing what the day’s challenges will yield
But a little thank you here — a little thank you there
Throw in some love — tell me you appreciate my care
A few kind words will go a mile
Especially if it’s said with a smile
Who am I you ask?
And is there a message I’m sending?
Damn right I am —
I’M A CAREGIVER and my work is never ending.
Eric Scanlan, Survivor
Los Angeles, California
January | February 2009 S T R O K E C O N N E C T I O N
9
C OV E R S TO RY
Bright
after
Stroke
Brain anatomist Jill Bolte
Taylor’s stroke gave her
remarkable insight into how
the two hemispheres of our
brains work together.
by Jon Caswell
Studio photos by Kip May
10 S T R O K E C O N N E C T I O N January | February 2009
r. Jill Bolte Taylor’s stroke made her famous. She tells the
story in My Stroke of Insight, a New York Times bestseller.
Jill may be the perfect
person to write about stroke.
Before her stroke — a bleed that
progressively obliterated her left brain hemisphere
— she was a neuroanatomist in the Laboratory
for Structural Neuroscience at Harvard University.
Using donated brains,
she investigated
how schizophrenia
affects the brain, a
subject of personal
interest because her
brother suffers from
the disease. She was
also a member of the
board of the National
Alliance on Mental
Illness. Years before
her stroke, she traveled
the country as the
“Singin’ Scientist,”
raising awareness
about post-mortem
brain donations for
scientists to study. She
taught gross anatomy
and brain anatomy to
doctoral students for
years and published
scholarly papers in her
field. Jill obviously
has the academic
credentials to talk about
stroke. And as a result
of an arteriovenous
malformation (AVM)
spilling blood into her
left brain, she has the
personal experience.
Jill’s stroke progressed over several hours after
she woke on Dec. 10, 1996. She was 37. When
she realized that she was having a stroke, the
brain scientist in her was so fascinated that she
did not dial 9-1-1. Instead of getting the help she
needed immediately, Jill observed the progressive
deterioration of her left brain with a kind of “this
“She immediately
wrapped me up
in her arms, and
I melted into the
familiarity of
her snuggle….
Somehow she
understood that I
was no longer her
Harvard doctor
daughter, but
instead I was now
her infant again.”
is so cool” enthusiasm. As that hemisphere shut
down, she lost language and the ability to localize
herself in time and space. Periodically part of her left
brain would kick in, and she would realize that her
circumstances were dire and that she needed help.
After enormous struggle over several hours, she
contacted a co-worker who called 9-1-1.
After two days in the hospital, her mother,
whom she calls G.G., came to see Jill. Within
minutes of entering Jill’s room, G.G. climbed into
bed beside her. “She immediately wrapped me up
in her arms,” Jill wrote in her book, “and I melted
into the familiarity of her snuggle…. Somehow she
understood that I was no longer her Harvard doctor
daughter, but instead I was now her infant again.”
But G.G.’s loving embrace was not all that
was needed. The AVM and a golf ball-sized clot
needed to be removed, and that required brain
surgery, including the removal of part of her skull,
a craniotomy. The idea of surgery was difficult for
Jill to accept. However, after G.G. explained that she
would have to come live with Jill to keep her safe,
she agreed to the surgery, which required her body
becoming strong enough to survive it.
Five days after her stroke, she and G.G. returned
to Jill’s apartment to begin that process. Sleep was
now Jill’s primary means of recovery. Generally she
would sleep for about six hours, then wake up for
about 20 minutes. When Jill was awake, G.G. was
there to help her to the bathroom or to eat. After a few
days, she could stay awake a little longer, and G.G.
helped Jill recover her physical and cognitive abilities.
For example, G.G., a teacher before retiring, would
ask her multiple-choice questions that required her
to work her mind before answering. Her mother also
used children’s toys, books and puzzles to help Jill
regain her cognitive abilities.
In the two weeks before Jill’s surgery, G.G.
consistently reminded Jill of her progress, and
together they celebrated every accomplishment. She
recovered most of her physical abilities, enough so
that the night before her surgery on Dec. 27, Jill and
a friend climbed a hill near Jill’s home that overlooks
Boston. There she had an epiphany: No matter what
the future held, she understood that her body was
“the life force power of trillions of healthy cells.
January | February 2009 S T R O K E C O N N E C T I O N
11
less. I needed those around me to
be encouraging. I needed to know
that I still had value. I needed to
have dreams to work toward.”
G.G. lived with Jill for about
five months after she left the
hospital, constantly challenging
her. By July, eight months after
surgery, Jill returned to work
full time, though she admits she
was not completely competent
mentally or physically. A
year after her stroke, she left
Harvard and moved back home
to Bloomington, Ind., where
she began teaching anatomy at
Indiana University. Although
she has made a complete
recovery, she said it took almost
eight years.
The fact that Jill’s stroke only
affected her left brain hemisphere
had profound implications.
She not only lost the ability to speak or do math, she lost the
sense of time and her awareness of being an individual. She
describes it as being “a fluid,” simultaneously in touch with
everything. She did not perceive physical or emotional losses
because she could not experience separation or individuality.
There are significant differences between the ways the left and
right hemispheres process information. For instance, the left
brain keeps track of time, and without it, the natural cadence
of her life slowed way down. Without the judgment of the left
brain, expressed in the language of the left brain, she perceived
herself as whole and perfect despite her physical and cognitive
limitations. “[M]y left hemisphere no longer inhibited my
innate awareness that I was the miraculous power of life.”
She describes living from
the right hemisphere as “sitting
in the lap of the universe,” a
place of extraordinary peace.
Her sharing of that sense
of connectedness is what
made her speech at the TED
conference so compelling (see
“Jill’s Recent Adventures” on
page 13). She makes it plain
that these feelings were so
seductive that there were times
she didn’t want to return to
Photos (clockwise from left):
being an individual. Instead
Jill received hundreds of
of interacting with people as
get-well cards from all over
personalities, she perceived
the country; Jill (with G.G.)
shows off the scar from her
them as “concentrated
craniotomy; Jill and G.G.
packages of energy.” She
“I view the garden in my mind as a
sacred patch of cosmic real estate that
the universe has entrusted me to tend.”
For the first time since the stroke, I felt my body was strong
enough to endure the upcoming craniotomy.”
Because of where the AVM and clot were located, there
was some fear that she might lose her ability to speak. After
surgery G.G. asked her daughter to say something. When Jill
responded, both mother and daughter cried.
As most stroke families understand, recovery is where the
real work begins. And although she worked hard with G.G.
and others after surgery, sleep still played a crucial role in her
recovery. “Let survivors sleep when they are tired. Don’t wake
them unnecessarily,” Jill said. “Sleep is vital for the brain to
make sense of what it has previously learned. It helps brain
cells reorganize information. Sleep was my godsend; without
it I would not have recovered.”
Jill said that a peaceful environment also facilitates
healing. “I found the TV and radio to be pure noise that
made it even more difficult for me to make sense of the
world. I needed my caregivers to pay attention to my
immediate environment to help minimize distractions,”
she said. “It also helps if family and friends attend rehab
sessions so they know how to work with their survivors
when they are alert and able to learn.”
As much as she valued her mother’s and other caregivers’
help, Jill understood that her recovery was up to her. “I was
the one who chose to try or not. I needed my caregivers to
be inviting, and to remember that if I could not understand
language, speaking louder didn’t help me understand, it just
scared me away from wanting to connect with you. I firmly
believe that if I had been placed in a conventional rehab center
where I was forced to stay awake and do rehab on someone
else’s schedule, I would have chosen to zone out more and try
12 S T R O K E C O N N E C T I O N January | February 2009
chose to interact with people based on whether she felt a positive or
negative energy from them.
In fact, she formed the opinion that a hospital’s No. 1
responsibility should be to protect a patient’s energy level. “Most
hospitals are on a cycle of taking vitals every hour,” Jill said. “The
medical community certainly knows that the REM (rapid eye
movement) sleep cycle of the average person runs between 90
and 115 minutes. It would be helpful to patients to shift the vitalmonitoring routine to every two hours so the patient can complete a
regular sleep cycle. In addition, the families can pay attention to the
energy level of the patient and how they respond to different visitors.
When you are really ill, you need a little positive contact from others
and absolutely no negative contact. It is important that everyone takes
responsibility for the energy they bring into a patient’s room.”
My Stroke of Insight records a remarkable story of how a brain
hemorrhage took away a brain scientist’s capacity to do science and
produced a profound new awareness of life and her connection to it.
Jill ends the book with these words:
“I view the garden in my mind as a sacred patch of cosmic real
estate that the universe has entrusted me to tend. As an independent
agent, I and I alone, in conjunction with the molecular genius of my
DNA and the environmental factors I am exposed to, will decorate
this space within my cranium…. Your body is the life force power
of some 50 trillion molecular geniuses. You and you alone choose
moment by moment who and how you want to be in the world. I
encourage you to pay attention to what is going on in your brain.
Own your power and show up for your life. Beam bright!”
>c\mh
<Gdoog`
Bj`n\GjibR\t
Jill’s Recent Adventures
The publication of My
Stroke of Insight was the
result of Jill sharing her
experience with attendees
at the Technology,
Entertainment and Design
(TED) conference in Aspen,
Colo. in February 2008. (To
view Jill’s TED speech, visit
www.TED.com and type
her name in the search window.) As a result
of that speech, she was named one of TIME
magazine’s 100 Most Influential People in the
World for 2008. Oprah Winfrey saw a recording
of the speech and scheduled Jill to appear on
her XM Radio program, which attracted the
attention of publishers. My Stroke of Insight
landed in bookstores on May 12, 2008. Jill
appeared on an Oprah show in October. The
book stayed on the New York Times bestseller
list for months. Since May it has been
translated into 20 languages and published in
23 countries, with an international promotional
tour through the fall.
ŸO\f`>\m`jatjpmn`ga
ŸN``fc`gkamjhjoc`mn
ŸH\dio\dia\^`onjatjpmjrigda`
Ÿ@skm`nn_d^pgo`hjodjin
ŸM`e`^oh\idkpg\odji
ŸM`^`dq`\nr`gg\nj`m\`^odji
Ÿ<kkg\p_tjpm^jpm\b`\n\^\m`bdq`m
ŸKmjo`^otjpmdi_dqd_p\gdot
Ÿ@sk`^oi`rnomd_`ndinpkkjmodib^\m`bdq`mn
=`^jhdib\^\m`bdq`majmnjh`ji`m`lpdm`n\
gjib(o`mh^jhhdoh`iojaodh`\i_`i`mbt)
=pok`mc\kn`q`ihjm`dhkjmo\iogt'o\fdib
^\m`jatjpmn`gardgg]`^mdod^\gojnp^^`nn)
K`mnji\gdu`_nk`^dØ^\ggtajm^\m`bdq`mn'`\^c
gdifdn^pnojh_`ndbi`_ojm`km`n`io`skm`nndjin
amjhoc`>\m`bdq`mn=dggjaMdbcon)
@q`mtkpm^c\n`rdggnpkkjmo`_p^\odji\i_
^jhhpidotkmjbm\hn)>jind_`mdo\idiq`noh`io
ditjpmjriapopm`'\nr`gg\noc`c`\goc\i_
r`gg(]`dibjatjpma\hdgt\i_amd`i_n)
Visit www.shopheart.org
or call (800) 233-1230 to order
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January | February 2009 S T R O K E C O N N E C T I O N
13
A Blueprint for Recovery
by Kathy Spencer, Survivor
Carroll, Ohio
y name is Kathy Spencer
and I had a massive ischemic
stroke on Oct. 23, 2005, at the
age of 53. One minute I was
fine and the next I couldn’t
move my entire right side, my
dominant side. One night in
the hospital, I remember lying
in bed, begging God to let me
walk again. I was working
so hard and not seeming to make much progress. Then one
Sunday, as I waited for someone to push my wheelchair to
lunch, a sermon came on TV. It was entitled “Perseverance
+ Patience = Peace.” I looked up and told God, “I get it!” I
was persevering but I wasn’t being patient! When you have
a stroke, you have to persevere and you have to be patient.
I changed my thinking that day; I kept persevering but
celebrated every step of progress!
A newborn baby’s brain has few connections but in
24 months it develops all kinds of connections — able to
walk, talk and feed itself. It made sense to me that it would
take my brain at least 24 months to reroute and make new
connections, but I had to keep working and not give up!
Rehab became my new full-time job.
I begin and end my days thanking God for all of my
blessings. One blessing is that I’m a stubborn woman! It’s
14 S T R O K E C O N N E C T I O N January | February 2009
been three years and my perseverance is still paying off so I
want to share some of the things that I found to be so helpful
along the way.
It’s crucial to keep a positive attitude and surround
yourself with positive people, listen to motivational speakers
and celebrate every success. What we say to ourselves is
important! Focus on what you can do rather than what you
can’t do. Don’t refer to your arm or leg as your “bad” arm;
rather refer to it as your “weak” or “affected” side. We are
not stroke victims, we are stroke survivors!
Don’t let people enable you. They may mean well but
when possible, try to do things yourself. (Of course, that is
with the doctor’s permission.) Set goals every day. If you
walked 12 steps today, do 15 tomorrow. It’s important to
stretch your muscles when you wake up and before you go
to bed. I did acupuncture three times a week, reflexology
once a week and massage once a month, as well as home
therapy in addition to my regular therapy three times a
week. Persevere with patience!
My toes didn’t move for four months but when they did,
I bought a jar of 75 marbles. I poured them out and picked
them up one at a time every day until my toes were working
well. To strengthen my ankle, I “wrote” the ABCs in the air
with my foot. I walked on my treadmill with a metronome
to help my gait and used a full-length mirror to check form.
Persevere with patience!
I got exercises to strengthen my “winging” shoulder. I couldn’t move
my arm at the time so my husband Carl moved it until I could do it
myself. Your arm works better when your shoulders work!
I’m a piano player. I listened to piano CDs every night and visualized
my right hand playing the melody. After seven months, one finger barely
moved, then another, until they all moved! If you aren’t a musician,
number your fingers 1 to 5, your thumb is 1 and so on. Visualize moving
them in patterns every day — for example, 1, 3, 5, 3, 1, 2, 4, 2, 4, and
so on. Persevere with patience!
Get in arm/leg clinical trials. Nine months after the stroke, I got into
an arm study at the University of Cincinnati. It was a month-long study
where I used a low-level electrical stimulation system called the Ness
H200 for three hours a day. My occupational therapist at Ohio State
University saw some improvement after one month. I knew I needed to
use the device a lot more so I rented it, then purchased one. It was the best
money I have ever spent.
It’s important to use all learning styles for our brain; so I stood in my
pantry with the device on and said out loud, “I’m opening my hand; I’m
picking up the can and setting the can down.” Our brains need repetition
in the rerouting process, but if your hand isn’t working, it’s impossible
to do repetitions. The device will do it for you until you can do it by
yourself, but it is crucial that you actively use it every day.
When my wrist started working, I got a one-and-a-half pound weight
and did wrist raises and curls until I had full strength. After using the
electrical stimulation device for seven months, I could open my hand and
pick up a juice glass,
take a drink and put it
It’s crucial to keep a
down! After 10 months,
positive attitude, surround I could push down a
piano key! I ordered
yourself with positive
finger splints to help
with the tone.
people and celebrate
I’m still working on
every success.
“fine-tuning” myself.
I have foam tubing on
my spoon and pen and
I write every day. I pick up nuts and bolts, working on precision and
speed and practice line dancing for agility. I am still making progress!
With the plasticity of the brain, we can improve until the day we die.
Everyone teaches us to adapt our lifestyle when we have a stroke,
but I’m suggesting we only adapt until we get our lives back. Nothing
comes easy. It’s a lot of hard work, every single day, but again, how
much time and money is your life worth for the rest of your life? God
made amazing brains that can reroute, and there is an amazing machine
that lets us do repetitions to help the rerouting. We have to persevere
with patience because this is the rest of our lives!
Editor’s Note: To watch a video of Kathy playing piano post-stroke, go to
youtube.com/watch?v=ns2RGb-5hOo
Photos (clockwise from far left):
Kathy enjoys a tandem tricycle ride with
husband Carl; after her stroke, Kathy
teaches her granddaughter Jenna to play
the piano; in the early days of recovery,
Kathy required support just to stand; Kathy
with grandson Aiden and father Matt; Kathy
reading to grandchildren Aiden and Zoey;
after months of hard work, Kathy gives a
thumbs-up with her affected hand.
January | February 2009 S T R O K E C O N N E C T I O N
15
Why Rush?
by Jon Caswell
ven though the American Stroke Association and
all healthcare providers emphasize that stroke is a
medical emergency, we occasionally hear concerns
like the following from one of our readers:
I question the urgency of getting to the emergency room spoken
of in most articles about stroke. In the case of my husband Jim, the
GET HELP!
emergency room showed no concern when he arrived with stroke
symptoms. He was examined, blood was taken and he was admitted to
the hospital. However, the stroke itself was not treated that evening,
nor for most of the next day! By the second day in the hospital, after
scans and blood work, he was put on medication. He spent five days
in the hospital, came home with meds and had physical therapy for
a few weeks. About a year later, he had a second slight stroke in the
middle of the night. He woke me and said his leg seemed paralyzed
again, and I could see his mouth was affected. We raced to the hospital
in a rainstorm. Once again he was tested, and it was ascertained he
had had a second stroke, but again no meds or measures were taken
in the emergency room. At the end of the second day, he was put on
additional meds, and we connected with a fine neurologist.
He has had several tiny strokes, probably not even severe enough
to be labeled TIAs. When we questioned the doctors about the
“miracle” shot that could stop a stroke from getting worse, we were
told that was almost never administered because if it is a bleeding
stroke instead of a blockage one, the drug would prove fatal. We have
never been given a definitive answer about why it is so important
to get the person to an emergency room when no treatment is given
when you get there! We are hoping you can address this.
Sincerely,
Barbara Thompson, Grateful wife of survivor Jim Thompson
Wildwood, Missouri
16 S T R O K E C O N N E C T I O N January | February 2009
First and foremost, the reason to dial 9-1-1 if a
person suspected of having a stroke is this — time
lost is brain lost!
However, given her experience at her local
hospital, it is easy to see why Mrs. Thompson
would question the urgency if the hospital is
not going to respond quickly. When it comes to
the treatment of acute stroke, all hospitals are
not created equal. That is why the American
Stroke Association has joined forces with the
Brain Attack Coalition to create the Primary
Stroke Center Certification Program, which
is implemented by The Joint Commission
(TJC). This commission evaluates stroke care
provided by hospitals. Hospitals that follow the
“Recommendations for Primary Stroke Centers”
(published by the Brain Attack Coalition and the
American Stroke Association) are certified as
primary stroke centers.
Primary stroke centers take stroke seriously and
know how to treat it. They are adept at using tPA,
the clot-busting “miracle” drug that Mrs. Thompson
asked about. It is important to remember that this
drug can only be used within three hours of the onset
of symptoms, making it extremely important to
note the time that the first signs of stroke occurred.
For this treatment to be considered, there must be
enough time to determine — through an imaging test
like a CT scan or an MRI — whether the stroke is
ischemic (caused by a clot) or hemorrhagic (caused
by a bleed). Often tPA is not administered because
patients do not get to the hospital within this crucial
three-hour treatment window. This is yet another
reason to rush to the hospital when stroke symptoms
are observed.
There is generally at least one primary stroke
center in each major metropolitan area in the
United States. It is very important for stroke
families to know where these centers are and to
get their loved one to that facility, even if it is not
the closest hospital to them. Research indicates
that patients have better outcomes when treated at
a primary stroke center even when tPA is not an
option. (For information on how to find the primary
stroke center nearest you, visit StrokeAssociation.
org/QualityCare.)
There is yet another factor for stroke families
to consider in getting treatment: Recent research
indicates that stroke patients who arrive at the
emergency room in an ambulance are twice as likely
to receive a CT scan as those who “walk” in.
And finally, when speaking to 9-1-1, say “I think
this is a stroke” even if there is only one symptom,
and even if the symptoms have gone away.
Don’t Ignore This Warning
Stroke families often ask about transient ischemic attacks
(TIAs) and what to do about them. While TIA is often
labeled “mini-stroke,” it is more accurately characterized as a
“warning stroke,” a warning you should take very seriously.
TIA is caused by a clot; the only difference between a
stroke and TIA is that with TIA the blockage is transient
(temporary). TIA symptoms occur rapidly and last a
relatively short time. Most TIAs last less than five minutes;
the average is about a minute. Unlike a stroke, when a TIA is
over, there’s no permanent injury to the brain.
The warning signs of a TIA are exactly the same as for an
ischemic stroke:
• Sudden numbness or weakness
of the face, arm or leg, especially
on one side of the body
• Sudden confusion, trouble speaking
or understanding
• Sudden trouble seeing in one or
both eyes
• Sudden trouble walking, dizziness, loss
of balance or coordination
• Sudden, severe headache with no known cause
Why do some clots dissolve while others don’t?
According to Dr. Emil Matarese, director of a primary stroke
center at St. Mary’s Medical Center in Langhorne, Pa., the
body has naturally occurring clot-busting agents. “Eventually
all clots will dissolve, but whether there is damage depends
on how long the clot is in place,” Dr. Matarese said. However,
because there is no way to predict when a clot will dissolve
on its own, time is of the essence. “Whenever you have
stroke symptoms, dial 9-1-1 immediately and get to the
emergency room so you can be evaluated. Don’t wait to see
if the symptoms go away.”
While the vast majority of strokes are not preceded by
TIA, about a third of people who experience TIA go on to
have a stroke within a year. “TIA is a warning stroke and
gives a patient time to act and keep a permanent stroke
from occurring,” Dr. Matarese said. “By recognizing TIA
symptoms and getting to the hospital, the patient can get
help in identifying why the TIA occurred and get treatment
— either through medication or surgery — that can prevent a
stroke from occurring.”
If a survivor experiences TIA after they have had a
stroke, they should go to the emergency room immediately
because something in their treatment plan has not worked.
In essence, according to Dr. Matarese, there should be
no difference in response to a TIA or a stroke. Although a
TIA resolves itself before there is damage, there is no way
to predict which clots will dissolve on their own. Stroke
— and TIA — are medical emergencies; dial 9-1-1 and tell
the operator you think it’s a stroke and note the time the
symptoms started. Remember: Time lost is brain lost.
January | February 2009 S T R O K E C O N N E C T I O N
17
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Living with type 2 diabetes can be a challenge, but managing it doesn’t
have to be. By enrolling in The Heart of Diabetes™ program, you can
access tools to help you get one step closer to setting and reaching
your treatment goals. Enroll today by visiting www.IKnowDiabetes.org
and learn how you can better manage your type 2 diabetes.
Some things can be a
challenge.
Managing your type 2 diabetes doesn’t have to be.
18 S T R O K E C O N N E C T I O N January | February 2009
Diabetes & Stroke:
Balancing Both
by Jon Caswell
erhaps you are one of
the increasing number of
Americans who have gotten the
unsettling news that you have type
2 diabetes. It would not be that unusual.
There are, after all, more than 15 million Americans with
the diagnosis, an increase of more than 60 percent since
1990. Experts estimate that another 6 million have the
disease but haven’t been diagnosed.
All diabetics face potential cardiovascular health
consequences: The harsh reality is that the leading cause of death
among people with diabetes is cardiovascular disease (CVD).
If you have had a stroke, you already have a form of CVD that
affects the blood vessels of the brain. If you’re a stroke survivor
with diabetes, you should take precautions. To understand what
diabetes means for stroke survivors, Stroke Connection talked to
Daniel Jones, M.D., a doctor of internal medicine and dean of the
School of Medicine at the University of Mississippi.
Diabetes increases the risk of recurrent stroke, which is
already high for survivors. “Diabetes also increases the risk
of other CVD as well as kidney disease,” said Dr. Jones,
immediate past president of the American Heart Association.
Of course, co-occurring diseases generally mean
co-occurring medications. Diabetics may take insulin or
drugs to affect the pancreas, while stroke survivors are often
on blood pressure and cholesterol medications as well as
medications to prevent blood clots, such as aspirin. Because
high blood pressure and high cholesterol greatly aggravate the
vascular complications of diabetes, medications that treat those
conditions are especially important.
And whenever multiple medications are used, there is a
risk for harmful drug interactions. “The one drug survivors
should be particularly careful about is warfarin,” Dr. Jones
said. “Although there is no particular risk associated with
persons who take insulin and warfarin, there is always a risk
that a particular individual with certain risk factors might
have a problem. Survivors should take all their medications
with them on every doctor visit so possible drug interactions
can be monitored.”
Diabetes can cause blindness, nerve (such as diseases
of the nerves of the legs and feet) and kidney disease, and
increases the risk of limb amputation. Preexisting CVD
exacerbates those problems. “At their core, blindness and
nerve disease are cardiovascular diseases, so survivors with
diabetes are at increased risk for both those conditions,”
Dr. Jones said.
Lifestyle changes, especially diet and exercise, are
typically part of the prescription for both stroke and
diabetes. The good news is that eating patterns that are
good for diabetes are also good for improving cholesterol
and blood pressure. However, because their ability to
exercise is often compromised, survivors need to balance
calorie intake with calories burned, Dr. Jones emphasized.
Successful lifestyle changes can also reduce the number
of drugs patients have to take. “Patients often have
unrealistic expectations of diet and weight loss, and become
discouraged at the difficulty of losing weight,” Dr. Jones
said. “It is important for survivors to take a long-term view
so they don’t suffer disappointment with the lack of results
in the short term.”
The heArT of DIAbeTeS
T
he American Heart Association created The Heart of Diabetes campaign to raise
awareness of the connection between type 2 diabetes and cardiovascular disease. The
program encourages patients living with type 2 diabetes to get regular physical activity, eat
healthy foods and work with a healthcare provider to develop a comprehensive treatment
plan. By reaching these goals, people can better manage their type 2 diabetes and reduce
or delay associated risks, including heart attack or stroke. Visit IKnowDiabetes.org to enroll.
January | February 2009 S T R O K E C O N N E C T I O N
19
L I F E at the C U R B
A Unique Perspective on Survival
by Stroke Survivor and Comedian John Kawie
happy Trails To You
‘Maybe you should try the paddleboats,’ MaryJo said.
MaryJo runs the stable and books trail rides for a popular upstate mountain resort where Marilyn
and I were escaping the New York City heat. We always end up here at some point during summer,
and every time I swear I’m going to try horseback riding. This trip I meant it, so we found ourselves
down at the barn.
We figured when she discovered I was a stroke survivor she might give me an easygoing older
horse (you know, one that would be eligible for Medicare Parts A and B) or a pony, or maybe even a
burro. But a paddleboat?
I tend to be drawn to Westerns with loner/outsider themes like the old TV show Have Gun Will
Travel, or those Sergio Leone spaghetti westerns where Clint Eastwood plays the rugged, ghostly
man with no name. Paladin or one of Clint’s characters might opt for a pack animal to replace their
trusted steed, but not a paddleboat. “Have Gun Will Paddleboat”? I don’t think so. A stubbly bearded
Clint in his poncho, chewin’ on a stogie riding a tricycle on water? Not a chance.
Still, I wanted to be challenged. Marilyn must have sensed this because she turned to me and said,
“Let’s hike up to the stone tower. It’ll be a good workout.” Although I had my doubts about dedicating
an entire afternoon to hiking up a mountain, I carefully weighed my options: mountain… paddleboat…
mountain… paddleboat. The moment of truth was at hand: Paladin or Pee Wee Herman?
So off we went to conquer a mountain.
This tower is located on the highest peak of the resort. In
order to get there you have to hike up some rugged terrain.
Well, maybe it’s more like a steep gravel path, but to me if
you can’t get there by subway it’s rugged terrain. After what
seemed like 1,000 sessions of physical therapy, we finally
reached the tower. The first words out of my mouth were,
“Ah, there’s a bench,” and I collapsed onto it.
The path we took up was called Huguenot Drive, in honor of the French Huguenots who explored
this place in the 17th century. While I tried to imagine hiking up here wearing a frilly velvet coat
and tights, Marilyn was studying the map. “Let’s go back down this way,” she exclaimed, pointing
to a trail that wound around the mountain like linguini around a fork. I asked sarcastically, “We’re
not going back the way we came, because…?” “There’s no adventure in that,” Marilyn responded,
finishing my sentence. “We’ll just follow Reservoir Trail,” she continued.
Trail? They should call it Reservoir Fire Pole, because that’s how narrow and
steep it was. Even the chipmunks avoid this route. As we cautiously descended
I happened to kick a stone and I bet it hasn’t reached the bottom yet. I had
visions of being found years from now by some archeologist on vacation:
“Fossilized Tourists Found Embedded on Side of Mountain.”
When the sun sank into the trees the lodge finally swam into focus.
It could have been a mirage due to my weakened condition, but at this
point I didn’t care. Three hundred years ago some guy named Jacque
probably took the same trail and said, “Theese* place is tres hazardous
no? Next time mon ami, the paddleboats.”
The trail wound around
the mountain like
linguini around a fork.
*NOTE: “Theese” is not a typo. It’s my version of French.
Learn More
About John...
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 2009
Geriatrics: When taking aspirin with PLAVIX the risk of serious
bleeding increases with age in patients 65 and over.
WHO IS PLAVIX FOR?
PLAVIX 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.
WHAT SHOULD I TELL MY DOCTOR BEFORE TAKING PLAVIX?
Before taking PLAVIX, tell your doctor if you’re pregnant or are breast
feeding or 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?
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.
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, especially if you are taking the following:
• aspirin
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• warfarin
• heparin
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
New York, NY 10016
PLAVIX® is a registered trademark of sanofi-aventis.
PLA-OCT07-B-Aa
After surviving a stroke,
some of the toughest
challenges are the ones
you can’t see.
INCREASED RISK OF A
MAJOR RISK OF
HEART
ATTACK
ANOTHER
STROKE
If you’ve had a stroke, you may be facing a major risk of having
another. You may also be at increased risk for having a heart attack.
PLAVIX is the only prescription antiplatelet medicine that helps
protect against both. Recovering from a stroke can be difficult
and you’ve worked hard to make progress. If you’ve recently had
a stroke, you should know PLAVIX can help protect against another
stroke or even a heart attack. PLAVIX may be right for you. Be sure
to talk to your doctor to find out.
IMPORTANT INFORMATION: If you have a stomach ulcer or other
condition that causes bleeding, you should not use PLAVIX. When
taking PLAVIX alone or with some other medicines including aspirin,
the risk of bleeding may increase, so tell your doctor before
planning surgery. And, always talk to your doctor before taking
aspirin or other medicines with PLAVIX, especially if you’ve had a
stroke. If you develop fever, unexplained weakness or confusion, tell
your doctor promptly as these may be signs of a rare but
potentially life-threatening condition called TTP, which has been
reported rarely, sometimes in less than 2 weeks after starting
therapy. Other rare but serious side effects may occur.
PLAVIX offers protection.
PLAVIX is proven to help
keep blood platelets from
sticking together and
forming clots, which helps
PLAVIX helps keep
Blood platelets
can stick together blood platelets from
keep your blood flowing.
sticking together.
and form clots.
Since 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.
Please see important product information
for PLAVIX on the previous page.
US.CLO.08.09.060/September 2008
Printed in USA
264US08AB20610-09-08 sanofi-aventis U.S. LLC
Talk to your doctor about PLAVIX.
For more information, visit www.plavix.com
or call 1-888-761-9659.
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.
© 2008 Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership
NON-PROFIT ORG.
U.S. POSTAGE PAID
PERMIT NO. 4
LONG PRAIRIE, MN
National Center
7272 Greenville Avenue
Dallas, Texas 75231-4596
StrokeAssociation.org