By Dave Gardner
Thomas Notchick awoke in an ambulance and his return to consciousness marked the beginning of a battle to rebuild his life.
Notchick, 53, a Dunmore resident who was working as a manager in the food service industry, had spent an evening this past December in his garage. He began to feel “woozy,” presented with a drooped face and speech problems.
Family members recognized that the symptoms could be a stroke and immediately called 911. Medical examination revealed his body’s right side to be non-functional, his blood pressure was topping 245 and a brain imaging study confirmed a stroke.
A stroke is caused by an interruption of blood flow to an area of the brain. This is serious, because brain cells that are deprived of oxygen begin to die at unpredictable rates and damage depends on where the stroke occurs in the brain.
The most common type of stroke, called an ischemic, occurs when a vessel carrying blood to the brain is blocked by a blood clot. However, Notchick had suffered a hemorrhagic stroke, where a brain aneurysm or weakened blood vessel had burst, creating an internal brain bleed and a strong possibility of death.
The attending medical team had determined it was too risky to attempt a surgical closure of the bleeding vessel in Notchick’s brain and his blood pressure was medically lowered to decrease the bleeding and allow the circulatory system to heal.
After five days in Geisinger’s intensive care unit and another six days in the system’s neuro unit, Notchick’s consciousness returned during his transport to Allied Services.
“I returned to reality very slowly, but really woke up in the ambulance,” Notchick said. “I had speech loss and some loss of understanding when spoken to, plus no feeling on my right side.”
Silent stroke survival
The recovery, under the supervision of Allied, progressed quickly. Notchick had occupational and speech therapy and in a big surprise he learned that imaging studies revealed he had a silent stroke in past.
“I had to start all over again at Allied, including how to do basic hygiene and chew foods again,” Notchick said. “Each day would start at 6 a.m. and I eventually began to speak simple words. I also learned how to walk again and now do quite a bit of walking, although I use a wheelchair when I’m tired.”
A true family effort with rehabilitation also helped Notchick after his discharge. He does tire but said unlike many stroke patients, he has not suffered from depression and anxiety, although the possibility that another stroke could occur does enter his mind.
Notchick is quick to acknowledge that quality healthcare and health insurance played a key role in his treatment, along with the supportive efforts of his family. Sometimes he is a bit confused upon awakening and takes a cocktail of medication to help relieve brain pressure.
“If I had it to do over again, I would have kept my eye on my blood pressure,” Notchick said. “Now, I have it read twice a day.”
Notchick’s battle with stroke is not unique. Each year nearly 800,000 people experience a new or recurrent stroke, making the condition the fifth leading cause of death in the United States where stroke-related death occurs every four minutes.
More than two-thirds of stroke survivors will suffer from some sort of disability, making stroke the leading cause of American adult disability. Yet, up to 80 percent of strokes can be prevented
Call an ambulance!
Ramin Zand, M.D., neurology director of clinical stroke operations and northeastern regional stroke director with the Geisinger Health System, explained that the medical community’s biggest challenge with stroke involves people calling an ambulance when stroke symptoms appear. Perhaps people who don’t make the call lack the knowledge of the applicable risk factors and physical signs, or they may be weighing subsequent financial cost factors.
“Brain cell death depends on the specifics of the patient’s situation and the time they are deprived of oxygen,” Zand said.
Treatment of an ischemic stroke usually involves the use of chemicals by medical staff to dissolve the clot. Or, a catheter may be inserted through the circulatory system and the clot physically removed.
“The subsequent outcomes for this depend on age, brain side where the damage occurred, and the specifics of the patient’s situation,” Zand said.
Options with hemorrhagic stroke treatment are limited. The favored approach, as was used with Notchick, lowers the blood pressure thereby allowing the bleed to ebb and the broken blood vessel to heal.
“Once again, the situation is influenced by the size and location of the bleed,” Zand said. “In most cases we work to control and stabilize the bleeding.”
Prevention also plays a key role in stroke management, but if a stroke occurs, the brains recovery is influenced by the patient’s neuroplasticity. This involves the remaining brain cells re-routing electrical signals around the dead neurons, and greatly varies by person and whether the central command structure of the brain was damaged.
“At one time, it was thought brain cells would never regenerate, but this has been proven to be wrong,” Zand said. “Some areas do regenerate, such as involved with memory, creating additional hope for recovery.”