Publication Date: Wednesday Oct 11, 2000

Stroke warning

Dr. Peter Nelson brought some 3,000 babies safely into the world during his 18 years as an obstetrician- gynecologist at the Palo Alto Medical Foundation.

As a clinician and surgeon, as well as department chairman, he was quick to order an evaluation whenever he saw evidence of a problem for one of his patients.

He did not take care of himself quite so well. He expected to work night and day for his unpredictable clients, but even after work, he would not slow down. A friend drew a cartoon of Nelson as Mr. Fixit, with a kitchen sink, wrench, home repair book, and the electric current plugged into his ear. "Hey, this is no problem!" joked the punch line.

Unfortunately, it was. The busier Nelson became, the more he smoked--usually a pack a day. His eyes were often red and his wife, Lisbeth, worried about his health. She talked to friends and to his sister, a nurse, in an effort to come up with ways to slow him down. But Nelson was too busy to take her seriously.

Then, while driving home from a friend's party on New Year's Eve almost five years ago, Nelson clipped a retaining wall. Alcohol was not the cause-- he was on call and had been careful not to drink. He took Advil and went to bed, but was awakened by a terrible, nauseous headache and shivering. In the morning, his arm was limp. When Lisbeth suggested he go to see a doctor, Nelson categorically denied anything was wrong.

"My invincibility reigned," he now admits wryly, remembering how he brushed off his symptoms thinking they were the temporary result of exhaustion and stress. "When you're a busy practicing physician you don't act sick. You just don't have that option."

Eventually he was seen by a colleague, who said he might have suffered a transient ischemic attack (TIA), usually a warning sign of impending stroke. Even when a CAT scan suggested the 47-year-old Nelson had suffered a stroke, the neurologist sent him home, telling him to rest.

"I was really scared," recalls Lisbeth. "He was not coherent and he didn't seem able to focus. Normally he's a very good actor, and covers things up."

By the time Nelson finally reached the emergency room 24 hours after the onset of symptoms, a major blockage in his right carotid artery had caused complete paralysis of his the left side. His face drooped, his speech was slurred and he had lost partial sight in his right eye. He had suffered a severe stroke.

But because of the delay in getting treatment, he was unable to take advantage of major advances in stroke treatment that Stanford Hospital was pioneering at the time, and now uses routinely at its Stroke Center. When a blockage or bleeding occurs in the brain, the area affected is deprived of oxygenated blood and the cells quickly die. Tissue plasminogen activator (TPA), a powerful clot-buster, can now reverse the multiple paralyzing effects of an ischemic stroke like Nelson's. (The majority of strokes are caused by a loss of blood circulation in the brain and only about 15 percent by hemorrhage.) But because few people recognize the signs, less than 5 percent of people in the throes of stroke get to the hospital in time to take advantage of it.

Nelson's career as an obstetrician was over. For a long time, he couldn't drive, balance a checkbook or even be left alone, lest he wander across a red light in front of cars.

"You go from being completely competent to completely incompetent in one fell swoop. It's a devastating process," he says.

By means of constant effort, exercise and sheer determination, Nelson slowly regained his sight, movement, visual, spatial and numerical abilities. But he has lost his famed ability to multi-task, as well as skills he used to take for granted, like putting together a garden bench, automatically remembering the day's appointments, or finding his car again in a parking lot.

He now devotes much of this time to teaching and lecturing about stroke prevention. He wants everyone to know what he, like many others, did not until it was too late: that optimal recovery from stroke depends on getting to the hospital within the three-hour window after the onset of symptoms.

This not as easy as it sounds. Numbness, dizziness, sudden severe headache, lapse of memory or dimness in one eye can easily be attributed to lack of sleep, stress, or even too much time at the keyboard. Stroke signs are often confusing, and a recent American Heart Association study found that barely half the respondents could recognize even one. An earlier study by the National Stroke Association found that 91 percent of respondents did not know sudden trouble with vision can be a stroke symptom, and 85 percent were unaware that loss of balance can indicate stroke.

Though the risks of stroke increase with age (Nelson's mother suffered one at 76), stroke can happen at any age. Meanwhile, stroke is the third highest cause of death in the United States and the leading cause of disability.

The aftermath has incalculable costs, both financially and in loss of productivity and future hopes.

The good news is that stroke is now largely preventable. Much depends upon knowing and reducing risk factors and warning signs. Recognizing the onset of stroke can make all the difference to surviving it and even regaining one's previous quality of life.

After knowledge comes action. Nelson gives regular talks for the Peninsula Stroke Association (PSA), an organization that offers survivor and caregiver support groups as well as informational lectures in Santa Clara and San Mateo counties. Recently, Nelson drew a crowd of 250.

"Nobody argues with the idea that a heart attack victim goes straight to hospital," he told them. "So if you think you're having a stroke, don't wait to see your primary physician. Call 911 and go to the hospital now."

Anne Jacobs, executive director of the Peninsula Stroke Association, adds that anyone suspecting stroke should mention this to the dispatcher, as it will assure an initial evaluation from paramedics and rapid response at the hospital.

While the PSA is raising awareness of stroke's causes and effects, the American Heart Association's launch of "Operation Stroke" AIMS TO focus community attention on this long-neglected malady, while helping to institute new protocols amongst paramedics, emergency-room staff and doctors to reduce time between onset of stroke and brain-saving treatment.

"Stroke is preventable, yet very few people are receiving appropriate emergency therapy in time," said Dr. Gregory Albers, professor of neurology, director of the Stanford Stroke Center and keynote speaker for the AHA event. "People should be able to recognize the symptoms and call 911 if they think they, or somebody they're with, is having a stroke. This can make a substantial difference to the outcome." 

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