Stroke clinic offers health, hope to patients

Ken Kellar

A stroke can be one of the most frightening experiences in a lifetime.

The condition can be sudden and fatal, and even if a patient survives there can be severe neurological damage, as the brain suffers from an impact to blood supply during a stroke.

For those in Fort Frances and the area who have survived a stroke, there are programs in place to help those who are living with the aftermath.

Marilyn Erwin is a registered nurse and the community coordinator with the Stroke Prevention Clinic at La Verendrye General Hospital. She oversees the clinic and two programs that are offered to those who are dealing with the aftermath of a stroke, as well as those who care for them.

“Originally, these clinics opened for secondary stroke prevention, so you often hear them called that still,” Erwin said.

“Anyone who had had a stroke or a TIA, which stands for a Transient Ischemic Attack, we would know that this person has risk factors and they could easily go on to have another stroke. But now we also include people who are just at risk and thankfully, at this point, have not had a stroke.”

According to the Heart and Stroke Foundation of Canada, a stroke occurs either when the supply of blood to the brain is blocked in the vessels causing to cell death, which is known as an ischemic stroke, or when vessels in the brain rupture, increasing pressure on and damaging the brain, which is called a hemorrhagic stroke. A TIA occurs when blood to the brain is temporarily blocked, similar to an ischemic stroke, but the symptoms are not permanent and usually disappear after an hour. TIA’s are usually considered warning signs of risk of a more serious stroke.

Erwin said the clinic works in a preventative capacity, looking to help patients and those at risk manage different factors that could contribute to a stroke.

“What we do is we screen the risk factors which each individual has, and we show them where they are at in that. Then we ask them, ‘Now which would you like to tackle first?'” Erwin explained.

“As we go through each risk factor, they can tell me themselves whether they think they’re in a very bad place, like ‘I really got to do something’ or ‘I think I’ve met all standards I do to be safe.'”

Some risk factors, such as blood pressure or blood sugar levels, are hard data, numbers that can be plotted and followed over time, leaving very little room for interpretation. Other risk factors are far more open to reflection by the patient.

“Very often we’ll ask them, ‘What’s your opinion on where you are with your diet?’ and that kind of thing,” Erwin said.

“So they can actually look and just think about themselves and judge and then see where they should be.”

The clinic also allows for closer monitoring of things like a patient’s blood pressure, as Erwin can potentially meet with a stroke patient more frequently than their doctor.

“I usually give patients a blood pressure sheet and they track their blood pressure for two weeks,” Erwin said.

“I can photocopy it, write a letter to their doctor and make him aware of what’s happening so that then he can actually phone them and say, ‘You know what? I think we should change some of your medicines.'”

The clinic also provides two programs that help those in the aftermath of a stroke, “Moving On from Stroke (MOST)” and “Living With Stroke.”

“MOST goes over a period of three months,” Erwin explained.

“It’s a long course, you meet twice a week for two hours, and it has an exercise factor to it,”

Before patients begin the MOST program, they undergo an assessment by a physiotherapist, who communicates with a team in Thunder Bay, where the program is run, in order to personalize the exercise component to the particular needs of the stroke patient.

“The first hour is discussion based,” Erwin said.

“There’s a great emphasis on goals, each week they hold them all accountable, [and ask them] ‘How far did you get,’ ‘What held you back,’ and that kind of a thing, and then the last hour is exercise.”

Erwin said that the exercise portion of the MOST program includes chair, balance and Theraband workouts and culminates with a 20-minute walk around the hospital.

The other program offered through the stroke clinic is “Living With Stroke.”

“The ‘Living With Stroke’ program is a six week program, once a year, completely local people,” Erwin said.

“They call it community reintegration, rather than rehab. It’s after your rehabilitation is complete, and then there are eight modules that we do over a period of six weeks.”

The Living With Stroke program teaches participants about life after having a stroke, and different aspects of coping with changes and preventing future occurrences. However, Erwin noted that the program isn’t strictly medical.

“They talk about emotions, activities and relationships, how friendships have changed,” she said.

“People reacting to them or they can’t keep up with people that they used to hang out with and that kind of thing. It’s very much a grieving thing.”

The social support aspect of the program is evident at the monthly lunch meeting that was born from a group of people who were nearing the end of the six-week program.

“They were saying, ‘We don’t want to stop meeting, we really think this is great,'” Erwin explained.

“So then I said ‘well if you’d like to meet once a month,’ and they said, ‘what about if we have a little lunch or something and then we can chitchat?'”

Erwin said that at first she tried to provide the group with information and content during the lunches, but eventually the group told her that they were more than happy to simply meet and chat.

“It was very obvious that they just really enjoyed the companionship and knowing that somebody else gets it when they’re talking about something about their stroke,” she said.

“So that’s what it fell into, it was really a bunch of friends who knew where each other were coming from with their stroke. Sometimes they share experiences that have occurred since the last month and sometimes we just have non-stop laughter, you know, because we’ll be talking about something.”

To see the group together is to not see stroke patients. At the lunch last Thursday, those in attendance shared food and conversation. A casual observer could be forgiven for thinking they had walked into a room of employees and volunteers on lunch break. But each person in attendance had either suffered a stroke, or supported someone who had. Each person also had to learn to deal with the stroke in very different ways.

“I’ve had several people who could not recognize numbers,” Erwin said.

“One gentleman told me he can no longer recognize money. He said, ‘If you show me a quarter or a dime or a toonie, I couldn’t tell you which one’s worth more.’ It’s almost as if every day he’s presented with money from a foreign country.”

The brain is a complex biological machine, and a stroke can affect different parts of it in different ways. People who experience a stroke often have difficulties with their long or short-term memory.

Another common side effect of stroke is called aphasia, a disorder that impairs an individual’s ability to process language, according to the National Aphasia Association. They may be able to read words, but spoken language sounds like gibberish to them, or vice versa. There are several different types and levels of severity of aphasia.

“It’s a very cruel illness,” Erwin said.

“Because one day or one hour ago, you could have been perfectly fit, driving a truck, and the next thing you know, you’re in a wheelchair.”

One thing that Erwin stressed, however, is that stroke does not make a person less intelligent. She compared the brain to a filing cabinet that has been meticulously organized and alphabetized, where the collection of items in the cabinet can be collectively called ‘intelligence.’ A stroke, she said, is like an earthquake that hits the room the filing cabinet is in.

“[The filing cabinet] tipped over, everything fell out and then someone who had no idea how to read or write came and shut everything in the wrong place,” she explained.

“It’s all still in there. Can you find that and talk to somebody? No.”

“I hate the word, but I’ve heard people say, ‘Oh, I’m stupid.'” Erwin continued.

“I said, ‘You’re not. You’re the same but you just cannot access that information.'”

The stroke prevention clinic and the programs it offers are a boon to those people in the community who have suddenly found their lives impacted in a significant way by a serious medical condition. The clinic itself helps those who have had a stroke, or who are at high risk, to manage their health to prevent a possible stroke in the future.

The programs “Moving On from Stroke” and “Living with Stroke,” while also focusing on the health of patients, offer an additional healing opportunity by helping those in attendance re-establish important social connections and see, through the actions of others, that life can still be lived.

“We try to help them see it as every big event in life changes you,” Erwin said.

“If you get married, huge change. If you have children, huge change. But most of those events are planned for and you look forward to.”

“Stroke is a very negative change,” she continued.

“However, you can have a positive life after it and it’s by learning how to adapt, like this, and finding people who are going to help you through those more difficult times.”

Anyone looking to speak with Erwin about the clinic or programs it offers is encouraged to call 274-3261 ext. 4542.