Most people associate turning 60 with reaping the rewards of a lifetime of work in exchange for retirement, traveling the world and basking in the light of their first grandchild. All that can change in the blink of an eye, according to Dr. Jay Selman of Northern Westchester Hospital’s new stroke designation center.
In this country, every 45 seconds, someone suffers from a stroke, but the primary line of treatment, as Dr. Selman and Northern Westchester sees it, should take place outside the walls of a hospital. With chest pains, people are aware and ready to make a trip to the emergency room as an indication of a possible heart attack. “We hope we can have the same effect when it comes to the symptoms of a stroke,” said Dr. Selman.
Signs like numbness, loss of balance and coordination, slurred speech or partial paralysis on one side could mean a stroke. And recognizing them in time might mean the difference between a normal life and a semi ambulatory life.
Call 911 and get to the hospital by either ambulance or car (depending on whether the EMTs determine that it’s safe for home transport). Dr. Selman also recommends some sort of medic alert system for seniors living alone, but the concept behind the new center begins in the community well before the onset of symptoms. The main operating principal is to stay connected to the community by providing information through primary care physicians and talks given to local groups on the subject.
All advice begins with stopping smoking and that’s immediately followed by keeping up a consistent stream of exercise. Nothing complicated, he says, “take a walk with your spouse.” Couple these lifestyle changes with a proper diet, and “we would have an incredible impact in this country on heart disease and stroke,” he said.
This comes as a result of keeping cholesterol and blood pressure levels under control. In turn, the good news is there can be significant results in the form of medication where lifestyle changes and family history falls short. Of course, with any medication comes the risk of side effects, and it’s up to the general practitioner to help weigh the cost/benefit to each patient.
Unfortunately, when the second phase of the center’s initiative has been reached by a community member, the treatment has been removed from their hands. EMTs are the first responders from the hospital. Dr. Robert Marcus heads an E/R department that trains EMTs to be aware of the symptoms and give the highest priority to their transport.
Upon arrival, a rapid assessment must be performed to determine if a stroke has occurred, and if a patient would benefit from a drug called tPA. The first criteria for this medication is if it is given within three hours of the onset of symptoms.
The next key component is lab work. Cat Scans and computer tomography will allow Neurologists like Dr. Selman to determine whether the administration of tPA will do more harm than good.
The results can be dramatic, but criteria such as the prior health of the patient and the severity of the stroke still make the end result uncertain. Although having easy access to that information at their homes or offices within a minute or two does help to facilitate matters and potentially improve the chances.
Made possible by the hospital’s IT technology, he said, “It’s really a center without walls,” as patients then move through Neurology, ICU and aftercare Occupational Therapy. Still, all this is not just an intramural event.
Northern Westchester Hospital is part of the Cornell/Columbia Stroke Network, which allows 25 hospitals in the tri-state area to pool knowledge with each other. “That puts us on the cutting edge,” said Dr. Selman, but he again regressed to what’s at stake on this issue.
First, in terms of societal impact, he said, you’re potentially taking a 62 year old adult who is contributing through employment and productivity to becoming a heavy consumer of services. In addition, a stroke can also move other family members from the work force into the role of caregiver, which also is a drain on society.
On an individual level for families, “It can be devastating,” he said, as a loved one loses sight, speech or mobility. For the future, he remains, “cautiously optimistic,” and hopes the community can get there together with the hospital and make a difference when it comes to stroke awareness and prevention.
Rich Monetti interview of Dr. Jay Selman