Transcription:
Caring for a Stroke Survivor

Announcer: This is Hello Healthy, a Dignity Health podcast.

Cheryl Martin: After a stroke, most people need some kind of support. It's common for a relative or friend to step in as an unpaid caregiver, doing whatever they can to help. It can be for a few hours a week, or full-time.

On this episode of Hello Healthy, a Dignity Health podcast, you'll get a glimpse of what's involved in caring for a stroke survivor. I'm Cheryl Martin. Our guests are Dr. Rahul Shah, neurocritical care physician with Dignity Health, and Veronica Rojas, a caregiver for her mother. Thanks to both of you for being on.

Dr. Rahul Shah: Thank you for having us.

Cheryl Martin: Veronica, let me begin with you. Tell us a little bit about yourself.

Veronica Rojas: Hi. My name's Veronica. I'm 22 years old. I was born and raised here in Bakersfield, California, and I take care of my mom full-time.

Cheryl Martin: Veronica, your mom's suffered a stroke. Walk us through that. When did it happen, and the signs and symptoms?

Veronica Rojas: Yeah. So last year in November, my mom suffered two strokes within a week. Some of her symptoms were it loss of appetite. She started sweating a lot. Her speech started deteriorating. When we asked her to raise both of her arms, her right arm was lower than her left.

Cheryl Martin: Dr. Shah, you were one of the doctors who cared for Luz and I understand that there are different types of strokes. What kind of stroke did Veronica's mother have?

Dr. Rahul Shah: So Luz Rojas, Veronica's mother suffered from what we call an ischemic stroke which essentially involves cholesterol blockage or a blood clot that blocks off one of the major blood vessels supplying blood and oxygen to the brain and resulting in the cells that it's supplying to die and get damaged. And that's what Luz suffered from. There's obviously different types of strokes. The ischemic strokes as I described are the commonest. But the other kinds are hemorrhagic stroke, which basically involves a blood vessel busting open because of high blood pressure or some other cause and causing damage to those brain cells as well.

Cheryl Martin: You said that hers was a common one. So on the spectrum, would this be considered a mild stroke, severe stroke? Where would you place it?

Dr. Rahul Shah: Hers was definitely what I would call a moderately severe stroke. It involved a significant area involving the left side of her brain which resulted in, as Veronica mentioned, the patient having weakness on the right side of her body, especially her arm and having some speech issues as well.

Cheryl Martin: So what's the treatment plan for a stroke such as this one?

Dr. Rahul Shah: It all depends upon time and I'm sure a lot of the stroke awareness modules always stress on identifying stroke symptoms early and bringing them to the hospital quickly. And that is because if the patient arrives to a hospital within a set amount of time and they meet criteria, they can be given what's called tPA, which is a clot-busting medication, with the hopes of dissolving the blood clot and opening up the blood vessel and restoring blood supply. Furthermore, in certain centers like Bakersfield Memorial hospital, we also have the capacity to do thrombectomy. What that means is we have a specialized surgeon who can go into the groin with a catheter all the way into the brain and pull out that blood clot to restore the blood supply. But all of this can only be done if it's within a certain amount of time and the damage is not yet complete.

Cheryl Martin: So what was Luz's course of treatment?

Dr. Rahul Shah: Unfortunately, Luz, by the time she arrived to us, the damage to certain areas of her brain was complete. So she couldn't undergo this treatment. And if I remember correctly, she also had a second stroke within a few days of having the first one itself, within the same area, which caused more damage to the left side of her brain, which was unfortunate, which is why we took care of her in ICU. And with a lot of rehabilitation and obviously help and a lot of excellent family support, she's recovering fairly well as of now.

Cheryl Martin: That's good to hear. Now, Veronica, the stroke resulted in your mother having some debilitating issues as the doctor has mentioned where she needed more extensive care. Talk about that and also your role as a caregiver.

Veronica Rojas: Yeah. So after being discharged from Memorial, she was sent to Encompass for rehabilitation. And there, they helped her start walking with the Hemi walker. So once she was sent home, my role was to always be by her side while she was walking to make sure she doesn't fall. But from the stroke, she has like no grip, no movement in her right arm at all. So, I have to do a lot. You know, I help her get dressed in the morning. I have to help her bathe. I now run errands for her. I have to cook for her. So that's what my role has been taking care of her.

Cheryl Martin: What has that been like for you? Because at age 22, I'm sure that was not on your list or you didn't imagine that you would be a caregiver.

Veronica Rojas: Yeah. It's definitely been difficult adjusting. You know, I'm doing things now that I didn't do before. Before, you know, I just had to take care of myself and now I'm taking care of two people, myself and now my mom. And I have had to learn how to cook. I didn't know how to do that before. And yeah, it's definitely, you know, emotionally challenging, mentally, physically, but also rewarding to be able to help a loved one go through that recovery.

Cheryl Martin: What has it been like for you? You mentioned emotionally rewarding when you do see progress.

Veronica Rojas: Yeah. So it's emotionally rewarding because I know my mom would much rather prefer a family member to take care of her then a stranger. You know, it's different, you take care of your family, like the quality of care is just different because, you know, it's your mom or your loved one. So it's just been nice to see her go from not being able to walk and being limited to only two words to now her giving me commands and speaking a lot more and being able to walk on her own now.

Cheryl Martin: That's great. Dr. Shah, anything else that you want to elaborate on on Luz's condition, the condition she was in and then just some of the side effects of her stroke?

Dr. Rahul Shah: No, I think, you know, I would just probably add on what Veronica said and she summarized it really well. Sometimes we think of strokes as these causes of death and we have these numbers of mortality and morbidity. But, you know, we are doing better and better with helping stroke patients survive, but I think it still is and stroke has gone down as a cause of death from number three a few years back to number five in the United States. But it is still the biggest cause of debilitation. And I think it's important to realize from Luz's story and Veronica's story that it doesn't just affect one person. It is a big stressor for society in general. And obviously, not everybody's as lucky to have family members and daughters that can put a lot of their life on hold to take care of their loved ones. I know Veronica personally, and I know she wants to actually become a doctor and she has put off applying for her medical studies for now, for a year, just so that she can focus on taking care of her mother. And that is more than commendable. And I think, you know, the most important thing is the patients do need constant therapy. Even after they survive a stroke, that's where the important and difficult parts increase. A lot of physical therapy, a lot of occupational therapy and not just visiting the clinic for an hour, but what they do for the rest of the day, where you have a caregiver working on you, exercising and doing those things so that you can regain the strength and speech and everything. I think those are important factors.

Cheryl Martin: So rehabilitation is key in stroke recovery then?

Dr. Rahul Shah: Absolutely. That probably is the most important statement I could make. You know, as a physician in the ICU, I am responsible for keeping patients alive, hopefully getting them better. But I think the most important part of their recovery starts after they leave the hospital where the physical therapy, the occupational therapy, the speech therapy, the social support, the emotional support, those determine if a patient is going to get to a certain significant level of independence in a few months versus be completely dependent for the rest of their life. And Luz's example is a great example of how with good medical care in the hospital, but then more importantly, great care afterwards can result in significant improvement for a lot of the patients.

Cheryl Martin: Dr. Shah, you mentioned emotional support and clearly, Veronica, you have given your mother that and so much more. What are other things that you want the public to know about stroke awareness and specifically about being a caregiver?

Veronica Rojas: Yeah. So I would just, you know, urge the public to be familiar with the signs of a stroke and to not hesitate to act when you feel like something is wrong and this just ensures that your loved one or anyone, you know, gets the care that they need and to get it fast because time is important. And also about being a caregiver, I just know there's anyone out there who's also going through the same thing, it's difficult. And sometimes you want to help your loved one as much as you can, but sometimes you forget to also set some time apart for yourself and make sure you're okay. So yeah, I would just, you know, urge the public to be aware of the signs of stroke, and also to make sure they take care of themselves if they're taking on that caregiver role.

Cheryl Martin: Dr. Shah, would you briefly outline what are the signs of a stroke?

Dr. Rahul Shah: Absolutely. This is where the acronym that I believe a lot of us might have heard of, FAST, comes into picture. F stands for face. So if you notice somebody with a drooping of their face or just the face looking unequal. A stands for arm. Essentially, like Veronica mentioned, if one arm seems weaker or one leg seems weaker or one side of the body seems as if it's drooping or not lifting okay. S stands for speech. If somebody that you know or see is having slurred speech or not being able to bring the right words out or not being able to speak. And then the last most important one is T which stands for time. Act fast, call 911. Like I said, we have amazing treatments now available to sometimes even reverse stroke completely, but only if a patient makes it to the hospital in time and obviously if they meet certain criteria. Not everybody meets every criteria. But if they do, there is potential for us to do a lot more and decrease the amount of damage and eventually the amount of debilitation that the patient may suffer.

Cheryl Martin: Thank you so much. Now, Dr. Shah, the timeline of course is going to differ for each stroke patient. What advice do you give caregivers light of that?

Dr. Rahul Shah: Absolutely. And that's something very important to understand. I think with the brain, we often don't talk about hours or days. We talk about weeks to months and even longer with recovery. And each patient is different. And it also depends a lot on, A, the size of their stroke, the area of the brain affected and also how healthy or fit the patient was beforehand. And so patience is key for caregivers and for patients as well. I know it's easier said than done, but the brain takes its own time to recover. And sometimes the best thing we can do is just support it in every way we can and give it it's time to heal and not try to rush the process. And I know it's not easy to see your loved one go through some of those things or not be independent. But if with the right care and if their stroke is not very big or very devastating, patients can recover to a very good level of independence a lot of the times.

Cheryl Martin: Veronica, you mentioned the importance of self-care. What do you do for your own self-care and your advice for others who are caregivers?

Veronica Rojas: Yeah. So what I do is I try to find things to do outside of the house when I do have free time. So some of the things I'm doing is volunteering or, you know, shadowing Dr. Shah. But if it's not those two things, either I go hang out with a friend or, you know, just someone to talk to that's outside of the house, just because, you know, I take care of my mom most of my time. So, you do need some time to get out and kind of interact with other people and just have a good support system for yourself as well.

Cheryl Martin: Dr. Shah mentioned that you plan to be a physician as well. As a result of you caring for your mother, has this given you a greater incentive to be a doctor?

Veronica Rojas: I would say it has. I definitely have learned. I would say that this has made me want to pursue medicine a lot more.

Cheryl Martin: And Dr. Shah, any other advice that you may have for caregivers?

Dr. Rahul Shah: I think, as I mentioned earlier, just patience to focus on their health. I always mention to family members when they're in the ICU in the hospital, that their job, I think, starts once the patient is out of the hospital. But also the fact that, like Veronica mentioned, you can't take care of somebody if you don't take care of yourself first, And I think that's very important to preserve your own wellbeing. But it is also extremely gratifying when you can see that slow, but steady recovery in your loved one from basically bedridden to a point of where they can walk and that first step they take and the first meal that they can eat and stuff. I think it's very gratifying. And just to be patient with it, I think, is the most important thing and to just stick with the therapy.

Cheryl Martin: Anything else either one of you would like to add before we close?

Dr. Rahul Shah: Since we were talking about strokes, I would offer the most important thing I would mention is that strokes can be prevented. So as family members, you know, hopefully before you have to take on the role of a caregiver, if people can focus on trying to avoid strokes from happening by taking better care of themselves, by working on their hypertension, their cholesterol levels, their diabetes, stopping smoking, or any sort of drug abuse. I think if we can prevent strokes from happening, then we don't have to probably discuss the whole aspect of taking care of stroke survivors in the first place. So I think maybe if anything else, I think that would probably be the most important message to try and avoid strokes in the first place by taking better care of our health.

Cheryl Martin: Very well said. Dr. Rahul Shah, neurocritical care physician with Dignity Health. Thanks so much for sharing your expertise on this important topic. And Veronica Rojas, we so appreciate you telling a part of your journey as a caregiver to your mother, a stroke survivor. To learn more, visit dignityhealth.org/bakersfield/neuro.

And if you found this podcast helpful, please share it on your social channels. Be sure to check out the podcast library for other topics of interest to you. And thanks for listening to this episode of hello Healthy, a Dignity Health podcast.