A stroke can happen to anyone at any age. Over 100,000 young and middle aged women will suffer a stroke this year. In fact, more than 30 percent of strokes occur in women before the age of 65.

For women, a stroke can be a killer. Strokes kill twice as many women as breast cancer every year, and more women than men die from strokes. What makes this more deadly is the fact that 30% of the women in this country cannot recognize a stroke symptom and nearly 20% of women report they do not know about the risk factors.

There is good news — up to 80% of strokes are preventable. Women can improve their odds for not having a stroke by learning about the lifestyle changes and medicines that can lower their stroke risk.

Some risk factors are the same for men and women including a family history of stroke, high blood pressure, high cholesterol, smoking, diabetes, being overweight, and lack of exercise. However, there are risk factors unique to women:

• Taking birth control pills;
• Pregnancy can cause changes in the body such as increased blood pressure and stress on the heart;
• Using Hormone Replacement Therapy (HRT), a combined hormone therapy of progestin and estrogen, to relieve menopausal symptoms;
• Having a thick waist and high triglyceride (blood fat) level; post-menopausal women with a waist size larger than 35.2 inches and a triglyceride level higher than 128 milligrams per liter may have a five-fold increased risk for stroke; and
• Being a migraine headache sufferer; migraines can increase a woman's stroke risk 3-6 times.

Understand what a stroke looks like.

• Sudden numbness or weakness of face, arm, or leg – especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Stroke is treatable.
Studies have shown that women take 46 percent longer than men to get to the emergency room after stroke symptoms begin. Realize that a stroke is an emergency and the first 3 hours are the most important. Once three hours pass after the first signs of a stroke, doctors are limited in how or if they can treat a stroke.

Primary Stroke Centers Save Lives
In 2007 MIEMSS (The Maryland Institute for Emergency Medical Services Systems) designated over twenty Primary Stroke Centers in hospitals throughout the state — including both Upper Chesapeake Medical Center in Bel Air and Harford Memorial Hospital in Havre de Grace.

There is no question that the advent of Primary Stroke Centers has dramatically improved the coordination of care for people experiencing an acute stroke. Key to the success of the program is the speed with which individuals experiencing stroke symptoms can be helped. Now, MIEMSS directs all EMS personnel to follow protocol geared to the swift and efficient treatment of individuals with stroke symptoms. This protocol includes identifying persons with suspected acute stroke and transporting them to the nearest Primary Stroke Center.

“We became Primary Stroke Centers back in the fall of 2007,” says Barb Cysyk, RN, Manager of the Primary Stroke Centers at Upper Chesapeake Health. “What this designation means is that we have all of our processes, protocol, and people in place to quickly respond when an individual arrives with an acute stroke. It is modeled after trauma centers in terms of managing the care process and getting people evaluated very quickly,” Ms. Cysyk explains. “So we triage them and treat them fast. It takes coordination from several different departments, starting with the EMS team in the field. They are very important to us in terms of their ability to recognize a stroke and communicate to us that they are bringing in an individual experiencing stroke symptoms.” After that, she continues, “our stroke team jumps into action.’”

Ms. Cysyk adds that, “For a community hospital, we developed a unique role with our stroke team—that of a designated stroke facilitator. There are various team members in various positions throughout the hospital that basically volunteer one to four days a month to drop everything and respond when a potential stroke patient is coming in to the Emergency Room. The facilitators don’t provide hands-on care, but work beside the Emergency Department team. They are the time keepers and coordinators ensuring that all of the necessary steps are taken so the evaluation proceeds smoothly.”

That is critical, because time is of the essence. One of the key goals is to make sure that, when appropriate, an individual having a stroke receives tPA, a powerful clot busting agent, as soon as possible. You need to administer the medication within three hours of the stroke’s onset to improve outcomes and decrease the chance of serious bleeding. tPA can reduce the amount of disability from a stroke.

“I always say that it takes a village to be a stroke center,” Ms. Cysyk observes. “A lot of what we do is to prevent complications and get individuals back to functioning at the highest level possible,” she said.

After hospitalization for a stroke, many individuals still require rehabilitation to improve problems with physical, speech, and mental functions. Our experienced team of physical therapists, occupational therapists, and speech language pathologists are dedicated to helping individuals reach their maximum potential and improve their quality of life. The Upper Chesapeake Health stroke recovery rehabilitation program offered at Physicians Pavilion II and Harford Memorial Hospital can help individuals regain lost skills, relearn tasks, and work to be independent again. There is often great potential for recovery from a stroke, and rehabilitation can improve the individual’s recovery.

Upper Chesapeake Anticoagulation Service Aids in Preventing Strokes for At Risk Individuals
Not long ago, Veena Kamuth, PharmD, of Outpatient Pharmacy services at Upper Chesapeake Health, became concerned about a patient whose blood work had just been taken at the Upper Chesapeake Anticoagulation Service. The patient’s bleeding time was alarmingly high. The patient was taking Coumadin, a powerful anti-clotting medication used to prevent stroke.

Coumadin affects an individual’s bleeding time. So Dr. Kamuth immediately sent the patient to the Emergency Department of Upper Chesapeake Medical Center, where he was admitted for observation and given medication to reverse his bleeding levels.

Fortunately, because of his visit to the Anticoagulation Services, swift action was taken to avert a potentially life-threatening crisis. The service, which opened in January of 2005 and has offices at both Upper Chesapeake Medical Center and Harford Memorial Hospital, currently sees approximately 100 patients daily.

“At the time that we began, there were 25 similar centers in Maryland, but none in this area,” Dr. Kamuth says. “So our residents, who were on Coumadin, had to drive down to an anticoagulation program somewhere in Baltimore. And that certainly wasn’t convenient.”

Today, Harford and Cecil county residents can schedule regular appointments at the Upper Chesapeake Medical Center and Harford Memorial Hospital with pharmacists, who are trained specifically in the management of Coumadin. Indeed, the beauty of the service lies not just in its convenience and personal touch, but the quickness and agility with which the pharmacists can respond to potential problems. That is critical, because time is of the essence.

The majority of our patients have not suffered a stroke, but have cardiac conditions that put them at higher risk for experiencing a stroke. John Wunder, a 68-year-old retiree who lives in Fallston, MD, had a heart valve replacement six years ago — and he feels indebted to the service. “Before I came here, I had to go to a lab to have my blood drawn,” Mr. Wunder says.

“It was very difficult and time-consuming. And it took awhile to get the results back, which could be unsettling. The service at Upper Chesapeake Health has made my quality of life, living with Coumadin, 100% better!”
Jeanette Englesson, a 78-year-old resident of Aberdeen and retired nurse, couldn’t agree more. Both she and her husband, George—who for years owned The New Ideal Diner in Aberdeen—suffer from atrial fibrillation and attend the service regularly. And they can’t praise it enough. “We are delighted with it. Just delighted,” Mrs. Englesson stresses. “Our fear is of having a stroke or a bleeding problem. At the Anticoagulation Service, you know that they are watching out for you, and have you in a controlled situation. The pharmacists are so knowledgeable and friendly. You don’t mind going at all.”

Team Members of Upper Chesapeake Health:
AT LEFT: Venna Kamath, Pharmacist, Anticoagulation Services
and AT RIGHT: Maria Minichiello, Neuro Physical Therapist