Diana Reynolds Roome

Struck Down But Not Out

Diana Reynolds Roome
From San Jose Magazine

Few people associate stroke with active people in the middle of busy lives. But stroke has a way of stopping a career in its tracks. These stroke survivors are reclaiming theirs, but will never see life and work quite the same way again.

When Leslie Moreland returned from climbing in the Himalayas, she felt on top of the world. At 50, she had reached a 17,000 ft. summit in Nepal, backpacked in the New Mexico wilderness for ten days, and kept up her level of fitness by hiking and bicycling near her San Jose home. As co-founder and CEO of her own company consulting in career management and organizational change for high tech companies, Moreland was equally goal-oriented. “I love seeing opportunity and working out how to do things faster, easier, better,” she says.

Nor did she let trivial obstacles bother her. One morning in late ’99, she was surprised to find herself brushing her hair with the back of the brush. When she kept making mistakes on the keyboard because her right arm felt numb, she assumed this too would pass, and made a series of conference calls. Later, while doing errands, she repeatedly dropped her car keys. By now concerned, she called her doctor’s office and got an appointment for 10 o’clock the next morning. She never made it. By evening, she had an excruciating headache and went to bed early, determined to sleep it off. As she says now, “It was the worst thing I could have done.”

Moreland’s husband was out of town, so nobody noticed when she suffered a seizure during the night. When she woke up briefly, she only knew she had bitten her tongue badly and felt desperately tired. She hauled herself out of bed to get breakfast for her teenage son, only to collapse on the kitchen floor where Ryan found her unconscious. As she said later, “I had every single symptom of stroke, and didn’t even know it.”

Because a sudden severe headache, lapse of memory, dizziness, or dimness in one eye can easily be attributed to lack of sleep or stress, most people never imagine stroke could be the cause. While chest pains are taken seriously as a possible sign of heart attack (some people even carry personal defibrillators along with their cell-phones), the more ambiguous warning signs of stroke often go unrecognized.

For this reason, fewer than 5% of people in the throes of a stroke get treatment in time to benefit from the powerful clot-busting drug, tissue plasminogen activator. Stroke is reversible for 30% to 40% of patients, if tPA is administered within three hours of the onset of symptoms.

“For every patient I treat, five don’t arrive in time,” says Dr. Harmeet Sachdev, neurologist and director of the Stroke Center at Good Samaritan Hospital in San Jose. One who did was Chuck Hoffman, who attributed the black spots dancing in front of his eyes and numbness in fingers and toes to the effects of an unusually stressful morning. Driving from his Milpitas office for a lunch appointment, he got on the wrong off-ramp and bumped another car. When he stumbled out of his car, his speech was so slurred that the other driver threatened to report him for drunk driving. He called his colleague by cell-phone, who called Hoffman’s wife. She happened to work as an auxiliary at Good Samaritan Hospital and advised them to go in at once.

By the time he reached the hospital, his left side was completely paralyzed, and two burly orderlies carried him into emergency. As he slowed down, things around him were moving fast. Though he was unable to speak, tests revealed that Hoffman was suffering an ischemic stroke and was a suitable candidate for tPA. Because of his colleague’s and wife’s quick action, the drug was administered well within the necessary three-hour window.

“It was like magic,” recalls Hoffman. “Soon I was squeezing the doctor’s hand so hard he said, ‘That’s enough!’ I could push him away with my left foot and was ready to get up and go to a convention in San Francisco.”

Hoffman was kept in hospital under observation for three days, until he left for the convention “over my wife’s objections and the doctor’s.” He returned to his regular working day, and never needed therapy. “I watch my weight and what I eat, and if anything, my energy is better now,” Hoffman says.

For Moreland, recovery took much longer. Her stroke was caused by a bleed in the brain, and therefore was not treatable by tPA even if she had reached the hospital within three hours. Like ischemic stroke, caused by a blockage (usually a blood clot), effects are unpredictable and depend upon the area of brain deprived of oxygen. After two weeks in intensive care at O’Connor Hospital, Moreland started the long road to rehabilitation and recovery. Though she was able to walk and use her hands, she had lost coordination and balance.

“My limbs worked, but the commands between the brain and the body weren’t there,” she recalls. “I wanted to yell at my brain to get the message through.”

Quick recognition of names and faces, so vital in her business life, became an ordeal. Minor tongue paralysis made it hard to enunciate words clearly, but worse was the difficulty in retrieving words when she needed them. Always adept with numbers, Moreland had to completely re-learn basic math skills. Getting organized was a nightmare because she could no longer focus on a task. On top of all that, it took away every shred of confidence “Stroke is like a massive car accident,” says Moreland. “All of a sudden, you’re thrown into this new you. You don’t fit the way you fit before. The shock is tremendous because you don’t have time to get ready for the change.”

One thing that did not change was Moreland’s determination. As she improved, telling the world about stroke became a new imperative. Though she had known nothing about it before, she quickly learned that stroke can sometimes be prevented. Last year, Moreland stood up in front of 400 people at the American Heart Association’s fundraiser on women’s heart health at the Fairmont Hotel and told her story. It was a challenge she prepared for with typical efficiency, working with a speech coach until she was sure of her words, though she was far from certain she would get through it. She carried it off with flair and style, suggesting that if everyone in the audience would tell five people about the warning signs of stroke, together they could reach hundreds, even thousands of people.

With the help of her family and the Digital Clubhouse in Sunnyvale, she told her story in multi-media format, as part of a Peninsula Stroke Association project for stroke survivors. Her three-minute mini-movie is now used to introduce some of their presentations. She visits patients and their families at Stanford Hospital, to tell them about therapy, care, and transportation.

“To a certain extent, we have a responsibility to let people know about stroke,” says Moreland. “Above all, survivors need to know that though life will be different, there is life after stroke.” All this has, in a sense, been therapy for her as well. “I’ve crossed a line,” she says. “I’m feeling really optimistic.”

Hoffman too became an informal spokesman for the American Heart Association, speaking out wherever he could about warning signs and the necessity to get to hospital in good time. For Dr. Sachdev, who saved his life, he will speak at the drop of a hat. Few hospitals in the Bay Area (or the USA) offer a full-scale, specialized stroke response and Good Sam’s success rate in returning patients to acceptable, independent functioning is already considerably higher than average. But Sachdev is far from satisfied. His team of physicians, nurses, pharmacist, radiologist, and paramedics constantly strive to reduce “door to doctor” time and “door to drug” time. But however fast the stroke team works, it may not be fast enough if the patient has delayed getting treatment.

“Come straight to emergency if you suspect stroke,” says Sachdev. “Don’t even call the primary care physician. It is always better to err on the safe side, and we have proved without a doubt that it is cost-saving in the end.”

The cost of stroke, in financial and human terms, is enormous. The leading cause of disability in the USA, stroke leaves over four million people to cope with physical, emotional and often financial devastation. The aftermath varies widely, from paraplegia, loss of balance, cognitive impairments, speech loss, and personality changes. Stroke also appears to be affecting people at a younger age.

“Silicon Valley is a haven for stress related high blood pressure, a primary cause of stroke,” says Jan Tomlinson, stroke nurse specialist and clinical research coordinator for the Good Samaritan Stroke Center. In this area, incidence of stroke in people under 65 has doubled over the past few years. Yet the public is still uninformed about risks and warning signs, and even doctors sometimes fail to recognize symptoms, which are various and often confusing.

The Peninsula Stroke Association, a prevention, support and advocacy organization serving Santa Clara and San Mateo counties, would like to see at least one physician specializing in stroke in every hospital, and a stroke advocate in every emergency room. Until that happens, says Anne Jacobs, PhD, PT, “the consumer needs to be more informed and more demanding. People need to ask for treatment if they suspect stroke.”

Moreland and Hoffman have reclaimed their lives for the most part, but though the effects of their strokes are no longer obvious, they are profound. Both are determined that others should not come as close as they did to losing their lives, or the lives they had known. They want everyone to hear how they exhibited classic symptoms of stroke, failed to recognize them, and almost lost everything as a result.

“Don’t wait like I did,” says Moreland, “but call 911 immediately.”

She offers the acronym below, which she devised to help people remember the DANGER signs.

D – Unexplained Dizziness or unsteadiness
A – Absentmindedness or temporary loss of memory or mental ability
N – Numbness or unexplained weakness on one side of the body
G – Garbled speech or trouble talking
E – Eye problems like sudden dimness or loss of vision
R – Recent onset of severe headache