One Resident’s Fight Following An Ischemic Stroke: Learning To Live Again After A ‘Brain Attack’

By Kendra Bobowick

Doctor Louise McCullough’s medical background conjured a frighteningly clear picture when she learned her father Andrew had suffered a stroke in 2002. Luckily, she was nearby her parents’ house in Sandy Hook when her mother called to tell her the news.

“It’s a fluke I was [in Connecticut], and I drove immediately to the emergency room, took one look at him and said, ‘Oh man.’” At that time Dr McCullough lived in Maryland, but happened to be in Connecticut that day.

When she looked at her father, Dr McCullough said, “I knew immediately that it had been a massive stroke.” About one third of his brain had died with the attack, she said.

Strokes, or brain attacks, occur when blood flow to a region of the brain is obstructed and may result in death of brain tissue, according to medical descriptions found at NeurologyChannel.com. Strokes are medical emergencies that require immediate medical attention. Warning signs of stroke include the following: Sudden numbness or weakness, especially on one side of the body, sudden confusion, sudden vision problems in one or both eyes, sudden difficulty walking, dizziness, loss of balance or coordination, sudden, severe headache with no known cause, sudden difficulty speaking or understanding speech.

Dr McCullough’s mother, Wendy McCullough, who is her husband’s primary caretaker, offers advise based on her experience.

To those who may have a stroke in the family, she said, see an attorney and handle a living will and discuss power of attorney, save receipts and documents, do as the doctors say.

“If you go through this, save every piece of paper,” she said. “Make sure you get into a good rehab, make sure you make use of any counseling, either emotional or financial, to make sure you can cope.”

Of the two types of strokes, ischemic stroke is caused by blockage in an artery that supplies blood to the brain, resulting in a deficiency in blood flow (ischemia). Hemorrhagic stroke is caused by the bleeding of ruptured blood vessels (hemorrhage) in the brain.

Dr McCullough’s father, Andrew McCullough, a renowned physicist, was 63 in 2002 when his ischemic stroke occurred. During ischemic stroke, diminished blood flow initiates a series of events that may result in additional, delayed damage to brain cells. Early medical intervention can halt this process and reduce the risk for irreversible complications.

Her father’s stroke partly influenced his daughter’s career decisions. Dr McCullough refocused on working in Connecticut rather than Maryland where she was at Johns Hopkins University. She is currently the assistant professor of neurology and neuroscience at the University of Connecticut and director of stroke education for the university’s Health Center and Hartford Hospital Stroke Center. The experience she had with her father also partly fuels her interest in improving stroke victims’ care. She describes a sense of helplessness when looking back on Mr McCullough’s debilitating stroke four years ago saying, “About one hour into his symptoms, they had nothing to offer him. If the stroke happened now they would have more to offer.”

Everyone is feeling the strain of her father’s situation, she explained.

“They’re frustrated and so am I and everyone else with the lack of progress in stroke rehabilitation.”

Coming from a medical background, Dr McCullough said that watching the limited treatments available to her father “was extremely frustrating for me.”

Diagnosing For Treatment

Depending on whether the stroke is a result of a clot or hemoridge, the wrong treatment could be fatal. Blood thinners or clot breakers can “cause a bleed,” said Dr McCullough.

Specialized facilities, such as Johns Hopkins, “had more up their sleeve,” she explained. Certain treatments must be administered within three hours in order to be effective, she said. Dr McCullough also said that, unfortunately, the time of a stroke’s onset cannot always be pinpointed.

Several instances can create a problem determining the time an attack occurred. A stroke may take place during the night and “[The victim] may wake up with difficulties,” she said. Or, a stroke occurs and, “no one sees them,” until sometime later.

In her father’s case, Mr and Ms McCullough were both home when his stroke happened.

Dr McCullough said, “He went to bed at 10 pm and mom was downstairs and heard a thump.” She believes that must have been when her father stood up, and then fell, she said. “He developed a severe stroke at the onset with complete right side paralysis and inability to speak.”

She is intent on steadily improving the treatment and help available to stroke patients, and has published writing on the subject in publications including, Journal of Cerebral Blood Flow & Metabolism, the Journal of Neuroscience, and particular articles including, “Gender and Stroke, Why Your Sex Makes A Difference,” where she warns that people should essentially drop any misconceptions that stroke is more of a man’s than a woman’s affliction. In this article she indicates that stroke and mortality have increased in women over the past three decades. She also said that heart disease and stroke take more women’s lives than the next five leading causes of death combined — cancer, chronic respiratory diseases, diabetes, Alzheimer’s, and unintentional injuries.

Regardless of gender, Dr McCullough describes the risk factors that can contribute to stroke. She also explains the difference between factors than can be helped, and those that are “nonmodifiable.”

 “The biggest risk factor for stroke is age,” she said. Genetics and race, which also can factor into stroke risk, are also nonmodifiable, Dr McCullough explained.

However, “you can eat healthy, maintain a healthy weight, and exercise,” she said. “Obviously, diet is important. We have a huge proportion of obese Americans and sedentary living.”

She explained, “The more sedentary, the more obese, the more obese, the more you’re inclined to have hypertension.”

Aside from age, Dr McCullough said that several of the other high risk factors are hypertension, high blood pressure, and high cholesterol.

“In fact, if you treat hypertension, you can prevent a lot of strokes,” she said.

Smoking is also high on her list of risk factors.

She advised that people with diabetes, “need to start treatment at prehypertension stages.”

Lifestyle also counts in the stroke equation.

“Lifestyle and diet are really big factors,” she said.

Already advising people to eat healthy, she also indicates that exercise is favorable.

“Exercise regularly, even just for 20 minutes four times a week,” she said. Dr McCullough indicates that the physical activity should be something “vigorous, like a brisk walk, something to get your pulse up.”

Sounding The Alarm

Often, people do not have the symptoms including numbness and weakness on one side of the body, loss of vision in one eye or double vision, trouble speaking or swallowing, she said. Dizziness and trouble walking are also on the list.

Passing attacks or mild attacks may not register an alarm in a victim, explained Dr McCullough.

“You see so many people with transient attacks that go away,” she said. Essentially, there may be a blockage and the body breaks it up, she said.

People may also talk about symptoms without realizing there may be a severe problem.

She said, “They may say, ‘I slept on my arm funny,’ if their arm is numb.”

Unfortunately, the numbness could be a symptom leading to a big stroke, so “pay attention,” she said.

While a person with symptoms may decide to call the doctor, this is not what she advises.

“People who call their primary care physician do worse,” she said. Too much time is wasted on waiting for a call back from the doctor’s office, she explained. She stressed that those experiencing symptoms or witnessing someone else who is suffering should call 911, she said.

Also, “Go to the hospital by ambulance,” she said. “You have more attention, there is no time in the waiting room…”

To learn more about the signs, Dr McCullough said the American Heart Association’s website, Americanheart.org, is a “great” reference.

This site offers Stroke Warning Signs per the American Stroke Association

Immediately call 911 or the emergency medical services (EMS) number so an ambulance (ideally with advanced life support) can be dispatched. The site advises, “Also, check the time so you’ll know when the first symptoms appeared. It’s very important to take immediate action. If given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.

Living With Change

Life changed immediately, permanently, and dramatically for both her parents, Dr McCullough said. “It has been a tough haul, especially for my mom taking care of him; it’s part of the reason I came back to Connecticut.”

Dr McCullough’s parents are “trying to make the best they can of a bad situation,” she said. On the day the stroke took place, she said her mother remembers the moment vividly.

“She told me she kept saying ‘get up,’ ‘get up,’ but he couldn’t say anything.” Since that time Mr and Ms McCullough’s day-to-day life has become a continual schedule of doctors appointments and therapy. Ms McCullough’s attention is devoted to doing everything for her husband, she said.

Sympathizing, Dr McCullough said, “As a family member of a victim, it’s extremely hard.”

She sympathizes with both parents’ struggles and readjustments. Referring to her mother, she said, “The caregiver stress is huge. She does almost all of his care. He can’t drive or be left alone.”

Her father’s stroke has left him with aphasia — a disorder that impairs the expression and understanding of language as well as reading and writing. From her observation, Dr McCullough said, “It’s horrible. You can’t write, you can’t understand written words and can’t read.”

Wendy McCullough has chosen to be her husband’s full-time caregiver. She explains, “Your life completely revolves around the disabled person.”

Although options are available, such as live-in or part-time help, or transfer to a nursing home, she wants to be with her husband, she explained. Ms McCullough is aware, however, that not all spouses, whether the victim is the husband or wife, are able to care for their partner.

She said, “It does change your life and a lot of times people can’t deal with that. A lot of victims wind up alone in nursing homes.” She pictures her husband, and then herself in this situation. “Some people can’t cope and have to put their spouses into long-term care.”

She looks at life now and explains, “We have had a devastating stroke. What happens is, it takes over everything.”

Not every person copes as well as she and her husband have done so far, she said.

“Let’s put it this way, people resent the loss of freedom and you just have to say to yourself, ‘That’s the way the cookie crumbles,’ but many people are not like that, they’re bitter.”

Considering the situation in reverse, she said, “If it happened to me I would not want to be stuck in a home with my brain intact but not able to speak.”

She mentions a flip side to caregivers’ consequent bitterness, Ms McCullough said, “A lot of the patients are bitter.” Her husband is not like that, she said. Frustration can lead to the bitterness she has described, or turn to pity.

“You can start feeling sorry, but that’s not good either; you can’t think like that,” she said. She has often explained how she is getting along. “If you have the right frame of mind and a good family, you’re fine.” She also understands her family’s feelings that they want to do more, although they are not able to, she said.

Considering that her daughters live away from home with their own careers and their own families, she said, “Technically, they can’t. They’re not right down the street.”

Everyday Frustrations, Complications

Every incident of everyday life is altered, from the continued friendship and companionship between a husband and wife to the now-complicated matter of ordering lunch in a restaurant.

“His mind is perfectly fine, but he can’t speak,” Ms McCullough said. “Sometimes they have little pictures on the menus and then he can just point,” she said.

His vision is also limited following his stroke, which creates a problem with the table settings.

“He can see a fork on the left side of the table just fine, but not if it’s on the right,” Ms McCullough said.

Emotionally, both she and her husband have their battles to face. She explained, “The biggest emotion is the fact that [stroke] takes such a toll on the mind — to be reduced really to relying on someone else.

“No matter how much they love you…” she said, expressing doubts without finishing her thought.

Jumping to a more comfortable explanation, Ms McCullough said, “I compare my life now to how I used to take the kids to soccer, here or there, and you don’t expect that in retirement age to again be mom’s taxi.”

Most upsetting for her is the communication gap the stroke wedged between her and her husband.

“The awful thing about a stroke is you’ve lost your memories — you can’t talk about them anymore,” she said. “You lose your capability to share memories.”

Also, when Mr McCullough wants to make remarks about something on the news, for example, “he can’t discuss them anymore.” Their case is an extreme, she stressed, and the impacts of a stroke have to do with its severity.

Dr McCullough said her father, a previously active and vibrant man and former physicist, is also in a difficult situation, she said. “He’s stuck too,” she said. “He can’t produce speech; it’s extremely frustrating for him trying to talk.”

He can’t get the words across to Dr McCullough’s children. “He can say the kids’ names, but they ask him questions and he can’t answer.”

Isolated by his condition, she said her father becomes upset.

“He’ll bang his hands on the counter and wheel away,” she said.