Claudia Cox

Tennessee expects more and younger stroke victims 

The Tennessean
Rachel Stults      
January 20, 2009
       
Claudia Cox was at her baby shower when she had her first stroke. She was 29 years old and seven months pregnant.

She had a terrible headache, and the pain was so bad she didn't want to go to the party.

Something else was wrong, too. At the grocery store, her mother-in-law had to prod her to move as Cox stood still, staring blankly at items on the shelves. At the shower, she couldn't open her presents, and others noticed her mouth was drooping.

The Antioch resident was taken by LifeFlight to Vanderbilt University Medical Center, where she spent 21 days in intensive care. They saved her life — and her baby — but Cox was left to deal with the consequences of her stroke: paralysis on her left side, a droop in her mouth and issues with balance and walking.

After years of steady and even declining episodes of stroke across the nation, a spike is expected over the next five years in the number of stroke patients and in increasingly younger stroke victims.

"Everybody says, 'You're too young to have a stroke,' " Cox said. "I never thought I would have one."

A nearly 15 percent increase is expected by 2012 in the number of stroke patients discharged from hospitals across Middle Tennessee, according to Saint Thomas Health Services, which acquired data from research firm Thomson Reuters. From 2007 to 2012, the number of stroke discharges in the state is expected to grow from 11,538 to 13,238.

The predictions are based on hospital discharge data from Davidson, Robertson, Cheatham, Dickson, Williamson, Rutherford, Wilson and Sumner counties.

Tennessee is in a swath of states referred to as the stroke belt. Factors such as the state's high rate of obesity, diabetes and hypertension, along with the aging baby boomer population, are to blame for the increasing risk of stroke, health experts say. And now, the flagging economy may also play a role, doctors say.

"You've got people who aren't going to the doctor. They may not be able to afford medications," said Dr. Michael Kaminski, stroke program director for St. Thomas Hospital and physician leader for neurosciences for Saint Thomas Health Systems. "As you don't manage these risk factors with stroke you face a higher burden of consequences."

Blockages cause strokes

Stroke is a type of cardiovascular disease that occurs as result of blockage of blood vessel supplying oxygen and nutrients to the brain. Almost every 45 seconds an American has a stroke.

"As a therapist I have seen more people in the last five years 30 years old and older with stroke," said Trent Nessler, managing director of Saint Thomas Health Services Outpatient Rehabilitation Services. "Typically, it was 50 and above, and seeing a 40-year-old patient with a stroke was unusual. And now you're seeing individuals in their 30s on a regular basis."

Officials with the Tennessee Department of Health say stroke in the state has been decreasing over the past 10 years, though it hasn't been dropping at the rate they expected; Tennessee is still 2nd highest in the nation for deaths from stroke.

Despite the slowing decline in stroke victims, Dr. Zahid Samad, health disease and stroke prevention director for the state department of health, is not anticipating the kinds of increases hospitals are expecting.

"My professional, personal opinion is the (numbers) should be going down," Samad said. "We feel the health-care providers have been quite aggressive in addressing and treating the risk factors."

Hospitals prepare

Stroke hospitals across the area are gearing up in preparation, expanding inpatient and outpatient services to help stroke victims like Claudia Cox return to normal daily functions as quickly as possible.

Saint Thomas Health Services is expanding its outpatient facility at Baptist Hospital and developing a comprehensive neurological center.

"The way you approach a stroke patient is very different from the way you approach an orthopaedic patient," Nessler said. "They have multiple issues, cognitive issues, motor issues, there may be feeding issues, there may be speech issues. With a neurological rehab team, they're working together collectively to meet the patient's goals and objectives where they're returning to normal activities."

Late last year, Skyline Medical Center expanded its neurological intensive care unit from 6 to 12 beds and inpatient rehabilitation units from 31 to 41 to meet the increased demand.

Strokes have remained steady over the past five years at the Pi Beta Phi Rehabilitation Institute at the Vanderbilt Bill Wilkerson Center, from 73 stroke patients in 2003 to 68 last year. But health experts at the center also anticipate possible expansion in services in response to more stroke patients and patients with other neurological disorders, such as Parkinson's disease.

Therapy helps recovery

Cox, who began outpatient rehabilitation services at Vanderbilt and has now moved to Baptist Hospital's comprehensive center, says working with therapists has improved her quality of life beyond what she thought possible after that frightening day in April last year.

"I'm limping right now, but I walk," she said. "My balance is good. Before, I couldn't move anything (on my wrist or arm.) I could just close my hand. But that's normal for stroke patients — they always keep it closed and tight. Now I have a little bit of movement in my wrist and my arm. I've really started seeing improvements."