Your loved one is showing signs of having a stroke. You call 911 and have him taken to the hospital. He is diagnosed as having a stroke and is admitted. YOU NEED ANSWERS. This web site is dedicated to helping stroke survivors and their families understand and cope with the devastating effects of stroke.

1. WHAT IS A STROKE?
A stroke is a BRAIN ATTACK. A stroke causes damage to part of the brain. It happens when the blood supply to part of the brain is suddenly stopped. The oxygen and nutrients that keep the brain healthy are not available and that part is damaged. The body parts, which are controlled, by that part of the brain are also affected.

2. HOW DO STROKES HAPPEN?
Strokes can happen in different ways. The blood supply to the Brain is stopped suddenly when:

A. The arteries are narrow and become blocked from the inside. Arteries are like tubes that carry blood throughout the body. As we get older the arteries can become narrowed. Smoking, diabetes, high blood pressure, high cholesterol or fats can also make arteries narrow.

B. One of the arteries could burst. This could happen if there is too much pressure inside. High blood pressure can cause this. A faulty artery at birth could also be a cause. This kind of stroke may happen in younger people. When the arteries burst blood leaks out and damages that area of the brain.

C. Sometimes a blood clot forms. This happens if you have had previous problems. This clot may become loose and travel through the arteries. If it travels to the brain it may get stuck in a small artery. This would block the flow of blood and damage to that part of the brain would occur.

D. A tumour, infection or swelling in the brain. These factors may cause outside pressure on an artery and may cut off the blood supply to that area of the brain. All these conditions have the same result. The blood cannot reach a part of the brain, nutrients cannot feed the tissue and that part of the body is damaged.

3. KINDS OF STROKE
There are three kinds of strokes.

1. Thrombus---A blood clot forms in a brain artery and blocks the flow of blood.

2. Embolus---A blood clot, or other material that moves through the body and lodges in the brain artery, cutting off the supply of blood.

3. Haemorrhage---A weakness in the wall of the brain artery that may rupture resulting in bleeding into the surrounding area of the brain. Most strokes are due to blockage of the feeding artery. This blockage may be the result of local clot formation [thrombosis] or due to plugging of the artery by a blood clot, which comes from somewhere else in the body [embolism]. Sometimes the blockage can clear quickly with full recovery occurring in minutes or hours. When this occurs it is referred to as a T.I.A or TRANSIENT ISCHEMIC ATTACK. A smaller number of strokes are due to rupture of the feeding artery causing artery causing bleeding into the brain [haemorrhage].

4. IN THE HOSPITAL
You have just been taken to the hospital and have been diagnosed as having suffered a stroke. You need answers and you really don't know where to begin. As a stroke victim the hospital will try to stabilize your condition. They will try to find out what caused your stroke and will appoint a team of specialists to undergo your rehabilitation. A total assessment of your condition will be evaluated and a program will be put in place to help in your recovery process. Your rehabilitation in a rehab centre will depend on:

1. Your attitude [your desire to help yourself recover]
2. Your age and the availability of a bed in the rehab unit
3. Your family and their attitude in helping you to recover
4. Your stroke team and their assessment of you
If you are lucky enough to be given a bed in a rehab unit do not waste your time it is precious. Do your exercises and listen to your therapist. You may have only four to six weeks to learn before you go home.

5. REHABILITATION
Your family doctor is your key to information about your condition. Although a number of specialists will be involved in your recovery the STROKE TEAM will be your best source of information while in the hospital or rehab unit. The team consists of SOCIAL WORKERS, RECREATIONAL THERAPIST, NURSES, NUTRITIONIST, DOCTORS, SPEECH PATHOLOGIST, OCCUPATIONAL THERAPIST and PHYSIOTHERAPISTS. When you are ready to leave the hospital you may be assigned a HOME CARE CO-ORDINATOR. The STROKE TEAMS aim is to minimize the effects of the stroke and to maximize recovery of the stroke victim. These professionals are here to help the family understand what has taken place, what's happening now and what to expect in the future. Make use of these valuable resources if you have any questions. Write them down on paper and ask the appropriate "Team Member" for an appointment to discuss your concerns. You will find they can be most helpful and it will help you cope better with the situation by knowing the answers that are of concern to you.

6. OUTPATIENT
Depending on your condition you can either be sent home or go to a rehabilitation centre. There are many factors, which will determine this of which I will go into at a later time. If you are being sent home it is the responsibility of the family or social worker to make sure that the patient can function adequately in the environment. E.g. the stroke survivor is in a wheelchair. Can the family get the wheelchair in the house? Do they need a ramp? Can you use the wheelchair once you get it in the house? Can the patient function in the house, in the wheelchair by her self? I could go on but I think you can understand the magnitude of this problem. The social worker or occupational therapist will or should be aware of all problems concerned with sending a person home then suggest ways of correcting the problems. You as a family member should have input into all aspects of the recovery process and convey your concerns to the proper TEAM MEMBER so a solution can be arrived at before it becomes a major problem.

7. ON YOUR OWN
There will come a time when you will be discharged form the hospital system. Your stay in the hospital rehab unit or your outpatient care program will cease to exist. There are only so many beds and funding is limited so you must make good use of your time. You may qualify for home care depending on your situation but this is usually for personal care reasons and has little to do with your recovery process. Look to your community, your churches and organizations for further support. I know a lady who took speech therapy for seven years after the hospital system finished with her. The church got behind her and various ladies gave their time to help with her speech until she said "Thank you," I've had enough but it was her decision. Get involved with an organization that you can call on for information friendship and support they can be a source of great help for family members as well as the stroke survivors.

DO NOT OVER LOOK THIS VALUABLE RESOURCE

8. CHANGES IN PERSONALITY
Stroke affects personality and behaviour. There are two general reasons why personality can change after a stroke. The first is a reaction to a serious illness. Having a stroke is a very frightening experience. Like any sudden and unexpected illness it can put you face to face with death and turn your world upside down. People who were independent and capable begin to feel dependent without control of their lives. The second reason is because of the direct effect the stroke has had on the brain function. The brain directs thinking and feeling as well as movement and perception. Damage to certain parts of the brain can actually reduce emotional control and increase fearfulness or irritability. The stroke survivor may have less control over their emotions. It may be harder to adjust to change and learning. Relearning everyday things is often more difficult than expected. Stroke survivors may seem impulsive, stubborn or insensitive. They may not be aware of the effect they are having on those around them. This can be a direct cause of the damage that has occurred. These changes can be very distressing for the families of stroke survivors who are trying so hard to help.

9. INTIMATE RELATIONS
Will having intimate relations cause another stroke? The answer is no. Most stroke survivors are able to resume intimate relations after a stroke. If there is a medical reason why you cannot continue your doctor will discuss this with you.

Will a stroke effect my ability to enjoy intimate relations? Probably not. If there seems to be a problem you should talk to your doctor. There may be a medical problem that can be treated.

My partner seems to have lost interest in intimate relations. Will this change? Many people need encouragement, support and patience. People worry about health and the change in their appearance. As you recover physically and emotionally intimate relations usually resume as before.

Who can I discuss intimate relations with on the stroke team? We recommend that you talk to either your doctor or social worker. You can talk to any team member with whom you feel comfortable. The important thing is that you need to let someone know that you need to discuss intimate relations so they can help you.

10. PAIN
Will I have PAIN after my stroke?
Some people do have pain after a stroke and others do not. A part of the body that does not move normally can be painful. For example, the shoulder on the weak side is often painful. Weakness reduces movement in the arm. It hangs heavily and stretches the ligaments. This produces pain. The pain usually goes away as movement returns to your body. Increase activity in your arm reduces pain even if it does not regain normal movement. Do not let your joints get stiff or tight. The paralyzed body part must be exercised. Pain in the shoulder can get worse if your develop the "shoulder-hand syndrome". This will cause pain in the whole arm, especially in the shoulder and the hand. The hand swells and becomes cold to touch and the skin changes. Shoulder-hand syndrome can be treated and most patients fully recover. Pain can come directly from the damage to the brain. Damage to the thalamus can cause pain. The thalamus is part of the brain that sends messages about feelings to another part of the brain. Pain caused from damage to the thalamus is difficult to control. Tell your doctor about your pain especially if it gets worse.

11. SWALLOWING PROBLEMS
After a stroke you may have swallowing and feeding problems. This is called DYSPHAGIA. Dysphagia can make chewing your food, holding food in your mouth, moving food to the back of your mouth and moving food through your throat hard to do. Other signs of swallowing problems are drooling, dry mouth, feeling of food caught in the back of your throat, coughing or choking while eating and poor tongue control. Your stroke team will check out how well you are able to swallow. This is called a swallowing assessment and is usually done by a speech-language pathologist and a clinical nutritionist.

12. STROKE GROUPS
A stroke group can be one of the best investments you can make on your road to recovery and in the caregiver's quest for answers. Check and see if there is a stroke group in your area and go to one of their meetings. The caregiver can go and talk to other caregivers and find out how one could cope with a particular problem. Remember they have gone through what you are going through; will probably have the answer or give you comfort until you find your own way through the problem. I have been associated with a stroke group for 23 years and as a spouse of a stroke survivor I can tell you it was the best move my wife and I could have made and we have never looked back. It kept us in focus and gave us a program in which we could work on TOGETHER and rebuild our lives TOGETHER. Look in your community for support. You have a hard enough battle without going it alone.

13. RETURNING TO WORK
This is a difficult question to answer.
Returning to work depends on the kind of work you did and the effect of your stroke. If your stroke changes your ability to do what you did before, you have several choices:

• change the way you work
• change to a different job
• not return to work

14. YOUR SOCIAL LIFE
If you have physical changes, loss of speech or problems thinking, it may be hard to socialize the way you used to. You will be able to continue your social life with a few changes.
My disability has stopped me from doing an activity that I used to do.

• Although it may b difficult to do certain things with your disability, you may be surprised as to what you can do with special equipment or a change in approach.
• For example, if you were a golfer, you may need to use a motorized cart instead of walking. Your swing may need to be changed to a one handed swing. you may need to tie your weak hand to the golf club to help your grip.
• If you enjoyed needlepoint before, you can buy a holder that allows you to stitch with one hand.
• Activities can be enjoyed from a wheelchair. this includes hiking, sailing and fishing.
• The recreation therapist, occupational therapist, or physiotherapist will help you learn new ways to enjoy hobbies.

15. GIVING CARE AT HOME
"I am afraid that I will not be able to manage!"
Families often fell this way. Looking after a family member with a stroke causes a big change for everyone. It is important to take one day at a time.
closer to the end of rehabilitation, you will know how much help will have to be given. discuss your feelings with a member of the stroke team.

"What do I need to know?"
It depends on how independent your family member becomes. It varies in each person. You are encouraged to be at the hospital during the times that different activities such as dressing, transferring and walking are being practiced.
If there is something special a team member wishes you to learn, a meeting will be set.

When do I practice what we have been taught?
When your family member is ready, there will be visits home. They begin with short trips such as a car ride. If this goes well, the visits can be for the whole day, then the weekend. This gives you a good chance to see how things are going.
Tell the team about problems as they come up. "Who is there to help?"
It depends where you live. There may be home care services.
They provide nurses, homemakers, physiotherapists, social workers, occupational therapists and speech therapists who visit in the home. you may need some of the people at one time or another.
Friends and neighbours often offer help. Do allow them to help. It will mean a change for your family member and a rest for yourself.

"I'm so tired! Will it ever end?"
A stroke affects that person who has had it as well as those people who are close to that person. Recovering from a stroke takes a long time. You may have many demands placed on you. We will try to help you deal with problems and plan for the future.

"What about me?"
You might stop doing things that interest you. It may be that you no longer have the time. you may feel what you would like to do is not important now. You need to continue doing things you enjoy. It is important to have a healthy lifestyle. that care you are able to give to the person with a stroke partly depends on how well you care for yourself.

16. FINANCES
Who can I talk to about finances? Talk to the social worker. He/she can answer questions about pensions, sick benefits, and income.