On Tuesday, September 14, during Stroke Support Association’s regular support groups for stroke survivors and caregivers, Dr. Nancy Gibbs gave a presentation titled “Aging and Stroke.”
Dr. Gibbs, who is a retired Kaiser Geriatrician and Palliative Care physician, had a stroke herself in June of 2019.
“Stroke is a life-changing event that happens in a moment,” said Dr. Gibbs. “I was perfectly healthy– not a thing wrong with me. I was driving to Chicago with my friend, and I don’t have much recollection of that trip, because I woke up in the intensive care unit in an Oklahoma City hospital.” It turns out that Dr. Gibbs had an infection in her heart valve that was throwing clots to her brain.
Her stroke affected her vision, and for a long time she suffered from double vision and lost peripheral vision. Gradually those issues improved. Other changes and challenges included weakness on one side, plus infections. Due to her heart infection, her pre-stroke knee replacement became infected, and she had to undergo three more operations on her knee. She has also not been able to drive since her stroke.
After her stroke, Dr. Gibbs entered a nursing home, then acute rehab. “As a doctor, I spent most of my career treating patients in nursing homes, and then I myself became a patient in a nursing home.”
Dr. Gibbs, who used to play tennis and golf, was surprised that she couldn’t do the most basic aspects of those sports post-stroke. “What was in my head wasn’t translating into my body.” No matter how hard she tried, she couldn’t even chip or hit a golf ball. Part of Dr. Gibbs’ recovery, and by extension stroke recovery for every patient, is learning to accept limitations. “That’s part of the journey, too; I know that I’ll never be able to do life the way I used to. On the other hand, I can do a lot of things I couldn’t do a year ago. I focus on what I can do, rather than what I can’t.”
Stroke and Aging
Dr. Gibbs pointed out several ways that aging can affect stroke treatment and recovery:
- Aging can complicate stroke recovery because of whatever comorbidities you may have had before the stroke. It may be challenging for your medical team to determine what symptoms are stroke-related and what can be attributed to something else.
- “However,” Dr. Gibbs said, “Don’t let ageism get in the way of your rehabilitation. Don’t let someone else decide ‘Oh well, she won’t ever be able to do that.’ You never know.”
- Don’t limit yourself on things like travel. There are lots of resources and accommodations for stroke survivors these days. Dr. Gibbs’ mother, now aged 101, had a stroke years ago, but she and her husband never let it get in the way of their love for travel.
The Recovery Journey
What happens post-stroke “can be an arduous journey…it’s an ongoing journey,” said Dr. Gibbs.
Don’t give up on yourself. Recovery from stroke can happen over the course of a lifetime, not just during the first 6-12 months as so many doctors claim. Dr. Gibbs said, “Just keep working at it. Keep practicing. Slowly, slowly, you will make progress.” She continued, “You are always in rehab, because no matter what the deficit you have, there is always something you can or should be doing so it doesn’t get worse, like stretching to avoid contractures. Also, you can learn to make an adaptation that will be helpful to you in doing something a little bit better.” For instance, if your left arm has been affected by the stroke, such that you cannot use it, you can compensate by learning first just to raise that arm or use the “good arm” to help the affected arm do a task.
Fatigue after a stroke is normal. A stroke is a brain attack. The brain needs time to heal itself. Rest and sleep are important to allow the brain to heal in as many ways as it can.
- Don’t begrudge yourself a nap, unless it interferes with your nighttime sleeping. Everything takes more effort than it did before the stroke. It takes more effort even to take a shower and get dressed or go grocery shopping. “More effort means more fatigue,” said Dr. Gibbs, “so more rest is a good thing, and then you’re more likely to be able to do whatever you want to do later.”
- Be conscious if your wish to nap is to escape the reality of your stroke. Perhaps you are depressed and sleeping to escape that depression. Consult your doctor. Many new stroke patients are prescribed a temporary course of antidepressants in the beginning of recovery. Understand that your depression can be psychological and/or physiological (your brain has been damaged.)
- It may feel strange during those times when your brain tells you that it needs to go to sleep right now. Heed that direction when you can. At some point, you will get back into a predictable rhythm of naps, if needed.
- Be realistic and kind to yourself. You wouldn’t treat a loved one who had a stroke harshly because he or she didn’t bounce right back into the usual routine. Check in with yourself and listen to what your body says: “I can do this, and that, but then I have to rest.”
- “When you become frustrated in not being able to do a task well, give yourself a pass,” said Dr. Gibbs. “Say to yourself, ‘Wait a minute, let me start over.’ When we get anxious, it all gets worse, and that’s true for all of us, no matter what you’re doing. Take a deep breath and try again.”
- “Don’t take on too much. If you have fifteen things to do, choose the top five, if you can, for a while,” said Dr. Gibbs. When you give yourself permission to scale back, it can be a relief during early recovery. “Later on, you can try to do a little more each day,” said Dr. Gibbs, “but some days, you will need to gently tell yourself, ‘Nope, not today.’”
Prevention of Another Stoke:
Unfortunately, having a stroke increases your chances of having another stroke. Now is the time to tend to those risk factors that you can reduce. Dr. Gibbs suggests the following:
- Watch high cholesterol. Talk to your doctor about how to lower it and whether to take a statin.
- If you have atrial fibrillation, you may be prescribed a blood thinner.
- If you have diabetes, keep it well-controlled.
- Eat a healthy diet, and exercise as directed.
- Don’t smoke and keep within a healthy weight range.
How to Talk with Your Doctor and Medical Therapists
Regardless of whether a person has had a stroke, talking to your doctor can be daunting. “Often a patient puts his best foot forward and does not report on difficulties or symptoms,” said Dr. Gibbs. “The patient may say, ‘I’m okay, and when I get a little pain, I take a Tylenol.’ In reality, there’s a lot of pain, and the person is not doing well, and that’s what should be communicated to the doctor.”
Dr. Gibbs suggests the following:
- “Take notes to your appointment with questions that you and the caregiver want to ask,” said Dr. Gibbs. “Write it down or you’ll forget. Don’t prepare twenty-five questions, because that will overwhelm the doctor, but do write down your major concerns.” She continued, “As a doctor myself, I could not help my patient unless I knew what he or she needed. So be honest and forthright. There are no silly questions.”
- If you don’t understand what the doctor is saying, tell the doctor, “I’m sorry, but I don’t understand.” You won’t get the answers you need if you don’t ask and understand.
- “If your doctor is not listening to you, maybe it’s time to change doctors,” said Dr. Gibbs.
- In rehab (whether speech, physical, or occupational), tune in to your feelings about your treatment. “If you know it’s not right, change it,” Dr. Gibs advised.
Being the sole or primary caregiver of a stroke survivor is understandably stressful, especially in the first year. Like stroke survivors, caregivers need to learn to tune in to themselves and pay attention to their own needs. Self-care is very important and knowing when to give yourself a break–and then taking it—should be a daily commitment.
Dr. Gibbs ended her talk by highlighting neuroplasticity, the brain’s ability to rewire itself after a stroke. New neural pathways can compensate for the loss of function in another part of the brain. “Our brain is much more adaptable than previously thought. You can teach an old dog new tricks.”
Many thanks to Dr. Gibbs for her presentation.
–Betsy Hardiman, Stroke Support Association Group Administrator