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Stroke victim Steve Mallroy with wife Melissa (left) and daughter Traci.

Stroke Stories
Attitude is All
By Mary Lou Baker

Annapolis resident Heidi Menocal was in bed in an Aspen, Colorado, hospital, recovering from a ski accident, when she suddenly experienced double vision, vertigo, a severe headache, and a loss of sensation on her left side. She "celebrated" her 32nd birthday later, in the hospital, being treated for the brainstem stroke that sent her first to Anne Arundel Medical Center, then to Johns Hopkins Hospital, then to Sinai Hospital in Baltimore for 10 days of rehabilitation.

Since that life-transforming day in 1996, Menocal has worked to regain normalcy through outpatient speech therapy at the former Center for Neuro Rehabilitation in Eastport and with a behavioral optometrist to treat her double vision. "He wanted to give me glasses with very thick prisms," she recalls. "I was too vain, so sought out another solution with weekly sessions of Feldenkrais Functional Integration (FI) in Baltimore." Often categorized as somatic education, FI works with a patient's nervous system to teach it new ways to use the body more efficiently.

Menocal credits much her recovery to her poststroke therapy and she has become a guild-certified Feldenkrais practitioner to help fellow stroke victims. She gives individual and group classes at the Healing and Wellness Center in West Annapolis. She still experiences balance problems on uneven surfaces and stairs. "I did not realize how many houses don't have railings for their front steps," she says. "I am stuck until someone can help me up or down." Once an avid sailor and skier, she is now restricted to passenger status and regrets she can no longer get out on the slopes to snowboard with her teenaged son.

Like many stroke victims, Menocal experienced episodes of depression despite the "tremendous support" of her family and friends, who delivered meals to the house and arranged car pools and babysitting for her then 6-year-old son. The former ballet dancer and teacher for the Ballet Theatre of Maryland has learned to live with the changes in her once-graceful movements. "I notice them but don't let them bother me," she says. Asked for any words of wisdom on the subject of coping with a stroke, she quotes her 96-year-old grandmother: "Life is what you make it."

At age 31, Menocal did not fit the average profile for stroke victims. (The risk of stroke increases with age, with most occurring in people over 65.) Neither did Steve Mallory, a hard-charging aerospace engineer for Martin Marietta who had a major brainstem stroke at 36. His was more severe, robbing him of the use of his legs and arms as well as causing speech problems. Despite these crippling physical handicaps, Mallory used his spiritual and emotional strengths to establish StrokeNet, an international online stroke support "community" whose messages are available in eight languages.

StrokeNet is a registered nonprofit organization offering free services to adult stroke survivors and their families. "We also have health professionals, physical therapists, and students as members-all of them specifically interested in helping members of the stroke community," says Mallory. Based in Abington, Maryland, the Web site has several private chat rooms as well as dozens of forums related to topics affecting the stroke survivor or caregiver. "I am a strong believer that using the computer heals the brain by using and exercising it," he says. "I want to help other stroke survivors get their online life started and show them there is life after having a stroke."

Mallory's wife, Melissa, a graphic artist, designed the attractive site that enables visitors to share stories and communicate with each other at any time of the day or night. "We encourage members to share photos and exchange personal experiences they've had with stroke-it is comforting to both the stroke survivor and the stroke caregiver-caretaker to know they're not alone." Steve says Melissa's job description as his stroke caregiver includes "dentist, nurse, speech and physical therapist, rehab coach, cheerleader, computer technician, and handyman."

Being the caregiver for a stroke victim can be a challenge, as my former babysitter has recently discovered. Now in her 40s, she moved back from Virginia to her childhood home in Annapolis to care for her 75-year-old father and 74-year-old mother, both of whom had strokes, within a week of each other. Her dad was still practicing law when he had the first in a series of transient ischemic attacks (TIAs or "ministrokes") caused by a blood clot that blocks a blood vessel or artery and causes temporary loss of oxygen to the brain. TIAs, which account for about 80 percent of strokes, can cause short-term loss of consciousness and produce symptoms ranging from slurred speech to imbalance and forgetfulness.

Heidi Menocal, a former ballet dancer and teacher for the Ballet Theatre of Maryland. (Photo by Greg Barber)

While her dad was able to return to his home, her mother's stroke was so severe she required hospitalization and eventually a move to a rehabilitation center. With two children, ages 10 and 14, the caregiver is burdened with responsibilities that threaten to overwhelm her. While one of her brothers is a source of moral and financial support, she bears the brunt of ferrying her dad to therapy sessions, running the household, carpooling the kids, and making daily visits to her mother. It's been 10 months since she assumed the caregiver role, with no end in sight. She walks her dog, attends prayer meetings, and lives "one day at a time." She has also begun taking aspirin daily-a measure she hopes will prevent her from following in her parents' footsteps.

Among the most difficult things for stroke victims to accept are their dependence on others and (in some cases) their inability to verbally communicate. Annapolis resident Gloria Pierzga's husband Joe had been in and out of the hospital with pancreatic cancer when he had the first in a series of "ministrokes" at the age of 73. Pierzga says that while the cancer had more serious implications, the strokes left him not only immobile but also unable to speak. He died 2 years ago, just after their 54th anniversary. "He was so frustrated-his brain said one thing and his body another," she says. Pierzga, approaching 80, is evangelistic about the importance of exercise. "You have to keep moving-you can't sit still."

Sharon D. Sauls, 35, the CEO and founder of SKY Neurologic Rehabilitation Center on Admiral Cochrane Drive in Annapolis, helps stroke victims keep moving-and more. Her 4-year-old health care business offers therapy for people suffering from strokes, brain injury, and other debilitating brain-related conditions. Noting that stroke is a leading cause of long-term disability, she says that SKY staff treat between 15 and 40 clients a day with physical, occupational, and speech therapy tailored to the patient's individual needs. SKY's patient profile is 62 percent age 59 and under, 55 percent male, and 38 percent seniors. "We treat our patients and their caregivers like family members," says Sauls, whose staff includes thirteen therapists. With SKY's unique services so much in demand, Sauls has opened a branch in Pikesville and plans to open another facility in southern Maryland.

Janice Norton, RN, coordinator of the stroke program at Anne Arundel Medical Center (AAMC), says AAMC has rehabilitation resources available to stroke patients, depending on how the stroke affected that person. "Some people may need physical, occupational, and/or speech therapy-every patient is different," says Norton. Norton also recommends seeking psychological and emotional support for patients and caregivers.

"Timing is critical in the treatment of a stroke victim," says Norton. "Patients should call 911 or go to the emergency room if they suspect they are having a stroke. That way, treatment and evaluation can begin rapidly and some victims may be eligible for a "clot busting drug" (tPA) that can help break up a clot that's obstructing blood flow in the brain. The sooner the patient is at the hospital, the better."

Medical technology and research have made it easier to both diagnose and treat the results of stroke. Magnetic resonance imaging (MRI) scanners, a relative rarity as few as 5 years ago, are now standard equipment at many hospitals and are used for the quick diagnosis so critical to successful treatment. New drugs enable emergency room medical personnel to treat patients diagnosed with stroke with measures that not only save lives but also prevent further destruction of brain cells. The availability of stroke-specific therapy is recognized as an essential ingredient in a patient's recovery.

And then there's the almighty computer, which for many stroke patients is a "lifesaver." Pay a virtual visit to strokenetwork.org/staff/stevemallory and learn all about it.

Freelance writer Mary Lou Baker enjoys writing about health issues and is a frequent contributor to What's Up Annapolis magazine.

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FAQ About Stroke

What is a stroke?

A stroke, sometimes called a "brain attack," occurs when blood flow to the brain is interrupted. When it occurs, cells in the immediate area begin to die because they do not get the oxygen and nutrients they need to function.

How common are strokes?

Stroke is the third leading cause of death in the United States and a leading cause of serious, long-term disability. About 600,000 new strokes are reported annually.

What causes strokes?

There are two major kinds of stroke. An ischemic stroke is caused by a blood clot that plugs a blood vessel or artery. About 80 percent of strokes are ischemic.) A hemorrhagic stroke is caused by a blood vessel in the brain that breaks and bleeds. About 20 percent of strokes are in this category.

What are the symptoms of a stroke?

The symptoms of stroke happen very quickly, which is why a bolt of lightening is the icon for this medical event. Look for sudden numbness or weakness in the face, arm, or leg (especially on one side of the body); sudden confusion and/or difficulty speaking or understanding speech; sudden trouble walking, dizziness, imbalance; sudden severe headache.

What should I do?

Call 911 immediately if you see stroke symptoms or experience them yourself. Stroke is a medical emergency. Immediate treatment can save lives and improve chances for recovery.

Why is there a need to act quickly?

Ischemic strokes can be treated with a drug called tPA that dissolves blood clots obstructing blood flow to the brain. The "window" to start treating patients is 3 hours, but to receive effective treatment, patients should get to the hospital within an hour.

What are the risk factors for stroke and how can strokes be prevented?

High blood pressure, heart disease, smoking, diabetes, and high cholesterol all increase the risk of stroke. So do physical inactivity, obesity, excessive alcohol intake, illegal drug use, snoring or obstructive sleep apnea, increasing age, some blood disorders like sickle cell anemia, high cholesterol/blood lipid levels, and family history of strokes. Males have a higher incidence of stroke than females and African Americans are considered at higher risk for stroke than other groups.

Prepared with the assistance of Janice Norton, RN, Stroke Program Coordinator, Anne Arundel Medical Center