“A man is more likely to have a stroke than a woman of the same age,” says physician Mary Ann Bauman, a spokesperson for the American Heart Association. “But more women suffer strokes than men because women usually live to an older age, when strokes are more common.”
And women typically don’t fare as well as men after a stroke.
Unfortunately, many women don’t know the signs of a stroke. And even those who do may not recognize when it is happening to themselves.
she didn’t see it coming
“I was director of critical care in a primary stroke center hospital,” says Jennifer Caribardi. “I’m a nurse, and I’m very well versed in stroke and neuro diseases.”
Jennifer was 58 and on her neurological rounds several years ago at that hospital in Kingwood, Texas, when she found herself thinking that “the floor looked very inviting. It also felt like I had slept in my glasses and they were a little cockeyed; I was seeing things funny.”
Jennifer wanted to go back to her office, but her nurses insisted on taking her blood pressure, which was very high. “I was irritated because I didn’t want to believe anything was wrong with me. I didn’t have time to have a stroke!” But her co-workers took her to the emergency room.
why it’s so important to know the signs
This is usually how someone gets help because a stroke typically renders people unable to call for help.
“Over 95 percent of the stroke patients I treat didn’t call the paramedics,” says Michael Hill, a professor of neurology at the University of Calgary in Canada. “It’s the family or friend, or maybe the patient was on the phone with her daughter and all of a sudden her speech goes blurry and unintelligible. It’s the daughter who calls 9-1-1.”
That’s why it’s so important to know the signs of a stroke.
“It’s not usually about helping yourself,” notes Hill. “It’s usually about helping your mother or your grandfather or your sister or your colleague. It’s about helping everybody in society.”
In a 2012 American Heart Association survey of 1,205 women, 49 percent didn’t know that sudden weakness or numbness in the face or a limb on one side of the body is a warning sign of stroke. What’s more, 56 percent didn’t know that sudden trouble speaking or understanding speech was a sign, and 77 percent didn’t realize that a sudden severe headache could signal a stroke.
Those are the classic warning signs. But women may also have symptoms that men typically don’t have. And those—hiccups, nausea, tiredness, chest pain, shortness of breath, pounding or racing heartbeat, or sudden pain in the face, arm, or leg—can make it harder to diagnose a stroke in a woman.
Jennifer gets to the ER
By the time Jennifer Caribardi arrived at the ER, her vision had gotten worse.
“I had a girlfriend sitting with me, and I kept asking her, ‘Is that cabinet crooked?’ ‘What’s wrong with that door?’”
The ER staff was trying to figure out what was wrong, when “all of a sudden the left side of my face felt like it fell off.” When Jennifer touched her face, it was numb. When she tried to talk, “nothing came out.” And when she was being moved from a stretcher to a bed, “my left arm and left leg wouldn’t listen to me. It was very frightening.” That’s when she knew. “I was having a stroke.”
Doctors couldn’t administer the clot-dissolving drug tPA until they brought Jennifer’s blood pressure down. Luckily, they were able to do that within three hours. (After that window, tPA may not work as well.)
she starts to recover
Within 45 minutes, Jennifer was able to move her left side. “And I was able to put some sentences together.” But she was still having trouble with language. “I couldn’t name things immediately. I had to think about what they did. Like I couldn’t think of the word ‘table,’ but I knew that it was a flat surface with four legs that you eat off of.” Even today, “especially if I’m tired, that still can happen.”
A few days after she was discharged from the hospital, “I still had some balance problems, and my left leg every once in a while just wanted to drag unless I really concentrated on it. And I continued to have speech issues.”
But after working with speech, physical, and occupational therapists for two weeks, Jennifer recovered most of what she had lost.
bumps along the way when she returned to work
“I thought I was invincible. But fatigue was a huge issue, and when I got tired, I had difficulties with speech and walking. And I didn’t see any vowels when I was reading.” More speech therapy seems to have taken care of that. “And I was angry and depressed, and went through the ‘Why me’s.’”
Jennifer was lucky. “I got the clot-buster early, which is why we want people to dial 9-1-1. Everybody kept telling me, ‘You got the tPA in time. You’re going to get it back.’ And for the most part, I have.
Her message: “If you have vision problems, speech problems, weakness problems, call 9-1-1. Don’t wait to see if it goes away.”
This is even more important for women
“When both men and women get tPA, the women do as well as the men,” says Michael Hill. “But among men and women who don’t get tPA, women fare worse. We don’t know why.”
And tPA isn’t the right treatment for all strokes. “In our hospital, we treat only about 25 percent of our strokes with tPA or other clot-dissolving procedures,” Hill notes. “So on average, women would fare worse than men in a majority of cases.”
In a registry that tracked 1,370 stroke patients for a year, women had worse outcomes than men—they were less mobile, less able to take care of themselves or do their usual activities, and they reported more depression, anxiety, and pain.
These are reasons why women need to lower their risk factors for stroke, which is the leading preventable cause of disability,” says Mary Ann Bauman.
how to lower your risk
The American Stroke Association recommends keeping a lid on blood pressure and cholesterol, staying at a healthy weight, exercising regularly, eating a DASH diet (to lower blood pressure), and limiting alcohol to one drink a day (two a day for men).
“For every 10-point drop in your systolic blood pressure, which is the top number,” says Bauman, “you lower your risk of stroke—and heart disease—by 30 to 50 percent.”
get screened for atrial fibrillation
The American Heart Association also recommends that all women over age 75 get screened for atrial fibrillation, notes Bauman, who is a spokesperson for the association. Atrial fibrillation is an irregular heartbeat in the upper heart chambers. After age 75, it’s more common in women, and it increases the risk of stroke fourfold.
“Sometimes my patients tell me, ‘Okay, if I die, I die,’” says Bauman. “But I tell them, ‘You don’t always die. You sometimes wind up not living very well.’ Women need to recognize that about strokes.”
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