After stroke, Portland woman's brain on the rebound
Kate McCarron's stroke started on a Friday, with a little tingle in her leg.
On Saturday, McCarron, then 46, felt very tired. Sunday, when she went to play soccer, the Portlander says she "just seemed out of sorts."
Monday, her left side felt numb. She went to a neurologist for an MRI exam. They couldn't pinpoint the problem, but "I knew something was wrong," McCarron said. "My husband's a physician, and I could just tell from the look on his face."
When McCarron woke up on a Tuesday morning, she couldn't move her left side. She rushed to Oregon Health & Science University, where it still took doctors almost a day to find the source of her paralysis: A small blood vessel leading to a deep part of her brain was closing, choking off a dime-sized region of her brain that controlled motion.
"Most strokes happen all at once, but strokes in this location can behave differently," said Dr. Helmi Lutsep, the OHSU stroke specialist who treated McCarron.
In these smaller, deep strokes -- called lacunar strokes -- a vessel can partly close, or "stutter" open and shut. Some blood gets through, but not enough for the brain's needs. So the impact of the stroke hits slowly, over four days in McCarron's case. While these strokes are rarely deadly, Lutsep said, they can cause significant and sometimes permanent damage.
Having a stroke creep on gradually may sound as unusual as a woman in her 40s having a stroke. But neither event is that rare, as McCarron learned in 2006 when she had her stroke. An estimated 25 percent of the strokes caused by closed vessels are lacunar strokes. And up to 30 percent of those may follow this slow path, Lutsep said.
And there seems to be a rise in the number of strokes among middle-aged people, perhaps fed by an increase in obesity, or cholesterol and blood-pressure problems. Women in midlife face special risk. Before 45, men and women have strokes at similar rates, Lutsep said, and men pass women in their late 50s. But women have more strokes from about 45 to 54, she said. The reasons aren't clear, but some doctors think hormonal changes around menopause play a role.
McCarron didn't have many risk factors for a stroke. She's normal weight and exercised regularly. But her blood pressure was high, which may have helped cause the stroke. She now takes a blood pressure drug and a medicine to prevent blood clots.
McCarron spent days in the hospital recovering. When she got out, she still had no movement on her left side. She started rehab, a laborious but vital part of retraining the body.
"It was hard, but I was determined and motivated," she said. "About four weeks after my stroke I remember looking at my left hand and saying, 'open,' and it opened."
Still, months after her stroke, McCarron couldn't do many of the tasks she used to. She could only type with one hand, a problem since she is a business executive, and had trouble aligning her left foot and knee for walking. Not long ago, Lutsep said, doctors would have told McCarron that she could expect to live like that forever. They thought stroke victims quit improving after about six months.
But recent work shows that certain kinds of very focused, repetitive rehab can help people even years after a stroke. This "high-intensity task training" cycles patients through a series of tasks for several hours a day, many days of the week, said Andrea Serdar, a physical therapist who has studied task training. McCarron was Serdar's first task-training patient not involved in a research study.
Patients getting this rehab might pour cereal into a bowl while sitting, then while standing, then with their eyes closed, Serdar said. Then they might carry a mug, kick a ball, walk across the room and start the cycle again. It's like cross training, with repetitive practice that can help people relearn skills like typing and tying shoes.
"If you spend enough time and you practice enough different ways, you can actually change the brain wiring," Serdar said. "The brain's a lot more changeable than we believed in the past."
The brain is probably not growing many new cells, Lutsep added. But with practice it may be making new connections, so existing brain cells can take over the roles once performed by cells killed in the stroke.
For three hours a day, five days a week, McCarron practiced stacking pennies, carrying a cup and taking a pitcher out of a cupboard. She used weights to build her strength back up. Her drive to get better impressed the people around her, from her doctors and therapists to her family.
"A physical therapist ... three to four months into her recovery mentioned the staff had had a meeting to discuss why and how she had made the progress she had," recalls her husband, David McCarron. "Their conclusion: Kate had taken full responsibility and had done everything they asked of her."
Soon, McCarron was able to type with both hands and improve her stride well enough to jog around the 3.5-mile Fairmont Loop, with some stops to walk. Then, in June, she got an e-mail with an invitation she couldn't pass up: The chance to run in the New York City marathon and help raise money for the National Stroke Association.
McCarron had never run a marathon, even before her stroke. And she was still having trouble with her left foot rolling to one side and her left knee hyperextending. But she set a goal of running the marathon, raising at least $5,000 and finishing "ahead of the sweeper truck."
In late October, McCarron and her family flew to New York. She had already passed $5,000 in fundraising. When she walked into Times Square, she was shocked to see her picture on a billboard with the words "Hello New York, Goodbye Stroke."
On Nov. 1, for almost 6 1/2 hours, McCarron ran the streets of Manhattan in a T-shirt that read, "I am not a plodder! I am a stroke survivor!" She spoke to many people along the route about the risks and signs of stroke, and the ability to recover. Some people worried about her and asked if she was feeling OK. She was.
"At one moment, around miles 24/25, I got a surge of energy and it was almost like I had never had a stroke and was running normally!" she wrote in an e-mail about her successful run. "What a feeling even if just for a moment!"
National Stroke Association’s mission is to reduce the incidence and impact of stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke.