Stroke and Palliative Care

Understanding Stroke

 Stroke is a disease of the brain. It happens when the blood that goes to the brain is interrupted. Brain tissue then does not get enough blood, which means it does not get the oxygen or nutrients it needs. As a result, affected brain cells get damaged or die, and this leads to the symptoms a stroke causes.

Sometimes a stroke is caused by a blockage, such as a blood clot. This is called an ischemic stroke. About 80 percent of stokes are ischemic.

Other strokes occur when a blood vessel breaks and bleeds in or around the brain.

This is called a hemorrhagic stroke. About 20 percent of strokes are hemorrhagic. Some hemorrhagic strokes are caused by a ruptured aneurysm (a ballooning of the wall of a blood vessel) in the brain.

There are several things that may increase your risk of having a stroke. These include smoking, diabetes, a family history of stroke, high blood pressure, atrial fibrillation and high cholesterol.

Understanding Palliative Care

Palliative (pronounced “pal-lee-uh-tiv”) care is specialized medical care for people facing serious illness. It focuses on providing you with relief from the symptoms, pain and stress of a serious illness like stroke. The goal is to improve quality of life for both you and your family.

Palliative care is provided by a team of doctors, nurses, social workers and other specialists who work alongside your other doctors to give you an extra layer of support. It is appropriate at any age and at any stage of your illness. You can have it together with curative treatment.

Treating the Symptoms of Stroke—How Palliative Care Can Help

The most well-known stroke symptoms are paralysis and weakness on one side of the body. If you are living with the effects of a stroke, you may also experience trouble speaking or understanding speech, headaches, inappropriate behavior, loss of balance, memory difficulties, visual problems and emotional problems.

Obtaining quick treatment when a stroke first begins can help to minimize long-term problems. Although palliative care is important at any stage of illness, it is best to involve the palliative care team sooner rather than later.

Your palliative care team can help explain whether symptoms such as memory, speech or visual problems will be permanent, or whether they will improve over time. The palliative care specialists can use medicines and other therapies to help you with depression or anger, which are common after a stroke.

If the stroke is caused by a blockage, medicines can dissolve a blood clot and allow the blood to flow. Sometimes the clot may be removed surgically. If the stroke is caused by a hemorrhage, treatment may involve surgery, controlling high blood pressure to reduce brain swelling, and seizure medicine.

When you are living with stroke, you may also have problems with muscles and movement. You may have spasms that cause pain. Palliative care specialists are experts in managing the symptoms of a serious illness like stroke. They can help you manage these symptoms through medicines that block nerve reactions, and other treatments that help you to live more comfortably overall.

Your palliative care team will also help you to understand the benefits and side effects of each treatment, and how they fit in with your personal goals for care and recovery. The specialists will work together with your other doctors to help you manage pain and the side effects of your medicines.

If you have trouble swallowing, you and your family must decide whether to get a feeding tube. Palliative care specialists can help you with these decisions. They will counsel you and your family on what to expect. Your team will also help you decide whether the feeding tube is an option you can live with. The specialists will fully explain the benefits, and then balance that information against any drawbacks.

Your palliative care team will be there for you to talk about your needs and expectations for the future at home. The specialists will tell you what to expect physically and mentally, and help you develop a realistic plan. They’ll discuss whether you might need home health care, and the services of assisted living, skilled nursing or acute rehab.

The team specialists will tell you exactly what they can provide at each level of care. They will also tell you what they are not able to do. And they will assist you in getting the support you need for the best quality of life.

Palliative care specialists help you and your family to cope with the challenges of living with stroke—from the side effects of medical treatment to family caregiver stress. They will be your sounding board and your first line of defense against any symptoms of pain, discomfort, depression or anxiety.

In addition, they will help you and your loved ones to make both large and small decisions. They will enhance the communication between you, your family and your other doctors, and help you to clarify your goals for care.

These are some of the many benefits of palliative care.

How to Get Palliative Care

If you or a loved one needs palliative care, ask your doctor for a referral.

Finding a hospital with a palliative care team in your area is easy. Just go to GetPalliativeCare.org/providers for a state-by-state list. To find out if palliative care is right for you, take our quiz.

For detailed information about stroke diagnosis, treatment, risks, life after stroke and more, visit the American Stroke Association (strokeassociation.org). To connect with others who have experienced stroke either as a survivor, as someone who cares for a loved one after stroke or as a friend or family member of someone who has had a stroke, visit the American Stroke Association’s Stroke-Specific Support Network (suportnetweork.heart.org/stroke).

You can also read the new national neurology guidelines recommending early palliative care for strokes: http://newsroom.heart.org/news/stroke-patients-should-receive-customized-palliative-care.