Wednesday, July 17, 2024

Norfolk stroke survivor represents increasingly young population of stroke patients

Jeff and Loree Peele on the day that Jeff was released from Sentara Virginia Beach General Hospital, after five weeks of hospitalization following his stroke in January, 2015. (Courtesy of the Peeles)

NORFOLK — Loree Peele was taking a shower in her Norfolk home one morning, when she called out for her husband, Jeff.

He didn’t respond, and when she was done showering she went into the bedroom where she found Jeff still in bed, inert and out of it. The scene was eerily similar to how Loree Peele’s mother had been when she had a stroke several months before.

“As soon as I walked over there, I knew it,” she said.

Jeff Peele couldn’t move his right side. His words were jumbled, and he had a glazed look in his eye.

The diagnosis: a hemorrhagic stroke—a shocking diagnosis for someone who, at age 51, had only been to the doctor twice since he was 18.

Jeff Peele was overweight, and as it turned, he had sky-high blood pressure that had never been diagnosed because he didn’t go to the doctor for regular checkups.

He initially went to Sentara Leigh Hospital, at his wife’s insistence, because of Sentara’s excellent reputation. He then spent thirteen days at Sentara Norfolk General Hospital, followed by three weeks at Sentara Virginia Beach General Hospital.

Within three months, Loree Peele said her husband went “from bed, to walker, to cane.” Twenty-seven months later, Jeff Peele still has no feeling on his right side, which can be awkwardly debilitating. He can’t feel food on his right side, feel his nose run from his right nostril or use his right hand.

But he can still drive, work out and cut the lawn. The “stubbornness,” he said, which kept him from going to the doctor all those years, has also been useful in rehabilitating him after his stroke.

Stroke on the rise in younger people

Jeff Peele was 51 years old when he had his stroke in January, 2015, while traditionally most stroke victims are older than 65.

Strokes are the fifth leading cause of death in the U.S., according to the Centers for Disease Control (CDC), and are notably on the rise in people under age 65. In 2009, 34 percent of people hospitalized for stroke were under age 65.

A study published last month in the Journal of the American Medical Association (JAMA) found that ischemic stroke hospitalization between 2003 and 2012 increased 41.5 percent for men, and 30 percent for women between the ages of 35 and 44.

Most strokes are ischemic, meaning a blood clot forms in a blood vessel that supplies blood to a part of the brain. A hemorrhagic stroke happens when an artery in the brain bursts or ruptures.

Some of the underlying causes of both types are the same: aging blood vessels, high blood pressure, diabetes and obesity.

The JAMA study also found that these stroke risk factors, apart from aging blood vessels, nearly doubled for people hospitalized for stroke who were between the ages of 18 and 64.

“The risk factors that have [caused strokes in the elderly] have crept down into the younger population,” said Dr. Pankajavalli Ramakrishnan, a stroke neurologist and neuro-interventionist at Riverside Neurovascular Specialists in Newport News.

Dr. Smaranda Galis, a neurologist at Sentara Neurology Specialists in Suffolk and the Stroke Program Director at Sentara Obici Hospital, has also noted a rise in younger patients. “I’m seeing younger people with diabetes and hypertension,” she said. “These traditional risk factors are accumulating.”

Strokes can be triggered by many normal activities, like drinking coffee, blowing your nose or having sex, according to a 2011 Dutch study from the University Medical Center in Utrecht—but the underlying causes of stroke are usually the same.

Ramakrishnan listed them off:

“High blood pressure, cholesterol, diabetes, smoking, obesity,” she said. “People are not active. It’s not a surprise that we are seeing far more strokes than we used to.”

There’s a sliver of the young population at risk of stroke because they are pregnant or on the birth control pill, the latter of which is a known risk factor, Ramakrishnan said.

“Pregnancy and post-pregnancy are increased times for strokes, simply because of the changes that happen in the body,” she said. “You don’t want the fetus or the mother to suffer from blood loss, so there is increased propensity for clot formation.”

Although what causes this is the body’s own self-protective mechanism kicking in, for some women, especially those who already have other stroke risk factors, the clot formation predisposes them to stroke. “It’s not a mystery, but it is a very low prevalence,” she added.

Younger brains mean easier recovery

“We know younger brains are more plastic,” Galis said. “Younger people are at an advantage,” she added, in stroke recovery.

“A plastic brain absorbs information like a sponge,” Ramakrishnan added. That’s important because a stroke essentially kills a part of the brain, so the stroke recovery process involves a patient re-learning the functions of that part of the brain.

That brain plasticity comes in handy in three main ways, Galis added. The first is adaptation, since the stroke patient must rely on alternative physical movements. The second is the regeneration of new brain cells, and the third, and most important, involves the rewiring of the neural network, which allows the damaged part of the brain to reconnect with neighboring parts of the brain.

Younger patients are also easier to treat because they have more undamaged parts of their brain, Ramakrishna said.

“I’ll see an [older] patient who comes to see me after a stroke,” she said. “They knew of one stroke, but they have lots of scars on their brain—indicating small silent strokes. [Those] scars develop in the deeper part of the brain. That person will take longer to recover.”

Jeff’s Peele’s recovery went quicker than it might have—in part because of his own doggedness, but also likely because of greater brain plasticity. He did speech therapy for three months, and he downloaded memory apps on his phone, his wife said. He also played card games and board games to help recover his short-term memory loss, which suffered during the first year and a half after his stroke.

He also lost 50 pounds, changing his meat-based “Carolina carnivore” diet to a primarily plant-based, vegan diet. His motto nowadays is not to eat anything with a face on it, or anything that comes from something with a face on it, Loree Peele said.

“It has been a journey,” she said. “This has completely changed our lives. It has definitely given us more compassion and empathy for people. When we’re out together, I’m like his guard dog.”

The couple were high school sweethearts, and they’ve been married for 30 years. One thing that the stroke didn’t take away, Loree Peele added, is her husband’s long-term memory.

“He’ll still remember things from high school that I don’t.”

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