Almost every American in the last 40 years has been entertained by Garry Marshall's movie and television work. We have smiled and laughed with Garry Marshall's productions "Pretty Woman," "Princess Diaries," "Happy Days," "Laverne and Shirley," "The Odd Couple," and "Mork and Mindy," among his many other motion picture and television programs. On July 19, Garry Marshall died of a stroke, complicated by pneumonia. We can learn important lessons from his unfortunate demise.
Stroke (also called CVA -- CerebroVascular Accident) is a common health risk. After heart disease, cancer, and lung diseases, stroke is the fourth leading cause of death. It can have long lasting neurological effects, and it is one of the most common causes of disability.
Annually, stroke occurs in 795,000 people, and one of every 6 people with stroke will die of it (130,000 deaths annually). Even if a patient survives the initial stroke, recurrence is common. 42% of men and 24% of women who have had a stroke suffer from another stroke within 5 years.
Garry Marshall's pneumonia was also typical of a course that many stroke patients have. After a stroke, mortality occurs from actual brain damage during the first week. But 2 to 3 weeks after a stroke, patients have complications from their immobility. They develop pneumonia, blood clots in the lungs (pulmonary embolus) or bloodstream infections (septicemia). The reason for the high frequency of pneumonia is due to reduced immunity after stroke, and reduced evidence of pneumonia on an x-ray (resulting in delayed diagnosis). Patients have to be managed by an experienced health care team to minimize complications.
Who is at high risk of stroke? Patients at higher than normal risk are people who smoke or who have high blood pressure, heart disease, the abnormal heart rhythm atrial fibrillation, diabetes, high cholesterol, obesity, inactivity, alcohol abuse, sleep apnea or clots in the carotid arteries in the neck.
This article is important because stroke is 80% preventable. So it is important to discuss your own risk of stroke with your doctor, and get prescriptions and advice to avoid a stroke.
There are treatments that can reduce risk of stroke in some patients: take pills to keep blood pressure and cholesterol normal, stop smoking and excessive drinking, take blood thinners and/or anti-platelet drugs for heart disease or atrial fibrillation, exercise and maintain normal weight, eat a healthy diet with 5 or more helpings of fruits or vegetables, get sleep apnea diagnosed and treated, and have a carotid ultrasound to see if you have carotid artery stenosis (narrowing) which can be treated with radiology or surgery if necessary. You can discuss these with your physician
It is important to realize that stroke is a real medical emergency. Your outcome from a stroke is much better if you get to an emergency room in a hospital that has a stroke center or experience in stroke care. In one study, the doctors evaluated more than 58,000 patients who had a stroke, and were then treated with tissue plasminogen activator (tPA), a clot-dissolver that improves stroke outcomes if given within 3 hours of the first stroke symptom. The authors found that if patients got to the emergency room faster, and received treatment more quickly, outcomes were much better. For every 15 minutes sooner treatment from the time of the first stroke symptom, there was a 2% increase in ability to walk and there was a 1% to 2% increase in ability of a patient to return to independent living after recovery from the stroke. At the emergency room, treatments began 6 times more rapidly if there was arrival by ambulance compared to arriving by car!
Therefore, the sooner you recognize a symptom of stroke, the greater likelihood you will call paramedics and get to a hospital. Here are some of the symptoms of stroke: sudden weakness or numbness of an arm or leg or one side of the body, sudden confusion or speech problems or trouble with vision or difficulty walking, or sudden severe headache.
The national stroke association has a short memory aid for suspecting stroke, called FAST. If you have Face droop, or Arm drifting when you hold arms out straight, or Speech slurring, then it is Time to call 911.
So here are Dr. Cary's tips for you about stroke:
• If you are having symptoms of any kind, try to get to the emergency room to have symptoms resolved as soon as possible.
• Use an ambulance or paramedic to get to the hospital in case of symptoms of stroke or heart attack. Patients arriving by ambulance receive emergency care much more rapidly than patients arriving by car.
• Never think, the symptoms are only mild, I can wait it out.
• Know where there is a hospital with a stroke center near you. Use that center when you suspect a stroke.
• Check out your own personal risk of stroke using a stroke risk calculator.
• Discuss your risk for stroke with your doctor. Be sure you get specific suggestions for reducing your risk and preventing stroke. For more information about how to discuss prevention with your doctor, and get a second opinion if necessary, see my website and book Surviving American Medicine.
Just as with Garry Marshall, stroke can cause death within weeks of the event. You can take steps now to reduce this risk. After giving us so many happy and hilarious memories in his work, Garry Marshall in his passing gives us a reminder to take steps now to lengthen our lives.
The opinions expressed are those of Dr. Presant and do not represent opinions of City of Hope or other organizations.