The story seems like fiction.
A 9-year-old boy in Latin America loses his mother to a stroke. His six older siblings raise him, providing the guidance and financial support to become the only member of their generation to attend college. Then he goes to medical school. Decades later, he’s known around the world as a physician, professor, scientist and writer focused on the disease that claimed his mother.
But Dr. José Biller’s tale is true.
And in the days leading up to Sunday – which is World Stroke Day – he’ll be doing what he does all year long: working to turn a spotlight on the second most common cause of death in the world and the No. 1 cause of adult disability.
About every 40 seconds, someone in the United States has a stroke. A stroke-related death occurs about every 4 minutes. Those stats are even more excruciating when you realize that 80 percent of strokes are preventable and that advancements in treatment have improved the odds of recovery.
“What’s your reason for preventing stroke?” is the theme of this year’s World Stroke Day. For Dr. Biller, the reasons are many, and they date back to the late 1950s.
Osias “Oscar” Biller and his wife Elena emigrated from Europe to South America in 1920, settling in Argentina then moving to Montevideo, the capital of Uruguay.
Oscar owned a restaurant and Elena was known as a kind, gentle, gregarious woman. The family was close-knit, with all seven children often gathering for meals and celebrations. The large brood set the Billers apart in their neighborhood as most families had only two kids.
Soon the Billers stood out for another reason.
Oscar died of a heart attack. Six months later Elena died of a stroke.
“This was the first time I encountered the word ‘stroke’ or ‘brain hemorrhage,’” José said.
His four brothers ranged in age from upper teens to early 20s, and they worked hard to keep the family afloat. His two sisters helped care for him. Seeing how stressful life was for them, José sought a different path.
“I had a lot of respect and love for my siblings because of what they did and the opportunity I was given,” he said. “I never took anything for granted.”
In medical school, José was fortunate to have excellent professors in neuroanatomy and neurology. He set out to become an internist until a rotation with a neurologist introduced him to that field’s challenges and the critical thinking skills it required.
Add in his personal experience and he’d found his calling.
“Stroke is one of the conditions where the affected patient is not the only one who has to overcome a number of issues – it’s a family disease,” said Dr. Biller, who is now the chair of the Department of Neurology at Loyola University Chicago Stritch School of Medicine.
Beyond the obvious pain and anguish endured by a stroke patient, the impact can reverberate throughout a family.
It can start with the need for relatives to become caregivers. This could be for days … or decades.
Once a close relative has had a stroke, it’s another risk factor for you. You now have a family history.
“The education of family is critical, particularly among certain socioeconomic groups that perhaps do not have knowledge of the warning symptoms or risk factors,” Dr. Biller said. “Therefore I always talk about prevention. It may not be a very sexy subject, but it’s a critical component of health care.”
High blood pressure, also called hypertension, is the No. 1 cause of stroke and the most important controllable risk factor. Getting it under control usually comes down to lifestyle changes such as eating healthier, becoming more physically active and drinking less alcohol.
Controlling blood pressure also lowers your risk of heart disease.
Educating people about stroke has all sorts of great ramifications. While prevention tops the list, another key is teaching the warning signs.
Do you know how to spot a stroke FAST?
“Oftentimes the person at home with Grandma or Grandpa is a child,” Dr. Biller said. “In our society, we need to teach those warning signs to children at the grade-school level and to incorporate them in cartoons and other things aimed at children.”
Another component of stroke care that drives Dr. Biller is recovery. He’d like to see more emphasis on programs that help stroke survivors rehabilitate and reintegrate into a quality life.
Something else he’s pushing: overlooked complications, such as depression, which can afflict as many as 50 percent of stroke survivors.
“Also the proper care of the caregivers,” he said. “They should be part of the equation, too.”
There are two primary kinds of stroke: hemorrhagic and ischemic.
A hemorrhagic stroke means it stemmed from bleeding in the brain. That’s what Elena Biller had.
An ischemic stroke means it’s caused by a blood clot. That’s what took the life of Dr. Biller’s oldest brother.
While stroke is often considered something that happens to the elderly, that wasn’t the case with Dr. Biller’s family: His mom was in her 50s and his brother was 62.
Perhaps more relevant than their age is the timing of their strokes.
His mom died in 1957, his brother in 1991. It wasn’t until the mid-1990s that major advancements in stroke care have greatly improved the chances for survival.
The first big advancement was a clot-busting medication called tPA which can do wonders when delivered within the first four and a half hours of a stroke’s onset. This is another reason why it’s so important for people to know the warning signs.
The next wave of innovation brought new surgical and endovascular tools that have further brightened the outlook for stroke patients. The stroke systems of care, which start the moment someone calls 911, and improvement in stroke units have also seen remarkable advances.
“The advancements in the last two decades have brought us a world apart from where we used to be,” Dr. Biller said. “We have to acknowledge that our population is growing and aging, and this means more people will be afflicted. So we have reasons for hope – but there’s still a lot of work to do!”