Babies and Strokes

This is a brain. It is also the unfortunate outcome of a baby whose mother experimented with cocaine, resulting in a premature birth and a bleed in the baby's brain. A bleed in the brain means the baby had a stroke. Hey! Wait a minute! Babies and strokes don't go together, or do they?

Note: for all you baby-makers out there, I'm not trying to scare you from having kids. This post is just a dose of reality.

You probably don't know the name Duncan Guthrie. He started a charity in 1952 for his daughter, Janet, who had polio, and he was determined to find a cure for the disabling disease. With money funded by the charity, research, in time, led to the first oral polio vaccine which wiped out new cases of polio in the UK. Now called Action Medical Research, the charity encompasses so many other afflictions, and that leads us to babies and strokes.

In 2009, Action Medical Research estimated at least one baby out of 2,300 in the UK born full-term were victimized by a stroke. These strokes often were unexpected at the time of birth or before, i.e. some developing babies had strokes in utero. The researchers didn't know if the babies, who are now barely three years old, had trouble using language because they hadn't matured to the point where anybody could tell the difference between a three year old saying gibberish or not.

But of the 100 or so children in the study, the researchers are working feverishly to know how stroke affects their language skills. Magnetic Resonance Imaging, most commonly known as MRI, is administered to the child to watch how stroke affects different parts of the brain. Sometimes, the brain readjusts itself, said the researchers, especially in a newborn, to compensate for the section that was harmed. Known by the medical term as plasticity, the brain takes charge of the imperfect tissue with the good part of the brain. In fact, in the first 28 days of life, stroke is more common than after.

So the big question is, how do you know if the newborn had a stroke? Newborns most likely would show no signs of a stroke unless they have a seizure. Seizures symptoms include staring, rhythmic and spasmodic episodes in the face, arms, and legs, stiffening of muscle groups, and pauses in breathing. Generally, newborn stroke survivors show less movement on one side of their body. "Handedness," the term given when newborns favor one hand over the other, could be a symptom of stroke.  Parents often mistake this as meaning that the baby is advanced for his or her age. In healthy babies, handedness appears at about 12 months.

According to the American Heart Association Journal (AHAJ), the incidence of stroke in newborns in the first 28 days is very elevated compared to infancy and childhood years. The following can happen at a rate of 1 in 4000 newborns:

     * Arterial Ischemic Stroke (where blood flow is stopped in an artery to the brain by a clot)
     * Sinovenous Thrombosis (where a clot appears in one of the veins in the brain)
     * Hemorrhagic Stroke (where an artery bursts in the brain).

After the newborn period, the risk of stroke decreases significantly and remains low until post-55.

This is what can happen in pregnancy and childbirth:
     * Proteins travel from mother to fetus, which aids in clotting. But if there's too much clotting, a
        stroke for the baby is more likely.
     * At the point of labor and delivery, childbirth can result in physical stress on the baby’s head with
        the arteries and veins in the baby’s head leading to clots and stroke.
     * Newborns have twice as many red blood cells as an adult which can lead to excessive clotting.
       (Stroke can sometimes be prevented by giving newborns blood transfusions the blood is diluted
       with saline).
     * Dehydration can cause the blood to clot, some signs of which are a dry mouth, dry skin, and
        fewer than six wet diapers a day.

A number of factors that can put a newborn at risk for stroke include:
     * If the newborn has a hole in the heart, it facilitates a clot going up to the brain.
     * If there is a genetic history of clotting problems, the risk of stroke increases.
     * If serious infections such as sepsis exist, clotting may result.
     * If the mother takes an illicit drug, like cocaine or heroin, a stroke, albeit needless, may occur.

For expectant mothers, if clotting disorders are part of your genetic history, tests can be done in-utero ahead of time to help the baby's outcome. All expectant mothers should eat nutritiously, stop cigarette smoking, and avoid dehydration.

Here's the bottom line: there’s not much research so far on how to treat strokes in children, including newborns and fetuses.

An excerpt from a blog, Raising Arizona Kids, tells one story of thousands:

"Chandra Whitfield, of Mesa, learned just a few months ago that her son, Joey, suffered a stroke in-utero.

At first, Joey was an easy going, happy, typical baby, welcomed by his parents and brother Daniel (3 ½).

But at around 8 weeks, Chandra began noticing a few things about Joey that seemed different from her experience the first time around with Daniel. She mentioned her concerns to Joey’s pediatrician at the next well check.

The doctor diagnosed Joey with tortocollis, which can occur while a baby grows in the womb if the muscles or blood supply to the fetus’ neck become injured.

He prescribed some stretching exercises and suggested that Chandra put toys on on Joey’s left side to encourage him to turn his head.

That helped, but at four months, Chandra begin to notice that Joey wasn’t reaching for toys with both hands- just his right hand.

At his six month well check, he still didn’t seem to be using his left arm and hand – and Chandra decided to trust her 'mommy gut' feeling that something wasn’t right.

She asked the pediatrician for a referral to a pediatric neurologist, just to rule out that anything was seriously wrong.

Finally, Chandra and her husband, Chris, received some tough news about their little boy.

Joey was diagnosed with left-sided hemiparesis (weakness on the left side of the body) due to a stroke in-utero. An MRI followed and confirmed the diagnosis.

Since the diagnosis, Chandra says she feels 'as if a fire has been ignited in me.' She began working to raise awareness about childhood stroke.

She and her family have walked in the Stroke Walk, a fundraising event.

She’s been selling purple awareness bracelets and donating the funds to the Children’s Hemiplegia and Stroke Association (CHASA), she’s got plans for a website, and volunteers for CHASA.

Chandra also sent a letter to Governor Jan Brewer requesting that May 7 be declared 'Childhood Stroke Awareness Day.' Here are Chandra and Joey on the day just a couple of weeks ago when they received the news that the request was granted, and more.

Arizona now joins several other states in declaring May as Childhood Stroke Awareness Month. CHASA hopes to build a grassroots effort to add more states to the list.

"Joey is a year old now and doing well. He works with a physical and occupational therapist to help strengthen his left side. The testing and therapy will continue, but so will Chandra’s will to get the word out to others to raise awareness—and to grow a community. Because what Chandra says has helped the most is the connection she’s made with other parents of children who have suffered stroke in-utero."

My God. Babies and strokes. It happens. And now you know.

Hurricane Sandy, Part 2, aka Has G-d Had Enough?

Tuesday, October 30.
We awake to the chill in the air. I knew I couldn't stay here and so did he. My nerves were frazzled because I had something like Post-Traumatic Stress Disorder (PTSD) from the storm. As a stroke survivor, I had some trouble going with the flow now, and I was near the end of my patience. But I tried my darned-ist not to say anything to my friend about the heat and lack of hot water. We were leaving anyway. And he had more problems than I did.

My friend went down to the basement to check for moisture, but he found more--15 inches of rain and sea water. His boiler, water heater, washer, and dryer among other things went south to hell. We had breakfast and, when the tide started retreating around 11 am, we went back to Philadelphia to stay in his mother's apartment who didn't live there anymore. She had died on Thursday.

We brought our computers, but in an assisted living facility, there was no need for Wi-Fi for the great majority of the people who lived there because they don't use computers. If someone wants to go online, they have a certain area where it's possible on the dining floor, but the Internet was out for awhile, I imagine because of the storm. I continued writing my blog. He watched television and we ate dinner at his sister's house two miles away, going over roads that were absolutely passable, and then returned to his mother's apartment for much needed sleep.

A side note on the sleep issue is there's much evidence that getting a good night's sleep--at least 7 hours--is so important for stroke survivors. But it's not uncommon for stroke survivors to have problems sleeping. Maybe they have an arm or leg muscle that quivers in a spasm (called "tone" in physical therapy jargon) or are kept awake with over-thinking the day. At least once a week, my muscles go into "tone" in the middle of the night and I am forced to get up and stretch. And wow, do I over-think. More than a few times, I got up at 3 am and thought until 7. Any stroke survivor could identify with these conditions.

But the really shocking news is that even if you have average weight and are healthy, and have normal readings in both blood pressure and cholesterol, sleeping less than six hours a night consistently could quadruple your risk of a stroke, according to a recent study at the University of Alabama. The extensive test was done on over 5,600 people, aged 45 and older. Researchers concluded that sleep is just as critical as diet and exercise. The reasons, say the researchers, is that deprivation of sleep can cause changes in the blood pressure, heart rate, and glucose levels, all critical factors that might possibly lead to a stroke if any one of those factors goes too high.

Wednesday, October 31.
The entries from here on out would be shorter. The storm and all the destruction left behind had passed.

My friend wanted to return to his house at the shore because standing water in the basement could spell disaster. So back we went sixty miles--again. We left the computers and our other belongings in his mother's apartment. He rented a pump along the way which operated on gasoline. When we arrived in the town next to his, his town was inaccessible because there was a breach in the water system, and back roads were not the answer. There was no doubt about it. New Jersey got hit hard by the hurricane. The police figured out almost all the ways someone could get in. We decided to go for a pizza dinner in the neighboring town and think, and after that, he figured out a way to get back to his house because the police didn't think of everything.  When you live in a place for sixty-four years, you just know.

When he went down to the basement, surprisingly, the water level diminished to four inches in a few places, seeping through the cracks in the floor, and simply wet in most places. But the pump didn't have a hose that was long enough to extricate the water and put it into the street which wasn't flooded anymore. The rest of the day was allotted to my thoughts, partly of G-d and how we were spared from the hurricane this time. But I still wondered, would next time be the last time? To put it simply, has G-d had enough?

We slept at home on Wednesday.

Thursday, November 1.

The power came to life just before noon, and I flipped a lot of switches needlessly, just to make sure it was really on in the whole house. My friend went back to Philadelphia to retrieve our belongings and bought a shop vac at Loews because the water level was manageable now. But on the border to his town, the police stopped him. They had finally figured out all the ways to enter his town. One of the cops said there's no law against walking. So he parked and got out of the car with the shop vac and all our belongings and walked the mile back to the house.

His sons came to help him clean out the soggy, moldy basement. The house was cold and damp, at least to me, because I take Coumadin which makes most of us who take it feel a lot colder than the temperature readings indicate.

In general, there's a lesson to be learned in everything that happens to us. Maybe for the next monster storm that hits us, we'll know the answer. Maybe it's just a wake-up call for us to get our heads out of our asses and evacuate. But just between you and me, after all was said and done, the storm was thrilling, especially because we lived to tell about it.

Hurricane Sandy, Part 1, aka Has G-d Had Enough?

The hurricane came on slowly, like a tiger stalking his prey. All I heard was the low wind, but then there's usually wind on the beach block of South Jersey's shoreline, especially in the downtime from fall to spring. The fall was over a third finished, but there it was: Hurricane Sandy.

Sunday, October 28.
My friend's mother died, and we had a graveside service at the shore where she lived for over fifty years. The wind was already blowing, but the gusts slowed down as if the wind wanted to pay its respect to his mother, too.

My friend motioned for me in my wheelchair to walk to the chairs the cemetery had set up for family members, but I sat on the edge of the crowd, not trusting myself on the uneven terrain, common to all cemeteries. (You may not have noticed because you don't walk in my shoes and you may not have had a stroke). The service ended a half hour later, and we all went back to his sister's house in Philadelphia which was sixty miles away for the after-gathering.

While in Philadelphia, a few people said that the bridges to the barrier islands, where we are from in New Jersey, would close down at 4 o'clock, so we left his sister's house at 2:45 in order to make the 4 pm deadline. It started to rain, and he took the Atlantic City Expressway, intending to go from Exit 44 to Exit 2, to make it back in time.

But near Exit 5, the police slowed us down by having one patrol car in each of the three lanes and, at Exit 5, the patrol cars stopped and another officer, who was standing in that wide-legged stance that only policemen and workout guys have, told us to turn around.

''She had a stroke," he said, pointing to me, "and I'm returning to the house to get her pills." It was no lie. I needed my Coumadin.

But the patrolman must have heard that excuse before, so he repeated himself. "You have to turn around."

My friend, who knew the back roads, went onto Exit 5 and kept going beyond where he should have gone. He took a circuitous route which took us close to his home, but we still had to go over the bridge. At 3:59 pm, he took the bridge which closed at 4 o'clock promptly. I know because we were the last car that was allowed to go over. The roads were empty and the town was ghost-like.

When we pulled up to his place, I saw and heard the roaring ocean from his house.

"The ocean looks dangerous," I said, "but the ride was thrilling." I know it sounds crazy, but you weren't there. Those two, diametrically opposed statements were both accurate. We went to bed early, him, because the funeral day was tiring, and me, because I love a storm when I'm safely inside and under the covers. But this storm was different, with strong winds at 75 mph that howled and moaned, and I was afraid the windows would break.

But before I slept, I thought about all the ways we had fucked up this world. Not me, specifically, but "me" as part of the world--wars, pollution, homelessness, hunger, the super PACs? I wondered, was G-d trying to give us a last warning? Was this flood representative of the last one, involving the Bible's Noah and the Ark? Was G-d even so tired of us that He decided to start over? Was this it, the east coast version of the Big One?

With so many questions to myself, asked and answered, I slept for 2 hours that night.

Monday, October 29.

We awakened to a flooded street. According to my friend, the last time the streets were flooded was in 1962 with a nor'easter that blew out the boardwalk. With Sandy, the sea water covered our driveway ramp and started to creep up to the bottom step of the entrance to his home. The storm was encroaching. We lost power, electric and gas, somewhere around 11 am. But we couldn't leave because we were trapped. So we sat in the house that day with nothing to do but stare at the flood or read a book when the light let us.

When I thought that I couldn't stand it any longer, I said, "We could microwave popcorn," I said, but he replied, "No power. Remember?"

A little while later, he said, "You could check your computer for the weather," but I replied, "I have no battery power left."

When it got dark, my friend made us dinner--the leftovers from the funeral food--and, being the ultimate saver, he used a flashlight to find a new headlamp that was a Christmas gift from nine years ago. He put the batteries in and I was a virtual miner, focusing the light on my head at the stairs to the bedroom. He led the way, with the light on the next step, and all the ones after, to guide me. When I reached the top, I moved toward the bed. He helped me into bed and, because I hadn't hardly slept the night before, I slept deeply.