The Broken Class

When a stroke strikes, it hits hard — and its victims are often left penniless and defenseless.
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Illustration by Lorraine Tuson

Peter Cornelis was a rising star in the industrial fastener industry and often called on the Detroit Three automakers for business. He was an international marketing executive and super-salesman who was about to go on a world tour of his company’s facilities when he had his first stroke.

“I was on the way up; I was the golden boy,” says Cornelis, now 57, who has survived six strokes. “Then I blacked out in my office at home one day. I woke up in a puddle of pee and called 911. I knew it was a stroke, and it was severe.”

Cornelis had suffered an aneurysm — a blood vessel had burst in his brain and caused damage that eventually paralyzed the left side of his body. Luckily, he got to a hospital and was quickly treated. The outcome for stroke victims is much better if they’re treated within three hours. Or as Cornelis puts it, “time loss is brain loss.”

Cornelis tried to go back to work but, suffering from chronic headaches, was let go by his employer, entering the ranks of what he calls “the broken class.” He had several more strokes and surgeries to put coils into his brain to reduce the blood flow to the aneurysm. Finally he had a craniotomy to repair the aneurysm and relieve the pressure on his brain. Afterward he couldn’t speak. “I was lucid and heard and understood everything,” Cornelis says. “But you look like an inanimate object.”

After months in hospitals, he spent many more months in nursing homes and in physical and occupational therapy. When he got home all he could move was his left hand. Slowly, he re-taught himself to paint, eventually using both hands. He spent a year and a half in a wheelchair and is now on disability, suffering from fatigue and short-term memory loss. He’s now able to walk around his neighborhood, if somewhat erratically, with assistance.

“But the big losses are beyond physical damage,” he says. “It’s the emotional damage. You shed tears or laugh at the most inopportune times. You even laugh at funerals.” Cornelis says he knows stroke survivors who have blind spots, “like looking through Swiss cheese. Some people see only half of the food on their plates.”

Every 45 seconds, someone in the United States has a stroke, the third leading cause of death after heart disease and cancer, and the leading cause of long-term disability among adults. And the costs are enormous — to the victims, their families, and to businesses, insurers, and governments. According to the American Stroke Association, almost $62.7 billion in stroke-related medical costs and disability occurred in 2007.

About 700,000 strokes occur in the United States each year, and over 160,000 people die, says the National Stroke Association. About 500,000 of these are first, or new strokes. Nearly three-quarters of all strokes occur in people over the age of 65, and the risk of having a stroke more than doubles each decade after age 55 — not good news for aging Baby Boomers. In turn, four out of five families will be affected by stroke at some time, while 65 percent of those who have a stroke either die or require special care.

In Michigan, about 5,000 people die each year from strokes and stroke complications, an average of 13 deaths a day in 2006, according to the state’s Department of Community Health.

Blue Cross Blue Shield of Michigan estimates its average cost for a stroke statewide in 2007 was $10,000 to $15,000 just for the hospital stay, surgery, and drugs, according to spokesman Jon Ogar. That does not include doctor fees and rehabilitation costs, including physical and occupational therapy, which can go on for years and be tremendously expensive. It is estimated that of those who survive and who had been working full time, only 53 percent are back at work one year after the most common type of stroke.

A stroke is an interruption of the blood supply to any part of the brain, sometimes called a “brain attack.” If blood flow is stopped for longer than a few seconds, the brain cannot get oxygen. Brain cells can die, causing permanent damage.

There are two basic types of stroke, according to the American Stroke Association: When a blood vessel carrying blood to the brain is blocked by a blood clot, it’s called an ischemic stroke. Most strokes, perhaps 80 percent, are ischemic. When a blood vessel breaks open, causing blood to leak into the brain and destroying tissue, it is a hemorrhagic stroke. The break is called an aneurysm.

Beyond just getting older, the greatest risk factor for stroke is high blood pressure, says Dr. Brian Silver, a neurologist and stroke specialist at Henry Ford Hospital in Detroit. “We could cut strokes by 40 percent,” he says, “if everybody cut their blood pressure.”

He also notes diabetes, irregular heartbeat (atrial fibrillation),smoking, high cholesterol, and obesity may increase the chances of a stroke, while regular exercise can reduce it. “A sedentary lifestyle increases risks,” he says. “Treadmill tests show those who are the least efficient, based on oxygen use, have three times the risk of stroke.”

Silver says no absolute connection has been established between strokes and the classic Type-A high-stress businessman or woman. “But there is some literature that Type-A’s might be at higher risk” from executive lifestyles, which often involves high stress, high-fat and high-salt restaurant meals, drinking, and no time for exercise, Silver says. “And stress increases a hormone that can injure the body.”

Silver counsels his stressed-out executive patients, both men and women, to  “try to work out strategies to reduce the stress like reading a book, getting enough rest, and abstaining from alcohol or coffee late at night (as it effects sleep). “If the job is so high-pressure, they need to unload some of the work on others,” he says. “They need to ask themselves: Is the job worth my health?”

Women executives may actually face more stress because many want families, as well as jobs and success. And they most often are the main caregivers in the family. “If you put a lot of stress on the body, eventually you’re going to break it down,” he says. Indeed, 62 percent of those who die of strokes are women.
Silver, who is Canadian, points out that in Canada women who give birth can get up to a year off and still keep their job. “There’s no letting up here,” he says of the United States. “Women don’t get cut any slack.”

While many illnesses can be fatal, a stroke is particularly insidious. Victims may live for many years with severe disabilities that tax them and their caregivers, often spouses or children.

A study of ischemic stroke, the most common kind, by Dr. Devin Brown of the Neurology Department at the University of Michigan in Ann Arbor, projected that the costs may exceed a staggering $2.2 trillion from 2005 to 2050 in the U.S. alone.

To help reduce the number of strokes and control costs, the Centers for Disease Control has developed a  “toolkit” of programs that state health agencies may use to help employers. The toolkit — available at www.cdc.gov/dhdsp/library/toolkit/index.htm — includes suggestions about which health benefits, services, and interventions can improve overal health.

The toolkit includes ideas like work-site checks of blood pressure and cholesterol, more drug coverage or reimbursement for drugs, providing rehabilitation services, and training employees in CPR, and the use of defibrillators.

“Having a stroke is like an atom bomb on your life,” Cornelis says.  “Your friends, your family, your job all scatter. People look at you like you’re broken. With open-heart surgery — in a couple of weeks, you’re home. But a stroke is for the rest of your life.”

Regaining his ability to paint gave Cornelis the idea of starting a stroke Web site, www.hope4stroke.com. Two-and-a-half years later, Cornelis says, the site is now up to 3 million hits a year and is a support center for survivors and caregivers.

“One thing everyone says is ‘I want my life back,’” he says. “We try to help survivors with their depression, and with the financial degradation” of lost incomes and jobs. “Ninety-five percent of stroke survivors are devastated financially.”

The Web site is also raising money to build a state-of-the-art facility that would combine speech, physical fitness, therapy, and occupational therapy. “There are lots of devices that can help build strength, to retrain eyes, to live again without surgery,” Cornelis says.

One peculiarity of stroke is geography, says Dr. Lewis B. Morgenstern, director of the stroke program and a professor of neurology at the University of Michigan. Logic would predict more strokes in bustling high-stress areas like New York, since stress can be a factor in high blood pressure, the main cause of stroke. But the reality is that New York has the lowest incidence of stroke based on population.

Surprisingly, strokes strike the highest percentage of people in a swath across the southeast United States, from Alabama through Georgia, and into the Carolinas. Morgenstern says research is going on to discover why. Michigan, he adds, is somewhere in the middle in the rate of strokes.

But wherever you live, Morgenstern says, you need to get to the hospital fast if you have stroke symptoms, like sudden numbness or paralysis; trouble seeing, speaking, or walking; or a severe headache. Yet only about 30 percent of victims seek medical help within the critical three hours after a stroke when the only drug shown to be effective against stroke — TPA, or tissue plasminogen activator — is most effective.

“But there are also non-obvious symptoms, and sometimes a large stroke injury may have no symptoms,” says Silver, of Henry Ford Hospital. “In tests of people over 65, 10 percent had evidence of strokes and brain damage.”

Even if the symptoms go away, a person should be examined by a doctor, experts say. For example, a patient may have had a transient ischemic attack (TIA), sometimes called a ministroke — a warning sign that a much larger and devastating stroke may happen soon.

All these warnings are even more urgent for African-Americans, who suffer from strokes at a higher rate than any other group, research shows. According to the American Stroke Association, about 48.1 white males and 47.4 white women die of stroke per 100,000 population; while the rate for black males is 73.9 and for black women 64.9. Experts believe the sharp difference is due to the higher incidence of obesity, smoking, and especially high blood pressure among black people. In addition, sickle cell anemia, common among blacks, can block blood vessels in the brain and cause a stroke.

Two big factors in avoiding stroke, as well as recovering from one, are to simply eat sensibly and get regular exercise, says Dr. Lisa DiPonio, clinical assistant professor in the department of physical medicine and rehabilitation at the U-M Medical Center.

“I can tell you from experience that people who take care of their bodies do 100 times better after a stroke,” she says. “They walk, talk, eat better — they recover faster. If they have normal weight and worked out before the stroke, I talk to them about aggressive rehabilitation. But if they’re overweight and didn’t exercise, my feeling about being aggressive is much less.” And the longer the rehabilitation period, the bigger the price tag. Two to six weeks of in-hospital rehab usually follow a stroke and are part of the hospital bill. But once the patient leaves the hospital, outpatient therapy can cost $25,000 or more, depending on progress and what an insurance company will pay for.

Then there’s the cost of a nursing facility — or if the patient goes home — a private caregiver. If the caregiver is a family member, as is frequently the case, he or she usually has to quit outside work, DiPonio says. That can mean years of lost wages.

“For each survivor, recovery is unique to themselves,” Cornelis says. “Getting over a stroke is like training for a marathon every day.”

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