healings in motion central valley stroke guide, 4th edition

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Mission Statement ......................................................................... Page 2

We Are Making Progress by Ken Cohen, Director, Health Care Services, San Joaquin County......................... Page 4

Stroke Remains a Public Health Problem by Alvaro Garza, M.D....... Page 8

Increasing Stroke Awareness by Mary Nicholson,

Founding Director, Healings in Motion............................................ Page 11

What is a Stroke by Mary R. Lopez, RN, MSN................................. Page 12

Know Your Stroke Risk Factors by Mary Velasquez, MS, NP............. Page 14

Blood Pressure: In Perspective by Manny Alfonso, RN, MSN.......... Page 18

Having Stroke Symptoms? Why Call 911....................................... Page 22

Certified Stroke Centers by Breanna Garrison, MSN, RN................. Page 24

Telehealth &Telemedicine................................................................ Page 28

The Telestroke System..................................................................... 4

Your New Community Pharmacist, Ken Stearns............................... Page 36

Navigating Through Recovery by Pam Galley, RN, MAOL............... Page 39

Acute Rehab by Monique Bedi, RN, CRRN...................................... Page 52

Cooking Post-Stroke by Rosanna Redding....................................... Page 54

Financial Solutions Before and After Stroke by Jim Chong............... Page 62

Stroke Support Group..................................................................... Page 64

Brain Aneurysm/AVM Support Group............................................ Page 65

Stroke & Caregiver Support............................................................ Page 66

Sutter Stroke Camp........................................................................ Page 68

Resources/Glossary...................................................................Page 70 - 83

Helpfull APPS Supporting Recovery................................................. Page 84

Glossary.............................................................................. ............ Page 86

Table of Contents

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Healings in Motion Mission Statement Healings in Motion’s mission is to increase stroke awareness through educational programs and events and support recovery from stroke, Traumatic Brain Injury and some neurological impairments. Healings in Motion also supports Caregivers, who play an intricate role in recovery.

Acknowledgements Planning and coordination of the Central Valley Stroke Guide was led by Mary Nicholson, Founding Director of Healings in Motion. Partners for Stroke Awareness and Progress collectively contributed articles, expertise and camaraderie to provide a useful tool for stroke survivors, caregivers, Social Workers, Clinicians, medical teams and others serving San Joaquin County and Stanislaus County.

Healings in Motion recognizes that there are many other resources that may not be featured in this publication. Information printed in the Central Valley Stroke Guide is provided voluntarily by agencies or determined to be helpful resources for stroke awareness and/or stroke care. Inclusion of an agency or service does not imply endorsement, nor does exclusion reflect a business or organization’s contribution to the community, stroke awareness and/or stroke care.

Advertising Policy Statement The acceptance of advertising in this publication does not constitute or imply an endorsement by Healings in Motion and it is highly recommended that you consult your doctor before using any medicine or therapy.

Healings in Motion accepts no responsibility for any claims made in any advertising in this publication. This guide is to increase your options and know what services and products are available. It is up to you to investigate and determine if anything presented in this guide is beneficial to you. Contact information provided in this guide has been confirmed to the best of our ability.

Send inquires and/or donations to Healings in Motion, 56 S. Lincoln Street, Stockton, CA 95203 or [email protected]

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Today I am pleased to share good news that San Joaquin General Hospital (SJGH) is now a Level III Trauma Center and accreditation of both San Joaquin General Hospital and St. Joseph’s Medical Center as “stroke centers” of excellence. Other hospitals in our community are working toward this certification as well. It wasn’t that way just a few years ago. Due to the recession, many of the patients seen by SJGH disproportionately suffered preventable chronic diseases and behavioral health conditions. In addition, a high percentage of patients were diabetic and subsequently depressed.

Our goal was to increase continuity of care and safety for our patients. By estab-lishing a successful plan for trauma care and stroke management, including increasing stroke response protocol, we all made progress as a community and together we can continue.

I recently received a call from friends, who informed me that their five year old niece had been rushed to Massachusetts General Hospital, in Boston, with a stroke. Subsequently, the niece was diagnosed with a rare form of Leukemia. But it was the quick action of the parents, who recognized the symptoms of stroke in their very young daughter that resulted in her receiving immediate medical care. That action probably saved this little angel’s life. This incident reminded me again that treatment of stroke requires many elements to be successful. It requires knowledgeable people being able to recognize the symptoms of stroke and to seek immediate and timely medical care. It requires pre-hospital paramedics to work with hospital emergency departments to treat and transport stroke patients to the nearest hospitals with the capacity to provide the very best care possible. It may require critical rehabilitation, post hospital and in-home support services; and it always requires a dedicated and

We Are Making ProgressKenneth B. Cohen, Director, Health Care Services Agency

San Joaquin County

loving family and care givers involvement and support through the recovery process. This is a complex team effort and all of the elements must function accordingly.

Although we “are making progress” in San Joaquin County, there is much more to do. Recent national studies and the Centers for Disease Control (CDC) research have reported that more and more people are having strokes at younger ages noting that in 2009, between 532,000 and 852,000 people between the ages of 15 and 44, in the US, may have had a stroke. While the underlying reasons for this are still being researched, experts point to the increase in risk factors such as diabetes, high blood pressure and obesity among this population being a possible cause. And as I came to understand, even rare medical conditions can result in stroke, and that is of-ten the first symptom of the underlying disease. So, if you think you are too young for a stroke, think again.

Community outreach and education is valuable in awareness and prevention. It is a privilege for me to support the patient-driven agency, Healings in Motion. Healings in Motion promotes prevention and advocates for people who have had strokes and brain injuries. They also support the vital role Caregivers play in recovery and Healings in Motion has provided a lot of the remarkable local energy that is needed to motivate improvements and drive progress.

Let’s work together to intensify the community health education needed to inform the public about risk factors for stroke, including the early signs of stroke in the youngest of patients, and what might be done to reduce them. Physicians and medi-cal practitioners need to be mindful of and incorporate into their medical practices screening tools for diabetes, obesity and high blood pressure for even their youngest patients. Emergency Medical Services (EMS) Agency will continue to enhance our local 911 system to assure that it continues to provide rapid care and transport to those hospitals that are capable of providing the best care and treatment. About Kenneth Cohen. Under Ken’s leadership, the following agencies provide San Joaquin’s health services: San Joaquin County Public Health, Behavioral Health, Emergency Medical Services, Correctional Health Services, Veteran Services and Public Guardian/Conservation. Ken also serves as Chairman of the Board for Health Plan of San Joaquin County

Kenneth Cohen, Director of Health Care Services for San Joaquin County

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Stroke Remains a Significant Public Health Problem

Alvaro Garza, MD, MPHMedical Director, San Joaquin County Public Health

Cerebrovascular accidents, commonly known as stroke (and, because of their similarity to heart attacks, are also referred to as brain attacks) happen when a clot blocks the blood supply to the brain or when a blood vessel in the brain ruptures.

Stroke is a leading cause of death in the U.S. Every year, nearly 800,000 people in the U.S. have a stroke, and nearly 130,000 of them die; that’s one of every 19 deaths. Strokes cost the nation nearly $40 billion yearly, including health care, medications, and lost productivity.

In San Joaquin County, stroke is the fifth leading cause of death. With a yearly aver-age of about 276 deaths, it accounts for just under 6% of all, or about one of 17 deaths. The death rate from stroke, at just under 45 per 100,000 people, com-pares poorly with the rate for California, at under 37. Statewide, the highest death rate from stroke is among African-Americans.

In our county, nearly ten percent of adults aged 65 and older have had a stroke, compared to under nine percent statewide, and the highest rate is in those over 79 years of age. These lead to a hospitalization rate for stroke of about 560 per 100,000 population, compared with 520 for California; or just under 4000 stroke hospitalizations yearly in the county and about 200,000 in the state.

Heart disease and stroke are often mentioned together as they’re both possible results of cardiovascular disease and they share risk factors. Thus, taking actions to prevent one helps prevent the other.

Common modifiable risk factors include: high blood pressure, high cholesterol, tobacco smoking, overweight and obesity, diabetes, excessive alcohol intake, and physical inactivity.

Stroke is an important public health problem, affecting a significant portion of our communities. Social and environmental conditions influence all of the risk factors mentioned and can be improved for the betterment of all. For example, education and training, good-paying and safe jobs, safe neighborhoods where all residents can do physical activity, affordable healthy foods within walking distance, and affordable accessible transportation to important sites for daily activities. As these social and en-vironmental conditions improve, so do our opportunities for healthy choices. As a result, our stress is reduced, our blood pressure is lowered, we do less smoking and drinking, we reduce or control our weight better and our cholesterol is lowered. The result is better cardiovascular health and less suffering from stroke.

Together, we can all help make the healthy choices be the easy choices every day, everywhere for everyone.

Alvaro Garza, MD, MPH

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Increasing Stroke Awareness Mary A. Nicholson

Founding Director, Healings in MotionCoordinator, Partners for Stroke Awareness

“Strokes only happen to old people”, “I’m physically fit, a stroke can’t happen to me”, “strokes only happen to poor people”. These are some of the misconceptions about a stroke. A stroke can happen to anyone at any age, not just the elderly – more than 30 percent of strokes occur in women before the age of 65. Women have fewer strokes than men (43%), however, more women than men die (62%) from a stroke. A baby can have a stroke in the mother’s womb. While strokes are occurring to people at a younger age, the risk of a stroke increases with age. Every 45 seconds someone is having a stroke. As a stroke survivor, I can tell you about the pain and stress endured by everyone in my

circle. Luckily for me, everyone pitched in to help. Stroke can be devastat-ing. It is the leading cause of adult disability in America, and the number one reason for nursing home admission. Stroke is also the 4th cause of death both nationally and in the state of California. Surviving a stroke comes with a price. Stroke can completely take away your abilities to walk, talk, think, remember or even breath. Everyone is a stake-holder in stroke awareness. It could save your life or someone near or dear you. Partners for Stroke Awareness and Progress You are invited to become a Partner for Stroke Awareness and Progress in San Joaquin and Stalaus Counties. Working together we surely can make a measurable difference. For more information call Healings in Motion at (877) 672-4480 and stay connected at www.strokecentral.org and “like” us at www.facebook.com/strokehub . Think F.A.S.T.!!! References: The Establishment of an Optimal System of Acute Stroke Care for Adults -A Statewide Plan for California http://www.cdph.ca.gov/programs/cvd/Documents/CHDSP_stroke_system_2009.pdfUnited to Increase Stroke Awareness in Our Community!

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What is a Stroke?Mary R. Lopez RN, MSN

Administrative Director, Patient Care Services Dameron Hospital - Celebrating 100 years!

A stroke, often called a cerebrovascular accident (CVA), is what happens when blood can’t reach the brain. It may be called an ischemic stroke (most common) or a hemorrhagic stroke. Although the two types of stroke occur differently, the risk factors and outcomes are often the same. Let’s explore both types.

The Ischemic Stroke

An ischemic stroke occurs when a blood clot or other blockage in an artery keeps blood from reaching the brain. Clots form when blood vessels become clogged with fat and cholesterol, a condition known as atherosclerosis. In this case,

blood can’t reach the brain, and brain cells suffer from the lack of nutrients and oxygen that would normally nourish the brain cells.

There are actually two different types of ischemic stroke, depending on where the clots form. Clots can form inside a blocked blood vessel in the brain causing a thrombotic stroke. Embolic strokes result from clots that form elsewhere in the body and travel toward the brain until they become blocked in a narrow artery.

Ischemic strokes may also be caused by a deformity in a valve within the heart or as a result of a condition called endocarditis. This occurs when the lining inside the heart becomes inflamed that creates a non-smooth surface. Clots can form on these non-smooth surfaces and then break off and travel to a small artery in the brain.

The Hemorrhagic Stroke

A hemorrhagic stroke occurs when a blood vessel in the brain bursts or breaks, causing bleeding in the brain. This type is most often a result of:

1. Long term (chronic) high blood pressure that constantly puts pressure on the vessel wall;

2. An aneurysm which is a weaken portion of a vessel that balloons out and eventually ruptures and causes bleeding within the brain;

3. An arterio-venous malformation, or AVM, which is a group of malformed blood vessels that can rupture and cause bleeding in the brain; or

4. The buildup of the protein amyloid inside the arteries which can cause a hemorrhagic stroke, especially in older individuals.

Transient Ischemic Attach

A transient ischemic attack (TIA) is a so-called pre-stroke, or a warning sign of an impending serious stroke that could cause damage. A TIA does cause temporary stroke symptoms that then go away, but it means you should get checked out immediately by your doctor or in a hospital emergency department, and start making changes to prevent a more serious stroke.

References:www.strokeassociation .orgwww.mayoclinic.org/diseases-conditions/stroke www.nlm.nih.gov

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Know Your Stroke Risk FactorsMary Velasquez MS, NP, ACNP-BC

Chest Pain Center l Stroke Program CoordinatorMemorial Medical Center, Modesto, California

The chance of having a stroke increases if a person has certain risk factors, or criteria, that can cause a stroke. Many strokes can be prevented – the best way to protect yourself and others from stroke is to understand personal risk and how to manage it.

Two types of Risk Factors – Controllable and Uncontrollable

Controllable risk factors generally fall into two categories: lifestyle risk factors or medical risk factors. Lifestyle risk factors can often be changed, while medical risk factors can usually be treated.

Uncontrollable risk factors include age, gender, race, heredity, previous stroke or TIA (Transient Ischemic Attack.

• Age — The chance of having a stroke approximately doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.

• Heredity (family history) — Your stroke risk may be greater if a parent, grandparent, sister or brother has had a stroke.

• Race —African Americans have a much higher risk of death from a stroke than Caucasians do. This is partly because blacks have higher risks of high blood pressure, diabetes and obesity.

• Sex (gender) — Stroke kills more women than men. Use of birth control pills, pregnancy, history of preeclampsia/eclampsia or gestational diabetes, oral contraceptive use, and smoking, and post-menopausal hormone therapy may pose special stroke risks for women. Be sure to discuss your specific risks with your doctor.

• Prior stroke, TIA — These are “warning strokes” that produce stroke-like symptoms but no lasting damage. A person who’s had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn’t. Recognizing and treating TIAs can reduce your risk of a

major stroke. TIA should be considered a medical emergency and followed up immediately with a healthcare professional.

• High blood pressure —This is the leading cause of stroke and the most important controllable risk factor for stroke.

• Cigarette smoking — The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.

• Diabetes mellitus — Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. While diabetes is treatable, the presence of the disease still increases your risk of stroke.

• Carotid or other artery disease — The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed (stenosis) by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked by a blood clot.

• Peripheral artery disease — PAD is the narrowing of blood vessels carrying blood to leg and arm muscles. It’s caused by fatty buildups of plaque in artery walls. People with PAD have a higher risk of carotid artery disease, which raises their risk of stroke.

• Atrial fibrillation — The heart’s upper chambers quiver instead of beating effectively, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.

• Other heart disease — People with coronary heart disease, heart attack or heart failure, dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects like Patent Foramen Ovale (PFO or Hole in the Heart) also raise the risk of stroke.

• High cholesterol causes an increased risk for stroke. Also, it appears that low HDL (“good”) cholesterol is a risk factor for stroke in men, but more data are needed to verify its effect in women.

• Physical inactivity and obesity — Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs. Try to get a total of at least 30 minutes of activity on most days.

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Remember, the best way to protect yourself and others from stroke is to understand your risk and how to manage it.

Sutter Health Stroke Team, Modesto, Left to Right: Annie, Administrative Assistant, Cindy Young RN, Stroke Performance Improvement, & Mary Velasquez, Missing: Dr Harner, Neurology Medical Director

Mary Velasquez MS, NP, ACNP-BC is a nurse practitioner at Memorial Medical Center (MMC). She is a Certified Cardiovascular Care Coordinator, the MMC STEMI Center Program Manager, & Stroke Program Coordinator for MMC’s Chest Pain Center. Mary has over 25 years of experience working with stroke patients and providing care and treatment.

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Blood Pressure: In PerspectiveManny Alfonso RN MSN CNS CCRN

Clinical Nurse SpecialistSt. Joseph’s Medical Center

Blood pressure, a two-word phenomenon, does not really require the myriads of medical jargons that are often confusing and misunderstood to define its’ mechanisms for the novice. Allow me to offer you some simplistic analogies and metaphors of each word to appreciate its’ essence in sustaining life. Blood is produced within the body with the sole intent of what may be comparable to become a messenger or a courier that delivers sustainable “goods” vital to life. These sustainable “goods” are in the form of oxygen for us to breathe and nutrients that our body needs to meet the energy demands of our everyday lives.

However, blood rich in oxygen and nutrients within the body is USELESS, unless its mission in life to sustain life itself is not mobilized. Now enters the word “pressure” as in blood pressure with this question in mind: What is blood pressure? It is the force that moves blood through our circulatory system. How does these life-sustaining “goods” arrive to the major organs of the body such as the lungs, heart, brain, kidneys, liver and stomach? What major body organ, that perhaps without it, nothing else matters? It’s the heart, often called the “the pump” that circulates the blood throughout the body. Each heart beat is the “pump” or pulse that drives the flow of blood within a very efficient and intricate maze circuitry made up of arteries and veins, very similar to pipelines or plumbing system that are inter-connected to the major organs. The arteries are the strongest and compliant blood vessels with elastic properties. Within these “pipelines” travel the oxygen & nutrients-rich blood for distribution to the major organs so that each can perform their mission in life to keep us healthy and alive. The veins on the other hand, are also blood vessels or pipelines that work in concert with the arteries, collecting “used blood” after the major organs have consumed the “goods” from blood delivered by the arteries. Think of a “round-trip ticket” metaphor…when the arterial “pipelines” delivers the oxygen & nutrient-rich blood to the major organs, the vein pipelines collects these “used blood” for “recycling” in the lungs, it’s delivered back (round-trip ticket) to the heart to repeat the cycle of pumping blood with pressure created by every heartbeat. >Normal Blood Pressure As blood flows, it exerts its’ force against the sides of the blood vessels. The strength of this force is the blood pressure. Another analogy one can imagine, much like certain areas the California State Highway System, blood vessels

can get damaged through wear and tear in due time. One need not go very far from the Stockton community to observe and experience the bump and grind of highway construction between I-5 and State Hwy 99. These much needed and overdue repair will provide added relief and safer travel. Take this analogy to the wear and tear of constant barrage high blood pressure against the walls of the blood vessels, especially the arteries. Narrowing of the arteries, especially the ones that are closer to the major organs can cause HIGH blood pressure. High blood pressure against the walls of the “plumbing system” can lead to “potholes” that weakens it. Substances such as high cholesterol level in our body begin to stick against the walls of the plumbing system, causing it to narrow and become less pliable or less elastic.

The heart itself can also accumulate unwanted fatty deposits within the small arteries called coronary arteries, causing them to get stiff and narrow and can lead to heart attack. No tax dollars will be able to repair them as in our highway system. Once the damage is done, the body will just try to adjust from the “grid-locks” that causes resistance within the blood vessels. How? The heart will have to “pump” harder try to push the flow of blood through the plumbing system against resistance. High blood pressure, therefore, is the only means that blood flow through the plumbing system that the body gets accustom to. In time, the heart will begin tire and fail, thus leading to heart failure. High blood pressure can clip-off portions of fatty deposits, clots that can travel to the brain. These clots can block delivery of the “goods”, causing the brain cells to “starve” and die due to lack of oxygen and nutrients. High blood pressure can also cause a stroke in the brain by causing the plumbing system there to become weak by the shearing force of high blood pressure. The weakened walls of the blood vessel as the result of this shearing force can cause a tear leading to blood leaking throughout the brain, bleeding stroke also called hemorrhagic stroke.

What does the blood pressure reading actually means? There is the top number called “systole” and the bottom number called “diastole”. Think of the top number or systole as the heart muscle beating or contracting to push the “goods” through the plumbing system. On the other hand, think of the bottom number or diastole as the very short time period that the heart muscle is relaxed after each beat or contraction, so that it can fill with blood to repeat the cycle again (heartbeats). According to the National Heart, Lung and Blood Institute:

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Categories for Blood Pressure Levels in Adults

Category Top Number Systole Bottom Number DiastoleNormal Less than 120 And Less than 80

Pre-High Blood Pressure 120-139 Or 80-89High Blood PressureStage 1 140-159 Or 90-99Stage 2 160 or higher Or 100 or higher

As you can see in the sample table above, the lower the number in Systole or top number as in 118/70, the less the heart has to push its’ pressure within the plumbing system to deliver the “goods”. Also the higher the bottom number or Diastole, the more that the heart has to try and stretch like a rubber band on a sling shot (the stretching is the Diastole, the bottom number) to create enough force for each heartbeat as in 170/100. The stretching force of a rubber band can only last for a short period of time as it loses elasticity and becomes saggy due to over-use. Think of the bottom number Diastole as the stretching of the rubber band because the top number Systole is very high due to resistance within the plumbing system…the bottom number Diastole has to continually stretch to create enough power to push or high pressure to deliver the “goods” > High Blood Pressure.

To maintain normal blood pressure and prevent high blood pressure, keep a health body weight; eat diet rich in fruits and vegetables, and low-fat dairy products, cut down on salt intake, take regular aerobic exercise (e.g., brisk walking) at least 30 minutes a day, most of the week and moderate alcohol drinking – keep under a maximum of 2 drinks a day for men and 1 drink a day for women.

References: www.nhlbi.nih.gov

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Having Stroke Symptoms?Why Call 911 and What Happens When You Do

When you call 911, a call-taker will answer the phone and say “911” or “911, what’s your emergency?” Ideally, you should tell the call-taker what the emergency is, for example:

• “Looks like my husband is having a stroke!”

• “My mother is having a stroke!”

• “My neighbor has stroke symptoms…”

The best and fastest way to get a response to your emergency is to patiently answer all the questions the call-taker asks you. Seeing the “sudden” change in a love one is difficult and you understandably may be terrified, but if you can remain as calm as possible and answer questions clearly, things will go much faster. When seconds count, you don’t want to waste any time repeating yourself, or screaming while the call-taker tries to calm you down.

It may seem like the call-taker is wasting time asking silly questions, but what you don’t know is that an ambulance is already in-route to your location. Answering the questions save paramedics/ officers/deputies precious time at the scene because your information is being relayed to them over their mobile data terminals. Also, it may seem that questions are irrelevant or obvious, but call-takers follow a set pat-tern of questions that have been proven to be important. At every call, the call-taker has a fill-in-the-blank screen on his/her computer that is to be followed. The screen includes the location of the person having the stroke, the name, address, and phone number of the reporting party, space for more details if needed, and a space for the call type. All the questions help paramedics know what to expect upon arrival and actually speeds up the process.

Paramedics are trained to identify the stroke symptoms and move swiftly to take the person to a hospital that is trained in stroke excellence. There is a plan already established with Emergency Medical Services and the hospitals, including a stroke team, ready to meet paramedics upon arrival and take the patient for immediate care. Hospitals who are Certified Stroke Centers have a protocol including a pro-cess called, “door to needle”. That means that if you can get to the hospital within 3 hours of the on-set of the stroke systems and you are not having a hemorrhagic (bleeding) stroke, and not using blood thinners, you may qualify for the only FDA

approved blood clot-busting agent, (Plasminogen Tissue Activator (“tPA”), which may reverse the stroke symptoms.

When someone is having a stroke, the brain is being deprived of oxygen and nutri-ents. The longer it takes to get help, the more potential damage is being done to the brain. That is why it is said that, “Time is Brain!”

Cheryl Heaney-Ordez, RN, MSN, Director, Emergency Services, Stroke Program Team Leader, Dignity Health at St. Joseph’s Medical Center, points out that “one of the most important things you can do to improve your chances of recovering from a stroke, is to activate the 911 system early. We [St. Joseph’s Medical Center] oftentimes see many patients who put off coming to the emergency department for several hours and sometimes the next day. Unfortunately, for these patients, it is often too late for us to do anything that could potentially reverse the effects of the stroke. So remember this simple phrase if you, or someone you know, thinks they may be having a stroke: F.A.S.T. – Face is drooping, Arm is weak, Speech is unclear or slurred, Time to call 911 for help. Remember that time is of the essence, so act fast and calls 911 early on - don’t wait!”

When you call 911 you put a team into action right away for the best stroke care.

From left to right:Dr. Michael Herrera, Stroke Program Co-Medical Director; Jason Ellison, PharmD; Dennis Elmer, RN, BSN, ED Clinical Educator; Cheryl Heaney-Ordez, RN, MSN, Director Emergency Services, Stroke Program Team Leader; Meg Borelli, RN, Quality Services, Stroke; Rae Charos, DNP, RN, FNP, Vice President/Chief Nurse Executive; Manny Alfonso, RN, MSN, CNS Stroke Unit; Tuan Ly, RN, MSN, Director Stroke Unit; Dr. Dean Karnaze, Stroke Program Medical Director. Not pictured: Dr. Venkata Emani, Stroke Team Chair

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Certified Stroke CentersProviding a Higher Standard of Care for the

CommunityBreanna Garrison, MSN, RN, CNL, CNRN, SCRN

09:00 - “My arm is numb.” “That is strange, why does my arm feel numb all of a sudden? I’m sure it will go away in a few minutes.”

09:05 - “My arm is still numb.” “Could I be having a stroke? No, not me, I’m sure it’s something else: something I ate, something I did…”

“Am I having a stroke?” “I’m having a stroke.”

Do not delay if you have signs or symptoms of stroke.

Dial 911 and get to the Emergency Room immediately. Ideally request to go to the nearest stroke center.

Time is brain, quite literally (Saver, 2013). There are immediate treatment options

for some types of stroke, and time is extremely important in determining these

potential treatment options. High quality treatment and management of stroke

patients are primary goals of Joint Commission Certified Primary Stroke Centers.

The Joint Commission is an organization that certifies facilities as Primary Stroke

Centers. The Joint Commission’s Primary Stroke Center Certification Program was

launched in 2003, in collaboration with the American Heart Association/American

Stroke Association. Becoming a Primary Stroke Center is a voluntary process; that

is to say that the hospital electively applies to become and maintain Primary Stroke

Center certification by meeting certain stroke and transient ischemic attack (TIA or

“mini stroke”) patient care standards, while maintain a focus to improve outcomes in

this patient population (Joint Commission, 2014).

The role of a Joint Commission Certified Primary Stroke Center is to provide the

community a high standard of care. Patient care standards are outlined and must

be met in order to meet this certification achievement. These standards of care

range from immediate care in the Emergency Room (ER), to assuring appropriate

follow up care after discharge from the hospital. One example of a requirement

of a Primary Stroke Center is the ability to provide 24 hour a day / 7 day a week

access to a physician knowledgeable about the acute treatment of stroke (both

types – ischemic (clot) and hemorrhagic (bleed)); so no matter when the stroke

occurs, at midnight or a six in the morning, the patients receive consistent and high

quality care. Imbedded in the criteria of a Primary Stroke Center is implementing

best practice guidelines. Essentially this means that the facility and all the healthcare

providers (physicians, nurses, therapists, pharmacists, radiologists, etc…) follow

recommendations for best possible patient care. This establishes a consistent

approach to caring for each individual who is cared for at the stroke center (Joint

Commission, 2014).

So, what does this mean for the community? As a Primary Stroke Center, the

expectation is that the stroke or TIA patient will receive ALL necessary care. This

includes appropriate treatment in the ER, whether that means treatment with the

clot-busting medication for some types of stroke (tPA- tissue plasminogen activator),

blood pressure management, surgical intervention, or transfer to higher level of care

as necessary (This may include the need to transfer to a more comprehensive stroke

Breanna Garrison, MSN, RN, CNL, CNRN, SCRN

Stroke Coordinator/ Neuro Clinical Specialist Doctors Medical Center Modesto

26 27

center depending on the type of stroke and resources required). These expectations

of care are set throughout the entire patient’s stay at the stroke center: Does the

patient need to be on a medication to prevent blood clots, does the patient have any

abnormal heart rhythms that need to be managed, what are the patient’s personal

risk factors for preventing future strokes, has the patient received all necessary

education related to stroke, has the patient been seen by a physical therapist or

occupational therapist if needed, etc… As the treatment and management of stroke

changes, or as new discoveries of best care are put into practice, the stroke center

must also continue to evaluate and review updated treatment recommendations to

make sure the facility is constantly providing the highest level of care.

Prevent the leading cause of disability in the United States – Stroke (Go, et al, 2014).

Prevention of stroke is another role of Primary Stroke Centers, as approximately

80% of stroke are preventable (National Stroke Association, 2014). Again…80%

OF STROKES ARE PREVENTABLE. Prevent a stroke by knowing your personal risk

factors AND work to manage your risk factors.

The risk factors for stroke are high blood pressure, diabetes, smoking, physical

inactivity, high cholesterol, atrial fibrillation, to name just a few.

Know the signs and symptoms of stroke – Spot a Stroke F.A.S.T. Facial drooping, Arm weakness (or leg weakness), Speech difficulty, Time to call 911 Know the less common signs and symptoms of a stroke – Sudden dizziness/loss of balance or coordination, sudden vision change/loss, or sudden severe headache. These could also be signs of a stroke. When an Ischemic stroke occurs it is rarely painful, so know the signs and Act FAST to spot a stroke and save a life. Stroke is Preventable, Treatable, and Beatable (AHA, 2013). Find award winning hospitals near you; this link shows Joint Commission Certified Primary Stroke Centers and facilities that meet the goals and patient care quality standards of the American Heart Association/American Stroke Association Get With The Guidelines Awards. http://www.heart.org/HEARTORG/HealthcareResearch/FocusonQuality/QualityMap/My-Healthcare-Quality-Map_UCM_448880_

SubHomePage.jsp

References Advanced Certification for Primary Stroke Centers. (2014). The Joint Commission. Retrieved July 30, 2014 from http://www.jointcommission. org/certification/primary_stroke_centers.aspx Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., Blaha, M., et al. (2014). Heart Disease and Stroke Statistics 2014 Update: A Report From the American Heart Association. Circulation, 129, e28-e292. Saver, J. L. (2006). Time is Brain – Quantified. Stroke, 37, 263-266 Stroke Prevention. (2014). National Stroke Association. Retrieved July 30, 2014 from http://www.stroke.org/site/ PageServer?pagename=PREVENT Warning Signs of Stroke. (2014). American Heart Association/American Stroke Association. Retrieved July 30, 2014 from http://strokeassociation. org/STROKEORG/WarningSigns/Stroke-Warning-Signs-and-Symptoms_

UCM_308528_SubHomePage.jsp

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TELEHEALTH

Telehealth describes a mode of delivering health care services and public health via communications technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth and telemedicine have transformed the delivery of health education and the practice of medicine by eliminating the significance of time and distance. Telehealth has emerged as a critical component of the healthcare crisis solution and holds the promise to significantly impact some of the most challenging problems of our current healthcare system: access to care, cost effective delivery, and distribution of limited providers. Telehealth can change the current paradigm of care and allow for improved access and improved health outcomes in cost effective ways. Use of Telehealth Consumers: Consumer demand for and availability of a wide range of self-health promotion, education, care, and in-home telehealth applications are emerging. As a result of the rapid expansion of the Internet, the lines of distinction between consumer, provider, professional, and student are becoming less distinct with the assistance of information technology. Here are ways that telehealth is being integrated into today’s lifestyles and business landscape. 1. Internet access from home or local libraries. Some libraries offer “Doc in a Box” where consumers, using computers, can ask a physician, located at a hospital, questions related to stroke care, headaches or other medical questions. 2. Another information source is through telephone dial-in services, noted in local telephone directories and newspapers, which identify ways to access audio tapes on a variety of health and environmental issues. Professional: Continuing education courses for physicians and other health care providers. Provider: Providers use of the internet or videos, by facilities and practitioners, provides patients and their care givers with information regarding disease processes, recovery or rehabilitation programs, and home care information.

Community: Access to the California Smoke-Free Cities program cosponsored by the California Healthy Cities Program, in partnership with the League of California Cities. Collaboration: Professional: Area medical specialists and other professionals can meet via teleconferencing in libraries, community colleges, hospitals, and other sites to keep stakeholders connected and updated. Public health offices can broadcast health alerts to all providers and practitioners in the community. Physicians and facilities use professionally prepared videos to educate patients preoperatively, giving the patient time to develop and discuss questions prior to a procedure.

Reference: CA Telehealth Resource Center 2001 P. Street, Suite 100, Sacramento, CA 95811 (877) 590-8144, www.caltrc.org

TELEMEDICINE

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Mike Lapolla, Director of Academic Health Services and Director of the Telemedicine Center in Oklahoma suggests that telemedicine is “the metaphor....for an electronic umbilical cord that professionally links metropolitan and rural health care providers. Who knows the countless ways that we can all benefit from that?”

Telemedicine has already demonstrated that it can improve accessibility to health care services. Without it, both physicians and patients are limited to relatively immediate geographical vicinity. Telemedicine has the potential of having a greater positive effect on the future of healthcare and medicine, especially in rural, underserved or remote areas where it can bring high-quality care where often little (or none) is available. Propelled by advances in multiple technologies such as digital communications, full-motion/compressed video, and telecommunications, providers see an unprecedented opportunity to provide access to high-quality care, independent of distance or location. Telemedicine is quickly expanding beyond hospitals to broader points of service in the public and private sectors, including home health, long-term care, and correctional facilities

Because telemedicine, the physician’s black bag has boundless potential to practice medicine and for health professionals to provide health education in the same fundamental manner as they have always done. Telemedicine has already demonstrated that it can improve accessibility to health care services. Without it, both physicians and patients are limited to relatively immediate geographical vicinity.

MEDICAL SPECIALTIES

Telemedicine can support many other functions including:

Cardiology Obstetrics Psychiatry and Psychology Dentistry Oncology Radiology Dermatology Ophthalmology Rheumatology Gynecology Orthopedics Speech Neurology Pathology Surgery and surgical subspecialties Neurosurgery Pediatrics Toxicology Nephrology/renal Pharmacology Trauma/disaster medicine dialysis Pharmacology Wound Care Vital Sign Monitoring

Home Health

The need for increasing home health services is being driven by several factors including: demographic trends, the shift in health care to more cost-effective approaches such as managed care and other risk-sharing systems, and the desire of patients, health care delivery organizations, practitioners, payers, and employers to control costs while still providing quality care. As a result, the home health care market is poised to expand dramatically.

Home health care can be delivered using a variety of technologies, such as: telephones, computers, monitoring devices, and interactive video (via cable television) that can help reduce or eliminate patient travel for hospital or clinic visits, resulting in lower costs for the patient. Home-based telemedicine could be particularly effective for post acute hospital care and for monitoring patients with such conditions as asthma or diabetes. Monitoring allows preventive measures to be taken before problems get so severe that hospitalization becomes necessary. This could be particularly helpful to people whose mobility is limited or who may not be well enough to travel. Telemetry devices for providing electrocardiograms and blood pressure readings could provide a more cost-effective method of care by reducing medical visits for conditions that are not severe and for preventable purposes.

Home Telehealth and Remote Monitoring

Home Telehealth is a service that gives the clinician the ability to monitor and measure patient health data and information over geographical, social, and cultural distances. This monitoring includes use of both video and non-video technologies. The application of these technologies allows for increased access to health services, improved disease management, improved self-care management and earlier and proactive interventions for positive outcomes.

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The decisions of which technology to use are driven by the patient’s clinical need and the objectives and resources of the organization. Technologies utilized include: Store & Forward, video, messaging, and remote monitoring which may include some or all of the following sensors- ECG, pulse oximetry, vital signs, stethoscope, weight , and glucose.

Home telehealth technologies can support post-discharge, home health, chronic care management, schools, skilled nursing facilities, sub-acute care and senior living facilities. Home telehealth & remote monitoring technologies can provide education, monitoring, patient self-directed care and the ability for individuals to have more effective access to health care. These applications extend the vision of the clinician to facilitate quicker assessment and proactive intervention for many populations living with chronic and acute healthcare problems to improve quality of life.

Telemedicine and Long-Term Care

Access to a range of medical specialties can be cost effectively provided by telemedicine to residents of long-term care facilities. Travel time, cost, and inconvenience are avoided by eliminating travel except in cases where the consultative diagnosis shows that it is necessary for treatment, thereby improving the quality of care and reducing patient risk.

Beneficiaries of telemedical services would not be limited to patients. The family members of residents can benefit as consumers of health education delivered via communication networks, expanding their knowledge of topics related to their relatives. Primary care physicians and other caregivers at long-term care facilities could learn from increased direct consultative interaction with specialists and from formal educational events. Staff capabilities, morale, and retention, often a problem in the long-term care industry, is affected positively. The easy transmittability of patient electronic records, including digital images, are more conducive to a managed care environment. Specialists, hospitals, and other providers would gain access to more lives and would thus be able to spread their costs more effectively.

Comparing the benefits offered by telemedicine with the current and future needs of the long-term care segment of health care yields an undeniable, striking fit.

References:

US News and World Report, 2014, “Doctoring at a Distance, Advances in Telehealth Bring Remote Expertise Close” http://www.intouchhealth. com/downloads/USNewsandWorldReport2014Edition_InTouch.pdf

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The Telestroke System Enables Speedy Stroke Care

Using Videoconferencing Technology

Rather than driving long distances for care, doctors log into the Telestroke system and, via enhanced a “robot” videoconferencing technology, consults with onsite nurses and physicians to review or make a diagnosis for stroke patients.

Stroke is the fourth-leading cause of death and the top cause of adult disability in the United States, the 5th cause of death in the Central Valley. The brain gives us life and so time is important for brain health. Telestroke emphasizes speed. There is roughly a three-hour window from the time of the first stroke symptoms until the window closes on administering the tissue plasminogen activator, “tPA”, the best hope for busting the clots that otherwise can lead to permanent brain damage.

A patient with stroke symptoms arrives at the hospital with stroke symptoms. The emergency department team or stroke team confirms the stroke symptoms.

A telestroke physician is on-call 24/7. A nurse rolls out the robot –an InTouch RP-Lite or one of the other models, to the foot of the patient’s bed.

The vascular neurologist connects remotely to the robot via software on a

workstation, a personal laptop or even an iPad. The physician can pan, zoom and tilt the robot’s camera to the extent of checking the patient’s pupils. With headphones on, he or she can listen to the patient’s heart and lungs via a stethoscope on the robot, and talk to the patient. The patient, who sees the off-site neurologist’s face on a screen atop the robot, can answer. The doctor can guide the on-site ED staff as it works through physical tests involved in stroke diagnosis. The Telestroke neurologist and the on-site team both have access to the patient’s health records, which the neurologist updates. The neurologist makes a recommendation – for tPA hopefully.

Telestroke has been a game changer in stroke care. Now we just have to get everyone to respond to the stroke symptoms to put the best stroke care into motion. To learn more about telestroke, go to www.intouch.com

Alex G. Spanos Heart and Vascular Center

Mercy General Hospital, Sacramento, CA

Surgeons were among the nation’s first graduates from the International College of Robotic Surgery (ICRS). Surgeons perform more cardiac procedures than any other hospital in the state. With the daVinci Surgical System, surgeons are able to perform delicate and complex operations through few tiny incisions with increased vision, precision, dexterity and control. http://www.dignityhealth.org/sacramento/hospitals/mercy-general-hospital/alex-g-spanos-heart-and-vascular-center

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Your New Community PharmacistKen Stearns, Community Manager

Walgreens Company

The role of your community pharmacist is rapidly changing and the trends will continue to accelerate during this era of change in health care and the need for a healthier environment and future. Pharmacies are no longer just dispensing drugs. They are now providing important health services through innovative programs and approaches. Pharmacies are devoting more time to provide a wide spectrum of ser-vices. Some of these services include: screen tests, wellness programs, vaccinations, clinics and on-site educational events. With more engagement in wellness, pharma-cist are establishing valued partnerships and making care easier for the consumer. Pharmacists are also increasing the community pharmacy’s value as a health care resource.

Many important health care services, once solely rendered at a doctor’s office, are now available on a walk in basis. The Center for Disease Control and Prevention recommends yearly immunizations and health tests. To assist, Walgreens provides a wide range of health care and clinical services as extensions of our traditional phar-macy services. In addition to our extensive immunization program, Walgreens has expanded its preventive health care services. Testing for total cholesterol and HDL, blood glucose, and A1C is now available at over 1600 pharmacies in 33 states. Each test includes a free blood pressure check and personal consultation with a Walgreens pharmacist.

Furthermore, the passing of SB493 recognizes pharmacists in California as a “Health Care Provider “This legislation also establishes a new Advanced Practice Pharma-cist, whose roll is currently being defined and established by the California Board of Pharmacy. This change will further advance the practice of pharmacy and will allow the pharmacist to help in the evaluation and direct management of our patient’s healthcare.

These changes make it easier to help you manage your health care needs, whether it is stroke prevention or post stroke care. Medication goes hand-in-hand with recovery from stroke. It is comforting to know that your new community health care provider is your pharmacist, just down the block or only a call away.

The shift to having community focused pharmacy creates a win-win for both the patient and the pharmacist. Pharmacist will help you navigate through health care questions and address your needs, concerns and help you understand the meds prescribed.

Your neighborly friends at Walgreens invite you to stop by and meet us. Pharmacist, like Christine Chau, pharmacy manager at our West Lane location, has been with Walgreens for over 17 years. She is very dedicated to serving our community and providing health and wellness to all. You’ll find this same friendly attitude at all Wal-green stores.

Prevention & wellnessVaccines, Health Screenings & Testing, Physicals & Wellness Visits

TreatmentIllness, Aches & Pains, Minor Injuries, Skin Conditions

Monitoring & managementOngoing Health Conditions, Medications & Treatments

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Phone: (209) 248-7187 or email: [email protected]

1620 N. Carpenter Rd. Suite D-43, Modesto, CA 95351

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Navigating Through RecoveryPam Galley, RN, MAOL, Continuum Administrator

Kaiser Permanente, Central Valley Area

In speaking with stroke survivors the stories of when and how the stroke occurred is a pivotal turning point in their lives. They often recount the journey of recovery that followed and for those with a severe stroke the levels of care, and care settings, required to regain function. For those that did not survive, families may recount the difficult choices and grief process.

For all adults, it is important to take the time to identify a health care agent that is aware of your values and

decisions that honor your goals and values in the event you are unable to speak for yourself. Having a health care agent, and/or an Advance Healthcare Directive, will ensure your wishes are honored in the event you cannot speak for yourself and help your loved ones to have the peace of mind knowing any decisions made were actually just acting on already established wishes.

Rehabilitation Services Following a stroke, the doctor and hospital staff will provide information on rehabilitation programs. However, you and your family make the final choice on the post-acute hospital plan of care. It is important to fully understand the plan of care following the initial hospital stay following a stroke.

Stroke survivors usually have at least some healing and often recover further with rehabilitation. Progress and recovering following a stroke is unique to each person because of the often complex rehabilitation needs. There is a range of rehabilitation programs across care settings to help after a stroke to reach goals such as the following:

• Re-learn basic skills such as talking, eating, dressing and walking.

• Increase strength, flexibility and endurance.

• Regain as much independence as possible.

Pam Galley, RN, MAOL, Continuum Administrator

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A person may start rehabilitation in one program and then transfer to another. For example, a person may discharge from the hospital to a skilled nursing facility to build strength then transfer to an acute rehabilitation hospital when able to tolerate the intense rehabilitation program followed by a discharge home with home health for a short period of time to adapt the ongoing rehabilitation in the home environment. Rehabilitation works best when a team is established that consists of the stroke survivor, family, physician and care team. It is helpful to establish a care team lead. The care team lead may be the stroke survivor or a designee. It is helpful for the care team lead designee to also be the healthcare agent or decision maker so that in the event healthcare decisions have to be made there is awareness of the values, goals and health plan for the stroke survivor.

Rehabilitation Specialists Treatment following a stroke is unique to the person. You may work with any or all of the following specially trained professionals:

Physician - A physician is always in charge of care. Several kinds of physicians may have a role including primary care doctors, geriatricians (specialize in working with older adults), neurologists (specialize in brain and nervous system), and physiatrists (specialize in physical medicine and rehabilitation).

Nurse - Nurses often play a key role in coordinating care, and they also provide direct care and education to patients and family. Rehabilitation nurses specialize in nursing care for people with disabilities

Physical Therapist - Physical therapists evaluate and treat problems with moving, balance, and coordination. The physical therapist will provide education, training and exercises.

Occupational Therapist - Occupational therapists evaluate and treat functional limitations in order to maximize the ability to perform activities of daily living. Activities of daily living include dressing, cooking, bathing, toileting, writing, and other common household and work-related tasks.

Speech-language pathologist - Speech-language pathologists help patients get back language skills and learn other ways to communicate. Speech-language pathologists also work with patients who have swallowing problems (dysphagia).

Social worker - Social workers help the rehabilitation team work together to reach

individual determined, realistic goals including goals related to emotional, social and economic functioning.

Psychologist - Psychologists evaluate and treat mental and emotional health. Psychologists use interviews and tests to identify and understand problems. They may also treat thinking or memory problems or provide advice to other professionals about patients with these problems. Rehabilitation psychologists are specialists that assist people with a chronic or traumatic injury or illness to achieve optimal physical, psychological and interpersonal functioning.

Prosthetists and Orthotists - Prosthetists specialize in the fabrication of artificial limbs (prostheses) and orthotists specialize in fabricating devices (orthotics) to support or control a part of the body--such as an arm or leg--that has been impaired due to recent surgery, stroke or injury. These devices include a range of splints, braces and special footwear. The prosthetists and orthotists work alongside doctors, nurses, physical therapists and occupational therapists to provide the best possible rehabilitation.

Rehabilitation Care Settings Following a stroke, rehabilitation programs can be found in a variety of settings based on your needs, lifestyle and priorities. Your care team will provide options and make recommendations based on your age, overall health and degree of disability.

Acute Care and Rehabilitation Hospitals A specialized hospital, referred to as either a long term acute care (LTAC) or acute rehabilitation hospital, this is the highest-level care setting outside of a full service hospital. 24-hour medical care and full range of therapy services provided in a hospital settings. This is the most demanding level of directed care and includes several hours of therapy a day. This setting may be required for continued hospital care due to many medical issues that require continued monitoring and benefit from a demanding therapy regimen. How much acute rehabilitation therapy your loved one receives depends partly on his/her rate of improvement. Stroke survivors on an acute rehabilitation unit are expected to make measurable functional gains every week as measured by the Functional Independence Measure Score (FIMS). Functional improvements include activities of daily living skills, mobility skills and communication skills. The typical rehabilitation expectation is improving 1 to 2 FIM points per day. Central Valley Specialty Hospital in Modesto includes 80 long term care acute rehabilitation beds and is the only acute care rehabilitation hospital in the Stanislaus County.

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Sub-acute Facilities Less demanding than acute programs, a sub-acute facility is often a unit of a skilled nursing facility that provides daily nursing care and a range of rehabilitation services and therapies. Sub-acute patients are medically fragile and require special services, such as ventilator or tracheotomy care and tube feeding. This setting provides the 24-hour medical care for those that are unable to handle the demands of acute programs. Therapy frequency is based on your needs and ability. Facilities with subacute level of care include the following:

Central Valley Specialty Hospital 730 17th Street, Modesto, CA 95354 - Phone (209) 248-7700

Windsor Elmhaven Care Center 6940 Pacific Avenue, Stockton, CA 95207 - Phone (209) 477-4817

Skilled Nursing Facilities Often referred to as nursing homes, skilled nursing facilities offer 24-hour nursing care and therapy with less intensity of an acute facility. Skilled nursing facilities provide short-term or long-term care. Medicare.gov Nursing Home Compare is an excellent resource on quality of care information on every Medicare and Medicaid-certified nursing homes. It recommended that you visit the skilled nursing facility in advance.

Things to consider when picking a skilled nursing facility:

Skilled Services - Verify that the skilled services that have been recommended are available and offered with the recommended frequency. Ask what therapy services are offered (physical therapy, occupational therapy, speech-language pathologist) and how many days a week each therapy service is available.

Bed Availability and Proximity - Verify that a bed is available. If bed availability is uncertain it is recommended to visit more than one facility. Consider if the facility is close enough for family and friends to visit.

Resident Appearance - Residents in the skilled nursing facility should appear clean, well groomed and appropriately dressed.

Facility Appearance - The facility should appear clean and well kept, have good lighting to prevent accidents and falls, and free from unpleasant odors.

Staffing - California facilities are required to provide a minimum of 3.2 hours of nursing care per resident per day. As an example, a facility with 100 residents is required to provide a minimum of 320 hours of nursing care in 24-hour period. Considering 8 hour nursing shift assignments, there should be at minimum 40 nurses scheduled in a 24-hour period. Nursing care is provided by registered nurses (RN), licensed vocational nurses (LVN) and certified nursing assistants (CNA). The number of licensed and unlicensed nursing staff directly responsible for nursing care must be posted daily for each shift. Review the posted staffing ratio looking for a ratio of at least 3.2 hours per resident. In addition, ask how many RN’s, LVN’s and CNA’s work each shift. There should be a minimum of one registered nurse per shift.

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SKILLED NURSING FACILITY LISTING

SAN JOAQUIN COUNTY STANISLAUS COUNTY

Arbor Nursing Center900 North Church StreetLodi, CA 95240(209) 333-1222

Acacia Park Nursing & Rehabilitation Center1611 Scenic Drive Modesto, CA 95355(209) 523-5667

Bethany Home Society San Joaquin County930 West Main StreetRipon, CA 95366(209) 599-4221

Avalon Care Center - Modesto515 East Orangeburg Avenue Modesto, CA 95350(209) 529-0516

Creekside Center9107 N Davis RoadStockton, CA 95209(209) 478-6488

Bel- Air Lodge Convalescent Hospital180 Starr Avenue Turlock, CA 95380(209) 632-1075

Crescent Court Nursing Home610 S Fairmont AvenueLodi, CA 95240(209) 367-7400

Brandel Manor1801 N. Olive Street Turlock, CA 95380(209) 667-5600

Crestwood Manor1130 Monaco CourtStockton, CA 95207(209) 478-2060

Casa De Modesto1745 Eldena Way Modesto, CA 95350(209) 529-4950

Delta Rehabilitation & Care Center1334 S. Ham Lane Lodi, CA 95242(209) 334-3825

Covenant Village Care Center2125 North Olive Avenue Turlock, CA 95382(209) 664-5300

Fairmont Rehabilitation Hospital950 S. Fairmont Avenue Lodi, CA 95240(209) 368-0693

Crestwood Manor 1400 Celeste Dr. Modesto, Ca 95355(209) 526-8050



Golden Living Center - Chateau1221 Rosemarie Lane Stockton, CA 95207(209) 477-2664

Elness Convalescent Hospital812 West Main Street Turlock, CA 95380(209) 667-2828

Golden Living Center - Hy-Pana4545 Shelley Court Stockton, CA 95207(209) 477-0271

English Oaks Convalescent & Rehabilita-tion Hospital2633 West Rumble Rd Modesto, CA 95350(209) 577-1001

Golden Living Center - Portside2740 N. California Street Stockton, CA 95204(209) 466-3522

Evergreen Nursing & Rehabilitation Care 2030 Evergreen Avenue Modesto, CA 95350(209) 577-1055

Good Samaritan Rehabilitation & Care Center1630 N. Edison Street Stockton, Ca 95204(209) 948-8762

Garden City Healthcare Center1310 West Granger Modesto, CA 95350(209) 524-4817

Kindred Transitional Care & Rehabilita-tion - Valley Gardens1517 East Knickerbocker Drive Stockton, CA 95210(209) 957-4539

Ha-Le Aloha Convalescent Hospital1711 Richland Avenue Ceres, CA 95307(209) 537-4581

La Salette Health & Rehabilitation Center537 E. Fulton Street Stockton, CA 95204(209) 466-2066

Hy-Lond Health Care Center - Modesto1900 Coffee Road Modesto, CA 95355(209) 526-1775

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Lincoln Square Post-Acute Care1032 N. Lincoln Street Stockton, CA 95203(209) 466-5341

Modesto Post-Acute Center159 E. Orangeburg Avenue Modesto, CA 95350(209) 526-2811

Manteca Care & Rehabilitation Center410 Eastwood Ave Manteca, CA 95336(209) 239-1222

Oak Valley Care Center 275 South Oak Avenue Oakdale, CA 95361(209) 848-4159

Meadowood 3110 Wagner Heights Rd. Stockton, CA 95209(209) 956-3444

Riverbank Nursing 2649 West Topeka Avenue Riverbank, CA 95367(209) 869-2569

Windsor Hampton Care Center442 Hampton Street Stockton, CA 95204(209) 466-0456

San Luis Care Center709 N Street Newman, CA 95360(209) 862-2862

Windsor Elmhaven Care Center6940 Pacific Avenue Stockton, CA 95207(209) 477-4817

Vintage Faire Nursing & Rehab3620 B Dale Rd. Modesto, CA 95356(209) 521-2094

New Hope Post-Acute Care2586 Buthmann Ave Tracy, CA 95376(209) 832-2273Plymouth Square1319 N. Madison Street Stockton, CA 95202(209) 466-434Vienna Nursing & Rehabilitation Center800 So. Ham Lane Lodi, CA 95242(209) 368-7141



Windsor Hampton Care Center442 Hampton Street Stockton, CA 95204(209) 466-0456Riverwood Healthcare Center5320 Carrington Circle Stockton, CA 95210(209) 473-3004St Jude Care Center469 East North Street Manteca, CA 95336(209) 823-1788Tracy Nursing & Rehabilitation Center545 West Beverly Place Tracy, CA 95376(209) 835-6034Wagner Heights Nursing & Rehabilita-tion9289 Branstetter Place Stockton, CA 95209(209) 477-5252Wine Country Care Center321 West Turner Road Lodi, CA 95240(209) 334-3760

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Home Health Care If you are able to return to home but unable to travel for rehabilitation services, home health may be arranged to provide nursing and therapy. Medicare.gov Home Health Compare is an excellent resource for a listing of home health agencies and the list of services available. Home Health agency services include nursing care, physical therapy, occupational therapy, speech therapy, medical social services, and home health aide. Skilled home care is covered under Medicare and insurance plans if you are homebound and with doctor certification that you need one of the following:

• Intermittent skilled nursing care

• Physical therapy

• Speech-language pathology services

• Continued occupational therapy

Skilled home care does not cover full time nursing care or homemaker services (meals, shopping, cleaning, etc.). Caregiver Recommendations: As a caregiver, build and rely on a team of support. The most important advice is to ask questions and take notes. Caregivers have to balance reliance on the healthcare team and that of the role of advocate, which requires questioning at times the medical team. A common complaint that I have heard as a nurse it that it is difficult to retain and track all of the information gathered and information provided. I have found it very beneficial to establish a notebook or binder to collect all of the information in a central location. In some cases it is helpful to create a calendar specific to the appointments and medication regimen. Key Patient and Caregiver Tips: Recovery is Individual Recovery depends on the multitude of factors including the type and extent of the stroke, motivation level, support system, rehabilitation program, overall health of the individual. In addition, although the most rapid recovery usually occurs during the first few months following a stroke, some survivors continue to recover over time extending into years. Although difficult to completely ignore, try to avoid comparisons. As a caregiver, your goal is to give the person you are caring for the power and permission to be in control of his or her own life as much as possible. To support recovery the caregiver needs to be mindful of not helping too much.

Medications Lists Be aware of the medications prescribed, the reason for the medication, side effects and any special instructions. Bring the list of medications to all medical appointments and hospital visits. Pillboxes and/or medication applications for smart phone or tablets can be helpful for medication tracking. Smart pillboxes now exist that will track medication administration and provide reminders

The Medicare “Home Health Compare” web tool includes the following Home Health Agency Checklist for choosing a home health agency: Home Health Agency Checklist Use this checklist when choosing a home health agency.

Name of Home Health Agency:Questions Yes No

Medicare Certified?Medicare Certified? (If you have both)Offers the specific health care services I need (like skilled nursing services or physical therapy?Meets my special needs (like language or cultural prefer-ences)?Offers the personal care services I need (like help bathing, dressing and using the bathroom?Offers the support services I need or can help me arrange for additional services, such as Meals on Wheels that I may need?Has staff that can provide the type and hours of care my doctor ordered and start when I need them?Did they explain what my insurance will cover and what I must pay out-of-pocket?Are background checks done on all staff?Are there testimonial letters from satisfied patients, family members and doctors that testify to the home health agency providing good care?

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Medical Team Meetings and Appointments Write in advance all of your questions and take the time to ask and get adequate responses to your questions. I coordinated the care for my brother as he fought cancer for over three years and made it a point to sit down and have a quiet conversation with him before each appointment to ask and write down all the questions he had, what symptoms he was experiencing, and what he wanted to get out the appointment. I would let him take the lead but if he didn’t bring up something that I was aware of I would gently ask if it was perhaps something to ask the physician about. For example, with a terminal diagnosis depression was something I could see him struggle with at times. If he was communicating his struggle with depression I would suggest he ask his doctor if there was anything recommended to help with the depression. Take notes so that you can refer back to the information provided. Ask for written information following physician visits. If you have concerns that your care is becoming fragmented by multiple specialists or inconsistent information request an interdisciplinary team meeting with all of your providers and care team. Remember that there is never a “dumb” question when it comes to your health, or the health of your loved ones.

Home Safety Falls are common after a stroke. If a fall does occur and it is serious or results in severe pain, bruising or bleeding, go to the Emergency Department for evaluation and treatment. All falls, serious or minor, must be reported to the care team. General guidelines for home safety include the following:

• Minimize clutter so that it is easier to move throughout the home.

• Make sure lighting is adequate to see any obstructions or hazards.

• Remove throw rugs and runners.

• Have a telephone in each room placed at a level the stroke survivor can easily reach.

Ask your physician about the need for a home visit to evaluate your home and complete a home safety assessment and make home modification recommendations.

Reduce Risks Survivors that have had a stroke are at high risk for having another one. Following treatment recommendations reduces the risk for another stroke. Eating a healthy diet, exercise, taking medications, as prescribed, and regular physician visits are all important aspects of life after a stroke.

Seek Support Evaluation of emotional health and emotional lability (the ability to control emotions) is important. Post-stroke depression is common, affecting up to half of all stroke survivors. If depression or emotional lability is suspected consult a physician to develop a plan of care. Depression is also common for caregivers and should not be overlooked. Community resources, such as support groups, are available and can be very beneficial. Stay in touch with the case manager, social worker or discharge planner to help find community resources. On the other hand, if you are getting overwhelmed with a flood of advice it may be helpful to remind others that you have the full support of a medical care team. As a caregiver it is important to take care of you and take breaks from caregiving by asking for help.

References: http://www.strokeassociation.org & www.medicare.gov

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Acute Physical RehabilitationMonique Bedi RN, CRRN

Acute Rehabilitation Program CoordinatorLodi Health-Lodi Memorial Hospital

Acute Rehabilitation after stroke is very important. Studies have shown that rehabilitation is responsible for most of the recovery experienced by patients after a stroke, and that with little or no rehab, reduced improvement can be accomplished. Stroke rehabilitation provides a targeted and organized plan to re-learn functions and activities of daily living, in the shortest period of time possible. A team of professionals assist the patient and family to cope with the deficits and re-learn compensatory techniques if needed.

Acute Rehabilitation is the special level of rehabilitative care designed for patients who need an intensive, coordinated approach to overcome their new challenges. Patients spend most of their time out of bed and participating in therapy or social activities. Each patient’s length of stay varies based on needs and progress.

Physician specialized in rehabilitation manages the care and meets with inter disciplinary team to promote recovery to the fullest potential. The team includes rehabilitation nurses, physical therapist, occupational therapist, speech/language pathologist. Social worker, nursing case manager, recreational therapist and registered dieticians.

Referrals are usually made by case managers in acute hospital settings.

Intensive family training enables each patient and family member and ability to gain the confidence and skills needed for return home.

About Lodi Memorial Acute Rehabilitation

This team of specialty-trained therapists and nurses offer vast experiences to facilitate recovery in patients with complex medical and physical conditions. Strokes, neurological disorders, multiple trauma, spinal cord injuries and other complex conditions are treated

What to Expect: Physician visits 5 days a week, 3-hours of therapy per day 5 days a week plus weekend therapy, one-on-one therapy sessions, group therapy sessions, intensive family/caregiver training and education throughout the stay, recreational activities with therapist both indoor and outdoor. Meals are provided in an environment for social dining and therapeutic training.

Special program features: Private patient rooms Dynavision for treatment of visual and attention deficits Bioness functional-electrical stimulation for recovery of arm and leg function and Wii interactive games

https://www.lodihealth.org/

About Central Valley Specialty Hospital (CVSH)

“Our mission is to provide all our patients with the highest quality Acute Care, Acute Rehabilitation, and Skilled Nursing Care. We are committed to upholding a culture of shared values that provide dignity, growth, and value to our patients, employees, and physicians.

Acute Rehabilitation Services at Central Valley Specialty Hospital includes pulmonary ventilator weaning, neurological diagnosis, infectious diseases, wound managements, neurological/ trauma including coma recovery, post stroke care and recovery, acquired brain injury, spinal cord, central nervous system disorders, post operative deficits, telemetry monitoring, multi-organ failure, chronic and/or critically ill, amputation, multiple IV antibiotic therapy, cardiac or transplant patients, osotmy and colostomy care, enteral feeding program ( TPN), Restorative Nursing, Laboratory and Radiology Testing, Hemodialysis / Peritoneal Dialysis, Chest tubes and more.

CVSH is designed to provide care for medically complex patients who have experienced catastrophic illness and/or multi system failure and are in need of a longer stay in an acute setting. These patients usually come from neighboring Acute Care Hospitals and are in need of Acute Care/Skilled Nursing services for a longer period of time to recover and return to optimal health.

For more information go to http://centralvalleyspecialty.org/

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COOKING POST-STROKERosanna Redding, BA and MFA

The first time I was left at home alone after having a stroke I was shocked, infuriat-ingly frustrated and felt utterly defeated when I went to the kitchen to make myself something to eat and found I could not spread peanut butter on a piece of bread or even open a can of soup. I was trying to operate one-handed in a two-handed kitchen without the proper tools. Not impossible mind you, but very difficult!

It was not until my occupational therapist handed me an Aids for Daily Living catalog that I knew I was on the road to living successfully one-handed in a two-handed world! There are gadgets “out there” for doing almost anything one-handed. My area of interest and expertise, if you will allow me that, is cooking. No need to reinvent the wheel to learn to cook for yourself at minimum, and perhaps, for oth-ers if you are so inclined. Here is my list, with photos, of the tools I feel are essential in a one-handed kitchen. In addition, on my website, OneHandCan.com, you will find videos and further information that may be of assistance to you in your quest to regain your independence in the kitchen and elsewhere and become accustomed to your post-stroke “new normal”. Live Re-abled, not disabled. CUTTING, CHOPPING, SLICING & PEELING Knives are personal choice tools, believe it or not. If you have good knives keep them sharp. A simple sharpener (Fig.1) is easy to use and works as well as a fancy one. If you do not have at least one good all around knife, get one and keep it sharp. If you are going to buy a “general purpose” knife I recommend going to a store where you can touch, hold and get the feel of different knives. This is where the “personal” comes into play. It is important to get a knife that fits your hand and is well weighted for you. A knife that is too heavy or too light may create more stress and fatigue and less efficiency when used. Remember, it is VERY important to protect your “good”, fully functional body parts from over use.

Peelers come in lots of shapes and sizes. The two I recommend are the “Y”

shaped peeler and the palm peeler. The “Y” peeler (Fig.2a) is a great tool to use when the food you are peeling is impaled on an adapted cutting board, (Fig.5). Sim-ply impale the potato, apple or whatever and peel all visible areas. Carefully remove from prongs, turn, impale again and repeat until all peel is removed.

The palm peeler (Fig.2b) is used in a way to accommodate using both your “good” hand and your less functional hand. Rather than holding the peeler in the palm of my hand, as intended, I put the finger ring of the peeler around my index finger so it will rest on the back of my hand (Fig.2c). I then can place my hand down on a sturdy surface and drag whatever I am peeling across the blade. This works very well with carrots, celery and asparagus.

Slicing devices, better known as mandolins in kitchen parlance, are great for quick, uniform slicing and julienne cutting. There are simple handheld models and heavier freestanding models (Fig.4a, 4b). Regardless, they are all dangerously sharp and must be used with great care and caution! You could cut off a fingertip by just brushing against the blade. No, I’m not kidding. To lessen this possibility they gener-ally come with an attachment to hold the food being sliced, but they are terribly inefficient and do not work well. I purchased a cut resistant glove to wear when I make use of my mandolin, but that’s not failsafe either. Still, when used with all that upmost in mind, I find mandolins to be very useful tools for slicing larger amounts of ingredients uniformly and rapidly and for julienne cutting potatoes, squash, etc.

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Cutting Boards are available in a variety of adapted configurations. No matter which style appeals to you, having one in your adapted kitchen is imperative! Some have 3 spikes to impale ingredients, others only 2 spikes. I prefer 3 spikes inasmuch as 3 are better than 2 and are more versatile in how you can use them. There is one board from Sweden, I believe, that has a small vice. The board I have designed, The CanDo Cutting Board (Fig.5), has 3 spikes, 2 repositionable side walls for left or right handed users, and a strapping system to hold odd shaped and bunches of ingredients, i.e. herbs, scallions, etc. Would you be surprised to read I feel mine is the best, most versatile, efficient and easiest to use?

Incidentally, I suggest having a bench scraper (Fig.6), on hand which facilitates scooping up and transferring cut ingredients from the cutting board to wherever needed.

Bowls and Bowl Holders Bowls with slip resistant bottoms (Fig.7a) are very helpful in a one-handed kitchen. If, however, you do not have any and do not wish to purchase any there are other products that will help keep your bowls in place when using them. Rubberized or silicone shelf liner is useful (Fig.7b).

It is relatively inexpensive, as little as a dollar a roll, and can be cut into pieces the size you want. Dysom™ although more expensive and harder to find will also work, as will silicone pads.

StickyBowl™ and Staybowlizer™, (Fig.8a, 8b), are two similar tools for holding a bowl steady while stirring, mixing and/or transferring ingredients, i.e. for scooping

batter into a cake pan. They are both made of slip resistant silicone and can also act as a giant suction cup to secure it to a smooth surface. Bowls can be held upright or at an angle, which aids scooping, when positioned atop either of these particular cooking aids. They are especially helpful for those of you who like to bake.

Measuring Measuring ingredients and transferring them to where they need to be is not as easy as it may seem at first blush. Before discovering flat bottom measuring spoons, (Fig.9a), there was much crying to do over spilled olive oil, vanilla, salt…you get the picture. I own two sets of flat bottom measuring spoons. One is plastic. One is metal. Both sets are essentially the same. Both sets are magnetic and nest together nicely for ease of storage, and have an elongated spoon end for containers with smaller openings like spice jars and a fully rounded spoon end for everything else. Having two level “spooned” ends, as well as flat bottoms, allows them to sit flat and upright without using a second hand or propping method to keep them from tipping and spilling their contents. For larger measuring needs, and equally as helpful with sticky ingredients, i.e. honey, mayonnaise, peanut butter, etc., push-pull

Adjust-A-Cups™, (Fig.9b), are a great find. They can be found in mini, 1 cup and 2 cup sizes. Essentially they consist of inner and outer cylinders that push and pull not unlike a piston. The outer transparent cylinder has a multitude of markings; on the mini - teaspoons, tablespoons, ounces; for the larger models - cups, milliliters, ounces, and pints. One pushes the outer cylinder to the appropriate mark, fills the cylinder with the ingredient being measured and then pushes on the bottom of the inner cylinder to release the ingredients. This can be accomplished entirely one-

handed with the mini size in that one can hold, push and even use a clean finger of the same hand to swipe off ingredient remnants.

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With the larger sizes, when measuring sticky ingredients, I simply push the bottom of the inner cylinder against my body to release the contents. A bit of a balancing act on the rim of the bowl may be necessary to scrape the remnants from the larger measuring cups with a spatula, knife, etc.

Draining and Straining (pasta, veggies, etc.)

Safety is of upmost concern when dealing with pots of boiling hot water, especially in large, cumbersome pots that are difficult enough to handle when full of cold water. My tools of choice for this hot, steamy job are either a large, long-handled colander scoop or a Clip & Drain™, (Fig. 10a, 10b). A large slotted spoon will also do the trick with a few additional dips into the pot. The Clip & Drain™ is a self-explanatory tool that one simply clips to the side of a pot prior to tipping out the liquid that needs to be dispensed with. Because of its size it works especially well with saucepans. For larger pots, of the sort used for boiling pasta and potatoes, a large long-handled colander scoop is most helpful. It allows one to scoop out relatively large amounts of boiled ingredients then drain and transfer them; without ever having to engage in the, otherwise, potentially very dangerous activity of moving a large, very hot pot to the sink and pouring everything into a freestanding colander and so on.

Grinding Pepper I love cooking with freshly ground pepper. Using a standard pepper mill is all but impossible one-handed. However, using a squeeze, push, tilt/gravity or battery/electric type pepper mill, (Fig.11), works nearly effortlessly. Inasmuch as I have come to the conclusion that I need to protect my “good” hand from overuse, as much as I can anyway, and still do the things I need and want to do, I have chosen to use a battery operated pepper mill. Of the battery type one can find models from the most basic to the type I received as a gift that has a light, fine to course grind choices and other unnecessary features. The more features the higher the cost, of course. I have not yet found a tilt/gravity type that I like. I don’t believe the mechanics have been perfected. Otherwise, I do recommend the other manual pepper mills.

Most of the tools mentioned above can be purchased at brick and mortar kitchen and/or housewares store, i.e. Bed, Bath and Beyond, Sur La Table. In addition, shop kitchen and specialty sites online. Check out OnehandcanSHOP.com. You can also find more and other cooking aids online by doing a search for aids for daily living, which will usually lead to sites where adapted cooking aids are among your browsing choices.

You are not disabled unless you choose to be. Learn to live re-abled. Happy and safe cooking.

About Rosanna Redding BA and MFA is a stroke survivor who used her inventive skills to create tools for others with use of one hand. Rosanna is a motivational speaker who encourages others not to give up. www.onehandcan.com

Left to right: Jennifer Halligan, RN, Stroke Co-Coordinator, Mary Barnes, RN, Clinical Education; Mick Smith, Regional Director, Quality & Systems Improvement, Ameri-can Heart Association and American Stroke Association, Northern California; David Culberson, CEO, San Joaquin General Hospital; JoAnne Pineda, Sr. Program Director, Quality & Systems Improvement, American Heart Association and American Stroke Association; Dr. Sheela Kapre, M.D., Chief Medical Director, Dr. Syung Jung, M.D., Stroke Program Director Missing: Leslie Gill, Quality Improvement Coordinator, Stroke Co-Coordinator, San Joaquin General.

San Joaquin General Hospital Stroke Team Gets “Bronze Achievement Award” from the American Heart Association and American Stroke Association

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Financial SolutionsBefore & After a Stroke

Jim T. Chong, JTChong & Associates, Solutions4Life

I remember around 20+ years ago when my dad had gone numb unexpectedly and was rushed to the hospital...later to learn that he had experienced a stroke. He is one of the fortunate ones as the medical professionals were able to identify it as a stroke relatively quickly.

Stroke and other major life situations can strike at any moment and can lead to devastating financial consequences if you are not prepared. Here are some things to consider in any case.

No matter what your financial situation is planning ahead is most beneficial. The cost of waiting until a stroke or unforeseen major life situation occurs can be extremely expensive both emotionally and financially not just to yourself, but also for those making key decisions on your behalf.

BEFORE a stroke occurs, get educated on what is available to you. One significant issue is how to pay for the hospitalization and the aftermath, including potential ongoing care, therapy, and the inability to work. Having the proper financial vehicles in place is very instrumental to having some level of control. For instance, there are insurance policies that pay out in the event of a chronic or critical illness condition. There are government resources that provide thousands of dollars per month to help offset medical and care costs.

The real difference between planning BEFORE and planning AFTER a stroke or other catastrophic life event can be summarized by the amount of options available. If you are properly prepared, you can greatly reduce the emotional and financial stress that surfaces after you or a loved one has a stroke or other catastrophic illness.

Summed up, here are some valuable solutions for life…

The PROBLEM is...

Most people do not spend sufficient time planning financially for the inevitable, which is costly later, not only financially, but in time, energy, and potentially their livelihood. The SOLUTION is...

Spend some time with the appropriate sources to identify the things you need to have in place BEFORE a stroke or other catastrophic illness occurs. Here are some action items to consider that I strongly suggest doing BEFORE a brain attack or stroke occurs:

Assess what you currently have in place to cover your needs financially. For example, health insurance, benefits, catastrophic coverage, medical directives, etc). Review any plan in place periodically to account for any changes (annually is suggested).

• Visit an attorney that specializes in trusts and wills to find out why they are important and the differences between the two (many will give a compli mentary appointment).

• Set up an appointment with a financial professional to determine what op tions are available to you today for coverage, etc.

Here are readings from these two publications which can currently be found online: a. “Taking Care of Tomorrow” - CA Dept of Aging http://www.rureadyca. org/sites/default/files/uploads/ TakingCareofTomorrow. pdf

b. “Medicare and You” –produced annually for seniors and people with a disability http://www.medicare.gov/Pubs/ pdf/10050.pdf

“Planning is taking the future and bringing it into the present, so you can do something about it now.” ~Alan Lakin

Jim T. ChongFinancial Solutions for Insurance, LTC, & Senior Benefits, CA DOI #0F65589(209)534-8000

Scott Tibbedeaux, AttorneyEstate Plans, Wills & Trusts(209)932-9785

Dominic Vassegault, MEP, CEP, Certified Senior Advisor, Certified Mediator(916)509-7053

Layla Baskin,Delta Senior Referral ServicesSenior Placement(209)242-3716

Jo Anna Wright, CPRES, BRE#01381441Certified Probate

Real Estate Specialist(209)346-1014

Brain Aneurysm/AVM Support Group San Joaquin County & Beyond

Our support goes beyond meeting dates… we stay connected!

Survivors, Caregivers & Friends are welcome! 2nd Thursdays, 5:30pm-7:00pm

Dameron Hospital-Annex Building 525 Acacia Street

Stockton, CA 90302

Living through a brain aneurysm is worth Celebrating!

For more information:

Call: Healings in Motion at

(877) 672-4480

Email: contact@

healingsinmotion.org

Join us at:

facebook.com/ BrainAneurysm

Support2014

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Stroke and Caregiver Support

San Joaquin

Dameron Hospital- AnnexBrain Aneurysm/AVM Support Group/ San Joaquin Area 525 West Acacia StreetStockton, CA 95203Contact: Mary Nicholson, Healings in Motion 877-672-4480 2nd Thursday/5:30-7:00PM

Dameron Hospital- AnnexCentral Valley Recovery, Awareness, Preventing Strokes, (CV-RAPS”), a lunch and learn525 West Acacia StreetStockton, CA 95203Contact: Mary Nicholson, Healings in Motion 877-672-4480 http://cv-raps2014.eventbrite.com2nd Tuesdays monthlywww.healingsinmotion.org

St. Joseph’s Medical Center1800 North California StreetStockton, CA 95204Basement, Room 3Contacts: Katie Wright and Sandra Hormiga209-467-6365 1st Wednesday, 10:30am-12pm www.stjosephscares.org

Sutter Tracy-Stroke ClubContact: Laura Cook209-830-21373rd Thursdays, 3-5PM

Stretch and Stroll for Stroke Awareness Michael Faklis Park. 5250 Cosumnes Drive Stockton, CA 95219Led by Cami Cardio, S4LHealings in Motion209-292-3792

Caregiver Support

Caregiver SupportCatholic CharitiesIn-Home Respite/Home ModificationContact: Maryanne Trann209-444-5931www.ccstockton.org

Family Caregiver Support Program102 S. San Joaquin StreetP.O. Box 201056Stockton, CA 95201209-468-2202wwmsjaging.org

Foster Grandparents/Senior Companion Program702 N. Aurora StreetStockton, CA [email protected]

Tracy Volunteer Caregivers1217 El Portal Street, Suite 105,106Tracy, CA 95376209-835-2772www.tracyvolunteercaregivers.org

Caring for the Caregiver“Having the Heart to Care”Annual Event in NovemberRobert Cabral Ag Center2101 E. Earhart Avenue Stockton, CA 95206877-672-4480www.healingsinmotion.org

Stanislaus

Central Valley Specialty Hospital730 17th Street, Modesto, CA Wednesdays, 10AM-11:30AM

Stroke Resources PO Box 77321Modesto, CA 95357 (209) 521-1786www.strokeresources.orgStroke & Caregivers Weekly, Wed, 10amStroke Conference

UniQue ImAgingMemory Impairments700 McHenry AvenueModesto, CA 95354Contact: Cynthia Wilson209-852-69163rd Monday, 11AM

UC Davis Ambulatory Care Center Greater Sacramento Brain Aneurysm & AVM Support 4860 Y. Street, Sac Room 3015, 916-734-65114th Saturday, 3-PM

Sacramento Area

UC Davis, Ellison Ambulatory Care Center Aphasia Communications Group,4860 Y Street, Sacramento, CA Contact: Amy Bord916-703-0328 Fri, 12-2PM

Mercy Learning Center Stroke Survivor & Caregiver 6007 Folsom Blvd. Suite 200, Sacramento, CA 95819916-537-51773rd Tuesdays, 11AM-12PM

Atria El Camino GardensStroke Support2426 Garfield AvenueCarmichael, CAContact: Tess Carter916-486-0231Wednesdays, 11:30AM-12:30PM

Kaiser Roseville1001 Riverside AveRoseville, CA 916-688-2674- 4th Tues

Green Haven Stroke Support Luncheon Aviator’s Restaurant, 6151 Freeport Blvd.Sac, CA 916-392-56143rd Mondays, 11:30AMContact: Jerry or Peggy Miyata916-392-5614

El Camino Gardens Senior CenterRichmond Stroke Support4538 Juno Way, Sacramento, Ca 95864Contact: Virginia Zebowski916-488-5722Wednesdays, 11:30AM

Sutter General, Sac Stroke SupportMeet in Cancer Center2800 L Street, Sacramento, CA Contact: Rachel 916-454-69761, 3,5th Thursdays, 11AM-12:30PMwww.sacstrokesupport.com

Sutter Medical – Elk Grove2nd Chances8170 Laguna Blvd.Elk Grove, CA 95758MOB II, Classroom 1, Ste.1142nd/4th Thursdays, 10:30AM-12PMwww.sacstrokesupport.com

Sutter Rehabilitation Institute Stroke Support Group Date: 2nd Tuesday of each month, 1:30pm-3pm 6 Medical Plaza, Roseville, CAContact Teresa Carter 916-781-4036

UC Davis Stroke Support4860 Y Street, Room 3015-ASacramento, CA Contact: Kevin Wheeler916-734-3467Tuesdays, 2-3PM

Easter SealsTraumatic Brain Injury 3205 Hurley WaySacramento, CA 95864Thursdays, 7-8:30PM

Sutter Rehabilitation Institute Traumatic Brain Injury Support Group Last Wednesday of each month 2-3 p.m. 6 Medical Plaza, Roseville, CA877- 870-2588http://www.sutterroseville.org/

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Sutter Stroke Camp

Usually this great camp experience takes place in September at the Silver Spring Conference Center, located at 17301 Silver Spur Drive, Tuolumne, CA 95379.

For 2014, the dates are Friday, September 26 - 29.

100 stroke survivors and Caregivers go to a beautiful camp in Tuolumne, CA to learn more about stroke and prevention in a relaxed environment. Therapist participate offering therapies and assistance as needed.

Enjoy usual camp activities such as campfire sing along, bingo, dance, arts and crafts activities, s’mores and horseshoes!

Additional activities include hiking, yoga, speech therapy, physical therapy, occupational therapy, bingo arts and crafts…meet new stroke friends and more!

The cost to participate is $150.00. There are some limited scholarships available.

For more information contact Sutter Neuroscience Institute, P.O. Box 160727, Sacramento, CA 95816.

For more information contact: Spencer Ellis (916) 455-4821

THE NU YOU WEIGHT LOSS PROGRAM

PHYSICIAN DESIGNED AND DIRECTED OVER 10 YEARS OF PROVEN SUCCESS

James Holmes, M.D., P.T.

1502 St. Marks’s Plaza, Suite 5 Stockton, CA 95207

(209) 466-8683 for appointments and information

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Advocacy

Department of Managed Health Care 980 9th Street, Suite 500 Sacramento, California (888)466-2219 http://www.dmhc.ca.gov

Healthcare Solution California Health Plans (888)959-2273

National Patient Advocacy www.npaf.org

Schmidt Public Affairs 917 Prince Street Alexandria, VA 22314 703-548-0019 www.schmidtpa.com

Ombudsman Program 102 S. San Joaquin Street Stockton, CA 95201 (209)468-3785 www.sjaging.org

Alternative Meds

National Center for Complementary and AlternativeMedicine (NIH) P.O. Box 7923 Gaithersburg, MD 20898 (888) 644-6226 www.nccam.nih.gov

Aneurysm

The Brain Aneurysm Foundation 269 Hanover Street, Bldg 3 Hanover, MA 02339 (781) 826-5556 (888) 272-4602 www.bafound.org

Aphasia/ Audiology

American Speech-Language-Hearing Association 2200 Research Blvd. Rockville, MD 20850-3289 (800) 638-8255 www.asha.org

CA Speech-Language Hearing Association 825 University Avenue Sacramento, California 95825 (916) 921-1568 www.csha.org

University of the Pacific Speech, Hearing and Language Center 751 Brookside Road Stockton, CA 95207 (209) 946-2381 www.pacific.edu

Anxiety Disorders

Anxiety Disorders Association of America 8730 Georgia Ave., Suite 600 Silver Spring, MD 20910 (240) 485-1001 www.adaa.org

Biotic Equipment

Ekso Bionics developed and is manufacturing powered exoskeleton bionic devices that can be strapped on as a wearable robot to enhance the strength, mobility, and endurance of soldiers and paraplegics. These assistive robots have a variety of applications in the medical, military, industrial, and consumer markets. It enables individuals with any amount of lower extremity weakness, including those who are paralyzed, to stand up and walk 510-984-1761 http://www.eksobionics.com/

Blood

Delta Blood Bank 65 N. Commerce Street Stockton, CA 95202 Tel (888) 94-BLOOD (52663) http://www.deltabloodbank.org/

Brain

Brain and Behavior Research Foundation (formerly NARSAD) 60 Cutter Mill Road, Ste 404 Great Neck, NY 11021 (800) 829-8289 www.bbrfoundation.org

Brain Injury Association 1608 Spring Hill Road Suite 110 Vienna, VA 22182 (800) 444-6443 www.biausa.org

Brain Injury Resource Center P.O. Box 84151 Seattle, WA 98124 Voice: (206) 621-8558 www.headinjury.com

Brain Resource 1,000 Sansome Street Suite 200 San Francisco, CA 94111 (415) 399 7990 www.brainresource.com

The Brain Resource Center 263 W End Ave # 1D New York, NY 10023 (212) 877-2130 www.brainresourcecenter.com

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Harvard Brain Tissue Resource Center McLean Hospital 115 Mill St. Belmont, MA 02478 (800) 272-4622 www.brainbank.mclean.org

Sharp¬Brains 660 4th Street, Suite 205 San Fran¬cisco, CA 94107 415.318.3467 www.sharpbrains.com

ThinkFirst Foundation 1801 North Mill St., Suite F Naperville, IL 60563 Voice: (630) 961-1400; Toll-free: (800) THINK-56 Fax: (630) 393-1402 www.thinkfirst.org

Brain Attack Coalition

Mission: Reducing the occurrence, disabilities, and death associated with stroke. www.brainattackcoalition.org

•American Academy of Neurology (AAN) www.aan.com

•American Association of Neurological Surgeons www.aans.org

•American Association of Neuroscience Nurses www.aann.org

•American College of Emergency Physicians www.acep.org

•American Society of Interventional and Therapeutic Neuroradiology www.snisonline.org/#

•American Society of Neuroradiology (ASN) www.asnr.org/

•American Stroke Association www.strokeassociation.org/

•Centers for Disease Control and Prevention (CDC) www.cdc.gov/Stroke

•Congress of Neurological Surgeons (CNS) www.cns.org/

•National Association of EMS Physicians (NAEMSP) www.naemsp.org

•National Institute of Neurological Disordersand Stroke (NINDS) www.ninds.nih.gov/

•National Stroke Association www.stroke.org/

Clinical Trials

Clinical trials are research studies that are designed to determine if a medicine is safe and effective for patients. The FDA and medical experts agree that the best way for patients to obtain access to medicines before they are approved in the United States is through participation in a clinical trial.

To find out if a clinical trial exists for a specific medicine for a particular disease, visit www.clinicaltrials.gov

For questions about Genentech trials, contact our Trial Information Support Line at 888-662-6728.

Cognitive

Association for Behavioral and Cognitive Therapies 305 Seventh Ave., 16th Fl. New York, NY 10001-6008 (212) 647-1890 www.abct.org

Clothing

Adaptive clothing is available for stroke patients who have difficulty dressing themselves due to weakness, immobility, or

poor coordination. Clothing for the disabled stroke patient is also designed to make it easier for caregivers to assist a patient when getting dressed. Adaptive clothing uses solutions such as velcro or snap closures rather than buttons to make dressing easier, can be applied from a seated position, accommodates problems like swelling or poor circulation, and allows for quick changes when incontinence is an issue. Even pants can be changed from a seated position with no standing

Buck and Buck Shop by Need http://www.buckandbuck.com/shop-by-need/stroke-clothing.html

Silvert’s Adaptive Clothing Stroke Clothing Store http://www.silverts.com/stroke-clothing/Education

Stroke Rehab Adaptive Clothing.http://www.stroke-rehab.com/adaptive-clothing.html

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Community Health Library

Community Health Resource Libraries are dedicated to provide medical information to help people make informed decisions about their health and health care. Most health libraries provide free public access to a variety of resources including books, journals, videos, and a variety of medical websites. Some hospitals offer virtual libraries through their website.

Maino Community Health LibraryProvided by Sutter Gould Medical Foundation 1700 McHenry Avenue, Suite 60B Modesto, CA 95350 (In McHenry Village) www.suttergould.org/learning/learning_mainolibrary.html

Financial Resources National

Benefits-Public and Private Assistance www.benefitscheckup.org

Centers for Medicare Health Insurance Marketplace Affordable Care Act www.healthcare.gov

Coalition for Non-Profit Housing and Economic Development (202)745-0902 www.cnhed.org

Credit Report –FREE AnnualCreditReport.com is the official site to help consumers obtain their free credit report., once every 12 months from each of the nationwide consumer credit reporting companies: Equifax, Experian, and TransUnion.

Central Source LLC P.O. Box 105283 Atlanta, GA 30348-5283 https://www.annualcreditreport. com/index.action

Dealing with Debt (Video) https://www.youtube.com/watch?v=Yv-I-x-X6gk&feature=youtu.befree

Homefree Funding (301)891-8400 www.homefreeusa.org

Home Owners HelpLine (888)995-HOPE

Homeownership Preservation Foundation (888)995-HOPE www.995hope.org

HUD Department of Housing and Urban Development/home counseling| (800)569-4287 www.hud.gov/counseling

The Low Income Home Energy Assistance Program (LIHEAP) helps low-income households with heating and cooling costs. LIHEAP also offers home weatherization assistance and emergency assistance for households facing utility disconnection due to nonpayment. 3040 Continental Drive Butte, MT, 59702 (866)674-6327 http://liheap.ncat.org/

Medicare (800) 800-633-4227 TTY (877) 486-2048 www.medicare.gov

My Money Financial Literacy and Education Commission C/O Office of Financial Education Department of the Treasury 1500 Pennsylvania Avenue, N.W. Washington, D.C. (800)FED-INFO www.mymoney.gov

Neighborhood Assistance Corporation of America (NACA) (888-302-6222 www.naca.com

Neighborworks America (202)220-2300 www.nw.org

Social Security (800)772-1213 www.ssa.gov

The National Fair Housing Alliance (202)898-1661 www.nationalfairhousing.org

Veterans Benefits Admin www.VBA.VA.gov

Financial Resources Regional

Coping with Debt Federal Trade Commission http://www.consumer.ftc.gov/articles/0150-coping-debt

Covered CA (800) 300-1506 TTY: (888) 889-4500 www.coveredca.com

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The Centers for Medicare & Medicare Services (CMS) http://www.cms.gov/ Office of the Regional Administrator 90 – 7th Street, Suite 5-300 San Francisco, CA 94103-6706

San Francisco Regional Office (Region 9) should be your initial point of contact on any Medicare, Medicaid, or State Children’s Health Insurance Program issue in the following States: Arizona, California, Hawaii, Nevada, and Pacific Territories

Regional Administrator, David Sayen 415-744-3501 [email protected]

Deputy Regional Administrator, Catherine Kortzeborn 415-744-3501 [email protected]

Supplemental Security Income (SSI) provides monthly financial support to disabled adults and children who have limited income and resources. SSI benefits are also payable to people 65 years and older without disabilities who meet the financial limits. (800)772-1213 http://www.ssa.gov/ssi/

American Elder Care Research Organization www.PayingforSeniorCare.com and the Eldercare Financial Resource Locator Tool. Find help locating information about long-term care resources the public and private programs available to assist in covering the cost of such care. 736 Cole St. San Francisco, CA, 94117 (641)715-3900 Ext. 606151# http://payingforseniorcare.com/contact-us.html

We Connect http://www.weconnect.net/index.php/explorehhh/money

Financial Resources Local

Catholic Services 1106 N. El Dorado Street Stockton, CA 95202 (209) 444-5951 www.ccstockton.org

San Joaquin Department of Aging and Community Services Low Income Energy Payment 102 S. San Joaquin Street Stockton, CA 95202 (209) 468-1000 www.sjgov.org

CARE

Receive monthly relief www.pge.com/CARE (866) 743-2273

Disability Resource Agency for Independent Living (DRAIL) Modesto: 920 12th Street Modesto, CA 95354 Stockton: 501 W. Weber Avenue, Suite 200-A, Stockton, CA 95203 www.drail.org

El Concilio Main Administrative Office 445 N. San Joaquin Street Stockton, CA 95202 (209) 644-2600 www.elconcilio.org

REACH Relief for Energy Assistance through Community Help (One time relief up to $200. See Salvation Army) (800) 933-9677 http://www.pge.com/en/myhome/saveenergymoney/financialassistance/reach/index.page?

Visionary Home Builders Beautiful Affordable Housing 315 N. San Joaquin Street

Stockton CA, 95202 209) 466-6811 http://vhbofca.org/

United Way - San Joaquin The mission of the United Way of San Joaquin County is to improve the lives of people by mobilizing the caring power of the communities. PO Box 1585. Stockton, CA 95201-3085 (209) 469-6980 http://www.unitedwaysjc.org

United Way - Stanislaus The mission of the United Way of Stanislaus County is uniting our community to strengthen lives through education, health and financial independence. 422 McHenry Avenue Modesto, CA 95355 Call 2-1-1 for Resources (209) 523-4562 http://www.uwaystan.org

Financial Information RESOURCE GUIDE, Genesis Healthcare (866) 745-CARE www.genesishcc.com

Note: The financial burden caused by a stroke causes heartache and is very stressful. Seeking counseling

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and letting your doctor know about insurmountable stress can prevent more illness.

Depression is also a side effect from the challenges faced. You are not alone. Find a Support Group and meet others who have been where you are today.

Stroke Effects on Survivors • Physical functioning, mobility, dexterity • Vision, touch and senses • Speech and communication • Emotions and cognition • Identity and self-worth • Activities of daily living, work, interests • Energy, vitality, vigor, stamina

Stroke Effects Family & Friends • Stroke is distressful for family and friends • It hurts to see your loved one with a disability, ill and dependent on others • Family activities, order, cohesion, stability and finances are affected. • Friendships change.

Headaches

American Headache Society 19 Mantua Road Mount Royal, NJ 08061 Voice: (856) 423-0043; Fax: (856) 423-0082 www.achenet.org

National Headache Foundation 820 N. Orleans, Suite 217 Chicago, IL 60610 Voice: (888) 643-5552; Fax: (312) 640-9049 www.headaches.org/

Learning/Re-Learning /Retention Learning Disabilities Association of America 4156 Library Road Pittsburgh, PA 15234 Voice: (888) 300-6710 www.ldaamerica.org

Lumosity Lumos Labs, Inc. 153 Kearny Street San Francisco, CA, 94108 www.lumosity.com

LGBT Stroke Support

LGBT Elder Services Free Publication Navigating the System: A Know-Your Rights Guide for LGBT Elders in California http://issuu.com/lgbtagingcentes/lgbt_elderlawpublication_final_

SAGE Service & Advocacy for Gay, Lesbian, Bisexual and Transgender Elders www.sageusa.org

Caring for a loved one with Dementia http://www.lgbtagingcenter.org/resources/pdfs/providingLGBTclientcare.pdf

FORGE Transgender Aging Network A special care service for the significant others of aging transgender seniors www.forge-forward.org (414)559-2123

National Association of Mental Illness (NAMI) http://www.nami.org/Content/ContentGroups/Multicultural_Support1/Fact_Sheets1/GLBTovery_Community_Integration_booklet.pdf

Magazines/Publications

Central Valley Caregiver Guide (877) 672-4480 www.healingsinmotion.org

Central Valley Stroke Guide (877)672-4480 www.healingsinmotion.org

San Joaquin County Aging and Community Services Resource Directory (Seniors, Disabled, Caregivers, Providers) (209) 468-1104 www.sjaging.org Stroke Connect (888) 478-7653 http://www.strokeassociation.org/STROKEORG/StrokeConnectionMagazine/Subscribe/Subscribe_UCM_308576_SubHomePage.jsp

Stroke Smart (800) 787-6537 www.strokesmart.com

Hearing Health (866)454-3924 www.hhf.org

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Neurological Impairments

Center for Neurological Disorders, P.A. 1319 Summit, Suite 200 Fort Worth, Texas 76102 (888)339-9629 http://www.cndpa.com

Innovative Neurotronics 3600 N. Capital of Texas Suite B150 Austin, TX 78745 (888)884-6462 (512)721-1900 www.walkaide.com

The Merck Health -Patient Neurology Handbook www.merckmanuals.com

Mercy Neurological Institute of Greater Sacramento 3400 Data Drive Rancho Cordova, CA 95670 www.mercyneuro.org

Neurological Disorders and Stroke P.O. Box 5801 Bethesda, MD 20824 (800) 352-9424 www.ninds.nih.gov

National Spasmodic Dysphonia Association 300 Park Blvd., Suite 415 Itsaca, IL 60143 Voice: (800) 795-6732; Fax: (630) 250-4505 www.dysphonia.org

NIH Neurological Institute P.O. Box 5801 Bethesda, MD 20824 (800) 352-9424 or (301) 496-5751 stroke.nih.gov/

Specialists on Call 31200 Via Colinas Suite #203 Westlake Village, CA 91362 (818) 597-9690

List of Neurologist and Neurosurgeons

San Joaquin Medical Society (209) 952-5299 www.sjcms.org

Stanislaus Medical Society (209) 527-1704www.stanislausmedicalsociety.com

Occupational Therapy

The American Occupational Therapy Association, Inc. 4720 Montgomery Lane PO Box 31220 Bethesda, MD 20824-1220 (301)652-2682 www.aota.org

Pain

American Chronic Pain Association P.O. Box 850 Rocklin, CA 95677 (916) 632-0922 (800) 533-3231 www.tacpa.org

American Pain Foundation 201 N. Charles St., Suite 710 Baltimore, MD 21201 Voice: (888) 615-7246 www.painfoundation.org

The Facial Pain Association 408 W. University Ave. Suite 602 Gainesville, FL 32601 (800) 923-3608 www.tna-support.org

Physical Therapy

American Physical Therapy Association 1111 North Fairfax Street Alexandria, VA 22314-1488 Phone: 800/999-APTA (2782) www.apta.org

Stroke

American Stroke Association 7272 Greenville Ave. Dallas, TX 75231 (888) 478-7653 (4-STROKE) www.strokeassociation.org [email protected]

National Stroke Association 9707 E. Easter Lane, Suite B Centennial, CO 80112 (800) 787-6537 www.stroke.org

Pediatric Stroke Network P.O. Box 445 Greendale, WI 53129 (414) 855-0626 www.pediatricstrokenetwork.com

Healings in Motion 56 S. Lincoln Street Stockton, CA 95203 (877)672-4480 www.healingsinmotion.org Twitter@Brain2Retain

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National Heart, Lung, and Blood Institute P.O. Box 30105 Bethesda, MD 20824-0105 (301) 592-8573 www.nhlbi.nih.gov

Telehealth/Telemedicine (See Technology: Here We Grow!)

Intuitive Surgical, Inc. daVinci Robotic 1266 Kifer Road, Bldg 101 Sunnyvale, CA 94086-5304 (408)523-2100 www.davincisurgery.com

Stryker Corporate 2825 Airview Boulevard Kalamazoo, Michigan 49002 (269)385 2600 www.stryker.com

INTOUCH Health Remote Telemedicine 6330 Hollister Avenue Santa Barbara, CA 93117 (805) -562-8686 www.intouchhealth.com

Travel

AAA Roadwise Review A Tool to help seniors drive safely longer (800) 922-8228 www.csaa.com

Access-Able Travel Source www.access-able.com

Association for Drive Rehabilitation Specialists www.driver.ed.org (828)855-1628 (866)672-9466

Environmental Travel Companies (ETC) ( 415) 474-7662 Outdoor Adventures and education program for people with disabilities and economically disadvantaged youth, including water skiing, water rafting, kayaking and cross-country skiing.

ID Placard for the Disabled (Issued by DMV) (800) 777-0133

Transportation

Paratransit Dial-A-Ride This service is provided to those who qualify under the Americans Disabilities Act (ADA). This service is for those who, due to their disability, are functionally unable to ride RTD’s fixed routes.

To get an application for this service call 209-982-4514, Ext. 3

The RTD County Hopper A deviated fixed routed bus service connecting Stockton, Tracy, Lodi, Manteca, Ripon and Lathrop. Reservations are needed 1-2 days in advance.

For more information call (209) 982-4514 Ext. 3 http://www.sanjoaquinrtd.com/mobility/ada.php

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Helpful APPS Supporting Recovery

CakeHealth is designed to make tracking your healthcare costs and benefits easier.

After registering online, the app connects to your health insurance and imports your

health information. Users can check on their bills and see their remaining benefits

anytime on any computer. Items are broken down using graphs and pie charts,

making the app easy to sort through, unlike your medical bills. This app is available

for iPhone.

Cozi is a FREE calendar app aimed at keeping families in sync. But it can be used

as a great tool for multiple caregivers involved in the care of a stroke survivor. The

features include a shared calendar that is color-coded for each person. It keeps track

of appointments and assigns which caregiver is involved and allows you to see the

calendars of others in your circle. www.cozi.com

iTherapy is for both cognition and language rehabilitation. It can be used by the

caregiver or clinician. It allows the clinician to assign homework, check up on the

stroke survivor’s progress and to send personalized messages when they have

reached a milestone. It has 50 different tasks with over 12,000 items to complete. In

a sense, it is a therapist on the go. This app is available for iPad. https://itherapy.com

Mango Health & Medication Management-

Mango Health offers a free personal and health journal to help you manage

medications and nutritional supplements and reach health goals. This APP features

medication reminders, checks for drug interactions and records medication

administration.

Naming TherAppy is also targeted toward aphasia patients. There are four

options: naming practice, naming test, describe and flashcards. Naming practice will

show and describe a picture, then ask the user to name the object. Describe does

the opposite, it shows a photo and asks the user to describe how it looks, tastes,

smells, etc. It’s equipped with 500+ photos and a male voice that delivers cues and

questions. This app is compatible with iPhones and iPads. http://tactustherapy.com/

apps/naming/

SmallTalk helps people have a conversation when you don’t know what to say.

With aphasia it is helpful because it focuses on texting-to-talk. Simple photos paired

with functional expressions communicate exactly what you need to say. It comes

with a male or female voice. Examples are “I have aphasia”, “Speak slowly” and

“what should we do today?” You can personalize and expand the vocabulary as

you go. This app is helpful in everyday situations, doctor’s appointments, grocery

shopping and emergencies. http://www.smalltalk.org/main/

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GlossaryAtherosclerosis-Plaque buildup is made up of fatty deposits and other cells that can build up in the walls of your arteries over time. As plaque continues to build, it can narrow arteries. One major cause is a high level of bad (LDL) cholesterol.

Carotids – blood arteries supplying oxygen rich blood from the heart to the brain; runs parallel on each side of your neck

Infarction –death of tissue caused by failure of blood supply, commonly caused by a stroke

Occluded Artery-a partial or complete blockage

Lipids-cholesterol… fatty acids, oils, waxes that are not soluble

Macrophages-white blood tissue made in your bone marrow that gobbles up foreign materials

Neuroplasticity is the ability the brain has to “re-wire” or reorganize itself by forming new neural connec-tions throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury.

FAST is an acronym used to help individuals remember the most com-mon stroke symptoms: F = Face; the faces droops on one side; A = Arms; one arm drifts downward when raised; S = Speech= the speech is slurred or garbled; T = Time; Call 9-1-1

Image by Genentech

Thrombus-blood clot obstructing blood flow to the heart

Embolus-blood clot lodged in a blood vessel obstructing blood flow

Plaque-food residues or bacte-ria build up on the inner wall of an artery in atherosclerosis

Tissue Plasminogen Activator- is the only FDA ap-proved a protein agent involved in the breakdown of blood clots.

Image by Genentech

Image by Genentech

Emboli (clots) form in the heart or in blood vessels and are carried by the blood to the brain.

Image by Genentech

Image courtesy ofDr. Gary Steinberg

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Our doctors are experts in medicine and being accessible.We believe expert care should also be convenient care.

That’s why we have online services that allow you to

email your doctor, refill prescriptions and check lab

results from your computer, tablet or mobile phone.

It’s another way we plus you.

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Memorial Medical CenterSutter Gould Medical FoundationSutter Tracy Community Hospital

healings in motion central valley stroke guide, 4th edition

Documents

stroke survivors

stroke symptoms

stroke support group

increasing stroke awareness

stroke caregiver support

stroke risk factors

certified stroke centers

cooking poststroke