Striking Back at Stroke: A Doctor-Patient Journal.

Hutton, C., & Caplan, L. R. New York: The Dana Press 2003, 240 pages, $27 (Hardcover), ISBN 0-9723830-1-8

This is a remarkable book for people who have had a stroke and their family members and friends, as it will take them by the hand and help them cope with a stroke. This book is different from most stories because Cleo Hutton writes it as a personal journal. She started her journal entries on the day she had her stroke, and she takes us day by day through all her trials and tribulations to her ultimate success as a stroke survivor. Cleo Hutton never changed the original writing. It is printed just as she wrote it from day one, and this is what makes the book unique. She truly captured the confusion and isolation a person feels when gradually adjusting to a stroke.

Her daily journal entries are followed by her doctor's explanations, from a clinical perspective, of what was physically happening to Cleo at the time. The book also includes copies of Cleo's x-rays to display where the brain infarction took place. The doctor's objective account is very instructive and balances Cleo's subjective recall. This book further defines the scope of her journey: her struggle with complications in the recovery process, heart surgery, wrestling with rehabilitation again, the homecoming, being on her own when she leaves her husband and lives independently, fighting the residual effects of a stroke, and finally her new beginning as a stroke survivor. The doctor follows her right along with his objective analyses of what is happening to Cleo. He explains the setbacks, the heart surgery, and why there is pain after a stroke. He also discusses why it's important that people look to the future and not dwell excessively on the present or the past.

Dr. Caplan also addresses seizures, which can occur during recovery, but are not a very common complication of stroke. Often the seizures can be pre vented and/or controlled with medication. Cleo discusses the stress put on close family and personal relationships as a result of her seizures. In particular, she describes the seizure she had one morning at 3 am, and the devastating effect her seizures had on her husband. Cleo offers considerable evidence that her husband was having an extremely hard time adjusting to the vast changes the stroke brought into their life. Cleo also describes her sex life after the stroke and how it affected her marriage. Her doctor, again, follows her explanations with objectivity, covering the personality and emotional changes that occur after a stroke.

Dr. Caplan gives the reader a clear explanation on how rehabilitation hospitals use a team approach, with many different professionals working together to help the person to recover. He covers assessments of cognitive functions, speech, physical and occupational therapy, and how testing is often carried out by a variety of practitioners. Cleo also adds a section on the financial toll that is created when a family member has a stroke and ways to financially recover after that. She reports on her medical and pharmaceutical costs, as well as the costs of vision and dental care.

It is easy, after reading this book, to understand why the book is a recommended reading by the National Stroke Association (NSA). It addresses and answers most questions that stroke survivors or their family members would have. Cleo Hutton has published articles in the American Heart Association/American Stroke Association's Stroke Connections and the NSA's Stroke Smart magazine. She deserves special thanks for her courage to let the reader witness her personal struggle in this book. Louis R. Caplan, M.D., is a Professor of Neurology at Harvard Medical School and Chief of the Stroke Service at Beth Israel Deaconess Medical Center. He is one of the nation's leading clinical researchers in the field of stroke and the author of the American Heart Association Family Guide to Stroke Treatment, Recovery, and Prevention. He deserves credit for presenting the clinical and medical perspective in an easy-to-understand format.

Along with being very informative, the book is also very inspirational and Cleo's conversational style makes the book an easy read. Striking Back at Stroke is a bold, wrenching account of what it takes to survive a stroke and its aftermath. The directness, boldness, and honesty with which Cleo tells her story may surprise some readers, and others may welcome its realism. For example, in her journal in June 1993 Cleo wrote: "My family support system in nonexistent. The children are busy being children and do not need the additional stress of seeing a ghost of a mother. Larry and I do not communicate anymore. I skip meals and find eating only a chore of necessity. I am alone and unlovable" (p. 170). This book is a helpful aid in the hands of a physician, counselor, student, and family; in short, for anybody who's life has been touched by a stroke. As a stroke survivor, I give the book a high rating.

Birgit Stahr

Rehabilitation Counseling Master's Student

Rehabilitation Counseling

Louisiana State University