If you have lived in San Diego for some time or were a fan of the old "Tonight Show" starring Johnny Carson, you are likely familiar with Joan Embery. A champion of environmental, conservation and preservation issues around the world, she is best known as spokeswoman for the Zoological Society of San Diego and her more than 100 appearances on Carson's show. She is also an accomplished horsewoman.
Not long ago, Embery was on safari in Africa and suddenly had difficulty speaking, her face appeared distorted and some of her fingers were not functioning. A trip to the local hospital left her initially diagnosed with Bell's palsy, a sudden, temporary weakness or paralysis in the muscles on one side of the face caused by damage to the facial nerves.
Told that there was no treatment for the condition and that it would resolve over time, she continued her safari.
"This is something I'm just going to have to live with," Embery says she remembers thinking at the time. "I can't do anything, really, about it. It'll go away in time."
Embery finished her safari and travelled back to San Diego, a 30-hour trip. However, immediately upon her return, she fell, was unable to speak and was rushed to the hospital. She had suffered a stroke — a follow-up to the occurrence in Africa, which she now knows was not Bell's palsy, after all.
"Symptoms of stroke are varied and can involve different parts of the body, making the diagnosis more challenging," says Dr. Kirill Shishlov, an emergency medicine specialist with Sharp Grossmont Hospital, a Joint Commission-certified Primary Stroke Center, one of just two in San Diego.
"Normally, you would have arm or leg weakness or numbness, usually on one side of the body, and often involving the face," he says. "Bell's palsy has a similar presentation but it involves the face only, and often affects the forehead as well, whereas the stroke usually spares the forehead."
Dr. Shishlov notes that differences between Bell's palsy and stroke can be subtle, and there is a high risk of misdiagnosing a stroke, a highly time-sensitive condition. He says it is imperative to remember the "FAST" mnemonic device that lists the signs of stroke; this can help people to determine whether to call 911.
Call if you experience or witness any of the following:
B – Balance: Sudden loss of balance
E – Eyes: Sudden blurry or loss of vision
F – Face: Facial weakness or drooping on one side of the face or an asymmetrical smile
A – Arms: Arm or leg weakness or numbness on one side of the body
S – Speech: Altered speech, slurring and the inability to speak or find the right words
T – Time: Act fast and call 911 immediately if you suspect a stroke
"Since the most common reason for stroke is an acute obstruction of one of the arteries in the brain that carry oxygen to a particular area of the brain, it is imperative to restore the blood flow to the affected area in order to minimize damage," says Dr. Shishlov. "There is clot-busting medicine that can be administered in order to break up the clot. It works best if administered as early as possible in order to decrease the probability of side effects."
In fact, according to Dr. Shishlov, after a certain amount of time, the risks of the medication outweigh the potential benefits and it's not recommended to provide it - so it's critical to seek help right away. There are also medical interventions that can directly retrieve the clot, depending on location and timing as well, further reinforcing the time-sensitivity of treatment.
Embery was extremely lucky to have landed in one of Sharp's designated stroke centers. Her stroke was diagnosed and treated immediately. It was mere months before she was back in the saddle again.
"I want to do everything," she says. "I want to jump on my horse and go ride. I want to clean up my ranch. I want to drive my truck. I want to go out and give programs, or go out and do TV shows — all the things that I do."
Thanks to the team in the Sharp emergency department and rehabilitation center, she can now do all of those things — and more.
Click the video above to watch Joan's story.
This story was updated in April 2019 to reflect the new mnemonic for the signs of stroke.