Certified Primary Stroke Center

The Kozel Stroke Institute at HDH provides the highest quality of care to individuals who experience a stroke, from emergency treatment to inpatient hospitalization and rehabilitation.

In funding the Stroke Institute, Ed and Betty Kozel understood that immediate access to quality stroke care is both challenging and crucial for a rural community: “We know all too well that strokes can affect anyone, not just seniors.”

The Kozel Stroke Institute follows the guidelines of the American Stroke Association (ASA), which provides access to a national data bank of stroke care compliance. These guidelines help ensure that HDH delivers optimal care to coronary artery disease, stroke, and heart failure patients in accord with the latest evidence-based medicine.

Know the signs of stroke. Every second counts

A stroke is a medical emergency. Call 9-1-1 immediately if you are experiencing any symptoms.

Time is critical when treating a stroke. Fast treatment will reduce disability and save your life. Anyone arriving at Healdsburg Hospital with symptoms of a stroke will receive immediate care by a team of specially trained doctors, nurses, and therapists. Our team is available 24/7 and you can rely on us whenever you are in need.

Learning the signs of stroke can save your life or the life of someone you know.

Symptoms are easiest to remember by the National Stroke Association’s acronym, FAST:

F – Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?

A – Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

S – Speech Difficulty – Is speech slurred? Is the person unable to speak? Are they hard to understand? Ask the person to repeat a simple sentence like, “the sky is blue.” Is the sentence repeated correctly?

T – Time to call 9-1-1 – Call 9-1-1 immediately if someone has any of these symptoms, even if they go away. Check the time symptoms started, so it can be reported to the doctor.

A stroke is a medical emergency. Call 9-1-1 immediately if you are experiencing signs or symptoms of a stroke, such as:

  • Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, or loss of balance or coordination
  • Sudden severe headache with no known cause
  • Double vision

Even if the symptoms last only a few moments and then disappear, these may be signs of a serious condition that won’t go away without medical help.

A stroke occurs when a blood vessel in the brain becomes blocked or bursts. Both of these conditions stop or interrupt blood flow. Oxygen is carried by the blood. Brain damage can begin within minutes when blood flow stops or is interrupted. Rapid treatment of stroke can prevent or reduce permanent brain damage.

Stroke is the third leading cause of death in the United States. It is the leading cause of serious, long-term disability. Strokes occur rapidly and may lead to permanent disability.

According to the American Stroke Association, someone in the United States suffers a stroke every 40 seconds. Over 700,000 people in the United States suffer a stroke each year.

Stroke can affect people of all ages; it is now being diagnosed in teenagers in Sonoma County.

Stroke prevention is still the best medicine. Speak with your primary care provider to learn if you are at risk for stroke. The most important treatable conditions linked to stroke are:

High blood pressure. Treat it. Eat a balanced diet, maintain a healthy weight, and exercise to reduce blood pressure. Check with your doctor to see if high blood pressure medicine is appropriate for you.

Heart disease/irregular heart rate. Manage it. Your doctor can treat your heart disease and may prescribe medication to help prevent the formation of clots. If you are over 50, ask your doctor about aspirin therapy.

Transient ischemic attacks (TIA’s). Seek help. TIA’s are small strokes that can last for a few minutes or hours. They should never be ignored and can be treated with drugs or surgery. These signs are often the first warning that a big stroke may be coming in the very near future.

Diabetes. Control it. If you have diabetes, it’s important to understand your increased risk of stroke. Multiple studies have shown that people with diabetes are at greater risk for stroke. Work closely with your doctor to manage your symptoms.

An estimated 80 percent of strokes can be prevented by reducing the leading risk factors for these conditions: unhealthy diet, tobacco consumption, harmful use of alcohol, and physical inactivity.

Here are a few simple tips:

Check in with your doctor. Have an honest conversation about your current diet, weight and alcohol consumption.

Know your numbers and know your risk. Blood pressure, cholesterol, body mass index and blood sugar can all play a key role in your stroke risk.Your doctor can help you understand your role in your own health.

Stop smoking. If you have trouble quitting, medical help is available.

Get active. Exercising five or more times a week will reduce your stroke risk. Check with your primary care physician if you plan to start an exercise program.

Eat well. Eating five daily servings of fruits and vegetables has been shown to reduce stroke risk by 30 percent. Watch your intake of sugar and carbohydrates, especially if you are diabetic.

Alcohol. Drink in moderation.

Use less salt. Too much salt is related to high blood pressure (hypertension). According to the World Health Organization (WHO), hypertension is responsible for 51 percent of all deaths globally from a stroke.

Quickly diagnosing the type of stroke you are having and the correct treatment necessary can be crucial in saving your life. Our state-of-the-art technology provides doctors the latest imaging tools to pinpoint the location, type, and extent of stroke damage.

CT Scan

A CT scan is generally the first test a possible stroke patient is given upon arrival at our Emergency Department. It is quickly administered to distinguish the type of stroke the patient may be having. Low dose X-rays are used to produce two-dimensional, detailed sections of the brain.

Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging is a painless advanced diagnostic test that provides a higher level of detail for precisely locating a stroke and determining the extent of stroke damage. The images the MRI produces are very useful to doctors when the stroke involves small blood vessels.

Magnetic Resonance Angiography (MRA)

Magnetic resonance angiography is similar to MRI. It also uses radio waves and magnetic fields to provide detailed images of the blood vessels in the brain and neck. With MRA imaging, specific areas of blockage can be identified.

Computed Tomography Angiography (CTA)

With CTA, three-dimensional X-ray views of blood vessels are studied. This test is sensitive for identifying aneurysms and other abnormalities of the blood vessels, which may cause major bleeding and stroke.

Carotid Duplex Scanning

With this technology, sound waves are bounced off blood vessels in the arteries of the neck to provide detailed information. Blockages in these carotid arteries are often diagnosed this way. This procedure is non-invasive and does not expose the patient to any radiation.

Transesophageal Echocardiography (TEE)

TEE is a test that checks for blood clots in your heart that can break loose and cause a stroke.

After initial care, physical therapy may be necessary. Our rehabilitation staff includes occupational and physical therapists and speech therapists who specialize in stroke rehabilitation. Case managers are available to assist families with decision making, rehabilitation placement options, insurance questions, and arranging transportation after discharge.

Spiritual care can be an important part of healing and living as well. At your request, case managers will assist you with inviting local chaplains to the hospital. Your own minister, priest, rabbi or other spiritual support provider is always welcome to visit. HDH also sponsors a stroke support group.

After a stroke, messages to your muscles may be impaired. Actions which were once simple, like sitting, dressing or walking may be difficult or even require assistance. These mobility tasks will quite often need to be relearned with the help of skilled therapists who are experts in the mechanics of movement and overall mobility.

How physical and occupational therapy can help you after a stroke

Our physical therapists (PT) and occupational therapists (OT) will meet with each patient and develop a personalized care plan. Families are encouraged to actively participate in the rehabilitation after a loved one has had a stroke.

Physical and occupational therapy will begin at the bedside. Your plan of care will focus on self-care, working on tasks such as dressing, eating and using the bathroom, as well as learning how to walk, sit, stand, and get in and out of bed. The team will work with both the patient and family to allow a safe return home. Many patients will need to continue with therapy once they are home. We will work with your physician to determine a plan of treatment.


Therapists will work with each patient to develop exercises to meet their individual needs. Our goal is to maintain the movement of the muscles and joints. If a certain muscle group is not able to perform movements actively, the therapists will assist, using passive motion. Both active and passive motion help to maintain the movement necessary for the positioning of the body as needed for day-to-day tasks.

Family education

We will begin working with family members as soon as possible. A large part of the transition to home is to teach those who will be assisting the patient. This training includes everything from teeth brushing and hair combing, to providing the family and patient the proper training for safe walking while at home.

Communication and swallowing problems after a stroke

After a stroke, a person may have difficulty communicating. This is known as aphasia. Aphasia is the loss of a previous ability to speak or understand spoken or written language due to brain injury.

As with speaking, swallowing may also be affected for several reasons:

  • Muscles of the lips and tongue may be weaker.
  • Speech may not be clear.
  • Breathing muscles may be weaker, impairing the patient’s ability to swallow safely or to speak loudly enough to be heard in conversation.
Problems after a stroke

Here are some challenges that may be experienced:

  • Not being aware of one’s surroundings
  • Poor attention to tasks
  • Memory difficulties
  • Poor reasoning skills
  • Poor problem-solving skills
  • Trouble concentrating
  • Slower processing of new information
  • Difficulty accurately organizing thoughts to tell a story
  • Switching topics or going “off on a tangent”
  • Problems taking turns during a conversation
  • Difficulties staying on one topic
  • Inability to “keep up” during a conversation
  • Reacting with either too much emotion or very little

A speech-language pathologist is an expert in the areas of speaking, swallowing, and cognitive-linguistic functioning. While a stroke patient is in the hospital, his or her ability to speak and swallow will be evaluated. The initial screening for swallowing problems may be conducted by nursing staff. If a problem is detected, our speech-language pathologist will meet with you to make sure you are able to eat and drink. Other tests may include whether or not a patient can generate the sounds necessary for speech and whether or not the stroke has impacted the patient’s cognitive-linguistic skills.

If a stroke patient is having difficulty with swallowing, further testing may be necessary. This may include the use of imaging equipment which allows a speech-language pathologist and a physician to actually watch the muscles of the throat while a patient is swallowing different types of foods.

After the speech-language pathologist meets with you, an individualized treatment plan is started, which will focus on the treatment needs of each patient for stroke rehabilitation. We care about our patients and will work closely and compassionately with you after your stroke.

Learning the signs of stroke can save your life or the life of someone your know.

The Kozel Stroke Institute utilizes advanced medical technology, known as remote presence “real time” technology, to transmit critical information, connecting physicians at the patient’s bedside with stroke experts at California Pacific Medical Center. These specialists team with HDH nurses and doctors to provide rapid care to protect the brain of the stroke patient, maximizing the opportunity for a successful outcome.

Few rural hospitals anywhere in the country can offer this advanced level of stroke care. The Kozel Stroke Institute is a Certified Primary Stroke Center and assures local residents prompt treatment. Since January of 2009, the program has impacted over 100 patients per year.


Joint Commission Seal

Certificate of Distinction by The Joint Commission for advanced certification as a Primary Stroke Center