A Family Doctor's Tale - STROKE

DOC I HAVE A STROKE

Strokes are very common in elderly patients especially those with heart conditions, high blood pressure and diabetes. Because most of them have difficulty in movement of their limbs they may need care givers to look after them.
The problem is worse in patients with dysphasia -difficulty in talking and understanding as it is more difficult to get them to do what the care giver wants them to do or cooperates with them.

A stroke is known also  known as a cerebrovascular accident(CVA). It happens when the blood vessel to a part of the brain is blocked(due to a blood clot) or burst.The brain cells in that part cannot get the oxygen and nutrients so they are damaged and unable to function.


A stroke occurs when:


1.there is a blockage of an artery in the brain by a blood clot, piece of fat or air bubble traveling in the blood from another part of the body. This leads to lack of supply of oxygen and nutrients to the brain cells. As a result the brain cells died leading to loss of function of the  part of the body controlled by the brain cells.
     
2.there is rupture of an artery in the brain leading to internal bleeding and damage to the brain cells. This can be caused by high blood pressure, head injury or a weak artery wall from birth (aneurym).


3.there is compression by a brain tumor or tightening of the artery wall.


Causes of Stroke are:
1.High Blood pressure-
 Hypertension damages the arteries of the brain by causing bleeding or blockage
2.High cholesterol-
Cholesterol deposit thickens the walls of the arteries, making them narrow and reducing blood flow.
3.Diabetes mellitus
The high blood sugar level thickens the arteries hard and make the blood thick so that less blood is able to flow through them.
4.Heart disease
People with heart disease are more like to have poor blood flow to the brain. Some heart disease like atrial fibrillation can throw out blood clots which can block the blood supply of the brain
5.Obesity
A BMI of 23.0kg/m² and above increases the risk of getting high blood pressure, diabetes and stroke.
6.Smoking
Tobacco smoke narrows arteries and reduces oxygen supply to the brain.
7.Drinking of Alcohol
Alcohol can cause liver and kidney damage. increase blood pressure and affect diabetes
8.Cerebral aneurysm, tumor,cancer metastasis,
These can cause blockage and bleeding in the arteries of the brain
9.Trauma or surgery of the brain
These can cause bleeding or form blood clots in the arteries of the brain
10.Stress
Repeated stress, if poorly controlled, can lead to high blood pressure.


TIA or Transient Ischemic Attack:
It is a early warning sign of a stroke
TIA occurs when blood supply to a part of the brain is temporarily cut off causing slight damage to the brain cell.
It may last seconds to up to 24 hours.
The symptoms of a TIA are often vague and temporary:

1.temporary numbness or weakness occurring suddenly in one arm or leg or on one side of the face
2.temporary difficulty in speaking or slurring of speech
3.sudden difficulty in seeing or 'blackout' in one eye
4.temporary dizziness or fainting or loss of balance
5.Temporary confusion,poor coordination or understanding
6.unexplained headaches or a change in the usual headache pattern


Early treatment of a TIA can help prevent a stroke from occurring in the future.


Symptoms of Stroke:
1.sudden  numbness or weakness, usually on one side of the body,often with loss of feeling
2.difficulty in speaking or understanding
3.difficulty in swallowing
4.loss of concentration and memory
5.sudden difficulty walking
6.loss of control of passing urine or passing motion
7.behavior changes such as laughing or crying at the wrong time, feeling depressed or showing bad temper.
8.sudden severe giddiness, loss of balance and coordination
9.sudden severe headache with no known cause
10.sudden vision loss in one eye


Stroke is an EMERGENCY.
Purpose of treatment is to:
1. preserve life
2. limit the amount of brain damage
3. lessen the extent of disability and deformity
4. prevent recurrence.


Admission to hospital is necessary to determine
1. the cause of the stroke
2. the extent of damage to the brain using MRI of the brain
3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).
4. whether Surgery is necessary to stop bleeding or remove a blood clot
5. risk factors for stroke are investigated and treated (diabetes, high blood pressure etc)


During the acute phase of stroke:
1. A clear airway must be maintained
2. Sufficient fluid and electrolyte intake must be maintained
3. adequate nutrition in the form of glucose, proteins and calories must be given
4. adequate nursing care is provided to prevent bed sores etc
5. Proper medicines are given


Once the stroke is stable:
The stroke patient is started on a rehabilitation program
This will include
a.exercises to strengthen his muscles,
b.speech training for patients with dysphasia (difficulty in talking)
c.training on how to carry out his daily activities.
d.advice about his diet


Immediate care improves the chance of a complete recovery. 


A stroke can be very devastating and depressing for a patient.
He will feel that part of his body and brain function is incapacitated.
Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends


Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:
Please do:
1.be understanding and patient.


2. keep the patient cheerful and hopeful


3.learn how to help him with the diet, daily exercises and other care necessary for him


4.allow the person more time to do any task


5.encourage and praise the patient to do as much as possible for himself at his own pace.


6.involve the person in family discussions and activities.


7.be encouraging and praise his daily efforts.


8.encourage the person to look at, touch, and move his affected limbs.  


Do not:
1.ignore him or treat him like a child .


2.encourage the person to do things using the good side only.


3.pull on the affected arm or leg as it can be extremely painful.


4.interrupt or speak up for him.


5.make discouraging remarks.


6.allow the person to squeeze rubber balls as this may tighten his hand muscles.


7.let him be depressed


8.let him develop bed sores. Try to turn his body regularly.


In order to help the person be as independent as possible, there are special aids(such as tripod walking cane) and appliances(wheelchairs) which can be used to help him with his daily activities.
There are also special clothes and shoes which uses velcro instead of buttons or zips.
Make the home a safe place with non-slipmats and grab bars


Prevention of a stroke is the same as the prevention of a heart attack as both involve the avoiding the blockage or bleeding of a major artery to the brain or heart.


1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.


5.Control the Diabetes
Check for diabetes starting from the age of 40 years. If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.


2.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more bean curd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.


3.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.


4.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless. Examples include brisk walking, swimming, cycling. 


6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.