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| Sunday, 23 February 2003 |
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| News Business Features Editorial
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Compiled by Carol Aloysius Today is National Stroke Day : Brain attack! Stroke is the third leading cause of in-hospital deaths in Sri Lanka
and the most important cause of disability. Whereas in the past this Dr. Jagath Wijesekera, well-known Consultant Neurosurgeon, recently spoke to 'Sunday Observer' staffer Carol Aloysius on this unusual trend.... Q: Is it true that the hospitals in this country now have young people being admitted after a stroke?. How many young patients do you estimate as being in your wards today? A: I would say around forty percent of our stroke patients are under forty years of age. I have even seen small children of three and four years of age as well as teenagers between the ages of 15 and 19 being brought into our wards after a stroke. Q: And the reason for this? A: There are several reasons why so many young people are getting strokes. But the most important reason is Rheumatic heart disease. This disease, if neglected can affect the heart valves and lead to blood clots being formed. If these clots enter the blood stream they could end up in the brain. The result will be a stroke. Q: Can one prevent this disease from leading to a stroke in young people? A: Rheumatic fever is an eminently preventable disease. And so too is stroke resulting from it. Parents of young children who are more prone to this disease, should be vigilant and take their child to a hospital and have him checked if he develops joint paints with high fever, without delay. The condition can easily be diagnosed with a blood test . If treated in time there will be no danger of the child's heart being affected. Q: What are the other causes of strokes among young ( and old) in this country? In what order would you list these risk factors? A: I would say that 50 percent of strokes is due to High Blood Pressure. Of the balance 50 percent, around 25 percent are Diabetic patients while the rest are persons who have high cholesterol and heart disease. Smoking and excessive use of alcohol, lack of physical activity and exercise and lack of a healthy diet are also important risk factors. Q: Are all these risk factors preventable? A: Yes. Stroke is, I emphasise, a largely preventable disease. This is because most of the risk factors associated with stroke can be eliminated with will power and a change of life style and eating habits. By controlling these risk factors you can not only minimise the risk of stroke, but reduce the risk of other major `killer diseases' like heart disease and cancer. Q: Once a person gets a stroke, can he or she prevent another stroke simply by minimising these risk factors? A: Certainly. Take smoking for instance. If a person who has had a stroke stops smoking completely, the chances of him getting another stroke will reduce significantly every year so that in five years he will be like someone who has never had a stroke. The same thing applies to excessive alcohol intake and eating healthy foods instead of junk food, and consuming a low salt diet. Q: Most young people and even older persons of today work under stressful conditions. Can stress bring on a stroke? A: Yes, Stress is an important cause for stroke. Q: There is a belief that when one gets a stroke, nothing can help him and that if he recovers, he will be bedridden. Is this true? A: This is a myth. Early intervention can definitely reduce the extent of disability - and death. If a patient is taken to a hospital then we can treat him in time before the brain swells and clotting takes place. Most deaths occur due to brain swelling which can be avoided with clod busters. Q: Ideally when a person gets a stroke where should he or she go? And when? A: To the Stroke Unit at the General Hospital which is the only complete Treatment and Rehabilitation Centre for stroke victims in this country. Here he will receive the best co-ordinated treatment from our doctors, nurses, therapists (speech, physiotherapists and occupational therapists) as well as from the social workers who together work as a team to help the stroke patient. If a patient is taken to a hospital within three hours and treated, his life can be saved and there won't be any serious disability. Q: What happens when a stroke victim is brought there? A: We treat the acute phase first, diagnosing whether the patient has had an ischemic stroke (which accounts for 80 percent of strokes or haemorrhagic stroke and then give neurosurgical intervention if necessary. If the patient is very ill we send him to the intensive care unit.) Q: And after he has recovered? A: We hand him over to our therapists-speech, occupational, physiotherapy - for rehabilitation - so that he will be able to function in society and be independent. Q: You say there is only one such unit in the country right now. Have you plans to set up more in the future? A: Yes. The concept of a stroke unit is one of the major advances in management of stroke. Stroke related morbidity and mortality can be reduced by setting up these units in major hospitals in the country. It is the plan of the National Stroke Association to do this in hospitals islandwide where all the necessary infrastructure is already there. Q: What do you need to put this plan into action? A: We need adequate nursing cadre, more speech and physiotherapists. Most importantly, we need funds. Q: So if anyone wants to contribute towards this worthy cause whom should they contact? A: The Treasurer, National Stroke Association C/o The Sri Lanka Medical Association, No. 6, Wijerama Mawatha, Colombo 7. ***************** National Stroke Day gets off ground The National Stroke Association of Sri Lanka in collaboration with the Ministry of Health has declared the last Sunday of February every year as the National Stroke Day, to help focus the attention of the public on stroke. The inaugural National Stroke Day will be on Sunday 23 February 2003. Some of the activities that the Association is planning to organise for the National Stroke Day include: a 'health walk', a seminar on Stroke/healthy life styles, exhibition on Stroke/healthy life styles, poster competition on stroke by schoolchildren, a 'health check' and public educational activities such as health talks on electronic media. These events will be held at the Town Hall premises of the Colombo Municipal Council, and will commence at 7.00 am with the Health Walk. Members, the public are welcome to participate in these events and to have a free health check on their blood pressure and cholesterol levels. ***************** Managing a stroke - some guidelines . Early intervention is a must. A person who has had a stroke should be taken to the hospital within three hours of the stroke - ideally the stroke unit which offers co-ordinated care. 2. An immediate scan must be done to detect any sign of haemorrhage in the brain. This could provide an important guideline regarding treatment. 3. Physiotherapy should begin as soon as possible. 4. Connect the patient and his/her family to a supportive network. 5. Counsel family members on diet, exercises etc. to be given to the patient. N.B. Most people know about strokes but are not aware when they actually get a stroke, since there is no accompanying pain as in the case of a heart attack. So they go to their G. P. instead of going to the hospital. By the time they are diagnosed it may be too late for full recovery. Hence early intervention is very important. These guidelines are based on an interview which the Sunday Observer Health Page did with Prof. Charles Warnon, a Neurologist from the UK during his visit to Sri Lanka. ***************** What is a stroke? It is a disturbance of brain function due to a disruption to its blood supply. When the blood supply is disrupted, the brain cells are deprived of oxygen and other nutrients, causing some cells to become damaged and others to die. A stroke is also known as a Brain Attack. A: Most strokes occur when a blood vessel carrying blood to the brain becomes blocked resulting in inadequate blood supply to an area of the brain (ischaemic stroke). Q: What are the warning signals of a stroke? A: May be one or more of the following: Sudden blurring or decrease in vision in one or both eyes. Numbness, weakness or paralysis of the face, or in either an arm or a leg on one or both sides of the body. Difficulty in speaking or understanding Dizziness, loss of balance or an unexplained fall. Difficulty in swallowing. Headache (usually severe and abrupt in onset) or unexplained change in the pattern of headaches. Sometimes such episodes may last only a few minutes to a few hours. Such symptoms should never be ignored, as they indicate that a part of the brain is not receiving enough blood. Such a condition, if neglected, may lead to a stroke. If you or someone you know experience any of the above warning signals, seek medical attention immediately. Q: What are the effects of a stroke? A: Some strokes are fatal while others may cause permanent or temporary disability. As a result of a stroke certain areas of the brain are damaged and functions normally controlled by these brain areas become impaired. The most common effects of a stroke are paralysis on one side of the body and loss of ability to speak/language skills. How are strokes treated? In general, treatment for people affected by strokes are of three types: Drug Treatment: aims at reducing the extent of brain damage and thereby increasing the likelihood of a good recovery. General Care: aims at helping with swallowing difficulties and bladder and bowel control, and minimizing the complications of a stroke. Rehabilitation: aims at maximizing recovery from stroke, so that the patient could become as independent as possible and regain his/her normal life style. Q: Can a stroke be cured? A: There is no known drug that can completely eliminate the possibility of a stroke or offer a guaranteed 'cure'. However, early diagnosis and quick action can reduce the severity of a stroke. Q: How can the risk of having a stroke be minimized? The risk can be reduced by: Seeking immediate medical attention if you experience any of the warning signals. Controlling high blood pressure. For this you need to have your blood pressure checked and treated if necessary. Controlling high bloodsugar (diabetes). Controlling excess fats in your body such as cholesterol. A healthy diet low in fat and salt but high in fiber (fruits and vegetables). Giving up smoking. The National stroke association of Sri Lanka (NSASL) aims to promote knowledge and awareness about strokes and to encourage healthy life styles, and strategies for stroke prevention. For further information, please contact:- ***************** Bringing light to darkness A stroke is a sudden disturbance of brain function due to a disturbance in its blood supply, when this sudden disturbance of brain function occurs due to an interruption in the blood flow it is called an Ischaemic Infarct stroke. Eighty per cent of strokes are Ischaemic strokes. Strokes are also caused by a rupture of blood vessels. This is known as Haemorrhagic stroke. Risk factors are: High blood pressure, heart disease, diabetes, high cholesterol, cigarette smoking and excessive intake of alcohol. What happens after a stroke? Strokes cause - (1) A disturbance of brain function Symptoms last for 24 hours. If symptoms last less than 24 hours it can be a transient Ischaemic attack (TIA = or Mini stroke) These mini strokes can last for even 5 minutes but must be taken as a warning signal. Patient must seek immediate medical attention even if symptoms disappear. Diagnosis - A CT scan is all essential tool to distinguish between an infarct and haemorrhagic attack. Treatment Acute management - early treatment is important to improve outcome, Drugs given to dissolve blood clods. 'Clod busters' effective only within 3 hours of a stroke. About 40 per cent of patients who have a stroke and get paralysed don't recover completely. Paralysis can hamper mobility and lead to patients becoming bed-ridden. When this happens patients can develop bed sores, respiratory problems, pneumonia and mental problems. Mobility helps a stroke victim to be independent. Rehabilitation is done at the stroke unit and is a team effort. Although the most susceptible group is between 60-65 years, stroke now affects young people as well, as our hospital admissions prove. Around 40 per cent of persons in hospital for stroke are less than 40 years. Prevention Exercise, modifying one's lifestyle, eating fresh fruit and vegetables and low fat diet, abstaining from smoking and drinking and taking the prescribed tablets for diabetes and pressure can prevent stroke. ***************** More about strokes A stroke is a sudden illness of the brain Signs of a stroke are: 1. Numbness or weakness of one side of the body. To reduce the risk: 1. As soon as danger signals appear get medical attention immediately. Take a low fat, low salt diet. 7. Refrain from taking high levels of alcohol. ***************** Let's make way for a bedridden - free society by Dr. Shyamali Damboragama, Consultant Community Physician, Health Education Bureau Stroke is the 3rd leading cause of death in hospitals and the leading cause of disability in Sri Lanka. following a stroke many patients have been bedridden due to inadequate and inappropriate care. There are several reasons for this gap in proper care for stroke victims. Firstly, because of a lack of care at home, most family members who are the carers of the elderly in their homes work during the day leaving the elderly patients at home without sufficient care. Secondly, untrained care results in the patient becoming bedridden. Wrong advice such as "you shouldn't move but rest because your blood pressure exceeds 200" makes the patient stay in bed and then become bed-bound. Hence before the patient is discharged and sent home, his family will need a lot of support and guidance to make sure that they are not so over protective and so delay his recovery. They must be made aware that excessive rest for stroke patient can sometimes be detrimental and make them bedridden. Thirdly, another important factor that makes a patient bedridden is the cessation of rehabilitation after being discharged from hospital. The patients receive rehabilitation training at hospital but because the home environment do not have conditions for rehabilitation they tend to become bedridden. This is in spite of the fact that nowadays many special aids are available for use in the home to facilitate performing ordinary tasks like bathing or eating by stroke patients. There are several ways to prevent stroke patients from being bedridden. Firstly, the National Health Service needs to look into the possibility of building a rehabilitation centre or hospice for stroke and elderly patients to be sent after discharge from hospitals. This facility should be built with the objective of improving patients' Activities of Daily Living (ADL) through quality care and rehabilitation. The patients can return home when they are ready. At least in each major hospital or neurology unit a centre with a physiotherapist and an occupational therapist should be available to make recommendations for house adaptation and physiotherapy. They could give advice on how to make a bathroom more accessible to the patient and to install handrails in the hall at home and how and where this services can be obtained. There are also very simple non-expensive devices in the market for patients to do exercises themselves. These need to be introduced to patients to maximise their early recovery. Stroke patients can do various exercises alone. These include using their strong arm to support their weak arm etc. This centre can also support families with day care - respite care services. A family support centre in the same unit too is very important. The care givers of the family too needs a lot of social and psychological support and needs to get their health checked regularly to enable them to take care of their loved ones more comfortably. This centre could also support patients with application for an ID for the disabled for disability allowances for renting of a wheelchair, a special bed and other equipments etc. and link patients with the Social and Welfare Departments Integration of Medical Care and Welfare Services is an urgent and critical need for these patients. Another way to overcome this would be for the national health service to focus an effort to bring nursing support to the homes of the patients. One method that can be employed to bring nursing and rehabilitation services to the home is through a community health nurse, primary health care workers or through trained health volunteers. This kind of home care of the hospital services is a first step forward. This will shift the medical care from waiting for patients to come to the hospital to one of reaching out to them. Provisions of home care by the community health workers or volunteers depend on building interpersonal relationships with patients and their families. The community workers need to be trained for 1-3 years in a hospital to acquire sufficient clinical nursing skills and expertise before venturing out for home nursing. For this to be successful there needs to be a close association with the hospital and community health team. Prevention of stroke in the community The most effective way of prevention is to encourage all people to enjoy a healthy lifestyle. Engaging in exercise, taking a healthy diet, rich in fresh fruits and vegetables, controlling stress and refraining from smoking and alcohol consumption and thereby improving your lifestyle, will go a long way to reduce the risk factors for getting a stroke. |
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was a
disease more or less confined to the elderly, today hospital admissions
have shown that younger and younger patients are becoming victims of this
debilitating disease.
