Stroke wards to ward off stroke

By Kumudini Hettiarachchi

The danger signals are loud and clear and as the years go by the problem will not go away but become more acute. It is inevitable and Sri Lanka will have to live with it in the face of an ageing population.

With age being a major risk factor that cannot be changed and the World Health Organization predicting that by 2050, just over 40 years on, 1 in every 4 persons will be above 60 years old worldwide, 25% of Sri Lanka’s population will fall into the category of the aged.

With it will come the spectre of strokes, more aptly called “brain attacks”, which not only result in death but also major disability among survivors. The stroke figures are estimated to be around 5-10 persons per 1,000.

A carer tending to a patient at the Stroke Unit of the National Hospital. Pix by Saman Kariyawasam

How should Sri Lanka deal with this situation? While making people aware of measures to prevent getting into the vice-like grip of a stroke, The Sunday Times understands that the right path to take as a country would be to open up more Stroke Wards in hospitals across the country.

In the event of a person falling victim to a stroke, quick and immediate treatment along with rehabilitation in a Stroke Ward under the care of a multidisciplinary team would be the answer.

“Age is a risk factor that we cannot change. It is non-modifiable,” stresses Consultant Neurologist Dr. M.T.M. Riffsy of the Colombo South Teaching Hospital. But good awareness programmes to prevent strokes and also in case of a stroke, proper treatment at a Stroke Ward are of paramount importance.

Sri Lanka along with countries such as India, Indonesia and Myanmar has been identified as having to look into the crucial matter of a high number of aged people in the future, adds Consultant Neurologist Dr. Sunethra Senanayake of the Colombo North Teaching Hospital. “In Sri Lanka, this is not due to the country having a big population but because the health services are such that life expectancy is high.”
Strokes are No. 3 on the list of the commonest causes of death and have the dubious and tragic reputation of being the leading cause of disability. It affects not only the victim but also everyone around that person. It disrupts employment, life and compels families to have a full-time carer for the victim.

What is a stroke?

Identified as a “medical emergency”, strokes occur when the blood flow to the brain stops and brain cells die due to big or small arteries in the neck and the brain having deposits of fat. The fat deposits would form an irregular surface which would promote blood clotting.

Strokes fall into two categories – ischaemic stroke (80%) caused by a blood clot that blocks or plugs a blood vessel and haemorrhagic stroke (20%) caused by a rupture or bursting of a blood vessel resulting in a bleed to the brain.

There could also be “mini-strokes” or transient ischaemic attacks (TIAs) which come about when the blood supply to the brain is briefly interrupted and could be a warning sign of an impending stroke.

The risk factors which are preventable to a certain extent are:

Hypertension – Every person over 40 should get his/her blood pressure checked once in six months. “For some, hypertension is a long-standing, long-term problem and what must be remembered is that just because it is controlled with medication does not mean that it has been cured,” stresses Dr. Senanayake.

Adds Dr. Riffsy, “Just because you are fine, does not mean that you can stop the medication. The decision to reduce the medication has to be taken by your doctor after evaluating your condition. Hypertension can exist without any clinical symptoms. It is a silent killer.”

Symptoms like dizziness and vertigo are felt only when the pressure is very high, it is understood.
People are advised to keep the blood pressure down by having leisure time, relaxing with family without stress and by doing regular physical exercise.

Diabetes or high blood sugar
High cholesterol
Smoking - which if a person stops brings the body back to normal in one-two years.
Obesity – As this is a common cause, it is essential to maintain the correct weight to height and ensure that the waistline is trim, stresses both neurologists.
Exercise – Regular exercise in the form of at least half-an-hour more than three days a week. “Don’t start strenuous exercise newly but gradually increase it,” advises Dr. Riffsy.
Excess alcohol.

Some other risk factors are:

Ischaemic heart disease
Rheumatic (valvular) heart disease
Infection of the valves (Infective Endocarditis)
Rhythmic abnormalities in the heart (being too fast or too slow)
In rare instances it could be familial.

The warning signs would be:

A sudden loss of speech or slurring of speech
Weakness of one half of the body
Numbness of one half of the body
Sudden loss of vision in one eye or one-half of an eye
Dizzy spells, unsteadiness and weakness in both legs

If even one of these symptoms is experienced, come to hospital immediately, says Dr. Riffsy, if possible to a Stroke Ward where a multidisciplinary team will take charge.

Such a team will consist of neurologists, rehabilitation physicians, trained nursing staff, physio, speech and occupational therapists, radiological back-up, a psychologist, a counsellor and also a social worker. Along with acute care of a stroke victim, he/she also needs immediate rehabilitation which can be started in a Stroke Ward.

Stroke wards are proven to be better in the management of stroke patients, The Sunday Times understands, with countries such as Australia, United Kingdom and America establishing more of these units.

Unfortunately, Sri Lanka has only two such units – Ward 16 of the National Hospital and the recently established ward at the Kurunegala Teaching Hospital. But establishing a Stroke Ward, it is understood, is not a complex process. Any General Hospital with a CT machine could have one, with slight restructuring of the system.

Once out of hospital, with the carer also being trained and the family advised on modifications to the home such as a holding bar in the bathroom or a walking stick for the patient, most stroke survivors also need long-term rehabilitation. Once again Sri Lanka has only the Ragama Rehabilitation Centre to deal with not only stroke survivors but all others needing rehabilitation.

To be safe and not sorry, Sri Lanka needs more Stroke Wards and also more rehab facilities to meet the impending crisis.

A first

The 2nd Annual Sessions of the Association of Sri Lankan Neurologists conclude today, with the highlight being the first-ever International Stroke Conference.

The inauguration ceremony was held on Friday, with the Presidential address being ‘A step forward in stroke care in Sri Lanka’. A special feature was the oration on ‘The National Strategy for Stroke Care’ by Prof. Graham Venables, President of the Association of British Neurologists.

Prevention always being better than cure, here are some tips:

Lead a healthy lifestyle.
Eat healthy food – four servings of fruit and vegetables a day (one serving being two tablespoonfuls). The rule of thumb could be: eat a quantum of carbohydrate like your fist, a volume of fruit and vegetable to fill your palms when kept together and a quantity of oil the size of the tip of your thumb.
Reduce the salt intake. Avoid instant food as they are laced with salt.
Avoid red meat and take chicken without the skin. If you want to eat red meat, restrict it to about twice a week as also egg. Eat as much fish as you want but avoid prawns and crab if you have cholesterol. The consumption of dairy products would depend on your cholesterol levels.
Drink 2-3 litres of water a day
If you feel like having a drink, restrict your alcohol to 50 ml of arrack or whiskey or ½ a pint of beer or one glass of red wine a day.
Reduce the intake of sugar

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