Stroke

What is it?

It induces disability of higher order and possible reason for mortality. Detailed reading is available here.  Typically it is either ischemic(loss of supply of blood to brain) or heamorrhagic(rapture of blood vessel or bleeding). Stroke affected person needs immediate attention, the first hour is the most important as recurrent stroke or other problems based on the patient’s other problems could arise.  In US of A  and UK – newer treatment are available (tissue plasminogen activator, or t-PA – not effective for hemmoragic folks, Ancrod – snake venom ) which can be effectively used to prevent damage and recuperate faster. But usually the life of stroke affected person is changed for ever and has slower recovery(TIA – milder form of stroke is usually warning and recovers faster)

Once patient is recovering, prevention of embolism is as important.  Once stroke makes an appearance, near and dear family needs to step and become caregiver to the patient and each other. Acceptance for the patient and self is the most difficult piece, once that is done, rest things fall in place. External/professional caregivers will have limitations and challenges and in general in case of Indian families  – near family needs to right thinking. This could involve adjustments in approach to life and generally everything.

Treatment

Heparin  does is usually the first mode depending on the patient hsitory. Warfarin is used in the earlier stages of treatment and usually stopped, aspirin in other form of Clopidogrel on other hand is continued for anti-platelet action to prevent clotting. But best way to prevent clotting or heamorrhage is physical exercise and general calmness of mind.  Warfarin and aspirin dosage are to be prescribed by an expert  to prevent untoward event.   Vitamin K plays an important role during the treatment. While taking warf one needs constant INR monitoring. For the patients already using stamlo or similar drugs for controlling cardiovascular wellness(blood pressure), expert doctors can prescribe the dosage and timings (which are crucial). In general feet swelling is noticed in immoble folks affected with stroke.  Prevention of infection due to neutropenia  – is important but not controllable per se. So cleanliness, prevention of cold etc is super important while giving care.  Incontinence  can be overcome by use of adult diapers and regular timings and “sensitivity” towards the patient. Speech impairment and apraxia (inability to control the limb movement)/paralysis usually follows. Latter two can be treated with physiotherapy aided by the willingness of the patient to undergo the routine.

UK site has better updated information from time to time. In India btw stroke is 2nd biggest reason for mortality and age related immobility.

Can it be prevented from happening again?

Rehabilitation and family care are the most important factors which promote recovery,  Many medicines prevent recurrence of  stroke, but except aspirin in 1% of the cases, no medicine has been proven to enhance rehabilitation.

Research to follow up on.

Some of the research followed here sounds flimsy(spirituality, healing touch, spousal care taking pattern etc) but has roots in the difficult to handle aspects of the event.

Anticoagulants – have seperate branch of study.

Ahajournal has provided lot of information and tactical stuff but breakthrough is still awaited.

FDA has great site to follow up on medicines/sideeffects.  In developing countries the local agencies are not so transparent or helpful as usual.

Healthnet too has good information.

Stroke Association

How to take care

1) Patience with patient/self.

2) Sense of belonging to patient and self

3) Acceptance

4) Healthier food habits

 Is India better place to take care of patients

Yes from personal experience as the family support system is the most critical piece in the caring of the patient. Most of the drugs (except tPa possibly) are available and treatment known to the doctors.

At home

One of the challenges for meaningful life after stroke comes from the badly designed house/apartments/common spaces, shopping areas etc. Depending on the disability minimum which is required is the need for support(railings), space, access to wheelchair(depends on disability) and stepless design to common areas. I guess here the developed world is far ahead of developing countries. One needs to use common sense at home to drive the comfort of patient.

Guidelines at strokecenter, Center for accessible environments are pretty exhaustive for local places which may need adaptations for local deployment.

Stroke

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