STROKES
STROKE is one of the most alarming things that can happen to you or to a companion. It ranges from a very minor and short-lived impairment of, say, speech or power in a limb to a devastating illness causing collapse, coma, severe disability and even death. It is always due to a problem with the blood supply to the brain of the patient - either a blocked vessel or a burst vessel with the latter tending to lead to the more severe symptoms. Blocked vessels on the other hand may unblock after an interval or an alternative blood supply may open up to the affected part of the brain allowing it to recover (leading to a TIA or "mini-stroke" instead of a full stroke).
THE worst thing about the early stages of a stroke is uncertainty about what is happening and what is going to happen. This leads to anxiety in the patient which is not going to help them and so reassurance so far as you can give it is very important. If they are lapsing into unconsciousness then it is important to protect the airway by putting them in the recovery position if possible - i.e. on their side with their neck slightly extended. On the other hand if the symptoms are quite minor then they may be having a TIA from which they will make a rapid and complete recovery. We are always happy to discuss this type of situation with you but in the case of the collapsed and unconscious patient - especially if their breathing seems in difficulties - summoning a 999 ambulance may be the most important action that you can take. With a possible TIA, especially if it is mild and following a previous pattern, it may be prudent to wait a few hours to see what is going to happen before calling the doctor although I must reemphasise that we are only too happy to advise by 'phone if you are in doubt.
WHAT will the doctor do?
Firstly the patient's safety is the immediate problem and unconscious patients may have breathing problems which may be compounded by swallowing problems and the loss of the protective "gag-reflex" which prevents inhalation of liquids and solids. In this case the use of the recovery position in which to nurse the patient before the ambulance arrives to take the patient to hospital is potentially life-saving. Anyone with first-aid knowledge can do this .
Secondly, where there is no immediate threat to life the doctor needs to make a decision as to whether to admit the patient to hospital. In most cases the patient will be admitted - more for nursing care and rehabilitation than for emergency medical care though, rarely, this may be required. Where the patient is kept at home this may relate to the patient's age, other medical conditions which may be present, availability of carers willing to be "on tap" 24 hrs per day and evidence of early signs of recovery.
Thirdly, where the patient has had a probable TIA and is recovered, or nearly so, then the doctor may want to consider preventative measures to reduce the risk of further attacks in the future. Such preventative measures may include Aspirin, Warfarin and blood pressure treatment if this is high.
IN the long term the patient will want to live as normal a life as possible. The TIA patient and those who have had a small stroke the amount of disability left will be nil or very little and specialist rehabilitation services will not be required. Patients who have had major strokes will need a lot of assistance, both in day to day living and with rehabilitation aimed at minimising their disabilities. If they have been in hospital with the original stroke the it is likely that a lot of this will already be teed-up for their discharge. If, however, you think that more needs to be done for the patient then contact either ourselves, the District Nurse or Social Services. Click here to go to links (for further information re sources of information and help).