LIVE BY DESIGN | What is useful to know about strokes and the imperative to act quickly?

A friend, Dineo, (not her real name) told me recently she was recovering from a stroke. A few days ago, my nephew postponed our dinner arrangement because his friend had had a stroke and the prognosis was not good. Indeed, the outcome was a funeral. Last Sunday, 24 November, controversial American preacher, TD Jakes had a medical emergency while delivering his livestream sermon. A mini stroke is suspected. This week, on one of my community chats there was a post about one of its members having been rushed to hospital. Again, it was a stroke.

Would I know a stroke if I saw one? Would I know what to do? I fear not. Those classes called life skills could do with some updates. When things happen in clusters in my life. I take that as the universe telling me that I need to pay attention. I decided to learn the “need to know” essentials.

Dineo told me her story. She had been a car passenger when her partner, the driver, heard that the words coming out of her mouth sounded like gobbledygook. Within minutes, normalcy restored itself and Dineo felt absolutely fine again. My friends continued with the plan for their day, except for one phone call, Dineo made an appointment with her doctor.

Roll forward to the next day. The GP listened to the story and in Dineo’s words: “I was given hell.” Dineo and the GP have interacted over several years. The GP’s frankness in her reprimand was, in part, due to the fact that she was aware of Dineo having once worked as a medical professional, albeit decades ago.

Why was the doctor furious?

Dineo had had a stroke. A stroke is a medical emergency. Call emergency services 112 in RSA or more famously 911 in the USA. A stroke means there has been a blockage in the blood supply to the brain. The severity of the impact of a stroke depends on how quickly or not you get medical attention. The earliest possible treatment with medication like tPA (a clot buster) can minimise brain damage. The best chance for this treatment to be effective is to get the injection within three to four hours.

That was why Dineo’s doctor was furious. Her partner needed to have driven her straight to the nearest emergency care centre. That they continued with their plan for their day was a mistake – luckily one they did not pay for dearly. Dineo was fortunate to recover well and start a programme of preventative treatment to lower the risk of recurrence.

It struck me that I am among those who do not know enough. I also would not have recognised the stroke symptoms. I also would have been fooled by the quick recovery into thinking that whatever had happened was nothing too serious.

Dr Robert Brown, neurologist at the USA’s renowned Mayo clinic, advised that if you observe any stroke symptoms,
“DO NOT WAIT TO SEE IF THE SYMPTOMS STOP. Every minute counts. SEEK IMMEDIATE MEDICAL ATTENTION.”

I am considering cutting out and placing the graphic below in my car – to remind me of the five most common symptoms:

1. Trouble speaking or understanding what others are saying;
2. Numbness, weakness or paralysis in the face, arm, or leg;
3. Problems seeing in one or both eyes;
4. Balance – trouble walking;
5. Headache – a sudden severe one.

Dr Brown recommends memorising the mnemonic F.A.S.T.

• F=FACE Ask the person to smile, observe if one side droops
• A=ARMS Ask the person to raise both arms – observe if one arm lags.
• S=SPEECH Ask the person to repeat a short phrase. Notice if slurred or different.
• T=TIME If you’ve observed any of these signs, get emergency medical help FAST.

There are different kinds of strokes, but all require speed as the imperative to get emergency care. The ischemic stroke, the most common, is the result of a blocked artery in the brain. When the blockage is a short temporary disruption, it is known as a Transient Ischemic Attack, a TIA. for short. A haemorrhagic stroke, the more serious one, is caused by the leaking or bursting of a blood vessel in the brain.

You cannot know the consequences ahead of time. Each stroke will be specific to the person. The impact the stroke has will depend on how long the blood supply to the brain is interrupted and exactly which part of the brain is affected.

In 2019, News24 covered the story of George Scola who after having a stroke, aged 37, created a foundation www.strokesurvivors.org.za.

Apparently, it is the fifty-five plus age group that are most susceptible. The prevention strategies all sing the hymn sheets of a healthy lifestyle. Watch out for high blood pressure. Reduce that saturated fat in your diet and watch that your cholesterol levels stay low. Do not smoke. Be alert to diabetes; diet and exercise can help keep you blood sugar in a healthy range. Maintain a good weight for your height.

I am astonished at my level of ignorance. For the last decade of my mum’s life, I was her principal caregiver up to when she died, at home, just short of ninety. She had hypertension and diabetes. She was an ex-smoker. In my ignorance, I never had conversations with domestic workers and carers about what they might need to keep a look out for. I now feel, in retrospect, that my lack of information was irresponsible.

Holiday times approach. Many of us travel to family reunions. We may be off the beaten track, away from access to our normal medical network. It behoves us to be observant and have clarity, wherever we are, about our best access to emergency care. I do not want to dampen holiday spirits. I just want us all to be ready for when “life happens.”