Hit by a killer
By Kumudini Hettiarachchi
It creeps up on you without your knowledge. Just a numbness in the fingers
or a slight blurring of the vision. Who has the time to bother with minor
irritations like that, with the hectic routines of today?
But don't ignore it. For it could be the early warnings of a silent
killer, in fact, the second largest killer in the world - strokes or brain
attacks.
However mild the symptoms, don't put off consulting a doctor and seeking
treatment, for another day. For, 15 to 20 million people the world over
are struck down by strokes every year and five million of these victims
die within the first year. Five million more are disabled for life.
Taking into consideration the seriousness of strokes, The Sunday Times
checked out the facilities available in Sri Lanka, both in the state and
private sector, if unfortunately, one falls victim to this disease.
As soon as there is a suspicion that you may be coming in for a stroke,
you need to consult a doctor immediately. In the outstations, state doctors
will admit stroke patients to normal medical wards and treat them there.
The diagnosis of a stroke will be on the basis of the history and examination
of the victim. Once the patient is admitted to hospital, further investigations
in the form of Computerised Tomography (CT) scans will be carried out to
ascertain the type of stroke the victim has suffered - whether it is an
ischaemic or haemorrhagic stroke (See graphic for explanation).
CT scanners are available in Colombo, Kandy, Galle, Badulla, Ratnapura
and Anuradhapura.
Sometimes Magnetic Resonance Imaging (MRI) scans are also taken, but
CT scans are more popular because they are cheaper. The "multi- slice"
CT scans would give very clear pictures of the structure of the brain and
indicate where the problem is. By determining the stroke type, doctors
can decide on the next course of action by way of treatment. Unfortunately,
the CT scanners in the state sector have a massive workload, thus creating
a long waiting list.
The treatment will also depend on how soon a stroke victim is brought
to hospital. If the stroke has been caused by a clot, and the patient has
been admitted within three hours, a clot-buster would be administered to
dissolve it. "It is done in selected patients, who qualify for such treatment.
Clot-busters cannot be given to each and every stroke victim," doctors
emphasise.
In certain cases of both clots and haemorrhages in the brain, neurologists
may decide to operate, to reduce the immense pressure on the brain caused
by the stroke.
In Colombo, at the National Hospital's Institute of Neurology, the hub
of stroke care, there is a 'Stroke Unit'. Here the patients are under the
care of a specialised team which includes neurologists, trained nurses
and also physio, speech and occupational therapists.
The all-round treatment provided at a Stroke Unit definitely reduces
the mortality and morbidity rates, doctors explain.
Doctors at the Institute of Neurology are also concerned about the lack
of community based rehabilitation for stroke victims. A doctor stressed
that even after all possible treatment has been provided, some patients
have severe or mild disabilities, depending on the virulence of the stroke.
Sending such patients straight home after their stay in hospital is
not the ideal situation. Some will have difficulty in walking, talking
or making themselves understood. Some may be partially paralysed. Others
may not be able to feed themselves alone. Even bladder and bowel control
is difficult for some. For the kith and kin who have to care for them at
home too it is a new and difficult learning experience
"That is why we are struggling to set up a half-way house for stroke
victims, where they will be in a community environment with rehabilitation
continuing," said a senior neurologist, hoping that the public will chip
in and help them to set up this essential facility.
From the hospital, stroke victims could move there and after some time
go home to their day-to-day lives. Then they will be better equipped to
deal with the ups and downs.
Stroke services have been strengthened with the setting up of the National
Stroke Association of Sri Lanka, which is a year old now. Anyone can join
this 175-member Association which supports medical care for patients, ensures
ethical standards, attempts to advance knowledge about strokes, encourages
and promotes research, makes people aware about the implications of strokes
and also supports community care.
The National Stroke Association of Sri Lanka can be contacted at 'Wijerama
House', 6, Wijerama Mawatha, Colombo 7.
Private sector
In the private sector, a patient suspected of having suffered a brain attack
is admitted to the intensive care unit and comes under consultants immediately.
Nawaloka Hospital's Medical Director explains that to diagnose the severity
of a stroke, the victim would have to undergo a CT scan and Nawaloka has
the fastest one in Sri Lanka.
There is also an operating theatre with neuro-surgical facilities and
the after-care would include being in the surgical intensive care unit
and later a neuro-surgical unit for patient rehabilitation. The nurses
are specially trained, supported by physiotherapists, he says. "We also
have a fully-equipped laboratory to check out why the patient suffered
a stroke, to determine the cause."
At Durdans Hospital too they treat both acute and chronic stroke patients,
says its Medical Administrator. When a stroke victim is brought in, the
patient is admitted to the intensive care unit, to tide him over the critical
period under the care of a neurologist. Once he gets over the crisis, he
is moved to a room to get after-care such as physiotherapy.
CT scans and all necessary investigations are also done in a fully equipped
lab, he added.
Protect & prevent
Want to protect yourself against strokes and also cut down the risk of
suffering a stroke?
•Eat more fruit. An easy step in the right direction will be to eat
food which is low in fat and salt, but high in fibre and potassium. You
haven't far to look — just visit the stall round the corner for some fresh
fruit.
•Another major preventive would be to stop smoking now. There is a direct
relationship between the number of cigarettes you smoke and the chances
of suffering a stroke. If you give up that fag today, the risks will decrease.
And at the end of five years the risk of getting a stroke due to cigarettes
will be nullified. You will be on the same level as a non-smoker then.
"The emphasis is on prevention. That is the main strategy we try to
use in stroke care. Prevention is the best," says National Stroke Association
President, Dr. Jagath Wijesekera. |
