Identifying a stroke FAST

SINGAPORE - It is no wonder that the diagnosis of stroke strikes terror in many.

After all, stroke is the second-highest cause of premature death and the eighth-highest cause of disability burden here, according to the Singapore Burden of Disease Study 2007.

MK, 42, an executive with a history of hypertension and hyperlipidaemia (high cholesterol levels) who also smokes socially, was worried about having a stroke.

Her 64-year-old mother had recently suffered an ischaemic stroke due to an artery blockage in her brain.

Her worry was sharpened by the fact that she had been experiencing intermittent numbness in her right arm for the past few months.

MK's family history of stroke and her own history of hypertension and hyperlipidaemia, coupled with her smoking and drinking habits, have put her at a higher risk of stroke than the average person.

After noting her medical history and doing a physical examination, I concluded it was unlikely that her symptom of numbness was due to a stroke.

I taught MK to use the "FAST" mnemonic - facial asymmetry, arm weakness, slurring of speech and time to act - to recognise early signs of stroke and advised her on how to minimise her risk of getting struck by the potentially fatal condition.

High blood pressure (hypertension) is a major risk factor.

Those with hypertension have 11/2 times the risk of suffering a stroke, compared with those who consistently have an optimal blood pressure of 120/80mmHg.

Hypertension causes the heart to pump harder to circulate blood in the body. This overstretching causes tiny tears and scar tissue that trap cholesterol and causes plaque to form, which then causes arteries to narrow.

If left untreated, hypertension can lead to stroke.

Lowering the risk

Lowering the risk

Thankfully, MK managed to control her blood pressure well, thanks to medication, treatment and regular follow-ups with the doctor.

Another risk factor for stroke is high cholesterol. This clogs arteries, which can then block the normal flow of blood to the brain and lead to a stroke.

MK was able to control her cholesterol levels by eating healthily.

She also did not have other diseases such as diabetes or atrial fibrillation (irregular and often rapid heart rate).

Diabetes sufferers are up to four times more likely to have a stroke, compared with someone without the condition.

Many of them also have hypertension and atrial fibrillation, further increasing their stroke risk.

There are also lifestyle risk factors, such as smoking, which damages blood vessel walls, speeds up the clogging of arteries, raises blood pressure and makes the heart work faster.

Such habits can double one's risk of stroke. That was why MK was advised to stop smoking.

In addition, alcohol consumption, especially binge-drinking, puts one at a greater risk of stroke.

Then, there is obesity, which puts a strain on the circulatory system.

Being morbidly overweight also makes people more likely to have high cholesterol, hypertension and diabetes.

Adopting healthy eating habits and increasing physical activity can therefore help to lower one's risk of stroke.

Caring for sufferers

Caring for sufferers

MK also wanted to know how she can best care for her mother when she is discharged from the hospital.

Stroke can cause mild to severe disability. This includes paralysis, problems with thinking, speaking, swallowing and eating, memory loss and depression.

These disabilities can lead to complications such as chest or urinary tract infections, pressure sores, constipation and stiff limbs.

Dealing with the aftermath of a stroke can, naturally, make some patients feel despondent.

Professional counselling can help such patients manage better and improve their quality of life.

Stroke sufferers may also end up having difficulty speaking and understanding conversations.

The caregiver needs to be very patient and encourage the patient in every possible way.

This can be done by using simple gestures or signals to help the patient feel in control again.

Rehabilitation to relearn functions that were lost should start as soon as possible, through physical, occupational and speech therapy.

A healthy diet is also needed for recovery. A dietitian can design a specific meal plan to achieve this, based on the patient's physical condition and nutritional needs.

The right treatment and care are important and part of this hinges on making healthcare safe, reliable and seamless.

Nurses can screen post-stroke patients for any risk factors, educate them and their caregivers on issues that may arise after a stroke and highlight any problems to doctors.

It is important to control the patient's risk factors and he should also be given an anti-coagulant or anti-platelet agent to prevent a second stroke from happening.

After the consultation, I referred MK to a care manager who could advise her on how to care for her mother when she returns home.

A stroke can be debilitating. But if we act FAST and learn how to properly care for our loved ones who are affected by the condition, we have the power to help them bounce back, stay happy and live well.

enquiries@nhg.com.sg

Dr Ang is a family physician and associate consultant at Clementi Polyclinic, which is run by National Healthcare Group Polyclinics (NHGP). The NHGP's nine clinics are part of the National Healthcare Group, the Regional Health System of central Singapore.

This article was first published on June 19, 2014.
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