Living with
Stroke

What is stroke?

A stroke (medically called acardiovascular accident) occurs when you don’t have enough blood supply to the brain. As a result, brain cells die because they cannot get enough oxygen or nutrients to meet their energy requirements.

 

Normally, blood flows uninterrupted from the heart through the two large carotid arteries in the neck that divide into a large and rich network of smaller blood vessels. The multiple branches of this network supply all the different parts of the brain with enough nutrients and oxygen for the high amount of energy production that is required for brain function. When one of these vessels becomes blocked or bursts, then the part of the brain it supplies blood to will become damaged, in some cases permanently.

 

Stroke is a life-threatening medical emergency that can cause permanent disability. Therefore, it is important to take all preventative measures possible to reduce your risk of suffering a stroke, and you must seek medical attention immediately if you do experience the symptoms of stroke.

How could you know if you have had a stroke?

Usually a stroke is not painful, while smaller and more acute types of stroke may cause symptoms that are easy to ignore. However, even small strokes are incredibly dangerous, and treatment must be sought immediately to avoid larger and more serious strokes from occurring.

 

Seek medical help immediately if you experience any of the following signs:

  • Sudden weakness, numbness and/or paralysis in an arm, leg or side of the face (you may struggle to move or feel sensation on one side of your body)
  • Sudden difficulty speaking or understanding what others are saying (you may appear confused or be slurring your words)
  • Sudden confusion and disorientation (you may become difficult to rouse or struggle to remain conscious)
  • Dizziness, trouble sitting or standing up and difficultly walking (you may lose your balance easily and fall over)
  • Sudden change in vision (you may experience blurriness or blindness in one or both eyes)
  • Sudden and abnormally severe headache accompanied with any of the above symptoms and/or nausea and vomiting.

It is important that if anyone around you notices that you have these symptoms (drooping on one side of your face, difficulty lifting limbs, difficulty keeping balance or falling down, confusion and slurred speech, for example) that they phone a healthcare provider or the nearest emergency service immediately. The sooner treatment is started for stroke, the better the chance of recovery!

What are the different types of stroke?

There are two different types of stroke:

  • Ischaemic stroke: This is the most common type of stroke and happens when the blood vessels of the brain become blocked or narrowed. As a result, a part of the brain, or many different parts, receive insufficient oxygen and nutrients supply and will, therefore, become damaged. The risk of ischaemic stroke is increased by other conditions, like heart disease caused by atherosclerosis, diabetes and high cholesterol.
  • Haemorrhagic stroke: This type of stroke occurs when a blood vessel in the brain bursts or becomes leaky. This can occur because of genetic predisposition to weakness in some of the brain’s blood vessels (aneurysm or a condition known as arteriovenous malformation) or due to conditions that damage blood vessels over time like hypertension.

What does it mean if you have had a “mini-stroke”?

A mini-stroke, medically known as a transient-ischaemic attack (TIA, pronounced tear), is a temporary period, usually over 24-hours, where you may display symptoms of stroke.
The symptoms are usually worse at the onset (for example, on waking in the morning) and tend to improve or resolve over time (for example, by the end of the day).
TIA is a sign that an artery supplying your brain is becoming more and more blocked or narrowed over time and that you are at high risk of having a severe ischaemic stroke if left untreated.

What causes stroke?

According to recent studies, stroke causes an estimated 25,000 deaths a year in South Africa and is a major cause of disability nationally. Stroke is also the second leading cause of death worldwide (after coronary artery disease), with the incidence of stroke increasing yearly.

The Lancet Global Burden of Disease Study (2010) predicts that by the year 2030, there will be some 20 million annual stroke-related deaths and more than 70 million people worldwide will be living with some form of disability caused by stroke.

 

The risk factors for stroke include:

  • Cardiovascular disease: Coronary artery disease, heart failure and certain arrhythmias, such as atrial fibrillation, significantly increases your risk of stroke.
  • Age: The risk of having a stroke increases with age (the risk roughly doubles every decade from 55 years onward). Certain other risk factors for stroke are higher in women post menopause.
  • A family history: If you have a close family history of stroke or heart attack, it could mean you too are at high risk. You are at particular risk of stroke if your father or brother has had a stroke or heart attack before 55 years of age, or your mother and sister before 65 years old.
    On the other hand, some genetic conditions result in weakening of the blood vessels of the brain (aneurysm and arteriovenous malformation) and these could cause haemorrhagic stroke.
  • High cholesterol: Having high cholesterol leads to atherosclerosis (fatty deposits in arteries that cause them to stiffen and narrow) that may lead to ischaemic stroke.
  • Hypertension: Hypertension is the leading cause of heart disease and stroke. Elevated blood pressure results in damage and weakening to the brain’s blood vessels which could haemorrhagic stroke. Additionally, high blood pressure potentiates the risk for atherosclerosis (fatty deposits in arteries that cause them to stiffen and narrow) which may also lead to ischaemic stroke.
    Hypertension is usually caused by a mix of unhealthy lifestyle factors like a high-salt diet, obesity and lack of physical activity.
  • Diabetes: Having diabetes leaves you with a greater risk of having high cholesterol, hypertension and coronary artery disease which can all cause stroke.
  • Overweight and obesity (this includes lack of physical activity and unhealthy diet): The higher your weight or the less active you are and the more unhealthy your diet, the higher the chance is that you will have heart disease and other conditions like hypertension and diabetes that can all cause stroke.
  • Smoking: Tobacco smoke is the second leading cause of heart disease and stroke after hypertension. Cigarette smoke contains over 4,000 highly dangerous and toxic chemicals (like nicotine) that can cause blood vessels to narrow and become severely damaged.
  • Alcohol: Long-term, excessive alcohol consumption damages the heart and blood vessels.
  • Stress: When you experience stress, your body releases the stress hormones, adrenalin and cortisol, for a “fight or flight response”. This causes your heart rate to go up and blood vessels to constrict. Chronically, this can lead to hypertension and increased risk of heart disease and stroke.

Living and managing

Knowing your risk factors and reducing them can significantly reduce your risk of having a stroke or prevent you from having another one.
The Heart and Stroke Foundation of South Africa estimates that some 80 % of strokes can be prevented through managing the risk factors for stroke, including many modifiable lifestyle behaviours.

 

By working closely with your doctor, you can reduce your risk of stroke by focusing on the following healthy lifestyle habits:

  1. Manage your blood pressure (low-salt diet)
    As hypertension is the biggest cause of stroke and heart attack, keeping your blood pressure levels within healthy limits is very important to prevent stroke.
    Click here to read more about how to better manage your blood pressure. Limiting your dietary intake of salt is an important step to manage and your reduce blood pressure.
    You can view the salt content of common food types and brands here. Download the Cooking from the Heart Low-salt Booklet so that you will never be tricked by complicated, and often misleading, food labels. The booklet is essential for healthier cooking, shopping and snacking!
  2. Eat a healthy diet low in fat and cholesterol
    Click here to read about how to eat a heart-healthy, low-fat diet.
    If your cholesterol levels are high even with a healthy diet, speak to doctor about medication to manage your cholesterol levels.
  3. Exercise and try to maintain a healthy weight
    Try to keep as active as possible. You don’t have to join a gym do this; instead, just take regular walks, ride a bike or dance along to the music on your radio.
    Your goal should be 30 minutes of moderate activity (makes you sweat and your heart beat a little faster) most days of the week.
    Regular physical activity helps you manage your blood pressure and glucose levels, lose weight, and alleviates stress, thereby reducing the risk of heart disease and stroke.
  4. Manage your diabetes
    Eating a healthy low-fat and low-sugar diet, exercising regularly and maintaining a healthy weight will all help you successfully manage your blood sugar levels.
    If your blood sugar levels are still above normal levels, even with healthy lifestyle habits, then speak to your doctor as you may need to take medication to manage your blood sugar levels.
  5. Manage stress
    When you’re stressed, your heart rate and blood pressure go up – this is not good for your heart or blood vessels. Furthermore, you may not manage your blood pressure or other chronic conditions and forget to exercise, eat right or take your medicines when you are anxious.
    Therefore, find ways to relieve stress, like practising meditation, mindfulness or yoga.
  6. Stop smoking
    Talk to your doctor about ways to quit smoking, as tobacco smoke significantly increases your risk of stroke and heart attack.
  7. Limit your alcohol consumption
    As excess alcohol consumption damages the heart and blood vessels, you will need to speak to your doctor or healthcare provider about what amount of alcohol is appropriate for you. Generally, to stay healthy, it is recommended that women not exceed one glass of alcohol per day, while men should have no more than two glasses per day.

How can you prevent another stroke if you have had one before?

If you have had a stroke or TIA, you will need to take extra effort to manage your lifestyle (manage any conditions you may have, like hypertension and diabetes, and avoid tobacco smoke and unhealthy foods).

Additionally, your doctor may recommend that you receive medication to prevent another stroke. These include:

  • Anti-platelet therapy: Platelets are the cells in your blood that form clots. Anti-platelet drugs make these cells less likely to stick together, preventing them from forming clots.
    The most commonly used anti-platelet medication is aspirin. Your doctor can help you determine the right dose of aspirin for you or might prescribe other anti-platelet medications for you to take.
  • Anticoagulants: These drugs reduce blood clotting or break down any clots that may have already formed. Some people refer to them as ‘blood thinners’.
    Heparin is a fast-acting anticoagulant, commonly used for short-term treatment in the hospital just after a stroke has occurred.
    Warfarin, on the other hand, is slower acting and may be used over a longer term to reduce your risk of stroke. Warfarin is a very powerful blood-thinning drug, so you’ll need to take it exactly as instructed by your doctor and you must closely watch for any side-effects. You will also need to have regular blood tests to monitor warfarin’s effects on your blood consistency.

*If you have a bleeding condition, these treatments may not be suitable for you. Additionally, if you are going to have any surgical or dental treatment, speak to your doctor about whether it is safe for you to continue these medications.

If you notice any side-effects like bleeding gums or excessive bleeding from small wounds, or you feel dizzy, do NOT stop taking your medication as this may increase your risk of stroke, but immediately contact your doctor or healthcare provider and they will advise you on how to adapt your dosage.

What can help after having a stroke?

Recovery after a stroke will take time. A complete recovery may not be possible depending on how severe the stroke was, and which areas of the brain were affected.

The effects of the stroke depend on which areas of the brain were damaged, and to what extent. For example, if you had a complete blockage or major blood vessel rupture in the area towards the back of your brain, there may be permanent consequences to your sight; however, if the blockage or bleed was only partial, and in the speech or motor areas of the brain, then you might only have limited mobility or speech deficits that can be improved over time.

 

Recovery also depends on how quickly the stroke was diagnosed and treated (it is very important to diagnose and treat stroke early on). Starting rehabilitation early, if possible, will also increase your chance of recovering greater function.

Rehabilitation should be aimed at improving independence and confidence in any of the affected modalities (movement, sensation, feeding, general body functions, energy levels and psychological/mental health). It will probably involve a range of healthcare professionals like physiotherapists, occupational and speech therapists, dieticians and social workers, amongst others.

 

You will need to work closely with your healthcare team to make sure you can function at your best possible level after stroke to carry out essential tasks that make up daily living.

  • Physical effects and their possible management may include:
    • Speech and language problems which are very common after stroke.
      Aphasia is the inability to properly use (speak) and understand language. There are many types of aphasia that can include difficulties in reading or writing, but are commonly divided into expressive aphasia (jumbling words, using incorrect words or just using words that seem to make no sense in context) and receptive aphasia (not being able to understand words said to you or attaching the incorrect meaning to words used). Aphasia results from damage to the language parts of the brain.
      Dysarthria (mechanical trouble speaking), on the other hand, is not due to damage to the language areas of the brain; rather it manifests as slurred speech due to paralysis or weakness in facial and jaw muscles. A speech therapist will work closely with you to help you adopt methods to communicate effectively or ways to improve your speech.Strategies for improved communication after stroke include methods and tips that can be utilized in other areas of your recovery as well:

      • Focus on one task at a time (don’t multi-task).
      • Try to write things down in advance to refer to (keep a pencil and paper, or other means of communication, handy).
      • You can use picture or word cards to refer to common items or concepts like “hairbrush” or “lunch”.
      • You can use scrabble pieces or digital keyboards to communicate if you prefer.
      • If you cannot write or type, try using simple hand gestures or sign language if possible.
      • Friends, family and caregivers can also help by only communicating one idea at a time, speaking slowly and clearly, paying attention to body language or hand signals, and using “yes or no” questions as much as possible that require a simple shake or nod of the head to answer.
    • Incontinence (bladder and/or bowel) is common after stroke because you may lose complete or partial control over some of the muscles that control these bodily functions.
      Some stroke sufferers may only experience urge incontinence (increased urge or a sudden, unexpected urge to urinate), constipation or diarrhea. Others may have complete incontinence – involuntary urination and/or uncontrolled bowel movements.
      Depending on what sort of incontinence you have, you may require more simple solutions, like keeping a clear path to a nearby bathroom; keeping a nightlight on in case you need to use the bathroom when it is dark, or always leaving the seat up to make it easier.
      Alternatively, you may want to consider a portable toilet or bedpan. However, if you have complete incontinence then you may need to use some type of additional incontinence product.
      If you have stomach cramps, constipation, or pain or discomfort on urination, then speak to your doctor or healthcare provider about medication to provide relief of these symptoms.
    • Muscle problems, especially in the hands, feet, arms or legs, are common after stroke and include limpness/softness (flaccidity) or shortening and tightness (spasticity) and associated physical weakness.
      Strength and mobility (moving around) can sometimes be improved with targeted and regular exercise under the guidance of a trained physiotherapist. Additional support and mobility aids like splints, orthotics, walkers and wheelchairs may also be needed.
      If you have problems with mobility, make sure that you have limited steps you need to negotiate in your house, workplace or place of learning and make sure there are alternative means to move between levels (like elevators or wheelchair ramps) if needed.
      You can also work with occupational therapists to adapt certain common everyday instruments like hairbrushes, toothbrushes, clothes zips or buttons, pens or other writing aids, eating utensils, computers or cellphones, and even car displays and instrumentation, so that you can achieve maximum functionality.
    • Problems with swallowing, known as dysphagia, are also common after stroke due to problems controlling the muscles in your throat. Dysphagia can cause choking or aspiration (inhaling objects into the small airways of the lung which can cause pneumonia). You can work with your physiotherapist and occupational therapist to improve swallowing, while you may need to consult a dietician if you need to change how you prepare food to make it easier to swallow.
    • You may also experience very low energy levels (fatigue) after suffering a stroke. Fatigue is incredibly common, even long after a stroke has occurred, and is both physical and mental. You may experience tiredness that doesn’t go away, even after a night’s sleep, or fatigue after very light activity. This is all normal. Tips to prevent you becoming easily fatigued include:
      1. Making a schedule of your day, noting when you have periods of activity versus when your times of low or high energy are. Make time for regular rest periods. Plan your activities well in advance (at least by a day) to ensure that you have given enough time to complete each task and have not over-taxed yourself.
      2. Arrange your space at home, work or school to make sure that you can easily move around. Avoid having to travail physically tiring blockages like stairs. Also try to arrange your space so that frequently-used items are easy to reach.
      3. Practice energy-saving habits, such as sitting in a comfortable and supportive chair rather than standing while cooking, ironing, washing, etc. Furthermore, you may find it helpful to consider online shopping.
      4. Eat a healthy diet that provides you enough energy to stay active – include regular healthy snacks. You can see Cooking from the Heart for healthy and easy-to-make snack options.
      5. Get enough sleep.
      6. Include regular downtime in your life, like watching a favourite TV show, chatting with friends over tea, reading or meditation. Avoid using alcohol or drugs to help you “unwind”.
      7. Stay active: Talk to your healthcare team about what sort of activity you should be doing, and how often.
  • Difficult emotions are expected to be part of your recovery journey, but depression can slow down your recovery and severely affect quality of life. You must be able to recognize the symptoms of depression and seek medical help if they occur. Having a support system, or someone you can talk to regularly about your negative feelings and difficulties, will help you manage your emotions.
Sources

The Heart and Stroke Foundation South Africa. (n.d.) Stroke. Available from: http://www.heartfoundation.co.za/stroke/

 

The Heart and Stroke Foundation South Africa. (n.d.) Signs of a Stroke. Available from: http://www.heartfoundation.co.za/recognise-a-stroke/

 

The American Stroke Association. (n.d.) About Stroke. The American Heart Association. Available from: https://www.stroke.org/en/about-stroke

 

Mayo Clinic staff. (n.d.) Disease and Conditions: Stroke. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

 

MedlinePlus. (n.d.) Health Topics: Stroke. Available from: https://medlineplus.gov/stroke.html

 

Whitworth G. (2019) Stroke Drugs. Healthline. Available from: https://www.healthline.com/health/stroke/drugs

 

The Heart and Stroke Foundation Canada. (n.d.) What is stroke? Available from: https://www.heartandstroke.ca/stroke/what-is-stroke

 

The Heart and Stroke Foundation Canada. (n.d.) Stroke: Recovery and Support. Available from: https://www.heartandstroke.ca/stroke/recovery-and-support

 

Heart and Stroke Foundation South Africa. (n.d.) Stop Smoking. Available from: http://www.heartfoundation.co.za/stop-smoking/

 

Rodrigeuz A. (2016) Anticoagulant and Antiplatelet Drugs. Available from: https://www.healthline.com/health/anticoagulant-and-antiplatelet-drugs

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Sources

The Heart and Stroke Foundation South Africa. (n.d.) Stroke. Available from: http://www.heartfoundation.co.za/stroke/

 

The Heart and Stroke Foundation South Africa. (n.d.) Signs of a Stroke. Available from: http://www.heartfoundation.co.za/recognise-a-stroke/

 

The American Stroke Association. (n.d.) About Stroke. The American Heart Association. Available from: https://www.stroke.org/en/about-stroke

 

Mayo Clinic staff. (n.d.) Disease and Conditions: Stroke. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

 

MedlinePlus. (n.d.) Health Topics: Stroke. Available from: https://medlineplus.gov/stroke.html

 

Whitworth G. (2019) Stroke Drugs. Healthline. Available from: https://www.healthline.com/health/stroke/drugs

 

The Heart and Stroke Foundation Canada. (n.d.) What is stroke? Available from: https://www.heartandstroke.ca/stroke/what-is-stroke

 

The Heart and Stroke Foundation Canada. (n.d.) Stroke: Recovery and Support. Available from: https://www.heartandstroke.ca/stroke/recovery-and-support

 

Heart and Stroke Foundation South Africa. (n.d.) Stop Smoking. Available from: http://www.heartfoundation.co.za/stop-smoking/

 

Rodrigeuz A. (2016) Anticoagulant and Antiplatelet Drugs. Available from: https://www.healthline.com/health/anticoagulant-and-antiplatelet-drugs