Apr 23, 2019
Atrial fibrillation (AF) is an irregular heart rhythm with rapid and irregular beating. It is estimated to increase the risk of stroke 3 to 5-fold and to be associated with around a quarter of all ischaemic strokes. Additionally, AF is associated with more severe strokes leading to higher mortality and disability. We have discussed this topic with Prof. Dr Anita Arsovska, University Clinic of Neurology, Medical Faculty, University “Ss Cyril and Methodius”, Skopje, North Macedonia, FESO, SAFE Board Member.
Apr 19, 2019
Portugal AVC, stroke support organisation and a member of SAFE, recently published a collection of 21 life stories of stroke survivors. We present you the text that Portugal AVC President, António Conceição, shared with us on this occasion.
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Author: António Conceição
We started with posting on Facebook 2 or 3 testimonies, that arrived to us, of people describing their post-stroke life. We quickly realized that these were the most read posts and that they had incredible reactions: We were contributing, with concrete examples, all very different among them, to the motivation of other stroke survivors!
That way, throughout the next year, we challenged some survivors and caregivers to give their testimony. With completely different life stories, some of them truly difficult, but with something in common: to show how it is possible, even with adaptations, to rebuild a life and reach happiness again!
We have gathered 21 life stories, available on our website, truly extraordinary, with different ages, circumstances and time passed after the stroke. All of this with a worry in the background: to take strength where it seems to lack!
We thought about putting into paper these amazing life stories, to make them more accessible, and in a lasting way. We found a writer of children’s books, a psychiatrist that doesn’t practice, an extraordinary and very sensible person, and we challenged her to compile all of these testimonies, with total respect for the story and style of each person.
Out of this came out a book that has had fantastic reactions, a lot more than what we were expecting. As the writer wrote in the preface: “When nothing seems to be in favor, there is still an unknown inner strength left, a never seen before resilience, an unbelievable ability to overcome, a selfless and unconditional love that no one imagined possible… (…) With more or less difficulties, you are able to discover a new life path, with the goal of accepting what seemed unacceptable. (…) And, if in a sea of physical, emotional, social, familiar, logistic and financial problems, there are those who are able to turn their lives around and find the inner peace and sense of life that most human beings look for, that means it is possible to survive, it is possible to win, it is possible to restart!”.
The book was published on the National Stroke Survivor Day (31st March) and had a formal launch on the last Portugal AVC Meeting (13th April).
It’s one step further in the path of Portugal AVC, who has as one of the main goals to support the stroke survivors in the path of rehabilitation and integration, as complete as possible!
About Portugal AVC
Founded on September 23rd, 2016, the Portugal AVC represents the 1st national associative entity led by stroke survivors of stroke. It includes stroke survivors’ family members, as well as health professionals, caregivers and friends who embrace this cause.
The Portugal AVC is made by and with stroke survivors, who cover three out of five positions in the Executive Board, including the President.
Photo credit: Portugal AVC
Apr 19, 2019
“There is no stroke rehabilitation center in Kutaisi, Georgia, and after their hospital treatment, patients are discharged to go home. Unfortunately, patients’ carers do not have enough information on how to take care of them once their loved ones are back home. Due to swallowing problems, many of stroke survivors return to the hospital very soon after their discharge, this time not because of stroke, but because of aspiration pneumonia- a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs” says Tamar Janelidze, MD, neurologist, co-founder and board member of Georgian stroke support organization, Medical Foundation Mkurnali.
SAFE: What is one issue related to the life after stroke in your country that you think needs special attention?
TJ: In Georgia, there is an observed growth trend in cerebrovascular diseases. For last years, at the national health sector level, special attention is paid to acute strokes. In general, stroke is one of the main causes of disablement of the population of Georgia. In particular, most of patients that survived stroke are disabled, and 30-40% of them needed permanent care. Because of a deficiency in rehabilitation services in Georgia, no correction of neurological impairment can be made completely for stroke patients that reduces the quality of life. In response to the urgency of this disease, it is very important to study the methods for fighting this disease and for the management of its complications, as well as for its proper diagnosis.
In Georgia, at our hospital, at the premises of the neurology department, there have been established the stroke management units, the so-called stroke units, which allow not only for effective treatment of stroke patients, but also for assessing the complications and possible risks associated with stroke. 65% of patient had dysphagia, which evolves as a result of infringement of brain blood circulation, and appears as inhibition of swallowing reflex, or as its complete elimination.
SAFE: What would be the solution, i.e. what is your organisation’s position regarding this issue?
TJ: There is the risk of an aspiration of foods in the airway that consequently may lead to aspiration pneumonia. Our organization contributes to the introduction of dysphagia screening in the neurology department, which include the studies were actively started for the detection of dysphagia. First, swallowing reflex is checked and lingual condition is assessed in all patients, as well as there is differentiated whether dysphagia is a neurological complication or not. Then the studies are carried out through video-photofluorography roentgenoscopy. Patient swallows the contrast substances of different consistencies, and radiologist assesses radioscopically the swallowing process. Also, in some cases, of high importance is to assess the pharynx condition, for which we apply to an endoscopy.
After the mentioned examination, an attending physician and radiologist make decision on how the dietary regime of patient should be carried out. Of all 120 examined patients, dysphagia was detected in 85, and an appropriate examination regime and treatment were chosen for them, and in some of them the need of gastrostomy was identified. Analysis of latest data has shown that the problem of proper diagnosis of dysphagia allows for reducing the complications, even such as aspiration pneumonia that in turn is the most dangerous complication in terms of mortality.
Thus, proper diagnosis is a guarantee of preventing possible disablement and anticipated mortality.
SAFE: Please tell us more about your organisation.
TJ: Our organization participates in s patient’s educational program not only for stroke patients. We also have relations with government of Kutaisi and also Kutaisi University and try together to make our patients’ lives better.
Apr 19, 2019
Author: Nora Mork
People with a chronic pain are constantly facing obstacles and difficulties that they otherwise wouldn’t. However, this doesn’t have to mean that it’s impossible to have a full and satisfying life even with the chronic pain.
You just have to learn to live with it properly and avoid making these common mistakes:
Allowing Fear To Rule Your Life
Fear is understandable in this situation but what is not is allowing it to rule your life. You are still you and there are always ways to fix this situation. There are medications available and many other things that could help you overcome your pain and have a regular life. Certainly, nothing will go back to being completely normal but maybe you should embrace your new normal instead.
Misusing the Pain Meds
Pain medication should never be used to completely block your pain. This is impossible because those pain medications become ineffective over time. They can be really helpful but it all depends on how you use them and what you expect will happen because of them.
Pain medications can only remove about 50 to 60 percent of pain. You’ll have to use other things as well to support the meds. You have to learn to live with a certain amount of pain.
You should also avoid using the pain meds to do more and get through certain things. You can’t move too fast in your recovery process and end up having more pain than before. Stick to the schedule and what your doctor told you.
Overwhelming yourself when you are feeling okay
At times you’ll feel a lot better – almost like normal – and you’ll realize that these are the times that you can do things like you used to. Soon, you’ll increase the amount of work you do during “good times”.
But this will only increase your amount of pain and result in you not being able to fix it later. Never overwhelm yourself when you are feeling good. Take frequent breaks and rest often – sit or lay down, change your position as necessary and don’t do the extremely difficult things.
Find the right kind of help
“Pain management counselors can really help you learn pain management techniques and how to move on with your life properly. Don’t think that the relief can only come from pills. You have to learn other, more effective and natural ways of managing your pain. And you can really learn a lot from these professionals,” says Hannah Thomas, a psychology blogger at Academized and Australian help.
But, you also have to learn to rely on yourself – physicians are there for you but they are there to teach you how to handle yourself and your pain, not to be available to you any time of day or night. They also can’t always understand what you are going through.
This is why you have to understand to rely on yourself but also find a support group that can help you with their experiences and so on.
Not learning about your patterns
As you go through the process of being in a severe pain through feeling just small amounts of pain, you will learn to understand and recognize your patterns. For instance, when it happens and what happens. Ask yourself whether some fears or certain emotions make things better or worse for you. If some people have an effect on your pain – be it a good one or a bad one.
Then, you can learn to avoid of milden these effects. This is a great way to learn to live – in part – with the pain.
Thinking that you can’t go on
“Everyone sometimes feels like they can’t keep living in pain and they feel desperate but they are wrong. People can survive anything and still have a full and happy life with pain.
So, learn to live with it and overcome it in difficult situations,” says Milo Banks, a health writer at Big Assignments and State of writing.
Failing to refill your prescription
For one, you need to remember to always refill your prescription – meds aren’t the only pain management that you should use but they should still be a part of it. Failing to do so will only result in your recovery slowing down.
You should also remember to refill it in time – for example, never let your meds run out during the weekend or holidays, get a prescription before that. The doctors have their own lives which they shouldn’t have to stop in order to get to you because of your mistakes.
Having chronic pain is scary but it’s also possible to have a good life with this illness. Hopefully, you’ll avoid these mistakes and have a good life.
About the author: Nora Mork is a health and psychology writer and editor at UK Writings. She helps people by sharing her experience in the articles at Boom Essays and Essay Roo blogs.
Apr 17, 2019
This article was first published on ESO website | Author: Giuseppe Reale, MD – ESO YSPR Committee
Same stroke, same treatment and lower limb weakness, but forget about upper motor neurons!
Sometimes it seems that stroke treatment is all about time, tissue and recanalization, whatever it takes. However, it is important to remember that danger might be just around the corner, even after a successful recanalization.
A 66-year old man was carried to our Emergency Department 4 hours after the acute onset of right hemiplegia and aphasia. CT-Angiography (CTA) showed a M1 left middle cerebral artery (MCA) occlusion and the patient underwent to systemic thrombolysis followed by mechanical thrombectomy in general anesthesia with right femoral access. When the patient was admitted to the Stroke Unit, he presented only right lower limb weakness, being able to flex the thigh at hip, but not to extend the leg at knee. The right patellar tendon reflex was absent, while the left was elicitable. The segmental weakness pattern and the reflex asymmetry suggested a femoral neuropathy. CTA of lower extremities excluded the presence of iliacus hematoma or femoral artery aneurysm. The patient had a spontaneous recovery of the neurological deficits within one week. The electromyography performed three weeks later did not show any finding of denervation at the quadriceps muscle, suggesting a previous femoral neuropraxic block.
An 82-year old woman with the same symptoms and radiological findings of the previous patient underwent thrombolysis and thrombectomy with right femoral access in general anesthesia.
When transferred to the Stroke Unit, she presented just a mild drift of the right lower limb, but the day after she developed a complete plegia of the right lower limb associated with “mild pain and an unpleasant cold sensation”. The right lower limb was cold and distal pulses were absent. CTA of the lower extremities demonstrated a pseudoaneurysm of the common femoral artery, associated with distal arterial occlusion. The patient underwent emergency femoral endarterectomy without any complication.
You can read the full article here.
