29 October 2013
By Kasmiah Mustapha | kasmiah@nst.com.my
In conjunction with World Stroke Day today, two survivors tell Kasmiah Mustapha how they are coping
THEIR lives were turned upside down. From being independent and leading successful lives, two stroke survivors had to relearn everything from scratch.
It was a long and difficult journey for Alvin Tay, 52, and Shahrizan Jamaluddin, 57. Stroke had rendered half of their bodies paralysed and robbed them of the ability to speak coherently.
As a manager for an insurance agency, Tay’s hectic working life lead to a sedentary lifestyle. A diabetic for 20 years, he also has high blood pressure and borderline cholesterol. At the time of the attack, in June this year, he weighed 90kg.
When he experienced numbness on the right side of his body, his family members rushed him to a medical centre where he was diagnosed with multiple acute stroke, better known as influx. From his scan report, it was found that Tay had five clots in his left side of his brain. He couldn’t speak properly and was paralysed on the right side of his body, from head to toe.
Ten days after the attack, Tay was brought to the National Stroke Association Of Malaysia (Nasam) centre in a wheelchair. At that time, he could not even lift his head, which was tilted to the right. He was in tremendous pain. He had to use all his energy just to move his right arm.
“I was depressed when the doctor told me there was nothing that could be done. I thought my life was over and that I would be a burden to my family. But my wife, my strongest supporter, told me not to give up hope. She told me that I could get better,” says Tay.
“When I joined other stroke survivors at Nasam, I realised I needed to help myself so that I could get my life back because I was not alone. It helped to know that there were others who were in the same condition or even worse but they were not letting their disability hold them back.”
Tay became more diligent in his rehabilitation and even continued the exercises at home. He spent 70 per cent of his time on rehabilitation every day.
Through determination, he is now able to walk, albeit slowly. Although the right side of his body has not fully recovered, he has decided to work two to three hours a day just to keep in touch with-his business.
“As stroke survivors, I believe we can heal and get better one step at a time. It was difficult and tough at first. I couldn’t even lift my head and it was a Herculean task to lift my right hand. But with therapy and support from everyone, I was able to do it,” he says.
FOCUS ON REHABILITATION
An assistant manager in the marketing department of Universiti Kuala Lumpur, Shahrizan, was required to travel nationwide to promote the university. She was dealing with several health issues including diabetes, hypertension, high cholesterol and the narrowing of blood vessels.
In 2007, she suffered her first stroke. She had felt a twitching sensation on her left cheek and felt extremely tired . She knew something was wrong and asked a neighbour to send her to hospital. She was suffering from influx on the right side of her brain. After a few months of treatment, she was able to return to work but her movements were slow.
She had another stroke in 2009 due to her inconsistency in rehabilitation. That year, she had to quit her job. To make matters worse, she suffered a third stroke in July this year. Fortunately for her, the three strokes did not leave a major impact. Although her speech is a bit slow, she is still able to walk with the help of a cane.
Now, her focus is on continuing her rehabilitation at Nasam as she wants to be independent again. It is not easy as she can no longer drive and has to take the bus from her house in Telok Panglima Garang in Banting to Petaling Jaya. She also has to get someone to deliver food since, for safety reasons, she is not allowed to cook.
Recognise symptoms
President of the Malaysian Society for Neurosciences, Professor Dr Hamidon Basri, says it is important for people to recognise stroke symptoms as it is vital to seek immediate treatment. When stroke happens, the person has 10-15 per cent risk of dying. If they survive the attack, they will be living with permanent disability.
He says stroke is known as brain attack and it happens when the flow of blood to the brain is interrupted, either due to blockage by a clot or when a blood vessel bursts or ruptures. When a person suffers from stroke, time is of the essence because the longer you wait, more brain cells will die and the more severe the stroke will be.
“Stroke can happen suddenly. One minute you are talking, walking and doing your work. The next second, you may be stricken. You will suffer neurological symptoms such as face drooping, numbness in your arms and slurring of speech. These are the warning signs and you need to get admitted immediately.
“Stroke treatment is time sensitive. At 90 minutes the stroke is small, but grows bigger if nothing is being done after three hours and in 24 hours, almost half the brain is affected.”
MODIFIABLE FACTORS
Dr Hamidon says if the symptoms last less than 24 hours it is known as Transient Ischemic Attack (TIA) or a mini stroke. They need to seek medical attention immediately because after the mini stroke, they are at risk of a major attack.
He says there are four major risk factors for stroke that can be modified through healthy lifestyle — diabetes, hypertension, high cholesterol and smoking.
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Hypertension is one of the
risk factors for stroke. |
Controlling hypertension will lower the risk of stroke by 30 per cent, better managing cholesterol will reduce the risk by 28 per cent and with lower blood sugar level, 21 per cent. When people stop smoking, the risk is reduced by 50 per cent.
Dr Hamidon says there are about 15,000 to 20,000 new stroke cases a year in the country. There is a decreasing trend in stroke cases in developed countries because of better prevention, treatment and aftercare management. But in developing countries such as Malaysia, the trend is increasing and it is estimated that within the next 10 to 20 years, the number of new cases and survivors will increase significantly.
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Physical activity reduces
the risk of stroke. |
“The worry is stroke will become epidemic due to lack of awareness and prevention steps. If you have all the risks factors, you need to lead a healthy lifestyle with plenty of physical activity. Thirty minutes of daily physical activity will reduce the risk of stroke by 27 per cent,” he says, adding that a study done in Kuala Terengganu found that one reason why stroke patients delay seeking medical aid is the belief that the symptoms are minor and will go away.
Other reasons include seeking help from traditional healers as well as staying alone and waiting for someone to send them to hospital. In some areas, the hospitals are also not prepared to treat stroke patients.
STROKE AND AF
STROKE can happen when a blood clot in the heart travels to the brain and blocks the blood flow. The blood clot occurs in people with atrial fibrillation (AF), a condition that causes the heart to beat too fast, too slow or with an irregular rhythm.
National Heart Institute (IJN) consultant cardiologist and electrophysiologist Datuk Dr Razali Omar says the impact of a stroke will be more devastating for patients with AF. Once those with AF have a stroke, there is a 40 per cent chance they will get another stroke within a year.
He says: “AF can cause a massive stroke. And 91 per cent of stroke in AF is caused by blood clots that form in the left atrial appendage. The fibrillation causes blood to stagnate in the left atrial appendage of the heart. The stagnant blood becomes an ideal environment for a thrombus or blood clot to form. The blood clot, or a portion of it, dislodges from the left atrial appendage and travels through the arterial system to lodge itself in the blood vessels of the brain, restricting blood flow and causing a stroke.”
Dr Razali says people with AF are five times more at risk of stroke and they have a 70 per cent chance of death or permanent disability. AF patients have poorer survival rates and more recurrences of stroke during the first year of follow-up.
“However, three out of four AF-related strokes can be prevented with the appropriate use of anticoagulation therapy. With increased awareness as well as early diagnosis of AF, we hope to be able to minimise and even prevent AF-related strokes in the future,” he adds.
A four-week study of 1,435 acute medical admissions at Hospital Kuala Lumpur found that 40 patients had AF. Of these, two had stroke, one had a heart attack and 16 were diagnosed with heart failure.
AF risks increase with age and it is estimated that one in four people aged 40 and older will develop the condition. It is estimated that up to 15 per cent of all strokes are caused by AF.
SURVIVORS’ STRUGGLE
TO raise awareness on stroke and the struggle faced by the survivors, the National Stroke Association of Malaysia (Nasam) and Boehringer Ingelheim will screen a movie titled Against The Wind.
It’s about how stroke survivors struggle to overcome their disabilities.
In addition to living with permanent disability, they also have to deal with emotional and financial issues. Some of the survivors were abandoned by their spouses and had no one to take care of them.
Directed by Taiwanese director Wayne Peng, the movie was shot over three years and features eight stroke survivors and their families.
Nasam founder and director Janet Yeo says the movie shares the inspiring stories of the survivors and their agonising daily struggles as many are unaware of the issues that stroke survivors face.
“After a stroke, your whole life changes — emotionally, mentally and physically. When we look at a stroke survivor, we only look at the disabilities. Nobody knows how they feel and what happens at home.
When I had a stroke 25 years ago, I had to deal with numerous issues such as financial and marital. In the last 16 years since I started Nasam, I had met many survivors who had been abandoned by their spouses or children,” says Yeo.
“For a stroke survivor to recover and deal with their disabilities, they need family support. Otherwise, they will not be motivated to go for rehabilitation. Some of them will get depressed and this will affects their rehabilitation. Hopefully the movie will raise awareness about stroke and that prevention is the best strategy.”
Yeo says Nasam will host the screening to the public nationwide as well as in Singapore and Taiwan.
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