When to visit a doctor in stroke

    17-Oct-2020
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Dr M Akham
The world is crippled by COVID-19, the whole world is reeling under its impact.
Many are avoiding hospital visits due to fear of COVID-19 and rightly so. Some of the mild, common diseases can be managed by over the counter medications. However, we would not like to miss the diagnosis of a life-threatening condition. It is all the way more important to look out for symptoms of serious, life endangering conditions. When the type of ailment is such like a stroke, it is important to visit the doctor in time because in stroke, visiting the doctor in time could mean life and not visiting the doctor could mean death.
What are the conditions under which we need to call on the doctor ? Though this article is mainly based on NICE guidelines, it should not be taken as a substitute to your clinician/physician’s advice and not be taken as a self treatment.
Nice guidelines are wonderful in the field of healthcare. The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health in England, which publishes guidelines in four areas: 1) the use of health technologies within the National Health Service (England) and within NHS Wales (such as the use of new and existing medicines, treatments and procedures), 2) Clinical practice (guidance on the appropriate treatment and care of people with specific diseases and conditions, 3) guidance for public sector workers on health promotion and ill-health avoidance and 4) guidance for social care services and users.
So what exactly is stroke ? Stroke is a medical condition when blood supply to part/parts of the brain is disrupted.  It is a serious life endangering condition. It could be ischaemic- when blood supply is cut off due to blockage; Hemorrhagic- when blood supply is reduced due to weak blood vessel there is another condition called Transient Ischaemic condition- where cut off of blood supply is transient and cut off period is less than 24 hours.
Stroke : It is easy to spot it yet we delay in seeking help. We all have heard of facial weakness, arm and leg weakness, but unsure when to call for help. There is something called FAST, a quick examination any of us could do for self and for near ones and call for help immediately.
I will be writing in detail about FAST symptom and how to interpret it as a non medic. F in FAST stands for face-the face may be dropped on one side, one eye shut and unable to open, one side of mouth dropped on one side and the best way to demonstrate it is by asking him/her to smile.
In my daily practice, I have seen many who present to hospital saying they are unable to smile and later diagnosed to have a stroke. A in FAST stands for Arm weakness, when he or she is asked to raise both arms and keep it, they might be unable to do it due to weakness on one side of the arm. They might also experience numbness and loss of sensation on the affected arm. S in FAST is for speech. They might not be able to speak in full sentence, could be slurred or distorted. He or she might appear confused. T is for time. Now is the time to call the doctor/ambulance. If any of the signs mentioned above is/are present, it could be a stroke and the best we can do at this point is pick up the phone and call Ambulance.  
Time is crucial here as treatment is time dependent and could save lives if appropriate treatment is given within the window period (for rough idea, thrombolysis within 4.5 hours and thrombectomy within 6 hours from time of onset). So, if one is a “risk group” it is wise to keep phone numbers of one or two ambulance services.
In case of emergencies like stroke, ambulance supported by frontline paramedics is life saving, it is necessary to promote this service. If the services of Ambulance is not available, then also, the patient needs to be rushed to the doctor, the earlier the better. Self driving is to be avoided. So also the self medication unless it is a medication already prescribed by a physician.
What makes one more prone to have a stroke and how could we, as a community, prevent it. High blood pressure, high cholesterol, irregular heart beating, Diabetes and smoking; all these makes one prone to have a stroke compared to someone who doesn’t have.
So one knows what one can do and what changes can be incorporated in the daily activity to prevent it. Such acts will reduce chances of stroke and the need for visiting doctors in such critical times. Alcohol is not friendly to stroke, so better avoid it or limit strictly to the intake the doctor allows.
Exercise is required for preventing stroke as well as for post stroke rehabs. For post stroke rehabs, in initial stages, it is to be done under supervision of the professionals depending on the part damaged and all, that is not discussed here. For preventing stroke, exercise is highly recommended. It is rather the most important part of stroke management.
There is a physical activity guideline for adults, the adults are to do some type of physical activity every day, any type of activity is good, the more the better. In addition, the adults should do strengthening activities that work all the major muscles (legs, hips, back abdomen, chest, shoulder and arms) on at least 2 days a week, at least 150 minutes or moderate intensity activity a week which is 30 mins per day for 5 days or 75 mins of vigorous intensity activity a week.
During lockdowns, I would suggest this regime to be supplemented with a mild intensity exercise for about fifteen minutes or so in the evening. The time spent sitting or lying down needs to be reduced and long periods of not moving should be broken with some activity at least.
 In Covid time when chances of other ailments increase particularly the mental stress and stroke, exercises should work wonders. I hope the readers found this article useful. Please do provide feedbacks in the email below.
The author is currently working as a trainee, Junior Doctor, in AE, Health Education, England. She can be reached at [email protected]