Poles die of stroke much more often than the rest of Europe. Among those who survive it, as many as 70%, i.e. almost a quarter more than in other countries – become disabled.
In Poland, the number of people dying from stroke is one of the highest in Europe. In the first month after a stroke, 40 percent of them lose their lives. sick, and after a year as much as 60 percent. – it is twice as much as in Western Europe and the USA. Of those who will survive, as many as 70 percent – almost a quarter more than in other countries – becomes disabled. – Within an hour, seven Poles have a stroke, three of which are fatal. Every fifth person does not walk, and almost half of them need help from others in basic life activities. Despite the frequency of this disease, the level of social awareness about it and the methods of prevention is very low – says prof. dr hab. n. med. Anna Memberska, President of the Section of Brain Vascular Diseases of the Polish Neurological Society, Head of the II Neurological Clinic of the Institute of Psychiatry and Neurology in Warsaw.
How to recognize a stroke
A stroke occurs when the blood vessels that carry oxygen and nutrients to the brain become blocked or damaged by a blood clot. The thrombus can be the size of a pinhead or a grain of rice. There are also several centimeters. A sick person may lose the use of limbs, the ability to coordinate movements, stop speaking or see, and also lose the ability to understand speech. In many cases, a stroke is life-threatening. – If there is cerebral ischemia, necrosis is not avoided. However, you can try to reduce its area. Therefore, the patient should be given anticoagulants as soon as possible. Sometimes procedures are also performed to clear the vessels – explains Adam Kobayashi from the Institute of Psychiatry and Neurology in Warsaw. Unfortunately, three times more stroke patients die in Polish hospitals than in the old EU. – The death rate in stroke is high, mainly because treatment is started too late. When someone has a toothache, they seek help even at 3:3 AM. A stroke does not hurt and its symptoms are ignored by patients, says Dr. Kobayashi. Worse, they are also often very unusual, but the most characteristic symptom is the drooping of the corner of the mouth, paresis of the arm or leg. Unfortunately, the doctors themselves do not recognize a stroke in time. And although it is not a problem for an experienced neurologist to say that something is happening in the central nervous system, a headache or tingling in the arm or leg are so uncharacteristic that they can be ignored by other medics.
– Unfortunately, the awareness of this problem is still insufficient. In hospitals, a patient with a headache or numb hand is usually not given priority. And the time when you can help him is about four and a half hours, explains Dr. Kobayashi. He also emphasizes that any unusual, persistent headache requires diagnostics. It happens, however, that the patient does not feel any symptoms and it is easier for the other person to notice disturbing symptoms. Dr. Kobayashi explains that if we suspect someone has a stroke, we can do a simple test. You have to ask the sick person to raise both hands in front of him. If he holds one higher than the other, chances are he has had a stroke and an ambulance needs to be called. You can also make the sick person squeeze his hand first with one hand and then with the other. The difference in the strength of oppression is also an indication for calling an ambulance. Also, if the patient is unable to touch his / her nose with his eyes closed, a stroke may be suspected. Speech disorders are also symptoms. The sick person may gibberish as if they were drunk. It also happens that he has trouble understanding what is said to him. – The problem with a stroke is that it doesn’t hurt. Unlike a heart attack, which manifests itself in severe pain, a stroke can be painless and therefore often not alarming. Meanwhile, every minute counts, warns Dr. Kobayashi.
Prevention of stroke
Prevention of strokes is primarily physical activity, a diet low in animal fats, not smoking, controlling blood pressure and cholesterol levels. Treatment of atrial fibrillation is also necessary. Patients are often unaware that common cardiovascular disease is directly related to the risk of stroke. Meanwhile, arterial hypertension is the most important risk factor for a stroke, and atrial fibrillation, the most common heart arrhythmia, can lead to strokes that are particularly severe, says Prof. dr hab. n. med. Andrzej Rynkiewicz, Head of the 2st Chair and Clinic of Cardiology at the Medical University of Gdańsk. Atrial fibrillation almost fivefold increases the risk of stroke, and at the same time reduces the chances of surviving it twice. Stroke due to atrial fibrillation is particularly severe and handicapped, meaning that such patients are less likely to recover from it, and half of them die in the first year after it occurs. – It should be emphasized that we can effectively reduce the risk of stroke in people suffering from these diseases, because we have effective, safe and modern drugs at our disposal – emphasizes Prof. Rynkiewicz. Drugs that lower blood pressure are available in Poland. In contrast, the best method of preventing stroke in people with atrial fibrillation is by administering oral anticoagulants. Until now, only preparations were available whose dosing required at least once a month to determine the clotting time of the blood. It is inconvenient because the patients have to go to the clinic for such examination, and after receiving the result – to the doctor. There are devices for self-determination of blood clotting time. However, they cost about 18. PLN, and a disposable test strip PLN 100. Besides, the test result should be interpreted by the doctor anyway. Two new drugs have appeared on the market, the use of which does not require continuous blood tests and clotting time determination. Unfortunately, these drugs are not reimbursed. Monthly therapy costs over PLN XNUMX. Meanwhile, stroke prevention is particularly important in Poland, because we still have too few stroke treatment centers, and the patient has to wait even several months for the necessary rehabilitation and is rehabilitated far too short and too little intensively.
Rehabilitation after a stroke
– Many effects of stroke can be reduced thanks to treatment and intensive and professional rehabilitation – emphasizes Adam Siger, vice president of the Stroke Foundation. Dr. Kobayashi talks about stroke patients returning to work. – A patient aged around 40 did not walk as a result of a stroke and could not move his right arm. After two years, thanks to rehabilitation, he comes to me on his own and says that he is starting work. Another one, due to a stroke, stopped seeing in one eye. Rehabilitation also brought good results in this case, the patient can see and even drive a car. We had a patient, a coach of a top league volleyball team. He also returned to his profession after his illness – says the neurologist. Dr. Kobayashi explains that until recently it was thought that the nervous tissue did not have the ability to regenerate. Meanwhile, it turned out otherwise. Besides, man doesn’t use the whole brain. If part of it dies, the rest can take over its functions. Rehabilitation – through constant stimulation to movement – activates the brain to act. – It’s like a child learning to play the piano. Initially, he can knock out sounds with just one finger. However, constant exercise activates the brain and the young pianist is able to coordinate the work of both hands on the keyboard. Rehabilitation has a similar effect on the brain, explains the neurologist.
Specialists emphasize that early rehabilitation should cover every patient. It begins on the 1-2 day of hospital stay. Must include physical therapy, occupational therapy, speech therapy, neuropsychological therapy, and appropriate nursing care. Rehabilitation should begin in the ward where the patient is staying. From there, he should go directly to the neurological rehabilitation department, where 3-9 weeks are treated. Adam Siger, a physical therapist and vice president of the Brain Stroke Foundation, says that if the patient is lucky, his stroke will be treated in a hospital with a rehabilitation unit. However, if there is no ward, after leaving the hospital, a frantic search begins. Such patients have priority, but still have to wait in line for the admission. Five-week therapy in the ward, however, is only an introduction to further rehabilitation, which should take place at home. In this case, it is even worse. Patients wait up to four years for such help. This means that everything that was achieved in the rehabilitation ward in a hospital is wasted, and the cost of caring for such a patient increases and becomes higher than the cost of rehabilitation, which he did not receive on time. He can, of course, buy the therapy privately, but the cost of one hour is about PLN 100, which means that the patient needs about PLN 2 per month. zloty. For many patients, this is an unattainable amount. However, if the patient will receive the necessary rehabilitation under the National Health Fund, he or she is entitled to only 60 treatments. This, unfortunately, is not enough. Some patients also need the help of a neuropsychotherapist or a speech therapist. Unfortunately, as part of the NFZ, none of these specialists will come for a home visit. Meanwhile, many people find it virtually impossible to move around after a stroke. – Unfortunately, rehabilitation available in Poland covers only 40% of needs, which means that 60% of patients cannot count on help in this area – says Dr. Kobayashi.