Hidup mulia

Last week a middle age lady was admiited late in the evening .. I was just about to go home. My partner was oncall so I can just go back and let her attend to the patient … But as usuall that guilty conscious always steps in .. A gentleman wouldn’t do such a thing … She came with her husband and daughter … Her daugther was there with her when I attend to her and her husband came shortly afterward … As usually we talk to patient to know what was the problem and treatment follows afterward .. However this lady was unable to talk clearly, she can however obey command like lifting her hand or knodding if there is pain where I touch her … The husband was actually by her side when her problem starts .. The 2 of them were havin lunch on their kitchen table around 12 noon .. While eating she suddenly puts her head on the table … Like any loving husband he came close to her asking what was wrong … She tried to explain but her voice was bearly heard …. she can’t lift her left hand and she was unable to walk as her left leg was also weak … Her husband quickly grabbed the phone and call the ambulance and here there are in front of me … She was actually just discharge from our ward 3 days ago for stroke on the left side of her body however prior to her discharge she was a able to use her left hand and able to walk unassisted … At home she was able to go the market with her husband and even do house work … She however miss 2 doses of aspirin we prescribe for her as a secondary prevention …. When I examine her, she had slightly high blood pressure, difficulty in swallowing despite of presence of gag reflex .. She was unable to feel and lift her left arm and leg…  She had a second stroke ….

Studies have shown that there are 5% risk of developing a second stroke in a year despite of secondary prevention we gave …. Like this lady, others may present with seizure or sudden loss of consciousness … There are 2 causes of stroke which are hemorrhagic cause and secondly due to insufficient blood supply also known as ischaemic stroke  … Finding out the cause of stroke is vital as it matters in deciding which medicine to give … About 70-80% of stroke patient are due to ischaemic stroke which also has underlying hypertension, narrowed blood supply of the brain causing brain cells to die menifesting in weakness and numbness to the body part it controlled hence, when patient present to us, we stop their antihypertnesive agent for atleast 24 hours to avoid reducing blood supply and widening the area of dead brain cells.

Stroke cause by bleeding in the brain however requires us to reduced her blood pressure and stop any blood thinners such as aspirin, ticlopidin or clopidogrel to reduce the severity of the bleeding. This group of patient need emergency brain surgery provided the onset is within the golden period of surgical intervention… CT- brain is required to differentiate between the 2 causes of stroke …

The prognosis differ depending on the severity of stroke … Most of the patient I saw sustained sustained life long disability, some are bed bound requiring 24-7 assisted to eat, pass motion and urine, taking bath, some can even walk by themself out of hospital… Knowing all this, stroke is a disease not to be treated but prevented .. Eat low salt diet and practice active life style such as walk a lot and go out playing sports or jogging for half and hour, 3 times a week …

In memory of Yasmin Ahmad … Al-fatihah