Stroke is a lot more common that most of us realise, but so are dangerous stroke myths. Get your facts straight with the help of our local stroke experts, so you can ensure you minimise your and your loved ones’ risk.
Like many of us, he mistakenly believed strokes only happened to older people. But on a Saturday in April 2008 while moving house with his wife, George Scola, who was 36 at the time, suffered a debilitating stroke. “I was carrying a couch and suddenly felt dizzy. I leaned up against a wall and tried to sit down but I couldn’t move my right leg or arm. I fell to the ground, which is where my friend found me. When he asked what was wrong, I tried to answer him but my speech was completely garbled. I wasn’t in any pain – I just couldn’t move and was speaking garbage. I didn’t understand what was happening to me as I knew nothing about strokes. Luckily I got to the hospital about 45 minutes later.
“I spent two months in hospital learning how to speak and walk again. Within six months of that life-changing morning, I’d lost my business and was divorced. I was also stuck with a disability; I still don’t have full use of my right foot and arm. It feels like I’m stuck with half a body that’s 41 and the other half that’s 2. Before the stroke I was in a high-pressure job in property finance but now I’m unable to work full days as I get very tired. I got very depressed initially – a stroke is a very unglamorous condition – but now I see it as a challenge. It’s all about adapting, improvising and overcoming. I co-founded the Stroke Survivors Foundation, and two years’ ago, I walked for over six months from Messina to Cape Town to raise awareness – to make stroke survivors know there’s life after a stroke, even if there are limitations.”
Stroke is the major cause of disability in South Africa with 240 people suffering one every day, according to the 2007 Heart Disease in South Africa report. But despite the frequency of strokes, there are still many misconceptions and myths surrounding strokes, says Dr Kevin Ho, the medical director of pharmaceutical company, Boehringer Ingelheim in South Africa. “This may be related to the fact that a stroke can present as an unpredictable cataclysmic and devastating event which may not be well understood,” he says. “Steps can be taken to prevent stroke by diagnosing and managing risk factors, and this together with stroke awareness needs to be publicised more widely.”
Here’s the truth behind some of the most common stroke myths:
Myth no. 1: “Strokes are very rare”
Stroke is the third most common cause of death in South Africa, and causes more than 25 000 deaths every year, says Dr Vash Munghal-Singh, the CEO of The Heart and Stroke Foundation SA. “Around 240 people suffer a stroke every day – that’s 10 an hour,” reports Dr Munghal-Singh. “Of these, 60 die – and even more are left with permanent disability. It’s the third most common cause of death in South Africa, with only HIV/AIDs and ischaemic heart disease causing more deaths than stroke.”
Myth no. 2: “A stroke isn’t a medical emergency”
Stroke should be considered a medical emergency as it can result in severe disability or even death. “It’s a race against time; the earlier the treatment, the better the chance of recovery, particularly if administered in a few hours,” says Dr Ho.
Myth no. 3: “Strokes and heart attacks are the same thing”
They share many of the same risk factors but the symptoms experienced are very different. “A stroke is also known as a ‘brain attack’ and can injure the brain in the same way that a heart attack damages the heart,” says Dr Munghal-Singh. “It happens when the blood supply to part of the brain is interrupted, by an artery either bursting or becoming blocked. The brain cells become deprived of oxygen and the person develops the symptoms of stroke.”
There are two kinds of stroke: the most common is ischaemic stroke, which occurs as a result of a blockage – usually a clot – in a blood vessel that supplies blood to the brain. A haemorrhagic stroke occurs when a blood vessel in the brain bursts, bleeds into it and damages it.
Myth no. 4: “You’ll know you’re having a stroke because it’s so painful”
Injury to brain tissue doesn’t, in fact, usually present with pain. “In addition, strokes also occur while patients are sleeping and aren’t discovered until the patient wakes,” says Dr Ho.
Myth no. 5: “I’m too young to have a stroke”
While increasing age is a risk factor for stroke, many people don’t realise that stroke can affect younger people – even children. Recent research has revealed that up to 10% of strokes happen to younger people, says Dr Munghal-Singh. “Statistics from the US show that strokes in children, teenagers and young adults are on the rise. Not surprisingly, there’s also an increase in the risk factors for stroke in these age groups, such as tobacco use, high blood pressure and obesity. South Africa is moving in the same direction: statistics show that from 1999 to 2003, premature adult deaths (15 to 64 years old) from stroke increased by 28%.”
Myth no. 6: “If stroke symptoms pass, you don’t need treatment”
It’s vital you seek medical attention for any stroke-like symptoms, even if they pass – temporary symptoms of stroke is called a transient ischemic attack (TIA) and is also a medical emergency. “The risk of developing another stroke significantly increases in patients with a history of stroke or temporary stroke symptoms and remains high throughout the life,” says Dr Ho. (see sidebar, The Signs of a Stroke)
Myth no. 7: “Stroke recovery happens fast”
Stroke recovery can occur over days to months depending on the severity and location of the stroke, but unfortunately some patients never recover fully.
Myth no. 8: “You can’t do anything to prevent a stroke”
This is one of the most dangerous myths of all, because there’s much that can be done to prevent stroke, says Dr Munghal-Singh.
- Control your blood pressure: High blood pressure, or hypertension, is the top cause of stroke and contributes to 52% of strokes. Controlling your blood pressure can make a massive difference to stroke risk.
- Shake the salt habit: Excessive salt intake is a major culprit when it comes to high blood pressure. Research shows that South Africans are consuming far too much salt – thus increasing risk for high blood pressure, and consequently stroke, says Dr Munghal-Singh. “A reduction of salt intake by 2g per day reduces cardiovascular events by 20%. Replacing salt with fresh herbs and spices can ensure that your food still tastes great,” she advises.
- Stop smoking: By smoking, you’re doubling your chances of having a stroke, as smoking decreases the amount of oxygen in the blood, which makes the heart work harder so that blood clots are formed more easily and can lead to a stroke. “Avoid smoking completely, as even secondhand or ‘passive’ smoking can raise your risk of cardiovascular disease significantly – by about 25 to 30%,” advises Dr Munghal-Singh.
- Say no to heavy drinking: Excessive alcohol intake can result in high blood pressure and increase risk factors for stroke. Drinking more than two alcoholic drinks a day can raise stroke risk by 50%. Men should consume no more than two units of alcohol a day and women not more than one unit. (A unit is equal to 120 ml wine, 340 ml beer or 25ml spirits or liqueur).
- Cut your cholesterol: High blood cholesterol accumulates in the arteries, increasing risk for blockages and clots, and ultimately for stroke. Following a healthy, cholesterol-lowering diet, regular physical activity and avoiding smoking is key. “A cholesterol-lowering diet includes plenty of vegetables and fruit, choosing healthy fats (vegetable oils like canola, olive or sunflower oil, nuts and seeds, soft tub margarines and avocado) rather than unhealthy fats (such as fatty meats, butter, cream and deep-fried foods), including fish in your diet at least twice a week, choosing wholegrain, high-fibre starches rather than refined, sugary foods,” says Dr Munghal-Singh.
- Keep diabetes in check: Cardiovascular disease is the number-one killer and cause of disability in diabetics. Good diabetic control can help to prevent cardiovascular complications. “Invest in your health and follow the winning formulation for a healthy diabetic lifestyle: a healthy diet, regular exercise, avoiding smoke and taking your medication according to your doctor’s instructions,” says Dr Munghal-Singh.
- Control your atrial fibrillation: Atrial fibrillation (AF), or irregular heart rhythm, increases risk of stroke as blood is more likely to clot as it pools in the heart. The clots can then travel to the brain, causing a stroke. In fact, AF makes you five times more likely to have a stroke, says Dr Munghal-Singh. “But it’s not all bad news: knowing the symptoms of AF, taking action if you have these symptoms and following your doctor’s instructions can prevent three out of four AF-related deaths from stroke.”
- Maintain a healthy weight through diet and exercise: This is an essential part of preventing stroke, as well as many other serious conditions such as heart disease, diabetes and cancers.
- Take aspirin: Aspirin is the most commonly used anti-platelet medicine in the treatment of stroke. It reduces the blood clotting effect by making platelets (blood cells) less ‘sticky’, thus lowering the risk of having another stroke. While aspirin may be beneficial as a preventative measure for people who’ve had a stroke or who are at high risk of stroke, it’s unclear whether taking aspirin reduces risk for having a stroke in healthy, low-risk people, cautions Dr Munghal-Singh. “It’s essential to speak to your doctor before taking any medication as there are risks associated with taking any medications. Your doctor will assess your individual situation and determine whether preventative aspirin therapy could help you.”
The signs of a stroke – Act F.A.S.T.
Symptoms of stroke reflect the area of the brain that’s affected and can present in various ways, says Dr Ho. “The best way to recognize the warning signs of stroke is to remember the acronym, ‘F.A.S.T.’:
- Face Drooping: Does one side of the face droop, or is it numb?
- Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
- Speech Difficulty: Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like “the sky is blue.” Is the sentence repeated correctly?
- Time to call for medical help: If the person shows any of these symptoms, even if the symptoms go away, call for an ambulance and get them to the hospital immediately.”
The latest treatments
Acute treatment of stroke revolves around re-establishing circulation to the parts of the brain that are affected. An important factor is defining the time at which stroke symptoms first occurred as this has bearing on treatment strategies – the sooner one presents to a hospital, the better, says Dr Ho.
Current treatment options include:
- Thrombolytic therapy: an injectable medicine known to dissolve clots given within a few hours of symptom onset.
- The mechanical removal of clots by means of approach from remote blood vessels but this is only available in a limited number of highly specialized stroke centres.
- Preventive options: identify and manage risk factors such as hypertension, diabetes, high cholesterol, smoking and atrial fibrillation (AF). For AF, anticoagulants are used to thin the blood. “Boehringer Ingelheim’s new product, Pradaxa, targets a specific clotting factor and has been shown in clinical trials to be effective, safe and more convenient compared with Warfarin,” says Dr Ho.
For more info
Stroke Survivors Foundation: 082 889 1800, www.strokesurvivors.org.za, info@strokesuvivors.org.za
The Heart and Stroke Foundation South Africa: 021 447 6268, www.heartfoundation.co.za, heart@heartfoundation.co.za
This article was translated into Afrikaans for Leef magazine:
Carla Hüsselmann 