World Stroke Day highlights even the fit and young are vulnerable, writes Robyn Leary
This Saturday I hope to complete my 23rd Parkrun at Rondebosch Common. My time will not be good; 43 minutes over the 5km course will put me at the back, way back, of the field. But, at this point, I’m happy just to be upright.
This Saturday, October 29, is also World Stroke Day, which, a few years ago, would have passed without my blinking an eye.
I thought stroke only happened to old people, who then died without ever recovering, a burden on their families.
As I found out in 2012, a stroke or a cerebrovascular attack (CVA) can happen to anyone. I didn’t fit the profile, I thought. Forty-five, fit and healthy, I believed I was immune. I’d never been a smoker, my blood pressure had always been normal, and I didn’t drink excessively.
And that was my first mistake because there is no real profile for stroke.
As Professor David Le Feuvre, a consultant neurosurgeon at Groote Schuur Hospital and the UCT Private Academic Hospital, and Professor Pamela Naidoo, who heads the SA Heart and Stroke foundation, told me: “Stroke does not discriminate.”
Since my own stroke, I have met stroke survivors in their 30s, mid-40s, 50s and, yes, in their 60s, 70s and 80s. Each of their backgrounds is different, each of their recovery stories is different. To borrow an old adage, there really are “different strokes for different folks”.
Le Feuvre admits “we just don’t know enough about stroke”, that the more answers the medical profession have, the more questions they face.
What they do know is that most cases, about 85 percent of them, are ischaemic strokes: a blockage preventing blood getting to the brain. The rest are made up of haemorrhagic strokes, where there is a bleed to the brain.
And among non-communicable diseases, stroke – after ischaemic heart disease – is the second biggest killer in South Africa. About 150 000 stroke cases, a conservative estimate, occur in South Africa a year. But in some rural areas, stroke is often not even reported.
Naidoo, the new chief executive of the Heart and Stroke Foundation, agrees not enough has been done to educate people about stroke and she is making it her mission to do so.
Stroke and heart disease are natural bedfellows, because they share the same modifiable risk factors: you are more at risk if: you suffer from hypertension (high blood pressure); you smoke; you are obese; have a high cholesterol; you abuse alcohol; you have an unhealthy diet and are not physically active.
The foundation’s message for prevention of stroke and heart disease is simple: eat healthily and in moderation, and exercise.
Of course the question of what constitutes healthy eating nowadays in a world of competing diet fads is confusing.
Le Feuvre believes “we eat far too much” and we shouldn’t be adding sugar to anything. He advises a diet of fresh fruit and veg, fish and virgin olive oil; in essence a Mediterranean diet.
But, says Naidoo, while SA follows global dietary guidelines, we have to be careful to take cultural factors into account when promoting a Mediterranean diet, which is perceived by many as being too expensive and not culturally appropriate within the South African context.
Le Feuvre adds: “Of course, the wealthier you are, the healthier you can eat. Healthy food is expensive.”
There are non-modifiable risks for ischaemic stroke: a family history of stroke; migraine sufferers are believed to be at a slightly higher risk; if you’ve suffered a TIA (transient ischaemic attack, or mini-stroke) you are at greater risk of a full-blown event. So even if you eat healthily and exercise, you may still get a stroke. So, what’s the point of following a healthy lifestyle? The point is if you continue smoking a pack a day, eating cream doughnuts for breakfast every day, you will almost certainly have a stroke. The odds are not good.
In many respects, I was extremely lucky after my stroke. For one thing, I was able to get to a hospital relatively quickly after the attack. Le Feuvre stresses urgency is imperative; you need to get to hospital as quickly as possible, preferably a major city hospital with a stroke team, or a dedicated stroke unit.
“There is a lot that can be done,” he says. A clot-busting agent can be administered to avert serious brain damage, but it has to be administered within three hours of the stroke.
“And if that fails to have an impact, a neuro-interventional procedure is possible. That is where Le Feuvre and the team at Groote Schuur step in. Unfortunately, only about 1 percent of stroke patents find their way into their care.
Post-stroke I was fortunate too. I could afford a medical aid that agreed to admit me to a specialised rehab facility, a stroke “bootcamp”, where I learnt to walk again and to look after myself.
Other factors that played a role in my recovery were: my age, the sustained support of my family, friends and my employer, and, most important, motivation. According to Le Feuvre, the more motivated a patient, the better their chances at recovery.
In my case, there was strong motivation: I had no desire to give up my independence and move back home with my ageing parents. Now, after lots of physical therapy, I live independently. Every day I marvel that I can stand by myself.
I have met some amazing people, from my therapists, who do all the hard work, to fellow stroke survivors who have faced down challenges greater than mine. Less than a year after my stroke, I joined a group of “strokers”, many still in their wheelchairs, paragliding off Signal Hill.
I have been back at work for four years, three of them full-time.
My left side is still weak – I suspect it always will be – and I have to avoid stress, which can play havoc with my cognitive skills.
I’ll never be the person I was before, but come Saturday I’ll put on my scuffed running shoes and cherish every step, however slow.
* Robyn Leary is the Cape Argus assistant editor