Home Stroke Huge strides in stroke treatment depend on fast action

Huge strides in stroke treatment depend on fast action

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Defence Force medic Vincent Lawford remembers lying at Palmerston North Hospital, virtually watching the stroke he was having disappear before his eyes.

A mere 45 minutes earlier, the 29-year-old had been in the chef’s kitchen at Linton Military Camp, putting away capsicums.

Then came a wave of vertigo, double vision and nausea.

“I was stumbling like a drunk person.”

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His medical training did not prompt him to consider he could be having a stroke.

He was not showing the classic symptoms of a drooping face, a weak arm and slurred speech.

“If I had been at home, I probably would have tried sleeping it off and the outcome would have been worse.”

Balance and eyesight disturbances were Lawford's lesser-known symptoms of a stroke.

MURRAY WILSON/STUFF

Balance and eyesight disturbances were Lawford’s lesser-known symptoms of a stroke.

Once the ambulance crew came, he acknowledged his right side felt different, although not exactly weak.

It was enough to alert MidCentral Health staff to the likelihood of a stroke and they were in the hospital’s emergency department ready to act as soon as he arrived.

There was a tele-link available to Wellington Hospital, radiology staff were ready to carry out a CT scan to see whether they could spot a clot clogging an artery to his brain, and the clot-busting drug Alteplase was ready to be administered.

“Within five minutes of getting the drugs in me, my vision came right in front of me.”

He was kept in hospital overnight and walked out the next day, almost completely unscathed by his brush with the second most common cause of death and disability in New Zealand.

Lawford was back home the day after his stroke.

MURRAY WILSON/STUFF

Lawford was back home the day after his stroke.

He had two weeks off work, he has had some headaches and he had to pace his return to running.

He is still banned from playing contact sport while on blood thinners, part of the concoction of “old man drugs”.

Investigations are still needed to find out why he had a clot in the first place, because he did not have the high cholesterol that is often the culprit, but for the most part, he’s fine.

His experience of rapid treatment for stroke patients has become embedded practice at Palmerston North Hospital, with support from a regional service with specialist back-up in Wellington.

It means when stroke patients arrive after hours for the local specialist team, staff in Palmerston North can connect to specialists at Wellington Hospital for advice in assessing patients and providing fast treatment.

At any time, if it seems the clot-busting medication is not working, patients can be sped to Wellington for the latest hi-tech intervention of clot retrieval.

That regional service has been working since January. Since April, four MidCentral patients have been sent for clot retrieval, but in three cases, the drug had worked to dissolve the clot by the time they got there.

The fourth person, who had the procedure, was almost back to normal on return to Palmerston North three days later.

MidCentral Health stroke lead doctor Karim Mahawish and clinical nurse specialist for the stroke service Imogen Watson. Staff aim to get people suffering strokes into treatment within 10 minutes of their arrival at the hospital.

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MidCentral Health stroke lead doctor Karim Mahawish and clinical nurse specialist for the stroke service Imogen Watson. Staff aim to get people suffering strokes into treatment within 10 minutes of their arrival at the hospital.

Stroke lead doctor Karim Mahawish said in all cases of acute, ischaemic strokes, the most common kind of stroke, the key remained the importance of acting fast.

“We lose 2 million brain cells every minute a stroke goes untreated.”

Hospital staff aimed to get people arriving at hospital with a likely stroke “from door to needle” within 10 minutes.

“Within half an hour, we see some patients regaining use of a paralysed limb.”

Mahawish said the further option of clot retrieval, where a wire is inserted through the groin through major blood vessels and into the brain, had revolutionised stroke treatment further.

“People who would have ended up in a rest home permanently paralysed are able to leave hospital within hours, independently mobile.”

He said the worst thing about strokes was not just that they could kill, but they could leave people seriously and permanently disabled despite the work of a range of rehabilitation health professionals.

Stroke service clinical nurse specialist Imogen Watson said prevention was better than treatment, which was why the unit also cared for people who had a transient ischaemic attack, a sort of mini-stroke and warning sign.

Managing other conditions such as diabetes, high blood pressure and high cholesterol could reduce the risk substantially, and giving up smoking was more effective than any medication that could be prescribed, she said.

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