Recovering from a stroke: life-saving treatment and beyond
Fast, specialist treatment can be the difference between life and death. Alex Wright is living proof.
Alex feels lucky to be alive. Last year his doctors were unsure if the 28-year-old would ever walk again.
On Good Friday 2016, Alex’s wife Kathy and newborn son Jordan went to the beach. Alex had planned to join them after a run with his dogs. He was fit, healthy and a regular runner with dreams of one day completing a marathon.
But while jogging, Alex had a feeling something wasn’t right. He pushed through, assuming it was “a part of running”, but the feeling worsened. He became dizzy and the dog lead kept slipping from the palm of his hand.
“I thought ‘I have to find someone’, so I managed to run another 250 metres. I saw a lady in my neighbourhood and collapsed,’’ Alex explains. “I couldn’t move and sheer panic set in.”
Paramedics recognised Alex was having a stroke and he was rushed to a nearby hospital, which had a stroke unit. He received clot-busting thrombolysis treatment, which returned blood flow to the area of the brain that had been cut off by the stroke.
The treatment may have saved his life, but he’d lost movement in the left-side of his body. “Stroke wiped out entire right side of my brain. It’s a miracle I’m alive,” he says.
“I’d suffered from a severe right-sided hemisphere stroke, due to a dissection of my right carotid artery. The exact cause is still unknown; with some theories in the mix. Mostly I’ve been told that it just came down to sheer bad luck.”
Stroke units offer crucial care
Stroke Foundation Clinical Council Member, Associate Professor Tim Kleinig, says survival and recovery depend on fast access to treatment.
“There are treatments available that can stop the stroke’s impact and even reverse the damage, however these are time-critical,” he says. “It’s also critical that patients with stroke are admitted to a stroke unit, so they’re correctly diagnosed, stroke prevention treatments are started, complications are prevented and recovery enhanced.”
The National Stroke Audit 2015 described stroke units as the cornerstone of stroke management, and counted 87 nationally at the time of the report.
Stroke units bring together specialist doctors, nurses and allied health professionals in one location, as well as the technology required to effectively diagnose, treat and rehabilitate a person affected by stroke. There are regular patient planning meetings and the team receives ongoing professional development specific to stroke.
But the audit highlighted room for improvement, with only 39% of patients spending at least 90% of their hospital stay on the stroke unit, accessibility limited the potential benefits. This compared poorly to the UK which has 83% of patients spending at least 90% of their time on the unit.
Encouragingly though, the proportion of patients accessing stroke units had improved, jumping from 58% in 2013 to 67% on 2015.
Professor Kleinig says advancements in the prevention, diagnosis and treatment of stroke have been saving lives.
Over the past three decades, stroke death rates have fallen by 70% for males (from 90 to 27 per 100,000 population) and 65% for females (from 84 to 29 per 100,000 population), an Australian Institute of Health and Welfare report shows.
He says endovascular clot removal (ECR) treatment, in particular, has the potential to dramatically change how stroke is treated in Australia and could save thousands of people from death and severe disability.
ECR is used to treat ischaemic stroke, which occurs when a vessel suppling blood to the brain is blocked by a clot (4 in 5 cases of stroke). It involves removing the clot with a small coil-like device that is threaded up into an artery until it hits the blockage.
“This treatment is technically challenging and needs to be performed by specially trained teams of health professionals. It’s also – as with most stroke treatment – time critical, which is why people need to recognise the signs of stroke and get to hospital quickly, and the health system needs to have the systems and processes in place to support it.”
Treatment and rehab
Every stroke is different and care depends on the severity and type of stroke a person has had. According to Stroke Recovery Association NSW, treatment for stroke is generally divided into three stages of care:
- Hospitalisation in an acute hospital or stroke unit. This will last about 10-14 days. It’s high dependency care and patients are only discharged from this area once medically stabilised. During this stage the patient and the family will be going through a lot of emotional turmoil and grief and it’s important that a hospital social worker provides support.
- Rehabilitation. This is ongoing care and treatment in a ward or hospital, which focuses on returning the patient to maximum functioning. It can last anything from 14 days to 6 months, depending on patient progress and stroke severity. Patients are regularly reviewed by the treatment team but it can be a long process. During this stage a patient may become depressed and lack motivation, as they come to terms with their health and limitations.
- Discharge. The length of a patient’s stay in the rehabilitation centre will depend on how they progress with their recovery. Staff will regularly meet with them and their family to discuss discharge options. While having a patient come home is a positive step, there are many considerations and a lot of planning is required.
While Alex lost movement in the left side of his body, he was determined to walk before his son Jordan did, and got stuck into his rehabilitation.
“I was very determined to get my life back to normal so I spent hours in my hospital room between sessions doing relentless exercises,’’ he says. “I made huge physical improvements at a rate that surprised all of the medical team.”
Today, he is driving again, working 3 days a week as a plumber and running. “I beat my son to walking; I was pretty happy with that.”
He still struggles with some weakness on his left-side and translating his thoughts. “Every day I still am faced with challenges that are a consequence of my stroke, however I am determined to live life to the fullest and be the best father I can for my son.”
Read our story on How to Prevent a Stroke.