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Sunday, April 3, 2016

My Story Part 2 By Prof. Channa Ratnatunga

If you are experiencing these symptoms, check them out

In “My Story Part II” Prof. Channa Ratnatunga who recovered from a severe stroke writes about pre-stroke symptoms that he had experienced but ignored
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Following the unexpected good response both nationally and internationally to “My Story” ( Sunday Times Plus –January 3, 2016 ) I thought it would be a good opportunity to write about some features of my experience with pre-stroke symptoms which like any busy person I ignored with catastrophic consequences. They are often associated with a future stroke and need to be taken very seriously. Further it would hopefully keep the interest up regarding the need for public awareness about current advances in the treatment of strokes.
The brain is supplied blood and hence oxygen through four arteries: two of them in front and two behind. My stroke occurred by a block in the place where the two behind joined each other on the brain stem. It is the more uncommon of the two types of strokes. The more common of the strokes is found with a block in one of the two arteries in front.
For about a year before my stroke I found while reading, two images of the letters- especially in the night when I was tired after a hard day’s work. Eye surgeons found no defect in my eyes except the usual refractive errors that had been corrected by my spectacles. Since it did not impinge on my work I decided to ignore it thinking it was due to ocular myasthenia which my mother is supposed to have had in the last few years of her life. About two years previously, after delivering a lecture I got into my car and all of a sudden I had a sensation of myself and my car seeming to ‘float’. As it passed off within seconds I ignored the event. When it happened again, about a week before my stroke, while driving, I stopped the car and the sensation passed off in seconds. As it happened for the second time, I should have been more concerned, but attributed it to my anti- hypertensive medications, and thought they were over-acting.
Then, when my wife pointed out to me that she had noticed that I had a squint, which appeared and disappeared while at the dinner table, I refuted the fact because I had no gross double vision, nor had I been told of a squint by my friends or patients. These were all premonitory symptoms of the impending catastrophe and I am writing about it because others should be wary of such symptoms. Like most people, even I with a medical background felt that such things won’t happen to me, but it did! Such premonitory symptoms are called TIA’s (Transient Ischaemic Attacks) and are very common with impending strokes.
When the front two arteries to the brain are the source, the more common kind- such TIA’s have a different set of features. They are more recognizable in that they may present as a transient weakness in the use of the upper limb, lower limb, side of the face or a transient difficulty with speech. You must be seen by a neurologist, and that too pronto! They will check your heart by an echo cardiogram for pieces of clot that could be shot off with its contraction, scan the arteries going to your brain or some may so desire even to do a CT scan of your brain. That you can prevent a stroke is now technically well within the scope of modern medicine.
In more so-called advanced countries, media coverage, both electronic and print, is good on such matters. The electronic media coverage will customarily use prime time slots , as this message to the public is so vital. For it is a warning of a very preventable illness. It would help people to go to the correct place. Strokes can be prevented if a person’s TIA’s are diagnosed for what they are. There is time, in a sense, brief though it may be. It is possible to stop or reverse the progression, if such warnings are heeded. Please go to a neurologist if you have some unusual symptoms like what I have described.
Up until recently much of what was done for strokes caused by an arterial block was by and large, rehabilitation. No wonder it went over to the management of Ayurvedic Physcians. I noticed that only a very few stroke patients attended the gym that I attend. They had gone on to the traditional medical care, who use innovative techniques, oils of assorted varieties with massage and are effective to some extent.
My message to the public, I can’t emphasize enough, is that it is important to realize that the western world has now made the “ quantum jump “ in the care of acute strokes. That they have successfully treated acute strokes by using medication to dissolve the block, failing which, they take the block out by a special catheter passed up from the upper thigh, which is guided deftly to the brain by the  Interventional Radiologist, and the block is extracted. It is a commonplace procedure now in the technologically advanced countries, yielding dramatic results. If the patient goes within four to six hours, he or she may even literally walk out of the hospital the next day!
In my case there was a delay of more than 24 hours because we did not know of the facility and also due to various other medical and logistic issues. I am writing this article so that people will know what to do. Luckily even though it was late in my case, the result of the procedure were good. I am quite independent now and able to write about it to you. I have taken it upon myself, sort of morally obliged to inform the public of this great advance in care. To reiterate- go as soon as you can. It is definitely available at the Central Hospital Colombo, where mine was done. Go as quickly as you can as it will save some brain cells and the patient will get a better result.
I know it will take time for people to abandon the traditional ideas of “ hopelessness and inevitability” but I hope that if I, like Al Gore on climate change , write and talk about it often enough, it will enter the “ psyche”  of my fellow citizens.
The catheters that are used to take the clot out are expensive. The imaging equipment I gather too is very expensive. How can we initiate a programme like this for all those who get strokes? A main hospital with the facilities can have feeder hospitals where a 24/7 service will triage all those who come as “strokes”. As strokes, can also be, though less commonly, due to bleeding into the brain, or very rarely be due to a brain tumour, it should be quickly assessed by a competent doctor, who can decide to transfer from the feeder hospital to the main hospital where it can be attended to can then attend to it.Stroke care needs acute intervention. There would be a need for cath labs (like what is used in cardiology ) but they should be dedicated for strokes, manned by Interventional Radiologists, 24/7. Sounds a tall order as far as commitment of the Radiologists is concerned, unless we train a number of them. This will allow us to mount the service in a limited fashion at first, in a big city or two at least. That we must offer this service, eventually to all those affected by a stroke is a must. In my book it is inevitable, now that it has been shown to be a very effective mode of care. How we can offer it to all who need it, whether they are able to afford it or not is the challenge.
I gather the intervention can be done if the medication induced clot dissolution fails. So advanced are the facilities in developed countries that after delivery of the clot dissolution medication directly to the site through the catheter passed up to it, imaging shows immediately whether dissolution is successful or not. Because time is of the essence, if the clot does not dissolve, they go ahead with the retrieval procedure using the same catheter. I am writing about what cutting edge facilities are available abroad, just so that you realize that they believe it is cost effective to do so. A Neurologist in Australia informs me that they are planning to mount a service, next year to provide an ambulance with CT scan facilities and trained staff to reach the patient, so that time which is so valuable on these occasions is not lost .
We in Sri Lanka must mount such a service, no doubt at a lower key at present. If there is a good ambulance service, an adequate and committed critical mass of interventional Radiologists, and an organisation to provide the catheters to those who really can’t afford it, we are on the correct track. The organisation like the ‘Heart to Heart Foundation’ which provides catheters and coronary stents, for needy heart patients funded by philanthrophic businessmen and other donors like banks, in Sri Lanka, can be a blueprint for a similar organisation to fund retriever catheters for stroke intervention. Some Neurologists should play a proactive leadership role. I am sure there will be many, like yours truly willing to help.

3 comments:

  1. I think it is very laudable of Chester to publicise and campaign for advancement of Stroke care in Sri Lanka. Acute care of Stroke has advanced to an amazing degree and is of great importance but it is worth emphasising that preventive measures such as attention to hypertension, diabetes if present, hyperlipidaemia, regular exercise, weight control, sensible diet, leading a less stressful lifestyle including use of relaxation measures such as meditation, yoga etc, remain of paramount importance.

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    1. Razaque aka RAZ.April 8, 2016 at 5:43 AM

      My wife & I both fell foul to the above conditions mentioned and did take most of the above actions / precautions. Despite this we both went down with AVR's & multiple bypass between a space of 10 weeks of each other.
      Only thing we did not do is meditation despite my daughter being one of the highest qualified in Yoga --- just short of LEVITATION!!!
      I suppose we deserve what we got for not taking advise from our kids??
      So all you guys take note.

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  2. I agree with Mahendra, and I too laud the writer. Simple preventive measures like you mention are important and certain other practices like not allowing dehydration to happen by drinking adequate amounts of water especially in a hot climate, deep conscious breathing, daily walking say, for 10 minutes in the morning and 10 minutes at night can be equally important . These seem like what the Ayur. physician might say but they make sense.
    Zita

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