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November 3, 2009

Think FAST campaign launched to help UK stroke patients

By Rebecca McQuillan
The Herald

GLASGOW, U.K. — Strokes can happen at any time, muses Gladys Young, 61, shifting her position in her armchair and gazing with a frown through her French windows at the angry grey sky. They don't spare those who are providing for a household, busy at work or living alone.

When it happened to Gladys, early one morning last December, here in her Glasgow bungalow, she was by herself.

She had been asleep, but when she got up at 1am to go to the loo she noticed a numbness in her upper arm. "I thought it was the way I had been lying, " she says, with a little shrug.

She went back to sleep, but when she got up at 7am and went to the bathroom, her leg was numb. She began to wonder if it could be a stroke. What she needed was a second opinion, and she got one from an unexpected source: her dog, Kyle.

The Shetland Collie trotted into the doorway of the bathroom and stopped still.

"He stared at me, tilting his head from one side to the other, " says Gladys, casting an affectionate glance at the dog, who is snoozing at her feet. "I said, 'It's all right, son' and when I spoke, I realised my speech was slurred."

The former elderly care nurse needed no more convincing. She made her way to the phone and called a friend, Wendy, who came round immediately and called 999. The paramedics took Gladys to Glasgow Royal Infirmary and she didn't see her home again for five weeks.

She knows now that while the symptoms of stroke may be vague, like the muffled sound of a distant explosion, the effects are anything but. She was temporarily unable to walk and even now, 10 months on, she can hardly move her left arm.

Now she would call the paramedics if she noticed any numbness in her arm, but back then, she felt embarrassed about dialling 999.

"Unless you have a massive stroke, the symptoms are quite mild, " she says. "I would not have thought of phoning an ambulance because I would have felt it was stupid and that other people needed it more than I did."

That attitude is understandable perhaps, but it is costing people their mobility, their power of speech - and in some cases, their lives.

There are 12,500 strokes a year in Scotland, with more than one in five affecting those aged under 65. The mortality rate in the first month is around 15per cent and a lot of those deaths occur in the first 48 hours. Strokes are also the single greatest cause of severe disability in adults.

That's why a new campaign, called Think FAST, is being launched today by NHS Greater Glasgow and Clyde, in conjunction with the charity Chest, Heart & Stroke Scotland. FAST is an aide memoire designed to help people spot the symptoms so that they seek help quickly - strokes are "brain attacks" and anyone who has one needs attention urgently.

FAST stands for three symptoms and the solution: Facial weakness; arm weakness; speech problems - it's time to call 999.

Dr Christine McAlpine, lead clinician with NHS Greater Glasgow and Clyde's stroke managed clinical network, says: "A stroke is caused by an interruption of the blood flow to the brain, by either a blood clot (thrombosis) or burst blood vessel (haemorrhage). As a result, brain cells are deprived of the oxygen and other nutrients they need. Some brain cells become damaged and others die.

"No two strokes are the same, and the symptoms depend on the area of the brain affected and the extent of the damage incurred.

"If the patient is to make a full recovery it is important that they receive medical treatment as quickly as possible to prevent further damage to the brain. Delay can result in long-term disabilities such as paralysis, severe memory loss and communication problems.

"They may need clot-busting drugs, or other treatments, such as surgery to stop bleeding."

David Clark, chief executive of Chest, Heart & Stroke Scotland, says recent improvements in stroke treatment have saved thousands of lives. Yet time is of the essence - he says that clot-busting drugs can be used, but only if administered in the first three to four hours.

And Dr McAlpine stresses that milder symptoms should not be dismissed: "If in doubt, you should dial 999. We'd much prefer you came along to the hospital. If it's not a stroke, great. But if you waited 24 hours, something else could happen - you might have another stroke."

If any of the FAST checklist symptoms occur, it's time to call an ambulance.

David Logan, 46, believes that a friend's swift action saved his life. On the day of his stroke, in March 2007, David had gone to work, fitting air conditioning units on the sixth floor of a Glasgow office block.

His stroke occurred half an hour after he started work.

He says: "Very, very suddenly, I started feeling dizzy. It came on that quickly it was unbelievable. I shouted across to my mate Andy and as I was shouting, my mouth drooped on one side. Andy noticed and as he was walking towards me, he was dialling 999. He had recognised one of the symptoms of stroke and acted quickly."

When David tried to stand, his left leg buckled beneath him. "I would say I am quite level-headed, but it was the scariest thing that has ever happened to me.

"I had the most amazing pain in my head. It was so severe that all the way down to the ambulance I was putting my hand up to my head and saying, 'Something for the pain' over and over. It was like my skull was trying to burst through my head. I won't forget that for the rest of my life."

At hospital, David was given clot-busting drugs. His stroke, it turned out, was caused by a clot having travelled up to his neck and getting stuck, causing an arterial blockage.

The right hand side of his brain was starved of oxygen, causing him to become paralysed on the left side.

Both David and Gladys went through weeks of demanding physiotherapy after their strokes.

Gladys moved from hospital to Lightburn rehabilitation centre, before being discharged home after five weeks. "I've never worked so hard in my life, " she says. She now manages on her own, without carers, but to her disappointment, can't take Kyle for walks any more - her "brilliant" neighbours do that.

David spent the first two months in a wheelchair, in Glasgow Royal Infirmary, before going to the Southern General's physical disability rehabilitation unit. Though he will never be able to return to work, he can now walk again and drive.

David was just 44 when his stroke occurred and he had had a quadruple heart bypass nine months earlier. Although the operation was not linked to the stroke, his lifestyle was.

He had what he calls a "typical working man's diet" and smoked; he still does, though he has now joined an NHS Smokefree group and is determined to quit.

He says: "I feel as if I'm in the last chance saloon because the next thing that happens to me isn't going to be pretty."

His life now is very different from what it was, but his friend's quick action gave him the best possible chance of recovery.

"I probably owe that guy my life, " he says.

"My message is simple: if you have any doubts at all, no matter how small, get to a phone as fast as you can. It's as urgent as someone having a heart attack.

"Look very closely at the person, speak to them. Can they lift their arms? It could be a life or death call."

WHAT TO DO

A stroke can happen at any time. Quick diagnosis and treatment can greatly improve chances of recovery.

Think FAST and save a life. If any of the following symptoms occur, dial 999.

FACE Can they smile? Does one side droop?

ARM Can they lift both arms? Is one weak?

SPEECH Is their speech slurred or muddled?

Age and general health have a bearing on whether someone has a stroke. However, the risks can be minimised by paying attention to risk factors such as high blood pressure, smoking, lack of exercise, bad diet and high alcohol intake.

Copyright 2009 Newsquest Media Group

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