Medical Features

10 Questions You Should Ask Your Doctor After Your Stroke

Post on 13/12/16

 

It’s normal for questions to race through a Survivor’s mind, in the days after a stroke. Dr Shermyn Neo prioritises the top 10 questions you should ask your doctor.


1. Why did I have a stroke?

Stroke can be divided into ischemic and hemorrhagic strokes. An ischemic stroke occurs when blood supply to a part of the brain is blocked. The most common reasons for an ischemic stroke are artherosclerosis or arteriolosclerosis, which lead to vessel narrowing or wall damage. These are the outcomes of years of hypertension, hypercholesterolemia, diabetes mellitus that are not well-controlled. Other contributing factors include smoking, obesity and certain heart and blood conditions. You should ask your doctor about your specific risk factors.

2. What are the chances of me getting another stroke?

The risk of having another stroke increases after a stroke. Every person’s risk is different, depending on the cause of the first stroke, the existing risk factors and the patient’s commitment to lowering his/her risk of stroke. In general, the risk of another stroke is 10% in the first year and 25% in the first five years. The good news is that you can reduce your risk with medications and lifestyle changes. 

3. How do I reduce my risk of another stroke?

Many of the risk factors that contribute to a stroke can be controlled. High blood pressure, high cholesterol and diabetes can be managed well with medications and lifestyle changes (including regular exercise and attention to dietary choices). Once controlled, these medications should not be stopped, as doing so will only result in worsening control of your medical conditions. 

Smoking is a large contributory cause of stroke and the most effective, fastest and cheapest way to reduce your risk of stroke is to stop smoking.

Set concrete goals with your doctor so that you know when you are on track.

4. When can I expect to recover from my stroke?

Stroke recovery may be within a few minutes in a lucky minority. Most patients take several weeks to months to recover and recovery can continue up to a year. A considerable number will have residual deficits from their stroke. Your stroke rehabilitation team may include a neurologist, a physiotherapist, an occupational therapist, a speech therapist, a nutritionist and other allied healthcare providers. You should get to know your team so that you can work closely with them to individualise and optimise your recovery process. 

5. What kind of medications do I need to take after my stroke?

After a stroke, most of our patients have to be on anti-platelet and statin medications to reduce the risk of future strokes. Many patients ask me how long they have to be on these medications and I tell them that taking these medications is like buying health insurance.

As long as you have health and life to protect, you must continue to take these medications, same as how you will continue to pay your insurance premiums to ensure that you have continued coverage or protection. 

A significant proportion of our patients may experience depression after stroke and they often benefit from a course of anti-depressants during the post-stroke period, which can help to elevate their mood and energy levels to participate in rehabilitation during this crucial period. 

6. What can I or can’t I do after a stroke?

The challenges that each patient faces are different and unique but each can be overcome. Some patients may have difficulty with mobility while others may have problems with communication. You need to work with your rehabilitation team to find new and creative ways to cope with the challenges. The recovery after stroke can be very rewarding. 

Some patients may want to drive again after stroke and in fact many do return to driving (after assessment and approval by their neurologist, of course!). Many of our patients return to work, school, sports and so on. With determination and a good rehabilitation programme, our patients can achieve their goals.

7. Are there support groups that I can join to meet other people who have been through this?

The Singapore National Stroke Association (SNSA) is a national support group for stroke patients and their caregivers, founded by the very people they serve — stroke survivors and caregivers, with guidance from doctors and other healthcare providers. In addition, to organising programmes and creating opportunities for stroke survivors and their caregivers to acquire relevant knowledge and experience a solidarity in their journey towards recovery, they also seek to raise public awareness on stroke and champion the rights of stroke survivors and their caregivers.

More information about SNSA can be found at www.snsa.org.sg.

9. How do I know if I am having another stroke?

It is important to identify the signs of a stroke quickly because the longer the brain is without oxygen, the higher the chance of permanent damage. A simple mnemonic to remember is F.A.S.T.

F for Face – is there anything abnormal about your face; is your face smile drooping on one side. A for Arm – are you unable to raise one arm higher than the other? S for Speech – is your speech slurred or unclear; test it with a short sentence. Finally, T is for Time – the most important component of the message. If you suspect that you might be having a stroke, you have to get to the hospital as quickly as possible so that you can receive appropriate medical attention and treatment.

10. What should I do if I suspect that I or my loved one is having a stroke?

As mentioned above, you have to get yourself or your loved one to the hospital where treatment is available. Acute stroke treatment (intravenous thrombolysis and mechanical thrombectomy) is mostly available only in government hospitals. Many patients who seek help at their general practitioners first will have to be redirected to the hospital for treatment, and in the process, losing precious time. The fastest way to get to the hospital is to call ‘995’ for the Singapore Civil Defence Force ambulance service.

Since 2016, our emergency medical services have been trained in prehospital assessment and notification of suspected strokes so that the neurologist at the receiving hospital can be alerted to the patient’s impending arrival and be on hand to evaluate him/her quickly. This can speed up the process of getting appropriate treatment to the patient if he/she is found to have a stroke.


Dr Shermyn Neo is a senior resident training to become a neurologist at NNI TTSH. Neurology excites her because of the limitless potential of the brain. Likewise, she is often encouraged by the limitless human spirit that neurology patients demonstrate in the face of their illness. The challenges that a neurologist and their patients face are unique and she feel privileged to share their fascinating journeys with them, be it a heroic recovery from tetraparesis caused by a flare of neuromyelitis optica or an equally amazing return of language abilities in a patient with aphemia from an acute ischemic stroke.

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3 Comments

Tan puay ching says:

How to change my thinking? Why i keep blaming people who saved me for making me go through so much hardship? 9 years after stroke i still dont have balance? Will i ever recover? Doctor always say i cant stop my tremble completely is it true?

Mdm Tan Cha Boh says:

Doctor , I had a mild stroke last May and had been recovering well but I am still on Aspirin. The only problem now is I sometimes tires out easily. I am thinking of taking Yomeishu, a tonic drink from Japan. This tonic drink has a 14 percent alcohol content . Doctor, can you please advise whether I can take Aspirin and alcoholic tonic drink at the same time? I only intend to drink a small amount of Yomeishu at 3 to 4 hours with Aspirin ? Thanking you in advance for your advise.

The Editor says:

Dear Mdm Tan, thank you for your comment. We are here to provide support to stroke survivors such as yourself, as your continue on your path of recovery and rehabilitation. Please see the response from Dr Kinjal Doshi, a clinical health psychologist at SGH:

Why i keep blaming people who saved me for making me go through so much hardship?

1. It is common for survivors to feel angry at those who saved them, especially when they feel that their current self is not the same as their self before the stroke. When you are experiencing greater difficulty doing things that were previously easy to do, such as maintaining balance, it is easy to become frustrated with oneself and become angry with those who allowed for you to have to experience such difficulties. It is also frustrating when one is not able to know, for certain, whether one would completely recover and feel like it was before they had the stroke. The anger towards others, therefore, is a reflection of how frustrated and difficult you feel adjusting to your post-stroke self. One can address this with counseling and psychotherapy – by having the opportunity to acknowledge this feelings and work through them so that you can resolve your feelings of anger.

How to change my thinking?

2. I think it important to recognize that you are motivated to change your thinking. You can begin by recognizing the different thoughts you have – what the thoughts are, when they are more likely to occur, and how they make you feel. It helps to write them down so that you can see them more clearly, especially how it affects you. It helps to ask yourself if the thought is of any benefit to you (e.g., does it make you feel like you can cope versus does it make you feel angry and upset with others). If you would like to change them, you can start by telling yourself what it is you need to hear that can help you address the thought (I recognize that I am finding it difficult to balance like before, and it upsets me; I have to remember to be patient with myself). A counsellor or psychotherapist will be able to help you through this process.

Editor: Do also consider contacting the Singapore National Stroke Association (SNSA) and join us for the activities designed specifically for stroke survivors and caregivers. You may find out more about SNSA here: http://www.snsa.org.sg

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