Impact: Surviving a Stroke

Aug 26, 2023

Impact: Surviving a Stroke

A medical stroke impacts the lives of more than 9000 New Zealanders every year. In this episode, we visit Middlemore Hospital and meet Max and Iutita, two patients who recently survived a life-changing stroke. With physical and neurological challenges to overcome, we follow the beginning of their journey to recovery and the interventions required to get them back to daily living.

Thanks to NZ on Air

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Content

0 -> *

3.56 -> (BEEPING)

6.88 -> OK, ready? Code stroke coming in.

10.52 -> Time is a priority. If you suspect someone's having a stroke, just call 111.

16.8 -> On an average day,

18.56 -> one, two, four or five code strokes.

24.24 -> Nothing would move.

25.56 -> You know, 'Well, where's my bloody arm?'

37.28 -> This is really quite a shock. We never thought this could happen to our mum.

46.96 -> Captions by Antony Vlug.

49.04 -> Captions were made with the support of NZ On Air.

53.04 -> www.able.co.nz Copyright Able 2019

62.68 -> Every day, Emergency Department staff at Middlemore Hospital treat up to five new stroke patients.

71.44 -> Across the country, more than 9000 New Zealanders will be struck by a stroke each year.

78.16 -> So, a stroke is an insult to the brain.

80 -> It's damage to the brain caused by a problem with blood flow,

84.08 -> so it could be not enough blood getting to the brain,

86.72 -> often because there's a blood clot blocking blood flow to the brain,

90.6 -> or it could be because of bleeding into the brain then damaging the brain,

94.44 -> so it's damage to the brain that happens suddenly for a variety of different causes.

102.36 -> So, the Emergency Room may have received a call from an ambulance crew

105.56 -> saying that they're bringing in a patient with stroke-like symptoms,

108.64 -> and the Emergency Room will activate what we call the code stroke.

112.52 -> Can you open your eyes again?

114.76 -> Very good. What have you found so far?

116.6 -> So, so far, she's got partial facial droop on the right-hand side.

121.36 -> Yes, can you see my whole face?

124.4 -> Yeah. Can you see my finger?

127.24 -> Look at my nose. Can you see my finger?

129.64 -> Look at my nose. Can you see that?

131.72 -> I think views are OK.

133.24 -> To alert people involved in the hyper acute assessment of patients

137.92 -> who have come in with stroke symptoms.

140.96 -> It's vital that anyone who appears to be having a stroke receives urgent hospital treatment.

146.76 -> The blood clots that cause a stroke can be fatal. But too few people recognise the signs.

153.76 -> Can you put your hand up in the air?

157.12 -> Keep it up.

158.4 -> Good.

160 -> Can you touch your nose?

161.96 -> Touch your nose.

164.2 -> Oh, very good.

166 -> Very good.

167.32 -> We're gonna get a line in, and then we're gonna take you right into the scanner to have a look.

176.6 -> Patients are treated as acute for up to a week until the medical team is sure their condition is stable.

185.6 -> David Maxwell was rushed here five days ago.

189.84 -> I fell on the floor, and...

193.8 -> I fell on this arm,

195.32 -> well, which was the arm

197.88 -> that wouldn't work.

199.32 -> I remember my son-in-law

201.72 -> lifting me up,

203.32 -> and then it was blank.

204.92 -> Well, I was amazed.

206.88 -> Nothing would move.

208.76 -> Like, I got on my back,

210.72 -> and I tried to slide off the floor—

213.36 -> off the bed, and...

216.52 -> nothing would move.

218.08 -> You know, 'Well, where's my bloody arm?'

221.8 -> And one arm was working all right,

224.48 -> but this...

228.36 -> damn thing here, my right arm,

232.36 -> I couldn't move it.

234.72 -> It was so shocking to me.

237.2 -> He's starting to come to terms with the impact.

241 -> The common stroke-like symptoms are weakness or numbness,

245.44 -> often down one side of your body, so that could be the face; it could be face and arm; face, arm and leg;

251.28 -> or any combination of those.

253.72 -> Problems with your speech, so that may be slurring of speech

257.56 -> or it may be not being able to get the correct words out or saying incorrect words.

262.44 -> It's— It's hard

264 -> for anything

266.68 -> to get the messages.

269.24 -> See,

271.08 -> I want to lift it.

275.64 -> And then it comes.

282.36 -> When a patient with a suspected stroke comes in into hospital,

286.48 -> often there are quite a lot of people involved.

288.52 -> The priorities are to make sure we can stabilise the patient,

292.16 -> so the sooner you treat them, the better their chances of making a good outcome or a full recovery,

298.76 -> so time is so crucially important.

303.16 -> There are quite a few different symptoms of a stroke.

306.24 -> Often, prehospital crews, like ambulance crews, use something called a FAST test.

311.28 -> So the FAST test stands for — F stands for face, so if you look at a patient,

315.28 -> is there any obvious facial drooping on one side or the other.

318.96 -> The A stands for arms,

320.8 -> so ambulance crew often get patients to hold up their arms and see if one arm drifts down.

326.4 -> The S stands for speech. Is there a sudden new speech problem?

330.24 -> And T stands for 'time to get help' or 'time to call 111'.

339.76 -> A month ago, Lutita Filipo was fiercely independent and living alone.

345.36 -> At 76, she's unable to feed herself, dress herself,

350.2 -> or speak clearly.

352.84 -> Obviously, she had reduced sensation in her right-hand side.

357.8 -> There wasn't much strength in her right-hand grip as well.

361.36 -> So, with the rehab that we've been doing with her,

365.84 -> I've seen it's improved.

368.64 -> And I can tell as well by the strength in which she grips, like, say, the pegs.

373 -> And also by her reaction that she herself body language-wise is able to tell me

377.6 -> that there is an improvement, and I can sense it in her.

384.88 -> Oh. Yay.

390 -> Brain scans help determine whether further emergency treatment is needed to break up the clot.

396 -> There are different types of brain scans, but the commonest brain scan that we use

399.12 -> is something called a CT scan, or a CAT scan.

402.2 -> The reason that we do a CAT scan is that we want to have a look at the brain tissue

406.4 -> and try and differentiate, amongst other things, is this stroke caused by a blood clot

411.24 -> or lack of oxygen going to the brain.

415.68 -> Eyes looked good, so she was following...

418.24 -> I had to keep her eyes open. She's got a bit of a thing.

420.48 -> I don't know if that's caused her eyelids to droop slightly,

423.16 -> but when I held them up, she was following quite well.

427.76 -> Brain scans also help us decide whether someone's had a large stroke,

433.12 -> and whether someone is having a stroke but the brain is not irreversibly damaged.

438.84 -> Stroke can cause severe and permanent damage to the brain.

443.28 -> Delays in treatment impact the long-term disability.

449.08 -> The scan of a healthy brain shows a uniform colour and pattern.

454.88 -> In this scan, a stroke is evident. It's the dark patch.

461.52 -> Patients may be left with disability

464.64 -> or neurological deficits as a result of that stroke

467.2 -> so will require much more intensive input from other specialists —

471.04 -> physiotherapists, occupational therapists, speech therapists, dieticians. The list is endless.

481.04 -> Mrs Filipo suffered a heart attack, then a seizure and finally a stroke, all within days.

488.76 -> Her lifestyle heightened her risk.

491.32 -> Her stroke was a medium- to large-sized stroke,

495.44 -> so it was causing her a lot of problem with her weakness down the right side

501.68 -> and also her trouble with talking, which I think at the moment is still a very big problem for her.

509.32 -> But other factors do come into play, such as her age

511.92 -> and also other medical conditions that she's suffering from.

517.6 -> And you can see here that on the left side of the brain,

521.96 -> that it's a little bit darker overall compared to the right side of the brain.

526.76 -> Also we could see on her scan that she's actually had a smaller stroke in the past, which is over there.

535.6 -> The dark area is permanent damage to Mrs Filipo's brain.

540.08 -> The family was shocked to learn their mother had an earlier stroke that no one was aware of.

545.76 -> She didn't have a history of having a stroke before, so it may have been quite mild

551.32 -> or maybe caused no symptoms in her case, and she didn't appreciate that she had a stroke.

557.44 -> If you've had one stroke, you're at risk of subsequent and often more major strokes.

565.08 -> Mrs Filipo was on medication for diabetes and a heart condition before her stroke,

570.92 -> but at times she forgot to take her medication, and her children admit none of them eat well.

578.56 -> She suffered high blood pressure

581.68 -> and diabetes

583.84 -> from what I know,

585.96 -> so it was unhealthy

588.48 -> at the beginning.

590.4 -> And it just accumulated to...

594.6 -> A stroke.

598.84 -> There is assurance that it will,

602.28 -> from the medical side of things, that it will progress, but it takes time.

609.64 -> And we've been patient. We're just thankful that she's...

614.56 -> back with us.

618.52 -> The quicker the patient is investigated, including brain scans, the better for the patients.

623.52 -> Within the first five to 10 minutes of the patient arriving in hospital,

627.76 -> it just gives us more information quicker.

632.8 -> One week after his stroke, Max with moving to the rehabilitation ward.

641.08 -> This stroke has affected his right side.

643.88 -> His speech is fine, but he gets easily confused.

649.32 -> Welcome to Ward 23. Thank you.

651.72 -> Thank you for having me. It's a pleasure. (CHUCKLES)

654.8 -> There's just a bed unmade in his bed-space in G2. OK.

658.48 -> You just pop it over. OK.

665.52 -> Mrs Filipo's family visits daily.

668.24 -> Their mother's already been here for six weeks and faces months of recovery.

676.32 -> It's mentally and physically,

679.2 -> spiritually straining.

680.8 -> Yeah, been pretty difficult for me in the sense that...

686.84 -> to see someone

688.88 -> close to us, especially one of our parents,

692.12 -> in that sort of condition,

694.2 -> in that sort of predicament.

696.16 -> Very difficult.

699.6 -> They're anxious their mother could have another stroke and doubt she can live alone.

704.4 -> She's doing better today. Yeah, I wonder what...

707.76 -> Anna's an assistant in nursing.

710 -> She knew her mother's general health put her at risk of a stroke. She wishes she'd intervened.

718.12 -> Their mother's loss of speech is hardest to accept.

722.04 -> Mrs Filipo uses facial expressions to communicate.

725.44 -> Morning, Mum! Hello, Mum.

727.64 -> The gestures in our culture is everything — the eyebrows, the... yes, the no.

734.32 -> (INDISTINCT CONVERSATION)

736.56 -> That's what I owe— gain from her —

739.8 -> recognition of faces, familiar— you know, being familiar with people.

744.4 -> She might be un— not able to speak, but her recognising us as kids was a big gain for us,

751.04 -> like she still recognises us.

754.76 -> Max is starting daily therapy.

758.36 -> Simple exercises replicate tasks you do in daily life.

772.84 -> Whoa. It's OK.

774.84 -> This is his affected side from the stroke,

777.28 -> so his coordination is reduced on this side,

780.04 -> so it just takes you a little bit longer to, kind of, process the same movement on this side.

784.72 -> Cos being right-handed, it affects— And you're right-handed. Yeah.

788.52 -> Cos you're right-handed as well, aren't you? Yeah, yeah.

790.24 -> Yeah.

791.28 -> So we wanna get that hand moving as best as we can. Yeah.

796.32 -> Good.

796.92 -> A vegetarian for 40 years, Max thought he had done everything right.

803.36 -> But stroke doesn't discriminate who it affects.

807.28 -> 75% of strokes happen to people over 65.

811.92 -> But doctors are alarmed at the high number of much younger people having strokes.

818.16 -> The incidence of stroke is higher in Maori and Pacifika people,

822.72 -> and part of that is probably due to a higher risk of heart disease.

828 -> One of the most important factors is blood pressure.

830.6 -> High blood pressure is a powerful risk factor for stroke in the population.

835.4 -> And trying to treat blood pressure as aggressively as possible

838.68 -> will reduce the risk of stroke and reduce the number of patients having a stroke,

842.96 -> so blood pressure control is vitally important,

845.76 -> but there are also other issues that need to be addressed — issues around control of cholesterol,

851.28 -> issues around good diabetes control, issues around smoking,

856.36 -> so smoking does increase the risk of not only strokes but heart disease and other diseases,

861.6 -> so we have to address those factors.

864.16 -> Obesity is linked to a whole raft of different medical conditions, including strokes.

870.72 -> Mrs Filipo's family now understand how poor diet impacts health.

876 -> The whole family is committing to a healthier lifestyle.

880.08 -> Change of diet, change life—

882.6 -> you know, the...

883.76 -> well, the lifestyle— Yeah, more of a diet, especially coming from a Polynesian family.

888.84 -> It has changed. It has made us think a bit more about our health, really.

894.56 -> Guess I don't really take it seriously till it hit Mum,

899.24 -> like taking medications when you're supposed to.

904 -> Just looking after yourself in general.

906 -> It's cheaper to buy takeaways or... Whatever they've been eating here — I don't know what they've been...

911.08 -> Need to have healthy food.

913.96 -> You know,

915.64 -> just change of diet, really, because,...

919.08 -> you know, portion-wise.

922.2 -> (CHUCKLES) Portion-wise cos... we like to eat till we pop. (CHUCKLES)

927.04 -> But really, you're supposed to eat just enough to live, you know.

932.44 -> Yeah, you eat to live, not live to eat.

934.76 -> Said we're gonna end up like this if we don't look after ourselves.

940.2 -> So big change to our family, like...

945.48 -> thinking more of the future, not just the present.

949.36 -> Which is important.

951.08 -> We're ready

952.28 -> to go. Yeah.

954.4 -> (SOLEMN MUSIC)

960.6 -> Most patients have a dramatic loss of strength after a stroke.

965.12 -> Physiotherapists concentrate on getting them to transfer from a bed to a chair and then to stand.

974.72 -> Mr Maxwell was originally a hoist transfer,

977.2 -> so we needed two people and a mechanical hoist to help move him from the bed to his wheelchair.

982.92 -> And we were working on the pivot that we did with him,

985.44 -> but he didn't quite have enough power

988.96 -> and, sort of, the planning of the movement to get from bed to chair.

992.48 -> Max is 102kg

995 -> and is too heavy for his wife to manage.

998.12 -> Physiotherapists are rebuilding his strength so he can transfer on his own.

1006.2 -> I think he's got good room for even more progress as well.

1010.08 -> Yeah, he's got good potential to make... to make some good gains.

1015.72 -> Up.

1016.92 -> Perfect.

1018.52 -> Awesome. Lovely.

1019.68 -> Two nurses help you at the moment. Yeah.

1021.6 -> To go bed to chair. Yeah.

1022.92 -> We're trying to get you strong enough to have just one nurse.

1025.4 -> Yeah, yeah, OK. That's why we practise.

1027.68 -> Whatever it takes. (CHUCKLES)

1030.48 -> And up again.

1031.32 -> Max is working hard.

1033.44 -> Like all patients, he will see improvements,

1036.36 -> but there will be long-lasting consequences of his stroke.

1041.32 -> It really does depend on the brain's ability to recover and just giving it time,

1045.28 -> so some people do recover very well after a stroke.

1049.6 -> Other people who work just as hard at the recovery sometimes don't recover quite as well.

1053.96 -> Well done.

1055.96 -> Did you find that second one a bit easier?

1057.84 -> No, no. Oh, yeah, yeah. Yeah.

1060.08 -> I got a habit of saying no.

1063.08 -> (CHUCKLES)

1068.76 -> Tyler's got a nice name, eh.

1072.56 -> Hello, Lutita.

1074.84 -> (SPEAKS SAMOAN)

1083.16 -> Are you ready to do physiotherapy? (SPEAKS INDISTINCTLY)

1087.52 -> All right.

1089.64 -> Two months have passed.

1092.84 -> Mrs Filipo's speech is still difficult.

1096.56 -> She may never walk independently.

1099.36 -> (SPEAKS SAMOAN)

1100.88 -> When you're ready to stand, and then you can lean on to the...

1105.36 -> on to the bed.

1106.56 -> All right?

1108.08 -> OK, ready? (SPEAKS SAMOAN)

1109.52 -> Stand here, from here.

1110.88 -> Ready? (SPEAKS SAMOAN)

1112.2 -> Tasi, lua, tolu.

1113.6 -> Up.

1114.68 -> Good.

1116 -> All right.

1117.76 -> OK, so...

1120.72 -> (SPEAKS SAMOAN)

1123.32 -> Green. (SPEAKS SAMOAN)

1124.6 -> What colour is this?

1126.72 -> Lanu meamata.

1128.16 -> Lanu meamata.

1129.84 -> Green. Green.

1132.6 -> Though she speaks English, it's less taxing on her brain to do therapy in Samoan, her native tongue.

1139.4 -> (SPEAKS SAMOAN) How many balls do you see?

1142.36 -> Tasi.

1144.12 -> Lua. Lua.

1146.16 -> Tolu.

1147.48 -> Fa. Fa. Very good.

1149.96 -> The brain can hopefully recover through what we call neuroplasticity,

1153.28 -> so areas of brain that don't originally have a role in, perhaps, controlling her speech

1159.2 -> or her motor function hopefully will be able to take on some of that role.

1167.32 -> Yeah, very good. OK.

1169.96 -> Yeah.

1172.16 -> (SPEAKS SAMOAN)

1174.16 -> How do you feel about that session? Feel fantastic.

1178.88 -> Feel fantastic.

1180.64 -> OK, that's good.

1183 -> Yeah, do you feel like...

1185.52 -> (SPEAKS SAMOAN)

1188.04 -> Accomplished? Do you feel like you've accomplished a lot? Yeah, yeah. (SPEAKS SAMOAN)

1194.84 -> And do you feel more confident?

1197.28 -> Oh, very.

1198.88 -> Very confident.

1201.24 -> OK.

1202.84 -> That's really good.

1205.96 -> All right.

1212.96 -> Probably, the most important thing is she needs time.

1215.16 -> The area of changes we can see on that scan are permanent and irreversible,

1220.52 -> but fortunately Mrs Filipo may still recover because hopefully the remaining healthy areas of brain

1226.8 -> will take on the functions that have been lost by the damaged brain.

1232.52 -> Max has now been in hospital for four weeks.

1235.44 -> That's a smaller one. Yes.

1237.32 -> But it's still a huge effort to get into a car.

1244.84 -> Here we go? Yeah, so just standing up.

1250.64 -> (GRUNTS)

1253.2 -> Yeah? Yeah, so when...

1255.24 -> try and take that right foot to the side.

1258.28 -> You're turning your bottom towards the seat. Yeah.

1272.36 -> Good. Yeah? Yeah.

1274.48 -> So, you can stick your bottom out, sit down. Just watch your head.

1286.92 -> Watch your head. Good.

1288.92 -> You in? (CHUCKLES)

1291.08 -> Bloody little car.

1295.32 -> This one in.

1298.28 -> Well done.

1299.28 -> (CHUCKLES)

1300.32 -> Do you wanna go? Yeah, yeah. (CHUCKLES)

1302.76 -> I'm happy

1304.36 -> with what I've done

1306.28 -> and

1308.36 -> with the...

1310.68 -> sitting.

1312.76 -> And standing and leaning.

1315.68 -> It's all...

1318.28 -> under control.

1320.2 -> Easy-peasy.

1323 -> No thanks to you (!)

1325.72 -> (LAUGHS)

1328.76 -> (SIGHS)

1333.88 -> 10 weeks after her major stroke, Mrs Filipo is leaving Middlemore Hospital.

1341.44 -> But she's not able to return to her own home.

1345.48 -> She's needing fulltime support from her family.

1359.72 -> The Community Stroke team starts weekly sessions of physiotherapy,

1363.72 -> speech and language, and occupational therapy.

1367.68 -> The commode that she was sitting on, the bed lever,

1371.76 -> the shower chair, and we had a handheld shower,

1374.4 -> cos she's got a bath at home. OK.

1376.4 -> And so all that is working out well? Yes.

1378.4 -> It's all the right sizes and it fits and everything's good and—? Yes.

1381.24 -> OK, cool.

1383.6 -> She's a little bit slow. Yeah.

1386.44 -> Therapists assess Mrs Filipo's progress and set new goals.

1392.08 -> Therapies will continue for months.

1394.08 -> So next time when I come, I'll do a lot more.

1397.12 -> It can be a big shock when you go from being in the hospital,

1399.48 -> where everything's done for you — the nurses just come around and they flit all about you

1402.96 -> and do all these things, and then you get home, and you're like, 'Now I have to do it all.'

1406.48 -> You have to do it all. (LAUGHS)

1408.52 -> So, you've been home since Friday?

1410.96 -> Four days. How have you guys found it?

1413.88 -> Um,

1415.68 -> felt under it.

1417.36 -> Yeah.

1418.6 -> And...

1419.72 -> feel free.

1421.52 -> OK. So, you like to garden. Hmm.

1424.44 -> You like to pray.

1426.36 -> Oh, like pray.

1430.08 -> Pray...

1432.68 -> all my sins, yeah.

1435.76 -> I say

1437.84 -> a pray for

1440.2 -> me.

1441.32 -> Is there a plan for when you'd like to go back to church?

1445 -> Would that be quite important to you? Hmm.

1446.96 -> To get to go to church? Hmm. Yeah?

1449.52 -> So we can make that one of her goals. Yes.

1451.16 -> So what we like to do is, over the next couple of sessions, we wanna create a set of goals

1456.32 -> that are really functional and really personal — things that you wanna work towards.

1467.36 -> Max is still at the hospital

1469.64 -> and needs to make further gains before he can be discharged.

1476.32 -> Eight.

1480.04 -> Nine.

1480.88 -> And how are you feeling?

1483.12 -> Improving.

1484.84 -> What's improved so far?

1487.12 -> My...

1489 -> actions, arm actions.

1492.68 -> I think a lot clearer.

1495.6 -> I used to stumble with words.

1498 -> And...

1500.04 -> No, it's all...

1501.8 -> It's all on the up and up.

1504.36 -> One.

1506.28 -> Two.

1506.96 -> At the beginning, I could barely move it,

1510.96 -> and through therapy,

1512.96 -> I can...

1515.08 -> do a lot of actions, you know.

1519.72 -> OK, Sundeep. Hmm.

1521.24 -> Thank you very much. You're welcome. Yep. I'm

1525.36 -> very, very pleased.

1528.08 -> (INDISTINCT SINGING)

1532.28 -> (ALL SING INDISTINCTLY)

1537.2 -> Mrs Filipo's speech is slowly improving.

1541.08 -> She's back at church for the first time since her stroke — back in her community.

1553.72 -> Max is making slow but steady progress.

1557.12 -> He meditates daily and uses that practice to patiently accept

1561.36 -> the impact of his stroke.

1565.24 -> Regardless of what function returns, he and Mrs Filipo both feel lucky to have survived.

1572.88 -> I have no fear.

1574.8 -> Since I've realised that I'm not bulletproof,

1581.4 -> I have lost all my fear.

1586.8 -> Because I know I'm mortal.

1589.6 -> I never used to realise—

1592.16 -> never thought

1593.84 -> that I was gonna die

1596.68 -> until the stroke,

1599.28 -> and then

1602.28 -> you...

1604.12 -> I see

1606.16 -> all the trees and the leaves and...

1610.48 -> And they're so wonderful now.

1613.52 -> Good afternoon, sir. Hello.

1615.12 -> Good afternoon, ladies. Kia ora.

1619.36 -> Don't even waste a second or a minute, you know.

1621.96 -> If you think that someone's having a stroke,

1624.36 -> if you feel that someone's face has dropped

1626.52 -> or their arm's weak or the speech has suddenly got worse,

1629.12 -> don't wait to see what happens to their symptoms.

1631.68 -> Even if the patient is sitting around telling you, 'I'm all right. I'm all right,'

1634.76 -> you call an ambulance straightaway and get to hospital,

1638.56 -> because the chances of making a full recovery or a good recovery or a better recovery are...

1646.8 -> is much higher in those patients who are treated very quickly.

1652 -> Captions were made with the support of NZ On Air.

1656 -> www.able.co.nz Copyright Able 2019

1660.72 -> OK. Pretty good.

1663.32 -> You're putting a lot of weight through your hand.

1674.36 -> Attitude was made with funding from New Zealand on Air.

1678.92 -> The Attitude Awards celebrate success in the disability sector.

1682.64 -> Tune in Sunday, the 1st of December at 11am for an hour-long special from the event.

1688.32 -> Or watch it online at...

Source: https://www.youtube.com/watch?v=WamFq_u2txI