Wednesday 29th December 2010

The statistics are frightening - around 150 000 people have a stroke every year, it's the largest form of disability and the 3rd most common cause of death in the UK - with 25 % of patients under 65 when they have one. Women are also 3 times more likely to die of a stroke than Breast Cancer.

Causes range from smoking, drinking and lifestyle factors (weight and diet), to high blood pressure and diabetes. Family History of strokes can be significant, along with a history of previous small strokes (TIA's).

Symptoms vary - but are all significant - and can range from headaches and confusion, to weakness on one side (unilateral). What is universal is that any signs will come on suddenly and should be checked out immediately. The national FAST (Face, Arm , Speech, Time) campaign highlights the condition , and details can be found online - www.dh.gov.uk.

(L to R) Specialist Stroke Matron, Sue Potter and Nurse Practitioner Tina Vaughan talking to a member of the hospital board at the recent stroke evening

Chesterfield Royal Hospital currently has an 18-bed stroke unit ,which recently gained a Highly Commended judgement for their care systems from an inspection team and says it’s committed to providing local patients with a high degree of care as near to home as possible. They also have a 20 bed Ward at Walton (Speedwell) that acts as a rehabilitation facility.  There are now plans to merge these two wards in the spring and create a one-site, 36-bedded unit, which will provide patients with a high standard of continuous care in familiar surroundings.

New and effective treatments have also proved vital in limiting the effects of strokes if administered early enough (another benefit of having good localised services say nurses at the unit). One of those drugs was first used at the Royal a year ago and has been used on many patients over the last year - with good results.

The Chesterfield Post was invited to an event at the Hospital where the developments were showcased to Members of the hospitals Governing Board. We spoke to staff and patients about new treatments and plans for the future of the unit.

Thrombolysis is a drug given to qualifying patients on admission, with strict guidelines. It’s not licensed for anyone over 80 and has to be given within three hours. If the assessments show that the patient has had a small stroke they will not be given the drug, nor if they have had a major one as treatment in those cases will differ. Currently the drug is only administered during certain hours though these will be extended shortly.

Nurse Practitioner Tina Vaughan took us through the procedure for administration of the drug on the ward saying, "Once the patient comes in by ambulance to A&E, they are given an NIHSS assessment which will establish symptoms and the severity of the stroke. Patients are usually CT scanned within 10 mins, with a stroke consultant from the wards on scene. Patients are then taken to the Stroke ward where they are weighed as the dose is given according to weight. The drug is then given, with a current fastest time of 25 mins from door to needle. We are working on getting that down though!"

Sue Potter is the Specialist Stroke Matron at the hospital and she told us, "When it works it's fantastic - we're still as enthusiastic each time we use it, it makes a real difference, even if it can’t stop the stroke it can reduce the disabilities which it may cause".

Tina's advice to anyone who thinks they may be having a stroke is to get help fast. Do NOT dial a Doctor - ring 999 as time is critical. Even if you think it is a small stroke, don't be tempted to wait and see - the symptoms may not subside and the crucial 3-hour window may be lost for the drug.

Steve Brown was the first patient at the Royal to be given thrombolysis a year ago when he had a stroke on Dec 21st 2009. After treatment he was allowed home on Xmas Eve.

The Chesterfield Post spoke with Steve, who told us that he is unable to remember much about being ill and relies on his wife Jenny for information - he is though in better health and has no real effects from the stroke - although he still tires easily, particularly after walking any sort of distance and relies on his walking stick.

Steve added he, "Had been in good health, but had been in a stressful job, I was the proverbial white van man - working for myself and very long hours. I never relaxed.  I'm driven now mind you, I'm never relaxed but have to rest after 4 or 5 hours - my sleep pattern is coming back, but it's all over place".

One year on Steve had this advice to anyone currently recovering from the effects of a stroke, "Don't let it grind you down, you do get there, be patient, there was no way I was stopping in hospital - I tried my damndest to get home and they let me out - attitude is everything, I'm taking 10 tablets every day - but I have to got to stick to the regime and get stronger. If you feel like doing something, do it, but don't push it. It's all about attitude, a positive attitude".

Steve's wife Jenny was with him when he had the stroke. It was, she admitted, "A stressful and scary time - we were going out, Steve said he felt weird and didn't look very well, sort of flopped back. He did speak again, but it was like the lights were on but no one was home - the trouble was Steve's symptoms were slightly different to those described in the ads."

She added that "The paramedic arrived in less than 10 mins", and, after being admitted to hospital, she was spoken to by the consultant about thrombolysis.
Her response was "Just do what you have to do - just make him better".

The Unit was described by Michaela, one of the Speech therapists on the team as, "A multi disciplinary unit which provides a decent service for the patients of North Derbyshire, it means that they don't have to go out of county to get a good service".

She added, "We're all proud of it and really excited about the rehab unit moving from Walton. It will mean a seamless transfer of care and this should aid and shorten recovery time as the patient will not have to re adjust to different surroundings and staff when they're transferred to Walton. It will reduce the handover time between one area and another which physiologically can be difficult for patients".

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