Suffering a stroke hurts everyone in the family

By Maria Kegel

JAKARTA (JP): At 38, Liswar Saybi had it all.

He was a high-income executive who was promoted to marketing manager the year before at a major timber company.

But in December 1982 Liswar suffered a stroke that paralyzed his entire left side and impaired his speech.

"I lost everything. It was so emotional -- I cried every day. Moving my body was the biggest difficulty for me."

He said he could not continue his career, and subsequently had a nervous breakdown.

The company paid for his one month hospitalization, and his family supported him. Physiotherapy and speech therapy helped him regain some of his independence, but it was slow going.

About one and a half years later, he was introduced to a pediatric nurse by his neighbors, and "my situation improved after we got married".

Secretary of the Indonesian Stroke Foundation Dr. H. Suhardi said the effects of stroke are felt emotionally, economically and socially both for the victims and their family.

He said the patient deals with anger, repeatedly asking "why me and why can't I walk".

They can overreact to simple situations, get angry easily and have mood swings, and if the anger is allowed to continue, it can lead to depression, he warned.

Jaka Ahmad was 10 years old when his father had a stroke. He said his father subsequently became bad-tempered, and he found himself "hating him because of it".

"Everything my two sisters and I did seemed to be wrong. He used to be a very active man, but then all he could do was spend time in a wheelchair or in bed."

It took one and a half years before family members could adjust to the situation, but Jaka said even now, 14 years after his father's stroke, there were still family upsets.

A specialist in rehabilitative medicine at Cipto Mangunkusomo Hospital, Dr. Widjaja Laksmi, has worked extensively with stroke victims and their families.

"It's really a difficult time for both the family and the patient, so when we do rehabilitation, the family and patient are present here together," she said.

Frustration runs high as the patient may be able to understand what is being said, but they cannot respond, she said, adding that the stroke's impact could make them either overconfident or underconfident about their abilities.

"Strokes affect productive people in their 40s and early 50s who might be at a top position in their company. Suddenly they may have to walk with a cane, but they are not mobile enough and cannot communicate, so they are no longer the decision makers or teachers, and this lowers their income substantially."

Effects

Widjaja said the number one complaint from families was the stroke's effects on the victim's cognition, such as a loss of memory, distorted perception, having little or no attention and behavioral changes, depending on the location of the stroke.

"A daughter whose mother had a stroke reported that the patient was angry every day and wanted to watch violent movies."

A stroke happens when a blood vessel, or artery, supplying blood to the brain bursts, or becomes blocked by a clot.

The nerve cells in that area are damaged and die off within minutes, and, as a result, the area of the body controlled by those cells cannot function properly.

The stroke's effects can be temporary or permanent, ranging from mild to severe, depending on several factors: how much of the brain was affected; which brain cells were damaged; and how quickly the blood supply was restored to the affected area.

A person's vision, behavior, speech, thought processes, and the ability to move parts of the body can be affected. At worst, a stroke can cause coma or death.

A common example of behavioral changes is a patient will neglect the side of the body that is paralyzed, which is usually the left side.

They might forget to slip their left arm through a sleeve when dressing, saying that it's not their hand, or they eat what is only on the right side of their plate, so caregivers have to rotate the plate for them, Widjaja said.

"It's a denial of anything that comes from the left side, so we have to talk to them from the right side as they won't pay any attention to what's happening on the left."

Changes in behavior stem from the fact that the stroke affects the central nervous system.

"There will be a lot of life changes and the problem is how to adapt now to the challenges and to cope emotionally from the loss of employment and the struggle to be independent," she said.

A neurologist at the Gatot Soebroto Army Hospital, Dr. Hardhi Pranata said slurred speech, difficulty in swallowing or chewing, paralysis of the limbs, a loss in memory and control of bodily functions were just some of its many effects.

To reduce the risk of a second stroke, survivors take for the next several years to life a brain metabolic activator and an antibloodlet aggregation, he said.

Suhardi and Hardhi cited the main risks leading to stroke that are controllable as: hypertension caused by excessive salt intake; cardiac problems; diabetes; cholesterol levels in the diet; smoking; being overweight; inactivity; stress and blood viscosity.

Hardhi explained that people with two or more of these factors were at a higher risk than others and should adjust their lifestyle to help lower their chances of having a stroke.

"Those living in the city have a higher fat intake from eating at fast food outlets, for example, while in rural areas people have a different diet, but because they consume more salt, they run risks, too."

Risks

There are other risks that people are not able to control, which include age, medical history, the occurence of a previous stroke and heredity.

"Sex and race are also major contributors to the risk of stroke, with Africans having higher odds than Causcasians. And although men are more susceptible to strokes, once women reach postmenopausal age they run the same risk," Hardhi said.

He added that people often overlooked stroke symptoms, which may include:

* A sudden developed difficulty in understanding or speaking simple sentences.

* Blurry or impaired vision in one or both eyes which does not improve with blinking.

* Any new paralysis, weakness or numbness that appears in your leg, arm or face, and especially on one side of the body.

* An unexplainable but sudden and intense headache, which is nothing like you have experienced before.

* Severe dizziness or a loss of balance or coordination, especially if another warning sign is present at the same time.

If any of the symptoms disappear, usually within 10 minutes to 20 minutes, they should not be ignored, but instead treated as an emergency.

Suhardi said strokes were on the increase in the country, and both doctors were concerned about a trend of younger people suffering them.

Although the average age of a person who has one is 55 years old, people in their 20s are having them, Suhardi said.

He attributed the development to increased drug abuse.

"There is a higher incidence of strokes among drug users. (Drug abuse) is a major risk factor, contributing to high blood pressure -- it is a real trap for our people," he said.