By Danit Nitzan, Ha'Artez
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Gray disease stroke
By Danit Nitzan
Stroke is the third most common cause of death and the main cause of disability
In old age, but its risk factors and signs are not well known
in public
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Illustration: Ruth Gavily
Heart disease followed by cancer
They are the first causes of death
most common in the western world. Embed
My mind is the third factor
In its prevalence, but despite the lesson
The highest of those who suffer from it, Gormy
The risk of stroke, and the symptoms
For his appearance, much less is known
than those of heart disease and cancer.
And if the stroke is less "dramatic".
in the manner of its appearance than heart attacks or
Cancer, its effects on the victims
from him and their families
No less dramatic.
Stroke is not only a significant cause of death - it is also the main cause of disability in old age
adult. It affects two people out of 100 in the adult population. Stroke
It will affect every tenth person aged 50-45 and every third person aged 75-65
Among those who have had a stroke, about 10% die within a few days. Of the survivors, 30% die
Within a year, approximately 39% need treatment in an institution. This is according to the data of the Ministry of Health.
About 50% of stroke victims remain fully or partially impaired a year later, and only about a quarter
Some of the victims get through the incident easily and are able to return to full function later
Rehabilitation.
In Israel, the number of stroke victims is estimated at 13-12 people per year. majority
The patients are in their seventies, but there are also younger ones.
The most common cause of stroke (85-80%) is a sudden interruption in blood supply
As a result of the clot that blocks an artery in the brain and causes a lack of oxygen, resulting in death
of neurons in the same area. This condition is called a cerebral infarction (similar to a myocardial infarction
caused by a clot blocking blood vessels in the heart).
The clot can form in the cerebral arteries themselves or be carried from an extracranial source
into the brain (embolism). The sources of embolisms to the brain are in the heart cavity, father's request
the arteries or in the narrowing of the carotid arteries in the neck. The reason for the formation of clots
In the arteries it is usually atherosclerosis - thickening of the inner wall of
the artery and consequently its narrowing. A clot may form on the sclerotic thickening,
which can drift into blood vessels inside the brain and cause a cerebral infarction. The infarct causes damage
to the brain tissue and as a result a neurological deficit that interferes with function - depending on the location
Brain damage.
In contrast to the situation of a blood vessel being blocked by an artery, it is also possible for it to expire
The wall of the artery and blood floods the brain tissue in the same environment. This is a cerebral hemorrhage.
Blood ejected from the ruptured artery forms a clot that interferes with the function of the cells in the area. bleeding
In the brain it can be formed due to high blood pressure in combination with atherosclerosis, due to rupture
Aneurysm in an artery, disorder in the blood clotting mechanism or taking blood "thinning" drugs.
There are warning signs for the onset of a stroke - but they are not recognized by the public as signs
The heart attack warning. The signs are sudden weakness or temporary numbness of a hand,
leg or part of the face, temporary disturbance in the ability to speak, temporary blurring of vision or
Temporary loss of part of the visual field. These are all warning signs of a stroke occurring
brain, and prompt examination and treatment can help prevent a more severe stroke
in the future.
The main risk factors for stroke, says Prof. Natan Bornstein, director
The neurology department and the director of the stroke unit at the Tel Aviv Medical Center are
Hypertension, high blood cholesterol, diabetes and smoking. the prevailing estimate
In Israel it is that a quarter of the population suffers from high blood pressure and that only about 60-50%
of which are actually treated, a rate similar to that of the world. Also, out of these
that are treated, not everyone achieves the
Recommended blood pressure levels.
Although hypertension is usually identified with heart attacks, however, when there are no therapists
In it, a cerebral infarction may occur following the formation of arteriosclerosis
and blocking them with blood clots. Alternatively, cerebral hemorrhage appears, following bleeding in the tissues
inside the brain
Stroke victims may suffer from difficulties in movement, balance, walking,
In swallowing, speaking. Sometimes they lose the ability to dress and eat by force
themselves, to control the brackets or the eyesight. People who have experienced a stroke are prone to
More suffering from depression.
Better to prevent
One of the characteristics of the injury of the stroke is the long-term struggle with
the disease A stroke patient continues to live years after the brain event, and thanks
For drugs and medical treatment, his life expectancy is similar to that of the general population. hall
The quality of his life - and the quality of life of his family members - is much worse than that of
the rest of the population.
To rehabilitate a stroke victim, many systems are activated: the Ministry of Health, the National Insurance,
Special rehabilitation departments, nursing departments in hospitals, physiotherapists
and speech therapists, doctors in the community, drug treatments as well as the patient's family
that she has to take care of him and take care of him every moment of his life after he experienced a stroke.
The cost of rehabilitating a stroke victim and treating him is enormous, says Prof. Bornstein.
In the United States, health economists estimate that every year the economy loses about 50
A billion dollars in stroke costs, the price of drugs, hospitalizations and treatments
and in the loss of working days. Even an injury that seems minor, like a partial loss of
The ability to use the fingers severely impairs the ability to function independently. Certainly a loss
The ability to speak, or paralysis, will have a decisive effect.
Since stroke is the main cause of disability in old age, and with a very severe and expensive disability
It's a lot to deal with, says Prof. Bornstein, it's better to focus on stroke prevention -
A much cheaper and humane option.
As for the first risk factor for having a stroke, hypertension, says Prof.
Bornstein that "it is enough to reduce the diastolic pressure by 18 mm Hg to
Reduce the risk of stroke by about 40% if you lower the cholesterol level below
to 190 by medication or a drastic change in lifestyle, even then you reduce the
The risk of stroke is about 40% if a person suffers from heart rhythm disorders - atrial fibrillation
Common among 15% of the adult population - will receive the drug Coumadin, will decrease
The risk of having a stroke was reduced by 68%, according to controlled studies, which proved it again
And again." But among adults suffering from atrial fibrillation, only 25% are treated
On Coumadin, says Bornstein.
In Prof. Bornstein's idyllic world, those who belong to the stroke risk group
(who have a history of stroke in their family, history of blood pressure or diabetes and smokers)
They will be invited for detection and diagnostic tests, they will receive encouragement from their doctors to act to maintain
themselves, will receive medication to lower blood pressure or lower cholesterol or heart rate -
and will receive help in changing lifestyles. "But it will probably only be done in the world
My idyll", he says.
The Wounded Caregiver Syndrome
The families caring for those left disabled by stroke carry a heavy burden.
Studies show that family members of stroke victims tend to fall ill with various diseases
at a higher rate than the general population.
Sandra Levy, a social worker with a master's degree in the sociology of medicine,
who specialized in social work in health settings, researched the issue of dealing with
Families with chronic illness. "I also know the field from the therapist-specialist side,
Because this is my specialty, and also from the other side, after my husband suffered a stroke that left him
He is 100% disabled and most of his body is damaged," Levy says.
According to her, the difficulty in dealing with a stroke stems from the fact that not all types of damage are noticeable.
"What makes life difficult for the stroke patient's partner are also small things.
For example, a healthy and normal appearance that makes others think that the person is fine, but his behavior
different - for example, he starts spending a lot of money suddenly, or thinks differently or
With another logic, and the partner should not only take care physically, but also pay attention
for the small deviations. And there are moods, and there is denial that something is wrong, and there is a need
Endless patience."
What makes it very difficult for the partners, Levy adds, is that many times the husband is hurt
The stroke can actually do things, but does not want to. "Medicine encourages you
The patient to be a kind of child, who must follow medical instructions, obey the authorities,
to obey, and that he is allowed to behave abnormally. And he is also exempt from responsibility like a child.
This makes it easier for the doctors, but this approach does not help the chronic patient left behind
functions. These patients are self-centered, not seeing Ben's needs
The family takes care of them and they don't take responsibility."
Levy tells of another type of coping, that a psychiatrist prescribed her husband a medicine "that turned
Same for the zombie, and I didn't connect the medicine with the falling asleep at all. only after
After many inquiries and much concern, another doctor told me that the medicine is anesthetizing and that I should try it
Lower the dose - because psychiatrists do not know the uniqueness of patients
Embed. And it did work. Since then I have learned to examine the dosage, the side effects, the
The dates and how to use the medicines that are prescribed for my husband".
In Levy's idyllic world, there will be funding in the health basket for support groups for patients
Stroke and their families, space will be allocated for groups and salaries for caregivers, "because the support group
As effective as supportive rehabilitation therapy, also for the victim, but even more so for my son
The victim's family."
Many studies, Levy says, have shown that spouses who take care of chronic patients suffer
More morbidity and mortality than others, because of the constant burden and neglect of their needs
for the benefit of the patient. "They are always asked how the patient is doing, and they say -
Maybe someday they'll ask me how I'm doing?"
the associations
Lily Maor, chairman of the Naman association for assistance to stroke victims and their families, founded the
The association in 1996 after her husband suffered a stroke and she was helpless in the face of the difficulty
To find out among all the different bodies what his and her rights are, to collect the
The payments due to her, the prescriptions, the reimbursement for adjustment
their home for his needs, and to continue living together with a husband who became disabled.
The purpose of the association is to provide assistance to the families of stroke patients and mutual aid: whoever is available
If he has skills, education or a profession that others can use, he contributes from them.
The association established, for example, a club for stroke victims who are not yet 65 years old - yes only
From this age it is possible to be accepted for activities in the various clubs for the elderly - including activities
similar to those that help stroke victims visiting senior citizens' clubs. in Da Club
The alternative has a physiotherapist and a speech therapist, who work in the association on a voluntary basis.
The association also distributes a newspaper "in which we try to publicize the rights",
Maor explains. "Some deserve a wheelchair with a deductible of 20% or
Special shoes, but they don't always know that."
According to Maor, every aspect of the family's life changes following an injury to one of them, along the way
Klal the father of the family, mashvet. There are medical, bureaucratic, structural problems - you
All of them must be solved and all of them must be treated. You need to adjust the apartment, the panels
The times - for example, to make a "work arrangement", that is, to divide the burden of maintenance
and the care of the patient among the family members who can do so.
Maor says that when her husband was in rehabilitation, she was advised to take him home for the weekend,
May he have a good time. "But in the cottage with the stairs we lived in I had no option
even bring it into the house. Only after I renovated and adapted the house could he
was to come."
In Maor's idyllic world, the family members of the stroke victim will be recognized as "caregivers", yes
They support him practically, physically and mentally, and face responsibilities and difficulties
and serious damage to their quality of life.
In the management of another association, the "Association for Help for Stroke Patients", member Dr. Yitzhak Zaks,
that he has a stroke - the left side of his body is half paralyzed. He tells about
The dramatic change in his life: "The patient goes out into the community without real support. It's hard for him
To know what his rights are and to prove that he deserves what he is asking to receive. the head of the family
Become the one who needs help, and it does terrible things to him. His children do not know
To treat him, the expenses for doctors, medicines, technical aids are enormous, and the apartment
Suddenly not suitable. It is impossible to adapt to the new situation alone, and the only support there is
It is mutual help of the associations, because also a few hours of nursing per week, which the insurance
The National Fund finances, they are only enough for help with bathing in the end."
In the idyllic world of Zacks, the Ministry of Health, the health insurance funds, the National Insurance,
The municipalities, the rehabilitation institutions, will compile all the relevant information in the brochure they will submit
The stroke victims will have every detail of information they need: their financial rights,
The help they can get, a list of addresses, telephones and bodies that stand by
at their disposal. But in the meantime, "many don't even know about property tax concessions
that they deserve," says Dr. Zaks. "The various bodies do not volunteer information about
rights, and a disabled person cannot go to many places where he can get help,
Because of an accessibility problem." Before the HMO branch he belongs to, there were four
Parking spaces for the disabled, he says, but for the light rail route they canceled the
These parking spaces.
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