Dr. Andrew’s Stroke Survival Guide

This is Dr. Nadine Andrew. She’s a Senior Research Fellow in the Department of Medicine at Monash University. She’s the Research Data Lead for the National Center of Healthy Aging. She is lead investigator on the NHMRC-funded PRECISE project… The most comprehensive stroke data linkage study to date! In short, she knows her stuff.

We’ve talked before about how sample size is important when it comes to scientific studies. It’s frustrating; sometimes we see what looks like a great study until we notice it has a sample size of 17 or something.

Dr. Andrew didn’t mess around in this regard, and the 12,386 participants in her Australian study of stroke patients provided a huge amount of data!

With a 95% confidence interval because of the huge dataset, she found that there was one factor that reduced mortality by 26%.

And the difference was…

Whether or not patients had a chronic disease management plan set up with their GP (General Practitioner, or “family doctor”, in US terms), after their initial stroke treatment.

45% of patients had this; the other 55% did not, so again the sample size was big for both groups.

Why this is important:

After a stroke, often a patient is discharged as early as it seems safe to do so, and there’s a common view that “it just takes time” and “now we wait”. After all, no medical technology we currently have can outright repair that damage—the body must repair itself! Medications—while critical*—can only support that and help avoid recurrence.

*How critical? VERY critical. Critical critical. Dr. Andrew found, some years previously, that greater levels of medication adherence (ie, taking the correct dose on time and not missing any) significantly improved survival outcomes. No surprise, right? But what may surprise is that this held true even for patients with near-perfect adherence. In other words: miss a dose at your peril. It’s that important.

But, as Dr. Andrew’s critical research shows, that’s no reason to simply prescribe ongoing meds and otherwise cut a patient loose… or, if you or a loved one are the patient, to allow yourself/them to be left without a doctor’s ongoing active support in the form of a chronic disease management plan.

What does a chronic disease management plan look like?

First, what it’s not:

• “Yes yes, I’m here if you need me, just make an appointment if something changes”
• “Let’s pencil in a check-up in three months”
• Etc

What it actually looks like:

It looks like a plan. A personal care plan, built around that person’s individual needs, risks, liabilities… and potential complications.

Because who amongst us, especially at the age where strokes are more likely, has an uncomplicated medical record? There will always be comorbidities and confounding factors, so a one-size-fits-all plan will not do.

Dr. Andrew’s work took place in Australia, so she had the Australian healthcare system in mind… We know many of our subscribers are from North America and other places. But read this, and you’ll see how this could go just as much for the US or Canada:

❝The evidence shows the importance of Medicare financially supporting primary care physicians to provide structured chronic disease management after a stroke.

We also provide a strong case for the ongoing provision of these plans within a universal healthcare system. Strategies to improve uptake at the GP level could include greater financial incentives and mandates, education for patients and healthcare professionals.❞

See her groundbreaking study for yourself here!

The Bottom Line:

If you or a loved one has a stroke, be prepared to make sure you get a chronic health management plan in place. Note that if it’s you who has the stroke, you might forget this or be unable to advocate for yourself. So, we recommend to discuss this with a partner or close friend sooner rather than later!

“But I’m quite young and healthy and a stroke is very unlikely for me”

Good for you! And the median age of Dr. Andrew’s gargantuan study was 70 years. But:

• do you have older relatives? Be aware for them, too.
• strokes can happen earlier in life too! You don’t want to be an interesting statistic.

Some stroke-related quick facts:

Stroke is the No. 5 cause of death and a leading cause of disability in the U.S.

Stroke can happen to anyone—any age, any time—and everyone needs to know the warning signs.

On average, 1.9 million brain cells die every minute that a stroke goes untreated.

Stroke is an EMERGENCY. Call 911 immediately.

Early treatment leads to higher survival rates and lower disability rates. Calling 911 lets first responders start treatment on someone experiencing stroke symptoms before arriving at the hospital.

Source: https://www.stroke.org/en/about-stroke

What are the warning signs for stroke?

Use the letters F.A.S.T. to spot a stroke and act quickly:

• F = Face Drooping—does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
• A = Arm Weakness—is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S = Speech Difficulty—is speech slurred?
• T = Time to call 911

Source: https://www.stroke.org/en/about-stroke/stroke-symptoms

Last but not least, while we’re sharing resources:

Download the PDF Checklist: 8 Ways To Help Prevent a Second Stroke

Taking Rest Seriously (More Than Just Sleep)

This is Dr. Matthew Edlund. He has 44 years experience as a psychiatrist, and is also a sleep specialist. He has a holistic view of health, which is reflected in his practice; he advocates for “a more complete health: physical, mental, social, and spiritual well-being”.

What does he want us to know?

Sleep, yes

Sleep cannot do all things for us in terms of rest, but it can do a lot, and it is critical. It is, in short, a necessary-but-not-sufficient condition for being well-rested.

See also: Why You Probably Need More Sleep

Rest actively

Rest is generally thought of as a passive activity, if you’ll pardon the oxymoron. Popular thinking is that it’s not something defined by what we do, so much what we stop doing.

In contrast, Dr. Edlund argues that to take rest seriously, we need do restful things.

Rest is as important as eating, and we wouldn’t want for that to “just happen”, would we?

Dr. Edlund advocates for restful activities such as going to the garden (or a nearby park) to relax. He also suggests we not underestimate the power of sex as an actively restful activity—this one is generally safer in the privacy of one’s home, though!

Rest physically

This is about actively relaxing our body—yoga is a great option here, practised in a way that is not physically taxing, but is physically rejuvenating; gentle stretches are key. Without such things, our body will keep tension, and that is not restful.

For the absolute most restful yogic practice? Check out:

Non-Sleep Deep Rest: A Neurobiologist’s Take

this is about yoga nidra!

Rest mentally

The flipside of the above is that we do need to rest our mind also. When we try to rest from a mental activity by taking on a different mental activity that uses the same faculties of the brain, it is not restful.

Writer’s example: as a writer, I could not rest from my writing by writing recreationally, or even by reading. An accountant, however, could absolutely rest from accounting by picking up a good book, should they feel so inclined.

Rest socially

While we all have our preferences when it comes to how much or how little social interaction we like in our lives, humans are fundamentally social creatures, and it is hardwired into us by evolution to function at our best in a community.

This doesn’t mean you have to go out partying every night, but it does mean you should take care to spend at least a little time with friends, even if just once or twice per week, and yes, even if it’s just a videocall (in person is best, but not everyone lives close by!)

If your social life is feeling a little thin on the ground these days, that’s a very common thing—not only as we get older, but also as many social institutions took a dive in functionality on account of the pandemic, and many are still floundering. Nevertheless, there are more options than you probably realize; yes, even for the naturally reclusive:

How To Beat Loneliness & Isolation

Rest spiritually

Be we religious or not, there are scientifically well-evidenced benefits to religious practices—some are because of the social aspect, and follow on from what we talked about just above. Other benefits come from activities such as prayer or meditation (which means that having some kind of faith, while beneficial, is not actually a requirement for spiritual rest—comparable practices without faith are fine too).

We discussed the overlapping practices of prayer and meditation, here:

The Science Of Mantra Meditation

Rest at home

Obviously, most people sleep at home. But…

Busy family homes can sometimes need a bit of conscious effort to create a restful environment, even if just for a while. A family dinner together is one great way to achieve this, and also ties in with the social element we mentioned before!

A different challenge faced by a lot of older people without live-in families, on the other hand, is the feeling of too much opportunity for rest—and then a feeling of shame for taking it. The view is commonly held that, for example, taking an afternoon nap is a sign of weakness.

On the contrary: taking an afternoon nap can be a good source of strength! Check out:

How To Nap Like A Pro (No More “Sleep Hangovers”!)

Rest at work

Our readership has a lot of retirees, but we know that’s not the case for everyone. How then, to rest while at work? Ideally we have breaks, of course, but most workplaces do not exactly have an amusement arcade in the break room. Nevertheless, there are some quick resets that can be done easily, anywhere, and (almost) any time:

Meditation Games: Meditation That You’ll Actually Enjoy

Want to know more?

You might also like:

How To Rest More Efficiently (Yes, Really)

Take care!