Sunday 15 September 2019

Recognising signs of illness, and knowing when to act

Ask the GP...

Strokes - the vast majority of them are preventable.
Strokes - the vast majority of them are preventable.

Nina Byrnes

Our GP on how to recognise the signs of stroke, and act fast, and advises on knee pain caused by a Baker's cyst.

Q. My husband has narrowing of his blood vessels. He has been told he has an increased risk of stroke. I worry about this, are there any signs I should watch out for?

Dr Nina replies: Brain tissue starts to die at a rate of up to two million brain cells a minute if the blood supply is reduced or cut off. The disturbance of flow in a blood vessel in the brain is called a stroke, and can occur due to the presence of a blood clot (ischaemic) or bleeding (haemorrhagic).

Strokes are most common in those over 60 but can occur at any age, even in children. Until fairly recently, treatment of those who suffered a stroke mainly focused on rehabilitative care involving physiotherapists, occupational therapists and speech and language therapy. This care is still essential for those who suffer prolonged weakness or paralysis, but today acute strokes are seen as a brain attack, a potentially treatable medical emergency.

Strokes usually occur without any warning. Recognising the signs and acting fast can reduce the chance of long-term brain damage and disability.

The word FAST is used to draw attention to the signs of a stroke and to stress the importance of seeking urgent medical help. F stands for face: Has the face fallen to one side, can the person smile? A stands for arms: Can they raise both arms above their head and keep them there? S stands for speech: Is the person's speech slurred? T stands for time: If any one of the symptoms is present call emergency services urgently.

Other less classic signs of stroke can include confusion, loss of balance or dizziness, blurring or loss of vision, and sudden headache. If blood-thinning medication is given early (within three to four hours) in the case of a clot, permanent paralysis or nerve damage may be avoided. Strokes due to a bleed are more difficult to treat.

The risk factors for stroke include: a family history of stroke, high blood pressure, heart disease, diabetes, obesity, high cholesterol, smoking and excess alcohol intake. They are very similar to those for other heart and vascular disorders. You cannot change your genes but many of the risks are manageable. A healthy lifestyle goes a long way towards reducing your risk of stroke.

If you are considered to be at a higher risk of stroke your GP can make sure your blood pressure is controlled, and advise you re exercise and weight loss. Those at risk should stop smoking, and keep alcohol well within normal limits.

Stroke can cause temporary or permanent disability. In a transient ischaemic attack (TIA) a clot temporarily reduces blood flow to the brain but then dissolves or moves on. The symptoms of a TIA last less than hours. These should be taken seriously as they usually indicate underlying problems increasing the chance of stroke down the line. In those with more significant strokes, symptoms may resolve slowly over weeks to months.

Unfortunately in some cases permanent disability remains.Stroke kills more people each year than breast, lung and bowel cancer combined. Of those who survive 65pc will make a reasonable recovery. Prevention is best but every minute counts. If you think someone you know is having a stroke, call an ambulance. Don't delay.

Q. My leg is a little swollen and my knee is sore. The back seems especially tender when I touch it. I can feel a soft lump here. What could this be? Is it something I should worry about and should I see my doctor?

Dr Nina replies: A Baker’s cyst is a fluid filled cyst that occurs in the bursa behind the knee.

Baker’s cysts occur most commonly in young people aged four to seven, or in those aged 35 to 70. In younger people the cyst occurs in a normal joint where fluid moves into a pouch at the back of the knee. In older people with degenerating joints, increased production of synovial fluid puts pressure at the back of the joint causing swelling to occur. Baker’s cysts can also occur if there has been a tear or damage in the joint leading to inflammation.

If Baker’s cysts enlarge they can cause pain and swelling behind the knee. There may be an ache around the knee or a sensation of fullness or pressure when standing. With larger cysts it may be difficult to bend your knee. More rarely people notice a sensation of clicking and locking of the knee. These cysts aren’t dangerous but rupture may lead to pain and swelling of the calf. There may also be bruising and tenderness.

The symptoms associated with a Baker’s cyst can be very similar to those associated with a clot (DVT) in the lower leg, and so it is important to visit your doctor to ensure this is not the case. Many Baker’s cysts will resolve by themselves and don’t require any treatment.

If you have pain, applying ice may help. Taking over the counter, or rarely prescription, medication may help reduce inflammation and pain. It is important to discuss any medication with your doctor or pharmacist. If the cyst is large or causing a lot of pain or discomfort you may require drainage or removal of it, though this is rarely the case. Steroid injections into the joint are also sometimes used.

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