“Stroke continues to be an epidemic, and it is important to know how to recognize it early to improve survival and quality of life.”

ANGEL FERNANDEZ DIAZ AUTHOR OF THE BOOK “Ictus. Five letters that will change your life

Angel Fernandez Diaz is a neurologist at the Hospital del Bierzo, where he mainly treats pathologies related to epilepsy that is difficult to control, neuromuscular problems, sleep pathologies and strokes. It is to this disease that he dedicates his second book entitled “Ictus. Five Letters That Will Change Your Life, which is intended to be a guide for patients and caregivers facing a new life. The text has just been published, almost coinciding with World Stroke Day, which is celebrated on October 29.
The first thing we need to do is let citizens know what we are talking about: what is a stroke?
In simple terms, this is a problem of brain irrigation. Either the artery or vein is blocked and blood does not flow through, causing the area to remain unirrigated and die, or the artery or vein ruptures and blood pools in the brain, causing what is called a spill.
What are the consequences?
It is estimated that in these strokes, where an artery is blocked and we are left without blood supply, two million neurons are lost every minute. What will happen is that this person will either have difficulty speaking, or will not be able to move his leg or arm correctly, or his mental state will change. Sometimes, with luck, these symptoms can be reversed, but even if we do not act quickly, it is very likely that they will persist and the quality of life will be greatly reduced unless death occurs first.
In what cases is it easier to eliminate the consequences?
Time is of the essence. This translates to “run to the nearest hospital to take action.” Today we have more tools to treat stroke caused by a blocked artery than stroke caused by stroke. The first is much further advanced, and the hemorrhages are getting worse because they cause more disability and more deaths.
What is the number of victims?
In Spain, it is estimated that around 120,000 people suffer a stroke each year, of whom around 25,000 die. The rest are left with varying degrees of consequences and disabilities. In Bierzo their number is large, we can talk about 200-250 per year. The León Hospital, which is our reference point for certain procedures, receives approximately 1,200 stroke patients per year between the areas of León, Bierzo and northern Zamora.
What symptoms can we use to identify a possible stroke?
There is a very diverse range of symptoms, which can sometimes make it very difficult to detect that a person is having a stroke, but there are a number of signs, the appearance of which is very indicative. If one of them appears, we’ll have to be on guard. These include difficulty speaking, paralysis on one side of the face, or the inability to move a leg or arm. If any of these occur, a stroke code chain should be activated that will allow you to be transferred to the nearest hospital.
How can we prevent them?
The most important thing is physical exercise, it is necessary for the prevention of cerebrovascular diseases. Even for those who have already had a stroke, exercise can help reduce mortality. We should also avoid tobacco use, excessive alcohol consumption, and other conditions that we cannot control, such as pollution. And be sure to check cholesterol, sugar and other indicators. It is very important to sleep well and have quality sleep. It is clear that this is a protective factor.
How is stroke treated in Bierzo? What remedies and treatments do they have?
There are only 17 accredited stroke units in Spain. We have a care team here consisting of a neurologist, an emergency department and an intensive care unit. We have access to a number of treatments, especially fibrinolytic therapy, which attempts to break up the clot through an intravenous injection. If we had to do a thrombectomy, a type of brain catheterization, we would need to transfer the patient to Leon. Here we have the biggest “but”: the delay in translation, since other information centers have fewer mountain passes or less geographical distance than between Bierzo and Leon.
After admission to the ward and treatment, the second part begins – rehabilitation…
This is the fundamental part. If we manage to leave it without consequences, we will all congratulate ourselves, but if it remains with them, physical and mental rehabilitation must be prescribed. Occupational therapy that allows a person to not only stand, but also perform daily activities. Also speech therapy and cognitive rehabilitation. We still have a lot of progress to make nationally in these parts.
This week was World Stroke Day. What message do you want to send?
In fact, stroke continues to be an epidemic, and it is important to know how to recognize it early to reduce time to care and improve survival and quality of life. And we must continue to work to ensure that no stroke survivor is left behind. Increasing the patient and family association movement is important because with many voices you reach more places.
You have been treating this pathology for many years and now you have decided to publish a book about it. For what purpose?
This comes from observing over time, especially in the post-Covid era, where we saw that when resources were overwhelmed, you went very fast and could not stop long enough to take care of families, you realized that when they left. At home they were very nervous and tense. People were not prepared, in the sense that they did not understand many aspects of why a family member does not recognize them, why people only talk to them if they are standing on the right side and not on the left, why they are worried, out of breath. ..There are two ways to approach this: either stand up one by one and give explanations, or prepare a book that explains how you can help the patient and their caregivers, the reason for their symptoms and how to proceed. This is a kind of survival guide.
What are the key points of this guide?
The first thing I explain is that they must be mentally prepared to return home. We will have to learn to adapt and know how to feed them, how to learn to swallow again, how to position a paralyzed limb, or how to avoid contractures and wounds. We also mention other aspects of life that can be more isolating, such as intimate relationships. Or we talk about issues that concern them, such as issues related to their driver’s license, assistance they are entitled to, or why they have difficulty going to the toilet. We have selected the main problems that teachers brought to us with.
Would you highlight anything else from this text?
This is a book for ordinary people, not specialists. It is intended for people who have a mother, father, husband or child at home with a stroke and they don’t know what to do and don’t understand why certain things happen. Written in short chapters, six to eight pages, in simple, clear, and accessible language. There are also links to other sources and resources that provide additional information, such as illustrations of how to move or lift a patient in bed. This will be a helpful guide.
What kind of collaborations have you had?
There are a number of chapters in which I was advised by two hospital colleagues, Blanca and Carmen. And there is a chapter entirely devoted to sexuality, written by sexologist Rosa Maria Montagna.