Stroke accounts for more than 10 percent of deaths in Singapore and is the leading cause of adult disability here.

Do high blood pressure, diabetes and high cholesterol automatically increase your risk of developing stroke? Can you reverse your lifestyle habits to prevent stroke? If your loved one has a stroke, does it mean you’re at risk too?

Dr Wee Chee Keong, Consultant at the Department of Neurology at the National Neuroscience Institute, a member of the SingHealth answers question about stroke.
Question by catbear

Dear Dr Wee, my dad, who is 67 years old, recently had symptoms of what I think is a TIA (dizziness, loss of balance, momentary loss of vision in an eye). I’m concerned that he may develop stroke later on, just like his dad (my grand dad). His doctor has already put him on high blood pressure medication. He is also on atorvastatin since June last year. Will these medications help delay the onset or even prevent stroke? What else can we do to prevent stroke, given that he’s quite stubborn when it comes to changing his diet?

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Hi Catbear, The symptoms you mentioned – particularly the transient loss of vision in 1 eye – are quite concerning. You are right in thinking it may be a stroke symptom. I suggest you bring your father to see a doctor for further evaluation, soon. Hypertension which your father has is well known as one of the major risks for developing a stroke. It is good that he is already on treatment, but if he has a transient stroke he very likely needs more than just anti-hypertensives and statins. The doctor you bring him to should be able to tailor a treatment regime based on the risk factors found after assessment. Wishing you the best.

Question by dylan77 (Republished by Forum Admin)

Dear Doctor, I noticed that my parents, who both have high cholesterol, do not like to be advised on what to eat. I’ve advised that them it’s not good to eat fried foods or eat out every day but they think it’s ok because they’re taking their cholesterol medication religiously. Is this true? Can you please share what types of foods are good to prevent stroke? How many times can they still eat fried chicken a week? And what kind of exercises they can do to prevent stroke? They’re both in their 60s and mobile.

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Dear Dylan77,

Thank you for your questions. Having 2 elderly parents myself, I understand the concerns one might have for our parents and how difficult it can be to change their beliefs. If it helps, you can tell them Dr Wee said having cholesterol pills is not an excuse for dietary indiscretion.

Dietary advice can be difficult to give over a forum like this, but let me point you to health promotion board’s “My Healthy Plate”. There is some useful information there.

How many times a week can they eat fried chicken ? Well that’s difficult to answer.

In general, the principle of a healthy is not to try to determine the maximum amount of unhealthy food one can have without incurring health “penalties”, like stroke or heart attacks and then indulge that limit; but to be as healthy as possible.

In addition, consider also other lifestyle changes like regular exercise which has been shown consistently to reduce the risks of both cardiovascular and cerebrovascular diseases.

Question by ABF (Republished by Forum Admin)

I am a woman in my early 30s. In my early 20s, I discovered I had high cholesterol. A doctor I saw said it was unusual for a young person like me to have high cholesterol, but he also said he thought it was not necessary to start medications yet because of my young age, as cholesterol takes years to ‘harden’. I don’t think it’s due to my diet as I do make a conscious effort to avoid fried and fatty foods, except for the occasional indulgence. It seems that it is genetically inherent as my mother was tested and it was found that her body naturally overproduces cholesterol. She had a mild stroke some years ago and has been on statins ever since. She is currently in her late 50s.

My question is: When would you recommend I start seeing a doctor to start on medication? What side effects would these medications have on a young person like me? I also have rheumatoid arthritis and currently trying to conceive. I am wary of having to take so many drugs, but I am also quite concerned after my mother’s brush with stroke. What do you think of more ‘natural’ remedies like red yeast rice (e.g. Hypocol)?

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Dear ABF, Thank you for sharing your problems; it does seem to be a quite a handful. You are right, there are no medications with absolutely no side effects. Doctors usually make recommendations on statin treatment after a careful consideration of risks and benefits. These are amplified especially during pregnancy and the potential effects on the fetus.

I will suggest that you talk this through with your family practitioner and rheumatologist. Do schedule regular discussions as the decision to start or stop certain medications can vary according to disease activity (rheumatoid arthritis in your case) and change as we progress through our life stages.

With regards to “natural” remedies, I have little knowledge of them. From what has been published in medical journals however, red yeast rice products have been shown to contain lovastatin. This may mean that it may not be entirely free from statin side effects.

Question by catlady

Dear Dr Wee, I suffered from a transient stroke a few years ago. Ever since then, my body doesn’t feel the same. It has been years but my one of my arms still feels numb occasionally. However when I go to the A&E, they admit me to run tests, but they cannot find anything wrong. I’m not sure if the numbness is linked to stroke or could be linked to the other problems that I have? I have spondylitis as well as poor blood circulation due to varicose veins.

What is the most common/obvious symptom that points to stroke? For your info, I am now in my early 60’s. Thank you in advance.

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Dear Catlady, Thank you for your questions. After a transient ischemic attack / stroke, it is common for people to be worried or feel anxious about it recurring. You did the right thing going to A&E to have your symptoms examined and investigated. It is quite reassuring that they did not find any symptoms of a recurrent stroke.

There are a number of conditions which could cause intermittent numbness in your arm. The best way to find the problem is to consult a doctor. A neurologist may be able to help you with this. Not all cases of stroke are easily recognisable, especially by lay persons. However, most can be picked up using the F.A.S.T method. A “Spot a Stroke” video explaining F.A.S.T and more information about stroke can be found in the links below. Please share them with your friends.

Question by healthblur

I previously had a scare where someone just fainted in front of me. I called the ambulance and lucky they came fast. But I remember I was at a loss of what to do. If someone has a stroke in front of you, what should I do to help while waiting for the ambulance?

Lie flat or sideways? Sit up if they awaken? Give them a drink or not? Any kind of Food? Massage the head or body or leave alone? Talk to them to keep them alert or let them rest? I think many others would like to know too! Thanks

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Hi Healthblur, Thank you for being a good Samaritan, and for trying to learn more! Stroke patients are slightly different from those who have loss of consciousness. Lying down does not help them as much as it does those who have fainted, though we should definitely get them somewhere safe while waiting for the ambulance.

Many of them also develop swallowing problems as a result of the stroke, so giving food or drink may cause them to choke.

Best thing to do is to get them seated somewhere safe – so they do not fall over and wait for help to arrive. Talking to them in the meantime can help keep them calm in the meantime.

You can also look at the reply to Catlady’s post to learn how to identify a stroke.

Question by Rachel

My mother in law suffered a stroke recently and is still in hospital waiting to be discharged. The physiotherapist has started to come in and send her for some therapy. My mum in law says it’s very pain and complains. So we asked the physiotherapist to stop. The physio day’s she’s just trying to help.

My question is: how soon after the incident should a person start physio / rehab or whatever? I’m torn between listening to my mum versus the professional. What kind of gentle or ‘introductory’ rehab might help the elderly ease into it better?

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Hi Rachel, Thank you for your question and sorry to hear about your mother in law.

Rehabilitation is an integral part of stroke treatment and is important for recovery of function. Early rehab within 2-3 days of admission is quite standard although, the optimal time to initiate rehabilitation is not clear from medical literature.

Each person’s rehabilitation “prescription” is different and takes into account their baseline function and the deficits (problems) caused by the stroke. So it is not a general exercise program based on their ages.

Question by Rachel

The doctor also told us that he put her on low dose paracetamol or aspirin - I can’t remember- as it helps thin the blood. Which is correct? Are they the same thing?

Is this also good for the heart in low doses if I just want to ‘prevent’ stroke for my dad who also has diabetes and a heart condition?

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

The medication should be aspirin – it is a common medication used for prevention after someone had previous stroke. This however carries with it bleeding risks and is hence not usually given to people who have not had a prior stroke or heart attack. The risks of bleeding may be higher than the risks of stroke or heart attack for these people.

Question by gemini29

Hi Dr Wee, my father is 2 years post ischaemic stroke and all is good except that he has double vision (diplopia). Can this problem be treated? Or will it eventually lead to sight loss? Appreciate your advice. Thank you.

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Hi Gemini29, Thank you for your question. Stroke does sometimes cause double vision. When it does, it is usually due to misalignment of the visual axes. i.e. one eye is looking straight at an object while the other is looking slightly off, causing 2 images to form.

Stroke typically causes sudden damage to brain tissues. Unless there is another repeat stroke, the damage does not usually progress over time. Recovery also tends to max out in about 6 months to 1 year. If your father is still having diplopia, the first step would be to confirm that this is due to misalignment of the visual axes with a doctor. Once that is done, specially made prisms fitted over spectacles can help in a number of cases.

Question by sl190994

Hi Doctor. 1 year post stroke my aunt, who is 50 this year, is experiencing intermittent pins and needles in her fingers, hot and cold sensations on the right side of her body, sometimes even lose sensation in her left arm. How can she better cope with this problem? If there is medication to take, what are some side effects she should expect? Thank you for your time. :)

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Dear sl190994, Thank you for your question. It is known that a small number of patients do suffer from post stroke pain syndromes, i.e. they get pain and discomfort on the side affected by the stroke during the recovery phase.

However it is difficult to advise on your aunt’s problem without seeing her. It should be properly diagnosed by a physician. Do bring her to a neurologist to have it looked at.

Question by mshong

Hi Dr Wee, my 60-year-old father had a stroke in August 2016 and was discharged in December. He suffers from aphasia but thankfully has regained functional use of all limbs. However, he complains of giddy spells on and off. It happens no matter how many hours he sleep. May I know if this is normal? What can he do about these giddy spells? Thank you.

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Dear mshong, So sorry to hear about your father’s stroke. Though he still has some aphasia, it’s great to hear he has regained the use of his limbs.

Giddy spells in general are quite non-specific complaints and can be caused by many different reasons. A common cause in stroke patients would be a sense of unsteadiness due to residual weakness after the stroke. As your father had aphasia, he may also have some problems describing his symptoms in more detail.

A family physician should be able to help get you get some idea on what may be causing his giddy spells and recommend some initial investigations and treatment.

Question by Lizlim

Dear Dr Wee. Hypertension and stroke run very strongly in my family. I heard about a simple, non-invasive screening test, the carotid ultrasound. I think this test can effectively prevent a lot of suffering and medical expense, to individuals and to the nation, in the long run. Can this test be requested at Govt polyclinics, at least for high-risk patients like myself? And can we work on making this test widely available in Singapore?

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Dear LizLim, Thank you for the post. I’m glad you are taking charge of maintaining your health and finding ways to manage your risks. The answer to your question about screening though is rather lengthy, so I will break it into parts and try to explain.

You are right in saying that the carotid ultrasound is a relatively simple and indeed non-invasive test which can be used to detect carotid stenosis. The test also readily available in restructured hospitals in Singapore.

To be sure, health screening comes under the purview of the Ministry of Health (MOH) and is beyond my level. There are however epidemiologic reasons that may help us understand why carotid ultrasound screening is not within our local recommendations.

To simplify what is actually a rather complicated matter, we can start our discussion from the U.S. Preventive Services Task Force recommendation. In 2014 they issued a recommendation where they actually advised against screening for carotid stenosis in the general population.

There were several reasons for this, among which was that the U.S prevalence of this condition is low – 0.5-1%. In Asian populations like Singapore, this condition affects even fewer people.

In addition, even if carotid stenosis is found, the treatment is generally to control cardiovascular risk factors such as hypertension, diabetes and cholesterol which are already in our MOH recommendations. So there is little benefit in finding out, and I cannot recommend that everyone goes for the test.

That is not to say that doctors cannot make the decision to recommend carotid ultrasound screening for a patient based on the person’s unique risks, examination findings and circumstances.

These patients may still benefit from having this screening test done; it is just that for the majority of people it does not help.

Hope this makes the situation clearer.

Best regards

Question by MKK

Dear Dr Wee Chee Keong:

Gong Xi Fa Cai!

I am in my mid-60s and am on statin medication to manage cholesterol issue. I also have breathlessness if I climb up overhead bridge briskly and therefore am on seretide inhaler.

I live alone in a quiet condo where access to the lift lobby (and therefore to my apartment) is via security access cards (ie, NO security guard on 24/7 basis). Increasingly, in Singapore's tight labour market where take-up rate for security guard jobs is dismal, most condos have increasingly tapped into CCTV/mechanical devices for estate security.

In the event that I should have any of the FAS symptions and I telephone 995, I'd like to know if:

(a) I should take an aspirin pronto - would that help in any way or would it exacerbate the risks because there may be different health conditions?

(b) I should immediately take the lift to get down to the condo's waiting porch area that would be easily accessible to the ambulance staff upon arrival and just sit there to wait?

(c) In the event that I should lose consciousness, do you know if all SCDF ambulance staff are equipped and trained to gain urgent access (eg, by de-magnetizing the lift lobby glass door or by smashing it) bearing in mind that every second counts in saving lives and/or minimizing the extent of damage for more likely full recovery?

Thank you

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Dear MKK

You got me on this one ! I do not know the exact capacities on the SCDF ambulances with regards to gaining access through physical barriers. I suspect though this may be limited to the fire department in SCDF. So if possible do try to get to somewhere safe and accessible.

With regards to the question about aspirin, approximately 20% of strokes in Singapore are caused by bleeding rather than an obstruction in the blood vessel so I’ll suggest not taking, especially emergency departments are only minutes away for most locations in Singapore.

Kind Regards

Chee Keong

Question by EMC

Dear Doctor, Generally how many years of life span can a stroke patient survive ?

Answered by Dr Wee Chee Keong, Consultant at the National Neuroscience Institute

Dear EMC,

Thank you for this question.

It is a difficult one to answer though. For ischemic stroke (stroke caused by blood vessel obstruction) patients, the mortality in 1 year approximately 20% from the latest figures from the Singapore stroke registry. Much depends on the age of the person when their stroke occurred, and older people tending to do worse than younger ones.

Though it is well known that stroke survivors have increased mortality in the longer term compared with the rest of the population from studies that have followed them up for up to 20 years; the cause of this is uncertain and medical knowledge of this is not precise enough for doctors to prognosticate life expectancy for most patients after a stroke.

Best regards

Chee Keong

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