milton keynes hospital stroke guide

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For patients, carers and relatives Stroke Guide

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This document was developed in conjunction with Milton Keynes Hospital Trust, Milton Keynes Council and the NHS to help guide people through the Stroke rehabilitation process.

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Page 1: Milton Keynes Hospital Stroke Guide

For patients, carers and relativesStroke Guide

Page 2: Milton Keynes Hospital Stroke Guide

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BACKGROUNDIntroduction 4

Effects Of A Stroke 8

Medical Tests And Investigations 9

What To Expect 13

Care Pathway 15

HOSPITAL INFORMATIONHyper Acute Stroke Unit 18

Acute Stroke Unit 19

Frequently Asked Questions 26

Diary Of Progress 30

Car Parking 30

Making A Complaint 31

Before Returning Home 33

WHEN YOU RETURN HOMEWhat Will It Be Like? 36

Coping 38

Relationships And Family 39

Social Life And Hobbies 40

Getting Back To Your Daily Routine 41

Intimacy Following A Stroke 42

Contents

STROKE GUIDE CONTENTS

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MAKING CHANGES TO YOUR LIFESTYLELifestyle Service Listings 44

LEAFLETS The Eatwell PlateGuide To Food LabellingSmart Swaps - Taster RecipesGet Active, Stay ActiveDon’t Let Drink Sneak Up On YouSmokefree - Guide to Finding The Right Support

COMMUNITY INFORMATIONHealth Services In The Community 48

Specialist Services 50

Outpatient Services 51

Other Services 52

Social Care Sevices 55

Social Support 57

Financial Support 61

Travelling 63

Useful Contacts 66

Useful Websites & Links 72

MY DIARYMy Information 74

My Diary Notes 75

Questions To Ask 80

Medications 81

Names To Remember 84

Letters To Keep Safe 85

STROKE GUIDE CONTENTS

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3 STROKE GUIDE BACKGROUND

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IntroductionWHAT IS A STROKE?A stroke often happens suddenly, without warning andcan affect people of any age. It can happen when theblood supply to part of the brain is disrupted.The symptomsdepend on the part of the brain affected and the extent ofthe damage incurred.This is why no two strokes are thesame and why recovery is so variable.

A TIA (Transient Ischaemic Attack)Also known as a ‘mini-stroke’, this is where the supply ofblood to the brain is temporarily interrupted.The symptomsare very similar to those of a stroke, but the difference isthat they resolve.This can mean an episode can last asshort as a few minutes to hours, but no longer than 24hours.TIAs should be treated very seriously as they areoften a warning sign that a full stroke is coming.

TYPES OF STROKEThere are two main causes of a stroke, which require different types of treatment.These are explained on the following pages.

STROKE GUIDE BACKGROUND

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Diagram 1 Ischemic stroke

STROKE GUIDE BACKGROUND

Ischaemic stroke (infarction)

Most strokes (accounting for over 80% of all cases) occurwhen the blood supply to the brain is stopped due to ablood clot.This blood clot restricts the flow of blood tothe brain.

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Diagram 2 Hemorrhagic stroke

STROKE GUIDE BACKGROUND

Haemorrhagic stroke (haemorrhage)

This type of stroke (up to 20% of all cases) is caused bybleeding in or around the brain from a burst blood vessel.

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THE BRAINThe brain is divided into two halves – the right and the left.The location of the stroke is especially important in understanding which parts of the body will be most affected.

The left side of the brain controls the right side of thebody… and vice versa. Each side of the brain has different functions and this will dictate what affect thestroke has, or what symptoms the person experiences.

In the majority of people, the left side of the brain is responsible for language (reading, writing, speaking andunderstanding), and the right side of the brain controlsour ability to make sense of what we see, hear andtouch; our ability to judge size, speed, distance and position in space.

Memory, vision, movement, sensation, and hearing arecontrolled by both sides of the brain. Therefore thesefunctions can be affected whichever side of the brain is damaged.

STROKE GUIDE BACKGROUND

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Effects Of A StrokeIt is important to remember that no twostrokes are the same. How your stroke affects you depends on:

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• Weakness, clumsiness,heaviness or paralysisdown one side

• Swallowing difficulties• Disturbed vision• Loss of bladder/

bowel control• Tiredness and difficulty

sleeping• Numbness/altered

sensation • Pain• Loss of balance

• Communication difficulties: writing,speaking, reading, calculating

• Psychological effects:mood swings, anxiety,depression

• Reduced concentration,memory, ability toprocess information

• Difficulty recognising and knowing how to use familiar objects

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1. The area of the brain damaged2. The severity of the stroke3. Your age and general health

THE MOST COMMON STROKE EFFECTS

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Blood tests: These can beused to check for certainconditions that may havecontributed to your stroke,such as blood sugar leveland cholesterol level. Highlevels can increase the riskfor further stroke.

Echocardiogram (or cardiac ultrasound scan):This may be used to lookfor any heart problems thatmay have contributed toyour stroke.

Electrocardiogram (ECG):This heart tracing testmeasures the rhythm andactivity of your heart. Irregular heart rhythms cancause strokes and need tobe treated.

Chest X-ray: This looks forunderlying conditions suchas heart or lung complaintsthat may have contributedto the stroke.

Medical Tests and Investigations Below are some of the tests which may beoffered to you. It is unlikely for someone toneed all these tests – your doctor will decidewhich ones are appropriate for you.

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CT (Computed Tomography) scan: This isthe type of brain scan whichidentifies what kind of strokeyou have had and the extentof the damage the strokehas caused. It is also used to exclude other types of illness that have similarsymptoms to a stroke. Ascan should be done within24 hours of having a stroke.

MRI (Magnetic Resonance Imaging)scan: This is another typeof brain scan which gives amore detailed picture thana CT scan.

Carotid Doppler or Duplex ultrasound scan:This is used to find out ifthere has been a narrowingof the blood vessels in theneck (the carotid arteries),which supply blood to thebrain.This narrowing cancause a stroke.

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11 STROKE GUIDE BACKGROUND

Thrombolysis: When youwere admitted to hospitalyou may have been offeredThrombolysis a ‘clot dissolving’ treatment. Thistreatment is only suitable

for a small proportion ofstroke patients. Having thistreatment can help restoreblood flow to the affectedareas of the brain, so reducing the amount of

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12STROKE GUIDE BACKGROUND

brain damage that occurs.However, the treatmentmay not cause the bloodclot to completely dissolveas they can vary in sizeand make-up. Overallthough, most patients improve quicker followingThrombolysis treatment.

Locally this treatment isonly available at Luton andDunstable Hyper AcuteStroke Unit.

Thrombolysis is offered topatients who arrive within4.5 hours of stroke symptomonset. The treatment is notgiven after this time, as todate, it is not shown to reduce the damage alreadycaused to the brain tissue.

Thrombolysis not onlyhelps to dissolve the clot,but will also thin the bloodand therefore there is a 5 – 8% risk of haemorrhagefollowing treatment. Forthis reason you may not beeligible for Thrombolysis if:• You have recently

had surgery• You fell prior to / as a

result of your stroke and sustained a bonefracture

• You are already on anticoagulants and yourInternational NormalisedRatio (INR) is not withinthe normal range.

Any of the above reasonsputs you at an even greater risk of haemorrhagefollowing Thrombolysis.

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There is no way of predicting how a person willbe affected long term. You have to wait for timeto pass and allow the initial healing process totake place. Sometimes this feels like no-one istelling you what is going on, but this is not thecase – it is just too early to know what the outcome will be.

This can take several weeks to months, but during this time you may notice improvement in some of your symptoms or the effects of the stroke. When this improvement slows down it may be clearer what the long term effects of the stroke are going to be.

Most useful recovery happens in the first few months, but people can continue to recover for several years after the stroke.

WILL I HAVE ANOTHER STROKE?Having a stroke increases your risk of having another. However there is a lot that can be done to help such as

What To Expect

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taking medication to thin your blood, controlling high blood pressure, cholesterol and diabetes, and altering your lifestyle to reduce known risk factors (secondary prevention).

You will need the help of doctors and nurses to identify individual problems and make sure they are well controlled. More complex situations may need access to specialist services such as preventative surgery.

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Stroke Care Pathway

1

2

3

4

5

6

Individual Getting Better

Diagram 3 Health Service Facilities

STROKE GUIDE BACKGROUND

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1. In-Patient Services:• Hyper Acute Stroke Unit (Luton and Dunstable Hospital)• Acute Stroke Unit (Milton Keynes General Hospital)• Hospital Social Service Team

2. Early Supported Stroke Discharge:• Early Stroke Rehabilitation Team

3. Specialist Services:• Stroke Clinical Specialist• Stroke Social Worker and Social Work Assistant

4. Community Services:• General Practitioner• Intermediate Care Services• Reablement At Home Team

5. Out-Patient Services:• Milton Keynes Neuro-Rehabilitation Services• Speech and Language Therapy Team

6. Milton Keynes Social Services:• Adult Social Care Access Team (ASCAT)• Community Occupational Therapy• Milton Keynes Centre for Integrated Living (MK CIL)• Continence Service • Podiatry

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There are certain criteriawhich will need to be metbefore you are taken there,the main one of which isknowing the time whenyour stroke first started.

Luton and Dunstable Hospital have access to a stroke consultant 24hours a day. Followingscans and blood tests, they can confirm your diagnosis and offer you the correct treatment.

You may be dischargedback to Milton KeynesHospital or directly to yourhome as soon as possible.If you are dischargedhome, you need to ensurethat your GP refers you foran out patient consultantappointment at MiltonKeynes Hospital. You mayalso be referred to the EarlyStroke Rehabilitation Teamfor further therapy at home.

Hyper Acute Stroke Unit Some patients who have had a stroke mayinitially be taken to Luton and DunstableHospital, to the Hyper Acute Stroke Unit.

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The Acute Stroke Unit The Acute Stroke Unit in Milton Keynes hasbeen established to provide a co-ordinatedteam with specialist expertise in stroke rehabilitation as part of the in-patient service.

At this hospital, the Department of Medicine aims to provide as many stroke patients as possible prompt access to the Acute Stroke Unit.

STROKE GUIDE HOSPITAL

It is the aim of the Unit to: • Provide educational programmes for

staff, patients and carers • Provide specific interventions from

involved professionals • Develop an individual rehabilitation

programme for each individual• Facilitate discharge to an appropriate

destination

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DoctorsWhilst on the Acute StrokeUnit, your medical care willbe managed by consultants.They are supported by ateam consisting of professionals with specialistknowledge in strokes.

The doctors will ensurethat you are medically stable and, where possi-ble, will aim to minimise theamount of damage to yourbrain and make sure youget appropriate secondaryprevention medication. Attheir earliest opportunity,they will discuss (with you,the patient, and your family) the nature andseverity of your stroke as well as your potentialprospect of recovery. Thisgives you and your family

the opportunity to find outas much as you can aboutyour condition. It is importantto be aware that the doctorswill be asking you and yourfamily to consider long-termdischarge plans. Discussionswill occur on a regularbasis at different stages ofyour rehabilitation. Meetingwith the doctors is by appointment only – pleasespeak to the ward clerk ora member of staff.

NursesThe Ward Sister leads ateam of nurses experiencedin caring for people whohave had a stroke. Thenurses are divided into two teams: Red and Blue.On arrival to the ward, youwill be allocated to one ofthe teams.

THE TEAM

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In the absence of yournamed nurse, the nurse in charge of the wardshould be able to help you with any particularquestions or concerns, but if not, appropriate help will be sought.

If you would like to commenton any aspect of the servicethe ward provides, pleaseask to speak to a memberof staff. Alternatively, youmay wish to make an appointment to see theWard Manager or telephonethe ward on 01908 243202.

The Ward Manager typicallymeets with family memberson Tuesday afternoons.

Occupational TherapistsHaving had a stroke youmay experience difficulty in carrying out everydaytasks. You may also experience changes in theway you think and react.The OT will help you identify areas of difficultyand work alongside you todevelop ways to undertakethese tasks.

Assessments and treatmentwill usually take place inthe hospital setting, butwith your permission an‘access’ visit or ‘home’visit may be necessary tosee if any changes wouldbe helpful to increasesafety and independencein the home.

You will also meet your‘named nurse’ who will

be responsible for assessing your individual

needs and planningyour nursing care.

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Physiotherapists (Physios)A stroke can often limitmovement on one side ofthe body, thus the otherside tries to compensatefor this. We aim to help youregain movement, balanceand stamina, as well asmanage weakness or lossof feeling of the limb.

The physiotherapist willhelp prevent muscles frombecoming too loose or tight,which will in turn minimisefuture complications.

Your physiotherapist willadvise on correct positioningand ways of moving on the ward to enhance

STROKE GUIDE HOSPITAL

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recovery and prevent secondary complicationssuch as muscle/joint stiffness and pain.

DieticiansWeight loss and malnutritionoften occur in stroke patients with eating andswallowing difficulties.Good nutrition is essentialin your recovery and rehabilitation, and our aimis to ensure the diet youare having is adequate foryour needs. Any patientexperiencing nutritionalproblems will be referred to the Dietician for supportand advice.

Speech and Language TherapistsYour speech and languagetherapist will support youand your family/carers

when swallowing and/or communication difficulties occur.

SWALLOWING: A strokemay affect the nerves and muscles involved in swallowing. We will assessyour swallowing and adviseyou on how to best managethis. Sometimes a personmay need to be ‘Nil ByMouth’ for a period of timeand alternative ways of feeding may be needed.There will be regular reviewsof your swallowing duringthis time.

COMMUNICATION: Difficultieswith talking, understandingspeech, reading or writing.We work closely with you,your family and carers to ensure that you are able tocommunicate as effectivelyas possible.

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Social WorkersWe aim to help you returnhome and stay there safelyso that you can live your lifeas independently as possiblefollowing your stroke. Wecan do this by arranging asocial care assessment. If itis not possible for you tocarry on living in your ownhome, we will look at alternatives, such as sheltered housing or a residential/nursing carehome. An assessment is

made on an individual basisand referrals will be made byThe Team as appropriate.

Stroke Clinical SpecialistHaving had a stroke, youmay benefit from consistentsupport in accessing information, and knowinghow to access a full range ofservices. The Stroke ClinicalSpecialist provides advice,information, support and referral on to appropriateservices for all those with aGP in Milton Keynes.

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Meals and DrinksThe Hospital Trust operatesa ‘Protected Mealtime’policy. This allows you (thepatient) to eat your mealsat your own pace to improve your nutritional intake. If you require support to eat your meals,they will be placed on to ared tray to alert membersof staff of your needs.

Visitors are discouragedfrom visiting at meal times

unless they are assistingyou (the patient) to eat anddrink. Due to health andsafety regulations, we regret that it is not possibleto reheat food itemsbrought in by family/friends.

VisitorsFor safety reasons and thecomfort of all patients,there is a limit of two visitors atthe bedside. Ask the wardstaff about visiting times.

WARD INFORMATION

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Frequently AskedQuestionsWhat items will I need in hospital?A selection of day clothessuch as tracksuits or loosefitting clothing and a pair ofshoes/trainers. You will beencouraged to dress in normal day clothes, thiswill enable you to feel more comfortable during rehabilitation and will helpmaintain your dignity.You will need to have a selection of toiletries touse. The hospital providestowels and disposablewipes (flannels) to help with infection control. Pyjamas and nightdressesare available, however, you may prefer to wearyour own.

Please mark all your possessions with yourname. We regret that the Trust cannot take responsibility for any personal items unless they are handed to thestaff to be placed in thehospital safe.

How will I know who carries out what role?The nursing staff and sometherapy staff wear uniformsfor work, others wear theirown clothes. Every memberof staff should be wearingan identification badge andthis will have their job titlewritten on it.

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How long will I be in theAcute Stroke Unit?The average stay for strokepatients is varied. Asstrokes affect everyone differently, you may be in forone week, or sometimesmuch longer than fourweeks. Once you havebeen on the ward for abouta week, the team shouldhave a good idea of howlong you will need to remainhere. Please be aware that following a Team decision,you may be moved off theunit if you have reachedyour full potential and areeither ready to go home or waiting an alternativepackage of care.

How will I know how I am doing?When admitted to theAcute Stroke Unit, you areassigned a Specialist

Consultant and a NamedNurse who will provideyour care whilst you are onthe Acute Stroke Unit. In addition, if you require therapy you will have access to OccupationalTherapy, Physiotherapy,Speech & Language Therapy,a Dietician and a SocialWorker, if appropriate. The staff across these disciplines involved in your care are known asyour multidisciplinary team (MDT).

Your multidisciplinary teamwill meet twice a week onthe Acute Stroke Unit to ensure your healthcareneeds are met to enableyour safe discharge. Youand or your next of kin willbe provided regular updatesfrom your multidisciplinaryteam. If you do not feel

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Everyone has an important part to playin your rehabilitation.

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informed or have questionsor concerns during yourstay in hospital, do nothesitate to speak to yournamed nurse or a memberof your multidisciplinary teamwho will endeavour to help in any way they can.

How can family/friendsget involved in my rehabilitation?Family and friends often askwhat they can do to help therecovery process. Everyonehas an important part to playin your rehabilitation and thisincludes not only the physicalaspects, but also social,emotional and psychologicalelements too. Family andfriends are encouraged toattend rehabilitation sessionssuch as Physiotherapy andOccupational Therapy, aslong as you are in agreement.

Once your condition allows,you may wish to leave theward (with family/friends) forshort periods. Initially, thismay be around the hospitalgrounds or to the restaurant.Later on this may be furtherafield, perhaps to the citycentre for lunch. After discussions with the Team,home leave may be granted.In this instance, advice ontravel arrangements will bediscussed with you.

Will I have rehabilitationafter discharge?Your rehabilitation needs willbe specific to you. There areseveral different kinds of rehabilitation once you aredischarged and this will bediscussed with you prior toleaving the hospital. If you areunsure about things, do nothesitate to ask a staff memberfor clarification.

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It may help to talk to your family about what they rememberabout your stay in hospital, how they felt when you wereill and the things that happened while you were there.There is a diary section in the back of this guide for youto record your progress and thoughts. It can be helpful tolook at this with them and carry it on into your recovery.

Car ParkingYour visitors can apply for a temporary parking permit, if they plan to visit the site on a regular basis. For an application form,ask a member of staff.

Diary of Progress You may not remember your time in hospital clearly, and this can be confusingand frightening.

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PALS can help by:• Advising and supporting

patients, their familiesand carers

• Providing information onNHS services

• Listening to concerns,suggestions or queries

• Helping to sort out problems quickly.

When is the PALS team available?Opening hours: 9am-5pm,Mondays to Fridays, not including public holidays.

An out-of-hours answer-phone service is available.Messages will normally bereturned within 24 hours.

Making a Complaint The Complaints and PALS (Patient Adviceand Liason Service) Team provides confidentialadvice and support to patients, families andtheir carers.The service can also help withany issues or concerns about standards ofcare patients and their carers wish to raise.

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How do I contact the PALS team?

! TELEPHONE01908 243633or 01908 243181

" E-MAIL [email protected] or [email protected]

# POSTMilton Keynes PCT HQHospital Campus Standing Way Milton Keynes MK6 5NG

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Before Returning HomeDon’t be afraid to ask your doctor or namednurse anything you are unsure about. Remember all the staff are there to help.

STROKE GUIDE HOSPITAL

Upon leaving the hospital you should: • Ask for a copy of your discharge letter • Check your medication• Have you got what you need?• Do you know what it is for?• Do you know when and how to take it?• Know what support you will have when

you leave the hospital• Make an appointment with your GP

within two weeks to discuss ongoingtreatment

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35 STROKE GUIDE HOME

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It is a very positive step, butit will take time and effort to get back to a normal life.You won’t have the samesupport you had in hospitaland it can be a difficult timefor you and for your relatives.

After your stroke, yourbody will need time to healand get back any abilitiesyou have lost. This takestime, practice, determinationand patience.

In many ways your recoveryis a journey that is very

personal to you. Even ifyour stroke symptoms aresimilar to someone else’s,your ability to recover oryour motivation to recovermay be very different.

It’s normal to go throughtimes where you feel depressed or frustrated because you don’t seem to be getting better.

What Will It Be Like? Leaving hospital and returning home is amajor step in your recovery and is likely to have been a goal you’ve been working towards for some time.

It will take time and effortto get back to a normal life.“

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Setting small goals in yourdaily routine can help yourecover and show you thatyou are improving. A smallgoal could be somethingas simple as making adrink for yourself, or walkinga few steps further withoutneeding a rest.

After you have had astroke, you’ll probably feelvery tired and won’t havemuch energy. It will taketime before you feel wellenough to cope witheveryday life and manymore months to get backto full strength. Don’t push

yourself too hard as thiscan end up making yourrecovery take longer.

Keep doing the exercisesyou have been shown, butdon’t overdo it as this canset your recovery back.

You will need to slowly increase your activity tobuild up your strength, butmake sure that you restwhen you need to. You willneed to take things veryslowly. Make sure you incorporate regular rest inyour daily routine and don’tfeel guilty about it.

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You may not feel like seeing a lot of people atonce, so start by seeingone or two friends at a timefor short periods.

Your recovery may take along time and as you getbetter and begin to domore, you may find that

things get on top of you.During this time you maylack confidence, worryabout your recovery, oreven feel depressed. Talking about this to yourfamily or a close friend can help.

Coping When you’ve had a stroke, you may feel differently about things and may not want to do things you used to enjoy.

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Your family may make a fussand might not understandwhy you’re not keen on thehobbies and interests youused to enjoy.

Your family and friends wereafraid you might die, so theymay want to do everythingfor you when you get home.If this annoys you, talk tothem calmly about how youfeel. Don’t bottle things upand get angry.

If you have young childrenyou may feel under evengreater pressure to get backto normal, do the importantthings first – other jobs canwait. Take a nap at the sametime as the children anddon’t be afraid to ask yourfriends and family for help.

Relationships and Family After you’ve had a stroke, you and the people around you may seem to change.

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Meeting people regularly,every day if possible, is animportant source of well-being.Talking to others can be abig help. Many people findsupport groups, such asstroke support groups andclubs helpful, as they providea chance to meet peoplewho have been through a similar experience.

Returning to hobbies andinterests is also an importantpart of the recovery process.You could even look at trying new things. Try not tobe put off by thoughts thatyou are unable to do thingsas well as you could before.Many activities can beadapted to enable you tocarry on enjoying them.

Social Life and Hobbies There are many things you can do yourselfto improve your psychological well-being.

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Talk about it with your familyand think about how you can adapt things at home to help.

If you used to work, you maynot be well enough to returnfull time straight away. Whenyou’re feeling better, it’s agood idea to arrange to goback and see your colleaguesand talk to your line manager.Depending on your job, youmay be able to do a fewhours a day at first.

If you don’t depend on paidemployment you could always do some voluntarywork. Many people find itworthwhile and can meanyou have a reason to get upin the morning, and you arenot then tied to the necessityto get to work when you really don’t feel well enough.

Getting Back To Your Daily RoutineLots of people worry about coming home from hospital or returning to work after a critical illness, it is normal to wonder whetheryou’ll be able to cope.

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These issues can be short-term and relatively easy to overcome, but forothers, they are more serious and long lasting.

It’s normal to be worriedabout when it’s safe to starthaving sex again. Your partner is likely to be worried about this too.

Most people find it difficult totalk about sex, but try torelax and keep a sense ofhumour. Cuddles are really

important. Take things slowlyand see what happens.

Sometimes, medical problems such as impotence(being unable to get andkeep an erection) can affectsex. If you’re worried, talk toyour GP.

Intimacy FollowingA Stroke Depending on the area of the brain affected,a stroke can cause physical and emotionalchanges that affect a person’s sex life.

Most people find it difficult to talk about sex,but try to relax and keep

a sense of humour.

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43 STROKE GUIDE LIFESTYLE

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Lifestyle Service ListingsThere are a number of changes you canmake which will improve your health and reduce your risk of stroke.

The following section includes the relevantinformation to support on the following:

• Stop smoking

• Eat a healthy varied diet

• Moderate your alcohol intake

• Achieve and maintain a healthy weight

• Keep physically active

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Change4lifeTips, information, and advice for a healthy lifestyle.! www.nhs.uk/change4life

Active Milton Keynes Exercise Referral SchemeExercise programme for adults in Milton Keynes" TELEPHONE 01908 254 241# [email protected]

Health and Lifestlye Opportunities (HALO)Weight management group for adults in Milton Keynes" TELEPHONE 01908 243 126

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Smokefree Milton KeynesStop Smoking Service for residents of Milton Keynes! TELEPHONE 0845 200 23 23" www.smokefreemk.org

CRi: Milton Keynes Alcohol Support ServiceDrug and alcohol recovery service in Milton Keynes! TELEPHONE 01908 250 730

Reactivate Milton KeynesA variety of local physical activity opportunities for adults in Milton Keynes" www.milton-keynes.gov.uk/sportsdevelopment

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Health Services In The Community

If a community service is required, speak to a healthor social care professionalwith whom you have mostcontact, for example your GP.

General PractitionersOn discharge from hospitalyou will receive a copy ofyour discharge summary.Contact your GP in the first week after you have left the hospital to arrangean appointment.

Reablement at Home TeamThe Reablement at HomeTeam provides a short-termservice for clients who requirehelp washing and dressing,this can be for as little as oneday up to a maximum of sixweeks. The service aims tosupport clients to becomeas independent as possible.Care focuses on encouragingclients to do as much forthemselves as possible,

Not all community services are appropriate foreveryone.Your needs will be assessed in hospitalby the members of the team and referrals will bemade by each member as appropriate.

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working at all times towardsyour jointly agreed rehabilitation goals and objectives.

Reablement at Home isonly accessible by healthor social care professionals.All referrals are madethrough the Single Point ofAccess. A trained operatorwill take the referral.

Early Stroke RehabilitationTeam (ESRT)The Milton Keynes EarlyStroke Rehabilitation Team(ESRT) provides up to sixweeks therapy and rehabilitation to stroke patients in their homes, or as close to home as possible, by coordinatingan early and safe dischargefrom the Hyper Acute orAcute Stroke Unit.

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Stroke Clinical Specialist Aims to provide in-depthknowledge and expertise;consistent education, support and advice in accessing information anda full range of servicesfrom the NHS, social care and others. This service is available to people whohave had a stroke or TIA,their relatives and carers,members of the generalpublic, professionals andvoluntary organisations.

Social Worker and Social Work Assistant These members of theteam work in partnershipwith family members andhealth, social and localcommunity organisations.Their aim is to improveservices for people whohave had a stroke, by encouraging them to participate in communitylife and return to work,where appropriate.

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Specialist ServicesThe impact of a stroke can be quite significant,not only on the person, but also on family,friends and carers. It can often feel like atime of abandonment, when it is hard to access help, advice and support.

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Neuro-RehabilitationServicesNeuro-Rehabilitation Unit is amulti-disciplinary team whichaims to support people toachieve their goals in theirhome, social, work andcommunity lives. It helps toassist people and families tounderstand, adjust to andmanage their disability.

Outpatient PhysiotherapyHeld at Milton Keynes Hospital, your GP will be

required to refer you on tothis service.

Speech And LanguageTherapy TeamYou may require continuedsupport for your communication and/orswallowing when you leavehospital. The Speech andLanguage Therapist (SLT)will liaise with your ward staffand Community SLT servicesto arrange appropriate follow-up.

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Outpatient Services

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District Nursing Service If you are housebound andhave a nursing need, then adistrict nurse will visit you athome to carry out woundcare, medication managementand continence issues. Thiswill be discussed with youand arranged as necessary,otherwise speak to your GP.

Continence Service Problems with bladderand/or bowel control arevery common after a stroke.Though this can be extremelydistressing, many of theseproblems will resolve overtime. Bladder/bowel controlcan often be regained, but ifnot, the problems associatedwith this can be managedeffectively.This will initially be

addressed by nursing staffor your rehabilitation team.Depending on the outcome,a referral may be made toa local continence advisoror specialist, such as aurologist, gastroenterologist,gynaecologist or geriatrician.

Podiatry/ChiropodyService Podiatrists specialise in theassessment, diagnosis,treatment and managementof a broad range of footproblems and pathologies. If you have a medical needfor chiropody/podiatry youwill probably be referred toan NHS chiropodist by ahealth professional. Alternatively, you can referyourself to this service.

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Other Services

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However, if your chiropodyneeds are mainly cosmeticyou might not be acceptedby the service, and it wouldbe quicker perhaps to contacta private chiropodist fromthe Yellow Pages or contactAge UK. If doing so it is advisable to make sure thatthe chiropodist you engageis state registered.

Community Occupational Therapy This unit provides an assessment of service usersin their own homes, supplyingequipment and adaptationsas appropriate, to enablemore independent living(and/or assisting of carers).

If you are having difficultieswith day to day activities forexample dressing, movingaround your home orcooking, then a CommunityOccupational Therapist

may be able to assess yourneeds and give advice orsuggest appropriate adaptations and equipment.

Have Your Say If you would like to raise acomplaint, compliment, comment or concernabout health services provided by Milton KeynesCommunity Health Services(MKCHS), we would like tohear from you.

What do you think aboutour services? Have membersof staff been helpful orhave things not gone well?Your experiences help usto continue to make improvements to our services.

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How do I give feedback to MKCHS?

! TELEPHONE01908 243 568

" E-MAIL [email protected]

# POSTMKCHSStanding Way Eaglestone Milton Keynes MK6 5NG

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Adult Social Care Access Team (ASCAT) This Milton Keynes Councilservice assesses need, andcan organise a wide range of social care services for people aged 18 and overwho are disabled, frail, havea sensory impairment ormental illness, to enablethem to live as independentlyas possible.

Support can also be provided for those whocare for others.

They provide help in many different ways, which includes: • Personal Budget to

purchase care/services • Care at home • Day care • Extra Care Support• Respite care • Residential care • Meal delivery services • Equipment and

adaptations

When contacting ASCAT a Customer Liaison Officer(CLO) will gather informationand, if appropriate,arrangements will be madefor a social worker to meetwith an individual to completean assessment of theirneeds. This also involves

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Receiving a personalbudget is the council’s

preferred option of providing care.

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Social Care Services

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establishing whether theirneeds meet MK Council’s eligibility criteria, formalising a care plan (if eligibility criteriais met) and discussing finances to assess whetheran individual will be requiredto pay towards the cost ofthe services. Receiving a

personal budget is thecouncil’s preferred option of providing care.

What this means can be discussed with the CustomerLiaison Officer, or at the social worker’s visit.

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Social SupportMilton Keynes Centre for Integrated Living (MK CIL) The Milton Keynes Centre for Integrated Living MK CIL) can provide the following services: • A wide range of information

on local and national support groups, benefits,equipment, transportand mobility, statutory andvoluntary organisations,leisure, holidays and care.

• Equipment display areas • Help with first time

applications for disability-related benefits (e.g.Disability Living Allowance{DLA} and AttendanceAllowance {AA})

• RADAR keys for accessible public toilets

• Application forms forDisabled ParkingBadges (Blue Badges)

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Age UK Milton Keynes Works with and for localolder people to make a real and positive differenceto their well-being andquality of life. In particular,they run a home sitting service for carers and provide home visiting andbefriending, shopping andlight housework, adviceand information.

Carer Support Carers MK staff can assistby providing information,advice, and help to securethe services you may need. They will also provideemotional support and alistening ear, give advice on how to protect health,offer training to help carersin their role, provide accessto therapy sessions andlinks to other family carersand support groups.

Carers should be living in, or caring for someone living in, the Borough ofMilton Keynes.

Different Strokes Milton Keynes A national charity who offerssupport and advice for strokesurvivors of working age tooptimise their recovery, tak-ing control of their own livesand to regain as much independence as possible.

The group meet everyTuesday for most of the year2pm – 4pm at ShenleyLeisure Centre. The exerciseand support class is designedto encourage mobility, confidence, fitness and self-esteem and also tomeet other young survivorsin similar situations.

Partners and families, whohave also had to survive

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the stroke trauma are welcome to obtain help, advice and mutual supportand join in the exerciseclass.Volunteers are also welcome.

Stroke Activity ProgrammeProviding stroke specificsupport in the communityfor patients after their rehabilitation. Runs on aTuesday afternoon atBlackberry gym with qualifiedARNI instructors (Action forRehabilitation for NeurologicalInjury). The programme encompasses: • Task-related functional

movement training• Physical coping strategies• Stroke-specific

resistance training• Increasing flexibility and

stamina• Increasing self-esteem

Please talk to your healthcare professional to be referred to the programme.

Monday ClubFor anyone who has recentlyhad a stroke, their partner or family member. It is thechance to meet with peoplein a similar position and havea chat.

Time: The group usuallymeets on the secondMonday in the month, 2pm – 4pm at the Peartree Centre. There is no need to book, just turn up for afriendly welcome.

Talkback Club Welcomes people who haveaphasia due to stroke. Theaim is to help members toincrease their confidenceand communication skills ina relaxed atmosphere.

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Activities for all abilities areorganised as well asocca-sional wheelchair friendlyoutings and lunches.

Meeting: Friday 9.30am to 12 noon at the PeartreeCentre.

Milton Keynes Council –Passport to Leisure The Passport to LeisureScheme provides discountedaccess for residents of

Milton Keynes to a variety of leisure facilities in the area.You will qualify for thisscheme if you are a residentof Milton Keynes and are in receipt of the appropriate criteria and relevant benefits.For a full list of the eligiblecriteria and for an applicationform visit your local counciloffice, local library or housingoffice, alternatively you canaccess this electronically viathe MK council web-site.

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Citizen Advice Bureau(CAB) Offers free, independentand confidential advice onany subject including welfarebenefits, face-to-face, byletter, fax, email and phone.They also offer a benefitcheck to clients in order to maximize income.

They prepare appealcases, represent at tribunallevel and have their ownspecialists in welfare benefits and tax credits.

You can get free and independent advice on allstate benefits from WelfareRights. You can get adviceon what you can claim, howto claim, writing letters andcompleting forms. A WelfareRights Adviser can evenrepresent you at an AppealsTribunal if you need it.

Help with NHS costs A booklet called “Are youentitled to help with NHScosts?” is available fromthe MK Centre of integratedLiving (CIL), any Job CentrePlus office, pharmacy, doctor’s surgery or thePost Office. Ask for bookletHC11 to see if you are eligible for any help withhealth costs.

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The Citizen Advice Bureau offers a benefit

check to clients in orderto maximize income.

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Financial Support

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Travelling

You must not drive after a stroke until you have had confirmation/advicefrom your consultant and informed the DVLA atSwansea and your insurance company.

The Driver and Vehicle Licensing Agency (DVLA) will often contact your consultant before they determine whether or notyou are fit to drive. TheDVLA alone have the right to grant or revoke licences. It is the patient or their representative’s responsibilityto notify the DVLA and theinsurance company aboutthe stroke. Failure to do so

is an offence and the consequence of inactionmay be that the insurance is invalidated.

The Blue Badge is administered by MiltonKeynes Council. For furtherinformation and/or an application form contact Milton Keynes Council or the Milton Keynes Centre for Integrated Living (MK CIL).

Concessionary bus fares are available for disabled residents living in the MiltonKeynes area. In order toqualify, disabled people needto get their application formssigned by their GP. These

DRIVING AND TRANSPORT

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forms are available from theCivic Offices in Central Milton Keynes.

The Royal Association forDisability and Rehabilitation(RADAR) is a national organisation of and for disabled people. The NationalKey Scheme offers independent access for

disabled people to lockedpublic toilets around thecountry. A RADAR key canbe purchased from MK CIL(Centre for Integrated Living).

You will have to providesome proof that you are aBlue Badge holder or paperwork to show thatyou have a disability.

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Holidays are an importantpart of life, but after a stroke itcan be more difficult to findsomewhere suitable. Thereare a variety of useful organisations that can helppeople with disabilities toarrange a holiday, includingbreaks in the UK and abroad,holidays with assistance, andrespite breaks. People oftenask whether it is safe to flyafter a stroke or whether thereare any special precautionsthey should take. There don’tseem to be any reasons whypeople who have had a strokeshouldn’t fly, but it is alwaysadvisable to speak to yourown doctor about this, asstrokes can happen for different reasons.

The Stroke Association Insurance Services, run by

Heath Lambert, has createdtravel insurance that catersfor stroke survivors and fortheir families and friendstravelling with them.Some ofthe benefits include:

• All pre-existing medicalconditions are covered

• No upper age limits onour single trip policies

• Annual multi-trip policieswithin the EU are availableup to age 69 (worldwidepolicies up to age 64)

• Purchasing your cover isquick and easy and noseparate calls to medicalscreening companies are required

• Cover is available withinthe UK, Europe andworldwide.

HOLIDAYS & TRAVEL INSURANCE

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Useful ContactsAcute Stoke UnitMilton Keynes Hospital, Standing Way, Eaglestone, Milton Keynes MK6 5LD! TELEPHONE 01908 243 202

Early Stroke Rehabilitation Team (ESRT)Bletchley Community Hospital, Whalley Drive, Bletchley, Milton Keynes MK3 6EN! TELEPHONE 01908 363 074

Stroke Clinical Specialist TeamBletchley Community Hospital, Whalley Drive, Bletchley, Milton Keynes MK3 6EN! TELEPHONE 01908 650 424 " EMAIL [email protected]

Outpatient PhysiotherapyMilton Keynes Hospital, Standing Way, Eaglestone, Milton Keynes MK6 5LD! TELEPHONE 01908 243 031

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Milton Keynes Neuro-Rehabilitation Services Bletchley Community Hospital, Whalley Drive, Bletchley, Milton Keynes MK3 6EN! TELEPHONE 01908 379 440

Speech and Language Therapy TeamMilton Keynes Hospital, Standing Way, Eaglestone, Milton Keynes MK6 5LD! TELEPHONE 01908 243 095

Continence ServiceBletchley Community Hospital, Whalley Drive, Bletchley, Milton Keynes MK3 6EN! TELEPHONE 01908 650 401

The Complaints and Patient Advice and Liason ServiceTeam (PALS)Milton Keynes PCT HQ, Hospital Campus, Standing Way Milton Keynes MK6 5NG ! TELEPHONE 01908 243 633 or 01908 243 181 " EMAIL [email protected] or [email protected]

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The Complaints ManagerMKCHS, Standing Way, Eaglestone, Milton KeynesMK6 5NG! TELEPHONE 01908 243 568 " EMAIL [email protected]

Podiatry & Chiropody ServiceBletchley Community Hospital,Whalley Drive, Bletchley Milton Keynes MK3 6EN! TELEPHONE 01908 363 066

Community Occupational TherapyBletchley Community Hospital,Whalley Drive, Bletchley, Milton Keynes MK3 6EN! TELEPHONE 01908 253 772

Adult Social Care Access Team (ASCAT)Civic Offices, 1 Saxon Gate East, Milton Keynes MK9 3EJ ! TELEPHONE 01908 253 772 " EMAIL [email protected]

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Milton Keynes Centre for Integrated Living (MK CIL)330 Saxon Gate West, Milton Keynes MK9 2ES! TELEPHONE 01908 231 344 " EMAIL [email protected]

Age UK Milton KeynesThe Peartree Centre, 1 Chadds Lane, Peartree Bridge, Milton Keynes MK6 3EB! TELEPHONE 01908 550 700" EMAIL www.ageconcernmk.org.uk

Carer SupportAcorn House, 375 Midsummer Boulevard, Milton Keynes MK9 3HP! TELEPHONE 01908 231 703" EMAIL [email protected]

Stroke Association240 City Road, London EC1V 2PR! TELEPHONE 0303 3033 100 " EMAIL [email protected]

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Different Strokes 9 Canon Harnett Court, Wolverton Mill, Milton Keynes, MK12 5NF! TELEPHONE 0845 130 71 72 " EMAIL [email protected]# WEB www.differentstrokes.co.uk

Different Strokes Milton Keynes9 Rossini Place, Old Farm Park, Milton Keynes MK7 8EZ! TELEPHONE 01908 969 877 " EMAIL [email protected]# WEB www.differentstrokes.co.uk

Citizen Advice Bureau (CAB)Acorn House, 375 Midsummer Boulevard, Milton Keynes MK9 3HP! TELEPHONE 01908 604 475 # WEB www.mkweb.co.uk/citizens_advice

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Independent Benefits Advice Welfare Rights GroupAcorn House, 373 Midsummer Boulevard, Milton Keynes MK9 3HP! TELEPHONE 01908 200 900" WEB [email protected]

DVLADrivers Medical Group, Swansea SA99 1TU! TELEPHONE 0300 790 68 06 " WEB www.dft.gov.uk/dvla

Blue Badge & Disable Parking SchemeMilton Keynes Council, Civic Offices, 1 Saxon Gate East, Milton Keynes MK9 3EJ! TELEPHONE 01908 253449

Stroke Association Insurance Service (Heath Lambert)! TELEPHONE 01603 828 396 # EMAIL [email protected]" WEB www.stroke.org.uk/shop/insurance_and _

finance/ insurance_services/travel_insurance.html

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Useful Websites & LinksNHS Choiceswww.nhs.uk/conditions/stroke

Stroke Associationwww.stroke.org.uk

Different Strokeswww.differentstrokes.co.uk

Headwaywww.headway.org.uk/stroke

Age UKwww.ageuk.org.uk

Crossroads Carewww.crossroads.org.uk

Connectwww.ukconnect.org

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My Information Date of my stroke

Date I was admitted into hospital

Name of my consultant

Name of Acute Stroke Unit Nurse

Date I was discharged from hospital

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My Diary Notes

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Questions To Ask

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THROMBOLYSISAlteplaseYou may also hear the term, thrombolysis or clot buster.Alteplase is a medicine routinely used after heart attacks. Ithas also been proven effective in acute stroke if treatment isstarted within four and half hours of the onset of symptoms.Only a small number of patients will be suitable to receive alteplase and locally it is given in the Hyper Acute Stroke Unit at Luton and Dunstable Hospital.

ANTI PLATELETES/BLOOD THINNERS These reduce the stickiness of blood.

AsprinThis may be given following a stroke if there is no bleed.

MedicationsThe following medicines are commonly given to stroke patients:

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If you have problemswith your medicationdon’t just stop taking

them, talk to your GPor pharmacist first.

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Dipyridamole Or ClopidogrelThis is sometimes given with aspirin to make blood less sticky.

ANTI COAGULANTSThese prevent harmful blood clots from forming and are usedwhen someone has atrial fibrillation (an irregular heart beat).

Warfarin Or Alternative Anticoagulant This may be given to people who have an irregular heartbeat(atrial fibrillation), mitral valve replacements and other cardiacconditions. Your blood (INR) will need to be checked regularlyif on Warfarin but not if you are taking any other anticoagulants.

STATINSCholesterol Lowering DrugsStatins are commonly used to lower cholesterol. Most patientsare given a statin to lower their cholesterol to 3.5 or less andused for secondary prevention.

Blood Pressure TreatmentsVarious drugs are used to treat blood pressure, for exampleDiuretics (water tablets), Beta-blockers, Calcium ChannelBlockers, ACE inhibitors, Angiotensin II Receptor Antagonistsand Alpha Blockers. They all work in different ways. You maybe prescribed more than one type and you should only stopthem under medical advice.

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MY MEDICATIONS LIST AND DOSAGE

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Names To Remember

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Letters To Keep SafeYou can hole punch any letters or documentsyou receive including information from the hospital, appointments and reminders.

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M14210

This guide was produced in collaboration with:

• Milton Keynes Council

• Milton Keynes Clinical Commissioning Group

• Milton Keynes Hospital NHS Foundation Trust

• Central and North West London NHS Foundation Trust - Milton Keynes Community Health Services

Available in audio, large print,braille and other languages

01908 252542

Milton Keynes CouncilPublic HealthCivic Offices1 Saxon Gate EastCentral Milton KeynesMK9 3HN

T 01908 254 213E public.health@milton–keynes.gov.uk