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Showing posts with label Medical. Show all posts
Showing posts with label Medical. Show all posts

Tuesday 26 September 2023

The financial impact of having a stroke

 

One way to alleviate some of the costs incurred after a stroke is to review your health insurance to ensure you are getting all the benefits you are entitled to. — Freepik

A big financial impact

The aftermath of a strokr can be expensive with medicines, assistive devices, home modifications, and caregiver costs, coupled with potential loss of income. 


The financial impact of a stroke can be overwhelming and unpredictable.

The lifetime cost of ischaemic strokes – which comprise over 80% of strokes and are caused by blockage of blood vessels supplying part of the brain – were estimated at US$140,481 (RM659,698).

This includes the cost of inpatient care, rehabilitation and follow-up care.

A study that looked at the cost of post-stroke outpatient care in Malaysia in 2015, found that the average total cost incurred was US$547.10 (RM2,569.18).

Of this figure, 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses.

The main factor in the cost of post-stroke outpatient care was the severity of the stroke.

Increased costs was also associated with a haemorrhagic stroke – the other main type of stroke, which is caused by the bleeding, or haemorrhage, of a blood vessel in the brain.

Leading a safe and cost-effective life post-stroke requires a combination of self-care, medical management and lifestyle adjustments.

Here are some steps that can help:

> Follow medical advice

It’s important to follow your healthcare provider’s advice on medication, rehabilitation and lifestyle modifications.

This may include taking medication as prescribed, attending rehabilitation sessions, and making changes to your diet and exercise routine.

> Manage chronic health conditions

If you have other chronic health conditions such as high blood pressure or diabetes, it’s important to manage these conditions to reduce the risk of future strokes and other health complications.

> Make home modifications

Consider making modifications to your home to reduce the risk of falls and improve your safety.

This may include installing grab bars, non-slip mats and handrails.

> Use assistive devices 

Assistive devices such as canes, walkers and wheelchairs, can help you maintain your mobility and independence.

> Adopt healthy habits

Adopting healthy habits such as eating a balanced diet, exercising regularly and getting enough sleep, can help you maintain your overall health and reduce the risk of future strokes.

> Stay socially active

Staying socially active and engaged can help reduce the risk of depression and improve your overall quality of life.

Consider joining a social group or doing volunteer work.

> Manage finances

Stroke can have a significant financial impact on the family, especially if the stroke patient is the sole breadwinner.

So it’s important to manage your finances carefully.

By following these steps and working closely with your healthcare team, you can lead a safe and cost-effective life post-stroke.

Managing the financial impact


As mentioned above, no doubt, one of the biggest challenges post-stroke would be the financial impact on the patient and their dependents.

Financial burdens following a stroke may be due to medical expenses and decreased income because of the inability to work, whether it is the patient themself or a family member who has to quit their job to become a full-time caregiver to the patient.

Addressing financial needs post-stroke can be challenging, but here are some strategies that can help:

> Review your insurance coverage

Examine your insurance coverage to make sure it includes all the necessary benefits and services, such as rehabilitation and home healthcare.

Consider speaking with an insurance specialist to ensure you are getting the most out of your coverage.

> Explore disability benefits

If you are unable to work because of stroke, you may be eligible for disability benefits.

Socso provides a range of benefits for employees, including medical treatment, rehabilitation and financial assistance.

There are also many NGOs (non-governmental organisations) that offer financial assistance to stroke patients and their families, including the National Stroke Association of Malaysia (Nasam), Stroke Care Malaysia, etc.

These organisations can help with medical bills, transportation costs and other expenses related to stroke care.

> Create a budget

You and your dependents should review your daily expenses and financial commitments to see what can be adjusted to compensate for the decrease in income and increase in stroke-related expenses.

A leaner budget might have to be created for the family to follow, to ensure that you don’t go into unsustainable debt, or even bankruptcy.

What’s good for yourself

It is also important, though challenging, to develop a sense of what is good for oneself after a stroke.

Here are some methods that can help:

> Listen to your body

Pay attention to your body and how it responds to different activities and situations.

Take note of what makes you feel better or worse. and adjust your routine accordingly.

> Set realistic goals

Set achievable goals that are tailored to your abilities and interests.

This can help you build confidence and a sense of accomplishment, which can improve your overall well-being.

> Prioritise self-care

Make self-care a priority, including getting enough rest, eating a healthy diet, and engaging in physical activity, as recommended by your healthcare providers.

> Seek support

Connect with others who have experienced stroke or other health challenges.

Consider joining a support group or seeking individual therapy to help you process your emotions and develop coping skills.

> Practice mindfulness

Mindfulness practices such as meditation, yoga or deep breathing, can help you become more aware of your thoughts and feelings, and develop a greater sense of inner calm and well-being.

> Experiment and adjust

Be willing to experiment with different approaches to self-care and self-discovery, and be open to adjusting your routine as needed.

By focusing on self-care, seeking support, and staying open to new experiences and perspectives, stroke patients can develop a greater sense of what is good for themselves and their overall well-being.

In a nutshell, it is not impossible for a person to regain a normal life after a stroke.

The real challenge lies in how stroke survivors can manage their post-stroke life and deal with the challenges from then on effectively.

Remember, there will always be light at the end of the tunnel for stroke survivors!

Dr Lee Tze Yan is a senior lecturer in molecular medicine at Perdana University. Matthew Teo Yong Chang is an occupational therapist specialising in stroke rehabilitation and senior lecturer at Manipal University College Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.


Tuesday 27 June 2023

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Sunday 25 January 2015

Living life to the fullest

Chan, an avid mountaineer and myelofibrosis patient, with a photo of himself (in red jacket) and fellow climbers at the summit of Mount Kinabalu. Photo: UU BAN/The Star >>

Despite having a rare blood disorder, Tan Sri Chan Choong Tak not only continued his active lifestyle , but also took up mountain-climbing.

FORMER Dewan Negara president Tan Sri Chan Choong Tak’s motto in life is to live it to the fullest.

Not surprising then that among his many accomplishments are two Malaysian Book of Records titles as the oldest Malaysian to reach the top of Mount Kilimanjaro’s Uhuru Peak (on Aug 31, 2003, at the age of 70) and the oldest Malaysian to reach the top of Mount Kinabalu’s King George Peak (on Aug 29, 2004, at the age of 71).

Uhuru Peak is the highest point on Mount Kilimanjaro, which is the tallest freestanding mountain in the world (from sea level) and the tallest mountain in Africa, while King George Peak is located on the more challenging and lessclimbed Eastern Plateau of Mount Kinabalu, Sabah.

What makes these two records more significant – aside from the impressive fact that Chan only took up mountain-climbing in his sixties – is that he was suffering from a rare bone marrow disorder at the same time.

His condition, primary myelofibrosis, is one of a group of diseases called myeloproliferative neoplasms, which are caused by abnormal production of blood cells in the bone marrow.

In the case of myelofibrosis, the problem lies in the abnormally-increased production of megakaryocytes, which are the cells that directly give rise to platelets. This results in an initial increased number of platelets in the body.

Cytokines – protein growth factors that are produced by megakaryocytes – are also correspondingly increased.

And as these cytokines are what stimulate the bone marrow’s fibroblasts to produce collagen, this results in an excessive amount of collagen being made.

The collagen deposits in the bone marrow as webs of fibre – similar to scar tissue on the skin – resulting in the disease’s characteristic fibrosis of the bone marrow.

With the collagen taking up so much space in the bone marrow, regular blood cell production is disrupted.

Red blood cells (RBCs) are usually decreased in number and abnormally formed, resulting in anaemia, while white blood cells (WBCs) are abnormal and immature, resulting in increased infection rates.

With production of blood cells in the bone marrow disrupted, the spleen, which is the body’s secondary supplier of blood cells, steps up to meet the body’s needs.

This extra work usually causes the spleen to enlarge (splenomegaly), resulting in pain or a feeling of fullness below the left rib.

Occurring commonly in those above 50 years of age, myelofibrosis is caused by a spontaneous genetic mutation (i.e. not inherited) in the affected person’s blood stem cells. This is what causes the uncontrolled production of megakaryocytes.

The cause of the mutation itself in primary myelofibrosis is, as yet, unknown.

Accidental discovery

As the symptoms of myelofibrosis, like fatigue, shortness of breath, pallor, frequent infections and easy bruising, are quite vague, diagnosis can be quite difficult.

In Chan’s case, he did not notice any signs or symptoms of myelofibrosis prior to his diagnosis.

In fact, it was a combination of a road accident and his wife, Puan Sri Cecelia Chia’s sharp eyes that alerted them to the possibility of a problem.

He shares: “My son gave me a racing bike for my 60th birthday – that was 21 years ago. So, I used to cycle around. Then, I met with a road accident.”

Chan was cycling along the narrow, winding roads of his hillside residential area in Seremban, Negeri Sembilan, when he suddenly met an oncoming car.

With no space to avoid the car, he braked hard and was thrown to the ground in a head-first fall.

“My helmet broke and I thought I would be paralysed. My friend, who is a doctor, straightaway rang up the hospital and they sent the ambulance,” he says.

Fortunately, Chan suffered no major injuries from the accident.

However, his cardiologist son insisted that he be checked more thoroughly for brain injuries, which resulted in him seeing a neurologist.

While his brain turned out to be fine, his wife noticed that his platelet count from the blood test were quite high – between 600,000 to 700,000 platelets per cubic millimetre, when the upper limit for normal is 400,000.

His son then sent him to consultant haematologist Dr Ng Soo Chin, who prescribed hydroxyurea to bring down his platelet count.

That seemed to work quite well for Chan, and it was, in fact, shortly after this that he began mountain-climbing with a group of fellow MBA (Masters of Business Administration) alumni from Tenaga Nasional Bhd.

Chan was then a director of the company, and had gone to Ohio University, United States, to study his MBA along with other Tenaga Nasional executives.

“So, as I climbed, I continued to take hydroxyurea and everything was normal.

“But Soo Chin said, hydroxyurea will eventually bring down your red corpuscles (another term for RBCs), and recommended anagrelide,” he says. Anagrelide is a platelet-reducing agent.

Accelerating disease

Chan continued happily with the two medications, until the year 2011, 18 years after his initial diagnosis.

By then, he was seeing consultant haematologist Datuk Dr Chang Kian Meng at Hospital Ampang, Selangor, as Dr Ng had advised him to continue his follow-ups at a public hospital as his medications are quite expensive.

Chan shares that Dr Chang started him on epoetin alfa and pegylated interferon that year as his blood cell levels were fluctuating.

While interferon decreases the production of blood cells in general, epoetin alfa stimulates the production of RBCs to counteract the effects of anaemia.

However, his haemoglobin levels dropped even further, and he started requiring blood transfusions about once every two months.

The transfusions made a big difference as he reports feeling “very energetic” after receiving the first one. (Fatigue is a common symptom of anaemia.)

The following year, it was the WBCs turn to go “completely haywire”, when a blood test revealed that they had dramatically increased to about 56 from the regular range of about 4 to 10.

He also started experiencing profuse night sweats and cramps, along with the occasional itchiness that had started in his seventies – all of which are among the symptoms of myelofibrosis.

“Then, both Dr Chang and Soo Chin agreed that I had entered into myelofibrosis in acceleration,” he says.

The only cure for myelofibrosis is a bone marrow transplant, but aside from the difficulty of finding a suitable donor and the riskiness of the procedure, Chan’s age rendered him unsuitable for such a treatment.

Fortunately for him, a new drug had recently been approved by both the European Commission and the United States Food and Drug Administration for use in myelofibrosis at that time.

A new drug

The drug, ruxolitinib, inhibits certain enzymes in the JAK pathway, which regulates blood cell production. Half of primary myelofibrosis cases are caused by mutations in the JAK genes, which results in the dysfunctional production of blood cells in the bone marrow.

However, the drug was not available in Malaysia then. (It was only launched in the Malaysian market in 2013.)

This is where his political connections as a Gerakan life member and former secretary-general came in useful.

Then Minister in the Prime Minister’s Department and Gerakan president Tan Sri Dr Koh Tsu Koon offered to help pass on the letter Chan had written to the Health Ministry requesting approval to use the drug on compassionate grounds, to the Health secretary-general.

Four days later, Chan received the approval he needed, and received his first dose of ruxolitinib in October 2012.

Since then, after some adjustments in dosage, Chan’s blood cells are back in the normal range and his last transfusion was in December 2013.

He is currently doing well enough for his doctor to lower his dosage of ruxolitinib, while still taking epoetin alfa and interferon.

Life goes on as normal for this active 81-year-old, who still climbs hills, reads newspapers of various languages and blogs daily, works out in the gym and does regular morning calisthenics.

Of his condition, Chan shares that he never felt the need to know about the disease, being only interested in his blood test results.

“I didn’t know what myelofibrosis was all about until I was asked to do this interview. That was the first time I went into Google to see what was myelofibrosis,” he says with a laugh.

“But I knew it was a dangerous disease, but I wasn’t bothered. I continued to carry on with my normal life.”

He adds: “I’m not bothered with what happens because I have full trust in my doctors.

By Tan shiow China The Star/ANN

 Related:

101 Ways To Live Your Life To The Fullest personalexcellence.co/blog/101-ways-to-live-your-life-to-the-fullest/  - If your answer to any of the above is a no, maybe or not sure, that means you're not living your life to the fullest.

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