Everybody thinks that wealthier patients will get better outcomes than poor patients because they can afford more and better care and treatments. But this is not always true. From my many years mediacl experince the post-stroke recovery are sometimes worse and slower in patients who are more wealthy. Paradoxically, the poorer patients can have better results. There was a 65 year old woman patient who is independently wealthy. Her family are also wealthy. After her stroke, her children were very concerned about her and employed two caretakers to help them care for her around the clock. Everyday her every need is met. Someone is always there to spoon feed her, help her with the bedpans. After a year of this, she wasn’t able to stand or walk, and soon died of complicated syndrome of pneumonia. There was another sixty years old woman stroke patient who was poor. She didn’t have many people to cater to her needs. Whenever she regained any abilities, she needed to use them to help herself. Before the end of a year she could use cane to go shopping herself. She lived to her eighties.
Why is this? Le’ts first understand what’s happening in a stroke. Stroke occurs when blood vessels gets blocked by blood clots. Without the blood flowing to deliver nutrients, the brain cells networks necessary for regulating major functions such as movements die off. The reason some people recover from stroke is that activity can stimulate other brain cells to sprout new connections and replace the old network. It’s because the poor patient had to be more active. With more activities, more collateral circulation develop her breain and more new neural pathways grow to help her regain her function. At the same time, her body got more exercise from the activity. Let’s think about this: if you tie up a healthy person on a bed for a month, would he have trouble walking afterward? Wouldn’t he require a period of exercise to regain his abilities? Therefore, one day of early activity would result in one day of early benefit.
I also encountered some stroke patients who were too afraid of pain, fatigue of the recovery effort. Sometimes they cry and yell. Their loved ones feel distressed by their suffering and gave up supporting the patient’s efforts to regain function. This is a huge mistake. The belief that in sickness the doctor is the ultimate authority on treating the condition is a bigger mistake. No matter how highly renowned, how sincere they are, the doctors can’t replace your legs, your arms to initiate activity and to stimulate self-healing system.