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Ask Kate: Let’s talk about sex!

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Sex after stroke

Dr Kate Allatt is a stroke survivor, internationally published author, charity founder, GripAble ambassador and inspirational leadership speaker.

As we enter so-called ‘Divorce Month’ Kate asks: Should occupational therapists be doing more to address sex and intimacy after stroke? 

Intimacy in relationships is a basic human need and one that is all too often non-existent for young people after their stroke.

Imagine a lifetime of intimacy abstinence because you’ve lost your body confidence or self-worth. What if your partner is sex obsessed but you feel put off or your partner just can’t make the step change from carer back to lover?

Just imagine how utterly sad, worthless, invisible and lonely this can be for so many stroke survivors and their partners who suffer silently in the community.

One husband even commented that it ‘feels like it’s like having sex with a dead body’ after his wife’s stroke.

Others worry that they want to go for a wee when they orgasm because they’ve developed undiagnosed coital incontinence.

Some service users report no change to their sex lives after stroke on my closed Facebook groups, though this is unusual.

So it raises the question: do many occupational therapists actually start conversations with stroke survivors and their partners about the tricky subject of intimacy and sex after stroke?

I can answer that – no.

Why? Because it’s embarrassing and talking sex is taboo for many therapists and service users.

There appears to be a lack of training on the subject for occupational therapists. Indeed, perhaps there are some ownership issues over which therapist on the MDT should even be talking about sex.

Yet sex is at the core of our very evolution. We know that intimacy and sex are good for our physical and mental wellbeing. Sexual health is an essential part of patient-centred holistic care.

Dr Kate Allatt

Service users often expect the therapist to start the conversation on intimacy and sex issues after stroke, yet, in many cases, therapists expect patients to talk about the intimacy difficulties.

Perhaps occupational therapists assume there are no intimacy and sexual issues if they are not mentioned? I’m sure there must be health inequalities with non-heterosexual communities after stroke.

So what else gets in the way?  Is it embarrassment? Time? Pre-conceived judgments? A lack of training?

Maybe it’s not just that therapists lack the training to start these difficult conversations with patients and it’s something more?

Perhaps they don’t have the motivation and lack the emotionally intelligent behaviours to start these difficult but vital conversations?

Occupational therapists need to be as comfortable talking about sex after stroke as they are discussing where to put grab rails in homes.

That’s why I’ve developed a sex after stroke training course aimed at occupational therapists to help service users to develop skills, confidence and knowledge about intimacy and sex after stroke.

Together, we patients and occupational therapists can develop training to help young stroke survivors maintain or develop loving, intimate relationships so they may be happy and flourish after stroke at home.

Please reach out with any comments and ideas on Twitter @kateallatt

Dr Kate Allatt

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KardiaMobile: Early AF detection in the patient’s pocket

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KardiaMobile by AliveCor is a pocked-sized ECG capable of detecting atrial fibrillation (AF) – a leading cause of stroke in the UK.

The NICE-backed technology can be prescribed to NHS patients for at-home AF monitoring.

Sean Warren is UK&I Business Director at AliveCor. We sat down with him to find out more about how KardiaMobile could help identify the half a million undiagnosed cases in the UK.

Why is early detection of AF so important?

Stroke is the single largest cause of complex disability in the UK. And if you have AF, you are five times more likely to have one.

If we can detect more atrial fibrillation, more patients can be protected. The new novel anticoagulants in particular have huge success rate in reducing stroke risk.

How are people accessing KardiaMobile?

The NICE recommendation guidance states that physicians can prescribe the technology. We also support ICSs and CCG level facilities from a primary and secondary care perspective.

KardiaMobile can be procured directly from ourselves and we’re listed on the NHS supply chain catalogue.

But we’re also looking to empower patients to self-manage. You don’t have to get this via a medical institution, you can purchase KardiaMobile yourself via Amazon or Shopify.

Where is KardiaMobile already being used within the NHS?

In community care, doctors, nurses and cardiac physicians are visiting patients’ homes and taking ECGs. Patients are going to GP practices and GPs, nurses and healthcare assistants are taking their ECGs.

But the particular area where we have received the NICE recommendation is in an ambulatory setting.

When a patient comes in with some form of symptom, the device is prescribed to them for a longer period of time.

They can take multiple ECGs anytime, anywhere, and then share them directly with their physician to confirm if there was an abnormality or everything is okay.

What challenges does this help to overcome?

If you’re told by a physician that you may have a problem, the only way to capture and diagnose that problem is to have a symptom correlating ECG. So you must be symptomatic at that period of time and have an ECG.

That causes huge conflict, because for the stars to align for that to happen, it’s very difficult.

Especially if you have paroxysmal atrial fibrillation, which means you may be in AF once a month. But you may not be showing those symptoms straight away.

Sean Warren

A patient is told to get an ECG the next time they are symptomatic. But what are your options in that scenario?

You can go to your GP surgery, you can go to an emergency department, or you call an ambulance or paramedic to come to you.

Which may not be practical at the best of times…

Well, if it’s 2am, and you wake up in the middle of the night with palpitations, the GP surgery isn’t open, your emergency department is 45 minutes away.

And in Covid times, you’re discouraged to travel when you don’t need to. And if you do go to A&E, you could be waiting for four hours.

An ambulance might take an hour to arrive, if you’re lucky. But by now, you’re no longer symptomatic. So your ECG comes back your paramedic says you’re absolutely normal.

Is this a common problem?

Over 80 per cent of arrythmia patients will arrive at the hospital or have an ECG, no longer experiencing symptoms or abnormalities they were feeling earlier.

So if certain arrhythmias can become symptomatic for one to three minutes and then subside, so then then what happens, so you still have this worry, you still have this concern, and that there’s potentially no option.

People reference often AF as the ticking time bomb. You need to identify the AF quickly because you’re fighting the race against stroke.

If a patient with KardiaMobile wakes up having palpitations, they boot up their phone, take an ECG and within 30 seconds, they have a medical-grade reading.

This captures that abnormality which can then be shared with a physician who can use that diagnostic quality ECG to confirm that there was an abnormality and intervene if needed. This intervention could protect that patient from having a life-changing stroke.

So the patient is taking control

An ambition for us as a company is to empower self-management. Right now, physicians do not have the time because they’re under so much pressure.

Instead of getting the patient to come into the hospital, putting yourself at risk and other people at risk, these devices can in theory go out in the post, a patient can completely self-manage.

They are told, okay, when you have an abnormality, let us know.

Patients quite like that as well. That’s the feedback that we have, because the device is so easy to use. Patients are happy then that they’re there.

There’s no situation that a patient is diagnosing their own health, but they’re putting themselves in a situation where they can detect an abnormality.

It’s as easy as a traffic lighting system to then confirm with a physician.

How are you looking to adapt the technology in the future?

A 12-lead ECG is the standard of care for detecting and diagnosing abnormalities across the whole area.

So ideally, the situation would be that you’d have one in your pocket. We’re working on similar things like that in the future.

There are multiple QT-prolonging drugs which cause significant problems, such as antihistamines, antibiotics and hydroxychloroquine.

Also things like antipsychotics and antidepressants. These patients need to be monitored so that drugs can be titrated correctly.

We’ve been recognised by the European Society of Cardiology, the American Heart Association and the Mayo Clinic in the US and where our technology can be utilised to support those patient cohorts.

Anything else you would like to add?

We often hear that the first time a doctor learns about this technology is through a patient. And patients are new key opinion leaders.

What they’re doing and saying is so important because they have a life that we’re trying to change.

If we can educate the public to then educate physicians and vice versa, that can be very impactful.

We’re basically here to ask the question: Could a patchless, painless wireless technology offer a better solution?

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Stride for Stroke: Paul’s story

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Paul Howard Stride for Stroke

IT manager Paul Howard was living a pretty sedentary and unhealthy lifestyle at 42. But the thought of having a stroke never crossed his mind.

“Probably in the back of my head I thought it was possible. But it was not the sort of thing I thought about,” he tells Stroke Rehab Times.

“I knew I was unhealthy. I used to drink and smoke too much and didn’t exercise enough.

“But when I went into casualty, I thought worst case scenario was that it could be some sort of heart condition.”

Paul had been feeling ill over the preceding five or six months. He was continuously lethargic and out of breath, devoid of energy yet unable to sleep.

“I had massively high blood pressure, which was causing all my organs to fail. I had congestive heart failure, kidney failure, water on the lungs, water on the brain.

“I finally went into casualty in January 2015 because I was feeling pretty terrible.”

Paul spend three-and-a-half weeks in hospital, suffering multiple strokes over the first fortnight. He has no memory of his time there, bar some fractured hallucinations and blurry encounters with doctors.

“I spoke to one neurologist who gave me competency tests which I failed miserably. I think that’s the only time I spoke to a neurologist.

“I had one outpatient appointment about six months later, where they just checked me over for five minutes and looked in my eyes, and that was it. That’s the last I spoke to them.”

Paul lost 95 per cent of his eyesight during episode, though doctors can’t say for certain how much of that was physical damage to the eye and how much was neurological damage from the stroke itself.

Nonetheless, he remains hugely grateful to be ’99 per cent’ the person he was before.

Understandably, the experience pushed Paul to rethink his lifestyle and take on some healthy habits.

“Before Covid, I was walking five to 10 kilometres a day throughout the week plus weekends, if I was out and about doing things. But that was mainly just trying to make myself more active which obviously helps with the blood pressure.

“I stopped habits that weren’t conducive to a healthy body. So I just cut my drinking down, stopped eating so much rubbish and exercised more.”

After having isolated for close to two years, Paul jumped at the chance to get back out there and take on the Stroke Association’s Stride for Stroke challenge.

He aims to walk 1.3 million steps over the next 130 days – that’s 10,000 per day.

“Now things are calming down a little bit and I’ve had the three vaccines, I’ve decided it’s time to start getting back to doing a generous amount of walking every day.

“It’s been interesting trying to fit in a good hour or so of solid, continuous walking each day. It’s nice to get out the house and reacquaint myself with exercise again.”

As for what advice Paul would give to young people living the lifestyle he was?

“Don’t get old and don’t be unfit! (Laughs).

“Don’t be sedentary. Get out there and do some kind of exercise. It doesn’t have to be a lot. Just do something so you’re not just sitting around all the time.”

You can support Paul’s 1.3 million steps Stride for Stroke via his JustGiving page.

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Robocath: Precision robotics for better outcomes

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Robocath carotid stenting

Robocath has been developing robotic treatment innovations for cardiovascular disease since 2009.

It’s R-One machine has been designed to enable surgeons to remotely perform delicate stent procedures and there are more indications in the pipeline.

Lucien Goffart is CEO of the French medtech company. Before joining Robocath, he spent four years at Boston Scientific in France as director of the Interventional Cardiology and Structural Heart Division.

“The Robocath story started with the R-One for cardiology. But our founder always had in mind to expand the robot’s capabilities for neural interventions,” Goffart says.

“Last year we initiated a carotid treatment trial at a French hospital. That was our first step.”

In carotid stenting, a catheter is used to insert a balloon into a narrowed artery to improve blood flow and reduce the risk of a stroke.

It’s a precise and delicate procedure and only a limited number of hospitals and physicians are capable of performing it.

In November 2021 as part of a clinical trial, Robocath announced its first robotic carotid stenting at Rennes University Hospital using the R-One.

Goffart says:

“For the patient, the most important aspect is the precision of the intervention.

“The robot can move millimetres at a time. So it’s very precise. Being precise means a better treatment for the patient and a better outcome afterwards.

“In the future, we’re going to be able to use the remote technology to treat the patient as soon as they are identified as having a stroke. The intervention will happen faster than what it is today.”

Feedback on the R-One has been positive so far, Goffart says. The machine can be set up in minutes and surgeons who have used it in Europe and South Africa have mastered it within just two or three procedures.

Last week, Robocath announced the conclusion of its safety and efficacy study for robotic coronary angioplasty performed with R-One.

The technique, which follows the principle as carotid stenting, is often used during heart attacks to improve blood flow to the heart. The results of the 62-patient study are set to be published in May.

Goffart says:

“We are also improving our platform and developing new capabilities to treat be able to perform an entire PCI procedure.”

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