Introduction
What is supposed to be done after a stroke? How does life change after a neurovascular event? The acute onset of stroke does not let time to digest the milestone that supposes in patients and their families.
Ischemic stroke represents around 80% of total strokes and it is due to a stopping in blood brain circulation (Institut Català de la Salut de Barcelona Generalitat de Catalunya, 2022). This interruption in blood flow can be originated by a heart thrombus or even an arterial thrombosis secondary to atheroma plaques in their walls.
When suffering from an ischemic event, brain arteries need to be checked out. It could happen that arterial walls thicken due to cholesterol and this plaque breaks so the small fragments migrate to distal vessels of the brain, stopping blood flow and damaging brain areas. This is called atherothrombotic stroke and some risk factors are high cholesterol levels, diabetes, high blood pressure, smoking, obesity or sedentary lifestyle. Secondary prevention includes taking antiplatelet pills, controlling blood pressure lower than 140/80 mmHg and cholesterol LDL<55 mg/dL (Institut Català de la Salut, 2022). Also avoiding smoking, doing physical activity, and avoiding emotional distress.
A cardiologic study directed to the detection of arrhythmias such as atrial fibrillation should be performed. In this case, thrombus are originated in the heart and migrate to the brain circulation. People suffering from arrhythmias, ischemic heart disease or with a mechanical heart-valve have increased risk of cardioembolic stroke. Secondary prevention includes taking the anticoagulant medication and controlling blood pressure lower than 140/80 mmHg and cholesterol lower than 70 mg/dL, as doing physical activity and avoiding emotional distress (Institut Català de la Salut, 2022).
Another etiology of ischemic events is the lacunar stroke, due to a focal stop in brain microcirculation which is damaged by high blood pressure, cholesterol, high sugar levels, or a cardioembolic source.
Hemorrhagic stroke supposes 20% of strokes and it is often generated by an acute increase in blood pressure (Institut Català de la Salut, 2022). Patients who suffer from Amyloid disease have a higher risk of suffering from hemorrhagic lobar strokes.
Page 2 represents an algorithm of secondary prevention depending on the type of stroke. Pay attention to the fact that the common idea is the control of cardiovascular risk factors, with special attention in blood pressure in hemorrhagic strokes.
Apart from the importance of studying the etiology of stroke so we could prevent it, it is essential to develop rehabilitation to restore previous functions and recover autonomy. The main key points that must be trained are swallowing, speech, mobility, and daily life activities (Pla Director de la Malaltia Vascular Cerebral, 2022). It starts at the hospital and continues at discharge, so there is an improvement during the first 3-4 months in mild strokes and until six months in moderate strokes, starting an adaptation after that time (Institut Català de la Salut, 2022).
Process
The fanzine was designed for a local celebration of World Stroke Day in a third-level hospital in Catalonia (Spain). Information for the comic script was collected from the weekly post-stroke webinars content, from the guide provided to patients at discharge and from conversations with the multidisciplinary stroke team (rehabilitation, nursing, and neurologists). Images and visual metaphors were shared through the story, keeping in mind the structure of eight-page fanzines. Manually inking was used to create the panels, and digital methods made the coloring. The multidisciplinary stroke team followed the creative process so they could contribute with ideas and revision.
An eight-page color fanzine was created, including an inner A3 illustration summarizing the “FAST” acronym (F means face, A identifies arm, S stands for speech, and T means time is of the essence), which in catalan is known as “RÀPID” (R riure, A aixecar els braços, P parlar, I ictus, D de pressa!). It was printed in color and shared with patients, families, and health professionals in the local celebration of the World Stroke Day at Germans Trias i Pujol Hospital.
Conclusion
The creative process of a health-related fanzine is challenging as it requires summarizing ideas in a clear and concise message. The purpose of the inner page is to work as a poster which could be shared and hung up in public common spaces, stimulating patients to be part of the health education chain as leading voices of the illness experience.
One of the future goals of the fanzine may be to generate a primary prevention public health dynamic, so it could bring together patients' experiences and society.
References
Institut Català de la Salut de Barcelona Generalitat de Catalunya. (2022). eSalut MetroNord (Version 1.1) [Google Play]. https://ticsalutsocial.cat/en/app/esalut/
Pla Director de la Malaltia Vascular Cerebral. (2022, March). Superar l’ictus: Guia adreçada a les persones afectades d’una malaltia vascular cerebral i als seus familiars i cuidadors [Overcoming stroke: A guide for people affected by cerebrovascular disease and their relatives and carers]. Departament de Salut. https://scientiasalut.gencat.cat/handle/11351/1834.3
Sociedad Española de Neurología. (2020). El atlas del Ictus en España 2019. https://www.sen.es/images/2020/atlas/Atlas_del_Ictus_de_Espana_version_web.pdf
