What to expect at our Stroke Clinic - with Dr Sageet Amlani

It’s a tough reality that many of those who have had a stroke, have life-altering consequences – two in three people in fact. These can be unseen and relatively mild through to more dramatic changes. Thankfully, with the right care and support, rebuilding your life is possible.

St John & St Elizabeth Hospital’s Stroke Clinic is one of the UK’s best equipped private facilities for post-stroke care and rehab, and offers an extensive range of services, personalised treatment programmes, and all the clinical and emotional support necessary for a speedy recovery.

After the medical emergency of a stroke has passed, it’s really important to uncover the root cause and tailor a rehabilitation programme around this. The Stroke Clinic provides an intense level of support with a whole team of experts, including physiotherapists, occupational therapists, dieticians, speech & language therapists, and neuro-psychologists, as well as your stroke consultant, who will see you every day. It’s possible to make big gains in the early stages of recovery, so having the expertise of a specialist multi-disciplinary team is truly invaluable.

We’ve asked Dr Sageet Amlani – Lead Stroke Medicine Consultant at St John & St Elizabeth Hospital what a patient can expect when they are admitted to our Stroke Clinic.

What can people expect when they come to the Stroke Clinic at St John & St Elizabeth Hospital?

When people come to the clinic, as well as a full assessment, we do a full review of previous investigations and results to ensure continuity of care.

They’ll be under the care of their consultant and will be seen by them every day. They’ll also have access to physiotherapists, occupational therapists, dieticians, speech & language therapists and neuro-psychologists.

Neuro-psychologists are really important and not used enough in the NHS. They’re trained to assess and treat people who are having issues with their memory, concentration, planning, language, reasoning and other aspects of learning and understanding. When any of these faculties are lost or impaired after a stroke, there’s a grief reaction associated with it, and people can feel anxious and depressed, so having a neuro-psychologist available who can help people through this, is really huge.

What does a typical day look like in the Clinic?

Typically nurses will wake you up and then you’ll have breakfast. The food is very good here and you can also make off-menu demands if you have allergies or particular likes or dislikes! Once you’ve had your assessment, a timetable will be created for you that’s tailored around your specific needs, and your consultant will meet with you to talk through your plans for the day and set goals with you for the day and week ahead.

After your first week, you’ll have a meeting with your consultant, staff team and family to talk through what you’ve achieved and to set further goals. Your progress will be measured throughout the length of your stay, so no matter how long you stay with us, you’ll have a clear picture of where you’re at and what you can work towards next.

If you stay with us for longer than a week, you won’t be stuck inside on the ward for the whole duration of your stay. One of the things we do is take people outside to St John’s Wood High Street, where there are lots of lovely shops and cafes. This helps improve spacial awareness and navigating roads, and the aim is to help people get back to a normal life as quickly as possible. Often, people will have spent weeks in hospital, and so being able to go to the shop and do something normal can give a huge confidence boost and make a world of difference.

For people who have had a stroke, what’s important to keep in mind?

You can make big gains in the early stages of recovery, but rehab doesn’t stop at the end of your hospital stay! You can continue to improve your whole life long, so keep at it and don’t give up.

What are the benefits of a respite period in a hospital following a stroke (compared to recovering at home)?

It really depends on how severe your stroke has been. In hospital, we can provide an intense level of rehab with a whole team of experts, which you just wouldn’t be able to get at home, and actually in lots of other establishments. Some people might also need care throughout the night, rather than just during the day, so they might feel safer here, knowing they have all the care and support they need at hand.

Another thing is that medical investigations are done a lot quicker here. In the NHS, some of these are done in outpatients, so it can take a while to get the results. This means it can be take some time before we understand why the stroke happened in the first place. Here, they’re done immediately and acted upon straight away. This is really important as we can work on fixing the root cause and make sure another stroke doesn’t happen.

At our Stroke Clinic, we’re actually really selective over who we accept, and we’ll never admit someone if we think they’ll do better at home. We also won’t keep anyone here longer than needed. In fact, lots of my patients are discharged before the end of their planned 3-week stay, because they’ve achieved all their goals and are ready to take on the rest of their recovery at home.

What does a typical week look like for you?

I have three children, the youngest of whom is two, so there’s no typical week – it really depends on which one is sick at which time!

Often I get up at 5:00am to sort out the kids’ breakfast and that type of stuff. I’ll then come to John & Lizzie’s first thing in the morning to check-in with my patients. Once I’m sure they’re ok, I’ll pop over to the Royal London Hospital in Whitechapel where I have my NHS practice.  There, I focus on hyper acute and acute medicine; essentially looking after people who have just had a stroke and need emergency care. After my NHS practice, I’ll often come back to the Stroke Clinic here in the evening to see my patients and find out how their day has gone, and then I’ll either go home or go to the running track. I’ve run the London Marathon for our Hospice, St John’s, a few times, and it’s actually the reason I work here, as the hospice looked after my dad when he wasn’t well. On Wednesday mornings I also run an outpatient clinic here, which also allows me to follow-up with patients who have been discharged and see how they’re doing.

Could you share a success story?

One patient that stands out for me is a lady that had been in hospital for a couple of months already. She was paralysed in one leg and hadn’t been able to move it at all for the last 2 months. A week after she came to our Stroke Clinic, she was able to kick her leg and within 2 weeks she was walking with a stick! After 6 weeks with us, she was able to walk upstairs and was well enough to go back home. With this case, we did the relevant tests and found the cause of the stroke. Once we knew this, we were able to treat the cause and massively reduced their risk of it happening again. Psychologically, this made a huge difference, as she could go home confident and not in fear that she would get sick again.

Do you have a certain “type” of patient?

No – and that’s surprising actually! Generally, there are risk factors which can accumulate over life, such as diabetes, smoking, high blood pressure and cholesterol. For some people though, it just comes out the blue.

For example, the stroke could be linked to cancer, as people are at higher risk of blood clots in the legs with cancer; it could be due to a hole in the heart; it could even be down to vigorous exercise which has led to a tear in a vessel; or it could be caused by neck manipulation, which can happen to older people when they go to the hair dresser. My job is to find out why the stroke has happened, analyse its location and size and use this information to guide the rehab process.

Some useful terminology

Thrombolysis: a procedure where we give a powerful blood thinner in the first few hours after a stroke to dissolve blood clots, improve blood flow and prevent permanent damage to the brain.

Thrombectomy: a procedure where we go in through the groin or wrist via a major blood vessel to pull out clots from arteries in the brain.

TIA – Transient Ischaemic Attack: often called a mini stroke. This is a temporary period of stroke-like symptoms, which generally lasts a few minutes and doesn’t cause any lasting damage. 1 in 3 people that have a TIA will go on to have a stroke, so it’s good to heed the warning and make lifestyle changes to reduce the risk of one happening.

To find out more, visit our Stroke Clinic page