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Professor Peter Sandercock
"She will be assessed"
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Thursday, 11 January, 2001, 12:26 GMT
Princess Margaret: The medical care
Princess Margaret is being treated in hospital
Princess Margaret is being treated in hospital
Princess Margaret has been admitted to hospital following a second minor stroke. She is said to be experiencing a worrying loss of appetite. BBC News Online talks to experts in the care of stroke patients.

Princess Margaret's loss of appetite, which has led to her admission to hospital, could be linked to swallowing problems after a stroke, according to a stroke expert.

However, Philip Bath, Stroke Association professor of stroke medicine at the University of Nottingham told BBC News Online that it was also possible, although less likely, that it could be a symptom of depression.

Professor Bath said 45% of people have swallowing problems after a stroke, and that it is more likely to happen if they have had a previous stroke, as the Princess did in 1998.

He said: "If you believe some of the reports that have come out, she has not been eating for a while, maybe a month.

"There are also fears that she has been depressed - clearly one of the cardinal symptoms of depression being a loss of appetite.

"She probably hasn't been on top of the world for a while, and then possible had a second stroke and suffered swallowing problems."

Swallowing problems

Strokes can damage the complex system if nerves and muscles which control swallowing.

Food can "go down the wrong way" and get into the lungs causing coughing or choking, and in severe cases chest infections and pneumonia.

Catherine Collins, chief dietician at St Georges Hospital in London said stroke patients often had trouble controlling liquids in their mouths.

Therefore, there was a risk of dehydration unless fluids were actively administered.

She said losing as little as 2% of the body's normal fluid content made patients drowsy or confused.

Problems eating solids can lead to malnutrition and secondary problems such as reduced resistance to infection and pressure sore risk.

Swallowing is tested as soon as the stroke patient gets to hospital.

Neurologist Professor Peter Sandercock, a stroke expert from the University of Edinburgh, told the BBC: "Patients are normally tested at the bedside.

"If swallowing really is a problem then what we would do is a clinical x-ray, giving them a fluid which appears dark on x-ray.

"Then we can see if they cannot swallow or if fluid is going down the wrong way."

If there are problems, the patient can be fed by mouth, by a tube going into the nose and down to the stomach, or directly into the stomach.

When problems do not clear up in a few days, patients are assessed by speech and language therapists and dieticians.

A stroke occurs because part of the brain is deprived of oxygen either because a blood vessel becomes blocked or bursts. The resulting effects of the stroke vary enormously depending on which area of the brain is affected.

When stroke patients are admitted to hospital, they receive acute stroke care.

Treatment options

Treatment is based on test results.

Patients are likely to be asked to make lifestyle changes, such as giving up smoking, cutting back on alcohol, losing weight, reducing cholesterol and doing more exercise.

Doctors may also prescribe aspirin or cholesterol or blood pressure lowering drugs.

Tests are also carried out to see if the arteries in the neck are narrowed, which could mean patients need surgery.

Professor Bath said modern medicine had "quite a potent package" to treat strokes.

Once you have had one stroke, Professor Bath said the chances of having a second one within five years stand at around 40% - or 15 times the risk of someone who has not had a stroke.

Exclusive care

Princess Margaret has been admitted to the exclusive King Edward VII Hospital, where basic rooms cost 365 a night.

An intensive therapy unit can cost from 798 a night, with special nurses, physiotherapy and escorts which the Princess is likely to need, costing extra.

Patients at the hospital, a favourite of the Royal family, are offered luxuries including a comprehensive wine list, and meals are served course by course "to ensure the food is fresh".

But it also offers top-class medical care and one of the highest nurse to patient ratios in the country.

Princess Margaret is staying in a secure wing, in one of the hospital's 62 luxury, air-conditioned rooms.

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