Monday, August 22, 2011
strokes
Brain attack
Your Health
DR GITA MATHAI
Keep your brain healthy by doing the crossword everyday
An elderly person’s worst nightmare is suffering a stroke. It conjures up visions of being confined to bed with the inability to move or speak and, worst of all, loss of bowel and bladder control. A cerebral stroke occurs when blood supply to a part of the brain stops for any reason. Though strokes can occur at any age, they are more common after 65 years. With the increase in life expectancy in India, the incidence of stroke has doubled from 175 to 350 per 1,00,000.
Although it is uncommon for strokes to occur in young people, it can happen in youngsters born with a malformed blood vessel in the brain, brain tumours or those who suffer severe dehydration. Also, at any age, irregular heartbeats can lead to small clots in the brain called emboli, which can block vessels. The chances of having a stroke increase in those above 65 years if they have diabetes, hypertension, obesity, elevated blood lipids (cholesterol and triglycerides), are smokers, take more than 60ml of alcohol a day and do not have an active life.
Pregnant women can also suffer a stroke because of an increase in clotting tendency . In fact, the number of such women having a stroke has increased internationally. This upsurge has been blamed on older age at first pregnancy, an inactive life prior to and during pregnancy and obesity.
The manifestations of a stroke are giddiness, weakness or paralysis of muscle groups, blurring of vision, inability to speak or loss of consciousness. This is followed by paralysis of a limb, or a side of the body. A stroke occurs when blood supply to an area of the brain is cut off, either as a result of a block or a bleed.
Usually, there are a few warning TIA (transient ischaemic attacks) before a stroke or cerebral attack. There can be sudden blurring of vision, inability to speak or weakness of a limb. These signs are due to spasm of a diseased vessel in the brain or to small amounts of blood leaking. Many people do not take these symptoms seriously since recovery is spontaneous and complete. But appropriate preventive treatment at this point can prevent a full-blown stroke.
In the absence of treatment, TIAs are soon followed by the real thing — a stroke. The devastation caused by it depends on the extent of damage to the brain. This in turn depends on the site and size of the block or leak. Thirty three percent of stroke victims recover, 33 per cent have permanent disability and another 33 per cent die. Cerebral stroke is responsible for 1.2 per cent of the recorded deaths in India.
The most common effect is paralysis of a part of the face or one side of the body. Muscles in the throat and mouth lose co-ordination, making it difficult for the person to swallow and talk. Speech may become slurred and distorted. If the speech centre in the brain is affected the person may understand everything that is said but be unable to reply. Memory loss may make recollection of present events a blur. Quite often though past memories are intact. A person may also lose the ability to make judgements, reason and understand concepts. This makes them appear unnecessarily stubborn. A strange numbness or pricking sensations may occur in the paralysed limb. Since all these effects are because of damage to the brain, they are difficult to treat with medication.
All injuries heal given time and treatment, the brain is no exception. It is capable of rewiring itself so that lost skills are regained to an extent. A person who is predominantly right handed can learn to write with his left hand. Physiotherapy makes the paralysed muscles flexible and stronger. Since a few muscle spindles may be still active, they can be retrained to enlarge and take over the function of the paralysed muscles. The bladder can be trained to empty itself every 3-4 hours. By speaking slowly and using simple sentences, it is often possible to be understood. The brain can be stimulated with puzzles and poetry to enable faster healing.
Better still, try to prevent a stroke.
• Keep diabetes and hypertension in control.
• Take medications to reduce lipid levels.
• Take aspirin and clopidogrel, usually prescribed to diabetics and those with high pressure, regularly to prevent a stroke.
• Walk, swim or cycle for at least 30 minutes a day.
• Stimulate yourself intellectually by learning new skills and doing puzzles.
When it comes to brain circuits, the correct mantra is “use it or lose it!”
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Sunday, August 14, 2011
hear hear
Hear, hear
Your Health
DR GITA MATHAI
The ears are one of our five sense organs but most of us take very little care of them. And a lot of us are gradually losing our hearing owing to neglect, misuse and wilful damage. The inability to hear properly and the consequent misinterpretation of what is heard can lead to misunderstandings with friends and social isolation. It can also be dangerous, as motor horns, bells, sirens and even warnings shouted may be missed.
Some babies are born deaf as an isolated defect or part of a complex plethora of congenital defects and syndromes. Sometimes the mother contracts measles, mumps or chicken pox during the first few months of pregnancy and deafness occurs in the baby as a result.
Hearing should be checked soon after birth. Some babies can hear, but develop post-lingual (after speech develops) hearing loss. Minor hearing loss can begin by age 20, with difficulty in hearing whispers and soft speech. By the time one reaches 65, 30 per cent have significant hearing loss while 50 per cent are quite deaf by the time they cross 75. Age related gradual degenerative deafness is called presbycusis.
The ear consists of the outer ear, middle ear and inner ear. Sound waves enter through the outer ear and cause vibrations at the eardrum. Three small bones of the middle ear amplify these vibrations as they pass to the inner ear, which contains a fluid-filled snail shaped structure called cochlea. Sound waves make the tiny hairs attached to the nerve cells in the cochlea move in different directions. This transforms the sound waves into electrical signals that are transmitted to the brain.
Continuous exposure to loud sound can damage the fine hair on the nerve cells, leading to progressive loss of hearing. This can be occupational in people who work with loud machinery. It is becoming common in teenagers who use “in ear” earphones to listen to loud music prolonged periods. Even soft piano music should not be listened to for more than two hours at a stretch.
Difficulty in hearing can also occur because of the external ear canal being blocked with wax. This can also lead to severe ear ache. It can be tackled with wax dissolving eardrops. A physician can clean it out. Ear buds tend to push hard wax further inwards, blocking the canal further. Pins and other sharp objects should never be inserted into the ear as they can damage the eardrum.
The middle ear is prone to viral and bacterial infections. Fluid and pus can collect, causing temporary hearing loss. Viral infections are unavoidable but immunisation is available against H. Influenzae and pneumococcus, the two common bacteria that cause ear infections in childhood. These injections are not part of the free national immunisation schedule; they are classified as “optional” vaccines and have to be paid for.
If left untreated, middle ear infections can result in hearing loss. The infection can spread outwards damaging the eardrum or inwards causing brain fever and meningitis. It can also damage the nerves conducting sounds to the brain.
Childhood infections such as measles, mumps and chicken pox could cause deafness as a complication. This too is preventable with immunisation. Vaccinations for all these diseases should be completed by the age of two.
Hearing loss can develop because of a defect either in the conduction pathways or in the nerve cells. It can also be a side effect of medication such as chloroquine, quinine and aspirin as well as antibiotics like gentamicin and kanamycin.
A sudden blow to the head, or a poke with a sharp object can also rupture the eardrum. Sudden loud noises can have the same effect. In war zones, there are “epidemics” of deafness where large numbers of the population cannot hear. Children are particularly vulnerable.
Once hearing loss has set in it should be evaluated professionally to assess the severity, whether one or both ears are affected and if it is reversible and curable.
Small holes in the eardrum can heal spontaneously or with medication. Larger holes require surgical repair, with skin grafts. In permanent hearing loss, a hearing aid should be considered, particularly in older individuals. Hearing aids vary in price, size and usability. The individual has to be fitted with the aid that suits him best. Cochlear implant surgery is also an effective but expensive solution.
Tips to preserve hearing:
• If occupational exposure to loud noise is inevitable, use ear mufflers.
• Turn TV and music volumes down.
• Do not place foreign objects in the ear.
• Children should be immunised against measles, mumps, German measles, chicken pox, H. influenza and pneumococcus.
• Women should complete their immunisation schedule before marriage.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
DR GITA MATHAI
The ears are one of our five sense organs but most of us take very little care of them. And a lot of us are gradually losing our hearing owing to neglect, misuse and wilful damage. The inability to hear properly and the consequent misinterpretation of what is heard can lead to misunderstandings with friends and social isolation. It can also be dangerous, as motor horns, bells, sirens and even warnings shouted may be missed.
Some babies are born deaf as an isolated defect or part of a complex plethora of congenital defects and syndromes. Sometimes the mother contracts measles, mumps or chicken pox during the first few months of pregnancy and deafness occurs in the baby as a result.
Hearing should be checked soon after birth. Some babies can hear, but develop post-lingual (after speech develops) hearing loss. Minor hearing loss can begin by age 20, with difficulty in hearing whispers and soft speech. By the time one reaches 65, 30 per cent have significant hearing loss while 50 per cent are quite deaf by the time they cross 75. Age related gradual degenerative deafness is called presbycusis.
The ear consists of the outer ear, middle ear and inner ear. Sound waves enter through the outer ear and cause vibrations at the eardrum. Three small bones of the middle ear amplify these vibrations as they pass to the inner ear, which contains a fluid-filled snail shaped structure called cochlea. Sound waves make the tiny hairs attached to the nerve cells in the cochlea move in different directions. This transforms the sound waves into electrical signals that are transmitted to the brain.
Continuous exposure to loud sound can damage the fine hair on the nerve cells, leading to progressive loss of hearing. This can be occupational in people who work with loud machinery. It is becoming common in teenagers who use “in ear” earphones to listen to loud music prolonged periods. Even soft piano music should not be listened to for more than two hours at a stretch.
Difficulty in hearing can also occur because of the external ear canal being blocked with wax. This can also lead to severe ear ache. It can be tackled with wax dissolving eardrops. A physician can clean it out. Ear buds tend to push hard wax further inwards, blocking the canal further. Pins and other sharp objects should never be inserted into the ear as they can damage the eardrum.
The middle ear is prone to viral and bacterial infections. Fluid and pus can collect, causing temporary hearing loss. Viral infections are unavoidable but immunisation is available against H. Influenzae and pneumococcus, the two common bacteria that cause ear infections in childhood. These injections are not part of the free national immunisation schedule; they are classified as “optional” vaccines and have to be paid for.
If left untreated, middle ear infections can result in hearing loss. The infection can spread outwards damaging the eardrum or inwards causing brain fever and meningitis. It can also damage the nerves conducting sounds to the brain.
Childhood infections such as measles, mumps and chicken pox could cause deafness as a complication. This too is preventable with immunisation. Vaccinations for all these diseases should be completed by the age of two.
Hearing loss can develop because of a defect either in the conduction pathways or in the nerve cells. It can also be a side effect of medication such as chloroquine, quinine and aspirin as well as antibiotics like gentamicin and kanamycin.
A sudden blow to the head, or a poke with a sharp object can also rupture the eardrum. Sudden loud noises can have the same effect. In war zones, there are “epidemics” of deafness where large numbers of the population cannot hear. Children are particularly vulnerable.
Once hearing loss has set in it should be evaluated professionally to assess the severity, whether one or both ears are affected and if it is reversible and curable.
Small holes in the eardrum can heal spontaneously or with medication. Larger holes require surgical repair, with skin grafts. In permanent hearing loss, a hearing aid should be considered, particularly in older individuals. Hearing aids vary in price, size and usability. The individual has to be fitted with the aid that suits him best. Cochlear implant surgery is also an effective but expensive solution.
Tips to preserve hearing:
• If occupational exposure to loud noise is inevitable, use ear mufflers.
• Turn TV and music volumes down.
• Do not place foreign objects in the ear.
• Children should be immunised against measles, mumps, German measles, chicken pox, H. influenza and pneumococcus.
• Women should complete their immunisation schedule before marriage.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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