strokes

Stroke alert https://www.telegraphindia.com/1170918/jsp/knowhow/story_173704.jsp

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Your Health - Dr. Gita Mathai

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The Indian population is now aging, and non-communicable diseases - basically lifestyle diseases - such as diabetes, high lipids and hypertension are prevalent. While those suffering from such diseases are usually correctly diagnosed, the disease itself is often inadequately controlled. Sometimes, patients skip medication during fasting (for religious events), or else they "forget" or there is a few days delay in replenishing the exhausted stock of pills. Lifestyle modifications (diet and exercise) are ignored or inadequate. This means that the sugars, the blood pressure and the lipid levels can go up and down like a rollercoaster. This causes catastrophic events such as a stroke.

In developed countries, strokes - a clot or bleeding in the brain - occur around the age of 65 but they occur around 15 years earlier in India. Also, earlier it was thought that only men were at risk but now more and more women are suffering strokes. Major risk factors include diabetes, hypertension, alcoholism and tobacco use. Now, the fad of fast food (laden with trans fats) and diet drinks have added to the risk.

A stroke occurs when blood supply to a part of the brain is compromised or completely cut off. Blood supplies oxygen to the brain, without which brain cells die. The symptoms of a stroke depend on the area of the brain affected, the extent of the damage and whether the blood supply is partially or completely affected. Partial symptoms may occur intermittently for days or weeks. At that time, if the symptoms are recognised as TIA (Transient Ischaemic Attacks) it is possible to treat the precipitating factor and prevent progress to a full blown stroke. Unfortunately, TIAs may not be taken seriously as they pass off spontaneously and recovery is complete.

Blood supply may be compromised because blood vessels in the brain have become narrow or blocked by fat deposits, or a clot (embolus) produced somewhere else in the body has travelled to the brain via blood. It can also be due to a bleed into the brain. This may be cased by to congenital malformations in the blood vessels of the brain leading to it suddenly bursting. Damage may also occur because of trauma to the head, when blood collects in the space around the brain.

The symptoms of stroke include headache, drowsiness, loss of consciousness, clumsiness, confusion, loss of memory, dizziness, loss of bowel and bladder control, weakness or paralysis of a limb or one part of the body, difficulty in swallowing and loss of balance.

A stroke is a medical emergency. Good results are seen if treatment is started within three hours. If the stroke is due to a block in one of the arteries supplying the brain, emergency treatment with a tablet of Aspirin should be given at home. (This is contraindicated if the stroke is due to a bleed). The potent clot busting drug TPA (Tissue Plasmogen Activator) can be given intravenously. Blood clots can be surgically removed. Blood thinners and anti clotting medication can be administered, sometimes directly into the brain. Narrowed vessels can have stents placed in them to open them up. Bleeding blood vessels can be surgically clipped. Risk factors like diabetes, hypertension and high lipids can be treated. Irregular heart beats can be medically corrected.

The human brain is a remarkable organ. It is possible to lead a fairly normal life with a damaged brain. About 70 per cent of stroke patients manage to achieve this. Undamaged areas compensate and take over required activity . Much of this requires expert training, with close co-ordination between physicians, physiotherapists and occupational therapists, as people relearn how to walk, swallow, speak and co-ordinate arm and leg movements. Rehabilitation is the key to stroke recovery.

The writer is a paediatrician with a family practice at Vellore and author of StayingHealthy in Modern India .

If you have any questions on health issues, please write to yourhealthgm@yahoo.co.in

panic attacks

One of my patients, a middle-aged mother, regularly turns up at emergency chest pain ICUs with a "heart-attack". She develops trembling, giddiness, hyperventilation (rapid breathing), tingling in the hands and, most frightening of all, palpitations, chest pain and sweating. During an attack, she looks like she would collapse. Each time, after spending a fortune, she is sent home in 24 hours with the good news that she did not have a heart attack. She is fortunate that none of the centres she visited advised her to go in for an angiogram, angioplasty or offer her by-pass surgery.

What she actually had were classic "panic attacks" that were rapidly progressing to a "panic disorder". These attacks can start in childhood, when it may not be recognised as such, be present through adolescence and become incapacitating in adult life. It is more likely to affect women.

A panic attack is an exaggerated version of the body's normal "flight or fight" reaction to danger. The difference is that the chemicals and hormones causing the physical symptoms are released when there is no perceivable threat. Some people are more vulnerable to these chemical changes in the blood. This sensitivity can run in families. It may be in response to difficult changes in life, such as loss of a loved one, birth of a child or a change or loss of a job. It can also occur for no known reason.

These symptoms are not always caused only by a panic attack, they can also be due to smoking, consumption of excess caffeine (coffee, tea, cola, energy drinks, health supplements, weight loss products), some prescription and OTC medications, and cough mixtures as well as diseases, such as an over active thyroid gland, or cardiac issues like mitral valve prolapse or intermittent irregular heartbeats.

So before you dismiss such an episode as a panic attack, make sure the patient has a through examination and relevant tests done to rule out other reasons that could have led to the symptoms. These causes are usually treatable.

It is normal to have one or two panic attacks in a lifetime, especially if precipitated by major stress. However, if the attacks are frequent and for no reason, it is classified as a panic disorder and requires treatment. Otherwise, the person may start avoiding social situations or refuse to leave the house. He or she cannot function normally and may become depressed or suffer from other psychiatric disorders.

Sometimes you can stop panic attacks by making simple lifestyle changes.

• Have 4-6 helpings of fruits and vegetables a day. The antioxidants and flavonoids in these help control symptoms.

• Eat meals on time. This prevents jitteriness from low blood sugars.

• Avoid junk food.

• Limit caffeine and alcohol intake.

• Stop smoking

• Take a brisk walk or jog for 40 minutes in the fresh air everyday. This releases chemicals from the calf muscles that negate the panic causing chemicals.

• When the attack occurs, close your eyes and take deep breaths to slow the heart rate.

• Do yoga daily, concentrating on stretching and breathing.

• Meditate for 10-20 minutes a day.

Medication is required when panic attacks do not respond to lifestyle changes. Anti-depressants are effective but may have to be continued for several months. They may be prescribed along with sedatives to help relaxation. Unlike anti-depressants, some sedatives can be habit forming so they should be taken for only a short time.

Improvement takes time. Patience is the key. Maintain a diary and record the frequency of symptoms. It is important not to alter medications or dosage (stop, increase or decrease) without the doctor's permission. Medication works best when combined with psychotherapy. Regular sessions with a counselor may help.

Dr Mathai is a paediatrician and author of StayingHealthy in Modern India. Mail your questions to rhealthgm@yahoo.co.in