Home detecting a stroke!

The SLTM way

About 10 per cent of hospital beds, the world over are occupied by stroke patients, and according to WHO statistics, stroke is the second commonest cause of death and the first cause of major disability causing disease in the world, with five million of the affected dying annually in the world.

This shows what a serious disease the stroke is and how important it is for the people to understand the disease and the steps they could take to prevent it.

The media has a major role to play in this public health education process. So said Dr. Githanjana Mendis Consultant Neurologist and Director General of Institute of Sports Medicine when he spoke at the Health Quest Programme No. 4 on - strokes held last week at the Institute of Sports Medicine Auditorium at the Sports Ministry, Colombo.

Dr. Mendis speaking further said:

How do we detect a stroke in the home setting?

The mnemonic SLTM is useful in remembering this.

Standing - check whether the patient (who was previously normal) can stand without unsteadiness.

Laughing-check whether his mouth moves to a side when he laughs

Talking check whether he has slurring of speech when he talks.

Memory-check whether his memory is functioning normally.

These functions should be checked on a patient with a suspected stroke, and it is likely that if one of the functions above is impaired after event, the event is actually a stroke.

What should you do while transporting the patient to hospital?

1. Reassure the patient; keep the patient at ease as far as possible.

2. Don't give him/her anything to eat or drink.

3. Transport the patient by turning him to one side, most preferably the left, not a flat position.

Risk factors for stroke include those you can change (modifiable) and those you can't change (non-modifiable) -such as age.

Risk factors you can control include:

1.High blood pressure (hypertension) High blood pressure is the most important modifiable risk factor. It is important to keep your blood pressure under control if you are hypertensive, by taking appropriate drugs. It is advisable to check the blood pressure of a hypertensive patient at least monthly.

The best would be to check your blood pressure daily, if possible. Even people without hypertension should get their blood pressure checked around every six months, specially if they are above 40 years of age. What we have to remember is that the diastolic blood pressure is the significant determining risk factor in stroke. A diastolic pressure more than 110 Hgmm being the high risk factor.

2. Smoking - this comes second in the modifiable factor list. We should bear in mind that this also includes secondhand smoke.

3. Diabetes - About one-quarter of people with diabetes die of stroke. Having diabetes doubles your risk for stroke because of the circulation problems associated with the disease.

4. High cholesterol - (hypercholesterolaemia) - High cholesterol can lead to coronary artery disease ad heart attack, which can damage the heart muscle and increase your risk for stroke.

5. Coronary artery disease, which can lead to heart attack and stroke.

6. Other heart conditions, such as atrial fibrillation, endocarditis and heart value conditions.

7. Physical inactivity - exercise is the best way to encounter this. Walking is a really effective exercise. But is not slow walking that is effective, but walking or jogging.

8. Being overweight.

9. Use of some medications, such as birth control pills - especially by women who smoke or have a history of blood-clotting problems- and anticoagulants or steroids. In postmenopausal women, hormone replacement therapy has been shown to slightly increase the risk of stroke.

10. Heavy use of alcohol - people who drink alcohol excessively, especially people who binge drink, are more likely to have a stroke. Binge drinking is defined as drinking more than five drinks in a short period of time.

11. Use of cocaine and other illegal drugs.

A stroke may occur in two ways. A blood vessel (artery) that supplies blood to the brain may burst and cause bleeding into the brain (haemorrhage). A stroke also may occur when a blood vessel which supplies the brain is blocked by a blood clot (thrombus).

Within minutes, the nerves cells in that area of the brain are damaged, and they may die within a few hours. As a result, the part of the body controlled by the damaged section of the brain cannot function properly. Today, in any hospital around 10 per cent of the beds are occupied by stroke patients.

An ischemic stroke is caused by a blood clot that blocks blood flow to the brain. A blood clot can develop in a narrowed artery that supplies the brain or can travel from the heart (or elsewhere in the body) to an artery that supplies the brain.

Blood clots are usually the result of other problems in the body that affected the normal flow of blood, such as:

1.Hardening of the arteries (atherosclerosis). This is caused by high blood pressure, diabetes, and high cholesterol.

2. Atrial fibrillation or other irregular heart rhythms.

3. Certain heart valve problems, including having an artificial heart valve, heart valve disease such as mitral valve prolapse, or narrowing (stenosis) of a heart valve.

4. Infection of the heart valves (endocarditis)

5. Blood-clotting disorders.

If you have symptoms of a stroke, seek emergency medical care. General symptoms of a stroke include sudden onset of:

Numbness, weakness; or paralysis of the face, arm or leg, typically on one side of the body.

Vision problems in one or both eyes, such as dimness, blurring, double vision or loss of vision.

Confusion, trouble speaking or understanding.

Trouble walking, dizziness, loss of balance or coordination.

Severe headache.

Symptoms vary depending on whether the stroke is caused by a clot or bleeding. The location of the blood clot or bleeding and the extent of brain damage can also affect symptoms.

Symptoms of an ischemic stroke (caused by a clot blocking a blood vessel) usually occur in the side of the body opposite from the side of the brain where the clot occurred. For example, a stroke in the right side of the brain affects the left side of the body.

Symptoms of a haemorrhagic stroke (caused by bleeding in the brain) can be similar to those of an ischemic stroke but may be distinguished by symptoms relating to higher pressure in the brain, including severe headache, nausea (vomitish feeling) and vomiting, neck stiffness, dizziness, seizures (fits), irritability, confusion, and possibly unconsciousness.

What is a transient ischemic attack (TIA)?

A transient ischemic Attack (TIA) is like a mini-stroke, because the symptoms are like those of a stroke but the difference is that it does not last long. A TIA happens when blood flow to part of the brain is blocked or reduced, often by a blood clot. After a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain has permanent damage.

A TIA is a warning: It means you are likely to have a stroke in the future. If you think you are having a TIA, go to the nearest hospital as quickly as possible. Early treatment can help prevent a stroke. If you think you have had a TIA but your symptoms have gone away, you still need to call your doctor right away.

What are the symptoms of a TIA?

Symptoms of a TIA come on suddenly. The symptoms are similar to the ones of a stroke.

What causes a transient ischemic attack?

A blood clot is the most common cause of a TIA. Once the clot dissolves, blood flow returns, and the symptoms go away.

Sometimes a TIA is caused by a sharp drop in blood pressure that reduces blood flow to the brain. This is called a low-flow TIA. It is not as common as other types.

TIA symptoms typically disappear after 10 to 20 minutes but may last up to 24 hours. Since there is no way to tell whether the symptoms are caused by a stroke or TIA, emergency medical care is needed for both conditions.

The management of a stroke is done as a multi-disciplinary approach. So, therapists from various aspects of medicine would get-together to treat a stroke patient. They include doctors, nursing staff, physiotherapists, occupational therapists and dieticians. They all play an important role in bringing back a stroke patient to his usual functional life.

However, with all these interventions, it should be kept in mind that around 50 per cent of the stroke patients encounter some kind of disability 10-15 per cent get bed-ridden, 10 per cent have to spend the rest of their lives in a wheel-chair and another 10 per cent would have to live in a 'vegetable state' for the rest of their lives.

So, it should be re-iterated that all these undesired complications could be avoided as much as possible, by modifying the risk factors which were mentioned above. Apart from those, the prophylactic use of Aspirin is also implicated in the prevention of strokes, specially of their thrombotic type.

When you have an ischemic stroke, the oxygen-rich blood supply to part of your brain is reduced. With a haemorrhagic stroke, there is bleeding in the brain.

After about 4 minutes without blood and oxygen, brain cells become damaged and may die.

The body tries to restore blood and oxygen to the cells by enlarging other blood vessels (arteries) near the area. If the blockage is in a large blood vessel, such as the carotid artery, the body may not be able to supply blood to the affected area through other blood vessels.

If blood supply is not restored, permanent brain damage usually occurs. If you have symptoms of a stroke, you need emergency care, just as though you are having a heart attack. If medical treatment begins soon after symptoms are noticed, fewer brain cells may be permanently damaged.

Treatment given 2-6 hours from the onset of stroke would be really useful in preventing major damage. Every effort should be taken to take the patient to hospital at least within 24 hours of the onset of the stroke.

Digital prescribing

Colombo Medical Faculty has developed a software for practicing doctors for digital prescribing.

Presenting a paper regarding this study at the 32nd Annual Academic Sessions of the College of General Practitioners' Sri Lanka, held last week at the SLMA Auditorium in Colombo Dr. A. K. P. Ranaweera said;

To develop a computer software for the practising doctor which is secure, easy to use and helpful for maintaining a drug inventory, patient records and digital prescribing.

Microsoft Access Basic was used as the programming language. The basic structure was formulated with past experience.

The basic structure was adopted to meet the requirements and needs that were identified following discussions with several General Practitioners in Negombo area. Further improvements were made after testing.

Features of the software that was developed

The software has password protection with an encrypted database to safeguard the confidentiality of the records. It can be used by doctors with minimum computer literacy.

It has following features to maintain own drug inventory; easy data entry forms, automatic update of stocks, quick display of drugs with stock values below a reorder level and quick search and display of supplier information.

Features to maintain patient records are; three independent ways of search for quick retrieval of patient information, easy access to details of past consultations, easy viewing of relevant details of the patient, features for serial recording of heights, weight and blood pressure, automatic calculation of Body Mass Index (BMI), digital photograph of the patient and features for serial recording of any investigations chosen by the user.

Features for digital prescribing are; ordering drugs at the touch of few keys, easy ordering of investigations, warnings when prescribing drugs which are allergic to the patient, warning when prescribing drugs which are out of stock and ability to print prescriptions automatically.

Yoga remedy for diseases

Hatha Yoga: Four of the common, but serious diseases affecting mankind could be cured by practising Hatha Yoga claims Hatha Yoga professional Charmin Warnakula, an ex-policeman turned Yoga therapist now.

He was speaking to the HealthWatch last week on his Hatha Yoga therapy, as he wanted to make the HealthWatch reading public aware of this Yoga therapy which can not only cure, Asthma, Diabetes, Heart Diseases and high Blood Pressure, and most importantly help them become useful healthy peaceful citizens of this country.

He says all this is possible because Hatha Yoga involves the spiritual upliftment of the person through a mind body training programme.

Charmin who had his yoga training for one and a half years at the Patna Institute of Yoga in India, said that Hatha Yoga is over 5000 years old and comes from the Mohenda and Harappa civilisations in India.

Irshi Pathanjali has been responsible for spreading it in the West and Asia.

According to Charmin for a person interested in learning this yoga programme, all that he has to do is to do half an hour training a day, and in six months time, he can become proficient in the general Hatha Yoga programme.

Charmin says in Sri Lanka there are many who have got cured of their sicknesses by doing the Hatha Yoga exercises and most of them have turned a new leaf in their lives. To get the best results from this programme one has to give up meat eating and take to a vegetarian diet.

There's a meditation and a breathing exercise component in this programme which helps a person to overcome stresses in life and builds up a humane out look in him so in the long run the Hatha Yoga programme helps in building up a peaceful society as well.

Charmin has brought out a self study cassette on Hatha Yoga, which he says is the first of its kind in the country.

The cassette could be had by those interested in self study of the course by calling him up on 2842726.

Fruits and vegetables may lower gallstone risk

Women who regularly eat fruits and vegetables may have lower odds of developing painful gallstones, the results of a large study suggest.

Of more than 77,000 U.S. women in the long-running Nurses' Health Study, researchers found that those who ate the most fruits and vegetables were less likely to require surgery to remove their gallbladder.

Usually, this surgery is performed because of gallstones, masses that develop when bile stored in the gallbladder hardens into pieces of stone-like material. These "gallstones" may cause no symptoms, pass through the intestine, or result in severe pain, block the bile ducts, cause infection, or can even be fatal.

Fruits and vegetables

The findings suggest that a diet rich in fruits and vegetables particularly leafy greens, citrus fruits and other vitamin-C-rich foods can prevent gallstones from forming or from causing symptoms, Dr. Chung-Jyi Tsai at Harvard Medical School in Boston and colleagues report in the American Journal of Medicine. The results are based on data from 77,090 female nurses who, in 1984, were between the ages of 37 and 64.

They answered dietary questionnaires that year, and had the rates of gallbladder removal called cholecystectomy - were followed through 2000.

Cholecystectomy is the most common treatment for symptomatic gallstones; stones that do not cause symptoms are generally left untreated. So rates of cholecystectomy are indicative of the rate of painful gallstones.

During the study period, Tsai's team found, roughly 6,600 women had their gallbladders removed. But those with the highest intake of fruits and vegetables at the study's start were 21 per cent less likely than those with the lowest intake to have the surgery.

The risk reduction was independent of other factors that increase the risk of gallstone formation, such as age, weight and diabetes. Women in the group with highest intake of fruits and vegetables typically ate seven or more servings a day; those with the lowest intake generally ate less than three servings.

Vitamin C

Citrus fruits, leafy green vegetables, and all foods rich in vitamin C seemed to be particularly protective, the study found. According to the researchers, dietary fiber, antioxidant vitamins - which include vitamin C - and minerals such as magnesium may all theoretically help prevent symptomatic gallstones.

However, they add, the benefit is likely due to a complex interaction of nutrients.

"Because any single constituent in fruits and vegetables is unlikely to explain fully the beneficial effect," Tsai's team writes, "it is reasonable and practical to recommend an abundant fruit and vegetable consumption."

SOURCE: American Journal of Medicine

NEW YORK Reuters

Smoking weakens anti-clotting effect of aspirin

By increasing the activity of platelets, blood cells that help clot the blood, smoking may weaken the anti-clotting effect of aspirin, new research suggests. A small daily dose of aspirin is usually recommended for patients who have had a heart attack or stroke to prevent platelets from building up and blocking critical blood vessels.

"Aspirin and other antiplatelet treatments are central to the prevention of heart attack and stroke," Dr. Michael Domanski told Reuters Health. "A clearer understanding of how to best predict the level of protection provided in a specific individual is a research question of potentially great public health importance."

As they report in the American Journal of Cardiology, Domanski of the National Heart, Lung and Blood Institute in Bethesda, Maryland and colleagues conducted a study to determine which factors predict a poor anti-clotting response to aspirin.

NEW YORK Reuters