Health Watch

Stroke:

What can WE do?

World Stroke Day on October 29:

Dulshani Gunawardena

A stroke (or a brain attack) can be described as a condition when the blood supply to the brain is blocked off, leading to permanent paralysis and death.

How does it happen?

Oxygen and Glucose, essential for the cell functioning, are supplied to the various cells all over the body through the blood stream. 80 percent of all blood pumped

by the heart goes to the brain, which has a high concentration of cells. These brain cells control the nervous system, which in their turn, control all body functions.

Children’s blood vessels are very clean and elastic. However, as we grow older, the cholesterol in the blood stream gathers on the inside walls of these blood vessels, reducing their elasticity. The blood pressure increases at these cholesterol ‘mounds’, leading the cholesterol layers to get damaged. Blood cells gather upon this wounded cholesterol layer. With the blood pressure further increasing, a blood clot from these blood cells, gets dislodged and blocks the blood vessel.

The blood flow to the particular part of the brain is interrupted, thus creating paralysis of the connecting nerves.

A stroke can occur in two ways.

1. Complete blockage of blood vessels-occurs in 80 percent of all stroke cases

2. Bursting of blood vessels-occurs in 20 percent of all stroke cases.

Though the methods of treatment are slightly different, the symptoms are basically the same.

Are you overweight?

BMI or Body Mass Index is the accepted method in calculating the appropriate weight of an individual in proportion of his/her height.

BMI = Weight(kg)/ Height2 (m2)

For conversion ease, 1 inch=2.54cm.

For example, if one is 55kg with a height of 1.65m (5 feet 5 inches), her calculations will be,

BMI= 55/(1.65)2 = 20.2

BMI Chart

18.5 Underweight

18.5-25Normal Weight

25 Overweight

The optimal BMI for Asians is 23.

Symptoms

The symptoms vary on the part of the brain affected.

Numbness, weakness or paralysis of the face, arm or leg on one or both sides of the body. However, it should be specially noted that paralysis is not synonymous with a stroke, is the common misinterpretation. Paralysis is merely a symptom of stroke.

Difficulty in speaking and understanding what is being said.

Dizziness, loss of balance or an unexpected fall.

Difficulty in swallowing.

Headache-usually severe and abrupt.

Sudden blurring or decrease of vision in one or both eyes.

Mini Stroke (TIA)

Many stroke victims experience a mini stroke two to three days prior to the initial stroke, which lasts for around 10 minutes and then disappear. Do not ignore these warning signals. Contact a doctor immediately.

Treatment: A stroke, like a heart attack, occurs instantly, with no prior warning.

Rush the victim immediately to the nearest hospital, preferably one with the CT scanning facility. Do not keep the patient at home. Do not try out home remedies.

In general, treatment of stroke is threefold.

Drug Treatment: Aims at reducing the extent of brain damage. The type of drug treatment depends on the number of hours between the initial attack and admittance to hospital. If less than four and a half hours, a CT scan is administered and the patient is administered Thrombolysis. This treatment greatly increases the chance of recovery. Unfortunately, this facility is not available at every hospital, so it is best to rush a patient to a hospital with such a facility available, or if such is unknown, to the National Hospital.

General care: Aims at helping with swallowing difficulties and bladder and bowel control, thus minimizing the complications caused by a stroke.

Aims at maximizing recovery from a stroke, so that the patient could become as independent as possible and regain his/her normal lifestyle.

Rehabilitation: Rehabilitation of stroke victims is essential to get them back to their normal lifestyle. This is a long, yet steady process, employing not only nurses and medical officers but also physiotherapists, occupational therapists, social workers and counsellors.

Rehabilitation requires no great financial expense, but is rather based on human resources. It is a very timely need in Sri Lanka to implement a program in training the required personnel as well as recruiting volunteers.

In assistance of stroke victims, the Social Services and Social Welfare Ministry has introduced many programs, including community based rehabilitation programs, counselling services, social security provisions and monthly public assistance.

Are you at risk?

Immediate risk factors towards stroke are High Blood Pressure, Diabetics, high lipid concentration in blood and obesity. An unhealthy diet, physical inactivity, tobacco consumption further increases the risk.

Prevention: Though sudden in its outset, a stroke doesn’t materialize out of thin air. It is the ultimate result of complications occurring within the blood vessels over a long time.

The yearly expenditure of the Government on stroke related cases is Rs.2000 million, and this is with the minimal facilities available in Sri Lanka.

Of all stroke cases in Sri Lanka,

Thirty percent fully recover

Ten percent die within a month

Sixty percent are permanently disabled

The number of deaths and permanent disabilities can be greatly reduced if proper treatment programs, specially with regard of rehabilitation, are observed.

Owever, stroke is preventable. Stroke prevention can be classified as measures taken by the individual and through policies.

Individual measures: Simply described, this focuses on building up a healthy lifestyle. It helps preventing not only stroke but many other diseases. Three fields can be addressed in this issue. Diet, Exercise and Reducing tobacco consumption.

Diet: A balanced diet being essential is a common though very much unheeded fact. The average Sri Lankan’s diet consists of many risk factors.

Minimum daily consumption of food and vegetables is 400g - the Sri Lankan average is 150g. Maximum daily consumption of salt is 5g (equivalent of a teaspoon) - the Sri Lankan average is twice this amount.

The amount of oily food taken is very high. Especially in urban areas, the trend of having fast food over home-cooked meals is increasing.

How serious is it?

Fourth major cause of all deaths worldwide, with 5.5 million victims per year.

Four out of five deaths due to stroke occur in developing countries.

Fifth major cause of death in Sri Lanka, with 25,000 victims per year.

Is not confined to the aged, with 25 percent of victims below 60 years.

Exercise: An optimal amount of 30 minutes moderate exercise daily is essential both to be in shape and increase the overall health. This includes simple day-to-day physical activities brisk walking, climbing stairs and gardening. Reduction of tobacco consumption, or rather completely quitting smoking greatly minimizes the odds of a stroke. Statistics reveal that a majority of male stroke victims are smokers.

Policy measures: At times, such as in the case of tobacco consumption, education is not sufficient to bring forward changes. Therefore, policy measures maximize the odds.

What does the future hold?

As the theme for World Stroke Day, conveys, this is an issue all about us and what we, the individual can do. The basic and simplest method is to work towards achieving a healthy lifestyle, with a balanced diet, adequate exercise and quitting tobacco consumption. It is also essential that we educate ourselves regarding this issue as a means of greater national benefit.

The article is based on lectures delivered by Dr. Padma Gunarathne (Consultant Neurologist/ NHSL),Dr. Palitha Karunapema (Consultant Community Physician/ NCD Unit) and Sunil Samaraweera (Additional Secretary, Social Services and Social Welfare Ministry )at the seminar on strokes at the Health Education Bureau on last week.

Oral health

Oral health means being free of chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the mouth and oral cavity.

Causes of oral diseases

Oral diseases share common risk factors with the four leading chronic diseases, cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, including unhealthy diet, tobacco use, and harmful alcohol use. Poor oral hygiene is also a risk factor.

Oral health facts

The most common oral diseases are dental cavities and periodontal (gum) disease.

Around 60 to 90 percent of school children worldwide have dental cavities. Severe periodontal (gum) disease, which may result in tooth loss, is found in five to 20 percent of middle-aged adults; the rate varies across geographical regions.

Incidence of oral cancer ranges from one to 10 cases per 100,000 populations in most countries. Birth defects such as cleft lip and palate occur in around one per 500-700 of all births; the birth prevalence rate varies substantially across ethnic groups and geographical areas.

Around 40 to 50 percent of people who are HIV-positive have oral fungal, bacterial or viral infections, which often occur early in the course of HIV infection.

Traditional curative dental care is a significant economic burden for many high-income countries, where five-10 percent of public health expenditure relates to oral health.

How to reduce the disease burden

The burden of oral diseases and other chronic diseases can be decreased simultaneously by addressing common risk factors such as tobacco use and unhealthy diet:

Decreased intake of sugars and well-balanced nutrition prevent tooth decay and premature tooth loss.

Tobacco cessation and decreased alcohol consumption reduce risk for oral cancers, periodontal disease, and tooth loss.

Fruit and vegetable consumption is protective against oral cancer.

Effective use of protective sports and motor vehicle equipment reduces facial injuries.

Dental cavities can be prevented by a low level of fluoride constantly maintained in the oral cavity. Fluoride can be obtained from fluoridated drinking water, salt, milk, mouth rinse or toothpaste, as well as from professionally-applied fluorides. Long-term exposure to an optimal level of fluoride results in fewer cavities in both children and adults.

By using these prevention strategies, the high cost of dental treatments can be avoided.

Courtesy: WHO

Gene therapy cures congenital form of blindness

Exhilarated scientists on Saturday announced they had used gene therapy to restore eyesight to children blighted by a rare, inherited form of creeping blindness.

Youngsters were able to walk unaided around dimly-lit obstacles, take part in lessons at school without extra help, and one child saw the colour of his father’s eyes for the very first time.

The revolutionary treatment targets a disease of light-catching retinal cells called Leber’s congenital amaurosis, or LCA.

Caused by flaws in any one of around 13 key genes, LCA triggers severe loss of vision and abnormal eye movements in early infancy, usually leading to total blindness in the twenties or thirties.

Doctors led by Jean Bennett of the University of Pennsylvania School of Medicine tested a way of tackling this tragedy by inserting a corrective gene in a disabled cold virus.

Their study was published online by The Lancet on Saturday, coinciding with a presentation at a conference of American ophthalmologists in San Francisco.

The modified virus was injected into the eyeball, and infected the diseased cells, in effect, acting like a Trojan horse to deliver the right DNA to the retina. Twelve patients aged eight to 44 years were recruited in the small, experimental study, and were given the treatment in the eye that had the worst vision.

None of the patients recovered normal sight, but all of them had an at-least 100-fold increase in so-called pupillary light response, meaning the constriction of the pupil when exposed to light.

Six of the 12 recovered sufficient sight that meant they may no longer be classified as legally blind.

The best results were among four children aged eight, nine, 10 and 11.

All four gained vision that enabled them to walk unaided along a dimly-lit simulated street route.

“Another child, who since birth, could only see light and shadows, stared into his father’s face and said he could see the colour of his eyes. Later they played soccer together,” the university said in a press release. Normally reserved, the researchers used such words as “dramatic” and “spectacular” to describe the outcome, even though the trial is only a Phase 1 test, the first and most cautious level of a three-phase process to assess prototype treatments for safety and effectiveness.

AFP

Health and fitness

Here are few foods which help in fat reduction along with a stress free life and regular exercise.

Beans - rajma, green gram, horse gram, cow peas, chick peas and others.

Protein rich foods: dhals, low fat milk, nuts, seeds, beans and white meat. Fruits with high fibre and anti oxidants - pomegranate, apple, pear grapes, guava, papaya, pineapple, melons, peach and strawberries.

Whole grains - whole wheat flour, barley, oatmeal, quinoa, unpolished rice, unpolished rice flakes and broken wheat. Capsaicin in chillies are believed to be thermogenic food.

Green tea - catechin polyhenols.

The Hindu