Three people tell you what it’s like to experience a stroke, so that you’ll recognize one when it hits you. Better still, follow our advice so you’ll never fall victim to this insidious and disabling condition.
Bharat Nadl’s office overlooks a picture postcard swimming pool, complete with swaying palm fronds and inviting loungers. Yet ask him how often he takes a dip, and all Nadl can do is shake his head sadly. His duties as ( EO of The Juhu Sea Princess keeps him on the go all day. "Running a hotel is a 24 hour job," he says. "You cannot just hand over the day’s rota to the staff and expect them to do the needful. You’ve got to be there to see that it’s executed.~
Nadl enjoys his job and takes pride in being a hands-on CEO, leaping to snuff out the spark of a crisis before it gets out of hand, handles customer demands – and complaints – personally "because a hotel’s reputation stands or falls on the quality of service it offers."
Nadl (right) barely noticed – or rather wouldn’t acknowledge – the stress involved in all this wheeling, dealing and cajoling. But over the years his body responded to the pressures by stacking on the pounds, aided considerably by chronic inactivity and generous meals from t he hotel’s kitchens. The CEO, however, didn’t see his expanding girth as a ‘big’ problem. "Initially it was the arrogance of youth – I thought nothing will ever get me, then the complacence of middle age: I accepted the widening waist, and the High Blood Pressure and diabetes diagnoses, as a part and parcel of getting older. It seemed to me that nearly everyone got these conditions post SO, and I was just joining the club."
The hotelier popped the prescribed pills, got regular medical exams and thought he had a grip over his health quandaries.
But as time passed and work took priority, the regular check-ups fell by the wayside.
In September 2007 Nadl found himself "feeling a bit under the weather. "Walking to the next cabin left me fatigued, but staying confined to my desk made me restless. I had difficulty concentrating during conversations."
Suspecting that his blood pressure was acting up, Nadl made a mental note to check in with his GP. Unfortunately several days elapsed before the thought was put into action, as Nadl reached home late every day and "headed straight for bed, too spent to even consider a trip to the doctor."
But with each passing day the feeling of malaise only heightened. On S Ch October 2007, while on his regular rounds of the hotel, Nadl found his vision getting hazy. "I felt so shaky while walking that I couldn’t take the corners without knocking against the wall. I must have lost balance a dozen times and hit my head," recalls the CEO. ‘The 3 upper floors had taken on an entirely new aspect. It was as if I was on unfamiliar territory."
Returning to his desk, Nadl sank into his chair with a sigh of relief thinking the ordeal was over. But his eyes continued to play tricks. "My peripheral vision had blacked out. I couldn’t see the glass door at my side which under normal circumstances I’m keenly aware of, even when I’m immersed in my paperwork."
The little anomaly was to assume enormous significance. But Nadl merely thought his number had changed. A trip to the ophthalmologist found no difference in the CEO’s vision, and he was sent instead to an endocrinologist who ordered a blood sugar test. The report sent Nadl reeling. "My fasting number was a 34S mg/ dl! When I complained about my vision, the specialist packed me off to Dr P Ashok, neurologist at t he P D Hinduja hospital."
"Why haven’t you been taking care of yourself," remonstrated Dr. Ashok, the minute he was introduced to Nadl. Based on the hotelier’s explanation he suspected t hat Nadl had initially suffered a Transient Ichemic Attack (TIA). "Vision loss is one of the earliest clues of stroke or even an impending one," says Dr Ashok. "Any obstruction in an artery supplying blood to the brain or reduction of oxygen-rich blood in certain areas of the brain, can impair sight."
There was more bad news: A CT scan would have provided detailed view of Nadl’s brain, but his super sized proportions eliminated this option. Shockingly the MRI indicated thrombolitic stroke. Nadl had been walking around with a clot in one of his brain’s arteries for several days! ‘The stroke had occurred in the occipital lobe of the brain – the area responsible for vision and movement, which is why his judgment was affected even when he was touring familiar routes," explains Dr. Ashok.
Looking back, the news shouldn’t have come as a surprise. Nadl had 3 major stroke risk .factors – 4 if you count a previous history of heavy smoking. He’d quit only a few years back. He was also obese, had High Blood Pressure and diabetes.
Sometime in mid 2006 Bhupendra Chandra (right), 45, chartered accountant was walking towards the Mahim railway station when "suddenly I heard a piercing sound in my ears that penetrated my skull. It felt as if my head was going to burst from the pressure inside," recalls Chandra. He passed out on the sidewalk and found himself, 5 days later, in the ICU. The "thunderclap" headache was a clue that indicated he’d suffered a stroke. Like Nadl, Chandra was a high risk can did ate for the condition, weighing a whopping’ 20 kg, and having high BP and high cholesterol.
Former travel consultant Kalpana Asane, was 32 years old when she suffered a hemorrhagic stroke. Of course no one suspected stroke when this Vile Parle resident complained of giddiness and collapsed at her desk. The nearby maternity home turned her away. By the time Asane got help 4 precious hours had elapsed. Tests showed an artery in her brain had ruptured leaving her left side permanently paralysed. Her blood pressure had been an abnormal 225(200 at the time of the attack.
HOTHEADS
We Indians can rightly pride ourselves for being tops in a number of fields – chess, computers, cricket – but we can also claim the dubious distinction of being the stroke ca pital of the world. Extrapolating from statistics in developed countries, experts estimate that India may be seeing as many as 200 strokes for every 100,000 cross-section of the population. That’s an incredible 20 million strokes annuallyl Dr Ashok cites diabetes as the leading cause for these damning figures, and expects them to rise even more in the coming decades, given our susceptibility to the condition.
Yet you can beat the statistics if you take a few cruci measures right now, to change the course of your destiny.
Manage your blood pressure. One of the most important things you can do to reduce your stroke risk is keep your blood pressure under control. Even if you’ve had a stroke, lowering your blood pressure can help prevent a subsequent tran sient ischemic attack or stroke. The best ways to manage hypertension? Follow a low sodium diet, get some exercise, drop extra pounds (even a 10 per cent weight loss would do the trick), control stress, and most importantly, take your blood pressure medication religiously.
Lower your cholesterol and saturated fat intake. Go easy on the butter chicken, ghee and parathas. Eating less cholesterol and fat, especially saturated fat, will prevent plaque buildup in your arteries.
Don’t smoke. Quitting reduces your risk of stroke by a whopping 40%. Forget the sugar fix. If you have diabetes, stick to the straight and narrow – a high fibre, low refined carb, diet, exercise daily and take your medication. Strict control of your blood sugar may reduce damage to your brain if you do have a stroke.
Maintain a healthy weight. Being overweight contributes to other risk factors for stroke, such as High Blood Pressure, ca rdiovascular disease and diabetes. Nadl has shed 20 kg since his stroke with swimming and diet modification. Chandra is still struggling; the festive season keeps his weight yo-yoing between 103 and 113 kg.
Exercise regularly. Apart fromlowering your blood pressure and blood sugar levels, a daily sweat session helps increase your level of highdensity lipoprotein (HDL) cholesterol, makes blood vessels flexible and your heart stronger. It may also aid weight loss and stress control.
Manage stress. Stress can cause a temporary spike in your blood pressure – a risk factor for brain hemorrhage – or long-lasting hypertension. It can also increase your blood’s tendency to clot, which may elevate your risk of ischemic stroke. Simplifying your life, exercising and using relaxation techniques like yoga and meditation are all approaches that you can learn to reduce stress.
Drink in moderation, if at all. Alcohol can be both a risk factor and a preventive measure for stroke. Binge drinking and heavy alcohol consumption increases your risk of High Blood Pressure and of ischemic and hemorrhagic strokes. However, drinking small to moderate amount of alcohol can help boost your HDL cholesterol and decrease your blood’s dotting tendency. Feed your noggin. A brain-healthy diet should include:
• Five or more daily servings of fruits and vegetables, which contain nutrients such as potassium, folate and antioxidants that may protect you against stroke. (One serving equals 1 apple! banana,S to 6 french beans, half cup of leafy greens, cooked etc).
• Foods rich in soluble fibre, such as oatmeal and beans.
• Foods rich in calcium, a mineral found to reduce stroke risk.
• Soy products, such as tofu and soy milk, may help reduce your low-density lipoprotein (LDL) cholesterol and raise your HDL cholesterol level.
EMERGENCY, EMERGENCY!
When it comes to having a stroke, the saying. goes – "Time is brain." It’s an apt phrase, because once you begin to feel the signs and symptoms of stroke, the clock starts ticking. Bharat Nadl had made matters worse for himself by running to different doctors before getting help thereby delaying his treatment, and suffering partial vision loss.
Brain tissue is fragile material that constantly needs to be nourished by the flow of blood. Anytime this supply of blood is interrupted – as is the case with all types of stroke – brain t issue starts to die. In an emergency medical setting, numerous procedures may be tried to halt further brain damage, depending on the type of stroke. But time is of the essence. The longer it takes to receive proper medical care, the greater the risk of severe brain damage.
No matter what caused your stroke symptoms, getting to the hospital quickly improves your chances of survival and reduces the amount of disability that may result.
"One of the main reasons is that with ischemic stroke, you may be a candidate for one of several treatment methods used to clear away an artery blocking blood clot," says Dr Ashok. Most commonly,
this involves an intra-venous injection of the ‘clot busting’ tissue plasminogen activator (TPA) drug. This drug circulates throughout the body, eventually reaching and is solving the blood clot that’s causing the stroke."
However, for intravenous use, TPA is only a consideration if it can be administered within the first three hours after the start of symptoms. After three hours, the risk of bleeding outweighs potential benefits.
Fortunately, recent advances have led to interventions that extend this time window. One advance involvement is using X-ray imaging to guide the threading of a tiny tube (catheter) through arteries to the site of the clot where TPA is then given. This can be used in some situations up to six hours after the start of symptoms, and in certain cases even longer. Additional intra-arterial therapies include a catheter device with a tip that can be screwed into a blood clot like a tiny corkscrew, after which the clot can be withdrawn.
This device may be used with TPA, extending the window of opportunity to remove the dot up to eight hours in some people.
HEMORRHAGE CONTROL
Emergency treatment for a hemorrhagic stroke is typically provided in the intensive care unit. This allows for optimal medical management, including controlling headache, keeping blood pressure and body temperature under control, and preventing brain swelling, seizures or other complications. In some cases, neurosurgery to drain or remove a blood clot or a procedure to dose off a bleeding aneurysm may be warranted.
THE 2 STROKES
Strokes happen in two main ways:
The Blood Starved Brain. This is called an ischemic stroke, and accounts for about 80 per cent of strockes. Ischemic strokes are often related to atherosclerosis, the process of narrowing and hardening of arteries. This is frequently the case in the carotid arteries in the neck. Areas of atherosclerosis are prone to blood clot formation (thrombosis) which can cause artery blockage. Blood clots can also form elsewhere in the body such as in the heart due to a heart rhythm problem called atrial fibrillation and be swept downstream to block a narrower brain artery.
A blockage in the main carotid artery that supplies blood to the brain stem and the organ as a whole, can cause permanent paralysis and sometimes even sudden death.
The Bleeding Brain This is called a hemorrhagic stroke. Rupture of a ballooning weak spot (aneurysm) in an arterial wall is a common cause. Another is uncontrolled. High Blood Pressure, which can cause small arteries inside the brain to become brittle and susceptible to cracking and rupture.
WARNNING SIGNS
Call for emergency help if you or someone nearby suddenly experiences one or more of the following:
Confusion, trouble speaking or understanding or slurred speech
Numbness or weakness or the face, arm or leg, especially if all these occur on only one side of the body. “No one thinks of constipation as a sign of stroke,” says Dr. Ashok. “But when it happens in association with numbness it’s something that needs to be looked into, because they could be a sing of a transient ischemic attack. A TIA ups the likelihood of your suffering a full blown stroke by 6% with each passing year.”
Vision trouble in one or both eyes, or double vision.
Sudden unsteadiness, dizziness, loss of balance or loss of coordination.
A severe, “thunderclap,” headache or an unusual headache with no apparent cause.
ARE YOU AT RISK?
Stroke is in your destiny if you are overweight have High Blood Pressure have diabetes have a family history of the condition have high cholesterol smoke
ADVANCES CONTINUE
Developing new agents to break up blood clots is a key in emergency stroke care. A major trail is being done on ancrod, a drug derived form the venom of the Malayan pit viper. It can be administered up to six hours after stroke symptoms begin. Another clot-busting drug being tested V10153-has a nine-hour treatment window. It also has the advantage of being active only at the site of clot formation, therefore reducing the risk of unwanted bleeding.
Trials are also being down on inducing hypothermia to slow down the cell damage that occurs in the hours after a stoke begins. Numerous drugs that may have a damage slowing effect on brain cells also ate being tested.
Brain Drain
Depending on how much time the brain suffers from lack of blood flow a stroke can bring in certain permanent disabilities like
Paralysis or loss of muscle movement. Lack of blood flow to the brain can cause a person to lose control of certain muscles.
Difficulty talking or swallowing. A stroke may cause a person to have less control over the way the muscles in the mouth move, making it difficult to talk, swallow, eat or speak. Speech therapy may be an alternative with medication.
Memory loss or trouble with understanding. It’s common that people who suffer strokes have some memory loss. Others may develop difficulty understanding concepts, This complication may improve with rehabilitation therapies.
Pain. Some people who have a stroke may have pain, numbness, or other strange sensations in different parts of their body.
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