FAQs on Stroke
Yes, because the basis of atherosclerosis is still not understood. Also if there is a hereditary element this cannot be modified by modification of risk factors. However, by taking precautions, one can definitely delay the occurrence of stroke to a later age. Though stroke is highest in the 65 years plus age group, stroke can occur at any age.
Birth injuries, infections and inflammations can cause stroke in babies. Children with congenital and other types of heart disease, some genetic vascular abnormalities likely to increase blood clotting are prone to get a stroke. Young adults with hypertension, and often associated with smoking get a stroke. Women in the child bearing age are at risk from stroke if they have hypertension, are on oral contraceptives without medical supervision, during pregnancy when they are vulnerable to hypertensive disorders and clots in the venous system called cortical venous thrombosis
Age above 65 years is the highest risk factor. Hypertension especially if untreated or paroxysmal is a definite risk factor. Diabetes, Obesity, Smoking, Alcohol consumption especially binge drinking, cardiac disease, rhythm abnormalities of the heart and primary blood disorders can all predispose to stroke
Stroke is otherwise known as a brain attack and like a heart attack can occur at any time to anyone. Some risk factors however, make one more prone to stroke and some of them can be modified to reduce the risk of a brain attack. Regular medical check up at least once in 2 years above the age of 40yrs will help early diagnosis of high blood pressure and diabetes mellitus which are risk factors for stroke
Stop smoking now !
If you take alcohol, restrict it to one drink a day or less. Stop if you can
Eat foods which are low in fat and cholesterol
Reduce your salt intake – animals remain quite healthy without added salt to their diet !
Regular physical activity improves cardiovascular fitness and reduces stroke risk.
Maintain ideal body weight. If you are more than 10Kg over ideal body weight for your age and height your risk of stroke doubles.
Some factors unfortunately are not under our control. Age above 55 years, previous history of heart disease or stroke, family history of stroke or heart attack all increase the risk of stroke.
Early diagnosis and treatment of stroke can save life and reduce disability. If anyone you know shows signs of a stroke act immediately and rush them to hospital as quickly as possible.
Remember BEFAST
B for balance problems E for loss of vision F for facial asymmetry A for arm weakness S for speech difficulty T is for time as time is brain and it is important to remember that minutes save lives.
Early intervention improves chances of recovery. The sooner a patient reaches a comprehensive stroke centre after onset of symptoms the more chances or treatment is possible. If the patient comes with four and a half hours, a clot busting treatment called tPa can be given for suitable cases and this saves life and reduces disability. Sometimes a mechanical breaking up of the clot is also possible. In general embolic infarctions recover well. If the haemorrhage is limited , stroke due to haemorrhage also improves quite well in 6 to 8 weeks as tissue destruction does not take place.In the acute phase however, if the haemorrhage is large and especially in the lower part of the brain (Cerebellum) it can be fatal. Thrombotic infarctions, especially if early treatment is not done almost always leave behind a variable degree of disability.
The limbs of the opposite side of the body may be paralysed. There may be reduction in the sensation on the opposite side of the body sometimes. In most left brain strokes, speech and language are affected and this may even be permanent. A visual disturbance called hemianopia where only half the field of vision is normal may occur. In large infarctions, intellect, memory and higher mental functions can be affected.
Limb paralysis may occur on the opposite side of the body and is often less dense than in an anterior circulation stroke and does not usually involve the face and speech. Speech disturbance when present is often in disordered articulation and swallowing and not in language. Disturbances of eye movements, sensation, motor co-ordination and vital functions like breathing, blood pressure, etc are more frequent with posterior circulation strokes.
Even if fully recovered after a stroke, the factors which caused the stroke in the first place will still be there, eg. Hypertension. This needs regular check up and adjustment of drugs by the doctor, at least once in 6 months as a routine, or whenever there is a problem.
As for the drugs prescribed, they are often required to be taken lifelong. Often when the blood pressure or diabetes is controlled by medication, one feels that one is cured of the condition and patients discontinue drugs. Hypertension and Diabetes are lifelong illnesses which can be controlled as long the medication is taken. In thrombotic strokes blood thinners and drugs to manage lipids (fats) will also be given. In embolic strokes sometimes long term anticoagulants may have to be given.
Strokes caused by carotid occlusion by a thrombotic plaque can be treated surgically. The procedure is called carotid endarterectomy and involves removing the obstructing thickened plaque. Sometimes, if there is severe narrowing, and poor collateral blood supply from the opposite side, this may be combined with a bypass using a teflon graft. Strokes caused by aneurysms and arteriovenous malformations are treatable by radiosurgery (using Xrays in a focussed manner to destroy the vascular malformation) and by microvascular neurosurgery, where the malformation is carefully dissected and removed. When a stroke is due to an intracranial haemorrhage and the haematoma is causing pressure symptoms, it may need to be operated and removed surgically.
Yes . Aspirin produces reduction in platelet stickiness or aggregation. This is done by blocking the production of endoperoxides and thromboxanes which mediate platelet aggregation. The ideal dose of aspirin necessary to prevent stroke has not yet been determined. It has been found useful in reducing the risk of recurrent TIA's and stroke in males who have had a TIA. It is also useful to reduce stroke risk in patients with nonvalvular atrial fibrillation, which can predispose to stroke.
Aspirin is used in stroke prevention as an antithrombotic drug. Other drugs of this group are Clopidogrel (Plavix), Dipyridamole (Persantin),Ticlopidine (Ticlid).
Anticoagulants interfere with clotting mechanisms and are used to prevent intravascular coagulation (clotting of blood within the blood vessel).They are given to prevent embolism in conditions like atrial fibrillation and myocardial infarction (heart attack).They are sometimes given for people with TIA's to prevent recurrence of TIA/stroke. Drugs commonly used are heparin (injections usually used only in the acute or subacute stage), Warfarin ( tablets to be taken daily over a long time). Since these drugs interfere with clotting, there is a risk of bleeding. It is important to observe the urine for pinkish colour, which will indicate microscopic haematuria ( minimal bleeding ). Bleeding in the stools, excessive menstrual bleeding, haemorrhages in the skin (petechiae), excessive bruising, persistent oozing from superficial injuries can occur with prolonged use as a side effect. It is therefore important to have tests which check clotting (eg prothrombin time) done at regular intervals to detect in time an increase in bleeding tendency. While on anticoagulant therapy, it is advisable to avoid intramuscular injections,as far as possible.
Aging Well
Dr.Prithika Chary, Consultant Neurologitst & Neurosurgeon
“Habits that are established young in life may help determine how healthy you will be in old age. Maintaining good habits and positive attitudes is what we should all be aiming for. Once a couch potato does not mean always a couch potato. It’s never too late to establish good habits, but it’s never too early either.” – a report from .
The NIH Word on Health, June 2002.
Successful aging — a term coined by MacArthur Foundation researchers is well within your grasp. What does it require? The desire and means to sidestep disease, sustain a high level of mental and physical function, and engage actively in life. It is not just about living longer, it is about living better. Successful aging is about quality of life, not just the number of years lived
Healthy aging = Independence + Dignity + Choice
What does a person’s ‘age’ really mean? It does count the number of years lived, but as we continue to live longer, we need to watch how well we are living and how successfully we are aging, A chronic illness may be considered unhealthy but, if managed properly, the person suffering from that illness may be able to lead a normal, healthy life, A healthy lifestyle will have a positive impact on a person at any age. Proper diet, exercise and preventive healthcare are three primary means to maintaining your physical health.
Successful aging is also tied very heavily to a person’s mental health. Just as with physical health, decline in mental health is not a consequence of growing older. Keeping the mind active through stimulating activity such as reading or word games or even talking with friends and neighbors about a current news event helps keep the mind agile. Sharing and caring about others builds up a good support system.
If you live to celebrate certain milestones of age, your life expectancy expands . On average, a 65-year-old has roughly 18 more years to live, while a 75-year-old has about 11 years longer. In other words, the longer you live, the longer you’re likely to live. The oldest old are often remarkably healthy. Longevity without quality of life is not necessarily a desirable endpoint.
Aging depends on multiple factors – genetic makeup and heredity, health history, environment, personal nutritional and health habits, financial resources, activity level, and attitude
The key to successful aging is a healthy, common sense lifestyle.
- Visit your doctor regularly.
- Participate in activities that stimulate your brain, such as reading, crossword puzzles, playing bridge, and other mental exercises
- Manage stress through techniques such as relaxation, meditation and yoga.
- Treat depression. Depressed elders have higher rates of dementia, lower quality of life and higher rates of death.
- Treat depression. Depressed elders have higher rates of dementia, lower quality of life and higher rates of death.
- Exercise daily, such as walking 30 minutes per day. Physical activity significantly lessens the chance of cardiovascular complications that could cause dementia..
- Control hypertension, diabetes and heart disease—risk factors for dementia—through physical exercise, quitting smoking, controlling blood pressure, lowering cholesterol, and avoiding obesity.
- Follow a healthy diet and take vitamins, including vitamins C and E, and folic acid.
- Limit alcohol consumption. Alcohol has a direct toxic effect on the brain that adds to the loss of nerve cells and synapses.
What can you do to age successfully ?
Your road map to healthy aging is good nutrition, adequate physical activity, accident prevention, medication safety, taking right precautions with the weather, and socializing
Don’t Retire: Get a Part-time Job or Volunteer
Treat your brain like any other muscle – exercise it. Working or volunteering in a complex environment can provide challenging problem-solving opportunities for older adults to flex their mental muscles.
Social Support Network
Isolation is a powerful risk factor for poor health so it’s extremely important for seniors to develop a support network of friends, family and others before a crisis occurs. Support comes from many sources and from all age groups, successful agers learn how to ask their support network for help and accept help when needed.
Relationships are Essential
Humans are social beings, developing connections with others that are often maintained over a lifetime. Not only do successful agers maintain close relationships with family and friends, but they also develop new relationships by participating in their community.
Resilience and Adaptability
Maintaining a flexible attitude helps successful agers bounce back from life’s misfortunes. This ability to make changes as we age helps us maintain a balance in life and enables us to transition as function declines.
Keep Playing
Successful agers cultivate their interests (particularly non work-related ones) before retirement. Engaging in fun activities enlarges your circle of friends, creating a support network and helps you keep a healthy, happy outlook toward life.
Healthy Habits
Eat healthy and exercise. Quit bad habits. Drink in moderation and stop smoking. If you’re struggling with health habits, find a role model and observe their habits.
Keep Learning
Retirement doesn’t mean retreating from the world. It’s a time to learn new skills and interests. Aging people with new interests have more positive experiences.
Healthy Attitudes
Positive attitudes are essential for successful aging. Negative attitudes contribute to physical and mental illnesses which reduce life span and quality of life.
Maintaining Autonomy
A sense of choice is essential to successful aging. Individuals who learn how to maintain their independence as their life changes will age successfully. Successful aging includes vibrant faith in our ability to make the best of life. Sooner or later, all persons begin to dwell on the fact they are aging. How they handle or act upon their thoughts determines the outcome.
- If you are 30, quit smoking and alcohol, start walking, getting enough sleep ,eat the right foods, keep learning something new and be resilient – learn to bounce back from the bumps of life and enjoy life with enthusiasm and energy,
- If you are 40 do all of the above and have a health checkup to enable early detection of chronic disorders like hypertension and diabetes mellitus which can be controlled.
- If you are 50 do all of the above and have a cancer screening and bone densitometry done
- If you are 60 do all of the above and do not retire from life – keep both body and mind alert and active. Retirement is the best time to stop acting your age. Take care to avoid falls and loneliness.
- If you are 70 do all of the above and celebrate the fact you made it this far with good quality of life. Share your love and wisdom with others.
- If you are 80/90 or above do all of the above and congratulations on aging successfully ! “Old age to the unlearned is winter time, to the learned it is harvest time” – Old Yiddish proverb
Talk for Lioness Assembly
Sincere Friendship
- Friendship. It’s something many people take for granted.
- They are unaware how powerful and positive friendship can be, or they would take it more seriously.
- The right friends can help you feel worthwhile. The right friends can even help get you elected president. Friendship improves your health.
- School, work, parenting, and even old age are better and more fun when shared with friends.
- “Friends are angels who lift us to our feet when our wings have trouble remembering how to fly.”
- “Make new friends but keep the old; one is silver, but the other’s gold.”
- Whether the need to form new friends is caused by a change in interests, a move to another city, a promotion to another level or into another profession, or the death of old friends or even of a spouse, shifting to new friendships that serve current needs makes it possible to feel connected even if old friends are seen less frequently, if at all.
- The variety of roles that we must play throughout our life–as student, worker, spouse, or parent–changes, as does the place that friendship holds in our life.
- But we still need friends, ranging from casual to close or best friends, and of both sexes. Friendship plays a continual role, although at different stages it will be less or more important to our emotional stability, depending upon the other primary attachments in our life.
- Even if you are lucky enough to be raised in a very responsive and loving family, it is inevitable that you will someday leave home.
- But friends-old friends whom you have cultivated over the years or newer ones whom you develop in your new communities-will always be available to you for affirmation and companionship.
- Friends can be a source of self-esteem, affection, and good times. In times of despair, friends offer hope
- A class of youngsters in California in 1993 shaved their heads so their friend and classmate, who was undergoing treatments for cancer, would not feel self-conscious about his bald appearance. His dozen friends kept their heads shaved until they learned their friend’s cancer was in remission
- What a glorious relationship friendship proves to be, where trust, honesty, faithfulness, loyalty, being a good listener, having ideas in common, and love are what count. These are all traits or feelings you can acquire.
- Age, attractiveness, and intelligence, largely a question of birth and luck, are considered unimportant for a close friendship
- Friendship is like a flower – it needs care and nurturing to grow, it has to be handled delicately or it can get crushed, it is beautiful to behold, soft and gentle, and the experience is a delicate but pervasive fragrance, which surrounds you with its goodness.
- Your friend is the field where you sow with love and harvest with gratitude. He is your home, he is your table. Even when he is silent, two hearts continue to talk. When you have to leave him, don’t suffer, for you will see the importance of the friendship all the better because of its absence.
- Just as a mountain climber sees the landscape around him better when is far from the plains.Let him know and share not only your moments of joy but also your moments of sorrow. And know that a friend is not by your side to help you kill the time, but rather to help you enjoy life in all its fullness. – Khalil Gibran
Just as a mountain climber sees the landscape around him better when is far from the plains.Let him know and share not only your moments of joy but also your moments of sorrow. And know that a friend is not by your side to help you kill the time, but rather to help you enjoy life in all its fullness. – Khalil Gibran
Selfless Service
- The man who serves the world really serves himself.
- That man who helps others really helps himself.
- When you serve a man, when you serve your country, always think that the Lord has given you a rare opportunity to improve, correct and mould yourself by service.
- Be grateful to that man who has given you a chance to serve him.
- Selfless service is an antidote for anxiety, depression, loneliness, and other manifestions of being cut off from the universe that nourishes us.
- Why is selfless service effective? Because most of our “self” is in others!
- Only a higher love can replace a lower love. Only by replacing a desire for personal gratification with a desire for elevating someone else can the spinning mind regain control
- Selflessness cannot be rationed out.
- It cannot be restricted by giver or recipient.
- If we want to be free, we have to let it flow freely.
- Dedicating a few hours a day or week to helping others and focusing on personal needs the rest of the time is only the first step in the right direction.
- It does not give the sense of freedom that comes from total trust and surrender to your inner gyroscope which tells you how, when, and where to serve.
- True selfless service is 100%, all the time.
- Karma Yoga is selfless service unto humanity. The important point is to serve humanity without any attachment or egoism.
- A Karma Yogi should be absolutely free from greed, lust, anger and egoism. Then only he can do real useful service.
- A Karma Yogi should have an amiable, loving, social nature. He should have perfect adaptability, tolerance, sympathy, cosmic love and mercy. He should be able to adjust himself to the ways and habits of others. He should have an all-embracing and all-inclusive heart
- When the thought of doing good to others becomes part and parcel of a man’s very being, then he will not entertain any least motive at all.
- He takes immense delight in serving others, in doing good to others. There is peculiar joy . He gets inner spiritual strength and power by performing motiveless and selfless actions.
- Never underestimate the power of your actions.
- With one small gesture you can change a person’s life. For better or for worse.
- God puts us all in each other’s lives to impact one another in some way.
- Look for God in others.
- Serving God in every human form is the service at its best. It glorifies the human as a divine and dignified being, and is the most rational and effective way to eradicate many social evils and deficiencies.
The Myths of Menopause
SHIVANI ARORA
Menopause is one of the most important stages of a women’s life. But this stage is often dreaded by most women, who don’t really know the beauty of this period. There are several myths regarding this stage and Dr Prithika Chary, consultant neurologist Apollo hospitals, dispels a few myths about menopause. She is interested in women’s health and set up the women’s health centre for Apollo Hospitals, Chennai. Dr Prithika is the chief resource person of Creative Karma, her own initiative, through which she does life enhancing workshops, seminars and talks on the influence of the mind and brain on health.
How exactly do you view menopause?
A women’s life goes through many stages, the important ones being puberty or the beginning of menstruation, child birth and menopause. Physiologically puberty marks the beginning the menstruation or the monthly periods and menopause marks the end or the cessation of periods. Unfortunately most women consider menopause as a negative milestone in their life. But I as both a doctor and a woman, believe that it is both psychologically and physically a freedom. It is a freedom to do what they have always wanted to do, like pursuing a hobby, socializing etc.
What happens during and after menopause and how does one deal with it?
Dealing with menopause is very attitudinal. If one has the right attitude and believes that menopause is just as natural as puberty, they may be able to deal with it easily. People with a positive attitude may not experience hot flushes at all, and if they do it is easier for them to manage. Very few women require medical intervention to deal with mood swings. A good support system at home itself is helpful in dealing with mood swings. Other risk factors have to be dealt with specifically. Post menopausal women require good amounts of calcium and dietary calcium alone is not sufficient. Oral calcium supplements are required. Regular exercise is also important for post menopausal women to manage their weight. It is also emphasized that a woman who has attained menopause should be given the same amount of importance as men when they visit a cardiologist, as the risk of heart disease is equal.
How does one look at the positive side of menopause?
It is very important to look at the positive side of menopause. I always believe that menopause is a freedom to be yourself and do what you always wanted to do. Jokes have been made about this stage and people don’t consider it natural. It is important to consider it just as natural as any other stage in one’s life. Cessation of menstruation frees a woman of the cycle. She is not bound by the fear of child birth and this enables her to express her sexuality better. Instead of getting into an emptiness syndrome she must get into a freedom mode and chase her dreams. I believe that 60 is an age of re direction and not retirement. Women are lucky that they get the indication of redirection a good 10 years ahead of men!
Menopause is indeed a stage of freedom in life. You can enjoy this freedom if you have the right attitude and follow the basic rules of good health like eating right, exercising regularly, getting adequate sleep and of course having good support from the family. Immerse yourself in life enhancing activities and enjoy them with positive enthusiasm and you will develop a new dimension of wellness.
TIPS TO STAY HEALTHY DURING MENOPAUSE
- Have a positive attitude and look at menopause as a freedom.
- Save your bones- get adequate calcium both from diet and supplements.
- Do not give up drinking milk fearing weight gain.
- Maintain an ideal body weight.
- Exercise required- cardio exercises, strength training.
- Have a positive attitude and look at menopause as a freedom.
- Get adequate sleep
- Make sure you have good support from family and friends.
- Do not isolate yourself and just enjoy this phase of life .
ACTIVITIES RECOMMENDED AFTER MENOPAUSE
- Travel.
- Train yourself in some skill you missed out at an earlier age because now you have the time, the affordability and it diverts the mind and gives you a sense of achievement.
- It is time for social networking and bonding with friends.