IN the United States, one person is diagnosed with a stroke every 40 seconds. This dreaded and debilitating illness is so common it victimizes more than 2,000 individuals each day and killis about 133,000 each year. In the Philippines, the prevalence is between 1.9 to 6.59 percent.
I have friends who had developed a stroke of one type or another, with varying degrees of severity. It is a life-changing ailment that adversely affects the life of the entire family involved, especially the spouse. If the victim is the breadwinner, the devastation is even greater.
Prevention is best, and luckily about 80 percent of stroke is preventable, but when it happens, speedy diagnosis and treatment spells the difference between full or partial recovery, minor or major residual disability. Stroke is the fifth leading cause of death in the United States and the leading cause of major disabilities among adults.
What are the types and causes of a stroke?
To simplify it for our layman readers, the most common two types and causes of a stroke are artery blockage or bleeding. Arterial obstruction (carotid “neck” artery stenosis) is due to arteriosclerosis (hardening of the artery), which could cut off circulation to the brain.
The other form of arterial blockage is from a clot coming from the heart moving up to block a brain artery (usually among persons with atrial fibrillation, where the left upper chamber of the heart quivers instead of beating normally, thus accumulating clots in the left atrium, which could break off and flow upwards to obstruct the brain artery). The second type of a stroke is caused by bleeding on top of the brain from a fall (trauma) or bleeding within the brain tissues itself, which is more dangerous.
What is Atrial Fibrillation?
Popularly known as A-Fib, atrial fibrillation is the most common type of heart irregularity. Some are related to heart valve disease. About 6.4 million Americans have A-Fib not related to any heart valve problem. A-Fib increases the risk for a stroke by five times.
The actual cause of A-Fib is not clear. It is more common among seniors and 10 percent of adults 80 years and older have A-Fib. The patient may have no symptom at all and not know they have A-Fib. The common symptoms are tiredness and shortness of breath. Most patients feel their heartbeat skips once in a while.
A-Fib won’t go away on its own. To reduce the risk of heart failure or a stroke, medical consultation is mandatory.
What is TIA?
Transient Ischemic Attacks (TIA) is the temporary episode of a mild stroke that disappears rapidly. This is caused by spasm of an artery to the brain or by a tiny soft clot that blocks an artery to the brain, which dissolves spontaneously, allowing normal circulation to resume. TIA is a warning, and immediate medical attention is warranted. The various imaging studies available for carotid arteries (located on the left and right side of the neck which supply blood to the brain) include ultrasound (and doppler), and if these are not diagnostic or clear, one of the following may be used: angiography, magnetic resonance angiography (MRA), and CT angiography.
What is carotid endarterectomy?
When a person develops TIA or a mini-stroke and confirmatory tests show there is significant blockage in one or both carotid arteries, the calcified plaques blocking these neck arteries could be removed by a surgical procedure called carotid endarterectomy. This is a brain-saving procedure which must be performed reasonably urgent, in accordance with the evaluation of the surgeon, before a major or massive stroke follows.
Can a lay person diagnose a stroke?
A non-medical individual, actually anyone at the scene, could make a rapid diagnosis using the acronym FAST. In most articles, this stands for Facial drooping, Arm weakness, Speech difficulties, and Time to call emergency services. For me, I prefer T for Tongue deviation, all four letters to represent physical abnormalities. Calling 911 for emergency rescue is vital. But any two of the above four signs are enough to suspect a stroke. Facial drooping becomes evident when you ask the person to smile. Comparing the strength of the two arms will show you which side is weaker. Asking the patient to talk will reveal slurred speech or inability to talk.
The tongue usually points to the side of the facial droop and the weaker arm, opposite the side of the brain affected. The right side of the brain controls the left side of the body, and the left half of the brain, the right side of the body. The active dynamics of the pathology must be assessed without delay and treatment started immediately. Brain cells could die within minutes. In a stroke, every minute counts.
Do you have the risk factors for a stroke?
Genetics is one, but since we cannot alter our genes as a standard of care for stroke prevention with our current science and technology, there practical strategies we can apply to minimize the risk for the development of a stroke. Someday, preventive genetic engineering and manipulation for all diseases will be available. In the meantime, here are some tips to greatly reduce the risk for having a stroke, heart attack, and even cancer, basically by living a healthy lifestyle or making necessary lifestyle changes.
• Eat healthy, mostly fish, vegetables of various colors, nuts, and some fruits. Minimize intake of red meats (especially processed foods, which are toxic to the body) and cut down on carbohydrates, like rice, bread, sweets in general, which catapults the risk for T2 diabetes. The Philippines has one of the highest rates for T2 diabetes in the world, courtesy of “kanin.” The no-rice high-protein legume and vegetable diet is now becoming very popular and a trend.
• Drink about eight glasses of filtered water daily. Stay away from soft drinks which are toxic and increase the risk for metabolic syndrome for children and adults. Any form of this “liquid candy” causes eight gain and is harmful to the body.
• Do daily exercises. Simple brisk walking for 30 minutes each day improves overall health by strengthening muscles, equilibrium and balance, and boosts the immune system, and ward off major illness, including Alzheimer’s and even cancer.
• Practice stress management with R&R, even at work, and especially during the weekend with the family
• Discontinue tobacco use and take alcohol beverage in strict moderation. These two items are the causes of most of our infirmities today. They are not worth developing a stroke or heart attack for.
• Regular medical and dental check-ups are essential. Take your medications religiously and follow the advice of your physician, including a low-fat, low carbs, and low-salt diet.
Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]