Stroke kills but can be prevented
by Dr Harinder Singh Bedi

UNLIKE cancer and heart disease, which are extensively publicised, public knowledge of strokes is negligible. Yet strokes are an important cause of death, afflicting approximately half a million people in developed countries.

Most people know the risk factors that lead to heart disease such as high cholesterol and high blood pressure and diabetes. Stroke shares many of these risk factors — in fact, the two diseases coexist quite often and may have to be tackled at the same time. The modifiable risk factors are high blood pressure, cigarette smoking, diabetes mellitus, high blood cholesterol and lipids, physical inactivity, obesity and the presence of heart disease.

The figures present quite a grim picture. Last year there were 7,50,000 full-fledged strokes in the US and half a million transient ischemic attacks (TIAs) or ministrokes. The ministrokes are more of a concern because they may at times be ignored by the patient, but they are the harbingers of a deadly stroke and timely treatment provides dramatic relief.

The cause of a ministroke is generally temporary interruptions of blood flow to the brain. The symptoms last from a few seconds to 24 hours.

They do not themselves cause permanent neurological damage but are precursors of a major stroke. They need a quick diagnosis and treatment as well as appropriate follow-up to prevent future injury.

Ministrokes are often under-diagnosed. A US National Stroke Association study shows that 2.5 per cent of all adults aged 18 or older (about 4.9 million people) have experienced a confirmed TIA. An additional 1.2 million Americans over the age of 45 have most likely suffered a ministroke without realising it. Again though we do not have reliable data for the Indian population, we must learn from these grim figures. These findings clearly show that if the public knew how to spot the symptoms of stroke, specially ministrokes, and sought prompt medical treatment, thousands of lives could be saved and major disability could be avoided.

The problem is that the symptoms of a ministroke may be subtle and temporary. The symptoms to watch out for are:

• Trouble seeing in one or both eyes.

• Numbness or weakness in the face, arm or leg specially on one side of the body.

• Difficulty in walking, dizziness, loss of balance or coordination.

• Confusion and difficulty in speaking or understanding.

• Severe headache with no known cause.

A TIA precedes a stroke in more than 20 per cent cases. A TIA is actually a brief stroke that has virtually all the symptoms of a major one, though it does not cause any permanent damage. But it is a dramatic advance warning that a full-fledged stroke may occur. A TIA patient is 16 times more likely to have a stroke than otherwise. If you have any of the above symptoms you must immediately see a doctor. People who ignore these symptoms in the hope that it will pass after a good night’s sleep can land up in serious trouble in the form of a major stroke, which could have been prevented. So, TIAs are extremely important stroke warning signs. Don’t ignore them! Treat them as a life-threatening emergency. Even if a full-blown stroke is in progress treatment by clot-busting drugs (if indicated) within three hours will greatly reduce the severity of the stroke.

One of the most important causes of a stroke or ministroke is a blockage in the artery to the brain — the internal carotid artery. The block is of a cholesterol plaque or atheroma. The disease is called carotid artery stenosis and it affects the artery as it courses to the brain under the muscles of the neck. It can be easily diagnosed by a thorough examination and a simple test called a carotid doppler.

In this the doctor is able to look for a block by a simple scanner called doppler which is applied over the neck. There is no injection or anaesthesia required for this test. If the block is more than 75 per cent and the patient is symptomatic, surgery is indicated.

The treatment is by a delicate but very simple and effective procedure called a carotid endarterectomy. Simply put, the doctor removes the block in the carotid artery and repairs it. It can be performed under local or general anaesthesia and takes less than half an hour to perform.

During surgery while the artery is clamped to repair it, blood supply to the brain may be maintained by the use of a shunt, which temporarily bypasses the block. For the repair the surgeon may use a piece of vein from the patients own leg or a special biocompatible cloth (Dacron or PTFE — polytetra-flouroethylene). Special magnifying loops and very fine sutures, which are not readily visible to the naked eye, are used for the repair.

The results are very gratifying as the risk of developing a major stroke is dramatically reduced. Roughly, out of a population of a million people, there are about 50-100 people who would benefit from carotid endarterectomy.

When severe disease coexists in the heart and the brain, the two systems may be tackled at the same sitting in a major operation called combined carotid endraterectomy plus bypass surgery. The author has one of the largest series of this procedure in India with results matching international standards. The series has been presented at various international conferences and, in fact, some techniques developed in Punjab have been published in medical journals and used by other surgeons also.

In spite of having excellent results with this surgery, it is still emphasised that a stroke is quite easily avoidable . You can greatly help yourself by simple ways of changing your lifestyle:

• Quit smoking

• Reduce alcohol intake to no more than one drink a day (if at all)

• Increase your physical activity, perform regular aerobic exercises

• Control blood pressure by regular medication

• Control diabetes

• Practise yoga

Stroke is thus not an unavoidable certainty of life. It is not the "stroke" of luck. Nearly 80 per cent strokes can be prevented and the morbidity and mortality associated with this disease can be greatly reduced by lifestyle changes, control of the risk factors and surgery where indicated.

How to look 30 at 50
by Dr Ravinder Chadha

AGE is a state of mind, a fact of life. An individual is known to attain the maximum physical strength at the age of 30 years and then the body starts declining because of physical inactivity, an increase in weight and slowing of metabolism. Those working in the offices get promotion in the jobs, which involves more of deskwork and lack of physical activity. The only way you can look and perform like a 30-year-old when at 50 is to develop Power.

Power is the ability to increase your muscle strength with simultaneously improving control. Power is one of the important components of fitness apart from speed, stamina and flexibility, and it becomes even more important with age.

Aging is associated with following changes in the body:

• Muscle strength decreases especially after 60 years.

• Bone mass declines after peaking in the second and third decades, especially in women after menopause. It is difficult to build bone mass in later years but with physical activity, the rate of loss can be reduced.

• Aging causes reduction in the cardiac muscle size thereby reducing cardiac output.

• The decreased elasticity of the blood vessels may increase systolic blood pressure in the elderly by 10mm Hg.

• The pancreas’ release of insulin becomes slow, leading to an increase in the body’s sugar level.

• There is a decrease in synovial fluid, thinning of articular cartilage and a decline in ligament flexibility leading to osteoarthritis of the knee and other joints.

• Age also slows down the reflexes, decreases the metabolic rate and most people become overweight due to physical inactivity, but there is also the associated muscle loss.

Power is not just all about body building. It also increases one’s strength so that one can climb stairs without exhaustion, add speed to one’s walk and carry weight easily.

An elderly person finds it hard to get up from a chair due to the lack of muscular strength in leg muscles. The decrease in the strength in old people is considered to be due to disuse rather than the aging process.

Power can only be developed by slowly increasing your aerobic activity and strength training.

Therefore, pushing your body a little harder than you used to do can strengthen fast twitch fibres in the muscle. In our body, there are fast twitch fibres, which help us in quick movement, and slow twitch fibres which aids less intense activity.

As one grows, one tends to it easy and not to push too hard which leads to the slowing of fast twitch fibres.

To estimate the effectiveness of fast twitch fibre, we should assess the speed of the walk and compare it with the time taken in the past. If speed has decreased it denotes an initiation of loss in power, as strong muscles are required to lift the leg for each step.

In order to stay physically active beyond 50 years it is imperative to start resistance exercises to improve power. One needs to work at a greater intensity than one is to, even if it is just for a few minutes at a time. Increase in the intensity of your aerobic workouts like increasing speed for 1/2 km in a 2-km walk. Every week the distance of 1/2 km can be increased. Similarly, the speed on a stationary cycle or in a swimming pool can be gradually increased.

Remember to move fast within your limits but stay in control.

The body will take a few weeks to adapt itself to the type of training and the nature of the overload/train, which is put on the muscles.

Strength training improves power, bone strength, lean body mass, glucose tolerance and gait. Resistance exercise means training/working with weights, which requires more physical strength.

It can benefit people of all age groups. Some people are reluctant to work with weights as they believe that lifting weight will cause rapid muscle growth in a short span, which is not true.

However, resistance training is an indispensable part of the fitness programme when combined with aerobic
training.

To improve power is to start strengthening with lightweights/ resistance tube/ band three times a week. Today elastic resistance tubes or bands are being used for weight training. These tubes/bands come in different colours according to their strength and flexibility and are easier to carry while on vacation or business trip. The following points must be kept in mind for power training:

1. It is important to follow a balanced programme of exercise that involves legs, chest, back, shoulders, arms and abdomen.

2. Start working with light resistance and ensure that a correct technique is maintained when doing each exercise. Lighter resistance load and more repetitions should be undertaken to increase strength. This method decreases the chances of injury and stiffness.

3. Perform each exercise with a smooth slow action when using the resistance band, start with the lightest resistance, blue band, and then slowly progress to black.

4. Practise your training programme by doing two sets of 10 repetitions at each exercise session. Then progress to three sets.

One can be assured of increased speed in one’s walk and similar strength as was possessed by an individual at the age of 30, if strengthening exercises are religiously undertaken thrice a week for a period of three months.

AYURVEDA & YOU
Wholegrain foods: key to good health
by Dr R. Vatsyayan

MODERN researchers are discovering what Ayurveda had been pleading for: wholegrain cereal foods offer numerous health benefits and lower the risk of many diseases.

Generally, grains include cereals like wheat, barley, rice, maize and oat. The kernels of the grain consist of its outer part called the bran, the main part of the grain known as endosperm and the smallest part called germ. The wholegrain contains all the three layers whereas in the case of refined cereals, the outer layer is removed. A host of eatables like white bread, cakes, desserts, sweet and savoury biscuits, noodles, pizzas and food articles of "maida" are made of refined cereals.

Wholegrain cereals are a rich source of B group of vitamins and many minerals such as iron, magnesium, copper, phosphorus and zinc. With an antioxidant effect, they also contain protein, carbohydrates and a large quantity of soluble and insoluble fibre. Wholegrain cereals also have certain phytochemicals that can help lower the blood cholesterol level. On the other hand, refined cereals, which are devoid of the bran and germ layers, are not only less nutritious but also their excessive and prolonged usage results in many health hazards.

Refined cereals are considered detrimental to easy digestion and proper assimilation of food. Studies have shown that people who eat large amounts of refined cereals do so at the expense of more nutritious food resulting in the increased risk of many diseases.

In western countries too, there is growing awareness in this regard and it has been found that refined cereals generally have higher gastric intolerance than their wholegrain counterparts. Eating refined cereals causes a sharp rise in blood sugar, demanding a strong response from the pancreas. Experts believe that cereal fibre is particularly protective against this condition and people with type-two diabetes should eat wholegrain cereal products.

Cereals rich in soluble fibre are also known to reduce the cholesterol level. It means that the occurrence of coronary artery disease, which is caused in part by high cholesterol, can also be countered by the use of wholegrain cereal fibre to a large extent. Wholegrains are naturally low in saturated fat and they can be an effective part of any weight loss diet. By enhancing the movement of food through the digestive tract and increasing the bulk of stool, they are specially beneficial in diseases like constipation and irritable bowel syndrome. It has been found that many types of cancers, including those of esophagus, stomach, colon and rectum, can be prevented by eating healthy and correct food and maintaining the right bowel pattern.

In countries where the traditional wholegrain diet of full bran wheat flour, brown rice and barley is taken, health problems like bowel cancer, diabetes and coronary artery disease are reported much less than in the West. Ayurveda has abhorred the use of food articles which are sticky and difficult to digest and are devoid of their nutritional contents.

In our country, where much of the urban population uses wheat flour available in bags, one should ask for brand which includes sufficient bran. To maintain good health, it is advised that if we eat three or four cereal serves in a day at least half of them should be wholegrain.