- In just the past five years, with the growth of sophisticated imaging technology, highly effective and targeted medications and catheter-based procedures that can repair vessels or grab and remove artery blocking clots, the chance of recovery today from a stroke is better than ever before. That’s the good news. The bad news is stroke, the fourth leading cause of death and the leading cause of adult disability in this country, is a potent and potentially growing foe. Currently, coronary artery disease claims more victims worldwide than stroke. However, experts are now saying that if the rate of obesity, diabetes or undiagnosed hypertension continues to rise, in the coming five years “brain attack” patients will outnumber heart attack patients.
When a blood clot forms, obstructing the flow of blood to the brain, it is called an ischemic stroke. When a blood vessel ruptures and causes damage and compression of neurons in the brain, it’s called a hemorrhagic stroke. Since the brain depends on a continuous source of blood to control our various body functions, when that flow is interrupted by either an ischemic or hemorrhagic stroke, those body functions can stop working or only work on a limited basis. Thus, the time window to save the brain from permanent damage is very short – up to three hours in most of the stroke centers and eight hours in specialty centers.
We know the symptoms of a heart attack: chest pain, pain going down the left arm, shortness of breath, palpitation and sweating. In contrast, warning signs of a stroke are typically painless and much less obvious than those of a heart attack: numbness on one side of the face, arm or leg; visual blurring; slow speech; feeling mixed up or confused. Individuals having these symptoms tend to deny them or put off getting treatment, thinking that whatever is causing these things will go away. Unlike with a heart attack, people typically don’t seek immediate treatment for stroke. For example, although stroke commonly occurs in the early morning hours, when an individual wakes with numbness in the fingers or hand, he or she will usually attribute it to having “slept on it wrong” and ignore the symptom.
As with a heart attack, fast action is key to survival and recovery from a stroke. Treatment with the clot busting drug tPA is effective only within the first three hours after a stroke occurs. Catheter-based clot retrieval from a blocked artery in the brain extends the time window to eight hours, 12 at the maximum. We have made some headway. With eight hours the time limit in specialized centers, I see about 40% of patients coming into the ER within that recommended treatment window. Of course, this number needs to go much higher and our work continues.
The most important thing is to prevent the stroke from happening in the first place by making people more aware of the risk factors for stroke -- some of which they can’t control, but most of which they can. Included in the uncontrollable risk factor category are age, gender, family history of stroke and heart disease, and certain ethnicities, such as African Americans with sickle cell anemia, or South Asians who are at higher risk for cardiovascular disease as shown by certain genetic factors in their blood lipid profile.
Risk factors that can be modified, treated or controlled include hypertension – by far the leading cause of stroke -- diabetes, smoking, cholesterol pattern of high LDL levels in the blood (I call it “lethal” density lipoprotein) or low HDL (think of it as healthy cholesterol). South Asians have a high incidence of this type of cholesterol pattern. Other risk factors include excessive alcohol intake, poor diet, inactivity and obesity. Young women taking oral contraceptives who suffer from frequent migraines, menopausal women in their 40s and 50s on hormone replacement therapy, and some patients who have the congenital heart condition called patent foramen ovale (PFO), present in about 25% of the general population, are also at increased risk for stroke, especially when other risk factors are present.
Two other risk factors have emerged in recent years -- atrial fibrillation and sleep apnea, both of which can trigger a stroke. In atrial fibrillation, when the heart isn’t beating properly, clots can form and travel to the brain. With sleep apnea, when a person stops breathing several times during sleep, the flow of oxygen to the brain is obstructed.
Here are my recommendations for everyone who wants to stay free of stroke’s potentially devastating impact.
1.40 million people in the US have hypertension and have not been diagnosed. Don’t be one of them. Have your blood pressure checked once or twice a month, either by your primary care physician, at the mall or at home. (See box for recommended levels).
2.If you are currently on medication, take it regularly. If side effects are a concern, talk to your doctor. We have so many options today for medications that are effective and have no or few side effects.
3.Stop smoking. Smoking is a leading cause of both heart disease and stroke.
4.Lose weight. Obesity is directly linked to hypertension and diabetes, both major stroke risk factors. Even a loss of 10-20 pounds to start with can make a difference.
5.Get 20 to 40 minutes of cardiovascular activity at least five times a week.
6.Watch your alcohol intake, especially hard liquor. Red wine is good, but no more than two drinks per day.
7.Eat a low fat, low salt diet, with lots of vegetables and lean protein. Check out the South Asian Heart Center’s “Cooking from the Heart” cookbook, with recipes from South Asian home cooks who are following the center’s excellent recommendations for a heart healthy lifestyle. (www.southasianheartcenter.org)
8.When you visit your primary care physician, have a discussion about getting checked for the cardiac conditions atrial fibrillation and possibly PFO. Also ask for a referral for a carotid artery ultrasound to see if there are any blockages in those arteries leading to the brain.
9.If you wake often during the night and feel tired during the day or have been told you snore excessively, ask your doctor if you are a candidate for a sleep study to determine if you have sleep apnea.
Recently I attended the South Asian Heart Center’s annual fund raising gala. When the almost 800 members of the audience were asked how many had been affected by cardiovascular disease, either personally or in their families, almost everyone stood. It was a powerful moment. My goal is that by continuing to increase awareness of stroke’s warning signs as well as its risk factors, we don’t get the same response at some future gala when the question is asked about stroke. We have the power to do that; I invite you to join me in the fight against stroke.
Good numbers to know
• Normal blood pressure – below 120/80
• Prehypertension – 130/80
• Hypertension – 140/90 or higher
• Hb AIC – below 6.0 (for diabetes)
•HDL – more than 45 for men, 55 for women
• LDL – less than 100, closer to 65
Warning signs of a stroke
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause
Physician’s fast action helped her survive a stroke at 39
Because Neelima was in a coma and couldn’t make the decision herself, her brother Venkata Vegesna, a biomedical engineer at Boston Scientific used his critical thinking skills to agree that doctors should use an advanced catheter-based procedure to administer the medication and unblock the artery. “The combination of my brother’s knowledge and courage, the availability of the procedure, and the expert care of the stroke team at Good Samaritan, including Drs. Noor and Harmeet Sachdev, made it possible for me to be where I am today,” she says. “I’ve regained my speech, am walking again and am almost at full recovery.”
Neelima also credits her survival and recovery to her perseverance in diagnosing the stroke and taking quick action herself. “I urge everyone, listen to your body, and don’t let work be an excuse for not seeking medical help even if you’re not certain what the problem is.”
An active patient advocate, Neelima says what she learned about the patient experience during her stroke and recovery was “priceless.” Besides trying to understand the changes in her body, she at times felt helpless, frustrated and emotionally lost. Neelima says that it was the great support system with friends and family that helped her recover, including her friends Ace and Sarah Pacecho who took her into their home after the stroke
“No one can survive alone especially after a major medical event,” Neelima says. But I’m lucky. For me, the pieces all fell in place for the better.”
By Dr.Harmeet Sachdev MD, FAAN.
Dr.Harmeet Sachdev MD, FAAN. is a leading neurologist and pioneer in rendering state-of-the-art treatment for stroke victims in the Bay Area. In July 1996, he was the first neurologist in the state of California to use the clot busting medicine tPA in a community hospital to open up the blocked artery in the brain of a 49 year old man, Since then he helped create one of the first Certified Stroke Center in the nation in the South Bay (Good Samaritan Hospital). A champion for stroke education at the national and international levels, Dr. Sachdev is a member of the Stroke Council, Brain Attack Coalition, Western States Stroke Consortium and Academies of Neurology in the United States and India, where he helped to set up tPA treatment units for stroke. He received his medical degree from Punjabi University in India and received neurology training at Stanford University Medical School, where he is currently a Clinical Adjunct Associate Professor of Neurology. Dr. Sachdev is currently Director of the Stroke Center at Good Samaritan Hospital in San Jose and is also affiliated with El Camino Hospital, Los Gatos.)
Source: India west