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| Sunday, 10 April 2005 |
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Features |  |
| News Business Features Editorial
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Compiled by Shanika Sriyananda Are you courting a stroke? By Dr. Padma S. Gunaratne, Consultant Neurologist, The National Hospital of Sri Lanka Stroke, which is the commonest cause of disability in adults, is a neurological disease caused by sudden dysfunction of part of the brain. It is the third leading cause of hospital deaths in Sri Lanka and a significant number of stroke patients die at home and in Ayurvedic hospitals. Survivors of stroke attacks are left disabled and dependant for a long period or for the rest of their life.
Reasons for stroke The dysfunction of part of the brain in stroke happens as a result of the narrowing or blocking of a blood vessel or by the sudden rupture of a blood vessel in the brain. Lack of oxygen supply to brain tissues with impaired blood flow of a blocked vessel causes an injury to brain. The symptom of an injury to the brain is a functional disability. Bleeding into the brain by a rupture of a blood vessel can also be the reason for the stroke. This happens only in about 15 per cent of stroke patients. When a blood vessel ruptures the force of the blood stream damages the brain cells. The pressure effect caused by the blood accumulated in the brain tissues enhances brain damage. The underlying cause of stroke in most is hardening of vessels known as atherosclerosis which causes damage to the mucosa (inner layer of a blood vessel) overlying the fat deposit .This promotes formation of a blood clot (a thrombus) in the lumen of the blood vessel. This clot may block that vessel completely. Sometimes a part of the clot (emboli) may break off, travel forward and block a distant smaller vessel. All these may result in a stroke. Loss of elasticity of the blood vessel, when it is hardening, makes the vessel to rupture easily. This is seen mostly in patients with long standing high blood pressure. Symptoms The symptoms and the severity of a stroke are determined by the location and the extent of brain damage caused by the stroke. It is impossible to mention all the symptoms of strokes. However, the commonest known symptom that could be seen is weakness of one side of the body. Weakness may occur involving half of the face, the hand and the leg of the same side. Loss of awareness of urination, difficulty of swallowing and speaking also may occur with these symptoms. Visual disturbance is another presenting symptom of stroke. They may develop loss of vision of one eye, double vision or loss of vision of one half of the visual field. Loss of vision of one half of the visual field is a major disabling symptom. That would make impossible for the patient to work in an unfamiliar surrounding since he is likely to hit on objects in the affected side when walking. Speech disturbance caused by a stroke could be a distressing symptom to the patient as well as to the care givers. Some of the stroke patients develop difficulty in expressing themselves. They may understand the speech of others. Some may have poor understanding of others speech. They may talk fluently. Difficulty in articulating words also could be a feature of a stroke. It is not uncommon for the patient with speech disturbance to be labelled as confused or a lunatic. Lack of public awareness of the varying speech disturbances of strokes creates a wrong impression of the patient. Sudden onset of difficulty in walking, inability in maintaining balance, numbness of one half of the body, giddiness and vomiting are other occasional symptoms. When bled into the brain tissues the patient is likely to develop headache and vomiting. Sudden onset with gradual recovery is the characteristic feature of all stroke symptoms. It is not uncommon for stroke patients to improve completely within a short period of a few minutes to hours. When symptoms improve within 24 hours it is named as a Transient Ischaemic Attack or TIA. TIA could be the warning symptom of an established stroke. Risk Factors There are several factors that are known to enhance atherosclerosis. Presence of long standing high blood pressure is the most important risk factor for development of stroke. Diabetes mellitus and smoking are two other important risk factors. Presence of any type of heart disease increases the risk of development of stroke. Increased blood cholesterol levels, overweight, being on hormone replacement therapy at menopause and excessive consumption of alcohol are some others. Ageing and the presence of strokes or heart attacks among parents and siblings are non modifiable risk factors. Presence of multiple risk factors in an individual further enhances the risk of development of stroke. Management Management of stroke patient includes emergency management, long term rehabilitation and measures for prevention of further attacks. Avoidance of risk factors will significantly reduce the possibility of developing another worse attack. In the first few hours of the development of a stroke it is important to maintain breathing, blood pressure, body temperature and blood sugar to salvage affected brain tissues to the maximum. It has been scientifically shown that rehabilitation of stroke patients is best done by a team of multidisciplinary professionals working in a stroke unit. The team consists of medical officers, nurses, physiotherapist, speech therapist, occupational therapist and a social worker. Rehabilitation of patients in a stroke unit reduces the death rate of patients by one third. Stroke management in Sri Lanka As at present the care given to stroke patients in Sri Lanka is highly unsatisfactory. The scientifically proven type of rehabilitation is hardly available for patients. The establishment of stroke units is least expensive and affordable to a developing country like Sri Lanka. Dengue alert With the onset of the rainy season, the health authorities are ringing the alarm bells about the spread of dengue virus and have urged the public to clean their environs. Meanwhile, the Ministry of Health has announced a National Dengue Eradication Week from April 4 to 10 to clean the environs.The Ministry, together with the Health Education Bureau (HEB), commenced a series of awareness programs to educate the public in endangered areas. They warn that if a person is suffering from symptoms similar to dengue fever, haemorrhagic manifestations, petechial rash, bleeding from nose or gums, brown or black coloured vomit or faeces and severe and continuous stomach pain he should be taken to a hospital as soon as possible as he could be in danger of developing Dengue Haemorrhagic fever (DHF). According to HEB, if dengue fever is suspected: * Let the patient have bed rest, and give plenty of fluids to drink. * Refrain from sending children with fever to school. * Do not give Aspirin or drugs containing Salycilates. * Monitor for dengue symptoms even after taking treatment. Remember, dengue is a virus spread by the bite of an infected 'Aedes Aegipti and Aedes Albopictus mosquitoes. If you or a family member has high fever, headache, rash on face and extremities, muscle and joint pains, abdominal pain, nausea and vomiting for about three to four days take the patient to the nearest government hospital. Be alert to a sudden drop in temperature in a child having fever. According to Dr. Kanthi Ariyaratne, Acting Director HEB, the most important step to eradicate dengue mosquitoes is to keep the environs clean and tidy. Little Khizar's gift of life By Shanika Sriyananda "Thank you everybody", little Khizar Raza's voice echoed in the Apollo Hospital Auditorium when he thanked the doctors and the hospital staff for giving him a healthy life. Four-year-old Khizar, a Pakistani national, was amazed to hear his voice echoing in the hall and tried to speak again and again. Khizar was born as a blue baby with several streams of blood entering his heart through seven separate channels. Blood from his liver was also draining into the heart through another distinct channel. This resulted in the bluish discolouration of the baby's skin tone. The first heart surgery - a temporary shunt operation was performed by Pakistani cardiologists in Pakistan when Khizar was just two-months-old, as they diagnosed the baby's heart as being located on the right side of the chest with only a single heart chamber instead of the two ventricles. But with no change, the baby was critically ill from low oxygen levels. Thanks to Gift of Life Programme, little Khizar was flown to New Jersey, USA for urgent major heart operation as facilities for such surgery were non-existent in Pakistan. The surgery - the Glenn shunt - improved the baby's condition, but only marginally and after a nine months stay in USA, he returned home. But without any major improvement, despite regular medicines to relieve heart failure, the oxygen levels started to drop slowly as impure blood from the lower half of his body mixed with pure blood circulating in his heart. Again thanks to the Gift of Life Programme the little boy was brought to the Appolo Hospital Colombo, where his tiny heart was finally put to right. After a six-hour complex surgery, the doctors separated the areas where blue and pink blood were being pumped into the heart from one single chamber into seven different pipes, three weeks ago. The success story of this complex cardiothoracic surgery performed in Sri Lanka was announced at an international tele-conference, which linked Chennai and New Delhi, last week. Dr. Prasad Kirshnan, Cardiac Surgeon told the 'Sunday Observer' that it was a very complex heart surgery as the tiny heart had been operated on twice. "The operation was further complicated by scarring around the heart from the two previous operations. It was a high risk surgery", he said. According to Dr. Kirshnan, the successful repair of the Khizar's heart would allow him to lead a very normal life in future. Continuum care for mom and baby While the World Health Organisation, which celebrated yet another World Health Day last week, is calling for new approaches to save lives of children and mothers, the Ministry of Health says country's maternal and infant mortality has reduced significantly due to improved health care facilities. According to Minister Nimal Siripala de Silva, the maternal mortality has been reduced to a level of around 5 from the very high level of 165 deaths per 10,000 live births and infant mortality by 16 from its levels of 140 infant deaths per 1,000 live births in 1945. " It has been achieved through a multipronged approach of free education, social services and improvement in healthcare delivery system. However, according to WHO over 10.6 million children die before age five, and half a million women die in childbirth as hundreds of millions of women and children do not have access to life-saving care. 'Make every mother and child count' - report released on World Health Day says the resulting death toll could be sharply reduced through wider use of key interventions and a "continuum of care" approach for mother and child that begins before pregnancy and extends through childbirth and into the baby's childhood. About 530 000 women a year die in pregnancy or childbirth, more than three million babies are stillborn, more than four million newborns die within the first days or weeks of life, and altogether 10.6 million children a year die before their fifth birthday, according to WHO's latest figures. To achieve a significant drop in maternal and mortality rates, the WHO has given the sole focus to improve the health of mother and child. The WHO estimates that out of a total of 136 million births a year worldwide, less than two thirds of women in less developed countries and only one third in the least developed countries have their babies delivered by a skilled attendant. The report says this can make the difference between life and death for mother and child if complications arise. The report states that almost 90 per cent of all deaths among children under five years of age are attributable to just six conditions. These are: acute neonatal conditions, mainly preterm birth, birth asphyxia and infections, which account for 37 per cent of the total; lower respiratory infections, mostly pneumonia (19 per cent); diarrhoea (18 per cent); malaria (8 per cent); measles (4 per cent); and HIV/AIDS (3 per cent). Most of these deaths are avoidable through existing interventions that are simple, affordable and effective. They include oral rehydration therapy, antibiotics, antimalarial drugs and insecticide-treated bednets, vitamin A and other micronutrients, promotion of breastfeeding, immunization, and skilled care during pregnancy and childbirth. (SS) International Campaign to stop genetic engineering of smallpox virus Non-Governmental Organizations have urged the World Health Organisation (WHO) to stop Smallpox Genetic Engineering to prevent large number of public health, biosafety and biological weapons risks. The Third World Network (TWN) and the Sunshine Project (SPoUS) of the US has launched an international campaign against the genetic engineering of smallpox virus and requests the NGOs around the world to take action immediately to stop the project. According to TWN and SPoUS the proposal to genetically engineer smallpox, which would also permit smallpox genes to be inserted into related poxviruses and the unlimited distribution of small segments of smallpox DNA, poses a large number of public health, biosafety, and biological weapons risks. Urging the World Health Organisation to reject a proposal that would permit the genetic engineering of smallpox, they also request the WHO to ensure that all remaining stocks of the virus, including viral chimeras, or hybrids with other poxviruses, are destroyed within two years. They also claimed that with increased smallpox experimentation, the world stands closer to the accident or deliberate act that would cause a release of the virus. The two NGOs invite individuals and civil society organizations to take action and voice their opposition to WHO and their national public health authorities. Holistic healing : Balancing the doshas Dr. Danister L. Perera We tend to identify most with our physical bodies; yet, in actuality, there is more to us than what meets the eye. We can see that underlying our physical structure is the mind, which not only controls our thought processes but helps assist us in carrying out day-to-day activities such as respiration, circulation, digestion and elimination. The mind and the body work in conjunction with one another to regulate our physiology. For the mind to act appropriately, to assist the physical body, we must use our senses as information gatherers. We can think of the mind as a computer and the senses as the data entered into the computer. When the mind registers that a particular food is entering the gastrointestinal tract, it directs the body to act accordingly by releasing various digestive enzymes. However, if we overindulge the taste buds with too much of a certain taste, such as sweet, we may find that the ability of the mind to perceive the sweet taste is impaired; and thereby the body is challenged in its ability to process sweet foods. Maintaining the clarity of our senses is an essential part in allowing the mind and body to integrate their functions and help in keeping us healthy and happy individuals. In Ayurveda we view a person as a unique individual, made up of five primary elements. The elements are ether (space), air, fire, water, and earth. Just as in nature, we too have these five elements in us. When any of these elements are present in the environment, they will in turn have an influence on us. The foods we eat and the weather are just two examples of the presence of these elements. While we are a composite of these five primary elements, certain elements are seen to have an ability to combine to create various physiological functions. Ether and air are combined to form what is known in Ayurveda as the Vata dosha. Vata governs the principle of movement and therefore can be seen as the force which directs nerve impulses, circulation, respiration, and elimination. Fire and water are the elements that combine to form the Pitta dosha. The Pitta dosha is the process of transformation or metabolism. The transformation of foods into nutrients that our bodies can assimilate is an example of a pitta function. Pitta is also responsible for metabolism in the organ and tissue systems as well as cellular metabolism. Finally, it is predominantly the water and earth elements which combine to form the Kapha dosha. Kapha is what is responsible for growth, adding structure unit by unit. Another function of the Kapha dosha is to offer protection. Cerebral-spinal fluid protects the brain and spinal column and is a type of Kapha found in the body. Also, the mucosal lining of the stomach is another example of the Kapha dosha protecting the tissues. We are all made up of unique proportions of Vata, Pitta and Kapha. These ratios of the doshas vary in each individual; and because of this, Ayurveda sees each person as a special mixture that accounts for our diversity. Ayurveda gives us a model to look at each individual as a unique makeup of the three doshas and to thereby design treatment protocols that specifically address a persons health challenges. When any of the doshas (Vata, Pitta or Kapha) become accumulated, Ayurveda will suggest specific lifestyles and nutritional guidelines to assist the individual in reducing the dosha that has become excessive. We may also suggest certain herbal supplements to hasten the healing process. If toxins in the body are abundant, then a cleansing process known as Pancha karma is recommended to eliminate these unwanted toxins. All these factors should function in a proper balance for good health. They are inter-related and are directly or indirectly responsible for maintaining equilibrium of the tridoshas. To be continued. Health update Anaemia disrupts mother infant relationships Latest research in the US have found that new mothers who are mildly deficient in iron can disrupt the solid foundation that is established by healthy mother and infant interactions. A study found that those with anaemia were less emotionally in tune with their babies. Loss of blood during childbirth can often lead to anaemia - particularly among women who do not take vitamin supplements during pregnancy, it suggests. Previous studies have shown that anaemic women may be more prone to depression in the period immediately after giving birth. They also experience a slow down in thinking and memory. It also found that the mildly iron-deficient mothers were less sensitive to their baby's sounds and they also scored lower on giving their babies chances to lead interactions. Dr Murray-Kolb of the study group said: "New mothers should be aware of their iron status which, we know now, affects the child as well as the mother. Iron deficiency is easy to correct and could be a big part of post-partum problems with mother/child interactions." Courtesy: BBC News Good health habit: wash your hands Every second, a child in developing country dies of diarrhoea. But did you know that a very simple 'good health habit' - washing your hands can save you and your family from diarrhoeal diseases? According to the World Health Organisation's World Health Report diarrhoeal diseases are amongst the top three killers of children in the world. In India alone there are about 6,000,000 diarrhoeal deaths annually. The highest mortality from diarrhoea in children is under the age of five. The common symptoms are the abnormal pain, nausea and vomiting but those who are ill or malnourished could lead to severe dehydration, which could become life threatening without treatment.
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| Produced by Lake House |
Stroke is a disease mostly seen in the elderly. However, 25 per cent of
stroke patients are less than 60 years of age. A person who had been
physically active and leading a normal life could suddenly become disabled
and a cripple following a stroke. 
