the 25th hour: what did you do, i walked for 1hour, stay healthy my friends.......

Hi guys,
What would you do if you have one extra hour in a day.
I would exercise.
We started at 01:30hours and when we returned it was still 01:38hrs.
We walked for 1 hour at dead of night with a temperature of -7C it was wonderful.
It was actually Swaroop's idea, he had not done any exercise and not gone out of the house today.
so that was good message,
we have to do some exercise every day,
no matter whats the time.
The guideline says that each week you have to exercise for atleast for 150minutes thats 30minutes a day for five days of week.
now there was recent study, that says not enough if you are doing daily exercise
if you are sitting or not active that nullify's the effect of your exercise
more bad if don't exercise and sit for prolonged hours than it increases your risk of stroke, heart disease, diabetes more than normal people
now i don't want to scare but i have no option
today's is you day
start you exercise today.......

smokers to reduce and stop and SELF THERAPY novel concept in treatment of many diseases

Hi this post comes after long time. I will not give any reasons....
as the title suggest this was very goods instance I would like to share with you guys.
It is about quitting smoking......
when any patient visits stroke prevention clinic,
we advise them to stop smoking and there is stepwise guidance
to change to medication like nicotine patches, and others....
but usually the most important factors turns out to be motivation.
If person is very motivated he has walked in the clinic with prior thought that he has to quit.
These kind of men and women are few.
Most are hesitant.
We had tried a different option for young lady who was smoker for many years and had tried three times to stop smoking with drugs/medication and was unsuccessful.
We (our team of Pharmicist, Clinic Nurse) advised her not to start any medication, that proposition was not acceptable to her, but to reduce her frequency of smoking.
This was quite agreeable to her.
This information may not be new.
but it helped us gain the patient confidence.
Quitting may not be a option for many, as they fear the side-effects like headache, hypertension etc due to withdrawal.
But reducing the number or spacing them such to not cause side effects empowers the patient.
this takes to totally new concept
SELF THERAPY
that is giving the patient his rightful power to treat himself or herself.
this way they can control themselves.
The role of the clinician and team is more as as facilitator, which changed from dictatorial approach which has been prevalent for more than 4 centuries.
This form of therapy particularly works for life style modification, weight loss, epilepsy, diabetes, hypertension, headache, back pain, depression, addictions, like wise smoking cessation.
Which brings us back to our initial topic of smoking cessation.
The term should be changed to smoking reduction and cessation.
In next few posts we would talk more about self therapy and its implementation

Indian Stroke Association

young stroke

It is alarming to see more and more young patients coming with stroke or paralysis.

I would like to warn,

taking over the counter steriods pill or

pill to boost your muscular body which include anabolic steriod can be very dangerous.

It particularly predisposes to stroke , exact nature of association is not known but can cause both

ischemic type or hemmorrhagic stroke .

Please refer to earlier blogs to know more about the types of stroke.

In India the young stroke are more comonly due to cardioembolic source, particularly the valvular heart disease. 

Also i would like to raise a caution in individuals with migraine

if you get any unusual features then your usual type of headache, please visit a neurologist.(other physician may not understand the gravity easily and may loose important time. 

The unusal feature could prolongation in  your usual time of headache , sudden increase in severity of headache, new deficit ie weakness, loss of vision, double vision etc

save your self -------

save others ------

do Vitamin supplement help in stroke? I guess not....

Occasionally patients ask me does taking vitamin supplements help in stroke prevention and also does it improve recovery from stroke?

Truth: many patients are on over the counter vitamin supplements. Usually patients ask them to be prescribed by there doctors or doctors start them 

Truth : Most of the latest trials  have shown that there is no direct benefit by taking vit supplements in prevention of stroke except only in condition called hyperhomocystenemia where there increase homocysteine level more than >20 its usual value , which predisposes to increase risk of stroke so taking folic acid 5mg per day in these subgroup of patients helps.

False: Vit E,  Vit A,  slows down lipid layering of your arteries which is chief cause of  atherosclerosis and narrowing of you arteries all over the body including the brain.

False: Cyanocobalamin or vit B12 is useful in stroke recovery

Truth: vitamin supplements may not be useful for stroke prevention and stroke recovery.

hypertension increases stroke risk

If one thing I would like to do in my life is to advocate reduction of blood pressure in the masses.The most of the recent and old trials have shown that if you reduce the blood pressure of a patient with hypertension by as low as 10mmhg systolic or diastolic we reduce the stroke risk by as high as 33% or 1/3rd. This is higher than taking any medication for stroke prevention. This is achievable target if all people specifically health care providers like  medical social worker, nursing staff, doctors, pharmacist and dietitian join hands and emphasize this to the patients.
              We need to tell the patient only one thing please monitor your blood pressure regularly at local clinic like every month. I think this small intervention can make a huge change in society.
              Hope for stroke free society...........

Stroke rehabilitation: Constraint Induced Movement Therapy

Atherosclerosis-1

Hypertension Part-2

Hypertension Part-1

3 Signs of a Stroke

22.Stroke warning signs

Stroke Prevention

SESSIONS FOR NURSES 25 - STROKE ASSESSMENT

Diabetes Patient Education Types of insulin

What Does Diabetes Do?

Cerebral Venous Sinus Thrombosis

How to Recognize, Prevent and Treat a TIA or Mini-Stroke - Part Two

How to Recognize, Prevent and Treat a TIA or Mini-Stroke - Part One

Risk Factors For Stroke (Stroke #2)

Types of Strokes

Stroke Animation Video

Stroke Treatment: Emergency Care

What Does a Stroke Do?

Stroke

Stroke man

American Heart Association Stroke Awareness Campaign Symptoms spot

Thrombolysis for Stroke

Stroke woman

How it feels to have a stroke

How do I prevent a stroke?

Stroke Heroes Act Fast

Symptoms of Stroke (Stroke #3)

Hypertension and Stroke (Health Tip)

Effects of Stroke (Stroke Recovery #1)

Save your parents there by save your self.......

The main thought behind this blog was-----

we often hear patients talk about there doctor..
saying they do not give enough time to them....
well thats true ...
in India the proportion of patient and doctor is highly inadequate......
so there by reducing the contact time...

we bring you a site where you can pose questions or we will act as if you have asked a question..
and will answer to them
a site for the people with the people......

the second objective is 
to act on time
a stitch in time saves nine
if we had to give royality for sentences to used on our sites and elsewhere
this statement would have got the maximum money he would have been competing for top spot in The Time.

in that stream we would like to say
save your parents,
know there illness better
like diabetes , blood pressure, heart disease
since they have it , we should not leave to them to understand and follow the treatment rules
they feel alone and suffering
but if you try to know about the disease
its mechanism and treatment
two people will be helped and saved
you and your parents
i cannot see more profitable business than this.......
you will know about so you try to prevent it and parents  will enjoy taking medicines and diet and exercise

So save your parents automatically you will save your self.........

Hypertension is not controlled in many patients beware and check at regular interval

Just to reiterate the point made in the title
This study we had presented in Jan 2009 in International Stroke Update
Showed that many patient who come for follow up do not have controlled blood pressure after there first stroke.
if patient had stroke and inaddition he has diabetes then his blood pressure was further less likely to controlled causing further ongoing damage.

Hypertension or increased blood pressure

Problem Statement :
Recent population based studies have shown of the three poeple walking on road in th productive age group(20-60years of age ) one has  hypertension i.e 1/3 . That  figure increases to one in two  as the age advances above 40years and ahead.   (http://www.whoindia.org/LinkFiles/NMH_Resources_National_CVD_database-Final_Report.pdf)

Story:
I would like to introduce all the blogs with story of one my patients and questions they asked me, so that even you may find your answers.

Mr Vijay(Name changed for privacy) , 42 years old gentleman works for a reputed MNC at administrative post. He was apprently well 4days back when he developed sudden episode of inability to speak or write and mild paralysis/weakness of the right hand which improved completely over a period of 30minutes. He was seen by us on the same day, investigated. He was told that he had minor stroke as his MRI was showing some lesion. He did not have family history of similar events. He was smoker and noted to have hypertension. His rest of investigation were reported to be normal. He was discharged after 3days. While discharge we had chat with him to know his views and doubt. We allied his fears of recurrence.

Mr Vijay: what is hypertension? why did i developed it ?
Dr: here the word tension means the pressure in the blood vessels,  
      some amount of pressure is reqiured to push the blood from the heart to variuos part of body uniformly.
      This is generated by property of the Heart and blood vessel tensile strength.
       it is controlled by varoius known and unknown factors in the blood and blood vessels.
      It usually increases while doing physical activity, during cold season, hightened emotional states but immeditely   is   controlled automatically by the body.
     But when these controlling mechanism fail there is a steady increase in blood pressure.
     This increase in blood pressure if mild early may not cause any external symptoms for the patient who may not have any problem.  outside But will develop problem in long run.
      Because our body has ability to bear this increased tension to some extent but the organs like heart, kidneys, eyes and brain get slowly affected.
     
     The normal blood pressure range is 90-130 for the systolic(upper) blood pressure and 60-80 for diastolic ( lower) blood pressure. When ever any doctor tells  you about blood pressure he mentions to values upper and lower in simple langauge. Both are equally important. By increase in blood pressure it means systolic above 130 and diastolic above 80. When it reachs above 140/90 we call them hypertensive. But the target changes if patient has both diabetes and hypertension then above 130/80 is considered as hypertension.

Myth: with age,  blood pressure increases and we dont have to treat it.
Truth: Any increase of blood pressure at any age has to be treated by doctor.

     Well for the reason why it happened to you it is a very difficult question there is interplay of various genetic/polygenetic and environmental factors, the environmental factors consist of the stress related to work family for long duration, excess salt intake, smoking, excess alcohol  intake, improper sleep due to work or snoring etc. The genetic factors are equally myraid and are still be explored. If family history is positive in one or more family members  first degree that is father, mother, siblings then more likely to have it. Its the loss of balance between the protective and increasing factors. Like in your case smoking could be the cause. 

Mr Vijay: How can I treat it? 
Dr: As we talked  yesterday about the circle approach  (Refer to the contents ---blog post)
you should know about the disease, exercise, diet and drugs this four pronged method can help you.

Mr Vijay: Which drugs are best?
Dr: There is no fixed receipe , it has to be taken with consultation of cardiologist or Internal medicine consultant i.e MD Physician.
Usually few test will required before start of treatment. I
f the problem is mild that is 140-160 systolic then you doctor might ask
life style modification ( to be elaborated in coming blogs ) and see for next two three months
if the blood pressure is controlled  then viola no need of medication
if not controlled then we have to start some medication.
we are starting medication in your case because your admission blood pressure was very high and its persisting to be high we have started two medication for you. Now your blood pressure is controlled.

Mr Vijay: What should I do prevent further problem?
Dr: This is best question you have asked.
       Because this suggest that you are motivated
       as motivation on the part of the patient is of utmost important for successfull treatment.
       The first and fore most advice is stop smoking
       and follow the instruction given by the doctor.
       Check your blood pressure first every 15days for first 6mnths
       so that if it is more than you report to your physician and make changes.
        Once your blood pressure is controlled then a monthly blood pressure log would be good
        always make it a note in you treatment book or separate notebook.

Mr Vijay : Thank you doctor
Dr: My pleasure

Contents of the blog

My plan for the blog is to comprehensively address the issues related to
prevention of stroke and other vascular illness like heart attack
which have similar repertiore of causative factors.

First we would go about problem statement of each risk factor-
for example hypertension
it will be described in easy words so that everybody can understand

and later in second part we will discuss the treatment issues
which will include
the circle appraoch
this was thought to us during our MBBS days by our teacher Dr Neglur Sir
he had told this for Diabetes patient
but i found in last 10years that it is universally useful in varying proportions for most of the diseases.
Principle
 if we consider treatment required for any disease is 100%
then what are its content and what are there respecrive proportions

1. Education about the disease is the first step and each person has to know what illness heor she has why it happened to them how can they prevent the further progress of it  this forms  25% of the disease therapy

2. Exercise : its a must we will be describing in detail what it means it again forms 25%

3. Diet: every care has to be taken to understand the dietary needs and it has to be followed it form 25% of the therapy proportion.

4. Drugs/medication: this is the last part of any therapy , and comprise the remaining 25% of the therapy , so if you taking medication regularly you are only doing 25% of the therapy, if the medication also your not taking properly then even that 25% is lost

who wins who loses we have to ponder

see you in coming blogs
i stop for today.

Do you love your self?

Well the answer though your tongue is saying yes, most of day-to day action are always on the contrary.
The lack of exercise.
The improper breakfast.
The untimely  and inadequate lunch.
The late night drinking and seeing movies.
Above all the lack of sleep.
 More than 50% of todays youth are involved in these kind of activities.
Well its time to wake. Shake your self of that junk habits.
Because you sure get your self into trouble.
Please read the blogs coming to what each of the above means what we can do to
avoid them

Stopstroke: INTERSTROKE trial

Stopstroke: INTERSTROKE trial: "Hello this is my first post Well the aim and purpose of this blog is discuss about prevention treatment and rehabilitation of stroke or sudd..."

INTERSTROKE trial

Hello this is my first post
Well the aim and purpose of this blog is discuss about prevention treatment and rehabilitation of stroke or sudden hemiparalysis occurring due to the clogging or blocking of the brain blood vessels pipes carrying blood to the brain, due to varoius reasons.
It is truly a devastating disease affecting the family the patient and our human society as a whole.
But there is good news its in our hand individually and collectively to prevent this malady.
This recent study has pointed out that ten risk factors/causative agents/things which can lead to stroke are taken care/ properly treated we can reduce the risk/possibility of its occurrence by 90%.

that means with our effort we can prevent 90% of stroke.

Ten modifiable risk factors are:
1. Treat and prevent Hypertension/ increased blood pressure
2. avoid and stop Smoking
3. Reduced weight specifically the waist line
4. Healthy diet- Indian diet with reduced salt and fat is acceptable with more servings of fruit
5.Regular Physical exercise
6.Control your Diabetes
7. Reduce your alcohol intake and stop
8. Treat cardiac problem valvular heart disease
9. Hyperlipidemia
10. Psychosocial factors--stress and depression

Reference
1.Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): A case-control study. Lancet 2010; DOI:10.1016/S0140-6736(10)60834-3. Available at: http://www.thelancet.com.