Tag: stroke

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Preventing Stroke Important for Independent Lifestyle

Tranquility - One way to relax and meditate. (Dr. Noorali Bharwani)
Tranquility - One way to relax and meditate. (Dr. Noorali Bharwani)

“There are many ways of breaking a heart. Stories were full of hearts broken by love, but what really broke a heart was taking away its dream – whatever that dream might be,” said Pearl S. Buck (1892–1973), a bestselling and Nobel Prize–winning author.

What stroke does to a person is to take away a dream. But where there is a will there is a way. Two basic things required for any kind of success are: patience and perseverance. With appropriate help from family, friends and caregivers much can be achieved, although it may take time.

What is more important is to prevent stroke in the general population and especially people who are at a high risk.

A commentary in the Canadian Medical Association Journal (CMAJ November 19, 2013) titled, “Stroke prevention in older adults with atrial fibrillation,” by Michiel Coppens, MD and colleagues, discuss the use of new oral blood thinners that reduced the risk of bleeding in the brain by 30 to 70 per cent compared with warfarin. The new medications were at least as effective as warfarin in preventing stroke due to reduced blood supply to the brain.

People with atrial fibrillation have irregular heartbeats, which make them prone to forming blood clots. Warfarin is the most commonly used drug (also used as rat poison) as a blood thinner in humans to prevent blood clots. The main drawback is that the patient has to have regular blood tests to make sure the blood is not too thin. It may cause internal or external bleeding.

The new oral blood thinners (dabigatran, rivaroxaban and apixaban) are approved in more than 80 countries for stroke prevention in patients with atrial fibrillation. Patients do not require blood tests to check if the blood is dangerously too thin.

According to the CMAJ article, the key points to remember are that many patients do not receive recommended blood thinner treatment. The new oral blood thinners offer consistent benefits over warfarin in older (age 75 years or older) patients with atrial fibrillation.

The article says the rate of internal brain bleeding, the most feared complication of blood thinners, is related to age and is sharply reduced by the new blood thinners relative to warfarin, making these agents particularly attractive for older patients.

Like any new medication, only time will tell whether the drugs are safe and superior to currently used warfarin or should I say rat poison? Talk to you again soon. Take care and don’t forget to listen to music, dance and laugh.

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Salty Advice About Dietary Salt

A spilled salt shaker. (iStockphoto/Thinkstock)
A spilled salt shaker. (iStockphoto/Thinkstock)

None of us are strangers to table salt. Everytime you eat something, you probably make a remark regarding the amount of salt in the food. Some people may think it is just right, some may find it too salty and some may feel extra salt is required.

Our body contains many salts. Table salt (sodium chloride) is a major one making up around 0.4 per cent of the body’s weight at a concentration pretty much equivalent to that in seawater. Somebody has calculated a 50 kg person would have around 200 gm of sodium chloride in his body. That makes around 40 teaspoons.

We continually lose salt when we lose water from our body as salt is in a solution. So when we are sweating, vomiting, having diarrhea or voiding water by act of urination, we are losing salt. Salt cannot be made in our body so we have to replenish it otherwise there can be serious consequences.

Salt is needed to maintain our blood volume and blood pressure. Sodium is also needed for nerves and muscles to work properly. Low levels of body sodium can make our brain swell and cause confusion.

Too much sodium is bad for us as well. Excessive consumption of sodium can increase blood pressure, and that salt is a major determinant of population blood pressure levels. Some research estimates suggest the numbers of deaths averted by moderate reductions in population salt consumption would be at least as many as those achieved by plausible reductions in population smoking rates (CMAJ June 12, 2012).

The fast food industry is making its own contribution towards increasing the general population’s salt intake. Fairly large population is relying on fast food industry to provide their daily food needs. Fast food tends to be more energy dense, contain more saturated fat and salt, contain fewer micronutrients and be eaten in larger portions than other foods, says the CMAJ article.

Fast food items such as fried potatoes, pizzas and sugar-sweetened soft drinks typically provide between one-third and one-half of daily energy intake but less than one-quarter of most micronutrients.

Now what? Too much or too little salt in the diet can lead to muscle cramps, dizziness, or electrolyte disturbance, which can cause neurological problems, or death. Generally, more emphasis is given to the evidence showing an association between salt intakes and blood pressure among adults. We also know reduced salt intake results in a small reduction in blood pressure. Evidence suggests that high salt intake causes enlargement of the heart and swelling of the legs.

There is a clear scientific evidence that a modest and long term reduction in population salt intake can result in a lower population blood pressure, and a reduction in strokes, heart attacks and heart failure.

Then what are we waiting for? Most of us consume more salt than we need. General recommendation is no more than six grams (about one teaspoon) of table salt a day. This includes salt used in cooking and at the table. If you have high blood pressure or heart disease then less than two grams of table salt per day will be helpful. Are you willing to try that?

So, how is your food tasting today?

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A New Blood Thinner to Prevent Stroke

A doctor reviewing MRI films. (iStockphoto)
A doctor reviewing MRI films. (iStockphoto)

It was only a year ago, I wrote about a new blood thinner (dabigatran) to prevent stroke in patients with irregular heart rhythm. Now we have a second drug (rivaroxaban) for the same indication. This is good news for patients who are on blood thinners like warfarin – a rat poison.

About 350,000 Canadians suffer from irregular heart rhythm called atrial fibrillation (AF). In the U.S. there are approximately 2.3 million adults with AF. The commonest cause of AF is getting old. The lifetime risk of getting AF is one in four after the age of 45. Before that it is not that common. Occasionally, you do see patients in their 20s and 30s.

Most common causes of AF are: hypertension, valvular heart disease, alcohol excess, thyroid disease, obesity, sleep apnea, genetic predisposition and it can be idiopathic (cause unknown). What I call GOK – God only knows!

The most dangerous complication of AF is stroke. It accounts for up to 36 percent of all strokes in elderly people. The cost of looking after patients with stroke runs into millions of dollars.

In order to prevent stroke, patients with AF are converted to regular (sinus) rhythm by applying direct-current electrical shock (cardioversion), by medications or by ablation therapy. If it is difficult to sustain regular rhythm, then the patients receive blood thinners (like warfarin) on a regular basis to reduce the risk of stroke by 70 percent.

The main advantages of warfarin are that it is cheap and is covered by provincial drug plan. Major disadvantages are that you need frequent blood tests to make sure that the blood concentration of the drug is at a safe level to keep the blood thin. But not dangerous enough to make you bleed in the brain or some other place. It is quite difficult to achieve the safe level and maintain it.

Over the years, there has been great amount of research to find a drug to replace warfarin. Last year, dabigatran (Pradax) was introduced. This year we have rivaroxaban (Xarelto) in the market. These new blood thinners do not require regular blood tests.

Rivaroxaban is an oral blood thinner invented and manufactured by Bayer as Xarelto. Rivaroxaban is well absorbed from the gut and maximum inhibition of factor Xa occurs four hours after a dose. The effects last eight to 12 hours, but factor Xa activity does not return to normal within 24 hours so once-daily dosing is possible. Compared to dabigatran which is to be taken twice a day. The daily dose for rivaroxaban is usually 20 mg once a day.

The newer oral blood thinners have been found to be better in preventing stroke than warfarin and the risk of side-effects like bleeding is less than warfarin. And remember – no blood tests.

There are two significant disadvantages to taking the newer drugs. One, there is no antidote to convert your blood to normal if you have a significant bleed after trauma or bleeding due to another cause. The mortality rate can be high. Second, the pills are expensive. So, you have to check with your insurance company if the cost of the pills will be covered. Xarelto is slightly cheaper than Dabigatran because of once a day dosage.

Now, only if we can permanently prevent atrial fibrillation, warts, common cold and hemorrhoids (just to mention a few) then life will be good. You won’t have to choose between the devil and the deep sea. But some of us will be out of business.

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Regular Physical Activity Can Reduce Your Blood Pressure and Prevent Stroke

When was the last time you had your blood pressure checked?

There are many things you can do to prevent stroke. One of the most important things you can do is to keep your blood pressure under control. It is also important to learn to recognize early signs of stroke because if you receive clot busting medications within three to 4.5 hours then your chance of survival and living without disability is considerably improved.

Stress and anxiety can raise your blood pressure. We know that anxiety does not cause permanent high blood pressure but it can cause dramatic temporary spikes of high blood pressure which can cause damage to our blood vessels and vital organs like heart and kidneys. It can damage the brain and retina. Persistent or recurrent anxiety can make us prone to picking up bad habits like smoking, drinking or eating too much unhealthy food. Combination of these factors can increase our risk of high blood pressure.

Nearly two-thirds of all cases of stroke and one-half of all cases of coronary heart disease are directly related to hypertension. What is scarier is that most cases of hypertension either go undiagnosed or untreated. That is why it is called a silent killer. You may have high blood pressure but may not have any symptoms.

World Health Organization says that hypertension causes seven million premature deaths worldwide each year. Hypertension affects 22 percent of Canadians. It is estimated that 25 percent of the 42 million people with high blood pressure in the United States are unaware that they have hypertension. It is a ticking but silent time bomb ready to explode any time.

The incidence of hypertension increases with age. Most elderly Canadians have high blood pressure – probably due to thickening of blood vessels. No cause is identified in 80 to 95 percent of people with hypertension. This is known as idiopathic or essential hypertension. Others have hypertension due to primary disease of kidneys or due to certain hormonal disorders.

We eat too much and we do not exercise enough. Our blood vessels become harder and less compliant with age. When the blood is pumped out of the heart into less compliant blood vessels, the blood pressure goes up. So the heart has to work harder – and eventually it becomes tired, weak and fails. It silently causes damage to our vital organs and eventually results in heart attack, congestive heart failure, stroke, kidney failure and blindness.

Normally, systolic blood pressure should be less than 140 mm Hg (mercury) and diastolic pressure of less than 90 mm Hg. Blood pressure is lowest in the early morning, rises as the day progresses, and then dips down during the night and earliest hours of the morning.

Hypertension can be prevented and treated with lifestyle changes – with or without medication. Eat a healthy diet, lose weight if you are overweight, do not smoke, limit alcohol intake, eat a low salt diet, minimize sugar intake, do regular exercise, relax and learn to manage stress with laughter and meditation.

If your doctor wants you take pills to control your blood pressure then make sure you take it regularly. Research has shown that 50 per cent of the patients with high blood pressure discontinue their antihypertensive medications by the first year. This is no good.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!