Healthysport

How To Enjoy Life as we Mature and Retire

READ MORE

Welcome To Healthysport!

Stroke Part 5 : The Bleeding Pipe

Details
Hits: 1426

When it comes to hemorrhagic(bleeding)  stroke, there is the good news and the bad. The bad news: It is a very critical (life threatening) condition. The bleeding  will build up in a contained structure (brain and skull) leading to high intracranial pressure which can suppress the overall structure of the brain leading to its lack of oxygen and demise. During my clinician days, the first rule of stroke alert is an immediate CT scan to check the brain. If bleeding  ( as opposed to clogging or blocking) is present, the size of the bleed is measured ( through CT and MRI). If it is very large or it causes a midline shift, which means the pressure is shifting the position of the brain,  a neurosurgical intervention is emergent.

///

[from PubMed]

Treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in your brain caused by the excess fluid.

After a hemorrhagic stroke, surgery through the skull (craniotomy) might be required to remove the blood and relieve pressure on the brain if the area of bleeding is large enough. Surgery may also be used to repair blood vessel problems associated with hemorrhagic strokes. Your physician may recommend one of these procedures if an aneurysm, arteriovenous malformation (AVM) or other type of blood vessel problem caused your hemorrhagic stroke:

  • Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can keep an aneurysm that has recently hemorrhaged from bleeding again.
  • Surgical AVM removal. Surgeons may remove a smaller AVM if it’s located in an accessible area of your brain. This eliminates the risk of rupture and lowers the risk of hemorrhagic stroke. However, it’s not always possible to remove an AVM if:
    • It is located deep within the brain.
    • It is simply too large.
    • Its removal would cause too much of an impact on brain function.

[from PubMed]

///

If an aneurysm is likely to rupture, a variety of surgical procedures can divert blood flow away from the aneurysm and repair the affected blood vessel, including microsurgical clipping, artery bypass and occlusion, flow diversion with stents and endovascular coiling. 

The most common symptom of brain aneurysm is a headache so unexpected, worse than a migraine. I had patients describing it as the most painful headache they have experienced. 





Now the good news: Sometimes the bleed is so small that the Neurologist will just let it be reabsorbed until it eventually disappears. This is the best outcome scenario. The other good news: bleeding stroke though critical in the acute phase usually shows a rather better outcome in recovery with less disability and shorter recovery period as opposed to infarction. 

***How about a clogged (infarction) stroke? There is a surgical hope for people with clogged (infarct) strokes as well. Besides the tPA during the first 3 hours  that can potentially reverse it; there is also a neurological  procedure called thrombectomy.

///

Thrombectomy is a medical procedure used to treat some cases of ischaemic stroke. This type of stroke is caused by a blood clot blocking blood flow to part of the brain and accounts for around 85% of strokes.

Thrombectomy is a treatment to remove the blood clot. It should be carried out within the first six hours of a stroke starting to be most effective. If you experience stroke symptoms, it’s important to get to the hospital as quickly as possible for treatment and to see if you’re eligible for the procedure.

///

In conclusion, there are different causes for stroke and they can be minimized by lifestyle changes. Let me repeat the keyword ‘minimized’ here, not a complete immunity. Anybody, including myself can have a stroke for any possible unknown cause. Anybody can have afib without knowing it, can have high blood pressure without knowing it, can have genetically weak blood vessels that can balloon and rupture without knowing it, can develop a blood clot in the leg without knowing it.

I used to work in the acute phase of stroke during my clinician days. I start moving the patient when appropriate as determined by the Stroke Team (yes, advanced hospitals certified as Comprehensive Stroke Centers have Stoke Teams). My role was the least glamorous. Under close monitoring, I get you up, transfer you to a chair, gradually walk you until ready for home or  rehab or an SNF. There are lots of cases whose strokes get reversed and they go home. There are those who might need a short term rehab to facilitate going home. There are those who may need long term care and they are transferred  to Nursing Homes. And then, there are cases called ‘stroke in evolution’ that I pay very close attention to. These are strokes that are still in progress and it is a must to monitor things like increased confusion, increased drowsiness or seizures. And immediately alert the Stroke Team again if needed. 

But I am not here to blog  about how I manage patients with stroke. There are many Doctors and Therapists and Nurses who deal with the medical and recovery aspects of Stroke. Each of these members have their own specialties and sub-specialties. I am  limiting myself to basic information that may help a layman in understanding what stroke is and how to manage one’s lifestyle to minimize the risk of having it. 

Evidence-based lifestyle changes can help. The first rule is a regular check up, like a car,  to see abnormalities in the system whether it is in the blood pressure, blood sugar,  bad cholesterol and well, lets face it, body weight. Obesity is not a good protection from  stroke. If blood work finds abnormalities in any of the tests, by all means take the prescribed medications. 

The next rule is lifestyle. We may not be able to control the medical factors that predisposes somebody to stroke - old age, heart diseases, blood vessel diseases, diabetes, kidney diseases - but there are factors we can control. 

Stop smoking, avoid abusing alcohol, avoid eating bad food that worsens blood pressure (high salt), or diabetes (high sugar and carbohydrates).

Work on proper nutrition and diet, exercise, reduce stress (that can increase BP, sugar) and when it comes to stress, it can be physical and mental or both.

Physical stress refers to any activity that is inappropriate for one’s age, An example is assuming you can still do (in your 50s) what you used to do in your twenties whether it is sports or gym work-out or running marathons.  It is more prudent to scale the exercise down as you get older, (not to avoid exercising completely) but scaling it down. Physical stress can also be environmental. Too much air pollution, super hot weather (heat wave), overworking no matter how much you love your work, chasing after cars and trains and any form of transport because you are late or in a hurry, climbing multiple stairs when the elevator is not working, deciding to play golf with old buddies out on a whim and you play the whole day ( I had a stroke patient who did just  that), trying to show off with the ladies that  you are super macho by lifting some heavy loads too much for your strength. There are lots of things you need to reconsider when you turn over 50 or 60 to prevent stroke.

And then, there is the mental stress. Avoid toxic relationships or engagements whether it is with family (spouse or children or relatives) even with your ex-friends and neighbors. If someone triggers anxiety or anger or fear inside you, avoid that person. That holds true with situations. If you are stressed out because you are forced to do something you don’t want to do - an introvert who is thrusted to a noisy party or an extrovert being imprisoned in a lonely isolation - please be nice to yourself and leave.  Working relationships that make you squirm or pause for fight or flight reaction is not healthy either Sometimes, social media can be toxic. If you are dealing with toxic FB friends who have all the time in the world to judge or bully or harass you,  learn to turn off your screen or phone to ignore them. 

There is a time to plant and a time to harvest, a time to work and a time to rest. Being over 50 is probably the peak of one’s life. This is the age you’ve earned what you worked hard for. You are respected for your experience, trusted by most for being reliable  and your confidence is more secure because you’ve been there and done that. 

The 60s however is the laurel of your life. There are no more heavy responsibilities if you have played your cards right during your working years. This is the decade of winding down. Mortgage has been paid, the kids are no longer dependent on you, gone are the challenges and struggles to support your family and you are done  trying to prove your worth. You are sure of yourself without a care about what others think about you. You do what pleases you and damn the bitter enemies LOL. You probably have set the bar lower when it comes to finding love and social connections. Me? I personally don’t even care if I were  treated non-existent by the world around me. I don’t mind not getting second looks. This is the age you can enjoy life fully provided you are prepared for it properly. You may have a steady income, like social security, that you worked hard for. Some may even have over-saved and accumulated wealth through proper investments, so now they have more money than what they need. They travel, go to expensive restaurants, watch movies, hang out with old friends, spend time in bingo or cruise ships, they deserve it. 

And then there are people like me who are closet introverts. I will talk more about introverts when I review the book ‘Quiet’  by Susan ___ in my next book review.

Reaction to the book 'The Beginning of Infinity (part 2)

Details
Hits: 1914

There were scientific prophets of doom in the past that were proven wrong. Thomas Robert Malthus of Malthusian theory, prophesied that exponential population growth against  linear food production growth would lead to hunger and starvation and lowering of life’s quality and the demise of humanity. Humanity defied him.

Paul Ehrlich is another prophet of doom mirroring the Malthusian who in the 1970s advocated population control due to the world resources’ unsustainability. So far none of his predictions have happened despite the world’s population increasing to more than 7 billion.

Other doom predictions include climate change (which is, at least to me,  real). The ticking nuclear war prediction pushes the world closer to the brink of annihilation (again, it is true to me) but humanity has so far deterred it. The existential threat of another and more deadly pandemic like covid-19 remains a threat. But I got optimism. Necessity can be the mother of all inventions. Or, as Steve Jobs had put it, Invention can create a necessity. 

What the prophets of doom fail to consider is the capacity of the human brain to solve the problems they warn about; their doom scenarios are real and probably correct but human intelligence is a weapon that can counter all  that. Instead of succumbing to Malthusian, humanity’s agricultural productivity matched and even exceeded in answering the needs of  the increasing population; scientists came up with solutions in countering climate change, and some are implementing them. Recent pandemic proved human intellectual capacity. The creation of the vaccine against the COVID  in a matter of months was unprecedented. ***The future depletion of fossil fuels is pushing for machines that use alternative sources.  

In my lifetime we have seen the magic of human intellect. I have worked in the health field and  witnessed progress all the way from laser treatments of kidney stones or eyes (for example), to robotic surgeries, to microvascular surgeries, to reversal of strokes through properly timed treatments and interventions and miraculous recoveries from illnesses by reducing complications, managing infectious diseases through proper isolation and containment and universal precautions.

And there are the revolutionary genetic  diagnostics and possible gene treatments; regeneration  of tissues and organ transplants are widening their scope and audacity in prolonging life. Though I am  happy to note all these advancements, humanity is merely touching the tip of the iceberg. It is not prudent to say we are now  in the final frontier because every frontier is a precursor to  another frontier in the quest for knowledge. What I know today will be obsolete tomorrow. Knowledge is infinite. 

The reason is the capacity of his brain to pursue multiple solutions in meeting the problems thrown at him. The laws of Nature (or Physics) is what it is. Humans have the ability to question, criticize, alter, modify, test, learn from errors, experiment -- and most of all - explain. The most basic and fundamental  quest of Man is a good answer and explanation to his questions. So long as he is asking, probing, experimenting, theorizing, he will always come up with something.

Imagine for a moment if someone told you that what you know today is the most advanced knowledge Humanity can reach and there is no more to learn. Or if someone tells you that God is commanding you to quit learning now and just sit and pray for the rest of eternity. What if someone threatens you to stop learning now or you will be put to jail. 

That  person being told will most likely ask why, how, when, what;  that is a part of human nature. We immediately ask questions (even without verbalizing it) if we’re told about anything. If the response is ‘Because I told you so’ would make the person, especially the inquisitive,  wilt in sorrow and die. ‘I told you so’ in the form of dogma and threat and incapacitation does not match humanity’s nature. Without clear and concise explanations to questions and phenomena causes resentment, hate and distrust. 

***This is due to human nature’s inherent nature to explore the infinity around him. 

Yes, the quest for knowledge (or explanations) is infinite. Because the scope of knowledge is infinite. On a personal note,  I agree with the Biblical explanation of God. Is that the reason why God could not reveal himself through the limited senses of Man. When he appeared to Moses, he was in the form of Burning Bush. His name?  “I am what I am”; or the more recent one in the New Testament, “I am the alpha and omega”. For me, that is basically the law of Nature. And the extent of Nature, including the cosmos, is unlimited. It is Infinity.

Given the accepted theory of the big bang, one would venture to ask what or who caused the big bang and furthermore, who or what caused the one responsible for it and this question will repeat itself ad infinitum until a good explanation is offered. Another would say the earth will die in 5 billion years and someone would ask what happens next and the next after that id infinitum. Physicists claim that the cosmos started with a big bang and will end in a big crunch. In between the two events all of its elements (solar systems, universes, stars, planets, moons)  are speedily expanding out away from each other. 

Surely there would be multiple ‘explanations’ for these phenomena, and none is final most likely. These explanations could be in the form of conjectures open to criticisms leading to another conjecture open for question ad infinitum. 

And that is alright because that is how the human brain is designed. To suppress its conjecture and criticism is basically reducing its expansion and advancement, very similar to the old Chinese tradition of foot binding a girl  at a young age so she loses balance and keeps falling when she turns into a woman. Humans cannot tolerate brain binding. 

That is why it is important to allow open-minded societies (like Athens) and avoid close-minded ( like Sparta). You can extrapolate that between communism and democracy(the right one); or between dictatorships and freely-elected forms of governments. This can further be exemplified by the Dark Ages vs Enlightenment (Renaissance); between preindustrial vs industrial age.

Nature, or more specifically Physics is discovering and transforming more phenomena and keeps on searching for explanations. It is boundless and endless. Much like the lives we live. It is funny how the achievement of something has multiple paths. It is like computer languages that can accomplish the same outcome and it doesn’t matter if you do it in java or c++ or ruby or python or VS or the latest variety of exotics like php, asp, javascript,  (and its many progenies), ror, django. There are indeed many ways to skin a cat. But is the cat alive or dead?

  1. Book Reaction: The Beginning of Infinity(part1)
  2. Stroke Part 4: The good, the bad, and the bad (Cholesterol)
  3. Let's Take a Walk on the Wild Side
  4. Stroke Part 3: Burst vs Clogged Pipe
  5. Stroke Part 2: The Plumbing System
  6. CardioVascular for Seniors
  7. Stroke Part 1
  8. Balance Reinforcement Exercises
  9. Dementia Part 2
  10. Three Stretches

Page 17 of 78

Joomla templates by a4joomla