It’s all in the numbers

Stress, coupled with unhealthy diets and lifestyle habits, contribute towards a tendency to develop stroke

Stress, coupled with unhealthy diets and lifestyle habits, contribute towards a tendency to develop stroke

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A young life can be snuffed out or impaired by a single stroke. Knowing your numbers will alter the stroke risk factors.

When Dr Kok Chin Yong asks if you know your numbers, it’s not about maths or stats but your well-being.

“The levels of your blood pressure, weight, cholesterol and blood sugar all have a bearing on your health. These numbers, if abnormal, can carry the risk of blood vessels being blocked in the body,” says the consultant neurologist and internal medicine physician at Sunway Medical Centre Velocity (SMCV).

When blockages occur in the heart, it is called a heart attack. When they occur in the brain, it is called stroke (cerebrovascular disease), he explains. There is a reason to “ring the bell” because, contrary to the general view that stroke incidence increases with age, doctors are seeing younger cases today.

The 2017 Monitoring Stroke Burden study in Malaysia says 40% of patients are under the age of 60. Another stroke study in 2020 shows a parallel rise in modifiable vascular risk factors such as hypertension, diabetes, obesity, physical inactivity, smoking and air pollution in young adults globally. And, it is twice as common for young patients to have these risk factors compared to their peers.

Dr Kok Chin Yong

“One needs to be aware of their own numbers, to know them by heart, starting from as early as age 35. Prevention is key in reducing the incidence of stroke. One can start from simple things like jogging for 30 minutes daily. This alone is enough to alter many of the risk factors,” Dr Kok says.

Some people may need to make major lifestyle changes to reduce the risk of stroke but the trade-off is definitely worth it, he emphasises.

Stroke, Malaysia’s third leading cause of death, with 47,911 incident cases and 19,928 deaths reported in 2019, can be divided into two categories.

Ischemic stroke (75% of cases) occurs when blood clots or other particles block the blood vessels to the brain. Fatty deposits called plaque can also cause blockages by building up in the blood vessels.

Haemorrhagic stroke (25% of cases), which is more deadly, happens when an artery in the brain leaks blood or ruptures. The leaked blood puts too much pressure on brain cells, which damages them. By nature, the disease occurs suddenly and often without any warning, says SMCV consultant neurosurgeon Dr Gerard Arvind Martin.

The stresses that come with modern living, coupled with unhealthy diets and lifestyle habits such as smoking, all contribute towards a tendency to develop these diseases, he reasons.

“In the case of a subarachnoid haemorrhage (SAH) due to a ruptured aneurysm, the bleeding in the brain may present with a sentinel headache far in advance of the actual rupture, which itself presents the patient with a host of symptoms ranging from a very severe headache and neck pain to downright impaired consciousness and threat to life.

“Several factors affect the outcomes of haemorrhagic stroke, including a patient’s age, his level of consciousness when he was first brought to the hospital and the extent of bleeding,” Dr Gerard adds.

“Every minute counts and can make a difference between a potentially good recovery and a downright poor one, with the patient’s life being at risk.

“Survivors tend to be younger patients who present initially with better levels of consciousness. CT scan findings that show a smaller volume of blood within the brain and those without blood in the natural spaces within the brain, called ventricles, also tend to fare better. The main factor that can have a bearing on surviving a stroke is always prompt medical attention, as oxygen deprivation in brain cells is detrimental and the effects are irreversible.”

As for who are at risk, both doctors say it is those who have diabetes, hypertension, obesity and high cholesterol, or a strong family history of stroke and other cardiovascular diseases. The main issue in stroke among the young is that all these vascular risks were detected late and often during their first stroke. Hence, education and regular health screening are important.

Beware of these warning signs: weakness or numbness of the arm or leg, difficulty speaking, blurring of vision, facial drooping and loss of balance. Less commonly, dizziness or vertigo and clumsiness can occur. Symptoms show suddenly and some may experience them for a very short period of time. So, it is crucial to identify them early and act fast to avert a major disabling stroke, which can be devastating.

A stroke puts additional burden on households and caregivers, Dr Gerard notes. Apart from rising hospital costs, families need to be part of the patient’s rehabilitation, which may involve modifying their homes and engaging in programmes prepared by a rehabilitation physician or physiotherapist.

The costs go far beyond that of treatment, Dr Kok observes. “This is a real issue, given that young stroke is on the rise. Young patients are mostly breadwinners of their growing families and losing their jobs and productivity would have a huge impact on them. Some could use up their medical leave and Socso claims. Some would have to rely on their family for financial support. Patients with major disabilities need constant care and that could mean yet another financial burden.”

There are also the emotional effects of stroke. Up to 40% of patients have depression, a problem usually under-diagnosed because they themselves, or the doctors, often overlook the symptoms as part of the disease. “Yes, this psychological disorder would definitely slow their recovery by hampering rehabilitation, which is a period when patients need to be constantly engaged with the exercises.”

Dr Gerard Arvind Martin

The upbeat news is rehabilitation can help patients recover and even retrain functions that remain, resulting in many being competent enough to live fairly independent lives. A balanced diet, regular exercise, physiotherapy, and good management of weight and stress can further boost recovery, which is never immediate, Dr Gerard adds.

Dr Kok reckons it takes a village to help patients recover and SMCV aims for a multi-disciplinary approach. “Acute stroke treatment, such as thrombolysis, is given to those who recognise their symptoms early and seek help fast. For those who did not, we aim to commence good preventative medical therapy. As for those with major disability, we provide basic to advanced physiotherapy.”

SMCV’s stroke services include emergency treatment during working hours, handled by a team trained by its emergency physician to quickly identify cases. There are also in-house neurologists to manage cases and a group of young enthusiastic physiotherapists to aid recovery.

Post-hospitalisation is the beginning of the end of this life-changing episode, Dr Kok believes. Patients will be advised on medications and how to control risk factors.

A rehabilitation programme will be drawn up to hasten recovery and avoid complications such as spasticity and pain. Physiotherapists will provide a framework for rehabilitation and the patient usually needs to make return visits for further training. Follow-ups are also crucial to prevent a second stroke.

The road to recovery is not necessarily strenuous, but patience and consistency are vital.

“With milder forms of stroke, recovery is almost certain, albeit not completely,” Dr Kok notes. “Engaging in a good rehabilitation programme may be as important as the treatment itself. Our brain has the unique capacity to recover lost functions, to a certain extent, with proper rehabilitation.”