Today, it is important that we learn some common lessons about one of the most misunderstood problems faced by many middle-agedand elderly people in our society. This particular problem is broadly known as stroke, properly called a cardiovascular accident or CVA. We shall also explain why a stroke is a problem to do with the brain and not the heart contrary to what many people believe today.
We have seen questions on this page that seem to wonder ifa muscle twitch or spasm, or even itching affecting one part of the body could be a symptom of stroke. Some others ask if occasional aches affecting one limb on one side of the body are a symptom.
The simple answer to these kinds of queries is that they are not symptoms. Stroke is a major health event around the world and it is worth noting that in 2019, the last year before the COVID-19 pandemic ravaged the world, stroke was the second most common cause of death around the world. This made up just over 10 percent of deaths worldwide.
During the pandemic, stroke became a leading presentation of COVID-19 infection among middle-aged people whether they were obese or suffering already from another systemic disease condition such as hypertension, diabetes, obesity, or heart disease. Therefore, stroke is quite common from what we have seen above and it is understandable that people are worried about it and even fearful of it, hence the pattern of questions that such a concern generates.
Strokes are primarily of three types and all of them are problems that have to do with abnormalities of the vascular system within the brain. The most common of these is the ischemic type of stroke which results when there is a blockage in the artery supplying oxygen to the brain. There are several such arteries in different regions of the brain and when they become blocked, oxygen supply is disrupted and that part of the brain dies.
Depending on what part of the brain it is, the consequences will vary from mild to severe. The second most common cause of a stroke is the haemorrhagic type in which any of the arteries we described in the above paragraph ruptures and allows blood to seep or rush out of the affected vessel thereby causing that part of the brain to swell and causing damage to the surrounding brain tissue.
The last type of stroke is the transient ischemic attack, also called TIA, and is sometimes a mini-stroke. This situation is described with regards to situations whereby blood flow and oxygen supply to particular parts of the brain are stopped temporarily for as little as five minutes. Weakness of one part of the body could develop and the affected person might pause mid-speech or even suffer a fall. It is reasonable to understand here that such a person driving a vehicle or operating machinery can meet with an accident and sustain secondary injuries following their loss of control of the vehicle or machinery.
One big myth about the occurrence of stroke is that it cannot be prevented. This is not true because the causes of this devastating condition are known and well-documented. The most common factors leading to stroke are obesity, diabetes, high blood pressure, high cholesterol level, excessive cigarette smoking, abnormalities of the heartbeat, and injury to the head and neck. When you exercise regularly and eat a healthy, balanced diet it is most likely that these risk factors can be avoided thus cutting the risk of sustaining a stroke to a very high degree.
Other risk factors like large consumption of alcohol and living a life of stress which is common in Lagos and a few other places around the country, can be controlled by stopping those deleterious habits and relocating to more serene places. These practical steps can cut the risk of having a stroke.
There is the other myth people believe in, which is that the symptoms of a stroke are hard to recognise hence they persistently ask some of the bizarre questions already shared in the first paragraph. That assertion is wrong also. The symptoms of a stroke are well documented and they have not changed in over 100 years. They are dropping of one side of the face – known as drooping – thereby causing an uneven smile; slurred speech; weakness of the arm and leg of one side of the body such that the person is unable to maintain an erect posture without support.
Other symptoms are weakness or numbness in the face, arm, leg, or of one side of the body; not the twitching that people often talk about or the muscle spasms. There may be difficulty with seeing clearly with one or both eyes, difficulty with walking, dizziness, and loss of balance due mainly to a lack of muscle and nerve coordination. The person may also be confused or have some difficulty understanding what is being said or making comments.
Sometimes, there may be severe headaches of an uncertain origin. So it is not true that stroke is not easy to diagnose or that it is the result of witchcraft or of having stepped on something planted by evil people. In addition, there is a general belief among our people that stroke does not run in families; in fact, it does. When members of a family share the same or identical lifestyles, they are likely to develop the conditions that will make a stroke more likely among several of the family members.
Some of these features are diabetes, hypertension, and obesity. Others are genetic disorders that several family members may share such as sickle cell disease as demonstrated in the SSgenotype or SC genotype. Equally false is the assertion by many that stroke cannot be treated. Most patients in Nigeria present late to the hospital in whatever situation except when they are bleeding; when they cannot eat any longer and when they are in severe pain. The same is true for the stroke patient.
However, if a patient arrives early enough at the hospital, say within minutes of the development of those symptoms we have itemised above or even within a few hours, emergency treatment can be given by using an injection that can dissolve a blood clot. This is a major problem in our country where very frequently, the hospital first arrived will not have the relevant facilities to diagnose whether a stroke has been causedby a blood clot leading to a blockage of the artery or whether it is a burst artery.
Therefore, crucial time is wasted while trying to make a diagnosis and understandably, in such circumstances, the outcome will be unsatisfactory or death can even result. An operation can also help especially when a burst artery is to blame and severe pressure develops in the brain. An emergency operation to decompress the brain can save life. In the same way, a minimally invasive operation can be performed to remove a blood clot in the artery with the appropriate equipment. In the few hospitals in Nigeria where the requisite manpower is available, the equipment is at least 50 years old and has been discarded from the inventory of many other countries.
Lastly, there is the myththat stroke can only occur in the elderly; it is not true. The risk of stroke doubles every 10 years after the age of 55 years. However, we have seen on this page how a then-six-year-old girl suffered a stroke twice from severe hypertension due to a kidney ailment in 2015 and was saved through a major operation. There have also been records of strokes occurring in people with the haemoglobin SS at three years of age. Therefore, strokes can occur at any age depending on the cause.
Questions and answers
Dear doctor, I hope you are well. I am 69, diabetic and hypertensive. You advised me in August last year about my blood pressure. For some time now, it has not gone below 160/80mmHg. Sometimes, I have piercing headaches for a few seconds. I am on Amlodipine 10mg and Hydrex 25 mg daily. Doctor, what do I do to improve my BP control? 0803*******
You have done very well by reminding me about the advice you were given a year ago. However, it is important that you do not substitute your regular clinic appointments with the advice you obtain on this page because we do not have your medical history; only a tiny part of it. At any rate, you ought to run this by your doctor who will agree with me that at your age, it is only the systolic pressure that is lagging in terms of control. What you may therefore need is an additional medication that you can use for a certain duration to further control the figures. I am well, sir, and happy to be of service. Thank you for asking.
Dear doctor,when my late dad had a stroke, my aunt had cancer and my late mom had diabetes resulting in kidney dialysis, I knew it was a matter of time before their demise. Some ailments are not cured but controlled. Diabetes and other ailments can be controlled but not cured.0806*******
Well, thank you very much for your comments and contribution. As you will probably understand from this week’s essay, a stroke can be cured depending on the speed with which a patient gets to the hospital and what type of hospital the patient is taken to. These are two very crucial factors that determine survival. With diabetes, the fact that your mum became dependent on dialysis is an indication of poor blood sugar control and this means that either she failed to adhere to her instructions regarding the changes in diet or defaulted in her medications, both of which are very common problems with patients. With cancer, the major problem continues to be that nearly all of them report late for treatment. When most cancers are picked up early at stage 1, a cure is possible. We have witnesses who often read this page and some are known personally to us here as well.
Dear doctor, many thanks for your educative write-up on low energy in mentwo weeks ago. God bless your innovation. Now that the topic has been educative for me, what is your suggestion for getting the “other room”active for men? Also, what do you advice against uncooperative spouses as I have one? 0802*******
Thank you very much for your kind words. It is heart-warming that you found the essay beneficial. The focus of that essay was physical strength rather than sexual prowess but since you have asked about the other room, it is important to stress that it cannot be taken in isolation. Age is an important factor in the range of possible problems but you did not disclose your own or hers. A proper physical examination is in order to determine what the likely causes of that situation are. Then important investigations will follow including a hormone profile. It is only when these have been done dutifully that treatment can be effective. As for what you called an uncooperative spouse, there are often several reasons for that situation ranging from female frigidity and painful intercourse to excessive demands from the husband. At any rate, this aspect requires a heart-to-heart talk between the couple.
Dear doctor, thank you very much for the essay you published on low energy in men. In addition, your medical advice for everybody is indeed fantastic. My problem is a unique one and I did not see it among your list of causes as one of the reasons why I should develop low energy. I am suffering from that situation now because I have been living in another country now for more than one year alone. My wife is in Nigeria with the children and I just find that I am always weak with no strength to do the work I was employed to do. What do you think is responsible? And what should I do so that I don’t lose my job? 0802*******
Thank you very much sir for your kind words. That essay was focused on the raw physical energy that men are now noted to have and it was stated there that each succeeding generation possessed only about 50 percent of the strength of their predecessors. In your unique case, you have probably become less energetic than you ought to be because you are forced to eat poor food, junk meals, and fast foods because you are lacking in capacity to settle down and make proper meals that are rich in nutritious content. All of this is conjecture but it is reasonable to expect that if you have eaten poor meals for over a year, your energy will wane. So it is either you return home to spend some quality time with your family or you invite them to visit you. Your energy challenge may therefore have more to do with psychology than anything else. However, it is often better to be certain about the possible reasons for your current status and the easiest way to do so is to visit the hospital for a proper examination and relevant tests to be conducted.
Dear doctor, I am really impressed by your Sunday weekly column. You will make my day when I receive my copy of the expected compendium when it is eventually done. Thank you very much. 0803*******
Thank you very much for your kind words. Your request is noted.
Dear doctor,my son is 12 years plus,and for a long time he has complained that whenever he runs about a lot either as a football player or any other sport, he starts to experience some sharp pain under his right rib cage. He said he then pants very heavily and everything sort of stops after a few minutes when he must have rested. We have taken him two times to the hospital to see different doctors but after examinations and even chest x-rays on one occasion, we were told that he was alright. We are still concerned, though. Please what is your advice, sir? 0813*******
Thank you very much for your question. The good thing is that you took him to a couple of hospitals where appropriate tests were conducted. It would have been very concerning if this pain occurred in the left side of his chest but that is not the case here. Therefore, it is more than likely that the cause of the pain is due to spasms in the small muscles between the ribs in the lower part of the right rib cage. That is probably normal and should not alarm you unduly if as you said, the pain goes away after a few minutes of resting.
Dear doctor,I developed a serious pain in my right ear lobe two days ago and my 15-year-old son then noticed that it was swollen and reddish. I am fair in complexion so it is obvious and I am able to tell by using a mirror to inspect it. The pain is very serious and all I have done was to take Paracetamol. The pain has not stopped and I did not observe anything coming out of the ear hole. There is no pain inside the ear and I hear normally. What should I do, sir?0906*******
The ear can sustain infections like most other parts of the body. Your description seems to be a painful swelling affecting just the pinna; this is entirely possible because this part of the body is made of skin and cartilage. The skin can get bacteria that cause infection there especially if there was a bruise prior to the development of the painful swelling. My advice would be to take an antibiotic and a pain reliever but the choice of antibiotic to use has to be decided by your doctor. So you should see your doctor for that purpose.