Dr. Sylvester Ikhisemojie
Many people are today living with the effects of this phenomenon around the world. It is a sudden illness that strikes without any prior warning. It has nothing to do with the strokes associated with swimming or with tennis; it is a genuine health emergency with very profound effects. Around the world every year, some fifteen million people suffer from this illness. Some are left partially paralysed which means that they are often able to sustain a partial sort of recovery that enables them perform some basic functions but at a lower level than they were able to before they suffered the disaster. It means for example that a man who has suffered from a stroke may be unable to write again because the affected right hand is simply unable to do so. Such people are fortunate to begin with; others die within hours of suffering from a stroke while others recover completely in a matter of hours or days.
In some other situations, the person who has suffered a stroke is left with a profound memory loss that makes it frustrating to hold a conversation. A few people could become deaf while others become vegetative with no ability to do anything at all including such functions as passing urine and defecating in the toilet without getting themselves soiled. For these sorts of people, life takes on a completely new meaning. In the advanced nations of the world, such a situation does not necessarily mean a death sentence; in the Third World, lack of the necessary supporting health care infrastructure often means that people in situations like these are abandoned in the few poorly equipped hospitals available or kept at home at the mercy of their impoverished relatives who have no knowledge about how to deal with their new status of absolute dependency.
A stroke comes from the idea of receiving a blow. It occurs suddenly. Small strokes, called mini-strokes, often occur in people above 65 years of age. Sometimes, these occur at a lower age. Of the fifteen million people who suffer a stroke every year around the world, there are some five million who are able to recover completely. Another five million die and the remaining five million are left with some disability. This is a problem which results from the deprivation of oxygen supply to a part of the brain either from a blockage to a blood vessel within the brain or a bleed occurring from a burst vessel in the brain. When either of these occurs, there could be blurring of the vision, inability to maintain balance, deviation of the mouth or face to one side, inappropriate conversations, loss of hearing and mental confusion. Sometimes, the persons can even fall down suddenly. It is important when any of these features are observed in any person that such an individual is taken quickly to a hospital where doctors will examine them and try to determine what might have been responsible for that particular stroke.
Most strokes are caused by a blockage of blood vessels within the brain. That is called an ischaemic stroke. Others are caused by a bleed from a burst artery within the brain. The most reliable way to determine which one is responsible for the disaster that is unfolding is to request for a computerised tomogram of the brain (CT scan). This is a vital investigation that is sadly only available in some of Nigeria’s cities. It then means that hundreds of thousands of sufferers around the country are often misdiagnosed and therefore abandoned to their fate by a system that is rigged against the poor in every sense.
This scan is vital because the management of the different types of stroke is fundamentally different. An ischaemic stroke caused by a blocked artery in the brain results from a clot of blood which can occur within the vessels in the brain or in the neck or when such a clot is formed elsewhere in the body such as the legs and travel all the way to the brain where these effects are caused. Sometimes, such clots are formed from abnormalities in the heart beat that lead to the dislodgement of such clots such that they are able to travel in the blood stream to the brain. Another source of blockage in the brain is high levels of cholesterol which attract calcium salts into its substance and gradually blocks the lumen of the artery.
These cause a loss of oxygen supply to various parts of the brain with resulting brain damage. It is a constellation of these effects that are collectively known as a stroke. The key differences between both types of stroke are therefore based on their causes; the bleeding strokes called haemorrhagic strokes lead to a progressive swelling of the brain. Now, the brain is encased in the cranium which is bony and unable to expand in response to the blood pouring into it. The brain therefore becomes compressed against the skull bones with severe consequences occurring. Such a situation requires urgent confirmation of the diagnosis through a CT scan followed by emergency surgery to relieve the pressure on the brain itself.
Such a feat is achievable within a well organised healthcare system and may be available in Nigeria to some well funded individuals who can afford such care. In the end therefore, those with the financial wherewithal are the people most likely to benefit from such care.
At the other end of the spectrum are those who suffer the ischaemic type of stroke in which a blockage to the artery is the main cause. Such people are usually given medications that can dissolve such clots. Medications in that category are called thrombolytic agents and the simplest of these is aspirin. There are others such as warfarin and heparin, which is an injection. These agents help to dissolve the clots over several days or weeks and play a future role in preventing their re-occurrence. When clots like these are formed in the heart, it is possible to insert a stent into the affected vessels by a cardiologist or a radiologist to relieve the symptoms of a heart attack which is similar in some ways to happens in the brain that some people have likened to a brain attack.
Having developed a sort of overview of this malady, it is important to learn also how to prevent it from happening. Both the ischaemic (vessel blockage) type of the stroke and the haemorrhagic (vessel bursting) type are found in people with hypertension. These people are therefore advised to check their blood pressure on a regular basis and also take their prescribed medications. Most strokes of any type occur in the early hours of the day just when physical activity is picking up. That is because the blood pressure shows the most dramatic rise during the phase of awakening. As a result, diagnosed high blood pressure patients must take their drugs as soon as they wake up from sleep. It does not matter whether they have brushed their mouth or eaten; just take your medicines. That is a fact of life even for hypertension patients who are going in for an operation. When a surgery is planned, people are usually told not to eat or drink anything from the night before the operation. That is not so for people with high blood pressure; on the morning of the operation, they must take their medicines with a small quantity of water.
Ask the doctor
Dear doctor, I am a girl of 17 years. My menstrual blood is always thick and it’s unusual. It is so thick that I had to ask my mother what the cause was and she told me that it was because of the excess sugar I eat. Sir, is that true? Thank you. 0906xxxxxxx
No, dear girl, your mother has not told you the truth. That answer is the wrong one and it either she does not know what the answer is or she is trying to frighten you off the use of sugar. Needless to say, you must take sugar in moderation. Do not use it unnecessarily and do not take it in abundance because there are some other adverse health effects you might suffer from down the line. As for the thickness of your menstrual blood, it might actually be normal but you should see a doctor or a nurse for confirmation.
Dear doctor, thanks for your article on the health benefits of vegetables which was very educative. My question is for how long should the vegetable be cooked and which ones can be eaten raw? Thanks once again and God bless. 0803xxxxxxx
Vegetables should be cooked for about 8-10 minutes to avoid them being overcooked. Tomatoes, avocado pear, cucumber and carrots are some vegetable you can eat raw.
Dear doctor, please I think I have a medical issue because I have been having a side ache for some time now and the ache is very painful. It makes me feel so uncomfortable. Before now, it came only when I sit down but now even when I lie down, it is still the same. Please sir, what do I do? Thank you. 0813xxxxxxx
Well, if you have this level of pain, you ought to see a doctor. Depending on how old you are a pain in the side as you refer to could be due to anything ranging from an inflamed appendix to cancer of the kidney. Let a doctor see you and have you properly examined and I would urge you to be quick about it.
Dear doctor, my son has been vomiting for about four days and he has been admitted in a hospital. He is on treatment and he is not getting better. They first said I should wait for a surgeon to examine him bit the surgeon said the boy does not need an operation and that he has an infection. Is it possible for an infection to make a six-year-old boy to be vomiting and not passing stool for four days now? 0806xxxxxxx
That is possible. Common infections in our environment like typhoid and blood-borne infections can lead to problems such as this one. Sometimes, certain types of pneumonia affecting the lower zones of the lungs can cross into the abdomen through the diaphragm and affect the intestines directly by paralysing them leading to problems like this one that you described. When that happens, supportive care must be rendered using drips and intravenous antibiotics, abstinence from food and drinks until the intestines return to normal function. I am sure that is what your doctors are doing. You need to be patient and strong.
Dear doctor, I have suffered from malaria off and on since this year began and each time I take the drugs recommended for me I get well. Of late, however, I have been suffering from pains in my ankles, knees, and hips. They are so painful I can hardly walk around even the house. My appetite is good and I eat well unlike in the past. I do not experience any chills or fever or headache. I have done a blood test and there was still malaria parasite. What then is the problem? Is it possible to just be suffering from malaria with the regularity that my own now occurs, like every two or three weeks? I am confused. Please help me. 0803xxxxxxx
It is possible in theory to have malaria with the frequency you have described. One reason, which I would like to entertain very much, is that your treatment for the first attack was not proven to have been a successful treatment. By that I mean that you took a blood test, which confirmed the presence of the plasmodium parasite in your blood and you have the relevant treatment. Another test should have been conducted after completing the treatment to be sure it was cleared before letting you go. So what I assume is that you have not been getting new attacks but a chronic form of the disease resulting from incomplete eradication of the parasite. I believe this tactic should be tried so as to be sure that it has gone and that you do not harbour some other ailment.
Dear doctor, is it true that when one eats a lot of sugar, one will have pile? 0803xxxxxxx
Thank you very much for your question. It is not true.
Dear doctor, I am a 60-year-old grandfather. I was told by my doctor that I have internal haemorrhoids and he asked to me to do a particular test in which a tube will be inserted into my anus to see what is inside. He said he wants to make sure I do not have colon cancer. That has made me unable to sleep now for several days since he told me. I am in good health and have maintained a steady weight for the past seven or eight years. Is this cancer really a possibility with me? 0802xxxxxxx
First, judging from what you have said, colon cancer is not likely. However, any growth occurring in that region of the intestine could potentially cause you to have haemorrhoids because of the pressure the growth exerts. While an endoscopy is a gold standard to confirm this kind of diagnosis, there are other things your doctor could have done to allay your anxiety and get you some sleep. I should add that at your age, this ought to be a routine examination with or without having haemorrhoids.
Dear doctor, I am a 33-year-old woman. I was first diagnosed with uterine fibroids five years ago and told to undergo surgery. Three doctors said I would have to undergo a Caesarean Section at each childbirth after the surgery. Since I have never given birth, this means three or more operations (for fibroids and at least two kids).The fibroids has reduced in size and number from six tumours (with the largest being 18 cm) in my 2013 scan to three tumours (with the largest being 4 cm) in my 2018 scan, after making some dietary changes. Also, the fibroids is now pedunculated rather than intramural and sub-serosal. However, my belly has not shown any corresponding reduction in size. What could be responsible for this? What is the way out? Thanks. [email protected]
Well, I must congratulate you on the reduction of the fibroids especially because the unorthodox method you used worked for you. At some time in the future, I hope you will share these strategies with some of our readers. That said, you now have two babies and it is perfectly normal for you to have a large abdomen as a result of that. The only way to prevent that from happening is to do abdominal exercises designed to strengthen your abdominal abdominal muscles and ultimately help reduce the size. Think swimming and also think press-ups and sit-ups. They all help. Swimming in particular is a thorough sport as is riding. Good luck.
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