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Monday, November 5, 2012

Paralysed at thirty six You are never too young to suffer a stroke. Take the case of this young office-goer

Two years ago, Sudhakar Sawardkar was a healthy 36-year-old, who worked as head of administration at a tech-manufacturing firm. 

    It seemed like a regular morning on August 9, 2010 until he ambled out of bed to get to the bathroom in his Matunga home. His left hand felt a shade heavy, which he thought was the result of a weird sleeping posture. A look into the mirror before he reached out for his toothbrush, revealed a face twisted to the left. He rushed out to call his wife, but was unable to speak clearly. His speech was a series of slurs. 
    Sawadkar had suffered a stroke in his sleep, which was unfortunate because 10 hours had passed before he sought medical attention. The sooner a correct diagnosis is done, the less likelihood there is of long-term impairment, say experts. 
    Sawadkar's experience is proof that strokes, once an ailment associated with those aged 60 plus, can occur among young people. "A pressurising work schedule and unhealthy lifestyle are chief reasons," says Dr Rahul T Chakor, neurologist at BYL Nair Hospital,
Mumbai, who treated Sawardkar. "30 per cent of all stroke patients we treat are aged 30 to 40," he says. 
    In March this year, the seventh national congress of the Indian Stroke Association that was held in Pune discussed stroke among young Indians. Dr Shirish Hastak, director stroke services, Kokilaben Hospital and a member of the executive committee of the Indian Stroke Association, who was a participant, says, "High blood pressure and glucose levels are directly linked to strokes since they lead to increased fat deposits along blood vessel walls, restricting blood flow. 
Both, hypertension and diabetes are increasingly seen among young adult Indians." 
    A WHO report released in May 2012 confirms Hastak's claim. Twenty four per cent men and 22.6 women in India — aged 25 years and above — suffer from high blood pressure. Recent figures by the International Diabetes Federation put India second to China (90 million diabetics) with 61.3 million diabetics in 2011. India is likely to cross the 70 million mark in the next two years. 
WHAT IS A STROKE? 
The human brain depends on the 
arteries to transport oxygen-rich blood from the heart. When blood flow to a part of the brain is interrupted due to a blockage in a blood vessel or rupture in an artery, brain cells in the region suddenly die due to lack of oxygen. Since these cells do not have the ability to regenerate themselves, it results in permanent damage in that part of the brain. 
    This damage could translate to loss of sensation in one half of the body (paralysis), vision and speech loss, incontinence or bladder problems. 
    Sawardkar's MRI revealed that a clot had formed in a blood vessel on the front half of his right cerebral hemisphere (which controls motor coordination on the left side of the body). Even if he recovered his speech gradually, there was a high chance that his left arm wouldn't function again. 
THE ABUSIVE LIFESTYLE CONNECT 
Sawardkar says he hadn't imagined that additional work load and eating junk could leave him with a useless arm. 
    In the last one year before he suffered a stroke, his company had diversified into film produc- 
tion, doubling his responsibilities. Instead of the usual 10 hours, he was now putting in 16 hours a day. Grabbing hours a sleep, skipping breakfast and eating a fat-heavy lunch of fried rice, biryani or pizza did him in. He'd chase the calorie-high lunch with samosas, vada pav or cream biscuits in the evening. Dinner was usually a burger that he'd order in at work. "Other than consuming junk, my biggest mistake was to stop high blood pressure medicating for six months," says Sawardkar. 
DIAGNOSIS & TREATMENT 
Strokes can be of two kinds — ischemic stroke (involving a blood clot, like in Sawardkar's case) and hemorrhagic (artery bursts inside the brain). The first can be treated within the first four hours of the attack. If diagnosed in time, the clot(s) can be dissolved by tissue plasminogen activator (t-PA), reducing the impact of 
the damage by 50 per cent. 
    In a hemorrhagic stroke, surgery might be required to tackle the blood spill inside the brain, and seal the leaking artery. 
    It's the fact that strokes are painless that often leads to misdiagnosis. Most are 
passed off as headaches or regular weakness. 
    After two months of rest, Sawardkar suffered a heart attack. Nine more clots were discovered between his head and heart. These could dislodge any time, travel to his brain via the blood stream. A bypass surgery was mandatory. Sawardkar had to change his lifestyle if he had to survive, the doctors told him bluntly. 
CHANGE OF HEART 
Luckily for Sawardkar, the brain damage was minor and the motor function controlling his left hand was taken up neighbouring portions of the brain. He was able to regain his speech and full function of the arm within six months. "Sawardkar's is a rare case. In most, recovery is never complete," says Dr Chakor. 
    Sawardkar now works no more than 10 hours, wakes up at six in time for a morning walk at Shivaji Park, and runs miles away from vada pav stalls. His breakfast consists of two oil-free parathas with tea. Lunch includes a home-cooked green vegetable and four chapatis. Aerated drinks have been replaced by fresh fruit juices, fruits and salads. Fish and daal makes up dinner. 
    Worry and stress play a key role, as is evident in Sawardkar's case. "We are a family of seven, and our 1 BHK home leaves us no space to breathe. Buying a new home was a concern since I'm the only earning member," he admits. Now, when worry creeps up, he plugs in his headphones and listens to calming music. Things will fall in place gradually," he says with a philosophic smile. 

YOUNG, INDIAN AND PARALYSED 
A 2010 report by the National Commission on Macroeconomics and Health states: Number of stroke cases in India is likely to increase to 17 lakh in 2015 (that's a jump from 12 lakh in 2005). Of these, between 15% to 30% are accounted by those below the age of 40. 
CHIEF CULPRITS 
» » High Obesity blood and pressure consumption of junk food » » Smoking Worry and stress

SIGNS THAT COULD SPELL A STROKE 
Strokes are painless, and hit you suddenly. After 
the onset, you have just four hours to act if you 
must prevent permanent damage. Due to misdiagnosis, treatment is often delayed in 40% cases. Rush to a neurologist if: » You experience difficulty in speaking and comprehending what others are saying. » One side of your face is dropping or feeling numb. » There is sudden loss of control (numbness or constant flapping) in an arm or leg on one 
side of your body. » You experience difficulty in controlling balance, movement. » You suffer from dizziness, severe headache or abrupt loss of vision in one or both eyes


WHAT DID SAWARDKAR IN 
» » Skipping 16 hour work breakfast -day » Fat-heavy lunch of fried rice, biryani or pizza » Evening snack of samosas, vada pav or cream biscuits, and a 
burger dinner » Skipping his BP tablets


A pressurising work schedule and unhealthy lifestyle are chief reasons. 30 per cent of all stroke patients we treat are aged 30 to 40 
DR RAHUL T CHAKOR, NEUROLOGIST

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