Wake Up, Philippines!

Brain attack: Some hearty reminders

Posted in Diseases/Disabilities, Health by Erineus on May 20, 2009

By Julie Cabatit-Alegre Updated May 19, 2009 12:00 AM

MANILA, Philippines – When the late Fernando Poe Jr. suffered a stroke from which he would not recover, many called it a heart attack, thinking that the terms “heart attack” and “stroke” mean the same thing. “They do not,” says Dr. Artemio Roxas, Jr., director of the stroke unit and chief of the neurology section at the Medical City in Pasig City. Put quite simply, while both may be the result of blocked arteries, one occurs in the heart, while the other occurs in the brain, so that a stroke is also called a “brain attack.”

“There are two main types of stroke,” Dr. Roxas explains. Ischemic stroke occurs when blood flow to the brain is stopped by a blockage (bara) in a vessel, while hemorrhagic stroke occurs when a weakened vessel bursts or ruptures. In a third type, referred to as transient ischemic attack (TIA) or mini-stroke, the symptoms are temporary, but they are usually warning signs of an acute stroke that’s forthcoming. Heeding the warning signs and addressing the risk factors can prevent a major occurrence.

Stroke symptoms usually don’t involve much pain or discomfort, and are more likely associated with numbness or losing the ability to move. Often, strokes affect only one side of the body. The faster a stroke patient gets help and receives medical intervention, the greater is the chance for recovery. Up to three hours after the attack represent the window of opportunity.

How do you know if someone is having a stroke and, what can you do? Observe and remember “KAMBIO,” Dr. Roxas says, “for kamay, when one arm appears weaker than the other when raised; mukha, when the face appears distorted (tabingi); bigkas, when there’s difficulty in speaking or speech is slurred; and oras, or need to rush to the ER.”  In English, the acronym is “FAST” for face, arm, speech, and time.

“Recognition of a stroke is important,” Dr. Roxas stresses, “as well as urgent admission to a tertiary hospital as acute treatment is available that can minimize disability.”

Medical City has a special team at its stroke unit that is equipped to respond within minutes a patient is brought in. “Time lost is considered brain lost.”

Stroke kills about five million people each year and is considered as the second leading cause of death worldwide. At least 15 million patients have non-fatal strokes annually, and about a third is significantly disabled as a consequence. In the Philippines, it is one of the leading causes of death, together with other cardiovascular diseases (CVDs) including coronary heart disease, cerebrovascular disease, hypertension, peripheral artery disease, and heart failure.

“Even before a stroke happens, it is important to also understand its risk factors so that medical intervention is administered early and aggressively,” Dr. Roxas remarks. Non-modifiable risk factors or factors that we cannot control include family history, race and ethnicity, sex and age. “CVDs are still largely diseases of the elderly,” says Dr. Roxas. “However, there are modifiable risk factors for stroke which when eliminated or controlled reduce the risk of stroke significantly.” These include cigarette smoking, alcohol abuse, physical inactivity, obesity, diabetes, hypertension, and elevated cholesterol.

“There is a growing concern that because of the lifestyle and diet of Asians, particularly Filipinos, cholesterol levels are rising, resulting in an increasing risk of stroke,” Dr. Roxas notes.

The Asia Pacific Cohort Studies Collaboration, in the Journal of Epidermiology, reported a 25-percent increased risk of fatal or non-fatal ischemic stroke in the region associated with increasing total cholesterol. The same report confirms that cholesterol is rising substantially in Asia . Lipid-lowering agents, such as statins, indicate reduced cholesterol. Atorvastatin is widely prescribed for the treatment of high cholesterol, for increasing “good cholesterol’ (HDL) and decreasing “bad cholesterol” (LDL) and total cholesterol. Studies involving patients who have had a prior stroke also demonstrate that atorvastatin significantly reduces the risk of the recurrence of another stroke, a result not demonstrated before by statin in this population.

Atorvastatin is produced by Pfizer, a worldwide top-ranking investor in research and development, and leader in the pharmaceutical and biotechnology industries.

“A dreaded aftermath of a stroke is the increased possibility of the recurrence of another stroke,” Dr. Roxas observes.

Up to 40 percent of those who have experienced a first stroke suffer a second stroke within five years. There is also a high risk that they may later die of a heart attack.

“Awareness is the cornerstone to prevention,” says Dr. Roxas. “We at the Medical City stroke unit recognize that knowledge of stroke, including its recognition and risk factors, is an important strategy to prevent another stroke.”

Stroke education is given by senior stroke nurses to patients at bedside for them to be better informed about what a stroke is, how to recognize warning signs, and what to do when it occurs. The Stroke Society of the Philippines (SSP), where Dr. Roxas is 2nd vice president, has also developed a video program aimed to increase information dissemination. The 12-minute slide show is entitled “Stroke: It Could Be You.”

“Patients should ask their doctors questions,” Dr. Roxas says. “Don’t leave the hospital without knowing and understanding what you have. Be aware of the risk factors and make appropriate lifestyle changes. The best way to prevent a stroke is not to have one.”

Reduce your risk of having a stroke by following these hearty, friendly reminders:

• Check your blood pressure regularly.

• Stop smoking (if you eat nutritious food that is low in cholesterol and fats).

• Reduce your consumption of sweet and salty food.

• Control your weight.

• Control your diabetes, if present.

• Exercise regularly.

• Avoid excessive stress.

• Avoid excessive alcohol use (if you drink).

• Take medications regularly and faithfully using the proper dose prescribed as well as the duration recommended.