Now I'm no hyperchondriac but a reader of this column and new acquaintance of mine told me the other day, with that insouciant impertinence affected by Englishmen of a certain class, that I seem to have suffered from every affliction under the sun. Upon review I find it isn't so. All I've owned up to in these columns is having had gout once upon a time, mildly elevated cholesterol and having been a bit overweight once. That and a misspent youth. Nothing too remarkable there, I think.
I guess it's all relative. To some people any concern about health, particularly if it gets in the way of their appetites, is dismissed as hyperchondriac and taking the fun out of life. All the way to Howard Hughes, refusing to shake hands with people unless he was wearing gloves. Makes one rather wonder exactly how he did connect with Rosalind Russell and his other busty babes, doesn't it?
I will allow, however, that I am interested in the subject of health. Mine, and to the degree they are interested, of others also. My concern here is to lead a full and active life for as long as I find life worth living. If I need to inform myself and perhaps curb some of my grosser appetites along the way then so be it. After all, think back to the mid '80s. That sure changed a few sexual habits, didn't it?
A Chinese Fortune teller once said.....
In my mid-40's I went to see a Chinese fortune teller, who didn't speak any English, with my girlfriend at the time who was also Chinese and who translated. Among other things he told me, the thing he said that struck me most was I'd either die aged 64 or 94. I thought 64 was a bit too young and it got me thinking about the quality of those extra 30 years. He also told me that I had a woody/water constitution and that I should get out of Asia, the sooner the better. Now that last bit I put down to pure Chinese chauvinism and the old codger didn't like seeing 'gweilos' hanging out with Chinese women.
I'm now 57 and am in pretty good nick I'd say; my hair's gone grey and thinned a bit on top and a couple of liver spots on the back of my hands. Oh yes, and I could shed a few lbs perhaps. But apart from that I think it'll be a lot nearer 94 than 64, given I don't get hit by a Bali truck that is. And I'm still in Asia, despite the Chinese fortune teller, and rather looking forward to it all. I feel I have taken reasonable precautions against the normal degenerative conditions or 'lifestyle' diseases (heart disease, cancer, diabetes et al.) that nowadays cut so many of us down and am content to take my chances.
But what still scares the Bejasus out of me are strokes.
Brain Attack
Think of strokes like a brain attack. They can come upon you out of nowhere and strike you down, killing you outright only if you're lucky, but more likely leaving you a shadow of your former self, immobilised, an invalid, mute and trapped within your body unable to communicate for the the remainder of your days. Anyone who has had a loved one, friend or family member felled in this way and has seen the look of utter frustration in the eyes of the stroke victim, paralysed and unable to speak and yet attempting to communicate with the few meaningless words remaining to them, knows the full horror of it. The wreckage of a former vital human being is hard to bear.
Strokes are the third most common cause of death and something like 700,000 people suffered strokes in the US last year. Yet we hear little of it compared to heart disease and cancer. The reason for this I suspect is that less is known about how to prevent and treat it and we really don't want to think about it very much. If you survive a heart attack you can still go back to leading a valid life and cancer is no longer the inevitable death sentence it was regarded as 30 years ago. At least with these diseases, if you survive, you still have a life.
Of stroke victims, 25% die of the attack, 50% suffer moderate to severe impairment that is permanent. Only 25% recover most, if not all their faculties and that can be a long and hard road. Once you have had a stroke you have a 30% chance of having another within 12 months.These are not great odds. Our institutions are full of people incapacitated by stroke and none of us want to be among them. So what do we need to know about stokes and what can we do about it to prevent them happening to us?
What's a Stroke & Who gets it?
A stroke can be defined as a vascular event in the brain lasting 24 hours causing neurological damage. This means that a blood vessel in or to the brain has either bled or been blocked and that the brain tissue is starved of oxygen and other nutrients as the brain cells, dependent on a constant flow of blood, rapidly begin to die. Strokes are either ischemic (thrombotic), which is a block in a blood vessel leading to the brain and which account for 85% of all such events, or hemorrhagic - from the bleeding of a cranial blood vessel. Symptoms are severe headache and vision problems; sudden trouble standing or walking, confusion, partial or total loss of consciousness; nausea; sudden numbness or partial paralysis on one side of the body.
So who's most likely to suffer a stroke:
- those with high blood pressure
- people who have heart disease
- diabetes sufferers
- people with high cholesterol
- people who are stressed
- anyone over the age of 55, but increasingly people of 35 and up
- smokers
- people who are overweight
- drug abusers,particularly of coke & amphetamines
- heavy alcohol consumption
Of stroke sufferers, 70% have hypertension, 20% have cardiovascular problems and 20 % diabetes. Until a few decades ago strokes generally only happened to people over 50, but nowadays it increasingly attacks people in their mid-30's. That is why it is so important to notice TIAs (Transient Ischemic Attacks), which are like temporary mini-strokes which pass off without apparent side effects. The temporary effects can be dizziness, vision problems and temporary loss of co-ordination. They are significant signs that you are in danger of heart attack or stroke to come.
A few years ago an American doctor observed a little brutally, so as to make the point, that 'having a stroke was largely an optional event'. Reducing blood pressure and treating diabetes, raised cholesterol levels and obesity will cut the chances of having a stroke dramatically. He might have referred to drug and alcohol abuse also, which are major risk factors for hemorrhagic stroke. Now you know why your doctor is always checking your blood pressure. It's funny how they so seldom tell you why they do these things and why we don't ask, isn't it? Blood pressure should be under 140/90. The lower reading is the diastolic blood pressure, when the heart is resting and is the one to watch. Anything over 95 is a concern and at 105 the risk factor for a stroke is quadrupled. The good news is that since ischemic strokes are by far the greatest danger, if you look after your heart you will be looking after your brain too. At least so far as strokes are concerned. How do you do that? In brief, good lifestyle; exercise, diet and nutritional supplementation, in particular the antioxidants that slow cellular and vascular destruction. All of which I've covered here before and won't go into now.
Speed's the Thing......
Strokes are insidious, they sneak up on you and cut you down. People can dismiss the symptoms hoping that they will go away. Sometimes they do, but it is always a warning that you are at risk. Amazingly, it is an average 13 hours before many people seek help and are taken to hospital. Far too many people fail to recognise the symptoms of stroke or believe there is nothing to be done.
Speed, no - not the one that kills, is absolutely the key. It is essential that the distinction between hemorrhagic and ischemic attack is made as soon as possible. Treatment for the one is the the total opposite to the other. With one you've got to stop the bleeding and with the other the blood has to flow. And the sooner the better for both.
The first 24 hours after a stroke are the most important time in its treatment. The rate that the damage is done to the brain is greatest in the first six hours and most stokes are "complete" within 48 hours.
With recent surgical and pharmaceutical advances it is more important than ever that you and your doctor know what to do if you or someone near you is affected. In many cases doctors can prevent death or permanent disability if they can treat the victims within 3 hours of the first symptoms. That window of opportunity can increasingly be stretched to 6 hours. The drugs for this are called clot-busters, like TPA, and can have dramatic effects in increasing the chances of a full recovery. A recent survey showed that 40% of people so treated were able to return to work, drive a car and control their finances.
And What of the Boonies?
Well that's just terrific if you live in a major city with great hospitals within a few miles of you, and if you have people around you who can recognise what's going on and know what to do. It makes sense then to check out the local hospital facilities and that your doctor is up to speed on these things and what he would do for you in the case of stroke. Even so, its a lot of ifs. You could have done all this and just be in the wrong place at the wrong time, among strangers or people who ain't got a clue about such things.
And what if you live in the real boonies or are poor? What then? I don't mean to be flip, but if you've got to be ill at all - don't get a stroke. As the man says, "it's optional". Lifestyle is the best prevention.
Enter Your Friendly Broker.....
Other than that, for those who've got them, go check your medical insurance policy and seriously consider the emergency evacuation clause. Make friends with your friendly insurance broker, he's not there just to take your money, he or she's meant to provide a service and the good ones do. If they don't, get another one next time your policy comes up. And don't just leave it that, check out how it actually would work in practise. Pity to have paid the premium for it and not have it kick-in when its needed - now wouldn't it? That means making sure the people near you know who to contact in an emergency, that you have a local doctor who know's how the emergency evacuation system works and a proactive broker who comes to the party and smoothes the way. When it's a question of a few hours, if not minutes, you really don't want some cheapskate claims evaluator 6,000 miles away wondering what's wrong with the hospital down the Gang now do you?
Medical insurers are hard organisations to like and the brokerage system is not an attractive one. Nonetheless I suppose they are a necessary evil for want of a better way. Get good cover, pay the first $500 yourself so the premium is as low as you can make it. That means it really only covers something serious. Sweat the small stuff yourself, it's cheaper. Don't add many additional clauses but do seriously consider medical evacuation. Depending on your age you can can get all the cover you need for between $1,000 to $2,000 p.a.
Above all read the small print and beware the dreaded "Pre-Existing Condition"!
But then again, be careful out there! If there are some snake oil salesmen peddling remedies and nostrums, what of the dubious brokers abroad hawking insurance and other financial instruments of one kind or another? They are legion.
" Strokes scare the Bejasus out of me. What happens to you is all so arbitrary. The real damage is done in the first 3 - 6 hours. So speed & correct treatment are vital if there is to be anything like full recovery".
