STROKE IS IN DEED AN ATTACK

By Akingbade Thomas

When it comes to your health, I recommend frequent doses of that rare commodity – common sense. -Wincent Asky, 1960

One of the persons that had left a lasting impression on me, was my maternal grandaunt. I learnt the attitude of efficient and effective time management from her. Also, she was the first smart person I knew. She was then a clerk at a customary court, and whenever she comes home from where she worked, I was her favorite person to accompany her to her building site. She walked so smartly, that I had to practically run after her to keep up her pace.

I was about the age of 10 years then. One day, my mum was called up to travelled down to where she worked because she had become ill. Few days later, my mum came back to announced her death. I did listen to the story of how her illness started and how she eventually died. The part of the story that got me curious then, was the one where my mum said the cause of her illness was that she was struck by spiritual stone while she was having her bath. Following which she fell in the bathroom, one side of her body became paralyzed and she couldn’t talk again thereafter.

Due to my age then, I wouldn’t know what to make of the whole story, other than felt sad about the lost. But, as i grew older, I began to be informed through oral and written stories of how it’s possible to strike a person with stroke by 'wicked' people. This they said can be achieved by contracting a witch doctor, who is claimed to have power to project a supernatural stone ( capable of causing stroke) toward the intended person. According to this claim, when this projected stone hit the person, it causes stroke and sometimes death. It was then i understood the story of my maternal grandaunt incident.

As if I was being prepared for the profession i will later choose, this story of supernatural stone has been related to me in different variants by stroke patients i had come across as a physiotherapist. For many reasons and probably because of these stories, I have developed a specialized interest in Neurophysiotherapy – a subspecialty field in physiotherapy that is concerned with neurological conditions amenable to physiotherapy management. These neurological conditions includes, but not limited to: stroke, cerebral palsy, Erb’s palsy, Bell’s palsy, injection palsy and radiculopathy.

The features of most of these diseases are both scaring and startling. For instance stroke, its onset could make a man you saw and had a drink with few hours earlier, to become unable to sit, stand or walk, unable to talk, incoherent in speech, can’t remember his name, lost memory of events unable to recognize his wife and children, and some cases die within few hours.

With features likes these, it's easy for me know why the traditional/religious healers, came up with the "supernatural stone theory" as the cause of stroke. Was there not a theory of a god responsible for measles until medical scientist revealed the pathogenic organism responsible for measles?

Managing neurological conditions, present challenges beyond that which the mainstream medical intervention can handle. How do you manage a patient who believed the source of his illness is spiritual and not physical?

From basic medical psychology, the belief system of patient has significant effect on the outcome of treatment. Studies have shown that if you give another brand of analgesic to a man that has headache, and this analgesic is different from the brand that he has over time believed will cure his headache, he might likely not get relieved from the pains. People come up with belief (feeling of certainty) when they have consciously and unconsciously indulge in overwhelming references that support their particular belief.

In my attempt to help these groups of clients, i began to search for ways to cast doubt on these insidious beliefs. One field of study that has helped in doing this is behavioral neuroscience (physiological mechanism of behavior) – Belief is a behavioral concept. If i can help a client to acknowledge that the reason he believed an idea to be true is because he has consistently been told so. If the brain has consistently been filled with particular information without contradicting information on the idea, the brain overtime will code it as the only information on the idea –the truth.

So, if i can help a client to acknowledge that stroke is caused by a physical strike in his brain and not a supernatural strike, i am sure the outcome of my physiotherapy management will be significantly different from when a client holds on to spiritual cause of his stroke.

This mental reconditioning falls within the domain of Medical Psychologist specialty, but due to the challenges of availability of these specialists and organizational defect in health managements in Nigeria, this role is most times inevitably lumped up with the roles of physiotherapist. This is a role we don’t have choice than to fill most time, if a satisfactory treatment outcome is to be achieved.


Akingbade Thomas is a Physiotherapist.

THE BUILD-UP TO BRAIN ATTACK

Stroke, also known as brain attack, occurs when insufficient or lack of blood flow to the brain results in brain cells death. Since the brain is the supreme control center of almost all the functions of human body, death of brain cells result in that part of the brain not been able to control the body functions known to be its work properly.

Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, feeling like the world is spinning or loss of vision to one eye among others. These symptoms typically start suddenly, over seconds to minutes. This is the reason I suspect both the stroke victims and their relations are scared and startled when stroke occurs.

There are many factors that have been scientifically identified that can put one at the risk of stroke. These factors are grouped into two – factors that you can do something about: hypertension, high bad cholesterol, diabetes, obesity, alcohol and smoking. Factors you can’t do something about: Heredity, age, sex and previous stroke. Allow me to digress a little. The word “brain attack” is a descriptive phrase for stroke. The witch and some herbal doctors also describe stroke as “spiritual attack”.

Stroke (brain attack) – occurs when the “friendship” between blood transported in the arteries to the brain cells is blocked by an “enemy” called clot or rupture. What follows this strike is the lost of the role of blood in helping brain cells to remove carbon dioxide (a deadly chemical) and bring in oxygen (a life giving chemical). So, the brain cells die. The witch doctors also claim that stroke (spiritual attack) occurs when an “enemy” engages the services of wicked witch doctor to project an invisible arrow (clot) or stone (rupture) to a targeted person. The only difference between the description of the scientist and the witch doctor is that “brain attack” is scientific and made sense in the real world. While “spiritual attack” only made sense in the world of ignorance, myth and superstition.

The statistics of stroke is not good at all. Globally, about 16 million new cases of stroke and 62 million stroke survivors were estimated in 2005. In 2013, stroke was the second most frequent causes of deaths. This is expected to increase to over 25 million new stroke cases and 7.8 million stroke deaths by 2030 in the absence of significant global public health response. Between 1990 and 2010 the number of strokes which occurred each year decreased by approximately 10% in the developed world and increases by 10% in the developing world (e.g. Nigeria). It has been projected that the year 2030, about 80% of all stroke cases will occur in low and middle income countries of the world. Overall, two thirds of strokes occurred in those over 65 years old (the age one is expected to be enjoying the fruit of his labour).

When stroke occurs, it causes a significant negative socio-economic consequence to the victim, relations and the nation. Stroke is a terrible but preventable burden. It brings a suffering interruption on the lifestyle, work and finances of the victim; it brings the care-giver under a trying time, and the nation is deprived of human capacities when stroke occurs.

Though the symptoms of stroke could occur gradually or suddenly, but the factors that lead to the sudden appearance of these symptoms have a build-up aspect to them. Take for example; hypertension is a risk factor for developing stroke. Hypertension itself has risk factors. So if you prevent hypertension, you have prevented stroke. Also, if you manage hypertension properly, you will also have prevented stroke. One sure way to develop a build-up pathway for stroke is to have a lifestyle that predisposes to hypertension and manage hypertension wrongly when it’s diagnosed.

Most times, when i receive a consult letter of a stroke client, the first question that comes to my mind is – was it possible for the stroke victim to have prevented it from happening? The answer that i get from more than 95% of stroke victims is yes. I have found out that most of these clients are aware of their diagnosis of being hypertensive or diabetic. The ones that have not been diagnosed to be hypertensive or diabetics have at one time or the other been sensitized to regularly screen themselves for hypertension or diabetics.

Interacting with these groups of clients who ignorantly and carelessly bring themselves under the crushing burden of stroke, i have somehow become “fanatical” about the concept of preventive medicine through health education and promotion. Before i go on to discuss the physiotherapy management of stroke, I shall endeavor to do a part piece on how to prevent stroke this week and a conclusion next week. Hypertension (high blood pressure), accounts for 35 – 50% of stroke risk. Hypertension is the number-one risk or predisposing factors of stroke. If you can manage your blood pressure within the normal range, you would have reduced the risk of stroke by approximately 40%.

In my quest to understand patients better, i often ask the revealing question like; why didn’t you comply with your antihypertensive drugs? In that you know the consequence of failure to do so? Their response ranges from; i got tired of taking the drugs, i thought my blood pressure was okay, i was just careless, my pastor told me i was healed of hypertension, i was introduced to food supplements or herbal drugs that are said to cure hypertension etc.

Though the issues of faith healing and food supplements/herbal drugs are most frequent excuses hypertensive patients have, for not being compliant with their orthodox medical management, the issue of food supplements herbal drugs shall engage my focus in next week piece that I shall title “beware of pseudoscientists”. I shall also present the best way to manage hypertension so that it doesn’t predispose you to stroke.
To be continued………

BEWARE OF PSEUDOSCIENTISTS (1)

The build-up to stroke onset is a chain of events. The main risk factor for stroke is hypertension. Other risk factors include tobacco smoking, obesity, high bad cholesterol, and diabetes mellitus.

Hypertension which is the main risk factor for stroke also has the following as its risk factors: high dietary salt intake, obesity, genetic variation, and aging. Some of these risk factors for hypertension can be controlled (e.g. high dietary salt intake, obesity), while some can’t be controlled (e.g. aging and genetic variation).

If the hypertension risk factors are controlled, hypertension can be prevented. But when it’s already developed, it can be treated. So the combined effect of controlled hypertension risk factors and effective management of established hypertension makes stroke prevention a possibility.

The neuro-rehabilitation physiotherapist is as concerned in preventing the occurrence of stroke as well as the best management of stroke. The Neurophysiotherapist is particularly interested in monitoring, the management of hypertensive patient who is also stroke victim. This is to prevent second stroke occurrence which has a higher mortality rate compared to the first stroke occurrence. Secondly, uncontrolled hypertension in a stroke victim can have a significant and unimpressive treatment outcome of stroke patients.

Due to the low level of health education and awareness in Nigeria, many stroke victims are not aware of their blood pressure status prior to the day of the brain attack when they are rushed to the hospital. In a study done by Ullasi et al, 2011, in which they screened 731 market workers in Enugu on their awareness level of hypertension, the results revealed that 42% of the screened population were hypertensive, of this number, 70.6% didn’t know they were hypertensive before the screening.

This results and some other like it, confirm the abysmal level of awareness among Nigerians of the risk factors of stroke. This is the reason why the prevalence of stroke is increasing.

A more disturbing aspect of the stroke prevention education is the stroke victims who are aware that they are hypertensive prior to stroke occurrence, yet choose to stop or be inconsistent in taking their anti-hypertensive drugs, even when they have been told by their physicians that uncontrolled hypertension can lead to stroke.

These groups of stroke victims are a victim of riskier factors than hypertension, based on my interaction with them. These riskier factors include but not limited to faith healers, food dietary supplement merchants and herbal healers. For the purpose of this discourse, I want to focus on the frustrating effects of activities of some of the food/dietary supplements merchants, which I prefer to also, refer to as pseudoscientist. The activities of these pseudoscientists have serious counterproductive effects on the effort to educate people on the need to be aware of their blood pressure level and to take the management of their hypertension seriously.

A pseudoscience is a claim, belief, or practice presented as scientific, but which does not adhere to the scientific method. It’s often characterized by contradictory, exaggerated or approvable claims.

The activities of these pseudoscientists came to my attention through a client who fell a victim of their activities.

This client is 47 years old man who runs an ICT firm. In 2014, he was referred to me by a physician with a diagnosis of transient ischemic attack (TIA) which is a mild and fast resolving type of stroke, due to uncontrolled hypertension. After about two month of physiotherapy management, he got a full recovery except for a very mild abnormal feeling in the affected limbs.

At the time i was discharging him, i took time to educate him on the need for him to make a conscious and deliberate effort at managing his hypertension at the medical clinic from where he was referred to me. He did call me once in a while after this time and i usually ask him how well he’s following my advice in the management of his hypertension and his response is always in the positive.

It was shocking and annoying experience in February this year, when this same man was referred to me with a diagnosis of a major stroke. This time he was brought in a wheel chair to the clinic.

In the course of assessment, he told me how he had stopped going for check up at the medical clinic one year prior to this second stroke. My next question to him was why? Responding, he said he was browsing on how to treat hypertension and clicked on one of the Google results titled “Proven high blood pressure solution”. After reading the author’s solution, this client said he was convinced that the best way to manage his hypertension was what the author advised.
Wanting to know the content of what this man said made him stop taking his drugs, I ask him to give me web address of the author. Although I had read all kinds of stuff online about the management of hypertension, but this particular one that convinced this client is not just an outrageous claim, it’s a malicious and criminal intention. The sole aim of the author was to defraud hypertensive patients. Below is an excerpt of this pseudoscientist even though he claimed to be Biochemist:
To be continued………..

BEWARE OF PSEUDOSCIENTISTS (2)

“Since you are visiting, it means to us that you are probably somewhat frustrated with your association with high blood pressure or some other related diseases. That's easy for us to understand because we firmly believe that the conventional medical practices, as a whole, have sorrowfully neglected their duty to STOP Heart DISEASEs. They practice a lot of 'Drill, Fill and Bill,' but little or no attention is paid to stopping the cause of the diseases.
OptimalHealth offers you a FRESH and Natural APPROACH to achieving a disease-free Life... where body stay healthy for a lifetime. Right now you are here and am ready to lead you by the hands out of hypertensive life.
Reason why should be confident that I can help you…
I am Adelodun Dele Victor , a trained Biochemist and a Health Researcher. I am an advocate of Proven Natural Therapy. Precisely in 2014 I was in the Laboratory for 8 months reaching on effective natural alternatives to synthetic drugs in treating hypertension, while by co-researcher was working on natural alternative to diabetes drugs.
What you don't know and you should know from today is:
You've been given a death sentence the day you started taking anti-hypertensive drugs.
Am not just saying this, several researches have confirmed it that synthetic drugs do little or nothing in saving patients’ lives from diseases like diabetes, hypertension, stroke, cancer, and other. But rather worsen the condition over time.
And to confirm this, just ask yourself, “Why as this thing not disappeared or at least get better after 1, 2, 3 years of medication?"
According to new research...
Blood Pressure Medications and Diabetes Medications Don't Work, They Only Make Matter Worst.
Here are some scientific revelations:
Blood pressure medications can lead to increased risk of stroke
New research from the University of Alabama at Birmingham published in the journal of Stroke, a research led by George Howard; Dr.P.H. shows that anti-hypertension medicines can increase stroke risk by 248 percent.
In The research, a number of black and white participants ages 45-plus from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) were followed for 6.3 years
At the conclusion of the follow-up period, more than 820 participants had experienced a stroke.
Howard says the risk of stroke went up 33 percent with each blood pressure medicine required to treat blood pressure. Hypertensive individuals on three or more blood pressure medications had a stroke risk of 2.5 times higher, compared to people without treatment
Dr.Howard concluded the research by saying:
"We want to raise the issue that, despite great advances in a pharmaceutical approach, relying solely on this approach is going to come at a dear price of people's lives."

To confirm if indeed the work this pseudoscientist reported does really exist, i did a search on George Howard, Dr. PH: this is what I found:
George Howard is a professor at the department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL. He’s currently the overall project principal investigator for the Reasons for Geographic and Racial Differences in stroke (REGARDS) project.
His research topic is – Differences in the role of black race and stroke risk factors for first versus recurrent stroke. The objective of this work was to assess whether black race and other stroke risk factors have differential effect on first versus recurrent stroke events.

For this work, he recruited 29,682 black or white participants aged 45 years and older. He followed-up these participants for over an average of 6.8 years. The results are: 301 of 2,993 participants with a previous stroke at baseline had a recurrent stroke, while 818 of 26,689 participants who were stroke-free at baseline had a first stroke.

He therefore concluded that the association of age and black race differs substantially in first versus recurrent stroke risk with risk factor playing a similar role (almost all the “traditional” risk factors for a first stroke proved to also be a risk factor for a second stroke, suggesting that controlling these factors may help around both conditions).

The magnitude of malicious distortion of Prof George Howard by this pseudoscientist proved his sole intention, which is financial fraud.

There is no argument that food supplements have it use. But the activities of most of its merchants in Nigeria appear to be a clog in the wheel of medical management of lifestyle diseases if they are left on checked.

Usually, my clients do seek my advice on the best choice of management between pharmaceutical drugs and alternatives (herbs and food supplements). In the management of hypertension after i might have explained what pharmaceutical drugs management is and what alternative management is, i leave them to make their choice.

According to the U.S. food and drugs administration (FDA); food supplements, also known as dietary supplements are products which are not pharmaceutical drugs, food addictives or conventional food, and which also meet any of these criteria:

(1) The product is intended to supplement a person’s diet, despite it not being usable as a meal replacement.

(2) The product is or contains a vitamin, dietary elements, herbs used for herbalism, amino acid, any substance which contributes to other food eaten or any concentrate metabolite, ingredient, extract or combination of these things.

(3) The product is labeled as a dietary supplement.


The intended use of dietary supplement is to ensure that a person gets enough essential nutrients. Food supplement should not be used to treat any disease or as preventive healthcare. An exception to this recommendation is the appropriate use of vitamin D. In some circumstances, are dangerous. Food supplement are unnecessary if one eats a balanced diet, according to the U. S. National Institute of Health.

According to the American Heritage Science Dictionary, a pharmaceutical drug also called a medication or medicine, is a clinical substance used to treat, cure, prevent or diagnosed a disease or to promote well being. Pharmaceutical drugs may be used for a limited duration or on a regular basis for chronic disorders. A medication is a drug taken to cure or ameliorate any symptoms of an illness or medical condition.
With the above definition and explanation of what food supplements are and what pharmaceutical drugs are, patients can make their free informed choice.

For effective management of established hypertension, there must be compliant with antihypertensive drugs use and lifestyle modification (low salt intake, exercise regularly, maintain normal weight etc). On the part of the hypertensive patient, i usually advise them to register at a medical clinic closest to their house, keep regular appointment with their physician and go to the nurses at the center to check their blood pressure whenever the physician gives them appointment time that is more than one month.

Findings of many research works on effective management of hypertension, agrees with the advice above. Stroke can be prevented if you prevent or manage its risk factor effectively.