From Indias largest newsroom, I'm Arun George and this is the
Times of India podcast. On Monday the 26th of February,
the Co founder of Zeroda and CEO Nitin Kamath wrote in a social
media post that he had suffered A mild stroke six weeks ago out
of the blue. In his post, he said that his
father passing away poor sleep, exhaustion, dehydration and
possibly overworking out any of these could be possible causes.
Kamat said he had noticed his face drooping and had struggled
with reading and writing. He wrote that he expects to make
a recovery fully in the next three to six months.
My colleague Lata Misha in Mumbai and I spoke with two
neurologists who are specialists on strokes to try and better
understand who is at risk of a stroke and what can be done to
prevent one. Doctor Sherish Hastak is the
Regional director, Neurology, Stroke and Neurocritical Care at
Global Hospital in Mumbai. He's been working in this field
for over 35 years. Doctor Sherish says that while
it's sad that someone as young as Kamath has suffered a stroke,
he's not surprised since he has patients across age groups.
You know, this is a very sad thing for a young, active person
to have and of course I wish him a speedy recovery.
That's the first thing. I have quite a number of
patients of young stroke. So I'm not surprised that he's
young and he's had a stroke. So my thinking is that stroke
can happen from 1:00 to 2:00. I mean, it's something that
happens at all ages and at all times.
So yes, of course it's much more common in the older age group,
but but it doesn't mean that the younger people are completely
immune to stroke. Doctor Shirish praised the Zero
Das CEO for speaking up about suffering from a stroke.
He says this helps raise awareness about something that
doesn't typically get as much attention.
Mostly celebrities will try to, you know, not talk about their
the negative side of their life and stroke is a negative side of
your life, so to say. And it's a disabling negative
side sometimes. Of course, I think Nitin is
recovering fairly well and I'm happy about that, but it can be
a disabling disorder and so celebrities will mostly hide
these disorders. And so I think I salute Nitin or
having come out in the open. So I think it's something that
will help create awareness about stroke and and create this idea
that stroke is recognizable and treatable.
That's something even Doctor Pavanuja has praised.
Dr. Pavan is a neurologist practicing in multiple hospitals
in Mumbai and is on the executive committee of the
Indian Stroke Association. Doctor Pavan says that given
many celebrities choose to not talk about suffering a stroke,
Nitin Kamal's choice to go public with it will only help
people at large. My salutations to him that at
least he's talking. Mithun Chakravarthi had a
stroke. He's not ready to talk people
who have a voice they should discuss so that the all those
lay people out there they become more aware.
Suppose a doctor now start, you know discussing about.
They see some different angle. They say that you know this is a
business talk, but someone who has already suffered it.
If he talks then you know it is a community which gets more
awareness and so many people will be benefited.
So what is a stroke? Doctor Shirish says there are
two types of strokes that people can suffer.
I think I need to make the people aware that there are two
types of strokes. One is where the blood vessel in
the brain is blocked and this is called an ischemic stroke and
the other type of stroke is when the blood vessel in the brain is
ruptured and that's called a hemorrhagic stroke.
Doctor Pavan says data for India shows that there are particular
patterns when it comes to who suffers a stroke.
He also explains that in 15% cases of people who suffer a
stroke there is a high possibility of death and in 20%
of the cases there is a chance of lifelong disability.
In general, the incidence of stroke, that means how many
people will get a stroke in India is roughly about 125
people per lakh. There are variations.
So some states where lot of, you know, unhealthy eating habits
are there, especially northern states, they have a higher
burden. So there are few states in which
the hemorrhagic disease burden is higher.
So they are towards the West Bengal, eastern part of the
country where there are more hemorrhages.
Kerala has more hemorrhages like even in Punjab the hemorrhagic
strokes are quite high here in Maharashtra, the hemorrhagic
strokes are less now the disability part.
So how many of them are disabled?
So in general moderate to severe disability.
As we say that you know person is out of his previous
functionality job or you know responsibility at home, that
same function person cannot do needs assistance that is to the
tune of 20%. So 20% people have lifelong
disability and out of that at least half they are having
spasticity also. So that means that their limbs
are rigid and not in the proper position.
So they don't derive much benefit from even physiotherapy.
They need to go for higher treatments like sometimes you
know, Botox injections or brain stimulation techniques.
So this is the burden and the death rate is about 15%.
So all those people who will suffer a stroke out of that 15%
will die because of the stroke or its complications.
A recent AIM study showed that the age group of those suffering
a stroke has been changing. Basically, the Indian Stroke
patient is getting younger. Doctor Pavan tries to decode why
this shift in the demographic seems to be taking place.
The Causeway is basically of two types.
You can divide these younger people into less than 30 and
more than 30. If it is less than 30, then we
typically get all the factors which are associated with the
poor development of the heart or the cerebral circulation.
So someone who's got a, you know, valvular heart disease,
the valves are not functioning properly, they are generating
clots. So there are many reasons which
are developmental anomalies in the younger people.
But it is very interesting to know that above 30 what trend we
are seeing is not of these younger people, same causes.
In fact what we are seeing is the older people's Causeway
coming here. So cholesterol deposition in the
arteries, in the carotid arteries, in the brain arteries.
So I think these are the younger people by age, but biologically
they are older, their behaviors are older, they are drinking,
they are smoking, not exercising, you know, eating all
junk food, not sleeping properly.
So they are, they are getting atherosclerosis blockage much
earlier and I think that is the most, you know, important thing.
One message we should spread is that don't get the stroke
earlier by inviting it. Doctor Shirish points out that
another factor that has been noted in studies is pollution,
particularly air pollution, which may be contributing to the
higher number of strokes. In the recent times there's been
a lot of thought about pollution and stroke, and pollution seems
to be a very important factor and probably pollution.
If you see you know the low and middle income countries have a
much higher risk because a is there, pollution is higher,
their population density itself is high, and because you have a
high population density the pollution is higher and
pollution will make you predisposed to strokes.
Doctor Pavan says that when it comes to strokes, there are risk
factors and then there are triggers which result in a
person suffering a stroke. So risk factor means whatever
are the factors which are there in the general population also.
But if you have them more than one together, then you are
having a higher chance of having a stroke.
So let's say someone who is like 65 years old, has high blood
pressure, diabetes, cholesterol and is smoking.
He has four risk factors for having a stroke.
It doesn't mean that he smokes a cigarette and he gets a stroke.
So this is not a trigger, but having all four, he has about a
two and half times lifetime risk more than a person who is not
having these risk factors. Now what are these triggers?
So very commonly we see the strokes coming up, you know in
the winters or in Octobers where there is a change in weather
where there can be viral infections.
So people who are typically have had suffered viral infections,
they are prone to having a stroke because of coagulability
in the blood. So blood is generally more
thicker, easily clotting. Similarly, there are other
triggers that we know. Among the potential causes that
Nitin Kamath listed for his stroke were lack of sleep and
other aspects like dehydration and excessive working out.
We asked the two specialists about these.
Doctor Shirish says sleep apnea is a major factor when it comes
to people who suffer a stroke. Sleep deprivation, and
especially if you have a sleep disorder called obstructive
sleep apnea and obstructive sleep apnea is, is fairly
common. I mean, even in the young age,
it's not necessarily that you have to be old in order to
suffer every disorder. So obstructive sleep apnea I
have seen in a number of young people and it's fairly often
missed because it happens at night and you're sleeping.
And So what I do is to all my young stroke patients and even
otherwise to my stroke patients, I will ask them that.
Do they do they snore heavily? And this is a question I'll
usually ask the partner Does this person snore heavily at
night? Does he wake up?
You know, because of snoring heavily and choking sensation
and is asleep at night Poor. And also you know, watch and ask
if there is a history of headache early in the morning
and an exhaustion in the day. Especially obstructive sleep
apnea can be linked to stroke and stroke risk.
And of course, obstructive sleep apnea also produces blood
pressure or hypertension, and that's another link to stroke.
Doctor Pavan says that while sleep apnea is a major factor,
he says he does see a lot of patients who just have really
bad sleeping patterns. He explains why trying to
stretch your day is always a bad idea.
And even with patients, he explains the one rule he tells
them to stick to. We are not discussing
obstructive sleep apnea. We are discussing a poor sleep
time and poor sleep quality because lot of these people,
they are having, you know, sacrificing their sleep.
Lot of other activities that are supposed to be done in the
daytime. They are doing continuously
working or continuously attending phone calls or you
know, bingeing, binge watching, binge eating, binge drinking at
night. As a outcome of this, there is
no time for sleep or that sleep time is altered.
It is sleep fragmentation. As a result what happens is the
hypothalamus in the brain gets disturbed.
There is a bio clock in the hypothalamus which allows us to
rest at certain times and during the rest there are some
reparative hormones that are released in the body and you are
restored and made healthy once again.
Now imagine that you didn't go through all this every night for
night after night. Then you know you are having all
the bad hormones getting released, all the stress
hormones getting released and lot of inflammatory substances.
So these inflammatory substances also Causeway inflammation in
the blood vessel wall lining and there clotting and you know
blockages of the artery take place.
So this is one reason why we are saying that adequate amount of
good sleep night after night should be taken.
And I typically tell my patients that 11:00 PM to 7:00 AM, no
device you must sleep otherwise medicines will not work.
I think it is all it is all common sense that if you are
challenging your body, going out of the way to challenge your
body then obviously there might be more problems.
Doctor Shirish explains why dehydration may not seem like an
obvious Causeway of a stroke, but how he's seen a case where a
patient who was fasting suffered a stroke.
So if you get dehydrated your blood becomes thick and then it
is prone to form clots and because the blood has to remain
in the fluid state in order to flow.
But if it becomes thick then it tends to clog and and that can
of course lead to stroke. But usually dehydration has to
be severe in order to lead to stroke.
And I remember one of my Jain patients, he was only 40 years
old and he fasted for about 5 days with no food, no water and
he developed a stroke. So he was certainly unable to
talk and his right hand and leg became weak.
And of course he did recover the hand and leg power overtime, but
unfortunately his speech did take a long time to recover.
Another factor listed as a possible factor is working out
excessively. We have been hearing about this,
you know, contributing to heart attacks.
Could this contribute person for suffering a stroke as well?
So you want to try to do everything and you know not not
take it down under. Sometimes you have to you have
to be the down under. You say OK, it's a bad day.
I'll take rest, I'll relax. So people who take on lot of
these responsibilities, sometimes you know they they
land into troubles. So we have to accept that you
know, some days you have to relax, take it easy.
So just working out extra that we see all the time that gyming
people or you know the marathoners they workout.
I think if you take adequate rest, do adequate hydration,
then it doesn't matter. But if you get everything wrong
on a particular day, then you land into stroke.
Are there any first aid like tips for people who are dealing
with a person suffering stroke? So the first thing we need to
understand is you should be able to recognize a stroke or
recognize the devil. And unlike a heart attack, the
stroke manifests by different symptoms.
You know, in the heart attack it's pretty simple because it's
either it's pain, pain and pain in the chest, so it's simple to
recognize. But whereas if you have a
stroke, then you need to recognize the stroke.
And for this, I think what you need to do is you need to
remember an acronym and the acronym is called B fast.
So it's BEFASTB fast. And each of this stands for a
symptom. So the B stands for balance
problems. E stands for eye problems.
So if you suddenly lose vision in one eye or if you lose vision
on one side of your eye, you know this could also be a
stroke. Then the F stands for face.
So if your face is deviated to one side it could be a stroke.
Then is the arm. So if you develop an arm
weakness, you know. So if your arm starts drifting
down, and the arm of course includes the leg as well, so if
your leg starts giving you trouble, you know then your leg
is dragging, then that could also be a stroke.
And then the S stands for speech and I think again within in the
social post said that his speech was impaired and then the speech
impairment also indicates that this could be a stroke.
And the T stands for time. So be fast and rush in time to
the hospital and rush him tied to a proper hospital is what I
would insist on patients and people.
Doctor Pavan says it's important that a doctor first diagnosis
what type of stroke a patient has suffered, and only then
should treatment be given if it's because of a clot in a
blood vessel, the treatment is very different from what would
be given if there's a rupture in a blood vessel in the brain, so.
Let us decide first whether this is ischemic or hemorrhagic.
So let's say that you have a hemorrhagic stroke in the brain.
You don't want to give a blood thinner, you want to drop the
blood pressure very very quickly to manageable levels.
So if you want to give like some some basic care to this person,
you know let's say that just first aid as you mentioned it's
not definitely not medicine. But if you want to just give
some basic care to this person, please see to it that this
person you you protect his airway, breathing and
circulation. So suppose there is a person who
has had a major stroke and becomes unconscious or he is
like partly conscious or he is vomited and you know his airway
is blocked. Then at least we should try to
clear his airway so that he can breathe.
If he is not breathing, well then we can give him like a CPR
and try to maintain his circulation if he's already
collapsed. So the same rules that follow
for the heart attack, CPR, airway breathing and
circulation, they also are applicable to these people who
have had a stroke. In fact don't even give water
because what happens is sometimes, you know, the
swallowing may be deficient, it may be very defective.
So you give some water and that may go into the lungs because he
is not able to manage the oral secretions.
So it's better not to do anything just straight away get
the, you know, the vehicle need not be an ambulance unless the
patient is really down and get into the some stroke ready
hospital. There are also plenty of
misconceptions about strokes. We asked Doctor Shirish what is
one of the biggest misconceptions that he
encounters among patients. But are there any misconceptions
about strokes that you'd like to address that you believe that
you see with a lot of your patients?
Yes, I think one of the misconceptions I want to, you
know, very clearly convey to the people is that a stroke is non
treatable. You know that's a misconception
people have because I think a lot of them go to the hospital
too late or go to the wrong hospital and don't see the right
people. Stroke is treatable if you reach
your hospital in time in a fair number of patients.
Not in all, I would never say in all, but they're in a fair
number of patients are treatable, especially treatable
if you rush to your hospital rapidly and in time.
And finally, let us ask Doctor Pavan what advice he had for
those who may believe they're completely healthy and not at
risk at all from a stroke, Sir. What advice would you give for
people to reduce their risk of experiencing a stroke,
especially if they believe that they are fit and healthy?
Everyone should introspect. Even when you call yourself fit.
Are you doing too much? Too much is not good.
I think there is a bell shaped curve so you do too less.
You are not protected and you do too much.
You are overexposed to all the risks and injuries.
So probably somewhere in the we are not going to prove ourselves
to anyone by doing an extra mile.
You have to do it. You have to protect yourself,
right? So first thing is that do some
introspection and think how much is required and how much is
necessary rather than trying to anchor the world.
Second is eat right, sleep right, exercise right, Do
whatever it takes. Do some meditation, do some
exercise so I am not telling any new things.
I am just, you know, revisiting or reiterating whatever we
already know. Today's episode was produced by
Jayaraj Singh and Sahil Gupta. For a daily spotlight on people,
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