How To Handle Stroke & Head Injuries?

[00:00:00]Salam brothers and sisters uh welcome to this evening session. Uh please to note your choice of being with us this evening.

[00:00:10]Um of course I'm sure it's a very wise choice to hear from Dr. Nachi who is actually a practicing surgeon >> and and I'm sure he's treating this as a sava. I know sava is selfless service to enlighten all of us. Um I ask that all of us please mute ourselves while the session is going on so that we don't be interrupted and uh as brother Dr. Nachi is explaining you could write your questions down so that it would be easy uh when the Q&A comes for you to um ask him all your doubts.

[00:00:51]So Dr. Nachi is a very well-known surgeon. So he performs brain and nerve surgery at the pantai hospital. You can see on the screen he's a consultant neurosurgeon have actually requested Dr. Nachi before he talks on this subject to please share his journey uh from you know from his early days or maybe from his initial medical school up to becoming a qualified uh brain surgeon. it'll give us an idea of the challenges and appreciate appreciate his work. Uh so dear brother Dr. Nachi appreciate your effort in enlightening us. So the floor is yours. Thank you.

[00:01:39]Uh Sam brother Sam all the participants in this uh uh WhatsApp study circle session um is my voice clear?

[00:01:50]Yes.

[00:01:51]>> Okay. Okay. This um I did my um uh my MBBS is in India. Okay. A place uh called Bulbar in Karnataka. And uh in those days we have to finish fiveear course um after your HSC equivalent. And then um we [clears throat] did uh I did my one year housemanship in Tanjaw Medical College in India. Then when I come here the at the at that time the regulation says you have to do housemanship here as well. So I started my journey repeating the housemanship in Moa. Then thereafter I was posted to uh EPO as a medical officer. Then uh after one year I was transferred to uh to to a smaller place okay in Parag itself. And uh after about one and a half years um I was called up um for the army. So they they was trained in Tandak Malaka and was was serving the army for three years as a captain and >> yeah and um uh when I actually when I was in the army I was applied for scholarship to do surgery which I couldn't get the scholarship because of uh some financial concent constraints at that time. So I went to Edinburgh. I did my FRCS part one.

[00:03:22]Edinburgh is in UK and uh I joined also the University Malaya hospital. Then uh thereafter I did my part two of the FRCS also in Edinburgh. Then I became a lecturer in University Malaya and uh I took up a general surgery because at those days there's no direct neurosurgery specialtity like they have now. So you have to do the four years of general surgery then you become a general surgeon.

[00:03:50]>> Yeah.

[00:03:52]>> Anything? No.

[00:03:54]>> Okay. Then I did >> Yeah. I did the four years of general surgery there. uh uh then I became a lecturer in general surgery and I was doing and I I got trained both in University Malaya uh in neurosurgery.

[00:04:10]Then thereafter I went to Singapore. The next two three years uh two and a half years I was a senior registister in neurosurgery department Singapore General Hospital. Uh then thereafter I was uh offered a scholarship to go to Oxford and I was at Oxford um I finished another two years of uh neurosurgical training program. I came back to University Malaya. I worked for a couple of years and in 1997 I started working in Panta Hospital. In 2013 I joined Manipal uh college as as a teacher uh full-time there for a while. Then um as um [clears throat] at uh when I reached 75 I my age then I came back to Pantai and I'm still working there. So this is my journey. So, so it normally takes after five years even now nowadays you can do a masters in neurosurgery direct which means after your MBBS you have to do two year housemanship in Malaysia then thereafter you have to do two years of MOO ship then thereafter you apply for a masters in uh neurosurgery which will taking another four years then thereafter usually between one to two years you'll get a gazetman and you become a consultant neurosurgeon that's a training pathway in Malaysia So here's brother Ed is a long journey so thank you so much for sharing all yours brother.

[00:05:41]Yeah. So I I'll start the topic. I chose this topic stroke because the stroke is linked to many other medical problems.

[00:05:51]Okay. Which has contributed uh to for people having uh suffering stroke and nowadays we are seeing stroke almost um in in Pantai hospital in a in an average day we are seeing about five or six patients who are coming for stroke symptoms of stroke. So it's a very big burden. Okay. And um as we know uh the if if you have heart attack okay uh you you can you either of course a massive heart attack you don't leave okay you may die okay if it is a minor heart attack you can you can have a strand strening done okay or or angio plasty done balloon angoplasty okay or even a surgery okay uh cabg surgery done Okay. But in stroke wise this uh there is no such procedures. It may it may cause a lot of disability which is a burden for the patient and the family for forever. Say you may not die but you may have severe disabilities and so on.

[00:07:00]So the best is the best interest to prevent and so on. So I just wanted to have an overview of this stroke. It's not a comprehensive is a very very uh superficially overview but I think it's very important for all of us to know uh why we are getting stroke and what are the cost causitive factors so on can I have a next slide please next slide yeah okay actually uh you must look at it as a brain attack just like you got a heart attack okay we all clear it comes suddenly you know brain attack you may think that you are quite Well, very all right but it can come suddenly and in fact if we are looking at it 25% or to 40% of all the people who said somebody died peacefully in their sleep is most likely they had a uh stroke. Okay.

[00:07:52]Another another 30% 40% maybe because of massive heart attack they they die in their sleep. Okay. But the majority of the people don't die you know they they they they they have come with some sort of a disability.

[00:08:06]Okay. So what you need to attack what you need to know is that stroke it it comes in suddenly like a lightning.

[00:08:14]Okay. And um uh in Tamil they call it pakawadama. Okay. Pakawad means one side I mean one one one side right side or left side of the hand and leg does not work. So stroke is not does not always do that. Okay. There are many other ways they can present as well. So what happens that when the stroke uh stroke actually happens because the blood supply to some part of the brain is interrupted.

[00:08:43]How can it get interrupted is either the blood vessel is blocked okay by a clot.

[00:08:49]Okay. Or or we call it artheroma or or cholesterol plaque. Cholesterol kind of a plaque. Okay. it can obstruct or the blood vessel can rupture in both ways the uh the blood does not reach the target part of the brain. Okay. And uh if there's a block and so on what happens that there's no blood supply the brain cells will swell first and they die. If there was a there's a big big [clears throat] block a big vessel the whole of the brain one part of one half of the brain may be swell swell up and when the brain swells up there's no place in the head you know if if you have a in your in your abdomen if an organ swells up actually uh the abdomen can uh can expand you know and accommodate the swelling but the brain is actually in a very tight compartment of your skull you can't exp expand And so what happens is that the pressure in the head goes up.

[00:09:50]No blood supply to the brain and you can die. If it's a massive we call it a massive stroke. Okay. So what happens that if it's a smaller area then it all depends which part of the area is affected either by the blockage or the bursting of the vessel and that will result in the loss of the function of that part of the affected brain. Okay.

[00:10:12]Next uh next slide please.

[00:10:15]This is a Malaysian statistics. I think 2024 to 26 that this kind of statistics that you have. We have new cases. Uh the annual incident is 52,000 new cases in Malaysia. It's a lot. Okay. And how many hospitals are there in Malaysia to accommodate all these 52,000 patients?

[00:10:36]You must understand. Okay. This is um national second leading cause of mortality in the country. The first one is you know that as you're getting older is one of the commonest causes actually pneumonia. Okay, this is for you die of pneumonia is a commonest cause. Second uh leading cause of mortality means death in our country is stroke and mortality rate is up 32 deaths every single day. Every 1 minute and 20 seconds there is one person dying because of stroke. There's only a small percentage who die. Majority live with disability. Okay. So, so it's quite a very high burden.

[00:11:22]The age trends this very important.

[00:11:25]Okay. This is another reason why I want I chose this topic was those days only the older people get it 65 and above. Now what is happening is that we are seeing people with 30s late 29 28 29 have seen strokes. Same thing with the heart attack also they seeing it long younger people. That means something is going on in the whole world as well as Malaysia. There is a significant increase in young adults with strokes. Studies are showing now the peak is not at the old age. No peak is the stroke incidence is the age men among men aged 35 to 49.

[00:12:06]Okay. And the 50% increase in the jump in the women as well in the same age. You know it was not happening about a decade decade ago but it's happening now. We'll find out what are the causes why it is happening.

[00:12:21]If we talk about the gender breakdown about 55% of the stroke patients that we see in Malaysia may men women about 45%. But if you look at the death rates due to stroke the women they they overtake men even though they have only 45% compared to 55% of strokes.

[00:12:45]more women die uh um up to 60% of the uh deaths and stroke are actually women.

[00:12:53]Okay, this about uh the roughly um overall stroke statistics. The next slide please.

[00:13:02]This is to to understand. Okay, don't get confused. This is the brain to your to your right hand is a is is a back part of your brain. You are seeing a side view. The front part is to your left left side. Front side is if you look at the top is have a frontal lobe.

[00:13:20]Frontal lobe is confined for your thought processes. Okay. Your your judgment, your foresight, everything is in the frontal lobe. If you go a bit higher on top, you find a motor cortex.

[00:13:36]Okay. If the motor cortex suppose the blood supply is disrupted okay then the motor cortex there's no movement if is on the right side of the motor cortex they affected the left side left hand and left leg will not move okay they got paralyzed this lakadama okay if it's a frontal lobe they become confused okay they may talk they may talk incoely and so on and if we look below the frontal lobe you have a broadcast area which is speech area they may get slurred speech okay incomprehensible speech and so on and if somebody suddenly says I'm getting smell of jasmine does not mean that he's talking nonsense it may be part of a u uh stroke okay uh which is happening at the the lower part of the frontal lobe if you have the temporal lobe uh usually your intellectual functions are uh they may behave suddenly like a childlike behavior and things like that. Okay. And if you go down below there's a brain stem. Lot of strokes which when you have a brain stem is affected it can cause death immediately because it it it uh the the brain stem function is to control your breathing your heartbeat and so on.

[00:14:56]>> Okay. So if if uh if the breathing and heart is affected then it can cause the death. So the brain stem stroke is the most nasty part of the stroke and if we talk to the to your right the bottom cereal that is talking >> okay that's a small part of the brain >> brothers please uh mute yourselves >> yeah if you look at the bottom uh to your right cerebulum that's a small part of the brain back part of the brain that if you have a stroke there then you can't walk you can't balance you cannot stand and so Even though you can your your movements are strong there's no coordination.

[00:15:38]Okay. And if we look at the uh one more area you got speech comprehension.

[00:15:43]Whatever we talk they can't understand you know they can't understand that's the wix area. And if you look a bit higher than that occipital lo and some people may be surprised that's the part that you see. Some people say whether you have a head you have you have your eyes at your back of your head. Yes, we have that the front of the where we have eyes, they only transmit the light.

[00:16:06]Okay, and uh the images are projected and you see the images due to some areas in the occipital loa. Okay, that's back part of the brain and so on. So you find there are so so many areas of the brain with the different functions and if we have a focal not a focal one area one small area where the blood supply is interrupted then you will have um a disability in in the function of that part. This what I wanted to tell next u next slide please.

[00:16:43]Okay, this is a pictorial diagram where you are seeing at the bottom you are seeing the top part of the brain and the the the the the one at 12:00 is the frontal loes the front part. Okay. And you find that there's a maroon color kind of thing and uh that arrow you point out what is the representation you find that uh there's a human being there. No. Okay. You will find the face face is represented a lot by that part of the brain compared to your leg your toes and so on which is in the groove between the right and left lo you can see the feet there okay is it's represented representation is very very small okay shoulders and arms alo okay but the hand itself you see quite big so you find that certain areas of the brain the representation for movements and so on is a much bigger area is given for us. Okay, next slide please.

[00:17:44]Okay, from the brain all the fibers from the top from the gray matter you find all the colored things that you're finding. So they all come down the green the blue all the nerve fibers will come from the top they all go down to the brain stem and so on and all all different parts of the organs and so on.

[00:18:05]say they all the fibers are uh represented very symmetrically and and so on. you don't worry worry about whatever is labeled uh uh so what I want to tell you is that there outer part outer areas are you got a gray matter and also inside the brain there are certain areas of the brain which are very vital okay and uh they called ganglas and so on so they also project some fibers and so on and these fibers will reach the target organ for function okay the fibers have to eventually from the from the motor cortex in the brain pain must reach the hands and legs for the movements. Okay. And the speech area is to your tongue and so on. So these are the ways these fibers all travel.

[00:18:50]Okay. Next slide please.

[00:18:53]Okay. This is a uh p uh picture where you're seeing a brain and you can see in the bottom there was a blood what you're seeing is a blood vessel and the one one of the blood vessels you can see the yellow thing in the in the in the left bottom the yellow part is a cholesterol plaque.

[00:19:15]Okay. When we are taking food and many cholesterol comes from food and our body also manufacture some cholesterol eventually they block they block it. It is it becomes a narrow and when it's a complete block what happens is that you can see the brain there the blue shadow that is that part of the brain is dead because that that's the blood vessel the yellow part small yellow uh region below the blue area you can you can see that's where the block happened and uh the blue area is where the brain becomes u uh did that part of the brain dead doesn't kill you but the function of that part is gone most likely forever. Okay. And if you look to your right hand okay you also can see the brain there and there is a black uh sorry white red area and there's a blood vessel there which has ruptured. The rupture cause of rupture is also the same. the the what happens that the the there's a there is a cholesterol plaque in the uh blood vessel and this plaque is weakens the walls of the blood vessel. When the walls of the blood vessel is weakened, it can rupture. Okay. So when you when the blood vessel ruptures, you got two problems. Number one, the blood was ruptured and the blood cannot travel to the target part of target part of the of the brain. And number two, the blood itself is causing pressure. Okay, because there's a mass there's a mass this uh uh uh there is no space for the for the blood clot in the in the in the brain. So it press it presses on the adjacent brain and it can cause damage to the adjacent brain as well. And if the blood clot is very big then what happen the overall pressure in the whole of the brain is increased. When the overall pressure in the brain increases, the blood supply to the brain is interrupted because the blood cannot overcome the pressure of the uh uh pressure in the brain in the in the in the skull pressure is high inside the brain cavity. So the blood supply blood cannot reach. Okay. And and that also can cause death. Okay. The next slide please.

[00:21:39]Okay. What are the types of stroke that you are seeing? Okay. First of all, I say the stroke can happen at any age.

[00:21:46]Okay. If if it happens at the very young age is usually due to some other problem. They born with some weakness inherent weakness of the blood vessel or some abnormality in the blood vessel and so on. This these abnormalities near and weakness are very small portion maybe 1 to 2% only. Majority don't come under the young age group. Okay. They are more common those days in the early now in the middle as well. So actually what you looking at is that there are three different types of stroke. The we just now saw two types. One was the iskeemic stroke where we say the vessel blood vessel was blocked. Okay. So this most common is up to 80% of the uh strokes are blocks. Okay. is uh because of the block there's a blood supply to the brain is cut off for that part and you and you suffer the effects of the block.

[00:22:45]Number two is a what he call transient eskeemic attack. This is what he called a mini stroke. It's the same exactly the same as the eskeemic stroke. But what happens is that the there was a temporarily this this this plaque temporarily had blocked the part of the brain sorry part of the blood vessel but it had cleared on its own. After some time it it the the the clot the the the block plaque is broke is break down into small small parts and then it clears that is called transcendent eskeemic attack. Then somebody says I suddenly I suddenly I couldn't speak or suddenly I couldn't move my hand but after 1 hour 2 hours the power came back means he has suffered from transient eskeemic attack or TIA. Okay. So, so we can't let it go, you know. Oh, it's only tension now you're okay. People with the tension eskeemic attacks, majority of them proceed in the the next few days into a into a bigger stroke. So even though you become okay, I think you have to come and see a doctor. Okay, you had this episode but it went off by itself and so some people they just can't see blind. Okay. For for for for minutes to hours uh even even even several hours then suddenly they can see okay actually it's not eye problem okay it is actually a stroke in the in the in the area of uh part of the brain which serves the vision. The last one the matri is a hemorrhagic stroke which I we also saw which is caused by the bleeding in the brain due to rupture of the blood vessel.

[00:24:32]Okay, the next slide please.

[00:24:36]Okay, this is the CT scan of the brain.

[00:24:39]Okay, normally when you do a CT scan of the brain I this you can see the arrow it shows the dark area where some blood vessel supplying that part of the brain quite a quite a large part of the brain.

[00:24:52]We I know exactly which vessel is called middle cerebral artery which is a big artery. Okay. Okay. Not a branch artery is a main artery on the right side of the brain. Okay.

[00:25:05]And uh on your left is on the right there for us. Okay. And uh this change into black color it takes about 2 to 3 days to see in a uh CT scan. Okay. So I know that this this scan is taken after the patient suffered the stroke. Okay. Uh at least 3 to four days afterwards. Okay. Because uh if you want to see immediately then uh you have to do an MRI scan. You can do immediately. Okay. Uh so here there's a block in the vessel. So what what I is on the right side and it where the arrow is at the center that's the area is a motor cortex motor cortex means which controls the movements of the body. So be being on the right side and and if the area of movement of the body is affected he is paralyzed on the left hand left leg he can't move and looking at the extent of the stroke this is permanent for him. If suppose at 45 he had this attack and he's paralyzed on the left side you can't left hand left leg or the left side of the face is going to be permanent for the rest of his life. Okay. Okay. This is as how serious it is. Now, next slide please.

[00:26:27]Here is is in the similar area. What you are seeing in the white area. Okay. The CT scan most probably done immediately.

[00:26:36]Okay. If it is a block, it takes the brain to change uh by swelling and uh dying to become a dark area like earlier slide. But bleeding you can see immediately. Okay.

[00:26:50]immediately. This is very very immediate because I can see the the white part is the blood and surrounding the white part if you can see properly there's little bit ho of darkness that is a swelling of the brain because of the pressure of the blood clot into the surrounding brain.

[00:27:09]So this here also the same area like the previous eskeemic stroke. Okay.

[00:27:16]So he would have had left side hand and leg paralysis. So because it is this clock is pressing onto the normal part of the brain out and causing damage. We normally I normally what I do is I go and operate and take all this blood clot so that we can save at least a unaffected part of the brain from dying due to pressure local pressure.

[00:27:42]Next um slide please. Okay. Next we need to know what are the signs and symptoms.

[00:27:50]So this lady is pressing onto her head.

[00:27:53]Okay. Most likely is having headaches but all of us have headaches, right? Okay. So what happens that all of us have headaches. The characters of headaches can be very different.

[00:28:07]Usually the our headaches we say morning we get up. Hey, I'm just having just hold on some.

[00:28:14]Hello.

[00:28:15]Hello.

[00:28:16]>> Hello.

[00:28:17]>> Yeah. Yeah.

[00:28:18]>> Yeah. Yeah.

[00:28:21]Yeah.

[00:28:29]>> Yeah.

[00:28:30]>> Vision intubate.

[00:28:32]>> Yeah. Yeah. I think you call anesthetist intubate. You do CT city scan of the the whole the whole thing you do. And you also got fracture ribs, right?

[00:28:45]Okay. Just the all there and ask them to inhibate. I will have a look afterwards.

[00:28:49]Yeah. Okay. Okay. Thank you. Thank uh sorry about that.

[00:28:56]Okay. I because I'm on call this week.

[00:28:59]Okay. And um so we have a patient. Okay.

[00:29:03]Anyway, this uh stroke uh uh what happened that headaches. Yeah.

[00:29:10]Headaches normally what happens that we said we are having some heaviness in the headache then you got suddenly s suddenly you got a throbic headaches it become severe later so it is a slow progression if somebody says suddenly I was very well just like a lightning I had a you know for no reason no such a heavy headache which means the blood vessel has burst blood vessel has burst okay normally the block doesn't cause sudden headache so much okay but but If the blood vessel has burst you have a sudden was very very well suddenly when you're talking to you joking and laughing suddenly holds a head and said severe pain you have to suspect patient is having a stroke is one of them next slide please okay this is what do you call um if you look at the second slide second one from your from your left the red [clears throat] part or the white part I don't know which part is yeah red part is the stroke part which is called hemiplasia. Sometimes what happens only one hand is affected. Okay that means on your you can see monoplasia mono means one one in the third part you can see two hands have gone that means is some peculiar conditions where only two hands can't move but the rest of the legs all can move called dip pleasure. The next one is you see the red part is paraplegia only both the legs it never it never never because of the brain it always the spinal cord okay some something happened to the spinal cord you going it's not a stroke it's not a stroke spinal cord and also the cord pleasure is also that means below the neck you can't move anything whole body that is also spinal cord so we have whole body right left leg everything then it is not a stroke okay It is a it is a damage to the spinal cord. So the last two are definitely spinal cord uh problem and um uh in the second one is very typical of a uh stroke called hemiplasia. Next slide please.

[00:31:23]Okay. How the stroke affects just now we saw the parts of the uh brain. Okay. So the the brain when um the frontal part of the brain thinking part of the brain uh is affected due to either ismic stroke or hemorrhagic stroke you get confusion suddenly get confused.

[00:31:46]You don't know where he is. He can't identify who you are. He can't think at all properly. Okay. Okay. See confusion there. He doesn't know what time it is.

[00:31:58]You don't know where he is. Just hold on. Sorry.

[00:32:01]Sorry, as I am seeing there's one patient who just came in. They just told me that patient is already fixed dilated people. So that they're doing a CT scan very likely a stroke. Okay. Anyway, what am I? Yeah, confusion. Then of course as I told you what if there's a burst you can have a burst vessel suddenly you can have severe headaches and uh blur vision. Okay, this is another thing.

[00:32:26]Some for no reason why suddenly you got very clear vision became blood vision for for no reason you have to suspect it's a stroke. Paralysis we already told you the hand or leg can completely no movement at all you call paralysis but there was some movement uh but not as strong as before then he call it weakness. Next is the cerebulma the back part of the brain. I told you that one is important for your coordination. So if there was a stroke then you'll get loss of coordination. If it's a brockas area or venex area then you'll have trouble speaking. Okay you can't speak very slur speech. And then uh next one is uh face drooping of the face one side of the face crooked face that you can have. So these are the common ways by which the stroke affects. If we have any of these then you must suspect in our in our family members that it could be a it is a stroke. Okay. Could be a stroke.

[00:33:25]Next slide please.

[00:33:31]Hello. Next slide. Yeah. Um okay. This but whatever it is occasionally it may not be due to stroke. It may be due to epileptsic seizures that you see or it could be a very severe migraine headaches. We need to find out or it could be just a dizziness for your ear.

[00:33:50]Suppose sometimes you can have a ear problem, ear infection whatever it is you can have some dizziness or you may have a sudden rise in blood pressure or low pressure or due to low uh sugar level in your all lot of reasons why you can have dizziness. Okay. The crooked face you can due to a bell pulsive due to a viral infection of the nerve also can have there's a condition called trienal neuralgia can cause very severe headaches or severe facial pain and so on and numbness and weakness can be due to nerve disorders also can happen. So all these uh you cannot assume okay you have to think first of all it could be a stroke and then the patient uh you have to take to hospital to to to rule out these problems. Okay. Um next slide please.

[00:34:42]Okay. This we we have to talk about this very important thing. What what do you think is a cause of the stroke? Okay.

[00:34:48]One of the main causes of stroke a vast majority is a high blood pressure. We call it hypertension. High blood pressure.

[00:34:57]Hypertension or high blood pressure. And number two is a diabetes.

[00:35:04]Okay. Both are prevalent in Malaysia.

[00:35:06]I'll tell you the statistics later.

[00:35:08]We'll go through each one of them. Uh uh from high blood pressure, diabetes. Then next is the cholesterol. High cholesterol. Okay. Also very prevalent in Malaysia. Next is obesity. Obesity.

[00:35:24]You know the overweight and obesity.

[00:35:27]Your your uh BMR is very high. BMI is very high. Okay. Obesity. The other one is smoking. Okay. Very little. I don't think smoking only causes cancer of the lung. It causes about 80 different medical problems smoking alone. Uh next one is the stress. We have always underestimated stress. Stress is one of the very very important uh uh causitative agent for not only stroke but is also for stress can cause high blood pressure. Stress can cause make the diabetes worse. Okay. Stress stress can cause obesity worse. Okay. And stress can cause uh heart attacks.

[00:36:12]Stress can cause uh strokes. Okay. So stress is now getting what you call very important uh um recognition as one of the causes of major illnesses in our body is stress. Okay. Next um slide please.

[00:36:31]Okay. Hypertension is so called a silent killer because uh this is I think all of us have to understand it very clearly because majority 90 95% of the people with high blood pressure got no symptoms okay they are telling oh I don't have pressure I don't have headaches don't have nothing I don't think I got pressure no majority of the high blood pressure patients it is called no symptoms at all okay that is why They call it the silent killer.

[00:37:03]Okay. Okay. It can cause damage to the arteries without symptoms. Okay. It significantly increases the risk of both the type of strokes. ES schemic strokes or hemorrhagic strokes. Okay. So we must understand uh exactly. So how do we know we got no symptoms? How to know that we have got high blood pressure? You have to go for checkup. You are 30 years old.

[00:37:26]No symptoms. Go for your first checkup.

[00:37:29]Otherwise you will not know that whether you got high blood pressure or not. So majority of the Indian patients who I see in the hospital, they first come to know they got high blood pressure or even diabetes or even chole what do you call high cholesterol only when they have a stroke or when they have a heart attack when they come and see I couldn't I got paralyzed here or I got heart attack pain then they test very high blood pressure or very very high uh sugar levels okay so They didn't know because they never had a checkup. They most probably had this for years and all this doesn't happen on one day. Okay, you must have had a pressure for 10 years, 5 years, 15 years, you know, kind of thing before these things happen. So, it is extremely important that that you go for this checkup. Okay, that is why hypertension [clears throat] is called a silent killer. Next slide, please.

[00:38:31]Next slide. Yeah. So what you reading actually nowadays you can buy this I can buy in shopppee or whatever it is I don't know 100 something only you can always check up you know every house must have one uh I think okay on and off you know is the older people can check younger people also can check what you're seeing the reading there are two readings one only called sysolic reading and the other one called diasolic reading sysolic reading is when the heart is contracting to pump the blood you get that 120 there you can See when the heart after after contracting to pump the [clears throat] blood it will relax. When you relax that's a pressure that's called 80. Okay that's called diastolic this one. So what you seeing is 120 by 80 is an ideal uh ideal blood pressure for adults.

[00:39:23]Okay. And the bottom you're seeing the pulse rate 80. So so I think it's very useful. Okay. Now and then you can check you can have this. I think every house should have one. Next slide please.

[00:39:36]Okay, this is called the categories of hypertension, high blood pressure. If we took at the right, you can see your pressure should be less than 120 systolic. Uh and the diastolic pressure should be less than 80. And the moment you have goes above 120 to 129, you always consider uh prehypertensive already. you know your possible you must check between 120 129 and then uh of course this is about 80 plus not less than 80 okay 80 82 83 like that so what happens is um uh uh the um uh when when to take the blood pressure not when you after running come and sit down and take it will be high you must take at least half an hour at when you're in a rest resting stateh when you're in a resting for half an hour your pulse rate all calm come down you have doing an activity then only you take this blood pressure then it'll be accurate the moment you have the systolic pressure between 130 to 139 or it's not and it's or the diastolic pressure between 80 to 89 you already have hypertension stage one okay you have to look after look and see find out what is causing this hypert hypertension we'll we'll talk about what what are the causes of hypertension whether I need to do take some measures to to not to proceed to stage two okay so so there are certain measures you can undertake to to arrest the hypertension from progressing from stage one to stage two okay at stage two is 140 or 90 and then if you have a blood pressure of more than 180 systolic and more 120 hypertensive crisis when you have such a pressure doctor always admits the patient to reduce it by intravenous drugs because it is very dangerous kind of thing that's why it is known as a crisis okay I think this one for us to understand why there are two readings in in the in the blood pressure uh monitoring and we should know what are the range that that uh where we consider stage one, stage two and stage uh and and hypertensive crisis. Next slide please.

[00:42:05]Okay.

[00:42:07]About 30% of all Malaysians adults are hypertensive.

[00:42:13]Okay. That means one in third adults after 40. Okay. After 40 very sadly they have got hypertension in the criteria that just now we saw. Okay. They have about 30% of the errors and what we find is very shocking is out of the 29.2% 17.3 that means is about 60% maybe about 60% of of all the people who have hypertention that is un they're aware of the condition whereas another 40 45% completely unaware that they high blood pressure. If you take a machine to their house and then and then you measure them they got pressure they say you got no symptoms okay but they have already pressure there quite a quite a number okay 17.3 plus 11.9 become 29.2 do. So I see so we look after the 30% uh 11.9 are completely unaware.

[00:43:11]Okay the control rate among those who are aware and who are on treatment only less than less than 50% of the have the blood pressure under control.

[00:43:24]Okay that means poorly manage high blood pressure. They are aware they got high blood pressure. They are taking medication but the not appropriate uh medication maybe may be maybe maybe not enough dosage whatever okay so only less than 50 so that mean the rest of the people are going to continue to have complication due to high blood pressure now if you look at the most shocking is number four the young adults between 18 to 39 years is called and these are the people who think oh I'm young I won't get high blood pressure they So there's a misnomer. Undiagnosed high high blood pressure is heavily concentrated in this in this 18 to 39 group. Okay. And these are the people who are now we are seeing them. Okay. With lot of cardiovascular complications and even stroke. Okay.

[00:44:16]Next slide please.

[00:44:20]Okay. What we know is that high blood pressure in Malaysia is strongly tied to lifestyle and metabolic diseases. Okay, there is a small component of genetic as well. Okay, there is genetic we can't change. Okay, and as grow older your pressure can will go up that also you can't change because you have you will eventually get old. Okay. And genetics you are born into the thing can't change. So there is some proportion 20%, 15% maybe genetics. Rest of the things there's a cause. One is a high cholesterol. How many percentage of people have? One in three of the adults in Malaysia have got unacceptable levels of cholesterol. Very high.

[00:45:05]And what is very very shocking is overweight and obesity rates affects more than half of the population, adult population in Malaysia. Okay.

[00:45:17]Okay. This is not acceptable at all.

[00:45:20]Obesity. All these are risks to hypertension. The other ones are diabetes. One in five, one in four, one in five people in Malaysia have diabetes as well. So all these by itself is bad.

[00:45:35]Cholesterol can cause heart attacks, can cause strokes. Okay. Overweight and obesity can cause any number of diseases. You can tell I've got no time for that because there's a separate topic actually. Overweight and obesity. Same thing with diabetes can cause so many problems. your leg problem, ulcer problem, bone heal, nerve problem, okay, strokes, um this heart attacks and so on, cat eye, eye problem, vision, okay, so so many things. Diabetic is another big topic which is another another lecture actually. Okay, but all these can contribute to have hypertension.

[00:46:16]Next slide please.

[00:46:19]So causes of hypertension as you see just now I told you that's one small part where there's genes if you look at to your left left half of the screen is genes you can't do anything number two is the smoking and vaping vaping is becoming a very common cause for some reason Malaysian government is very reluctant to ban the whole of Malaysia vaping okay so cigarette smoking is there some control uh next is obesity Okay. Um down below you can see high salt intake.

[00:46:54]Normally you put salt in your food you cannot you I mean the taste becomes spoiled right. But if you put in tacos or you put in uh your potato crisps or pretzels or somewhere you can any or salted nuts. No. Uh then you can take any amount of salt. It all depends in which food you mix the salt. Okay. You can take you can take high salt people with high alcohol consumption also. Next I told you the stress is becoming a big factor. Okay. And our lifestyle does not lifestyle uh you know work there's lot of stress and because our work we go below is a lack of exercise. Okay. We got no time for exercise at all. Okay.

[00:47:41]Okay. And of course aging you can't do anything. There only two factors here you can't do much. One is genes and the other one is aging. The rest of the things I think you can do something the this this on the left side what you're seeing is a primary or essential hypertension. 98% of the people have come into this left side the secondary hypertension is about only 2% of the people because they got inherent heart problem born with that or some sort of a kidney problem because of some ad or thyroid conditions. certain medication which can cause people people have got with observative sleep apnea they show this is a secondary all this only about two to three% majority to your uh left that that is where and what is important is quite a number of that you can you can manage next slide please so factors affecting again is similar similar thing like u the previous And what what it says is that nonmodifiable factors was age, sex, race and genetics not modifiable. Modifiable are smoking, alcohol, obesity, high blood, high cholesterol, sedentary lifestyle, salt intake. These are the things. Okay.

[00:49:03]Okay. This when you smoke a cigarette within the first 10 seconds whether you smoke or you are a passive smoker somebody in your house smokes in front of you both have the same effect. Okay.

[00:49:16]The moment you smoke in the first minute itself you have the blood vessel will constrict vessel constriction. Okay. And then it can it promotes increased cholesterol hyper lipidmia and both will cause the clogging of the arteries and so on. Of course in addition to the s in addition your no exercise you have a sedentary lifestyle it promotes to obesity and also to increase uh cholesterol and I told you the salt intake what will cause what happens the retention of water when you take salt you feel thirsty you will take water because the the the the salt will make the the water to go into the tissues so you feel thirsty okay and increase the hydrostatic pressure and so on. So, so what you find is that all these obesity, cholesterol, diabetes, hypertension, all these are interlin you know to our lifestyle.

[00:50:13]Next slide please.

[00:50:16]So I told you the hypertension is not just not just only causes stroke you can look around. Yeah, he can cause uh uh from heart failure to so many things coronary artery disease or heart attack uh bleeding in the brain, stroke is schemic stroke can cause blindness.

[00:50:38]Okay, one of the common causes of kidney disease failure, people coming for diialysis is either high blood pressure or diabetic or both and so on. So you got lot lot of things can happen due to high blood pressure. Next slide please.

[00:50:54]Next. Yeah. Now you go to diabetes which another cause for um uh stroke. Diabetes is actually is not an acute diabetes.

[00:51:04]It's a chronic condition. Okay. Where why people have diabetes is either our body cannot produce enough insulin.

[00:51:16]Okay. we take uh uh glucose we take carbohydrates and so on is converted to glucose in our body. Okay. And if you if you our body is the the insulin is produced in our pancreas in our body and if if that pancreas is damaged or not producing enough then you get definitely you get diabetes which usually happens in the in the ch childhood diabetes where the pancreas cannot produce enough. The majority of the adults usually the the pancreas can produce just enough or hardly enough. Okay. Or that's one cause. The other cause is that or proper use of insulin properly.

[00:52:00]That mean there is insulin but the body cannot use that insulin properly to maintain the balance of blood sugar in our body. This is what happens in most of the adults that you have. Okay. Okay.

[00:52:13]Now what if we look the second paragraph when there is not enough insulin or the body becomes resistant to its effects blood sugar levels becomes too high and in the last paragraph you can see there are two main types of diabetes type one which happens in childhood where the pancreas doesn't function pancreas doesn't function there's no insulin so no other you can't take oral oral medication okay insulin you have to be given by injections only when type two diabetes is more common in adults. Okay.

[00:52:46]Who can often be managed with lifestyle changes as well as medic medication.

[00:52:53]Okay. Uh next slide please.

[00:52:58]What is the prevalence in Malaysia? As I told you is a prevalence 21.1%.

[00:53:03]Okay. Under international diabetes federation undiagnosed case of diabetes 50% of people living in diabetes are undiagnosed.

[00:53:13]Okay. They only discover when they have a stroke or when they have a heart attack, when they have something else.

[00:53:18]Okay. Therefore, okay, all undiagnosed because we all never go for checkup.

[00:53:23]Okay. Never go for checkup at all. Now, demographics, the prevalence varies significantly by ethnicity. The Indian community where most of us belong has the highest prevalence. Okay? It's not 21.1%.

[00:53:40]People say they're almost 40%. Okay.

[00:53:42]Here the what the the figure given is between 25% to 37.9% followed by Malaysian and Chinese. Okay.

[00:53:51]Next uh slide please.

[00:53:54]Uh this is the one I told you person type two diabetes. Person without diabetes is a pancreas which is an organ in our body. Okay. Just below the stomach and it produces a substance called insulin. it will this insulin helps the glucose in the blood to get into the tissues and so on. So in the blood there is no sugar. Okay. If you look to the right side in the here the pancreas produces either less insulin.

[00:54:21]Okay. But a lot of times what happen there's insulin is produced but there is so much insulin so much glucose in the body that insulin that's produced is not enough. Okay. means over product over uh burden overburden by glucose. glucose burden is so high that that the amount of insulin produced either not enough or is too much or the last one you can see here right lower part some insulin can move into the cells but some cannot because of the resistance there's some resistance for the blood to go in okay this one of the one one other main cause where there's resistance for the glucose to move into the uh cell cells or can cause diabetes next slide Diabetes symptoms. Majority of the diabetes got no symptoms at all. This only what what you are seeing uh frequent urination, feeling thirsty, feeling hungry, getting tired, blurring vision, cuts are very slow to heal. There is a loss of weight loss, numbness in feet, which means this person might have had diabetes for many many years, uncontrollable, very high.

[00:55:34]And what you're looking at is all complications. When they get complications of the long-standing diabetes only you get the symptoms otherwise there no symptoms. Okay. If it is a diabetic is very slowly progressing over time there no symptoms at all.

[00:55:50]Almost no symptoms. So don't wait for symptoms. You go for testing. Okay. Just a message here. Next slide please.

[00:55:59]Okay. These are a lot of drugs and medications are given. Okay. Sometimes be wondering those who are some of you may be a diabetic here they'll be wondering why why they giving so much of medication the base medication you call metformin down there metformin what happens it is it it it has got some some very good functions you know it it reduces the liver is liver will release the glucose so the production of the glucose in the liver is the metformin will reduce that and sugar absorption from the intestine your food you take the sugar the absorption of the intestine is reduced by metformin.

[00:56:35]It also helps the muscles and tissue to absorb the glucose better. Okay? So that the blood glucose is less that also metformin is doing it and metformin does not force the pancreas to produce more insulin. So this a basic thing you don't overwork or overburden the pancreas. So in addition metformin we will do a lot of medication you do in the middle upper part is a DPP4 okay the diet peptid pepidase 4 these inhibitors they they block the enzyme DPP enzyme and when is blocked what happens the pancreas can produce more insulin than necessary more to for more insulin to to to to help the glucose homeostasis similarly you got and If you look at the uh there's a there's a injection there symbol there GLP1 also what happens it makes your your your your stomach full so you don't eat so much it stops the liver from to from releasing the glucose and so on it has sometimes you have a combination therapy and lately we got ggt2 inhibitors so these are this this what happens that all our glucose that we take will go to the kidney and all the water will come out as the urine and and the kidney will reabsorb the glucose into the body. You don't let the glucose go down. So, uh in the urine so inhibitors will prevent the glucose absorption by the kidney and your urine in the urine a lot of glucose will be lost when in in the glucose burden in the body is reduced. So there there are these are some of the medication that you give the people may combine this depending upon the need. So uh okay hold on please.

[00:58:30]>> Hello hello hello yeah yeah.

[00:58:44]Okay. So you give uh 1 g 1 g set and tds. Yeah. Yeah. P. Yeah. Yeah.

[00:58:54]>> Okay.

[00:58:55]>> Okay. Okay.

[00:58:56]>> Thank you.

[00:58:58]>> Um sorry again. Uh okay. Next slide please.

[00:59:05]Okay. How to prevent the complication of type two diabetes? I think quite a number of us are quite aware but we may not following only to ensure the cholesterol levels are normal because choleos and glucose are also there is some connection there. I've got no time to go through that. Eat a balanced diet.

[00:59:26]Okay, that's important. maintain a healthy body weight because uh the the obesity you have then it makes the diabetes worse because obesity produces abdominal obesity it doubles or triples the the the the diabetic incidence okay there is a reason we got time I'll talk about that as well and if there any doctors are given a medication should take it without without forgetting you must always uh uh also check your blood glucose level at home is very very important. Uh next slide please.

[01:00:03]Okay, this this glucometer you can always buy you can always buy and check.

[01:00:07]Huh? Cuz the 5.5 is quite a normal one.

[01:00:10]Okay, next slide please.

[01:00:14]Okay, abnormal obesity is the worst.

[01:00:16]Obesity means fat. Fat is actually uh accumulated in in the in the subcutaneous tissue of our body and and also it can be in everywhere. Fat can be in the liver. Fat can be anywhere but the first thing that is produced is uh is in the in the abdomen. Abdominal fat is the worst predictor for diabetes, worst predictor for stroke, worst predictor for uh heart attack and so on.

[01:00:44]Okay. So you always measure this. Okay, you must make sure that uh your abdomen is as flat as possible. Okay, you may not have six packs, but at least don't have this one bulge, one bagu, which is uh not good. Next slide, please.

[01:01:03]Okay, in uh one in two adults in Malaysia, overweight, obese, overweight means your body mass index is more than 25 kg per square meter. obvious is more than 30 kg per square meter. Females are slightly more than the men 54.7.

[01:01:21]If you look at the below Indian ethnicity, they are worse. We we are we are worse in a lot of things actually here. Uh 63.9% of Indians they are either overweight or obese adults. The age group where we find all these 55 59 which is the largest and so on. This is general overweight. If you look on the right side is abdominal. Just now we saw the bulging abdomen. Okay. The the there's a this should be uh waist circumference. If it's more than 90 cm for men and 80 cm for women, you got abdominal obesity. You got many times higher risk for stroke and heart attacks. Okay. 90 cm for men, 80 cm for women. Okay. And the abdominal obesity females have got 64.8%.

[01:02:13]Indians they have 68.3%.

[01:02:16]Okay. And as grow older is getting worse. Okay. Uh 60 to 64 year age group.

[01:02:23]Next slide please.

[01:02:26]This is uh if we look at it uh uh I I can't see the bottom of the slide because this all the countries are named there. It is Southeast Asia. Okay.

[01:02:37]Cambodia, Laos, Thailand, Singapore and all these rest of the things the 44.2 into the red one is Malaysia. We are top in obesity.

[01:02:47]Oh wait. Uh now we can see just now we can see uh just now I was able to see the countries.

[01:02:55]Oh anyway uh 44 point. So we are very high. So next next one next slide please.

[01:03:04]Okay this healthy is 18.5 to 24.9.

[01:03:08]That's a body mass index. I think you all can put your your WhatsApp sorry your Google it ask I your BMI uh they will ask you your weight in kilograms okay and your height in whatever then uh uh when you enter they will tell you what is your BMI your BMI must be between 8 not more than 20 25 if it's 25 and 29 you're already overweight already okay next slide Okay. If you're overweight, you're losing in your lifetime 10 years or to 15 years obese and overweight. I'll go to the next slide please because we we have to hurry up a bit. Okay. To prevent obesity again stress will make it worse.

[01:03:57]Stress we produce cortisol. Cortisol will make you hungry and make you put on weight. Okay. So and it causes diabetics as well. So stress is very not a good at all. Eat healthy food. Okay. Carboids reduce uh and stop fast food, obesity. Okay.

[01:04:18]Not lot of cheesy products. Uh burgers um uh uh all the meat products, eggs and so on, they they all produces cholesterol and also promote obesity.

[01:04:33]Get rid of alcohol and so on. do regular exercise. Avoid sedentary. Avoid TV means don't don't be uh don't avoid sedentary activities and buy a weighing scale and better have a record if you're overweight. Uh at least once a week you record your weight. Next slide please.

[01:04:51]Cholesterol. What you're seeing a blood vessel there. The yellow thing is the cholesterol plug. Okay. Blocking the vessel. Next slide please.

[01:05:00]Okay. There is a doctor will tell you there's a good cholesterol and a bad cholesterol. Good cholesterol. We all need cholesterol for a lot of things.

[01:05:09]Okay. For all our hormones and enzymes and all are made of must have a part of which the cholesterol but it must be a good cholesterol. Okay. But our food unfortunately majority are in the bad cholesterol. HDL cholesterol is high density lipoproteins and LDL is called low density lipoprotein. These are low density proteins are the dangerous ones which will go and block the blood vessels. Okay. We normally measure both the HDL LDL and the total cholesterol when you go for cholesterol testing.

[01:05:43]Next slide please.

[01:05:47]Okay. Then the total cholesterol should be less than 5.2. This is actually an old recommendation. Nowadays most doctors will say four or less better less than 4 mill moles per liter or better LDL which is a very bad cholesterol must be less than 2.6 our doctors will normally here tell less than 2.2 is better cortisol bit higher bit better 1.2 1.4 Four is very good but it's very difficult to raise the good cholesterol level. Okay. Tigly is the less rest uh part of the uh like like other other fats which is not doesn't belong to cholesterol. The triglyide that must be less than 1.7.

[01:06:29]Okay. Uh next slide please.

[01:06:34]Okay. I tell you the cholesterol is important for lot of things. All our cell membrane is is got part of it is cholesterol. If we don't have cholesterol, our cells will break down.

[01:06:45]For nerve conduction, okay, is like a wire, electrical wire.

[01:06:50]Your two naked wires will got a spark.

[01:06:53]Similarly, the nerves two naked nerves will cause dysfunction. No fun. So, it will affect the function of the nerve.

[01:07:00]So, you must have a insulating effect.

[01:07:02]There's a called like a plastic in the wire. We got a milein over the nerves which will insulate. So if you don't have cortisol you don't have nerve conduction. So our bile salts and important because bile acids is also important to digest the fat that you take. Okay that alo you need all our steroid hormones all our hormones whether the gluccocortic hormones or male hormones or female hormones all of them vitamin D is part of our cholesterol and so on. So cholesterol is important. That's why we can't bring the cholesterol to zero. But you must have a control over the cholesterol at least about to 4 to 4.5 total cholesterol.

[01:07:39]Next slide please.

[01:07:42]Okay. This cholesterol um how do you get a cholesterol? The first part is it telling you what are the important for what the sources of cholesterol exogen from outside. You can take from see cholesterol you can only get from animal products. No plant can produce cholesterol. You must understand this.

[01:08:04]Suppose you got uh all the ma that you fry they got no cholesterol. Whether is ma jago ma kapasawa crown nut oil whatever oil or ginger oil they all plant products. They don't have zero cholesterol. Okay. So all animal products have cholesterol. Only animal products have cholesterol. But uh all the oils have got saturated fats and other fats which are also not that very not that good. But cholesterol is the worst. Okay. So vegetarian diet is of course you you you can cut down that.

[01:08:39]But beyond that our own body we don't belong to the plant kingdom. We belong to the animal kingdom. So our own body also produce cholesterol. So even if you are you are if you are vegetarian of course you bring bring down your cholesterol quite a lot but you don't eliminate okay you can still have some people can have a little bit of high cholesterol because our own body also can produce a cholesterol. Next slide please.

[01:09:06]This is called list lipid equal high cholesterol. You can look at this. The cholesterol is between the inner layer and the outer layer of the blood vessel.

[01:09:13]You can see the blood vessel blood wall blood vessel wall is multi-layered and between the inner layer and outer layer is that and when this will rupture you know when when this chole rupture and go inside that then it becomes a blockage okay at the same time this weakens the wall wall of the blood vessel and it can rupture okay it's rupture inside inside the blood vessel rupture becomes a cloth okay obstruct if rupture outside the blood vessel wall then then that's the blood blood will leak out leak out.

[01:09:48]Next slide please.

[01:09:51]This is one of the person who didn't make it. It is actually the neck part of it. Neck is is called uh caroted artery.

[01:10:00]You got internal and external carrot artery. This is going to the brain onto your right side. Left side is going to the face part of it. And you can see a clock of of the plot. Uh you can almost completely blocking the blood vessel.

[01:10:12]Next. Next slide please.

[01:10:15]Okay. This is a type of food that is increases your cholesterol. Next slide.

[01:10:21]Okay. Is a food which you can lower the cholesterol is on your on your left side. You find majority of them are all actually vegetables except salmon. There one fish. The rest of them all vegetables. food that high in choleos or mostly almost all of them are uh annual products. Next slide please.

[01:10:46]the the okay now we come back to the what are the warning signs of um this one there's a synonym we all call be fast be fast if you see there's a warning there's a warning sign that somebody's having a stroke okay B for balance somebody sudden loss of balance on B and there sudden loss of balance and coordination and difficulty in walking as B eyes sudden change in the vision which become blood or you can see double vision F. Number three, sudden face drooping or numbness on one side of the face. A number four arm. Sudden arm or leg weakness causing it to drift downwards.

[01:11:27]Cannot raise up the hand. S number five speech slur speech difficulty repeating the phrases or confusion. These five things you may not have all of them. You may have only one one of the five or you may have two of the five, three of the five. All of the five. Okay. And the next one is very important. Number six called T is that time be fast under be fast time. Time to call emergency service immediately because if you can reach before 4 hours to the hospital if there was a block there is a medication now which can dissolve the clot and you become normal. Beyond after 4.5 hours you give the medicine it's got no value.

[01:12:07]You got permanent damage and paralysis.

[01:12:10]Next slide please.

[01:12:14]Okay. So, what to do if there are signs of stroke? Every second matters. Okay.

[01:12:20]Okay. Cell loss. For every minute a stroke goes untreated, approximately 1.9 million brain cells are lost forever.

[01:12:27]There's a reversible damage. Early arrival at emergency facility allows to identify the type of stroke whether it's schemic or hemorrhagic and you can administer life saving treatments and we can give a tpa medication. you call tissue plasmminogen. This one we call LT place nowadays available in all the hospitals provided you you you go immediately okay by the time you do the you if you go within the first hour they do a CT scan or MRI by second hour by the by the third hour the medicine is already given okay it'll take a while after that is no use if you are eskeemic stroke but if it's a hemorrhagic stroke is a bleed you can't give the medication because it makes the bleeding worse what the the this medication does is that it dissolves the the cholesterol plant. It dissolves and disperses it. Next slide please.

[01:13:23]So be fast but again this is just you can look in your uh Google it. You can look at this for signs. Next slide please.

[01:13:33]Okay, this is uh again it tells you the eskeemic stroke on your left side is the dark area is where the brain is dead and this side hemorrhagic stroke where there's a bleed. Next slide.

[01:13:46]So it is the medication I told you which you are given with must be given within 4 hours which mean don't reach at 4.5 hours to the hospital you reach with the first hour because they have to do the MRI scan for you then only you can do this. Next slide please.

[01:14:05]The treatment of hemorrhagic stroke. So we told you he eskeemic stroke we can give healthy place and so on we come early. If it's hemorrhagic stake where there's a first thing if it's quite big enough then we have to operate. Next slide please.

[01:14:20]Okay. This is somebody who didn't make it. There's a big bleed in the basal ganglia region of the brain. This area called basal ganglia. Okay. Must have died. This this this autopsy specimen.

[01:14:31]The dark area is the blood. Next slide please.

[01:14:34]Okay, this is one most probably is my case. My where this is a brain which I opened up and this is the covering of the brain. You can see the blood vessels over the brain also inside the brain.

[01:14:45]The the the bigger blood vessels are veins. The smaller ones they see is arteries. Okay. And then I'm just open this uh brain. The next one, next slide. uh they can see when I open the brain you can see the blood uh on the top the 12:00 position you can see the blood there we vacate the blood and so on anyway next slide please okay after the stroke what you do you have to give if it is esmic stroke you have to give anti-coagulants as I told you as you come in later on they give you antiplat antiplatter called blood thinning medicines and then to get the blood thinning medicine very often you have to give they have got high blood pressure they got diabetes they got chole they have medication for all. Next is maybe for many many months or even for years you must have rehabilitation therapy, physical therapy, speech therapy, occupational therapy, cognitive therapy, behavioral therapy depending sometimes combination of all the therapies sometimes one or two of these therapies and the last one here is a lifestyle changes where you have to have look after your nutrition to do exercise and if you're smoking or taking alcohol you have to quit that. Next slide please.

[01:15:56]Stroke prevention. Next slide.

[01:16:01]Okay. This is yesterday's Swami's thought for the day. Yes. Swami is very very always cared about our health. He said the yellow part you read which means to attain the dharma moka moka you cannot attain that without having a healthy body. Okay. You need a good health is essential. Okay. Uh Swami has emphasized this all the time. The next slide please.

[01:16:36]Okay. So we already talked about this.

[01:16:38]Okay. Food, blood pressure, exercise.

[01:16:42]We'll talk about meditation a little bit. Okay. Glucose monitoring, taking medication. Next slide, please.

[01:16:49]Okay. To prevent a stroke, exercise and lifestyle changes, mindfulness and relaxation practices, counseling and therapy, medication monitoring. Next, next one.

[01:16:59]Okay. Benefits of meditation. Nowadays all neurosurgeons all over the world they are telling meditation is very improved good because it improves concentration. It causes physical structural changes to the brain and the preservation the brain as it ages. There is stress reduction with the meditation.

[01:17:19]There is increased empathy with the which which again helps in the uh goodness of the body and there's also pain reduction. Next slide please.

[01:17:31]Okay, these all these are different different articles. Okay, many many there are thousands of articles telling benefits of meditation. Next slide.

[01:17:43]Okay, this this all uh different different aspects which I've got no time to go through. Next slide please.

[01:17:52]This is a this is a functional MRI scan actual MRI scan where mindfulness significantly reducing anxiety after 20 minutes of meditation practice. Okay, next slide.

[01:18:04]Okay, this is a FDGP PET scan which shows that there is a frontal frontal increases with talomic and basic gangalia decrease of certain parts which promotes health. Okay. Good for diabetes, good for hypertension, good for stress, good for obesity as well. Uh good good for stroke prevention and and good for to prevent uh heart attacks.

[01:18:28]Next slide please.

[01:18:30]So I just want to finish it because we got only another five minutes. Swami says health is wealth. Without a healthy body man cannot execute any of his thoughts however good they may be. This is from Sri Satya speaks volume 35 uh May 27 2002 and the next slide please. Okay, with that I think I'll finish because we hearing time. I don't know whether got any time for questions.

[01:18:57]That's it. Um it's open to you bl you have covered a lot in a short time.

[01:19:06]I'm sure there's a lot to absorb and I think participants as um doctor has been mentioning can always go in Google to get more information but most importantly I think we need to take advice do our medical checkup exercise manage food and so on. So in the next few minutes if anybody has any questions you could uh unmute and ask. Um if there's no if I could ask one question you know from childhood I've always been wondering >> headache >> headache everybody everybody we experience headache and I always wonder what's happening inside the head inside the brain whenever we experience headache >> can can you share on that >> yeah 99% of the headache is not coming from the brain because brain cannot feel the uh feel any pain brain is a funny organ suppose because your toe is injured you feel the pain actually actually the brain feels the pain in the toe but if I've done operations where uh without I give anesthesia to put the patient to sleep I make the incision to open the skull only the the scalp and the bone after that I tell them okay we come out of anesthesia patients are fully awake we operate because we cut the brain they can't feel anything okay so the what you were trying to tell is that the the pain is not coming from the brain itself. Just now I told you the headaches due to the bleed. It is not because of the uh because of the bleed damage to the brain but because of the pressure in the head there's a covering of the brain within the skull. So the covering covering of the brain that's there that's there's a membrane that one can feel pain not the brain itself. So the pressure pressure is applied uh to the covering of the brain to the blood clot the there's a mass effect that can cause pain but but majority 99% of the time that's not the cause it is the pain is coming from the outside of the brain outside of the skull outside of the muscle is the blood vessels under your skin they become very uh the tension in that okay so for for a lot of reason you can have tension not enough sleep you can tension. You got worries. You can have okay certain types of foods like chocolates of certain people can have certain stress will cause this certain stress like you see suddenly a bright light. Some people get headache migraine. Some people get a very strong smell they get a headache.

[01:21:40]These are stress for the this for the smell and so so the many many factors which will cause the the constriction of the blood vessels in your scalp you know. Uh that is main cause of headaches.

[01:21:54]See, thank you. So, we have three minutes. Anybody like to ask any question, please?

[01:22:00]>> Yes, sir. Mr. Ready, I have a question.

[01:22:04]>> Uh, doctor, I actually had a heart attack uh 9 years ago. Uh, a myioardial infection nine years ago. And I have four stances in my artery, two on the right and two on the left. Uh I my first question is that uh for a person in my situation uh what is the risk of having a stroke compared to uh a normal person who has not had any uh heart attack before and uh second thing is that uh what are the preventive measures or screening medical screening I should do uh consideration considering my current uh uh heart situation.

[01:22:47]>> Thank you. Okay. Okay. The the we just now we saw that the causative uh the causes for the uh for stroke and heart attack is the same. Okay. People would have had either heart attack or a stroke or both. Okay. Now what happens? You had you had a scent done and you most probably you had a medication called plavix. Okay.

[01:23:09]>> Yes. Yes.

[01:23:09]>> Okay. They would have given 75 milligs.

[01:23:12]You're taking daily that would have thinned your blood. Okay. Number one.

[01:23:16]And uh they would have given they would have found out what could be the cause.

[01:23:20]Most likely you could have had a cholesterol or high blood pressure. I'm not sure which one you had.

[01:23:25]>> Uh it was both high blood pressure and cholesterol as well.

[01:23:29]>> Yeah. So so so if if your if your both pressure and your high cholesterol are controlled and you you are doing a regular exercises and so on okay your your your compared to the other people your chance of having stroke is uh not to say same as other people you reduced u significantly uh you can say uh to another another uh you chance of getting soaked compared to a normal person. Okay, maybe about maybe another 10 or 15% more than the other people if provided that your cholesterol pressure uh sugar all controlled.

[01:24:16]>> Okay.

[01:24:18]Yeah. And at the moment now I mean I'm taking all the medicine on a daily basis without fail >> and uh so far I mean uh it's stable you know but uh that's why I just uh any advice that should I go for any screening medical screening you can you you what what you can do is uh you you do an MRI scan okay it will show you whether you have had multiple minor minor they call it mini many strokes they call Lacuna influx whether you have you have had that or not. You suppose your MRI showed you had multiple small small infin micro not many micro mini strokes. Why you didn't realize had that? Okay. Uh that that tells you that you have a risk of high high uh major stroke is about maybe 20% 30%. If not, it's about 10% only. But the the thing is that what you can only do is that you drink enough water. Don't go don't don't get your body dehydrated. Number one, that's not mean to over overdrinking. That's also bad. Just enough. You should not feel thirsty. Number one. Number two, continue taking the plavix. Okay? There usually they give either cardiprine or plavix. If you had an attack, then they give or put a stand, they give a plavix.

[01:25:43]is a bit uh more powerful medication okay they would have taken and make sure that you you monitor your blood pressure your weight you must monitor you're mindful of what you're eating exercise is extremely important okay and avoid try to do stressful situations do meditation >> okay thank you very much Sarah >> sam okay thank you brothers and sisters thank you doctor thank you so much for your sharing we look forward forward to hearing from you uh in the months to come. Uh brother goin, anything you like to say before we close.

[01:26:22]>> If possible, we only covered the stroke this week. Maybe the head injuries also we can cover in the following month is much better. Dr. Nachi, is it okay with you?

[01:26:31]>> Sorry, >> head injuries today covered only stroke.

[01:26:35]>> Uh what about head injuries? Doctor, do we have another next day and next week?

[01:26:40]can most probably I don't know whether they all got overdose of me or not.