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, ideas and stories that matter, subscribe to us. We are available on TOI Plus, Spotify, Apple, Google Podcasts and all other platforms of your choice for any new steps. E-mail us. At toipodcast at timesinternet dot in.