Stroke: Major Cause of Disability

By Dr. Anis Ansari

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Stroke is one of the most devastating illnesses that can affect people.

Due to its major disabling features, it is the least preferable of any of the major diseases. During stroke patient may lose control of their arms, legs, ability to talk, eat or to see properly. Large stroke can cause death. Other can leave long term complications which are difficult on patients and their families.

Stroke is the third leading cause of death in the US and second worldwide in both men and women. There are 200,000 cases of death due to stroke and 795,000 new and recurrent cases of stroke every year in the US.  Cardiovascular diseases (stroke and heart attack) cost staggering $444 billion in terms of medical care and lost productivity.

There are 5.8 million adults living with long term disability in the US.

Stroke (brain attack) is a medical emergency which occurs when blood supply to a certain part of brain is completely cutoff or greatly reduced. Strokes are of two types. Ischemic strokes makes up 80% of cases while hemorrhagic stroke 20%. Cardio embolism (clot from the heart) is responsible for 20% of all ischemic strokes.

Symptom depends on the area affected.

Definition of the stroke is sudden onset of focal neurological deficit lasting more than 24-hour period. It is called transient ischemic attack (TIA; mini stroke) if symptoms are resolved within 24 hours.
Symptom of stroke includes sudden onset of facial droop, arm and leg weakness, slurring of speech, inability to talk, inability to eat, difficulty seeing with one eye or both eyes, confusion or alteration of their mentally status, and trouble walking as well as balancing.

People who have history of hypertension, atrial fibrillation, diabetic mellitus, high cholesterol, family history of stroke are at high risk this problem. Aggressive treatment of hypertension is very important in reducing the risk of a stroke. Med-wire News on September 29, 2011based on meta-analysis of 12 studies involving more than 500,000 patients showed that pre-hypertension (systolic BP 130 to 139 and diastolic BP 85-89) are at increased risk of having stroke.

Workup of stroke includes Doppler ultrasound of the carotid arteries in the neck. If blockage is more than 70% then surgery is needed to bypass the blocked area. Cerebral angiography is the gold standard for identifying the blockages inside the brain arteries. Balloon angioplasty can be done and stent can be placed if necessary.

Aspirin is usually used to prevent stroke. If stroke occurs while on aspirin then stronger ant-platelet drug like Plavix is prescribed.

Preventive measures includes dietary modification, exercise, control of hypertension, diabetic, cholesterol and smoking cessation.

In terms of treatment, time is of the essence. After sign and symptom of a stroke is recognized, 911 should be called. Patient should be transported by paramedic who can assess their ABC (airway, breathing and circulation). They can provide much-needed oxygen and an intravenous access.

On arrival, the Emergency room physician will quickly assess patient, order lab tests, emergent CT scan of the head and activate the stroke team if available. Onset of a stroke is determined before any decision is made to administer the clot busting drug (t-PA) transminogen plasma activator.  They must reach ER within 3 hour and meet certain criteria before being eligible for above medication. There are some patient who can qualify for this medication up to 4.5 hour of the onset of symptom unless their age is more than 80, are diabetic , have prior episode of ischemic stroke, and taking oral anti-coagulation regardless of INR.

Long term complication will include skin breakdown, depression, and aspiration pneumonia, difficulty in learning, concentrating and memory.

Some patient requires comprehensive rehabilitation where physical (walking), occupational (strengthening) and speech therapy (speech, memory, and balancing check books) are provided. A video swallow study is performed to determine the type and consistency of food they will be able to tolerate.

US government officials have announced an initiative to Prevent 1 million heart attacks and stroke during the next 5 years. Naturally, up to date protocol and public education is a very important part of the same process. Early recognition and rapid response will prevent a large number of death and disability.

Anis Ansari, MD, Chairman, Department of Medicine, Mercy Medical Center, Clinton, Iowa.


Shahid Khan gifts $10 million to University of Illinois

Shahid-KhanCHAMPAIGN,IL–Shahid Khan, president of Flex-N-Gate Corporation in Urbana, Illinois, and his wife Ann Carlson Khan, have continued their generous support of the University of Illinois at Urbana-Champaign by making a gift of $10 million to fund the new north addition of Huff Hall. The addition, known as the Khan Annex, houses programs of the College of Applied Health Sciences, including the Center on Health, Aging, and Disability and the Master of Public Health program. The Khan Annex was formally dedicated at an event on Thursday, September 22.

“We wanted to invest in a facility that would support the mission of the College of Applied Health Sciences: education and outreach that will promote health across the lifespan and will improve the self-sufficiency and quality of life of all people,” said Ann Khan. “This facility will provide a modern environment for faculty and students to collaborate in their education and research.”

The Khan Annex provides over 24,000 square feet of state-of-the-art of laboratory, instructional and professional collaboration facilities. The Center on Health, Aging, and Disability includes a conference room, a project development “Collaboratory,” a video conferencing room, and a graduate student resource center. The new addition also will house the James K. and Karen S. McKechnie Laboratory, classroom facilities, and faculty offices. The addition to this iconic building completes the architectural design envisioned nearly 90 years ago when Huff Hall was still on the drawing board. The original design called for two wings, connected by a central structure to form a Block I in the heart of this historic campus. The Khan Annex completes the original vision.

Shahid and Ann Carlson Khan are longtime supporters of the University of Illinois. Beneficiaries of their generosity include Krannert Center for the Performing Arts, the University Library, the College of Business, and the College of Applied Health Sciences, where they have funded five endowed Khan Professorships. The Khans have also funded the Khan Outdoor Tennis Complex at the University of Illinois, home to the University’s men’s and women’s tennis teams.


The Tender Plants Of Our Society

By Sara Yousuf

483px-Handicap.svg July fourth, 2009. A Saturday at ISNA in Washington D.C. on an Independence Day morn. But not just any Saturday at the ISNA bazaar in Washington D.C., where my family and I manning a booth for HelpHandicap Foundation, a non-profit organization enabling people with disabilities in India. It was a Saturday that would mean so much to my family and I, and, I think, also to various Muslims with disabilities who would attend it and go home with a spark of hope amongst them.

It was the day the first panel discussion on disability would take place in ISNA history. There would be four speakers, one of whom would be my father, Mr. Mohammed Yousuf. Also featured would be, a psychiatric doctor, Mona Amer, who had done research on the inclusion of Muslims with disabilities, the general topic of the panel, the distinguished Imam Zaid Shakir, and Mr. Mobin Tawakkul, who had written with my father a chapter in a book about the lives of people with disabilities, along with Ms. Isra Bhatty, who would be serve as the moderator in the discussion.

My brothers, my mother, and I were really excited about the discussion. After handing out brochures all of Friday, and having trouble getting to sleep out of over-excitement, we were up in a flash Saturday morning. My mother and father had given me camera-duty. At first I thought, “Oh, what a snap this will be, only five-ten minutes here and there.” Later did my mother tell me that I had to videotape the entire discussion, which would last for two-hours plus, when I noticed that maybe my task would not be such a delicious piece of cake.

Well, my five- and nine-year-old brothers and I took our seats, three rows down from the stage. When asked why, I merely told the older of my brothers that though my hand may ache, I would not like to crane my neck. I turned on the camera before the panel started; in fact, I started it when I spotted my father talking to one of the speakers. Enjoying myself blissfully, I did not notice the time left on the camera before the memory was full.

The discussion started—finally! I thought. Of course, I couldn’t wait to hear my father speak, as I am sure neither could my brothers nor my mother. The first speaker was Dr. Mona Amer, and I really liked the way she started off. She asked the audience why most of them had come to the discussion: because they, someone they know, or someone in their family has a disability, knew a speaker in the discussion, were interested in the topic, or had just heard about the discussion; or because they were interested in the topic or had heard about the discussion.

Though I am not an adult, I wanted to be a part of the panel, too, so I raised my hands for the first two reasons. As I had predicted (I’ve always understood human feelings, and this I could feel in the crowd), most hands were in the air for the first reason: because they themselves had a disability or knew someone with a disability. From that moment, I was hooked in the discussion as I watched it through the screen of the camera.

Halfway through the doctor’s speech, my hand ached to be in another position. By this time I was so into the panel that I was only thinking, seeing, hearing the panel, and nothing else. Well, I did also notice my throbbing hand. For a second I thought, “Well, when you take pictures, you can turn the camera sideways and the pictures come out vertical.” Flipping the camera, I said to myself, “By the way, the video looks better vertical.” So I kept on switching the camera every five minutes or so.

Imam Zaid Shakir started his speech then, and he, along with the doctor before him, really started emphasizing and I really started to think, not just listen. Why was I here? Was I a part of this? How could I, an ordinary preteen from the mid-north of America, work towards the “inclusion of disability in North America”, when I was only a child? What could I do to change my corner of the universe? Now wait a minute……change the universe? Ha! That was long-term! How would I even begin to change the lives of those with disabilities? Moreover, what could I do? Could I, a single kid, amend the way the common society overlooks these people with disabilities???

I, an eleven-year-old, sat there amongst the couple hundred of people in Conference Room D in the Mount Vernon Place Convention Center, in Washington D.C., thinking.

Next, a video was to be played about the issue of including people with disabilities. I shut off the camera while watching, and I can tell you that though my brain was working, my face was totally frozen, struck by awe. In the movie, a part was entitled to the problems in the masjids in their local areas. One brother stated that yes; his masjid’s bathroom was made into an accessible bathroom for wheelchair use, but had been turned into a storage area for janitor supplies and boxes! To myself, I think: why is this happening, happening that the masjid’s handicap features are being changed?

It was like the video sent me flying. Thinking I began about everything in the video. How could I help? Donations? Articles? Words? Actions? HOW?!?! Answers I needed, not questions.

I turned the camera back on for my father’s speech. The projector screen displayed the image of cupped hands holding rich brown soil in which was growing a s mall, two-leafed, lime-green plant, about the size of your average thumb.

My father explains that those with a disability in our community are like this plant. Tender, small, totally dependant. It needs sunlight, water, and air.

Now I completely understand what my father means. Those hidden in our communities need sunlight—love and attention, water—knowledge to nourish them, and air—friends, people around them.

Who can give them these three necessities of basic living? Who? Who is responsible for this amongst us?  



We are.

We are the ones responsible. We can change the way Muslims with disabilities are excluded in their local masjid and our societies. We can try to include them in every way possible. You’re the one who can change your corner of the universe. You, yes, you!