Prevent the preventable Premium

I had been conducting awareness sessions on preventing heart diseases, but a friend's husband's heart attack made me doubt their effectiveness. Despite greater understanding of risk factors, heart attack patients are getting younger. My husband reminded me that doctors are meant to teach, so I changed my strategy to "catch them young" and participated in World Heart Day activities in schools. A young man collapsed and was resuscitated out of cardiac arrest due to a blood clot in his lungs. Pulmonary embolism is a life-threatening condition that can affect healthy people who sit still for long periods. It is preventable by avoiding immobility and staying hydrated. I'm back to telling people about disease prevention.

For several years, I had been conducting awareness sessions on preventing heart diseases. A few days before this year’s World Heart Day, a friend’s husband in his mid-fifties suffered a massive heart attack and that made me doubt if such sessions make a difference. Over the years I had noticed a shift in the age profile of heart attack patients from 60 and above to 40 and below. The disturbing trend has evolved despite a greater understanding about the risk factors. The reason could be a chasm between what people know they should be doing and what they actually do.

I told my husband, “I have been telling ‘Know your numbers — BP, blood sugar and body weight’ — and propagating ‘Ek chammach kam and chaar kadam aage (one spoon less of salt, sugar and oil and four more steps of walking)’. It doesn’t seem to have made much impact.” He said, “That doesn’t mean you will stop telling people how to prevent a heart attack. Everyone has the right to make choices. Haven’t you seen the statutory warning and the ghastly picture of mouth cancer on cigarette packets? Has it made everyone quit smoking?”

He reminded me that ‘doctor’ is derived from a Latin word docere, which means ‘to teach’. I mulled over it and changed my strategy to “catch them young” and participated in the World Heart Day activities in some schools. Instead of I giving a talk, the children explained the circulatory system, demonstrated resuscitation measures, displayed blocks in arteries and opening them up with stents. They explained about healthy habits, heart-healthy food and even took a pledge. I hope that the benefits will reflect as longer and healthy lives for them

The next month, a young man suddenly collapsed. The family lost no time in taking him to the nearest hospital. He was resuscitated out of cardiac arrest. It was not the usual heart attack or brain stroke. A large blood clot had lodged in his lungs and it was promptly dissolved with a clot buster. Supportive measures continued over the next few days and the young man miraculously survived. The distraught family wanted to know what had happened and why. The patient had mild fever for three days before the event, stayed mostly on bed and was not drinking enough water. Medical personnel know that immobility can make blood to clot within the leg veins. Such clots can break off, travel upstream and lodge in the arteries to the lungs. Without blood flowing into the lungs, oxygenation does not take place, blood does not return to the left side of the heart and circulation stops. Death is imminent and sudden like the fall of a curtain while the play is still on. It is ‘time up’. Unlike heart attack and stroke, there is not much awareness of this life-threatening condition known as pulmonary embolism. Pulmonary in Greek means “of the lung” and embolism refers to “a mass that originated somewhere and lodged elsewhere”. Pulmonary embolism is the third important cause of cardiovascular death that affects largely bed-bound patients recouping after surgery, a fracture or lying immobile owing to stroke or just debility. It can strike otherwise healthy people who sit still for a long time as in long-distance flights, hence known as “economy class syndrome death”.

Blood can clot within the deep veins of the legs during a train journey, travel by bus or car and even while sitting still in front of a TV or computer for hours together. It was shocking for the family to know that fatal pulmonary embolism is a threat not only for hospitalised patients but also for those in normal health. I quickly reassured them that it is eminently preventable by two simple measures to keep the blood moving: avoid immobility and inactivity by changing position, walking around or just wiggling toes and moving the ankles every half an hour or so and drink enough water and remain well hydrated at all times. Once again the teacher within the doctor in me got back to telling people about disease prevention.

(The writer is a cardiologist based in Jamshedpur)

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