Thread by @hyderabaddoctor

1. Arti to me "Dr, when will my husband Anuj start talking & walking?" Her two kids aged 3 & 5 were holding her hands, as Anuj was brought into my OPD for review one month after suffering brain hemorrhage. Anuj had become paralysed on right side and lost his speech due to stroke

2. Anuj, aged 33, had first consulted me three years ago for headache. On evaluation, his BP was 160/110 mmHg. On enquiry, he had a hectic work schedule of 13-14 hours per day and on an average he slept 4-5 hours/night. His job required out-station travelling on 10-15 days/month.

3. As per Anuj "I have breakfast in Hyderabad, lunch at Mumbai & dinner at Cape town. It is rare for me to have all 3 meals in the same city. I am a valuable employee of the multi-national company that I work for and 300 staff work under my leadership. I earn a handsome salary."

4. I offered him a few suggestions- ensure 8 hours of sleep, minimize daily working hours and eat healthy diet. I also suggested BP-lowering drugs.
Anuj replied- "Dr I do 45 min gym, my weight is normal, and I hate drugs. My BP would normalize at home without medications."

5. On an otherwise busy day, received a frantic call "Dr, Anuj has severe headache & vomiting, is unable to talk, and can't move his right hand or leg."
I suggested that he be brought to emergency dept (ED). In the ED, I recognized him at once, though he had not visited for 3 yrs

6. CT scan confirmed brain hemorrhage on left side. His BP was 220/140 mmHg. The bleed was large and he had to be taken for emergency surgery. Post-surgery, he was kept in ICU on mechanical ventilator.
On day 1, his boss visited- "Dr. give the best treatment, Anuj is our star."

7. On day 2, there was steady stream of visitors including top management of his company. All offered their best financial support. On day 3, only his close friends visited the hospital, offering any needed help to the family or Anuj. From day 4, no one from his company visited.

8. Anuj made a gradual recovery, and could be discharged after 8 days. At discharge, he was unable to talk or understand speech. He could not stand or walk and was unable to use his right hand. He needed his wife's help for activities of daily living.
#MedTwitter #stroke

9. At one-month review, Arti mentioned that the company had hired someone else in his place and they are not sure, whether Anuj will be taken back once he recovers (as he may not fit the job due to his neurological disabilities). Family is already facing financial troubles.

10. Later on, Arti managed to find a job, which could barely take care of family's needs. She could somehow manage to juggle between her job, taking care of Anuj and her two children.
All the "well wishers" from his company and his acquaintances were nowhere to be seen.

11. Take home messages
*Work-life balance is essential.
*Hectic working hours, less sleep and stress are detrimental to health.
*High BP needs drugs, if non-drug measures fail.
*Periodic check ups for BP, sugar & cholesterol are needed, even if one goes to gym/does exercises.