Is it possible that happy occasions such as birthdays have negativeeffects on some people? I recall a 74-year-old woman, in apparentgood health, who dreaded her upcoming 75th birthday. As theday approached, she became more and more anxious. She kept herfears to herself because they did not make sense. The "happyday" arrived and was celebrated as planned. Only some 7 monthsafter the event was she willing to confide her worries to herdoctor. She had vague complaints like a headache, dizzy spells,and fatigue but three different doctors found nothing more unusualthan a rapid heartbeat. What caused her 75th birthday anxiety?She finally admitted that her mother had died at age 75 andshe was convinced that she too was doomed to die at this age.
Such birthday-related stress may actually have a scientificbasis. In this issue of Neurology, Dr. Gustavo Saposnik andcoworkers1 report that vascular events (like strokes and heartattacks) are more common on birthdays. They suggest that thereason may be stress actually caused by the birthday.
The researchers counted all visits to a hospital emergency room(ER) in their region to determine the expected number of vascularevents that occur on a daily basis. Vascular events includedmajor strokes, transient ischemic attacks (TIAs or mini strokesthat last less than a day), and acute heart attacks. This expectednumber was compared with a control group, which included anexpected number of nonvascular conditions. Asthma, appendicitis,and head trauma were chosen as the control conditions becausepeople tend to go to the ER with these problems as quickly asthey would for the vascular events.
The chance of having a stroke, TIA, or heart attack on a birthdaywas 27% higher than the expected daily average. However, thenumber of vascular events that occurred during the birthdayweek (3 days before and 3 days after the birthday) was no differentthan the expected number of ER visits. There was no increasein the number of visits to the ER for any of the control conditionson the birthday. Also, there were more vascular events on birthdaysthan on other special calendar events like Christmas, New Year,or other holidays. Interestingly, milestone birthdays (40, 50,60) were no different from ones that occurred at other ages.
The researchers looked for a reason why vascular events weremore common on the birthday than any other day. They discoveredthat the group with the vascular events was more likely to havehad a history of high blood pressure. When the subgroup withhigh blood pressure was looked at more closely, the associationbetween vascular events and birthdays was even higher. Thiswas actually not surprising because it is well known that highblood pressure is a big risk factor for strokes and heart attacks.
The risk of having a vascular event increases rapidly afterage 45 years, earlier in men than in women. But even if ageis a risk factor that cannot be controlled, why should the riskbe increased on the birthday? The article mentions other studiesthat have shown an increase in stroke, heart attack, and evensudden cardiac death associated with stressful events. Naturaldisasters (e.g., earthquakes), terrorist attacks, and even majorexciting sporting events such as the World Cup Football (soccer)are associated with increased vascular events. These eventshave in common a tendency to provoke anxiety.
Anxiety can certainly increase blood pressure and speed up theheart rate, which are vascular risk factors. Normally the arteriesof the heart dilate (expand) during mental stress. However,in people with atherosclerotic arteries (clogged by fatty deposits),these vessels may actually constrict (narrow) with mental stress.When the vessel becomes too narrow a heart attack results. Studieshave shown that the risk of a heart attack doubles in the hourafter strong negative emotions like frustration or sadness.Mental stress may also cause certain areas of the brain to triggerirregular heartbeats and increase blood pressure.
Saposnik and coworkers suggest that people with known vascularrisk factors should be a little more cautious. They should avoidtoo much fatty or salty food and alcoholic drinks on the "happyday." Alcohol can decrease the heart’s ability to contractand increase irregular heartbeats. Too much physical activityand exposure to cold weather should also be avoided. If a bigparty is planned extra help may be hired to reduce stress. Surprisebirthday parties should probably be avoided. A mild tranquilizermight be prescribed if the birthday is stressful. Planning shouldbe done well in advance of the party to avoid last minute runningabout. These common sense plans, discussed with the patientand family before the birthday, may help assure "many happyreturns!" of the day.
The brain, like all organs in the body, depends on a steadyblood supply to function, but it receives way more than itsshare for its size. However, this is not surprising given allthe work the brain does with its own thinking and planning functionsas well as masterminding and controlling the body as a whole.The brain has two hemispheres (the right and the left) and,although they are connected, each half controls mostly the oppositeside of the body. Specialized areas in the brain control movementof the arms and legs, feeling, speech, hearing, and vision,as well as many other functions. If the blood supply to thebrain fails, loss of one or more of these specialized functionsoccurs in minutes. This rapid onset of deficit allows one tosuspect that a vascular event has occurred and what part ofthe brain is damaged. Unlike Alzheimer dementia or Parkinsondisease, which evolve over years, a vascular event comes onsuddenly, though may progress over minutes to hours. This eventis an emergency; it is a brain attack: call 911! Quick treatmentis needed if the brain tissue that has lost its blood supplyis to be saved from permanent damage. Usually, special treatmentcan be given only within 3 hours of onset of loss of functionso a vascular event is an emergency. It is taught that timeis brain tissue. It makes sense that this event is called astroke.
The most common type of vascular event in the brain resultsfrom blockage of an already narrowed and rigid brain blood vessel.This is most often due to atherosclerosis (clogging of the arterieswith fatty materials). Although this is more common in olderpeople, the process begins many years earlier and can happeneven to young adults. This blockage of the blood supply causesan ischemic stroke. Sometimes, a thickened and rigid vesselwall forms a blood clot which can block blood flow at the originalsite. This leads to a massive stroke with lots of damage. However,in other cases, the clot can break loose, float downstream,and block a smaller vessel in the brain. Depending on the sizeof this smaller vessel and the area it supplies, the damagemay be less. Such a stroke is called an embolic stroke. Yetanother type of stroke is caused when a weakened blood vesselruptures and blood jets out into the brain itself with eachheartbeat. This causes a hemorrhagic stroke. One of the majorcauses of this blood vessel weakening is high blood pressure.Sometimes deficits like weakness and numbness on one side ofthe body or loss of speech come on suddenly and disappear aftera few hours. This could be a transient ischemic attack (TIAfor short). Although the patient may rapidly improve, this typeof stroke cannot be ignored. It is a warning that a big strokemay be about to happen and medical help must be sought immediately.
Each type of stroke may produce similar signs because the lossof function depends more on the part of the brain that is damagedthan the type of stroke. However, different types of stoke needdifferent types of treatment. A person with an ischemic strokemay benefit from a treatment to try to dissolve the blood clot.This type of treatment would be avoided if a person had a brainhemorrhage. The type of stroke can now be determined with studieslike a computerized tomogram (CT) and a computerized magneticimage (MRI). The blood vessels themselves can be seen with anangiogram. These sensitive tools help confirm the suspicionof a vascular event in the brain and what area is affected.The best treatment for the particular vascular event can thenbe started.
The chances of having a vascular event increases rapidly afterage 45 years. Men have a higher risk than women until old agewhen women catch up and even surpass the risk in surviving men.One of the biggest risk factors for stroke is high blood pressure.This can and should be treated and watched very closely. Dietalso seems to play a key role in stroke risk. Obesity, diabetes,and too much cholesterol all can be at least partially, if notentirely, improved by what you choose to eat and avoiding overeating.Lack of regular exercise often goes along with poor fitnessand is another risk factor. New risks are being found regularlyby researchers. In the present issue of this journal, a newone has been identified that is somehow associated with a birthday.Because we do not yet know what, specifically, about a birthdayincreases risk, more research is needed. Many of the risk factorsfor vascular events are controllable and we certainly do notwant to stop celebrating birthdays.
Have your blood pressure checked regularly and, if it is high,take the medications you are given and follow the advice ofyour doctor. Change your diet so you have five to seven servingsof fruits and vegetables per day, avoid fatty foods (especiallydeep fried foods and fatty meats), and do not eat too much (onlyeat when you are hungry, not because you are bored or anxious).Enjoy getting regular exercise by walking, gardening, swimming,or even dancing. If you smoke, stop or get help to stop. Tryto reduce stress by taking time for activities you enjoy andpeople you like to be with. Many of the risk factors for strokecan be controlled: put yourself in charge of doing all you canto avoid this unhappy event.
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