Articles on stroke

Brain Stroke: 7 Goals For An Effective Recovery

Dr. Prasanna Hegde, Speech Therapist
Having hit by a brain stroke is devastating, for the health complications which might follow subsequently. But that is not the end of it. Stroke, once stabilized by medical or surgical treatment, has just left the person's ability to function, at one level. It is the events that follow which makes the difference. So start with having the right goal. Goals for effective functional outcome: 1. Functional ability first, then the Skill - Basic activities of daily living needs to be targeted first. We all crawled before we could walk. Communication in any way is the priority before speaking, sitting-standing before walking, practice before excelling. 2. Functional ability tomorrow should be better than today - Targeting 100% is definitely ambitious but lets agree that recovery post-stroke is not an overnight event. Rehabilitation is always a slow and progressive process. 3. "Practice" The only Thumb Rule- 'Practice makes man perfect' and man here is not just any person. It is a collective noun for every person. Every skill needs to be rehearsed multiple times and in various situations.  4. Medicines help you regain your health but not your function -  After discharge if the individual is not able to walk, not able to lift hand or not able to swallow or talk its not that medicines did not work. Medicines saved the life, but the rehabilitation makes you recover function. 5. Earlier the better - It is wise to start rehabilitation soon after the individual is medically stable. There are window periods for effective recovery and effective rehabilitation. 6. Its no overnight magic - Rehabilitation might not show immediate results. It takes time. Be patient and if you are doing it right, you will soon find the difference. 7. Get back to where you were - Though human tendency is to negotiate progressive treatment, your primary goal is to get back where you were and get back to what you were doing. With effective communication between patients, caretakers and therapists, rehabilitation is as easy as a cake walk. 

Living After a Stroke

Dr. Rajesh Pal, Physiotherapist
It is important to know about stroke especially after you or your loved one has had one because stroke need not mean the end of a productive life. The effects of every stroke is different and it needs determination to work hard with therapies and support and understanding of family and friends. By learning about stroke family and friends can understand what kinds of behaviour can be expected from the patient and decide what actions they should take to help the patient recover as fully as possible. A stroke may cause serious changes in a person's life.Common effects:Paralysis: Loss of control and feeling on one side or parts of the body. Aphasia: Loss of ability to speak, read or write, loss of ability to understand spoken language, or to name objects or express oneself. It can range from temporary slurring to complete inability to communicate.Other possible effects:Depression: Person who had a stroke may become depressed. Frustration, low self-esteem, and crying are all common. If depression interferes with the person's progress by draining strength and the will to recover, professional help is needed. Memory loss: A person affected by a stroke can have trouble recalling things which happened recently (SHORT term memory loss) It affects their ability to learn and retain new information. This normally returns with time.Emotional upsets: The person may seem irrational, laugh at inappropriate times, cry, swear or behave in a way that is unlike the person's former self.Judgement difficulties: People with left brain damage are usually overly cautious, anxious, hesitant slow , disorganized. People with right brain damage usually are impulsive, unrestrainable and not personally very safe.The sooner the therapy begins the better the chance for recovery. Therapies require a team effort on the part of the patient, physician, family, therapists, and nurses.Early physical therapy is needed to regain the lost functions like moving around in the bed, getting in and out of the bed, transferring to the chair and toilet, and walking/climbing stairs.Occupational therapy helps with self reliance and skills for self care, independent living and employment. It includes visual, vocational, memory training , home making etc.Speech therapy: enables to find out the best mode of communication to and by the person affected by the stroke. It also includes helping with swallowing difficulties, problem solving skills,Nursing care for the bed ridden person to prevent pressure sores, teaching a person with his medications.Making the home comfortable for the recovery process: Discuss with your therapists, they can provide suggestions on modifications to be made to your home to make it easily accessible, safe and clear of tripping hazards, and positioning in bed to encourage independence.Devices for the recovery process: ask your therapist about simple devices which can help with independent basic functioning, like a long handled shoe horn, special eating utensils, western commodes etc.AwarenessUnderstand the persons strength's and weaknesses. Remind on how much progress he has made and encourage to move ahead.Steer his attention away from stroke and encourage him to be involved in his favourite hobbies, outings and friends.Learn more about stroke to help him better.Maintain a positive outlook even if some days are better than the others.Recognize that emotional ups and downs are expected.Take care of yourself , share the responsibilities with others, set aside some time for yourself and relax.Join a Family Support Network to share your feelings with other family members who have been through care giving before, or going through now.  

Stroke Is Not the Old Age Weakness; It Is Something else..

Akhila KUmar Panda
What is a stroke?Stroke is called “Brain Attack”. It happens  when a part of the brain dies because of  either clotting or rupture of blood vessels. Stroke is one of the leading causes of death and disability in the world.Strokes can happen when:An artery is blocked due to blood clotting where a part of brain goes without blood for few minutes. An artery ruptures and starts bleeding into the brainHow do strokes affect people?The effects of a stroke depend onWhich part and how much of the brain is affectedHow quickly the stroke is treatedHow to recognise Strokes- There is an easy way to remember the features of a stroke. Just think of the word "FAST"Face –Uneven or droop on one side?Arm –  Weakness or numbness in one or both arms? Fall of one arm when holding both arms out?Speech –Trouble speaking? Does his or her speech sound strange?Time – If you notice any of these stroke signs, call for an ambulance 108. You need to act FAST. The sooner treatment begins, the better the chances of recovery.How are strokes treated?The right treatment depends on what kind of stroke you are having. You need to get to the hospital very quickly to figure this out.Damage of brain tissues is irreversible if you delay treatment.If you reach the hospital within 4.5 hours, then treatment ( IV actylase) can be given to prevent further brain damage which  reopens the   clogged arteries.Get medicines that prevent new blood clots. These medicines also help prevent future strokes.People whose strokes are caused by bleeding can:Have treatments that reduce the damage caused by bleeding in or around the brainStop taking medicines that increase bleeding, or take a lower doseSometimes  surgery is helpful but the decision should be taken by Neurologist. Can strokes be prevented? Many strokes can be prevented, though not all. You can greatly lower your chance of having a stroke by:Taking your medicines exactly as directed. Medicines that are especially important in preventing strokes include:- Blood pressure medicines to keep blood pressure normal (<140/90mmHg)- Medicines called statins, which lower cholesterol- Medicines to prevent blood clots, such aspirin or clopidogrel (blood thinners)Keep your blood sugar as close to normal as possible (if you have diabetes) Fasting : 100-120mmhg, PPBS 140-180mmHg.Making lifestyle changes:- Stop smoking, if you smoke- Get regular exercise (if your doctor says it's safe) for at least 30 minutes a day on most days of the week- Lose weight, if you are overweight- Eat a diet rich in fruits, vegetables, and low-fat dairy products, and low in meats, sweets, and refined grains (such as white bread or white rice)- Eat less salt (sodium)- Avoid Alcohol, If u drinkAnother way to prevent strokes is to have surgery to reopen clogged arteries in the neck. This surgery is appropriate for only a small group of people.What is a "TIA"? A TIA is like a stroke, but it does not damage the brain. TIAs happen when an artery in the brain gets clogged or closes off and then reopens on its own. This can happen if a blood clot forms and then moves away or dissolves. TIA stands for "transient ischemic attack."Some people improves symptoms on the way to the hospital. But the patient to be thoroughly investigated.Even though TIAs do not cause lasting symptoms, they are serious. If you have a TIA, you are at high risk of having a stroke. It's important that you see a doctor and take steps to prevent that from happening. Do not ignore the symptoms of a stroke even if they go away!

Diabetes Increases the Risk of Stroke

Ms. Swati Kapoor, Dietitian/Nutritionist
Before we explain the link between diabetes and stroke, we need to understand diabetes and stroke, and the causes behind them.What is diabetes?Diabetes is a metabolic disorder in which blood glucose levels deviate from normal levels. There are two types of diabetes: Type 1 and Type 2. Type 1 diabetics are those who are diabetic from their childhood or young adulthood. Type 2 diabetics are those who are diabetic from their adult lives. Diabetics could be Insulin dependent or independent, depending on the state of the pancreas. There are many factors which lead to diabetes such as: Age, Heredity (family history) , Alcohol abuse, Drug abuse, lack of physical activity, poor diet etc.What is stroke?A stroke is the impairment of the brain function due to disturbance in the blood supply to the brain, especially when it occurs all of sudden. There can be many factors which lead to a stroke, such as Age, Heredity (family history), Race, Sex (gender), Prior stroke history, heart attack, Alcohol abuse, Drug abuse, etc. Hypertension is also one of the major factors which lead to a stroke.How is diabetes linked to stroke?People with diabetes are up to 4 times as likely to have a stroke as someone who does not have the disease. Many people with diabetes have health problems that increase their risk for stroke. Although a lot of research is being carried out on why people with diabetes are at a higher risk for having high blood pressure and brain stroke, researchers are yet to arrive at any definite answer. Uncontrolled high blood pressure, or hypertension, is a major risk factor and a leading cause of stroke. As many as 2 out of 3 adults with diabetes have high blood pressure. When it comes to preventing diabetes complications, normal blood pressure is as important as good control of your blood sugar levels.What Lifestyle Changes Can Prevent and Treat High Blood Pressure?To treat and help prevent high blood pressure, diabetes and stroke: • Control your blood sugar • Stop smoking • Eat healthy • Maintain a healthy body weight • Limit alcohol consumption • Exercise • Limit salt intake • Visit your doctor regularly • Be stress free. Minimize stress levels. • Give your body sufficient sleep

Occupational Therapy Is Essential for Stroke rehabilitation

Dr. Chaitanya Ulhas Mantri, Occupational Therapist
“Paralysis is defined as complete loss of strength in an affected limb or muscle group.”The chain of nerve cells that runs from the brain through the spinal cord outdo the muscle is called the motor pathway. Normal muscle function requires intact connections all along this motor pathway. Damage at any point reduces the brain's ability to control the muscle's movements. This reduced efficiency causes weakness, also called paresis. Complete loss of communication prevents any willed movement at all. This lack of control is called paralysis. Certain inherited abnormalities in muscle cause periodic paralysis, in which the weakness comes and goes.The line between weakness and paralysis is not absolute. A condition causing weakness may progress to paralysis. On the other hand, strength may be restored to a paralysed limb. Nerve regeneration or regrowth is one way in which strength can return to a paralysed muscle. Paralysis almost always causes a change in muscle tone. Paralysed muscle may be flaccid, flabby, and without appreciable tone, or it may be spastic, tight, and with abnormally high tone that increases when the muscle is moved.Paralysis may affect an individual muscle, but it usually affects an entire body region. The distribution of weakness is an important clue to the location of the nerve damage that is causing the paralysis. The types of paralysis are classified by region:Monoplegia, affecting only one limbDiplegia, affecting the same body region on both sides of the body (both arms, for example, or both sides of the face)Hemiplegia, affecting one side of the bodyParaplegia, affecting both legs and the trunkQuadriplegia, affecting all four limbs and the trunk.The nerve damage that causes paralysis may be in the brain or spinal cord (the central nervous system) or it may be in the nerves outside the spinal cord (the peripheral nervous system). The most common causes of damage to the brain are:StrokeTumorTrauma (caused by a fall or a blow)Multiple sclerosis (a disease of that destroys the protective sheath that covers nerve cells)Cerebral palsy (a condition caused by a defect or injury to the brain that occurs at or shortly after birth)Metabolic disorder (a disorder that interferes with the body's ability to maintain itself).Damage to the spinal cord or peripheral nerves is most often caused by trauma, such as a fall or a car crash.INTRODUCTION TO STROKEImagine yourself in a marketing place and you suddenly collapse on the ground and are unconscious. It can be a STROKE!To be classified as stroke, focal neurological deficits should persist for at least 24 hours.Stroke is a disease that affects the blood vessels that supply blood to the brain. It occurs when a blood vessel that brings oxygen and nutrients to the brain either bursts or is clogged by a blood clot or some other mass. The former is called as the hemorrhagic stroke and the later an ischemic stroke.When the rupture or blockage of the blood vessel takes place, there is no enough blood supply and hence, no enough nutrients and oxygen to that part of brain. This damages the nerve cells and may lead to their (cells) death.As a result, that part of the brain is damaged which results in improper functioning of those body parts which are under the control of damaged brain area.The term cerebrovascular accident (CVA) is also used to refer to the cerebrovascular conditions that accompany either ischemic or hemorrhagic lesions.Stroke may be classified by the etiological categories, management categories and anatomical categoriesRisk of STROKE:Age (over age 65)Brain tumorCoagulopathy (blood clotting disorder)DiabetesHigh cholesterol levelHypertensionHeart diseaseInfection (e.g., meningitis, endocarditis)SmokingWarning signs of STROKE?Sudden severe headache with no known causeSudden difficulty seeing in one or both eyes (particularly in one eye)Sudden problems with walking, dizziness, loss of balance or coordinationSudden weakness or numbness of the face, arm, or leg on one side of the bodyDifficulty in swallowingCare and Rehabilitation Stroke rehabilitation is the process by which patients with disabling strokes undergo Occupational Therapy/ Physical Rehabilitation to help them return to normal life as much as possible by regaining and relearning the skills of everyday living. It also aims to help the survivor understand and adapt to difficulties, prevent secondary complications and educate family members to play a supporting role.Stroke rehabilitation should be started as immediately as possible and can last anywhere from a few days to over a year. Most return of function is seen in the first few days and weeks, patients have been known to continue to improve for years, regaining and strengthening abilities like writing, walking, running, and talking. Daily rehabilitation exercises should continue to be part of the stroke patient's routine.Hand TrainingGait Training

'Brain Attack' and 'Heart Attack': How Are They Different?

Dr. sudheerambekar
It is a common notion among people that 'brain attack' or 'stroke' and 'heart attack' are one and the same. There is also a profound lack of knowledge of common risk factors and symptoms of stroke. The inability of bystanders to recognise the common symptoms of stroke is a major hurdle in the appropriate management of patients with stroke as the golden hour is lost, especially in India where the pre-hospital services are not well organised. Treatment within the first 8 hours of onset of symptoms is most effective and prevents long-term morbidity and mortality. It is estimated that one person dies of a stroke every 36 seconds in India. In a study conducted among the rural population in Maharashtra in 2012, only 51% of the 373 respondents were able to correctly identify 'stroke' as a disorder of the brain, while 19% associated it with a heart attack! Also, one-third of the respondents (34%) did not know at least one risk factor for stroke. This phenomenon is seen in both developing and developed countries, although the proportions are lower in developed countries. What are the similarities and differences between 'stroke' and 'heart attack'?A heart attack refers to damage to the muscle of the heart, usually from a lack of blood flow. Most of the time, a blood clot forms in one of the arteries that supply the heart muscle with blood, blocking the flow of blood. As the heart muscle starves, it begins to die, causing chest pain and other symptoms of heart attack.A Stroke is a similar blockage in an artery in the brain or neck that supplies blood to the brain. When a clot forms in one of those arteries and stops blood flow, a section of the brain begins to die. When those cells die, the person loses whatever function those brain cells controlled. There is another category called the 'hemorrhagic stroke' in which a blood vessel bursts and bleeds in the brain.While the common symptoms of a heart attack are chest pain, tightness and shoulder pain, the symptoms of stroke are completely different and may range from nothing to a headache, paralysis of an arm or leg, unconsciousness, coma and death. Another type of stroke is a transient ischemic attack (TIA), essentially a “mini-stroke” caused by a temporary clot. TIA symptoms are identical to those of other kinds of strokes, but because they occur quickly and usually last less than five minutes, this brain attack often goes unnoticed.While a TIA doesn’t usually cause permanent injury to the brain, it serves as a warning for patients and gives them time to seek further medical treatment in preventing ischemic or hemorrhagic strokes.Because specific areas of the brain control certain functions, one can predict the effects of a stroke based on the location of the blockage. If the blockage occurs near the front of the brain, it can affect such things as organisation skills, memory, communication, and problem-solving. If it occurs lower down, near the brainstem, it can cause unconsciousness and an inability to breathe, swallow, or control elimination.if it occurs to one side near the temple, speech may be affected. In addition, which side (hemisphere) of the brain the stroke occurs on determines its side effects and which body functions are affected. The right side generally controls a person's emotions, creativity and abstract thinking. If the blockage occurs anywhere on the right side of the brain, it can cause the following symptoms: Paralysis or weakness on the left side of the bodyDisorientationExcessive talkingAn inability to perform routine tasks such as brushing the teeth, buttoning a shirt or tying shoelaceThe left side controls more of speech, logic, perception and organisation. If the stroke occurs anywhere on the left side of the brain, it can cause the following symptoms:Paralysis or weakness on the right side of the bodyDepressionAn inability to understand languageTrouble speakingMemory problemsDecreased attention span Heart attack and Stroke have many risk factors in common. They may be modifiable or non-modifiable. Some of the modifiable risk factors include High Blood PressureHeart DiseaseDiabetes MellitusCigarette smokingHistory of transient Ischemic Attacks (TIAs)High blood CholesterolLack of exercise, physical inactivityObesityExcessive alcohol useDrug abuse  Some of the non-modifiable risk factors include- Age > 55 yearsMale genderRace (Asians and African-Americans have a greater risk than Caucasians)History of prior strokeFamily history of stroke

The One-Minute Guide to Identifying Stroke

Dr. Avinash Vilas Wankhede, Cardiologist
Stroke is a paralysing monster that affects millions of people every year. The ensuing wheelchair- bound life can be quiet demanding for the patient as well as the caregiver.Stroke results from altered blood supply to the brain. The resultant lack of oxygen and nutrients leads to death of the nerve cells in the brain. This can happen either due to blood clots occluding the blood flow to the brain or haemorrhage, i.e., bleeding in the brain from the ruptured blood vessels.It proves to be fatal for many, but those who survive this attack tend to become both physically and emotionally disabled. Owing to its damage potential, it becomes all the more important to recognise the subtle signs of this hidden event inside the skull. Here is a short and crisp guide to identify an oncoming stroke:S - Sudden onset of abnormal signs is a hallmark. These signs develop within few minutes in an apparently normal looking person. E.g. suddenly looking lost or confused, losing balance.T - Talking is troublesome. The person looks confused. He is either unable to understand what is being said or he/she might just stare at you while you talk to the person. There may either be slurring of speech or the person may just turn mute while being completely fine a few seconds ago.R - Rumble-tumble gait. There is an imbalance and shakiness while walking. He/she may fall down due to unsteady gait and lack of coordination while walking.O - One side of the body feels weak or numb suddenly. There is an inability to move the affected arm or leg, as it feels numb and shaky. Half of the face looks dropped with a crooked smile and drooped eyelid.K - Killing headache might accompany. Severe, sudden head pain is experienced that appears to come out of nowhere.E - Eyesight troubles. Complete loss vision suddenly or blurring of vision or seeing streaks in one or both the eyes.These signs are seen depending on which area of the brain is experiencing the lack of blood supply. A person suffering from high blood pressure is at higher risk of stroke. In addition, obese individuals, people suffering from certain heart problems, diabetes and high blood cholesterol levels are also at risk of this menace. To make matters worse, addictive habits of smoking and alcohol add to the risk.The most important aspect while encountering a stroke is to be quick to act. If you notice any of the above mentioned signs in any of your near and dear ones, neighbours, colleagues or employees, without any apparent cause, immediately rush them to a hospital emergency. Along with examination, a CT scan and an MRI of the brain will confirm the type and location of the brain damage. A long-term medication and a series of other therapies follow the prevention and management of stroke.Important to remember that the amount of patients recovery depends upon how early you reach to a doctor without wasting time!

Stroke and Exercises

Dr. Vishwas Virmani, Physiotherapist
What is stroke?A stroke happens when the blood supply to the brain is suddenly interrupted. There are two main causesof stroke. Most commonly, an artery in the brain is blocked by a clot, stopping normal blood flow andthe delivery of oxygen and nutrients to the brain area beyond (ischemic stroke). This occurs in around85% of cases of stroke. The second cause is through a break in the wall of a blood vessel, leading to ableed in the brain (haemorrhagic stroke). This disruption in blood flow may lead to temporary orpermanent damage to the brain. The range of symptoms from stroke may include: weakness, numbnessor paralysis of the face, arm or leg on either side of the body, sometimes both; difficulty speaking orunderstanding others; loss of vision, blurring or reduced vision in one or both eyes; difficulty swallowingor eating; loss of balance; fatigue; reduced cardiovascular fitness; and difficulty thinking andremembering.Symptoms can appear alone or in combination and last for hours, days, months or even years. Ifsymptoms resolve within 24 hours, this is usually called a transient ischemic attach (TIA). A TIA shouldnot be ignored. Prompt investigation of the cause of a TIA may prevent a stroke. The degree of recoveryand the speed of recovery from stroke varies between individuals and recovery may take many years.How does exercise help?Exercise helps prevent stroke. Once a person is affected by stroke, regular exercise and physical activitycan also help reduce the risk of further stroke and improve post-stroke recovery, as well as help managesymptoms of stroke.Reported benefits include:- Improved strength and endurance- Improved walking ability and ability to complete day to day activities of daily living- Improved balance and coordination- Improved flexibility- Improved mood- Improved alertness and thinking abilityWhat exercise is best for people with stroke?The type of exercise or physical activity that works best for an individual with stroke will depend on theextent of their disabling symptoms, the medical conditions that may have been present pre-stroke or benew since the stroke, such as heart problems and diabetes, their exercise preferences and their ability toget out and about. Avoiding prolonged sedentary (sitting/lying) behaviour is likely to be important inthis population.Fatigue is often reported as a barrier to exercise, but there is some evidence that exercise can help, sopeople with stroke, including those with fatigue, need to find ways to participate in regular exercise orphysical activity. There has been a lot of research testing a range of exercise approaches to help peoplewith stroke at different points in the recovery process. This fact sheet focuses on exercises suitable forpeople who are living in the community with stroke.Cardiovascular Fitness and Endurance Exercises- Can be performed in a variety of settings including home and community and may includegroup work- Stationary cycle, leg or arm ergometry, graded walking programs and even seated exerciseprograms can improve fitness- Circuit classes (group work) and functional exercise (walking programs) can also improveendurance, and may include walking on a treadmill- For people with poor balance after stroke, treadmill walking with a body-weight support devicecan help some people improve their walking endurance and speed- Complementing formal exercise with pedometry to help increase lifestyle physical activity canbe beneficial and may help reduce prolonged sitting which is particularly problematic in peoplewith stroke-Strengthening Exercises- Can be performed at home, in a community centre, at a rehabilitation setting or local gym- Resistance training of upper and lower limbs and trunk can be achieved using free weights,weight-bearing or partial weight-bearing activities, machine weights, elastic bands, spring coilsor pulleys- Progressive resistance with high weights and low repetitions are valuable- 2-3 days a week appears to be the best frequencyBalance Exercises- Functional training with a focus on increasing speed of walking, moving around and overobstacles, stairs and slopes can improve balance in people with stroke- Tai Chi can improve balance and coordination and may help reduce fallsSpecial exercise considerations for people with strokeShort, intense and more frequent bouts of exercise (rather than long bouts), may be particularly suitedto people affected by fatigue, or those with significant disability from stroke. The beneficial effects ofexercise are cumulative.Before commencing a cardiovascular fitness training program, a medical review with your doctor isrecommended to discuss clearance and referrals to appropriate allied health practitioners includingaccredited exercise physiologists or physiotherapists.References and further information

All You Need to Know About Premature Ejaculation: Part I

Dr. Yuvraj Arora Monga, General Physician
What is Premature Ejaculation (PE)?  Definitions and how commonly it occurs!Background:Many of the sexual issues are primarily not big problems. Because of the taboos and social beliefs they are not discussed openly, hence failed to get resolved. And they become big, because of continuous worry they give.In fact most of the times they are not even any symptom of any organic disease processor functional problem. Many of them are very basic issues because of ignorance, myths, and social taboos lead to development of anxieties, distress and further worsening of the problem in question.With basic issues what I mean is, that very commonly men are concerned about their performance in bed with their partner either wife or girlfriend. How best then can do, concern about their masturbation habits, size of penis, sperm quality and many more.  I am not writing this as a routine article for the sake of it, but truly it is the synopsis of a practice / experience spread over few years and interaction with hundred / thousands of people (shall not call them patients barring small percentage).Premature Ejaculation (PE) is one of them. Not a disease; Not at all! The person is sexually fit, having normal erections but just fails to hold the orgasm/ discharge for reasonable time. A very basic problem, but one gets worried. But we need to reassure it is not a disease and can be easily manageable.We will discuss this topic of Premature Ejaculation (PE) in 4 parts including what is it, how it happens, how to approach to resolve this problem with behavioural methods, exercises, techniques and medical remedies both modern as well as alternative medicine. Defining Premature Ejaculation (PE):Premature (early) ejaculation (PE) many a times is called with different names like "rapid ejaculation", "early ejaculation" or simply called as "early discharge". PE is the most common type of sexual dysfunction in men younger than 40 years and seen across all age groups. In elderly, more than 60 years of men, erectile dysfunction can be seen more commonly. In a study conducted by the Journal of Sexual Medicine, that revealed that this condition is almost equally prevalent in sexually active men of all age groups. If a man experiences uncontrollable ejaculation (discharge of semen from your penis) either before or shortly after sexual penetration (usually within 1-2 minutes of penetration), you may be suffering from premature ejaculation. Mayo clinic at USA defines PE when a man “always or nearly always ejaculates within one minute of penetration”.An occasional instance of premature ejaculation might not be cause for concern, but, if the problem occurs with more than 50% of attempted sexual relations, an abnormal pattern usually exists for which treatment may be required.Premature ejaculation typically takes place with negligible sexual stimulation and even before you wish to ejaculate. As a consequence of premature ejaculation, both you and your partner may end up experiencing highly unsatisfactory sex. In fact, it can dramatically increase anxiety, which may worsen the problem. Another way of describing premature ejaculation by most therapist or clinicians who treat PE is that as the occurrence of ejaculation sooner during sexual intercourse than he or his partner would like. This broad definition thus avoids specifying a precise “normal” duration for sexual activity and reaching a climax. The duration of sexual activity is highly variable and depends on many factors specific to each individual.Take a situation, a male may reach orgasm after 7 to 8 minutes of sexual intercourse, but if his partner is able to achieve climax most of the times in 5 minutes and both are satisfied with this timing, then this is not PE. Alternatively, a male might delay his ejaculation for up to 15- 20 minutes of sexual intercourse, but if his partner, even with foreplay, requires 25-30 minutes of total sexual activity before reaching climax, he may still consider his ejaculation premature because his partner has not been satisfied (at least, not through intercourse). But in routine practice we do not like to call this kind of situation as PE. So every individual is unique. Every couple is unique. Same individual may have different sexual behaviour with different partners at different times. Varied situations and varied places of performing the act have a role to play in determining the outcomes of individual sexual performance/s.Statistics of PE:You are not alone! Premature Ejaculation-PE is a common sexual complaint. Estimates vary, but as many as 30-40 % men across the world including India experience problem of PE at some time of life. Approximately 30%-70% of American males experience premature ejaculation. The National Health and Social Life Survey (NHSLS) indicate a prevalence of 30%, which is fairly spread across all adult age groups. Estimates of premature ejaculation rates in India and many European countries are similar to those of the United States.That is all for today’s information on this topic. In the next follow up parts, I shall discuss, types of PE, how it happens, how to approach the men / couple suffering from it to resolve this problem. The therapy includes wide spectrum of approach including counselling, behavioural methods, exercises, techniques and medical remedies both modern as well as alternative medicines.