Stroke: Know the Signs, Save Lives

Your heart is not the only potential victim of cardiovascular disease. Your brain can be, too. Stroke is a type of cardiovascular disease that affects the arteries leading to and within the brain. A stroke occurs when the blood vessels that carry the oxygenated blood and nutrients to the brain are either blocked by a clot or break.

This prevents the brain from getting the oxygen and nutrients it needs, and within minutes to a few hours brain cells begin to die. Every 45 seconds someone in the United States has a stroke, and every three minutes someone dies of stroke. That’s about seven hundred thousand strokes a year, of which about 160,000 result in fatalities.

I can’t stress enough how important it is to learn how to recognize the symptoms of stroke because it can save your life or the life of someone you know. The most characteristic symptom is a sudden numbness, weakness, or paralysis of the face, arm, or leg, usually on one side of the body. Other symptoms include loss of speech or trouble talking, blurry vision, double vision, decreased vision, dizziness, loss of balance and coordination, an out-of-the-blue bolt of pain, headache, vomiting, or altered consciousness and disorientation or memory loss. Usually these symptoms strike suddenly and without warning.

It is important to recognize the signs and symptoms of stroke because every minute counts when it comes to treating one. The longer a stroke goes untreated, the greater the damage and potential disability. So if you have any of the signs and symptoms of stroke, it is important to get help immediately.

Eighty percent of strokes are ischemic, which means they are caused by an obstruction from a blood clot or particle of cholesterol plaque that reduces the blood flow to the brain. The brain cells die within minutes of this happening. There are two types of ischemic stroke. Thrombotic strokes are caused by clots that originate in the arteries that supply the brain, like the neck arteries, or the arteries within the head itself. Embolic strokes originate from blood clots that form away from the heart but are swept up through the bloodstream and into the narrow arteries of the brain.

The other 20 percent of strokes are hemorrhagic; they occur when a blood vessel in the brain leaks or breaks. The most common risk factor for hemorrhagic stroke is uncontrolled hypertension, though it can also be caused by an anatomical weakness of the blood vessel itself, that is, an aneurysm, or by an abnormal connection of the arteries and veins in the brain.

There are several risk factors for stroke.

People who have transitory ischemic attacks—a temporary halt to the flow of blood to the brain—have a ninefold increase of developing a full-blown stroke. At higher risk are those who have a family history of stroke, are older (the older we get, the greater the chance of stroke), and are African American, partly due to the high prevalence of high blood pressure and diabetes among the black community.

Other factors include hypertension, high cholesterol, cigarette smoking, diabetes, obesity, cardiovascular disease, and high homocysteine levels. Homocysteine is an amino acid in the blood, and people with elevated homocysteine levels have a higher risk of stroke. Women taking birth control pills or hormone replacement therapy may also be at higher risk for stroke.

The good news is that there actually are some things you can do to avoid being a victim of stroke. Even though you cannot do anything about your race, your sex, your family history, or your age, since cardiovascular disease and stroke go hand in hand, you certainly can look at your risk factors for heart disease and hypertension and focus on early screening.

Get your blood pressure checked; learn what your body mass index is; and check your cholesterol and glucose levels every two to five years.

Exercise, manage your stress, limit your alcohol consumption, don’t smoke, and stay away from foods with saturated fats.

Take a vitamin B complex, like B6, B12, and folic acid, which are essential in helping to reduce the levels of homocysteines in the body.

Don’t take illicit drugs, like cocaine, which may trigger a stroke.

People with risk factors for stroke should consider a brain-healthy diet that includes several servings daily of fruit and vegetables with nutrients rich in potassium, folate, and antioxidants. Eat foods high in soluble fiber, like oatmeal, to help reduce cholesterol, as well as foods rich in calcium and soy that help reduce your bad cholesterol and raise your good cholesterol. Foods rich in omega-3 fatty acids, which include, of course, plant oils, salmon and other cold-water fish like tuna, are also good weapons in the battle against stroke.

When it comes to the treatment of strokes, some hospitals have actually established special stroke emergency rooms that are manned by a multidisciplinary team well versed in their diagnosis and treatment. Whoever the doctor is, however, he or she must first determine the type of stroke and its location before treating it.

A wide variety of diagnostic tests are available to the doctor, and they all fall into one of three categories: imaging tests, which provide a better-than–X-ray picture of the brain; electrical tests, which record the impulses in the brain; and blood flow tests, which show any problem that may be causing changes in blood flow to the brain.

Essentially, all emergency room doctors will attempt to improve and restore blood flow to the brain of a stroke victim. One way to do that is by injecting a clot-bursting drug, or thrombolytic, that helps dissolve the clot. Other techniques include performing a surgical procedure such as a carotid endarterectomy, in which the surgeon opens the carotid arteries and removes the plaque from them, or angioplasty, in which a balloon-tipped catheter dilates the arteries to improve the blood flow.

Once a stroke has been diagnosed and treated, most individuals end up taking preventive medicines to minimize the chances of recurrence. Some may receive antiplatelet drugs to make platelet cells in the blood less sticky and less likely to form a clot, or anticoagulants, which again prevent the blood from clotting. In cases of hemorrhagic stroke, where a blood vessel has ruptured, surgical intervention is needed to minimize further bleeding by clipping, cauterizing, or removing the clot and any vessel that is actively bleeding.

Stroke survivors must cope with a life-changing experience. They are often significantly disabled and, as a result, need a strong support system. Usually the support system is a team of rehabilitation doctors, which might include a psychiatrist, a dietitian, an occupational therapist, a physical therapist, a speech therapist, and social workers.

A stroke victim has to deal with impaired movement, which has implications for walking, balancing, speaking, swallowing, and breathing; bladder and bowel dysfunction; and diminished sex drive—as well as all the emotional issues that result from those problems. A stroke victim’s family is also profoundly affected because they now have to take part in caring for the individual.

Stroke can change your life completely, so learn to recognize it and treat it urgently to minimize the terrible disabilities it can inflict on its victims.

The Other Victims of Stroke

The obvious result from a major stroke is devastating disability—such as speech impairment, weak hand and leg movement, and depression. But a stroke can also have an indirect effect on the health of the victim’s family and friends.

Imagine a very strong and vibrant man who has never been sick, who has been a good husband and provider, who has been a great father. His family, and especially his wife of 45 years, marveled at his strength. He was healthy and looking forward to a peaceful and blessed retirement. Then one day he suffered a major stroke, which left him unable to speak and walk. For the family, the confusion and shock were intense. How could this have happened?

This is not a fictional story. It happened in my family. When I first met my future father-in-law, I never imagined that one day his life would end up in such a way. However, this same scenario is played out over and over again in many families across the United States and around the world.

All of a sudden, responsibilities that were the stroke victim’s are now delegated to other members of the family, and in some cases the majority of the responsibilities falls on the spouse. From everyday things like shopping or paying bills to new responsibilities like making daily trips to the rehabilitation center; feeding, bathing, and keeping up with all the medications; and becoming a motivational guru.

All of this can have a tremendous impact on the caregiver’s health. Suddenly, what was once an ordinary life becomes an extraordinary one burdened by the pressure and eased by the love for the ailing family member. We doctors sometimes forget about the families, and that’s a big mistake. When dealing with stroke survivors, focusing on the family as a whole is always important. We must listen, support the changes that are needed, and monitor stress and the effect that it has on the people taking care of stroke survivors.

Family members take care of one another; they become the pillars of health care in the home and improve the outcome that any therapy in the hospital could bring. I remember the look of my mother-in-law as she dealt with her husband’s disabilities, a look of love, duty, and compassion. But we must always make sure that, as we take care of others, we take care of ourselves.

If you don’t take care of your own health, you may very well end up being unable to take care of the person you love. So stay healthy. They don’t say “in sickness and in health” for nothing.

Migraine: Not Just a Bad Headache

There are headaches, and then there are migraine headaches. Any headache can make you miserable, but a migraine can be excruciating. In fact, the most severe migraine headaches can just about bring you to your knees.

More than 28 million Americans suffer from migraine headaches. Their frequency and severity varies from person to person, but they strike women three times more often than men. And if there is a history of migraine in your family, there is an 80 percent chance you will have them as well.

Most people who suffer from migraines will have a first attack by the age of 30. Often they begin in childhood and then increase in frequency in adolescence. The condition usually continues through the thirties and forties, but attacks tend to decrease in frequency and severity with age, and they are rare after age 50.

Some people with these painful headaches will experience a variety of visual symptoms–such as flashing lights, blind spots, or zigzag patterns–either before or during the headaches themselves. Migraines make many people feel nauseous or light-headed. Vomiting and an extreme sensitivity to light and sound are other common symptoms. A migraine can incapacitate you for hours or even days.

While there is no cure for migraines and the exact cause of migraines is not known, they are now viewed as a vascular and inflammatory problem, so the new therapies being developed for migraine sufferers are focusing on these two pathways.

Not long ago, aspirin was the sole remedy for migraines, but today there are medications that can help reduce the frequency of migraine headaches and stop the pain once it has started. Severe cases are now treated with triptans, a class of drugs specifically developed to treat migraines. These drugs normally provide relief within 15 minutes to two hours in most people.

Preventive medication is available for serious migraine sufferers, though they do not eliminate the migraines completely. The beta-blockers used to treat high blood pressure and coronary artery disease can reduce the frequency and severity of migraines, and certain antidepressants can also help prevent migraines.

It’s important for migraine sufferers to avoid certain triggers, such as smoking, or certain foods or smells that may have triggered their headaches in the past. If you are a woman, birth control pills and other sources of estrogen may also trigger or make the headaches worse. Regular aerobic exercise is highly recommended to reduce tension and to help prevent migraines.

You Are What You Eat

I think Americans generally pay more attention to the gasoline they put in their cars than to the food they put in their mouths. We are a society of excess, and one of our more impressive excesses is the way in which we eat and what we choose to put in our mouths.

We are the leading country in the world in almost everything, yet our mortality rates, our cancer rates, and our neonatal death rates don’t rank among the best in the world. We lead in research, we lead in academic training, we lead in freedom of information, yet we don’t lead in taking care of our health.

We have all the knowledge in the world about everything in life, but that has made no impact on our health. Why? I think nutrition is part of the reason, and I think I know why.

No one is ever taught about nutrition. We certainly don’t teach the subject in grammar school, and it’s rarely taught in high school. Some colleges may offer it as an elective. But our parents certainly don’t talk to us about carbohydrates and proteins the way they do about the birds and the bees. If you combine this lack of knowledge with our appetite for diversity, taste, and presentation, what you have is a lot of people who know nothing about the food on their plate.

It’s never too late to learn about nutrition. The fundamental issue with nutrition is learning how to balance your caloric intake with the number of calories you burn. Everything we eat has a caloric value. If you take in more nutrients that contain a lot of calories and you don’t burn them up, the excess caloric energy is going to be stored as fat, and you’re going to gain weight. That weight and that fat will then interfere with all the normal functions of your body.

On the other hand, if you consume too few calories, say fewer than 1,200 calories a day, then your body doesn’t have sufficient energy to maintain adequate functioning. The caloric intake for a normal adult should range between 1,500 and 2,000 calories a day.

The body requires certain nutrients in order to work properly. Nutrients are the chemicals our body gets from food. These nutrients are used to build muscles, improve cell-to-cell transmission, and manufacture hormones. In describing nutrients, the word “essential” means that the body must consume them; it cannot produce them on its own. The nutrients we need include:

Essential amino acids.
The body requires amino acids to produce new body proteins and replace damaged proteins to build and maintain the body.

Vitamins and minerals.
These are recognized as essential nutrients that are specifically linked to the functionality of cells. If we’re deficient in vitamins and minerals, we develop a weak immune system, cell metabolism disorders, premature aging, scurvy, goiters, and bone loss.

Fatty acids.
Also essential, fatty acids are crucial for maintaining the body’s normal health. They are responsible for the normal formation of hormones and creation of some of the biological pathways responsible for dealing with inflammation and cell repair.

Sugars.
They are essential because they provide the fuel our cells need to function adequately, which allows the other nutrients to be utilized properly. If cells don’t have the sugar molecule necessary to generate the energy required for repairing, functioning, transmitting, and utilizing nutrients, then cellular damage and disease will result.

Each nutrient carries out one or more unique tasks your body needs to function. And because you need many nutrients to stay healthy—protein, fat, carbohydrates, vitamins, minerals—you have to eat a wide variety of foods to get them all.

It’s when we don’t recognize the necessity of all those elements that we begin getting into trouble. It’s like filling your gas tank with gasoline and forgetting to change the oil every 3,500 miles, or forgetting to put water in the radiator. The car needs the gasoline, the oil and the water, all in the proper proportions, in order to function properly. The same is true of the human body.

The problem, as I’ve mentioned before, is that about one-third of all American meals are prepared foods. And the problem with prepared foods is that their contents are not nutritionally balanced.

Our lack of knowledge of nutrition, combined with our obsession with processed foods, is really damaging our health. So we have to get back to fundamentals, a good example of which is the diet of people who live in the Mediterranean. Their diet is well balanced with vegetables and fruit, fish and lean meat, and the good unsaturated fats like olive oil.

Today, many people think that if they stick to low-fat or nonfat foods, they won’t gain weight. That’s a myth, because gaining weight has to do with calorie intake. If you take a salad and you add cheese and eggs and everything else in the book, even if you select low-fat ingredients, you’re still consuming a tremendous load of calories. And size matters, too; the size of your portions does make a difference in terms of the total amount of calories consumed. It’s just a plain mathematical calculation.

There are no magical foods that are going to help you burn calories or increase your cell metabolism either. There is no such a thing as a food that is more active in the body than others. People think that eating a grapefruit each day or having cabbage soup for lunch is going to burn off their fat. But that’s a myth. There is only one way to burn off those extra calories: exercise, any exercise at all.

How to Eat
It’s not just what or how much we are eating that’s the problem these days, it’s the way most of us eat. Many people skip breakfast, gulp down a quick lunch at noon, and then consume a large meal at seven o’clock at night.

Trouble is, they don’t need all that fuel at night. They need a little bit throughout the day when they are active—either moving, thinking, or both.

So what happens in the middle of the day if this is the way we eat? Without a supply of energy, our metabolism gets altered. Our blood sugar level is erratic. Our hormones go haywire trying to figure out where to obtain the fuel we need. People are always telling me, “I don’t eat, so how come I’m not losing weight?”

That’s the answer. Their metabolism is out of whack, and they need to get it back in order.

Supplements
If you eat a balanced diet with fruits, vegetables, grains, fish, and all the rest, you don’t need to take supplements. But how many of us really eat such a balanced diet?

And even if we do, because we are all predisposed for certain diseases and the aging processes, being proactive and adding certain supplements to our diet may be a good idea. But before popping supplements like candies from a bag of M&M’s, check with your doctor about what’s best for you. Some supplements can be toxic. Others may cause allergies or cross reactions with medications you may be taking. But there is no doubt that certain supplements can have specific health benefits and can lower the cost of health care at the same time.

An Important Word About Supplements
Many supplements contain active ingredients that can have strong effects on your body, and some supplements can interfere with prescription medicines. Always consult with your doctor or pharmacist before taking supplements.

I am particularly bullish on five supplements that have been well studied and are proven to support optimal health.

Omega-3 Fatty Acids
I love the omega-3 fatty acids. They are an important contributor to the improvement of human health. Some studies have shown that omega 3s are good for the prevention of heart disease, as well as for depression, rheumatoid arthritis, and asthma. You can get omega 3s by eating leafy greens and fish or by taking a fish oil tablet. Omega 3s assist with fat metabolism and help maintain a balance of good and bad cholesterol.

Calcium
Calcium is another very good supplement, specifically calcium with vitamin D. Calcium intake is an important factor in bone health and may play a role in the prevention of colon cancer, though it doesn’t appear to be the silver bullet that everyone hoped it would be. Research has shown that calcium supplements can significantly lower the occurrence of hip fractures among those aged 65 and older.

Folic Acid
Folic acid and folate are forms of a water-soluble vitamin B that occur naturally in leafy vegetables such as spinach and turnip greens, dry beans and peas, fortified cereal products, and some other fruits and vegetables. Folic acid supplements have been a lifesaver in the prevention of neural tube defects in children. They are also very beneficial for cell function and the prevention of heart disease.

Glucosamine
I also like glucosamine. It has good anti-inflammatory effects, especially for individuals with arthritis. It doesn’t prevent arthritis, and it doesn’t repair or rejuvenate cartilage, but I think it’s a very good supplement because it helps promote joint function and relieves the symptoms of inflammation and pain.

Other supplements that are thought to make a positive contribution to health include saw palmetto, the fruit of the fan palm, for men. Native Americans consumed it as food and used it to treat urinary and genital problems. Some research has shown that it could be effective for the treatment of an enlarged prostate in men. It increases urinary flow and has no known safety hazards.