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Stroke

Stroke  

___What is a Stroke?

A stroke occurs when the blood supply to a blood vessel in the brain is blocked or a blood vessel breaks causing brain cells in the blood vessel territory to die. Brain cells do not regenerate. The problems experienced after a stroke like the inability to move one side of the body like before, numbness on one side of the body, speech or visual problems are usually a result of brain cells that have died due to stroke. Persons who have had one stroke are at risk of having another stroke. It is important that you practice secondary prevention of stroke now, and this Stroke education sheet will help you and your family do just that. Please be sure to ask your doctor any questions about this information or any other questions about your health.

___What to look for: Warning signs and symptoms of stroke

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination 
  • Sudden, severe headache with no known cause                             

___What to do if you’re having symptoms: Call your doctor                                

  • Not all the warning signs occur in every stroke. Don’t ignore signs of stroke, even if they go away!
  • Check the time. When did the first warning sign or symptom start? You or the person who is with you will be asked this important question later. This is very important, because if given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.
  • If you have one or more stroke symptoms that last more than a few minutes, don’t delay! Call your doctor. Do not drive yourself.
  • If you’re with someone who may be having stroke symptoms expect the person to resist going to the hospital. Don’t take “no” for an answer because Time Lost is Brain Lost.

___What you should know: Personal risk factors for stroke

        What risk factors for stroke can’t be changed                                                           

  • Age — The chance of having a stroke more than doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.
  • Heredity (family history) — Stroke risk is greater if a parent, grandparent, sister or brother has had a stroke.
  • Race — Many races have a much higher risk of death from a stroke than Caucasians. This is partly due to higher rates of high blood pressure and diabetes.
  • Sex (gender) — Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women.
  • Prior stroke, TIA or heart attack — The risk of stroke for someone who has already had one is many times that of a person who has not. Transient ischemic attacks (TIAs) are “warning strokes” that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who’s had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn’t. Recognizing and treating TIAs can reduce your risk of a major stroke. If you’ve had a heart attack, you’re at higher risk of having a stroke, too.

What stroke risk factors can be changed, treated or controlled?                                         

  • High blood pressure — High blood pressure or hypertension is the number one cause of stroke. High blood pressure can damage the small blood vessels of the brain. High blood pressure is the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke. If you keep your blood pressure low , you will lower your risk for another stroke. As always check with your physician as to when it will be safe to reach this goal. 
  • Cigarette smoking — Tobacco use in any form, especially cigarette smoking, is very bad for your health. In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk in women.
  • Diabetes mellitus — Diabetes is a risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. While diabetes is treatable, the presence of the disease still increases your risk of stroke. Diabetes causes disease of small blood vessels in the brain and can lead to a stroke. Keeping your blood sugar within normal range (70-105 fasting) will lower your risk for another stroke.
  • Carotid or other artery disease — The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque build-ups in artery walls) may become blocked by a blood clot. Carotid artery disease is also called carotid artery stenosis. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It’s caused by fatty build-ups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke. Causes of carotid artery disease are high blood pressure, diabetes, a diet high in fat, high cholesterol and smoking.
  • Atrial fibrillation — This heart rhythm disorder raises the risk for stroke. The heart’s upper chambers quiver instead of beating regularly, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.
  • Other heart disease — People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.
  • Sickle cell disease (also called sickle cell anemia) — This is a genetic disorder that mainly affects African-American and Hispanic children. “Sickle-shaped” red blood cells are less able to carry oxygen to the body’s tissues and organs. These cells also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.
  • High blood cholesterol — People with high blood cholesterol have an increased risk for stroke. High blood cholesterol can be reduced by eating right (avoid fried, fatty foods) and exercising routinely. It may also require medication. Recommended level of LDL (low density lipoprotein) is depending on risk factors and cardiovascular risks but HDL (high density lipoprotein) must be greater than 50 for women and greater than 40 for men.
  • Alcohol intake – If you drink alcohol, do so in moderation. Heavy drinking can lead to multiple medical complications, including increased risk for stroke. Recommendations: no more than two drinks per day for men and no more than one drink per day for nonpregnant women. Remember that alcohol is a drug. It can interact with other drugs you are taking.
  • Drug use – Drug addiction is often a chronic relapsing disorder associated with a number of societal and health-related problems. Drugs that are abused, including cocaine, amphetamines and heroin, have been associated with an increased risk of stroke. Strokes caused by drug abuse are often seen in a younger population.
  • Poor diet — Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. Include healthy eating habits that include reduced intake of saturated fat, trans fat and cholesterol. A diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.
  • Physical inactivity and obesity — Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stro Risk factors include elevated waist circumference and a Body Mass Index (BMI) greater than 25. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Try to get at least 30 minutes of moderate physical activity five days of the week, or 20 minutes of vigorous physical activity, three days a week, with your doctor’s approval.

___ Follow-up medical care after you leave the hospital

  • Medications must be taken as prescribed by your doctor in order for them to be effective in reducing your risk of another stroke. Do not stop your medications without speaking to your physician first.
  • It is important to keep your scheduled appointments and have your list of medications with you for all of your doctor visits. 

Deep Vein Thrombosis

Deep Vein Thrombosis

What is Deep Vein Thrombosis?
The blood supply of the leg is transported by arteries and veins. The arteries carry blood from the heart to the limbs; veins carry blood back to the heart. The leg contains superficial veins, which are close to the surface, and deep veins, which lie much deeper in the leg. Deep vein thrombosis (DVT) is a condition in which a blood clot (a blockage) forms in a deep vein. While these clots most commonly occur in the veins of the leg (the calf or thigh), they can also develop in other parts of the body. 

DVT can be very dangerous and is considered a medical emergency. If the clot (also known as a thrombus) breaks loose and travels through the bloodstream, it can lodge in the lung. This blockage in the lung, called a pulmonary embolism, can make it difficult to breathe and may even cause death. Blood clots in the thigh are more likely to cause a pulmonary embolism than those in the calf.

Causes of DVT  

Many factors can contribute to the formation of a DVT. The more risk factors a person has, the greater their risk of having a DVT. However, even people without these risk factors can form a DVT.

Signs and Symptoms of DVT in the Leg
Some people with DVT in the leg have either no warning signs at all or very vague symptoms. If any of the following warning signs or symptoms are present, it is important to see a doctor for evaluation:

  • Swelling in the leg
  • Pain in the calf or thigh
  • Warmth and redness of the leg

Diagnosis
DVT can be difficult to diagnose, especially if the patient has no symptoms. Diagnosis is also challenging because of the similarities between symptoms of DVT and those of other conditions such as a pulled muscle, an infection, a clot in a superficial vein (thrombophlebitis), a fracture, and arthritis.

If DVT is suspected, the doctor will immediately send the patient to a vascular laboratory or a hospital for testing, which may include a blood test, Doppler ultrasound, venogram, MRI, or angiogram.

Treatment of DVT
If tests indicate a clot is present, the doctor will make a recommendation regarding treatment. Depending on the location of the clot, the patient may need hospitalization. Medical or surgical care will be managed by a team of physicians which may include a primary care physician, internist, vascular (blood vessel) surgeon, or hematologist (blood disease specialist).

Treatment may include:

  • Medication. A blood-thinning medication is usually prescribed to help prevent additional clots from forming.
  • Compression stockings. Wearing fitted hosiery decreases pain and swelling.
  • Surgery. A surgical procedure performed by a vascular specialist may be required. 

Complications of DVT
An early and extremely serious complication of DVT is a pulmonary embolism. A pulmonary embolism develops if the clot breaks loose and travels to the lung. Symptoms of a pulmonary embolism include:

  • Shortness of breath
  • Chest pain
  • Coughing up blood
  • A feeling of impending doom 

A long-term consequence of DVT is damage to the vein from the clot. This damage often results in persistent swelling, pain and discoloration of the leg.

Preventative Measures
For those who have risk factors for DVT, these strategies may reduce the likelihood of developing a blood clot:

  • Take blood-thinning medication, if prescribed.
  • Reduce risk factors that can be changed. For example, stop smoking and lose excess weight.
  • During periods of prolonged immobility, such as on long trips.
    • Exercise legs every 2 to 3 hours to get the blood flowing back to the heart. Walk up and down the aisle of a plane or train, rotate ankles while sitting, and take regular breaks on road trips.
    • Stay hydrated by drinking plenty of fluids; avoid alcohol and caffeine.
    • Consider wearing compression stockings.

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