What You Know About Strokes May Save Your Life

By Jan Howard

A stroke, or cerebral vascular accident, is the third leading cause of death in the United States. It is also the leading cause of severe, long-term disabilities.

People over 55 years old have more chance of having a stroke, and the risk gets greater with age.

The good news is that 3.8 million people who have had strokes are alive today. But it’s important to know the warning signs and to know what steps to take now to prevent stroke. Even small changes toward a healthy lifestyle can make a difference.

Susan Law, RN, MSN, a geriatric case manager at St Vincent’s Hospital in Bridgeport, discussed “The Anatomy of a Stroke” November 6 at St Rose School, sponsored by the Parish Nurse Ministry. She was joined by personnel from St Vincent’s Medical Center Acute Rehab Unit, who discussed the function of the Rehab Unit and speech, physical, and occupational therapies.

“Stroke management is truly a team effort,” Ms Law said, noting the need for coordination between doctors and therapists. “Everyone has their own expertise.”

 A stroke is a sudden onset of an interruption of blood flow to part of the brain. It happens when a blood vessel gets clogged or bursts. Then that part of the brain can’t work, and neither can the part of the body it controls. The stroke can range from mild to severe. In any case it is a traumatic event and can be life threatening.

A person who suffers a stroke may experience some or all of the following signs:

Feeling suddenly numb or weak in an arm, hand, or leg, and lack of movement, usually on one side;

Unable to feel one side of the face or body;

Suddenly unable to see out of one eye;

Have a difficult time talking;

Unable to understand what someone is saying;

Feel dizzy or lose balance; or

Sudden or intense headache.

TIA (ransient ischemic attack) is a warning stroke that can happen before a major stroke. The signs are the same as a stroke, but usually last only a few minutes. They come and go.

“You get symptoms, then it goes away,” Ms Law said. “People feel they’re okay. This is a warning signal. Your doctor needs to get you on medication.”

Twenty percent of strokes are hemorrhagic, involving bleeding in the brain; 80 percent are ischemic, or caused by a blockage, with blood flow interrupted because of a narrowing of the artery or from a clot.

Uncontrolled high blood pressure, smoking, and heart disease are major causes of stroke.

Modifiable Risk Factors

There are risk factors that can be controlled or changed, Ms Law said, including the following:

Don’t smoke. The American Heart Association has named cigarette smoking as the most dangerous of the modifiable risk factors. It is the major cause of heart and blood vessel disease.

Eat a low-fat, low-salt diet. Eat fish or poultry more than red meat, consuming not more than six ounces a day. Serve more white meat from poultry than dark meat. Use skim milk and skim milk products. Remove all fat from meat and skin from chicken before cooking. Consume no more than three egg yolks per week. Cook with liquid vegetable oils and use more polyunsaturated margarines, such as safflower, cottonseed, corn, and soybean.

Take off extra weight. Being overweight is harder on the heart and raises blood pressure.

Avoid excessive use of alcohol. Limit yourself to one drink a day.

Blood Pressure. Know what your blood pressure numbers are, Ms Law said. Blood pressure should be no more than 140/90. High blood pressure means the pressure in your arteries is consistently above the normal range.

 “If you have heart disease, follow the directions of your physician,” Ms Law said. “Take your medicine, and ask your doctor why you need to take it.” Exercise is important. Look into a hospital that has a cardiac program. Rehabilitation is an important part of controlling heart disease.

One in four adults has high blood pressure, and many don’t know they have it because it usually doesn’t have any signs.

Know the numbers for HDL (high density lipoprotein), the good cholesterol; LDL (low density lipoprotein), the bad cholesterol; and triglycerides. High levels of blood triglycerides are often found in people who have high cholesterol levels and heart problems. Cholesterol should be 200 or lower. HDL carries harmful cholesterol away from the arteries and helps protect you from heart attack.

Cholesterol is a substance manufactured by the body, but is also found in egg yolks, organ meats, shrimps, oysters, fatty red meats, lard, butter, and whole milk dairy products.

“Look at your diet,” Ms Law said. Also, she added, “There are wonderful medicines for keeping cholesterol down. They help lower the numbers.”

Contributing factors for risk of stroke are obesity, lack of exercise, and diabetes.

Weighing more than 30 percent over ideal weight can double risk for developing heart disease. Check with your doctor or dietitian regarding how many calories you need a day. Have the dietitian instruct you on a proper diet. Set realistic goals, and once you have achieved the goal, continue the new eating habits.

The heart is a muscle and benefits from regular exercise like all other muscles in the body. Regular exercise of an aerobic type that increases heart rate and breathing can reduce the risk for heart disease. It increases the heart’s functional capacity, lowers the oxygen requirements of the heart, increases the tone of other muscles, and stimulates circulation.

If you have diabetes, control it, Ms Law said. “It is a chronic illness that can be controlled. If it’s not, over time it will damage blood vessels.”

Risk Factors That Can’t Be Changed

Risk factors that are unable to be modified include heredity, gender, and age.

Family history plays an important part. If two immediate family members have had a heart attack before age 55, the risk of developing heart disease is five to ten times greater than in a family with no history. Heredity also influences several risk factors.

Men and women can both develop heart and blood vessel disease. However, estrogen delays the onset of disease in most women by about ten years. One in nine women between the ages of 45 and 64 has some form of heart disease or stroke. The ratio soars to one in three at age 65 and beyond.

One in six men aged 45 to 64 has some form of heart or blood vessel disease. In men 65 and older the ratio decreases to one in eight.

Diagnostic Tests And Treatment

If you are experiencing any signs of stroke, call 911 for an ambulance or have someone drive you to the emergency room of the nearest hospital. Time is of the essence, Ms Law said.

“Meds have to be taken within three hours,” she said. “Get to the hospital as soon as you can.”

A doctor will order tests to find the cause of the stroke, Ms Law said.

These might include a CAT scan to detect bleeding in the brain, a carotid ultrasound to see if there is a blockage, and an echocardiogram to look at the valves of the heart.

Treatment could include drugs that prevent new blood clots from forming, surgery to remove clots and/or cholesterol buildup, treatment to help breathing and blood circulation, and rehabilitation.

“Stroke is a serious thing,” Ms Law said. However, because of advances in medicines and the expertise of therapists, she noted, “It is remarkable what people can do.”