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Recognizing A Stroke - And Getting Help

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Recognizing A Stroke – And Getting Help

Recognizing A Stroke - And Getting Help

September 28, 2006

By: Jean Johnson for Veins1

An estimated 700,000 strokes occur in the United States every year. While 500,000 of these are new strokes, 200,000 occur in people who have already been stricken once. Further, stroke is the third leading cause of death in the United States.

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The Centers for Disease Control offer 10 tips on preventing strokes:

1. Prevent and control high blood pressure by working with your physician on appropriate medications and making lifestyle changes that will influence weight and activity levels.

2. Prevent and control diabetes by staying active and controlling eating.

3. No tobacco. “Not smoking is one of the best things a person can do to lower their risk of high blood pressure.”

4. Treat atrial fibrillation – irregular heart beat – by working with a physician. The physician will also most likely prescribe medicines to reduce the chance of clotting.

5. Prevent and control high blood cholesterol. “All adults should have their cholesterol checked once every five years.”

6. Moderate alcohol use – excessive use elevates blood pressure.

7. Maintain a healthy weight.

8. Engage in regular physical activity for at least 30 minutes on most days of the week.

9. Cultivate a high-quality diet high in fresh vegetables and fruits, low in salt and saturated fats.

10. Know your genetic risk factors. If others in your family have had high blood pressure, diabetes and vascular conditions, alert your physician. Also know that family habits related to activity and eating may be precursors for stroke.

There has been an e-mail circulating through cyberspace telling of a woman’s death from stroke. The account goes that the woman tripped on a brick and fell at a backyard barbecue, but she passed the fall off on her new shoes. Although she appeared shaken, the story continues, once her husband and friends got her situated with a new plate of food, she settled down and seemed to enjoy herself. It was only later after the couple returned to their home that she became so gravely ill her husband rushed her to the hospital, where she passed away.

The gist of the account is that if her friends and family had been more assertive and insisted on putting the woman through a few brief checks that anyone can remember, they might have saved her life.

Indeed, the e-mail goes on to imprint into the minds of readers the first three letters of the word stroke: STR. Then it translates the acronym: Smile, Talk and Raise both arms. If someone can do this successfully, the message implies, then they probably have not had a stroke and there is no real medical emergency as far as brain function goes.

Part of what is at issue for survival is that people experiencing a stroke need to reach a hospital quickly. Procedures developed over the last 10 years can dramatically lessen the impact of blood clots on the brain. To benefit from intravenous therapies, intra-arterial therapies and anti-clotting drugs, however, patients must access care as quickly as possible, preferably in the first hour or two. And once the immediate six-hour window has passed, there is little medical teams can do to prevent the effects of stroke from becoming permanent. In other words – to prevent the part of the brain that was cut off from its blood supply from deteriorating.

There is a good reason why even the word “stroke” makes people knit their brows together and hunch in fear. Few other medical conditions are as debilitating. Paralysis, memory loss, balance problems that can lead to post-stroke falls, speech and vision impairments can bring an abrupt end to independent living. Worse, stroke patients can linger for years, often in nursing homes because the level of care they need is beyond what most families can manage. Then again, a stroke can also bring immediate death as in the case of the woman who was the subject of the mass e-mail.

While at essence the STR approach seems to be advice that won’t lead well-meaning people too far astray, we went to the National Institute of Neurological Disorders and Stroke (NINDS) to compare and contrast what experts have to say.

We found that the NINDS approaches things somewhat differently. Clearly, if there’s a single take-home message from these specialists in neurology and stroke it’s the word “sudden.” More specifically, the NINDS wants people to remember to watch for the following things:
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

Clearly the STR – Smile, Talk, Raise both arms – is a relatively unobtrusive way of evaluating facial and arm weakness, as well as speech. NINDS, though, wants to keep the focus on “Sudden” and expand the lens to include disconnects in other parts of the body – particularly in the eyes and the legs. Finally, experts point to that sudden headache that looms up from out of the blue and overtakes a person.

NINDS also underscores that time is critical, so much so that it puts its warnings in terms of: “Every second counts,” and “Time lost is brain lost.”

Further, NINDS best advice is that if there is any doubt, call 911 for trained emergency help. That is a suggestion that we at Veins1 would like to underscore.

The Internet is a wonderful tool for the spread of consumer health knowledge, and readers of reputable Web sites like this one can find information that enables them to have educated conversations with their healthcare providers.

It’s also true that people can consult consumer health sites for material useful in responding to emergencies. It would be a mistake, however, to rely too heavily on knowledge developed by Internet surfing, particularly when it comes to strokes. Indeed, “a little knowledge can be a dangerous thing,” is a truism that comes to mind. Thus, if there is even the slightest indication that someone might be having a stroke, the NINDS suggests calling for trained help immediately.

The Centers for Disease Control (CDC) lists the following risk factors for stroke:

High Blood Pressure: Sixty million Americans have hypertension or high blood pressure. This condition is sometimes called the silent disease since it is often marked by no symptoms whatsoever.

Heart Disease: Coronary heart disease in which the arteries that supply blood to the heart muscle become hardened and narrowed from plaque buildup. This predisposes someone to stroke. Clots forming in the compromised coronary arteries can break loose and lodge in the arteries of the brain, causing a stroke. Atrial fibrillation in the heart also predisposes people to strokes because the associated sluggish blood flood is prone to clotting.

Additional conditions and behaviors that the CDC lists as associated with strokes include: Diabetes, tobacco use, high cholesterol, and excessive alcohol use.

To some degree, stroke is also associated with age, ethnicity and geographical parameters. While the CDC states that “nearly three quarters of all strokes occur in people over the age of 65,” and that “the risk of having a stroke more than doubles each decade after the age of 55…. Strokes can – and do – occur at ANY age. Nearly one quarter of strokes occur in people under 65.”

The CDC further states that African Americans have higher death rates from stroke than whites, “even at younger ages.” Finally researchers at the CDC point to the southeastern part of the United States as the area that has the “highest stroke mortality in the country.” That said, the CDC notes that “it is not completely clear what factors might contribute to the higher incidence and mortality from stroke in this region.”

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