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Don't Have a Stroke: How to Prevent this Disabling Event from Happening to You.

Most people have seen the damaging effects of stroke — droopy facial muscles, muscular spasms, difficulty walking, speech and language problems, and challenges eating and swallowing.


Your Local Health | Written by BJ Towe
Stroke

Most people have seen the damaging effects of stroke — droopy facial muscles, muscular spasms, difficulty walking, speech and language problems, and challenges eating and swallowing.

There can also be unseen issues, such as with memory, cognitive abilities, vision, bladder control, and emotions. And stroke can take its toll on family members and friends in terms of time, emotional wear and tear, and financial stress. In the United States, the cost of stroke is over $36.5 billion annually, which translates into approximately $140,000 to $300,000 per person.  And that doesn't include loss of wages.

Stroke occurs when the flow of oxygen-rich blood to the brain is interrupted  — usually by a blood clot or a piece of plaque in the brain or neck — causing brain cells that control parts of the body to begin to die. Permanent brain damage, long-term physical disability, or even death can occur within minutes.

Fortunately, approximately 80 percent of all strokes can be prevented. All it takes is knowing your risk factors and how to manage them.

Are You at Risk?

Although stroke can occur in anyone, the National Institutes of Health reports that a variety of traits, habits, and medical conditions increases the risk of having a stroke or transient ischemic attack, or TIA. (A TIA is a short-lived stroke that doesn't result in brain damage but is a major predictor for future stroke.)

Risk factors you cannot control are:

  • Age. Beginning around age 50, your risk increases as you age.
  • Gender. Before age 75, men are at greater risk than women. After age 75, women are at greater risk.
  • Race and ethnicity. Risk is higher if you are an African American, Alaska Native, or American Indian adult than if you are Caucasian, Hispanic, or Asian American.
  • Personal or family history. Risk increases about 30 percent if you have a parent who had a stroke.

Douglas Massop, M.D., a Vascular Surgeon with The Iowa Clinic, says, “Stroke risk also increases when certain genetic factors or lifestyle behaviors are present.

“For example, the use of any kind of tobacco, high cholesterol, high blood pressure, being overweight, excessive use of alcohol, an unhealthy diet, and lack of exercise are all factors that increase stroke risk. However, these generally can be managed either through lifestyle changes or with medication,” he says.

“I cannot emphasize enough how important it is for people to quit smoking and improve their diet,” Massop adds. “If you smoke, you are twice as likely to have a stroke as a nonsmoker. A poor diet — one that's high in saturated fat, salt, and/or alcohol, and that lacks adequate fruit, vegetables, and whole grains — is also a major risk factor.”

To calculate your personal risk for stroke, use the National Stroke Association's online risk calculator at www.stroke.org (look for “Risk Factors” under the Prevention tab) or make an appointment for a stroke risk assessment with a primary care physician at The Iowa Clinic.

Predictors of Stroke: The Big 4

Dr. Massop says four medical conditions are particularly alarming in raising stroke risk. However, knowing whether you have one of these conditions and, if you do, taking steps to manage it will significantly lessen the odds that you'll have a stroke.

1. High Blood Pressure (Hypertension)

Uncontrolled high blood pressure increases a person's stroke risk by four to six times.

“Hypertension has earned the name 'the silent killer' because most people can't feel when their blood pressure is elevated. But this doesn't mean it isn't causing you harm,” says Sarah Tallman, D.O., an Internal Medicine physician with The Iowa Clinic.

“Over time, consistently elevated blood pressure causes premature aging of blood vessels, also called atherosclerosis and hardening of the large arteries, which can lead to stroke,” she says.

If you don't know your blood pressure, get it checked regularly at your doctor's office. In between doctor's visits, monitor your blood pressure using a self-serve blood pressure station, available at many pharmacies. If your blood pressure stays at or above 140/90 mmHg over time (or 130/80 mmHg for individuals with diabetes), discuss it with your physician right away.

“If your doctor recommends you take blood pressure medication, make sure you are diligent in taking these medications consistently and as prescribed,” Tallman adds.

2. Heart Disease-Especially Atrial Fibrillation (A-FIB)

Although a number of heart conditions can raise an individual's risk of stroke, David Lemon, M.D., David Lemon with The Iowa Clinic, says, “Atrial fibrillation is the biggest concern we have these days.”

A-fib causes a fast, irregular heart rhythm that can lead to the formation of blood clots. These can ultimately travel from the heart to the neck or brain and cause stroke.

“Atrial fibrillation is now present in the majority of stroke cases that are caused by heart disease. A recent report indicated that 10 percent of people over the age of 80 have A-fib — often without knowing it,” says Dr. Lemon. “This is one reason having an annual physical exam really is a good idea.”

When A-fib is present in individuals younger than age 70, in the U.S. the three biggest causes are high blood pressure, too much alcohol, and sleep apnea. Lemon says, “These are all very treatable, so we rule those out before moving to other forms of A-fib treatment, which can be invasive and expensive.”

Treatments for A-fib include:

  • Medication. Traditionally, warfarin (Coumadin®) has been prescribed to prevent blood clots from forming. Individuals who have been prescribed warfarin are closely monitored by their physician until the optimum dosage is achieved, and they are regularly checked after that.

“There are several new medications that also work well but have some drawbacks. These drugs don't require frequent doctor visits to monitor heart rhythm, as warfarin does, but there is no antidote if you have a bleeding incident while on the drug. With warfarin, we have an antidote,” Lemon says. Additionally, the new blood-clotting drugs are expensive.

  • Medical procedures. There are a number of minimally invasive and surgical procedures that doctors may use if medicine alone isn't enough to regulate heart rhythm.

3. Carotid Artery Disease

The internal and external carotid arteries on each side of the neck carry oxygen-rich blood to the brain, face, scalp, and neck. When a complex substance (called atherosclerotic plaque) begins to build up in the arteries, arteries narrow, blood clots form, and pieces of the clot and/or plaque can break off and the risk of stroke rises sharply.

Beginning at age 50, “Your primary care or vascular physician should routinely listen to your carotid arteries with a stethoscope. If they hear a whooshing (bruit) sound, it may indicate reduced blood flow caused by narrowing of those arteries. At that point, an additional, limited ultrasound screening test is needed,” Dr. Massop says.

Ultrasound screening is quick, easy, inexpensive, and can save your life. Call The Iowa Clinic Cardiovascular Services at 515-875-9090 to schedule your appointment. If a narrowing of a carotid artery is detected, one of two treatments may be necessary to restore blood flow to the brain:

  • Surgical carotid endarterectomy — the “gold standard” for preventing carotid embolic stroke. This surgical procedure is for individuals whose carotid arteries are blocked more than 50 percent with symptoms or more than 80 percent without symptoms. Patients are typically in the hospital only 24 hours and go home with a fairly quick and easy recovery.
  • Carotid artery angioplasty and stenting (balloon widening of the artery) — This treatment doesn't require surgical incisions and is usually performed using a local anesthetic. A vascular surgeon threads a thin tube with a deflated balloon on its end through a blood vessel in the neck. Inside the narrowed or blocked artery, the balloon is inflated to widen the artery and a stent (a small mesh tube) is inserted to keep the artery open.

4. Diabetes

“Although diabetes is primarily a blood sugar issue, it is closely tied to vascular disease,” says Dr.  Tallman. In fact, the American Diabetes Association reports that an individual with diabetes has two to four times the risk of having a stroke than an individual who doesn't have diabetes.

“When blood sugars are consistently elevated, this is incredibly damaging to blood vessels throughout the body and causes plaque to develop within blood vessels. This puts diabetic patients at risk of heart attacks and strokes at early ages,” she says.

Individuals with diabetes can lower their stroke risk by maintaining healthy blood sugar, blood pressure, and cholesterol levels by rigorously following their physician's recommendations for diet, exercise, and any medications.

“The great news is we have a lot of tools at our disposal to treat diabetes. Your physician can help you know which treatments are right for you,” Tallman says.

“You will never go wrong by exercising regularly, staying free of tobacco products, and keeping alcohol use in moderation,” she adds. “Your lifestyle choices can play a major role in reducing your risk — this means you have a lot of power to prevent strokes.”

Act Now to Reduce your Risk

“There are several early things you can do to reduce your risk. These include not smoking, maintaining a healthy diet and weight, controlling your blood pressure, exercising regularly, and avoiding excessive use of alcohol,” says Dr. Massop.

“If you know you are at risk for stroke due to any of the above factors, you should probably take an aspirin a day,” he advises. “It is very important to establish a relationship with a primary care provider who can evaluate and treat your risks.”

Determine your Risk

Complete the online assessment at www.stroke.org.

(Under the Prevention tab, click on “Risk Factors” and then scroll to the bottom of that page).

If you believe you are at risk, get a comprehensive medical assessment by calling  515-875-9000 and making an appointment with a primary care physician at The Iowa Clinic.

Post-Stroke Surgery & Lifestyle Changes Restore Health

As the rest of the world was lamenting over Y2K glitches that threatened to stifle computers and strand elevators, a blocked carotid artery was about to turn Shirley Gillman's world upside down.

The year 2000 brought lots of changes for native Iowan Shirley Gillman, who at the time was a nurse living out-of-state. She had surgery in Illinois to correct a blocked left carotid artery, but something went wrong: Just hours after her surgery, she developed blockage in the brain on the side of the surgery, which caused a stroke and rendered Shirley's dominant right arm virtually useless.

Now retired, Gillman says, “I was lucky; my legs were not affected. Still, the aftermath was pretty crucial. After a stroke, you have to be aggressive with rehabilitation. I started occupational therapy two weeks after surgery and was determined that I would get back to work.”

Relearning everyday tasks proved very difficult. Gillman worked hard just to hold a pen, tie her shoe, and brush her teeth. “I don't think we realize how much we use parts of our body until we can't use them,” she says. Like most stroke victims, she also suffered a period of depression.

Plaque Builds Up — Again

Gillman returned to Iowa later that same year. Two years later and when Gillman was mostly rehabilitated, her primary care provider, David Nordstrom, M.D., ordered preventive follow-up tests, which showed plaque had again built up in her left carotid artery, causing an 80 percent blockage.

“That's when I was referred to Dr. Massop,” she says. Using the less invasive technique of carotid angioplasty and stenting (a balloon procedure), “he put a stent in the left artery to prevent it from causing another stroke and said we needed to watch the artery on the right side. Five years later, he put a stent in that artery, too.”

Seven years have passed since that second stent procedure and Gillman's carotid arteries have remained clear without blockage or risk. That recently prompted Dr. Massop to decrease the frequency of her rechecks from annual to biannual.

Gillman Takes Active Role in Reducing Future Risk

“It's a wake up call when you find out that the artery you just had operated on is trying to close itself again,” says Gillman, who quickly acted to change some unhealthy behaviors.

“I stopped smoking cold turkey. I lost 50 pounds and I do try to eat healthy. My blood pressure is now extremely well managed and I'm diligent with my medicines,” she says. “There are a lot of people who don't want to give up their bad habits. That's like rolling the dice. They don't think stroke can happen to them, but it can.

“For a person at risk for stroke, (lifestyle changes) are important things to do. But you can't do it for another person; they have to want to do it for themselves,” she adds.

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