Tag Archives: stroke

Stroke

In this post I’ll be talking about Strokes (also known as Cerebral Vascular accidents). It is the fifth leading cause of death in the United States.  It also is a major cause of disability and in terms of treatment, missed work, etc costs an estimated $34 billion dollars a year in the U.S. alone. Although the risk for stroke rises as we age, according to the CDC website 34% of strokes were in people younger than 65.

There are two kinds of stroke. One is hemorrhagic, meaning that is caused by bleeding. The other is ischemic, meaning that it is caused by a a blockage in a blood vessel. The symptoms, however are determined by the location and size of the stroke. Symptoms include: Facial Droop, double vision, confusion, garbled speech, limb weakness (especially if it occurs on one side of the body), numbness, and headaches.

It is important that if one suspects he or she is having a stroke that medical care be obtained quickly. There is a 3 hour window of opportunity from the start of symptoms that ischemic strokes can optimally be treated with clot dissolving medications. More than three hours after the start of symptom and the likely hood of poor outcomes increases – and the riskier it is to use medications to try and unblock arteries.

An acronym used to keep in mind regarding stroke is the word FAST (Face – is the face symmetrical: is one side drooping? Arms – weakness in one arm. Speech – is it normal? Time – call 911 immediately if it seems someone’s having a stroke).

Ischemic strokes are the most common. Based on symptoms one can’t tell if a stroke is ischemic or hemorrhagic, so it’s better to get to a hospital quickly. At this point in time there may be fewer acute treatments to stop hemorrhagic strokes, but even then supportive treatment is available.

Sometimes symptoms resolve quickly (within a few minutes). This is called a Transient Ischemic Attack, or TIA. This should not be ignored because people who have had a TIA are at increased for having a major/bigger stroke.

Although there isn’t anything that can be done about some risk factors such as age, there are many things one can do to reduce the risk of having a stroke:

1) Control your blood pressure if you have high blood pressure.

2) Lower your cholesterol if you have high cholesterol.

3) Control your diabetes if you are diabetic.

4) If you smoke, stop. If you don’t smoke, don’t ever start.

5) if you have an irregular heart rate, talk to your doctor about whether you need to be on blood thinners as certain irregular heart rhythms increase your risk of ischemic strokes.

6) Exercise (this will help with numbers 1-3 above)

An aspirin a day….

For this post I thought I would write about staying healthy, but in a slightly different manner than I’ve done in previous blogs. In older blogs I’ve written about screening, vaccinations, etc.  In this one I thought I’d talk about using a medication to stay healthy, and in this case talk about aspirin.

Aspirin has been around for more than 100 years, and perhaps is a bit under appreciated since it is an over the counter medication (meaning one can buy it without a prescription). It is also something that is derived from a natural product. Willow bark had been used to treat fevers  and it was eventually found that salicylic acid was the active ingredient. Salicylic acid was then derived from this. I won’t go into the chemistry of this (I figure if you’re a bit of science nerd like I am you probably already know, and if not I don’t want to bore you).

Most people probably think of it as a pain killer or a headache medication.  It is much more than that. Aspirin plays an important role in treatment of patients who’ve had heart attacks – it helps treatment and also helps decrease the death rate from heart attacks. It is used in primary prevention heart disease as well. In the past high dose aspirin was used in the treatment of Rheumatoid Arthritis. It’s use in this latter population (at least for treatment of Rheumatoid Arthritis) has been eclipsed by other medications. However it still should be used to treat/prevent heart disease in this group of patients.

Use of aspirin in ischemic stroke patients is advised as well.

Though less studied at this point, aspirin use to prevent recurrent deep venous thrombosis, is a consideration (this is after someone has been treated with coumadin for an acceptable length of time).   A link to a review on this subject can be found here: http://www.ncbi.nlm.nih.gov/pubmed/24745726

There is some evidence linking aspirin intake to a decreased chance of developing colon cancer. At the moment there is not enough evidence to routinely suggest people take aspirin solely to prevent colon cancer. There is also some evidence that it only helps prevent colon cancer in certain groups of people – those that have a particular form of a particular gene. The only recommendation is for aspirin to help reduce the risk of heart disease.

Aspirin, like any other medication, has its downside as well. It can cause stomach ulcers. If the ulcers are large enough they can cause a lot of bleeding. It should not be used in children, except in rare circumstances and even then only then under the guidance of a pediatrician or other health care provider who provides a lot of treatment to children (EG pediatric rheumatologists, family practice physicians, etc).