Here we are, on the dreaded Monday after the Superbowl. With the sodium bloat from all of the chicken wings, pizza, various forms of cheese, chips and dip, and soda it’s amazing we were able to pry ourselves out of bed this morning! Today not only marks a day of nation-wide sick calls and diet shame, it also marks the start of the second week of American Heart Month! So on that note, we’d like to talk to you about sodium. The favorite word of anyone with heart disease or at risk of developing it! Or not so much…
This Friday, February 5th, people across the nation are asked to wear red to raise awareness of heart disease in women as part of the American Heart Association’s Go Red for Women campaign. Heart disease is the number one cause of death for both genders in the United States. However, heart attacks are often deadlier in women. This is partially caused by a delay in seeking treatment as a woman’s symptoms can be more subtle than those of men. Although chest pain is the most common symptom of heart attack for both men and women, women are more likely to report shortness of breath, back or jaw pain with nausea and vomiting, according to the American Heart Association (AHA). Heart disease is also a significant risk factor for stroke (the 3rd leading cause of death for women). Let’s kick start this month by raising both community awareness of heart disease and also personal awareness of your own risk for heart disease and stroke.
If you know the risk factors for stroke you’re ahead of the curve. Stroke and heart disease share many common risk factors such as obesity, physical inactivity, unhealthy diet, high blood pressure, high cholesterol, diabetes and smoking. Increasing age and family history are risk factors you can’t change, however, it is important to be mindful of the effect these have on your personal risk.
Small diet changes and increases in physical activity can lower your risk of heart disease by up to 80% according to the AHA. Follow a heart healthy diet rich in fruits and vegetables and low in salt (sodium). Make it a habit to check nutrition labels as processed foods such as canned products and frozen convenience foods are frequently packed with sodium. Making one change in your diet at a time will make it easier to stick with your healthy living goals. Be active throughout your day in addition to regular exercise. Walking is great exercise for beginners. Alternate your regular pace with short bursts of brisk walking to increase the cardiovascular benefits! Whatever you choose to do to be active, just get out there and do it today for a healthier tomorrow.
High blood pressure often has no symptoms, therefore checking blood pressure regularly is crucial. Blood pressure should be less than 120/80 for most people. Have your blood pressure checked at your doctor’s office or pharmacy and register for the Walk N Roll so we can check it again for you then! High blood pressure is the number one cause of stroke, so be sure you know where you run and how to control it.
Many think that all cholesterol is bad, however there are two types: HDL which is “good” cholesterol and LDL that is “bad”. Although LDL often get’s all the attention, HDL levels are important to monitor as well. HDL is thought to lower risk of heart disease by clearing the blood of an excess of LDL and also by keeping blood vessel walls clean. Levels of HDL for women drop as estrogen production decreases after menopause. Family history also plays a role in your cholesterol levels, so make sure you know what your numbers are. The recommendation is that cholesterol be checked every 5 years starting in your 20’s for both men and women. Keep your LDL below 100 mg/dL and your HDL above 60 mg/dL to protect against heart disease.
Diabetes and cigarette smoking also increase your risk of heart disease as well. Visit our education page for a helpful link to quit smoking and stay tuned for information about diabetes and heart disease later this month.
This month’s stroke support group was joined by guest speaker, Dr. Laura Risley. Dr. Risley is a Vascular Neurology Fellow at Albany Medical Center, meaning she has completed her residency in the field of Neurology, and has specialized in stroke for her last year of medical training. Dr. Risley graciously volunteered her time to come discuss stroke diagnosis and treatment as well as answer questions for stroke survivors and their families. We would like to highlight the main content of this information session in hopes that it may benefit those who were unable to attend.
The main message Dr. Risley wanted to convey was–in the event of any stroke symptom or concern, call 911 right away! Do NOT wait. If you think that you may be having a stroke, that is cause enough to seek treatment. EMS will start IVs and check blood pressure and heart rate/rhythm on the way to the hospital. These steps reduce the amount of time needed at the hospital to provide life saving treatment. Request to go to your nearest hospital that provides tPA to get the “drip and ship” process rolling. From there you can be transferred to a stroke center such as Albany Medical Center to receive further care. (We’ll discuss tPA in further detail later in this post).
Dr. Risley explained that the majority of strokes (87%) are ischemic strokes, or caused by a clot or restriction of blood flow causing loss of oxygen to brain tissue. These clots most frequently come from cholesterol plaques that build up in the carotid arteries (the large vessels in your neck). Over time these plaques become bumpy and small pieces break off and travel to vessels within the brain. Medications such as aspirin and plavix (clopidogrel) help to prevent sticky cells called platelets from clumping up around these plaques and restricting blood flow.
For some who have heart conditions such as atrial fibrillation (AFib) clots can form in the heart by a pooling of blood in the upper chambers when they fibrillate, or twitch, rather than pump effectively. This also happens with congestive heart failure (CHF) when the heart muscle is weakened and unable to pump thoroughly. Dr. Risley compared this to paint thickening, or congealing, in the roller tray after time. These conditions are treated with anticoagulants, or “blood thinners”, such as warfarin, pradaxa or xarelto. These medications prevent the thickening and clotting of the blood in order to prevent heart attack and stroke. Some individuals have both carotid artery disease and heart conditions such as AFib and CHF and may need to take both aspirin and an anticoagulant.
Anticoagulants decrease risk of a secondary stroke by 67%. Those that have a history of ischemic stroke should be on anticoagulation to prevent a recurrent stroke, although some people may have other medical conditions that make these medications too dangerous.
Tissue Plasminogen Activator (tPA) was a prime topic of discussion. TPA is a clot busting drug that can be given within a three hour window after the first signs of stroke begin. The brain is very sensitive to injury and as soon as these cells start to lose blood flow, symptoms begin to occur. Over a million brain cells die each minute of a stroke. Death of brain cells cannot be reversed, however the area of injury surrounding the dead cells can often be saved with tPA and/or surgical clot removal. Certain conditions can prevent an individual from receiving tPA. A history of bleeding on the brain, and recent history of heart attack or surgery are a few such conditions. Use of newer anticoagulants such as pradaxa or xarelto prevent treatment with tPA as the bleeding times can’t be monitored or reversed with these types of medications. Treatment with tPA in these cases would have too high a risk of uncontrolled bleeding. Warfarin, however, can be monitored by an INR. If the INR is low enough, the decision may be made to treat with tPA to stop the progression of brain cell death associated with stroke.
For those patients that are not eligible for tPA, surgical removal of the clot may be possible in some cases by threading a catheter from the large artery in the groin up to the artery within the brain where the clot is located. For a general idea of the Penumbra device used click here. For the general idea of the Solitaire device used click here. The time frame for this procedure is longer than that of tPA, previously up to 6-8 hours after first sign of stroke. More recently however, certain cases have had successful outcomes when performed past this time period.
Stroke can also be caused by a bleeding of blood vessels, primarily caused by high blood pressure. These hemorrhagic strokes often occur deeper within the brain and account for the other 13% of strokes. Treatment for these strokes is limited, and consist mainly of controlling blood pressure and allowing the body itself to stop the bleeding on its own. For patients on the anticoagulant warfarin, correcting increased bleeding times is important as well. In severe cases, where bleeding causes a large mass of pooled blood on the brain, a surgeon can remove the blood to reduce pressure and restore brain function.
Another important topic of discussion was the recovery period. Stroke recovery takes on average 9-12 months. Although recovery can extend past the one year mark in some cases, the return of function is mostly limited to this period. Although the original area of brain that was damaged by the stroke will never heal, different areas of the brain can take over, building new connections to accomplish the same task. Although these new connections are not as effective as the original ones, with consistent therapy some degree of function can be returned.
If you missed Monday’s meeting, we encourage you to keep an eye on our Facebook page as Dr. Risley has offered to return later this spring or summer for another question and answer session. The expertise she shared was truly invaluable to the group. We hope this summary is beneficial to you in your recovery.
Can Stress Raise Your Stroke Risk?
Watch this short clip for more information.
Stroke is a medical emergency. Certain therapies can help reverse the effects of a stroke if medical care is sought immediately. Learn the signs and symptoms of stroke today and you could save a life tomorrow. The life you save may be your own.