Stroke: Causes and prevention

What is stroke?

Stroke is one of the most feared medical problems in the United States, affecting 895,000 people in the year 2007.

Stroke is also known as cerebrovascular accident (CVA), and is defined as a sudden loss of neurologic function. TIA (transient ischemic attack) is a CVA that resolves entirely in less than 24 hours, although most generally last less than one hour. The emotional impact of these diseases is devastating, and the financial cost is in the billions per year. In this article, I will address the mechanism, cause, treatment, and prevention of CVA and TIA.

There are two distinct types of stroke, called ischemic and hemorrhagic stroke. Ischemic stroke, which accounts for approximately 80 percent of all events, occurs when an artery in the brain is blocked by a blood clot. The clot may come from elsewhere in the body (the heart, neck or other source distant from the brain), or occur in the brain itself, when a clot forms right at the site of the stroke. The second type, known as hemorrhagic stroke, occurs when there is bleeding within the brain. The pressure caused by this bleeding prevents blood from getting to the rest of the brain, with devastating results. Fortunately, hemorrhagic stroke is less common than ischemic, representing approximately 20 percent of all CVAs. In this article, I will be discussing ischemic attacks only, as it is the most common type, and also the most preventable.

Causes of stroke: In many cases of stroke, the exact cause cannot be determined. However, many of the factors that increase the risk of stroke can be addressed. Smoking, high blood pressure, high cholesterol, and sedentary or inactive lifestyle are factors that all of us can address. A family history of CVA or TIA is important, but should not be a cause for pessimism. Working to reduce the risk of stroke is well worth the effort, and is shown to have great benefit.

Signs of stroke: Every person should know the signs of a CVA, and be ready to act when they occur. Weakness or frank paralysis of one side of the body, from the face to the toes, is clearly suggestive of CVA. Slurred speech, mental confusion, abrupt inability to keep one’s balance, and sudden loss of consciousness should warn family members and friends that a stroke may be in progress. Less common symptoms of CVA are isolated weakness of the face, arm, or leg, sudden blindness in one side of the visual field, difficulty swallowing, and simple difficulty in expressing oneself.

It should be made clear, however, that a stroke can only be diagnosed by trained medical personnel, who should be called immediately if a stroke seems to be happening. EMTs in Archuleta County are highly trained and extremely skilled in assessing a person with these symptoms, and deciding where the patient should go to receive treatment. Time is extremely important in the treatment of stroke. The sooner a patient can be seen by medical personnel, the better his or her chance of recovering from the event. Minutes can make a critical difference in whether a patient survives a stroke, and whether the outcome is full recovery, lifelong infirmity, or even death.

What happens in a stroke: Once medical personnel are on the scene, critical decisions must be made quickly. The patient may be flown directly to a stroke center, where a team of specially trained staff quickly work to accurately diagnose and treat the problem. Similarly to heart problems, these centers consider a stroke to be a “brain attack”, and use many of the same strategies used in heart disease to address the problem. The nearest centers are located in Denver, Albuquerque and Grand Junction, and usually mean a helicopter flight to save precious time. The patient may also be taken directly to Durango or Farmington, depending on the time elapsed, severity of symptoms, and multiple other factors. The best treatment also may be transport to Pagosa Mountain Hospital, where initial evaluation, including CT scan of the head, laboratory testing, and careful examination may determine the best course of action. There is no cookbook solution to the problem, so judgment by EMS personnel, virtually always in consultation with doctors by radio or telephone, is crucial. Factors such as weather and availability of air transport may also factor into the decision.

The treatment of stroke depends on the type of stroke, age, medical condition, and time elapsed since the start of symptoms. Aspirin is virtually always used in ischemic stroke to prevent further damage to the brain. Drugs that break down clots are being used in highly specialized units, for patients who fit specific requirements. Attention to blood pressure, respiratory function, fever, blood sugar, and cardiac function, are critical. Prevention of further clot formation using intravenous blood thinners is mandatory if the stroke has been proven to be ischemic. Early use of physical therapy, occupational therapy, and speech therapy is important in recovery and prevention of complications.

What to expect: The prognosis, or expected outcome, of a CVA varies from full recovery to loss of life. This again determined by age, severity of the stroke initially, and how rapidly the patient improves on his own. Unless a significant amount of time has passed since the onset of symptoms, virtually all patients should be hospitalized at least for observation. A TIA should not be considered a separate entity, but rather a herald of ischemic stroke and an opportunity to intervene.

Prevention of stroke: Stroke prevention is by far the most important information citizens need to have and act upon. Avoiding tobacco in any form is fundamental: the risk of stroke decreases dramatically and permanently if tobacco use is stopped. An active lifestyle, including regular and preferably daily exercise, also helps. Making sure medical problems, such as high blood pressure, diabetes, heart disease, and elevated cholesterol are addressed, also reduces the risk of stroke.

Alcohol consumption also affects stroke risk. Persons who consume one to two drinks per day are at lower than average risk, whereas those who consume five or more drinks a day have increased risk. The type of alcohol consumed is not important: a 12-ounce bottle of beer is the same to the brain as a 4-ounce glass of wine or 1 1/2 ounces of 86 proof spirits.

If you would like further information on stroke, or have questions on this topic, there will be a presentation at the Senior Center at 12:30 p.m. Wednesday, Oct. 15. All are welcome, and questions are encouraged.

(Article provided by Dr. Robert Bricca.)

Senior special events

Oktoberfest. Want to do the polka or do the Chicken Dance? Listen to some great German music while enjoying tasty German food?

Want to enjoy the fun of a silent auction or have some terrific beer?

If so, it’s a must that you buy a ticket and come enjoy the festivities at Pagosa’s annual Oktoberfest Saturday, Oct. 11, from 4:30—8:30 p.m. at the community center. Tickets can be purchased at the Chamber of Commerce, the community center or the Plaid Pony. Cost of the tickets are: Family Ticket — family of four for $40 pre-event and $45 at the door; Adult Ticket — $20 pre-event and $25 at the door. Kid Ticket — under 12 , $5, and under the age of 5, free. Archuleta Seniors, Inc. Member Ticket — $12 pre-event, $15 at the door.

This is the biggest fund-raiser event of the year for Seniors, Inc. so help support a great cause and have some fun doing it.

Cooking for one or two. On Friday, Oct. 10, lunch will include a short nutrition presentation by our dietician, Mikel Love. She will bring lots of information about cooking healthy and nutritious food for one or two people. She will also cover some great tips on how to save money on your food budget.

After lunch, everyone is welcome to join Mikel for a cooking demonstration/class. We will cook up some good food, talk about minimizing food waste, and review some tips for cooking meals in small quantities. Space is limited.

Chair massage. The benefits of a 15-minute chair massage can reduce stress and anxiety levels, minimize neck and shoulder pain, relieve headaches, increase energy, enhance creative thinking and problem solving skills, and boost immunity. Rebecca Cortez and Silverhawk, licensed massage therapists will be offering free chair massage on Oct. 14 the Den at 10 a.m. Reserve your massage today.

Porcelain doll collection tour. Margaret Rouke has been making porcelain dolls since 1993 when she retired as a dietician. She has amassed an amazing collection. Each doll is made from a mould and hand painted, with clothing designed for that doll. The tour is Tuesday, Oct. 14, at 9:30 a.m. The cost is $1. Deadline to sign up is Oct. 13.

Free movie and popcorn

“Secondhand Lion,” a tender comedy starring Robert Duvall and Haley Joel Osment, is a story about 14-year-old Walter who is placed on his great uncle’s farm in rural Texas, the last place on earth he wants to spend the summer. Matinee at 1 p.m. in the Den, Wednesday, Oct. 15

Pink Ribbon luncheon and celebration

Mothers, bring your daughters; sisters, bring your sis; and friends, invite friends to the Silver Foxes Den Pink Ribbon (Breast Cancer Survivors) luncheon celebration on Thursday, Oct. 16 at 12:30 p.m. in the Senior Cultural Center for Older Adults dining room.

Dr. Susan Smith, medical oncologist with Southwest Oncology in Durango, will be speaking about the latest medical information regarding breast cancer treatment and awareness. Reservations were required by Wednesday, October 8. Call 264-2167.

Medicare

The State Health Insurance Assistance Program through the State of Colorado Division of Insurance, or SHIP, helps beneficiaries identify and understand programs and plans, including Medicare prescription drug coverage, Medicare Advantage plans, Medicare supplemental insurance policies, Medicare Savings Programs, long-term care insurance and financing, and other public and private health insurance coverage options. SHIPs also assist eligible participants in enrolling in these programs and plans, all services are provided free of charge.

Open enrollment for Part D, prescription drug program begins Nov. 15.

All participants previously enrolled in a drug program are strongly encouraged to have their plan rescreened by meeting with a counselor to review plans as many plans do change each year. Make sure you get what’s best for you.

SHIPS-trained counselors, as well as Andy Fautheree from Veteran Services and a representative from the Department of Human Services, will host a presentation on Medicare and “What you need to know” on Thursday, Oct. 16, at 10 a.m. in the South Conference Room of the community center and again on Tuesday, Oct. 21, at 6:30 in the dining room of The Den located on the north end of the community center.

Menu

Suggested donation $3 for ages 60-plus and kids 12 and under, all others $5. Our meal program is partially funded through the Older Americans Act, United Way, Archuleta County, Town of Pagosa Springs and other contributions and grants. These funds help support the cost of the meal which is approximately $6. Menu subject to change. The salad bar opens at 11:30 a.m. with lunch served at noon.

Friday, Oct. 10 — Salisbury steak, masher and gravy, veggie medley, seasoned greens, fresh fruit, whole wheat bread.

Monday, Oct. 13 — Chicken and noodles, zucchini, apricot pineapple compote.

Tuesday, Oct. 14 — Enchilada pie, yellow squash, fresh fruit, salad.

Wednesday, Oct. 15 — Beef and sweet peppers, brown rice, orange spiced carrots, mixed fruit, wheat roll.

Thursday, Oct. 16 — Pink Ribbon Luncheon –Chicken Piccata, spaghetti, broccoli, mixed fruit, wheat roll.

Friday, Oct. 17 — Crunchy baked fish, whipped potatoes, mixed veggies, pineapple mandarin compote, whole wheat roll.