WORLD HEALTH
Every minute counts in strokes.
By Allan R. Handysides and Peter N. Landless
My 73-year-old wife has had a couple of ministrokes. Her doctor is concerned about the possibility of a major one. This has me worried, and I would like some advice. She has lost 30 pounds and now weighs 152 pounds.
You are quite right about a ministroke being worrisome. To have had more than one means there are definitely factors at work that require management. A ministroke is sometimes referred to as a transient ischemic attack (TIA), which means that there’s a temporary blockage of blood vessels to the brain. This is cleared away by the body’s mechanisms of repair. Usually a TIA will leave very slight residual damage, but accumulative incidents can result in serious impairment. The blockage is generally thought to be caused by a small blood clot, but a piece (or pieces) of atheromatous plaque that breaks off from an arterial wall could also be the culprit. Atheromatous plaque is associated with inflammation in the blood vessels. This tends to be widely distributed throughout the body. A person who has had an episode, or a TIA, should have an ultrasound of the carotid arteries to look for plaque.
Not only may TIAs be forerunners of a large stroke—they have been found to be associated with double the rate of heart attack (Journal of the American Heart Association, March 2011). It is very important for you to recognize the signs of both TIAs and stroke. The acronym FAST emphasizes the major features of a stroke and the need for immediate attention.
FAST means:
Face—impaired ability to smile.
Arms—weakness or paralysis.
Speech—slurred speech or lack of comprehension and confusion.
Time—is of the essence!
Your wife has probably been screened and should be on treatment to prevent further TIAs and even a heart attack. The main features are:
Exercise. This should be some 40 minutes every day. Walking is an excellent exercise, done at between three and four miles per hour and causing a light sweat.
Diet. Eliminate flesh—both red and white meats—and consume a diet abundant in whole grains, legumes, fruits, and vegetables. Nuts should be eaten daily—about one small handful—and two cups of low-fat dairy or dairy equivalent. This latter means the soy “milk” has to be fortified with vitamin B12, calcium, and vitamin D to make it equivalent to the dairy. If yogurt or cottage cheese is selected instead of milk, quantity is again important. Remember, soy milks may be high in both carbohydrates and fats. Do not use large quantities of fat, and avoid butter. Some oil is necessary, and—if available to you—evidence supports the use of olive oil, canola oil, sunflower oil, and corn oil, though it’s probably wise to use them alternatively and in moderation. Flaxseed oil is very rich in omega-3 fatty acids and is great on salads with lemon juice.
Your wife’s cholesterol needs to be watched. I would definitely suggest avoiding egg yolks. Reduction of salt is a useful measure for all. Cholesterol-reducing medications can play a very beneficial role. A low-dose aspirin (81 milligrams) daily may help prevent further small clots from forming. Rely on your trusted health-care provider to advise you.
Every minute counts in strokes, so learn the warning signs, put a list of telephone numbers by the phone (such as those of your doctor and local hospital or other emergency medical facility), know the location of your closest emergency medical facility, and make a list of the medications your wife takes and any allergies she may have and take that list with you to the hospital.
Then live positively. Pray daily. Avoid stressful confrontations. And place your life in God’s hands. He truly cares for us all.
Allan R. Handysides, a board-certified gynecologist,
is director of the General Conference Health Ministries Department.
Peter N. Landless, a board-certified nuclear cardiologist,
is an associate director of the General Conference Health Ministries Department.
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