Health Diabetes is another risk factor for stroke, along with strict attention to the other lifestyle choices mentioned above; keeping one’s blood sugar under good control helps reduce this risk. Most diabetics will be on aspirin and a statin drug to keep their LDL cholesterol level within normal range. Weight and blood pressure control are essential for diabetic patients, not only to reduce the risk of stroke, but of other complications as well. Diet and exerciseare both important factors in avoiding stroke. Snowbirds not only have year-round ability tomaintain a daily exercise routine but also, depending on where they spend the winter, are usually able to have easy access to fresh fruits and vegetables known to improve their cardiovascular health. ese actions are known to help control weight, blood pressure and lipid levels, as well as helping to avoid a stroke. Atrial brillation and certain other heart conditions are associated with an increase in stroke risk. In brillation, small clots can develop in the atrium of the heart, become dislodged and travel to an artery, blocking blood supply to that part of the brain. Anyone feeling palpitation as a new symptom should be checked to facilitate early detection and treatment for this condition. ere may be speci c treatment indicated to reverse the brillation, or the patient will be prescribed an anticoagulant medication to help prevent the development of clots. Hormonessometimes prescribed for women of menopausal age were found to be associated with an increase in strokes and have largely been avoided in treating menopausal symptoms. Family historyandraceare other risk factors, along with age. ose with a strong family history and those who are of African descent have a higher risk and should be particularly vigilant in managing their health. Signs and symptoms of a stroke are commonly taught via the acronymF A S T. Face - is it drooping? Arms - can you raise both? Speech - is it slurred or jumbled? Time - to call 911 right away. If any sudden onset of such things is experienced or observed by others, time is of the essence…even if there is sign of recovery. e reason for this is that the sooner emergency drugs or procedures are instituted, the better the chances for partial or complete recovery. If the symptom is a sudden and severe headache, a cerebral bleed could be the cause. Even if the signs or symptoms disappear a er a minute or two, medical attention is urgent as this may be aTIA (transient ischemic attack) ormini stroke. is usually occurs when there is a temporary obstruction to cerebral blood ow, o en caused by a clot or embolism. is event may be associated with an increased risk of a full stroke and requires investigation and treatment. Patients with a suspected TIAwill undergo scans and certain other tests to identify abnormalities and, if the diagnosis is made, will be put on aspirin or other medication. Treatment for stroke has advanced signi cantly in the last few years. Some recent surgical techniques dramatically improve the outcome in certain patients. e need to get to hospital quickly is an essential requirement for optimal outcome. e shorter the time of obstruction of blood ow to the brain, the better the outlook. Once diagnosis is made, appropriate emergency treatment can be started. In the case of an ischemic obstruction, a “clot busting” drug tPA (tissue plasminogen activator) can be infused to break up the clot that is causing the obstruction. is drug, approved more than 20 years ago, has a high degree of success in either reducing the long-term e ects of an ischemic stroke or returning the patient to normal, if administered within three hours of symptom onset. It has been found that out of every 100 patients who are treated with it, 32 will have a better outcome. Unfortunately, studies show that a large number of stroke patients do not get to a hospital in this time period or are seen in a hospital where such specialized diagnosis and treatment are not rendered. Snowbirds, especially those with previous stroke or risk factors, should be mindful of where they choose to spend their winter vacation, knowing that proximity to a major hospital is an important consideration. Not all hospitals have such expertise and, when a 911 call is made, paramedics know exactly where the nearest stroke centre is located. When a patient presents to a hospital in North America without the specialists ideally present, telemedicine is becoming more available to assist in getting this care. Recent research has shown that for persons who received this drug even up to nine hours a er stroke symptoms rst appeared, there were proven bene ts to receiving it. For larger clots in major cerebral arteries, surgical removal of the obstruction (mechanical thrombectomy) is becoming far more common as bene ts can be proven even up to eight hours from the onset of stroke symptoms. e results can be dramatic and, in many cases that are indicated for such surgery, recovery can o en be sudden and complete following the procedure. Such treatment is o ered now inmost centres in North America where neurosurgical specialized services are available. We are far more aware now of the lifestyle habits that can reduce the chance of stroke. Careful attention to blood pressure andmaintaining optimal blood sugar levels in diabetics are very important. Proper diet and exercise are recommended for this, as well as many other health issues. Be aware of symptoms which may mean that a stroke is occurring and call 911 to be certain that the best and earliest care is possible. Research has proven that administering the clot-busting drug tPA as early as possible for ischemic strokes is a signi cant factor in improving one’s outcome. For clots in major arteries, recent urgent surgical removal of major clots is having dramatic new success. Finally, remember what F A S T stands for? Face Arms Speech Time CSANews | FALL 2019 | 39
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