3. Goals
• What is a stroke?
• Is stroke common?
• What types of strokes are there?
• What are my risk factors for a stroke?
• How can I prevent a 1st or a repeat stroke?
4. Definition
• Stroke:
– interruption of blood flow to any part
of the brain resulting in injury to that
region
7. Statistics
• 795,000 Americans suffer a stroke each year
• 1 stroke occurs every 40 seconds
• Stroke kills > 137,000 people a year
• Every 4 minutes someone dies of stroke
8. Warning Signs!
• Sudden numbness or weakness of the face,
arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or
Call 911
understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of
balance or coordination
• Sudden, severe headache with no known
cause
9. Types of Strokes
• 2 Common Types
–Ischemic or “Dry” Stroke
–Hemorrhagic or “Wet” Stroke
14. Types of stroke
• Ischemic (Dry) = 85%
– Blockage can be due to:
• 35% Clogged with Cholesterol Plaques: Thrombosis
• 30% Floating Clots: Emboli
• 20% Small clots deep in the brain: Lacunar
• Hemorrhagic (Wet) = 15%
– 10% caused by hypertension: intacerebral
hemmorhage
– 5% due to ruptured aneurysm: Subarachnoid
hemorrhage
17. Non-Modifiable Risk Factors
• Age > 55 years old
• Sex: Male > Female
• Race:
– African American 2x > whites > Asians
• Family History
• Previous history of a stroke
18. Modifiable Risk Factors
• Obesity (belly fat) ≈ 2 x’s
• High Blood Pressure = up to 7 x’s
• High Cholesterol
• Heart Disease ≈ 2x’s
• Diabetes ≈ 2 x’s
22. What can you do?
• Monitor your blood pressure regularly
• Eat more fruits, veggies and whole grains
• Eat less salt, fatty meat, dairy and processed
foods
• Short Supervised Fast
• Take your medicines as prescribed
• Get gentle exercise as approved by your
therapist and doctor
24. What can you do?
• Know your cholesterol level
• Learn what foods have the most cholesterol
• Eat more fruits, vegetables and whole grains
• Does it have a Face or a Mother?
26. What can you do?
• Quit
• Get help
• Support your loved ones trying
• Avoid places and people who encourage
smoking
• Develop new habits, hobbies to fill the void
28. What can you do?
• Achieve your ideal body weight
• Eat more of the “good stuff”
• Supervised Therapeutic Fast
• Check your blood sugars regularly
• Gentle exercise as recommended by your
therapist and health care provider
30. What can you do?
• Learn about your body
• Take medications as prescribed by your doctor
• Eat a healthy spectrum of foods to maintain
good blood levels of all the important
vitamins, minerals and electrolytes
• If you are on a medicine like Coumadin or
Warfarin get your levels checked regularly
32. What can you do?
• Women ≤ 1 drink per day
• Men ≤ 2 drinks per day
• More Alcohol then this has been shown to
your blood pressure = risk of stroke
• Always avoid “binge drinking”
35. What can you do?
• Know your risk and your level
• Start low, go slow and keep on going
• Make a plan
• Develop a habit
• Stick with it
• Keep it varied
• Make it fun
36. You can do it!
• Knowledge
• Tools
• Choices
• Opportunities
39. Conclusion
• YOU are very powerful in your health
• There is a lot that YOU can do
• We can help you
• Learn about your body
• Learn about your risks
• Make a plan to achieve your best health
• Help those in your “Circle of Influence”
HI. I am excited to share some really interesting information with you today about a really important topic. Stroke. We call this a stroke primer or introduction because we want you to know more about your body and about the things you can do to keep it healthy! So put on your learning caps and lets go………
We all have heard of heart attacks. Well a stroke is a Brain attack. Many of the risk factors are the same and we are going to talk about that in great detail
Now stroke is a very common problem in America today. In fact it is the 3 rd leading cause of death right after Diseases of the heart and Cancers. Some other facts about stroke include……..
So this is serious stuff, but the god news like we will talk about is there is a lot that you can do to prevent your risk of future strokes. We never want you to be one of these numbers again or for a first time. Fortunately there is a lot you can do to prevent it. http://www.strokeassociation.org/presenter.jhtml?identifier=1033
You can think of a hemorrhagic stroke like a pipe leaking in your house. Water goes everywhere and you don’t get water to the sink where you really need it. In your house you need a plumber to fix the pipe before things work again but in your brain the body begins to heal. Sometimes you heal all the way just like if the water from your pipes isn’t too bad. Other times the water stains your carpet or the walls and can be improved but not fully returned to 100% And You can think of an ischemic stroke like a clog in your pipes. We’ve all had that experience right? The water gets blocked and can’t get to where it needs to. As a result you are left without “water in the sink” to use the example from before. In medicine we use all kinds of drugs, procedures and lifestyle changes to help open up the blocks and get good flow back to the “sink.” OR In a hemorrhagic stroke, a blood vessel breaks and blood leaks into the brain tissue and injures the brain. The body then has to heal the broken blood vessel and clean up all the old blood while healing the brain tissue. You can think about this like a bruise on your leg when you bump a table or corner. Some of the small blood vessels break and leak some blood under the skin leaving a bruise. IN time the body re-absorbs the blood and the bruise slowly gets better. Or: IN an ischemic stroke you can think of this like a http://www.blackdoctor.org/HealthiNationJPGs/Stroke.3DAnimation.brain.so.jpg http://www2.mhsi.us/images/ed_stroke.jpg http://s3.images.com/huge.56.282032.JPG http://i.ehow.com/images/a04/sa/5s/fix-kitchen-sink-pipes-200X200.jpg
The brain is actually pretty big…not like in this famous cartoon character….no the brian fills up nearly the whole skull especially in a young person The brain is amazing! It sits safely inside your skull,where it is protected by the bones and it is surrounded by fluid to help keep it hydrated and add additional cushion. The brain receives blood via 4 major arteries that run up through the neck. 2 in the back and 2 in the front. These blood vessels carry the oxygen and nutrition the brain needs to function at it’s peak The brain is also split into different areas each of which is involved with particular actions. Everything from speaking and writing to walking, peeing, and feeling emotions http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/8738.jpg http://kaanyucel.files.wordpress.com/2009/12/homer_simpson_xray2.jpg http://www.today.colostate.edu/userfiles/images/brain_anatomy_story.jpg http://www.neuroskills.com/edu/fullrightleft.jpg http://www.radiologyinfo.ca/utilisateur/images/16_mri_body_b.jpg http://www.bocaradiology.com/cases/neuro/thrombolysis/flair4.jpg http://www.nhs.uk/Livewell/over60s/PublishingImages/Stroke_mri_200140302-001_125x100.jpg
Here’s a very scientific picture of the blood vessels that come up into the brain. You can see the 4 main vessels and some of the smaller ones as they branch off. As you can imagine, dependent on which one of the blood vessels is injured, a different part of the brain may be harmed
Here is just one more picture showing how different parts of the brain get blood from different major artereis You may have heard your doctor talk about the Middle cerebral artery or other such blood vessels and the reason why that is important is just like you can see. Each blood vessel feeds a different area of the brain.
Now this is really complicated, but I am going to give you a quick look at the brain like never before. You see as I said, different parts of the brain are involved in different actions and different parts of the body. You can see how on the surface of the brain different body parts are represented. So for example, if this part of the brain was injured then the thumb might not works as well or if this part was hurt, then feeling to the tongue might be off. It is fascinating how the body develops these connections and nerve relationships over time. Knowing how your brain is laid out helps you to understand how an injury in one place may hurt the brain and likewise how time and rehabilitation can help the brain to heal slowly and return to a more normal state
Now let’s get back to discussing different types of strokes.
Okay now that we understand the concept of strokes, the basic anatomy of the brain and how a stroke can influence different parts of the body, lets
So these are some of the risk factors that you can’t change. That means you either have them or you don’t. It is good to know what your risks are though so you understand your disease more and so your doctor can prescribe the right lifestyle changes and medicine to help protect you and keep you healthy.
So these are the risk factors that you CAN control. It is great news, because there are more risk factors that are in your control than out of your control. SO take a look at these risk factors and we will go through each one number by number. Katarina Jood, M.D., research fellow, Sahlgrenska University Hospital, Goteborg, Sweden; Lawrence M. Brass, M.D., professor, neurology, Yale University, New Haven, Conn.; Oct. 29, 2004, Stroke http://www.cbc.ca/gfx/images/news/promos/2010/03/23/artery-cp-584.jpg http://www.news.harvard.edu/gazette/2002/12.12/12-stroke.html http://stroke.ahajournals.org/cgi/content/full/34/7/1586 http://www.stroke.org/site/PageServer?pagename=cholesterol
Okay, now let’s break it down point by point. I want you to pull out a pen and pencil or ask someone with you to take notes. We also have these excellent handouts that you can use to follow along . We are now going to learn what you can do to improve your health and lower your risk of future strokes.
So what can you do to reduce your risk of a stroke. Well when it comes to high blood pressure, one of the most common risk factors, you can do a lot. First learn about your blood pressure. What does it mean and how do you know it’s high unless you check it. You can get a cuff at home or even check it at the pharmacy or the store or swing by your locval fire house and they will check it for free. But you can’t help what you don’t know………so get to know your regualr blood pressures Next the food you eat 3, 4, or 10 times a day is powerful medicine so make sure you are eating healthy foods, like lots of fruits, veggies and whole grains along with less processed foods and less high fat, high cholesterol foods. A simple rule is if it comes out of a box, bag or can…then eat less of it…. Next, take your medicines as prescribed. If you and your doc have agreed to start a medicine then you need to take it as scheduled otherwise it won’t work or could even be dangerous. Finally, a little bit of gentle exercise is important. It helps open up your blood vessels and keep the heart, lungs, skin and other organs in good shape. It also helps get good blood flow to your brain to help you stay sharp.
Cholesterol is a thick greasy substance that can clog up your arteries. Especially when you eat it with high fat, highly processed foods. In fact there is a direct link between the amount of cholesterol and fat you eat and your risk of heart disease and strokes. So you want to reduce your risk of these bad things and there is a a lot you can do.
Tobacco is an incredible toxin and dangerous substance. Unfortunately it is also incredibly addictive. Many of us started off innocently enough and now we are hooked….am I right….do we all know someone who is still hooked on cigarettes? How many of you know people who have tried to quit 5, 6 even 10 times. That just tells you how tough it can be. Now tobacco damages the blood vessels, accelerates aging, oxidizes (or burns) the lining of the brain and also increases your blood pressure. So it doesn’t just increase your risk of bad cancers and lead to impotence…nope it is an all around bad actor……
Number one here is quit……..now that is notoriously hard. If you feel like hey I just can’t do it alone, then get help. That’s what friends, family, health care providers and therapists are for. You can do it and we can help. A few good tips include…….
So diabetes especially uncontrolled diabetes is the number one cause of amputation, nerve damage and kidney failure in America. Unfortunately it is also a big risk factor for stroke. Diabetes results in too much sugar in the blood stream and this high amount of sugar acts like diesel fuel in an unleaded fuel car. It damages the blood vessels and dramatically increases the risk of strokes.
What can you do! Fortunately a lot………number one is know your diagnosis. If you have been diagnosed with diabetes then you need to take it very seriously. You need to do your best to achiever your ideal body weight because being overweight increases your risk of diabetes by 300% and if you are obese your risk increases by 900%. So make a plan to lose weight and the studies show your sugar control will dramatically improve or possibly be eliminated. To lose that weight it’s all about the food and exercise you get.
So what is atrial fibrillation first of all. Well to let you know I have to teach you a little bit of anatomy. Normally the heart beats strong, full beats and squeezes blood up and out into the body. The heart beats at a pretty regular pace and works incredibly well. Sometimes for a variety of reasons which we won’t discuss here, the heart begin to beat in an uneven and rapid way. As a a result it is unable to squeeze fully and with good strength. As a result blood remains in the heart longer then usual and while it sits in the heart waiting to be squirted out to the body it has a higher chance of clotting. In turn when the heart finally does squeeze a full and strong squeeze, the thicker blood can then squirt out and go to the brain where it can cause a stroke if the thickened blood or clot ends up in the wrong place. Think about it this way. Water sitting stagnant in a puddle or a bird pond can develop lots of algae. Water flowing in a beautiful stream and moving fast rarely develops algae because it is moving so quickly and freely. In the same way, when you heart is beating regularly and consistently your risk of a clot and a resultant stroke is much lower
If you have been diagnosed with atrial fibrillation there are a lot of things you can do. Number one is learn more about it. Ask your healthcare provider for more information so you can understand what is going on in your body. Next if you are prescribed a medicine then take it as prescribed. If you are on a blood thinner to help reduce your risk of clots something like Coumadin or Warfarin or the like then take it as prescribed and have your blood levels checked regularly.
Drinking is often over-looked as a risk for stroke, but excess alcohol which means more then 1 drink a day for a woman or 2 for a man increases the risk of high blood pressure which can increase your risk of stroke, heart disease and heart attacks. So my personal recommendation is avoid alcohol altogether. It increases the risk of falls, liver disease and all kinds of other bad things. If however you choose to drink then please follow the simple recommendations above and always, always avoid binge drinking. The same thing for tobacco applies here. If you always drink when you are with certain people or in a certain place then try to avoid these people or places…..
Physical activity does not mean putting on tight funny looking clothes and going to a gym where you think everyone is looking at you. No physical activity is far more then that. Everyone can do something, somewhere every day. We know that the old adage “use it or lose it” does in fact carry some truth. It is crucial to stay active. It is also elemental that you remain safe. So discuss with your therapist and health care provider what are safe activities for you and when you should start them. The goal is to safely and slowly increase your strength, balance, mobility and cardio-vascular fitness. Doing this helps keep your heart strong, your blood vessels more flexible, your brain sharper and reduces your risk of depression, heart attacks, future strokes, falls and so much more.
