That way, I would know if I was on the right track in solving a problem. So, I will try to give the answers first.
Tokeep your brain (and yourself as a whole) healthy, know the answers to thequestions:
Whatis thehealth of my heart and circulation?
Whatcan I do, or what can I do differently to keep my circulation working as safelyand efficiently as possible?
Fundamentally,these are the only questions I ever get asked. The questions are simple, butthe answers are different for all of us.
Afew definitions are in order. First of all, what is a stroke? Technicallyspeaking, we call a stroke acerebrovascular accident. (As you can see, doctors love to confuse things byusing Latin and Greek. I supposed lawyers are just as bad.) Cerebro means brain. Vascular means blood vessel, or refersto circulation.
Andaccident, well, that always means something bad.
Astroke is damage to the brain caused by a problem with blood flow to the brain.
Thisis why cardiovascular doctors (also known as cardiologists) have always beenresponsible for preventing strokes, although they are not the doctors calledwhen you have a stroke. The doctors called when you have a stroke areneurologists (brain specialists). They should not be the first doctor you seeto prevent a stroke. Hopefully, you will never need to see one. You should seeyour primary care doctor or a cardiologist first.
Astroke is not a heart attack. Sometime in the past 50 years, our medicalvocabulary became even more confusing than it already was. The terms stroke andheart attack became interchangeable. They have a lot in common, but they aredifferent things. A stroke is brain damage. A heart attack is heart damage.
Cardiologistsprevent both. Historically we just have not been very aggressive about preventingstrokes. Having a stroke means you have had brain damage, which means aneurologist (a brain specialist) will need to help you. Preventing a strokemeans keeping your circulation healthy, which is not a job for a brainspecialist. Its a job for a circulation specialist (that is, a cardiologist).
Biologicallyspeaking, there are several types of strokes, but most of them are caused by aclot jamming up the blood flow to the brain. Those clots tend to come from theheart or the big blood vessels leading to the brain (the carotid arteries), orthey can form in the smaller blood vessels within the brain. No matter what,you dont want blood clots in your brain. Thats a stroke.
Thereare also bleeding strokes, but they are not the common ones. In fact, manybleeds in the brain start as a clot. We tend to fear bleeding, but in fact,clots are a much, much bigger problem.
Clotscan be prevented. Thats part of how we prevent strokes.
Acommon question is what are the signs of a stroke? Well, the whole goal is tonot have a stroke in the first place, but it is worth knowing what happens whenyou do clot off part of your brain. Remember, a stroke is brain damage. So,whatever part of the brain you damage may not work quite right again. It maynot work at all.
Picka function that your brain controls. If you clot off the part of the brain thatcontrols that function, it wont work. Just about anything related to brainfunction can be lost by a stroke.
Forexample, you may lose the ability to speak, to understand words, to see, toswallow, to move your arm or leg. You may not think right. You may be confused.Your face may droop. You may collapse. For better or worse, most strokes dontkill you. They just take something away, usually forever.
Ifyou have a stroke, you will get to know a neurologist all too well. They arethe experts who can tell you just how much of your brain has been damaged andhow likely you are to recover what you have lost.
Thereare many books to help you understand how to recover from brain damage. Thebook I wrote with Kristin E. Thomas, MD, YouCan Prevent a Stroke, is not one of them. I find them all a littledepressing.
Ifyou do have a stroke, sometimes dramatic things can be done to try to rescueyour brain. Several new studies have been published about some of thesehigh-tech procedures (where tubes get stuck into your head to suck out clots,or clots are melted with drugs). One of my favorite patients recently asked meabout these treatments. He wanted to know what was the best way to treat astroke. The answer was really quite simple.
Thebest way to treat a stroke is to not have one in the first place.
Whatis a TIA? TIA stands for transient ischemic attack. They are often referred toas ministrokes. Transient implies that you have symptoms that come and go.They are not permanent. Ischemic means some part of your body did not getenough blood. In this case, we are talking about part of the brain not gettingblood. Attack, well, thats got to be bad.
ATIA is a transient ischemic attack, or ministroke, where symptoms spontaneouslyrecover without permanent damage.
Havinga TIA means that some part of your brain did not get enough blood, and itdidnt work. Like with a stroke, any part of the brain may be at risk. Thedifference between a TIA and a stroke is that a stroke leaves evidence ofpermanent damage.
Usually,that evidence of a TIA is seen with an MRI scan of your brain. If you havesymptoms of some part of your brain not working, and the symptoms get better,and a brain scan shows no evidence of permanent damage (that is, a stroke),then consider yourself lucky. You have had a TIA. You have dodged a bullet. Youneed to think very hard about how you, and your doctor, are going to preventyour stroke, because it is coming.
Youdo not need to wait for symptoms before you actively prevent a stroke.
Ascenario we see every day involves seemingly cryptic or mysterious terminologyon a brain scan (MRI) report. Someone undergoes a brain MRI and there isevidence of an old stroke, or many old strokes. The MRI is read as smallvessel ischemic disease or age-related atrophy. All of this means that atsome point, the brain did not get enough blood flow, blood flow wasinterrupted, or brain circulation clotted. It is entirely possible, andactually quite common, to find brain damage on MRI that you were neversymptomatically aware of.
Inthe past, we often felt that these abnormal scans, in which the damage shownnever presented symptomatically, were much like the proverbial tree falling ina forest. If no one is there to hear the tree fall, does it make a noise? Ifyou never have any symptoms, does it matter that the MRI says you had a stroke?
Ifenough trees fall in the forest, theres no more forest. If enough of yourbrain gets damaged, you will eventually become demented.
Vasculardementia is the loss of brain function, especially the ability to think, due toinadequate or interrupted blood flow.
Thereare actually several ways in which we can become demented. We tend to use termslike Alzheimers and dementia interchangeably, but technically they aredifferent. Dementia means that your brain doesnt work. Alzheimers is aspecific disease in which unusual proteins build up in the brain for unknownreasons.
Wehave no good way of preventing or treating Alzheimers. But some of what wethink of as Alzheimers is actually vascular dementia. And Mother Nature saysyou can have both. We may not be able to prevent Alzheimers, but there is alot that we can do to prevent vascular dementia.
Weused to say that old folks simply became senile. The inference was that theirmemory was gone. Their ability to think rationally was gone. They were maybe alittle goofy if not downright crazy. It finally evolved into an insult. Ifanyone was ever confused or forgetful, they were accused of being senile.
Well,technically, senile just means old.
Naturalaging predictably changes circulation. As circulation changes, blood flow tothe brain can become less reliable. Clots form. Blood flow can be interrupted.The heart may not pump enough blood to the brain, and the brain suffers. Thenyou can in fact become senile if you develop vascular dementia.
Ageis going to change circulation. It should come as no surprise that the brainsuffers when circulation is inadequate.
Senilityis vascular dementia. If you want to avoid it, keep the circulation to yourbrain healthy.
Perhapsthe most important point is this: We do not need to simply accept growing oldthe way our grandparents did. We have the ability to keep the effects of timein check (at least when it comes to the heart and circulation). But we need tomake the choice to be an active participant. We can prevent the changes to theheart and circulation that lead to strokes, brain damage, and vasculardementia. They do not prevent themselves.
Thebasics of prevention are already mentioned above: Know your heart and vascularhealth, and ask if you are doing everything you can to keep things working.Well, how does one do that?
1.Establish a relationship with a physician.
2.Know the health of your heart.
3.Know the health of your arteries.
4.Know the regularity of your heartbeat.
5.Know if its time to take a medicine to prevent plaque in your arteries andwhether you need a pill to prevent a blood clot.
Thisis what we now call the Foxhall Formula, or protocol. It is a short list ofsteps everyone can take to make sure they are preventing strokes.
Toprevent strokes, it may not take a whole village, but it does take a goodrelationship with a doctor. There are things you will need to do, and thingsyou will need your doctor to do with you.
Noticethe list does not mention diet or exercise. Of course, fitnesshelps everything. A rational diet is important (more on that later), but ifa magic fruit existed to keep our arteries perfectly clean and plaque free, Idlike to think we would have found it by now.
Thelist does include a lot of questions to be answered; fortunately they are alleasy to answer but you have to ask.
Thisexcerpt is adapted from You Can Prevent aStroke, by Joshua S. Yamamoto and Kristin E. Thomas and is printed withpermission from RosettaBooks.
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