You have had a stroke. Hopefully, you went to the hospital when you developed your symptoms of weakness, numbness, altered speech or visual impairment. Your hospital care enabled you to limit the damaging effects of the loss of circulation to a portion of your brain. You’ve made it through the acute phase of stroke management. Now what?

You will want to obtain the best achievable outcome from the impairments you already have. If you have “motor” impairments weakness or clumsiness you can rest assured that randomized, controlled trials — the gold-standard method for determining a treatment’s effectiveness — have shown that physical therapy can improve your level of functioning. If you have speech impairment, then speech therapy might be beneficial, though this has never been proved by means of randomized, controlled trials.

While it is important to focus on rehabilitation following a stroke, there are also other issues to attend to. As a survivor of a stroke you are at increased risk for another.

Researchers at the Mount Sinai School of Medicine and Columbia University in New York studied 655 people who suffered first ischemic strokes. Ischemic strokes are due to plugged blood vessels and not bleeds, and comprise 85-90 of all strokes. Publishing their results in a March 2006 issue of the journal “Neurology,” the investigators found that in the first five years following the stroke there was an 18 likelihood of another. Over the same time period the research subjects also experienced a 5 likelihood of a heart attack.

Can you improve your odds? Absolutely! The process of using information from the first stroke to help prevent another is called “secondary stroke prevention.” The idea is that if there is something that can and should be done to reduce one’s risk, now is the time to do it. There is no point in waiting for yet another attack to occur before getting started.

A blue-ribbon panel from the American Stroke Association and American Heart Association reviewed the state of knowledge concerning secondary stroke prevention for patients with ischemic strokes and published their results in a March 2006 issue of the journal “Circulation.” They found that use of blood-pressure-lowering medications has a powerful effect in reducing the risk of a second stroke — ranging from 24-43 in better studies — and this benefit might even extend to patients who have normal blood pressure to start with.

If you have diabetes, then it is especially important to control high blood pressure. Using a medication from the groups of drugs known as “angiotensin converting enzyme inhibitors” ACEIs and “angiotensin receptor blockers” ARBs will not only help control blood pressure, but will additionally help protect the kidneys. If you have diabetes, then it is also important to consider use of cholesterol-lowering medication, especially from the class of drugs known as “statins.” Statins can additionally benefit people without diabetes and even those without elevated cholesterol levels. Of course, in diabetes it is also important to keep the blood-sugar levels as close to normal as is humanly possible.

Quitting smoking is also pivotal in preventing another stroke, and it is never too late in the game to benefit from this difficult but important change. Consumption of more than two standard drinks of alcohol per day also increases the risk of stroke and should be avoided. If you are obese, then it is in your best interests to lose weight through a combination of calorie reduction and sensible exercise.

If your hospital studies showed that a carotid artery is 70-99 narrowed severe stenosis and your recent stroke was downstream from this blood vessel, then you are much less likely to have another stroke if you have a surgical clean-out endarterectomy by an experienced surgeon whose complication rate is less than 6. If you have severe narrowing, but because of some medical or surgical problem the surgery is considered too risky, then insertion of a stent into the narrowed artery can serve as a substitute for endarterectomy.

The carotid arteries are pulsating blood vessels in the front of the neck that carry blood to much of the brain. If the carotid artery on the same side of the stroke is 50-69 narrowed moderate stenosis, then an endarterectomy can be considered, but the benefit of surgery in these circumstances is much less clear-cut. If the narrowing is less than 50 mild stenosis, then you are better off leaving the artery alone.

The above recommendations are based on studies in people with atherosclerosis hardening of the arteries which is the most common cause of strokes and, for that matter, heart attacks. But not every stroke is caused by atherosclerosis. That’s why medical testing is important in stroke patients — so that treatment can be tailored to individual circumstances.

What about blood-thinners? If you have atrial fibrillation a specific pattern of irregular heartbeats then you are at particular risk to have a stroke due to a blood clot being thrown into the circulation from the heart. In this case warfarin Coumadin is the blood-thinner of choice. If for some reason the warfarin cannot be tolerated or is considered too risky, then aspirin is a second-best choice.

If your stroke was due to atherosclerosis, then studies support the use of an “anti-platelet” drug. Platelets are the building blocks from which blood clots are made, and anti-platelet drugs interfere with the ability of the platelets to clump together to form a clot. Antiplatelet drugs of first choice include aspirin by itself, aspirin in combination with extended-release dipyridamole Aggrenox, and clopidogrel Plavix.

It’s important to realize that patients who address every risk factor for a second stroke are likely to have the best outcome and the lowest chances of another attack. Handling some risk factors and not others is better than doing nothing at all, but in fighting off a second stroke, you want to use every weapon in your arsenal.

C 2006 by Gary Cordingley

All strokes damage the brain by disrupting circulation, but strokes come in multiple varieties. Because different parts of the brain are specialized to perform specific functions, symptoms produced by strokes vary according to what part of the brain was injured. In one patient the symptom might be weakness on one side of the body. In another it might be a partial loss of vision. In still another, a loss of speech. And symptoms can vary in intensity from mild to severe according to how large the area of damage is and whether it occurred in a pivotal location.

Strokes can also vary according to another fundamental difference — whether they involve a blocked blood vessel or a hemorrhage. Most strokes are due to the former in which brain-tissue damaged by lack of circulation is called an infarction. But 10-15 of strokes involve bleeding from ruptured blood vessels within the brain tissue, and while it’s bad enough to have an infarction, hemorrhagic strokes intracerebral hemorrhages can be even more devastating.

One prominent figure with spontaneous intracerebral hemorrhage is Ariel Sharon, whose hemorrhagic stroke occurred while he was still prime minister of Israel. Although some patients with intracerebral hemorrhage recover to a point of being able to enjoy other people and regain some independence in functioning, Sharon’s poor clinical outcome is all too common in patients with this disease.

The additional problem with hemorrhagic strokes is that the new deposit of blood occupies space — sometimes a lot of it — and there is only so much space within the skull braincase to go around. The fresh hemorrhage crowds and distorts the brain-tissue next to it, and additionally subjects the rest of the brain to increased pressure that can itself be damaging. Because of these distortions and pressure-changes, a patient with intracerebral hemorrhage often shows a decreased level of consciousness or even coma.

Another kind of spontaneous bleed within the braincase is subarachnoid hemorrhage, often caused by ruptured aneurysms outside the brain but inside the braincase. While this, too, is a very serious condition, it is not the focus of this particular essay, and spontaneous intracerebral hemorrhages are not caused by aneurysms of this kind. Yet another kind of bleed that can be confused with primary intracerebral hemorrhage is secondary hemorrhage. This occurs in some patients who started out with infarctions of the brain but who had subsequent bleeding from fragile blood-vessels around the infarction’s edges. This kind of bleed is not quite as serious as that which occurs when the bleed is primary the initial event.

How are intracerebral hemorrhages diagnosed? Since the 1970s when computed tomographic CT scans were introduced, this imaging technique has been the most effective and sensitive tool. A fresh hemorrhage within brain tissue is dramatically evident on CT scans. And unlike infarctions that can take a day or two to show up on CT scans, hemorrhages are already visible at the earliest moment a scan can be made.

Although surgical removal of blood-clots from the surface of the brain — called subdural and epidural hematomas — can be life-saving and function-sparing, surgery for a bleed hematoma or blood-clot within the brain tissue itself is another story. Some studies comparing outcome between operated and unoperated patients with intracerebral hemorrhage showed improved outcome, on average, for operated patients, while still others showed worsened outcome. Operated or unoperated, patients had high rates of death and disability.

Because of the limited prospects for meaningful improvement, surgery for intracerebral hemorrhage is often an act of desperation. One crusty old clinician was blunt about the direness of the situation, saying, “Show me a patient with intracerebral hemorrhage whose life was saved by surgery, and I’ll show you a patient you wish you hadn’t operated on.” His point was that survivors of this operation usually show severe impairments.

However, one form of hemorrhage within brain tissue is probably a special case, and that is hemorrhage within the cerebellum, located within the bony braincase just above the nape of the neck. Surgical extraction of blood clots occurring within the cerebellum prevents excessive pressure on the nearby brainstem that handles a lot of basic and necessary functions, like breathing.

Administration of cortisol-type steroids is a nonsurgical treatment that has been studied in a scientific way, comparing treated patients to untreated patients with the same condition. The steroids didn’t help. Decreasing the patients’ blood pressures by administering medication has likewise been studied, but with the same outcome — no benefit. However, in a preliminary study one nonsurgical treatment showed promise. Intravenous administration of activated factor VII a natural component of the blood-clotting system reduced expansion of the intracerebral blood-clot, death and disability when given within four hours of the initial hemorrhage. A larger study is underway to see if this benefit holds up under further analysis.

Otherwise, what can be done acutely for this condition? Individualizing treatment seems rational, even if unproved. For example, if the patient had a bleed while taking a blood-thinner as was the case with Ariel Sharon then it makes sense to stop the blood-thinner or reverse its effects. Supportive management, like administering intravenous fluids to prevent dehydration, monitoring for irregular heartbeats and protecting the patient’s airway also make sense. If the patient can’t consume food in the usual way, feeding through tubes or intravenous lines can be considered, though this decision can be postponed until the patient’s prospects are more apparent.

Who is at risk for intracerebral hemorrhage? Neurologists at Malmo University Hospital in Malmo, Sweden, compared 147 patients with intracerebral hemorrhage with 1029 similar but stroke-free patients in order to determine risk factors. They found that hypertension high blood pressure, diabetes, elevated triglyceride levels in the bloodstream, history of psychiatric problems, smoking and surprisingly short stature were more frequent in patients with intracerebral hemorrhage.

However, when it comes to modifiable risk-factors those that one can do something about a variety of studies indicate that hypertension is the single most important factor. Thus, treatment of hypertension, when present, is probably the single most effective thing that one can do in order to prevent this disease.

C 2006 by Gary Cordingley

At one time, little could be done for people with heart disorders, and for those who suffered from a heart attack. Today, improved medicines and new methods of treatment allow many cardiac heart patients to live normal or nearly normal lives. Also, new kinds of equipment and new methods of performing heart operations have saved the lives of many people for whom there was formerly no hope.

The arteries of older people may become hardened or narrowed. This may be serious if it happens in the coronary arteries, for the blood supply of the heart is cut down. Severe chest pain may result. A heart attack occurs if the heart muscle is deprived of its blood supply. The heart muscle may be permanently damaged and replaced with scar tissue. Most people who have heart attacks recover. They must rest for several weeks or more, but they can usually then lead normal lives.

A heart whose muscle has been badly damaged cannot do a good job of pumping the blood. This condition is called heart failure. With this condition, fluid collects in some parts of the body, such as the lungs and ankles.

Doctors have a large variety of medicines and other treatments for dealing with heart disorders. A drug named digitalis is given to strengthen weak heart muscles. Drugs called Diuretics help to rid the body of excess fluid by way of the kidneys.

Diet is usually an important part of the treatment of cardiac patients. The doctor may prescribe a diet that is low in salt content. This is because fluids tend to collect in the body in the presence of salt. The heart must work harder to pump the extra fluids. The doctor often advises a patient to lose weight. The heart of an overweight patient must work harder to pump blood to the extra, unneeded body tissue. A low-fat diet may be prescribed because of a possible connection between fats and hardening of the arteries. Patients are also advised not to smoke. Smoking is a cause of serious lung diseases, and it also appears to increase the risk of getting some kinds of heart disease.

The beating heart provides the pressure to move the blood along in the blood vessels. When the space within the smaller arteries is narrowed, as may happen in older people, the heard must push harder to make the blood move. This results in high blood pressure. Drugs are used that cause the arteries to relax and thus lower the blood pressure. Other drugs bring about a lowering of the pressure by their effect on the nerves that control the small arteries.

The rate of the heartbeat is controlled by electrical impulses from the nervous system. These impulses set the pace for the heartbeat. Sometimes the impulses may cause an irregular beat or one that is too fast or too slow. Usually this is a temporary condition. If the problem is a serious one, an artificial pacemaker is set into the heart painlessly. The pacemaker is powered by a tiny battery that lasts for years. The life-saving pacemaker supplies electrical impulses to the heart, causing it to beat regularly and at a satisfactory rate.

Medical and surgical skill have saved or prolonged millions of lives. But some hearts are so badly damaged that they cannot be repaired. The first heart transplant was performed in December 1967, and we’ve come a long way since then. Take care of yourself. Your family loves you.

Urgency is a word which describes a pressing necessity, like there is a need to do something immediately. It is a normal feeling to have most especially in situations that are of utmost importance. Paying the electricity bill that has been long overdue, or finishing a business report that will be presented during a board meeting — these are only a few examples of urgent matters that we cannot afford to delay. But if a person feels the urge to pass water, a urinary problem might be involved. Most people need to pass water every three to four hours during the day and up to once or twice in the night. For normal urination, the muscular wall of the bladder has to contract at the same time as a valve mechanism at the outlet of the bladder relaxes.

Urge incontinence is a urinary problem characterized by a sudden uncontrollable urge to urinate and frequent urination. It is often necessary to use the bathroom as frequently as every two hours and bed wetting is common. With urge incontinence, the bladder contracts and squeezes out urine involuntarily. Sometimes a large amount of urine is released.

With urge incontinence, the bladder contracts and squeezes out urine involuntarily. Sometimes a large amount of urine is released. Accidental urination can be triggered by sudden change in position or activity, hearing or touching running water and drinking a small amount of liquid.

Urge incontinence occurs when a person experiences a strong desire to empty the bladder, followed almost immediately by an involuntary loss of urine. People with urge incontinence complain of urgency with little or no warning, and may experience troublesome symptoms such as not reaching the toilet in time, a frequent need to urinate, passing of urine several times during the night, and bedwetting. The volume of urine loss varies from small to large amounts depending on bladder capacity.

The most common cause of urge incontinence is inappropriate bladder contractions. Two bladder abnormalities commonly cause the disorder. The most common is a neurogenic bladder overactive type, which is caused by brain injury or spinal cord injury or disease that interrupts nerve conduction above the sacrum and results in loss of bladder sensation and motor control.

Medical professionals describe such a bladder as unstable, or overactive. A doctor might call the condition reflex incontinence if it results from overactive nerves controlling the bladder. Urge incontinence can mean that the bladder empties during sleep, after drinking a small amount of water, or when one touches water or hear it running like when someone else is taking a shower or washing dishes.

There are several neurological diseases and disorders associated with a neurogenic bladder, including the following

Alzheimer’s disease

Multiple sclerosis

Parkinson’s disease

Ruptured intervertebral disk

Stroke

Syphilis

Traumatic brain or upper spinal cord injury

Tumors located in the brain or spinal cord

Urge incontinence can also be cause by a bladder infection. Diabetes can cause excessive production of urine and very frequent trips to the toilet.

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system spinal cord and brain, or to muscles themselves. Multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, brain tumors, and other types of that occurs during surgery can harm bladder nerves or muscles.

Other causes for urge incontinence include atrophic vaginitis, diet, caffeine, and carbonated beverages. Spicy foods, and tomato-based foods can also irritate the bladder and cause muscle instability in some patients which can result to urge incontinence. Treatment with bladder retraining often cures the problem. Medication may also be advised to relax the bladder. Advice from a continence advisor is also usually helpful.

Clots cause 80 of all Heart Attacks and 83 of Strokes. Heart Disease is on the rise in this country as well as in places where the diet has been westernized like Japan and the Mediterranean. More than anything else it is due to lack of proper diet and exercise.

Atherosclerosis is the hardening of the arteries and this is how it happens; flowing through your arteries you have plasma, red blood cells, white blood cells and platelets needed for clotting as well as some other essential cells for your health. Due to lack of a good diet you also have things like Bad cholesterol LDL, sugars from uncontrolled diabetes, saturated fats as well as other bad things for your health; all these negative ingredients begin to collect, stick together and build up on the interior of the artery walls; this is called plaque. The outer layer of the plaque that faces into the artery gets hard hence hardening of the arteries, the substances on the inside stays soft. The outer hard layer of the plague will eventually crack and the soft interior will be exposed. At this point the platelets for clotting do exactly what they are designed for; come to the crack to protect it, thinking it’s an injury to the arterial wall, and form a clot; this creates even more blockage in the already narrowed artery.

Several things can begin to happen at this point, you may have various forms of chest discomfort, numbness, burning or even a dull ache. You may develop poor leg circulation, abnormally cold hands and feet, shortness of breath, high blood pressure, fluttering of the heart palpitations, nausea, weakness or dizziness and even impotence in men. Hardening of the arteries creates a blood flow restriction. When this becomes more serious the clots can completely stop the flow of oxygen rich blood resulting in Heart Attack, Stroke and Death. It is important to reduce the risk of clot formation, but what is even more essential is to stop the production of plaque build-up in your arteries. If you make a cake it takes various minor ingredients and one major ingredient; flour, without flour you do not have a cake. When plaque is created in your arteries, it also takes one major ingredient; Bad Cholesterol LDL. If you can stop LDL, plaque would not be formed. This is how bad LDL is created; Free-radicals are molecules or atoms that are missing an electron, they attack all kinds of cells in the body trying to steal an electron from them, free-radicals are the cause of all major disease; in the case of heart disease, free-radicals attack normal LDL cholesterol causing deformity or mutation, this makes the LDL cholesterol sticky. Now all the negative ingredients come together and you have plaque stuck to the walls of your arteries.

Free-radicals can not be avoided; they are in air and water pollution, junk foods we eat, and in medications we take; in medications these free-radicals are called side effects. Side effects can lead to disaster inside your body and in some cases death.

The only thing that stops free-radicals are antioxidants; they are molecules that have a spare electron. The only place to find antioxidants is in natural sources. Dietary supplements are needed for optimum health and contain antioxidants, eating natural foods that are un-processed is critical. Processing our food destroys the antioxidants. Most plants have around 1,000 to 1,500 antioxidants each, which does not seem like a lot compared to the amount of free-radicals you are taking into your body every single day; about a billion. Vitamins and minerals also contain antioxidants.

With the discovery of a fruit from South East Asia called the Mangosteen, scientists have been in a buzz about the amount of antioxidants this fruit contains. The Mangosteen fruit has an amazing 25,000 antioxidants. This fruit has been studied in Universities and by scientists for the last 20 years; they have proved that this fruit has the most powerful and the largest number of antioxidants in nature to date. You can read all the studies by going to pubmed at dot gov and typing in Mangosteen. The Mangosteen fruit has been providing thousands of people with medicinal benefits, due to super charged antioxidants called Xanthones. Two hundred Xanthones have been identified in nature, 41 are in the Mangosteen fruit alone and you can compare that to the Aloe Vera plant that contains only one Xanthone. One thing about Xanthones you need to know is that they must be consumed in their natural form. Xanthones can destroy more than one free-radical at a time, unlike normal antioxidants, due to carbon bonds that produce biological actions in the body. Xanthones are stable, super charged anti-oxidants. For more information you can call toll free 1-888-374-4148 and listen to a message about the Mangosteen fruit and its powerful medicinal abilities.

In Chinese Medicine, many of the symptoms of high blood pressure, such as pounding headaches, dizziness, and pressure behind the eyes are often related to a pattern of Liver Yang Rising or Liver Heat. It is important to see a physician for proper diagnosis and supervision of high blood pressure, but acupuncture and Chinese herbal medicine may also be useful for managing your condition. Certain herbs have been shown to have an anti-hypertensive effect. Certain other herbs have been shown to be useful for controlling cholesterol levels and improving cardiovascular function. Acupuncture has been shown to have a general relaxing effect which can be useful in stress related or essential hypertension. In addition, certain points are commonly used in the treatment of patterns that relate to high blood pressure.

One commonly used herb for symptoms and patterns related to high blood pressure is Tian Ma or gastrodia rhizome. Research in China has shown it to be useful in the treatment of symptoms related to high blood pressure such as dizziness, numbness of extremities, tinnitus, headaches, and pain behind the eyes. It may have a sedative and tranquillizing effect. It has been shown to have usefulness for renal hypertension and essential hypertension. Another useful herb is Ye Ju Hua or chrysanthemum flower, which has been shown to have a prolonged effect of lowering blood pressure through peripheral vessel dilation. It has also been shown to increase blood flow to the heart. Another herb that is used to clear Liver Heat and is commonly used to treat eye problems that may be beneficial for high blood pressure is Xia Ku Cao or prunella. Chinese research has shown that it has a moderate vasodilating effect. These herbs are often used in combination by practitioners of Oriental Medicine in the treatment of patterns related to high blood pressure.

Other herbs may be useful for improving heart and circulatory function. They may also help reduce cholesterol. Shan Zha, or hawthorn berries, have been shown to reduce cholesterol when taken for six weeks or more. It is often used in China to improve circulation and to treat angina pectoris. Another herb that is commonly used in China for cardiovascular problems is Dan Shen, or Salvia. It has also been shown to reduce cholesterol. It also may improve microcirculation in the body. In China, pills of Dan Shen are used in the treatment of angina and in the treatment of coronary heart disease. It also may help promote repair and regeneration of tissues by increasing the bodys metabolism.

Certain acupuncture points are also known to be useful in the treatment of patterns related to high blood pressure. Large Intestine 4 is a point that many people know can help to control headaches. It is on the back side of the hand in between the thumb and index finger. It is also commonly used point for blood pressure related patterns. Another point at the vertex of the head, Du 20, is also commonly used. An acupuncturist or Chinese herbalist always takes an inventory of symptoms, along with looking at a persons tongue and feeling a persons pulse in order to determine the specific combination of points and herbs that a person needs. Different people with high blood pressure are treated differently depending on the pattern they present.

During my time in China, I did clinical rounds in the cardiology department at the Chengdu Traditional Chinese Medicine Hospital. Modern drugs and diagnostic equipment were used hand in hand with Chinese herbs and acupuncture in order to treat conditions such as high blood pressure, angina pectoris, cardiac arrhythmias, heart enlargement, and stroke. I even saw Chinese herbs, such as Dan Shen, being given in intravenous and in injectable form. The conditions were diagnosed using modern science and traditional Chinese diagnosis. Drugs were used for symptom control and for emergencies. As peoples condition improved with the use of Chinese herbs and acupuncture, their doctors slowly adjusted the dosage of drugs that they received. The results I saw were better than either form of medicine could have achieved alone. We do not have the benefit of experiencing such a deep synthesis of modern medicine and ancient techniques yet in the West. Nevertheless, I believe that as people learn more about the benefits of Asian medicine, we may someday come close to achieving a more integrated system of care in the West that will be more clinically effective, more cost effective, and result in fewer side effects.