Stroke
Take Command and Reduce Your Risk of Another One As he walks, his right foot slowly rises about 2 inches in the air before it mechanically plunges to the ground, as if it were attached to a puppeteer's string. Often he still says "water" when he really means something else like "hand," "chair," or "tree." But John Candido is happy.
"I feel great. I'm not sick anymore," says the former New Jersey landscaper who had a massive stroke in June 1995.
Indeed, John, who was nearly 60 when it happened, came a long way in the first year after his stroke. With the help of therapists, he regained the use of his paralyzed right arm and leg. His speech, which was once limited to "One, two, three, water," returned to complete, understandable sentences after months of rehabilitation. He recovered so well that he is a volunteer—transporting patients in wheelchairs—at the center where he was treated, the Kessler Institute for Rehabilitation in West Orange, New Jersey.
But as healthy as he seems, John still is at high risk for another stroke.
"He doesn't worry about it, but I do because I know the statistics," says Mary Jo Candido, R.N., John's wife and chapter coordinator for the Northern New Jersey Chapter of the National Stroke Association.
In fact, people over age 60 who have had a stroke are 10 times more likely to have another one. Up to one in three will have another stroke within five years of their first one.
But even if you've had a stroke, this doesn't have to be your fate.
"Changing your lifestyle now can make a dramatic difference," says Lawrence M. Brass, M.D., professor of neurology and co-director of the Yale Cerebrovascular Center at Yale University School of Medicine. "In some cases, lowering blood pressure, quitting smoking, and making other lifestyle changes can reduce your risk of subsequent stroke by more than 50 percent."
Anatomy of a Stroke
When you were going through stroke rehabilitation, you probably noticed a lot of people your age working through similar problems. There are reasons for that.
Every minute, someone in the United States has a stroke. Of those, two of every three—more than 350,000 a year—occur in people over age 65. And after age 55, the risk of stroke doubles with each passing decade you live.
Stroke becomes more common as we age, in part, because it is provoked by many of the same lifelong habits—smoking, sedentary living, high-fat eating—that trigger heart attacks. In fact, most strokes are caused by the same mechanism as a heart attack, says Arthur Ancowitz, M.D., author of The Stroke Book and founder of the Stroke Foundation in New York City.
These "brain attacks," or ischemic strokes, occur when a blood vessel gets blocked and blood flow to a part of the brain ceases, causing death of brain tissue. A less common type of stroke, called a hemorrhagic stroke, happens when a weakened blood vessel bursts and causes bleeding in the brain. This kind of stroke, which killed president Franklin Roosevelt, is often more debilitating than an ischemic stroke, says Michael Schneck, M.D., assistant professor of neurological sciences at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Regardless of type, "most effects of stroke can improve with therapy," he says.
Even a small stroke, if it occurs in a vital part of the brain, can cause extensive damage that may rob you of speech, vision, or movement, Dr. Schneck says.
But at least one-third of all strokes are mild, meaning the person may have little or no disability. Another third of stroke survivors are completely debilitated, requiring special care. The rest are somewhere in between—such as having extreme weakness in one or more limbs. Those with moderate effects are often functionally independent in their daily activities, although they may or may not be able to return to work. But no matter how severe the initial damage, most stroke survivors do get better, says Richard C. Senelick, M.D., neurologist, medical director of HealthSouth Rehabilitation Institute of San Antonio, Texas, and co-author of Living with Stroke.
Some early improvement probably occurs as swelling surrounding the damaged area of the brain slowly diminishes in the first few weeks after the stroke, says Carlos Kase, M.D., professor of neurology at Boston University School of Medicine. It is also possible that in the months following the stroke other parts of the brain take over some of the functions of the damaged area, he says.
Still, it may take up to a year before a survivor regains many of the capabilities that he had prior to the stroke, Dr. Schneck says. "The first six months of rehabilitation are the hardest. Don't let yourself give up."
Preventing Another One
Now that you are better, you certainly don't want it to happen again. Depending on the type of stroke you had, your doctor may prescribe an anticoagulant drug like anisindione (Miradon) or antiplatelet drugs like ticlopidine (Ticlid) or aspirin.
Your doctor also might recommend a surgery, called a carotid endarterectomy, to unclog your carotid arteries. A surgeon makes a 3-inch incision in your neck and cleans plaque out of one or both of the carotid arteries, two major arteries that supply blood to the brain. Although surgery can't reverse the damage already done by stroke, says Dr. Ancowitz, this procedure can help prevent a recurrent or even an initial attack in those at high risk. Among people who have had a previous stroke, this surgery reduces the risk of recurrence in the following two years from 27 percent to 8 percent, says Richard Libman, M.D., assistant professor of neurology at the Albert Einstein College of Medicine of Yeshiva University in New York City.
But even if you take drugs or have surgery, it is still important to take command of your own health after a stroke.
Some risk factors for stroke are out of your control. Among these are family history of stroke, age, gender (men are slightly more prone to strokes than women), and race (African-Americans are almost twice as likely to have a stroke than Whites).
But many others, such as high blood pressure, high cholesterol levels, diabetes, a smoking habit, overweight, a sedentary lifestyle, and excessive alcohol consumption can and should be tamed.
"If a person has a stroke and doesn't stop smoking or change his diet or get his blood pressure under control, then his chances of having a second stroke in the next year are overwhelming," Dr. Ancowitz says. "Without those changes, all the ingredients that caused stroke number one will still be there to provoke stroke number two."
Here's a look at how you can dampen your chances of a recurrent stroke.
| Seek Help for These Warning Signs Strokes can fool you. The warning signs of a recurrent stroke, such as blurred vision, dizziness, and gait unsteadiness, can be subtle, says Michael Schneck, M.D., assistant professor of neurological sciences at Rush-Presbyterian-St. Luke's Medical Center in Chicago. A symptom like numbness in the hands will last only a few minutes, for instance, then suddenly disappear. But don't be deceived. "If there is even the slightest chance that you're having symptoms of a stroke, don't wait to see your doctor. All that does is delay treatment. Go to a hospital emergency room immediately, then have someone notify your doctor of the situation," says Richard Libman, M.D., assistant professor of neurology at Albert Einstein College of Medicine of Yeshiva University in New York City. Since a stroke can impair your judgment and ability to communicate, it's also important that people in your life be aware of a stroke's warning signs, says Harold P. Adams, Jr., M.D., director of the Division of Cerebrovascular Diseases at the University of Iowa in Iowa City. It's also important to remember that a stroke can occur in any area of the brain, affecting different parts of the body. So a subsequent stroke can have completely different warning signs than your first one. Here are some of the key warning signs of any impending stroke. * Sudden weakness or numbness of the face, arm, or leg * Sudden dimness or loss of vision, particularly in one eye * Double vision * Any sudden unexplained drowsiness, nausea, or vomiting * Sudden difficulty speaking, finding words, or understanding speech * Sudden severe headache with no known cause * Unexplained dizziness, unsteadiness, or sudden falls, especially with any of these other symptoms * Difficulty swallowing * Memory loss * Loss of consciousness |
Banish High Blood Pressure
"Uncontrolled high blood pressure is a major cause of stroke. Treatment is crucial," says Sidney C. Smith, Jr., M.D., professor and chief of the Division of Cardiology at the University of North Carolina at Chapel Hill and past president of the American Heart Association.
In fact, after a four-year study of 662 men and women in their sixties and seventies who had strokes, researchers at Allegheny University in Philadelphia concluded that those people who didn't correct high blood pressure were substantially more likely to have a recurrent stroke, says Milton Alter, M.D., Ph.D., clinical professor of neurology at Allegheny University Hospitals, a neuroepidemiologist, and co-author of the study.
That's because high blood pressure—a reading consistently more than 140/90 millimeters of mercury (mmHg)—strains your arteries, especially in the brain. This makes them more susceptible to clotting or rupture, Dr. Ancowitz says.
There are many ways to combat soaring blood pressure.
Shed pounds. If you lose excess weight, you'll be less likely to have high blood pressure, Dr. Ancowitz says.
Curtail cocktails. Limiting your daily consumption of alcohol to no more than two 12-ounce beers, two 4-ounce glasses of wine, or two cocktails containing 1 ounce of alcohol also can slash your chances of having a stroke, Dr. Ancowitz says.
Stay physically active. "Exercise is extremely important after you've had a stroke for many reasons. Not only will it help lower blood pressure and protect against the development of cardiovascular disease, but it will help you maintain muscle tone that is so vital during rehabilitation," Dr. Ancowitz says.
Regular exercise dilates blood vessels so that blood pressure falls and stays down when you're not exercising. Sweating also may coax sodium out of your bloodstream and help lower blood pressure, Dr. Ancowitz says. Plus, developing muscle strength through exercise will make daily tasks that much easier to perform.
Ask your doctor or physical therapist about the types of exercise that are best for you. But in general, try to get some type of moderately intense aerobic exercise for at least 30 minutes daily, Dr. Ancowitz suggests.
"If you can still walk, do that. If you can't walk, then try upper-body exercises like swinging your arms over your head. Just do as much as you can," Dr. Ancowitz says.
Stoke up on calcium. If you're not getting enough calcium in your diet, not only will you be at greater risk of osteoporosis but also you may be more likely to have high blood pressure. "Individuals that fail to meet the Daily Value for calcium are more likely to develop hypertension," says David McCarron, M.D., professor of medicine and head of the Division of Hypertension at Oregon Health Sciences University in Portland.
Edith Howard Hogan, R.D., a spokesperson for the American Dietetic Association in Washington, D.C., recommends consuming 1,500 milligrams of calcium daily. A 1-ounce slice of Swiss cheese, about the size of a domino, has 270 milligrams of calcium and only 7 grams of fat. A cup of low-fat yogurt, an 8-ounce glass of skim milk, or canned sardines or salmon packed with bones are also good sources. If you think that you're not getting enough calcium from your diet alone, ask your doctor about taking a supplement to boost your intake, says Hogan.
Dash for the herbs. Instead of reaching for the salt, which can raise blood pressure, add a touch of herbs and spices like ginger, oregano, garlic, or onion powder to your foods, Dr. Ancowitz suggests. Not only will that add aroma and zest to your meal but also it will cut down on your salt consumption and may lower your risk of a recurrent stroke.
You can save money by looking for these products in unusual places, Hogan says. Some drugstores, for example, sell spices for about half the price that you would find in a grocery store.
Try the dilution solution. In many cases, you can do a lot to shave the sodium content of a favorite food or ingredient, Hogan says. If, for example, you buy a sodium-rich spaghetti sauce, try adding a can of no-sodium-added stewed tomatoes to the mixture. That will dilute the sodium in the sauce without affecting the flavor.
Be wary of salt substitutes. Many salt substitutes contain potassium in the form of potassium chloride, which can help lower blood pressure in healthy people. But some men and women over age 60 who have weakened kidneys may not be able to rapidly excrete potassium from their bodies, says Thomas Pickering, M.D., professor of medicine at New York Hospital-Cornell Medical Center in New York City and author of Good News about High Blood Pressure. Also, excessive amounts of potassium in the blood can cause abnormal heart rhythms. Before using a salt substitute, check with your doctor, he suggests.
Snuff Those Puffs
Days after John Candido's stroke, his wife found him digging through her purse looking for something.
"He was still in the hospital, he couldn't walk and could barely talk, and here he was rummaging around for a cigarette," recalls Mary Jo Candido. "I said, 'Are you crazy? That's the worst thing you could do to yourself.' "
In fact, smoking elevates blood pressure, speeds up the narrowing of artery walls, and forces the heart to work harder. Overall, smoking at least doubles your chances of having another stroke.
"If you want to increase your risk of a recurrent stroke and take the chance of being further debilitated, then you should continue to smoke," Dr. Libman says. "Smoking is the most modifiable risk factor for stroke. You have complete control over whether you do it."
Although John Candido did smoke for a brief time after he returned home from the rehabilitation hospital, he eventually snuffed out his 40-year habit cold turkey.
Of course, there are many ways to quit. Deep breathing, for instance, helps many people learn to relax without cigarettes and can help you resist cravings, experts say.
Long, deep breaths mimic the sensation of smoking and can be reassuring and satisfying to someone who is trying to quit, says Mitchell Nides, Ph.D., a psychologist specializing in smoking cessation at the University of California, Los Angeles. "Deep breathing may be one of the best ways cope with an urge to smoke," he says.
Try the following deep-breathing exercise whenever you feel an urge to smoke.
Take a deep, slow breath through your nose or through pursed lips as if you were smoking a cigarette. But instead of smoke, feel the fresh air fill your lungs. Hold it in for a count of three. Then exhale slowly, letting all of the air out of your lungs. As you exhale, feel the muscles in your neck and shoulders relax. Repeat this exercise two or three times, Dr. Nides says.
| Make "I Can" Your Motto If you've had a stroke, it's easy to give in. If you're a caregiver, it's easy to overprotect. Resist these temptations. People who have had strokes often can do much more than many caregivers suspect, says Michael Schneck, M.D., assistant professor of neurological sciences at Rush-Presbyterian-St. Luke's Medical Center in Chicago. "Whenever possible, I advise caregivers to err on the side of independence," Dr. Schneck says. "Let the person who has had the stroke do as much as they want to, and then some. Don't let the survivor be an invalid." With adaptive equipment and techniques, many people who have had strokes can master skills like driving, gardening, woodworking, and other activities, says Caryn Abel, a recreation therapist at the Kessler Institute for Rehabilitation in West Orange, New Jersey. If you have a hobby or vocation that you would like to try, first clear it with your doctor, then ask your recreation therapist how you might do it, Abel suggests. It is also important that the stroke survivor be allowed to reassume a role within the family, says Wayne Sotile, Ph.D., director of psychological services for the Wake Forest University Cardiac Rehabilitation Program in Winston-Salem, North Carolina, and author of Heart Illness and Intimacy. "If the person with a stroke becomes a spectator instead of a participant in life, that can be devastating emotionally," Dr. Sotile says. "Allow the stroke survivor to be as much of a person as he can." So if the stroke survivor loves to cook, for example, but no longer has use of his arms, he can still be helpful in the kitchen by sharing his expertise with others, Dr. Sotile suggests. That will relieve depression and boost self-esteem. |
Sex: Love Conquers All
Intimacy hasn't been forgotten at Jim and Cathy Kalal's home in Harlan, Iowa.
"We're keeping on pace with the national record for sex in a month by a stroke survivor," Jim Kalal says, laughing. "I'm holding up my end."
Jim, a retired public utility administrator in his sixties, survived a paralyzing stroke in 1982.
| Caregivers: You Deserve a Break Today Caregiving is a grind that can wear even the best of us down. In fact, up to half of all long-term caregivers will seek help for a stress-related disorder. Often, the wearing routine of this ceaseless job creates more stress for the caregiver than the illness itself does for the person who is ill, says Wayne Sotile, Ph.D., director of psychological services for the Wake Forest University Cardiac Rehabilitation Program in Winston-Salem, North Carolina, and author of Heart Illness and Intimacy. "It's important for caregivers to realize that this isn't a sprint. It's a marathon, so you have to pace yourself," Dr. Sotile says. "The best gift you can give to people that you care for is taking time to care for yourself both mentally and physically." Here are some ways to lessen the strain of caregiving. Reach out for help. Don't be afraid to ask family members, friends, and neighbors to take some of the load off your shoulders, suggests Pam Erickson, R.N., private care manager for Eldercare Advisors in Denver. Make a list of people willing to care for your loved one when you need a break. Call upon those who have said, "If there's anything I can do, just ask." Even if the respite person will just cook a meal, do laundry, or do other chores for you once a week, accept it. It will ease your burden and allow you to have more quality time for yourself. If friends or family aren't available, consider home health care or nursing services listed in the Yellow Pages. Rates range from $10 to $18 an hour. Get away from it all. Take 30 minutes daily to do something that you enjoy, like gardening or reading. At least once a week, get outside the home, Dr. Sotile says. Go to a movie, walk around a park, or play bridge with friends for a couple of hours. Not only will these activities boost your morale but also, when you come home, you'll probably have new experiences and stories to share with your less-mobile loved one, Dr. Sotile says. Vent your feelings. At times every caregiver feels frustrated, angry, guilty, lonely, and overworked. Form a telephone network of caregivers who are facing similar problems so that you can share your ups and downs, Dr. Sotile suggests. The National Stroke Association, 96 Inverness Drive East, Suite I, Englewood, CO 80112 (phone number 1-800-STROKES), can provide a list of stroke support groups in your area with interested members. If you're having a particularly bad day, don't try to hide it from the person you're caring for, Dr. Sotile says. "Holding in your feelings and letting interpersonal tension accumulate isn't healthy for either you or the stroke survivor," Dr. Sotile says. "Sometimes you need to proclaim to the person you're caring for, 'I really need your help, love, and care today as much as you need mine.' " Set limits. People who have had strokes have mood swings, frustrations, and bad days, too. But that doesn't mean they have a right to take it out on you. "Ask yourself how you would react to this behavior if the stroke had not occurred," Dr. Sotile says. "If your loved one came home from work and started calling you names, you probably wouldn't tolerate it. So take off those kid gloves. Say, 'Listen, I love you, I care about you, and I know you're scared. But you can't treat me like this and get away with it. It's important to me that I am respected and loved. We can't let a stroke ruin what we have built between us.' You simply can't let yourself be violated, or else you're going to end up resentful, and that doesn't help anyone in this situation." If mood swings and other emotional outbursts persist for more than six months for either the patient or anyone in a caregiving position, seek counseling, Dr. Sotile says. The emotional effects of dealing with serious illness can be far-reaching, he says, so it is important for each family member to examine his feelings and seek help if needed. |
"I don't think you should ever give intimacy up because of a disability. You find what is the best way for you to fulfill your intimacy with each other. We have managed to do that. We're probably as sexually active as some of the younger couples in our neighborhood," says Cathy Kalal, R.N.
"I don't see Jim's disability," she adds. "I don't look at him like I'm longing for something that isn't there. He is who he is, and I am who I am."
Many stroke survivors and their spouses fear that sexual activity will trigger another stroke. In reality, although blood pressure and heart rate do increase during sex, the increase probably isn't enough to be concerned about, according Roger Crenshaw, M.D., a psychiatrist and sex therapist in private practice in San Diego.
"The sexual part of the brain doesn't dissolve during a stroke," Dr. Crenshaw says. "Just because there has been a muscular difficulty doesn't mean that the person can't desire and enjoy sexual activity."
| How I Did It: Iowa Man Leads an Electrifying Life Jim Kalal has a message for everyone who has had a stroke: Life goes on. "A stroke isn't the end of the world. You just change your routine, switch to another track, and proceed onward. You can still have the same enjoyment of life. I used to love golf. But since my stroke, I've found lots of other things to do," says Kalal, a retired public utility administrator in Harlan, Iowa. Now in his sixties, Kalal has lived with complete paralysis of his left arm and leg since his stroke in December 1982. He can stand and walk with the aid of a leg brace. "I was at least 30 pounds overweight, I had high cholesterol, my blood pressure was running high, I drank more than I should, and I was working in a high-pressure job," he says. "But for some reason, I didn't think it would happen to me." After rehabilitation, he went back to work but made little effort to change his lifestyle. His job overseeing the water, electrical, and natural gas needs of 2,500 customers continued to wear him down. His daily routine still included two or three drinks after work. In addition, he and his wife, Cathy, continued eating a high-fat diet that included lots of fried foods. In January 1991, he had a massive heart attack that forced him to retire. But a lesson was learned. Now he adheres to a low-fat diet, walks as much as possible, limits himself to one beer a day, and lives at a slower pace. "I think one of the things that saved me from another stroke is that I got away from the pressures. That's very important. I'm just more relaxed. I'm not living my life full speed ahead anymore." But he remains active. He uses a power mower to cut the grass on the couple's 4-acre lot, enjoys building doll furniture and wooden storage trunks for his grandchildren, and serves on his community's cemetery board. "I don't understand people who sit around and feel sad about what life has dealt them," he says. "I just don't have any room for that in my life." Still, there are times when anxiety does overwhelm him. "It's unrealistic to believe that a fear of recurrence isn't going to be in the back of your mind occasionally," Kalal says. "I just do everything that I can, including prayer, to prevent a stroke from happening again." |
In fact, intimacy of all kinds, including hugging and kissing, can boost self-esteem and relieve depression, says Dr. Senelick. The better your primary intimate relationship is after a stroke, he says, the better your odds are that you'll have a more complete recovery.
"It's a huge boost to your self-esteem if your partner still finds you attractive," says Domeena Renshaw, M.D., director of the Sexual Dysfunction Clinic at Loyola University of Chicago Stritch School of Medicine. "And yes, it's still possible to be a very good lover even if you've had a stroke."
Ask your doctor if and when you can resume sexual relations, Dr. Crenshaw recommends. Like all aspects of stroke rehabilitation, regaining intimacy may require some adaptation and experimentation. Here are some suggestions.
Take it slow. After you and your partner decide to resume sexual relations, put intercourse out of your mind for a couple of weeks. Instead, focus on the other pleasures of intimacy like kissing, touching, and hugging, suggests Dr. Renshaw, author of Seven Weeks to Better Sex. Gradually building up to renewed sexual relations will boost your self-esteem and self-confidence, reduce performance anxiety, and foster feelings of mutual trust.
"Love play that avoids the genitals can strengthen the relationship between a couple in this situation," she says. "It lets the person who had the stroke know that his partner really loves him in many ways. And that ultimately makes sex much easier."
Play it again, Sam. Setting the right mood is important, particularly after a life-changing event like a stroke, Dr. Renshaw says. Take time to reminisce about past romantic moments in your relationship. Play a favorite love song on the stereo. Take a moment to gaze at a full moon together and realize that the romance you had before the stroke can continue.
Stay in sight. Many people who have strokes lose vision in one eye. Either ask your spouse to move so that you can see him or her or tilt your head to the side so that your partner remains in your line of sight when you're making love, Dr. Renshaw says.
Go with your strength. Lie on the side of your body that is weaker so that your strong hand is free to caress your spouse's body. This position will also allow you to thrust by using your strong leg to push off against the foot of the bed or a wall, Dr. Renshaw says.
Keep laughing. Sex at any age or with any physical problem is better if you don't take it so seriously. Have fun, be frivolous, use your imagination, Dr. Renshaw says. Remember that you're not at a stockholders meeting—you're with someone you love. Enjoy it.
Check out your drugs. If you have difficulty getting or maintaining arousal, ask your doctor about it. Some medications prescribed for high blood pressure or depression, for instance, can interfere with your sexual abilities, Dr. Renshaw says. But under no circumstances should you discontinue taking a drug without your doctor's consent.
Give yourself time. After six months, if you're not back into the same sexual routine that you were in prior to your stroke, consider seeing a sex therapist who has experience in dealing with stroke survivors and their families, Dr. Crenshaw says.
"It usually isn't protracted therapy—just six to eight sessions that will help the couple deal with their specific concerns," Dr. Crenshaw says.
| 10 Empowering Ways You Can Help Your Caregiver Jim Kalal, a retired public utility administrator in Harlan, Iowa, wrote these 10 commitments after his paralyzing stroke in 1982. They have helped him maintain an understanding and fulfilling relationship with his wife and caregiver, Cathy. Originally published by the National Stroke Association, the commitments are as follows. 1. Don't ask my caregiver for anything that I can do for myself. 2. Make sure that I thank my caregiver each time she provides assistance to me. 3. Make sure that when my caregiver suggests we go out to eat, shopping, and so forth, I make every effort to go. 4. I will do my best not to complain about my stroke or handicap and my limitations. 5. I will try my utmost, on my own, to improve my skills, so as to improve the quality of my life and my caregiver's quality of life. 6. Encourage my caregiver to do things on her own, always giving my caregiver some space. 7. I will try to never feel sorry for myself, and I will do my best to keep my sense of humor. 8. I enjoy telling my caregiver that she looks nice, and to me she is always attractive. 9. I will not live in the past but live for today and the future, learning to live with my new lifestyle, my handicap. 10. I tell my caregiver I love her, because I do. |
| Hormone Replacement May Stop Stroke Recurrence For women, estrogen may bolster the fight against stroke and its recurrence. Preliminary data show that postmenopausal women who take the hormone appear to have a 50 to 70 percent lower risk of heart attacks than women who don't. They also may be less susceptible to strokes, says Lawrence M. Brass, M.D., professor of neurology and co-director of the Yale Cerebrovascular Center at Yale University School of Medicine. That's important because women account for more than half of all strokes and 60 percent of stroke-related deaths. "We don't have conclusive evidence that estrogen does lower stroke risk. But there are more than 400 known effects of estrogen in the body, many of which could contribute to a better outcome for this disease," Dr. Brass says. Estrogen may diminish the chances of a stroke or a recurrence by lowering blood cholesterol levels, slowing atherosclerosis, dilating blood vessels, or preventing blot clots, Dr. Brass says. The Women's Estrogen for Stroke Trial, a study being conducted by Yale University researchers of 652 postmenopausal women who use the hormone, may unravel some of the mystery in the near future, Dr. Brass says. If estrogen is proven to reduce stroke risk among women, it also may have the same preventive effects for men, he says. If you've had a stroke, it is worthwhile to ask your doctor about taking estrogen to reduce your risk of recurrence, Dr. Brass suggests. |
Rehabilitation Is a Lifetime Job
Although rehabilitation probably won't directly lower your risk of a subsequent stroke, it can vastly improve the quality of your life and help keep you more active.
Dr. Senelick says that exercise, along with other lifestyle changes like quitting smoking, can lessen your risk factors—such as hypertension, diabetes, or obesity—as well as reduce your chances of having another stroke.
That's why it is important to keep the muscles in the affected area of your body well toned even after rehabilitation ends, says Matthew Lee, M.D., medical director of the Rusk Institute of Rehabilitation Medicine at New York University Medical Center in New York City.
"If you don't do the exercises recommended for you, if you don't maintain what flexibility you've gained during rehabilitation, you're going to lose it. Your movements are going to get tighter and tighter, and eventually you may not be able to put a shirt or pair of pants on again. What's going to be affected is your quality of life," says Dr. Lee, co-author of Recovering at Home after a Stroke.
In addition to walking, strength training, or any other regular exercise you can get, the daily arm and leg toning regimen on the following pages is suggested by Regina Kelly, a physical therapist at Kessler Institute for Rehabilitation in West Orange, New Jersey. If you have recently had a stroke, be sure to check with your doctor before starting any exercise program.
Do one set (10 repetitions) of each exercise. Then rest for 1 minute, or until you feel able to continue, and do two more sets of 10 with rest periods in between. Switch sides where appropriate and then repeat the cycle.
Wear comfortable, loose-fitting clothing and do these exercises slowly and smoothly. Count out loud during your workout, says Kelly. Saying numbers aloud will require you to breathe normally, while helping to keep track of your reps.
Prescription for Prevention
With therapy, many people can regain use of the arms, legs, and speech after a stroke. Strokes are often provoked by many of the same lifelong habits—smoking, sedentary living, high-fat eating—that trigger heart attacks. But modifications in lifestyle can diminish your chances of having a recurrence.
Do:
* Exercise. Walking and other activities will help lower blood pressure, a major risk factor for stroke.
* Season foods with herbs instead of salt. Excess sodium can drive up blood pressure in some people who are salt-sensitive.
* Quit smoking. Lighting up doubles your chances of having another stroke.
* Continue practicing the exercises your physical therapist or doctor has recommended for you.
Don't:
* Drink too much alcohol. In excess, alcohol increases your risk of stroke. Limit yourself to no more than two drinks a day.
* Reach for salt substitutes. Many are made with potassium chloride, which can cause irregular heart rhythms in some people over age 60.
* Shy away from intimacy. Sex can boost your self-esteem. It is unlikely to cause a stroke.
* Give up.
UPPER -BODY EXERCISES
 | Making Fists Curl your fingers, beginning at the tips, and make a fist. Uncurl your fingers, completely straightening and spreading them. You can work both hands at once or alternate sides. |
Wrist Flexions To strengthen your wrist, sit in a chair and rest the forearm of your left hand on a table placed beside you, with your wrist extending over the edge, palm down. Bending at the wrist, raise the hand up and down, leaving your forearm on the table. Do three sets, rest, then turn your palm up and repeat. Switch arms.
Sitting Push-ups To strengthen your triceps muscle, sit on a firm surface like the edge of a bed and lean to one side. Support your weight with your bent elbow and forearm. Now push up so that your weight is on your hand and your arm is straight. Slowly lower yourself again and repeat for three sets. Switch sides.
Elbow Extensions Lie on your back on a firm bed. Touch your left hand to the opposite shoulder. Your elbow should be pointing toward the ceiling. Raise your hand slowly toward the ceiling until your arm is straight. Then lower your hand to the starting position. Do three sets with rest periods in between. Repeat with your other arm.
Biceps Curls This exercise can be done lying down, sitting, or standing. Begin with your arms straight and at your sides. Bend your left elbow, bringing your left hand toward your left shoulder. Straighten your arm and repeat for three sets. Rest, then switch sides.
Shoulder Squeezes To improve your posture and strengthen your back muscles, stand or sit straight and tall. Tuck your chin in and relax your arms. Pull your shoulders back and squeeze your shoulder blades together. Try to get your elbows as close together as possible behind your back. If you're sitting, you can bend your elbows slightly as you draw your arms back. Otherwise, try to keep your arms straight. Relax and repeat for three sets.
LOWER-BODY EXERCISES
Heel Slides On a firm bed, lie on your back with your legs straight. Bend your left leg at the hip and knee, sliding your heel up toward your buttocks. Your knee should eventually point toward the ceiling. Hold for a count of five, then return to the starting position. Do three sets with rest periods in between. Repeat with your other leg.
Leg Slides Lying on your back with your legs straight, slide your left leg out to the side. Keep the leg straight and toes pointed up. Don't lift the leg, just slide it. (As you get stronger, you can try lifting your leg up slightly as you swing it out.) Return to starting position and repeat. Do three sets with each leg.
More Leg Work Lie on your back on a firm bed with knees bent and feet flat. Keeping your knees bent, slowly lower your left knee out to the side as far as possible. Return to starting position. Repeat for three sets. Rest, then switch legs.
Bottom Lifts To strengthen your buttocks, lie on your back on a firm bed with your legs together and your knees bent and pointing toward the ceiling. Your feet should be flat on the bed. Using your arms for leverage, if necessary, lift your bottom as high as possible. Don¹t forget to breathe regularly. Slowly lower, then repeat for three sets.
Knee Extensions Lie on your back with a pillow or large towel rolled under your knees. Slowly lift one foot up a couple of inches. The back of your knee should remain on the pillow and your leg should become as straight as possible. Slowly lower and repeat for three sets. Rest, then switch legs.
DISCLAIMER:
This book is intended as a reference volume only, not as a medical manual. The information given here is designed to help you make informed decisions about your health. It is not intended as a substitute for any treatment that may have been prescribed by your doctor. If you suspect that you have a medical problem, we urge you to seek competent medical help.
