Thursday, December 13, 2007
Sunday, March 18, 2007
Stroke
Introduction
A stroke occurs when the blood supply to a part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within a few minutes, brain cells begin to die.
Stroke is a medical emergency. Prompt treatment of a stroke could mean the difference between life and death. Early treatment can also minimize damage to your brain and potential disability.
In the United States, stroke is a leading cause of adult disability and the third-leading cause of death; only heart disease and cancer cause more deaths annually.
The good news is that many fewer Americans now die of strokes than was the case 20 or 30 years ago. Improvement in the control of major risk factors for stroke — smoking, high blood pressure and high cholesterol — is likely responsible for the decline.
Signs and symptoms
Knowing the signs and symptoms of a stroke may make it possible for you or someone you know to get prompt treatment. The signs and symptoms of stroke usually occur suddenly; frequently there's more than one. Signs and symptoms include:
Sudden numbness, weakness, or paralysis of your face, arm or leg — usually on one side of your body
Sudden difficulty speaking or understanding speech (aphasia)
Sudden blurred, double or decreased vision
Sudden dizziness, loss of balance or loss of coordination
A sudden, severe "bolt out of the blue" headache or an unusual headache, which may be accompanied by a stiff neck, facial pain, pain between your eyes, vomiting or altered consciousness
Confusion, or problems with memory, spatial orientation or perception
For most people, a stroke gives no warning. But one possible sign of an impending stroke is a transient ischemic attack (TIA). A TIA is a temporary interruption of blood flow to a part of your brain.
The signs and symptoms of TIA are the same as for a stroke, but they last for a shorter period — several minutes to 24 hours — and then disappear, without leaving apparent permanent effects. You may have more than one TIA, and the recurrent signs and symptoms may be similar or different.
A TIA indicates a serious underlying risk that a full-blown stroke may follow. People who have had a TIA are much more likely to have a stroke as are those who haven't had a TIA.
Causes
A stroke is sometimes called a brain attack. The problem is with the amount of blood in your brain. The cause of one type of stroke — ischemic stroke — is too little blood in the brain. The cause of the other main type of stroke — hemorrhagic stroke — is too much blood within the skull.
Ischemic stroke About 80 percent of strokes are ischemic strokes. They occur when blood clots or other particles block arteries to your brain and cause severely reduced blood flow (ischemia). This deprives your brain cells of oxygen and nutrients, and cells may begin to die within minutes. The most common ischemic strokes are:
Thrombotic stroke. This type of stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot usually forms in areas damaged by atherosclerosis — a disease in which the arteries are clogged by an accumulation of cholesterol-containing fatty deposits (plaques). This process can occur within one of the two carotid (kuh-ROT-id) arteries of your neck that carry blood to your brain, as well as in other arteries. An ischemic stroke may also be caused by plaques that completely clog or markedly narrow an artery. This narrowing is called stenosis.
Embolic stroke. An embolic stroke occurs when a blood clot or other particle forms in a blood vessel away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus. It's often caused by irregular beating in the heart's two upper chambers (atrial fibrillation). This abnormal heart rhythm can lead to poor blood flow and the formation of a blood clot.
Hemorrhagic stroke "Hemorrhage" is the medical word for bleeding. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Hemorrhages can result from a number of conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). A less common cause of hemorrhage is the rupture of an arteriovenous malformation (AVM) — a malformed tangle of thin-walled blood vessels, present at birth. There are two types of hemorrhagic stroke:
Intracerebral hemorrhage. In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging cells. Brain cells beyond the leak are deprived of blood and are also damaged. High blood pressure is the most common cause of this type of hemorrhagic stroke. High blood pressure can cause small arteries inside your brain to become brittle and susceptible to cracking and rupture.
Subarachnoid hemorrhage. In this type of stroke, bleeding starts in a large artery on or near the membrane surrounding the brain and spills into the space between the surface of your brain and your skull. A subarachnoid hemorrhage is often signaled by a sudden, severe "thunderclap" headache. This type of stroke is commonly caused by the rupture of an aneurysm, which can develop with age or result from a genetic predisposition. After a subarachnoid hemorrhage, vessels may go into vasospasm, a condition in which arteries near the hemorrhage constrict erratically, causing brain cell damage by further restricting or blocking blood flow to portions of the brain.
A stroke occurs when the blood supply to a part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within a few minutes, brain cells begin to die.
Stroke is a medical emergency. Prompt treatment of a stroke could mean the difference between life and death. Early treatment can also minimize damage to your brain and potential disability.
In the United States, stroke is a leading cause of adult disability and the third-leading cause of death; only heart disease and cancer cause more deaths annually.
The good news is that many fewer Americans now die of strokes than was the case 20 or 30 years ago. Improvement in the control of major risk factors for stroke — smoking, high blood pressure and high cholesterol — is likely responsible for the decline.
Signs and symptoms
Knowing the signs and symptoms of a stroke may make it possible for you or someone you know to get prompt treatment. The signs and symptoms of stroke usually occur suddenly; frequently there's more than one. Signs and symptoms include:
Sudden numbness, weakness, or paralysis of your face, arm or leg — usually on one side of your body
Sudden difficulty speaking or understanding speech (aphasia)
Sudden blurred, double or decreased vision
Sudden dizziness, loss of balance or loss of coordination
A sudden, severe "bolt out of the blue" headache or an unusual headache, which may be accompanied by a stiff neck, facial pain, pain between your eyes, vomiting or altered consciousness
Confusion, or problems with memory, spatial orientation or perception
For most people, a stroke gives no warning. But one possible sign of an impending stroke is a transient ischemic attack (TIA). A TIA is a temporary interruption of blood flow to a part of your brain.
The signs and symptoms of TIA are the same as for a stroke, but they last for a shorter period — several minutes to 24 hours — and then disappear, without leaving apparent permanent effects. You may have more than one TIA, and the recurrent signs and symptoms may be similar or different.
A TIA indicates a serious underlying risk that a full-blown stroke may follow. People who have had a TIA are much more likely to have a stroke as are those who haven't had a TIA.
Causes
A stroke is sometimes called a brain attack. The problem is with the amount of blood in your brain. The cause of one type of stroke — ischemic stroke — is too little blood in the brain. The cause of the other main type of stroke — hemorrhagic stroke — is too much blood within the skull.
Ischemic stroke About 80 percent of strokes are ischemic strokes. They occur when blood clots or other particles block arteries to your brain and cause severely reduced blood flow (ischemia). This deprives your brain cells of oxygen and nutrients, and cells may begin to die within minutes. The most common ischemic strokes are:
Thrombotic stroke. This type of stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot usually forms in areas damaged by atherosclerosis — a disease in which the arteries are clogged by an accumulation of cholesterol-containing fatty deposits (plaques). This process can occur within one of the two carotid (kuh-ROT-id) arteries of your neck that carry blood to your brain, as well as in other arteries. An ischemic stroke may also be caused by plaques that completely clog or markedly narrow an artery. This narrowing is called stenosis.
Embolic stroke. An embolic stroke occurs when a blood clot or other particle forms in a blood vessel away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus. It's often caused by irregular beating in the heart's two upper chambers (atrial fibrillation). This abnormal heart rhythm can lead to poor blood flow and the formation of a blood clot.
Hemorrhagic stroke "Hemorrhage" is the medical word for bleeding. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Hemorrhages can result from a number of conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). A less common cause of hemorrhage is the rupture of an arteriovenous malformation (AVM) — a malformed tangle of thin-walled blood vessels, present at birth. There are two types of hemorrhagic stroke:
Intracerebral hemorrhage. In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging cells. Brain cells beyond the leak are deprived of blood and are also damaged. High blood pressure is the most common cause of this type of hemorrhagic stroke. High blood pressure can cause small arteries inside your brain to become brittle and susceptible to cracking and rupture.
Subarachnoid hemorrhage. In this type of stroke, bleeding starts in a large artery on or near the membrane surrounding the brain and spills into the space between the surface of your brain and your skull. A subarachnoid hemorrhage is often signaled by a sudden, severe "thunderclap" headache. This type of stroke is commonly caused by the rupture of an aneurysm, which can develop with age or result from a genetic predisposition. After a subarachnoid hemorrhage, vessels may go into vasospasm, a condition in which arteries near the hemorrhage constrict erratically, causing brain cell damage by further restricting or blocking blood flow to portions of the brain.
Ischemic stroke occurs when a blood clot (thrombus) blocks or plugs an artery leading to the brain. A blood clot often forms in arteries damaged by buildup of plaques (atherosclerosis). It can occur in the carotid artery of the neck as well as other arteries.
Risk factors
Many factors can increase your risk of a stroke. A number of these factors can also increase your chances of having a heart attack. They include:
Family history. Your risk of stroke is slightly greater if one of your parents or a brother or sister has had a stroke or TIA.
Age. Your risk of stroke increases as you get older.
Sex. Stroke affects men and women about equally, but women are more likely to die of stroke than are men.
Race. Blacks are at greater risk of stroke than are people of other races. This is partly due to a higher prevalence of high blood pressure and diabetes.
High blood pressure (hypertension). High blood pressure is a risk factor for both ischemic and hemorrhagic strokes. It can weaken and damage blood vessels in and around your brain, leaving them vulnerable to atherosclerosis and hemorrhage.
Undesirable levels of blood cholesterol. High levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, may increase your risk of atherosclerosis. In excess, LDLs and other materials build up on the lining of artery walls, where they may harden into plaques. High levels of triglycerides, a blood fat, also may increase your risk of atherosclerosis. In contrast, high levels of high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, reduce your risk of atherosclerosis by escorting cholesterol out of your body through your liver.
Cigarette smoking. Smokers have a much higher risk of stroke than do nonsmokers. Smoking contributes to plaques in your arteries. Nicotine makes your heart work harder by increasing your heart rate and blood pressure. The carbon monoxide in cigarette smoke replaces oxygen in your blood, decreasing the amount of oxygen delivered to the walls of your arteries and your tissues, including the tissues in your brain.
Diabetes. Diabetes is a major risk factor for stroke. When you have diabetes, your body not only can't handle glucose appropriately, but it also can't process fats efficiently, and you're at greater risk of high blood pressure. These diabetes-related effects increase your risk of developing atherosclerosis. Diabetes also interferes with your body's ability to break down blood clots, increasing your risk of ischemic stroke.
Obesity. Being overweight increases your chance of developing high blood pressure, heart disease, atherosclerosis and diabetes — all of which increase your risk of a stroke.
Cardiovascular disease. Several cardiovascular diseases can increase your risk of a stroke, including congestive heart failure, a previous heart attack, an infection of a heart valve (endocarditis), a particular type of abnormal heart rhythm (atrial fibrillation), aortic or mitral valve disease, valve replacement, or a hole in the upper chambers of the heart known as patent foramen ovale. Atrial fibrillation is the most common condition associated with strokes caused by embolic clots. In addition, atherosclerosis in blood vessels near your heart may indicate that you have atherosclerosis in other blood vessels — including those in and around your brain.
Previous stroke or TIA. If you've already had a stroke, your risk of having another one increases. In addition, people who have had a TIA are much more likely to have a stroke as are those who haven't had a TIA.
Elevated homocysteine level. This amino acid, a building block of proteins, occurs naturally in your blood. But people with elevated levels of homocysteine have a higher risk of heart and blood vessel damage.
Use of birth control pills and hormone therapy. The risk of stroke is higher among women who take birth control pills, especially among smokers and those older than 35. However, today's low-dose pills carry a much lower risk than their earlier counterparts. Hormone therapy for menopause also carries a slightly increased risk of stroke.
Other factors that can increase your risk of stroke include heavy or binge drinking, the use of illicit drugs such as cocaine, and uncontrolled stress.
When to seek medical advice
If you notice any signs or symptoms of a stroke or TIA, get medical help right away. A TIA may seem like a passing event. But it is an important warning sign — and a chance to take steps that may prevent a stroke.
If someone appears to be having a stroke, watch the person carefully while waiting for an ambulance. You may need to take additional actions in the following situations:
If breathing ceases, begin resuscitation.
If vomiting occurs, turn the person's head to the side. This can prevent choking.
Don't let the person eat or drink anything.
Every minute counts when it comes to treating a stroke or TIA. Don't wait to see if the signs and symptoms go away. The longer a stroke goes untreated, the greater the damage and potential disability. The success of most treatments depends on how soon a person is seen by a doctor in a hospital emergency room after signs and symptoms begin.
Screening and diagnosis
If you've had a previous stroke or TIA or think you're at risk of stroke, talk with your doctor about screening and diagnostic tests.
Before treating a stroke, your doctor must diagnose the type of stroke and its location. Other possible causes of your symptoms, such as a tumor, also need to be excluded.
The following are most often used as screening tools to determine your risk, but they may also be used as diagnostic tools if you're having a stroke:
Physical examination and tests. Your doctor may check for risk factors of stroke, including high blood pressure, high cholesterol levels, diabetes and elevated levels of the amino acid homocysteine. Your doctor may also use a stethoscope to listen for a whooshing sound (bruit) over your arteries that may indicate atherosclerosis.
Carotid ultrasonography. In this procedure, a wand-like device (transducer) sends high-frequency sound waves into your neck. The sound waves pass through tissue and then return, creating on-screen images that delineate any narrowing or clotting in your carotid arteries.
Arteriography. This procedure gives a view of arteries in your brain not normally seen in X-rays. Your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is manipulated through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye through the catheter to provide X-ray images of your arteries.
Computerized tomography (CT). In computerized tomographic angiography (CTA), a dye is injected into your vein and X-ray beams create a three-dimensional image of the blood vessels in your neck and brain. Doctors use CTA to look for aneurysms or arteriovenous malformations and to evaluate arteries for narrowing. CT scanning, which is done without dye, can provide images of your brain and show hemorrhages, but without as much detailed information about the blood vessels.
Magnetic resonance imaging (MRI). Using a strong magnetic field, an MRI can generate a three-dimensional view of your brain. This test is sensitive for detecting an area of brain tissue damaged by an ischemic stroke. Magnetic resonance angiography (MRA) uses this magnetic field and a dye injected into your veins to evaluate arteries in your neck and brain.
Echocardiography. Your doctor can use this ultrasound technology to compose images of your heart. He or she may also use transesophageal echocardiography (TEE). During this procedure, a flexible probe with a transducer built into it is placed in your esophagus — the tube that connects the back of your mouth to your stomach. Because your esophagus is directly behind your heart, very clear, detailed ultrasound images can be created, allowing a better view of some things, such as blood clots, that might not be seen clearly in a traditional echocardiography exam.
Treatment
Getting prompt medical treatment for stroke is of utmost importance. Treatment itself depends on the type of stroke.
Ischemic stroke To treat an ischemic stroke, doctors must remove any obstruction and restore blood flow to your brain.
Emergency treatment. Therapy with clot-busting drugs must start within three hours. Quick treatment not only improves your chances of survival, but may also reduce the amount of disability resulting from the stroke.
Injection of a clot-busting (thrombolytic) drug — such as a tissue plasminogen activator (TPA) — into your veins to dissolve a blood clot may be more effective in increasing your chances of a full recovery, compared with other treatment methods. Currently, though, only a small proportion of Americans who have had a stroke receive thrombolytic therapy. Reasons for this include:
A limited time window. Three hours has long been considered the window within which clot-busting drugs should be administered intravenously. Whether people can still gain some benefit from receiving clot-busting drugs beyond three hours is uncertain. After too much time has passed, the risks of bleeding or other complications from this type of therapy begin to outweigh the potential benefits.
A limited group of people who benefit from this therapy. TPA-type therapy doesn't treat hemorrhagic stroke. In fact, it may dramatically worsen a hemorrhagic stroke. Also, not everyone who has had an ischemic stroke is an ideal candidate for thrombolytic therapy. The ability of TPA-type agents to dissolve blood clots carries with it a risk of brain hemorrhage and bleeding elsewhere. With the diagnosis of an acute stroke, you and your doctor can work together to weigh the risks versus benefits of thrombolytic therapy in your individual case. Your doctor may not give you clot-busting medications if your blood pressure isn't controllable at the time when the TPA is being considered.
Surgical and other procedures. Your doctor may recommend a procedure to open up an artery that's moderately to severely narrowed by plaques. This may include:
Carotid endarterectomy. Your surgeon makes an incision in your neck to expose your carotid artery. The artery is opened, the plaques are removed, and your surgeon closes the artery. In people with marked blockages in the carotid artery who are candidates for the surgery, the procedure may reduce the risk of ischemic stroke. However, in addition to the usual risks associated with any surgery, a carotid endarterectomy itself can also trigger a stroke or heart attack by releasing a blood clot or fatty debris, although surgeons now place filters (distal protection devices) at strategic points in your bloodstream to "catch" any material that may break free during the procedure.
Angioplasty. Used less commonly than carotid endarterectomy, angioplasty can widen the inside of an artery leading to your brain, usually the carotid artery. In this procedure, a balloon-tipped catheter is maneuvered into the obstructed area of your artery. The balloon is inflated, compressing the plaques against your artery walls. A metallic mesh tube (stent) is usually left in the artery to prevent recurrent narrowing. Distal protection devices also may be used with angioplasty.
Other techniques. Doctors are also exploring new ways to remove clots. In a catheter embolectomy, a catheter is threaded into one of the arteries that lead to the brain and used to remove clots. You may also receive thrombolytic drugs directly into these arteries, via a catheter.
Preventive medications. If you've had an ischemic stroke, it's important to determine why the stroke occurred and to prevent another. Your doctor may recommend medications to help reduce your risk of having a TIA or stroke. These include:
Anti-platelet drugs. Platelets are cells in your blood that initiate clots. Anti-platelet drugs make your platelets less sticky and less likely to clot. The most frequently used anti-platelet medication is aspirin. Your doctor may also consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. If aspirin doesn't prevent your TIA or stroke or if you can't take aspirin, your doctor may instead prescribe an anti-platelet drug such as clopidogrel (Plavix) or ticlopidine (Ticlid).
Anticoagulants. These drugs include heparin and warfarin (Coumadin). They affect the clotting mechanism in a different manner than do anti-platelet medications. Heparin is fast acting and is used over the short term in the hospital. Slower acting warfarin is used over a longer term. These drugs have a profound effect on blood clotting and require that you work with your doctor to monitor them closely. Your doctor may prescribe these drugs if you have certain blood-clotting disorders, certain arterial abnormalities, an abnormal heart rhythm, such as atrial fibrillation, or other heart problems.
Hemorrhagic stroke Surgery may be used to treat a hemorrhagic stroke or prevent another one. The most common procedures — aneurysm clipping and arteriovenous malformation (AVM) removal — carry some risks. Your doctor may recommend one of these procedures if you're at high risk of spontaneous aneurysm or AVM rupture:
Aneurysm clipping. A tiny clamp is placed at the base of the aneurysm, isolating it from the circulation of the artery to which it's attached. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
Coiling (aneurysm embolization). In an embolization procedure, a catheter is maneuvered into the aneurysm. A tiny platinum coil is pushed through the catheter and positioned inside the aneurysm. The coil fills the aneurysm, causing clotting and sealing the aneurysm off from connecting arteries.
Surgical AVM removal. It's not always possible to remove an AVM if it's too large or if it's located deep within the brain. Surgical removal of a smaller AVM from a more accessible portion of the brain, though, can eliminate the risk of rupture, lowering the overall risk of hemorrhagic stroke. Other treatment options for AVMs include focused radiation or embolization, in which the small arteries supplying the blood to the AVM are blocked, shrinking the AVM.
Recovery and rehabilitation Stroke survivors who can go home to a healthy spouse or other companion are more likely to become independent and productive again. Encouragement and early treatment are important.
Recovery and rehabilitation depend on the area of the brain involved and the amount of tissue damaged. Harm to the right side of the brain may impair movement and sensation on the left side of the body. Damage to brain tissue on the left side may affect movement on the right side; this damage may also cause speech and language disorders. In addition, people who've had a stroke may have problems with breathing, swallowing, balancing and hearing, and loss of vision and bladder or bowel function.
Because numerous impairments may be involved, rehabilitation is facilitated by a diverse team, which may include a:
Rehabilitation doctor (physiatrist)
Nurse
Dietitian
Physical therapist
Occupational therapist
Recreational therapist
Speech therapist
Social worker
Psychologist or psychiatrist
Chaplain
The goal of rehabilitation is to help you recover as much of your independence and functioning as possible. Much of rehabilitation involves relearning skills you may have lost, such as walking or communicating.
With advances in research and brain-imaging techniques, doctors are gaining a new understanding of how brain systems adapt after stroke to regain function (brain plasticity). Research suggests that normal brain cells are highly adaptable and can undergo changes in function and shape that allow them to take on the functions of nearby damaged cells. As a result, rehabilitation efforts are being geared toward retraining unaffected brain tissue to compensate for the lost functions of damaged tissue.
Prevention
Knowing your risk factors and living healthfully are the best steps you can take to prevent a stroke. In general, a healthy lifestyle means that you:
Control high blood pressure (hypertension). One of the most important things you can do to reduce your stroke risk is to keep your blood pressure under control. If you've had a stroke, lowering your blood pressure can help prevent a subsequent transient ischemic attack or stroke. Exercising, managing stress, maintaining a healthy weight, and limiting sodium and alcohol intake are all ways to keep hypertension in check. In addition to recommendations for lifestyle changes, your doctor may prescribe medications to treat hypertension, such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers.
Lower your cholesterol and saturated fat intake. Eating less cholesterol and fat, especially saturated fat, may reduce the plaques in your arteries. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.
Don't smoke. Quitting smoking reduces your risk of stroke. Several years after quitting, a former smoker's risk of stroke is the same as that of a nonsmoker.
Control diabetes. You can manage diabetes with diet, exercise, weight control and medication. Strict control of your blood sugar may reduce damage to your brain if you do have a stroke.
Maintain a healthy weight. Being overweight contributes to other risk factors for stroke, such as high blood pressure, cardiovascular disease and diabetes. Weight loss of as little as 10 pounds may lower your blood pressure and improve your cholesterol levels.
Exercise regularly. Aerobic exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of HDL cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.
Manage stress. Stress can cause a temporary spike in your blood pressure — a risk factor for brain hemorrhage — or long-lasting hypertension. It can also increase your blood's tendency to clot, which may elevate your risk of ischemic stroke. Simplifying your life, exercising and using relaxation techniques are all approaches that you can learn to reduce stress.
Drink alcohol in moderation, if at all. Alcohol can be both a risk factor and a preventive measure for stroke. Binge drinking and heavy alcohol consumption increase your risk of high blood pressure and of ischemic and hemorrhagic strokes. However, drinking small to moderate amounts of alcohol can increase your HDL cholesterol and decrease your blood's clotting tendency. Both factors can contribute to a reduced risk of ischemic stroke.
Don't use illicit drugs. Many street drugs, such as cocaine and crack cocaine, are established risk factors for a TIA or a stroke.
Follow a healthy diet In addition, eat healthy foods. A brain-healthy diet should include:
Five or more daily servings of fruits and vegetables, which contain nutrients such as potassium, folate and antioxidants that may protect you against stroke.
Foods rich in soluble fiber, such as oatmeal and beans.
Foods rich in calcium, a mineral found to reduce stroke risk.
Soy products, such as tempeh, miso, tofu and soy milk, which can reduce your LDL cholesterol and raise your HDL cholesterol level.
Foods rich in omega-3 fatty acids, including cold-water fish, such as salmon, mackerel and tuna. However, pregnant women and women who plan to become pregnant in the next several years should limit their weekly intake of cold-water fish because of the potential for mercury contamination.
You obviously can't change some risk factors for a stroke — family history, age, sex and race. But knowing you're at risk can motivate you to change your lifestyle to reduce other risks. First-time heart attacks and strokes are often fatal or disabling; therefore, prevention is critical. The American Heart Association (AHA) recommends:
Early risk factor screening. The AHA recommends that all people, beginning at age 20, undergo risk factor screening that includes recording blood pressure, body mass index, waist circumference and pulse at least every two years, and cholesterol and glucose testing at least every five years.
Risk estimation. The AHA recommends that doctors estimate each person's percentage risk of developing cardiovascular disease within the next 10 years. The estimate would be based on the risk factor screening. The AHA recommends estimation of risk every five years for people age 40 or older, or for anyone with two or more risk factors.
Coping skills
Recovering from a stroke can be mentally exhausting. In addition to the various physical side effects, feelings of helplessness, frustration, depression and apathy aren't unusual. Diminished sex drive and mood changes are also common.
The rate and amount of recovery after stroke is highly individualized. Much depends on the extent of damage to your brain, and the intensity and duration of the therapy you receive. But your recovery also is likely to be influenced by your personality, life experiences and coping styles. Your own motivation to recover is a key factor in obtaining an optimal level of rehabilitation.
If someone close to you has had a stroke, you can play an important role in the recovery process by offering companionship and support. Here are some tips to help you communicate with someone whose speech has been affected by a stroke:
Stay in touch. Your friend or family member needs you but might not be able to tell you so. Make an effort to be there.
Keep conversation at an adult level. Address stroke survivors directly and don't talk down to them. Treat them just as you did before the stroke. Because someone has had a stroke doesn't mean he or she can't think anymore.
Use a normal tone of voice. Unless there's a hearing loss, you don't need to speak more loudly than usual.
Speak at a comfortable pace. Allow time for your words to be processed. Try to talk about only one topic at a time.
Avoid distractions. Reduce background noise and distractions from TVs, radios and physical activities.
Talk one-on-one. A stroke survivor may understand best when the conversation includes fewer people.
Keep caregivers in mind. They need support and friendship, too. Include them in your thoughts and plans.
Although stroke-related disabilities can be permanent, many people lead active lives after a stroke. Many are able to resume everyday life and responsibilities.
Risk factors
Many factors can increase your risk of a stroke. A number of these factors can also increase your chances of having a heart attack. They include:
Family history. Your risk of stroke is slightly greater if one of your parents or a brother or sister has had a stroke or TIA.
Age. Your risk of stroke increases as you get older.
Sex. Stroke affects men and women about equally, but women are more likely to die of stroke than are men.
Race. Blacks are at greater risk of stroke than are people of other races. This is partly due to a higher prevalence of high blood pressure and diabetes.
High blood pressure (hypertension). High blood pressure is a risk factor for both ischemic and hemorrhagic strokes. It can weaken and damage blood vessels in and around your brain, leaving them vulnerable to atherosclerosis and hemorrhage.
Undesirable levels of blood cholesterol. High levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, may increase your risk of atherosclerosis. In excess, LDLs and other materials build up on the lining of artery walls, where they may harden into plaques. High levels of triglycerides, a blood fat, also may increase your risk of atherosclerosis. In contrast, high levels of high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, reduce your risk of atherosclerosis by escorting cholesterol out of your body through your liver.
Cigarette smoking. Smokers have a much higher risk of stroke than do nonsmokers. Smoking contributes to plaques in your arteries. Nicotine makes your heart work harder by increasing your heart rate and blood pressure. The carbon monoxide in cigarette smoke replaces oxygen in your blood, decreasing the amount of oxygen delivered to the walls of your arteries and your tissues, including the tissues in your brain.
Diabetes. Diabetes is a major risk factor for stroke. When you have diabetes, your body not only can't handle glucose appropriately, but it also can't process fats efficiently, and you're at greater risk of high blood pressure. These diabetes-related effects increase your risk of developing atherosclerosis. Diabetes also interferes with your body's ability to break down blood clots, increasing your risk of ischemic stroke.
Obesity. Being overweight increases your chance of developing high blood pressure, heart disease, atherosclerosis and diabetes — all of which increase your risk of a stroke.
Cardiovascular disease. Several cardiovascular diseases can increase your risk of a stroke, including congestive heart failure, a previous heart attack, an infection of a heart valve (endocarditis), a particular type of abnormal heart rhythm (atrial fibrillation), aortic or mitral valve disease, valve replacement, or a hole in the upper chambers of the heart known as patent foramen ovale. Atrial fibrillation is the most common condition associated with strokes caused by embolic clots. In addition, atherosclerosis in blood vessels near your heart may indicate that you have atherosclerosis in other blood vessels — including those in and around your brain.
Previous stroke or TIA. If you've already had a stroke, your risk of having another one increases. In addition, people who have had a TIA are much more likely to have a stroke as are those who haven't had a TIA.
Elevated homocysteine level. This amino acid, a building block of proteins, occurs naturally in your blood. But people with elevated levels of homocysteine have a higher risk of heart and blood vessel damage.
Use of birth control pills and hormone therapy. The risk of stroke is higher among women who take birth control pills, especially among smokers and those older than 35. However, today's low-dose pills carry a much lower risk than their earlier counterparts. Hormone therapy for menopause also carries a slightly increased risk of stroke.
Other factors that can increase your risk of stroke include heavy or binge drinking, the use of illicit drugs such as cocaine, and uncontrolled stress.
When to seek medical advice
If you notice any signs or symptoms of a stroke or TIA, get medical help right away. A TIA may seem like a passing event. But it is an important warning sign — and a chance to take steps that may prevent a stroke.
If someone appears to be having a stroke, watch the person carefully while waiting for an ambulance. You may need to take additional actions in the following situations:
If breathing ceases, begin resuscitation.
If vomiting occurs, turn the person's head to the side. This can prevent choking.
Don't let the person eat or drink anything.
Every minute counts when it comes to treating a stroke or TIA. Don't wait to see if the signs and symptoms go away. The longer a stroke goes untreated, the greater the damage and potential disability. The success of most treatments depends on how soon a person is seen by a doctor in a hospital emergency room after signs and symptoms begin.
Screening and diagnosis
If you've had a previous stroke or TIA or think you're at risk of stroke, talk with your doctor about screening and diagnostic tests.
Before treating a stroke, your doctor must diagnose the type of stroke and its location. Other possible causes of your symptoms, such as a tumor, also need to be excluded.
The following are most often used as screening tools to determine your risk, but they may also be used as diagnostic tools if you're having a stroke:
Physical examination and tests. Your doctor may check for risk factors of stroke, including high blood pressure, high cholesterol levels, diabetes and elevated levels of the amino acid homocysteine. Your doctor may also use a stethoscope to listen for a whooshing sound (bruit) over your arteries that may indicate atherosclerosis.
Carotid ultrasonography. In this procedure, a wand-like device (transducer) sends high-frequency sound waves into your neck. The sound waves pass through tissue and then return, creating on-screen images that delineate any narrowing or clotting in your carotid arteries.
Arteriography. This procedure gives a view of arteries in your brain not normally seen in X-rays. Your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is manipulated through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye through the catheter to provide X-ray images of your arteries.
Computerized tomography (CT). In computerized tomographic angiography (CTA), a dye is injected into your vein and X-ray beams create a three-dimensional image of the blood vessels in your neck and brain. Doctors use CTA to look for aneurysms or arteriovenous malformations and to evaluate arteries for narrowing. CT scanning, which is done without dye, can provide images of your brain and show hemorrhages, but without as much detailed information about the blood vessels.
Magnetic resonance imaging (MRI). Using a strong magnetic field, an MRI can generate a three-dimensional view of your brain. This test is sensitive for detecting an area of brain tissue damaged by an ischemic stroke. Magnetic resonance angiography (MRA) uses this magnetic field and a dye injected into your veins to evaluate arteries in your neck and brain.
Echocardiography. Your doctor can use this ultrasound technology to compose images of your heart. He or she may also use transesophageal echocardiography (TEE). During this procedure, a flexible probe with a transducer built into it is placed in your esophagus — the tube that connects the back of your mouth to your stomach. Because your esophagus is directly behind your heart, very clear, detailed ultrasound images can be created, allowing a better view of some things, such as blood clots, that might not be seen clearly in a traditional echocardiography exam.
Treatment
Getting prompt medical treatment for stroke is of utmost importance. Treatment itself depends on the type of stroke.
Ischemic stroke To treat an ischemic stroke, doctors must remove any obstruction and restore blood flow to your brain.
Emergency treatment. Therapy with clot-busting drugs must start within three hours. Quick treatment not only improves your chances of survival, but may also reduce the amount of disability resulting from the stroke.
Injection of a clot-busting (thrombolytic) drug — such as a tissue plasminogen activator (TPA) — into your veins to dissolve a blood clot may be more effective in increasing your chances of a full recovery, compared with other treatment methods. Currently, though, only a small proportion of Americans who have had a stroke receive thrombolytic therapy. Reasons for this include:
A limited time window. Three hours has long been considered the window within which clot-busting drugs should be administered intravenously. Whether people can still gain some benefit from receiving clot-busting drugs beyond three hours is uncertain. After too much time has passed, the risks of bleeding or other complications from this type of therapy begin to outweigh the potential benefits.
A limited group of people who benefit from this therapy. TPA-type therapy doesn't treat hemorrhagic stroke. In fact, it may dramatically worsen a hemorrhagic stroke. Also, not everyone who has had an ischemic stroke is an ideal candidate for thrombolytic therapy. The ability of TPA-type agents to dissolve blood clots carries with it a risk of brain hemorrhage and bleeding elsewhere. With the diagnosis of an acute stroke, you and your doctor can work together to weigh the risks versus benefits of thrombolytic therapy in your individual case. Your doctor may not give you clot-busting medications if your blood pressure isn't controllable at the time when the TPA is being considered.
Surgical and other procedures. Your doctor may recommend a procedure to open up an artery that's moderately to severely narrowed by plaques. This may include:
Carotid endarterectomy. Your surgeon makes an incision in your neck to expose your carotid artery. The artery is opened, the plaques are removed, and your surgeon closes the artery. In people with marked blockages in the carotid artery who are candidates for the surgery, the procedure may reduce the risk of ischemic stroke. However, in addition to the usual risks associated with any surgery, a carotid endarterectomy itself can also trigger a stroke or heart attack by releasing a blood clot or fatty debris, although surgeons now place filters (distal protection devices) at strategic points in your bloodstream to "catch" any material that may break free during the procedure.
Angioplasty. Used less commonly than carotid endarterectomy, angioplasty can widen the inside of an artery leading to your brain, usually the carotid artery. In this procedure, a balloon-tipped catheter is maneuvered into the obstructed area of your artery. The balloon is inflated, compressing the plaques against your artery walls. A metallic mesh tube (stent) is usually left in the artery to prevent recurrent narrowing. Distal protection devices also may be used with angioplasty.
Other techniques. Doctors are also exploring new ways to remove clots. In a catheter embolectomy, a catheter is threaded into one of the arteries that lead to the brain and used to remove clots. You may also receive thrombolytic drugs directly into these arteries, via a catheter.
Preventive medications. If you've had an ischemic stroke, it's important to determine why the stroke occurred and to prevent another. Your doctor may recommend medications to help reduce your risk of having a TIA or stroke. These include:
Anti-platelet drugs. Platelets are cells in your blood that initiate clots. Anti-platelet drugs make your platelets less sticky and less likely to clot. The most frequently used anti-platelet medication is aspirin. Your doctor may also consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. If aspirin doesn't prevent your TIA or stroke or if you can't take aspirin, your doctor may instead prescribe an anti-platelet drug such as clopidogrel (Plavix) or ticlopidine (Ticlid).
Anticoagulants. These drugs include heparin and warfarin (Coumadin). They affect the clotting mechanism in a different manner than do anti-platelet medications. Heparin is fast acting and is used over the short term in the hospital. Slower acting warfarin is used over a longer term. These drugs have a profound effect on blood clotting and require that you work with your doctor to monitor them closely. Your doctor may prescribe these drugs if you have certain blood-clotting disorders, certain arterial abnormalities, an abnormal heart rhythm, such as atrial fibrillation, or other heart problems.
Hemorrhagic stroke Surgery may be used to treat a hemorrhagic stroke or prevent another one. The most common procedures — aneurysm clipping and arteriovenous malformation (AVM) removal — carry some risks. Your doctor may recommend one of these procedures if you're at high risk of spontaneous aneurysm or AVM rupture:
Aneurysm clipping. A tiny clamp is placed at the base of the aneurysm, isolating it from the circulation of the artery to which it's attached. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
Coiling (aneurysm embolization). In an embolization procedure, a catheter is maneuvered into the aneurysm. A tiny platinum coil is pushed through the catheter and positioned inside the aneurysm. The coil fills the aneurysm, causing clotting and sealing the aneurysm off from connecting arteries.
Surgical AVM removal. It's not always possible to remove an AVM if it's too large or if it's located deep within the brain. Surgical removal of a smaller AVM from a more accessible portion of the brain, though, can eliminate the risk of rupture, lowering the overall risk of hemorrhagic stroke. Other treatment options for AVMs include focused radiation or embolization, in which the small arteries supplying the blood to the AVM are blocked, shrinking the AVM.
Recovery and rehabilitation Stroke survivors who can go home to a healthy spouse or other companion are more likely to become independent and productive again. Encouragement and early treatment are important.
Recovery and rehabilitation depend on the area of the brain involved and the amount of tissue damaged. Harm to the right side of the brain may impair movement and sensation on the left side of the body. Damage to brain tissue on the left side may affect movement on the right side; this damage may also cause speech and language disorders. In addition, people who've had a stroke may have problems with breathing, swallowing, balancing and hearing, and loss of vision and bladder or bowel function.
Because numerous impairments may be involved, rehabilitation is facilitated by a diverse team, which may include a:
Rehabilitation doctor (physiatrist)
Nurse
Dietitian
Physical therapist
Occupational therapist
Recreational therapist
Speech therapist
Social worker
Psychologist or psychiatrist
Chaplain
The goal of rehabilitation is to help you recover as much of your independence and functioning as possible. Much of rehabilitation involves relearning skills you may have lost, such as walking or communicating.
With advances in research and brain-imaging techniques, doctors are gaining a new understanding of how brain systems adapt after stroke to regain function (brain plasticity). Research suggests that normal brain cells are highly adaptable and can undergo changes in function and shape that allow them to take on the functions of nearby damaged cells. As a result, rehabilitation efforts are being geared toward retraining unaffected brain tissue to compensate for the lost functions of damaged tissue.
Prevention
Knowing your risk factors and living healthfully are the best steps you can take to prevent a stroke. In general, a healthy lifestyle means that you:
Control high blood pressure (hypertension). One of the most important things you can do to reduce your stroke risk is to keep your blood pressure under control. If you've had a stroke, lowering your blood pressure can help prevent a subsequent transient ischemic attack or stroke. Exercising, managing stress, maintaining a healthy weight, and limiting sodium and alcohol intake are all ways to keep hypertension in check. In addition to recommendations for lifestyle changes, your doctor may prescribe medications to treat hypertension, such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers.
Lower your cholesterol and saturated fat intake. Eating less cholesterol and fat, especially saturated fat, may reduce the plaques in your arteries. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.
Don't smoke. Quitting smoking reduces your risk of stroke. Several years after quitting, a former smoker's risk of stroke is the same as that of a nonsmoker.
Control diabetes. You can manage diabetes with diet, exercise, weight control and medication. Strict control of your blood sugar may reduce damage to your brain if you do have a stroke.
Maintain a healthy weight. Being overweight contributes to other risk factors for stroke, such as high blood pressure, cardiovascular disease and diabetes. Weight loss of as little as 10 pounds may lower your blood pressure and improve your cholesterol levels.
Exercise regularly. Aerobic exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of HDL cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.
Manage stress. Stress can cause a temporary spike in your blood pressure — a risk factor for brain hemorrhage — or long-lasting hypertension. It can also increase your blood's tendency to clot, which may elevate your risk of ischemic stroke. Simplifying your life, exercising and using relaxation techniques are all approaches that you can learn to reduce stress.
Drink alcohol in moderation, if at all. Alcohol can be both a risk factor and a preventive measure for stroke. Binge drinking and heavy alcohol consumption increase your risk of high blood pressure and of ischemic and hemorrhagic strokes. However, drinking small to moderate amounts of alcohol can increase your HDL cholesterol and decrease your blood's clotting tendency. Both factors can contribute to a reduced risk of ischemic stroke.
Don't use illicit drugs. Many street drugs, such as cocaine and crack cocaine, are established risk factors for a TIA or a stroke.
Follow a healthy diet In addition, eat healthy foods. A brain-healthy diet should include:
Five or more daily servings of fruits and vegetables, which contain nutrients such as potassium, folate and antioxidants that may protect you against stroke.
Foods rich in soluble fiber, such as oatmeal and beans.
Foods rich in calcium, a mineral found to reduce stroke risk.
Soy products, such as tempeh, miso, tofu and soy milk, which can reduce your LDL cholesterol and raise your HDL cholesterol level.
Foods rich in omega-3 fatty acids, including cold-water fish, such as salmon, mackerel and tuna. However, pregnant women and women who plan to become pregnant in the next several years should limit their weekly intake of cold-water fish because of the potential for mercury contamination.
You obviously can't change some risk factors for a stroke — family history, age, sex and race. But knowing you're at risk can motivate you to change your lifestyle to reduce other risks. First-time heart attacks and strokes are often fatal or disabling; therefore, prevention is critical. The American Heart Association (AHA) recommends:
Early risk factor screening. The AHA recommends that all people, beginning at age 20, undergo risk factor screening that includes recording blood pressure, body mass index, waist circumference and pulse at least every two years, and cholesterol and glucose testing at least every five years.
Risk estimation. The AHA recommends that doctors estimate each person's percentage risk of developing cardiovascular disease within the next 10 years. The estimate would be based on the risk factor screening. The AHA recommends estimation of risk every five years for people age 40 or older, or for anyone with two or more risk factors.
Coping skills
Recovering from a stroke can be mentally exhausting. In addition to the various physical side effects, feelings of helplessness, frustration, depression and apathy aren't unusual. Diminished sex drive and mood changes are also common.
The rate and amount of recovery after stroke is highly individualized. Much depends on the extent of damage to your brain, and the intensity and duration of the therapy you receive. But your recovery also is likely to be influenced by your personality, life experiences and coping styles. Your own motivation to recover is a key factor in obtaining an optimal level of rehabilitation.
If someone close to you has had a stroke, you can play an important role in the recovery process by offering companionship and support. Here are some tips to help you communicate with someone whose speech has been affected by a stroke:
Stay in touch. Your friend or family member needs you but might not be able to tell you so. Make an effort to be there.
Keep conversation at an adult level. Address stroke survivors directly and don't talk down to them. Treat them just as you did before the stroke. Because someone has had a stroke doesn't mean he or she can't think anymore.
Use a normal tone of voice. Unless there's a hearing loss, you don't need to speak more loudly than usual.
Speak at a comfortable pace. Allow time for your words to be processed. Try to talk about only one topic at a time.
Avoid distractions. Reduce background noise and distractions from TVs, radios and physical activities.
Talk one-on-one. A stroke survivor may understand best when the conversation includes fewer people.
Keep caregivers in mind. They need support and friendship, too. Include them in your thoughts and plans.
Although stroke-related disabilities can be permanent, many people lead active lives after a stroke. Many are able to resume everyday life and responsibilities.
Friday, March 9, 2007
Top 10 Food Mistakes
Maybe it was easier when the only thing on the table was what you could hunt and gather. Sure, the menu was primitive. But at least there weren't any experts hovering over the fire, wagging their fingers and saying, "Eat this. No, no, don't eat that." Ours is an age of unprecedented bounty and convenience—and almost nonstop nutritional advice, much of it subject to change as new research findings come along or scientists change their minds. You try to keep up with the latest and make the smartest choices—but are they as healthy as you think? Here's a reality check, with tips from experts on how to make the very best of your good intentions.1. You reach for multigrain bread or cerealFoods labeled 7-grain or multigrain may seem like the healthiest choicesAMP#8212;especially with new findings showing that a diet rich in whole grains protects against heart disease, cancer, and other ills. The famed Nurses' Health Study documented lower rates of heart disease and stroke among whole grain eaters. Experts don't know all the reasons behind the benefits, but they do know that intact grains are rich in fiber and nutrients—including vitamin E, B vitamins, and magnesium—that are stripped away when grains are refined into flour.Unfortunately, many foods are only posing as rich in whole grains. "Take a closer look at the labels and you may find there's not a single whole grain in them," says Cynthia Harriman, director of food and nutrition strategies for the Whole Grains Council, a nonprofit consumer group in Boston.The reason: Labels can claim that products contain grains even if they're highly processed and stripped of most of their nutrients and all of their fiber. "White flour is made from grain, after all," says Harriman. Smarter Move Learn the lingo of food claims. Bread that's 100% whole grain means just that—it contains no refined flour. Cereal that's made with whole grain may have a little or a lot. Crackers labeled multigrain may not have whole grains at all.To be sure you're getting the grains you want, check the ingredients panel. Whole grains should be the first or second ingredient listed. Luckily, finding whole grain products is easier now that manufacturers supplying at least 16 g of whole grains per serving—what's considered an excellent source—are stamping their packaging with the Whole Grains Council's logo.2. You buy bottled water laced with vitaminsIt's a measure of how health conscious we've become that water is now fortified with nutrients and even medicinal herbs. But when asked for the l'eau down on so-called enhanced water, Prevention advisor Elizabeth Somer, RD, counseled: "Save your money." Many are bloated with unnecessary calories. The label of one leading brand, for example, reports that it supplies half the daily requirement for some nutrients. But to get that amount, you have to drink the whole bottle, which contains 125 calories. And for that you get just 6 of the 40-plus essential nutrients provided by most supplements. An entire bottle, notes Somer, supplies no more vitamin C than you'd get from eating two strawberries. Smarter Move Drink plain, refreshing, calorie-free water when you're thirsty—and take a multivitamin daily to make sure you get balanced levels of the essential vitamins and minerals.3. You choose veggie chips over potato chipsYou'd think you were at a farmers' market when shopping the snack aisle these days. Dozens of munchies are made from carrots, spinach, kale, and even exotic tropical vegetables. But scrutinize their ingredients and you'll find that vegetable coloring is all most of them have in common with produce. What could sound more virtuous than a brand called Veggie Booty—especially when the packaging advertises kale and spinach? The ingredients label reveals that vegetables are at the bottom of the list (that means they contribute less, by weight, than ingredients at the top of the list, like oil). Many of these seemingly healthful snacks are still loaded with calories: A 4-ounce bag of Hain Carrot Chips contains 600 calories—just as much as Lay's Classic potato chips.Smarter Move When you simply must have chips, look for brands with vegetables at the top of the ingredients list. Terra Chips, for instance, contain decent amounts of taro, sweet potato, parsnip, batata, and other vegetables. A tip-off to a snack's healthfulness is its fiber content. One ounce of Terras contains 3 g of fiber—not bad for a snack food. They're no bargain in the calorie department, however: At 140 per ounce, they're almost the same as regular chips. If you're counting calories, baked potato chips—at 110 calories per serving—are a better choice. An even healthier alternative? A handful of nuts, loaded with fiber, healthy oils, and vitamins and minerals; they'll even satisfy your urge to nibble. And if you want to be truly virtuous, go for the real thing: carrot sticks, jicama slices, lightly salted radishes, or roasted sweet peppers chilled in the refrigerator.4. You choose snacks that are "made with real fruit"Pictures of luscious-looking fruit adorn the packaging, and the labels claim that there is real fruit inside—but don't think you can count these snacks as one of the four to five daily servings the new dietary guidelines recommend. Because current law doesn't require labels to specify how much fruit is in the product, manufacturers can brag on packaging that food is made with real fruit if it contains only small amounts of fruit juice."Concentrated white grape juice or pear juice may sound healthy, but all that really means is fruit sugars and water," says Gail Rampersaud, RD, of the food science and human nutrition department at the University of Florida. Other downsides: Few of these snacks provide any fiber, and some faux-fruit munchies even contain small amounts of artery-choking hydrogenated fats. And they often have as many calories—almost all from sugar—as candy. For example, a 25-g serving of Fruit Gushers has 90 calories, just about equal to a handful of Willy Wonka's Everlasting Gobstopper jawbreakers.Smarter Move Treat these snacks as candy, which is what they really are, and eat them sparingly. Satisfy your sweet tooth with real fruit instead. If you're looking for convenience, pack a single-serving box of raisins or other type of dried fruit.5. You buy low-sodium products to cut down on salt Almost all of us could do with less salt, which has been shown to increase the risk of high blood pressure. Americans consume an average of 3,375 mg of sodium a day—way over the recommended maximum of 2,300 mg for healthy people (1,500 mg for the one in three among us who has hypertension). Because processed foods represent one of the biggest sources of hidden sodium, it's great news that manufacturers are making low-sodium alternatives. Problem is, many still contain more salt than the 140 mg most of us should get in a single serving. A 1-cup serving of a leading chicken broth labeled less sodium, for instance, contains 554 mg; 1 tablespoon of reduced-sodium soy sauce has 600 mg. Smarter Move "Be wary of products labeled less sodium," says Rampersaud. The law requires that the sodium level be only 25% less than the original product. But if that product happens to be very high in salt to begin with—like many soups and broths—you may still be getting a lot of sodium. "To ensure that you get 140 mg or less per serving, look for products marked low in sodium," says Rampersaud.6. You drink fat-free milk to bone up on nutrientsSmart move. But if you buy milk in glass or translucent containers, you may not be getting all the nutrients you should be. Although calcium in milk is relatively stable, vitamins A, B2, C, D, and E and amino acids all break down gradually when milk is exposed to light. Milk is especially susceptible because the riboflavin (vitamin B2) it contains acts as a photosensitizer, says Donald McMahon, PhD, an expert in dairy foods processing at Utah State University. In a study at Cornell University, levels of vitamin A fell as much as 32% when milk in plastic containers was exposed to fluorescent light for just 16 hours. Other studies have found that up to 60% of the riboflavin is lost under similar conditions. Light also oxidizes fat and diminishes the flavor of milk.Smarter Move Buy milk in opaque containers, which eliminate as much light exposure as possible. "A container that blocks light will maintain vitamin A, riboflavin, and other nutrients in milk for about 10 days," says McMahon.7. You toast your health with a glass of wine or beer More than 100 studies have found that moderate drinkers have about one-third lower risk of heart disease than those who abstain. But excessive drinking—three or more alcoholic beverages a day, most studies agree—has also been proven to send blood pressure climbing. New evidence shows that even light to moderate drinking on an empty stomach can contribute to high blood pressure risk. In a 2004 study that looked at data from 2,609 men and women ages 35 to 80, State University of New York at Buffalo assistant professor of preventive medicine Saverio Stranges, MD, found that the risk of hypertension was almost 50% higher in people who drank alcoholic beverages without food than in those who imbibed only with a meal. Smarter Move Enjoy that drink over dinner. "Consuming alcohol with a meal slows the rise of alcohol in the blood and speeds its elimination from the body," says Stranges. Together, those effects may help prevent increases in blood pressure. Drinking small amounts of alcohol with a meal is a good idea for another reason. Alcohol is known to help prevent the formation of small blood clots that might clog arteries and cause a heart attack—and which form most often after a big meal.One more advantage: Alcoholic beverages enjoyed with a meal are usually sipped, not chugged, which means you're less likely to become inebriated. The risks of regular overindulgence include weight gain, depression, and liver and kidney problems—as you can see, there are plenty of good reasons to save your drinking for dinner.8. You grab a granola bar for a quick breakfastSnatching an on-the-go breakfast is better than skipping it altogether; numerous studies show that people who eat a morning meal are slimmer and have lower cholesterol levels and better memory recall than those who don't. But many of those seemingly healthy breakfast bars so great for eating on the run are basically candy bars in disguise, says nutritionist Christine Gerbstadt, MD, RD, a spokesperson for the American Dietetic Association. "Even though they may contain granola or fruit, some bars are full of high fructose corn syrup and trans fats to keep them soft and sweet," she says. A top-selling granola bar contains nearly the same amount of sugar—14 g—and fewer nutrients than a strawberry Pop-Tart or a slice of chocolate cake. A leading breakfast multigrain bar packs 15 g of sugar as well as heart-harming trans fats. "That rush of sugar will leave you feeling drained and hungry by midmorning," says Gerbstadt.Smarter Move Check labels and choose a bar with less than 11 g of sugar and no partially hydrogenated oils (that's code for trans fats). Also, choose a brand that has at least 3 g of fiber, which slows digestion and provides sustained energy. For a healthier—and cheaper—option, do a little preparation over the weekend. Bake your favorite oatmeal-raisin cookie recipe with half the sugar and half the oil, and pop them into individual plastic bags for all of oatmeal's goodness without the mess. Or better yet, hard-boil a half-dozen eggs and grab one each morning along with some fruit and an English muffin for a portable breakfast.9. You have an after-dinner mint instead of dessertThe cooling taste of mint may sound like just the thing after a heavy meal, but it could spell trouble. According to the National Digestive Diseases Information Clearinghouse, mints are high on the list of foods that can cause heartburn, the telltale burning in the lower chest that occurs when juices from the stomach creep up into the esophagus. Mint seems to relax the muscle that keeps the valve at the top of the stomach clamped down, increasing the odds of reflux. Other surprising culprits: caffeine-containing food and beverages, such as chocolate, soda, and coffee.Smarter Move Skip the mints (and the Mississippi mud cake and cappuccino) and have a piece of fruit instead. If you're prone to heartburn, drink a tall glass of water after meals to flush out the esophagus. And then take a stroll. Walking keeps you upright and enlists gravity to keep acids from splashing up the esophagus. And it can help in another important way: "Being overweight increases the risk of reflux," says gastroenterologist Hashem El-Serag, MD, a heartburn expert at Michael E. DeBakey VA Medical Center in Houston. Getting into the habit of walking after a meal could help you keep the pounds off—and lower the risk of heartburn.10. You save restaurant leftovers to reheat laterIf you stop for a movie after the meal, your health may be in jeopardy. The food needs to be in your fridge or freezer within 2 hours (1 hour if it's over 90°F outside) or you're risking food poisoning. Another concern: nuking leftovers in take-home food bags, pizza boxes, fast-food wrappers, microwave-popcorn containers, and even on some paper plates. These can leach dangerous chemicals into the food when heated, reports Lauren Sucher, a spokesperson for the Environmental Working Group, a nonprofit consumer organization in Washington, DC. The chemicals include phthalates and bisphenol A, which are known to cause reproductive damage in animals, as well as fluorotelomers, which can release fumes that cause a flulike sickness. The seriousness of the danger remains controversial. "But why take a chance when it's easy to reduce your exposure?" asks Sucher. Smarter Move When nuking food, place it in microwave-safe containers, preferably glass or ceramic. And make sure you reheat those leftovers to at least 165°F to kill off any nasty bugs; bring soups and gravies to a boil.
How to Use Humor to Improve Relationships
Humor has long been considered one of the most effective tools to judge the quality of any relationship. If there is laughter present you can assume that the relationship is a healthy one. When the laughter ceases you can be quite certain that the relationship is on the down slide. This laughter barometer can be applied to any relationship at home, at work and at play. Laughter means that you're having fun and fun means that things are going well.. Take a look at the relationships around you. Do the couples laugh a lot together? Has the laughter stopped in some of your relationships?
Here are a few ideas you can use to make certain that laughter remains an ever present reality in your relationships thus ensuring their quality and endurance. Remember introducing humor to previously humorless relationships might take time but the results will be worth the effort. Start slowly by working on your own fun loving, cheery disposition. Laughter and humor are contagious so it won't be long before others catch the bug.
Here are a few ideas you can use to make certain that laughter remains an ever present reality in your relationships thus ensuring their quality and endurance. Remember introducing humor to previously humorless relationships might take time but the results will be worth the effort. Start slowly by working on your own fun loving, cheery disposition. Laughter and humor are contagious so it won't be long before others catch the bug.
* Remember that a sense of humor is learned, not inherited.
* Commit to becoming a humor hound. Look for humor everywhere. When something strikes you funny enjoy it. Let the laughter flow. After the funny event has passed recall it and enjoy it and laugh again.
* Begin to cultivate an atmosphere of humor and laughter in your relationships. Try to enjoy and share humor as often as you can.
* If you don 't laugh as much as you used to and want to correct the situation start associating with humorous, fun loving people and avoid the downers.
* Learn to laugh at yourself. If you don't, you leave the job to others.
* Look for funny items in your newspaper and cut them out and share them. I recall reading the want ads one night and discovered this gem : " The successful applicant should have 203 years experience." Obviously the writer meant to say 2 or 3 years experience. I immediately cut it out and placed it in my collection for future use.
* Encourage others to share their humor. Listen and appreciate it when they do. When someone sees that you have enjoyed their humorous contribution they will be eager to continue sharing.
* In my full day humor workshops I always ask the participants to break up into groups and begin sharing the funniest thing that has ever happened to them. The laughter that this simple activity generates is a joy to behold. Try this will your friends sometime.
* Collect cartoons and jokes and put them on display on the fridge or the bulletin board. Make sure to avoid racist, sexist or filthy humor. The is plenty of good clean humor to go around without resorting to these. Remember that there is a difference between dirty and earthy humor. I personally like earthy humor. I don't appreciate dirty material.
* Watch comedy movies and television programs as often a possible.
* Use humor to neutralize conflict in your relationships. When things get tense use self deprecating humor to lighten things up. I remember one evening having an argument with my wife, Carol. In the heat of the moment she said something totally out of character. She said something hurtful. In my surprise I looked at her and said, " Carol, when you say things like that you stoop to my level." She started to laugh and so did I. It wasn't long before things were back to normal.
Thursday, March 8, 2007
Beat the exam stress- Useful for students & parents
Sleep, eat, revise: beat that exam stress!Educational counsellors at YoungBuzz, a career guidance company, say that acceptance is the first way to deal with exam stress.
Exams are a part of life, be it professional, personal or academic.
According to YB, there are certain practical tips that can be done before the onset of exams:
1. Sleep well
Do not work all night. Get some sleep. Remember, your body needs rest.
You need at least six hours of sleep in order to start afresh.
2. Eat well
Eating a proper meal at regular times is very important. Eating properly would ensure you have enough energy to tackle your daily studies.
3. Talk to someone
If exams are really making you ill, worried or depressed, don't hide your feelings.
Talk to someone about it. A problem shared is a problem halved.
4. Take breaks
The concentration span of a human being is 45 minutes at a time. So don't tax yourself by trying to cram as much information as possible for hours.
When your mind is saturated with information, whether you put in one hour or ten, it does not make a difference -- nothing will go in.
5. Know your peak
Choose a time of the day when you feel most comfortable studying.
It could be early morning, late at night or in the afternoon, depending on your preference.
6. Plan your day
Try to establish a routine that allows time for meals, sleep, revising and relaxing.
You are allowed to enjoy yourself, and it is important to take a break from studies.
7. Get help
Ask a teacher or tutor about how to revise and how to work when you are in an exam.
8. Plan your work
Revise at times when you know you will work at your best.
9. Exercise
You need exercise to work well. Walk, run, play a sport -- whatever you enjoy.
10. Be positive
Stop thinking and worrying about the future and what will happen.
11. Do not mull
If it upsets you to talk to your friends about an exam when it is finished, don't do it!
In fact, don't even think about the exam you have finished. What is done is done. You cannot change what you have written!
Parents have had their own share of exams, be it in their personal, professional or academic life.
Certain tips that parents can follow during exams are:
1. Believe in your child
Parents of children taking exams are as stressed as their children are.
But the idea is to express confidence verbally as well as non-verbally, in the child's ability to do his/ her best. And to support them as they go about their task in their own way.
2. Do not judge
Judging can be a wrong approach, especially during a period of extreme stress like an exam.
You don't have to physically sit with your child and put the study material in his/ her head.
It matters if you are 'there' for them, so that they know you are there whenever your child needs you.
3. Be there
Providing a 'holding environment', a concept from child development, literally means holding your child, though not necessarily choking him/ her.
It is important that your child knows s/ he can call on you whenever s/ he needs you.
4. Do what your child likes
Take your child out for a walk; make his/ her favourite dish; discuss his/ her favourite game/ hobby.
That would help your child relax and lighten the pressure for some time.
5. Do not compare
Stop comparing your child with other children or siblings. Comparison often has a lifelong effect and may scar the child's self esteem permanently.
6. Understand your child's capacity
Learn to accept your child the way s/ he is.
You cannot suddenly expect him/ her to compete with the school protégé, but you can definitely encourage him/ her to do well in his/ her capacity.
Exams are a team effort for children and their parents.
And the best way to deal with them would be to support each other mutually during this stressful time.
Remember, exams are a part of your life and you have to give your best when you approach it.
But just treat them as a very important experience, which will only enhance your confidence for further exams.
Exams are a part of life, be it professional, personal or academic.
According to YB, there are certain practical tips that can be done before the onset of exams:
1. Sleep well
Do not work all night. Get some sleep. Remember, your body needs rest.
You need at least six hours of sleep in order to start afresh.
2. Eat well
Eating a proper meal at regular times is very important. Eating properly would ensure you have enough energy to tackle your daily studies.
3. Talk to someone
If exams are really making you ill, worried or depressed, don't hide your feelings.
Talk to someone about it. A problem shared is a problem halved.
4. Take breaks
The concentration span of a human being is 45 minutes at a time. So don't tax yourself by trying to cram as much information as possible for hours.
When your mind is saturated with information, whether you put in one hour or ten, it does not make a difference -- nothing will go in.
5. Know your peak
Choose a time of the day when you feel most comfortable studying.
It could be early morning, late at night or in the afternoon, depending on your preference.
6. Plan your day
Try to establish a routine that allows time for meals, sleep, revising and relaxing.
You are allowed to enjoy yourself, and it is important to take a break from studies.
7. Get help
Ask a teacher or tutor about how to revise and how to work when you are in an exam.
8. Plan your work
Revise at times when you know you will work at your best.
9. Exercise
You need exercise to work well. Walk, run, play a sport -- whatever you enjoy.
10. Be positive
Stop thinking and worrying about the future and what will happen.
11. Do not mull
If it upsets you to talk to your friends about an exam when it is finished, don't do it!
In fact, don't even think about the exam you have finished. What is done is done. You cannot change what you have written!
Parents have had their own share of exams, be it in their personal, professional or academic life.
Certain tips that parents can follow during exams are:
1. Believe in your child
Parents of children taking exams are as stressed as their children are.
But the idea is to express confidence verbally as well as non-verbally, in the child's ability to do his/ her best. And to support them as they go about their task in their own way.
2. Do not judge
Judging can be a wrong approach, especially during a period of extreme stress like an exam.
You don't have to physically sit with your child and put the study material in his/ her head.
It matters if you are 'there' for them, so that they know you are there whenever your child needs you.
3. Be there
Providing a 'holding environment', a concept from child development, literally means holding your child, though not necessarily choking him/ her.
It is important that your child knows s/ he can call on you whenever s/ he needs you.
4. Do what your child likes
Take your child out for a walk; make his/ her favourite dish; discuss his/ her favourite game/ hobby.
That would help your child relax and lighten the pressure for some time.
5. Do not compare
Stop comparing your child with other children or siblings. Comparison often has a lifelong effect and may scar the child's self esteem permanently.
6. Understand your child's capacity
Learn to accept your child the way s/ he is.
You cannot suddenly expect him/ her to compete with the school protégé, but you can definitely encourage him/ her to do well in his/ her capacity.
Exams are a team effort for children and their parents.
And the best way to deal with them would be to support each other mutually during this stressful time.
Remember, exams are a part of your life and you have to give your best when you approach it.
But just treat them as a very important experience, which will only enhance your confidence for further exams.
Subscribe to:
Posts (Atom)
