By John McElligott, MD
with Jeffery Heinrich, Ed.D, PA-C
The leading risk factor for stroke is smoking, especially when associated with high blood pressure. Seventy percent of all symptoms of a "pre-stroke" or "mini-stroke" go unrecognized. Many with full-blown stroke symptoms don't go to the hospital within 24 hours of the start of the first symptoms. Because a stroke can be a career-ending event for a trucker, it is important to visit this often preventable problem.
The Federal Motor Carrier Safety Administration has an extensive description covered in 391.41 (b)(7) to (b)(9), that describes several different conditions that can be affected by stroke. The regulations do not mention the word "stroke," yet a stroke is the most common event related to many of the conditions listed.
What you always wanted
to know about stroke
To understand stroke, you must pass Dr. John's body plumbing course 101 with a grade of A-plus. Let's start with the following components:
The pump is better known as the heart. The adult heart pumps 5 to 6 liters of blood a minute. That amount is almost all of your blood volume pumped in one minute. The key point is that you only have X number of heartbeats in a lifetime, so save them whenever you can. For example, don't smoke, don't abuse energy drinks, and refrain from using over-the-counter cold medications if you have any form of heart disease. The pump can be damaged by hardening of the arteries, thickening of the wall of the heart, or lack of muscle that can be caused by a heart attack.
Pipes are better known as arteries. These vessels range from microvascular as seen in the eyes to very large, such as the aorta. These pipes take blood from the pump to the various body parts, including the lungs, where oxygen is exchanged with waste carbon dioxide. Then there are the filters of the body, better known as the kidneys. The master of the pump and the pipes is the brain. The brain has sensors in the neck and the arteries leading to the brain and kidneys, which regulate the pressure in these vital structures.
The arteries carry oxygenated blood away from the heart/lungs to nourish all the tissues of the body. Return blood to the heart carries waste cleared by the liver from the gut to CO2 from the cells.
So, now that we are all graduates, let's see how a stroke happens and why it is so difficult to recover from and how easy it is to prevent. Stokes can be one of two types:
(1) hemorrhagic, which is marked by bleeding; and (2) ischemic, which represents a lack of blood flow.
Hemorrhagic strokes account for 15 percent of all strokes and ischemic strokes the remaining
85 percent. Stroke is the third-leading cause of death in the U.S. and the second-leading cause worldwide. Sadly, for survivors it is the most disabling. Treatments differ radically and survival is directly related to how fast treatment is rendered. Ideally, a stroke victim must quickly be hospitalized in a facility that has a stroke center.
Risk factors are described by the Centers for Disease Control in an informative presentation with excellent pictures on their website, cdc.gov. The CDC has a novel discussion of topics beginning with conditions followed by behavior and the dreaded heredity.
The effects of stroke can be very minor or catastrophic depending on the size of the area of the brain that is affected. Ischemic strokes are sometimes minor because the blockage of the artery occurs slowly and may be preceded by a mini stroke or transient ischemic attack, known as a TIA. These attacks are a warning sign of impending stroke, but most people don't go to their doctor or emergency room until full-blown stroke is evident. An alarming number of stroke victims are even smoking before to their arrival at the ER.
Ischemic strokes can become hemorrhagic if there are leaks or ruptures because of a weakness or as part of the treatment to try and reverse the full-blown stroke. So learn the TIA symptoms and get to the hospital during the golden hour when we can save you from a life as an invalid.
Hemorrhagic strokes are the most devastating and have various reasons for the bleeding into the brain. The CDC's website has graphic pictures. The two types of hemorrhagic strokes are intracranial and subarachnoid bleeds. Both are fatal events if not treated quickly.
Now, let's get back to life on the road to recovery from a stroke. Recovery from a stroke is a lifelong challenge. Taking into account your condition, behavior and heredity, you and your doctors must be vigilant in order to obtain maximum recovery and – in extreme cases – prevent a vegetative state. So where do you start?
- Make sure the condition that caused the stroke has been identified and treated – i.e., high blood pressure, diabetes, heart disease, high cholesterol, sickle cell disease, obesity and, most important, a previous TIA or mini stroke.
- Modifying behavior is a must. Smoking, diet and exercise must change.
- Medication to override heredity when appropriate.
- Begin a lifelong rehabilitation program to maintain your daily activities.
There are several initial steps following a stroke that are paramount in one's rehabilitation:
- Be patient and make sure you don't fall into a deep depression. Stroke patients often make near full recovery. This is assuming that the condition is treated, the behaviors eliminated, and heredity controlled. Depression can be the first nail in the coffin if not recognized and treated.
- Give your brain time to heal. The body has an amazing way of rewiring the circuits to get the arm, leg or whatever moving again.
- Find a physical therapist who knows that the importance of time in maintaining muscle tone is the cornerstone to recovery. If speech or vision is lost, you will need to add others to the team. Don't forget a good doctor.
- Take the rehabilitation time to get on a good diet that maintains your health along with a healthy supplement that contains vitamin D and omega fish oil.
- Remember that DOT mandates that with a TIA or stroke you are done driving for at least one year. So, my friends, spend the time wisely.LL
Editor's note: John McElligott is an MD and Fellow of the American College of Physicians. Jeff Heinrich, who serves as the column's medical editor, has a Doctor of Education degree and PA-C, which means Physician Assistant-Certified.