Welcome to the TBI-HELP Live Chat

Today's topic is: "Stroke Risk Reduction"

Our Guest is: Dr. Glenn Heiss, Psychologist, Department of Rehabilitation, Jamaica Hospital Medical Center.

[19:00:58] Mod: Good evening everyone! Tonight we are very excited to have Dr. Glenn Heiss as our guest speaker. Dr. Heiss is a psychologist for the Department of Rehabilitation at Jamaica Hospital Medical Center. He will be discussing Stroke Risk Reduction tonight. Welcome Dr. Heiss!
[19:01:24] Dr.H.: Thank you. It's a pleasure to be back in the chat room.
[19:01:40] Mod: What can I do to prevent a stroke?
[19:02:00] Dr.H.: There is no one answer, but I will deal with the major preventive steps one can take. All of these involve addressing the major predisposing factors for stroke, such as hypertension (high blood pressure,), diabetes, cholesterol and stress.
[19:03:28] Mod: Rail: I've just come through an encounter with high blood pressure- I know that it is one of the risk factors for stroke. what else should I know?
[19:04:05] Dr.H.: Well, to start with, you should know that these major risk factors are all controllable. Keeping in touch with one's doctors and adhering to treatment regimens (e.g. medication, diet, exercise) are the best first steps to take. So too with diabetes, keeping on top of one's diet and trying to keep glucose levels consistent and within the parameters set by one's physician will help limit the risk posed by the disease. There are some 'uncontrollable' risk factors for stroke: for instance, being African-American, male or over 65 all increase one's stroke risk, so prevention efforts focus on taking steps to alter the other, 'controllable' risk factors.
[19:06:46] Mod: Elaine: What can I do to decrease high blood pressure without medication?
[19:07:25] Dr.H.: Aside from medication, dietary changes and improved stress management are among the major ways to control blood pressure. I do want to point out, however, that some people are predisposed to high blood pressure and medication may be the best treatment of choice, depending upon the person.
[19:08:16] Mod: Lawrence: Dr. Heiss, can you tell us about stress and personality types?
[19:09:21] Dr.H.: Stress, which we all face, tends to be more detrimental and difficult to deal with for some people, increasing it's effects and potential for harm. The 'Type A' Personality type describes someone more prone to high-stress living, worrying, aggression and impatience and an inability to relax. Now, we all have some aspects of the 'Type A,' but what's recommended is to become better at coping with stress so as to avoid becoming overly worked up over things, which is better for keeping one's blood pressure lower.
[19:11:50] Mod: PattiSue: When blood pressure is high due to a TBI is it usually treated the same as a regular high blood pressure?
[19:13:02] Dr.H.: Blood pressure is usually treated with some combination of medication, exercise and/or dietary changes. To my knowledge, TBI-related blood pressure is treated according to the individual's unique spectrum of health-related issues and not necessarily differently because of a pre-existing TBI. For instance, medication might still be recommended, but less emphaiss placed on exercise, perhaps, depending upon the individual's physical functioning.
[19:13:56] Mod: Elaine: Do I need to be concerned about a stroke if am only in my twenties?
[19:16:00] Dr.H.: Strokes can and do occur at any age, and we have treated people for strokes in the teens and twenties. Sometimes in these cases, pre-existing conditions such as significant vascular problems or significantly high cholesterol have increased the individual's risk for stroke. But becuase the most significant risk factors are not age-specific, a 20 or 30 year old can, indeed, present with multiple risk factors.
[19:16:12] Mod: Lawrence: What do you do if one is in a high-stress job where stress might be inevitable?
[19:16:44] Dr.H.: Stress is inevitable for many of us. One can always learn new or more relevant ways of dealing with that stress, however. Now, the best treatment methods are comfortable for the individual and should be tailored to increase their efficacy and utility. But anyone can acquire some basic skills in techniques like muscle relaxation, deep breathing, visualizaiton and even meditation which can help make unavboidable stressors easier to handle and less physically detrimental.
[19:19:51] Mod: Do strokes run in families?
[19:21:45] Dr.H.: Strokes do, sort of, run in families, insofar as risk factors like diabetes and hypertension run in families. One can be assess how many potential risk factors one has, however, and act accordingly. Get checkups, monitor blood pressure and glucose levels (if relevant), work to manage stress better and strive to increase overall health. These are good strategies for many reasons, not just for reducing stroke risk.
[19:22:19] Mod: Elaine: Is physical activity recommended post mild stroke?
[19:23:34] Dr.H.: Well, physical activity is not contraindicated in most cases. Rehabilitation, in fact, usually involves some sort of physical therapy and exercise designed to restrore functioning and increase mobility. And the ancillary benefits of exercise, such as increased endurance, better heart rate and better energy utilization, are also beneficial for overall functioning. The activity should be undertaken with the guidance or direction of a professional, however, so it is not overly strenuous or risky in light of the stroke's effects.
[19:24:52] Mod: Pattisue: I've been reading about the value of laughter in relieving stress and helping to change disposition. What do you think?
[19:26:33] Dr.H.: Laughter is great medicine. Physiologically, it releases neurotransmitters in the brain which are associated with decreased muscle tension and a sense of well-being. Besides, it feels good. From a psychological standpoint, laughter is beneficial in helping maintain perspective, keep motivated, and 'override' states of distress. One can't have two incompatible responses at the same time, so if you're truly laughing at something, you can't be simultaneously worried.
[19:26:42] Mod: Lawrence: Is it now recommended that alcohol in mild amounts be considered to lessen risks?
[19:28:26] Dr.H.: Alcohol is recommended in some cases to reduce cholesterol levels and lessen heart attack risk, so it may, indirectly, have the effect of reducing stroke risk. I would not recommend moderate alcohol in and of itself as a preventive measure, however. On the flip side of that issue, it is recommended that alcohol consumption NOT exceed one or two drinks per day in order to keep it's potentially stroke-increasing effects at bay.
[19:28:39] Mod: Elaine: Where would I be able to obtain information to help reduce my risk factors?
[19:31:18] Dr.H.: Your physician is a good place to start to learn how to best control factors like hypertension and diabetes. Nutritionists can provide the best and most current advice regarding diet and cholesterol. And sources as varied as psychologists and psychiatrists, Massage therapists, clergy and relaxation specialists can provide detailed information regarding stress management according to your particular beliefs and comfort level. Almost all of these service professionals can be found online, and sources such as the National Stroke Association (referred to elsewhere on the website) can provide this information tailored specifically to strokes.
[19:32:43] Mod: What diet should I eat to reduce stroke risk?
[19:33:46] Dr.H.: Although specifics vary from person to person, a diet that is low in animal-based fats and low in sodium, but high in fruits and vegetables and grains is recommended. Our nutritionists stress all things in moderation when it comes to diet. They don't recommend excluding anything, like many of the current fad diets advocate. They also recommend adhering to the 'food pyramid' we are all (somewhat) familiar with in order to try and keep food groups in balance.
[19:36:03] Mod: Are smoking and stroke risk related?
[19:36:59] Dr.H.: Smoking is indeed related to stroke risk. Smokers are prone to higher rates of cardiac and vascular disease, and when the blood is not flowing as smoothly as it could be, one is going to be more prone to stroke. In addition, smoking is associated with less-than-ideal forms of stress management, ones that are more effective in the short-term rather than the long-term, so smoking can increase a person's risk for stroke.
[19:41:29] Mod: Lawrence: Any thoughts about yoga, meditation, imagery, and biofeedback as risk-reducers?
[19:43:44] Dr.H.: Those are all very viable options for reducing stroke risk and increasing wellness in general. What they have in common are emphases on slowing breathing and heart rate, becoming more aware of one's body, and subsequently, better able to notice changes (such as high heart rate or significant muscle tension). Each also involves an emphasis on increasing mental well-being and peace of mind, which have multiple potential benefits. Again, the key is to go with what feels organic and viable to you.
[19:44:45] Mod: Rail: My MD asked me to try the Mediterranean Diet (fewer refined carbo-grams, increase of whole grain, fruits and veggies, with up to 40 of calories in Olive Oil and a glass or two of red wine per day) I see that the Heart Association endorses that -what about stroke?
[19:46:43] Dr.H.: The Mediterranean Diet, and any dietary approach that emphasizes more unprocessed foods, fruits, vegetables and grains, and an overall reduction in fat/sodium will help reduce cholesterol, blood pressure and, subsequently, stroke risk. Again, the red wine question has been addressed and endorsed by the Heart Association, and they do know what they're talking about. As a specific stroke risk reducer, though, I haven't heard evidence about wine or alcohol per se.
[19:46:54] Mod: Lawrence: Any thoughts about psychiatric-type medications? Like tranquilizers or antidepressants?
[19:49:21] Dr.H.: Psychiatric medications can definitely be effective in reducing one's level of stress and the attendant blood-pressure/stress components. Because they are medications, however, they introduce new substances into the body even as they perform a positive function. This does not necessarily make them less effective or problematic (indeed, in some cases they are vital and possibly essential for a period), but more natural, mentally-based methods are 'purer' so to speak, and less likely to produce side effects in and of themselves.
[19:49:37] Mod: Please be advised that these are the general opinions of Dr. Heiss. Please consult your physician prior using any types of medication.
[19:50:18] Mod: What should I do about multiple medications I take for different conditions?
[19:52:06] Dr.H.: Many people take multiple medications for various reasons. The best approach is to be sure that your primary medical doctor knows everything you are taking -- even over-the-counter medications or supplements. Those substances are chemical compounds which can interact with other substances just like a prescribed medication can. Making sure that a medical professional knows everything you are combining is an effective strategy to minimize risk. Similarly, try to have all prescriptions filled ar the same pharmacy so that any potential interactions are more likely to be identified at the time the prescriptions are filled.
[19:53:54] Mod: Are there mental/emotional factors related to stroke risk?
[19:55:23] Dr.H.: Conditions such as depression and anxiety impact physical functioning as well. For instance, immune system functioning is weakened, and healthy behaviors are less likely to be followed when one is in some state of distress. Looking after one's mental well-being, then, and seeking out professional help for depressive or anxious symptoms, can improve both mental health and physical health. Mind and body are very closely connected. and just as problems in one area can lead to problems in the other, good habits with regard to either area can also have beneficial effects for the other.
[19:56:56] Mod: What are the physical warning signals evident prior experiencing a stroke?
[19:57:55] Dr.H.: Common warning signs one should be aware of include: sudden weakness, especially on one side of the body; sudden loss of balance or the ability to speak; severe headache, especially on one side of the head, dizziness, changes in vision or significant increase in blood pressure. Thee should be brought to the attention of medical professional immediately so that they can ebe evaluated and treated accordingly. Again, this is one more reason it is advantageous to be 'body aware' or in touch with how you usually feel and what your usual blood pressure is. Knowing your 'baseline' helps you notive any potentially serious changes more quickly and respond to them appropriately.
[20:00:29] Mod: Well I see that our time has ended for this session. I want to thank Dr. Heiss for a great and informative chat session. I would also like to thank our audience for their participation. Good night, be safe and we'll hear from you next week.
[20:00:57] Dr.H.: Thank you for having me back. I am glad to have been involved.