INTRODUCTIONA strange title for a book you might think - but not when you realise in England and Wales over 130,000 men, women and children suffer the effects of a stroke each year! That's correct, children as well, age is not a barrier to this dreaded insult.

Of all people who suffer from a stroke, about a third are likely to die within the first 10 days, about a third are likely to make a recovery within one month and about a third are likely to be left disabled and needing rehabilitation. Stroke leaves more people with a disability than any other medical condition. Over a quarter of a million people are left with long-term disabilities as a result of suffering a stroke in the UK.

My excuse for writing this E-Book, mainly because I am so dismayed by the utter lack of care and attention the medical profession appears to give to this scourge! I will tell you now, I have NO medical qualifications, all what I write here is MY thoughts and MY opinion, nobody else's. It is not to lead you or advise you in any medical way whatsoever. It is merely to (hopefully) point out a few facts and figures and what has helped me to some what recover. Make of it as you will but DO NOT take it as medical advise, that is left to the professionals!

I have tried to collate as much information that I think will be useful to a survivor.

I will try to keep it light-hearted and informative, I hope that is how you see it too.Oh yes there can be light at the end of the tunnel! My hope is that SOME of the folk in the medical profession might read this and realise just what and how it does affect thousands of people and their loved ones every year. Loved ones, now there's a thought, because believe me, it can affect the family as much, if not more than the poor sufferer of the stroke. These seem to be the forgotten ones by most accounts.

This information that is provided in this E-Book is offered as information only. It is entirely my own work and my thoughts. It has thoroughly been researched and verified at the time of going to press. No information or materials posted in this publication are intended to constitute a legal or binding relationship.

The author specifically disclaims any personal liability, loss or risk incurred, as a consequence of any advice or information presented herein.All information was correct at going to press. The author does not accept or offer any guarantee that the information given in this document will continue to be available.The information provided is the author's own experiences or his thoughts and he has no medical background. The idea of this book is to provide information about what happened to him when he suffered a stroke and information that he has researched and entered here to try to help and assist anyone who has suffered a stroke by pointing them in the right direction to get proper and correct help and treatment.It is your decision if you choose to act upon any information provided within this book and is entirely your responsibility to make sure it suitable for you.In no way is the information provided to be taken as medical advice. If you have a medical condition you should consult a doctor or a specialist before starting any new treatment.Remember, This book provides general information only. It is not meant to replace professional advice or imply coverage of specific clinical services or products.

No part of this publication may be copied, reproduced, back engineered or duplicated without the express permission, in writing, of the author.

This publication does NOT come with any resell or reproduction rights whatsoever. Any breach of copyright or intellectual property rights will be met with full legal action. You DO NOT have permission to resell or copy this book.

�2005 John H Stanway. All Rights Reserved

CONTENTS

Page 1 ...Stroke (My Story)

Page 2...What is a Stroke?

Page 3...Lower Blood Pressure

Page 4...Obese or Overweight

Page 5...Treatments

Page 6...My Thoughts

Page 7...Useful Addresses & Research Sources

Page 8...Thanks for Looking

We'll Be Round in a Stroke (My Story)

My day was ending the same as any other Saturday, or so I thought. I had just got back from pricing some jobs, (I used to be a self/employed plasterer), visited the local corner shop and bought my usual couple of cans of beer to enjoy with my 'Indian', we either had an 'Indian' or a 'Chinese' delivery on a Saturday night.

Put my beers in the fridge and sat down to watch a bit of 'telly'. The kids, (my two daughters) were having a 'Burger King' as was their usual on a Saturday evening.

I started to feel a strange pins and needles sensation in my right arm and also a bit in my left, I knew immediately that this wasn't just some overworked muscles playing up! I asked my wife for the keys for her car, of course she asked why because I had my own car in the garage and the van parked at the back of the house. I just said that I wanted to pop down to A and E because I wasn't feeling too well, I didn't use the word hospital as I didn't want to alarm the kids, well they were halfway through their meal and I knew if I said how bad I was really feeling they would all want to come, so there was no point in distressing them over something that might not be as bad I was hoping it wasn't but knew in reality that it was!

I had enough sense to think about not taking my car, it was my pride and joy and if I was going to conk out at the wheel then I would rather it be my wife's car than my own! Nice husband or what? It also made sense that I couldn't take my van because if I was to crash that then how would I get to work? Some things to be considering huh? Strange feeling that, walking out of your house not knowing if you were ever going to be coming back.Oh well.

How I made it to the hospital I will never know, I knew from the off that it was either a stroke or a heart attack that I was having. How I knew, don't

ask, I just knew. I had been telling myself for months, probably years actually, that if I didn't stop smoking and working so hard, the hours were awful, mostly 12 hour days and Saturday and Sunday, (remember this was around seven pm Saturday evening and I had only just got in from pricing some work), I would eventually have a heart-attack or a stroke!

I quite clearly remember thinking as I drove to the hospital "Well me old son, no point in complaining now, you knew it was going to happen, whatever is going to be is going to be!"

I got into A and E and thought things would be OK now, I was in safe hands. That was an understatement let me tell you. Let me just say, in no way do I have an axe to grind, nobody to upset, I am just going to relate the events as they ACTUALLY happened! If some folk don't like what I say then that is THEIR problem, they need to deal with it and maybe the appropriate authorities MIGHT ensure that things improve for folk whatever they suffer from!

I went up to the desk and told the nurse / receptionist that I thought I was having a stroke or a heart-attack, she took all my details then asked me to sit down, someone would see me as soon as possible! Walking into the place I had started to loose the use of my left leg. About ten minutes later I needed to go to the toilet and as I tried to walk I found I was dragging my leg, I went back to reception and told them that I really thought I needed to see someone. I was asked again to sit down, that someone would see me as soon as possible. Ten minutes later I needed to go to the toilet again! This I found afterwards is a natural reaction as you start to loose control or use of your muscles.

My leg was getting worse and I was really struggling to walk, this delay in seeing someone didn't help my peace of mind, especially as I thought I knew

what was happening to me. I was then called into a side room for a preliminary examination by a doctor, I was quickly examined, blood pressure etc, I was asked if my tongue felt OK and I said that it felt like a piece of leather and I found it slightly hard to speak properly, like speaking with a sweet in your mouth. I was then asked if I could swallow, which I could. She agreed, I was probably having a stroke.

The doctor, God bless her, told me to go back and wait in reception and someone would see me as soon as possible and they would keep an eye on me, starting to get a bit of a habit this, we ain't talking about toothache are we?

Got back to my seat, needed the toilet again! By now I could hardly walk at all, other people were starting to look at me.

I went back to reception and told them that I felt I now really did need to see someone. I was hanging onto the reception desk, she told me she would go and get someone and said not to move - that was a joke in itself - as I told her, if I let go now I would fall over! A young slip of a nurse came out and asked me to follow her into a cubicle at the back of A and E. I was now dragging my leg behind me and she just walked backwards watching me, no help at all! I needed to use my hands to help move my leg, a wheelchair would have been nice but apparently they were in short supply! This IS the health service that ALL parties boast about helping and spending more money on than the last government in power isn't it? Can you really believe in this day and age that someone who is obviously on death's doorstep could be just left to die quietly, if that is what is going to happen and nobody who should know better does a thing to help?

IF you or anyone you know is ever in the unfortunate position of being seriously in danger of dying then PLEASE do NOT try to get to a hospital under your own steam, (my big mistake), telephone immediately for an ambulance and let them take you in. That way you might just get attended to immediately because you will probably be treated as a medical emergency. Just one other thing, if your ever going to be ill, DON'T be ill on a weekend! Everyone is off on a weekend and most places run on a skeleton staff, including hospitals, and we all know there are plenty of skeletons in those places!

I had never been in hospital before this, only for minor checks, nothing serious, the most serious thing was, I once broke my hand doing karate, so ended a promising career, I think not!

Once in the cubicle I got on a trolley and waited for a what seemed an eternity, for a doctor to come and see me. Eventually one came, I remember very little about this visit as I was obviously now in the middle of having the stroke! I do remember the doctor agreeing that , yes, I was having a stroke.Now, not to be blowing my own trumpet but I had got the diagnosis correct about 3 hours before, thank you very much! A nurse came in from time to time to check my blood pressure, a bit of company on a Saturday night is always nice isn't it?

Around the eleven o'clock time I asked what was happening and they said they would keep me in overnight to keep an eye on me, I then telephoned my wife and said they were keeping me in until the morning, knowing full well I was in for a bit longer than that! The staff obviously knew I would be in a lot longer but didn't want to alarm me.

I fought against going to sleep as much as I could because I thought a doctor would come back to me, they never did. I don't know what made me think they would, but I thought if things were this serious then someone would do something but that wasn't to be. Now, whether or not you believe the next bit, it is entirely up to you but this is what happened.As I laid there I knew I was in a serious way and couldn't get myself, for once, through this. I had always been what I would describe as a hard man, I don't mean a trouble maker or someone getting into scrapes all the time.I had done karate seven nights a week up until the age of thirty six, gone to the gym three times a week, I used to say I could walk through walls and probably could have once. I also had worked on the buildings most of my life, working all hours of the day and night.

I had always taken care of me and my family, worked away from home when times were hard to have a better standard of living, rather than just surviving on the dole, working all hours, seven days a week. I did what it took to survive, this time, for once I couldn't do it on my own! I started to think about my family and my youngest daughter, how would she cope if I didn't get through this, I started to talk to her. I told her to hold my hand, stay with me because I needed HER help this time, I couldn't do it on my

own, I needed her to help me through it. I kept getting a picture of her smiling face in my mind saying "Come on Dad!" She stayed with me and thankfully I haven't left her!

I know that the brain can play strange tricks and a stroke is brain damage, unlike what a lot of folk seem to think, it is nothing to do with the heart.The amount of people who have told me not to worry, they can do all sorts with the heart nowadays, they have pills for everything. I don't want anything doing with my heart, thank you very much, there ain't nothing wrong with it! But that is how my mind process went that night and it did help me get through it, we all have our own way of handling things. Many times over the coming weeks I came realise there is nothing to fear in death, I must have come within a whisker that night but it wasn't my time. The manner of how you die is what is important, I hope I go in my sleep!

Around 5AM, JUST as I was starting to drift off into sleep, laying on a trolley for such a long time is terrible, you start to get sore no matter which way you turn, I was woken by two nurses. I asked what was going on as they seemed to be taking my clothes off. Some other time I might have not argued but tonight, I was not feeling too good. They informed me that due to government legislation they were only allowed so much 'trolley time' and then a patient had to be transferred to a bed. My 'time' was up in nearly more ways than one!

I explained to them that if they didn't mind, I was trying to have a stroke, could they come back in the morning, when I would probably feel a bit better? That was not to be! I stayed there until I was rudely woken the next morning around eight thirty by a bunch of people. Two specialists, who I recall wanted to run things up and down my feet to see if I had any sensation in them, a doctor, a nurse and about four other bods with clipboards, one a 'bed manager' another a 'ward manager' etc etc. get my drift?

The only ones I cared about were the specialists. Around nine o'clock the curtain across the cubicle was drawn back and in walked my beautiful wife, never had she been such a welcoming site. Poor woman must have nearly fainted seeing all these folk around me. After the introductions had been

made and we all knew who was who and we, my wife and I that is, had been told I would be kept in for a few days, the cubicle emptied thank goodness.

To say she was shocked is an understatement, poor lass had me to contend with and I'm NOT the best patient at the best of times, most blokes aren't!

The kids were with a friend so she was able to stay for quite a while. I needed to go to the toilet a few times during the morning and do you know, not one nurse or anyone offered any help to me or my wife as she struggled to get me there. That is something I will NOT forget or forgive.Mind, there is plenty more NOT to forget as time went on. My wife had to nearly give me a 'fireman's' lift, I was that bad, I couldn't move my leg, apart from dragging it that is!

Around two o'clock I asked my beloved if she could get me a drink of water and something to nibble on, I had been in there since seven thirty the night before, eighteen hours previous. No offer of food or drink up to that point!The machine that dispensed food and drinks in the A and E department was out of order, so she asked a nurse if there was any chance of getting something for me.

Her reply: "Oh haven't you had any breakfast or dinner, they should have brought it to you?" My reply was "Put it ALL on one plate and bring it in now!" True to her word, she brought me one piece of cold toast and a warm cup of tea, I kid you not! The meals had finished and there was nothing left. I did get a meal at 5.30pm after they had transferred me to the small ward they had at the back of A+E.

That afternoon, my wife helped me to the toilet a few times, my muscles had gone remember, no offer of a wheelchair or any help from any of the staff, the nurses stood back and watched as my wife had to practically gave me another 'fireman's lift' to the toilet. To be honest, I hardly knew what day it was. I was to learn later that one of the many effects, and probably the

worst to start with, is short term memory loss. Thankfully mine was relatively OK, though I was feeling very groggy.

When I was finally transferred to the ward at the back of A and E, it was a relief to think that something was actually happening. This was Sunday afternoon, I finally got into the 'Admissions' ward on Monday, Wednesday I was transferred into the 'Stroke Unit', this was were I would spend the next five weeks getting myself back together.

I'm not going to dwell on my stay in this unit but I do feel one or two things need to be said about the place:

Bad points:

I was supposed to have my own dedicated nurse, I shared her with one or two other patients, I don't know how many she looked after but she was our first 'port of call'. I saw her most days but hardly ever to speak to. She wanted to speak to me and my wife and that took about two weeks before she finally found the time from her hectic schedule, she spent a lot of time around the reception desk talking to other nurses! As my wife said to her when she said she had been trying to catch her to talk to: "Well, I've onlybeen here every visiting period for the last two weeks!"

Because of the short term memory loss that most folk seem to suffer from, one or two of the nurses took advantage of the fact. They would talk to and treat the patients like idiots, as if they belonged in a padded cell, their attitude was terrible. I realise that some nurses go to work, do their job and want to go home. Some go to work and do more than should ever be expected of them, that is the way of the world but it is no excuse for the way some of the nurses treated the patients like complete morons.

A stroke is one of most vile things that can happen to anyone, from one minute being a normal operating human being, to what could be less than a minute, (no wonder they call it a stroke), you could be turned into a complete lifeless shell of the original. To take advantage of that is unforgivable in my opinion!

One of the guys in the ward with me, there was five of us to a room, was a plumber, another in the other room was a joiner by trade. I suggested that when we all got out of hospital we should form a building company of our own, place an advert in the paper saying that 'We'll be round in a stroke!' The title of this book, that's where it came from. (I won't say their names

because of confidentiality but I'll never forget them!)

This brings me to one of the really bad things in the ward. When the 'permanent' night staff was off, they couldn't work every night, the 'day staff ' would do nights on a sort of rota system. One of these nurses should NEVER be let into a hospital unless it is as a patient herself; she was one of the most nasty, loud mouthed women I had ever had the displeasure to meet.

One night my poor 'mate' couldn't remember his room or where his bed was. He asked her quite politely where his bed was, all she could do was to shout and scream and I do mean scream at him. Screaming at him to get back to bed and stop annoying her, that he knew where his room was, that he was just trying to wind her up, she called him all sorts of things - she totally refused to help him - a real dedicated nurse this one!

I eventually got up and led him to his room; don't know how many others she woke up but it must have been a few. That woman was despicable as far as I was concerned! She shouldn't have been allowed anywhere near a patient. Don't forget I was in there trying to recover myself and having to listen to the outbursts from this woman!I once mentioned the episode to someone in authority, but I refused to say who the nurse was, all they would say was that unless you name names, then there was nothing they could do. The other nurses knew who it was OK but she got away with it. There was another nurse on duty with her that night but she never said or did anything.

Another time I was trying to help my 'mate' the plumber. He was getting help, trying to read and write again after the stroke. He had a paper with a load of questions on it, a bit like an exam paper.Things like: name 3 toys a child would play with, name 3 tools a bricklayer would use etc. Simple things but things to get the brain working again. I could see that he was struggling to write so I suggested that if I read the question to him, he could answer the question and I would write the answer down for him.Simple but affective...what happens...in walks my 'dedicated' nurse and says,

"Oh what's this then? John the therapist now is it?"As I said, she had hardly spoken a word to me since going in there now she wanted to be sarcastic!Well let me tell you, I didn't need to look but she NEVER took her eye off my 'mate', he was furious, she kept saying it was OK, nothing wrong as she walked backwards out of the door.I said to her before she scampered out that "I thought we were all there to help each other," - apparently not so in her case! To be so insensitive to two people who are trying to help each other after what they have suffered, beggar’s belief in my book.

This is supposedly in a 'Specialist Ward' where one would have hoped the staff would have got 'specialist' training, obviously not! Yet another one that should never be allowed near patients.

A lot of things were allowed to happen that would not have been tolerated in a normal ward, but like I say, these are folk with brain damage, they won't remember in the morning will they?

The good points: One of these two guys had a memory of about 2 minutes, that's all, it was really sad. He often walked around shouting for his wife, he thought she was there with him.

The other guy had Alzheimer's disease BEFORE he had the stroke. They were both lovely blokes in their own right. One would try to go on 'walk about' and sneak out of the hospital; he was once found about two miles away by the police. He wasn't a danger to anyone but himself poor lad, I say lad; they were both in their seventies!

My 'mate' the joiner, I used to sit with him on a night watching the television when everyone else was tucked up in bed, most used to retire by about eight o'clock! We had the same conversation EVERY night! It went something like this:

Him to me, "Hello mate, what's your name then?"

Me to him, "John mate, what's yours?"

Him after telling me, "Where are we?"

Me, "Hospital mate"

Him, "Hospital?... Why?... What's wrong with you?

Me, "Had a stroke mate"

Him, "A stroke? Bit young for a stroke aren't you? Am I in hospital then?

Me, " Yes mate, your in hospital as well"

Him, "Have I had a stroke mate?"

Me "Yes mate, you've had one as well"

Him, "When was that then mate?"

Me, " About two weeks ago"

Him, "When did you have yours then?"

Me, "About a week ago mate"

Him, "Did you really? What's your name then?"

A lot of 'mates' about wasn't there?

And so we returned to the beginning of the conversation, it was the same every night, sometimes a little different but never more than two minutes before we returned to the beginning! This would go on for about an hour or so before he would go to bed, I would have to show him where his room was and which bed to get into because he couldn't remember, and we didn't want him getting into bed with someone else did we?

The blind leading the blind comes to mind!

I sometimes used to manipulate the conversation; well I was allowed to wasn't I? I was nearly as bad as him poor lad, he had a great personality.As patients we all wound each other up but stand back anybody that tried to

do the same who wasn't a patient! We had a right, and as so many folks like to tell you nowadays, "I know my right!"

The majority of the nurses in there were fantastic, two stand out in particular, they had been there a while and I think one was coming up for retirement. They obviously knew the job inside out and made life so much easier for us patients, NOTHING was ever too much trouble for them! They showed me how to put on the tight stocking style socks that helped the circulation. I got so I was able to put them on myself placing a plastic bag on the feet first so they would slide easily over my feet.

To those two I would award an MBE! It's a true saying you know, that you always remember the good and the bad but very rarely the in-between.

The Ward Sister, I think that was her title, she was the head of the ward anyway, she was great. She ran the place very well, very regimental and she wouldn't stand for any nonsense either! I used to call her my Gloria Gaynor, she was about the same stamp as her. I was sat one morning in the cafeteria at the entrance of the hospital, reading the morning paper and having my usual bacon roll and cup of tea, when she leant over my shoulder, making me nearly jump out of my skin. "Now John, you know you shouldn't be having that, don't you?" she said in her soft quiet way. Then she went off laughing, a real lady. It was a pity she never worked nights she might have discovered a few things about her staff!

The 'permanent' night staff. These two ladies were marvellous, completely different to the day staff. Very laid-back, they used to get on with their job and made everything so pleasant for everyone. I used to sit some nights, after 10 o'clock with the younger of the two and we would chat about all sorts of things. She would often go and make three cups of tea for us and chat away once everyone else had dropped off into sleep.

It was during one of these chats, this was back in 2002 remember, that there was an earthquake somewhere around Birmingham and we felt the tremors in the hospital. The roof shook and I thought it was somebody walking about upstairs, not realising that there was no upstairs! She was quite shocked but it was all over before I realised what had happened.

The other older nurse had been away on holiday when I had first been admitted. On her first night back, she came over, introduced herself and shook my hand. A little different to one of the staff that had filled in for her while she was away! Two of the nicest people I met in there. I will be eternally grateful for their kindness.

Full honours have to go to the two physiotherapists in the ward though!They were brilliant, with a capital B! One should be made a 'Dame' and the other a 'Sir'. They had some patience let me tell you. Can you imagine what it must be like to try to encourage people to walk and exercise who don't have the inclination to even get out of bed in some cases? They hardly have the will to live some of them, never mind walk but they do succeed, God Bless them.

I would love to tell you their names but I can't, it wouldn't be fair on them.And I don't think they would thank me for saying so either, they weren't that sort of people. They got on with their work and did what needed to be done.When I was first admitted I told 'Sir' that I wanted to treat the stroke like a broken leg, off work six weeks then back at it. He told me that six weeks was optimistic but if I worked with him he would get me out as soon as possible.He was true to his word, I was out after five weeks!Some of the people were there for three to four months and then some of those had to be transferred to another 'unit', so five weeks was a relatively short time after suffering a stroke.

He worked on me twice a day, an hour in the morning and an hour in the afternoon. Once or twice the 'Dame' helped out with my treatment, she was great, she made you work and encouraged you like nobody else. She was head of the department I believe. To these two I will always be truly grateful, without their help I would not be as good as what I am now.

I walk, although I do have a 'dropped foot' that will never be right, the stroke destroyed the nerve endings and pain receptors etc in my foot. I don't really feel any pain so I have to be careful I don't hurt or cut it as I might not realise the damage done. The guy who I call 'sir' or as I already stated should be made a 'sir', I feel in a lot of ways saved my life, the encouragement he gave and the attention paid to me was fantastic. I will always be grateful that somewhere, someone had the foresight to employ a

man like him! I have always wanted to go back and say thanks to these two but I have never been able. It would be too emotional for me, another consequence of having a stroke, it can leave you very emotional indeed. You could be told a joke and you start to cry or someone could inform you that a member of your family has just died and you start to laugh, it is the way the stroke affects your emotional patterns.

I used to be able to walk through walls, now I can get upset and want to weep watching Andy Pandy saying goodbye to Looby Loo at the end of the kids programme! As I say to most people, I am now a far more nicer person than I used to be because I now get upset at the silliest of things, whereas before I never used to. That is unless of course if you talk to my wife, she will tell you about the angry spells that I get and have no control over. Not very nice then!Depends apparently, on which side of the brain is affected to how your emotions are affected.You can be very selective at times as well, to how much this 'short-term' memory loss affects you. It can help you forget the most mundane of chores that you meant to do yesterday!

Little did I know that once out of hospital you are virtually left to your own devices. I know a lot is made of the resources that the NHS has but in reality after you leave hospital, treatment to the physical side of your well being is just about forgotten.

Within the first three or four days after coming out of hospital I had people coming and going out of my house like it was a night-club! A District Nurse called, said she would always be available, don't hesitate to get in touch etc etc. Left the house she did, must have emigrated - never seen the woman again.

I had to go and see my own Doctor every week at least once a week etc. He played a blinder, and still does - a brilliant guy! IF you have a good doctor, work with them and use them to get you into better shape, that's what they are there for. Mine told me when I first came out of hospital to go and see him no matter what was troubling me, even with the most trivial of things.

If I wanted my blood pressure taken or I was feeling a bit 'peekish' go and see him, nobody was going to mind. The ladies out there seem to be able to relate to their doctors a lot better than us blokes, I certainly think it is a 'male' thing! If you brood about things and worry, which most stroke survivors will do, then that could be a bad thing because at the least it will probably raise your blood pressure!

I had always found it hard to relate to my doctor, I think a lot of people for the simple reason being, if you have a broken leg you can say, "Look this is broken". If I felt off colour or not well, I always felt like a bit of a sham, how do you relay the symptoms of feeling unwell? I now have a great relationship with him, without his help and advice I don't think my recovery would have been nearly as advanced as it is now.

A woman who was the sole person in my city dealing direct with 'stroke' patients, as she said, was the only person with 'stroke' after her name. Now I saw her about three times in eighteen months, then I got a letter off her stating that our 'regular' meetings would have to stop as it was now July and it would be two years in September next, since I suffered my stroke.The last time we had a 'regular' meeting was in the previous NOVEMBER!I didn't mind at all, she was a nice woman but to say we had 'regular' meetings made me smile. I telephoned her to wind her up and really to say thanks. I didn't get the chance, as soon as I mentioned about these 'regular' meetings, did she go on the defensive! We didn't part on a sour note but she was certainly put out by our conversation, didn't see the irony at all.That is unfortunate because she is a caring lady and not too many people connected to the medical profession appear to care, they do a job and that's that. I can fully understand their thinking and have no trouble accepting it.It makes all the difference when you come across the ones that do care, as she does, it makes it far easier especially after suffering severe brain damage.

The getting better part, the getting well enough to come out of hospital is easy enough to do, compared to what you face when you do leave hospital.Most folks do come out of hospital, then the anti-climax arrives! Just because you are out of hospital doesn't mean that you are cured, what about work and an income, what about the mortgage, the kids, the holidays, the car, these are all things you took for granted but now you have to face the

fact of maybe not having all these things around for too much longer. The banks and building societies have no compassion when it comes to money.My building society have been great but I have had to change my bank, I would love to name and shame them but all I will say is that they used to be a National bank but apparently not now, plus they are a place that monks live! I had a slight overdraft and I do mean slight because I was self/employed, as soon as I telephoned them to make them aware of what had happened to me the letters started. I hadn't banked for quite a few weeks, the first letter states - of course not - I'd been in hospital trying recover from a stroke! Did I realise that I was breaking my overdraft agreement by not banking etc etc? Of course I did, all this had been explained to them when I first phoned them. I'll cut a long story short - after many letters, phone-calls etc I walked away from them and got myself another account with another bank, I explained what had happened with this other bank and they accepted me straight away!

The other crowd told me down right lies, they put it in writing that they had no records of any of my calls to them, was I sure that I had actually rang them and not another bank? It was my fault I had broken the overdraft agreement, of course I couldn't really be blamed for it because I had suffered a stroke, hadn't I? A nice thing to say to some one isn't it? Really caring lot they were. When I produced the telephones bills with their number and times that I had phoned they suddenly discovered my lost records, agreed that I had made the calls but had no record of the conversations because they hadn't been taped. I have kept all this correspondence.I was going to go to the papers and the ombudsman about their treatment but after what I had suffered I just wasn't strong enough to face up to that ordeal, so I walked away.They threatened in the finish to take me to court and sue me for the money -I asked, nay begged them to take me to court - I promised them I would have any paper or TV station that would be interested there with me and I would show them for what they really are. Funnily enough they never did, what they did do was pass the debt on to a debt recovery company, who once I explained what had happened, said they would pass it straight back to the 'monks habitat'. I never heard anything more, the occasional letter but that is it. They did put a black mark against my name but after suffering what I went through, that is the least of my worries.

Another thing I realised throughout that ordeal, is that we don't deal with humans anymore, it's ALL the fault of the computer! That's the thing that makes ALL the decisions and sends out letters and charges what it pleases,

tells lies and much, much more, according to the 'call centre' staff, seeing as they are the only ones you seem to be able to get hold of! If the computer says it - then it MUST be right.

I put a question up on one of the forum's on a stroke website asking if anyone else had been treated badly by the banks or building societies after suffering a stroke, well let me just say, I was lucky after reading some of the replies. Some folk had lost their businesses AND their homes because of the attitude of these organisations! If you have to deal with anything financial like this, PLEASE make sure you take the persons name and position in the company if you phone or visit them. Take note of times and dates, keep a proper record then IF anything should turn nasty at least you will have proper records to refer to.

Friends and relatives can and should play a big part in your recovery. They can give you the confidence and encouragement to do things you might not otherwise attempt. As the saying goes, "They will be there to catch you when you fall."One of my neighbours, and now who I count as a very good friend, showed me NO sympathy at all when I first came out of hospital! That was exactly what I needed, I'm not saying everyone is the same, depending how you are effected you might need LOTS of sympathy, in my case I didn't. He once helped my wife in the garden, then told me that if it had been me out there, he wouldn't have bothered!! I've promised him, I'm going to get him at 'play-time'!He was quite brutal at times which gave me the chance to be brutal back. I have always had an awful sense of humour, my wife says it is MORE than awful! He has been great and I really do appreciate what he has done to help me, not that I suppose he will realise or think that he has because he is not that type of guy. He gets on with life and that's that.If he ever read this, which I doubt, I would have to say it was about someone else, I couldn't let him think I was being nice about him, could I?Whenever I get to feeling sorry for myself he always seems to appear, then slaps me down some more, which makes me realise just how fortunate I really am.

A few of my friends have stayed close, which is great, but I do think that we all have to realise that the world moves on and we can't expect friends or family to be there twenty four hours a day. A few of my ex-work colleagues and friends have drifted away, this I find natural in the greater scheme of things. It happens all the time, it is only when we are stuck in the same spot in time that we think everything is leaving us behind, it isn't and must accept losing maybe some friends and then gaining others.

I know a few others who have suffered strokes and they feel that they have been deserted but that is down to attitude, I don't believe it does any good waiting for the world to come to us, we must go out and get the life we want. That can not always be the case for a large number of the folk who have had a stroke and are confined to the space where they live.We do have choices, number one, we can sit and feel sorry for ourselves and vegetate OR two, we can TRY to improve the life we have, in whatever form that takes. I find just the act of trying makes me feel more positive and determined about things.

Some are left where they don't even know what day it is and never will, for those poor folk I don't have a clue because I haven't been there, thank goodness. Most survivors say the same thing, IF another person has not had a stroke they can not imagine what goes on in your head or how you feel.As one expert said, "The patient is the best expert on their own recovery."

I would love to go back to the day before my stroke but I can't but what I can do is go forward to tomorrow and believe me, I intend too! I have an old saying I use and refer back to all the time, and that is:'We can't go back and make a brand new start but we can start from now and make a brand new ending!'

Physiotherapy was a total joke AFTER I came out of hospital. I got to see a physio about four weeks after coming out of hospital at an Outpatient's Dept. I then had physiotherapy for one hour each week for about two weeks, it was then dropped down to once every two weeks and after about

three or four sessions, it was dropped down to once a month! One hour a month? Now ask anyone what good that is and they will tell you, absolutely a total waste of time.I do have an issue with one of the physio's but that is personal, what I will say is that, the people who couldn't walk at all got really good treatment, those like me that could walk to a certain degree were pushed through the system as quickly as possible and out the other end. Just another statistic!Just because you can manage to some extent, doesn't mean you should be abandoned or left to sort yourself out. Remember, ALL stroke survivors have suffered brain damage! How are they supposed to cope under their own steam?

I have a friend (now) who was in hospital at the same time as me, he got physio a few weeks after me for the first time, he was in a wheelchair most days and walked very little, his wife told me they gave up on the physiotherapy after a about a month or so because it kept getting switched around or he didn't get any at all.

I'm not saying that was down to the physio's themselves but I think it shows the enormous pressure they are under to perform.

This IS the great British National Health Service as I have already stated, that gets very highly praised by all parties to show what a great government they are, looking after all us sick people. Less words and MORE action might be more beneficial.

The physio's that treated me in hospital ran a meeting once a month to explain what and how stroke happens and how to cope with the effects.They used to do this for the patients and their families, it was great to be able to ask questions and get some genuine answers. This was about the only advice that was given freely, anything else and my wife and I felt we had to fight to get any information out of the system.

When I got out of hospital I attended meetings set up by a national charity, I wasn't pointed in their direction, I had to find them myself.

They are a charity set up by stroke survivors for younger stroke survivors.(www.differentstrokes.co.uk) A great place to meet others with the same problems as yourself, they know most of the answers to most of the problems you will face. They have leaflets, a website with a 'forum' so you can ask other survivors questions and get proper answers, they can send out monthly news letters etc.Lots of information about benefits, coping, services available for the survivor etc.

A leaflet about this organisation was pinned to the notice board in my hospital ward, nothing else was mentioned about it.

When I realised just how beneficial it was to have some point of reference and not feel alone I approached someone in authority and asked if it might not be a bad idea to have this charity mentioned at the monthly meetings run by the physio's in the hospital. It would be good that people wouldn't come out of hospital not knowing which way to turn. I offered to go in and speak myself, if it would help others.

Have a guess what I was told? You would never guess in a million years...I was told that if they let me go in to talk about this charity and maybe give out leaflets etc, then they would have to let in the Red Cross and other organisations etc.So because some other organisation might also want to help stroke survivors and their families it was a no go! I kid you not. Beggars belief doesn't it, that in this day and age, the establishment could be so petty...all looking after their own jobs and don't want others stepping on their toes?

So the only help and advice that was available was from the overworked physio's, it's such a pity that these two and their staff couldn't be 'cloned', the world would be a far better place to be!

That seems to be the crux of the matter in this country with the NHS.EVERYBODY appears to be under so much pressure to hit targets, (I had to get off a trolley at five in the morning), performance (get people through the system as quickly as possible), appear to be doing more than they can cope with, one person looking after the interests of all stroke survivors in a city were on average three hundred people suffer a stroke each year and she stays in contact with them for two years. That could be up to six hundred people at any given point wanting her time.

I went to a Primary Care Trust meeting, once and once only. I thought that maybe I could do some good, put back something into the community.Most folk there that I talked to, agreed that all that had happened was that it was paying 'lip service' to the real issues and doing nothing. The doctors and officials there appeared to be leading everyone down the same path.They were pointing the way they wanted your views to go.

I mentioned at the beginning of this article that I don't have an axe to grind or anybody to upset. What I have stated here is the TRUTH. These things did happen, some bad but mostly good. The bad needs to be addressed and the good improved upon. They are entirely my thoughts and feelings, no one else's.

What I do know is that my story is NOT an uncommon occurrence, I have talked with many people who have suffered a stroke, either in person or in forums on the internet, it is amazing that so many people have a far WORSE story to tell than myself about their stay in hospital but just as good, if not a better story than mine AFTER they came out, back into the real world again!My story in hospital is not unusual but the good things did outweigh the bad things, like the two big lads who were nurses, absolutely brilliant guys again - both from the Philippines. The lovely nurse with the 'dreadlocks' always had a smile and a nice word to say, she had the same name as my wife, the lovely lady who was in charge of the cleaning staff, she used to call us ALL her patients! She would do much more over and beyond the call of duty.She used to work 12 hour days because she liked to be there for 'her' patients! - told you that you always remember the good and the bad but NOT the in-between! Too many good things to mention really, I have related some of the main points, good and bad. It can't have been too bad, can it? I'm still here to tell the tail!

Every stroke survivor I know has attitude, that's what gets you through this terrible thing, GET ATTITUDE, kick some butt, never mind what others think!

If you have suffered a stroke yourself or you know somebody that has, remember:

A stroke 'survivor' is exactly that, a 'survivor'. A stroke 'victim' will always be that, a 'victim'!

YOU make the choice about which one you are!

This is a copy of an email I received recently off a friend. I have left it as it was sent to me. Personally I think it makes a lot of sense and IF only one person is helped then it is well worth mentioning.

Stroke Recognition

This is important information that each of us should know.

Simple and easy to remember.

During a BBQ a friend stumbled and took a little fall - she assured everyone that she was fine and just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm, Ingrid passed away.) She had suffered a stroke at the BBQ - had they known how to identify the signs of a stroke perhaps Ingrid would be with us today. It only takes a minute to read this-

----- A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed an getting to the patient within 3 hours which is tough.

RECOGNIZING A STROKE

Thank God for the sense to remember the "3" steps. Read and Learn!Sometimes symptoms of a stroke are difficult to identify.

Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer brain damage when people nearby fail to recognize the symptoms of a stroke.Now doctors say a bystander can recognize a stroke by asking three simple questions:

1. *Ask the individual to SMILE.

2. *Ask him or her to RAISE BOTH ARMS.

3. *Ask the person to SPEAK A SIMPLE SENTENCE (Coherently) (i.e. . . It is sunny out today) If he or she has trouble with any of these tasks, call 9-1-1 immediately and describe the symptoms to the dispatcher.

After discovering that a group of non-medical volunteers could identify facial weakness, arm weakness and speech problems, researchers urged the general public to learn the three questions. They presented their conclusions at the American Stroke Association's annual meeting last February. Widespread use of this test could result in prompt diagnosis and treatment of the stroke and prevent brain damage.A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved.BE A FRIEND AND SHARE THIS ARTICLE WITH AS MANY FRIENDS AS POSSIBLE, you could save their lives.

What is a Stroke?- In layman's terms:

There are two types of stroke, 80% - of strokes are ischaemic strokes, this figure does vary depending on who's presenting the figures but it is around the 80% - 90%. They are caused by a blockage in an artery which affects blood flow to, or within, the brain. An ischaemic stroke can also be called a TIA, or Transient Ischaemic Attack, if it happens for less than 24 hours.The other 10% - 20% are haemorrhagic strokes, also called brain haemorrhages where there is a bleed in the brain.There are also events which might be called strokes or might be called cerebrovascular accidents, which have similar results to strokes. An example of this would be an aneurism in the brain. This is a swelling of an artery, which balloons outwards and can damage or destroy brain-cells as it does so.

The damage to the brain caused by a stroke is caused by oxygen starvation in the case of an ischaemic stroke. In the case of a brain haemorrhage, the pressure of the escaping blood damages or destroys brain cells.

People who have had an ischaemic stroke are often prescribed aspirin or warfarin to thin the blood, ( I am taking a small aspirin dose every day) which helps to prevent the formation of more clots. However there are many different types of drugs on the market today designed to thin the blood, and some may not be suitable for those with a higher risk of haemorrhaging (bleed), as some of these drugs may affect blood clotting abilities.If you were to have a haemorrhage the last thing you want is to have the blood thinned down so it won't stop bleeding! Before taking and or altering the dose of such medications one should seek expert medical advice, ideally

from a Haematologist. Those on blood thinning drugs should have their INR monitored regularly, which is basically a blood coagulation (clotting) test.

Brain cells that have died cannot start working again. However, areas of the brain affected by swelling caused by the stroke may recover as the swelling goes down. The brain is very adaptive and with time can often find new ways to transmit information (new neural pathways) to avoid the damaged areas. When stroke survivors practise exercises to help their recovery, they are also encouraging the brain to develop these pathways, in exactly the same way (for example) as someone learning a musical instrument or an athletic exercise is encouraging the development of co-ordination of their body.

Every stroke is different! Every survivor will be affected very differently depending on where the brain is affected as well as what sort of stroke they have had and how severe and widespread the damage is. That's why it is emphasised that the role of the survivor is the expert in his or her own recovery.There are in my humble opinion, too many people out there that think they know what it is like to have a stroke and dispense advice when in reality they don't have a clue to what really goes on in somebody's head that has suffered this way.Their intentions are probably well meant but I and many others resent being told 'HOW' we 'SHOULD' feel or think! I know how I feel thank you very much and so does every other poor soul who has suffered this indignity.

I have, thankfully, the use of most of my faculties, otherwise I wouldn't be able to write this book. I am still unable to walk very far and have no energy, I get out of breath doing the simplest of tasks and often have to rest after exerting myself. This is three years after having a stroke! It is no good now telling friends, ex-work colleagues, family etc that you feel tired and still can't face the world some days. That you still feel sick or dizzy at times. Sympathy does wear a bit thin after a while!

Most folk aren't as fortunate as me and will be in wheel-chairs or unable to speak or walk for the rest of their lives, either that or worse. PLEASE - one request - if you know a stroke survivor do NOT tell them that they are LUCKY to survive or that they are LUCKY the way they have recovered from the stroke! Nobody but nobody is LUCKY suffering a stroke, I had doctors and nurses telling me I was LUCKY, these are people who should know better. Friends and relatives, yes, they don't know but those in authority and the medical profession should know better than that.

If you do talk about their recovery or their survival use a word like fortunate etc but NOT LUCKY! It is little things like this that can really effect the survivor and their recovery. When people have used the word while speaking to me I have always replied that "Yes, that's right, I was very lucky me!" Never call them a stroke 'VICTIM ' only a survivor, because that is what we are. I wasn't lucky but I do know I was very fortunate with the effect the stroke had on me. For that I will always be eternally grateful.

STROKE

The UK has one of the highest rates of death from heart disease in the world - one British adult dies from the disease every three minutes - and stroke is the country's third biggest killer, claiming 70,000 lives each year.Strokes are caused either by blocked or burst blood vessels in the brain. A range of other conditions, including heart failure, when blood is not pumped properly around the body, and congenital heart defects can also cause long term problems, and even death, for sufferers.

Stroke - ischaemic caused by blood clots or other obstructions - ischaemic stroke - accounts for 80% of all cases.

This is the type of stroke that I suffered.

A blockage is called a cerebral thrombus or cerebral embolism and can be caused by hardening of the arteries. In both types of stroke - those caused by blood clots and those caused by burst blood vessels - blood supply to the brain is interrupted, depriving the cells of oxygen and other nutrients. The cells are then damaged or die. Mini-strokes, or transient ischaemic attacks (TIAs), may be a warning sign of an imminent full-blown stroke.

EmbolicIn an embolic stroke, a blood clot - or embolus - forms somewhere in the body, usually the heart, and travels through the bloodstream to the brain.

Once in the brain, the clot eventually travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke.

ThromboticIn the other form of blood-clot stroke, blood flow is impaired because of a blockage to one or more of the arteries supplying blood to the brain - a thrombus. The process leading to this blockage is known as thrombosis and strokes caused in this way are called thrombotic strokes. In atrial fibrillation, where the two upper chambers of the heart - the atria -quiver instead of beating properly, blood is not properly pumped out of the heart. As a result it may form clots and if the clot becomes lodged in an artery in the brain, a stroke may result. The American Heart Association says around 15% of strokes are caused in this way. Blood clot strokes can also happen as the result of unhealthy blood vessels clogged with a build up of fatty deposits and cholesterol. The body regards these build ups as multiple, tiny and repeated injuries to the blood vessel wall and reacts as it would to bleeding from a wound, by forming clots.

The symptoms of stroke can be: 1. Sudden numbness or weakness of the face, arm or leg, particularly

if it is on one side of the body. 2. Sudden confusion, trouble speaking or understanding. Sudden

difficulty with walking, dizziness, loss of balance or co-ordination. 3. Sudden trouble seeing in one or both eyes. 4. Sudden severe headache with no known cause.

Anyone identifying themselves or friends or family as having a stroke should call emergency services, not a GP, as any delay reduces the chance of a full recovery. The speed of treatment after a stroke is extremely important as the longer the brain cells are deprived of oxygen, the more damage they will suffer. There does seem to be some debate about this but personally on reflection I would agree, call the emergency services and not hesitate in getting help IMMEDIATELY!

TreatmentClot-busting drugs can be used in the first minutes or hours - up to a maximum of three hours - after an ischaemic stroke to dissolve the clot. After this time aspirin, which is not as powerful, may be given.

Survival rates are better for patients in specialist stroke units, but such units are not always available. Rehabilitation programmes will be given to most stroke patients to help them recover lost mobility and speech.

Stroke - haemorrhagic

Stroke can leave patients without speech or any movement

In around 20% of cases, strokes are caused by ruptured blood vessels leaking blood into the brain - haemorrhagic strokes. Both types of stroke - those caused by blood clots and those caused by burst blood vessels - interrupt the supply of blood to the brain, depriving the cells of oxygen and other nutrients. The cells are then damaged or die. Strokes caused by the bursting of a blood vessel in the brain are the result of a cerebral aneurysm - ballooning of a weakened blood vessel in the brain -which is left untreated, high blood pressure, or a cluster of abnormally formed blood vessels (arteriovenous malformation). Aneurysms develop over a number of years and do not usually cause detectable problems until they break.

Types of haemorrhagic strokeThere are two types of haemorrhagic stroke - subarachnoid and intracerebral. In an intracerebral haemorrhage bleeding occurs from vessels within the brain itself. Hypertension, or high blood pressure, is the primary cause of this type of haemorrhage. In subarachnoid haemorrhage, an aneurysm bursts in a large artery on or near the delicate membrane surrounding the brain. Blood spills into the area around the brain which is filled with a protective fluid, causing the brain to be surrounded by blood-contaminated fluid.

The symptoms of stroke: 1. Sudden numbness or weakness of the face, arm or leg, particularly

if it is on one side of the body

2. Sudden confusion, trouble speaking or understanding. Sudden difficulty with walking, dizziness, loss of balance or co-ordination

3. Sudden trouble seeing in one or both eyes 4. Sudden severe headache with no known cause

Anyone identifying themselves or friends or family as having a stroke should call emergency services, not a GP, as any delay reduces the chance of a full recovery.

TreatmentThe speed of treatment after a stroke is extremely important as the longer the brain cells are deprived of oxygen, the more damage they will suffer. Clot-busting drugs and aspirin must not be given to patients who have suffered a haemorrhagic stroke. A CT scan or MRI scan will identify the type of stroke suffered. Treatment of haemorrhagic stroke is less developed than that of ischaemic stroke. A Medical Research Council trial is currently underway into treatment to remove blood clots surgically and drugs which prevent damage to brain cells during haemorrhages are being tested.

Risk factors and prevention

Lifestyle has an impact on heart disease and stroke risk

Heart disease and stroke may be inherited, but often they are the result of lifestyle. Changing eating, exercise and smoking habits can play a significant part in prevention.I smoked up to thirty cigarettes a day until the day of my stroke, I have never smoked since.As my specialist said to me: "John, it is amazing how many people find it very easy to stop smoking AFTER their first heart attack or stroke!"

Risk FactorsAgeFour out of five people who die from coronary heart disease are aged 65 or older. The risk of stroke doubles with each decade after the age of 55.

SexMen are more at risk than women and have attacks earlier in life. Death rates from heart disease and stroke for women are twice as high as those for all forms of cancer. The risk for women increases as they approach menopause and continues to rise a they get older, possibly because of the loss of the natural hormone oestrogen.

Family history (heredity)Children of parents with heart disease are more likely to suffer from the disease. Some races, such as Afro-Caribbean, are more prone to coronary heart disease and stroke than others.

SmokingSmokers are twice as likely to suffer heart attacks as non-smokers, and they are more likely to die as a result. Smoking is also linked to increased risk of stroke. The nicotine and carbon monoxide in tobacco smoke damages the cardiovascular system. Passive smoking may also be a danger. Women who smoke and take the oral contraceptive pill are at high risk of heart disease and stroke.

AlcoholDrinking an average of more than one drink a day for women or more than two drinks a day for men increases the risk of heart disease and stroke because of the effect on blood pressure, weight and levels of triglycerides - a type of fat carried in the blood. Binge drinking is particularly dangerous.

Drug abuseThe use of certain drugs, particularly cocaine and those taken intravenously, has been linked to heart disease and stroke. Cocaine can cause abnormal heartbeat, which can be fatal, while heroin and opiates can cause lung failure. Injecting drugs can cause an infection of the heart or blood vessels.

CholesterolThe higher the blood cholesterol level, the higher the risk of coronary heart disease, particularly if it is combined with any of the other risk factors. Diet is one cause of high cholesterol - others are age, sex and family history.

High levels of LDL (low-density lipoprotein), or "bad cholesterol", are dangerous, while high levels of HDL (high-density lipoprotein), or "good cholesterol" lower the risk of heart disease and stroke.

Blood pressureHigh blood pressure increases the heart's workload, causing it to enlarge and weaken over time. When combined with obesity, smoking, high cholesterol or diabetes, the risk increases several times. High blood pressure can be a problem in women who are pregnant or are taking high-dose types of oral contraceptive pill.

Physical inactivityFailure to exercise is a cause of coronary heart disease as physical activity helps control cholesterol levels, diabetes and, in some cases, can help lower blood pressure.

ObesityPeople who are overweight are more likely to develop heart disease and stroke, even if they have none of the other risk factors. Excess weight causes extra strain on the heart, influences blood pressure, cholesterol and levels of other blood fats - including triglycerides - and increases the risk of developing diabetes.

DiabetesThe condition seriously increases the risk of developing cardiovascular disease, even if glucose levels are under control. More than 80% of diabetes sufferers die of some form of heart or blood vessel disease.

Previous medical historyPeople who have had a previous heart attack or stroke are more likely than others to suffer further events.

StressSome links have been made between stress and coronary artery disease. This could be because it encourages people to eat more, start smoking or smoke more than they would otherwise have done.

PreventionEducationEducating people about the risk factors of heart disease and stroke andattempting to persuade them to adopt a healthier lifestyle can have an impact on the number of people dying from heart disease and stroke. Encouraging people to stop smoking, drink less, eat better and exercise regularly are particularly important.

Doctors can help by asking about smoking habits and encouraging patients to use nicotine replacement treatment, such as nicotine patches.

Regular monitoringPeople should also have regular blood pressure readings, height and weight monitoring, and tests for cholesterol levels. Those with high levels should be encouraged to improve their diet and can be treated for poor cholesterol levels with drugs - usually, statins or niacins. The American Heart Association recommends that blood pressure should be no more than 140 over 90 Hg. The association recommends a series of diets, with no more than 30% of calories coming in the form of fats, and limiting calories in the form of saturated fats to between 7 and 10%. People at risk should have less than 200mg dietary cholesterol per day. Sodium intake, most commonly found in salt, should also be controlled.

ExerciseBetween three and four sessions of moderate intensity exercise, lasting around 30 minutes a time, are recommended as the minimum for physical activity each week. Ideal body mass index (BMI) - calculated by dividing weight in kilograms by the square of height in metres - is between 21 and 25, and the preferable waist circumference is no more than 88cm (35 inches) for women, 102cm (40 inches) for men.For people already suffering from cardiovascular disease, the use of aspirin or warfarin, both of which prevent blood clotting, is recommended. Other drugs, including ACE (angiotensin-converting enzyme) inhibitors to manage blood pressure, beta-blockers to control angina, heart rhythm or blood pressure, and oestrogen replacement in post-menopausal women, may also be used to prevent repeat incidents.

Diagnostic tests

MRI scans can detect damage to the brain if they are administered.

When I had my stroke I enquired about a scan and was told that they knew the stroke had happened on the right side of my brain because of the affect it had on the left side of my body, so really there was no real purpose in having an MRI. The nurses told me that each scan cost about �15,000 to do, so I think that is where the answer lies! I will say that I did have other types of scans but the first was not until around forty hours after my stroke.

Lower blood pressure... reduces brain damage after stroke

French study finds less loss of nerve cells, preserving mental function

Lowering blood pressure in the years after a stroke reduces the death of brain cells that can cause loss of mental function, a new study finds.

Using MRI to get detailed pictures of the brain, French researchers report that people who got a drug to lower pressure after a stroke or a mini-stroke had significantly fewer "white matter hyperintensities" -- abnormalities that indicate tissue damage.

It's a small study that needs verification in larger trials, said Dr. Christophe Tzourio, lead author of the report and director of the neuroepidemiology unit at INSERM, the French counterpart to the U.S. National Institutes of Health. According to the report he was surprised and pleased with the effect.

The findings appear in the Sept. 7 issue of the journal Circulation.

The trial included 192 people with an average age of 60 who had had a stroke or mini-stroke in the previous five years. Roughly half were given perindopril, an ACE-inhibitor drug to lower blood pressure, while the other half received a placebo, an inactive substance.

Each participant underwent an MRI brain scan at the start of the study, and another one 36 months later.

The researchers report that the volume of new white matter spots in the brains of people who got the drug was just one-fifth that of people who got the placebo -- 0.4 cubic millimetres versus 2 cubic millimetres.

But the study's potential power to influence medical practice may be limited because of the small number of participants, a larger trial is needed but it would probably need several hundred's, maybe thousands to take part and this could have a cost prohibitive effect on the decision to hold one or not.

Other factors in the report are that lowering high blood pressure is beneficial still applies, especially for people who have mini-strokes, transient ischemic attacks (TIA). If you have a TIA, you obviously need your blood pressure lowered, more than if you have not had a TIA.

Daniel Lackland, a professor of epidemiology at the Medical University of South Carolina and a spokesman for the American Stroke Association, readily agrees. "This finding is consistent with everything else we know," Lackland said. "We've known for some time that lowering blood pressure successfully reduces the risk of dementia. This paper suggests that the loss of white matter is the link between high blood pressure and dementia."

The study also opens up a new area of research such as studies to determine whether lowering blood pressure can reduce the incidence of Alzheimer's disease and other forms of dementia but the other advantages of keeping blood pressure under control - notably a reduction in heart disease and stroke - show that you should get your blood pressure as low as possible.

But there's a bit of controversy about lowering blood pressure for all people in the first hours after a stroke, added Dr. Argye B. Hillis, a neurologist at Johns Hopkins Hospital in Baltimore. A subset of patients - those whose stroke is caused by blockage of a major brain blood vessel - might suffer more damage if the blood pressure is reduced in the acute stage of the stroke, she said.

Over the longer term though - the months and the years after a stroke - the evidence supports lowering blood pressure, she said.

B vitamins may cut fracture risk after stroke

Folate and vitamin B12 caused five-fold drop in breaks, study finds.

Taking folate and vitamin B12 supplements after suffering a stroke can reduce the risk of hip fractures, a new study reports.

The risk of hip fracture is two to four times higher than normal after a stroke. A study found almost a five-fold reduction in the risk of a hip fracture due to supplement use following a stroke, the researchers said.

"Stroke patients should routinely intake these vitamins to avoid hip fractures, because hip fractures are associated with more deaths, disabilities and medical costs than all other osteoporosis-related fractures combined," said study author Dr. Yoshihiro Sato, a professor at Hirosaki University School of Medicine in Japan.

Sato said these vitamins might reduce fracture risk by lowering homocysteine levels. High levels of homocysteine, (a naturally occurring amino acid), are a risk factor for both stroke and bone fractures. Sato said homocysteine may interfere with the microarchitecture of the bone. The finding appears in the March 2 issue of the Journal of the American Medical Association.

Joyce van Meurs, co-author of an accompanying editorial in the journal, said lowering homocysteine levels could have either a direct or indirect effect on bone. Directly, homocysteine may interfere with collagen cross-linking, a process she said is crucial for strong bones. So, lowering levels of homocysteine could lead to stronger bones.

Indirectly, high homocysteine levels are associated with other diseases, such as cardiovascular disease and dementia that may increase the risk of a fall or fracture, according to van Meurs. She said, the Japanese researchers accounted for these factors, so they're not likely the reason for the reduced risk seen in this study.

For the study, the researchers followed 559 Japanese stroke patients, aged 65 or over, for two years. All of the study volunteers had had a stroke at least one year before the start of the study and none was taking any medication that affected bone metabolism. The study volunteers were randomly split into two groups. Half were given 5 milligrams of folate, a water-soluble B vitamin, and 1,500 micrograms of vitamin B12 daily for two years, while the other half received two placebo pills daily.

At the end of two years, homocysteine levels in the group that received the vitamin combination were reduced by 38 percent. Six people in the treated group suffered hip fractures during the study period compared to 27 in the placebo group -- a nearly five-fold difference.

"In this Japanese population with a high baseline fracture risk, combined treatment with folate and vitamin B12 is safe and effective in reducing the risk of a hip fracture in elderly stroke patients," Sato said. Because the vitamins were used in combination, van Meurs said it's not possible to know from this study whether one supplement was more important in reducing the risk of fracture.

"The study shows a clear difference in fracture incidence between patients that receive folate/[B12] treatment and placebo," said van Meurs.

However, she added, "More and larger studies are needed in order to give a conclusive answer whether and to what extent these supplements preventfractures. If these results hold, this would add an effective, safe and cheap treatment for fracture prevention without adverse side effects. Meanwhile, since these supplements are thought to be beneficial without any adverse effects, I would suggest giving them to patients."

Sato strongly agreed that stroke patients should be given these supplements to help prevent fractures.

Gene raises young women's stroke riskThe discovery could lead to a test and even treatment, researchers say.

A key gene variant may help explain increased stroke risk in young American black and white women, researchers report. The finding might help scientists develop specific genetic screen that could someday spot affected individuals at high stroke risk. "The results of these tests would allow practitioners to counsel patients on stroke risk and to warn patients that specific environmental factors, such as oral contraceptive use, diet or smoking, may be particularly harmful," study author Dr. John Cole, of the University of Maryland School of Medicine, Baltimore, said in a prepared statement.

He added that the discovery might also lead to drugs that specially target the gene variants in order to reduce stroke risk.

The stroke-linked variant in question is what experts call a "structural variation," or polymorphism, lying in a gene called phosphodiesterase 4D (PDE4D). This association is also present for small blood vessel disease and for large artery atherosclerosis, according to the study, which was presented Monday at the annual meeting of the American Neurological Association in San Diego. Several previous studies have identified an association between PDE4D and stroke in different populations.

The next step in this line of research is to determine the specific PDE4D gene variants responsible for this association and how the variants affect proteins that are coded for by the PDE4D gene, said Cole, who is also affiliated with the Baltimore Department of Veterans Affairs Medical Center. "For example," he said, "does the genetic variant cause one to produce a defective protein, or decrease or increase the level of a protein, thereby predisposing to stroke? Does the variant make an individual more susceptible to stroke given a specific environmental exposure?" When these questions have been answered, it may be worthwhile to develop a genetic test for the PDE4D variants, Cole added.

Lower cholesterol levels cut heart attack, stroke riskMore study is needed before guidelines should be changed, researchers say.

Reducing "bad" cholesterol levels to new lows resulted in fewer problems, including heart attacks and strokes, in people with established coronary disease, a new study finds. However, there was no commensurate decline in death rates.

The study appears in the April 7 issue of the New England Journal of Medicine, but was released to coincide with a presentation at the American College of Cardiology's scientific sessions in Orlando, Fla. Participants in the study took a high dose (80 milligrams) of atorvastatin, better known by its brand name Lipitor, a drug made by Pfizer, which also funded the study.

The results are not enough to warrant an all-out change of current cholesterol recommendations at this time, the study authors said. "I don't think we ought to make a flat-footed recommendation based on one study," cautioned Dr. John LaRosa, lead author of the study and president of SUNY (State University of New York) Downstate Medical Center in New York City. "It was good, but they didn't reduce total mortality, so we need to be a little cautious," agreed Dr. Bertram Pitt, author of an accompanying editorial in the journal and a professor of medicine at the University of Michigan Medical School.

While current guidelines recommend LDL levels of less than 100 mg per deciliter of blood for people with stable coronary heart disease, more recent data have suggested that levels less than 70 mg per deciliter might be better, the study authors said. That previous research was not definitive, however. So the authors of the new study undertook a review involving 10,001 people with coronary heart disease who had LDL levels of less than 130 mg per deciliter. The participants in the study were randomly assigned to receive either 10 milligrams or 80 milligrams of Lipitor a day and were followed for about five years.

Those who were treated with the higher level of Lipitor had mean LDL cholesterol levels of 77 mg per deciliter. Those treated with the lower dosage had mean levels of 101. In the 80 milligram group, 434 patients (8.7 percent) had a heart attack, stroke or other event, compared with 548 patients (10.9 percent) in the low-dose group. That means there was an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a relative reduction of 22 percent, the study authors said. Although there were no differences in overall mortality, there was a slight increase in deaths not related to cardiovascular causes in the high-dose group, which is of potential concern, the study authors said. Nevertheless, LaRosa felt the results were striking: Even if there was no reduction in mortality rates, there were other significant benefits, such as living without the disability of stroke.

"The most common cause of death in this study in both groups was not coronary disease," LaRosa said. "A few years ago, if you told me you had a treatment that would lower the death rate of coronary disease so that it was no longer the most common cause of death in people that had it, nobody would have believed it." But it is the deaths not related to cardiovascular causes that has Pitt worried. "There are benefits, but is there any risk? That's a little uncertain," he said. "It's not clear-cut. People will have to look at it and decide."

It's also not clear if the lower cholesterol levels were related to Lipitor or would be seen with other statins as well. Other studies are ongoing, LaRosa said, and "within a year we'll at least be able to say that it applies to two statins or it doesn't." "I don't even think it's a question of statins," he added. "I think it's probably a function of how low you can get the LDL, however you do that." As for whether overall cholesterol policy should be changed, LaRosa noted that two other large studies addressing essentially the same question would be complete in about one year and may provide some answers. "When you are going to make official national guidelines, you want to make sure you are standing on absolutely solid ground," LaRosa said. All but one of the study authors acknowledged having received funds from Pfizer for research or being employed by the company. And all but one of the authors also acknowledged receiving fees and/or grants from numerous other pharmaceutical companies, including makers of other statin drugs.

Dispelling heart disease myths

Knowledge is a powerful weapon in avoiding illness. More than 50 years of research have increased our awareness of risk factors for heart disease. Yet heart disease remains the leading cause of death in the United States. Make sure common misconceptions don't stand in the way of heart-healthy habits.

Myth: I don't have a family history of heart disease. I have nothing to worry about.Fact: Although there's a strong genetic component to heart disease, there are other risk factors to consider. For example, excess body fat strains the heart. This can lead to high blood

pressure and diabetes - two major risk factors for heart disease.Physical inactivity may increase the risk of coronary heart disease, the most common form of heart disease, nearly as much as high blood pressure, high cholesterol or smoking. Mental health may also play a role. During episodes of stress, anxiety and anger, you may experience increased blood pressure and heart rate. These episodes may also promote plaque buildup in the arteries and the conversion of stored body fat into fatty acids, which increases cholesterol.

Myth: I don't need to think about heart disease until I'm older.Fact: Heart disease develops slowly. In fact, it can begin as early as childhood or adolescence. To reduce the risk of heart disease at any age:

Don't smoke. Exercise regularly. Get your doctor's OK before beginning

an exercise program. Lose excess weight. Keep your blood pressure in check. If your doctor

prescribes blood pressure medication, take it as directed. Limit the amount of alcohol in your diet. Eat a diet high in fiber and low in fat, cholesterol and

sodium.

Myth: If you've had a heart attack, you're bound to have a second.Fact: There are many things you can do to reduce the risk of a second heart attack or even prevent one. Lifestyle measures like those described above may save your life. Most people also benefit from medications to manage problems related to heart disease, such as arrhythmias, high blood pressure and high cholesterol.

Myth: Smoking causes lung cancer, not heart disease.Fact: Smoking is one of the most important preventable causes of heart disease. Smoking increases blood pressure, which damages the heart's blood vessels. Smoking also decreases levels of HDL or "good" cholesterol. This can lead to hardening of the arteries. It's never too late to quit. Within 20 minutes after quitting, your blood pressure may begin to decrease even if you've smoked for years. Within 24 hours, your risk of a heart attack may decrease. Within one year, your excess risk of heart disease may reduce to half that of a smoker. Within 15 years, your risk of heart disease may be similar to that of someone who's never smoked.

Put your knowledge into action. Start reducing your risk of heart disease today.

I smoked cigarettes from about the age of fourteen, that's for thirty-nine years before I had my stroke. Regardless of what some people say, and you will always get the "There is no medical evidence" brigade, I honestly believe that had a significant effect on me having a stroke. I never smoked again from the day I went into hospital, and may I add, I never will again.

If folk could just step back and smell what it does to them and their clothes, I think a lot of people would stop smoking immediately, never mind the medical advantages! When people walk past me who are either smoking or have just put one out, I straight away think, "Did I really smell like that?" Of course the answer is YES! When you smoke constantly, you do NOT smell the effects yourself, unfortunately!

Blood test approved to help doctors rule out heart attacks

The U.S. Food and Drug Administration (FDA) has approved a new laboratory blood test that will help doctors determine if a person with severe chest pains has had a heart attack. The Albumin Cobalt Binding (ACB) Test detects changes in the blood protein albumin. These protein structure changes can happen with heart attacks and various other conditions.

The FDA approved the test after a manufacturer's study was completed on people who were at high risk for a heart attack. Researchers observed that 63 percent of the more than 200 participants who had severe chest pains had a heart attack. The ACB test helped to correctly identify those who didn't have a heart attack. The ACB test must be paired with an electrocardiogram (ECG, a recording of the electrical activity of the heart) and a different additional blood test. If the ECG, ACB test and additional blood test don't indicate a heart attack, a doctor can have more assurance about sending a

patient home. The combined tests increase the accuracy in ruling out a heart attack. Each year, approximately 3 to 5 million Americans arrive at emergency rooms with heart attack symptoms, but only about 22 percent of these people actually have heart attacks.

Sometimes a heart attack is really a 'broken heart'Stress can temporarily stun main pumping chamber, a study finds.

It seems the heart can really break, although it can also recover rapidly from the damage wrought by a sudden emotional shock. The phenomenon is known as "broken heart syndrome," and it can trigger severe, temporary heart muscle weakness that mimics a classic heart attack, scientists claim in a new report. Their study describes 20 patients, almost all of them women who were hospitalised with all the symptoms of a heart attack, including chest pain, shortness of breath, fluid in the lungs and drastically reduced ability of the heart to pump blood.

A careful study found the problems were just temporary, caused by a massive release of stress hormones called catecholamines that can "stun" the heart. They include adrenaline, and flood the body following emotional shocks ranging from news of a loved one's death, to an armed robbery, to an car accident, the report said. Rather than requiring the drastic treatment necessary for a heart attack, the patients needed only supportive therapy for a few days to allow the heart to recover, the researchers said. This kind of thing has been described by others, said the study author an assistant professor of medicine. Although it's still important to remind physicians that the cardiac problem might be due to stress cardiomyopathy, rather than a heart attack.

The study appears in the Feb. 10 issue of the New England Journal of Medicine.

The report described 19 patients, 18 of them women, whose median age was 63 when they came for emergency treatment. All of them thought they were having heart attacks, according to the report.But physical examinations and blood tests did not show the symptoms of a heart attack, no blockage of the coronary arteries, no increased levels of the enzymes released when the heart muscle is damaged, no physical signs of heart damage. However, a striking feature of the syndrome was the heart's unique contraction pattern when viewed by echocardiogram. Although the base of the heart's main pumping chamber, the left ventricle, contracted normally, there was weakened contraction in the middle and upper portions of the muscle.

The patients' condition improved considerably in a few days, and they recovered completely within two weeks, while even partial recovery from a heart attack can take weeks or months, the researchers said. The physicians are doing studies to determine how stress hormones can stun the heart, why the condition strikes predominantly older women and whether there might be a genetic vulnerability to the condition, the report stated. They also are trying to determine how often it occurs. There have been several reports on stress cardiomyopathy, most from Japan but a few from the United States.

Apparently it is quite a regular occurrence said the medical director of the coronary intensive care unit. "It is not uncommon to see it in patients who have been referred to us."

The report concluded that it will lead to more questioning of patients before the physician comes up with a diagnosis. It also should prompt more measurements to detect elevated levels of the stress hormones described in the new report. The condition appears to be associated only with significant life events. Finally "We don't think that everyone who has an argument with a spouse goes into heart failure." Amen to that!

Obese or just overweight?

Being overweight limits the muscle's ability to expand and contract, an Australian study has found.

Apparently healthy obese people are suffering silent heart damage that sets the stage for serious cardiac problems, a new Australian study has found.

Using advanced ultrasound technology, the researchers found the blood-pumping left ventricle of severely obese persons had a significantly weakened ability to contract and expand. Smaller but still significant weaknesses in blood-pumping ability were found in people with lesser degrees of obesity or overweight, the study said.

"We detected subtle changes that we think are steps along the way to developing heart failure," said study author Thomas H. Marwick, a professor of medicine at the University of Queensland.

The research appears in the Nov. 2 issue of Circulation.

Heart failure is a progressive and potentially fatal loss of the heart's ability to pump blood. There are 550,000 new cases of congestive heart failure diagnosed in just the United States each year, never mind the rest of the world. It is the main cause of approximately 50,000 deaths annually and a contributing cause in more than 200,000 other deaths. One key finding in the new study was that these first signs of future heart failure were detected in obese persons who had no existing heart disease and were free of high blood pressure and diabetes. These are two major risk factors for heart failure. They also had a normal ejection fraction, the conventional measure of blood-pumping ability.

The study included 33 individuals of normal weight, with a body mass index (BMI) less than 25. (Body mass index is a ratio of weight to height and is used to determine if a person is healthy weight, overweight or obese.) There

were also 26 overweight participants, with a BMI between 25 and 29.9, 37 participants with mild obesity, a BMI between 30 and 34.9; and 46 severely obese people, with a BMI of 35 or higher.

The study also showed "a direct relationship" between the degree of obesity and the loss of pumping ability.

Trials have now been started to see if the heart-weakening effect can be reversed. The working hypothesis is that obesity does its damage by limiting the body's ability to respond properly to insulin, the hormone that allows the body to convert blood sugar to energy for cells. Other causes are suspected, but insulin resistance is a likely and plausible mechanism.

One trial is designed to determine whether exercise training can reduce insulin resistance. It is thought that it should be effective, no data is available yet but one only has too look at some of the top athletes who have diabetes to see how they have lived a full and active life.

Several other mechanisms may also be at work in obese individuals. We know that the larger the body is, the harder the heart has to work, so it builds itself up. This comes at a cost. The properties of the heart wall have to change for the worse and what you basically end up with is an overworked heart. Also extra fat tissue causes an increased production of hormones that can lead to scarring of the heart muscle. Finally, obesity can cause sleep apnea, (a disorder that causes you to stop breathing periodically while you sleep), which has a tremendous effect on the heart.

The Australian results should be taken as a warning by people who are overweight but regard themselves as otherwise fit and healthy.

Sometimes someone might say, 'I feel fine.' 'When I've had heart tests, the heart seems normal.' What this study suggests is that you can't bank on that, even if you are young and healthy, obesity causes changes in heart muscle that get worse with time.

Knowing how much you weigh is one thing but knowing how much of your body weight is fat can help you measure your health risks. That's where the body mass index comes in.

What is body mass index?

Body mass index (BMI) is a ratio between your weight and height. BMI offers a way of estimating your body fat content. Unlike your bathroom scale, which simply provides your weight, BMI relates your body weight to the health risks of being overweight.

If you have a high body mass index, you may face an increased risk of developing the following conditions:

high blood pressure heart disease high blood cholesterol diabetes stroke sleep apnea (a disorder that causes you to stop breathing periodically

as you sleep) osteoarthritis (a degenerative joint disease) respiratory problems certain cancers

Many of these conditions worsen as your waistline expands, some from the simple fact that carrying a few more pounds puts more pressure on our joints etc. Respiratory problems will arise, just try climbing a large set of stairs being say, 40 - 50 pounds overweight! In fact, the American Heart Association says obesity is a major risk factor for heart disease. Obesity also increases the risk of high blood pressure and high cholesterol.

How do I calculate my BMI?

Your BMI is determined by dividing your weight in kilograms by your height in meters squared. BMI charts and calculators are readily available online and through your doctor's office. To calculate your BMI yourself, use the following equation. The example assumes a weight of 140 pounds and a height of 5 feet 6 inches, which translates to 66 inches.

Step one: Multiply your weight in pounds by 0.45 (140 x 0.45 = 63).

Step two: Multiply your height in inches by 0.025 (66 x .025 = 1.65).

Step three: Square your answer from step two (1.65 x 1.65 = 2.72).

Step four: Divide the answer from step one by the answer from step three (63/2.72 = 23).

What's a good BMI number?

According to the National Institutes of Health, a body mass index below 25 is healthy. You're considered overweight if you have a BMI of 25 to 29.9.The classification changes to obese if your BMI is 30 or greater. (This is equal to about 221 pounds for a person who is 6 feet and 186 pounds for someone who is 5 feet 6 inches tall.)

Under the current classifications more than 55 percent of Americans are considered overweight. This means that more than half of the United States adults may be at risk from obesity-related diseases. It's important to remember that body mass index measurements may be misleading for certain people. Muscle weighs more than fat, so serious athletes and body builders may have unfairly high BMIs. Remember also that BMI is not intended for pregnant or lactating women, growing children, or frail and sedentary seniors.

Can I improve my BMI?

If your BMI is on the high side, weight reduction may be the best way to lower your score and improve your health. The simple solution is to burn more calories than you consume. Although it may be easier said than done, it's important to balance the foods you eat with physical activity. Remember that crash diets or magic remedies and potions can be unhealthy and the results rarely last. A lifetime of better health requires permanent changes in your diet and lifestyle, it doesn't have to be dull. I am now enjoying a more varied diet and I also eat at sensible times, unlike before I suffered my stroke when I would eat at all hours of the day and sometimes night! For help starting a diet or exercise program, consult your doctor.

Preventing childhood obesity

According to the National Institutes of Health, about 15 percent of American children are overweight. If these children become overweight adults, the number of Americans with diabetes could swell from 18 million to 50 million by 2050. Create healthy eating and exercise goals for the whole family rather than singling out an overweight child. Here in the UK there is a real concern about the number of people who don't even realise they are suffering from diabetes, never mind those that know they have it!

Keep the issue in perspective

As an adult, your ideal body weight is based on your body mass index, or BMI - a ratio of your weight to your height. People with a BMI of 25 to 29 are generally considered overweight. Those with a BMI of 30 or higher are considered obese.

With children, it's not quite that simple. They grow at different rates, so definitions of overweight and obesity get a bit more hazy. If you look at a lot of school age children, the girls are taller than the boys of their own ages in a lot of cases, yet as they get into their teens and beyond, boys will grow to be taller than the girls. In many cases children simply need time for their height to catch up to their weight.

Accept and encourage your child at any weight

For children, social isolation is often a consequence of being overweight.Here's where your acceptance has an impact. Focus on positive things. Comment on your child's efforts, skills and accomplishments. Make it clear that your love is unconditional - not dependent on weight loss. This is why it is mentioned that you should create healthy eating and exercise goals rather than isolate the child. If a child is grossly overweight, and we know

how cruel children can be to each other at times, they do in many cases get singled out by their own friends and class mates for ridicule and teasing.We used to have a boy at our school who's nick-name was 'Fat's', What that name had on his ego or what psychological effect it had on him we will never know, but if given the choice I bet he would have preferred to called by his own name!

Healthy eating for the whole family

A major aim for many households is to reduce fat and calories. You can do this by fixing meals that centre on plant-based foods - fruits, vegetables and whole grains. Always encourage your family to drink water rather than soft drinks or fruit juices with added sugar, in a growing child it has to be better for their teeth anyway.

In addition, keep healthy snacks within easy reach. Some alternatives to biscuits, chips and sweets include:

low-fat cheese, yogurt and ice cream low-fat crackers sliced apples, oranges and other fresh fruit peaches or pears canned in their own juice whole-wheat bagels spread lightly with peanut butter fresh vegetables with low-fat dips dried fruits such as raisins and apricots (for older children not at risk

from choking)

Remember that a growing child needs vitamins, minerals and protein. Help your child reduce fat and calories but not essential nutrients.

Going beyond individual food choices, give some thought to the overall process of eating. Encourage children to respond to their appetites and eat only when truly hungry. Easier said than done I know when they are surrounded by adverts on the television, on posters and their friends telling

them about the newest tasty fad to hit the market. MY children, in the past, have 'snacked' in between meals and then didn't want what was provided for the meal, now they are not allowed too. That simple fact will ring true with so many parents. Schedule times for your entire family to eat together.Savour the social experience as much as the food. Serve smaller portions and discourage eating in front of the television. Don't use food as a rewardor withhold food as a form of punishment.

Get your child moving

Help your child get 60 minutes of physical activity each day. This doesn't have to be 60 continuous minutes. Six 10-minute bursts of activity can be just as beneficial

Years ago many of us will remember being able to go out all day and only return home for our evening meals! I was brought up on the coast and would either be fishing, swimming in the sea all day, playing football on the beach or building 'tree houses' in the local woods. It is now a sad reflection on society that we can't allow our children the same freedom that we once enjoyed and so they suffer because they don't get the normal exercise that would be taken for granted in our early years.

Many children enjoy team sports. Please don't force participation on a child who's not interested in athletics but they can be encouraged. It is amazing if one or two of their friends are invited along, just how receptive they can be to a session on the trampoline or swimming! Other possibilities for physical activity include:

climbing on playground equipment simple games such as tag, hopscotch and hide-and-seek hiking biking skating Too many children nowadays just seem to want to sit in front of a

computer or television playing games all the time.

Create a culture that promotes weight control

Some factors that promote childhood obesity are tied to changes in our everyday behaviour. Suburban dwellers, for example, may run errands by car rather than on foot. Busy family schedules can lead to a fast food habit, especially where the mother in the family is working to supplement the family income. Television, computers and video games encourage to sit rather than get moving!

With your children, you can reverse these cultural trends:

Gradually reduce visits to fast food restaurants. Set fair but firm time limits for television watching, computer use and

video games. Discourage children from snacking while using the computer or

watching television. Whenever possible, walk to school, stores or other destinations with

your family. When driving, park farther from your destination and have the whole

family walk an extra block or two - or even from the end of the parking lot.

Plan weekend and vacation activities such as hiking, biking and swimming.

When doling out household chores give children active tasks such as vacuuming, car washing and mowing. is it not fair that they earn some of their pocket money / allowance?

If you try the strategies described above and still have concerns about your child's weight, consult your child's doctor. Remember that weight management is a lifetime project. Restrictive diets or weight loss programs that promise dramatic changes may only provide short-term results.Gradually developing a healthier lifestyle can help your child succeed in the long run. We weren't taught how to be good parents at school, we learnt as we went along and we also learnt lots off OUR own parents. Let us hope

that OUR children look back and thank THEIR parents for all the good help and advice they gave them in becoming fit and healthy adults!

Treatments

Medicines can control cardiovascular disease

I was going to include a list of drugs and their uses but I have decided against it as I don't want anyone to think that I have any medical training or am trying to imply that I have . I HAVEN'T!Any doubts about treatment or drugs should be discussed with your own doctor / specialist.What I do have is the experience of suffering a stroke and what that entails.

Drugs to treat heart conditions and stroke adjust the working of the heart or circulation of the blood.Most are taken orally as tablets or capsules to be swallowed, but they can come in the form of tablets held under the tongue, aerosols or patches. Drugs can also be administered directly into a vein or a muscle.

Treatments - operations

Surgery may be used where life is in danger

Operations available to treat heart disease and stroke range from relatively minor procedures such as angioplasties and the fitting of pacemakers, to heart transplants.

Pacemakers - Implantable defibrillatorsAn artificial pacemaker may be needed by patients with heart block or who have irregular heart rates or heart rhythms. A pacemaking system has a pulse generator and one (single chamber) or two (dual chamber) electrode leads. The pacemaker has a power supply or batteries and electronic circuitry, weighs about 20 to 50g and is almost completely hidden. They last on average between six and 10 years. Electrical impulses are conducted down the electrode lead to the heart, stimulating heartbeats. Some pacemakers discharge electrical impulses at a fixed rate, but most work on demand. The pacemaker may be fitted under local anaesthetic when an electrode lead is inserted into a vein at the shoulder or the base of the neck and guided into the correct chamber of the heart using an X-ray screen. The electrode may alternatively be attached directly onto the outer surface of the heart. The pacemaker box is positioned under the skin of the abdomen. There is a small danger of infection where the pacemaker is fitted.

Heart transplantsThere are around 300 heart transplants carried out in the UK each year. Heart transplants are usually carried out on people with severe heart failure caused by coronary heart disease or cardiomyopathy. They can also be carried out for patients with severe abnormalities of the heart valves, congenital heart defects or an uncontrollable fast heart rhythm. The average wait for a transplant once on the waiting list in the UK is six months. About 15% of patients die while on the waiting list. The heart is stopped and a machine takes over the function of the heart and lungs. The diseased heart is removed and the donor organ sewn in and connected to the main blood vessels. After the operation, immunosuppressant drugs are given to ensure the body does not try to reject the new heart. They must be taken for the rest of the patient's life. Rehabilitation programmes, including physiotherapy, begin shortly after the operation. Life should return to normal within six to eight weeks. Between 50% and 60% of heart transplant patients are alive after 10 years.

Coronary angioplasty, and stents

There are 23,500 angioplasties performed on patients with angina in the UK each year. Nine out of 10 operations are successful. Fatty tissue - atheroma - responsible for narrowing arteries, is squashed, allowing blood to flow more easily. A catheter is inserted into an artery under local anaesthetic in either the groin or the arm and guided using an X-ray screen to a coronary artery until its tip reaches the narrowed or blocked section. A balloon mounted on the end of the catheter is then gently inflated to a diameter of about 3mm, flattening the atheroma. A short tube of stainless steel mesh - a stent - may be inserted into the part of the artery to be widened to prevent re-narrowing after angioplasty. Ultrasound and laser angioplasty can also be used but are rare.

Coronary bypass surgeryCoronary bypass surgery is used to bypass the narrowed sections of coronary arteries by grafting a blood vessel between the aorta - the main artery leaving the heart - and a point in the coronary artery beyond the narrowed or blocked area. More than 21,000 patients have coronary artery surgery in the UK each year. The risk of death within a month of the operation is 2%. The graft to be used comes from another blood vessel within the patient's body. An incision is usually made in the middle of the chest and the breastbone split lengthways. Keyhole surgery, which involves less opening of the chest, remains rare and is currently being evaluated. During the operation, a heart lung bypass machine takes over the pumping of blood and breathing. Around eight in 10 patients experience immediate and lasting relief from angina. Most of the others find the bypass improves their angina, says the British Heart Foundation.

AtherectomyAtherectomy uses a rotating shaver on the end of a catheter, introduced through a blood vessel in the leg or arm, which is fed through to the blocked coronary artery. The high-speed rotating device at the tip of the catheter grinds the plaque into minute particles, clearing the artery. Balloon angioplasty may then be used on the artery.

Heart valve replacementHeart valve surgery may be required if drugs are unable to control the problem.

Valve replacement - Diseased valves are usually replaced by manufactured valves (artificial/mechanical valves), or animal valves (tissue valves/biological valves). The valves open and close around 40m times a year. They can make a clicking sound. Anticoagulants are taken with artificial valves because there is a risk of blood clots developing on the surface, but are not usually necessary with tissue valves. Long-term survival rates for patients with either type of valve are similar. Eight out of 10 tissue valves are still working after 10 to 12 years.

Valve repair - Usually done only for the mitral valve - between the left atrium and left ventricle.

Congenital heart disease treatments

Arterial Switch - Where babies are born with the major arteries switched round, an operation is carried out to reverse the defect.

Balloon atrial sepostomy - The atrial opening is enlarged using a catheter to improve the oxygen supply in babies whose major arteries are transposed.

Balloon valvuloplasty - A catheter is inserted into the opening of a narrowed heart valve and a balloon opened to stretch the valve.

Fontan procedure or operation - The right atrium is connected to the pulmonary artery directly or with a conduit, allowing blood to bypass an incomplete or under-developed right ventricle. The atrial defect is also closed to relieve blueness - cyanosis.

Pulmonary artery banding - A band is placed around the pulmonary artery to narrow it and reduce blood flow and high pressure in the lungs. Band can later be removed and the defect fixed with open heart surgery.

Shunt or shunting procedure - A passage is formed between blood vessels to divert blood from one part of the body to another and reduce blueness in infants with severe Tetralogy of Fallot.

Venous switch or intra-atrial baffle - A tunnel is created inside the atria to help correct transposition of the major arteries.

Carotid endarterectomy

Build up of plaque in the carotid arteries - major blood vessels in the neck, taking blood from the heart to the brain - can be surgically removed by carotid endareterctomy to prevent a stroke.

Treatments - rehabilitation

Rehabilitation helps recovery after heart attack and stroke

Rehabilitation is crucial for people who have suffered heart attacks or stroke leaving them without the powers of movement, speech and thought they had previously.

Attendance at rehabilitation programmes run by a hospital or another centre usually start four to six weeks after a heart attack or stroke and last for around six to eight weeks. Programmes can also be followed at home. The aim is to improve fitness and aid recovery at the same time as improving confidence and quality of life. This is done through exercise, relaxation and information on lifestyles, including diet and risk factors, and treatment. An exercise programme is worked out by a physiotherapist or exercise physiologist tailored to the abilities of the patient. Aerobic exercises, which help improve blood circulation, are used. A team approach will often be used, combining doctors, nurses, physiotherapists, occupational and speech therapists and counsellors, among others. Patients can draw strength from their knowledge and from seeing other patients at the same unit making progress.

BasicsThe first stage for many patients may be to be re-taught the basics of washing, feeding and toileting, which are essential if they are to get their lives back as close to normal as possible.

Each individual is encouraged to set their own goals, whether it is a housewife looking to take charge again of running the household, or someone hoping to get back to work in some capacity. Professor Anne Chamberlain, professor of rehabilitation medicine at the University of Leeds, said the process can be "very, very hard". "It is very frustrating. It requires a huge amount of energy, particularly when you can't speak and you can't get your thoughts in order. "The first thing patients always say is 'I want to walk'. "That is definitely a good aim but it goes on a basis of first sitting safely, then moving from the bed to a chair, then standing, then walking." And she added: "Some people may feel the energy required to go back to work is so high that they would prefer to put their energy into something else."

Understanding blood pressure

Undoubtedly, you've had your blood pressure checked. The familiar routine may be so common that you hardly take note of it. But blood pressure readings say a lot about your health.

Blood pressure definedBlood pressure is measured as one number over another. Normal blood pressure is less than 120/80 mmHg (millimeters of mercury). The upper number (120, in this example) is your systolic pressure. This is the amount of pressure on your arteries when your heart contracts or beats. The lower number (80, in this example) is your diastolic pressure. This is the amount of pressure on your arteries when your heart rests between beats. Together, these numbers measure the amount of pressure your blood puts on the walls of your arteries. Blood pressure naturally fluctuates throughout the day. It's higher when you're active and lower when you're at rest. A single high blood pressure reading doesn't necessarily mean that you have high blood pressure, or

hypertension. It is important to keep an eye on your readings, although high blood pressure is easily detected and can usually be controlled, it often has no symptoms. In fact, many people who have high blood pressure are unaware they have it. That's why it's often called "the silent killer." If you have several readings between 120/80 mmHg and 139/89 mmHg, you may be diagnosed with prehypertension. This means that you don't have high blood pressure now, but may be likely to develop it in the future. Consistent readings of 140/90 mmHg or higher are typically diagnosed as hypertension.

The danger zoneYour heart takes a beating when your blood pushes against your arteries too forcefully over a long period of time. Left untreated, this wear and tear may lead to various life-threatening complications. For example:

An overworked heart will eventually stretch and enlarge. This can lead to heart failure, preventing your body from getting enough blood and oxygen.

Damaged or diseased arteries can decrease the flow of oxygen-rich blood to the heart. If blood flow is restricted or stops completely, you may experience a heart attack.

Damaged or diseased arteries also affect blood flow to the brain. A blood clot in one of the arteries in the brain or a break in a weakened blood vessel can cause a stroke.

High blood pressure thickens and narrows the blood vessels in the kidneys, disrupting their ability to filter waste from the body. This may lead to kidney failure.

Who's at risk?More than 50 million American adults -- about one in four -- have high blood pressure, according to the National Heart, Lung, and Blood Institute (NHLBI). High blood pressure is more common among African Americans than Caucasians. Adults who have normal blood pressure at age 55 face a 90 percent chance of developing high blood pressure at some point later on. Other risk factors include:

having prehypertension being overweight being older than age 60 having a family history of high blood pressure consuming too much sodium alcohol or drug abuse

Making healthy choicesOften, a healthy lifestyle can help you keep your blood pressure in check. Consider these suggestions:

Lose excess weight.Work with your doctor to develop a safe, effective weight loss plan. Often, losing just 10 pounds can make a difference.

Exercise regularly.With your doctor's OK, regular exercise is a great way to improve blood pressure and overall health. Consider something as simple as a brisk daily walk.

Eat healthfully.Low-fat foods and plenty of fruits and vegetables can have a positive effect on blood pressure. Opt for healthier unsaturated fats. Whole grains, poultry and fish are other good choices.

Reduce your sodium intake.The NHLBI recommends limiting sodium consumption to no more than 2,400 milligrams per day (or about 1 teaspoon of table salt). Your doctor may offer a stricter recommendation based on your individual needs. Avoid processed foods. Choose low-sodium versions of packaged and frozen foods. Use spices rather than table salt to season your food. Being a smoker I always found that I used lots of salt on my meals to bring out the flavours, I used to always say how bland food was without it. I don't use it at all now, apart from I must add, when or should I say IF, I have a bag of chips, I have had about 4 / 5 bags of chips in the last 3 years! Only when visiting my home town which is a seaside town and who can resist having a bag of chips at the coast?

Drink less alcohol.If you choose to drink, do so only in moderation.

Check your blood pressure at least once a year.

If you've been diagnosed with prehypertension, your doctor may recommend more frequent screenings. If you've been diagnosed with hypertension, you'll need periodic office visits and perhaps regular blood pressure monitoring at home as well. I have bought one of these monitors for my own use. I take my own blood pressure about once a week now, just to keep an eye on it. I have found that my blood pressure has come down to what it was when I first came out of hospital. Taking it at home can produce a reading lower than what you will get at a surgery or at the hospital, as my doctor told me when I queried the readings that I was getting, being at home in your own surroundings will make you feel more relaxed and comfortable with it. Just having to visit your doctor or hospital can actually raise your blood pressure. It certainly has helped me relax when taking a reading, having suffered a stroke it is the one big thing that concerns most folk, certainly me. If you feel better and are more relaxed by taking your own blood pressure and are able to keep a watch on it yourself then that surely must be a benefit in itself. I would certainly recommend buying one, they only cost a few pounds.

Finally - If you smoke...STOP!

Although smoking doesn't cause high blood pressure, it injures blood vessel walls and promotes hardening of the arteries. This can be especially dangerous for people who have high blood pressure. When lifestyle measures aren't enough, high blood pressure can often be controlled with medication. These medications act in various ways to lower blood pressure. Sometimes a combination of medications is most effective and produces the least side effects. Two low-cost alternative drugs - amiloride and spironolactone may help patients who still have high blood pressure despite taking standard

hypertension drugs, an Indiana University School of Medicine study has found.

Amiloride and spironolactone are diuretics (water pills) that have been available for many years but are often overlooked by doctors, the researchers noted. The drugs work by limiting the amount of sodium the kidneys reabsorb or take back into the body during the process of producing urine. This study included 98 black Americans with high blood pressure. Some were given either amiloride or spironolactone, some were given both drugs, and some were given a placebo. All of the patients continued to take their standard medications to treat high blood pressure, also known as hypertension. On average, patients taking the drugs separately or together showed significant blood pressure declines. The findings were published in the September issue of the journal Hypertension.

"The kidneys do an incredible job of holding on to sodium, which was important to the survival of our early ancestors who lived in a salt-poor world, but today there's so much salt in the food we eat that the kidneys end up holding onto too much sodium," and that can lead to high blood pressure, researcher Dr. Howard Pratt said in a prepared statement. By limiting the amount of sodium that's retained in the kidneys, amiloride and spironolactone help lower blood pressure, Pratt said. He noted that doctors treating patients who don't respond to standard therapy for high blood pressure often prescribe higher doses of the medicine already being used or add a new blood pressure drug that could be expensive and often is also ineffective. The findings of this and other studies may convince doctors to try amiloride or spironolactone alternatives instead, Pratt said.

My ThoughtsSince coming out of hospital and gaining quite an amount of knowledge about strokes, the consequences, the attitude of the medical profession, the attitude of family and friends and by no means forgetting my own attitude, I thought I would include some conclusions I have come to,

good, bad or indifferent as follows.

One of the first things you will have to deal with when or maybe before coming out of hospital is filling in lots of forms about claiming benefits, mobility, disability allowances, income support, help with your mortgage interest and getting help in general. You may need to get help from your partner or some official body to help fill them in. Here in the United Kingdom we have an organisation called the Integrated Living Centre and they have lots of 'centres' in various towns and cities. I have included just one or two web addresses for them but if you go to one you should be able to get details of others maybe a bit closer to you. In my local centre, they were quite willing for people to go in on an appointment basis and help with any form filling, I don't know if that is correct for ALL centres but it is a good starting point.

They also show and advise on home alterations for various disabilities -from knives and forks to baths to chairs etc.This organisation is run by volunteers mostly, who give their own time to help others. There is probably an Integrated Living Centre in your own area but here are one or two of their website addresses:

West of England http://www.wecil.co.uk/

Lothian http://www.lothiancil.org.uk/

Milton Keyneshttp://www.mkweb.co.uk/mk_disability/DisplayArticle.asp?ID=6674

Leicestershire http://www.lcil.org.uk/

Colchester http://www.colchester-pct.nhs.uk/content.asp?page_id=103

I have included this link for the USA, although I know nothing of them it does look like a good starting point. You will also find plenty of useful links on page seven for both the United Kingdom and the United States of America.

Specialized Living Centre andCommunity Integrated Services

618-277-77301450 Caseyville Avenue

Swansea, Illinois 62226-4519

Serving the Thirty-Four Counties of Southern Illinois

http://www.pafslc.org/

When filling in forms, PLEASE - PLEASE DO NOT use the words 'Manage' or 'Cope'! These words do not NOW exist in your vocabulary!Don't put anything that suggests you can 'cope' or 'manage' with your everyday living.

The people looking at your claim for benefit will thank you very much and then reduce your benefit as much as they can. In recent months (this is now December 2005) there has been a lot of talk about this government trying to reduce the benefits to the long term disabled. They seem to think a lot of people are now claiming where they shouldn't. If you have suffered a stroke, you have suffered brain damage, nobody but nobody can dispute that. Some folks will be far worse off than others mentally.Having to fill in forms and fight the system to get what you are ENTITLED to is bad enough, don't make it harder by trying to be brave and say you can manage or cope.The authorities can only go on what you put in your replies.

Base any answers on the WORST days that you have - NOT the good days, we all have the good ones but they don't help the bad days when you need help and assistance from your partner / family / friends etc.

If you need help then seek it, don't feel too proud to ask, it is there.

There is a lot of talk from all sides of the medical profession about the amount of help out there for stroke survivors, there might be but believe me, YOU have to go looking for it. Nobody will put themselves out to help you unless you ask or plead. A very over-stretched health service

and financial package comes first. They struggle to make ends meet, the staff in and out of hospital are over-worked. It might seem a harsh reality but it is my experience, (and I know I'm not alone), if you or your family DON'T put yourselves out then you ain't going to get the help.

One of the main things I have picked up from other disabled people is 'attitude'! Get attitude, don't let the system grind you down, get attitude and if you have to shout and scream nice and loud to make yourself heard, then do it from the roof tops! Why should things look bleak just because you have suffered a stroke? Think positive and go forward DONOT look back. Treat it as another starting point in your life, just make sure you plan the ending! If employment is an issue and you find yourself out of work and feel up to it and want to get back to earning a living, if it means going into something entirely different, then pick something that YOU want to do. It might sound strange but NOW you have the chance to do all the things you never have had time for in the past or seek the training or help you need to do what YOU want! Which ever way you look at it, it is a turning point in your life - try to make it a positive one. Obviously a lot of this depends on your physical capabilities.

There is certainly in my area and I suspect in quite a few other areas of the UK, an attempt to try to get you through and out the other end of the system as quickly as possible. Various people who I have spoken to are of the same opinion and especially the physiotherapy side of things is definitely lacking in support once you leave hospital. If you are able to get your own private physiotherapist, then my advice would be to do it.We all need encouragement to do things and especially after suffering a stroke. It is hard to do things on your own and we all sometimes need to be told home-truths, especially someone like me who was always opinionated anyway, just ask my wife!

Emotionally you can find that you are affected by simple things that would never have bothered you before suffering a stroke.

I have stated to my friends and family that I can now get upset at such simple things as watching a child's programme on the television and get upset at the end when it is finished! This is apparently a consequence again of the stroke, it can affect the part of your brain that controls your emotions, that is why you might find that sometimes you get real angry about silly things and start to cry at someone telling you a joke. Don't worry about it, as I say to folks now, I am a far nicer person than I used to be before I had my stroke, I can get upset at things so easily. I used to always joke with my mother about the way she would cry at the end of a 'weepy' film, I now have to walk out of the room or it is me instead who ends up shedding tears!

Energy levels seem to differ from person to person, mine certainly haven't come to any thing they like they were before my stroke.

I get tired carrying a bag of sugar from the car to the house now - some days are better than others but most things easily tire me out. This again is where I think physiotherapy could help a lot more. When I was in hospital I got pushed into doing a lot more than I do now on my own but you do need help with a lot of things, they are impossible on your own. I asked my physio before I came out of hospital what the secret was for walking and he said, walk and walk then walk some more! He was, I think right, but I do find that at times my muscles cramp up and I have to stop walking for a day or two, otherwise they just get worse to the point were I can't walk at all. Everything in moderation as the say.

I have gotten myself a walking stick, which my physio in the hospital didn't want me to get, but unfortunately I have found the great British public have no consideration for others. When I first came out of hospital I tried to get by without using a stick when out shopping etc, what I found was, that because I walk unsteadily or stagger ever so slightly at times

then people would look at me as if I was drunk or worse! Nobody ever gave way, it is very hard to come to an abrupt halt if someone walks across in front of you when you are walking if you have a disability - I was fed up with the constant shoving and pushing and nearly falling over so I decided to get a stick. Well let me tell you, I don't advocate this for every one and most physio's will tell you to get by without one if you can, but I have rattled a few ankles with it believe me! It's amazing how you can use it as a defence mechanism, bang it down a bit hard or tap someone's ankle with it when they disregard you being there or get too close. Most folk do give you a wide berth when they see the stick and tend to show you a bit of courtesy - some still don't but that's today's society for you.

I do feel I would probably be a lot better with my walking and I think most folk would agree, if I had been able to continue without the stick but I felt there was no need to go on struggling and getting stressed about walking about and doing the normal everyday things. My feeling is, IF, you can manage without one, more the better but if you can't then don't be afraid to use one.

You can get help here in the UK with transport etc. The website that contains all the info is http://www.motability.co.uk/ here you can find info about finding a car, wheel-chair etc to help you get about. It has loads of info about dealers, schemes, financial assistance, how to apply, technical services and lots more. Well worth a visit. If you receive the higher rate of DLA (Disability Living Allowance) then you should qualify for a car or wheel chair etc. What happens is that you give up the DLA part of your benefit, which is paid straight to the supplier of the car and away you go. Most of the schemes run for 3 years but some do vary.You might have to pay an initial one off advance payment but depending on the car you want you don't always have to pay any advance fee. Don't forget you pay no road tax if you are disabled! Most of the schemes run by most car manufacturers also supply cars with them already insured.The garages I have approached have all said they take care of the paper-work for you, so you don't even have to do that! It is in their interests to make sure everything runs smoothly.

So to sum up you could get a brand new car with:Tax, Insurance, Breakdown Recovery and Servicing, all you would have to pay for is the fuel!

Most car manufacturers run some sort of motobility scheme. This of course won't suit everyone but it is all designed to help you if you need it.

If you are a home owner some councils are willing to help with repairs etc. You will have to check out your own council to see if they do have a department that deals with disabled home owners.

If they do help, then some of them do receive the monies back from any grants they supply if and when the house is sold but who cares if you intend to stay there for some time and the improvements or repairs could actually help you sell the house anyway! Plus if you remain there any length of time then a rise in the price of the property could outweigh any repayment of the grant.

A good start is to check out this website: www.eaga.co.uk they manage many public and private schemes aimed mostly at the low income households. They provide and deliver products , services and solutions that have a positive impact on the environment, society and energy use. They have helped over 7 million disadvantaged households throughout the UK since 1991. Eaga also works with housing associations, local authorities and the private sector.They are mostly concerned with energy or heating loss prevention.

Useful addresses

The United Kingdom:

www.differentstrokes.co.uk A charity set up by younger stroke survivors for younger stroke survivors. Plenty on this website, info and a forum to ask other survivors your queries.

http://www.stroke.org.uk/ The Stroke Association is the only national charity solely concerned with combating stroke in people of all ages. It funds research into prevention, treatment and better methods of rehabilitation, and helps stroke patients and their families directly through its community services.

http://omni.ac.uk/browse/mesh/D020521.html The National advisory Committee on Stroke was established in October 2002, to oversee the recommendations in the stroke element of the Coronary Heart disease and Stroke Strategy.

http://www.neuropsychologyarena.com/resources.socs.asp An index related specifically to Neuropsychology and Neuroscience. Lots of links to UK, USA and International associations. Virtually the only resource you will need.

Disabled Drivers Association, Ashwellthorpe, Norwich NR16 1EX Helpline: 0870 770 3333 Email: hq@dda.org.uk

http://www.dvla.gov.uk/drivers/dmed1.htm Has the medical rules for driving with specific health problems

http://www.dlf.org.uk/ The Disabled Living Foundation

http://www.dialuk.info/ DIAL UK, a national organisation for a network of approximately 130 local disability information and advice services run by and for disabled people. Last year DIALs helped over a quarter of a million disabled people.

http://www.ncb.org.uk/cdc/ The Council for Disabled Children

http://www.after16.org.uk/ This website is for teenagers and young people in the UK who have an impairment or disability and are wondering what opportunities and services there should be when they leave school.

http://www.dh.gov.uk/Home/fs/en Department of Health. Where to find information, services and equipment.

http://www.whizz-kidz.org.uk/Page.asp Helping children with disabilities live a life with no limits.

http://www.painrelieffoundation.org.uk/ The Pain Relief Foundation is a UK charity which funds research into the causes and treatment of human chronic pain.

http://www.foundations.uk.com/ Help and advice on repairs and home improvements for older and disabled people

http://www.scope.org.uk/downloads/issues/dp/North-East_1.pdf LOTS of very useful numbers for the North and North East of England

The United States of America:

http://www.ncd.gov/ National Council on Disability (NCD) is an independent federal agency making recommendations to the President and Congress to enhance the quality of life for all Americans with disabilities and their families.

http://www.americanheart.org Our mission is to reduce disability and death from cardiovascular diseases and stroke.

http://www.strokeassociation.org 2010 Goal. The American Stroke Association's goal is to reduce stroke and risk by 25 percent by 2010

http://www.strokecenter.org/ The Internet Stroke Centre is a non-profit, educational service of the Stroke Centre at Barnes-Jewish Hospital, Washington University Medical Centre and the Cerebrovascular Diseases Section of the Department of Neurology at Washington University School of Medicine in St. Louis

http://www.biausa.org Brain Injury Association of America

http://www.ssa.gov/disability/ The Social Security and Supplemental Security Income disability programs

http://www.wid.org/ WID is a non-profit research, training and public policy centre, promoting the civil rights and the full societal inclusion of people with disabilities.

http://www.nod.org/ National Organization on Disability's. The N.O.D. web site provides you with the latest in disability-related news, information and resources.

http://www.usatechguide.org/links.php?catid=109 Driving With A Disability in the USA

Australia:

http://www.strokefoundation.com.au/ The National Stroke Foundation is aiming to save 110,000 Australians from death and disability over the next 10 years. We will achieve this by using evidence based research and educating our community about stroke and prevention.

Research Sources & References

Sources:

Thomas H. Marwick, Ph.D, professor, medicine, University of Queensland, Brisbane, Australia; Nov. 2, 2004, Circulation

University of California

American Heart Association

INSERM (French counterpart to the U.S. National Institutes of Health.)

U.S. National Institutes of Health

Christope Tzourio, M.D., Ph.D., director, neurepidemiology unit, INSERM, Paris, France; Daniel Lackland, Ph.D, professor of epidemiology, Medical University of South Carolina, Charleston; Argye B. Hillis, M.D., neurologist, Johns Hopkins Hospital, Baltimore; Sept. 7, 2005, Circulation

Wake Forest University Baptist Medical Center, news release, Nov. 22, 2004

New England Journal of Medicine

The U.S. Food and Drug Administration

Indiana University, news release, October 2005

Thanks for LookingHaving now read through this E-Book, I hope you have found it of some help.

I would imagine the only reason you have purchased this e-book is because you or someone you know has unfortunately suffered a stroke. It doesn't have to be the end of the world but it does take determination.Not everybody who has suffered will be able to resume a normal as possible a life again. A stroke is one of most vile and odious insults that we can suffer. It can turn a normal, loving, caring human being into a shell of a person, left with no knowledge or understanding of what is going on around them.

It devastates families of the injured one and wrecks lives indiscriminately. Hopefully reading my story may help in some small way to helping you realise that everything doesn't have to be lost. One of the advantages of having suffered a stroke is that I now get out of bed when I want, go to bed when I want and do what I want, when I want! It may seem strange talking about the advantages of having a stroke but what other way is there of looking at it?I look out the window at all the poor souls rushing to work in the rain while I'm having my toast and tea and plan my day ahead, deciding on what I want to do...oh, yes!

It has given me a chance to reflect and really decide on what is important in my life, if I had not had a stroke I would have been still been working 12 hours a day, seven days a week - not any more.

I have included links to other websites, please use them as there is a lot of help out there but you have to look for it, it very rarely comes to us.

If one of your loved ones has suffered then encourage and encourage,forgive them their outbursts of temper and then encourage them some more.

Remember the saying that I use a lot:

"You can't go back and make a brand new start" BUT

"You can start from now and make a brand new ending!"

After reading this e-book you might have more of an understanding of what that means.

And finally to the unsung hero in all of this - My dear glorious lady, Margaret, without whom I am sure I would not be here now.Thank you so much for putting up with ALL my tantrums and behaviour, is there any wonder I love you so much?

Regards & God Bless to all.

John H Stanway

Update 2008.

Well, it's now been over 5 years since my stroke, nearly six actually and hasn't time flown.I have to admit it does seem to be in the distant past which is probably just as well.

A lot has happened since then, some good and some bad - but mostly good. I can't believe how much my life and that of my family has been altered.One thing I have learnt is that it is no good remembering the bad, think of the good, so I will give you an update on the positive things in our lives.

The first positive thing was realising that I now had the world at my feet, I could do absolutely anything I wanted without having to consider time restrictions.I have concentrated a lot of my time to the computer since the stroke, my thinking is that the brain is a muscle and 'you use it or you lose it'It definitely has paid off.

When I first got out of hospital and tried to use a computer, I would get so tired after an hour that I would sleep for twelve hours afterwards.Gradually that built up until I can now stay on the computer for twelve hours, with breaks of course, and it doesn't effect me anywhere near as much. I love technology, having nearly always worked with my hands before. Hence the website that you got this eBook off. I have built the site with the help of Dr Atiq Bhatti, he has provided a lot of the information for it obviously.Dr Atiq has become such a good friend since the beginning of the year but more of that later.

Looking back I thought I had 'got my head back' after the first year, then as that year passed I realised it was after next year that happened and thenI realised it was after the next year actually! I don't know whether you do ever really 'get your head back' but I do know it is a lot better now than even two years ago.

We have a caravan in the N/east of England on the coast, where my wife and myself originate from and go there nearly every school holiday. I could never have done that if I was working but now it doesn't matter where I am, does it? I do have the time to go on my own for a visit while the girls are in school term but unfortunately I do need my lady to help me with certain things so that is a no-no. The girls take their bikes and enjoy the freedom the beach and the park gives them. I'm nearly always up at dawn, out on the beach fishing and usually back before the family wake up with a few fish for breakfast. I do struggle on the sand but as they say 'no pain no gain', within reason, you have to be sensible. I have put on a lot of weight, due to different factors, this has effected my legs a lot and my stamina hasn't really come back so there is a few big rocks on the beach that I fish alongside. Somewhere to sit and rest. I still suffer with what is called a 'dropped foot' and walk with a bad limp.

Because of the what seems like the way of the world now and what happened where I live, I decided to start a Neighbourhood Watch Scheme. It is now probably one of the largest schemes in the town.Most scheme's consist of 10 / 12 houses, ours consists of 120 houses.The main part being down to a guy who again has become a very good friend, he knew a lot more people than me and has helped tremendously, without his help it wouldn't have grown like it has. I was asked asked to join the committee for NHW which I did but had to resign unfortunately due to health factors. It is so easy to get emotionally involved and especially after a stroke. As many of you will know that have suffered, your emotions go out the window and you can get upset and stressed at the silliest things at times. You have to watch your blood pressure closely, I monitor mine nearly everyday and have been quite fortunate to find that it is quite low, which is a good thing. The first signs of any stress and you have to chill out as my kids say!Before my stroke I could never have contemplated running such a scheme. I wouldn't have had the time. It has given me a chance to put a little back into the community, which is nice.

Because of my involvement with NHW, when the government brought out the NAG's (Neighbourhood Action Group's), I was approached and asked to get involved, the consequence being that now I am vice-chair,

can't use the word 'chairman' because of the political correctness that surrounds us all nowadays! Again this has given me a chance to put a bit more back into the society round me, the NAG covers a large part of the town.

As you can tell, it's not all doom and gloom, life is what you make it if you have a little bit of energy and movement. A lot of folk who suffer a stroke are left in wheel chairs etc and are very restricted in what they can achieve. Some go on and suffer some more. One lovely chap who was in hospital with me, was OK for about 6 months and then started suffering TIA's (mini strokes) but Dennis had a couple of major ones and finally and sadly died after about 3 years.

I have made some very good friends because of my involvement with the NHW and the NAG, who I would never have met before. I count myself fortunate and blessed for that. These folk are ALL, what I would term, nice folk. They have no ulterior motive, try to live a decent life and have morals. I ain't going to go off on one but so many folk we meet nowadays are in it for themselves, no morals or standards. you just have to look at society to know that. The people I am involved with, don't get paid, don't wear a uniform, don't get publicity, they do what they do because they want to 'put something back'.

At the beginning of this year 2008, I was introduced to a guy by the name of Atiq Ahmad Bhatti, HD, an Homeopathic doctor, I already knew of him and had done so for a long time, but nobody knew that.I was asked to sell some of his remedies by a guy who is a salesman and was being treated by Dr Atiq. He saw a good opportunity to make an income. As I said, I was already aware of Dr Atiq and his work and his reputation, second to none may I add. I obviously jumped at the chance to be involved with this man. From the first day of my involvement I knew exactly which way I wanted to go with this.

I set about building a website and as it grew I needed more and more information off Dr Atiq about his family history, homeopathy, remedies etc. We have worked closely together over a period of around 6 months.We have gradually grown, I think, very close as friends, I don't think he would contradict me on that, though we haven't met as yet! As most of you will not have had dealings with him yourselves, I must tell you will, he is a man of total integrity and decency. His only aim is to help humanity. This he has achieved!

It has taken a long time and it isn't anywhere near finished yet but the website will stay, I hope, long after I am gone. I hope we can keep adding to it, besides, it keeps me busy and out of mischief.

I live around 125 miles from the sea but because of my involvement with NHW I have met another great guy who takes me fishing with him over on the Suffolk coast. If I was fit and healthy I would be working and not able to go! He normally ends up carrying most of the gear because it takes me all of my time to walk. He is a big lad mind; he's worked on trawlers in the past. He's only 63 and had two heart attacks, so a bit of humping fishing gear around isn't too bad, is it? I always pray we don't catch too many fish because of the weight, having to carry them back to the car!

What I'm trying to say I suppose is, that if you are fortunate enough to be able to move around after a stroke, take advantage of the time you have, do something useful and DON'T just sit back and feel sorry for yourself.Life ain't fair, it never was and never will be. As we have found out, you never know WHAT is around the corner. Don't always take what the medical profession say about any disability you have, you never know what you can achieve until you try. You never know, you might start to enjoy your life more than you ever did before!

One last word about my wife, the poor lass has had to put up with a lot from me over the time since my stroke, tantrums, bad tempers, aggression etc. This isn't ALL the time, just sometimes thankfully. She understands that it is the effects of the stroke and not the real me when I am like that.No matter how well we look or how much we improve since having a stroke, you will always have a damaged brain, so sometimes logic goes out the window. People need to be aware of that, it is so easily forgotten as time goes by. She is one great lass and I am so fortunate to have her with me.

Stay safe

God Bless