stroke education for patients and families 3 university of pittsburgh medical center information for...

UPMC

Stroke Education for Patients and Families

Table of Contents

Stroke Basics Stroke Risk Factors .......................................................... 1

Stroke Warning Signs ...................................................... 5

Stroke Emergency Treatment ......................................... 6

Stroke Medical Treatment............................................... 8

Stroke Surgical Treatment ............................................ 11

Stroke and TIA Facts ..................................................... 13

Stroke and TIA: Finding the Cause ............................. 15

Some Tests You May Get CT and CTA ..................................................................... 16

Echocardiogram ............................................................. 18

Holter Monitor ............................................................... 19

MRI and MRA ................................................................. 22

TEE .................................................................................. 24

For Your Good Health Blood Pressure ............................................................... 26

Weight Management Tips: Diet .................................... 34

Cholesterol ..................................................................... 36

Smoking Facts ................................................................ 39

If You Have Diabetes Diabetes: Your Management Plan ................................ 42

Basic Diabetes Meal Plan .............................................. 48

Caregiver Support and Resources Caregivers Support ........................................................ 52

Stroke Resources ........................................................... 54

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S troke Risk Factors

University ofPittsburghMedical Center

Informationfor Patients

What is a risk factor?

A risk factor is anything that increases yourchance of illness, accidents, or other negativeevents. Risk factors may include:

• medical history• genetic make-up• personal habits• life style• aspects of the environment

Stroke and risk factors

A stroke occurs when the brain’s blood flowstops or when blood leaks into brain tissue.The oxygen supply to a part of the brain isinterrupted by a stroke, causing brain cells inthat area to die. This means that some partsof the body may not be able to function.

There are a number of risk factors that in-crease the chances of having a stroke. Somerisk factors cannot be reversed or changed.They are uncontrollable. But you can do some-thing about most of the risk factors for stroke.Some risk factors you can get rid of — likesmoking. There are other risk factors youcan’t get rid of, but can control — like diabetes.

Risk factors you cannot change

You cannot reverse the following risk factorsfor stroke. You should be aware of how theserisk factors apply to you.

AgeFor every 10 years you live, your risk of hav-ing a stroke increases.

GenderMen have 2 times more risk for stroke thanwomen have. But more women die of strokethan of breast cancer.

RaceAfrican Americans have 2 times more risk ofstroke than other races have. Hispanics andAsians have the greatest risk for stroke fromburst blood vessels. This type of stroke iscalled hemorrhagic (hem-er-RAJ-ik).

Past Stroke or TIAIf you’ve already had a stroke or a mini-stroke(TIA), your risk for stroke is now greater. TIAstands for transient (TRANS-yent) ischemic(iss-KEY-mik) attack. TIAs do not cause last-ing damage; however, they are a warning signthat a more serious stroke may occur.

Family HistoryYour risk for stroke is greater when heartattack, stroke, or TIA runs in your family.

Risk factors you can control

You can lower your risk of stroke when youcut out or reduce the other risk factors.

SmokingSmoking is a major risk for stroke for thesereasons:

• Smoking causes your blood to clot easier.

• Smoking increases the build-up of plaquein your arteries.

• Every time you smoke, your arteries nar-row and your blood pressure increases as aresult of the nicotine.

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Stroke Risk Factors


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When you quit smoking, you decrease yourrisk of stroke. For help to quit smoking, call800-533-UPMC (8762).

High Blood PressureThe number one risk factor for strokeis high blood pressure. Another name forhigh blood pressure is hypertension (hi-per-TEN-shun). When you control your bloodpressure, you can greatly reduce your risk of stroke.

Talk to your doctor to learn what your bloodpressure should be. Starting at age 55, youshould get your blood pressure checked twicea year, unless your doctor advises more fre-quent checks. This helps you keep your bloodpressure in the range set by your doctor. Youshould know your blood pressure numbers.In general, the top number should be lessthan 120, and the bottom number should beless than 80. The way to say a blood pressurewould be “120 over 80,” for example. The topnumber is called systolic (sis-TOLL-ik) pres-sure. The bottom number is diastolic (die-es-TOLL-ik) pressure.

High CholesterolAn unhealthy cholesterol (co-LESS-ter-all)balance can lead to fat deposits in the arter-ies. These deposits are called plaque (PLAK).Plaque narrows the arteries and can lead tostroke. You should have your first cholesterolcheck at age 20. After that, follow your doc-tor’s guidelines for regular cholesterol test-ing. The best time for a cholesterol check isafter you have not eaten for several hours.

You should learn what your cholesterol num-bers are. Here is what your numbers shouldbe:

• Total cholesterol should be lower than 200.

• Good cholesterol (HDL) should be higherthan 35.

• Bad cholesterol (LDL) should be less than100, based on your health history.

• Triglycerides (try-GLISS-er-rides), whichare fats, should be below 200.

To reach your goal, you may need diet, exer-cise, and medicine. If you had a stroke or TIAin the past, it’s very important to work hardto control your cholesterol to prevent strokeor a second stroke.

Carotid DiseaseThe carotid (kuh-RAW-tid) arteries are the2 main arteries that carry blood to your brainand neck. When plaque build-up narrowsthese arteries, carotid disease results. Medi-cine or surgery to clean out plaque in thecarotid arteries can reduce the risk for stroke.

Heart Disease• Atrial (AY-tree-ol) fibrillation (fib-ril-LAY-shun) is a type of irregular heart beat. It iscalled “AF” for short. AF is a common causeof stroke. The irregular heart beat makesblood flow through the heart in a sluggishway. Blood clots may form and lead to a stroke.

As with high blood pressure, you can have AFand not know it. You should check your ownheart beat regularly. Place the palm of yourhand up. On the wrist just below the thumb,place 2 fingers and press lightly. Move thetips of your fingers until you find your pulse.Now count the number of beats for 1 full min-ute. Feel if the beats come at an even pace orif they are irregular. If you suspect your heartbeat is irregular, call your doctor.

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When you have AF, the goal of treatment is torestore a regular heart beat. When this is notpossible, blood thinners may be prescribed.Getting treatment for AF helps reduceyour risk of stroke.

• Heart attack occurs when the blood sup-ply to part of the heart is greatly reduced orstopped. The result may be injury to the heartmuscle. The heart muscle is called the myo-cardium (my-oh-CAR-dee-um). Another namefor heart attack is myocardial (my-oh-CAR-dee-ol) infarction (in-FARK-shun), or “MI.”3 percent of people who have a heart attackwill also have a stroke.

• Congestive heart failure, or “CHF” forshort, is weakening of the heart muscle. Theheart becomes less able to pump the amountof blood the body needs to perform variousactivities. In most cases, CHF is present alongwith other risk factors. Some of these arehigh blood pressure, diabetes, and past heartattack. Getting treatment for these conditionshelps reduce your risk for stroke.

• Valve disease prevents the heart valvesfrom working properly. Blood clots can resultfrom valve disease. The blood clots may travelthrough the arteries to the brain and cause astroke. Medicine and sometimes surgery canhelp reduce your stroke risk.

DiabetesWhen a blood vessel in the brain becomesblocked and stops blood flow, a stroke occurs.This type of stroke is called an ischemic (iss-KEY-mik) stroke. Diabetes greatly increasesyour risk for an ischemic stroke.

Some types of diabetes prevent the body fromusing its insulin to break down blood glucose(sugar). This is called insulin resistance. Theresult is lower levels of good cholesterol(HDL), which can cause blood clots to form.

The blood clots may travel to the brain andcause a stroke.

Diabetes also causes plaque to build up in thearteries at a faster rate. Plaque narrows thearteries. This is called hardening of the arter-ies, or atherosclerosis (ATH-er-oh-skler-OH-sis). In time, plaque build-up can block anartery and cause a stroke.

People with diabetes also tend to gain weight.Obesity can lead to high blood pressure andhigh cholesterol, which are both risk factorsfor stroke. When blood glucose levels arehigh, damage from a stroke can be evenworse. Good control of diabetes can reduceyour risk for stroke. For good control, it’simportant to monitor and control blood glu-cose levels, follow your diet plan, and exercise.

ObesityExcess weight increases your risk of stroke.People who have a stroke or heart diseaseoften have excess body fat around their lowerbelly, or abdomen. This is sometimes calledan “apple shape.” Obesity also can bringother risk factors with it, such as high bloodpressure, higher bad cholesterol, and diabetes.Weight control and exercise improve yourcirculation and help reduce other risk factors.

Lack of Physical ActivityExercise is important to help control weight,blood pressure, cholesterol, and diabetes —all risk factors for stroke.

Alcohol, Coffee, and Drug UseHeavy alcohol use increases risk for stroke.Drinking 3 or more cups of coffee a day mayincrease risk of stroke in older men with highblood pressure. Use of street drugs, espe-cially cocaine and amphetamines, is a majorstroke risk for young adults. Using steroidsfor body-building increases risk of stroke.

STROKE RISK FACTORS

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For help in finding a doctor or health service that suits your needs, call the UPMC Referral Serviceat 412-647-UPMC (8762) or 800-533-UPMC (8762).



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The University of Pittsburgh Medical Center is an equal opportunity employer. Policy prohibits discrimination or harassment on the basis of race, color, religion,national origin, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or veteran status. Further, UPMC will continue to support andpromote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access toand treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this informationfor your health care needs. Ask your own doctor or health care provider any specific medical questions that you have.

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Poor NutritionA diet high in fat, sugar, and salt puts you atrisk for stroke. Studies show that eating5 servings of fruit and vegetables a day willreduce your risk of stroke by 30 percent.

StressStudies show a link between mental stress andnarrowing of the carotid arteries. Learningand practicing ways to reduce stress may helpreduce your stroke risk.

Estrogen

Birth control pills and hormone replacementtherapy (HRT) contain estrogen. The hormoneestrogen may change the blood’s clottingability. Blood clots may then form, which cancause stroke.

Resources

UPMC Stroke Institute412-647-8080www.upmc.com/services/stroke

American Stroke Associationtoll-free 888-4-STROKE (888-478-7653)www.strokeassociation.org

National Stroke Associationtoll-free 800-STROKES (800-787-6537)www.stroke.org

STROKE RISK FACTORS

UPMCPittsburgh, Pa., USA

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© UPMC 2003SYS13336 JS/JS ORIG 08/03Form # 6396-82190-0709

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Serviceat 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. Policy prohibits discrimination or harassment on the basis of race, color, religion, national origin, ancestry, sex, age, maritalstatus, familial status, sexual orientation, disability, or veteran status. Further, UPMC will continue to support and promote equal employment opportunity, humandignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. Thiscommitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information foryour health care needs. Ask your own doctor or health care provider any specific medical questions that you have.


S troke Warning Signs



Learn the signs.

When a person is about to have a stroke, there are warning signs. Some of the signs arephysical, and other signs are mental. Learn the warning signs of stroke.

What are the warning signs?

Here are the warning signs of stroke:

• numbness, weakness, or paralysis of the face, arm, or leg (on one or both sides of the body)

• vision that suddenly blurs or decreases (in one or both eyes)

• trouble speaking or understanding

• dizziness, loss of balance, or an unexplained fall

• difficulty swallowing

• sudden, severe headache that is unexplained

• sudden confusion

When you spot the warning signs and take action, you may be able to prevent a stroke.If a stroke occurs, taking action may mean that the damage is less severe.

Act fast!

When you or someone you know has one or more warning signs of stroke, take actionimmediately. Call 911 or your local ambulance service. Contact your doctor right away,too, so proper measures can be taken quickly.

Do not ignore the warning signs — they are very serious! Call 911.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Serviceat 412-647-UPMC (8762) or 800-533-UPMC (8762).The University of Pittsburgh Medical Center is an equal opportunity employer. Policy prohibits discrimination or harassment on the basis of race, color, religion,national origin, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or veteran status. Further, UPMC will continue to support andpromote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to andtreatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.





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Stroke Emergency Treatment


A stroke occurs when the blood supply to thebrain is interrupted or there is bleeding in thebrain. Within minutes, brain cells begin to die.It is urgent to seek emergency care at thefirst sign of a stroke. Early treatment savesmany lives and reduces the effects of stroke.

Stroke warning signs

These are the warning signs that you orsomeone you know may be having a stroke:

• numbness,weakness,orparalysisoftheface, arm, or leg (on one or both sides of the body)

• visionthatsuddenlyblursordecreases(in one or both eyes)

• troublespeakingorunderstanding

• dizziness,lossofbalance,orafallthatisunexplained

• difficultyswallowing

• sudden,severe,unexplainedheadache

• suddenconfusion

Learn the warning signs of stroke, and seekemergencycareatthefirstsignofastroke.

In the emergency room

Special procedures are followed as soon as astroke patient arrives in the emergency room.The patient gets a physical exam. Then testsare done to learn the cause and the extent ofthe stroke. These tests are called diagnostic(die-ag-NOS-tik) tests.

A CT scan is one of the most important tests.“CT” stands for computed tomography (tuh-MOG-ruff-ee). A CT scan is an x-ray thathelps detect the kind of stroke the patient hashad. The doctor needs to know the type ofstroke to decide on the best treatment for thepatient. The stroke patient also may haveblood tests and an EKG (electrocardiogram).(More tests may be done over the next fewdays to learn the extent and the effects of thestroke.)

The patient may have an intravenous (IV)line inserted. Oxygen also may be given. Thepatient’s blood pressure and body fluid balanceare watched closely. Stroke may lead toincreased pressure on the brain. The patient iswatched for confusion, drowsiness, and head-ache, which are early symptoms of increasedbrain pressure. The patient may be givenmedicine to prevent or treat this condition.

A stroke can affect the ability to swallow. Astroke patient is not allowed to take anythingby mouth until it is clear that he or she is ableto swallow.

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Forhelpinfindingadoctororhealthservicethatsuitsyourneeds,calltheUPMCReferralServiceat 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.



Emergency drug therapy

The most common type of stroke is ischemic(iss-KEY-mik) stroke. This type of strokeoccurs when a clot blocks a blood vessel inthe brain and blood flow is stopped. When aCT scan shows no signs of bleeding, manypatients with ischemic stroke can safelyreceive drug therapy.

Powerful drugs called “clot busters” can dis-solve blood clots that caused the stroke. Clotbuster therapy must begin within 3 hours afterthe start of a stroke. This is one reason it’surgent to get to a hospital emergency roomimmediately for stroke symptoms.

T-PA (Activase)One of the clot buster drugs is t-PA. It’s shortfortissueplasminogen(plaz-MIN-oh-jin)activator. The brand name is Activase. T-PAhelps restore blood flow to the damaged areaof the brain. For many patients, t-PA can stopor lessen brain damage from the stroke.

There is some risk for bleeding with t-PA.A patient receiving t-PA must be monitoredin the intensive care unit (ICU). The drug isgiven by an IV line over 1 hour.

STROKE EMERGENCY TREATMENT

Intra-arterial t-PAA newer method gives t-PA directly wherethe damage has occurred. This allows lowerdoses of t-PA to be used because the drug isinserted directly into the affected artery. Themethod is called intra-arterial (IN-truh-ar-TEER-ee-ol) t-PA. The drug is given duringa procedure called an arteriogram (ar-TEER-ee-oh-gram). This procedure takes about3 hours. Only staff with special medical train-ing can give t-PA in this way.

Drug research

Researchers are working to create new drugsthat can slow down or stop brain cells fromdying after a stroke. In the hours or days aftera stroke, nerve cells near the part of the brainwhere the stroke occurred can still becomedamaged. It is hoped that new drugs willprotect brain cells that are at risk for strokedamage that spreads. These drugs wouldreduce the disabling effects of a stroke. Newlycreated drugs are tested by research studies.Some of these drug research studies are con-ducted at UPMC hospitals.

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S troke Medical Treatment



A stroke occurs when blood supply to thebrain is interrupted or there is bleeding in thebrain. Within minutes, brain cells begin to die.It is urgent to get emergency care at thefirst sign of a stroke. Early treatment savesmany lives and reduces the effects of stroke.

After emergency treatment for a stroke,medical treatment aims to prevent the strokefrom getting worse. It also aims to preventother problems that can develop from thestroke. These types of problems are calledcomplications. The doctor continues tomonitor the stroke patient. The doctor mayalso prescribe more tests for the patient. Thetests help to find what caused the stroke andhow to prevent another one. These tests arecalled diagnostic (die-ag-NOS-tik) tests.

Medicines

The most common type of stroke is ischemic(iss-KEY-mik) stroke. This type of strokeoccurs when a clot blocks a blood vessel andstops blood flow to the brain.

Drug therapy may be given to patients withischemic stroke or those at risk of having is-chemic stroke. The medicines that are usedmost often fall into 2 groups: anticoagulants(an-tee-ko-AG-you-lents) and antiplatelets(an-tee-PLATE-lets).

AnticoagulantsDrugs in this group help to keep blood clotsfrom forming. Sometimes these drugs arecalled anti-clotting agents or blood thinners.They work by making your blood take longerto clot. There is some risk for bleeding whenyou take anticoagulants, so your doctor willmonitor you closely.

HeparinWhen a CT scan of a stroke patient’s brainshows no signs of bleeding, heparin may beprescribed. Heparin may not dissolve a bloodclot that already exists, but it helps to keep theblood clot from getting bigger. This drugalso helps to prevent new clots from forming.Heparin is given by intravenous (IV) line orby injection.

When you take heparin, you may have somerisk for bleeding. You need frequent bloodtests to check how clotting is affected. A doseof heparin is active for only 4 to 6 hours, so itis easy to control.

Tell your doctor right away if you have anysigns of bleeding:

• large bruises

• blood in your urine or stool

• black or dark stools

• bleeding gums

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Low-Molecular-Weight HeparinThis type of heparin may give you less risk forbleeding. It is given 1 or 2 times a day. Thisform of heparin is given by injection underthe surface of the skin (subcutaneous). Somecommon brand names for this type of heparinare Lovenox and Fragmin.

Tell your doctor right away if you have anysigns of bleeding:

• large bruises

• blood in your urine or stool


• bleeding gums

CoumadinCoumadin can help patients who have highrisk for having a stroke. This includes patientswho have had a mini-stroke (TIA) or have ab-normal heart valves. It also includes patientswith an abnormal heart rhythm called “AF”(atrial fibrillation). Coumadin is the brandname for this drug; warfarin is the genericname. Coumadin comes as a pill that is takenby mouth.

This drug works by reducing the effect ofvitamin K, a vitamin that helps your blood toclot. Because many foods contain vitamin K,it is very important to keep the same amountof vitamin K in your diet every day when youare taking Coumadin.

Foods that are high in vitamin K include:

• beverages: herbal teas containing tonkabeans, melilot (sweet clover), or woodruff;green teas

• fats: mayonnaise

• oils: soybean oil, canola oil

• vegetables: broccoli, brussels sprouts,cabbage, cauliflower, collard greens,green scallions, kale, lettuce, mustardgreens, parsley, spinach, turnip greens

You must take Coumadin exactly as yourdoctor prescribes. You will need frequentblood tests to check if the dosage needs to bechanged. Tell your doctor right away if younotice any signs of bleeding:


• bloody urine

• bleeding gums

Whenever you go to any kind of dentist ordoctor, be sure they know that you takeCoumadin. You should also wear a medicalalert tag that says you are taking the bloodthinner Coumadin.

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AntiplateletsPlatelets are blood cells that are sticky andhelp the blood to clot. Antiplatelets are drugsthat keep platelets in the blood from stickingtogether. This helps to prevent blood clotsthat could cause stroke. These drugs can helppatients who have had a mini-stroke (TIA) ora past stroke. These drugs may also be givento patients who are at risk for a stroke. Takethese drugs with food because they may irri-tate your stomach. Antiplatelets give you lessrisk for bleeding than anticoagulants do.

AspirinAspirin helps to keep platelets from “clump-ing” in patients who have some risk for mini-strokes (TIAs) or stroke. Aspirin is also ananti-inflammatory drug. Inflammation in thearteries seems to play a role in stroke. So thisis another reason why aspirin helps preventstroke. You must take aspirin for about 8 daysbefore it starts to slow “clumping.” Manyover-the-counter (OTC) drugs contain someaspirin, so it’s important to avoid them whenyou are taking aspirin. Check with your doc-tor before you take any OTC drug. Beforeyou have surgery or other procedures that areinvasive, you may need to stop taking aspirin.Tell your doctor if you have any of thefollowing:

• ringing in your ears

• dizziness

• confusion

• pain in your belly

PlavixPlavix is a pill taken by mouth once a day.This drug may cause headache or dizzinesswhen you first start taking it. Tell your doctorif you have any of the following:

• skin rashes

• chest pain

• fainting

• severe headache

• large bruises

AggrenoxThis new medicine combines 2 drugs: aspirinand Persantine. Both drugs help to keep bloodclots from forming. Together, the drugs areeffective in reducing mini-strokes (TIAs) andstrokes. This medicine is a capsule taken bymouth 2 times a day. Tell your doctor if youhave any of the following:

• signs of bleeding, such as black or darkstools, bloody urine, or bleeding gums

• skin rash

• stomach upset

• dizziness

STROKE MEDICAL TREATMENT

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A stroke occurs when blood supply to thebrain is interrupted or there is bleeding in thebrain. Within minutes, brain cells begin to die.It is urgent to get emergency care at thefirst sign of a stroke. Early treatment savesmany lives and reduces the effects of stroke.

The warning signs of stroke are:

• numbness, weakness, or paralysis of theface, arm, or leg (on one or both sidesof the body)

• vision that suddenly blurs or decreases(in one or both eyes)

• trouble speaking or understanding

• dizziness, loss of balance, or a fall thatis unexplained

• difficulty swallowing

• sudden, severe, unexplained headache


For any of the warning signs of stroke, call911 right away, and get to a stroke center foremergency care.

Types of surgery

After receiving emergency care, some strokepatients may be helped by surgery.

For Strokes from BlockageMost strokes occur when a blood vessel in thebrain is blocked and blood flow stops. Thistype of stroke is called an ischemic (iss-KEY-mik) stroke. The blockage may be caused by

a blood clot, and severe brain swelling mayresult. Life-saving surgery may be necessaryto remove the clot and the brain tissue thathas died from lack of oxygen.

A blockage also can occur when the arteryitself narrows. A harmful fatty deposit, calledplaque (PLAK), may build up in an arteryand then block it. Sometimes clots form,which can then break off and travel to blockanother artery in the brain. Some patients canbe helped by a procedure called angioplasty(AN-jee-oh-plass-tee). During the procedure,a tiny balloon at the end of a long, thin tubeis pushed through the artery to the blockage.When the balloon is inflated, it opens theartery. In addition, a mesh tube may be placedinside the artery to help hold it open. Thetube is called a stent. The procedure usuallyrequires a hospital stay of several days.

For Blockage in the NeckThe main arteries in the neck help supply thebrain with blood. They are called the carotid(kuh-RAW-tid) arteries. When patients havea serious blockage in these arteries, surgerymay be done to prevent a stroke or a mini-stroke, which is also called a TIA. The oper-ation is called a carotid endarterectomy(en-dar-ter-EK-tuh-mee).

This procedure cleans out and opens up thenarrowed artery. During the operation, thesurgeon scrapes away plaque from the wall ofthe artery. Blood can then flow freely throughthe artery to the brain. A patient usually staysin the hospital 2 to 3 days for this operation.

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STROKE SURGICAL TREATMENT

For Strokes from Altered Blood FlowBlood flow to the brain may decrease tempo-rarily in some patients. This is called a mini-stroke or a TIA, which stands for transient(TRANS-yent) ischemic (iss-KEY-mik) attack.While the brain is not getting enough blood,it cannot work properly. Patients who haveTIAs get symptoms for a short time that makeit difficult for them to function.

Bypass surgery may be advised for some pa-tients who continue to have TIAs. During theoperation, an artery on the outside of the scalpis re-routed to the part of the brain that is notgetting enough blood flow. When blood flowis restored, the brain works normally, and thesymptoms disappear. The hospital stay forthis type of bypass surgery is about one week.

For Strokes from BleedingBleeding in the brain causes some strokes.These strokes are called hemorrhagic (HEM-er-RAJ-ik). The bleeding may occur when aweakened blood vessel leaks or bursts. Thisis called an aneurysm (AN-your-izm). Whenan aneurysm occurs, the weakened artery maybecome like a balloon filled with blood. Pa-tients usually describe an aneurysm as theworst headache of their life.

There are several types of surgery to repairan aneurysm. A clip may be placed across theneck of the aneurysm (like a clip at the end ofa balloon) to stop the bleeding. A newer ap-proach is to thread a long, thin tube throughthe artery that leads to the aneurysm. Then

a tiny coil is fed through the tube into theaneurysm “balloon” to fill the space and sealoff the bleeding. Based on the type of surgery,the hospital stay ranges from several days to aweek or longer.

Resources

UPMC Stroke Institute412-647-8080http://stroke.upmc.com




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S troke and TIA Facts



What is a stroke?

A stroke occurs when the brain’s blood flowstops or when blood leaks into brain tissue.Normally the blood carries oxygen to thebrain to nourish brain cells. When the oxygensupply to a part of the brain is interrupted,brain cells in that area die. Death of braincells means that some parts of the body maynot be able to function.

There are different types of stroke:

• ischemic (iss-KEY-mik) stroke

• transient (TRANS-yent) ischemic attack, also called TIA

• hemorrhagic (hem-er-RAJ-ik) stroke

TIA, or transient ischemic attack

A TIA occurs when blood flow to the brain isblocked temporarily. TIA causes stroke symp-toms that last for a short time, then go away.This is why TIAs are called “mini-strokes.”Having a TIA means there is a problem thatshould be corrected. TIAs are a warningthat a more serious stroke may occur.One-third of all stroke patients had TIAsymptoms before their stroke. To preventa future stroke, you must get treatmentfor a TIA.

Symptoms of TIAThe symptoms you get with a TIA depend onthe area of the brain affected. Symptoms mayinclude:

• numbness, tingling, or weakness on oneside of your body (in your face, arm, or leg)

• trouble talking or understanding others


• change in vision (double vision, blurredvision, dimmed vision, or loss of vision)

• trouble with swallowing

Ischemic stroke

Ischemic stroke occurs when a blood vesselin the brain is blocked and blood flow isstopped. The blockage may be from a bloodclot. A clot that forms in an artery is called athrombus (THROM-bis). A clot that forms inthe heart or an artery leading to the brain isan embolus (EM-buh-lis). In ischemic stroke,the clot travels to the brain and blocks a brainartery. Oxygen is then reduced or completelycut off to that part of the brain.

Ischemic stroke has many different causes.The doctor must find the cause of the stroketo know what treatment is best for you.

Causes of Ischemic StrokeBelow is a list of the things that can causeischemic stroke:

• hardening of the arteries, or atherosclerosis(ATH-er-oh-skler-OH-sis)

• narrowing of one of the main arteries in theneck, or carotid (kuh-RAW-tid) disease

• small vessel disease, or lacunar (lack-YOU-ner) infarction (in-FARK-shun)

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• infection or inflammation of brain arteries

• irregular heart beat, or atrial (AY-tree-ol)fibrillation (fib-ril-LAY-shun)

• heart attack, or myocardial (my-oh-CAR-dee-ol) infarction (in-FARK-shun)

• small hole in the heart chamber wall, oratrial (AY-tree-ol) septal (SEP-tol) defect

• blood clotting disorder, or hypercoagula-bility (HI-per-co-AG-you-luh-BILL-it-ee)

Hemorrhagic stroke

Hemorrhagic stroke occurs when a bloodvessel breaks and blood leaks or spills intothe brain tissue. As a result, brain cells in theaffected area die. There are 4 types of hemor-rhagic stroke that commonly occur.

Intracerebral HemorrhageA small artery in the brain can break and spillblood into nearby brain tissue. Brain cells inthe area are destroyed. This stroke is called anintracerebral (IN-tra-ser-EE-brol) hemor-rhage (HEM-er-ij), or “ICH” for short. Highblood pressure is usually the cause of this typeof stroke.

Subarachnoid HemorrhageA large artery in the brain may become weak.It may stretch out, like a balloon filling withwater. The “balloon” is called an aneurysm(AN-your-izm). The aneurysm may break,spilling blood into the space between thebrain tissue and the membrane that covers the

brain. This membrane is called the arachnoid(uh-RACK-noyd) membrane. The stroke iscalled a subarachnoid (sub-uh-RACK-noyd)hemorrhage, or “SAH” for short.

Arterial Venous MalformationArteries and veins may be tangled, or mal-formed, at birth. This is called “AVM,” orarterial (ar-TEER-ee-ol) venous (VEEN-us)malformation. Over time, an AVM may breakapart. How serious the damage is depends onwhere the AVM is located in the brain.

Cerebral Amyloid AngiopathyIn the elderly, small blood vessels in the brainmay be weakened by deposits of protein. Thiscondition is cerebral (ser-EE-brol) amyloid(AM-ih-loyd) angiopathy (an-jee-OP-uh-thee), or “CAA.” Frail arteries then maybreak, and blood leaks into the brain. Howserious the damage is depends on the locationand amount of bleeding from the breaks.

Resources

UPMC Stroke Institute412-647-8080http://stroke.upmc.com



STROKE AND TIA FACTS


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UPMC

Stroke and TIA: Finding the Cause


S troke and TIA: Finding the Cause



It’s very important to find what causes astroke or stroke warning signs (TIA). Yourdoctor must know the cause to decide on thebest treatment for you. Your doctor will askquestions about your health now and in thepast. He or she will also ask about your fam-ily’s health. You will have a complete physicalexam. The doctor will also check your nervoussystem. This is called a neurologic (noor-uh-LOJ-ik) exam. This exam checks your level ofalertness, sensation, coordination, reflexes,muscle strength, and response to pain.

Diagnostic tests

After looking at the results of the physical andneurologic exams, your doctor may send youfor one or more tests. These tests are calleddiagnostic (die-ag-NOS-tik) tests. These testshelp to find what caused your stroke or TIA.They also help to detect the type, size, andlocation of the brain injury that resulted fromthe stroke or TIA.

There are 2 types of diagnostic test. The firsttype of test is called non-invasive. Duringa non-invasive test, no foreign object or sub-stance enters your body. For example, an x-rayis a non-invasive test.

The second type of test is invasive. An inva-sive test makes a puncture or cut (incision),injects a fluid, or inserts an instrument intoyour body. For example, tests that use an

intravenous (IV) line are invasive. Before youhave an invasive test, you must sign a consentform.

Diagnostic tests that are done the most oftenare x-ray, ultrasound, and computer-assistedimaging. Some of these tests combine invasiveand non-invasive procedures.

Questions and concerns

Generally, you have little or no discomfortduring a neurologic diagnostic test. You willhave no side effects, or the side effects areminor. Here are the 3 basic rules to followduring your test:

• Relax.

• Remain still.

• Do what the doctor, nurse, or techniciantells you.

It’s normal to have some anxiety before andduring a test. But a diagnostic test should notbe a frightening experience for you. Feel freeto express any concerns about your tests. Askthe medical staff any questions you may have.

My doctor’s name _______________________

My doctor’s phone ______________________

The University of Pitts-burgh Medical Center isan equal opportunity em-ployer. Policy prohibitsdiscrimination or harass-ment on the basis of race,color, religion, nationalorigin, ancestry, sex, age,marital status, familialstatus, sexual orientation,disability, or veteran sta-tus. Further, UPMC willcontinue to support andpromote equal employmentopportunity, human dig-nity, and racial, ethnic,and cultural diversity. Thispolicy applies to admissions,employment, and access toand treatment in UPMCprograms and activities.This commitment is madeby UPMC in accordancewith federal, state, and/orlocal laws and regulations.

This information is notintended to be used as asubstitute for professionalmedical advice, diagnosis,or treatment. You shouldnot rely entirely on thisinformation for your healthcare needs. Ask your owndoctor or health care pro-vider any specific medicalquestions that you have.


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continued

CT Scan and CTA Scan



What is a CT scan?

“CT” stands for computed tomography(tuh-MOG-ruff-ee). CT uses x-rays and acomputer to make a picture of sections ofthe body. The picture is called a scan. ACT scan shows the body’s organs in greaterdetail and more clearly than regular x-rays.

What is a CTA scan?

“CTA” stands for computed tomographyangiography (AN-jee-OG-ruff-ee). A CTAscan gives a view of specific blood vessels(arteries and veins). CTA is often includedin a CT exam.

Why are CT and CTA used?

CT and CTA help find problems in yourbody and how far disease has spread. Theyalso help show the effects of treatment andhow your body is responding to treatment.CT and CTA scanning can study manyparts of the body, such as the brain, neck,chest, abdomen, pelvis, spine, arms, and legs.

How do I prepare for the test?

This section gives you some general guide-lines to prepare for your test. Your doctor,nurse, or testing center will give you moredetailed instructions.

MedicinesAsk your doctor or testing center for in-structions. If you have diabetes, ask yourdoctor about taking your routine medicine.

DietYour testing center will give you instruc-tions. If your doctor or testing center tellsyou to take your routine medicine, take itonly with a small sip of water.

You may be asked to take a liquid prepara-tion and a bowel preparation before you cometo the testing center.

What to bringWhen you come for your test, please bring:

• a prescription slip or requisition fromyour doctor

• insurance forms, referrals, or both

• a list of your medicines, including anyspecial Glucophage instructions, over-the-counter drugs, and herbal drugs

• a list of allergies to food, latex, or medicine

PrecautionsTell the doctor or technologist if you’ve everhad an allergic reaction to a contrast enhanc-ing agent, iodine, or shellfish, or if you haveasthma.

CT and CTA scanning exposes you to someradiation. If you are pregnant or think youmight be, or if you are breast-feeding, tellthe doctor and technologist before your test.

What happens during the test?

You will put on a hospital gown and removeall metal objects that might interfere withthe scan. If a contrast enhancing agent is used,you’ll receive it in one of the following ways:

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• by drinking it

• by an enema (inserted through the rectum)

• by an intravenous (IV) line in your arm

The IV enhancing agent may give you abrief sensation that moves up your arm. Youalso may get a warm, flushed feeling; a tasteof salt or metal in your mouth; or nausea fora few minutes. This is normal, but youshould tell the technologist about these orother reactions.

You may also experience nausea, shortnessof breath, itchiness, or sneezing. If any ofthese occur, tell the doctor or technologistright away.

The CT scanner has a very large ring, likea donut standing upright. A narrow tablemoves through the center hole.





able to talk to the staff through an intercom.You will be asked to hold your breath for ashort time during the CT scan. You willhear whirring sounds and the table willmove during the exam.

CT and CTA scanning usually takes lessthan 30 minutes. Some tests are shorter orlonger, based on the number of areas testedand the equipment used. If an enhancingagent is used, the test will take longer.

What happens after the test?

When your scan is over, the technologistwill help you off the table. If you had achange in diet before the scan, you may re-sume your normal diet. If you received anenhancing agent, you should drink plenty offluids to flush it out of your body. If youcannot drink, you will be given fluids by IV.If you have diarrhea that lasts for longerthan a day, call your doctor.

How do I get my test results?

A doctor who is a radiologist will study yourscans and report the results to your doctor.Your doctor will discuss the results withyou. Talk with your doctor or testing centerabout how to get your test results.

My test appointment

Date: ____________ Time: ____________

Place: _______________________________

Phone number: _______________________

Special instructions: ___________________

____________________________________

____________________________________

CT SCAN AND CTA SCAN

The technologist will help you onto thetable and then will go into a room behind alarge window. The staff will watch youcarefully through the window. You’ll be




• by drinking it

• by an enema (inserted through the rectum)

• by an intravenous (IV) line in your arm

The IV enhancing agent may give you abrief sensation that moves up your arm. Youalso may get a warm, flushed feeling; a tasteof salt or metal in your mouth; or nausea fora few minutes. This is normal, but youshould tell the technologist about these orother reactions.

You may also experience nausea, shortnessof breath, itchiness, or sneezing. If any ofthese occur, tell the doctor or technologistright away.

The CT scanner has a very large ring, likea donut standing upright. A narrow tablemoves through the center hole.





able to talk to the staff through an intercom.You will be asked to hold your breath for ashort time during the CT scan. You willhear whirring sounds and the table willmove during the exam.

CT and CTA scanning usually takes lessthan 30 minutes. Some tests are shorter orlonger, based on the number of areas testedand the equipment used. If an enhancingagent is used, the test will take longer.


When your scan is over, the technologistwill help you off the table. If you had achange in diet before the scan, you may re-sume your normal diet. If you received anenhancing agent, you should drink plenty offluids to flush it out of your body. If youcannot drink, you will be given fluids by IV.If you have diarrhea that lasts for longerthan a day, call your doctor.


A doctor who is a radiologist will study yourscans and report the results to your doctor.Your doctor will discuss the results withyou. Talk with your doctor or testing centerabout how to get your test results.

My test appointment

Date: ____________ Time: ____________

Place: _______________________________

Phone number: _______________________


____________________________________

____________________________________

CT SCAN AND CTA SCAN

The technologist will help you onto thetable and then will go into a room behind alarge window. The staff will watch youcarefully through the window. You’ll be

18 19


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UPMCEchocardiogram


Echocardiogram

What is an echocardiogram?

An echocardiogram (ek-oh-KAR-dee-oh-gram),or “echo,” is a test that checks how well yourheart is working. It uses sound waves to producea picture of your heart.

Why is an echo done?

This test is done to help your doctor check:

• the size of your heart’s pumping chambers(ventricles)

• how well your heart muscle is pumping

• how well your heart valves are working

The day of your test

• No special preparation is necessary.

• You may eat or drink anything you like.

• Go about your normal activities.

• Take any medicines you normally wouldtake, unless your doctor tells you otherwise.

• Do not apply oil or lotions to your chest area.

• Plan to arrive 30 minutes before the sched-uled time of the test. The test may takefrom 30 to 60 minutes.

During the echo

You will remove any clothing above the waistand put on a hospital gown.

Sticky patches (called electrodes) will be placedon your chest. These keep track of yourheart’s rate, rhythm, and electrical activity.The electrodes will be connected to a machinethat will record the electrical activity of yourheart. This recording is called an EKG (elec-trocardiogram).

You will be asked to lie on your left side. Anurse or technician will put a gel on yourchest. The gel may feel cold. A small plasticdevice, called a transducer (trans-DOO-sir),will be placed on your chest, over your heart.The transducer sends and receives high-frequency sound waves. As the sound wavesbounce off different parts of your heart, theyare picked up by the transducer and sent to amonitor. The monitor shows a picture of yourbeating heart. You may hear a “whooshing”sound, timed with your heart beat. This is thesound of blood moving through your heart.

After the exam

After the echo is completed, you may go backto your normal daily activities. Technologistsand nurses are not allowed to discuss yourtest results. Your doctor will go over your testresults with you. Call your doctor’s office in2 to 3 working days to find out your results.





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UPMC

Holter Monitor


continued

H olter Monitor



A Holter monitor is a device that continu-ously records your heart’s rhythm duringdaily activities (usually for 24 hours). This isalso called an ambulatory electrocardiogram.The monitor records your heart’s rhythmthrough electrodes that are placed on yourchest. Electrodes are small adheive patchesattached by wires to a monitor. This testhelps show how your heart responds to nor-mal activity or to certain medications.

Why is this test done?

There are many reasons your doctor mayorder this test:

• to help detect irregular heart beats (cardiacarrhythmias, pronounced ay-RITH-me-uhs)

• to help evaluate chest pain

• to help check the heart’s activity after aheart attack

• to help check the heart’s activity after apacemaker has been inserted

• to help check how certain medicinesare working

• to help discover the cause of certain symp-toms such as difficulty breathing, dizziness,light-headedness, or fainting

How should I prepare for the test?

Wear loose-fitting clothing with a shirt orblouse that buttons down the front. This willhelp keep the electrodes from becomingloose. Other than that, there is no specialpreparation for this test. You may eat anddrink before this test.

How is this test done?

You will be told where and when to have theHolter monitor put on and taken off.

First, your chest will be cleansed. It may alsobe shaved. Having clean skin will help theelectrodes stay on until the test is done.Electrodes will be stuck to your chest. Thisis painless. You will be told what to do if anyof the electrodes loosen or fall off duringthe test.

Portable monitor

Electrodes

20 21




The electrodes are attached with wires to aportable (battery operated) monitor. Themonitor is worn in a pouch, which might beon a strap around your waist, shoulder, orneck.

While wearing the monitor, continue to goabout your daily activities in your usual way.You will be asked to keep a diary of your activity,medicines, and symptoms while wearing themonitor.

It is important to keep the monitor dry.

• Do not shower or take a bath until themonitor is removed.

• It is OK to take a sponge bath, but becareful not to get the monitor wet.

Do not disconnect the lead wires or electrodes.This will interfere with the recording.

Keeping your diary

It is very important that you fill in the diary.Write down any activities that you do and thetime you do them. Some examples of activityare:

• walking

• stair climbing

• exercise

• sexual activity

You also must include:• eating and drinking

• medicines taken

• periods of stress

Write down any symptoms you have and whattime you experienced them. The followingsymptoms are important to record:

• chest pain or discomfort

• any other pain

• shortness of breath

• dizziness or light-headedness

• fainting

• heart palpitations (racing or poundingheart beat)

• tiredness or fatigue

• nausea

Portable monitor


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Some Holter monitors have an “EVENT”button. Press this button when you experienceany symptoms. When the EVENT button ispressed, it “marks” the recording. If yourmonitor has this button, you will be shownhow to use it.

What to avoid

Certain things can interfere with your Holtermonitor’s recording. While wearing theHolter monitor, avoid the following:

• magnets

• metal detectors

• electric blankets

• high voltage areas

Time’s up!

Return to the place where you received yourmonitor, at the time you were told to. Theelectrodes and monitor will be removed.

Results

A computer will analyze the recording andprint out a report. Your doctor will analyzethe report and your diary. He or she will talkwith you about the results. Depending on theresults of this test, additional tests or treat-ments may be ordered. Your doctor will dis-cuss these with you.

Your appointment

Your appointment date: ________________

Please arrive by: ______________________

at: __________________________________

22 23

continued

MRI and MRA Scan



What are MRI and MRA?

“MRI” stands for magnetic (mag-NET-ik)resonance (REZ-oh-nentz) imaging. MRIuses magnetic fields and radio waves to makepictures of the body without using x-rays.The pictures, called scans, are 3-dimensionaland are shown on a screen.

MRI lets doctors see very detailed images ofthe inside of your body. MRI passes throughbone and takes pictures of soft tissue, such astendons, blood vessels, and the brain.

“MRA” stands for magnetic resonance angiog-raphy (AN-jee-OG-ruff-ee). An MRA scangives a view of specific blood vessels (arteriesand veins). MRA may be included with anMRI exam.

Checklist

The checklist below helps to show if you canhave MRI and MRA. The magnetic fieldsused are extremely powerful, so it’s very im-portant that we know about any metal in yourbody. Many items listed below are safe, butsome mean that you cannot have MRI or MRA.

Check all the items that apply to you:

� have a history of working with metal

� have metal in your eye or have ever had metal removed from your eye

� have shrapnel, BBs, or bullets anywhere in your body

� have a pacemaker, cardioverter, or defibrillator

� have aneurysm clips

� have embolization coil

� have had heart valve replacement or cardiac stents

� have hearing devices of any kind

� have implants of any kind (for example, dental, breast, penile, or ear)

� have had surgery in the past 2 months

� have fear of tight or enclosed spaces (claustrophobia)

� think you may be pregnant

� have had problems with past MRI or MRA

If you checked any of these items, call andtell your testing center before the day ofyour MRI exam. Do not assume that yourdoctor’s office knows about your metal im-plants or any other item. You are responsibleto alert us to these items.


For an MRI exam, no special preparation isneeded. On the day of the MRI, you may eator drink fluids, go about your normal activi-ties, and take your routine medicines, unlessyour doctor says otherwise. For an MRAexam, your testing center will tell you aboutany special preparation needed.

If the area of your body being tested is abovethe shoulder, do not wear any makeup, jewel-ry, hair pins, or hair products such as mousse,gel, or hair spray. These items may affectthe scan.

Tell the doctor or technologist if you’ve everhad an allergic reaction to a contrast enhanc-ing agent, shellfish, or iodine, or if you haveasthma.

UPMCMRI and MRA Scan



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What happens before the test?

Plan to arrive 30 minutes before your sched-uled exam time to register. You may be askedto change into a hospital gown and pants. Ifso, you must remove all jewelry and store per-sonal belongings in a locker. It’s best to leaveall valuables at home.

For some MRI and MRA exams, a contrastenhancing agent is used. If you are to receivean enhancing agent, an intravenous line (IV)will be inserted in your arm or hand. The en-hancing agent may give you a brief sensationthat moves up your arm. You may get a warm,flushed feeling; a taste of salt or metal in yourmouth; or nausea for a few minutes. This isnormal, but you should tell the technologistabout these or other reactions.


Most MRI and MRA exams are done insidea closed scanner. The magnet is like a tunnel,open at both ends, allowing light and air inside.

If you are large or have a fear of enclosedspaces (claustrophobia), please tell your doc-tor in advance so arrangements can be made.

The technologist will help you onto a scan-ning bed. You will lie flat on the bed. Thescanning bed will move into the center of themagnet. Inside the scanner, you should liequietly, breathe normally, and relax. Youmust stay as still as possible, so the picturesare clear. You’ll have ear plugs to block outthe machine’s loud knocking noise.

The technologist will be in a room behind alarge window and will see and hear you at alltimes. You’ll be able to talk through an inter-com. The exam usually lasts 1 to 2 hours.


The technologist will help you off the bed.You may resume your normal diet. If an en-hancing agent was used, drink plenty of fluidsto flush the agent out of your body. If you havediarrhea for more than a day, call your doctor.


A doctor who is a radiologist will study yourscans and report the results to your doctor.Your doctor will discuss the results with you.Ask your doctor or testing center about howto get your test results.

My test appointment

Date: ____________ Time: ____________

Place: _______________________________

Phone number: _______________________


____________________________________

MRI AND MRA SCAN








What happens before the test?

Plan to arrive 30 minutes before your sched-uled exam time to register. You may be askedto change into a hospital gown and pants. Ifso, you must remove all jewelry and store per-sonal belongings in a locker. It’s best to leaveall valuables at home.

For some MRI and MRA exams, a contrastenhancing agent is used. If you are to receivean enhancing agent, an intravenous line (IV)will be inserted in your arm or hand. The en-hancing agent may give you a brief sensationthat moves up your arm. You may get a warm,flushed feeling; a taste of salt or metal in yourmouth; or nausea for a few minutes. This isnormal, but you should tell the technologistabout these or other reactions.


Most MRI and MRA exams are done insidea closed scanner. The magnet is like a tunnel,open at both ends, allowing light and air inside.

If you are large or have a fear of enclosedspaces (claustrophobia), please tell your doc-tor in advance so arrangements can be made.

The technologist will help you onto a scan-ning bed. You will lie flat on the bed. Thescanning bed will move into the center of themagnet. Inside the scanner, you should liequietly, breathe normally, and relax. Youmust stay as still as possible, so the picturesare clear. You’ll have ear plugs to block outthe machine’s loud knocking noise.

The technologist will be in a room behind alarge window and will see and hear you at alltimes. You’ll be able to talk through an inter-com. The exam usually lasts 1 to 2 hours.


The technologist will help you off the bed.You may resume your normal diet. If an en-hancing agent was used, drink plenty of fluidsto flush the agent out of your body. If you havediarrhea for more than a day, call your doctor.


A doctor who is a radiologist will study yourscans and report the results to your doctor.Your doctor will discuss the results with you.Ask your doctor or testing center about howto get your test results.

My test appointment

Date: ____________ Time: ____________

Place: _______________________________

Phone number: _______________________


____________________________________

MRI AND MRA SCAN

24 25

continued

TEE (Trans-Esophageal Echocardiogram)



The TEE test takes a detailed picture ofyour heart and its major blood vessels. Thistest helps to detect heart valve disease, hearttumors, and blood clots inside the heart. Italso helps detect an aneurysm (AN-your-izm),which is a swelling, like a balloon, in a bloodvessel. TEE stands for trans-esophageal(trans-ee-SOFF-uh-jee-ul) echocardiogram(ek-oh-CAR-dee-oh-gram).

How does a TEE work?

The TEE test combines several procedures.It makes a picture by using sound wavesthat pass through skin and tissue without be-ing heard or felt. This is called ultrasound(UL-truh-sound). The special instrument thatsends and receives the sound waves is calleda transducer (trans-DOO-sir).

A tiny transducer is attached to the end ofa flexible tube with a light. The tube is calledan endoscope (EN-doh-skope). The scopeis passed into your mouth, through youresophagus (food pipe), and down behind yourheart. The word “trans-esophageal” means“through the esophagus.”

The transducer sends sound waves into yourheart and blood vessels and then receivesthe signals that bounce back, or “echo.” Thesignals are converted into pictures that showon a screen. This part of the test is calledan echocardiogram.


• Do not eat or drink anything, not evenwater, for 6 hours before the test. Ifyour doctor says so, you may take yourmedicine with a very small sip of water.

• Remove any full or partial dentures.

• Tell your doctor or nurse before the testif any of your teeth are loose.

• You will need to sign a consent form.


A doctor will perform your TEE test with thehelp of a nurse or technician. The technicianwill help you onto a bed and ask you to lieon your left side. You will be connected tomachines that monitor your blood pressure,heart rate, and oxygen levels during the test.You will be given a mild sedative by an intra-venous line (IV) to help you relax. You’ll re-main somewhat alert so you can cooperatewith the doctor and staff.

The TEE test may cause some mild discom-fort, but it should not be painful. The back ofyour throat will be numbed with an anestheticspray. Your throat will feel cool, and you mayget a bitter taste in your mouth. You will needto remove any full or partial dentures. To pro-tect your teeth, a plastic mouth guard will beplaced in your mouth. You’ll need to pressyour lips around the guard.

UPMC

TEE (Trans-Esophgeal Echocardiogram)









The doctor then will insert the scope intothe back of your mouth. You will be asked toswallow the scope, and you may gag for a fewmoments. The doctor will advance the scopeinto your esophagus about 12 to 14 inches.The transducer will take a picture of the topright chamber of your heart. This is called theright atrium (AY-tree-um).

Next, the doctor will advance the scope 4 to6 inches farther. The transducer will now geta picture of the lower left chamber, which iscalled the left ventricle (VEN-trih-col).

The scope will be in place at each site for 5 to10 minutes. If saliva collects in your mouth,a small plastic suction tube will remove it.


• You cannot eat or drink for at least 1 hourafter the test. The numbing effect of theanesthetic takes this long to wear off. Yournurse will check your gag reflex often bytouching the back of your mouth with atongue depressor. You must be able to gagto keep from choking on food or fluid.

• You may have a mild sore throat for up to24 hours after the test. This is normal.

• Your doctor may prescribe throat lozengesto relieve the mild soreness in your throat.

• You may have to stay in bed for 1 to 2hours while the mild sedative wears off.

• You must have a responsible adult driveyou home. You must arrange it in advance.

When to call the doctor

Tell your doctor or nurse if you have any ofthe following:

• choking on foods, fluids, or saliva

• severe pain or bleeding from your mouthor throat

How do I get my results?

Your doctor will discuss the results of thetest with you. Check with your doctor or thetesting center about how and when to getyour test results.

Questions and concerns

It’s normal to have some anxiety before andduring a test. But a diagnostic test shouldnot be a frightening experience. Feel free toexpress concerns about your TEE test. Pleaseask the medical staff any questions you have.

My test appointment

Date: ____________ Time: ____________

Place: _______________________________

Report to: ____________________________

Phone number: _______________________


TRANS-ESOPHAGEAL ECHOCARDIOGRAM


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26 27

Blood Pressure


What is blood pressure?

Blood pressure is vital to life. Blood pressuremakes it possible for blood to circulatethroughout our bodies. With each beat ofthe heart, blood is pumped out of the heartinto our blood vessels. The blood carriesoxygen and food to our vital organs — suchas the brain, heart, and kidneys — so theycan work. Blood pressure is the force(tension) that the blood exerts in ourblood vessels.

How is blood pressure measured?

A blood pressure check measures 2 things,so your blood pressure reading will have2 numbers. The first or top number showssystolic (sis-TOLL-ik) pressure. It showsthe pressure of blood against the artery wallswhen your heart contracts and pumps outblood. The second or bottom numbershows diastolic (dye-es-TOLL-ik) pressure.It shows the pressure of blood against theartery walls when your heart rests betweenpumps and fills with blood. An exampleof a blood pressure reading is 130/80(read as “130 over 80”). The systolic pressureis 130. The diastolic pressure is 80.

Why should I know my bloodpressure numbers?

You should learn and remember your bloodpressure numbers. Blood pressure numbersfall into 3 ranges. The ranges show if yourblood pressure is healthy or if you have ahealth problem.

Normal Blood Pressure

Your blood pressure is normal when the firstnumber is less than 120, and the secondnumber is less than 80. When your bloodpressure is normal, work to keep it normalby adopting a healthy lifestyle.

Hypertension

Hypertension (HI-per-TEN-shun) is themedical name for high blood pressure. Yourblood pressure is high when the first numberis 140 or higher, or the second number is 90or higher. When blood pressure remains inthis range, it is dangerous to your health. Ittakes several readings at different times todetermine if you have high blood pressure.

Pre-Hypertension

Your blood pressure may not be normal orhigh. A first number between 120 and 139or a second number between 80 and 89 isa warning. The medical name for this rangeis “pre-hypertension.” This means that youdon’t have high blood pressure now, butyou’re likely to have it in the future.

continued

BLOOD PRESSURE

What causes high blood pressure?

The cause of high blood pressure is oftennot clear. We know a physical cause of highblood pressure for only 5 percent of patientsin treatment. For example, kidney diseasemay be the cause of their high bloodpressure. But for 95 percent of patientsin treatment, we do not know a physicalcause of their high blood pressure.

Why is high blood pressuredangerous?

High blood pressure is dangerous becauseit puts a strain on your body. It can harmyour body in a number of ways. First of all,it adds to your heart’s work load. Over timeas your heart works harder than normal, ittends to get bigger. A slightly bigger heartmay still work well, but a heart that is tooenlarged may not be able to meet yourbody’s needs.

UPMC


High blood pressure also affects yourarteries and arterioles (are-TEER-ee-ols),which are the smaller arteries. As we growolder, the arteries harden and become lessflexible, even if we don’t have high bloodpressure. But having high blood pressuretends to speed up this process. Anothername for hardening of the arteries isarteriosclerosis (are-TEER-ee-oh-skler-OH-sis).

When high blood pressure damages thearteries, they may not be able to supplythe amount of blood the body needs. Whenthe body’s organs don’t get enough oxygenand food from the blood, they cannotwork properly. High blood pressure maycontribute to kidney disease or eye problems,for example.

Sometimes a hardened artery becomesnarrowed by a build-up of material calledplaque (PLAK). This is called atherosclerosis(ATH-er-oh-skler-OH-sis). A blood clotmay lodge in a narrowed artery, cutting offnormal blood supply to part of the body.

Another danger is that high blood pressureusually has no warning signs or symptoms.People can think they have perfectly normalblood pressure until suddenly they havea heart problem or a stroke. High bloodpressure may have silently damaged theirheart and blood vessels over a long time.

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Blood pressure Systolic Diastolic

Normal under 120 and under 80

Pre-hypertension 120 to 139 or 80 to 89

Stage 1hypertension

140 to 159 or 90 to 99

Stage 2hypertension

160 or over or100 orover

28 29

BLOOD PRESSURE

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3 continued

Am I at risk for high blood pressure?

Everyone has some risk for high bloodpressure. Our risk increases as we age.About 25 percent of adult Americans havehigh blood pressure. Some people havegreater risk than others. They are:

• men

• Americans of African descent

Other factors that increase your risk forhigh blood pressure are:

• family history of high blood pressure

• obesity

• cigarette smoking

• high cholesterol

• diabetes

• lack of exercise

• high alcohol use

• high salt intake

• aging

• stress

Why should I be concerned?

You can prevent serious health problemsif you take the proper steps to prevent orcontrol high blood pressure. It’s the mostimportant thing you can do to reduce yourchance of a stroke. When you do notcontrol high blood pressure, you are:

• 7 times more likely to have a stroke

• 6 times more likely to get congestiveheart failure

• 3 times more likely to get coronaryheart disease

What should I do?

You should have your blood pressurechecked as often as you can. If your doctortells you to have your blood pressurechecked once a month or several times ayear, be sure to do so. In addition, attendfree blood pressure screenings for the publicwhenever possible. You can have a bloodpressure check by a doctor, nurse, nursepractitioner, physician assistant, or medicalassistant at:

• your doctor’s office

• a clinic where you work or go to school

• a health fair, fitness center, or communitycenter

BLOOD PRESSURE

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4 continued

If your blood pressure reading is high ata public screening (for instance, at a mallor health fair), get it confirmed by yourdoctor or other health care professional.It is very important to see your doctor ifyou have a high blood pressure reading.You could have other health problemsthat need to be treated. Early detectionand treatment are key.

What exams and tests will I needto have?

Your doctor will give you a routinephysical exam and ask you questionsabout your health. If your blood pressurereading is high, he or she will give you3 or more blood pressure checks severalweeks apart. If your blood pressure readingis high on 3 or more careful readings, thedoctor will diagnose high blood pressure.In severe cases, a doctor may diagnosehigh blood pressure based on a singlereading.

To see if high blood pressure hasdamaged any organs in your body,routine blood and urine tests and anEKG (electrocardiogram) will be done.Most people with high blood pressurereceive “normal” test results, indicatingno signs of organ damage. For somepeople, the test results will indicate thatthey may have kidney disease, diabetes,or a hormone disorder. This is why it is soimportant to see your doctor when youhave high blood pressure. Other healthproblems can be detected and treatedbefore they get worse.

Can high blood pressure be cured?

High blood pressure can be controlled, butnot cured. It is a lifelong disease. If youhave high blood pressure, you can learn tocontrol it. It’s important to work with yourdoctor to find the best treatment for you.

How do I control high bloodpressure?

There’s a lot you can do to control highblood pressure. Changing your diet andliving habits can help lower blood pressure.Quitting smoking reduces blood pressureand risk for heart attack and stroke. Reducingyour alcohol intake helps. For some people,taking medicine also helps to reduce andcontrol high blood pressure. When youfollow the treatment plan your doctor givesyou, it becomes easier to maintain a lowerblood pressure.

How does the doctor decide mytreatment?

To draw up a treatment plan for you, yourdoctor will look at a number of factors.He or she will look at your blood pressurerange. There also may be signs that highblood pressure has damaged organs suchas your heart, arteries, kidneys, or eyes.You may already be in treatment for otherhealth problems, such as high cholesterol,diabetes, or heart, kidney, or lung disease.Your treatment plan may involve lifestylechanges alone. Or your treatment plan maycombine lifestyle changes with medicine.

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BLOOD PRESSURE

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5 continued

Lifestyle Changes

Lifestyle changes alone are usually triedfirst for people with:

• blood pressure in the pre-hypertensionrange

• no other risk factors for heart disease

• no evidence of damage to other organs

Lifestyle changes mean that you must:

• Achieve or maintain a healthy weight.

• Get regular exercise.

• Avoid too much sodium. (Do not addtable salt to your foods or eat saltyfoods. Ask your doctor about theDASH diet.)

• Eat a low-fat diet. (Follow guidelinesof the American Heart Association.)

• Get enough fiber in your diet.(Eat 5 servings of fruits and vegetablesevery day.)

• Limit your use of alcohol.

• Stop smoking.

• Learn to check your blood pressure athome.

• Reduce stress in your life.

Blood Pressure Medicines

Medicine combined with lifestyle changesis often tried first for people with:

• blood pressure in the hypertensionrange

• other risk factors for heart disease

• evidence of damage to other organs

When blood pressure is in the hypertensionrange, lifestyle changes plus a single,low-dose medicine usually are tried first.If this first attempt does not lower yourblood pressure, then higher doses of themedicine may be tried. Or several medicinescombined may be tried.

Types of Medicines

It often takes time to find the medicinethat best controls your blood pressure withthe fewest side effects. It may take someweeks for your body to adjust to a certainmedicine and for mild, annoying sideeffects to fade.

Diuretics. Diuretics (dye-uh-RET-iks)work in the kidneys to rid the body ofexcess water and salt by increasing the flowof urine. They are often called “water pills.”These drugs help to lower blood pressure.Examples are:

Generic name Brand name

furosemide Lasix

hydrochlorothiazide HydroDIURIL

metolazone Zaroxolyn

bumetanide Bumex

Beta blockers. Beta (BAY-tuh) blockershelp to slow the heart beat. They work byreducing the nerve impulses to the heartand blood vessels. Then the heart does nothave to work so hard. As a result, bloodpressure goes down. Examples are:


atenolol Tenormin

metoprolol Lopressor

propranolol Inderal

BLOOD PRESSURE

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6 continued

ACE inhibitors. “ACE” stands for an-giotensin (an-jee-oh-TEN-sin) convertingenzyme. ACE inhibitors prevent a certainhormone from forming. This hormone iscalled angiotensin II. It can cause theblood vessels to narrow. ACE inhibitorsrelax the blood vessels, and then bloodpressure goes down. Examples are:

Angiotensin II receptor blockers(antagonists). Angiotensin II receptorblockers prevent the effect of angiotensinII on the blood vessels. As a result, theblood vessels become wider, and bloodpressure goes down. Another namefor these medicines is angiotensin IIantagonists. Examples are:

Calcium channel blockers. Calciumchannel blockers (CCBs) prevent calciumfrom entering the heart muscle and theblood vessels. This makes the blood vesselsrelax, and blood pressure goes down.Examples are:

Alpha blockers. Alpha (AL-fuh) blockersreduce nerve impulses to the blood vessels.Blood can then pass through more easily, andblood pressure goes down. Examples are:


captopril Capoten

enalapril Vasotec

lisinopril Prinivil


losartan Cozaar

valsartan Diovan


amlodipine Norvasc

diltiazem Cardizem

nifedipine Adalat


doxazosin Cardura

prazosin Minipress

terazosin Hytrin

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BLOOD PRESSURE

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Alpha-beta blockers. Alpha-beta blockerswork like alpha blockers, reducing nerveimpulses to the blood vessels so that bloodpasses through more easily. They alsowork like beta blockers, slowing the heartbeat. As a result, less blood is pumpedthrough the blood vessels, and the bloodpressure goes down. Examples are:

Nervous system inhibitors. Nervoussystem inhibitors control nerve impulsesto relax the blood vessels. This allows theblood vessels to become wider, and bloodpressure goes down. Examples are:

Vasodilators. Vasodilators (vay-zoh-DYE-lay-terz) open blood vessels directly byrelaxing the muscle in the vessel walls.This causes blood pressure to go down.Examples are:

Always review with your doctor anyother medicines you take. This includesover-the-counter medicines, such as aspirin,NSAIDs (non-steroidal anti-inflammatorydrugs), and herbal medicines. Somemedicines may make your blood pressuremedicine less effective.


carvedilol Coreg

labetalol Normodyne


clonidine Catapres

methyldopa Aldomet


hydralazine Apresoline

minoxidil Loniten

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© UPMC 2008SYS354420 AEL/JDS REV 11/08Form # 7513-82178-1108

Pittsburgh, Pa., USAwww.upmc.com

UPMC is an equal opportunity employer. Policy prohibits discrimination or harassment on the basis of race, color, religion, national origin, ancestry, sex, age, maritalstatus, familial status, sexual orientation, disability, or veteran status. Further, UPMC will continue to support and promote equal employment opportunity, humandignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. Thiscommitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information foryour health care needs. Ask your own doctor or health care provider any specific medical questions that you have.


BLOOD PRESSURE

UPMC


Tips for high blood pressure

1. Get regular blood pressure checks.Write down the numbers, andknow them.

2. Know what your weight should be.Keep it at that level or below.

3. Do not use too much salt in cookingor at meals.

4. Eat a low-fat diet. Follow AmericanHeart Association guidelines.

5. Do not smoke cigarettes or use tobaccoproducts.

6. Take your medicine exactly asprescribed. Do not run out of pills,even for one day.

7. Make and keep your doctorappointments.

8. Exercise regularly.

9. Make sure your family gets regularblood pressure checks.

10. Reduce stress in your life, and developways to cope with stress.

For more information

Some useful resources include:

• National Heart, Lung, and Blood InstituteHealth Information Center Web SiteP.O. Box 30105Bethesda, MD 20824-0105phone: 301-592-8573www.nhlbi.nih.gov/hbp

• American Heart Association10 Duff Road, Suite 304Pittsburgh, PA 15235phone: 412-824-3122www.americanheart.org/presenter.jhtml?identifier=2114

34 35

Weight Management Tips — Diet


Successful weight management involvesreducing the amount of calories you eat,increasing your exercise level, and makinglifestyle changes. This information will helpyou understand how you can make changesin your diet to affect your weight.

A calorie is a measurement of energy. Justabout everything we eat has some calories,and we need a certain amount of caloriesevery day to keep us going. Some typesof foods have more calories than others.Carbohydrates and protein contain4 calories per gram, and fat contains9 calories per gram. This is why cuttingdown on the amount of fat you eat canhelp you lose weight.

You can lose about 1 pound a week if youreduce your calorie intake by 500 caloriesa day. To lose one pound, you need to cut3,500 calories out of your meal plan orexercise enough to burn off 3,500 calories.If you cut 500 calories each day for a week,that adds up to 3,500 calories (7 days times500 calories = 3,500 calories).

Adding exercise to your daily routine canspeed up the process.

Most people need a daily diet of at least1,200 calories a day. If you eat less, you couldbe missing important nutrients your bodyneeds. It’s important to take a multivitaminand calcium supplement if you are on aweight loss plan.

Here are some important tips to follow tolose weight:

• Eat at least 3 times a day. Smaller mealsspaced throughout the day can reducethe urge to snack on high-calorie foods.

• Start with a good breakfast every morning.Remember it’s important to “break thefast” and jump-start your metabolism forthe day. Skipping meals can lead to eatingextra calories at the end of the day.

• Bake, broil, grill, poach, or steam all ofyour meats, instead of frying.

• Steam your vegetables. Use somedifferent herbs and vinegar or lemon juiceto season them, or steam them overchicken broth for extra flavor.

• Drink between 6 and 8 (8-ounce)glasses of water a day. Chooselow-calorie or no-calorie drinks suchas tea, diet soda, or diet fruit drinks.Juice, regular soda, and some sparklingwaters can be high in calories.

• Limit your meat intake to 6 ounces aday. A 3-ounce piece of meat is about thesize of a deck of cards.

• Choose healthy, low-fat snacks. Nonfatyogurt, non-fat cottage cheese, fruit,vegetables, pretzels, and low-fat popcornare good choices.

• Pay attention to portion sizes. One ofthe easiest ways to lose weight is simply toreduce your portion sizes by one-quarter.

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WEIGHT MANAGEMENT TIPS — DIET

• Eat more fruits, vegetables, and wholegrains. These foods are high in fiber, fillyou up, and give you lots of nutrients yourbody needs.

• Read labels. If the label says an item has190 calories per serving, and you eat3 servings, you are actually eating570 calories.

• Limit the amount of fatty foods you eat,like fried foods, cheese, snack foods, anddesserts.

• Reduce the amount of butter, margarine,and oil you use by one-quarter to one-half.

• Remember: “low-fat” does not necessarilymean “low-calorie.” Often, low-fat itemshave extra sugar. They may be lower in fatbut may have the same amount of caloriesas the regular item.

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36 37

Cholesterol


What is cholesterol?

Cholesterol is an odorless, soft, fat-likesubstance found in all of the body’s cells.It is used to form cell membranes, hormones,and necessary tissues. Cholesterol is made bythe body, and we get additional cholesterolfrom foods. Cholesterol is an important partof a healthy body.

Why is cholesterol discussed asa health risk?

Having too much cholesterol in your blood(more than 200mg/dl) is a risk factor forheart disease. When people talk about theircholesterol level, they mean the amountof cholesterol in their blood. High bloodcholesterol levels can affect the heart bybuilding up cholesterol, in a form calledplaque, in the lining of the heart’s bloodvessels. Over time, this build-up can blockthe vessels. If blood cannot get to the heart,this causes a heart attack.

What causes high blood cholesterol?

A family history of high blood cholesterolputs you at risk for high blood cholesterol.Some of the foods you eat can increaseyour risk. If you eat foods high in dietarycholesterol and saturated fat, you will raiseyour cholesterol level. Saturated fat (animalfats) can raise blood cholesterol more thananything else in your diet. Being overweightor obese also raises your risk for highcholesterol.

For most people, eating foods lower insaturated fats and cholesterol can reducetheir blood cholesterol levels.

Where does dietary cholesterolcome from?

Cholesterol is found only in foods thatcome from animals. Foods that have veryhigh amounts of cholesterol are egg yolks,organ meats (liver, kidney, heart), and wholemilk products. Cholesterol is never foundin plant foods such as fruits and vegetables.Your diet should contain less than 300 mgof cholesterol per day.

Unsaturated fats

Unsaturated fats come from vegetables.They are liquid at room temperature andare divided into two types: monounsaturatedand polyunsaturated.

Polyunsaturated fats are found in corn oil;sunflower seeds and oil; safflower seedsand oil; and soybeans and soybean oil.These fats should make up no more than10 percent of the total calories in your diet.(See chart.)

Monounsaturated fats are found in canola oil,olive oil, and peanut oil. Monounsaturatedfats should make up 10 percent to 15 percentof the total calories in your diet. (See chart.)

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CHOLESTEROL

Saturated fats

Saturated fats come from animal sourcessuch as beef, veal, lamb, pork, ham, butter,cream, cheese made from cream, andwhole milk. They are usually solid atroom temperature and are often used instore-bought bakery items, candies, friedfoods, and non-dairy creamers.

Saturated fats are also found in coconut,palm and palm kernel oils, cocoa butter,hydrogenated oils, and shortening. These areknown as saturated vegetable fats. Saturatedfats should make up less than 10 percent ofthe total calories in your diet. (See chart.)

Tubs are better than sticks

The more firm the fat, the more saturated.For example, stick margarine and shorten-ings are more saturated than soft tub-typemargarines. As with all saturated fats, intakeshould be limited to less than 10 percent ofthe total calories in your diet.

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How can I reduce fat and cholesterolin my diet?

• Use vegetable fats instead of animal fatswhen cooking.

• Select lean meats, and trim visible fatfrom meat before cooking.

• Limit meat portions. Your total meatintake should be 5 to 6 ounces per day.

• Eat fish or skinless poultry more oftenthan beef or pork.

• Limit liver and other organ meats inyour diet.

• Choose low-fat or non-fat dairy productsand cheese.

• Eat more grains, fruits, vegetables, driedbeans, and peas.

• Limit the number of egg yolks you eatto 3 or 4 per week.

• Roast, bake, or broil meats and otherfoods instead of frying.

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CHOLESTEROL

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No more than 30 percent of your total daily calories should come from fat. Converting thisinto grams can be confusing. The following chart lists common daily calorie totals and goalsfor total fat, saturated fat, polyunsaturated fat, and monounsaturated fat in grams. Use thischart as a guide when making your food selections.

If you normallyeat this many

calories each day

Total fat shouldbe no more than

Total saturatedfat should be no

more than

Total unsaturated fat

Total poly-unsaturatedfat should be no more

than

Total mono-unsaturatedfat should be no more

than

1000 33 g 11 g 11 g 11 g

1200 40 g 13 g 13 g 13 g

1500 50 g 16 g 16 g 16 g

1800 60 g 20 g 20 g 20 g

2000 65 g 22 g 22 g 22 g

2200 73 g 24 g 24 g 24 g

2500 83 g 27 g 27 g 27 g

Smoking Facts


Bad news about smoking

• Smoking and second-hand smoke causeover 430,000 preventable deaths each year.

• Cigarettes and cigarette smoke containmore than 4,000 harmful ingredients.Many of these cause cancer.

• Cigarette smoke ruins clothing, furniture,and car seats, as well as family and socialrelationships.

• Cigarette smoking and second-handsmoke cause:

- shortness of breath

- decreased energy

- bone loss

- damage to blood vessels

- lung cancer and other types of cancers

- high blood pressure

- digestive disorders

- diabetes complications

- chronic lung diseases

- heart disease

- poor circulation

• Cigarettes are costly, at about $6 per pack.

• Smoking-related diseases generate morethan $50 billion a year in medical costs.

• Lost wages and lost productivity fromsmoking-related diseases cost another$50 billion a year.

• Smoking during pregnancy puts babiesat risk for low birth weight, prematuredeath, and sudden infant death syndrome,as well as for learning disabilities.

• Asthma, bronchitis, and respiratory andear infections increase in children ofsmokers.

• More than 6,200 children die each yearfrom infections and burns because ofparents who smoke.

• Cigarette smoking is a major cause offire-related deaths.

• Matches and lighters are a major causeof house fires.

• Each day, more than 5,000 children trysmoking, and 3,000 become hooked.

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SMOKING FACTS

Good news about quitting smoking

Immediately after your last cigarette:

• No more burns in your clothes, furniture,and car.

• Your body’s healing processes begin.

20 minutes after your last cigarette:

• Your blood pressure lowers.

• Your hands and feet warm up.

8 hours after your last cigarette:

• The carbon monoxide level in your bloodreturns to normal.

24 hours after your last cigarette:

• Your heart attack risk decreases.

• You are less short of breath.

• You save money ($6 per pack).

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2

3 days after your last cigarette:

• Your family and friends are happier.

• Your senses of taste and smell improve.

• Your skin begins to look and feel better.

• You have increased energy.

About 1 week after your last cigarette:

• Your mood improves.

• You are less irritable.

2 weeks after your last cigarette:

• Your circulation improves.

• Your lung function increases.

1 to 9 months after your last cigarette:

• Smoker’s cough decreases.

• Your lungs’ cleansing function returnsto normal.

• Your risk for infection decreases.

SMOKING FACTS

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1 year after your last cigarette:

• Your heart attack risk is half that ofa smoker.

• You’ve saved $2,190 or more from notbuying cigarettes.

• Freedom! You’re not a slave to smokingany longer.

5 to 15 years after quitting:

• Your stroke risk is equal to that of anon-smoker.

10 years after quitting:

• Your lung cancer risk is half that ofa smoker.

• Your risk of cancer decreases (includingcancer of the mouth, throat, bladder, etc.).

15 years after quitting:

• Your risk of heart disease is equal to thatof a non-smoker.






If you want help to stop smoking:

• Classes may be available in yourcommunity. Call 1-800-533-UPMC(8762) to find out more.

• If you are an inpatient at a UPMChospital:

- Ask your nurse if the hospital hasthe UPMC patient education TVchannel, which features a videoabout quitting smoking.

- Ask to talk one-on-one with asmoking cessation counselor.

• Go to UPMC’s patient educationwebsite (http://patienteducation.upmc.com). Under the Smokingcategory is Journey to a Smoke-FreeLife, a 42-page guide that can helpyou devise a successful strategyto quit smoking, as well as othermaterials about the dangers ofsmoking and other health topics.You can print out any or all of thesematerials.

• Additional resources are availablefrom the toll-free PennsylvaniaDepartment of Health Quit Line.Call 1-877-724-1090.

42 43

Diabetes: Your Management Plan


When you have diabetes, it’s very importantto keep your blood sugar (glucose) in goodcontrol. To do so, you need a personal planto help you manage your diabetes. Thispatient education sheet tells you how tocontrol your blood glucose level and manageyour diabetes.

What is good control?

Good control of diabetes means that yourblood glucose stays at certain levels. Theselevels are based on guidelines from theAmerican Diabetes Association (ADA). Hereare the numbers that show where your bloodglucose should be:

Self-Test

Before meals:

Normal is less than 100. Recommended goalis 90 to 130. You need to improve if yourlevel is often under 90 or over 150.

At bedtime:

Normal is under 120. Recommended goal is110 to 150. You need to improve if your levelis often under 110 or over 180.

A1c Test (A-one-C)

This test measures the amount of hemoglobinwith sugar attached. The results show youraverage blood glucose level over 3 months.The light areas on the chart show theacceptable range for A1C.

Average blood glucose level over 3 months:

Normal is 4 to 6 percent.Recommended goalis 7 percent or less.

Goals may vary from person to person. Talkto your doctor or diabetes educator aboutwhat goals are best for you.

For more information, see the UPMC patienteducation sheet Diabetes: Testing Your BloodGlucose.

continued

A1C Blood Glucose

(percent)

Acceptable levels

Unacceptable levels

* milligrams of sugar per deciliter of blood

*(mg/dL)

4

5

67

8

910

1112

65

100

135170

205

240275

310345


DIABETES:YOUR MANAGEMENT PLAN

Good control is important

Why is good control of your blood glucoseso important? Good control of your bloodglucose level reduces your chance of gettingcomplications (COM-pli-KAY-shuns).Complications are other health problemsyou can get from having diabetes. A largeresearch study shows that when people withType 1 diabetes keep their blood glucose ingood control, they are less likely to havecomplications. The people in the studyreduced their risk of eye problems by 76percent, kidney problems by 56 percent,and nerve problems by 60 percent. Thestudy was called the Diabetes Control andComplications Trial (DCCT).

Another large research study was theUnited Kingdom Prospective DiabetesStudy. This study shows that good controlof blood glucose helps people with Type 2diabetes reduce their risk of eye problems,kidney problems, and heart and blood vesseldisease. The research also shows that keepingblood pressure in a good range is importantto prevent complications. According to theADA guideline, recommended bloodpressure range is 130 / 80 (read “130 over80”) or less. For more information aboutpossible complications, see the UPMCpatient education sheets Diabetes: Short-Term Problems and Diabetes: Long-TermProblems.

Your health care team

It’s important to work closely with yourhealth care team. Your health care team usu-ally includes several members who have train-ing in different fields:

• Your primary care doctor provides yourexams and makes sure you get all aspects ofdiabetes care.

• An endocrinologist (EN-doh-crin-OL-oh-jist) is a doctor with special training inthe care of people with diabetes.

• A diabetes educator gives you the skillsand information you need to manage yourdiabetes every day.

• A dietitian helps you decide on a mealplan that works best for you.

• A pharmacist, social worker, exercisespecialist, psychologist, or otherspecialists help you with specific problemsthat relate to diabetes.

Talk with your team members anytime youhave problems or questions. You are notalone in dealing with your diabetes. You cancontrol your diabetes with help from yourhealth care team. Keep in mind, the mostimportant member of the team is you.



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Your personal plan

To work toward good control of your bloodglucose, you need a plan. Your health careteam will help you develop a “self-manage-ment plan.” Self-management means thatyou are responsible to carry out the plan.

Your plan should provide for:

• education

• healthy eating

• exercise

• medicines

• blood glucose testing

• problem solving

• reducing risks

• coping

Education

Diabetes is a life-long disease. You willalways have it, so education about yourdiabetes is very important. The more youlearn about diabetes, the better you cancontrol your blood glucose level and avoidcomplications. To learn how to manageyour diabetes, work closely with your healthcare team.

Healthy eating

To control your blood glucose level, youmust have healthy eating habits. A healthydiet has other benefits too. Healthy eatingcan lead to weight loss. Losing smallamounts of weight can often make a bigdifference in your health. Healthy eatingcan improve your blood glucose, bloodpressure, and cholesterol levels.

When you have diabetes, a meal plan isimportant. A meal plan tells you when to eat,how much to eat, and what kinds of food to eatfor meals and snacks. You need to eat a varietyof vegetables, fruits, and whole-grain foods.The meal plan can include sugar, salt, andsaturated fats, but in a way that fits into theoverall plan.

If you take diabetes pills or insulin, your mealplan should have about the same number ofcalories every day. Meals should be spacedthroughout the day. It’s important not to skipmeals or “double up” on meals.

A dietitian can help with your meal plan. Thedietitian will take into account your scheduleand foods you like and dislike. Each person isdifferent, so every meal plan is different. Formore information, refer to the UPMC patienteducation sheet Basic Diabetes Meal Plan orBasic Carbohydrate Counting. You can alsorefer to www.mypyramid.gov.

Physical activity

For most people with diabetes, exercise is veryimportant. Exercise helps your body use sugarbetter. As a result, your blood glucose levelgoes down. An exercise plan can be as simpleas taking a walk every day. Get a friend to walkwith you. When you do things with a buddy,it’s easier. You’ll be less tempted to skip a day.

Before you start an exercise program, talk toyour doctor. Exercise tends to lower bloodglucose level, so your doctor may need tomake some changes to your management plan.

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Medicines

The two main kinds of diabetes medicine areinsulin and pills. If you have Type 1 diabetes,you must take insulin by shots (injection). Ifyou have Type 2 diabetes, you may be able tostart with healthy eating and exercise. Mostpeople with Type 2 diabetes also need pills tokeep their blood glucose in a good range.Others may need to take insulin. The doctorwill help you decide which plan is best foryou.

Tell your doctor, diabetes educator, andpharmacist all of the medicines that you aretaking. Include prescription and over-the-counter drugs, herbal products, vitamins, andminerals.

Do not take any new medicines or herbaltreatments until you check with your doctor.For more information about medicines fordiabetes, refer to the UPMC patient educa-tion sheet Diabetes: Medicines.

Home blood glucose tests

You need to check your blood glucose levelsat home. A simple testing meter measuresthe amount of sugar in a drop of blood.The blood glucose numbers show if yourmanagement plan is working. Knowing yourblood glucose levels will help you and yourhealth care team decide if your plan needsany changes. You will be able to see howexercise affects your blood glucose. You willbe able to see if your medicines need to beadjusted.

Your doctor will tell you how often to checkyour blood glucose level. Some people checktheir blood glucose before meals, before andafter exercise, when they feel sick, or whenthey feel their blood glucose is low. Your

doctor also will tell you what to do aboutthe results of the test. For more informa-tion, refer to the UPMC patient educationsheet Diabetes: Testing Your Blood Glu-cose.

Problem solving

Having diabetes means you often need tomake decisions about your care. The moreyou know about diabetes and how yourdaily activities affect your blood glucoselevels, the easier it is to make wise deci-sions. Testing your blood glucose andkeeping good track of your readings is es-sential to know how different activities,food, medication and stress levels affectyour blood glucose readings.

Learning what affects your blood glucoselevels and what to do when they are higheror lower than desired takes practice. Look-ing for patterns and trends can help youdetermine what is causing the blood glucoselevels to go high or low, and can help youtarget what might need some adjusting.For more information, ask your doctor ordiabetes educator. Also, refer to the UPMCpatient education sheets Diabetes: TestingYour Blood Glucose, Nutrition and PhysicalActivity for People with Diabetes, andDiabetes: Short-Term Problems.

Risk reduction

To stay healthy with diabetes, it is impor-tant to reduce your risk of developingproblems. There are several things youcan do to reduce your risk. Maintaining ahealthy weight, keeping active, healthyeating, and taking medicines as ordered byyour doctor can help to control your bloodglucose, blood pressure, and cholesterol


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levels in the recommended ranges. Havingannual eye exams, frequently examining yourfeet, seeing your doctor regularly, and notsmoking are also important. For more infor-mation, refer to the UPMC patient educa-tion sheet Diabetes: Health Care Tips.

Healthy Coping

Dealing with diabetes can be difficult andstressful. Stress can have a negative impacton your immune system, increase your bloodpressure and heart rate, and increase yourchance of illness. Stress can also affect yourblood glucose levels when you have diabetes.Some techniques to help you relax includemaking quiet time for yourself, listening tosoft music, reading a book, and discussing aproblem with a friend or family member.Exercise can also help relieve stress andtension. Different things work for differentpeople. You need to practice what works bestfor you. For more information, refer to theUPMC patient education sheet Coping withStress.

Additional things to consider

Changes in lifestyle

You cannot help the fact that you havediabetes. But you can do a lot to help controlit. You may need to make some changes inyour lifestyle. These changes are importantfor a long and healthy life and to reduce thechance of complications.

• Follow a healthy meal plan. Space yourmeals evenly about the same number ofhours apart. Eat around the same timeeach day and about the same amounts.

• Take your medicines, and take them ontime.

• Make physical activity a part of yourdaily life. Chart the effect that exercisehas on your blood glucose level. You mayneed to make some changes to keep yourblood glucose from going too high ortoo low. For example, you make need toadjust your schedule for exercise, formeals and snacks, or for medicines.

• Do not smoke. Talk to your doctor orother members of your health care teamif you need help to quit smoking.

• Talk to your doctor about the use ofalcohol. Alcohol may affect your bloodglucose level. If you decide to have anoccasional alcoholic drink, ask yourdietitian how to fit it into your mealplan.

You may not be able to make all of thesechanges at once. You can work on some ofthese changes over time. Ask your doctoror diabetes educator to help you set goalsthat are right for you. As you succeed inmaking some changes, you can plan newgoals.

When you have diabetes, you have to thinkabout the routine things you do every day.But diabetes should not keep you fromdoing the things you like to do. When youkeep your diabetes in good control, you canfeel better and avoid getting other prob-lems from diabetes. For more information,refer to the UPMC patient education sheetDiabetes: Health Care Tips.

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The University of Pittsburgh Medical Center is an equal opportunity employer. Policy prohibits discrimination or harassment on the basis of race, color, religion, nationalorigin, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or veteran status. Further, UPMC will continue to support and promote equalemployment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMCprograms and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.



Intensive therapy

Intensive insulin therapy means that youcheck your blood glucose many timesduring the day. Then adjustments are madewith medicines, food, and physical activitybased on the blood glucose level. Thesefrequent changes keep the blood glucosein tight control. Tight control can helpreduce your chance of complications. If youare interested in intensive insulin therapy,talk to your doctor.

During pregnancy

If you have diabetes and plan to becomepregnant or think that you maight bepregnant, see a doctor. It is best to have goodcontrol of your blood glucose before youbecome pregnant. Good control can reduceyour chance of problems during pregnancy.While you are pregnant, it is important tohave your diabetes monitored very closely.When you control your blood glucose level,you help keep yourself and your baby healthy.

If you are pregnant, you may be able tocontrol your blood glucose with a meal planrecommended by your doctor, dietitian, ordiabetes educator. You also may need to takeinsulin. Your doctor will help you decidewhat is best for you. Do not take diabetespills during pregnancy until you check withyour doctor. Most diabetes pills have notbeen studied enough in pregnant womenand may be harmful.

Your diet, medicine, and exercise plans mayneed changes during each stage of yourpregnancy. You must check your bloodglucose often during pregnancy. After thebirth of your baby, other changes may beneeded. If you plan to breast-feed yourbaby, changes usually must be made to yourmanagement plan. Keep in constant touchwith your health care team to ensure asuccessful pregnancy.

A type of diabetes that some women getonly while pregnant is called gestational(jess-TAY-shun-ul) diabetes. Gestationaldiabetes usually goes away after pregnancy.

See the UPMC patient education sheetGestational Diabetes for more information.

If you have questions

If you have any questions, call a member ofyour diabetes care team.










Intensive therapy

Intensive insulin therapy means that youcheck your blood glucose many timesduring the day. Then adjustments are madewith medicines, food, and physical activitybased on the blood glucose level. Thesefrequent changes keep the blood glucosein tight control. Tight control can helpreduce your chance of complications. If youare interested in intensive insulin therapy,talk to your doctor.

During pregnancy

If you have diabetes and plan to becomepregnant or think that you maight bepregnant, see a doctor. It is best to have goodcontrol of your blood glucose before youbecome pregnant. Good control can reduceyour chance of problems during pregnancy.While you are pregnant, it is important tohave your diabetes monitored very closely.When you control your blood glucose level,you help keep yourself and your baby healthy.

If you are pregnant, you may be able tocontrol your blood glucose with a meal planrecommended by your doctor, dietitian, ordiabetes educator. You also may need to takeinsulin. Your doctor will help you decidewhat is best for you. Do not take diabetespills during pregnancy until you check withyour doctor. Most diabetes pills have notbeen studied enough in pregnant womenand may be harmful.

Your diet, medicine, and exercise plans mayneed changes during each stage of yourpregnancy. You must check your bloodglucose often during pregnancy. After thebirth of your baby, other changes may beneeded. If you plan to breast-feed yourbaby, changes usually must be made to yourmanagement plan. Keep in constant touchwith your health care team to ensure asuccessful pregnancy.

A type of diabetes that some women getonly while pregnant is called gestational(jess-TAY-shun-ul) diabetes. Gestationaldiabetes usually goes away after pregnancy.

See the UPMC patient education sheetGestational Diabetes for more information.

If you have questions

If you have any questions, call a member ofyour diabetes care team.




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Basic Diabetes Meal Plan


Diabetes meal planning starts with eating awell-balanced diet that includes carbohydrates(carbs), protein, and fat. These nutrients turninto sugar (glucose), which gives energy.Carbs (found in starches, fruit, vegetables,dairy foods, and sweets) raise blood glucosemore than the other nutrients. Eating toomany carbs can raise blood glucose levels,but you should not cut out these foods.Eating too few carbs may cause your bloodglucose to go too low. Eating a moderateamount of carbs at each meal, with a balancedintake of protein and fat, will help yourblood glucose stay in a healthy range. Hereare some tips to get you started. Your dietitianwill give you more specific information whenyou meet with him or her.

Limit your intake of high-sugar foods to 2or 3 times a week or less. These include:

• cakes (frosted, layer, plain), pies, and cookies

• candy (hard tack, chocolate, nougats, etc.)

• jelly, jam, and preserves

• table sugar, honey, molasses, and syrup

• regular ice cream, sherbet, regular andfrozen yogurt, fruit ices, and Popsicles

• regular soft drinks, fruit drinks (canned orconcentrated), and drink mixes with sugaradded

• milkshakes, chocolate milk, hot cocoa mix

• sugar coated cereals, granola,breakfast/snack bars

• canned fruits with heavy syrup, dried fruit,fruit roll-ups, candied fruit

• iced sweet breads, coffee cakes, breakfastrolls, and donuts

Eat 3 well-balanced meals a day and asmall snack at night. Each meal or snackshould contain protein. When planningmeals, select a variety of foods from each foodgroup, and watch your portion sizes (see foodguide on page 2).

Increase your fiber intake. Choose whole-grain breads and cereals. Eat plenty of vegetables,and choose whole fruits instead of fruit juices.When you look at food labels, look forproducts that contain at least 3 grams of fiberper serving.

Do not skip meals. Try to eat around thesame time each day. Meals are best spaced4 to 5 hours apart.

Reduce fat intake by baking, broiling, andgrilling your foods, and using some low-fatfoods. Be careful when selecting low-fatfoods; many are high in sugar.

Stay active. Your blood glucose level willimprove if you keep active. Check with yourdoctor before beginning an exercise orwalking program.

Lose weight if you are overweight. Losingweight gradually, even a small amount ofweight (5 to 10 lbs.) can help improve yourblood glucose level.

Check with your doctor or dietitian aboutalcohol intake, if you are taking medicinefor your diabetes.

Read “Nutrition Facts” labels. Sugar freeproducts may contain the same amount ofcalories as regular products and still containcarbohydrates.

continued

BASIC DIABETES MEAL PLAN

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Food Categories

CARBOHYDRATES

Starches(1 serving = 80 calories and 15 gramscarbohydrates)1 serving =• 1 slice of bread• 1 small roll or muffin• 1/2 bun• 1/2 small bagel or English muffin• 1/3 cup of pasta or rice• 1/2 cup hot or ready-to-eat cereal• 1/2 cup starchy vegetables• 4 large or 6 small crackers• 1 cup of soup• 3 cups of popcorn• 3 graham cracker squares• 3/4 cup unsweetened, dry cereal• 3 cups “lite” or low-fat popcorn

Fruits(1 serving = 60 calories and 15 gramscarbohydrates)1 serving = 1/2 cup water-packedfruit, 1 small piece of fruit (size of atennis ball)1/2 cup of fruit juice

Milk/Dairy(1 serving = 90-150 calories and 12grams carbohydrates)1 serving = 1 cup milk6 ounces yogurt

Vegetables (non-starchy)(1 serving = 25 calories and 5 gramscarbohydrates)1 serving = 1/2 cup cooked vegeta-bles, 1 cup raw vegetables

• whole-grain breads, rolls,muffins, or bagels• pasta, rice, noodles• oatmeal and bran cereals• starchy vegetables (peas, corn,

lima beans, and potatoes)• dried beans (kidney beans, lentils)• soup (broth and cream style)• popcorn, pretzels, graham crackers,

and vanilla wafers

• fresh fruit• unsweetened fruit juice• canned fruit in natural juice or water

• fat-free, 1 percent or 2 percent milk• low-fat buttermilk• lactose-reduced or lactose-free milk• soy milk• “lite” yogurt

• any cooked or raw vegetables, exceptstarchy vegetables (see starch list)

3 - 4 servings per meal(no more than 8 - 12per day)

3 - 4 servings per day



Recommended FoodsRecommendedNumber of Servings

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continued3

Food Categories

Sweets/Desserts/Other Carbs(1 serving = 15 grams carbohydrates)

PROTEIN

Meats/Meat Substitutes(1 serving = 35 to 100 caloriesper ounce, 7 grams protein, and0 carbohydrates)1 serving = 1 oz. meat, 1 egg,1/4 cup tuna fish or cottage cheese,1 slice of cheese, 1 tablespoon ofpeanut butter

FATS

Fats(1 serving = 45 calories, 5 gramsof fat, and 0 carbohydrates)1 serving =1 teaspoon regular or1 tablespoon reduced-fat dressing6-10 nuts

FREE FOODS

Unlimiteddiet soda, diet club soda, sugar-freePopsicles, artificial sweeteners,sugar-free drink mixes, sugar-freeJell-O, regular or decaf coffee and tea

Recommended FoodsRecommendedNumber of Servings

• 1/2 cup sugar-free pudding, custard,ice cream, or sherbet

• 2 small cookies• 1 frozen juice bar• 3 gingersnaps or small sugar-free

cookies• 1/4 cup fat-free salad dressing

• meat, poultry, fish, eggs, eggsubstitutes• low-fat cheese and cottage cheese• peanut butter, tofu, dried beans

• margarine, oil, salad dressing,mayonnaise• cream cheese, sour cream• peanuts, almonds, walnuts, pecans• gravy

Limited(1 piece, 1 tablespoon) sugar-free hardcandy, low-sugar jelly, light syrup,sugar-free gum, whipped topping, fat-free cream cheese(1 cup) raw vegtables

Limit, and substitutefor 1 serving starch,fruit, or dairy

Typically, 0-1 serving(1 oz.) at breakfastis recommended

Typically, 3 servings(3 oz.) at lunch anddinner

3 oz. of meat is roughlyequal to the size of adeck of cards

1 - 2 servings per meal

3 servings per day

To individualize your meal plan, contact a registered dietitian.


Sample Meal PlanBreakfast • 1/2 grapefruit (1 carbohydrate)

• 1/2 cup oatmeal (1 carbohydrate)• 1 slice wheat toast (1 carbohydrate)• 1 scrambled egg or egg substitute (1 meat)• 1 teaspoon margarine (1 fat) and sugar-free jelly• 1 cup milk (skim, 1 percent, or 2 percent)

(1 carbohydrate)• coffee or tea• artificial sweetener

Lunch • turkey sandwich[2 slices whole wheat bread (2 carbohydrates),3 oz. turkey (3 meats), lettuce, and tomato]• 2 teaspoons light mayonnaise (1 fat)• 1/2 cup sugar-free pudding (1 carbohydrate)• small banana (1 carbohydrate)• iced tea with lemon• artificial sweetener

Dinner • 3 oz. sliced roast beef (3 meats)• 1 cup whipped potatoes (2 carbohydrates)• 1 teaspoon margarine (1 fat)• 1/2 cup corn (1 carbohydrate)• 1/2 cup broccoli (1 vegetable)• tossed salad with low calorie dressing

(1 vegetable, 1 fat)• 1/2 cup peaches (1 carbohydrate)• coffee or tea• artificial sweetener

Snack • 3 graham cracker squares (1 carbohydrate)






52 53

Caregivers Information and Support

Caregivers are parents, spouses, children, brothers, sisters, partners, and friends. They are the mainstays in caring for the stroke patient and play an important role in the recovery process. A stroke patient’s recovery may last for a few short months, or it may last for three to five years, depending on the degree of the brain injury.

Providing care for a stroke patient can be a rewarding and satisfying experience. However, it can be stressful and frustrating. It is important to remember as a caregiver to take care of yourself.

Here are some helpful tips to follow:

1. Caregiving is a choice. We fall into this role unexpectedly, but you need not feel like a victim. Take charge of your life. Do not let your loved one’s illness or disability always take center stage.

2. Recognize how extraordinary you are. Your own good health is the best gift you can give your loved one. You deserve quality time. It is your right. Determine your priorities, ask family members and friends to assist with respite care, so you can get enough rest, exercise and enjoy outside activities. Call on nurses, psychologists, social workers, counselors and clergy for help to reduce feelings of isolation or suggestions of other people who might help.

3. Caregiving is more than a one-person job.

• Lookforhelp,askforhelp,andattimes,demandit.Don’tbeashamedtoeveraskforhelp.Ifpeopleofferhelp,accept it and suggest things that they can do.

• Beawareofwhatyouareabletodoandwhatyouarenotabletodo.Setrealisticgoals.Giveyourselfcredit;celebrate the large and small gains. Allow yourself to make mistakes. Trust your own instincts.

4. Information is very helpful• Educateyourselfaboutyourlovedone’smedicalcondition.Learnaboutnewmedicaltreatmentsandideas.

• Encourageindependenceinyourlovedone.

5. Look for signs of depression:• Lossofenergy

• Changeinappetitecausingweightlossorgain

• Lossofenjoymentfromthingsthatwereoncepleasurable

• Difficultywithconcentrationormakingdifficultdecisions

• Inabilitytosleeportoomuchsleeping

• Feelingsofhopelessnessorworthlessness

Don’t delay in getting professional help. Referral to a psychologist for counseling or antidepressant medications may be helpful.

6. Seek support from other caregivers. There is strength in knowing that you are not alone. Talk with a friend or confidant every day, and stick to topics other than the illness or disability you face every day. Remember that laughter will ease the stress and frustration.

Families Caring for Stroke Patients Have Real Concerns and Fears.

We may feel an intense sadness because our loved one has suffered a brain injury, has lost mobility, and possibly may never achieve normal life functioning. This sadness comes from wanting the miracle of a normal life.

There may be a sense of isolation even with everyday activities of life, which everyone else takes for granted.

There may be a fear of inability to care for the patient adequately, not understanding the emotional needs and behavioral changes of the stroke patient, feeling impatient with your loved one, feeling guilt, frustration, and fear of abandonment by family and friends.

Regardless of which label you give them, recognize that all these feelings are normal. Admit they exist, accept them, and put your efforts into dealing with them. Realize that your situation is not unique. There are many caregivers that have the same feelings about their situations.

Words from the Heart

• Youwillfindtheinnerstrengththatmostofusneverknewwehad,togetthroughthedifficultcaregivingdays.

• Youhavethepowertomakeadifference.

• You have the understanding that caregiving tests our abilities, our faith, and our character.

• Youcandefinefamilycaregiversbytheiremotions,theirspirit,andthesadnessintheireyesandalsothedetermination in their hearts. Caregivers are very special people.

54

Stroke Resources

UPMC Stroke Institute412-647-8080www.upmc.com/services/strokeinstitute

American Stroke Association 7272 Greenville Ave Dallas, TX 75231 1-888- 4-STROKE 1-888-478-7653 www.strokeassociation.org

National Stroke Association9707 E. Easter Lane Englewood, CO 801121-800-STROKES (1-800-787-6537)www.stroke.org

Health Hope NetworkStroke Survivor Connection412-904-3036www.healthhopenetwork.org

National Institutes of Health (NIH)9000 Rockville PikeBethesda, Maryland 208921-800-352-9424www.stroke.nih.gov

National Family Caregivers Association 10605 Concord Street, Suite 501 Kensington, MD 20895-2504 1-800-896-3650 or 301-942-6430www.nfcacares.org

National Alliance for Caregiving 4720 Montgomery Lane Bethesda, MD 20814 [email protected]

NOTES ABOUT MY CARE

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