“Another serious stroke is a possibility, so if you

have any sudden drooling, dizziness, or if you ever

laugh out loud at a Garfield cartoon, call 911

immediately.”

MAY IS STROKE AND TRANSIENT ISCHEMIC ATTACK (TIA) AWARENESS MONTH

DID YOU KNOW that 5,000 Americans suffer from a Transient Ischemic Attack? To find out more information on

this condition, read the article by PA Clark on page 4.

VASCULAR INSIGHTSVASCULAR INSIGHTSA QUARTERLY NEWSLETTER OF VASCULAR ASSOCIATES, LLC

IN THIS ISSUE

MAY 2011 www.ArteryandVeins.com ISSUE 0003

Stroke Prevention ...............pg.2

Lessons Learned .................pg.3

Transient Ischemic Attack .pg.4

TIA Continued ...................pg.5

Stroke Awareness ...............pg.6

1836 Florida Avenue, Panama City, FL 32405

Phone: 850-872-8510 • Fax: 850-872-7412

www.ArteryandVeins.com

Famous Faces who have suffered from a

stroke.

Late actress Elizabeth Taylor

Singer Bret Michaels

Actress Zsa Zsa Gabor

PreventionSTROKE

Up to 80 percent of all strokes can be prevented —start reducing the risk now.

Although stroke can happen to anyone, certain risk factors can increase chances of a stroke. However, studies show that up to 80 percent of strokes can be prevented by working with a health care professional to reduce personal risk.. It is important to manage personal risk and know how to recognize and respond to stroke signs and symptoms.

Stroke Prevention Guidelines

The following Stroke Prevention Guidelines will help you learn how you may be able to lower your risk for a first stroke.

• Know Blood Pressure (hypertension)High blood pressure is a major stroke risk factor if left untreated. Have blood pressure checked yearly by a doctor or at health fairs, a local pharmacy or supermarket or with an automatic blood pressure machine.

• Identify atrial fibrillation (Afib)Afib is an abnormal heartbeat that can increase stroke risk by 500%. Afib can cause blood to pool in the heart and may form a clot and cause a stroke. A doctor must diagnose and treat Afib.

• Stop SmokingSmoking doubles the risk of stroke. It damages blood vessel walls, speeds up artery clogging, raises blood pressure and makes the heart work harder.

• Control Alcohol UseAlcohol use has been linked to stroke in many studies. Most doctors recommend not drinking or drinking only in moderation - no more than two drinks each day.

• Know Cholesterol LevelsCholesterol is a fatty substance in blood that is made by the body. It also comes in food. High cholesterol levels can clog arteries and cause a stroke. See a doctor if your total cholesterol level is more than 200.

• Control DiabetesMany people with diabetes have health problems that are also stroke risk factors. A doctor and dietician can help manage diabetes.

• Manage Exercise / DietExcess weight strains the circulatory system. Exercise five times a week. Maintain a diet low in calories, salt, saturated and trans fats and cholesterol. Eat five servings of fruits and vegetables daily.

• Treat Circulation ProblemsFatty deposits can block arteries carrying blood to the brain and lead to a stroke. Other problems such as sickle cell disease or severe anemia should be treated.

• Transient Ischemic Attack (TIA)A TIA is a temporary episode of stroke-like symptoms that can last a few minutes to 24 hours but usually causes no permanent damage or disability. TIA and stroke symptoms are the same. Recognizing and treating a TIA can reduce stroke risk. Up to 40 percent of people who experience a TIA may have a stroke.

Article from the National Stroke Association http://www stroke org/site/PageServer?pagename=prevent

2 VASCULAR INSIGHTS | www.ArteryandVeins.com

Article by Bud Shuler, MD., FACS

“He couldn’t move his right arm, couldn’t speak, and lost control of his bladder function.”

My father-in-law is a great man, and not just because he is the father of my awesomely talented wife. He is however a stubborn “old fart.” Raised in central Colombia, he is the epitome of an ungracefully aging Hispanic senior. He doesn’t, like many of us, want to give in to Father Time and the limitations each additional day bring. He also is “rather” set in his ways. Until six years ago, he was

active, enjoying the newly found freedom of retirement, and doting on his three grandchildren. He had planned well for retirement, sacrificing as Dave Ramsey says, “living like no one else, so that he could live like no one else” during retirement. He did have a darker side. He refused to stop smoking, despite the pleas of his children to do so. His rather macabre opinion that he planned to “just die of a massive heart attack and be gone,” epitomizes the misunderstanding of many smokers. That is until March 23rd, 2005, when he arose from bed, only to collapse in a heap on the floor. He had just suffered a stroke.

He couldn’t move his right side, couldn’t speak, and lost control of his bladder function. Oh, he knew what he wanted to say, but he could only grunt. His leg and shoulder he fell on hurt badly, but he couldn’t tell anyone. If it wasn’t for the dull thud as he crumpled onto the floor, my mother-in-law would have found him the next morning. To a stoic, self sufficient, confident gentleman, he had entered hell on earth, completely coherent, feeling pain, and unable to move or communicate to those in this world. But he could pray, and he got to know his Maker well over the next few hours. Fortunately the blood flow was restored to his brain and his symptoms resolved, but not before he realized the error of a lifetime. There was nothing he could go back in his life and change, but there was something he could do from that day forward. Stop smoking. He didn’t do it for his family per say. He didn’t think about his wife, children, and grandchildren visiting him

in a nursing home, or the extensive care that would be needed to sustain his life. He didn’t think about the sacrifice of time and energy, or the mourning his family would endure. No, at that moment, lying in a hospital bed staring at the ceiling, he was coming to terms with his future. The immediate driving force to stop smoking was selfishly motivated. He didn’t want to “live” the rest of his life on earth, in the “hell” he had just experienced.

So imagine yourself, smoking your cigarette one moment, the next, helpless but aware of all that it around you. My father-in-law described the event as the most vulnerable he had ever felt in his life… pain, fear, humiliation, uncontrollable helplessness with nowhere to flee. There was no escape, but by God’s mercy.

You have a choice. You alone can change your future, and your family’s. Stop smoking today and avoid a stroke tomorrow.

Lessons Learned

www.ArteryandVeins.com | VASCULAR INSIGHTS 3

Article by: Jennifer Clark, PA-C, MPAS

Transient Ischemic Attack

T I A• Muscle weakness of the face, arm,

or leg (usually only on one side of the body)

• Numbness or tingling on one side of the body

• Trouble speaking or understanding others who are speaking

• Problems with eyesight (double vision, loss of all or part of vision)

• Changes in sensation, involving touch, pain, temperature, pressure, hearing, and taste

• Change in alertness (sleepiness, less responsive, unconscious, or coma)

• Personality, mood, or emotional changes

• Confusion or loss of memory

• Difficulty swallowing

• Difficulty writing or reading

• Lack of coordination and balance, clumsiness, or trouble walking

• Abnormal sensation of movement (vertigo) or dizziness

• Lack of control over the bladder or bowels

• Inability to recognize or identify sensory stimuli (agnosia)

Transient Ischemic Attack

Symptoms

4 VASCULAR INSIGHTS | www.ArteryandVeins.com

50,000 Americans suffer from TIAs (Transient Ischemic Attack) every year; and of those 50,000 people, approximately one third will unfortunately progress to have a stroke, also known as a Cerebral Vascular Accident (CVA). Most of us are aware of the detrimental effects of a stroke, but we are not as familiar with the signs and symptoms of a TIA or what we can do to prevent one from occurring. By understanding what exactly a TIA is, as well as the risk factors for developing one, we can enable ourselves to take proactive measures in preventing it from happening all together!

A transient ischemic attack is defined as a sudden focal loss of neurological function that completely resolves within 24 hours. This is caused by a brief period of inadequate blood flow from either the carotid or vertebral arteries to the brain. The symptoms of a TIA happen suddenly and can include vision loss often described

as a curtain closing over the eye, difficulty with speech, weakness or inability to move one side of the body, or facial drooping. . A stroke (CVA) differs from a TIA in that it is a neurological deficit that is often permanent and occurs as a result of tissue death due to lack of blood

flow to a region of the brain due to either a hemorrhage or a blockage of an artery.

Certain risk factors predispose

us to developing TIAs. Uncontrolled hypertension or high blood pressure is certainly the most important. This can be a silent risk factor since hypertension is often asymptomatic. It is important to check your blood pressure regularly, whether with your family physician or when you are at the store or the gym and a blood pressure monitor is available. Any blood pressure reading greater than 140/90 is considered high blood pressure and needs to be evaluated and treated. If you have a diagnosis of hypertension,

“Most of us are aware of the detrimental effects of a stroke, but we are not familiar with the signs

and symptoms of a TIA”

make sure you are taking your medications as directed and are following up frequently with your doctor to ensure it is controlled appropriately. High blood pressure can also be affected by our diet; therefore it may be recommended that you start a low sodium diet.

Elevated cholesterol, also known as hyperlipidemia, can lead to atherosclerosis, or development of plaque in the arteries. We should be screened for hyperlipidemia every five years, and if diagnosed should be on medications to help lower cholesterol, which in turn will help stop the progression of atherosclerosis. If diagnosed with hyperlipidemia, it is imperative to follow up frequently to monitor effects of treatment with medication and lifestyle modification.

Carotid artery disease is also linked to TIAs. This is often discovered by physical exam, if your practitioner hears any abnormal sound in the neck then an ultrasound can be obtained for further evaluation. A screening ultrasound may also be ordered based on age and risk factors. Taking a daily baby aspirin and maintaining control of cholesterol helps prevent progression of carotid artery disease.

Cigarette smoking not only increases the risk for TIAs, but it increases the risk for having a stroke by 2.5 times! By stopping smoking not only do you decrease chances for stroke and TIAs, but you help reduce risk of disease throughout the entire body. Smoking is linked to numerous types of cancer and disease, therefore quitting is one of the most important things you can do for your health.

Atrial fibrillation is another risk factor for TIAs. This is a diagnosis of an irregular heartbeat. If you check your pulse and notice that it is irregular, make sure you make an appointment for further evaluation.

Diabetes Mellitus that is uncontrolled is also a condition that can predispose you to TIAs as well as heart disease. Maintaining an ideal body weight and following the

American Diabetic Association recommendations for diet as well as frequent visits to your family medicine clinic or endocrinologist and ophthalmologist is essential for management of this disease. Obesity and sedentary lifestyle are both risk factors that we can reverse. Eating a sensible diet and cardiovascular exercise are very important lifestyle changes we all need to incorporate! The

American Heart Association recommends 150 minutes of cardiovascular exercise a week, or five 30 minute sessions. If you are completely inactive this may seem like a lot, but if you gradually change your lifestyle to incorporate physical activity, this is a highly attainable goal. Limit the use of alcohol consumption to more than two drinks a day for men and one drink a day for women.

Prevention consists of understanding risk factors and making necessary lifestyle changes helps decrease the chances of developing a transient ischemic attack in the future. While we can’t change our genetics, we do have the ability to change how we live our lives and our health, and making simple changes to the way we do things can help improve our quality of life for many years to come.

An ultrasound of a patient who has suffered a “mini stroke” or TIA.

www.ArteryandVeins.com | VASCULAR INSIGHTS 5

Every year, approximately 700,000 Americans suffer a stroke. Strokes happen when there is an interruption

in blood flow to the brain, usually due to a blood clot. The moment blood fails to reach brain tissue, brain cells rapidly die. The death of these cells causes symptoms ranging from temporary and subtle, to permanent and severe. Mild strokes can cause short periods of confusion and weakness, often affecting only one side of the body. Severe strokes can cause symptoms such as permanent paralysis and loss of the ability to speak. The majority of stroke sufferers will experience some type of permanent disability.

There are many risk factors that predispose a person to stroke susceptibility. Among these include:

• Diabetes• Arterial Diseases (such as atherosclerosis,

PAD, and coronary artery disease)• High cholesterol• Smoking• Heart attack or heart defects• Blood clotting disorders

The symptoms of stroke are broad and can range in severity, but usually come on suddenly. These symptoms, even when mild, should never be ignored and require immediate medical attention. Things to look for include:

• One-sided weakness, tingling, or numbness• Vision disturbances, such as loss of partial vision in one

eye• Inability to speak clearly or understand speech• Confusion, disorientation, memory loss• Trouble keeping balance• Severe headache

When symptoms are mild, people often ignore them and attribute them to aging or other known medical conditions. This is why stroke has been named “the silent killer.” These symptoms are not to be taken lightly.

Although this devastating condition can affect anyone, any age, at any time, stroke is largely preventable. A healthy lifestyle can greatly reduce ones chances of stroke, along with regular medical care. Ask your health care provider what steps you can take to make sure you do not develop the above mentioned risk factors. Or, if you are already at-risk, find out if your conditions are controlled and properly

medicated. You can help protect those you care about, as well, by not allowing symptoms to go ignored and insisting on immediate action. The faster a stroke has been diagnosed, the better the chances of limiting the damage and recovering from it.

Here at Vascular Associates, if you think you or someone you know may have had a stroke or is at-risk for one, ask about carotid ultrasound and how it may be able to help. This noninvasive test is

routinely used to determine if the path of blood to the brain is free from obstructive plaque build-up. The test usually takes about thirty minutes and requires no preparation on the part of the patient. Ask your provider if he or she recommends this step for you and start preventing stroke today.

Stroke AwarenessArticle by Krystal Alcott, DMS