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Recovering From Stroke with Acupuncture |
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Q: I had a stroke 7 years ago. It was due to a blood clot in the brain. I am making a good recovery, but I am curious to know if acupuncture would benefit me. Tim A: Tim, the best time to get acupuncture for stroke is immediately afterwards - ideally while still in the hospital, if the docs will allow it. Seven years is a long time to wait for acupuncture. But it still may help you… You won't know unless you try it. Scalp Acupuncture Usually scalp style acupuncture is used for stroke. Needles are "threaded" along the scalp underneath the skin. There are at least three different scalp systems (Dr. Jiao Shun Fa's original style from the 1970s, Dr. Zhu's, and Dr. Yamamoto's styles). Call... |
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Stroke Rehabilitation: A Novel Treatment Pays Off |
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In a landmark study, researchers at the University of Alabama at Birmingham used a randomized controlled trial -- the gold standard method for evaluating the effectiveness of a treatment -- to show that immobilizing the good arm of stroke patients and intensively exercising the weakened arm actually improved recovery, even when performed long after the stroke occurred. At one level, randomized controlled trials in the field of rehabilitation medicine have been so rare that the publication of each and every one should be applauded. At another level, the outcome of this study is so satisfying in terms of what we think we know about brain physiology (function) that even if the results turn... |
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You Can Prevent Stroke |
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If you’ve ever witnessed someone suffer a stroke, you understand the humbling nature of this disease. It can reduce the mightiest human being to an immobile, helpless creature. Impairment of crucial functions like speech, walking, and control of bowel and bladder can wrench control from the body in a moment. Even perpetually youthful TV personality Dick Clark was struck down by stroke at age 75, despite the outward appearance of perfect health. Clark’s stroke resulted in a six-week hospital stay and, judging from fragmented reports, significant disability. Stroke can be like a devastating fire that strikes without warning, leaving only smoldering rubble. Stroke can so ravage basic bodily... |
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Stroke: The First 24 Hours after a Brain Attack
Author:
Gary Cordingley
Although stroke is the third-leading cause of death in the U.S. and the number one cause of disability, this condition doesn't get the respect and attention it deserves. When people have sudden chest pain, they know they might have a heart attack. They call 9-1-1 and seek help immediately. But people who suddenly become weak or numb on one side of their body, or experience sudden problems with speech or vision, often act unhurried in seeking help.
Why is this? One possibility is that heart attacks are usually painful. Strokes are not necessarily painful, and even when pain is present, it can be mild. Pain is a powerful motivator, and some people have the mistaken belief that all serious medical conditions hurt, and the seriousness of the problem is proportionate to the intensity of pain. Also, because the brain is a more complicated organ than the heart, symptoms of strokes can also be more complex, making them harder to identify.
In both strokes and heart attacks a portion of a body-organ has experienced a sudden disruption of its circulation. Increasingly, strokes are called "brain attacks" to emphasize the parallel with heart attacks. As a neurologist, I sometimes describe a stroke as "a heart attack of the brain." Reflecting my bias as a brain specialist, I also describe a heart attack as "a stroke of the heart," but--what can I say?--this terminology hasn't caught on.
If you suspect stroke in another person, the American Stroke Association recommends a quick, 3-step, screening test to identify cases:
- Ask the person to raise their arms and keep them up. In many stroke victims one arm doesn't go up or, once up, sags.
- Ask the person to smile. A lopsided or one-sided smile can indicate trouble.
- Ask the person to repeat a simple sentence. If it comes out garbled or unclear--or not at all--a stroke is likely.
While it's better to have some system of detection than no system, this screen misses strokes affecting the parts of the brain involved in sensation or vision which are just as serious as strokes causing paralysis or loss of speech.
So now that emergency help has been summoned, what happens next?
The emergency squad, upon arrival, sizes up the situation and measures vital signs, including rate and adequacy of breathing, pulse rate and blood pressure. They insert an IV line, check the blood-sugar level via a finger-stick method, apply pads to the chest to monitor heartbeats, and often administer oxygen as well. Then they transport the patient to the nearest emergency department.
Upon the patient's arrival, the medical team obtains more history and examines the patient more thoroughly. They draw blood to measure blood-sugar, blood-counts and blood-clotting function, as well as other blood-chemicals, including those showing the presence or absence of a concurrent heart attack. They perform an electrocardiogram (EKG) and continue the process of monitoring vital signs and heart-rhythms initiated by the squad.
A computed tomographic (CT) scan of the head is usually done soon after the patient's arrival. CT scans can detect the 1-in-6 kind of stroke involving bleeding within the brain, but often fail to detect the more usual kind of stroke, called an infarction, caused by a blocked blood-vessel. This is because, in the first 24 hours, damaged brain-tissue can look just like healthy tissue to the scanner's x-ray beam. The CT scan also screens for other brain diseases, like brain tumors or infections, that might mimic a stroke, but call for completely different treatments.
So far, the discussion has been all about testing. What about treatment? What can be done to improve outcome, reduce the severity of the impairment and prevent death?
A useful way to think of a brain infarction is as a central core of forever-lost brain cells that no treatment can revive, surrounded by a larger zone of sick brain-tissue that may or may not recover. Early treatments focus on this surrounding tissue that is "on the bubble," trying to influence it to survive rather than die.
One dramatic but controversial treatment is to use an intravenous clot-busting drug called t-PA (tissue plasminogen activator). The potential benefit of using this drug is to reduce the eventual impairment of the patient caused by the stroke. However, the drug also increases the likelihood of brain-hemorrhage, and physicians are not unanimous in believing that the benefits of this treatment outweigh its risks. However, one point of agreement is that if t-PA is going to be used, it has to be administered within 3 hours of the stroke's onset. Arriving at the emergency room after 2 hours and 59 minutes isn't good enough because a clinical evaluation, CT scan and blood tests all need to be completed before the drug is infused.
Less dramatic treatments are every bit as important--and quite possibly more important--than use of a clot-busting drug. It's the simple things that often matter most, but because they're so simple, sometimes they are unappreciated or even forgotten.
One such treatment is to manage the body-temperature. Fever increases the size of the stroke, so when an elevated temperature is present, it needs to be decreased right away. Another little detail is to manage the blood-sugar. Oddly, an elevated blood-sugar is toxic to the oxygen-deprived but still-surviving brain cells. So the emergency team should aggressively treat elevated blood-sugars by administering insulin.
Yet another issue of crucial importance is to urgently treat severe anemia (decreased red blood cells) by transfusing blood. Oxygen molecules are transported to the brain attached to molecules of hemoglobin within red blood cells. So if there are fewer red blood-cells, less oxygen is delivered to the sick brain-tissue. Providing more red blood-cells increases oxygen-delivery.
Of course, if the patient's blood-pressure is severely elevated, it needs to be decreased, but mildly-to-moderately elevated blood-pressures might actually improve blood-flow to the damaged tissue. If the patient's blood-pressure is excessively low, this is bad, too, and is treated by infusing salt-water or administering medication. Dangerous heart-rhythms also need to be treated, as does a concurrent heart attack, when present.
The principal value of being in a hospital with a fresh stroke is to achieve clinical stability in a monitored environment where rapid interventions can be made when called for. The hospital also provides a setting in which more extensive tests can also be performed, though not necessarily in the first 24 hours, that seek to understand why the stroke occurred and what can be done to prevent another brain attack.
(C) 2005 by Gary Cordingley
About the Author
Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles see his website at: http://www.cordingleyneurology.com
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According to the American Heart Association's Heart Disease and Stroke Statistics, cardiovascular disease (CVD) is still the United States number one killer of men and women of all ethnic groups. The statistical update for 2005 utilized the statistics compiled for 2002, or the most recent year that data are available. Cardiovascular diseases include high blood pressure, arrhythmia, valve disease, congestive heart failure and stroke. Coronary heart disease (CHD) or hardening of the arteries is the largest killer of Americans. There were 494.4 thousand coronary heart disease deaths in 2002 including 179.5 thousand deaths from heart attack. The deaths from CHD included 241.6 thousand females of which 25.9 thousand were Black females. The number of deaths from strokes for Black females was 9.6 thousand. CVD* Profile: * 1 in 4 females has some form of cardiovascular disease. * Since 1984, the number of CVD deaths for females has exceeded those for males. * In 2002 CVD caused the deaths of 493, 623 females compared with 433,825 males. Females represent 53.2 percent of deaths from CVD. * In the United States in 2002, all cardiovascular diseases combined claim the lives of 493,623 females while all forms of cancer combined to kill 268,503 females. Breast cancer claimed the lives of 41,514 females; lung cancer claimed 67,542. * The 2002 overall death rate from CVD was 320.5. Death rates were ¬--265.6 for white females --368.1 for black females. * *In 2002 cardiovascular disease was the first listed diagnosis of 3,164,000 females discharged from short-stay hospitals. Discharges include people both living and dead. The risk factors for CVD are not only common in the African America community, they are also preventable. These factors include high... |
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