Preventing a “Stroke” of Bad Luck

Preventing a “Stroke” of Bad Luck

​By Richard P. Holm, MD
 
My mother was nearly 90-years-old when I noticed a change in her speech during our daily phone calls. When we got her to the hospital, the X-ray (CT) study of her brain implied a blood clot had formed within one of the brain arteries during the night. She was having a “stroke” of bad luck.
 
They say most elderly people eventually die of a blood clot, either to the brain, the heart, the kidneys, the legs or somewhere. This happens because, as we age, we develop an over-clotting disorder, or our blood vessels close off due to scaring.
 
By definition, a stroke is a vascular problem caused when the blood flow to a part of the brain is blocked. In 80 percent of cases, it’s a blood clot that originates within brain arteries or starts either in a carotid artery or in a chamber within the heart and is carried by blood flow to the brain. If started within three hours of the event, clot-busters can reverse much of the brain injury from this kind of stroke. However, in 20 percent of cases, brain tissue destruction is due to bleeding making clot-busters not helpful and even harmful.
 
Recently, the World Health Organization stated that three-quarters of all vascular problems are connected to poor lifestyle choices such as physical inactivity, use of tobacco and unhealthy dietary habits. The closest we get to a “fountain of youth” comes from living a healthy lifestyle and — aside from controlling high blood pressure — usually not from medicines. There are no short cuts and cholesterol meds are only minimally helpful.
 
In recent years, we’ve learned how blood clots and strokes can result from two medical conditions that require special treatment. An irregular heart rhythm condition called atrial fibrillation (A fib) may result in blood clots forming within the heart bringing a higher risk for stoke. A fib requires long-term anticoagulation by warfarin or a similar drug.
 
The second condition is moderate to severe sleep apnea which often causes both A fib and an increased risk for clotting. Sleep apnea requires nightly use of a continuous positive airway pressure (CPAP) mask and machine. Many people struggle using CPAP but, unfortunately, no good alternative exists. Generally, throat surgery or jaw thrust devices do not effectively treat moderate to severe sleep apnea. Although wearing CPAP can pose a challenge, people with sleep apnea should endeavor to make the mask device to work.
 
Understanding these issues just might prevent a “stroke” of bad luck.
 
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