health

Ministrokes Require Immediate Medical Care

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | March 4th, 2020

Dear Doctor: Our mom had half of her face go numb for a few minutes, and she also had trouble speaking. She went to the doctor and was told she had a ministroke. What is that? Is it dangerous?

Dear Reader: Your mother had what is known as a transient ischemic attack, or TIA. This occurs due to a temporary decrease or blockage of blood flow within the brain. The words “mini” and “temporary” sound reassuring, and, in fact, people tend to shrug off a TIA because the symptoms often improve quickly. However, a TIA is a strong warning sign of elevated stroke risk, which makes it a medical emergency. Up to 15% of patients go on to have a more severe stroke in the three months following a TIA, with half of those occurring within the first 48 hours after the initial event. Statistics show that long-term stroke risk is elevated as well.

The symptoms of a TIA are similar to those of a major stroke. They include weakness, numbness or sudden paralysis of the face, arm or leg, which usually involves just one side of the body; slurred or confused speech; difficulty understanding spoken and written language; changes to vision; dizziness; difficulty walking or standing; and the swift onset of a severe headache. Unlike in a stroke, the symptoms associated with a TIA are brief. They can last up to 24 hours, but in many cases they pass within the hour. In some people, as with your mother, the symptoms last for mere minutes.

It’s this short-lived nature of a TIA that causes up to one-third of patients to put off seeking medical care for more than 24 hours. Risk factors include high blood pressure, heart disease, diabetes, being 55 or older, having a family history of stroke, having had a previous stroke or TIA, the use of tobacco products and being overweight. TIAs occur more often in men than in women, but due to their longer life spans, the mortality rate is higher in women. Genetics, race and a poor blood lipid profile also play a role.

If you have the symptoms of a TIA, it’s important to seek medical care immediately. Diagnosis includes a complete medical history, physical exam and one or more of a variety of scans and imaging tests to evaluate the relevant blood vessels. Treatment may include the use of medications to lessen the risk of clotting, to dissolve existing clots, to lower blood cholesterol and to address any blood pressure issues. In some cases, angioplasty to open a clogged artery, or the use of a stent to prop open an artery, may be recommended. When severe blockage is found, surgery to clear the artery may be needed. The treatment approach is determined by the cause, location and severity of the TIA, as well as each patient’s medical status and history.

The reassuring news is that, with prompt and proper medical care, up to 80% of the strokes that occur after a TIA are preventable. That makes early diagnosis and immediate treatment all the more important.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Physical Health
health

Taking the First Steps to a Lifetime of Running

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | March 2nd, 2020

Dear Doctor: I’ve read that most New Year’s resolutions don’t even make it to March, and considering what happened to my plan to start running, I totally believe it. What can I do to be successful?

Dear Reader: You’re one of the estimated one-third of Americans who decided to change something about their lives in the new year. And according to a recent survey by YouGov, your goal to start exercising is among the most popular resolutions. (Saving money, losing weight, healthy eating and lessening stress round out the top five.) But as the hundreds of self-help books published each year remind us, change is hard. Even the most disciplined person does better with a game plan.

First, it’s important to be as specific as possible about your goal, which means deciding what success will look like. Is it running a set number of days per week? Running a certain distance? Competing in a specific race? Each of these are concrete objectives in which success is recognizable. Once you’re clear about what you want, you’re ready for the next step, which is a plan for how to achieve it. The trick here is to break down the main goal into reasonable and realistic increments.

For non-runners, a great way to start is with a daily 20-minute walk. Walking is easy, you can do it anywhere and it will jump-start the habit of regular exercise. Once this becomes part of your daily life, you can begin to add a few minutes of running into your walk. Alternate running and walking and gradually -- that’s an important word when it comes to achieving lasting change -- work toward easing that 20-minute walk into a 20-minute run.

If that’s enough, congratulations, you made it! If you want to push further, continue with this approach. Identify your new goal, then break it down into incremental steps you know you can stick with. Track your progress, and when you hit a milestone, celebrate with a reward. Whether the process of attaining the final goal takes weeks or months or even the entire year doesn’t matter. What’s important is that you’re taking the time to weave a new habit into your daily life.

All of which brings us to the flip side of progress, which is the inevitable slips and stalls that happen along the way. Chances are, you’ll fall off the resolution wagon at some point; it’s important to understand that you haven’t failed. If it’s a small blip, forgive yourself and return to your regular routine. If you’ve taken a sustained break and lost ground, forgive yourself and start from scratch.

Rebooting the pursuit of a goal can be a challenge, which is why being part of a like-minded community is so helpful. Whether it’s a friend or family member, a trainer at a gym, an employer’s wellness program or a local running club, having someone to share the journey with can make a big difference. If a running club sounds good to you, the Road Runners Club of America keeps an extensive list at their website, rrca.org.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Fitness
health

Edema Cannot Be Cured, But It Cab Be Managed

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | February 28th, 2020

Dear Doctor: I am a 76-year-old man who has dealt with edema in various intensities for several years. Now I have been diagnosed with early-stage congestive heart failure. I know I’m not the only senior affected by edema, and I hope you might consider devoting a column to it.

Dear Reader: You’re correct that many older adults experience edema, which is the medical term for swelling. It occurs when fluid becomes trapped in the affected tissues.

Edema can occur in any part of the body, and it shows up most commonly in the ankles, feet, legs and hands. This is known as peripheral edema. Symptoms include visible swelling or puffiness and skin that looks tight and shiny. Severe edema causes a condition known as pitting, which is when pressure applied to the swollen area causes an indentation that is slow to fade. Edema can also cause abdominal swelling, shortness of breath, elevated heart rate and chest pain.

A common cause of edema in older adults is venous insufficiency. This is when age, illness, injury or the side effects of medications cause the veins and the valves within them to be less efficient at returning blood to the heart. It’s an uphill journey from the extremities to the heart, and venous insufficiency allows the blood to pool.

Edema is also a symptom of congestive heart failure, a progressive condition in which the heart becomes unable to pump enough blood to meet the body’s needs. The back-up of blood from these conditions causes pressure, which forces fluid from tiny capillaries in the area and into the surrounding tissues.

These types of edema cannot be cured, so the goal is management. Exercise, particularly involving the affected limbs, can help veins return blood to the heart. So does spending time with the affected limbs elevated above the heart. Once swelling has lessened, compression garments, such as sleeves and stockings, can help prevent new fluid accumulation. Limiting dietary salt is important because excess sodium causes fluid retention.

Medications known as diuretics, or water pills, help the body release water and sodium via the urine. They’re helpful in managing congestive heart failure. Diuretics work by changing how the kidneys handle sodium, which increases the amount of water and sodium released in the urine. Studies show that this may also result in a drop in venous pressure, which can help capillaries to reabsorb some of the water they released. Water loss from diuretics can affect the electrolyte balance in the body, particularly potassium, which is crucial to heart function. Supplemental potassium is often prescribed. People who take a potassium-sparing diuretic must be monitored for excess amounts of the mineral.

It’s important to protect areas of edema from pressure and injury, as healing takes longer and infection is a risk. Moreover, if you experience redness, heat or pain; develop an open sore; develop shortness of breath; or start swelling on just one side of the body, seek immediate medical care.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

AgingPhysical Health

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