Doctor: Strokes come in different forms

Jun. 16—Every 40 seconds someone in the U.S. has a stroke, according to the Centers for Disease Control and Prevention.

Dr. Debbie Smith, a doctor of osteopathic medicine and an associate professor at Texas Tech University Health Sciences Center School of Medicine in Odessa, said strokes can be ischemic or hemorrhagic. Strokes can happen at any age.

The hemorrhagic type usually come from aneurysms.

"They're not that common. The most common ones are the ischemic ones, so the difference is the ischemic is a little clot that stops the blood flow and the hemorrhagic there's usually an aneurysm that bursts open and the blood just starts going to places where it shouldn't be and it damages the surrounding tissue," Smith said.

Generally speaking, strokes can be prevented with weight control, smoking cessation, eating a healthy diet and exercising among other things.

Some people have genetic conditions like sickle cell anemia. Smith said there are medicines to control the symptoms, but it also puts you at a higher risk for ischemic strokes.

Pregnancy also puts you at a higher risk for strokes, even though it is temporary, she said.

Signs and symptoms for both hemorrhagic and ischemic strokes are about the same. The most common things people cite are not being able to speak, or abnormal speech, flaccid muscle tone and not being able to move one side of their bodies.

"Some other symptoms that may be common are nausea, vomiting, headache (and) blurry vision. The most common are they can't talk very well or they stop feeling one side of the body," Smith said.

About 87 percent of strokes in the U.S. are ischemic and 13 percent are hemorrhagic.

Diabetes also is a risk factor for stroke, especially ischemic strokes, as are high blood pressure and heart problems like atrial fibrillation.

The acronym to look out for is FAST:

— Facial droop.

— Arm weakness.

— Speech difficulties.

— Time. Smith said the sooner you see it and get help the better outcomes you will have.

The goal is to get medical attention as soon as possible, but no longer than three hours.

"After three hours, the damage has been done and it's very difficult to regain some of the function you've lost," Smith said.

"If it is an ischemic stroke, there is a medication called TPA which stands for Tissue Plasminogen Activator," as long as there are no contraindications, she added.

"It basically just dissolves the clot and lets the blood flow go through and it cells the tissue around where the clot was. If it's a hemorrhagic stroke, obviously time is of the essence as well because the sooner it's identified as a hemorrhagic stroke then that's a surgical intervention. You have to go to immediate surgery ... The neurosurgeons really need to go in there and repair it so they can stop the blood flow from damaging the surrounding structures, which is usually in the brain," Smith said.

Smith said if a patient has had a stroke already, they are at risk of having another.

"That risk really doesn't go down until five years after your first stroke. You can have a stroke in 2020, you're really at risk of having another stroke until 2025 when maybe the risk starts going down. You can be 20 when you have your first stroke and have multiple ones after that," she added.

Exercise after surgery

Smith is a geriatrician, so most of her patients have had knee replacement, hip replacement from chronic osteoarthritis or they fall and suffer a fracture.

"The musculoskeletal surgeries that are done by orthopedists, they want to you do rehabilitation the day after surgery. The sooner you do rehabilitation — physical therapy — the better. Physical therapy is a form of exercise, so I always tell my patients you're going to have surgery, they're going to start you on physical therapy, maybe occupational therapy, which is a little bit different. Physical therapy the day after surgery make sure you learn the exercises, how long to do them, the frequency of it, the timing of it, so when you go home you can continue these regimens on your own," Smith said.

Exercise regimens depends on the patient.

"Not every patient is the same, so usually what I try to do is ... take into consideration the chronic conditions the patient has, see how interested they are in what types of exercises they can do, what sort of support they have in their lives to help them do the exercise because for some they can do certain exercises on their own and others may need some sort of help to do the exercises ... Make sure there's no reason why they can't do the exercises," Smith said.

The most common recommendation is to make sure they do 30 minutes of accumulated exercise at least three to five days a week. They can do 10 minutes on Monday, 10 minutes on Wednesday 10 minutes on Friday and they meet their requirements.

"But if they can do more, they should do more," she said.

When patients have a follow up appointment she reassesses to see if the frequency and/or intensity should be increased.

She recommends learning from the professionals and continuing with their own program with the help of a physician.