A min­istroke is a big warn­ing

Cape Breton Post - - LIFESTYLES -

DEAR DR. DONO­HUE: I’m a 66-year-old woman who had a scare last week. While vis­it­ing my daugh­ter, I got an at­tack of dizzi­ness, and I couldn’t talk. My daugh­ter rushed me to the hospi­tal, and the doc­tors told me I had a min­istroke. Will you please ex­plain its sig­nif­i­cance? — L.H.

AN­SWER: A min­istroke, also called a TIA (tran­sient is­chemic at­tack), is a warn­ing alarm that there’s trou­ble with the blood sup­ply to the brain and that a full-blown stroke could hap­pen. Such is the case for 15 per cent of those with a min­istroke within three months of its oc­cur­rence. Symp­toms are the symp­toms of stroke: numb­ness of face, arm or leg; in­abil­ity to move the arm or leg; men­tal con­fu­sion; slurred speech; the in­abil­ity to ex­press one­self; dizzi­ness; or loss of bal­ance. The symp­toms last only a short time — two to 15 min­utes, and never longer than one day. Full re­cov­ery oc­curs. How­ever, treat­ment must be­gin im­me­di­ately to pre­vent a stroke.

The carotid ar­ter­ies, the large ar­ter­ies on the right and left sides of the neck, have to be ex­am­ined to see if they have a buildup of plaque ob­struct­ing blood flow to the brain.

You must go on a pro­gram that low­ers choles­terol, and that’s most of­ten achieved by tak­ing statin medicines (Lip­i­tor and Zo­cor are ex­am­ples). Blood pres­sure has to be con­trolled. Medicines that pre­vent platelets (clot-form­ing cells) from cling­ing to plaque in ar­ter­ies are usu­ally part of the reg­i­men.

If a sig­nif­i­cant block­age is found in one of your carotid ar­ter­ies, then a de­ci­sion has to be made about clean­ing out that artery. A vas­cu­lar sur­geon can open the artery and clean it out, or it might be cleaned out like heart ar­ter­ies are — with a spe­cial kind of catheter, a thin, pli­able tube that is inched into the area of block­age from a sur­face artery.

The book­let on stroke presents the de­tails of this de­bil­i­tat­ing con­di­tion and how it’s treated. Read­ers can ob­tain a copy by writ­ing: Dr. Dono­hue — No. 902, Box 536475, Or­lando, FL 32853-6475. En­close a cheque or money or­der (no cash) for $6 Cdn with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

DEAR DR. DONO­HUE:

I have pe­riph­eral neu­ropa­thy, and it’s not from di­a­betes. Cur­rently I am us­ing cap­saicin gel. It helps some, but of­ten I am wak­ened with a lot of pain in my feet. My doc­tor pre­scribed Lyrica and Neu­ron­tin. I do not do well on painkillers. The next day I am groggy and have an un­easy feel­ing, so I do not take th­ese drugs. I won­der if there are other prepa­ra­tions that might help my neu­ropa­thy. — H.D.

AN­SWER: We have two kinds of nerves: mo­tor nerves that bring in­struc­tions to mus­cles on how to move, and sen­sory nerves that bring sen­sa­tions to the brain, telling it how we feel. Neu­ropa­thy in­di­cates nerve dam­age. You have a sen­sory neu­ropa­thy, which causes you pain.

Both Lyrica and Neu­ron­tin come in many dif­fer­ent strengths. Per­haps a lower dose would con­trol your pain without mak­ing you groggy.

An­tide­pres­sants con­trol pain. Amitripty­line, Cym­balta (du­lox­e­tine) and Ef­fexor (ven­lafax­ine) have dead­ened pain for many peo­ple with pe­riph­eral neu­ropa­thy.

Li­do­caine, a numb­ing agent, is avail­able in patches and gels, and is ap­plied to the skin. It doesn’t make peo­ple groggy.

A new for­mu­la­tion of cap­saicin is the Qutenza patch. It is ap­proved for the treat­ment of pain that of­ten fol­lows an out­break of shin­gles, but it can be used for other neu­ropathies too. The patch has to be ap­plied by a doc­tor.

DEAR DR. DONO­HUE: How can you tell if you have a blocked carotid artery? The left side of my face feels tight. — T.C.

AN­SWER: Fa­cial tight­ness isn’t a sign of a blocked carotid artery. A per­son can­not tell if the carotid artery is blocked. A scan or an ul­tra­sound pro­vides such ev­i­dence.

I wish I could come up with a di­ag­no­sis for your fa­cial tight­ness. I have to ad­mit that I don’t have an idea.

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