Pre­vi­ous TIA causes ap­pre­hen­sion, de­spite health progress

Cape Breton Post - - In Memoriam/ Advice/ Games - Keith Roach Dr. Roach re­grets that he is un­able to answer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: I had a TIA in July 2016. I had lots of risk fac­tors: mor­bidly obese, choles­terol of 255, el­e­vated blood pres­sure, Type 2 di­a­betes (well-con­trolled, but still) and heavy drink­ing. Since then, I have lost weight (from 250 pounds to 205, so far), re­duced my choles­terol to 172 (with statins and diet), started tak­ing Plavix and stopped drink­ing. Los­ing weight helped me con­trol my high blood pres­sure. I cur­rently take losar­tan, in­stead of the four meds I needed when I was heav­ier. I am, alas, al­ler­gic to as­pirin/ibupro­fen.

I have made a lot of im­prove­ment; my doc­tors are happy, but I am still very ap­pre­hen­sive. Does that ever go away? — S.S.

ANSWER: A TIA (tran­sient is­chemic at­tack) is a tem­po­rary loss of func­tion in the brain: This may in­clude lo­cal­ized weak­ness or a loss of speech. A TIA has the same risk fac­tors as a stroke, and as such, a TIA is rightly called a warn­ing sign of a stroke. The risk of de­vel­op­ing a stroke is much higher among peo­ple with a TIA, com­pared with those with­out one. It’s a call to ac­tion: time to make a change.

You re­ally have done so, and I am very im­pressed by your re­sults. Be­tween im­proved be­hav­iors and med­i­ca­tion, you have dra­mat­i­cally re­duced your risk for another TIA or stroke, and I un­der­stand why you and your doc­tors are happy. I con­grat­u­late you.

Any­one can have a stroke. You still have a risk for stroke, de­spite your out­stand­ing ef­forts. How­ever, that risk has dra­mat­i­cally de­creased, and will de­crease fur­ther as you main­tain your good be­hav­iors. Plavix re­duces stroke risk about as much as as­pirin does (maybe a bit bet­ter, at least in women), and so does a statin.

If your ques­tion is about the ap­pre­hen­sion, I can’t answer that. For most peo­ple, it does wane over time. How­ever, a TIA is a fright­en­ing ex­pe­ri­ence, and some peo­ple con­tinue to have ap­pre­hen­sion about it. In some ways, it is like post-trau­matic stress dis­or­der, and can be treated the same way if the ap­pre­hen­sion is af­fect­ing your daily life. See a men­tal health pro­fes­sional if that’s the case.

The book­let on stroke ex­plains this con­di­tion that is de­servedly feared by all. Read­ers can ob­tain a copy by writ­ing:

Dr. Roach, Book No. 902, 628 Vir­ginia Dr., Or­lando, FL 32803 En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

DEAR DR. ROACH: In a re­cent col­umn on a glomeru­lar fil­tra­tion rate ques­tion, you com­mented that half of adults over 70 will have a GFR be­low 56. I am 73 and have no­ticed the same trend, al­beit a small de­crease ver­sus five or six years ago. My doc­tor is watch­ing my med­i­ca­tions, as you sug­gested. I am also a veg­e­tar­ian and eat a lot of veg­gies/plant food, as you rec­om­mended.

My blood-test re­sults show the nor­mal GFR lev­els for African-Amer­i­cans and non-African-Amer­i­cans. Is there a cor­re­spond­ing num­ber for Asian In­di­ans, or do they fall into the non-African-Amer­i­can cat­e­gory? The rea­son I ask is that I read some­where that the red blood cell count is lower for Asian In­di­ans ver­sus Cau­casians, and thus, they of­ten get wrongly di­ag­nosed as ane­mic. — H.Z.

ANSWER: While nor­mal GFR lev­els have been cre­ated for peo­ple liv­ing in China and Ja­pan, I could not find spe­cific re­sults for South Asians, in­clud­ing peo­ple from In­dia, who should there­fore use the non-African-Amer­i­can num­bers.

The lev­els of red blood cells and he­mo­glo­bin are very sim­i­lar in Asian In­dian men com­pared with non-His­panic white men in the U.S.; how­ever, Asian In­dian women have he­mo­glo­bin lev­els about 1 point (g/dL) lower than Amer­i­can women. This does have im­pli­ca­tions when con­sid­er­ing whether a level is ab­nor­mal.

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