Previous TIA causes apprehension, despite health progress

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 (wellcontrolled, 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.

DEAR READER >> 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 posttraumatic 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.

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.

DEAR READER >> 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.