Archive for February, 2012

What To Do About A Stroke

A stroke occurs when the blood supply to the brain is suddenly altered. This can occur when a clot in a blood vessel blocks blood flow to brain tissue, or when a burst blood vessel causes a part of the brain to drown in its own blood. These conditions cause brain cells to die or at least become damaged, which can cause temporary or permanent changes in body and mind function. Every year, 800,000 Americans have a stroke.

A transient ischemic attack, also called a mini stroke, is a temporary stroke-like condition that usually resolves in a number of hours. TIAs are often a warning of a future, more serious stroke.

These are some risk factors for a stroke:

– Age: Most strokes occur in older adults, but as many as a quarter of them strike people younger than 65.

– Family history: This is especially true if a sibling or a parent has had a stroke.

– Gender: Men have strokes more than women. Pregnant women are at risk, however.

– High blood pressure, increased cholesterol, and smoking

– Diabetes

– Heart disease, especially atrial fibrillation

Signs and symptoms of a stroke include numbness or weakness of one side of the face, arm or leg; sudden difficulty speaking, remembering, or thinking; trouble with vision or swallowing; sudden difficulty walking or balancing; and sudden severe headache.

There is a clot-busting medication that can stop most strokes in their tracks if given promptly enough. Guidelines call for this drug to be given within 4½ hours of the very first sign of a stroke. Dominican Hospital here in Santa Cruz has this treatment available.

If you, a loved one or friend is having a stroke, do not go to your doctor’s office or to an urgent-care clinic. Call 911 and be taken by ambulance to the hospital. Research shows that people who arrive at the hospital by ambulance get there faster, get seen faster and are more likely to get necessary treatment in time to prevent permanent brain damage. Do not hesitate or delay. Don’t worry about a “false alarm.” Better safe than sorry.

If you think someone is having a stroke, the National Stroke Association recommends the F.A.S.T. test:

– “F” stands for face. Ask the affected person to smile. Does one side of the face droop?

– “A” stands for arm. Ask the person to raise both arms. Does one drift downward?

– “S” stands for speech. Is speech slurred?

– “T” stands for time. Call 911. Get the person to hospital ASAP.

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In a recent column, I said that antibiotics are usually not necessary to treat most upper-respiratory infections. I have been asked to discuss antibiotics in more detail.

An antibiotic is a type of medication that kills bacteria, or at least inhibits growth, thus curing an infectious disease.

The first antibiotic to be discovered was penicillin, which was produced from a common mold and was discovered accidentally by Alexander Fleming in 1928. It wasn’t used to treat disease until 1941, but it became extremely helpful when it was found to cure the myriad infections of the soldiers in World War II.

Today, there are more than 100 different antibiotics on the market, treating bacterial infections ranging from the minor, such as strep throat, to the life-threatening, such as meningitis.

As of yet, we have very few antibiotics that can treat viral infections. There are none to treat the common cold and only a few that can help treat influenza. However, bacterial infections — the cause of such common diseases as strep throat, bladder infections, skin infections and many ear infections, for example — can be cured by the use of antibiotics.

If an antibiotic is used, your physician will choose the one most likely to be effective against the type of germ causing your infection. Other factors in the choice of an antibiotic include medication cost, dosing schedule and potential side effects.

Antibiotics have been over-prescribed for a number of reasons, including patients’ expectations or insistence on use of antibiotics; physicians prescribing them because they don’t have the time or willingness to explain why they are not necessary; and medical legal reasons.

The consequences of over-prescribing antibiotics are twofold.

First is the possibility of a bad reaction to the antibiotic. This might span from minor conditions — a bothersome rash, diarrhea or a yeast infection — to a life-threatening allergic reaction called anaphylactic shock.

The bigger problem, as I see it, is the emergence of resistant germs. This happens when the overuse of antibiotics allows the development of germs that are no longer killed by most of the common antibiotics.

As opposed to the post-World War II decades, when drug companies were pumping out new antibiotics faster than germs could become resistant, we are now in a situation in which, for various reasons, drug companies are not putting in the resources to develop new antibiotics. This will become a serious crisis when we reach a time when many infections will not be treatable with existing antibiotics.

As I have emphasized previously, when seeing your physician for an illness, it is best not to have expectations of being treated with antibiotics. Rather, let your physician decide whether antibiotics are needed, and expect an explanation from him or her as to the reasoning behind that decision. You should also be given suggestions as to what you can do to make yourself feel better during the course of your illness.

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As we begin the year, I’d like to review routine immunizations that are recommended for adults.

I feel that immunizations have been proven safe and are very effective in preventing many illnesses, and they have saved a countless number of lives from potentially deadly diseases.

Why do adults need immunizations? Some adults incorrectly assume that vaccines they received in childhood will protect them for the rest of their lives. This is mostly true, except for three points:

  • Some adults believe they received vaccinations as children, but they never actually did.
  • Newer vaccines were not available previously.
  • The effectiveness of a vaccine lessens with time.

As we age, we become more susceptible to common infections, such as those caused by influenza (flu) and pneumococcal bacteria.

These are what I feel are the most important adult vaccines:

  • Influenza: every fall season for all adults, especially those past 65 years of age
  • Tetanus with diphtheria and pertussis (whooping cough): every 10 years
  • Pneumococcal (pneumonia): men and women age 65 and older
  • Shingles: everyone 50 years or older
  •  Rubella (German measles): women of child-bearing age

Young women and men may want to check with their doctors about HPV, human papilloma virus. Travelers, especially those going to Africa, Latin America or Asia, should consider hepatitis A and typhoid vaccines.

Next time you have a reason to see your doctor, talk about routine immunizations and make sure you are up to date. Remember, it pays to keep a step ahead of illness and disease.

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