Vascular Insights Issue #6

MARCH 2012

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ISSUE 0006

VASCULAR INSIGHTS A QUARTERLY NEWSLETTER OF VASCULAR ASSOCIATES, LLC

“I think the doctor will rule out D.V.T., Ernie. The longest journey you’ve ever been on, is a bus ride home from the Bingo Hall.”

Strokes can strike anybody...even the celebrities. Do you recognize any of these faces? They all suffered from a stroke at some point in their life.

IN THIS ISSUE Diary of a Stroke Survivor....pg.2 The Importance of Family..pg.3 Changing the World............pg.4 DVT Risks in the Office.......pg.5 PAD Risk Factors................pg.6

Top Row L-R: Mary Kay Ash, President Gerald Ford, Dick Clark Bottom Row L-R: Hugh Hefner, Ted Williams, Charles Schultz “Peanuts”

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Diary of a Stroke Survivor Article by: Kerry Wood

Thursday ......................................................................

I am home after three days and two nights in the hospital. my right arm is working at about 15 percent capacity after my suffering a stroke monday night. that explains the absence of capital letters. remember the lives and times of archy and mehitabel by don marquis? you will understand why i identify with the cockroach archy, who typed on marquis’s newsroom typewriter at night by hopping from key to key but of course was unable to operate the shift key. thus no words were capitalized in archy’s writings. i am typing with my left hand only and thus have archy’s restriction to lower-case letters. since i’m working on a computer and not a typewriter, apostrophes are available to me, though they weren’t to archy. a literary cockroach, c’est moi.

Friday ...........................................................................

Progress! I can peck with the index finger of my right hand, so the shift key is within my command. Adopting the positive attitude that doctors, nurses and therapists have been prescribing, I now think of my little ischemic stroke as an incident of growth. My right leg and arm are suddenly about three inches longer than before. Heavier, too, which accounts for the foot always catching the edge of the stair it’s trying to mount. Obviously, the right hand with the fork will have a hard time hitting my mouth, which has changed shape.

It is the morning of the fifth day since the wee embolus detached itself from somewhere and flew upward into my cerebral arterial tree. I was alone in the house, my wife being away on business. I had gone to bed early. I woke for a bathroom visit and discovered something was amiss with my right leg and arm. “Must have slept on it wrong,” I thought. “It will clear itself up.”

I’m unsure about the succeeding events. I broke two drinking glasses at different wake-up times.

I couldn’t seem to get them up to the kitchen counter before they slipped from my grasp. One glass I had used to take analgesic PMs, foolishly thinking that sleep would rectify my mystery malaise. Those pills were a major mistake.

I awoke again in the wee hours still refusing to admit what was happening to me. I had some cholesterol and hypertension problems, but they were under the control of prescription drugs.

Seeking activities to avoid unthinkable reality, I dressed and lurched downstairs to the garage to put out the recycle baskets and garbage can for the early morning pickup-a chore I’d forgotten to perform the previous night. I had to lean against the wall of the stairwell going down and coming back up. The right leg and foot were not performing well. I attempted to sweep up the broken glass in the kitchen. My right arm couldn’t work the broom. Keeping busy, I hauled laundry downstairs to the machine. I kept dropping items during my labored descent, leaning on and sliding down the staircase wall. Upstairs once again, I tried to brush my hair, but my right hand and arm wouldn’t cooperate. Finally I brought the cordless phone to my armchair and sat down to think.

I read carefully the telephone book’s warnings not to dial 911 2

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unless it was a true emergency. By this time it was 6:30-not so early that I would seriously disturb anyone, I thought insanely. I unlocked the front door, sat back down in my chair, and dialed. I was embarrassed at the difficulty I had enunciating that I thought I might be having a stroke. Minutes later the paramedics were in the driveway along with a fire engine. The crew worried about getting me down the slippery outside stairs and into the ambulance. I hoped the sirens hadn’t wakened my neighbors.

At the hospital, blood pressure off the map, I grew weary of telling people what month, date, and year it was; who was President, and how many fingers they were holding up. I politely and accurately responded to their inquiries wondering why they couldn’t answer those questions for themselves. When evenings came along, I turned on the TV so I could feel similarly superior to the candidates on Jeopardy and Wheel of Fortune. They sent me home the third day.

Stroke plus one month ........................

My thrombosis was not massive. I am recovering with a speed that seem undeserved given my idiotic refusal to accept what was happening and my eight-hour delay in calling the paramedics. Sure, I knew about strokes, but I had no headache, no loss of vision, and being alone there was no opportunity to discover my inability to speak clearly. I have much to be thankful for.

Everyone should learn about stroke symptoms and treatment of the various kinds of strokes.

A drug called rt-PA (recombinant tissueplasminogen activator) can virtually wipe out the effects of a stroke, but the patient must get to a hospital within 90 minutes of onset.

(Recent medical developments have extended that time limit.) Tests will determine whether one is a candidate for rt-PA. I waited too long and may spend the rest of my life with problems that could have been eliminated by this miracle clot-dissolving therapy. .........................................................................................................

About The Author Kerry Wood is a retired English teacher, textbook author, and awardwinning poet. His memoi-- Past Imperfect, Present Progressive-- is a smorgasbord of reflections on his early life, education and profession contained in stories, poems, and correspondence. He begins with recollections of being consigned to a Catholic military boarding school at the tender age of four in 1942 and spending his academic years there until 1946 and the end of WWII. Writes one reviewer: “The hats Kerry Wood has worn are multifarious and variegated: Russian translator, secondary teacher of English in Turkey and California, world traveler, sports aficionado, editor of literature anthologies, amateur poet and essayist, stroke survivor, devoted husband and father. Those curious about why an Ivy-League graduate would devote his career to teaching adolescents need only read former students’ tributes to Mr. Wood to realize that the author’s choice of vocation has been amply justified.” For further info, visit http://www.kerrymwood.com or email kerrywood@redshift.com

“Our family helps to develop our personalities”

The Importance of Family Article by: Jennifer Clark, PA-C

L

ast week a friend of mine was faced with one of the worst imaginable situations, his wife and mother of his two children suffered from a massive stroke at the young age of 35. After several days of exhausting all life saving measures he made the most difficult decision of his life out of respect for her wishes; he discontinued life support. Just like that his best friend, wife, and mother to his children was gone. With all of the hustle and bustle of daily life, it is so easy to get caught up in our jobs and careers and we can lose sight of what is most important….. family. Sure we all have certain struggles within our families whether it be personality differences or disagreements, but there is an unconditional love within a family that is unlike any other type of relationship. This love is vital to many aspects of our own personal lives. I would like to spend the rest of this article discussing some things that we may not be aware of in regards to the benefits of having a good relationship with our families.

As we grow from infancy to adults our family helps to develop our personalities. Interactions with our family teach us the importance of love, and what exactly unconditional love truly

means. Within a family a person can make a huge mistake, yet the love for that person doesn’t falter, we accept our family members along with all of their imperfections and faults. We learn from these imperfections and mistakes each other make and work together as a team to overcome them. Family gives us a safe place to be imperfect and to grow and learn from adversity. Perseverance through tough times helps create a bond which teaches us the importance of interpersonal relationships.

We also learn self-confidence, honesty, and humility from each other.

These are just a few of the things that make having a strong relationship with our family so vital. Many Psychologists have said that the most impactful influence on our lives is our family. Our experiences within our homes help to mold who we become. Sure, not everyone has the perfect home life, and a lot of times it is quite the opposite. I know firsthand what that is like, but taking the good from the situation is so important. Life is precious and can be taken from us in an instant. Enjoy the good times you share with your family and learn from the bad.

Small moments together are a blessing for the rest of our lives.

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And You Didn’t Think One Person...

Could Change the World?

Article by: Bud Shuler, MD., FACS

As Valentine’s Day has just passed, I wanted to take time to thank each of you for the impact that you have on the mission we carry forth into this world. We are challenged daily at home and in our offices (our second home) by events beyond our control. We cannot stop the occurrence of these events, and thus they are not for our worry as long as we remained focused on our “commitment to making a difference in the lives of others”. We, together, will overcome them.

But we, at Vascular Associates, must keep in mind the remainder of our mission statement which reminds us that we are to make a difference “in the lives of those with whom we work”. We would like to challenge each of you who read this to do the same. We may not have control over what has taken place in our lives, nor what happens to us, but we do have complete control over how we respond to that challenge. In doing so, those nearest to us, both in the hospitals, our offices, and at home, as well as those who we

meet in the journey of our lives can be influenced in a very positive manner. That impact we make is depicted by the blue water drop pictures we display in our office kitchen, one of which is displayed here. We, our actions and words, become like a simple drop of water in this world. When the drop comes in contact with the surface, it creates change and influences something much larger. Each drop (what is in our heart) further fills the larger body of water with what the drop contains. If we bring joy and positivity (our drop) into this world (the larger body of water) around us, we initiate change on the surface and ultimately influence the content of this world.

So let’s remember that each of our actions and words have an impact on the lives of those around us. It is in our power to choose what we give to the world and each other. Continue to be that positive change. And you didn’t think one person could change the world? In the life of our patients and colleagues, you already are.

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Visit our page and “like” it! www.facebook.com/arteryandveins

You’ll discover patient testimonies, upcoming events, daily quotes and inspiration, and much more!

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DVT Risk at the Office Sitting at your desk for hours at a time could double your risk for dangerous blood clots.

Learn how to prevent deep vein thrombosis and ease varicose veins.

• • • •

Swelling of the leg or along a vein in the leg.

Pain or tenderness in the leg, which you may feel only when standing or walking.

Increased warmth in the area of the leg that’s swollen or in pain.

Red or discolored skin on the leg

Danger of Pulmonary Embolism .........................................

What makes DVT so dangerous is that many people don’t know they have the condition until it develops into a pulmonary embolism, a blood clot to the lung. PE is a life threatening condition. More people die in the United States from a PE than from breast cancer and AIDS combined. Consult your doctor immediately is you have any of the following symptoms: Adapted from: Health Smart Magazine, 2008

D

eep Vein Thrombosis, or DVT, is a life threatening condition that occurs in approximately two million Americans each year.

DVT is when a blood clot forms in one of the large veins of the deep venous system, most commonly in the lower limbs.

We first heard about DVT when it was dubbed “economy-class syndrome,” in connection to the cramped legroom when flying economy. But new research from the Medical Research Institute of New Zealand found that office workers who sit for eight hours days are also at risk for DVT. In fact, sitting for three hours without some kind of activity more then doubles your risk. It can be hard to keep active if you have an office job, but little changes can make a big difference. Study author Professor Richard Beasley recommends workers get up from their desk at least every hour and move their feet from time to time while seated.

DVT Risk Factors ...............................................................

The following is a list of some of the most common risk factors for developing a DVT: • Immobility • Recent surgery • Obesity • Dehydration • Bleeding disorder/Family history of blood clots • Cancer • Pregnancy • Hormone replacement therapy/birth control pills • Recent traumatic injury DVT Symptoms ...................................................................

According to the American Heart Lung and Blood Institute, only half of people with DVT have symptoms. Consult your doctor immediately if you have any of the following symptoms:

• • • •

Unexplained shortness of breath Pain with deep breathing Coughing up blood Rapid breathing and a fast heart rate

Prevention ............................................................................

As with most conditions, prevention is the best medicine. You can stop varicose veins and SVT from developing into something more serious and lower your risk of DVT by following these simple suggestions: • • • • • • • •

Stand up from your desk at least once an hour—walk to the kitchen, pop out for a coffee or take the stairs to the floor above you and back.

Walk over to talk to a colleague rather than send an email.

Better still, go for a quick walk with your colleague while you talk.

While seated, regularly circle your feet in both directions and stretch your hands, arms and torso.

Move your legs and flex and stretch your feet to encourage blood flow in your calves.

Wear loose and comfortable clothing.

Drink plenty of fluids and avoid alcohol.

The anti-varicose diet, rich in fibre, flavonoids, Vitamin C and antioxidants, can reduce inflammation and improve circulation.

The good news is that DVT is preventable and treatable. DVT treatment options include blood thinners, clot busters, filters and compression stockings. With March being DVT awareness month, we encourage you to stay active and have a conversation with your healthcare professional about reducing your risk for developing a DVT. References: www.readersdigest.ca/health/healthy-living/dvt-risk-office; various DVT articles from Vascular Associates, LLC

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Peripheral Arterial Disease

& Risk Factor Modifications

Article by Clark Stream, PA-C

Over 10 million American adults have peripheral artery disease (PAD). Atherosclerosis is the most common cause of PAD and patients with PAD have a very high risk for heart disease and stroke. Atherosclerosis is the accumulation of fatty deposits in your arteries, a condition that may reduce blood flow to your heart, brain, as well as your legs. The most common symptom of PAD is intermittent claudication (pain in the calf with walking). Current research indicates that both genders are equally susceptible and 20% of people over the age of 65 suffer from the condition. The initial treatment for claudication consists of aggressive riskfactor modification. Modifiable factors that increase your risk of developing PAD include: smoking, high blood pressure, high cholesterol, diabetes, and inactivity.

Smoking is the number one risk factor for PAD. Smoking increases the risk of arterial disease and is connected with increased risk of amputation, stroke, heart attack and death.

Quitting smoking is one of the best ways to slow PAD progression. Smoking cessation is critical to successful management.

Hypertension (elevated blood pressure) is a risk factor for heart disease, stroke and PAD. Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. Adequate control slows the progression of PAD and reduces cardiovascular events.

Unhealthy cholesterol and lipid levels are well-recognized risk factors of atherosclerotic disease. The risk for PAD increases by 5-10% with every 10 mg/dL increase in total

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cholesterol levels. Levels of HDL (good cholesterol) below 40 mg/dL and high triglyceride levels increase the risk of PAD. LDL (bad cholesterol) levels should be below 100 mg/dL in all patients with PAD, and probably as low as 70 mg/dL when other risk factors are present such as diabetes, smoking or coronary artery disease.

People with type 2 diabetes have 4 times the normal risk for PAD and intermittent claudication. In fact, their risk for PAD is higher than their risk for heart disease.

Diabetics develop PAD at an earlier age and are at high risk for complications in the feet and ankles. Poor blood sugar (glucose) control increases the risk of developing PAD. Diabetic peripheral neuropathy (reduced sensation to the lower limbs) increases the risk for ulceration, foot infection, as well as for limb amputation.

A regular walking program helps patients lose weight, increase walking distances, improve muscle tone and reduce risk factors for heart attack, stroke and PAD. Research indicates that most people, after just six weeks of being in a walking program, have a 100 to 300 percent improvement in the distance they can walk before having intermittent claudication. According to the American Heart Association, exercise therapy is the best treatment for claudication.

The life style changes listed above can reduce your risk for PAD. A risk-factor modification plan for PAD may be used to prevent or lessen the progression of PAD once it has been diagnosed. Medical management is the cornerstone for the treatment of PAD. Consult your physician for diagnosis and treatment options for PAD.