Stroke Risk Kit by Hector Cavazos

WHAT IS A

STROKE?

AN INFORMATIVE GUIDE BROUGHT TO YOU BY:

Tenet Stroke Collaborative Group V.2 12/2018

CONTENTS HERE’S A LIST OF WHAT YOU’LL FIND INSIDE THIS GUIDE: What is a Stroke?

Pages 3 – 5

What Risk Factors Can I Change?

Page 5

What to Expect After a Stroke: Rehabilitation and Recovery Pages 6 – 7 Diet Plan and Cooking Tips

Pages 8 – 10

Medications

Page 11

Exercise and Walking Program

Pages 12 – 13

Stroke/Brain Attack Self-Management Zone Map

Page 14

Stroke and Cardiac Risk Assessment Tool

Page 15

Blood Pressure Log

Page 16

Stroke Risk Scorecard

Page 17

WHAT

IS A

STRO K E?

STROKE IS A DISEASE

that affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures).

RECOGNIZING STROKE SYMPTOMS • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body • Sudden trouble seeing in one or both eyes • Sudden confusion, trouble speaking or difficulty understanding speech • Sudden severe headache with no known cause • Sudden trouble walking, dizziness, loss of balance or lack of coordination EVERY MINUTE COUNTS – TIME IS BRAIN! If you have symptoms of a stroke, call 9-1-1 right away. It is important to get to the hospital as soon as possible if you suspect a stroke to reduce long term disabilities.

911

The effects of a stroke depend on several factors, including the location and how much brain tissue is damaged. However, because one side of the brain controls the opposite side of the body, a stroke affecting one side will result in neurological complications on the opposite side of the body. LEFT BRAIN

RIGHT BRAIN

If the stroke occurs on the brain’s left side, the right side of the body will be affected. This could produce any or all of the following:

If the stroke occurs on the brain’s right side, the left side of the body will be affected. This could produce any or all of the following:

• Weakness on the right side of the body

• Weakness on the left side of the body

• Changes in personality

• Quick, impulsive behavioral style

• General disorganization

• Lack of or poor judgment

• Slow, cautious behavior

• Impaired depth perception

• Memory loss

• Vision problems

• Speech/language problems

• Memory loss

• Easily frustrated

• Emotional changes

HOW DOES STROKE OCCUR? A stroke may be caused by anything that blocks or stops the blood supply to a part of the brain. Blood can be prevented from reaching brain tissue when a blood vessel leading to the brain becomes blocked (ischemic) or bursts (hemorrhagic). Ischemic Stroke is the most common type of stroke. It may occur when there is a blockage in a blood vessel in the brain. • An artery in or leading to the brain may become severely narrowed, usually from atherosclerosis. Atherosclerosis is a condition in which fatty deposits build up in the blood vessels, creating thickened areas called plaque. The plaque and the narrowing of the blood vessels can block the flow of blood. A small piece of plaque may break off from the wall of a blood vessel and completely block a smaller blood vessel downstream. • The blockage may be caused by a blood clot that forms in a blood vessel of the brain or neck. This type of blockage is called a thrombus. • The blockage may be caused by a clot or other material that travels from another part of the body to the brain or neck. This type of clot is called an embolism.

ISCHEMIC BLOCK

HEMORRHAGIC BURST

Hemorrhagic Stroke happens when an artery in the brain breaks and bleeds into the brain. A hemorrhage often happens without warning. It usually occurs as a result of high blood pressure. Sometimes it results from a blood vessel defect you have had since birth. • When a blood vessel inside the brain ruptures it is called an intracerebral hemorrhage. The blood causes damage to the brain, which in turn causes the surrounding brain cells to die. When the bleeding is excessive and increases quickly, the buildup of pressure can cause a person to go unconscious. • When a blood vessel bursts on the outside of the brain it is called a subarachnoid hemorrhage. This causes the blood to spill between the skull and the brain. • An aneurysm is also a form of a hemorrhagic stroke that is caused when an artery had a localized weak spot. When the pressure increases in an artery this causes the weak spot to inflate with blood as the heart beats. As this pressure increases so does the amount of blood to the weakened area causing a ballooning of the artery. If and when the balloon bursts, it results in a hemorrhagic stroke.

Transient Ischemic Attack (TIA) is a temporary decrease of blood and oxygen to a part of the brain, which may present with stroke-like symptoms. These may be referred to as a “mini-stroke” or “warning strokes” known as TIAs. This occurs when there is a temporary blockage or slowing down of blood to the brain for a small amount of time. Some small clots break down and are absorbed back into the blood stream. TIAs resolve quickly and leave no damage to the brain. Physicians are very serious about not dismissing these symptoms as they can be considered a serious warning sign of a possible future stroke.

WHAT STROKE RISK FACTORS CAN I CHANGE OR TREAT? Research has identified the following factors can increase your risk of stroke: • High blood pressure is the single most important risk factor for stroke. When 130/85 mm HG or higher, it is the No.1 cause of stroke.

RMAL NO

W LO

HIGH

• High Cholesterol increases the risk of blocked arteries. If an artery leading to the brain becomes blocked, a stroke can result. Recommended LDL levels are less than 70 for patients that have suffered a stroke.

• Atrial Fibrillation is when the heart’s upper chambers quiver, causing blood to pool and clots to form, increasing stroke risk. • Transient Ischemic Attacks (TIAs)– recognizing and treating TIAs can reduce the risk of a major stroke.

• Excessive alcohol intake – drinking more than two drinks a day for a man or one drink a day for a woman can raise blood pressure. Binge drinking can also lead to a stroke. • Illegal drug use – intravenous drug use and Cocaine use carries a high stroke risk. Illegal drugs commonly cause hemorrhagic stroke.

• Smoking damages blood vessels, which can lead to blockages within the blood vessels causing a stroke.

STRO

KE &

CARD

IAC RIS

K AS

Current

SESS Leve

MENT

esterol d Chol 200 Bloo less than total than *Normal ter than 50 (less 100, grea *HDL less than (bad ) *LDL 150 Diabetic) 70 if less than ides *Triglycer

High

king

ase Mellitus will incre – etes Diab to 140 al 70 *Norm s r meal Suga after Blood itting *Adm ht: ht Weig weig Body Over for each late Ideal + 5 lbs Calcu 110 lb le 5ft: *Fema for each inch ional 5 lbs addit lb + 5ft: 120 __ *Male inch ____ ional ____ addit ht ____ l Weig *Idea tyle Lifes ntar y Sede

Stress

& Tens

• Triglycerides blood level of 150 mg/dL or more. • Diabetes increases your risk of stroke because it can cause a disease of blood vessels in the brain. Normal range for the hemoglobin A1c level is between 4% and 5.6%, and for diabetic patients the target should be around 7%. Discuss your A1c goals with your physician.

Actio

Factors My Risk sure d Pres Bloo less High 80 or 120/ *Normal

Smo

Factors Risk ify My to Mod ribed Take presc ns I Will n as catio medi e ram your salt intak walk prog • Take your ease sed home daily • Decr the enclo ure w press ribed • Follo your blood ol diet presc k ester n as • Chec w Chol catio fat/lo medi low your sed program • Take the enclo w sed walk • Follo the enclo w • Follo

TOOL

• Physical Inactivity & Obesity can increase your risk of cardiovascular disease. Excess weight around the waist (waist measurement of more than 40 inches for men and more than 35 inches for women).

ion

ation ribed Cess presc n as Smoking catio onal medi 69 (Nati your 4-86 ribed • Take 0-78 presc 1-80 s n as • Call catio e meal medi r befor your suga • Take blood program your walk • Take the home , w at 9AM • Follo breakfast e 7PM dule: s befor r sche dinne on soda on a 0PM, • Eat cut back h at 12:3 ks and snac • Lunc program fruit for walk • Eat home w the • Follo

Hotline)

Complete the tool on page 15 to assess your level of risk for stroke.

in place walk up and TV-stand watching ed while ls get start gh • To g commercia program throu walk eyes it out durin home your w the and blow and close nose • Follo place gh the this in a quiet breath throu share • Sit ges and a deep yle chan • Take th lifest the mou above of the y some famil ribed • Makemation with presc n as infor catio medi your • Take 15

Here

dity

Atria

l Fibri

Othe

llatio

WHAT ARE SOME OF THE EFFECTS OF A STROKE?

HOW IS A STROKE DIAGNOSED? The following tests may be done: • CT scan, which uses computerized X-rays to take pictures that allow your doctor to see plugged blood vessels in the brain or neck • MRI (magnetic resonance imaging), which uses magnetism, radio waves, and a computer to take pictures of the brain and blood vessels in the brain and neck • Ultrasound scans to show blood flow in blood vessels of the head and neck • Cerebral arteriogram to look at the blood vessels in the brain • Electrocardiogram (ECG), which records the electrical activity of your heart

A brain injury from a stroke can affect the senses, motor activity, speech and the ability to understand speech. It can also affect a person’s behavior and thought patterns, memory and emotions. Paralysis or weakness on one side of the body is common. These effects may be temporary or lasting depending on the areas of the brain affected and the extent of the injury. Injured and dead brain cells cannot heal or replace themselves. A stroke can have a major impact on both you and your loved ones, please refer to the resource list on page 9 to help you deal with issues you may face. Some of the effects of a stroke include: • Paralysis – weakness or inability to move a part of the body • Aphasia – loss of speech; inability to say a phrase. Many stroke survivors think clearly even though their speech may be jumbled, fragmented or impossible to understand. Aphasia does not affect intelligence just speech. • Dysarthria – slow, “slurred”, garbled or speech that is hard to understand (“drunken” speech). Dysarthria affects how words are spoken. It can occur with aphasia but can also occur alone.

• Echocardiogram, which is an ultrasound scan of the heart

• Dysphagia – problems swallowing. People with this condition often cough or choke when, or immediately after, they eat or drink.

• Blood tests

• Vision changes

WHAT TO EXPECT AFTER A STROKE Some strokes caused by blood clots may be treated with clot-dissolving medicines or clot-removing procedures. These treatments can cause the symptoms to stop very quickly. Clotbuster and clot-removal procedures must take place within the first hours of stroke symptoms. They can prevent long-term disability or death. All strokes require careful observation, especially in the first 24 hours. You may need an IV and oxygen. Other medical problems that may have caused the stroke, such as high blood pressure or heart rhythm problems, will be treated.

HOW LONG WILL THE EFFECTS OF A STROKE LAST? Recovery depends on how much the brain was damaged. There may be some quick improvement within the first few days and weeks after the stroke. Other improvement may occur more gradually. If recovery does not begin within one-to-two weeks of the stroke, some muscle movement and speech may not return. However, some people may continue to regain speech and muscle strength over time. By the end of your rehab program, your doctor will be able to tell you more accurately what further recovery to expect.

• Inability to care for yourself • Fatigue after a stroke • Anxiety and frustration • Depression It is important to know that these things are not unusual. Get of plenty of rest and avoid situations that make you feel overwhelmed. The key to recovering from a stroke is accepting that you have had a stroke and understanding that it will be a long process toward recovery. For most people, that begins in the hospital by starting physical therapy. The therapists will help you with strength and mobility issues, as well as fine motor and speech exercises if needed. They will work on helping to overcome the emotional, mental and physical barriers imposed on you by the stroke.

The key to recovering from a stroke is accepting that you have had a stroke and understanding that it will be a long process toward recovery.

REHABILITATION AFTER A STROKE

OUTPATIENT REHABILITATION

Rehabilitation may start at the hospital or at a nursing facility. Most stroke rehab programs last several weeks to several months after you leave the hospital. The program includes physical therapy, occupational therapy, and if needed, speech therapy.

Designed to meet the specific needs of individual patients as they move through the final stages of their recovery process. Outpatient rehabilitation programs offer physical, occupational and speech therapy. Patients usually attend therapy 1 – 3 times per week according to the doctor’s order. Outpatient therapy is a great opportunity for you to get out of the house and back into the community.

• The physical therapist will help you improve your coordination, strength and endurance. You will learn to become more independent with mobility. • The occupational therapist will assist you in developing skills so you can perform eating, dressing, bathing and grooming tasks as independently as possible. • In speech therapy, you will work on improving your speech, language and thinking skills. The speech therapist can also assist with swallowing problems by teaching you ways to eat and drink safely.

ACUTE CARE REHABILITATION SERVICES Offers specialized comprehensive therapy services for 3 hours per day for patients who meet the admission guidelines and have been participating in therapy. The rehabilitation team includes a wide range of professionals trained to work closely with you and your family to develop a treatment plan. The team meets on a regular basis to review your progress and goals and will provide you with information on your progress, length of stay and discharge needs.

SUB-ACUTE CARE REHABILITATION Offers therapy services for patients who are medically stable but unable to return home or require less intense rehabilitation services. Physical, occupational, and speech therapy services are offered for 1 – 2 hours per day five days per week.

HOME HEALTH For patients who are homebound, physical, occupational, speech, and nursing services will come to your home and focus on your mobility and daily living skills, and teach you how to be as independent as possible in your own environment. Therapists typically come 1 – 3 times per week.

HOW CAN I PLAN MY CARE AFTER STROKE AND RECOGNIZE SYMPTOM WORSENING Place the Zone Map, located on page 14, on your refrigerator and refer to it daily so it can help you recognize your symptoms. If the symptoms are worsening, it can help guide you toward which action to take.

STROKE /BR

AIN ATTACK

SELF-MAN

AGEMENT ZON

E MAP

My personal risk factors for Stroke ¨ High blood are: ¨ Atrial pressure ¨ fibrillation ¨ Family histor Diabetes ¨ ¨ Sedentary y of Stroke Diet choices lifestyle ¨ or previous Smoking Stroke /TIA When I am ¨ High Chole discharged sterol I will ____ ____________ ____________ ____________ ____________ ____________ ____________ Patient Initials ____________ ____________ : ________ _ ___ ____________ ____________ • Fill your medications ____ at the pharm • Schedule acy on the day & go to follow of discharge -up appointment • Follow up with Neurologist with your Prima • Pay attent or Specialist ry Doctor within ion to as instructed 7 days • Get up slowly any symptoms that do not improve after you sit & tell your Docto or lie down r as soon as • Take your possible medicine as prescribed; • Continue do not stop diet as prescr them unless ibed-reduce • Exercise directed by the amount regula Doctor of salt and fat • Follow physic rly-balance activit y and rest periods al • Do not smoke therapy plan and rehab ilitation as prescr and if you do • Get your ibed smoke get help blood to quit • Monitor blood pressure and cholesterol checked regula sugar rly Your symptoms are under contro • No weakn l. ess that is gettin You have no symptom worsening or • No chang g worse or numb new symptoms es in speec ness on one h such as slurrin • No double side g or trouble vision understandi • No new heada or loss of vision ng people che • No seizur es

Personal risk factors & patient stated goal

Immediatel y after discharge from the hospital

Daily Self-C

are

GREEN ZONE ALL CLEA R This zone is your goal

YELLOW ZONE CAUTION: CALL YOUR DOCT OR This zone is a warni

RED ZONE It is VERY impor tant to CALL 911 if you have STRO KE/BR ATTACK SYMP AIN TOMS

• Your sympt oms are telling • Trouble with you that somet hing is wrong loss of balanc • Feeling more e or dizzine ss tired, No energ • Blood pressu y re • Fever greate that is higher than 140/9 0 or lower than r than 100 degre • Palpitations 100/60 es -fluttering in your chest or • Frequent fast heart rate cough • Cannot move ing, coughing & raising ng yellow or green your limb as sputum • Frequent much as you or painful urinat could before ion • Blood in urine or stool, frequent nose • Feeling, down, depre bleeds or vomiti ssed or hopele ACTION: Call ng blood ss your Doctor to report sympt om worsening CALL 911 WITH STROKE/BR 1.9 MILLION AIN ATTAC K SYMP TOMS BRAIN CELLS OR CHEST DURING A DIE EVERY PAIN STROKE. MINU TE THAT BRAIN CELLS STROKE SYMP DO NOT GET TOMS : OXYGEN • Sudden droop ing • Sudden weakn of the lower face on one side ess on one • Sudden loss side of the body, of balnce or such as arm trouble walkin • Changes hanging or in speech such leg dragging g or worsening as slurring, • Worst heada weakness trouble speak che ing or under • Double vision of your life standing people or loss of vision • Confusion or can’t think CHEST PAIN clearly OR SHORTNES S OF BREA TH ACTION: CALL 911

DIET PLAN Eating habits can impact your blood pressure levels. If you have high blood pressure, also known as hypertension, you will benefit from the following guidelines: • Reducing sodium (salt) in your diet • Increasing fruits, vegetables, and potassium-rich foods • Decreasing total fat, saturated fat and cholesterol in your diet

Read food labels to find out if prepared foods have sodium or fat. Look for words such as salt, sodium, fat, hydrogenated or partially hydrogenated fat. Include the number of recommended servings from the fruit and vegetables groups. Many fruit and vegetables contain potassium, a nutrient that has been shown to decrease blood pressure.

MEATS, POULTRY, FISH, EGGS AND MEAT SUBSTITUTES

SOUPS

Choose:

Limit to 5 – 6 ounces per day: • Meat, fish, poultry, shellfish, fresh or frozen, cooked without salt • Low sodium tuna or regular tuna that has been rinsed in water and drained • Tofu • Low cholesterol egg substitutes • Frozen entrees with a starch and vegetable should not exceed 600 mg sodium • Dried beans, peas, legumes (canned beans should be rinsed and drained) Limit to 1 serving per day: • Ricotta cheese, part skim (½ cup) • Low sodium processed (1 oz.)

Do not choose: • Cured or processed meats: corned beef, Canadian bacon, bologna, cured ham, luncheon meats, sausage, jerky, hot dogs (regular and “1/3 less sodium’) • Canned chicken, salmon, shrimp, sardines or meat • Peanut butter • Textured vegetable protein (TVP) products • Frozen dinner entrees (except those listed under choose) • Canned entrees, such as stews, chop suey, spaghetti • Processed cheeses (American, cheese spread, cheese food) • All other natural cheeses

• Cottage cheese (½ cup)

• Reduced or low sodium canned soup • Homemade soups and broth, with no added salt • Low sodium soup bases Do not choose: • All soups and broth, unless low sodium • “1/3 less salt” soups • Dehydrated soup mixes

FRUITS AND JUICES Choose: Eat 4 – 5 servings per day. Choose high-potassium fruits such as bananas, melons and strawberries. • All fruits and fruit juices • Low-sodium, salt-free vegetables

VEGETABLES Eat 4 – 5 servings per day Choose:

Do not choose: • Baked beans

• Canned vegetables, with no added salt

• Sauerkraut

• Raw vegetables

• Frozen seasoned vegetable dishes

• Fresh or frozen vegetables, cooked without salt • Canned vegetables, rinse and drain before preparing (limit to 1 cup per day) • Instant mashed potatoes, do not add salt when preparing • Low sodium tomato or vegetable juice • Tomato sauce, no salt added

• Pickles and pickled vegetables

• Coleslaw and potato salad, unless homemade, without salt • Tomato or vegetable juice • Tomato sauce • Tomato puree

BEVERAGES Limit caffeine to 300 mg/day Choose: • Coffee and tea (about 2 ½ cups) • Carbonated beverages, low sodium • Fruit punch, lemonade • Mineral water Do not choose: • Cocoa beverage mixes • Sport beverages • Soda 8

CONDIMENTS

MILK AND YOGURT

Choose:

Do not choose:

• Herbs and spices without salt (e.g. onion and garlic), horseradish powder, vinegar Limit: • Mustard (1 tsp/day) • Worcestershire sauce (1 tsp/day) • Ketchup (1 tsp/day)

Choose:

• Salt, herb and spice blends containing salt

Eat 3 servings per day: • Milk: reduced-fat, lowfat, fat-free, chocolate, powdered, evaporated

• Monosodium glutamate (MSG) Note: MSG has no taste, and so is not detected in foods

• Yogurt: low-fat or frozen Do not choose:

• Soy sauce

• Buttermilk

• Teriyaki sauce

• Instant hot chocolate/ cocoa mixes

• Steak sauce • Poultry seasoning

• Malted milk

• Relish • Barbeque sauce

SNACKS AND SWEETS Choose:

FATS Limit to 1 serving per day:

• Popcorn: homemade, unsalted; microwave, unsalted

• Fat-free frozen desserts, cakes and cookies

• Pretzels, unsalted

• Low-fat (noadded sugar) ice cream mousse

• Sugar, honey • Jam or jelly • Syrups: maple, corn, chocolate, etc. • Cranberry sauce • Hard candy • Gelatin • Sherbet or frozen yogurt (½ cup) • Popsicles

Do not Choose:

Choose: Limit to 6 teaspoon portions per day • Vegetable oils: canola, safflower, sunflower, corn, peanut, olive, soybean

• Popcorn: commercial seasoned or microwave with salt

• Margarine with first ingredients “liquid oil” and no trans fat

• Snack chips, pretzels or crackers with salt

• Diet margarine

• Ice cream

• Imitation whipped topping

• Cheesecake • Instant pudding mixes • Commercially prepared fudge, caramel or butterscotch toppings

• Unsalted nuts (1 oz.)

Do not choose: • Tartar sauce • Bacon, bacon fat, “1/3 less sodium” bacon • Gravy: canned, jarred or packet • Salt pork • Butter • Snack dips with instant soup mixes or processed cheese • Olives

Limit to 1 serving per day • Salad dressing: regular or fat-free (1 Tbsp) • Mayonnaise: regular or fat-free (1 Tbsp) • Fat-free cream cheese

This information is for educational purposes only. The contents should not replace advice from a medical professional. If you need medical assistance or have further questions, please contact your physician.

SEASONING YOUR FOOD

¼ Tsp.

How to add seasoning: • Add ¼ teaspoon dried, finely powdered, or ¾ to 1 teaspoon dried, loosely crumbled, or 1½ teaspoon fresh, chopped herbs for every four servings of food, pint of sauce, or pound of meat. • For the best flavor, add seasoning during the last hour of cooking. • For foods that cool in less than an hour or for salads, wet the herbs with a little oil or lemon juice and let stand for ½ hour before using to let the full flavor develop. • For a combination of herbs and spices, use about ½ teaspoon for every four servings. • One to two teaspoons of sugar can be added to vegetables during cooking. If a sugar substitute is used, add after foods have been cooked; the flavor can change when heated. • If using a salt substitute, check with your doctor first. • Add after foods have been cooked; the flavor can change when heated. Caution: Small amounts of herbs and spices should give the flavor you like. Too much may create a bitter or unpleasant taste.

FOOD LABELS The following are sodium labeling definitions: Sodium Free – less than 5 milligrams of sodium per serving Very Low Sodium – less than 35 milligrams of sodium per serving

Dried, Finely Powdered

¾ to 1Tsp.

Dried, Loosely Crumbled

1½ Tsp.

Fresh, Chopped Herbs

SEASONING CHART Beef: Bay leaf, basil, dry mustard, nutmeg, green pepper, sage, onion, marjoram, pepper, thyme, oregano, caraway, curry, garlic, parsley, rosemary Pork: Basil, caraway, cloves, nutmeg, garlic, onion, parsley, rosemary, sage, pepper, apples, applesauce, pineapple, allspice, oregano Fish: Bay leaf, basil, curry, cumin, dry mustard, green pepper, lemon juice, paprika, marjoram, onion, parsley Eggs: Basil, curry, dry mustard, green pepper, onion, paprika, parsley, nutmeg, pepper Carrots: Parsley, honey, cinnamon, mint, lemon juice, allspice, nutmeg, caraway seed, dill seed, ginger, thyme, pepper Potatoes: Onion, basil, parsley, paprika, bay leaf, green pepper, chives, celery seed, oregano, poppy seed, rosemary, thyme, pepper, garlic, nutmeg Rice: Turmeric, cumin, curry, allspice, honey, onion, green pepper, pepper

Low Sodium – less than 140 milligrams per serving

Broccoli: Lemon juice, pepper, vinegar, basil, caraway seed, dry mustard, nutmeg, curry, oregano, garlic

Reduced or Less Sodium – the product has at least 25 percent less sodium than the original product

Peas (green): Onion, basil, mint, sage, pepper, honey, rosemary, parsley, green pepper, oregano, garlic, poppy seed

Light – a product has at least 50 percent less sodium OR 1/3 fewer calories OR 50 percent less fat than the original product

String Beans: Lemon juice, nutmeg, dill seed, thyme, vinegar, dry mustard, oregano, caraway seed, sage, garlic, pepper

No Salt Added or No Salt – no salt has been added in the preparation of the product * Caution: Many products with less sodium, less salt, lite, or light on the label may still have too much sodium.

Spinach: Lemon juice, vinegar, onion, allspice, basil, oregano, pepper Corn: Green pepper, onion, paprika, pepper, curry

EATING OUT Today, many restaurants provide nutrition information about their menu items. Since most fast foods and ethnic foods (Chinese, Mexican, and Italian) are high in sodium, ask to see this information before making a selection. Upon request, some fast food restaurants will accommodate your needs, such as leaving the salt off your French fries, or the ketchup off your burger. Another choice is to order a salad and add a squeeze of lemon instead of dressing, which is generally high in sodium. At restaurants that prepare foods “made to order,” ask that your meal be prepared without salt or MSG. 10

MEDICATIONS

NATIONAL RESOURCES • American Heart/Stroke Association https://www.heart.org/ http://www.strokeassociation.org/STROKEORG/ 1-888-478-7653 • Centers for Disease Control and Prevention Division for Heart Disease and Stroke Prevention https://www.cdc.gov/dhdsp/ • National Institute of Neurological Disorders and Stroke https://www.ninds.nih.gov/Disorders/All-Disorders/StrokeInformation-Page, 1-800-352-9424 • Eat Right www.eatright.org

Take only medications prescribed for you, and be sure that all of your physicians are aware of the medications you are taking. These medications may include, but are not limited to: • Angiotension Receptor Blockers (ARB’s): relaxes blood vessels and increases blood flow to and from heart and brain. Examples: Diovan, Benicar and Avapro • ACE Inhibitors: relaxes blood vessels and decreased blood pressure makes it easier for the heart to pump blood. Examples: Lisinopril, Lotensein, and Vascotec • Beta Blocker: expands (dilates) blood vessels and reduces heart rate. Examples: Lopressor, Toprol XL, Tenormin, Coreg • Diuretics: removes excess fluid in your body. Examples: Lasix [Furosemide], Hydrochlorothiazide [HCTZ]

• Smoking Cessation https://smokefree.gov/ • Centers for Disease Control and Prevention • Stroke Prevention website www.cdc.gov/stroke • National Stroke Association www.stroke.org, 1-800-787-6537 • National Aphasia Association www.aphasia.org • National Council on Aging (local councils can provide resources in your area) https://www.ncoa.org/ 571-527-3900

RESOURCES FOR CAREGIVERS

• Vasodilators: dilates blood vessels causing lower blood pressure. Examples: Hydralazine, Isosorbide

• Stroke Family Warmline (1-888-478-7653). Connects stroke survivors and their families with an American Stroke Association (ASA) trained team member who can provide support.

• Anticoagulants: stops blood from clotting. Examples: Coumadin, Lovenox, Pradaxa, Eliquis

• Caregiver Action Network http://caregiveraction.org/

• Anti-Platelets: prevents blood from clotting. Examples: Aspirin, Aggrenox, Plavix

• Family Caregiver Alliance www.caregiveer.org, 1-800-445-8106

• Anti-Depressants: Prozac, Lexapro, Zoloft

• Family Caregiver 101 www.familycaregiving101.org

• Lipid Lowering Agents/Statins: reduces cholesterol levels in blood which clogs up arteries. Examples: Zocor, Lipitor, Pravachol

STROKE MAGAZINES/NEWSLETTERS • Stroke Connection (Subscription is free) www.strokeassociation.org, Search “stroke connection” • StrokeSmart Magazine (Subscription is free) www.stroke.org, Search “strokesmart magazine”

EXERCISE STARTING AN EXERCISE PROGRAM Exercise is very important for good health. Your healthcare provider may tell you that you need to get more exercise. To do this, you will need to get into the habit of exercising so that it becomes a part of your normal daily or weekly routine. The best exercise for you is one that you enjoy, and that you will do on a regular basis. If you start a walking program, but hate to walk, you are not likely to keep it up. Find an activity that you enjoy, perhaps basketball, soccer, dance or hiking. Try to involve family members or friends. Join a team or exercise class and make it fun. You can get exercise at many times of the day. For example, take the stairs instead of an elevator, park far away in a parking lot and walk briskly to the store, or walk during your lunch break. The benefits are lifelong, so have fun and stick to it.

DAILY ACTIVITIES THAT PROMOTE EXERCISE • Rake leaves • Sweep the porch • Gardening • Bike, hike, swim or dance • Vacuuming/housework • Take the stairs instead of the elevator • Park away from building entrances and walk • Use device to track daily activity, such as Fitbit, phone app, etc. • Walk the golf course instead of taking a cart

SIX-WEEK BEGINNER WALKING PROGRAM This six-week program is for the beginner walker who wants to improve overall health and increase energy. Walks start at 10 minutes or less and gradually work up to 30-plus minutes. Health experts have found that about 30 minutes a day of regular moderate exercise is effective for improving health and reducing the risk of many diseases.

Monday, Wednesday and Thursday are the core workout days, with Tuesdays and weekends optional at the beginning. Fridays are rest days or “Alternate Activity” days. Pick which days of the week work best for you and your schedule. Always start your walk with 3–5 minutes at an easy warm-up pace. To find more advanced plans or the plan that works for you, visit Heart.org/ NationalWalkingDay and take our walking plan quiz to get started.

MY WALKING PROGRAM

Week 1

Monday

Tuesday

Wednesday

Thursday

Friday

Easy walk: 5–10 mins

Easy walk: 10–15 mins

Easy walk: 5–10 mins

Easy walk: 10–15 mins

Rest

Stretch: 2 mins

NOTE: always rest when necessary!

Stretch: 2 mins

Easy walk: 10–15 mins

Easy walk: 5–10 mins Easy walk: 5–10 mins Week 2

Week 3

Week 4

Stretch: 2 mins

Brisk walk: 5–10 mins

Easy walk: 10–15 mins Stretch: 2 min Brisk walk: 5–10 mins

Easy walk: 15–20 mins

Easy walk: 10–15 mins

Stretch: 2 mins

Easy walk: 10–15 mins Brisk walk: 5–10 mins Stretch: 2 mins

Easy walk: 15–20 mins

Easy walk: 10–15 mins

Stretch: 2 mins

Brisk walk: 5–10 mins

Easy walk: 15–20 mins Window shopping is great!

Easy walk: 5–10 mins

Stretch: 2 mins

Weekend Workout (optional)

Easy walk: 10–15 mins Remember: rest when necessary.

Rest

Easy walk: 15–20 mins

Easy walk: 15–20 Rest mins Stretch: 2 mins

Easy walk: 15–20 mins Don’t window shop! Keep moving!

Brisk walk: 5–10 mins Easy walk: 15–20 Rest mins Stretch: 2 mins

Brisk walk: 20–25 mins

Easy walk: 25–30 Alternate mins Stretch: 2 mins Activity of your choice: Go dancing, rake leaves for 20+ mins

Easy walk: 25–30 mins

Easy walk: 25–30 Rest mins Stretch: 2 mins

Easy walk: 25–35 mins

Stretch: 2 mins

Week 5

Easy walk: Easy walk: 10–15 25–30 mins min Brisk walk: 10–15 mins Stretch: Stretch: 2 mins 2 min

Easy walk: 10–15 mins Brisk walk: 10–15 mins Stretch: 2 mins

Week 6

Easy walk: Total Time: 24–34 3–5 mins mins Easy walk: 15–20 mins Power Intervals –Power walk: 30 secs –Easy walk: 1 min Repeat 4–6 times.

Alternate activity of your choice for 20–30 minutes Easy walk: 30–35 mins Stretch: 2 mins

STROKE/BRAIN ATTACK SELF-MANAGEMENT ZONE MAP My personal risk factors for Stroke are: ¨ Atrial fibrillation ¨ Diabetes ¨ Diet choices ¨ High blood pressure ¨ Family history of Stroke or previous Stroke/TIA ¨ High Cholesterol Personal risk factors & patient stated goal

¨ Sedentary lifestyle ¨ Smoking When I am discharged I will ________________________________________________________ ____________________________________________________________________________ Patient Initials: __________

Immediately after discharge from the hospital

• • • • •

Fill your medications at the pharmacy on the day of discharge Schedule & go to follow-up appointment with your Primary Doctor within 7 days Follow up with Neurologist or Specialist as instructed Pay attention to any symptoms that do not improve & tell your Doctor as soon as possible Get up slowly after you sit or lie down

Daily Self-Care

• • • • • • •

Take your medicine as prescribed; do not stop them unless directed by Doctor Continue diet as prescribed-reduce the amount of salt and fat Exercise regularly-balance activity and rest periods Follow physical therapy plan and rehabilitation as prescribed Do not smoke and if you do smoke get help to quit Get your blood pressure and cholesterol checked regularly Monitor blood sugar

GREEN ZONE ALL CLEAR This zone is your goal

YELLOW ZONE CAUTION: CALL YOUR DOCTOR This zone is a warning

Your symptoms are under control. You have no symptom worsening or new symptoms • No weakness that is getting worse or numbness on one side • No changes in speech such as slurring or trouble understanding people • No double vision or loss of vision • No new headache • No seizures • Your symptoms are telling you that something is wrong • Trouble with loss of balance or dizziness • Feeling more tired, No energy • Blood pressure that is higher than 140/90 or lower than 100/60 • Fever greater than 100 degrees • Palpitations-fluttering in your chest or fast heart rate • Frequent coughing, coughing & raising yellow or green sputum • Cannot move your limb as much as you could before • Frequent or painful urination • Blood in urine or stool, frequent nose bleeds or vomiting blood • Feeling, down, depressed or hopeless ACTION: Call your Doctor to report symptom worsening CALL 911 WITH STROKE/BRAIN ATTACK SYMPTOMS OR CHEST PAIN 1.9 MILLION BRAIN CELLS DIE EVERY MINUTE THAT BRAIN CELLS DO NOT GET OXYGEN DURING A STROKE.

RED ZONE It is VERY important to CALL 911 if you have STROKE/BRAIN ATTACK SYMPTOMS

STROKE SYMPTOMS : • Sudden drooping of the lower face on one side • Sudden weakness on one side of the body, such as arm hanging or leg dragging or worsening weakness • Sudden loss of balnce or trouble walking • Changes in speech such as slurring, trouble speaking or understanding people • Worst headache of your life • Double vision or loss of vision • Confusion or can’t think clearly CHEST PAIN OR SHORTNESS OF BREATH ACTION: CALL 911 14

STROKE & CARDIAC RISK ASSESSMENT TOOL My Risk Factors

Current Levels

Actions I Will Take to Modify My Risk Factors

High Blood Pressure

• Take your medication as prescribed

*Normal 120/80 or less

• Decrease your salt intake • Follow the enclosed home walk program • Check your blood pressure daily

High Blood Cholesterol

• Take your medication as prescribed

*Normal total less than 200

• Follow the enclosed low fat/low Cholesterol diet

*HDL greater than 50

• Follow the enclosed walk program

* L DL (bad) less than 100, (less than 70 if Diabetic) *Triglycerides less than 150 Smoking

• Take your medication as prescribed • Call 1-800-784-8669 (National Smoking Cessation Hotline)

Diabetes Mellitus

• Take your medication as prescribed

* Normal 70 to 140 – will increase after meals

• Take your blood sugar before meals • Follow the home walk program

*Admitting Blood Sugar Overweight

• Eat on a schedule: breakfast at 9AM,

Calculate Ideal Body Weight:

• Lunch at 12:30PM, dinner before 7PM

* Female 5ft: 110 lb + 5 lbs for each additional inch

• Eat fruit for snacks and cut back on sodas • Follow the home walk program

* Male 5ft: 120 lb + 5 lbs for each additional inch *Ideal Weight _______________ Sedentary Lifestyle

• To get started while watching TV-stand up and walk in place during commercials • Follow the home walk program

Stress & Tension

• Sit in a quiet place and close your eyes • Take a deep breath through the nose and blow it out through the mouth

Heredity

• Make some of the above lifestyle changes and share this information with family

Atrial Fibrillation

• Take your medication as prescribed

Other

My Blood Pressure Log Name______________________________________________________________________________ My Blood Pressure Goal ______________________________________ mm Hg Instructions • Take at least two blood pressure readings one minute apart - once in the morning before taking medications and in the evening before dinner. • For best results, remain still for at least 5 minutes. Sit with your back straight and supported and your feet flat on the floor. • When you measure your blood pressure, rest your arm on a flat surface (such as a table) so your upper arm is at heart level. • Record your blood pressure on this sheet and show it to your doctor at every visit. • You can also use AHA’s Check. Change. Control.® Tracker (ccctracker.com/aha ), a free online tool to help you track and monitor your blood pressure. • You will need a campaign code to sign up for the CCC Tracker. Find the campaign code on the map for your state and sign up.

Date

194 | Tools and Logs: Building a Healthier Future

Date

Stroke Risk Scorecard

Each box that applies to you equals 1 point. Total your score at the bottom of each column and compare with the stroke risk levels on the back. RISK FACTOR

HIGH RISK

CAUTION

LOW RISK

Blood Pressure

130/≥80 or unknown

120-129/<80

<120/<80

Atrial Fibrillation

Irregular heartbeat

I don’t know

Regular heartbeat

Smoking

Smoker

Trying to quit

Nonsmoker

Cholesterol

>240 or unknown

200-239

<200

Diabetes

Yes

Borderline

Physical Activity

None

1-2 times a week

3-4 times a week

Weight

Overweight

Slightly overweight

Healthy weight

Stroke in Family

Yes

Not sure

TOTAL SCORE

High Risk

Caution

Low Risk

Risk Scorecard Results

High Risk 3: Talk to your healthcare provider immediately and ask about a stroke prevention plan. Make an appointment today. Caution 4-6: You have several risks that if elevated will place you at a higher risk for stroke. Take control now and work towards reducing your risk. Low Risk 6-8: You’re doing well at controlling stroke risk! Continue to stay informed about your numbers. Get tips at stroke.org.

Ask your healthcare professional how to reduce your risk of stroke.

Use FAST to remember warning signs of stroke: FACE: Ask the person to smile. Does one side of the face droop?

To reduce your risk: 1. Know your blood pressure.

ARMS: Ask the person to raise both arms. Does one arm drift downward?

2. Find out whether you have atrial fibrillation. 3. If you smoke, stop. 4. Find out if you have high cholesterol. 5. If diabetic, follow recommendations to control your diabetes. 6. Include exercise in your daily routine. 7. Enjoy a lower-sodium (salt), lower-fat diet.

b hep lahs

SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange? TIME: If you observe any of these signs, call 9-1-1 immediately.

1-800-STROKES (787-6537) •

stroke.org