DEAR READER: In yesterday's column, I began to describe the rehabilitation ("rehab") treatment that often follows a stroke and explained why it is necessary for your husband's recovery. Today, I'll describe rehab institutions and members of the rehab health professional team. If your husband's doctor expects he'll be able to make rapid gains, he likely will be transferred to a rehabilitation hospital. To benefit from this type of program, he must be able to engage in three or more hours of physical, occupational and speech therapy per day, five days a week. Stays in a rehab hospital typically are shorter than those in a skilled nursing facility.
DEAR DOCTOR K: My husband recently had a stroke. The doctors say he will need "rehab" after he is released, at a different type of hospital. Can you tell me what rehab is?
DEAR READER: Your question requires a long answer. So I'm going to devote both today's and tomorrow's columns to that answer. A stroke stops the blood supply to a part of the brain, and causes the death of brain cells in the area that no longer receives blood. The symptoms caused by a stroke are quite varied. Not only can strokes cause different types of symptoms, but the symptoms can also range from mild to severe. A patient's symptoms depend on what part(s) of the brain a stroke has damaged, and how bad the damage is.
DEAR DOCTOR K: My wife had a mini-stroke. The doctor said she has a narrowed artery in her brain. Can't the doctor open it up with angioplasty, as he would if she had a narrowed heart artery?
DEAR READER: "Mini-stroke" is another name for a transient ischemic attack, or TIA. A TIA causes stroke symptoms -- such as sudden weakness on one side of the body, blurred vision or difficulty speaking -- that last 10 minutes or more, but less than 24 hours. A TIA is a warning sign of an impending stroke. Four to 10 percent of people who have a TIA will go on to have a full-blown stroke.
DEAR DOCTOR K: My mother went to the hospital for what we all thought was a stroke, but the doctor said it was a TIA. What is a TIA? What does this mean for my mother's health?
DEAR READER: First, let me tell you about a patient. She was a woman in her 70s who was in good health. One day she was on a bus to the grocery store, a trip she had taken hundreds of times. Suddenly, she felt disconnected from the world. When she felt connected again, she realized she hadn't gotten off at the right stop. I'll come back to what happened to her later.
DEAR DOCTOR K: What are the warning signs of stroke? Why is it important to be able to recognize them?
DEAR READER: Nothing makes me sadder than to see someone suffer a stroke that could have been avoided. Not all strokes can be avoided, but many produce warning symptoms that can trigger preventive actions -- if they are recognized.
DEAR DOCTOR K: Do women need to take special precautions to prevent a stroke?
DEAR READER: Yes, they do -- and a new set of guidelines published earlier this year helps us to understand what those steps should be. The guidelines discuss stroke risk factors that women should consider from adolescence to old age. The first thing that may be surprising about the guidelines is that they include stroke prevention advice for young women.
DEAR DOCTOR K: What are the risks of taking a daily aspirin to reduce the risk of a heart attack or stroke?
DEAR READER: I didn't have to do much homework on this one, because I take a daily aspirin and already know the answer. It was front-page news in 1988 when colleagues of mine at Harvard Medical School reported the results of a randomized trial that found that a daily aspirin protected against heart disease. A simple, cheap, over-the-counter pill could protect against the No. 1 cause of premature death: heart disease (specifically, atherosclerosis of the arteries of the heart)? It seemed too good to be true.
DEAR DOCTOR K: I believe music helped my mother recover after her stroke. Is there a connection between music and health?
DEAR READER: The ancient Greeks certainly thought so: They put one god, Apollo, in charge of both healing and music. Recent medical studies seem to confirm what the Greeks thought. Music seems to slow heart rate, lower blood pressure and reduce levels of stress hormones. It can also provide some relief to heart attack and stroke victims and patients undergoing surgery.
DEAR DOCTOR K: Can you explain how high cholesterol causes a heart attack or stroke?
DEAR READER: Cholesterol is a type of fat that travels in the bloodstream. Our bodies need some cholesterol to survive. But high levels of cholesterol in the blood -- particularly low-density lipoprotein (LDL) cholesterol, or "bad" cholesterol -- increase your risk of cardiovascular disease.
DEAR DOCTOR K: My mother recently had a stroke, and it's severely impacted her ability to speak. What can be done to help her regain her speech?
DEAR READER: Losing the ability to speak, or to understand speech, takes away an important part of ourselves -- the ability to communicate easily with others. I would rather be blind or deaf than unable to speak or to understand others. But there is hope that your mother can improve.