What can be done to help my mother regain her speech after a stroke?

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. But there is hope that your mother can improve.

Is it possible to treat depression caused by a stroke?

DEAR DOCTOR K: My mother had a stroke that weakened one side of her body. But the bigger problem right now is her depression. Can that be treated, or is it caused by irreversible brain damage from the stroke?

DEAR READER: Strokes can cause significant problems. People can have difficulty moving (like your mother). They can have trouble speaking or understanding speech. They can have trouble thinking. Being suddenly hit with any or all of those losses would depress anyone -- including people who never suffered from depression before.

Why am I still experiencing pain six months after my stroke?

DEAR DOCTOR K: I've been in pain ever since I had a stroke about six months ago. What will relieve it?

DEAR READER: Pain is a frequent complication of stroke. It generally falls into one of two types, local or central. Local pain results from joint and muscle problems. Strokes can make some muscles weak and stiff. That, in turn, can make the muscles hurt when they move (or are moved). It also can cause the bones in a joint moved by those muscles to shift out of their proper place, producing pain in the joint.

Choosing your stroke rehab team.

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.

Why do you need rehab after a stroke?

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.

My wife had a mini-stroke. Can she have an angioplasty to open the narrowed brain artery?

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.

What is a TIA?

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.

What are the warning signs of a stroke?

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.

Do women need to take special precautions to prevent a stroke?

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.

Are there risks of taking a daily aspirin to reduce the risk of a heart attack or stroke?

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.