Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Monday, November 28, 2016

5 Questions to Ask After a Heart Attack

Similar ones needed for post-stroke, but will never occur.
"Serious as a heart attack." That's a phrase we use to make it clear we're not joking around; that something shouldn't be taken lightly. And for good reason -- few things are as life-changing or invoke more fear than a heart attack. Heart disease is the No. 1 cause of death in America, and a heart attack is often the first signal that the heart is sick. Heart attacks kill more than 120,000 people annually in the United States. But, each year, another 635,000 people survive them.
For those surviving a heart attack, there is often little time to think about the diagnosis in the hospital and how it may change your life going forward -- you undergo a quick series of tests and procedures to preserve and protect your heart, and then you're home. It's really only after discharge that you feel the weight of living with this new diagnosis. It is very easy to let it make you feel limited -- but it doesn't have to.
There are many eager helpers to lead you toward recovery. Your clinical care team will work hard to get you on the right medications at the right doses to heal your heart. And by asking the right questions, you can help get yourself on the path toward getting back the parts of your life that are most important to you.
As a cardiologist, there are five post-heart attack questions I try to help my patients answer. By asking these questions, you can help your cardiologist help you on the road to recovery:
1. How can I get back to doing what I love?
There's an enduring myth that people who've had a heart attack need to fundamentally reduce the activity they do forever. This myth probably comes from a time when we had little to offer patients other than bed rest. Now, with excellent medications and early stenting, activity is an important part of the heart's recovery. Of course, you can't run a marathon right away. But you can slowly work toward whatever activity (running, biking or even gardening) gives you pleasure. What's important here is to tell your doctor what those things are, so we're all working toward the same goals.
2. Can I still eat an occasional doughnut or slice of pizza, or drink a beer once in a while?
There are many bad eating habits that contribute to heart disease, and a part of the recovery process after a cardiac event will be adjusting your diet to focus on fruits and vegetables and away from foods high in fat or salt. But the change in diet is forever, so it should not be so restrictive that it's unsustainable. I tell my patients that they should identify a time once a week for a "guilty pleasure." For some, it's a slice of pizza on Sunday. For others, it's an extra glass of wine with dinner on Friday night. Whatever your guilty pleasure, giving yourself the opportunity to enjoy it at a rare interval may help keep your diet in check over the long term. Of course, every clinical situation is different, which is why it is important to ask your doctor what guilty pleasures are safe for you.
3. What can my family, friends and colleagues do to help?
The village that supports us when we are sick is remarkable. Family members, neighbors and colleagues all want to help you get better. Helping them identify specific ways to contribute to your recovery will go a long way toward your well-being -- and theirs.
In general, I suggest three roles for your support group:
First, they should keep you honest. A healthier diet is extremely important, especially in the early phases after a heart attack. Changing habits is hard. Having the help of the people you eat with can make it much easier.
Second, they should keep you moving. Exercise helps the heart recover after a heart attack. Some even consider it as important as the medications you take to protect your heart. Keeping you motivated to move is a critical role.
Third, they should watch for the signs of depression. More than half of patients who have a heart attack will have some amount of depression in the three to six months after the event. It can be hard to see in yourself, but the people who see you every day may notice something. And if we notice it, we can treat it.
4. When can I travel?
Nothing makes us want to see the world more than being faced with the idea that we are not invincible. Most cardiologists will recommend you avoid air travel for about two weeks after receiving a stent. However, individual clinical situations and travel plans are so varied that it's impossible to give a one-size-fits-all response. A candid conversation with your cardiologist about the places you want to go and ways you hope to get there can help you understand the relative risks for you. In most cases, this conversation will result in more travel with less anxiety.
5. What can I expect long term?
Understanding the roadmap to recovery will help you set your expectations. Your specific health status and expectations will drive a personal roadmap. Discussing how often you should see your doctor; what check-ins are appropriate for email, phone or video; whether periodic testing is useful; and what is a reasonable expectation for your quality of life is critical to understanding your condition. And the better you understand your condition, the easier it is to get back to living your life.
The ultimate goal is to prevent heart attacks.(In stroke there are two ultimate goals, prevention and 100% recovery) But once they do happen, knowing what to ask is the first step to preventing a second one. Check with your doctor or visit the American Heart Association's website for more about life after a heart attack and how to connect with resources to support your recovery.
Ameya Kulkarni, MD, is a board-certified interventional cardiologist with the Mid-Atlantic Permanente Medical Group in the Washington, D.C., area. He serves as the group's assistant chief of cardiology for the Northern Virginia Service Area and is co-director of the Louise Olmstead Sands Cardiac Catheterization Laboratory at Virginia Hospital Center. Dr. Kulkarni has strong interests in the application of technology to medicine and treating adults with congenital and structural heart disease. He sees patients in the Kaiser Permanente Tysons Corner Medical Center in McLean, Virginia.

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