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Stroke-Free for Life - book   added 11/16/01

From the book's web page:
In his new book, Stroke-Free for Life, renowned neurologist David Wiebers, M.D. will help you assess your risk of stroke, then walk you through preventive methods.  The Stroke-Free for Life plan makes use of the entire array of stroke treatment and preventive options but also puts a strong emphasis upon a number of lifestyle modifications and how these can often eliminate or lessen the need for medication and surgery. Stroke-Free for Life presents this groundbreaking new paradigm for prevention to the public. If you've already suffered a stroke, Stroke-Free offers a plan that can significantly reduce your risk of having another. If you've never had a stroke, but are at high risk of having one, Stroke-Free offers informative steps to prevention. Even if you are currently at low risk of having a stroke, Stroke-Free offers a plan to help keep you at low risk for life. Published simultaneously with this website's computerized risk assessment program, it has the potential to greatly impact the diagnosis and treatment of stroke. This authoritative guide includes:

* A comprehensive way to assess individual risk --- Dr. Wiebers provides a thorough self-assessment tool to help readers determine their own risk, including questions concerning lifestyle, medications, neurologic and cardiac history, family history, and other medical conditions.
    They have an on-line Stroke Quiz http://www.strokefreeforlife.com/book/pre_test.html 

* A personalized plan for preventing stroke --- Dr. Wiebers offers a "risk factor-by-risk-factor Prevention Toolbox" - cross-referenced from the risk assessment quiz so readers can focus on those that apply to them - with detailed recommendations for reducing stroke risk.

* A life-saving strategy for emergency stroke treatment --- Dr. Wiebers provides readers with a need-to-know list of stroke warning and life-saving advice about what to do and where to go if stroke occurs, and an overview of new treatment options.

* A stroke survival manual --- the final section of the book is a hands-on guide for coping after a stroke, from dealing with insurance, to choosing and working with doctors and hospitals, to navigating the health care system.

Notes from book

- Ischemic stroke has a 20% mortality rate within the first 30 days.  
    Survival is about 65% at 1 year and 50% at 5 years
- 60% - 70% of ischemic stroke survivors has some disability immediately after the stroke
    40% at 6 months, and 30% at one year (page 12)
- Think of ischemic stroke as a siege of the brain.   (page18)
    When the blood is cut off to a portion of the brain it starves.
- Hemorrhagic stroke is more of a flood than a siege ( page 23)
- You don't fix a clogged pipe the same way you fix a leaky one (page 29)
Body Mass Index table in the back of the book is similar to many on the web,
   such as  http://www.shapeup.org/bmi/chart.htm

http://www.mayo.edu/cerebro/division/cv_staff.wiebers.html  - extensive
Authors home page at Mayo where has been th Chair of Cerebrovascular Diseases for the past 6 years (page 31)

Links at the book's web page includes a Brain atlas: 
http://www.strokefreeforlife.com/links.html  

See more on this book at Stroke Book - portions

Excerpt from     Chapter 2

The Anatomy of a Brain Attack: The ABCs of Stroke


In twenty-five years of medical practice, I've discovered that patients fear stroke more than any other illness, including cancer. In fact, medical surveys reveal that people are more fearful of being disabled by stroke than of death itself. They've seen how ruthlessly stroke can disable people's minds and bodies, robbing them of speech and cognition, of expression and movement, of control over their lives. They've watched as entire families have been devastated by this seemingly sudden medical event. And they've worried that the same thing could happen to them or to someone they love.

Fear is a double-edged force. It can either paralyze us in the face of danger, or it can motivate us to act to prevent catastrophe. Many patients who have come to me with prestroke symptoms have been motivated by their fear of impending stroke to turn around their medical conditions. I wish some of my other patients had developed a healthy respect for the destructive power of stroke before it affected them.

The facts about stroke are indeed frightening:
  • Stroke is the third leading cause of death and the leading cause of disability in the United States.
  • Ischemic stroke (the most common type of stroke, which I describe later in this chapter) has a 20 percent mortality rate in the first thirty days. Survival is about 65 percent at one year and 50 percent at five years.
  • Between 60 and 70 percent of ischemic stroke survivors have some disability immediately after the stroke, 40 percent at six months and 30 percent at one year.
  • Subarachnoid hemorrhage (one of two types of hemorrhagic stroke) has a 40 percent mortality at thirty days. About half of those who survive are disabled. Statistics for intracerebral hemorrhage (the other major type) are similar.
I hope that grasping the consequences of stroke will have a cautionary impact on your thinking and behavior. Some of stroke's effects resolve on their own and others can be reduced or eliminated through rehabilitation. But regardless of the degree of recovery, a brain attack is a traumatic medical and emotional crisis that we should all seek to avoid if at all possible. And in most cases, stroke can be avoided. The best defense against stroke is to understand what causes a brain attack, assess your individual risk factors, and take steps to reduce those risks.


THE EFFECTS OF STROKE

Part of why strokes are so frightening is that their effects are so wide-ranging. The middle-aged woman experiencing a sudden, severe headache and stiff neck, the older man who suddenly finds his right field of vision going dim, the pack-a-day smoker who wakes up and realizes that the left side of his body is weak or numb--they all have markedly different symptoms, but all may be experiencing stroke. Stroke's symptoms occur throughout the body, but stroke itself occurs in the brain. Stroke is essentially a brain injury--an injury caused by the damage or death of brain cells, or neurons. Its effects are so widespread because neurons are responsible for sending the messages that control nearly every function in the body.

Neurons require lots of energy to perform their many functions. Blood rich in oxygen and other nutrients to fuel the brain is delivered twenty-four hours a day via an elaborate system of blood vessels. All told, the brain, which makes up only 2 percent of the adult body's weight, receives about 20 percent of the body's oxygen, and 15 percent of the heart's output of fresh blood at rest, and, in the fasting state, consumes up to 100 percent of the liver's output of glucose or blood sugar. The brain does not store oxygen or glucose and cannot function when it is deprived of them. As a result, if the brain's blood supply is disrupted, even for a short period of time, brain cells can become injured or die, affecting the body functions for which they were responsible.


What Happens During a Brain Attack

During a stroke, the blood supply to a part of the brain is interrupted by a blockage of a blood vessel, or a rupture of a blood vessel, sending blood into brain tissue and injuring or killing neurons in that area of the brain. The damage that results depends on the cause, severity, and location of the stroke. A person who has had a stroke on the right side of his or her brain, for example, may have difficulty moving the left side of the body or may experience visual problems or problems with perception. Someone who has had a stroke on the left side of his or her brain may have difficulty moving the right side of the body or may be unable to speak or to understand spoken or written language. In other words, injury to the brain can have repercussions throughout the body--and beyond. In addition to causing paralysis and other physical symptoms, stroke can affect language and communication abilities, perception, emotions, thinking, reasoning, and memory. It can even alter personality.

THE PREVENTIVE POWER OF KNOWLEDGE

Stroke is often unforeseen and poorly understood--which is why our greatest weapon against stroke is knowledge. I hope the information in this chapter--and in this book--will demystify stroke and give you power not just over fear, but over stroke itself. As you learn about the mechanics of stroke and its underlying causes, you will see that it often is not the sudden occurrence it appears to be. You'll see that there are steps you can take to keep your life stroke-free.

Finally, I believe in educating patients because an informed patient is a better diagnostic and treatment partner for me. Despite all the advances we've made in stroke medicine in the past decades, so much of what we still do is wade through the unknown. Although I have a lot of technology at my disposal, my best source of information about any individual case is my patient. The better educated a patient is about stroke, the more I can learn from him or her in terms of personal history, signs, and symptoms.

My judgments, like those of any doctor, are based on a mix of hard data, past experience, and intuition. What I've learned is that better educated patients have more evolved intuition about their own bodies--which makes them more valuable allies in puzzling out their problems and deciding on treatment. Whenever I'm facing a difficult decision with a patient about what course of action to take, I listen to the patient's instincts about what his or her body needs. Being able to listen to and hear my patients is one of my most important faculties as a doctor. And giving them the information they need to express and articulate their symptoms, feelings, and even their hunches, is one of my most crucial tasks.