Guide to Cholesterol Lowering Drugs and Supplements

CholesterolDrugThe amount of medications prescribed after a stroke can be staggering.  Not only is it imperative to keep your blood pressure under control, but it is of the utmost importance to control your cholesterol, as well.  Cholesterol can cause plaques on the sides of arteries that can either decrease the size of the lumen or break off and block the artery deeper into the brain.  In either case, high cholesterol is a large risk factor for a secondary stroke.

To understand the medications, it helps to understand a little about cholesterol.  Three different types of cholesterol are talked about when you are trying to reduce your numbers.  LDLs or low-density lipoproteins should be as low as you can manage to make them.  HDL or high-density lipoproteins are considered helpful cholesterol and should be as high as you can manage.  Triglycerides are a special subset of cholesterol, and most medications aim to make them lower.  All medications affect these three metrics on some level, but some are more impactful than others are.

 

Statins

Statins are the most popular drug type used to reduce cholesterol levels.  In fact, they are among the most prescribed medications in the world.  Some examples include Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin), although there are many others.  These drugs work by lowering both the LDLs and the triglycerides.  Unfortunately, they do not have much of an effect on HDLs.  Muscle pain and weakness are the primary problems with statins.  It can lead to a condition known as rhabdomyolysis, but this is a very rare side effect.  However, simple muscle pain is quite common, and some herbal supplements, such as Coenzyme Q10, have been studied for their use in blocking this side effect.

 

Bile Acid Binding Resins

Bile acid binding resins are not used as often as statins, but they are still helpful in lowering LDLs.  If you find that you are not getting the therapeutic effect of the statins or the muscle pain is just too great, then these drugs may help.  Some examples include Colestid (colestipol) and

Questran (cholestyramine/ sucrose).  Usually, the side effects tend toward GI upset, such as nausea, vomiting, and diarrhea, but one troubling effect is that it can raise triglycerides.  If you take this medication, you may need to take a supplemental one to control this metric and possibly one to help raise HDLs.

 

Cholesterol Absorption Inhibitor

Another common medication prescribed for cholesterol is the cholesterol absorption inhibitor, the only one of which is Zetia (ezetimibe).  As with the other medications, this drug tends to significantly affect LDLs and can lower them well.  Unfortunately, it only has minor actions on HDLs and triglycerides.  This is why diet and exercise are important in cholesterol management to help these other metrics become therapeutic.  Vytorin is a combination drug of this medication and simvastatin.  Both drugs together can really improve LDLs, and the side effects of Zetia are nearly identical to the statins.

 

Fibrates

While other medications are great at lowering LDLs, fibrates are specialists in raising HDLs and lowering triglycerides.  For this reason, they are often prescribed with the statins, or possibly Vytorin, for LDLs that are far from therapeutic.  A few examples of fibrates include Lopid (gemfibrozil) and TriCor (fenofibrate).  Very rarely are these medications taken without a drug for LDLs, and this may help you understand your treatment plan with a bit more clarity.  Nausea and stomach pain can be side effects of this medication, but the one that causes the most concern is gallstones.  If your gallbladder has been removed, then you need not worry about this, but stomach pain in the right upper quadrant can indicate that you have this serious condition.

 

Niacin

A supplement that is often used in controlling cholesterol is vitamin B3 or niacin.  While you could dose yourself with niacin over the counter, more potent and more reliable preparations are available via prescription.  Niacin can help to decrease LDLs, decrease triglycerides, and increase HDLs, making it an all-around stand out in the cholesterol medication puzzle.  Some patients do experience side effects, particularly flushing around the face and neck.  Vomiting, diarrhea, blood sugar spikes, and peptic ulcers are also a possibility, although they are not generally seen.  This supplement is also combined with lovastatin to produce Advicor.  Taking this combination can attack the cholesterol metrics on all fronts and reduce your intake to one medication.

 

Omega-3 Fatty Acids

Finally, omega-3 fatty acids, found primarily in fish, have shown great promise in decreasing cholesterol levels.  While many patients simply increase their food intake of this nutrient, it is not often enough to control significantly increased cholesterol metrics.  Some patients take supplements of omega-3 fatty acids over the counter, but this can often lead to large pills, confusion on how much to take, and questions over the potency of the supplement.  For this reason, there are currently two prescription preparations of this supplement: Lovaza and Vascepa (Icosapent ethyl).  What many patients don’t realize is that this supplement really only lowers triglycerides.  You may need other medications to handle the other metrics.  Side effects are rare and mild, such as a fishy aftertaste, belching, and rarely an increased risk of infection.

 

References

http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/cholesterol-medications/art-20050958

What to Watch for When Caring for a Stroke Survivor

Daughter teaching her senior mother to use touchpad.When you decide to become your loved ones caregiver following their stroke, you are taking on a great deal of responsibility.  Whether they live in your house, their own house, or a facility, you need to know what possible problems to watch out for when someone recovers from a stroke.  Even in a nursing facility, some of these issues may be overlooked as staff do not know your loved one as well as you do.  Caregivers are vitally important in the care and recovery of stroke survivors, regardless of where they reside.

However, much more responsibility is yours when your loved one lives with you or lives independently.  When a stroke is over, that isn’t the whole story, and other problems can arise from the stroke survivor’s deficits or medical history.  You, as a caregiver, need to educate yourself on the basics of stroke rehabilitation and treatment to fully help your loved one achieve their best.  You don’t need to be a medical professional, but you do need to watch out for these four important considerations for stroke survivors.

 

Physical Safety

Your first concern for any stroke survivor is to check their physical safety.  In nursing homes, you should determine if there is enough care staff, if the floors are free of clutter, and if they are able to get around without the risk of falling.  Falling after a stroke is an enormous problem, and it can lead to further complications that may further debilitate your loved one.  Many nursing homes have policies in place to prevent falls, but you should do your part, too, in ensuring they are safe.

At home, the problem becomes more complex.  You have to ensure that your loved one can safely carry out the activities of daily living.  This includes cooking, toileting, and bathing – the three problem areas that tend to cause falls.  If they live on their own, it helps to watch them perform these activities.  If they live with you, you need to supervise them during any activity in which they could fall.  Even crossing the room could be hazardous if the floor clearance isn’t available.  You have to think ahead to ensure that your stroke survivor remains as safe as possible.

 

Depression

Depression is very common in stroke survivors, and it is more likely they will have it than not.  Sometimes the depression arises from grief over the loss of function.  If your loved one’s independence is severely hampered by their deficits, they can fall into a depression.  However, strokes themselves can alter brain chemistry and create depression even if the loss of function isn’t present.  For instance, a stroke survivor with mild impairments is still at risk for depression due to chemical changes in the brain from the insult.

Knowing the signs of depression is half the battle in treating it.  Sadness that lasts for more than two weeks or a funk that just won’t lift are signs that it may be setting in.  Hopelessness and helplessness are other signs that indicate your loved one is giving up.  Feeling like there is no use in trying to follow their medical regimen or expressing that they wish they were dead are more severe signs of depression.  Fortunately, this mood condition responds very well to treatment.  In addition to antidepressants, your loved one may benefit from talk therapy and discussing how the stroke has impacted their lives.  It isn’t a sign of personal weakness to have depression.  It is a condition like the stroke itself that has recognizable symptoms and effective treatments.

 

Secondary Stroke

The risk of a second stroke after an initial insult is quite high.  In many cases, the second stroke is often more devastating than the first one, injuring more brain tissue, and causing more severe deficits.  For this reason, it is important to do everything possible to prevent a second stroke.  This means paying close attention to the medications, diet, and rehabilitation of your loved one.  Medications can help lower blood pressure and cholesterol, and these can reduce the incidence of further stroke.

Diet is important, as well, because many foods increase blood pressure and cholesterol.  Following a DASH diet should be a priority for you as a caregiver to help control blood pressure and keep your loved one healthy.  Exercise in the form of rehabilitation is important, as well, as this can often help lower blood pressure and cholesterol organically.  It is important to be aware of the signs of a stroke – facial droop, slurred speech, and one-sided weakness – that indicate a second one is underway.  If your loved one already has some of these symptoms, you need to look for new symptoms or worsening of their current deficits.

 

Related Medical Problems

Other medical problems are often concurrent with strokes.  For instance, many strokes are caused by diabetes, and getting this condition under control can help to reduce secondary strokes.  In addition, diabetes can cause further health issues, such as blindness and kidney disease, that can make a stroke survivor’s care far more complicated.  If diabetes is in the mix, you need to ensure that the blood sugar is kept within normal limits and a diabetic diet is followed.

Heart and cardiovascular disease are also common in stroke patients.  If cholesterol caused a blockage in the brain, it stands to reason that one could occur in the heart, as well.  For this reason, it is important to keep track of your stroke survivor’s cardiovascular health.  You should be prepared for a possible heart attack and watch them for the presence of clots in their legs or lungs.  Heart disease is a primary problem in the population at large, but stroke survivors are at even greater risk due to their history of clots, problems with blood pressure, and general state of decreased health.  Stroke survivors need to be treated holistically to avoid problems with other, comorbid conditions.

Deciding to Become a Caregiver

caregiver1A stroke can explode into the life of a family like a nuclear bomb.  First, you have the worry over your loved one’s health, if they will even survive.  Once they are stabilized, you begin to worry about what their life will be like post-stroke, what changes it will mean for them.  Lastly, you start to worry about what those changes will mean for your own life.  Whether your loved one is a parent, a spouse, a sibling, or a child, you will have to develop a way to deal with the results of this devastating condition.

Nearly every stroke survivor needs a caregiver.  From those with minor deficits to those who need total care, someone has to step up and act as the caregiver for the stroke survivor.  This is a person who monitors the health of the survivor, helps them cope with their limitations, and provides assistance as needed.  Some people don’t even have to think about becoming their loved one’s caregiver, but this would be a mistake.  Everyone who faces the challenge of caring for a stroke survivor should consider the choice they are making.  Without reflection and conscious choosing, you may feel burdened, and that’s unhealthy for both you and your loved one.

 

Evaluating Your Loved One’s Needs

Your first consideration in taking on the role of caregiver is your loved one’s needs.  Some stroke survivors involve expert care that requires equipment and medical knowledge.  On the other hand, some stroke survivors only need help with speech and preparing meals.  Most stroke survivors fall somewhere on this continuum, and this is why you need to fully evaluate what they need.  Sometimes, you just cannot provide what they need.  This doesn’t mean that you can’t be their caregiver.  It only means that you will need help in taking care of your loved one.

When you evaluate your loved one’s needs, you have to question whether you will be able to keep them safe and healthy.  If they are a fall risk and you have multiple floors in your home, you may find that you don’t have the ability to care for them adequately.  Often, this is where in home health care and nursing home facilities are considered.  Although many caregivers swear they will take care of their loved one no matter what, you have to consider if your care is the safest, best care they can get.  You don’t want your loved one to suffer more harm because their care is simply beyond your ability.

 

Evaluating Yourself

Evaluating yourself may be the hardest part of deciding to be a caregiver.  Some people, when faced with a sick loved one, strong-arm themselves into the role of caring because they feel it is their duty.  Or maybe they feel that they love the person and loving means sacrifice.  The problem with either line of thinking is that they are not sustainable.  Duty will eventually turn to resentment and poor care.  Pure love will eventually lead to depression and despair when you find you are not cut out for the role that you have taken on.

If your loved one needs care, you need to seriously look at yourself.  What is your life like?  Do you have children, a job, a house to run?  Are you not a very patient person?  Are you someone who doesn’t understand or cannot stomach the realities of medical care?  All of these are important considerations when determining if you should be the caregiver.  It is not selfish to examine yourself and find that you simply do not have the skills.  No matter how much you may want to be the caregiver your loved one needs, you may just not be capable of taking care of them, no matter how hard you try.  Save yourself and your loved one a great deal of heartache by recognizing this before taking on responsibilities that you are not equipped to handle.

 

Making the Choice

Making this choice is not easy.  You have to weigh the responsibility and skills you need against your time and temperament.  In some ways, you have to look at what would be the best course for your loved one.  Would they benefit more from you caring for them in the home or from someone else in a facility providing the bulk of the care?  Many family members make promises about nursing homes, but these are not often realistic when the stroke occurs.  Some people don’t realize the constant, high-pressure care that may come from caring for a severely disabled stroke survivor.

As the caregiver, you have to make the best choice for your loved one.  You should also be aware that nursing homes are not the only option out there.  In home care, adult day care, and respite care are all possibilities that may help you care for your loved one and still get help.  The most important point to recognize is that you do not have to face the problem alone.  You also need to quickly jettison feelings of guilt over needing help.  Your loved one may be a complex case that even trained professionals struggle to care for.  If you are not up to the task, the best form of help you can give your loved one is to know your limitations.  That way, both you and your loved one will be healthy, safe, and happy.

Blood Pressure and Stroke: What’s the Connection?

blood-pressureYou may have heard all about your blood pressure from you doctor, but no one ever takes the time to explain what the numbers mean.  Furthermore, no one explains exactly how blood pressure affects the body or what connection it has with stroke.  In fact, it can cause two different types of stroke, and it is usually found with increased cholesterol, as well.  These two factors together increase the risk of stroke exponentially.

For this reason, it is important to understand what your doctor is communicating with you when they say your pressure is 120/80 or 190/110.  Understanding the reason high blood pressure is not recommended for an extended period will help you to navigate the methods of lowering your pressure.  Most high blood pressure can be lowered by diet and exercise, specifically by controlling the amount of salt, or sodium, in your food.  Sodium is not just typical table salt, but it is often found in large amounts in processed foods.  Medications can also help to lower blood pressure and protect your blood vessels from the dangers of a pressure that is too high.

 

Explaining Blood Pressure Numbers

The blood pressure is expressed by two numbers told in a fraction.  It is measured in millimeters of Mercury, or mmHg, and you will often see this designation following the pressure measurement.  The first number is called the systolic pressure.  It is the first one that is said and usually the higher of the two.  It measures the force of the blood against the walls of the arteries when the heart is pumping.  This is why it is higher.  The pressure the heart exerts on the system when blood is ejecting from the heart is much higher than when it is at rest.  A normal systolic pressure is less than 120 mmHg.

The second number, usually expressed as the bottom number of the ratio, is called the diastolic pressure.  This is the amount of pressure the blood exerts on the walls of the arteries when the heart is at rest.  Between each heartbeat, the muscle rests for a fraction of a second to fill the chambers, and this number measures how much pressure is in the system at this time.  For this reason, it is a much lower number.  However, it is more significant if you have a higher diastolic pressure than a high systolic.  If the pressure on the walls is high while the heart is at rest, this means the arteries are taking on increased pressure, leading to weakening of the walls and a decrease in the size of the artery lumen, or inner space.  A normal diastolic is about less than 80 mmHg.

 

Blood Pressure Ranges

The American Heart Association is very strict about their blood pressure ranges.  In the past, a blood pressure that was 130/85 would have been considered normal, but now this patient would be labeled as pre-hypertensive.  This is because of how important it is to control blood pressure, and even incremental increases in either number can be devastating for the cardiovascular system.  Systolic pressures of 120 to 130 are considered pre-hypertensive, and this will usually prompt your doctor to monitor your pressure, encouraging diet and exercise.  Systolic readings of 140 to 150 are considered hypertension type one.  Depending on other factors, you may need medication at this point.  Higher than 160 is considered type 2 hypertension, and it usually does require medication in addition to diet and exercise changes.  Any blood pressure over 180 is an emergency, and it requires medical intervention to lower, usually by intravenous medications.

The diastolic pressure is even more closely monitored.  Pre-hypertension is considered any pressure between 80 and 90.  However, many medical professionals will still consider a reading of 90 too high for this lower number.  Stage 1 hypertension for diastolic pressure is 90 through 99, and anything over 100 is considered hypertension stage 2.  As these numbers show, there is much less room for increased pressure in the diastolic range, and this is because the heart needs the rest provided during the diastolic phase.  When the pressure is too high, the heart cannot rest, and this can cause an abnormally enlarged heart, leading to heart failure.  Any diastolic pressure over 110 is considered and emergency and must be lowered through medications in a hospital.

 

Stroke and Blood Pressure Connection

High blood pressure is intimately connected with stroke for a number of reasons.  First, the higher the pressure on the system, the weaker the walls of the blood vessels become.  In the brain, many of the arteries are very thin and increased pressure means that they can burst.  This will cause a hemorrhagic stroke, or bleeding inside the brain.  It is not the most common type of stroke, but it is a serious danger and occurs with higher blood pressures.

High pressure can affect strokes in two other ways, as well.  Plaques of cholesterol can build up on the inside of the artery walls when your cholesterol levels are too high.  If you have high blood pressure, as well, the plaques can break free under the constant high pressure and block off arteries in the brain.  This is known as ischemic stroke.  Finally, high blood pressure means that the muscular walls of the arteries must work harder to eject blood into the tissue.  This causes the smaller arteries to build up thicker walls.  Unfortunately, the space for blood flow through these small vessels is limited, and any increase in vessel size can block off the small vessels of the brain.  This type of pressure-induced stroke usually occurs as transient ischemic attacks or lacunar strokes.  Although they are less severe than other types of stroke, they can cause deficits that impact the life of a stroke survivor.  For these reasons, it is important to control blood pressure precisely and keep it well within normal limits.

 

References

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#

Five Tips for Caregivers

CaregiverIf you have decided to care for your loved one who is a stroke survivor, you are probably wondering how best to approach the situation.  Besides making your house stroke survivor friendly, you need to cultivate certain mindsets that are going to help you overcome this challenge.  No matter the level of independence your loved one has, it will still be challenging for both you and them to adjust to the new lifestyle that is before you.  To this end, you should take these five tips from an experienced caregiver into mind when approaching your new responsibilities.

 

Cultivate Patience

You will need a wealth of patience to become a great caregiver.  Often, your stroke survivor will become frustrated with their new limitations, and they will not have the patience to continue on in the treatment.  You will also find yourself frustrated with them, with the situation, and with the constant pressure of caring for your loved one.  It is okay to feel like you are losing your patience.

Although you may want to allow your temper to flare, it won’t be helpful to you or your stroke survivor.  The best way is to let off steam to your spouse, your best friend, or a trusted professional.  A stroke survivor may be very sensitive to your moods, and they can tell when you are losing patience with them.  The key to cultivating patience is to put yourself in their shoes, realize that they are not being difficult on purpose, and have empathy for their struggles.  It isn’t easy, and it takes practice.  If you work at it, though, you may find you have more patience when caring for your loved one.

 

Develop Routines

Routines are soothing for both you, your stroke survivor, and your family.  Routines are a way of saying that everything is all right because everything is going as it should.  If you are in charge of a household, you probably already understand the magic of routines.  You get the kids ready for school, feed them, get them on the bus, and get ready for work.  The same sort of routines can help with someone who has suffered a stroke.

You should have set patterns for your stroke survivor, as well.  Dressing should occur every day, and you need to allow them to express their independence as much as possible.  Meals should occur at about the same time every day.  Believe it or not, these routines will not only help you remember the care you need to give to your stroke survivor, but they will help you both to relax knowing that nothing has been overlooked.

 

Seek to Understand

As part of cultivating patience, it helps to understand.  The first thing you need to understand as a caregiver is the medical side of the equation.  A working knowledge of what type of stroke occurred, what deficits are present, and what treatments are in progress is helpful in making the rounds to the various doctors.  You should also seek to understand the medications and diet restrictions that your stroke survivor has to follow.  When you understand how these treatments improve their health and prevent further strokes, you are much more motivated to help your stroke survivor follow a healthy lifestyle.

Another aspect of understanding is to understand where your stroke survivor is in their recovery process.  Imagine that you had the stroke.  Imagine that you can’t speak, can’t take care of yourself, can’t even clean yourself.  Imagine that you had to depend on someone else, someone you love, for the very basics of life.  That’s a difficult position to be in.  Although some cognitive issues do crop up with strokes, most survivors know what is going on and feel some shame and humiliation from needing help at all.  Try to understand what they are going through from their perspective.  Imagine how difficult it would be, and have compassion for their struggles.

 

Have Fun

You may not find anything about caregiving or stroke surviving fun, and this could severely impact how well you adapt to the caregiving role.  Some stroke survivors can still understand humor and jokes, but some are unable to.  That’s okay.  Tell a joke anyway and laugh.  That will lighten the mood for both of you.  One thing that isn’t hard to communicate is affection.  Hug you stroke survivor, cover them in kisses, or simply smile at them.  You can communicate a sense of fun and affection to just about any level of stroke survivor, and this can help to ease the tension of caregiving.

Another aspect of having fun is taking part in fun activities.  For instance, many stroke survivor groups go to the bowling alley for a game.  The put up the bumpers and have a special ramp for the ball to sit on.  The survivor pushes the ball down the ramp, and they can knock over pins.  Even caregivers and volunteers play, and everyone has a good time.  You can also include your stroke survivor in family activities, craft projects, and outings.  Sitting them in front of the TV isn’t fun for anyone and can lead to depression.  Remember that your loved one is capable of having fun, and you just need to modify activities for them to participate.

 

Ask for Help

Finally, asking for help is the best tip you can heed as a caregiver for a stroke survivor.  No matter how much you try or how easy you think it should be, everyone gets overwhelmed by the responsibilities that come with caring for any ill person.  Your first line of help should be your family.  Children, siblings, and other extended family members should be tapped at least once per week to give you a break.  Even some family friends are willing to come over to help out and give you a rest.

Sometimes, though, this is either not possible or not enough.  This is when professionals can step in to help.  Home health aides can come into the house and assist you with washing, feeding, or any other task.  Some insurance companies cover this, but some do not.  You do not necessarily need help every day, either, and you could possibly work out a budget.  Another possibility is respite care.  This is when your loved one enters a facility for a weekend or a few days to give you the chance to recover.  Adult day care is another way of getting help without fully resorting to a long-term care facility.  In the end, you have to ask for help because taking care of a stroke survivor is stressful.  It doesn’t mean you are a failure or that you love your survivor any less.  It simply means you’re human, and you need some help coping with something that is a difficult task for anyone.

Ways to Socialize after a Stroke

iStock_000017968604XSmallHaving a stroke can be isolating.  If you have a deficit in speech or trouble getting around, it is easy to just stay in the house and not socialize.  In fact, many stroke survivors find that they get depressed, and this keeps them from getting around people.  Some are very embarrassed by the way their body behaves now – such as being unable to control bowel or bladder and the need for assistive equipment – and this will keeps a stroke survivor chained to their homes. Continue reading

Quick Guide to Stroke Related Conditions

blood-pressureStroke can happen suddenly, but many times the condition arises from another long-term condition.  Everyone seems to know the connection between high blood pressure and strokes, but it isn’t the only way or the most common reason to have one.  Instead, problems such as atrial fibrillation, high cholesterol, and thrombosis, or clots, tend to cause far more stroke issues.  Although it is important to understand and control your blood pressure, it helps to know the other chronic conditions to take action against them.  Of course, if you’ve already had one stroke, paying particular attention to these on-going problems can help prevent a second stroke. Continue reading

Hobbies that are Stroke Survivor Friendly

Family Plays Video GamesWhen you’ve had a stroke, you may feel like you can’t do anything.  Instead of focusing on what you can do, you may tend to focus only on your deficits and the things you are unable to do.  Unfortunately, this can lead to depression, withdrawal, and sometimes thoughts of suicide.  While your medications and doctor appointments are vitally important, you should not ignore the leisure activities that are going to help you feel more like your old self.  The opportunities for hobbies are limitless, even if you have severe deficits.  With some modifications, many old hobbies and new interests can be shaped to your needs. Continue reading

Grieving the Loss of Function after a Stroke

elderly_2131816bEveryone knows you go through a grief process when you lose a loved one.  In fact, most people know that there are five stages to the process, the first being denial.  What many don’t know or understand is that grieving is a process we go through for many life circumstances.  For instance, losing a job, getting a divorce, or sending the kids off to college can elicit grieving feelings in the person who feels the loss. Continue reading

Caregiver Coping Methods

CaregivingMuch of the information you receive from doctors, therapists, and the internet focuses on the stroke patient.  Of course, understanding stroke and the needs of patients is vitally important, but the needs of the caregiver may sometimes be overlooked.  Many stroke victims return home after the initial rehabilitation has taken place, and a great deal of those patients may come home with significant deficits.  If the survivor can’t live independently anymore, sons and daughters usually end up taking care of moms and dads who’ve endured the catastrophic injury of a stroke. Continue reading