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How to Manage Your Coumadin

M_Id_238313_AspirinCoumadin is the brand name of this drug, but it is also known by its generic name, warfarin. If you are on either of these medications, then the rules of Coumadin apply to you. Sometimes, it can be difficult to get your Coumadin to the right level, but it is important to pay very close attention to your usage of this medication to prevent another clot. Of all of your medications post-stroke, this one is probably the most important and the one that needs the most follow up.


Taking Your Coumadin

You need to take your Coumadin every day, preferably at the same time. It is best to take the Coumadin in the morning because it will affect your blood tests by the next morning. This allows your doctors to get a good idea of how the medication is working when the medication is taken at the same time every day. You also need to be sure of the amount you are supposed to be taking. Some schedules call for different doses on different days. Some dosages are half pills, as well, so it helps to set out your Coumadin for the week in a pill reminder.

It does not need to be taken with food, but if it upsets your stomach, you may want to take it with breakfast. In fact, many of your pills may need to be taken with food, and it is okay to take the Coumadin along with those pills. Be sure to make changes in your dosage as ordered because it can severely impact the way your blood reacts. If you are too low, you may end up having a clot and possibly another stroke. If you are too high, you may be more susceptible to excessive bleeding.


Blood Work and Adjusting

One of the most difficult things for patients to accept about Coumadin is that you have to have blood tests done periodically. When first starting the medication, you may need to have a blood test every few days or every week to ensure that your levels are where they need to be. Once you are stabilized, then the blood tests usually scale back to once per month. The test you will have is called the International Normalized Ratio, or INR. Blood thinners don’t actually “thin” your blood, but they affect clotting factors measured by the INR.

In the past, prothrombin time, or PT, was used as an indicator of the clotting potential of the blood, but it is much more common to reference the INR. Still, you may see it called a PT/INR test. In a person not taking Coumadin, the INR is always 1.0 or close to it. If you take Coumadin, your INR will likely need to be between 2.5 and 3.5. However, this varies widely between doctors and your range may be different. It is important to know your INR to keep track of how you are doing with anticoagulation therapy. When the results come in, your doctor will adjust your dose up or down to keep your INR in the preferred range.


Lifestyle Considerations with Coumadin

Again, the lifestyle considerations that come with Coumadin make it less than attractive. Sometimes, it makes patients non-compliant, they don’t take their medicine, and end up having a second stroke. You first have to realize that you will bruise easily. If your Coumadin is very high, you might bruise at the slightest pressure. Even with therapeutic levels, though, you will still have bruising. You will experience longer bleeding times. If you get a paper cut to your finger, it will take a long time to clot over and finish bleeding. Of course, the bigger the cut, the more blood you will have to endure. If a cut won’t stop bleeding, you need to go to the emergency room for help because your INR may be too high.

Another side effect of an INR that is too high is blood in the stools. This will usually look like tar, and it is a sign that you are bleeding in your intestines. Again, this is an emergency that needs to be treated. It can descend into losing a great deal of blood, requiring a transfusion. You may also experience spontaneous nose bleeds. Nutritionally, changes need to be made, as well. Vitamin K will counteract Coumadin, so you need to control how much of it you eat. This vitamin is usually found in green, leafy vegetables, such as broccoli, kale, romaine lettuce, and greens, among others. Vitamin K can additionally be found in one-a-day vitamins, and you should check whether your vitamin has K in it.

Posted on April 24, 2015

Utensil Adaptations for Independent Eating

dreamstimefree_275635Most stroke survivors strive for independence regardless of their limitations after their incident. Being independent is a great way to combat depression, feel good about yourself, and take some of the pressure off your caregiver. Even if you can only do a few things by yourself, it is important to do those things and to try to do as many other skills as possible. Eating by yourself is often considered an essential exercise for most stroke survivors. Besides bathroom skills, eating by yourself is usually at the top of the list.

However, eating with one arm paralyzed or facial droop can make the act challenging. You may be surprised to know that several medical supply companies have developed specialized tools to help stroke survivors gain this piece of independence. Your best source of information for modifications in this area is your occupational therapist. They can help you develop the skills to perform the activities of daily living, such as eating. As a result, they are a wealth of information for the stroke survivor and caregiver. If your therapist has not already suggested the following modifications, it may be beneficial to mention them, emphasizing your desire for independent eating.



Tabletops present the first problem for stroke survivors who want to eat independently. Most tables are either too high or too low for independent eating. For instance, if you are in a wheelchair, you may not be able to comfortably reach the table with your legs underneath the tabletop. Similarly, with a low table, you may not be able to span the space between the table and your mouth. You should experiment with tables at different heights to find the best one for you. Low tables are best for those in wheelchairs and high tables are for those with weaker arms.

Another problem with tabletops is that they are often slick. Even with a cloth on the table, it is easy to push the bowl or plate around if you are only using one hand. In this case, a great piece of equipment called Dycem can help to keep the plate stable. It is essentially a piece of rubber that grips both the table and the plate. This allows you to put as much pressure on one side of the plate or bowl without it skidding out from underneath your hand. Some placemats may also help with this problem and help keep bowls from moving. Non-slip shelf liner is another possibility for keeping the plate stable.


Bowls and Dishes

Bowls and dishes can present a problem as well. It is easy to push food around the dish and straight off the other side onto the tablecloth. This is embarrassing as well as frustrating for the stroke survivor, but there is equipment that can help with this problem. Many dishes are on the market now that have a side of the plate curled upward. You can push the food against this wall, get the food on the utensil, and then lift it to your mouth independently. Of course, this is not fine china and is made of plastic, but it will allow you to eat by yourself without the frustration of migrating food.

Bowls can be difficult, too. It is easy to knock them over and cause a spill. Sometimes it is hard to eat the contents of a bowl, since they are liquid, but bowls can help with the migrating food issue. For stroke survivors, wide bottom, non-skid bowls are available that can keep them from tipping over. They taper toward the top, helping you to push food onto your fork or spoon. Bowls are a great alternative to plates because they often don’t result in spilling the food when they are of the proper, wide bottomed shape.


Forks, Spoons, and Knives

Finally, the forks, spoons, and knives you use can affect how independent you are with eating. Often, a traditional fork isn’t very useful. With hands that are crippled by contractions or paralysis, the simple act of holding one of these slender items is more difficult than any of the other problems. You should get utensils that have handles on them that can allow for a better grip. Sometimes, a widened, rubberized end to the fork or spoon can allow for enough bulk that you can use it yourself.

In circumstances when you are unable to use your hands in any controlled situation, there are forks and spoons that have handles and are bent. These utensils actually have a slot where you can fit your fingers in and aim the business end of the utensil at your food. This will help you to scoop up your food, despite how weak your arms and fingers may be. Most stroke survivors will be unable to cut their own food, and often caregivers have to help with this particular skill. However, if you eat items that don’t require cutting, it is possible to be entirely independent while eating, depending on the severity of your stroke.

Posted on April 17, 2015

FAST: Signs of an Oncoming Stroke

Whether you’ve had a stroke or worry about one coming on, you should know the signs of a possible stroke in progress. You can memorize a list of symptoms, but researchers have come up with an easier way to remember the most important signs of a stroke. They created the acronym FAST, which stands for face, arm, speech, and time. Remembering these four criteria will help you to know if a stroke is in progress. Even if you’ve had one stroke, it is important to know this acronym so that you can judge if a second stroke is affecting you. Secondary strokes are an important and dangerous consideration for stroke patients.



Facial symmetry can tell you a good deal about a person’s well-being. If you’ve had a stroke, you may already have some drooping or facial asymmetry. In an initial stroke, this is a primary sign that the person is having a stroke. You should ask the patient to smile and check if it is even. Have them stick out their tongue and determine if it stays straight or curves to the side. You may also want to survey the face to see if one eye is drooping lower than the other. Even with a secondary stroke, it is possible that the degree of facial drooping can become worse. Examining the face and noticing differences can mean the difference between a mild and severe stroke.



Another place to look for symmetry is in the arms. If you are having a stroke, one arm will be harder to hold up than the other. Even drifting or trending downward can mean that the paralysis is starting to affect the limb. Again, patients who have had a stroke may already have this symptom, but a secondary stroke definitely makes it worse. Have the person hold both arms in front of them and watch for drift or struggling to keep one arm up next to the other. In some cases, the arm may be completely flaccid and unable to move at all, and this is a sign that you need to get help. Arm paralysis is a number one sign of a stroke in progress.



Sometimes when the other symptoms don’t show any changes, you may notice a change in a person’s speech. It is very difficult to talk while having a stroke, and the words can come out slurred or completely garbled. Some stroke survivors have speech symptoms, but caregivers and survivors need to look for a worsening in the situation. Where once you may have been able to speak with a slight slur, a second stroke could make it completely impossible for you to talk. This is a very helpful way to know if you are having a stroke because speech takes a great coordination of muscles. When you are experiencing paralysis, it becomes harder to control those muscles, and that leads to slurred speech.



Finally, time isn’t so much a symptom as it is something that needs to be documented for the medical professionals. If you notice any of the above symptoms, you should note down the time they started. If you don’t remember the time they started, at the very least, notice the time that you became aware of them. This is because time is brain when it comes to stroke. The longer the symptoms have been progressing, the worse the severity usually is. In addition, certain medications, such as tPA, can only be used within a certain time frame after a stroke. By knowing the time the symptoms started, medical professionals can determine if they are able to use all of the therapeutic methods at their disposal.

If you notice any of these signs, it is important to get to medical help immediately. Don’t drive yourself or your loved one to the hospital. Call an ambulance, because, as mentioned, time is brain. In an ambulance, a great deal more can be done with a stroke victim, and it is capable of driving faster under emergency circumstances. You don’t have to be completely sure about your diagnosis, either. If you suspect that one or more of these symptoms is appearing, note the time, call an ambulance, and wait with your loved one until help arrives.

Posted on August 25, 2014

Cooking after a Stroke

Independence after a stroke is important to most patients who have had the condition. Even if you struggle to walk or to partake of the activities of daily living, you still want to be able to do for yourself. One way you can assert your independence is by cooking meals for yourself and others. Of course, this will depend greatly on you level of deficit, but even those who are severely impacted by stroke can find ways to make their own meals. People can certainly do this simple chore for you, but it helps your confidence to be able to be self-sufficient in at least one part of your life.



Safety is one of the most problematic blockages to cooking for yourself. Dealing with fire and the possibilities of burning yourself are real problems and should be addressed. If you have paralysis to any of your limbs, you can very easily burn yourself and not even be aware of it. For this reason, you have to keep track of your paralyzed limb. You should check it frequently during your cooking project to ensure that there are no red spots or blisters. Even taking something from the microwave can potentially cause a burn.

Another consideration is your ability to move about the space and use equipment. Many of the equipment for cooking can be modified to help you use them more efficiently. You will need to consider if you are strong enough to lift a pot or pan. If not, then you may need some help while preparing a meal. Similarly, if you can’t reach items, you may need help. Although you may not achieve total independence in the kitchen, you can still do most of the work of cooking with help at specific spots. This will still give you a great feeling of confidence and self-sufficiency in your life post stroke.



Even if you are in a wheelchair, there are modifications that can be made to kitchens that will allow you to cook. From dropped counters to short stoves, you can reach the appliances from a wheelchair in a modified kitchen. Some modifications are easy, but some are very expensive and not practical. For those who are not in a chair, you can used specialized utensils that allow you to work one handed. Usually, you can get them and learn to use this equipment through your occupational therapist.

Bowls and cups are often a problem as well, but you can modify them by purchasing modified bowls that are resistant to spillage. Cups with handles are another possible modification that can assist you in cooking for yourself. You may even need to use a magnifying glass to get a good look at the instructions on certain packaging. With a little ingenuity and the help of occupational therapy, you should be able to cook meals for yourself. While it is true that you may need a little help with moving heavy objects or reaching appliances, you can do a great deal of the work yourself if you try.


Types of Foods

Any food can be made by a stroke survivor, but there are certain ones that you should be careful of. The microwave is an easy way to make food, but the packaged foods are often high in sodium, which can make your blood pressure too high. In addition, you need to eat low fat to help protect your heart from clots, as well. If you are on Coumadin, you also have to be aware of foods high in vitamin K, such as green leafy vegetables, broccoli, and other foods.

With post stroke conditions, you may have to prepare foods that are of a particular thickness. Your fluids may have to be mixed with a thickener in order to keep you from inhaling liquid particles. Your food is definitely something that will change. If you have a mechanical soft diet, you will need to stay away from anything that is particularly crunchy or hard to chew. For those who need pureed foods, the use of a blender or food processor may be necessary. Even if you need these modifications, you can still make your food yourself. Follow the rules set down for you by your speech therapist and make your own food the best you can.

Posted on August 11, 2014

Parenting after a Stroke

Although stroke is often thought of as an older person’s disease, it can happen to people who are quite young. Whether it is from heart problems or a lifestyle that leads to stroke, many young people find themselves facing the consequences of this all too common problem. Even young mothers and fathers with small children can have a stroke, and this can make parenting challenging. However, it is not beyond your capacity to raise your kids and still deal with the consequences of your stroke. Whether you’ve had a mild stroke or something more severe, you can still be a part of your children’s life.


Explaining Limitations to Children

Kids are remarkably adaptable to situations, and they may become better adjusted to your limitations than you are. Your kids love you, and they want to accept that their parents just the way they are. Some limitations may frighten kids, such as facial droop, and this may take some time for them to get used to. You need to explain that it doesn’t change who you are or the love you have for your children. In time, most kids can accept anything when they see Mommy or Daddy doing their best.

You may also have to explain paralysis, wheelchairs, canes, and other problems that come along with stroke. Use simple words, depending on your child’s age, and present them in a non-threatening manner. You can even let them handle any equipment you use so that they see that it is not scary. Some kids will want to know why you had a stroke, and this can be tricky to explain to young kids. Do your best to explain to them the particulars of why you have this condition, but be prepared for the question as your child ages. They will want to know more as they begin to understand more.


Sharing in Your Child’s Life

No matter your limitations, you want to share in your child’s life. This means that you find ways to be there for them, be a presence in their life. No matter what your limitations, you can still find ways to be a part of your child’s life. For instance, many schools and parks are handicapped accessible, and this will allow you to join your child when they play. You should go to school functions, as well, just like any other parent. This will show your child that you care.

One problem you may encounter is the reactions of other children. Your limitations may embarrass your child or elicit remarks from other kids that are not complimentary. When you are alone with your child, explain that sometimes people who are different are treated poorly. It is more a reflection on the child and their upbringing when they say things about a child’s parents. If the teasing becomes a problem, you may want to speak to a teacher or someone higher up in the school about the harassment. Nowadays, bullying is not taken lightly, and you should get some response from the establishment.


Doing What You Can

You have to face your limitations and be realistic after a stroke, but that doesn’t mean you are not able to do anything. It is important to do what you can. Maybe you can’t run around in the park or chase your children, but you can be there for them. Sometimes children need someone who will listen to them, who will accept them unconditionally, and will show them love. Although you have limitations, that doesn’t limit the amount of love that you can show your child.

That isn’t to say that all you can give is love. Stroke survivors, depending on limitations, are often able to go bowling, go to the movies, and have fun at amusement park and carnivals. If you want to be a part of your child’s life post stroke, you have to accept what you can’t do, make it a point to do what you can, and let the rest sort itself out. Your child loves you, and if you do your best to help them understand, you will be surprised at how easy it is to raise a child with stroke limitations. Don’t be afraid to ask for help, either, as this is part of accepting your limitations. Sometimes you can’t do what your kids want, but you can arrange for someone to take them where you can’t.

Posted on August 5, 2014

Stroke Riskometer: A Helpful App for Assessing Risk

Mobile devices are everywhere these days, and many enterprising entrepreneurs have come up with apps that range from games to lifesaving information packets. Stroke is no exception, and one of the best apps on the market to assess your risk is the app Stroke Riskometer. Not only does this app help you determine if you are at risk for a stroke, but it also has valuable information on common medical problems related to stroke and how to recognize a stroke as it is happening. In addition, the app is free, so it really is a no risk proposition to use this program.


Download and Setup

Installing this app is very easy. You simply go to the app store from your mobile device and plug the name into the search bar. You can use this app on both your iPad and your iPhone, in addition to other devices. When you get to the Stroke Riskometer screen, you can see the specs for the app and the basic information about what the app does. It is 38 MB, so you may want to download it while you are on a WiFi connection instead of 3G to save on data transfer rates.

Once you are sure you are able to download the app, simply press the download button, and the app will be delivered directly to your device. It usually only takes a few moments, and then you are able to use the program. Launch it from your main screen, and you will see the blue background. Overall, the graphics are slick and very professionally done. They make the experience of using the app very pleasant, and it is much easier than some of the online risk assessment tools. If you are familiar with apps, it is definitely worth downloading this one to assess your risk for stroke.



The usage of this app could not be simpler. It will start by asking your age, you sex, and your blood pressure. It’s okay if you don’t know your exact blood pressure, but you should know this information if you are at risk for a stroke. Put in the value that you remember from your last physical. The next questions will ask you about your waist and hip circumference. Most people don’t know this information, but you can easily obtain it with a soft measuring tape. However, the program does allow you to bypass these questions with an “I don’t know” option.

The rest of the questions focus on different medical problems you may have in your history. For instance, it asks if you have atrial fibrillation. This is an important condition when considering stroke, and it will go a long way toward determining your risk. However, some may not know what the condition is. In this case, you can press the help button and it will explain the condition to you. Other questions include lifestyle choices, such as how many fruits and vegetables you eat per day and how much exercise you complete per week.


Extra Features

Once you have completed the test, you will get a very nice looking graphic that details your stroke risk. It looks somewhat like a speedometer, and you can tell your risk by where the needle points on the compass. A great option with this app is that you can email your stroke risk to whomever you want. You can email it to a doctor or nurse, but these connections are often hard to make. It is best to email it to yourself, print it out, and take it along with you when you go to the doctors.

In addition, the Stroke Riskometer also has information on how to recognize stroke when it is happening. It goes over the FAST acronym and tells you what to look for. The F stands for facial drooping. The A stands for arm strength, and the S stands for slurred speech. Finally, the T is a reminder to note the start of the stroke for treatment purposes later on. By using this app, you can quickly and easily assess if you or another person is having a stroke. This app is highly recommended for its professional design, its insightful questions, and its wealth of information.


Google Play | Apple App Store

Posted on July 30, 2014

Atrial Fibrillation: What Stroke Survivors Need to Know

Atrial Fibrillation, or afib, is a common cause of strokes, and you may not even realize you have it. It is a disorder of the heart that causes the upper chambers to quiver like jelly. When they quiver, they cannot pump blood as effectively, and this can lead to clots. When the lower chambers of the heart, the ventricles, fibrillate, the person goes into cardiac arrest. The upper chambers, or atria, are not as crucial, but when they do not pump properly, heart problems and stroke can follow. You may have been told that afib is the cause of your stroke, so it is important to know as much about it as possible.


The Connection between Atrial Fibrillation and Stroke

You may wonder how a problem in your heart can lead to a clot in your brain, and you would be right in doing so. When the atria are unable to pump, the blood pools in the chamber, never getting fully ejected. As you may know, whenever blood stands still, it starts to form clots, and these can build up in the atria without your knowledge. At some point, the clot is ejected from the chamber. Either it stops fibrillating momentarily, or the clot is simply pushed through with the rest of the blood.

Once this clot is ejected into the heart, it can go anywhere. In fact, one place it can go is the coronary arteries and cause a heart attack. Another option is for the clot to travel up through the carotid arteries and into the brain, causing a stroke. Either option is a possibility, and neither one is healthy for a patient. Sometimes the clots caused by afib are smaller ones and can lead to less severe strokes. However, long untreated afib can form quite a large clot, and this can lead to severe impairment. Fortunately, afib is treatable.



Most people who have afib don’t realize it, and that’s why a stroke can come seemingly out of nowhere. If you were to take your pulse or have your doctor listen to your heart, you would notice that the beats are out of sync. Afib is an arrhythmia, which means the heart doesn’t beat on the rhythm it is supposed to. At lower rates, it is easy to miss the extra beats that afib sometimes presents as. It is only when you are examined by a doctor that afib can be found.

In some cases, the afib may be rapid. You would feel palpitations in your chest, chest pain, and faintness. This is relatively rare, though, and the slower beats are much more common. With rapid afib, you will experience some severe heart problems, shortness of breath, and other problems that will compel you to visit a doctor. The real problem is the afib that isn’t detectable by symptoms. It is this form of afib that tends to lead to strokes, but even if you have no symptoms, afib needs to be treated.



There are two steps to treating afib. One is anticoagulation and one is rate control. When you have a stroke, you are going to need anticoagulation therapy, anyway, regardless of the reason you had the stroke. This means that you will be placed on heparin in the hospital and then slowly introduced to Coumadin or warfarin. The medication takes a little while to become therapeutic, and you will need to get regular blood tests to ensure that it stays in the safe range. Failure to check you warfarin level could mean that another clot forms and leads to a secondary stroke.

The second prong of afib treatment is rate control. Medications, such as Cardizem and Amiodarone, can help to control rapid afib and sometimes convert the rhythm to normal. In some cases, your cardiologist may want to do everything possible to convert the rhythm, and this means that a cardioversion may be attempted. Under sedation, the heart is shocked to attempt to restore normal function. It isn’t always successful. Another way to treat this rhythm is to have an ablation done. This is usually conducted through a cardiac catheterization, and it centers on cauterizing the cells in the heart that are causing the bad rhythm. This is usually an outpatient or short stay procedure, using only small access through the artery that runs in the groin.

Posted on July 22, 2014

A Beginner’s Guide to Dysphagia

One of the most common side effects from stroke is dysphagia, but it may be difficult to understand if you’ve never heard the term before. Dysphagia means difficulty swallowing. To swallow, your muscles and throat must complete a complex set of maneuvers to protect your windpipe and allow the food or liquid to make it into the esophagus and stomach.

When you have a stroke, some of the nerves that control this function no longer work, and this means that your windpipe has no protection from incoming foreign objects. Dysphagia can affect stroke victims with varying severity, but it is important to always follow swallowing precautions when you have this condition.


Testing and Screening

Before leaving the hospital, most stroke survivors will be tested for swallowing difficulties. In fact, they may be NPO, or nothing by mouth, until the test has been performed, and this can be frustrating for stroke patients. If they were to eat or drink something, however, the food could go into the lungs and cause a severe case of pneumonia. In addition, choking and coughing can block off the airway, leading to respiratory arrest. There are many risks involved in eating or drinking outside of the dysphagia rules for your particular condition.

The test for dysphagia is performed like an x-ray. Usually, a speech therapist will evaluate you and then will look at the results of the test. It is generally called a cookie swallow, although it may have other names. In essence, the stroke survivor takes a bite of a piece of cookie, chews it, and swallows. While this is performed, special moving x-rays are taken that watch the mechanism of swallowing. It is from this test that the speech therapist determines what level of dysphagia precautions a stroke survivor needs.



There are a number of risks associated with dysphagia. The most immediate risk is of choking. In fact, eating or drinking items outside the dysphagia plan can lead to a completely blocked airway, the need for the Heimlich maneuver, and possibly respiratory arrest. Although some stroke survivors hate their dysphagia restrictions, the risks of disobeying them are quite severe and can even lead to death if the piece of food is unable to be dislodged. At the very best, it could lead to a scary moment for everyone involved as the food or drink is cleared. At worst, it can mean a trip to the hospital and the intensive care unit.

Another, less immediate, risk of dysphagia is pneumonia. Large pieces of food cause choking, but it is the small pieces and the bits of fluid that can cause pneumonia. This risk factor can sneak up on a stroke survivor who thinks they are getting away with not following their dysphagia precautions. The introduction of foreign material into the lungs means that infection can begin to brew. These infections are often very difficult to treat and can lead to another stay in the hospital. It is easier, safer, and much more convenient to just follow the dysphagia protocols.



Unfortunately, the only treatments for dysphagia are the precautions that are outlined by your speech therapist. You will have two precautions to follow: one for liquid and one for food. Your liquids will be made in a thicker consistency, depending on how severe your swallowing problem is. It can be anywhere from nectar – which is just a little thicker than water – to pudding thickness. Sometimes this can discourage a stroke survivor because it is difficult to quench the thirst with thickened liquids. In some cases, you can substitute lemon ice to help aide in swallowing and help quench that feeling of thirst.

Similarly, your foods will have to be prepared in a special way, depending on your ability to swallow. Most stroke victims are able to use mechanical soft precautions. This generally means that you can’t have anything that requires a great deal of chewing. At the extreme, pureed foods are for those that have a severe problem swallowing. Again, these restrictions can frustrate the survivor who is unable to eat the foods they want. If you have a severe swallowing problem, though, you have to weigh the indulgence in foods against the risk of winding up in the hospital again. Usually, with some creativity, even a pureed diet can be made to be palatable and tasty. Don’t give up on your precautions if you are frustrated, but find ways to make them work for you.

Posted on July 15, 2014

How to keep your spirits up post stroke

When you are trying to live with your new abilities post stroke, it may get you down. In fact, depression is a common side effect of a stroke, so it is important to focus on keeping your spirits up and monitoring for any signs of clinical depression. You may not feel much like laughing or enjoying life anymore, but that is only going to make matters worse. Like any other rehabilitation, you need to work with your mood to increase your happiness factor. You need to find a way to keep the depression at bay with a few simple tools.

Family and Friends

Isolation can make you feel worse than the stroke itself. Even if you are taken care of by family, you still need to get out and see your own friends. Stroke support groups are great for this sort of social interaction, and even some internet support groups can help with feeling your best. It may be difficult to get family to spend time if their schedules are hectic, but strive to find ways for them to get together. Also, look up old friends from before your stroke and get together with them. Sometimes, people think they are being bothersome when you really want the company. Do what you can to connect with people, friends, family, and support group participants.

Change Focus

So much of post stroke therapy focuses on what you are not able to do. It can feel like you can’t do anything, and that can be depressing. You need to change your focus onto the things that you can do. Very few strokes take all abilities, and you may still be able to do quite a bit that other stroke survivors cannot. In addition, as you rehab, you will gain skills that you may have thought were completely lost to you. The trick is to focus on an attitude of gratitude. You will feel better if you are thankful for the skills and the positive things in your life that you do have. Focusing on the negative will only lead to more negativity and sadness.

Funny Stories and Jokes

The world is full of things to make you laugh. Lose yourself in a silly television comedy. Read the funny pages, and look up jokes on the internet. By allowing yourself to laugh and seeking out comedy, you give yourself permission to feel good again. Maybe you have a favorite movie that always makes you smile or maybe you like telling jokes. It is important to tap into the humor that makes you human again. It may have been ages since you laughed, and that can keep your spirits low. Make a point every day to find something amusing and laugh about it. Even if it is silly, it will help to improve your mood.

Getting Out and About

In addition to getting out with friends and family, you need to get out of your house. Even if it is just a walk around the block, getting out will help to improve your spirits. You should try to go on as many day trips as possible, especially those that are through stroke survivor groups. Again, isolation can make you feel sadder about your situation, and getting out of the house allows you to focus on something else. You need to get away from the daily grind, like a mini vacation, to allow your mind the chance to rest. If mobility is a problem for you, discuss going on trips with your caregivers. Many places are handicapped accessible now, and that means that anyone can enjoy a trip to the mall, the park, or the movies.

When You Need Help

When does sadness become depression? It is actually very easy to tell when simple sadness leads to a clinical problem. Most people will feel down for an extended period, usually more than two weeks. You will experience a sense of hopelessness and helplessness, and these make you feel even worse. The above mentioned tips will not help you to move from your depression, either. One of the most severe signs is a willingness to die, suicidal thoughts, or giving up on life. If you feel any of these emotions, then you could very well have clinical depression. The good news is that depression is very treatable. It isn’t a character flaw, but a chemical imbalance in the brain, usually brought on by the stroke. Don’t hesitate to ask for medications to help you regain your happiness and enjoy life again.

Posted on July 8, 2014

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 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.



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.



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.



Posted on April 14, 2014

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