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Summer 2013

STROKE the

CLOCK is

TICKING

CALL 911 every minute counts


STROKE Publisher Melvin Miller Health Editor Karen Miller Executive Editor Howard Manly

Stroke Strokes still largely misunderstood.......................................4 Signs and symptoms............................................................... 5 A Closer Look......................................................................... 6 The Terrible Aftermath..........................................................8

Art Director Marissa Giambrone

Healthier habits reduce stroke risk factors............................10 Risk Factors............................................................................ 11

Proofreaders Rachel Reardon Martin Desmarais

Q&A with Dr. Thabele Leslie-Mazwi......................................12

For advertising opportunities Please contact Karen Miller at (617) 261-4600 or kmiller@bannerpub.com. Be Healthy is published by Banner Publications, Inc. Volume 1• Number 2 Summer 2013 Photo from front page: iStockphoto/Thinkstock Be Healthy is printed by Cummings Printing 4 Peters Brook Drive P.O. Box 16495 Hooksett, NH 03106 603-625-6901

In a Flash.............................................................................13 Fletcher “Flash” Wiley’s Story Reducing stroke impact requires quick thinking....................14

Healthy steps Smoking..............................................................................16 Healthy Eating: Potassium............................................................................... 18 Moroccan Chicken.................................................................. 19 Strengthening exercises.......................................................20 One garden at a time...........................................................22

LOCATION, LOCATION, LOCATION Studies suggest that patients who have suffered a stroke have better outcomes when treated at primary stroke services hospitals. To find out which hospitals in Massachusetts have made the list, visit www.Mass.Gov and search for “designated primary stroke services hospitals.”

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STROKES STILL

LARGELY MISUNDERSTOOD DESPITE OFTEN DEBILITATING, DEADLY CONSEQUENCES deposits, or plaque, in the vessel wall. Over time the plaque can grow large enough to narrow the artery, causing the blood to flow abnormally — if at all. The second type is called hemorrhagic stroke and occurs when the walls of a weakened artery rupture and cause bleeding in the brain. This kind of stroke is often triggered by high blood pressure. Although they constitute only about 13 percent of the cases, hemorrhagic strokes account for more than 30 percent of all stroke deaths, according to the American Heart Association (AHA).

Natalia S. Rost, M.D., M.P.H. Associate Director, Acute Stroke Service Massachusetts General Hospital

O

ne would think that a disease that strikes every 40 seconds, kills 133,000 people a year and disables thousands more would get a little more attention. Yet, stroke, the overall fourth leading cause of death in the United States, remains an enigma. Commonly known as a brain attack, stroke is a complex condition with a wide array of consequences that can permanently change a person’s physical and emotional well-being. There are two types of stroke. Ischemic stroke is the most common with roughly 87 percent of the incidences. This type of stroke is caused by a blood clot that cuts off the blood supply to the brain. One of the biggest culprits is atherosclerosis — fatty

4 Be Healthy | Stroke

Strokes start suddenly and without warning. “One minute you’re fine. The next you’re having trouble with your vision.” — Natalia S. Rost, M.D., M.P.H. In both types the brain is robbed of much needed oxygen and nutrients, and if left untreated, can cause irreparable damage. The AHA estimated in 2010 that the direct and indirect cost of stroke in the United States was almost $74 billion. And strokes are not one-shot deals. Having one stroke increases the risk for another. Of the 795,000 strokes that occur each year, almost one-fourth are recurrent. Regardless of the type, stroke can leave significant damage and is the nation’s leading cause of disabilities. The impairments depend on the severity of the stroke and where in the brain it strikes. Common consequences are partial paralysis, difficulty seeing, changes in behavior, reduced ability to speak and comprehend speech and memory loss.


Although anyone is a potential target, the typical patient is male, older than 55, or has a family or individual history of the disease. Blacks are impacted disproportionately by stroke and are twice as likely as whites to be afflicted. Minorities are also targets at a younger age. In Massachusetts, roughly one-third of the deaths from strokes in blacks and Hispanics occur before the age of 64, compared to only 8 percent in whites, as noted in Massachusetts Deaths 2010, a report published by the Massachusetts Department of Public Health. While stroke has fallen to the fourth most common cause of death for most in this country, it still remains the third leading cause of death among blacks. So common is this condition that a swath of Southeastern states (Alabama, Arkansas, Louisiana, Mississippi, North Carolina, South Carolina, Georgia and Tennessee) with large black populations is aptly called the “stroke belt.” It is the stroke belt that intrigued researchers at Ohio University’s School of Public Health Sciences and Professions. They conducted a survey of African American residents of Mississippi aged 18 to 74 to determine their awareness of stroke, including symptoms and risk factors. Only one-fourth of those surveyed could correctly identify the five warning signs. Worse news is that 17 percent could not identify any. Even worse, the respondents were unaware of the risk factors that can precipitate stroke. While most cited high cholesterol and smoking as factors, more than half failed to recognize lack of physical activity, excessive alcohol consumption and diabetes as causes. Decreased awareness is not confined to the stroke belt. Several years ago, the Centers for Disease Control and Prevention (CDC) sponsored a study in 13 states and the District of Columbia to examine people’s awareness of the warning signs of strokes and the importance of seeking emergency care. The CDC found that awareness varied by race, gender and educational status. Whites, females and more educated people were more likely to be aware of warning signs and more likely to call 911. But overall, the results of the study were not good. Not even half of those interviewed could name the five major warning signs of stroke. Only 60 percent cited the headache as a warning of stroke. More puzzling is that 40 percent of the respondents incorrectly identified sudden chest pain as a symptom. Chest pain is attributed to a heart attack, not a stroke.

Continued to page 6

SIGNS AND SYMPTOMS Almost 2 million brain cells die each minute a stroke goes untreated. It is important to recognize the signs of a stroke in order to seek immediate emergency care. If your stroke is caused by a clot, you may benefit from a medication that breaks up the clot and reduces the long-term disability associated with stroke. But you have only three hours from the onset of your symptoms to receive the clot-buster.

CALL 911 SHOULD YOU EXPERIENCE:

 Sudden numbness, weakness or paralysis of the face, arm or leg, usually on one side of the body.  Sudden confusion or trouble speaking or understanding speech. For instance, slurred speech or speaking gibberish.  Sudden trouble seeing in one or both eyes. Some people become blind in one half of their visual field.  Sudden trouble walking, dizziness, loss of balance or coordination  Sudden, severe or unusual headache with no known cause

You don’t need to experience all the symptoms to suspect a stroke. Any one symptom can be an indicator of a stroke Call 911. Source: American Stroke Association

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STROKES continued from page 5 Though the death rate from stroke is falling, Dr. Natalia S. Rost, associate director of the Acute Stroke Service at Massachusetts General Hospital, is not leaping for joy just yet. Survival rates have improved largely due to advanced medical techniques rather than from control of risk factors. There are five major symptoms of stroke: one-sided weakness, trouble speaking, trouble with vision, loss of balance or severe headache with no known cause. But Rost warns not to wait for all to occur before seeking medical help. The five symptoms do not have to occur in unison to cause concern. “Even a single sign is worrisome,” she said. Strokes start suddenly and without warning. “One minute you’re fine,” Rost explained. “The next you’re having trouble with your vision.” Some experience transient ischemic attacks (TIAs), commonly called mini-strokes. In a TIA, a person can experience one or all of the symptoms of stroke. The symptoms typically last a few minutes and then subside. That does not mean that you have dodged a bullet. People should consider TIAs as a warning. Up to 40 percent of all people who suffer a TIA will go on to experience a stroke, according to the National Stroke Association. Treating strokes is a matter of timing. Those with ischemic strokes may be eligible for treatment with a clot buster called tissue plasminogen activator, or tPA, that helps re-open the vessel. But for optimal results the drug has to be administered within three hours of the onset

of symptoms. A select few may still benefit after four-and-a-half hours. “They have a better chance of recovery,” Rost explained. “Within three months patients who received tPA have better outcomes.” Timing is not the only factor. The hospital of care is important as well. The Joint Commission is a nonprofit organization that accredits and certifies health care organizations and programs in the U.S. The Commission, as well as individual state health departments, have designated certain hospitals — Massachusetts General Hospital, for example — as primary or certified stroke centers. These hospitals are better staffed and equipped to diagnose and treat strokes more effectively. Some research has shown that patients treated at approved stroke centers experience better outcomes. Furthermore, those who are eligible for tPA treatment are more apt to receive it at these centers. The good news is that stroke is largely preventable. The culprits that increase its risk are high blood pressure and high cholesterol, obesity, diabetes, inactivity, smoking and heavy drinking. With increased awareness and effective treatments, the incidence should drop. That’s when Rost will leap for joy.

JUST 15 MINUTES

Researchers at the University of California, Los Angeles, recently found that for every 15 minutes faster that treatment with tPA for a stroke is received, a patient’s likelihood of discharge home improves by 3 percent and the likelihood of walking at the time of discharge improves by 4 percent. More significantly, death is 4 percent less likely.

A CLOSER LOOK Image courtesy of the National Institute of Neurological Disorders & Stroke

TWO MILLION BRAIN CELLS … AND COUNTING In an ischemic stroke (on the right) a blood clot blocks the flow of blood in blood vessels feeding the brain. The underlying condition for this type of obstruction is the development of fatty deposits lining the vessel walls. In a hemorrhagic stroke (on the left) a blood vessel bursts, causing bleeding in the brain. In both types of stroke, the brain is robbed of oxygen and nutrients causing the cells in the brain to die. It is estimated that two million brain cells die every minute during a stroke.

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THE

TERRIBLE AFTERMATH The effects of a stroke depend on the location of the obstruction and how much brain tissue is damaged. Every stroke is unique. Although any section of the brain can be targeted, most often the destruction occurs in the left or right side of the brain. One side of the brain controls the opposite side of the body. But one-sided weakness is not the only aftermath of a stroke. It can impair reasoning, emotions, perceptions and memory. Below are some examples.

RIGHT BRAIN

LEFT BRAIN

• Weakness or paralysis on the left side of the body and face

• Weakness or paralysis on the right side of the body and face

• Decreased feeling or sensation on the left side of the body

• Decreased feeling or sensation on the right side of the body

• Vision problems, which may include loss of vision on the left side of both eyes

• Vision problems, which may include loss of vision on the right side of both eyes

• Lack of awareness of impairment (left-sided neglect) • Behavioral changes, such as impulsivity and inappropriateness • Decrease in judgment, problem solving and decision making • Memory impairment

• Problems with speech and understanding language • Behavioral changes, such as cautiousness and hesitancy • Impaired ability to organize and reason • Memory impairment Photodisc/Thinkstock photo

8 Be Healthy | Stroke


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Being overweight or obese is the second leading preventable cause of death in the United States — and moving up fast.

READ MORE IN THE FALL ISSUE OF BE HEALTHY. To advertise, contact Karen Miller, Health Editor, at 617-261-4600 x 7800 or kmiller@bannerpub.com. behealthy.baystatebanner.com 9


HEALTHIER HABITS

REDUCE STROKE RISK FACTORS

S

omeone dies of a stroke every four minutes. Those who survive often spend a lifetime of disability and loss of independence. Yet, according to the National Institute of Neurological Disorders and Stroke (NINDS), an arm of the National Institutes of Health, 80 percent of strokes are preventable. ​Some risk factors for the condition cannot be controlled. Age, gender, race and family history are unchangeable. Other factors, however, can be modified by medical treatment or avoided altogether. ​By far, high blood pressure, or hypertension, the biggest contributor to stroke, is controllable through medications and healthy lifestyles.

​NINDS indicates that high blood pressure causes a two- to four-fold increase in the risk of stroke before age 80. ​Dr. Natalia S. Rost, associate director of the Acute Stroke Service at Massachusetts General Hospital, agrees. “There is ongoing damage to vessels in untreated high blood pressure,” Rost explained. Health professionals prefer a pressure that is 120/80 or less. “We now know that there is low impact damage even when blood pressure is only slightly higher than it should be,” she said. ​This is not good news for African Americans, 40 percent of whom are afflicted. Not only is the condition more severe in blacks than in whites, it develops earlier in life and is less likely to be controlled.

Although stroke is one of the leading causes of death in this country, it is largely preventable. Listed below are risk factors of stroke and the recommended readings to minimize the probability of a brain attack.

BLOOD PRESSURE

BLOOD GLUCOSE

CHOLESTEROL

SMOKING

HEALTHY EATING

DRINKING

BODY MASS INDEX (BMI)

WAIST CIRCUMFERENCE

EXERCISE

Normal: Less than 120/80

Never

18.5 - 24.9

10 Be Healthy | Stroke

Fasting: Less than 100 Random (after eating): Less than 140

At least 5 or more servings of fruits and vegetables each day

Women: under 35 inches Men: under 40 inches

Total: Less than 200 HDL: “Good” Cholesterol Males: 40 and above Females: 50 and above LDL: “Bad” Cholesterol Less than 100

Women: No more than 1 a day Men: No more than 2 a day

150 minutes a week of moderate activity


“That creates a perfect storm,” explained Rost. Researchers at the University of Alabama at Birmingham bore that out. They found that in those with uncontrolled hypertension the risk of stroke is three times larger for African Americans than for whites. The solution, according to Rost, is simple. “Check blood pressure regularly,” she advised. Annually is acceptable, but semi-annually is even better. And if one’s primary care provider is not available, the monitors at the local supermarket or pharmacy will do. But unless blood pressure is perfect, seek medical evaluation and treatment right away. Diabetes is another modifiable condition closely linked to stroke. Although associated with excessive sugar in the blood, the disease also causes destructive changes in the blood vessels throughout the body, including the brain. What’s worse is that if blood glucose levels are high at the time of stroke, brain damage can be more severe and extensive. Treating diabetes can delay or prohibit the complications that increase the risk of stroke. Heart disease and high cholesterol are precursors to a brain attack. Excessive “bad” cholesterol is the major cause of narrowing of blood vessels, leading to both heart attack and stroke. One heart defect in particular — atrial fibrillation — is responsible for one in four strokes. Atrial fibrillation is a type of irregular heartbeat in which the upper chambers of the heart quiver instead of contract forcefully. Blood tends to pool then clot, which can result in an ischemic stroke. ​Some risk factors of stroke, however, are preventable and under one’s control. Smoking is one example. Most people associate cigarette smoking with cancer, but its damage extends far beyond malignant tumors. The NINDS notes that cigarette smoking causes a roughly two-fold increase in the risk of ischemic (blood clot) stroke and a four-fold increase in the risk of hemorrhagic (bleeding) stroke. ​In addition, nicotine raises blood pressure, and carbon monoxide found in cigarette smoke robs the brain of oxygen. Cigarette smoke also makes the blood thicker and more likely to clot. ​Atherosclerosis, or plaque, the build-up of fat in the arteries, does enough damage on its own, but when paired with smoking, is more of a threat. “Exposure to compounds in smoke promotes atherosclerosis in the vessels of the brain,” said Rost. “It occurs faster than expected,” Rost said, “and it makes vessels more vulnerable to injury.” ​Although sitting all day and eating too many unhealthy foods do not directly result in stroke, these behaviors are highly linked to diseases that do, including hypertension, diabetes and heart disease. ​Exercise is protective, according to Rost. Thirty minutes of walking a day and a diet of fruits and vegetables can improve vascular health. ​The good news is that even a minor improvement in what the American Heart Association calls Life’s Simple 7 — elevated blood pressure, cholesterol and blood glucose, obesity, current smoking, physical inactivity and poor diet — could reduce the chance of a stroke by 8 percent within five years. ​Rost is keeping a positive outlook that the prevalence of stroke and disability will decrease down the line. “We can use all these risk factors to estimate the risk of stroke,” she said. “And we can continue to educate the public.”

RISK FACTORS are characteristics that can increase your chance of stroke. Some risk factors cannot be changed.

Age — Although a stroke can occur at any age, your risk of stroke increases as you get older.

Gender — Although men have a slightly higher incidence of stroke, women are more likely to die of stroke than are men.

Family or individual history —

Your risk of stroke is higher if a parent or sibling has had a stroke. Also, you are at higher risk if you have already had a stroke or transient ischemic attack, often called a “mini-stroke.”

Race — Blacks are at greater risk, partly due to a higher incidence of hypertension. Also, blacks can suffer strokes at an earlier age.

OTHER RISK FACTORS can be controlled through screening, medicine or lifestyle changes. High blood pressure Tobacco use and exposure to secondhand smoke High cholesterol Heart disease Diabetes Obesity and poor diet Lack of exercise Atrial fibrillation (abnormal heart beat) Sickle cell anemia Excessive alcohol use

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Q& A WITH DR. THABELE LESLIE-MAZWI Should people at risk for stroke take an aspirin a day?

Aspirin can be very helpful for patients at risk for stroke by keeping the blood thinned so it flows easily through the vessels. However, no medicine should be taken regularly without consulting your physician first. If you think you might need to be on standing aspirin you should have a discussion with your primary care doctor.

Why do some people recover completely from a stroke while others suffer permanent damage?

Stroke outcomes are heavily dependent on how much brain tissue is affected and what area of the brain is damaged. Patients with either large volumes of brain tissue affected or very important structures damaged are more likely to suffer permanent damage. A crucial component of stroke recovery is adequate rehabilitation, and for all stroke patients this should be pursued to minimize the chance of permanent deficit. Thabele M. Leslie-Mazwi, M.D. Neurologist, Critical Care Center Massachusetts General Hospital

Since mini-strokes, or transient ischemic attacks, resolve on their own, is it necessary to seek medical care?

It is absolutely essential to seek medical attention as a matter of urgency. TIAs should be viewed as a warning that something potentially much more serious is about to happen, and seeking medical attention allows protective treatment to be initiated to prevent a much bigger stroke from occurring.

Why is excessive weight linked to stroke?

Excessive weight is a risk factor for high blood pressure, diabetes, obstructive sleep apnea and high cholesterol, all of which increase the likelihood of having a stroke.

Why is sickle cell anemia linked to stroke?

In sickle cell anemia the abnormal blood cells do not flow properly. They tend to clump, and these clumps can block blood vessels in the brain, leading to strokes. Avoiding circumstances that cause clumping (dehydration and infection, for example) is an important step in preventing strokes in patients with sickle cell disease.

Should a person call 911 if he or she has only one symptom of a stroke?

Yes. Call 911 immediately with any suspicion of stroke. Remember to “Think FAST”— Face, Arm, Speech and Time. Any sudden weakness or loss of function should raise concern for stroke. The main reason people with stroke do not get properly treated is that they get to medical attention too late. Every single minute counts.

Do people with a stroke have a higher incidence of dementia?

No, but it does indicate that increased vigilance is needed because the tendency for stroke will be higher than for someone without a family history. Through appropriate primary care the vast majority of strokes are totally preventable. Make sure to tell your doctor about your family history.

Cognitive decline (decreased memory or judgement) related to stroke is usually called vascular dementia or vascular cognitive impairment (to distinguish it from other types of dementia). In the United States, it is the second most common form of dementia after Alzheimer’s disease. People who have had a stroke have a nine times greater risk of dementia than people who have not had a stroke. Vascular dementia is preventable, but only if the underlying vascular disease is recognized and treated early.

Does exposure to second-hand smoke increase the risk of stroke?

Does the consumption of green tea reduce the risk of stroke?

If stroke runs in a person’s family, does that mean that he or she will have a stroke?

If you’re a smoker you double to quadruple your risk of having a stroke. This happens through a variety of mechanisms, including damage to blood vessel linings and thickening of the blood. If you live or work with a smoker be aware that second-hand smoke exposure has been firmly linked to increased cardiovascular risk, especially heart attacks and stroke. For stroke, the risk may be as much as double. Avoiding primary or secondary cigarette smoke exposure is crucial to a healthy lifestyle.

12 Be Healthy | Stroke

New research suggests that drinking green tea may reduce stroke risk. Green tea consumption can be incorporated as part of healthy lifestyle choices, like diet and exercise. However, there are many factors, like high blood pressure, smoking, diabetes, high cholesterol and obstructive sleep apnea that are very clearly established as causes of stroke. Attention to these will ensure a longer, healthier life, free from not just strokes but a variety of other vascular diseases.


IN A FLASH Ernesto Arroyo photos

AS FLETCHER “FLASH” WILEY DISCOVERED,

SYMPTOMS OF A STROKE CAN HAPPEN QUICKLY ​By most accounts, Fletcher “Flash” Wiley, 70, a well-known Boston attorney, rarely misses a chance to talk about his athletic prowess. But on one day two years ago, Flash never made it to the golf course. In fact, he never even made it to his car. ​He said good-bye to his daughter and headed up the steps when vertigo hit him. ​“I couldn’t get my balance,” Flash recalled. ​He said he had suffered through bouts of dizziness before, but nothing like this. Unknown to him at the time, he was suffering a stroke, and the trouble he experienced with dizziness and loss of balance were some of the major signs. ​“I sat down on the steps,” he explained. “I knew I was having a medical situation. I had not felt anything like that.” ​Good fortune was on his side. Flash was talking on the telephone to an associate at the time. Though he didn’t know it, his speech had become slurred and unintelligible, virtually incomprehensible to his partner. But Flash kept right on talking. ​His colleague knew something was wrong. “Call 911,” he advised. Not really understanding the advice, Flash just repeated what he heard, trying to figure out why his friend was talking about 911. ​The sight of Flash sitting on the stairs saying 911 to his cell phone caught his daughter’s attention. She took one look at her father and wasted little time. She called EMS. Wiley was transported to the closest primary stroke center. He had suffered one of the most common strokes. Ischemic strokes are caused by blood clots that cut off the blood supply to arteries in the brain. One of the biggest culprits is atherosclerosis — fatty deposits, or plaque buildup in the arteries. ​Or, in Flash’s case, it could have resulted from an existing heart arrhythmia characterized by an irregular and often rapid heart rate. In atrial fibrillation, the most common type of arrhythmia, the electrical signals in the two upper chambers of the heart are out of whack causing them to beat erratically and out of synch with the two lower chambers. Blood often pools, then clots, which can result in a stroke. About 15 to 20 percent of people who have strokes have this heart arrhythmia. When Flash arrived at the emergency ​ room, complications prevented the medical team from administering tPA, the only FDA approved clot-busting drug used to treat people suffering an ischemic stroke, which accounts for roughly 87 percent of all strokes. est Don W photo

​Flash was hospitalized for about a week before being transferred to a rehabilitation center. Fortunately, his symptoms were relatively mild. ​The stroke impacted his right side, but he could use his left hand to compensate. “I was a little shaky on my motor skills,” he explained. “I could walk as long as I held on to something.” ​And that is when Flash showed major signs of recovery: he began plotting his escape. Flash had recently joined the North Shore Acappella singing group and they had a performance at Sculler’s Jazz Club in Cambridge in a few weeks. A trained negotiator, Flash used this scheduled appearance to convince his doctor that a release from medical care would be the best therapy. ​The doctor was willing, but had a list of demands for Flash to meet before talk of a release, much less an actual release. In fact, the doctor insisted Flash wasn’t going anywhere until he could climb steps on his own and be independent in daily living activities. ​Flash met the test, and sure enough, on May 24, he was right up on stage with his group as they performed before a packed audience. He needed a walker to make it to the stage and used a cane to move around while singing, but, as Flash tells the story, “I was able to sing on key.” For that, Flash ​ and the singing group received a standing ovation. ​In hindsight, Wiley had a couple of risk factors for stroke. In addition to atrial fibrillation, he has high blood pressure. Though controlled, Flash admitted his doctor wants it lower. ​But Flash now recognizes that he must make changes in his life. “I’m a little larger than I need to be,” he confessed. He said he is trying to follow a more nutritious diet. It’s the salt that’s the hardest to control. “That’s a big adjustment,” he said. “The substitutes are not really acceptable.” ​For exercise, he walks around the reservoir in Brookline. He adheres to his multiple medications. ​He sometimes walks with a cane, but, according to Flash, the cane is not really needed: it’s just there for comfort. And probably for show. The cane makes him look more dapper. behealthy.baystatebanner.com 13


REDUCING STROKE IMPACT REQUIRES QUICK

THINKING

— AND CALLING 911

T

Zonius Wiley Paramedic Boston Emergency Medical Services

14 Be Healthy | Stroke

hey call him Zonius — Zoni for short. But when most people call him, they are dialing 911. Zonius Wiley, 49, is a paramedic with Boston Emergency Medical Services (EMS). ​He’s been at it for a while. He became an emergency medical technician (EMT) in 1988 and a paramedic seven years later. Roxbury, Dorchester and Mattapan are his stomping grounds, but he answers the call anywhere in Boston. Zonius’s message is clear. “Call 911,” he ​ urged. “Even if you’re not sure what’s going on.” ​That uncertainty is common when it comes to strokes. Many people do not know the symptoms of a stroke and even if they do, they often fail to call 911. That’s particularly true among African Americans. ​These findings came as a surprise to the American Heart Association in 2011 when the organization determined that, although 89 percent of blacks interviewed indicated they would call 911, in reality the opposite was true. When the researchers interviewed black stroke victims only 12 percent admitted that they called EMS immediately. ​The reasons for not calling 911 varied. Fifty percent of the respondents said they thought the symptoms would pass, while three-fourths called a friend or family member first. Yet, dialing those three numbers can be ​ life-saving. The person on the other end of the line will help sort things out. They will ask about symptoms and medical history and make a quick assessment. ​But Zonius pointed out, “If you call, we’ll come out. It’s better to be safe than sorry.”


There are symptoms ​ that should prompt a call to EMS right away. One is the headache that won’t go away and is worse than ever experienced, said Zonius. Having trouble speaking is another. If you call and slur your words or speak nonsense, “that generates an immediate response,” he said. Upon arrival the para​ medics make quick work of the situation using the Boston Stroke Scale. They look for facial droop — one side of the face does not move as well. They ask you to close your eyes and extend both arms for 10 seconds. If one arm drifts, drops or is weakErnesto Arroyo photos er, that is a tell-tale sign. ​They ask you to repeat a short phrase. If you slur your words or repeat the phrase incorrectly or cannot say anything at all, that’s a big red flag. They also check your blood sugar and blood pressure, two risk factors closely associated with stroke. ​This simple overview can paint a pretty accurate picture. The paramedics notify the stroke team at the closest certified primary stroke center and transport you there. These stroke centers have 24-hour access to a trained stroke team and CT scanning that can result in increased accuracy in diagnosis and treatment. Some strokes are transient. ​ People experience symptoms, which go away in a few minutes. That’s no reason to not call, cautioned Zonius. Even those who experience a TIA or transient ischemic attack should call. ���He has heard all the reasons for not dialing 911. “Most of the time people are in denial,” he said. ​They reason that the symptoms will go away on their own. Some decide to go to sleep hoping they will feel better tomorrow. Those who have a doctor’s appointment the next day are more prone to put off calling, assuming the doctor will take care of it in the morning.

​Still others say they don’t want to be a bother. It’s not a bother, stressed Zonius. “Call 911 even if you are not sure,” he said. “We’ll figure out what’s going on.” ​Some prefer to drive themselves to the emergency room or ask a friend to transport them. That’s a mistake. Ambulances can get around traffic jams and bypass red lights. Also, a medical team in emergency rooms is waiting for patients transported by ambulance and will start treatment immediately. ​Although Zonius doesn’t encourage private transportation at all, he emphasizes distance over preference. “Go to the closest hospital,” he said, warning people not to try to reach their regular hospital of care if it is far away. ​Driving to the hospital during a medical emergency is more common than one would think. In its study, the AHA found that of those who thought they were having a stroke, only half arrived at the hospital by ambulance. Thirty-five percent of these patients did so because of lack of other transportation. ​All the more reason that Zonius strongly urges a call to 911. “If you know that something is off but can’t explain why, call us,” he said. “Call early. You’ve got a short window of time.”

“ If you know that something

is off but can’t explain why, call us. Call early. You’ve got a short window of time.” — Zonius Wiley

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SMOKING

IT’S FOR QUITTERS

As anyone who has tried to quit smoking can attest, it is hard — terribly hard. In fact, it often takes smokers between 7 and 11 times to successfully quit, according to the Massachusetts Tobacco Cessation and Prevention Program. Using a combination of methods — including counseling and medications — can dramatically increase the chance of a successful outcome. The reason quitting smoking is so incredibly difficult is that nicotine — found in all tobacco products — is highly addictive. In fact, the U.S. Surgeon General stated in a 1988 report that nicotine was as addictive as heroin or cocaine. Given the high level of cancer fatalities, African Americans have even more reasons to quit smoking. But cancer is not the only consequence of tobacco use. Smoking harms nearly every organ of the body and reduces the health of smokers in general, according to the Centers for Disease Control and Prevention. Smoking causes cardiovascular and respiratory diseases. Compared with nonsmokers, smoking is estimated to increase the risk of stroke by two to four times.

MAKING A PLAN TO QUIT Whether your decision to quit smoking is motivated by health risks, for family, to save money or just to feel better, begin by making a plan to quit. The first step is to consult your doctor to find out which anti-smoking tools will work for you. Before your quit date, work with your doctor to decide if you are going to use medications, join a support group or use a different plan to quit. Once these questions have been answered, it is time to take action. The American Cancer Society advises people to pick a day to quit and throw away all cigarettes and ash trays. Prepare by having substitutions available — things like gum and hard candies to put in your mouth and activities to distract you from thinking about smoking.

16 Be Healthy | Stroke

EFFECTIVE MEDICATIONS ARE AN IMPORTANT TOOL Despite nicotine’s addictive qualities, there are many effective treatments to help people quit. For more than 25 years, researchers have found clear evidence that several medications work well, especially in conjunction with certain types of counseling. According to the American Cancer Society, the following drugs can effectively double the chances of quitting: • Bupropion (Zyban®,Wellbutrin®, Aplenzin®), a prescription drug, works to reduce cravings but contains no nicotine. Initially developed to deal with depression, the drug was inadvertently found to lessen the desire for nicotine when prisoners taking Zyban for depression smoked noticeably less. • Varenicline (Chantix®) is a prescription drug that reduces the pleasure people get from smoking by attaching to nicotine receptors in the brain and blocking nicotine from reacting with them. • Nicotine replacements such as the patch, gum, nasal spray, inhaler or lozenge contain reduced amounts of nicotine to give a small, slow release supply of nicotine to lower cravings. Most are available over the counter, but some are obtained by prescription. Your primary care doctor can work with you to decide the best medications to use. In some instances, a doctor may recommend a combination of prescription medication and nicotine replacement, but the various combinations each have their own specific requirements. It is important to check with your doctor if you are using a prescription drug and an over-the-counter nicotine replacement product such as the patch. Like most medications, anti-smoking medications can have side effects. On July 1, 2009, the Food and Drug Administration required that bupropion and varenicline carry a black box warning — the agency’s strongest safety warning — due to side effects including suicidal thoughts, suicidal actions, hostility and depression.


Smoking is estimated to increase the risk of stroke by two to four times

NEW SMOKING CESSATION TOOLS MAY BE ON THE HORIZON Although there are a few relatively new anti-smoking tools, such as Chantix on the market, the search goes on for even more effective methods. For example, a tobacco vaccine has been in the testing process since 2006. The idea behind the vaccine is to keep nicotine from reaching the brain, making smoking less pleasurable. It is part of a new generation of treatments that are designed to attack the psychological dependency on nicotine.

COUNSELING IS EQUALLY IMPORTANT Individual and group counseling have proven to be very effective tools to help people quit smoking, especially when used in combination with medication. Support can come from health care providers, including anti-smoking groups at clinics, health centers and hospitals, so one of the first places to look for a support group is at your local hospital or health facility. Family and friends can also be very important sources of support. There are a number of other no-cost or low-cost ways to find counseling support. Telephone counseling has been proven to double people’s success in quitting smoking for good. The Smokers’ Helpline at 800-QUIT-NOW (800-784-8669) is a free, confidential, quit line sponsored by the Massachusetts Department of Public Health. This resource can answer your tobacco-related questions, refer you to tobacco treatment programs and give counseling over the phone. The Internet can also be a great resource and provides access to immediate help 24 hours a day. Quitnet (www.quitnet.com), one of the largest online quit-smoking communities, can connect you with experts or an online group of people chatting about their efforts to quit smoking. Quitnet also matches people with an online “quit buddy.” Blue Cross Blue Shield of Massachusetts members can sign up for the MyBlueHealth Wellness portal at www.mybluehealthma.com and create a personalized program that includes Quitnet, community forums and other wellness tools.

TIPS ON STICKING TO YOUR PLAN TO

QUIT

1. Once you have made the decision to stop smoking, the next step is to create a plan that works for you. Sticking to it will help you quit smoking. 2. Make a list of reasons why you have decided to quit. 3. Educate yourself on the impact of smoking and methods to help you quit. 4. Decide on a quit date — ensuring your timeline is right for you can be crucial. 5. Prepare your environment and change your habits to eliminate situations that would tempt you to smoke. 6. Keep a positive attitude. 7. Stay busy. 8. Be prepared to have other things to put in your mouth, such as peppermints, carrot sticks, cinnamon sticks or toothpicks.

Remember, if you can quit for one day, you can quit for one more and one more. But don’t forget, you’ll double your chance for successfully quitting smoking if you use the two proven strategies — medication and counseling.

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POTASSIUM IT’S MORE THAN JUST BANANAS An imbalance of sodium and potassium in the diet can increase the risk of high blood pressure and stroke. Sodium gets a bad rap, but actually it is essential to health. Sodium teams up with potassium to regulate major body functions. Together they help nerves fire off to power muscle contraction. They help kidneys function properly. They are necessary for energy production. The team also regulates blood pressure. And that’s the problem. Sodium and potassium are supposed to work in synch and provide balance, but the modern diet has become more sodium-heavy, pushing potassium to the rear. A diet low in potassium and high in sodium can increase blood pressure and ultimately the risk of stroke.

Health professionals recommend a daily intake of 4,700 milligrams (mg) of potassium, but today’s diet hovers closer to 2,500 mg. Yet, it’s not that hard to consume the recommended amount. Potassium is readily available in all food groups, including fruits, vegetables, fish, meat and milk products. You just won’t find much in processed foods that have become a staple in many diets. As an example, eat a baked potato with skin, a cup of cooked beet greens and three ounces of halibut or salmon for dinner and you’re more than half-way there. Throw in an avocado, banana, yogurt and orange juice and you’re close to the mark. People with chronic kidney failure, especially those on dialysis, have to limit their intake of potassium, however. Under these circumstances, it is best to consult with a physician to recommend a special diet. It doesn’t mean you have to cut out sodium altogether. While increasing potassium, limit sodium intake to less than 2,300 mg a day.

YOU DON’T HAVE TO LOOK FAR TO FIND IT — GOOD SOURCES OF POTASSIUM Food

Serving size

Potassium

(in milligrams)

Baked potato with skin

1 small

738

Beet greens, cooked

1/2 cup

654

Plain non-fat or low-fat yogurt

8 ounces

550

Avocado

3 ounces

540

Halibut, cooked

3 ounces

490

Orange juice

1 cup

496

Banana

1 medium

422

For a more complete list, visit the USDA National Nutrient Database for Standard Reference at ndb.nal.usda.gov/ndb/search/list.

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Patrick Geltinger photo


MOROCCAN CHICKEN WITH BROWN RICE AND LEMON SAUTÉED SPINACH An easy to fix meal that’s low in sodium and high in potassium. 4 servings | About $4.21 per serving

Per serving: Calories 369 Total Fat 11.5 g Saturated Fat 1.5 g Trans Fat 0.0 g

Chicken 2 teaspoons paprika 1 teaspoon cumin 1 teaspoon ground ginger 1 teaspoon turmeric ½ teaspoon cinnamon ½ teaspoon pepper 4 boneless, skinless chicken breasts, visible fat removed 1 tablespoon extra virgin olive or canola oil 1 small onion, chopped 1 teaspoon garlic minced from the jar, or 2 cloves minced or sliced 1 14.5 oz. can crushed or diced low-sodium tomatoes ½ cup water 1. In a small bowl mix paprika, cumin, ginger, turmeric, cinnamon and pepper. 2. Place the chicken on a plate or pie dish; coat with spice mixture. Allow chicken to stand in spices for 1 hour or refrigerate overnight. 3. In a medium skillet, heat oil over medium-high heat. Add chicken and brown for 5 minutes. 4. Reduce heat to medium-low, add water, top with onions, tomato and garlic. 5. Cover and cook for 10 minutes then flip chicken and cook for 30 minutes more until chicken is cooked through.

Polyunsaturated Fat Monounsaturated Fat Cholesterol Sodium Carbohydrates Dietary Fiber Added Sugars Protein Potassium Calcium

2.0 g 6.5 g 73 mg 190 mg 36 g 5g 0g 30 g 993 mg 86 mg

Brown Rice 1½ cups of instant brown rice 1. Prepare brown rice according to package instructions. Makes 4 servings.

Lemon Sautéed Spinach 1 tablespoon olive or canola oil 6 cups of spinach, washed and dried ½ lemon or 2 teaspoons lemon juice from the jar 1. In a saucepan or skillet, heat oil over medium-high heat. 2. Add spinach, handfuls at a time, leaving enough room to stir. If all the spinach won’t fit in the pan let some wilt down and continue to add spinach until all leaves are wilted. 3. Remove from heat and squeeze lemon over spinach (or sprinkle juice from jar).

For more recipes visit heart.org/simplecooking. Source: American Heart Association’s Simple Cooking with Heart Program behealthy.baystatebanner.com 19


STRENGTHENING EXERCISES not just for jocks DO IT YOURSELF The 2008 Physical Activity Guidelines for Americans sponsored by the Centers for Disease Control and Prevention (CDC) are clear. Perform muscle-strengthening activities for all muscle groups — arms, legs and trunk — on two or more days a week. While the recommendations for aerobic exercises, such as walking and running, vary by level of intensity, those for strengthening exercises remain firm — at least twice a week and all muscle groups. Unfortunately, not many people are heeding the message. In a recent report, the CDC determined that only 29 percent of Americans were meeting the guidelines. That’s disturbing, especially given the health benefits attributed to working out regularly. Exercise improves muscle strength and endurance, develops strong bones, and helps prevent or manage chronic conditions, such as arthritis and low back pain. In the elderly it helps maintain the ability to perform activities of daily living, such as climbing stairs, house cleaning and simple activities like carrying groceries. It’s not necessary to join a gym to get stronger. Exercising at home is fine. It’s economical and allows more flexibility in time. Free weights — specifically dumbbells and kettlebells — come in various sizes and materials and are easy to use. But it’s not necessary to buy weights. You can make your own from several household items.

IN ALL THESE

EXERCISES: • Breath out during the exercise • Hold the position for one second • Breath in as you slowly return to the starting position • Repeat 10 to 15 times • Rest for about a minute; then repeat 10 to 15 more times

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1. Fill a plastic milk jug or detergent container with water. A quart container weighs about two pounds. A gallon container weighs close to 10 pounds. For a greater challenge, a 5-gallon bucket weighs about 45 pounds. 2. Fill a sock with rocks and tie the end closed. 3. Use soup or vegetable cans or bags of rice or beans.

Back Leg Raise This exercise strengthens your buttocks and knee 1. Stand behind a sturdy chair, holding on for balance. 2. Slowly lift one leg straight back. Try not to lean forward. The leg you are standing on should be slightly bent.

Leg Straightening​ This exercise strengthens your thighs 1. Sit in a sturdy chair with your back supported by the chair. Only the balls of your feet and your toes should rest on the floor. Put a rolled bath towel at the edge of the chair under thighs for support. 2. Extend one leg in front of you as straight as possible, but don’t lock your knee. 3. Flex foot to point toes toward the ceiling.


GETTING STARTED

BREATH

Before starting, talk to your doctor if you have any health problems, joint surgeries, injuries or aren’t usually active. Basic exercises can probably be performed safely by most regardless of medical history. It is advisable to seek guidance from a trained exercise professional to ensure proper form.

Don’t hold your breath during exercises. Exhale while lifting and inhale while lowering the weight. Count to three as you lift or push. Pause, then count to three as you return to the first position. Perform each exercise in a controlled manner. Don’t let momentum do the work for you.

DETERMINE THE SIZE OF THE WEIGHT YOU SHOULD START OUT WITH

STEP IT UP

Depending on your physical condition you might start out with a one- or two-pound weight or no weight at all. Just moving a body part against gravity is strengthening. The weight should feel hard to lift or push, but not that hard. If you’re not able to lift the weight eight times in a row, it is too heavy, and you should go to a smaller size. If it becomes hard to lift after the eighth to tenth time, that’s probably where you should start.

REPS AND SETS

As exercises become easier, increase the weight or do another set. When two or three sets of reps are no longer a challenge it is time to increase the amount of weight. Increase the resistance by a couple of pounds.

TAKE A BREAK

Start with two sessions a week. While walking or jogging is an activity you can do every day, your muscles need a day to recover from strengthening exercises. If you do strengthening exercises Tuesday, wait until Thursday to repeat.

A repetition, or rep, is one complete movement of an exercise. For instance, one biceps curl is a rep. A set is generally 10 to 15 repetitions. Perform 1 to 3 sets of reps at least twice a week. Take a one minute break between sets. Your exercise program does not need to be lengthy. Fifteen to 30 minutes will do, especially when just starting out.

TIPS

Side Arm Raise This exercise strengthens your shoulders and makes lifting easier

Overhead Arm Raise This exercise strengthens your shoulders and arms and makes lifting easier

1. You can do this exercise while standing or sitting in a sturdy, armless chair. 2. Keep your feet flat on the floor, shoulder-width apart. 3. Hold hand weights straight down at your sides with palms facing inward.

Stop if the exercise hurts. It is normal to feel some minor muscle soreness, but you have overdone it if you experience sharp pain or sore or swollen joints. Over-exercising can cause injury. Be careful to listen to your body.

1. You can do this exercise while standing or sitting in a sturdy, armless chair. 2. Keep your feet flat on the floor shoulder-width apart. 3. Hold weights at your sides at shoulder height with palms facing forward. 4. Raise both arms up over your head keeping your elbows slightly bent.

4. Raise both arms to the side, shoulder height.

Images courtesy of National Institute on Aging, National Institutes of Health behealthy.baystatebanner.com 21


ONE GARDEN AT A TIME FRUIT AND VEGETABLE CONSUMPTION

A flourishing backyard garden

THE FOOD PROJECT IS ON

A MISSION TO INCREASE

A Dudley neighborhood resident purchases seedlings for his garden.

Lauren Carter Amanuel Haile loves vegetables, and he often thought about growing his own. So when he and his wife, Senait, moved into their new home in Roxbury, their large backyard seemed like the perfect place for a garden. With help from The Food Project’s Build-a-Garden program, Haile and his wife have been growing green peppers, tomatoes, salad mix and kale in a raised bed garden outside their home for the past year. They’re so excited about the garden they’re hoping to triple its size. “We’ve had a very good experience,” said Haile, 46. “We can see the difference from shopping at the grocery store. You can

Brandy Brooks (center), the director of community programs at the Food Project, works with project youths to build a raised bed garden.

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tell by the smell it’s really organic. We know it’s healthy, because we planted it and raised it, and we know how we did it.” Giving people access to healthy food is The Food Project’s main mission. The nonprofit organization runs 40 acres of farms in Eastern Massachusetts that donate food to local hunger relief organizations and distribute food to community-supported agriculture programs and farmers’ markets. And through its Build-a-Garden program, the Project helps local families, schools and organizations take control of their eating habits and incorporate more fresh fruits and vegetables into their diet. “We could just grow food and give it to people, but that doesn’t change the power dynamic around who has access to food and who has control of what they eat,” said Brandy Brooks, the project’s Greater Boston regional director. “Elevating the opportunities we have as individuals and family members and community members to grow some of our own food is actually a really important statement about the role we should be playing.” According to the Centers for Disease Control and Prevention, eating a healthy diet that includes plenty of fresh fruits and vegetables can help prevent stroke and other serious diseases. But multiple studies show that many Americans do not eat enough fruits and vegetables, and the cost of fresh produce — especially of the organic variety — can be prohibitive to those looking to adopt a healthier diet. Brooks said that raised bed gardens offer a cost-effective way to incorporate more fruits and veggies into the daily mix. “When you think about it, you might pay $2 for a packet of seeds that is going to produce pounds of fruit or pounds of vegetables,” Brooks said. The 4-by-8 gardens come with compost, seeds and a grower’s manual. Food Project youth and staff provide training on how to produce a variety of foods such as onions, greens, carrots, peppers, melons, squash, salad mix and tomatoes.


Raised bed gardens can be built atop most surfaces, including concrete or lead-contaminated soil, making them especially convenient in urban environments. “City soil has a tendency to be contaminated, particularly with lead and other kinds of heavy metals, and those soak up into your food if you’re not farming in clean soil,” Brooks said. “The raised bed method gives a really good way to provide that kind of growing space in a way that’s healthier in terms of the contaminant content of food.” The Project also encourages people to use organic practices — no pesticides or chemical fertilizers — to enhance the healthfulness of the food. “In that sense as well, it’s much healthier for the community and environment when people are using organic gardening methods rather than some of the conventional gardening methods,” Brooks said. Thus far, the Project has built over 800 raised beds for individuals, families and organizations across the Boston area. The program has become so popular that there are currently 20 people on the waiting list. Those who prefer not to wait can get started on the healthy path independently by visiting the Build-a-Garden page at www. thefoodproject.org and downloading the do-it-yourself manual and growing guide. “People report it does increase the fresh produce they eat,” said Brooks. “And with the kids, they get really excited about being able to grow food and then being able to eat these things

that they grow. Kids will say, ‘Oh I hate broccoli. I hate carrots.’ But they love their broccoli and their carrots. It becomes a really different thing when they’ve been involved in the process of growing and learning about all of these things.” For more information about the Build-a-Garden program, visit www.thefoodproject.org or e-mail buildagarden@thefoodproject.org.

Community members prepare a plot in the Dudley Greenhouse. (Photos courtesy of The Food Project)

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Behealthy — Stroke