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Eight Ways to Help Prevent a Stroke


									Improve Your Sleep and Improve Your Health

This Month’s In the News Topics:
Sleep Apnea May Spur Night Heart Attacks
A Popular, Unhealthy Fish?
Eight Ways to Help Prevent a Stroke
Sleep Disorders: How Does Aging Affect Sleep?
The Tangled Truth About Your Health
Six Warning Signs of Stroke
Smoking-Cessation Aids Beat Cold Turkey
Workers Lose Weight, Boost Productivity in Office Designed for Activity

Links of the month:
MyFoodAdvisor™ is a unique calorie and carbohydrate counting tool that can help with diabetes
management and nutrition. Tracking what you eat can help manage your diabetes and in turn
prevent the onset of complications. Learn about different types of food and make meal planning
fun and easy with MyFoodAdvisor.
Dietary Fiber Chart – Dietary Fiber Chart website

September Events:
Hooked on Health – September Newsletter: Why Strength Train
RTD Annual Coed Softball Tournament- Saturday, September 20, 2008 9am-2pm
RTD Walk-a-Thon – Drawing September 30 Contact Wellness Staff when finished x3145.

October Events:
                                       st       th
RTD Fall Fiber Challenge – Starts Oct 1 – Nov 30 Prize Raffle Drawing and Free gifts for
RTD Annual Health Fair – October 20-24 Free Flu Shots and Total Health Assessments

Sleep Apnea May Spur Night Heart Attacks
Obstructive Sleep Apnea May Trigger Nighttime Heart Attacks
By Miranda Hitti
WebMD Health News
Reviewed by Elizabeth Klodas, MD, FACC
July 21, 2008 -- Obstructive sleep apnea may make nighttime heart attacks more likely than
daytime heart attacks, a new study shows.
In obstructive sleep apnea, the upper airway becomes completely or partially blocked, interrupting
regular breathing, several times per night.
The new study, published in the Journal of the American College of Cardiology, recommends that
people who have heart attacks while sleeping at night be screened for obstructive sleep apnea.
The study included 92 people who had recently had a heart attack.
The patients reported what time their heart attack symptoms started. They also took part in a
sleep study about 17 days after their heart attack. The sleep study showed that 64 patients had
obstructive sleep apnea.
The patients with and without sleep apnea were pretty similar in their backgrounds and
medication use. But the timing of their heart attacks was different.
The patients with obstructive sleep apnea were six times more likely to have had their heart
attack between midnight and 6 a.m. than during the rest of the day. In contrast, the patients
without sleep apnea were more likely to have had their heart attack between 6 a.m. and noon.
Obstructive sleep apnea "may be a trigger" for heart attacks, write the researchers, who included
the Mayo Clinic's Fatima Kuniyoshi, PhD. Kuniyoshi's team calls for further studies to see if
obstructive sleep apnea treatment reduces heart attack risk, especially at night.

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A Popular, Unhealthy Fish?
Farm-raised tilapia is one of the most highly consumed fish in America. Yet it has very low levels
of beneficial omega-3 fatty acids and very high levels of potentially detrimental omega-6 fatty

That’s according to new research from Wake Forest University School of Medicine. Tilapia has
higher levels of long-chain omega-6 fatty acids than 80-percent-lean hamburger, doughnuts and
even pork bacon, says an article in the July, 2008 issue of the Journal of the American Dietetic

Omega-6 fatty acids are pro-inflammatory, and inflammation is known to cause damage to blood
vessels, the heart, lung and joint tissues, skin, and the digestive tract.

For their study, the authors obtained fish from several sources, including seafood distributors that
supply restaurants and supermarkets, two South American companies, fish farms in several
countries, and supermarkets in four states. They found that farmed tilapia contained only modest
amounts of omega-3 fatty acids: less than half a gram per 100 grams of fish, similar to flounder
and swordfish. Farmed salmon and trout, by contrast, had nearly 3 and 4 grams, respectively. At
the same time, the tilapia had much higher amounts of omega-6 acids.

This is important information. Cardiologists are telling their patients to eat more fish, but if those
patients are buying and eating farm-raised tilapia, they could clearly do better. As a follow-up to
this report, a coalition of more than a dozen doctors pointed out that tilapia should be considered
a better choice “than most other meat alternatives,” but my response is, why not eat the best fish
of all? So I strongly suggest adding wild-caught Alaskan salmon to your diet to get the benefit of
their impressive omega-3 fatty acid content and low contaminant load. It is more expensive than
tilapia, but a worthy investment in health that will reap dividends in the future.

Eight Ways to Help Prevent a Stroke

According to the American Stroke Association, approximately 700,000 Americans will suffer a
stroke this year. That means, on average, someone in America has a stroke every 45 seconds.
Strokes are a leading cause of severe, long-term disability, and addressing the associated risk
factors can be beneficial. Consider the following suggestions:

    1. Control your blood pressure either through lifestyle changes or medication.
    2. Exercise. People who exercise consistently have a lower risk of suffering a stroke.
    3. If you smoke, quit.
      4. Limit alcohol intake. If you drink alcohol, do so only in moderation. Moderate alcohol
         intake is defined as no more than one drink per day for women and two drinks a day for
      5. Manage diabetes and keep tight control of blood sugar levels.
      6. Lower cholesterol into a healthy range.
      7. Focus on your diet. Follow a diet designed for those with high blood pressure and heart
         disease - it may be helpful in preventing strokes.
      8. Take calcium and magnesium. These minerals are helpful in controlling high blood
         pressure, one of the strongest risk factors for stroke.

Sleep Disorders: How Does Aging Affect Sleep?
More than half of men and women over the age of 65 years complain of at least one sleep
problem. Many older people experience insomnia and other sleep difficulties on a regular basis.
As we get older, our sleep patterns change. In general, older people sleep less, experience more
fragmented sleep, and spend less time in stages 3 & 4 and REM sleep (for example, deep sleep
and dream sleep) than younger people. However, regardless of your age, good restorative sleep
is essential to physical health and emotional well-being.
What Causes Sleep Problems in Older People?
Several factors may contribute to the inability to sleep well as we get older. Some common
causes include:

       Poor sleep habits: Irregular sleep-wake patterns can affect an individual's circadian
        rhythm and make it hard to maintain a regular sleep schedule. Other behavioral issues,
        such as consumption of alcohol before bedtime, increased wakeful time in bed, or daytime
        napping, can also affect a person's ability to sleep.
       Medical illness: Certain chronic medical conditions are common in older people. Some of
        these conditions, including heart failure, arthritis, heartburn, menopause and Alzheimer's
        disease, can affect sleep. These conditions can make it hard to fall sleep or may cause the
        person to awaken frequently, ultimately affecting duration and the quality of sleep.
       Medications: Some medications may impair a person's ability to fall asleep or stay asleep
        and may even stimulate wakefulness at night.
       Psychological distress or psychiatric disorders: Old age is characterized by many life-
        events, some positive and some negative. For example, life changes such as the death of a
        loved one, moving from a family home, or physical limitations due to illness can cause
        significant stress and sleep difficulties.
       Sleep disorders: Sleep disorders such as sleep apnea, restless leg syndrome, and
        periodic limb movement disorder may be associated with aging in some cases.
       Retirement: Retirement often leads to a lot of downtime with less daytime activity; this can
        lead to an irregular sleep-wake schedule and chronic sleep problems.

Are You Getting Enough Sleep?
Every person's sleep needs are different. If you are getting less sleep than when you were
younger, but still feel rested and energetic during the day, it might just be that you now need less
sleep. However, if you are noticing that your lack of sleep is affecting your daytime activities, you
should talk to your doctor. There are steps you can take to improve your sleep quality.
Reviewed by the doctors at The Sleep Medicine Center at The Cleveland Clinic..

The Tangled Truth About Your Health
WebMD Feature from "Prevention" Magazine

By Chris Woolston

Midlife women are twice as likely as men to have a stroke. So why do doctors overlook the
danger? What you must know to protect yourself

In the popular imagination, strokes happen at senior centers, not motorcycle rallies. They're
certainly not supposed to befall a woman like Sandra Thornburg. In 2001, she was a vibrant, 43-
year-old exercise fanatic attending nursing school in Phoenix. Newly divorced, she embraced
singlehood by meeting new people and trying new things, Harley-Davidson bikes included.

Thornburg was sleeping after a day's ride in northern Arizona when a sharp pain knifed through
her head. She tried to get up, but her left side didn't work and her mind was in a fog. "I had no
idea what was going on," she says. When she got to the hospital, her prognosis was grim. "They
told my family I wasn't going to survive," she says.

A decade ago, it took a massive effort by researchers and others to alert women--and doctors--to
the long-overlooked risk of female heart attacks. Now, experts say, it's time to turn the spotlight
on another lurking danger: the devastation that can occur from a stroke, or "brain attack." More
than 100,000 American women under age 65 suffer strokes every year, according to the
American Stroke Association. That eclipses the 83,000 women in that age range who have heart
attacks. Even more surprising: The risk surges between ages 45 and 54. In those years, women
are more than twice as likely as men to have strokes. And at every age, strokes are harder on
women--they're more likely than men to wind up physically and mentally impaired.

"We all learned in medical school that strokes and heart attacks are male problems," says Lewis
Morgenstern, MD, director of the stroke program at the University of Michigan Medical School.
"The reality is far different."

Those grim statistics reflect plenty of missed opportunities: Doctors often overlook chances to
prevent strokes in women, especially those that hit at relatively young ages. If a woman does
have a stroke, studies show that her physicians will almost certainly take longer to diagnose it
than they would for a man. And even after her problem is recognized, she's less likely to get all
the treatments and tests that can improve her chances of a successful recovery.

But it doesn't have to be that way. Here is what's behind the gender bias--and the facts that can
save your life.

Who's vulnerable

Thornburg felt perfectly healthy before her stroke, but a simple medical exam would have shown
the ingredients for a catastrophe. "If the right risk factors are in place, a woman can have a stroke
in her 40s instead of her 70s," says David Katz, MD, MPH, director of the Prevention Research
Center at Yale University. "But if she takes care of herself, the chances are very remote."

Who's vulnerable continued...

Thornburg's vulnerability started with high blood pressure and high cholesterol--each encourages
a buildup of arterial plaque, the raw material for a stroke-inducing clot. (Most strokes occur when
a clot chokes off blood to the brain; another type, caused by a burst blood vessel in the brain, is
rare.) Studies show that women nearly halve their risk of stroke simply by bringing high blood
pressure under control. Lowering high cholesterol is just as helpful. But doctors are less likely to
check women's cholesterol than men's, and if it's high, they treat it less aggressively. As for
hypertension, it's undertreated in men and women. (For other risk factors that your doctor might
miss, see "Are You at Risk? 6 Surprising Signs,".)

Thornburg's bad numbers were particularly unfortunate because she was on birth control pills.
Most healthy women in their 30s and 40s can take the Pill without worry as long as they don't
smoke, says Cheryl Bushnell, MD, an associate professor of neurology at Wake Forest
University. But even nonsmokers like Thornburg should steer clear of oral contraceptives if they
already have a couple of stroke risk factors, such as high cholesterol, hypertension, obesity, or

Where docs fall short

Speed is critical in treating a stroke: There's just a 3-hour window to use a clot-busting drug
called tissue plasminogen activator, or tPA, which greatly improves a victim's chances of avoiding
death or lifelong disability. But gender differences in stroke symptoms can throw doctors off track.
Delays in diagnosis help explain why a study of more than 2,000 patients in Michigan found that
women were only about half as likely as men to get tPA.

Lori Manning knows what it's like to be on the wrong side of the gender divide. A 35-year-old
multitasking machine before a stroke suddenly left her confused and capable of saying only, "I'm
okay," Manning was a prime example of women who stray from classic stroke symptoms. Several
supposedly telltale signs--loss of balance and sudden weakness, numbness, or paralysis on one
side of the body--are less common in women than in men, a 2002 study showed. At the same
time, women are more likely to suffer pain, confusion, or loss of consciousness--less familiar
signs of stroke.

The symptom gap isn't the only thing that slows diagnosis. On average, women get to the
emergency room an hour later than men when a stroke hits, partly because stroke isn't on their
mental checklist of ER-worthy dangers. And when they reach the hospital, it takes women about
an hour longer to be examined by a neurologist.

In Manning's case, doctors lost time checking for meningitis. They diagnosed the stroke after
several hours--too late for tPA. Manning has spent the past 5 years relearning how to talk and
read, and only recently started to volunteer for the American Heart Association.

Where docs fall short continued...

Even after diagnosis and treatment, women continue to get short shrift. In 2005, Morgenstern
reported that female stroke patients often miss out on two critical tests that can help prevent
further problems: They get imaging of the carotid arteries in the neck, which feed the brain, only
57% as often as men do, and an echocardiograph, which gives a detailed view of the heart, 64%
as often (abnormalities in heart rhythm can increase the risk of stroke). One in seven stroke
patients has a second stroke within a year, Morgenstern says, and these tests are crucial in
preventing that blow.

Thornburg was lucky: Her doctors eventually realized she had a clotting disorder and put her on a
blood thinner to prevent a recurrence. Every step still takes concentration--but a few years ago,
she was able to walk 15 miles in an American Stroke Association marathon.

How to Protect Yourself

While doctors catch up, take these simple steps to stay healthy now and for decades to come.
Don't smoke The habit roughly doubles the likelihood of having a stroke.

Get regular exercise If you keep your circulatory system in shape, your blood pressure stays
low--slashing stroke risk.

Watch your numbers Your doctor should check your blood pressure every other year and
cholesterol levels every 5 years (more often if your numbers are high). When you get your
cholesterol tested, ask your doctor to also check your levels of highly sensitive C-reactive protein,
or hs-CRP. Raised levels signal inflammation; an hs-CRP over 3 mg/l means an increased stroke
risk, no matter how low your cholesterol, says Paul Ridker, MD, director of the Center for
Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston.

Pick produce Two large studies have found that each daily serving of fruits or vegetables trims
stroke risk by 6%.

Frequent the fish counter A 2005 Harvard study concluded that people who ate fish even
occasionally were about 12% less likely than seafood avoiders to suffer strokes. Eat fish at least
once a week or ask your doctor if it makes sense to take a fish-oil supplement daily, researchers

Talk before taking hormones If you're considering the Pill or hormone therapy for menopause,
make sure your doctor knows your habits and history--especially if you smoke or have had a
blood clot (or if a family member has had one).

Ask about aspirin A 10-year study of nearly 40,000 women found that taking a low-dose aspirin
(100 mg) every other day reduced the risk of stroke by 17%. Women over age 65 should consider
a daily low-dose aspirin, says Ridker, who led the study.

Are You At Risk? 6 Surprising Signs

1. High cholesterol encourages a buildup of arterial plaque, raw material for a stroke-inducing
clot. Yet like high blood pressure (a better-known stroke risk), it's under treated.
2. Birth control pills may double the odds of having a stroke. Even in their 30s and 40s,
smokers and women with other risk factors should think twice.
3. Hormone therapy for menopause symptoms contains far less estrogen than even low-dose
oral contraceptives--but still slightly increases stroke risk.
4. Sleep apnea interrupts breathing during sleep, raising blood pressure and stroke danger. Yet
doctors often overlook it in women.
5. Migraine with aura doubles the risk of stroke in women under 55, though it's not clear why.
Also unknown: what causes aura (the visual changes that can occur before migraine). What is
clear: Women with migraine-plus-aura outnumber men 3 to 1.
6. blood clotting disorders affect up to 8% of Americans, but often go unrecognized. If you've
had more than one miscarriage, you may tend to form blood clots. Other red flags include deep
vein thrombosis (DVT)--a blood clot in the leg sometimes called economy class syndrome,
because sitting for long periods in cramped seats can raise the risk.

2 Tests that could save you…and when to ask for them

The Ankle-Brachial Index
A doctor compares the blood pressure in your ankle with the pressure in your arm.
If your pressure is lower at your ankle, it's a powerful sign of clogged arteries, which can foretell a
Consider it if: You've been told you're at increased risk of clogged arteries--perhaps because
you're over age 50 and have diabetes or another condition that can threaten circulation.

A blood test for a clotting disorder

Consider it if: You or a family member has had deep vein thrombosis or another clotting

Originally Published on: July 1, 2008

Six Warning Signs of Stroke
Dr. Weil on Healthy Aging.

Knowing the signs of stroke is crucial, since speedy treatment is necessary to help reduce the
damage that can be caused by a “brain attack.” Be aware of these typical stroke symptoms:

    1.   Sudden loss of vision in one or both eyes
    2.   Weakness or numbness on one side of the body, including the face
    3.   Difficulty speaking
    4.   Disorientation, confusion, or memory loss
    5.   Dizziness, loss of balance, or loss of coordination
    6.   Severe headache that comes on suddenly with no apparent cause

The American Stroke Association suggests that anyone can identify a stroke by checking for the
signs of facial weakness, arm weakness, and speech problems. As a bystander, you can help to
determine if someone is having a stroke by asking them to perform three simple actions:

    1. Ask the person to smile.
    2. Ask the person to raise both arms above his or her head.
    3. Ask the person to speak a simple sentence.

If the person has any problems completing these steps, call 911 immediately and describe these

Smoking-Cessation Aids Beat Cold Turkey
Drugs and Nicotine-Replacement Therapies Better Than Placebo at Smoking
By Jennifer Warner
WebMD Health News
Reviewed by Louise Chang, MD
July 14, 2008 -- Smoking-cessation drugs and many nicotine-replacement therapies are more
than twice as effective at helping smokers quit than going it alone.
A new analysis of 69 studies comparing seven different smoking-cessation treatments shows six
of the seven treatments were more effective than placebo in helping smokers quit the habit for at
least six months to a year.
But researchers say smoking-cessation therapies are underused because of problems translating
those results to the public and providing widespread access to the treatments.
"We are confident that the recommended treatments will substantially increase rates of smoking
abstinence when given to smokers who wish to quit," researcher John Cunningham of Toronto's
Centre for Addiction and Mental Health, says in a news release.
For example, Cunningham says these results suggest that offering free nicotine-replacement
therapy to adults who want to quit smoking could provide major public health benefits.
(What do recommend for quitting? Share your story on WebMD's Smoking Cessation support
Helping Smokers Quit
In the study, published in the Canadian Medical Association Journal, researchers compared 69
clinical trials on smoking- cessation therapies involving nearly 33,000 people.
The results showed six therapies were more effective than placebo at helping smokers quit,

       Chantix (2.4 times more effective than placebo)
       Nicotine nasal spray (2.37)
       Zyban (also known as Wellbutrin) (2.07)
       Nicotine patch (2.07)
       Nicotine tablet (2.06)
       Nicotine gum (1.71)

Although the findings also favored the effectiveness of the nicotine inhaler over placebo, the
results were not conclusive.
In a related article in the same journal, Canadian researchers randomly surveyed 825 smokers
and asked them if they would be interested in receiving free nicotine-replacement therapy and
how they would use it. Nearly 60% of smokers said they would be interested in receiving free
nicotine-replacement therapy, and 94% of the interested smokers said they would use it to quit
smoking for good.
In fact, researchers found smokers who were interested in quitting smoking for good were more
interested in using nicotine-replacement therapy than those who planned to cut back or maintain
their smoking habits.
Experts say these results suggest that new strategies to inform smokers who want to quit about
their options may be needed to improve use of smoking-cessation therapies.
"Because of a powerful multinational tobacco industry, the need to prevent death and disability
from tobacco-related illnesses will not disappear,” writes J. Taylor Hayes, MD, of the Mayo Clinic
in a commentary in the same journal. "However, we have effective treatments to assist smokers
at their attempts to live free of tobacco. The success of our efforts hinges on our ability to place
these products in the hands of people who need them."

Workers Lose Weight, Boost Productivity in Office
Designed for Activity
Workers in an office re-engineered to boost physical activity lost weight and increased
their productivity, according to a six-month Mayo Clinic study.

The restructuring of the office at a financial staffing firm in Minneapolis included:
removing chairs and traditional desk seating; adding desks attached to treadmills;
replacing traditional phones with mobile sets; introducing walking tracks; and providing
high-tech activity monitors. Staffers were encouraged to conduct meetings while walking
and counseled about nutrition, United Press International reported.

The 18 volunteers lost a total of 156 pounds, 143 of that in body fat. Individual weight
loss averaged 8.8 pounds. Triglyceride levels decreased by an average of 37 percent,
the study found.

While the workers shed pounds, the company's bottom line added weight. During the first
three months of the study, revenues increased nearly 10 percent. At the study's midpoint,
the company recorded its highest-ever monthly revenue, the news service reported.

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