Stroke

 Stroke is a condition of blood arteries going to and in the brain, in which, becomes blocked and the blood supply is no longer able to traverse the artery.  As the blood does not reach its intended brain cells, the cells begin to die due to the lack of oxygen within minutes (CDC, 2023)(Cleveland Clinic, 2023).  Globally, stroke is the second most common cause of death (Cleveland Clinic, 2023).  Stroke is additionally a leading cause of disability.

There are two types of strokes: Ischemic stroke and hemorrhagic stroke.  A Transient Ischemic Attack (TIA), which are at times referred to as mini strokes, are medical emergencies as are stokes, however, are differentiated from strokes as it lasts for five minutes or less (CDC, 2023).  Ischemic strokes occur when either blood clots, fatty deposits (plaques), or other particles block the blood arteries (CDC, 2023).  These types of strokes account for 87% of strokes (ASA, 2023).  Hemorrhagic strokes occur when a blood artery ruptures or leaks blood and account for 13% of strokes (CDC, 2023)(ASA, 2023).  Two types of blood vessel malformations that can cause hemorrhagic strokes are aneurysms and arteriovenous malformations (AVMs) (ASA, 2023).  Uncontrolled hypertension is the most common cause of hemorrhagic stroke.  Hemorrhagic strokes can be either intracerebral, within the brain, or subarachnoid, between the inner and outer layer of dura that covers the brain (ASA, 2023).

Because death to brain cells can occur within minutes, it is important to recognize the signs and symptoms of stroke quickly and obtain treatment even quicker.  Symptoms of stroke include:

• Trouble speaking
• Trouble understanding what people are saying
• Paralysis or numbness of the face, arm, or leg
• Loss of muscle control on one side of the face
• Blurry or blackened vision
• Sudden partial or total loss of one or more senses
• Neck stiffness
• Emotional instability
• Dizzines
• Nausea
• Vomiting (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

There are several risk factors for stroke.  They can be divided into Lifestyle, Medical, and other types of risk factors, and include:

• Lifestyle
• Obesity
• Physical inactivity
• Heavy or binge drinking
• Illegal drug use
• Medical
• Hypertension
• High Cholesterol
• Smoking
• Secondhand smoke exposure
• Diabetes
• Obstructive Sleep Apnea
• Cardiovascular Disease
• Personal or family history of stroke
• COVID-19 infection
• Clotting Disorders
• Atrial Fibrillation
• Migraine Headaches - there is an increased risk with migraines, especially if migraines are preceded by auras
• Other
• Age - people 55 years of age and older are at greater risk
• Race or ethnicity -  African Americans and Hispanics have a greater risk
• Sex - men have a higher risk than women
• Hormones -  birth control pills or hormonal therapy with estrogen can increase risk (Mayo Clinic, 2023)(Cleveland Clinic, 2023)

Once diagnosed, it is important to treat a stroke as quickly as possible.  Regardless of what type of stroke is being treated, Blood Pressure management should be part of the treatment plan.  When treating an Ischemic Stroke, it is important to restore blood flow to the brain.  For Ischemic Strokes, treatments include:

• Tissue plasminogen activator (TPA) - must be given within 4 1/2 hours from the start of symptoms.  Helps to dissolve blood clots.
• Emergency Endovascular procedures - medications can be delivered directly to the brain through a catheter that is inserted into the artery to deliver the medication directly to where the stroke is occurring,
• Removing clot with stent remover - useful with large clots and can be done with or without TPA
• Carotid Endarterectomy - removes plaques that are specifically blocking the carotid arteries
• Angioplasty and stents - a catheter is inserted into the artery.  A stent can be placed to help support the section of the narrowed artery that was expanded.  (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

With hemorrhagic strokes, treatments include:

• Blood thinning medications
• Medications to decrease pressure in the brain
• Surgery -  with large bleeds, blood vessels may be repaired
• Surgical Clipping - clamps can be placed at the base of an aneurysms to stop blood from flowing to it
• Surgical AVM removal - when accessible, smaller AVMs can be removed
• Stereotactic Radiosurgery - multiple beams of highly focused radiation can be used to repair blood vessel malformations (Cleveland Clinic, 2023)(Mayo Clinic, 2023).

Once someone has had a stroke, they may experience complications, such as:

• Paralysis - particularly on one side
• Difficulty talking or swallowing - a stroke can affect the mouth and throat muscles
• Memory Loss
• Emotional Problems - may have difficulty in controlling emotions and/or develop depression
• Pain - pain and/or numbness may occur in parts of the body associated with locations in the brain that were affected by the locations in the brain that were affected by the stroke
• Changes in behavior and self-care ability (Mayo Clinic, 2023)

There are things people can do to try to prevent strokes, including:

• Controlling hypertension
• Lowering cholesterol and saturated fat intake
• Quitting smoking and other tobacco use
• Managing Diabetes
• Maintaining a healthy weight
• Eating fruits and vegetables
• Regular exercise
• Limit alcohol intake
• Treat Obstructive Sleep Apnea
• Avoid illegal drugs

Attached is the Cleveland Clinic's FAST reminder card.

For more information on stroke, visit one of the three references below.

ASA. (2023) About Stroke.  American Stroke Association.  Retrieved form https://www.stroke.org/en/about-stroke

Cleveland Clinic. (2023)  Stroke.  Cleveland Clinc.  Retrieved from https://my.clevelandclinic.org/health/diseases/5601-stroke#symptoms-and-causes

Mayo Clinic (2023) Stroke.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

Menopause

 Menopause is a phase within a woman's reproductive cycle where there have been twelve consecutive months without a mentrual cycle.  Menopause can occur naturally or be the result of surgery (where the ovaries and/or uterus is removed), chemotherapy, radiation therapy, or primary ovarial insufficiency (Mayo, 2023).  Although menopause can occur during your 40s or 50s, the average age for menopause to occur is 51 (Mayo, 2023).

When occurring naturally, ovaries stop producing estrogen and progesterone.  It is a gradual process that occurs in stages.  The first stage is perimenopause that can begin anywhere between eight to ten years before monopause.  During this period, estrogen and progesterone are produced at different levels and decrease durin this period.  The next period is menopause where the varies cease to release eggs and producing estrogen for twelve consecutive months.  During this time, women tend to have increased symptoms.  The last stage is postmenopause.  In this stage, symptoms decrease and there is an increased risk of certain health conditions such as osteoporosis, stroke, and heart disease (Cleveland Clinic, 2023)(OASH, 2023(Duke, 2023).

There are many signs and symptoms of menopause to include:

• Hot flashes (vasomotor symptoms) - a sudden feeling of warmth that encompasses the entire body
• Night sweats
• Cold flashes
• Vaginal dryness
• Urinary urgency
• Urinary Tract Infections
• Insomnia
• Emotional changes - irritability, mood swings, anxiety
• Dry skin
• Dry eyes
• Dry mouth
• Racing heart rate
• Weight gain
• Joint and muscle aches
• Difficulty concentrating
• Changes in libido
• Breast tenderness
• Increasing symptoms of PMS
• Irregular periods
• Hair loss (Cleveland Clinic, 2023)

These symptoms can occur over several years.

Menopause is diagnosed after twelve months without a menstrual cycle.  Some blood tests may be helpful when menstruation is or becomes irregular such as:

• Estrogen levels
• Follicle Stimulating Hormone (FSH)
• Luteinizing Hormones (LH) (Medline, 2020)

There are several treatments available for menopause including:

• Hormone therapy - can replace hormones that the ovaries no longer make.  Helps symptoms like hot flashes and vaginal dryness.  It can also help to prevent Osteoporosis.
• Estrogen therapy (ET) - can be used only with women who have had their uterus removed.  There is a risk with ET when used with women who still have their uterus intact of endometrial cancer.
• Hormone Therapy with both Estrogen and Progesterone (EPT) - can be used with women who still have their uterus intact
• Risks of hormone therapy include:
• Gallstones
• Deep Vein Thrombosis
• Pulmonary Embolism
• Stroke
• Risks are lower when therapy is started within 10 years of menopause
• NNon-hormonaltherapy 
• Changing diet - limit caffeine and spicy foods
• Avoiding triggers of hot flashes
• Keep the bedroom cool at night
• Quitting smoking
• Losing weight
• Exercise - can help with insomnia
• Support groups - an outlet for emotions
• Anti-depressants - can manage mood swings 
• Gabapentin - decreases hot flashes
• Clonidine - decreases hot flashes
• Fezolinetant - decreases hot flashes
• Medications to prevent or treat Osteoporosis (Mayo, 2023)

Although women who are in the post menopausal phase are not able to get pregnant, they should still take precautions to practice safe sex, such as using condoms, to protect themselves from sexually transmitted diseases.  If a woman experiences vaginal bleeding after menopause, she should seek medical attention as it can be a sign of serious medical conditions including:

• Endometrial or vaginal atrophy
• Uterine or endometrial cancer
• Endometrial hyperplasia
• Uterine polyps
• Cervical cancer
• Cervicitis
• Endometritis (Cleveland Clinic, 2023)

Cleveland Clinic. (2023)  Menopause. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/21841-menopause#symptoms-and-causes

Cleveland Clinic. Post-Menopausal Bleeding.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

Duke. (2023) Menopause Treatment. Duke. Retrieved from https://www.dukehealth.org/treatments/obstetrics-and-gynecology/menopause?utm_source=google&utm_medium=cpc&cr=obgyn_treatments&utm_campaign=OB+GYN+-+Condition+-+NB&keyword=menopause&gclid=Cj0KCQjw6cKiBhD5ARIsAKXUdybehANc9eRjm6npusX8I1nH28VI6GXo5RbOovSGFWttSkfbp807hMsaArDjEALw_wcB

Mayo Clinic. (2023)  Menopause.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

Medline. (2023) Menopause.  Medline Plus.  Retrieved from https://medlineplus.gov/menopause.html

NIH. (2023) What are the symptoms of menopause?  National Institutes of Health.   Retrieved from https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/symptoms

OASH. (2023)  Menopause.  Office of Women's Health.  Retrieved from https://www.womenshealth.gov/menopause/menopause-basics