Dear Dr. Roach: In February, I had a stroke. I received no warning, and the stroke affected my left side. My doctor put me on blood pressure medication, but not a blood thinner. The stroke has left me with numbness in my left side, but I can use my limbs OK. What I want to know is: What causes people to have a stroke? Once you have had one, are you in danger of having another? Finally, does everyone who has had a stroke need a blood thinner?
M.J.J.
A stroke is caused by a lack of oxygen supply to the brain. If this lasts long enough, brain cells die, and a stroke is defined as the sudden death of brain cells. Any time a person has a stroke, they are at a much higher risk for another, so treatment is almost always used to prevent another.
There are three main causes for stroke. A blockage in one of the arteries to the brain, usually caused by a blood clot in an area of cholesterol plaque, causes a stroke the same way that people get heart attacks. Treatment is designed to prevent another stroke by reducing the risk factors for cholesterol plaque with cholesterol medicines and careful blood pressure control, as well as the use of antiplatelet drugs like aspirin or clopidogrel. (Both antiplatelet drugs and anticoagulants like warfarin and apixaban are sometimes called “blood thinners.”)
An embolism is a second cause for a stroke. The most common embolus is a blood clot, often from the heart, which lodges in a brain artery and blocks blood flow. In this case, an anticoagulant is usually prescribed, and the person may need to control their atrial fibrillation if this is the underlying cause for the clot forming in the heart.
The third most common cause for stroke is a hemorrhage (bleed) in the brain. This often happens when blood pressure is very high. Blood pressure control is critical here, and neither antiplatelet drugs nor anticoagulants are used, as they can be dangerous.
This is only the barest discussion on strokes, as there are many other less-common causes, and an expert (neurologist) is appropriate to help. In some people’s unique situations, there may be different treatments from what I have outlined here.
Dear Dr. Roach: In a recent column, you confirmed that my information about AREDS2 vitamins may be helpful for age-related macular degeneration (AMD). Now I just visited my ophthalmologist, and he asked me if I used these vitamins. I expected him to be pleased when I told him that I had taken them for years. However, he explained that for dry AMD, the medicine was not effective.
He said I should take an ordinary multivitamin instead because too much of some of the special ingredients in AREDS2 was not good for me. Is there new information on this?
H.R.R.
There must be a miscommunication here. The original AREDS vitamin supplement was shown to reduce the risk of progression in people with dry AMD. However, the initial formulation was shown to possibly increase the risk of advanced prostate cancer and lung cancer in smokers. The new formulation, AREDS2, removed the possibly harmful supplements.
Although the effect of AREDS2 supplements is small, it’s one of the few effective treatments that we have (apart from quitting smoking, minimizing alcohol, and a healthy Mediterranean-style diet). New injections (Syfovre and Izervay) have been approved for dry AMD, but not all ophthalmologists recommend these treatments. You should follow up with your ophthalmologist again.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
