Time is of the Essence When Treating a Stroke
New Developments for Stroke Prevention and Treatment

When blood flow to any part of the brain is interrupted or severely restricted, the result is a stroke. The lack of an adequate supply of oxygen to the targeted brain cells damages them, and within minutes, these oxygen-starved cells begin to die. According to the Centers for Disease Control and Prevention (CDC), stroke is the third leading cause of death in the United States and a leading cause of adult long-term disability.

The effects of a stroke can be minimized if appropriate medical attention is received promptly. In addition, recent developments improve a physician’s ability to determine if you are at risk for a stroke and point the way towards better prevention and more individualized treatment.

Five Major Signs of a Stroke
According to the U.S. National Institute of Neurological Disorders and Stroke, there are five signs that someone may be experiencing a sudden stroke:

• Weakness or numbness of the face, arm, or leg. It may be a partial or complete loss of sensation or voluntary movement, or simply a tingling sensation in the affected area.
• Difficulty speaking or understanding. The victim may appear confused. Sometimes the face muscles become weak and drooling may occur.
• Impairment of vision in one or both eyes.
• Dizziness, loss of balance and coordination, or trouble walking.
• Onset of a severe headache without a known cause.

Despite its prevalence, few people recognize the signs of a stroke. If you suspect that someone may be experiencing a stroke, you can utilize the same uncomplicated tests that physicians use to assess whether or not a stroke has occurred. Known as the Cincinnati Prehospital Stroke Scale (CPSS), the tests consist of three straightforward demands:

• Smile
• Raise both arms
• Speak a simple sentence

If any of these commands cannot be followed, medical attention should be sought immediately. A prompt response is crucial, even if the initial symptoms seem to abate, because the damage to the brain and the potential disabilities increase with each minute that passes.

A Quick Response Improves the Outcome
In the past few years, more life-saving treatments have become available to those who are treated for stroke right away. A drug called
t-PA (tissue plasminogen activator) has proven effective for ischemic stroke victims if administered within three hours of symptoms. Ischemic strokes are diagnosed in 85 percent of stroke cases and are caused by fatty deposits that obstruct blood flow to the brain.

Unfortunately, a recent study by the Yale School of Public Health published in Stroke: Journal of the American Heart Association, found that almost two-thirds of stroke victims do not get to a hospital in time for t-PA to be effective. “One of the greatest challenges for acute stroke care is getting patients to the hospital as soon as they experience stroke symptoms so that therapy is given within the treatment window,” said Judith H. Lichtman, Ph.D., associate professor and lead researcher at the Yale School of Public Health.

Those victims not eligible for t-PA may be given aspirin or an antiplatelet medicine to improve blood flow. Other treatment choices include medications that control blood pressure, blood sugar levels, fever, and seizures.

The antibiotic minocycline may soon be available to treat strokes and could help those stroke victims who do not reach the hospital within the treatment window for t-PA. A new study published in October 2009 in the journal BMC Neuroscience showed this drug to be effective and safe in animals.

In 15 percent of cases, a hemorrhagic stroke is caused by a ruptured blood vessel in the brain that causes blood to accumulate and press on brain tissue. Treatment for hemorrhagic stroke is limited and there are few medications that have been effective.

Sometimes drugs that control blood pressure, brain swelling, blood sugar levels, fever, and seizures may be given. When severe bleeding is the cause, surgery to remove the blood building up in the brain or to repair an aneurysm may be needed.

New Developments Help Identify Risk Factors
Are you at risk for a stroke? The factors listed below increase your risk of having a stroke:

• Age 55 or older. The risk of a stroke more than doubles every 10 years after age 55. Almost three-quarters of all strokes occur in people age 65 and over.
• High blood pressure. According to the World Health Organization, high blood pressure is responsible for over 12.7 million strokes worldwide.
• Cigarette smoking. Smoking can double your risk of suffering an ischemic stroke.
• Diabetes, high cholesterol, obesity, and cardiovascular disease.
• High levels of the amino acid homocysteine.
• Use of birth control pills or other hormones.

A family history of stroke or heart attack also increases your risk. A study published in April 2009 in The New England Journal of Medicine helps explain why. Researchers identified two common genetic variants that increase the risk of stroke. Researchers used a new tool that rapidly scans the DNA of many individuals to find genetic variations associated with a particular disease. In this case, variations in genes located on chromosome 12 were identified. Physicians will be able to utilize this knowledge to personalize treatment. For example, patients with these genetic markers could be offered more rigorous treatment with blood pressure and cholesterol-lowering medications. The tool used to locate the genes associated with stroke has also been used to identify relationships between genetic variations and other diseases or conditions, such as type 2 diabetes, obesity, and heart disorders. Ask your MDVIP-affiliated physician for information about genetic testing.

By talking with your physician and familiarizing yourself with the current and emerging risk factors, symptoms, and treatments available for stroke, you can minimize or perhaps even avoid its devastating effects.

If you think someone may be having a stroke, act F.A.S.T. and do this simple test:

Call 9-1-1 immediately if you have any of these symptoms.

Note the time you experienced your first symptom. This information is important to your MDVIP-affiliated physician and can affect treatment decisions.

Source: National Stroke Association, www.stroke.org

ArterioVision™ Identifies the Risk
Fortunately, there is a new technology that can ascertain the extent of coronary artery disease so that you can get treatment before symptoms develop or your life is at risk. ArterioVision™, from Medical Technologies International, Inc., uses a painless, non-invasive ultrasound procedure to measure the thickness of carotid artery walls (carotid intima media thickness, or CIMT). Located on both sides of the neck, the carotid is a major artery supplying blood to the brain and provides a good indication of the degree of atherosclerosis that can affect blood flow to the heart. It is also close to the surface of the skin, enabling ArterioVision™ to precisely measure the thickness of its first two inner layers.

From NASA to You
The science behind ArterioVision™ and its image processing software originated at NASA’s Jet Propulsion Laboratory, the California Institute of Technology, and USC’s Keck School of Medicine’s Atherosclerosis Research Unit. NASA uses this test to screen astronauts as part of its Manned Flight Program. In fact, Medical Technologies International, its founders, and ArterioVision™ have been inducted into the Space Technology Hall of Fame.

"It is unusual to come across a technology that truly enhances a physician’s ability to detect at an early stage and even prevent major diseases such as coronary heart disease and stroke," said Bernard Kaminetsky, MD, FACP, medical director of MDVIP. "After stringent review and testing, I’m convinced that ArterioVision™ is a huge step forward."

In a continuing effort to assist MDVIP-affiliated physicians and their patients in the prevention and early detection of disease, MDVIP has arranged with Medical Technologies International to make the exam and the professional interpretation of results available to members at a reduced cost. Everyone can benefit from having a baseline test performed now and measuring changes over time. But if you are already at risk for coronary heart disease or stroke, you may want to discuss ArterioVision™ with your MDVIP-affiliated physician.

*Statistics courtesy of The American Heart Association

MDVIP Adds Another Top 10 Hospital
UCSF Medical Center Joins MDVIP's MCE Program

UCSF Medical Center, located in San Francisco, California, has recently joined MDVIP’s Medical Centers of Excellence program. UCSF is ranked among the top 10 hospitals in the nation and the best in the Bay Area, according to U.S. News & World Report's "America’s Best Hospitals 2009-10." Not only is this outstanding medical center ranked number 7 overall, but it has been ranked in the top 10 for nine consecutive years. In addition, it ranked near the top in at least six specialties, which earned it "honor roll" status.

"It’s gratifying that UCSF Medical Center is recognized as the best hospital in Northern California and among the top hospitals in the United States," said Mark Laret, UCSF Medical Center’s chief executive officer. "This rating is a testament to the quality of our faculty physicians, nurses, and staff."

UCSF Medical Center enjoys an excellent reputation as a leader in health care, combining innovative medicine, advanced technology, and compassionate care to improve and save lives.

In addition, UCSF is distinctive in its ability to offer:

• Northern California’s only nationally-designated Comprehensive Cancer Center offering new and better treatments for cancer patients
• Northern California’s only nationally-designated Center of Excellence in Women’s Health offering specialized care and health education for women
• A children’s hospital with 150 specialists in more than 40 areas of medicine
• One of the largest brain tumor treatment programs in the nation
• Northern California’s only comprehensive memory disorders center and only comprehensive epilepsy center
• One of the nation’s largest centers for liver and kidney transplants

"We’re enormously pleased to add UCSF to our Medical Centers of Excellence program," said MDVIP’s Medical Director Bernard Kaminetsky, MD, FACP. "They offer leading-edge medical knowledge in a wide range of specialties and advancements in virtually every phase of health care from prevention and early detection to treatment of disease."

Chart Source: America's Best Hospitals 2009-2010. U.S. News & World Report.

A Patient Story:
My Sincere Thanks to Dr. Homburg
An MDVIP-affiliated physician in Ft. Collins, Colorado

Robert Homburg, MD

My husband and I celebrated our 35th wedding anniversary this past March around the time that our primary family physician, Dr. Robert Homburg, was switching over to be an MDVIP-affiliated physician.

We could have spent $3,000 to go on a cruise to mark the occasion of our anniversary, or we could spend the money on a year of care from Dr. Homburg.

Talking it over, we decided we needed to give ourselves the same kind of care we get from our veterinarian for our pets. We can call our vet and he gets us in that day, or gives us guidance over the phone.

Three weeks post-op, Claudeen Jean and I competing in a dock-diving competition at the county fair.

Turns out we made a great choice! In March I started to have intense rib pain on my left side. Dr. Homburg was committed to investigating the cause and finding treatment for the pain (X-rays, medication, steroid injection, physical therapy). Although it offered some relief, the pain persisted. Finally Dr. Homburg sent me for
a CAT scan with contrasting dye. He called me that day to tell me that there was still no answer for the rib pain, but they found a tumor on my left kidney.

He immediately set me up with Dr. Michael Lee, a urologist in our area who specializes in robotic surgery. Usually Dr. Lee has a waiting list to get in for surgery, but somehow I got in and had surgery shortly thereafter. Dr. Lee removed a third of my kidney with the encapsulated tumor.

On my follow-up appointment with Dr. Lee, he told me that he usually didn’t get to have such positive post-op appointments with patients diagnosed with renal cell carcinoma; often he had to tell them they had less than a year to live!

One month post-op, Gladus Ruth and I are back to doing therapy dog visits.

I feel blessed to have had Dr. Homburg’s persistence in addressing my health needs and facilitating the referral to Dr. Lee. It is now more than eight months post-surgery, and I am enjoying the school year along with my young students. I am grateful to have a clean bill of health.

The priority we set for our health by going with MDVIP means that my husband and I will have more years to get to walk our dogs together. I am happy to get to return to doing activities with our three Labrador Retrievers.

Both Dr. Homburg and Dr. Lee told me to get out there and live life! Here are some pictures of me following doctors’ orders.

Pawsitively yours,

Amy Fristoe

Ring in the New Year with “Caring” Resolutions

As the new year approaches, you’re bound to be asked about your resolutions. Now is the time to consider some simple changes that can result in dramatic improvements to your mind, body, and spirit. Here are a few suggestions:

Take care of yourself: Make wellness a top priority this year. Whether it’s losing a few pounds, eating healthier foods, or exercising more, let 2010 be the year you take important steps towards healthier living.

Take care of others: Helping other people adds meaning to your life. There are many opportunities to volunteer in your community. Try contacting local schools, hospitals, or charitable organizations, and offer to volunteer, even if it’s only for a few hours a week.

Take care of the earth: Incorporating a few small changes in your daily routine can help make 2010 an environmentally-improved, “green” year. Ways to help include recycling plastic bags, using cloth napkins instead of paper, and fixing leaks to prevent excess water usage.

Top 10 Foods for 2010

If you want to improve your health in 2010, focus on improving your diet. By incorporating the following items in your everyday meals, you’ll be adding foods that provide a good source of fiber, vitamins, minerals, antioxidants, and other nutrients that help reduce your risk of heart disease and other health conditions.

1. Almonds — Like all nuts, almonds are an excellent source of protein. They also provide fiber, riboflavin, magnesium, iron, and calcium. The fat in almonds is monounsaturated fat, which is a healthier type of fat that can help lower blood cholesterol levels.
2. Apples — Fresh apples are an excellent source of pectin, a soluble fiber that can lower blood cholesterol and glucose levels. They also provide vitamin C, an antioxidant that protects the body’s cells from damage. Vitamin C also helps form collagen, keeps capillaries and blood vessels healthy, and aids in the absorption of iron.
3. Blueberries — Blueberries are a rich source of phytonutrients, compounds that help prevent certain diseases. In particular, eating blueberries helps prevent urinary tract infections. They also improve short-term memory and promote healthy aging. Blueberries are a low-calorie source of fiber and vitamin C.
4. Broccoli — Broccoli also contains phytonutrients, which can help prevent heart disease, diabetes, and some cancers. It is also a good source of vitamins A and C, both of which are potent antioxidants.
5. Red Beans — Red beans are a good source of iron, magnesium, phosphorus, potassium, copper, and thiamin. They are also a low-fat, low-calorie source of protein and dietary fiber. In addition, they contain important phytonutrients.
6. Salmon — Salmon is an excellent source of omega-3 fatty acids. This type of fat helps protect against irregular heartbeats, blood clots, and artery-clogging plaques. It helps decrease triglyceride levels, lowers blood pressure, and reduces the risk of stroke. It is a good source of protein and is low in saturated fat and cholesterol.
7. Spinach — Spinach is high in vitamins A and C and folate. It also provides riboflavin, vitamin
   B-6, calcium, iron, and magnesium. Spinach helps boost your immune system and can help keep your hair and skin healthy.
8. Sweet Potatoes — Sweet potatoes are fat-free, low in calories, and high in the antioxidant known as beta carotene. Beta carotene is converted into vitamin A and helps slow the aging process and reduces the risk of some cancers. Sweet potatoes are also a good source of fiber, vitamins B-6, C, E, folate, and potassium.
9. Vegetable Juice — Vegetable juice has most of the vitamins, minerals, and other nutrients found in the original vegetables. Vegetable juices that include tomatoes are good sources of lycopene, an antioxidant that may reduce the risk of heart attack, prostate cancer, and other cancers. Choose low-sodium varieties of vegetable juices.
10. Wheat Germ — The center of each grain of wheat contains a highly concentrated source of nutrients, including niacin, thiamin, riboflavin, vitamin E, folate, magnesium, phosphorus, potassium, iron, and zinc. It also contains protein, fiber, and some fat.

Source: Adapted and printed with permission from the Mayo Clinic, www.MayoClinic.com.

Mayo Clinic is an MDVIP Medical Center of Excellence.

New MDVIP-Affiliated Physicians Opened
September 2009 through December 2009
MDVIP opens in Delaware and Kansas

Beginning in January 2010, you will receive a monthly issue of Living Well from MDVIP, as well as regular health and wellness information from your MDVIP-affiliated physician. This educational information will be sent to you electronically.

Please provide us with your e-mail address by sending an e-mail to editor@mdvip.com. Include your full name, the name of your physician,
and your e-mail address.

Give the Gift of Health

Share the gift of health with your family and friends around the country. MDVIP has over 350 affiliated physicians in 28 states and Washington, D.C.

To apply for a membership and/or for a complete list of physicians, click here or call 866-696-3847.