Stroke

Emily Kane ND

INDEX


Strokes are brief episodes involving a lack of oxygenated blood flowing to the brain (90% are ischemic infarctions), or a sudden bleed within the brain tissue (10% are hemorrhagic) which causes permanent damage to the effected area of the central nervous system. In a classic stroke, the neurologic defects continue to expand for 24-48 hours after the infarction occurs ("stroke in evolution"). The most frequently seen stroke is called a "completed stroke," whose symptoms develop rapidly and maximally within a few minutes to an hour. The term "completed stroke" also refers to the fully established neurologic deficits after the stroke, whether from the acute or gradual kind. Neurologic symptoms solely relate to the area of cerebral infarction.

The course or prognosis of the stroke, also known as CVA - cerebral vascular accident - is unknown during the early days, unless death occurs. About 35% of patients die in hospital, and the mortality rate increases with age. The eventual amount of neurologic damage depends on the patient's age, state of health, and size and location of the stroke. It is unusual for total recovery to occur but the sooner improvement is seen, the better the prognosis for minimal deficits. Any deficit present after 6 months is likely to be permanent, but neurological retraining programs appear to be having some success. Further CVAs are common.

Stroke is a serious diagnosis. Make sure that you and your doctor definitively decide that you that you do not have one the following problems, whose symptoms may mimic stroke symptoms:
· Migraine
· Convulsive seizure
· Neoplasm (cancer)
· Meniere's disease
· Hyperinsulinism in diabetes mellitus patients
· Head injury
· Meningitis
· Uremia (toxic blood due to kidney failure)
· Hepatic coma (liver failure)
· Alcohol or drug intoxication
· Poisoning
· Epilepsy


How can Physical Medicine help with stroke?
Gentle, regular aerobic exercise can help prevent stroke. But if you or a family member already has suffered from one or more strokes, a simple hydrotherapy technique may provide relief, and even minimize long term sequelae. Hydrotherapy is discussed at length in the Introduction to Modalities section. One technique is to lower your body temperature, with a cold bath for example, as much as possible without inducing shivering as soon as possible after a stroke has occurred, or is suspected to have occured. The idea here is that if the stroke is ischemic (temporary restriction of oxygenated blood) the body naturally and preferentially preserves blood flow to the brain, so cooling the rest of the body will cause the blood to shunt rapidly to the brain. However, if the stroke is hemorrhagic, cooling the body rapidly will cause vasoconstriction, thereby helping to control the bleed. Another hydrotherapy technique with a similar rationale is to soak the feet in a hot foot bath, as soon as possible after the stroke has occurred, while applying a cold compress to the neck, face and scalp. If this technique can be applied as a stroke is happening, it may even abort the stroke. Make sure the ice-cold compress touches the skin over the carotid arteries under the jaw bone. Mustard paste or powder may be added to the foot bath to increase the heating effect. Make sure to continue this treatment for at least 20 minutes and keep adding hot water to the foot bath and make sure the cold compress stays really cold. Or, you may take a neutral bath that is neither freezing cold, nor warm. Immersion in water of neutral temperature is extremely soothing to the central nervous system.

If someone has collapsed due to a stroke, and is waiting to get medical attention, raise the head gently if you are absolutely sure no spinal injury has been sustained, and keep the paralyzed side up. Don't let the stroke victim lie on the paralyzed limbs if at all possible. The paralyzed limbs may be massaged to maintain proper circulation.

Two of the most distressing sequelae of stroke are inability to speak clearly, and inability to perform fine motor skills, particularly with the hands. For someone struggling to regain the ability to speak normally, speech therapy is highly recommended. And read on, because there is help with Acupuncture also. To help minimize permanent damage to hand coordination please begin exercises, such as the exercise ideas listed below, as soon as possible, and don't give up.
· squeeze a soft or spongy ball with the hands whever you're watching TV or talking on the phone or enjoying a sunset;
· stretch and reach for objects;
· count coins with the fingers;
· type;
· play piano;
· get some help to figure out safe movements routines that will allow you to bathe yourself, prepare a meal for yourself and put yourself to bed, as soon as possible.


Can diet and nutrition affect the outcome of my

stroke?

Yes, absolutely. Since strokes often occur because of fatty deposits in the arteries, which indirectly compromises smooth blood flow to the brain, it makes sense to eat a low-fat diet. Strokes also occur because of insufficient integrity of the walls of the blood vessels, so eating foods that improve vascular tone, notably the dark-colored berries (whose active ingredient is the blue-black pigment anthocyanadin) would be wise. In general, the eating principles for minimizing the chance of a recurring stroke, or to stay as healthy as possible after you've suffered a stroke, are to keep the diet:
· low in sugar, low in cholesterol
· low in unsaturated fats
· with these calorie percentages: 70% complex carbohydrates, 12-15% protein and 15-18% fat (preferably NOT animal fat).
· high in fiber
· low in Sodium. Sodium can raise blood pressure, putting excessive pressure on the vascular system.

Specifically therapeutic foods post-stroke include:
· high Potassium foods such as millet, buckwheat, oats, rice, raw goat's milk, raw leafy vegetables, watermelon, garlic, onions, cornsilk tea, diuretic foods such as dandelion greens and grapes.
· high Magnesium foods such as garlic, broccoli, celery, cherries, nectarines, pineapple, kumquats, watermelons, squash, pomegranate, guava, parsley, cucumber, dandelion greens.
· foods rich in Calcium (seaweeds, swiss and cheddar cheese, collard greens), Phosphorus (Brewer's yeast, wheat bran, pumpkin and squash seeds), Manganese (pecans, Brazil nuts, almonds, barley, rye, ginger, bay leaves), Sulfur (eggs), Iodine (clams, shrimp, haddock, halibut, oysters, salmon, sardines), and tryptophan (lean turkey breast, bananas.
· egg yolk, kale, celery, fish, raw goat's milk, veal joint broth, cod roe, rice polishings, nutritional yeast.
· increase omega-3 and omega-6 fatty acids: rich sources are vegetable, nut, seed oils, (especially flaxseed oil), salmon, herring, mackerel, sardines, walnuts, evening primrose oil, black currant oil.

If you have some kind of juice extracting machine at home, or are willing to invest in one, now is a good time to learn about the therapeutic effects of juicing. Don't underestimate the profound healing effect that raw vegetable or fruit concentrates can have on your body. Taking specific juice combinations, at least 5 pints of fresh juice weekly, can work well to minimize stroke sequelae. Try the following "health cocktails:"
· celery, carrot, prune
· carrot, celery, parsley, and spinach
· carrot and spinach
· carrot, beet, and celery
· carrot, spinach, turnip, and watercress
Other food combinations for post-stroke health to consider, based on you taste buds, are:
· prune and rice polishings
· raw goat's milk and 1 tsp. sesame, sunflower, or almond butter, 1 tsp. honey and sliver of avocado
· black cherry and egg yolk

Foods to be careful to avoid include:
· salt and salty foods: such as pickles, olives, chips, packaged snacks, prepared meats, especially canned ham, frankfurters, bacon, bologna, corned beef and lunch meats, frozen fish fillets, sardines, herring, caviar, anchovies, shellfish, dairy products, spicy foods: salsa, white and black pepper, mustard, ginger and hot foods, canned tomato juice, V-8 juice, processed cheese, canned, dried or instant soups, frozen peas and beans, most processed and refined foods, MSG, mayonnaise, salad dressings, gravies, ketchup, food with Sodium benzoate as a preservative, Sodium proprionate found in some cheeses and breads, baking powder, baking soda, ice cream, milkshakes, soft drinks, smoked meats and fish, Jello, pretzels, potato chips, salted nuts, candy, rennet tablets, pudding mixes, beverage mixes, spicy foods, alcohol, fried foods, fatty foods, pork. In addition, as a general rule, avoid overeating and try to prevent reaching higher than normal levels of blood calcium.

By age 40 everyone should have baseline blood chemistries (assessing liver and kidney and hormonal function, at least) which will then be a reference point for how "gracefully" you are aging. Blood work you and your doctor will evaluate later in life will have much greater significance if there's something to compare it to. Consult with your primary care physician (holistically oriented MD, DO or ND) about how often you should get routine physicals and blood evaluations. Remember, prevention is the very best way to approach your health care, and you need to get realistic assessments of vital health parameters relatively regularly after age 40.

Sometimes food alone is not enough to preserve maximal health. Many North Americans are malnourished, which, surprisingly, is especially likely to be true of you are more than 20% over your ideal weight. The following nutrients have been proven to be beneficial in miantaining healthy cardiac tissue, as well as reducing the likelihood of another stroke:
· Vitamin E 400-1600 I.U. daily. A good anti-oxidant which helps repair damaged tissues through various mechanisms.
· omega-3 fatty acids, 1 tablespoon daily, for example from raw flaxseed oil, to provide your body with a high quality fat with which to build new cells. Every single cell in your body has a cell wall which controls what goes in and out, and thus what triggers the nucleus of the cell, where the DNA resides, to make whatever protein is needed moment to moment. The cell wall is built largely of lipids (fat) and whatever fats and oils you ingest is what is available to make your cell walls. Thus, you want to provide your body with the finest quality fats and oils possible, to preserve the integral functioning of all the cell walls in your body. Don't feed your body saturated fats such as the fat on red meat, or lard. This only stocks up your body with ingredients which ultimately cause reduced nerve function (the brain and nerve sheaths are mainly made of fat), toxic build-up and heart disease.
· Coenzyme Q10, 10-50 mg daily. This is one of the most popular supplements in Japan, where most of the research has been done on this potent natural substance. It works specifically by allowing the maximal amount of oxygen conversion from body fluids in the cardiac muscle, thus reducing the need of the heart to work overtime to pump sufficient oxygen to the other tissues in your body. In large doses (250 mg daily for 7 days) it can turn congestive heart failure around. Please consult with your holistically trained MD, DO or naturopathic physician (ND) before experimenting with high doses.
· Vitamin C 3 g daily. The most researched anti-oxidant, Vitamin C, can "gobble up" the dangerous free radical electrons which cause progressive tissue damage. Vitamin C should be supplemetned by anyone who lives in a city, or commutes regularly in traffic, or who has a history of smoking.
· Bromelain 250 mg two or three times daily, away from food. This is a protein-digesting enzyme derived from the pineapple stem and acts as a potent natural anti-inflammatory. Many strokes are initiated by a mild infection or inflammation inside the blood vessels, where a plaque can begin to form. The plaque distorts the blood flow through the vessel, which creates an eddy which may in turn create coagulated blood which can cause a blood clot (thrombus) which then dislodges and gets stuck higher up in a smaller vessel, preventing blood flow to the brain. Bromelain will help reduce inflammation by digesting the by-products of tissue repair as it is in process. But if you take the bromelain with food, it will be used digesting the protein in the meal. So take it at least 2 hours away from food to maximize the antinflammatory effect.

What about herbal medicine to help after I've had a stroke?
· Achillea millefolium (Yarrow) is great, in tea or tincture form, for thrombotic conditions with hypertension, including cerebral and coronary thromboses; combine with Tilia platyphyllos (lime blossom) in essential hypertension.
· Allium sativum (good old garlic; eat one clove daily). Garlic is high in the two amino acids that contain organic sulfur compounds (Cysteine and Methionine) which help render fat soluble toxins more water soluble. Thus, garlic helps rid the body of toxins through the channels of urination, defecation and perspiration. Garlic also helps dissolve fatty stores in the body, where toxic wastes are more likely to accumulate.
· Arnica montana (toxic in high doses internally, use the homeopathic mother tincture, a 10:1 dilution of alcohol to plant material) 25 drops three times daily for shock or brain tissue changes, and to prevent further coagulation.
· Capsicum frutescens (Cayenne pepper) following stroke. This remarkable culinary herb is a classic, and powerful, "alterative" which means that it regulates an imbalance which has gone awry in either direction. In this case, if your stroke is ischemic (due to a clot cutting off proper blood flow to the brain) the Cayenne will stimulate the return of blood to the cerebral tissues. If, on the other hand, your stroke is hemorrhagic (a bleed inside the skull), the Cayenne will act as a local styptic (stenching blood flow). The best way to take Cayenne for maximizing your circulatory power is a hearty pinch in a small glass of water first thing each morning. You may want to find a small jar with a lid to shake up this firy-hot and tasty little toast. Especially great on cold days; it will keep your feet and hands warm for hours. Try to find organic (non-sprayed, non-irriadiated) Cayenne at your local health food store, and buy several ounces in bulk.
· Crataegus spp. (Hawthorne, white and black). This botanical is perhaps the most useful of the heart tonics, and works particuarly well to strengthen connective tissue, which is needed post-stroke for damage repair. It also works very well to digest fat, and will lower cholesterol if taken regularly. Eat the berries raw, or use a teaspoon daily of the tincture.
· Ginkgo biloba (standardized extract of Gingko leaves) is used all over the world to increase circulation, particularly to the brain. Because of this action, Gingko is widely used to promote long and short-term memory capacity. It does this by dialating cerebral blood vessels.
· Trifolium pratense (Red clover) is high in natural coumarin, a blood-thinning agent. Do not use in hemorrhagic stroke or if you are already on a prescription anticoagulants. However, you may want to switch to clover if your aspirin a day is bothering your stomach, or if you object to being maintained on pharmaceutical medication. Fresh Red clover sprouts work as well (you need at least a handful daily, in a salad or sandwich) as the tincture form. Please do NOT wean yourself off prescription drugs without consulting with a qualified healthcare professional.


Can Chinese Medicine help after I've had a stroke?

There are varying diagnoses of Traditional Chinese Medicine (TCM) that could describe what we in the West call "stroke." In TCM, the doctor or acupuncturist looks at the interaction between your constitution -- that is, what genetic/physical characteristics you were born with that impinge on your total health -- and the disease complex. In conventional medicine, the doctor is more likely to focus solely on the disease. Therefore, the first order of business with a Traditional Chinese Medical treatment is to arrive at the correct diagnosis, and select acupoints and/or herbal medicine accordingly. The following "patterns" are some of the more common TCM diagnoses which cover the symptoms of stroke: Penetrating Wind; Liver Fire; Phlegm, esp. Heart Misted by Cold Phlegm; Yang Shi (Excess); Yin Xu (Deficiency); Liver Yang Rising Causing Liver Wind; Stirring of Liver Wind. These perhaps do not mean much to someone who has not studied TCM, but are given to begin to familiarize you with a new vocabulary, and so that you can recognize that these unfamiliar concepts are not mumbo-jumbo, but thoughtful assessments of your condition, based on a tradition over 3,000 years old.

Some of the best known points to restore consciousness after a stroke are:
· Gall Bladder-20. This very important point is called "Wind Gate" and is located at the nape of the neck, on either side of the big muscles that hold the head onto the shoulders. This is an area of the body that is especially important to protect during a change of seasons. The term stroke is transliterated in Chinese as "Wind Stroke." The Chinese believe that all evil external influences that could disrupt our health come into the body through "Wind." Gall Bladder-20 is a point at the back of the head which is particularly susceptible to being penetrated by Wind. So, wear a scarf on a windy days and don't sit in a draft. By needling these points, one on each side of the top of the spine, pathogenic "Wind" may be cleared. In addition, the Spirit can be awakened, the Brain function clafiried, the "Heat" rising from the Liver cooled and the balance between the Qi (vital energy which runs through the meridians; a Yang substance) and the Blood (a Yin substance) can be restored. A powerful point.
· Governing Vessel-20 is located right at the top of the head and is often "pecked" with the thin needle to draw a tiny drop of blood to revive consciousness.
· Governing Vessel-26 is also on the midline of the body, and in this case directly above the upper lip. This point is famous for restoring consciousness after an epileptic seizure, but works well for shock of any kind. You can even work this point very effectively by pushing with your little finger into the horizontal groove between the bottom of the nose and the upper lip, firmly, at a 45 degree upward angle, until the stroke victim wakes up. In terms of Chinese Medicine, this point works by dispelling Wind, calming the Spirit, clearing the senses and eliminating "Mist" (can be psychological cloudiness or excess fat) around the Heart.
· Heart-5 is another point, located in the soft crook of the elbows, which pacifies the Spirit, regulates the Qi of the Heart, brings "Fire" down from the head and relieves stiffness of the tongue and slurred speech from Wind-stroke.
· Kidney-1, the beginning of the Kidney merdian, is located on the bottom of the foot, where the pads of the toes meet the arch. Although not the most comfortable point to needle, it works well to pacify the Spirit, restore collapsed Yang, revive consciousness, clear Fire and Heat (especially in the head), and nourish Kidney Yin (and thereby suppresses Liver Fire).

Just a few of the major points are being given here. Many more may work for you, depending on your TCM diagnosis, the style of the doctor, and your sensitivity to needle stimulation. After consciousness is regained, the following points may be additionally considered:
· scalp acupuncture is excellent for restoring physical function post-stroke. The limbs are affected on the opposite side of the brain from where the stroke occurred. So, if your right leg is paralyzed or partially paralyzed, you need to get scalp acupuncture on the LEFT side of your head, in the leg area. If you have a sensory deficit in the leg (that is, you can't feel pain or temperature) you will need to be needled in the leg sensory area. If your deficit is motor (can't control muscle function in the leg, a much more serious problem) you need to get a needle in the leg MOTOR area of the scalp. Scalp acupuncture is an entire TCM subspecialty. In China there are numerous doctors who specialize in this scientific art, particularly because it is one of the most effective tools known to TCM for restoring nerve function. Other points, on the body, to help minimize post-stroke sequellae are:
· Heart 7, near the inner wrist, as a general sedative -- it has a regulating effect on the inner organs and nourishes Heart Xue (Blood).
· Kidney 6, below the inner ankle pacifies the Shen (Spirit) and stabilizes the Will; nourishes the Heart; cools and clears Heat; clears Xu (Deficiency) Fire; and stimulates adrenals.

One of the most interesting treatments to come out of the more modern Chinese approach to stroke rehabilitation, is the acupuncture technique used to restore normal speech function. Although this may sound disconcerting, be open minded and consider the following: as soon as possible after the stroke, the sufferer who has resulting speech impairments (aphasia) will receive a course of 10 or more treatments of TONGUE acupuncture. The doctor or acupuncturist will grasp the patient's tongue with a piece of gauze, and lift it up gently to insert a long needle quickly and momentarily deep into the underside of the tongue at two points just outside the big veins that run under the tongue. Often the beginning of improvement will occur after the first treatment.

Another, extremely potent, aspect of TCM is the use of Chinese medicinal herbs, either loose and brewed into "soup" or formulated in pill form, and sold as "patents." Specific for stroke are:
· Ren Shen Zai Zao Wan (Tsaitsuowan) (patent) combined with Da Huo Luo Dan (patent) treats Liver Wind Stirring which refers to strokes with symptoms such as facial paralysis, limb paralysis, hemiplegia, numbness of limbs, pain, limb contractures, poor articulation and speech output problems. Administer as soon as possible after the stroke, once bleeding is stabilized.
· Xiao Huo Luo Dan to treat numbness, paralysis, muscle spasms.
· Bu Yang Huan Wu Tang for hemiplegia, deviation of mouth & eyes, difficult speech, salivation, frequent or incontinent urination.
· Zhen Gan Xi Feng Tang to treat thrombosis due to Liver Wind Stirring.
· An Gong Niu Huang Wan (patent) for the TCM diagnosis Fire Toxin with Heart Agitated by Phlegm Fire.
· Salvia Shou Wu (patent) plus Styrax 14 (patent)


How can Homeopathy help with stroke?

Please read the section on Homeopathy in the Introduction to Modalities. Homeopathy is a complex medical science in which minute doses of plant, mineral and animal substances are used, effectively, to treat many types of illness. Homeopathic remedies that may be choosen for the stroke patient are described below. Please consult with a qualified homeopath or naturopathic doctor to help select the best remedy for you.
· Arnica montana for the stroke which gives a cerebral lesion similar to a bruise, or a frank hematoma (for post acute crisis survival).
· · Belladonna is given when the face is flushed and you have a throbbing headache, the pain of which is worse with light, noise, any jarring movement, lying down and in the afternoon, but better in a semi-erect posture.
· Kali muriaticum can absorb the clot (for post acute crisis survival).
· Natrum muriaticum for when the face is pale and you have a throbbing headache, nausea, and vomiting.
· Nux vomica is the remedy for when the stroke occurs after a heavy meal or too much alcohol; and you feel vertigo followed by a momentary loss of consciousness.
· Opium for when the patient is unconscious, breathing heavily; when the face is dusky and cyanosed (blue, due to lack of blood.)
· Sulphur is for the heavy red-faced beer-drinking type, who complains of feeling heat on top of his head.
· Veratrum album is given when the clinical picture is one of collapse; shock, sweating and cold; with a cold sweat on the forehead.


What are some Subtle Energy Medicine approaches to help before, or after, a stroke?
Many people have derived great comfort from a series of remedies developed by a British physician, Edward Bach. These remedies are similar to homeopathic remedies, but are made exclusively from flowers. Some of the flower essences commonly chosen post-stroke to minimize central nervous system damage are:
· chaparrel
· red clover
· dill
· mallow
· mugwort
· clematis

Other people choose to work with color, either by wearing clothes of certain colors, or by using colored plastic gels in front of light sources in the home or office environment. Immediately after stroke, the following colors have shown therapeutic benefit:
· purple (helps to lower blood pressure by three pathways: vasodilation, slows heart rate, and helps to calm kidney and adrenals) applied to the face, neck and chest.
· indigo (an astringent, antipyic, antiemetic, and hemostatic) applied the the entire cranium.
After the stroke patient has stabilized, the following colors are useful to prevent further stroking:
· lemon (helps to dissolve blood clots; acts as a chronic alterative) applied onto the front of the body.
· magenta (regulates the circulation system) applied to the face, neck and chest.


Can psychological approaches help relieve my discomfort after having a stroke?

Consider the following ideas which may or may not ring true for you. If they do, think about how you can use the power of your own mind to avoid detrimental thought patterns for yourself.
· Stroke may come on because of a dominant and often obsessive need to control one's environment; LACK OF TRUST; do you find it difficult if not impossible to trust the intention or activities of others? Do you continually worry about financial and material security and well-being? There's a strong association between stroke and feelings of vulnerability and belief that external world is unsafe.
· Stroke may represent a kind of giving up; resistance; where you'd rather rather die than change (or think you would). This is clearly a rejection of life.

Affirmations may help you get beyond these negative thought patterns. You may write them across the bathroom mirror in lipstick, or recite them outloud to yourself while driving, cooking, and bathing, or find a ritual that is meaningful and relaxing for you to let the healing words sink in.
· Life is change, and I adapt easily to the new.
· I accept life: past, present, and future.




Emily Kane ND practices in Juneau, Alaska and can be reached at: (907)586-3655
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