Sep 19, 2016

Alcohol and Stroke: You May Be Just Asking For It

I had a hemorrhagic stroke--messy bleeding in the brain. Allow me to precede this post by saying  that I never had an alcohol problem. (I had other problems but not applicable here). This post about alcohol is a mixed bag--for stroke survivors and for people who have not had a stroke yet. You'll see why soon enough.

For starters, you probably don't remember Betty Ford, our First Lady in the 70s, unless you're an American. She was the founder of the Betty Ford Centre in Rancho Mirage, California, a luxurious complex for addiction and rehabilitation which handles mostly depression, addiction to drugs, and alcoholism. She was afflicted with all three, maybe because Gerald Ford was the president and clumsy or maybe because she had a mastectomy or maybe because she was stressed, but who knows. The Betty Ford Centre is her legacy and still very much the go-to place for troubled celebrities. For a 45-day stay, the counselor who answered my phone call said the cost is up to $25,000. Who has that kind of money? Celebrities.

Anyway, the first medical director at The Betty Ford Centre was Dr. James West, and family's questions abounded him. Here is one of the questions he answered:

Question: "My mother had a stroke three years ago. With intensive rehabilitation, she is now able to function pretty well. She is 60 now, but up until the time of the stroke, she drank almost every day. At the most she would have four or five drinks, but regularly. I never saw her drunk. These drinks would always be separated in the most 'civil and socially acceptable manner.' We were shocked a few weeks ago when a physician friend recommended that she abstain from alcohol. He said her drinking might well have caused her stroke. Is this possible?"

Dr West: "It is not only possible, but also probable. Having four or five drinks a day, no matter how socially graceful and acceptable at the Country Club, or any other social setting, is heavy drinking. The risk of high blood pressure is 50 percent higher in persons drinking three or four drinks a day than in non-drinkers. Hypertension is a major risk factor for cerebro-vascular hemorrhage (stroke), as well as myocardial infarction (heart attack).

"The four or five drinks your mother consumed are associated with a fourfold increase in the risk of a hemorrhagic stroke. This kind [of stroke] is commonly fatal, or always disabling stroke, is much more common in female heavy drinkers than in men who drink an equal amount. As she now re-enters her world of social functioning, it is imperative that she refrain from alcohol. Her risk of suffering another alcohol-related stroke is the same, or maybe even greater, than before."

Denise Mann, for WebMD Health News, in conjunction with Louise Chang, MD, said the same as West did years later. Mann wrote in 2012, "Heavy drinkers may be at a much greater risk for a bleeding stroke."

A new study suggests "people who drank about three or more alcoholic drinks per day also had the strokes almost a decade and a half before those who didn’t drink quite as much."

Mann goes on to say, "The study included 540 French people with an average age of 71 who had a less common type of stroke called an intracerebral hemorrhage. This type of stroke is caused by bleeding in the brain, not a blood clot.

"The people in the study and/or their caregivers or relatives were asked about drinking habits. Fully 25% were heavy drinkers. This was defined as having about three or more drinks per day, or about 1.8 ounces per day of “pure” alcohol.

"The heavy drinkers were about 60 when they had stroke. By contrast, the people who were not heavy drinkers were about 74 when they had a stroke. The heavy drinkers were also more likely to be smokers and did show some evidence of irregularities in their blood that would make them more likely to have a bleeding stroke."

Deepak L. Bhatt, MD, MPH, a cardiologist at Brigham and Women's Hospital in Boston and an associate professor at Harvard Medical School, concurs.

“The study does add to our knowledge that excessive drinking is bad for our health in a variety of ways, including increased risk of bleeding into the brain.”  

Bhatt says heavy drinkers may be more likely to have high blood pressure, which is a major risk factor for stroke. “If someone enjoys drinking, I don’t discourage them, but I will caution them even more so after this study to make sure that the amount is considered moderate.”

"We do know that one glass of red wine a day, on average, lowers heart attack and stroke risk, and that is still true," says Dr. Patrick Lyden, the chair of the department of neurology at of Cedars-Sinai Medical Center in Los Angeles. “If you don’t drink, don’t start because you think it will protect your heart, and if you do drink, keep it moderate. My rule of thumb is one glass of wine a night, and that is the same as a glass of beer or one mixed drink,” he says.

“This doesn’t mean you can save them up and have seven drinks on a Saturday.” (Even I know that!)

"Certain people should avoid alcohol, including those taking blood thinners," says Leyden. (I know that, too).

Another voice heard from, as recently as this year, Although alcohol in moderate amounts can protect you from having a stroke, there is no doubt that excessive intake can increase your risk of having a stroke. Chronic excessive alcohol intake can precipitate all types of stroke, and most notably sharply raises the risk of hemorrhagic stroke. This is, in many cases, the result of harmful effects of alcohol on the liver, as this organ makes proteins which are necessary to prevent spontaneous bleeding."

Yet more. A study found that drinking more than two alcoholic beverages a day when you reach middle-age raises the risk of a stroke in early old age more than do traditional risk factors, such as high blood pressure and diabetes.

The study published online January 29 in Stroke, with author Pavla Kadlecov√°, MSc, St. Anne's Hospital, Brno, Czech Republic, found that individuals "who consumed more than two drinks a day during middle age had double the risk for stroke between the ages of 60 and 75 years compared with those who consumed an average of half an alcoholic drink per day."

And finally, there comes the Copenhagen City Heart Study, with Dr. Thomas Truelsen et al, which found that "there may be differences in the effect of beer, wine, and spirits due to properties other than ethanol, a topic that has gained only little attention in stroke research. The differences in the effects of beer, wine, and spirits on the risk of stroke suggest that compounds in the wine in addition to ethanol are responsible for the protective effect on risk of stroke." Grapes, perchance? The study didn't say.

So my conclusions? If you don't drink alcohol, don't start. If you take blood thinners, really stop. If you do imbibe, watch the amount, especially if you're middle-aged or older.

Sep 5, 2016

The Words I've Been Longing To Hear: An Energizing Visit from the Cable Guy

The cable guy called first and then he showed up around 1 in the afternoon on Labor Day because the channels weren't appearing. I was reading David Foster Wallace's Infinite Jest and I put the book down because I thought it would be rude to just sit there reading, ignoring him. He was an older guy, about my age in his 60s, and I unlocked the door ahead of time so I wouldn't have to get up from the sofa. He was friendly, unpacking all his equipment and feeling the need for conversation.

"Do you have any plans for the holiday?"

"Nope," I replied. "Just hanging out. It's strange to see a person working on Labor Day."

"Christmas, the Fourth, Thanksgiving. The company is a bully in that way. Sometimes, I work 7 days a week. Just laid off 44 repair guys and I was retained. I don't want to lose my job, too."

Still unpacking.

"Are those your grandchildren on the wall?" gazing at my sons and feeling a little tiffed that he thought I was of the age to have grandchildren when I feel like 40.

"No. I'm waiting."

He told me to change channels because he wanted to see if the remote was the problem. I put on my favorite channel, CNN, because I was into politics. Apparently, so was he.

"How come it's always been a difficult decision who to vote for," he said.

"Yeah. I don't like either of them. But Romney I sort of liked," I said, omitting the part where my son lives in Massachusetts. TMI, I thought.

"Now I see it," gazing at the small diagnostic screen he brought with him. "There's something wrong with your cable box. Is it in the closet or out there?" He was pointing to my balcony.

I gestured with my hand to the balcony closet. He pulled the vertical blinds away and unlocked the balcony door.

And then he said it, those words I've always wanted to hear: "What happened to your leg? Broken?" He didn't know. I was wearing the AFO and part of it was sticking out of my pants.

"I had a stroke."

"Oh," was all he said. Then he proceeded to the balcony where he remained for 20 minutes to repair the box.

His and my reaction gave me a fantastic feeling for several reasons. He didn't make a big deal when I said I had a stroke. He just said, "Oh," like that was another run-of-the-mill thing like acid reflux. And I said I had a stroke like, once again, that was another run-of-the-mill thing like acid reflux. The stroke wasn't a badge of honor either, but this was the first time I acknowledged it without feeling gloomy.

But most importantly, he and I were having a conversation, and he thought something happened to my leg, never imaging it was a stroke. I was overjoyed that I was communicating with him and he never once thought it was that. At last, I said the words correctly and naturally. I remember the speech therapist's words, which I engineered into an acronym--HOSE: hydrate, over-articulate, speak slowly, and speak on the exhale. Evidently, I was doing just that.

I was on a roll. When he came back in, he asked me to sign his electronic clipboard with my finger. And he asked me if he should lock the door on his way out and I nodded, said too many "thank you's," and he left.

So it's now 2:30 and I am finished this post, on this Labor Day 2016 when nobody should be working.