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Diagnosed with microvascular ishemic brain disease. History of diabetes, cholesterol, hypertension, stroke. On physical therapy. Suggestions?

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Diagnosed with microvascular ishemic brain disease. Other than getting my diabetis, cholesterol and blood pressure under control is there anything I can do.? Some days I am not dizzy or no headache only to find following day back to where I was, is this going to be how it is for life I am 70 years old .Had hemorratic stroke 10 yrs ago. Receiving in home physical therapy for balance and coordination for 5 weeks now and told I will be on my walker for life. Any help would be appreciated as own doctor is very vague about what to do and expect.
Posted Wed, 11 Jul 2012 in Stroke
Answered by Dr. Anil Grover 3 hours later

The risk factors for getting a stroke in a 70 year old persons are same as getting a heart attack. I am providing the list and marking * which you have +/- about which I do not know and - as those which are certainly absent. The fact that you had hemorrhagic stoke modify treatment to the effect that doctor will have to go easy on blood thinners which you might be taking or will have to started because of recent finding of ischemic brain disease (akin to microvascular infarcts in brain rather than hemorrhage). As you have improved from the day you had hemorrhagic stroke you will improve as the day passes provided other risk factors ( some you yourself have enumerated) are kept under control. I will complete the list:

Diabetes +/- (If you do not have now, control it as a priority )

Hypertension +/-

Smoking +/-


Obesity and Sedentary Life Style+/- ( with diet and upper limb exercise you can
achieve an ideal body weight}

High Bad Cholesterol and Lipid Component +/-
Total Cholesterol above 190 mg%, LDL above 130 mg%, VLDL above 40 mg%,
Triglycerides above 150 mg%, Apolipoprotein B above reference value

Low Good Cholesterol and Lipid Component: +/-
Apolipoprotein a below reference range for the lab and
HDL below 40 mg% for man & and 50 mg% for woman

Family History 0f Coronary Heart Disease +/-
Increasing age*
Being a Man (as opposed to women) till the age 45-

A prescription drug clopidogrel (75 mg once a day) choice of adding enteric coated baby aspirin I will leave to the doctor for because of its side effects it may not be preferred by some. Continued physiotherapy, Tab Vertin (prescription drug) for dizziness as per your doctor's advice are the additional drugs to those for diabetes, blood pressure and cholesterol.

Please write precisely, what drugs you are taking? And what preexisting conditions as from the above list you have? Then I can give a precise answer(s). In these matters I can understand your doctor being vague but you can ask straight questions now I have provided the lead and I shall be only too happy to give straight unambiguous answers. It will be a pleasure if I can help you in any way. I have all the time in the world for answering so be elaborate in questions.

Best Wishes

Dr Anil Grover

Above answer was peer-reviewed by
Follow-up: Diagnosed with microvascular ishemic brain disease. History of diabetes, cholesterol, hypertension, stroke. On physical therapy. Suggestions? 2 hours later
Thank you for answering. I do have Type 2 diabetis presently on Metformin 500mg daily. and am now working hard to control as I did not prior to hospital stay in May 24th. I take full asprin 3.25 daily, Diovan 12.5 and Torporal XL 100 mg. for high blood pressure which has been under control since stroke 10 years ago. I have high cholesterol (281) in March and take 80 mg Lipitor daily. Have taken Klonipin 1 mg for anxiety since stroke which ruptured on left side cerebellum and 50 mg of Zoloft which I just started since hospital stay for dizziness and had MRI with contrast which showed the microvascular ishemic brain disease. Also I take magnesium 500 mg daily as diagnosed with hypomagnesium and had magnesium infusions up until last December. I also take lasix 40 mg and Klur 20mg for swelling in both ankles reason for swelling unknown. Surgeries I have had hysterectomy at age 29 because of uterus rupture, sinus surgery, 1995, gall bladder surgery 1987. no other surgeries. Family history of stroke, Father, sister and oldest son died from meningitis and brain stem problem at age 39 - 5 years ago. I am sure this is to much history but I am anxious to know if the damage done in my small vessels are repairable and will I be able to resume regular activities after I feel stronger. Other than a stroke or heart attack are there any other dangers with this disease. I have constant medium headache mostly in back of head or on top but take care of pain with only Tylenol which dulls it but does not take it away, as I have reactions to most pain medicine,like codeine, reglan, demoral. Dizziness is better but varies from day to day. Been check for inner ear problem and only slight problem. Told not enough to cause severe dizziness. I use a walker and am still doing inhome physical therapy. I hope I have not confused you with this long babbling but so want to get better and people have told me horror stories of people with this disease. I forgot to say I have had what they believe are TIA;s in past year. Any information you can give me would give me peace. I accept whatever may be but am a control freak with my own body not in anything else. Thank you.
Answered by Dr. Anil Grover 46 minutes later
Hi there,
No, I am happy that you have supplied all the details I need. No, ma'm you have not confused me. Coming to your main problems first.

a). Your BP is controlled, that is good news. No issue with drugs there.
b). I have some reservation about 325 mg aspirin in a 70 year old person who is otherwise taking so many drugs. Personally I would prefer a 75 mg of Clopidogrel but this is the call your doctor has to take. I am concerned about gastritis.
c). Your headaches are relieved by Tylenol, that is fine so long as you do not take more than 3 tablets a day ever. Severer headaches means you ought to consult a doctor.
d) For stroke you are taking physiotherapy at home. Fine. Do continue even if you feel tired that is your road to recovery.
e) You will not be as good as you were before your first hemorrhagic stroke but definitely better than what you are at present much better. That is not an empty promise you can hold me to this.
f) About pedal edema and lasix. That is OK. Request your doctor to do your potassium levels once in a while and serum protein levels once.
g) I hope you are not overweight. If you are cut your calorie intake by fats and carbohydrate and normal protein. I assume your kidney functions are normal.
h) I am glad that anxiety is controlled with Clonazepam and also dizziness is not a big issue and recovering,
i). I suggest cultivate a hobby and spend time say watching TV but not when you are doing physiotherapy.
h). I do not think your family history is relevant here

With Best Wishes.

Dr Anil Grover
MBBS, MD(Internal Medicine), DM (Cardiology)
Above answer was peer-reviewed by
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