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How to prevent transient ischemic attacks?

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Neurologist
Practicing since : 1988
Answered : 1387 Questions
Question
I had several TIA's ten years ago and have been taking Plavix since then. Are there better alternatives these days to prevent stroke.?
Posted Thu, 28 Aug 2014 in Brain and Spine
 
 
Answered by Dr. Dariush Saghafi 2 hours later
Brief Answer:
There've ALWAYS been better options than drugs!

Detailed Answer:
Good evening ma'am. My name is Dr. Saghafi and I'm a neurologist from the XXXXXXX OH area of the world. I'd like to answer your question on "better alternatives" in a word by saying, "Lifestyles."

But before I give you those little gems of wisdom (most of which I'll wager you already know or heard about) it is important to know whether or not there were any solid REASON(s) discovered for why you had these TIA's. I might even want to go further as a nosey neurologist and ask you for more details on exactly what your symptoms were and how your doctors decided you had a TIA as opposed to anything else. I will tell you that I'm always just a bit skeptical when I hear the phrase, "....had SEVERAL TIA's....." We generally don't like to believe in SEVERAL TIA's since it is almost always the case that after 1 or 2 (at the most)....KABLAM! The Big One. Think of it like minor earth shocks....how many do you usually hear about before you get a real live Earthquake....not many....same idea with TIA's. So, assuming these episodes were TIA's and assuming that no embolic source could ever be found in order to then, justify the use of something like Plavix....I am going to now share with you the BEST WAYS we as neurologists know of to avoid either TIA's or more importantly, STROKES!

1. GET YOUNGER & try to swap out your family history of strokes for some more stable genetic composition. And young lady, I'm not kidding at all. That's a fact. The most important risk factor for suffering a stroke is age and family genes....unfortunately, we're still pretty poor at controlling those aspects of things...I guess Loreal and Avon are masters at it....but this old fiddle faddle of a neurologist can't really do much for his patients in turns of choosing a different family blueprint or turning the heads of time backward.....BUT IF WE COULD then, we would be altering the MOST IMPORTANT risk factors for strokes known to the human race.

2. Control BP by eating good healthy diets, limiting intake of alcohol, eliminating cigarette smoking (any tobacco, tobacco products including chew, illicit drugs such as marijuana, crack, etc. etc.). And then, to go one step further get away from people, parties, and public places where smoke tends to hang out.

3. Keep diabetes at bay with blood sugar levels at 100 or just a smidge above. Eat foods with less of a glycemic index (i.e. about 50% sugar than what's generally contained in packages). Frown upon even "pre-diabetic conditions"....try to use the minimum amount of sugar for everything.

4. How about some exercise? You're an Aussie, right? You're bred for athleticism, how about a good aerobic program 2-3x/week that can get your heartrate up at least 20% above its resting levels for at least 20 minutes. You need to sweat a bit....shouldn't be hard there on the island..right...boy I wish we could have a little of that weather here in XXXXXXX for about 6 months out of the year! Got arthritis you say or maybe in a wheelchair for a reason? Allow me to introduce you to exercise regimens that can be done courtesy of the XXXXXXX Arthritis Foundation for people who are at all stages of arthritis (rheumatoid or otherwise) or even immobilized for some reason.

5. Then, of course, there is that issue of the cholesterol (the good, the bad, and the VERY BAD as far as strokes are concerned- HDL, LDL, VLDL). Any food that is oily or greasy....I want you to take a good look at the oil that you comes out of the pan, or drains onto paper napkins, or floats on top of soup or casseroles, or can be seen glistening in a bowl of delicious ON FIRE Chili! Now, I want you to imagine all of the oil and grease that you see from anything fried or sauteed literally floating in your bloodstream and clinging on to the inner walls of the arteries and veins. Because that is EXACTLY what happens! There are actual foam beds that appear as white surf on the beaches in a storm ejected from the heart after a nice square meal of chicken wings and BarBQ chips with your favorite Ranch or cheese dressing.

And this foamy frothy HEAD within the bloodstream starts the work of clogging up the arteries from your feet to your head for up to hours after you've had such a meal....now multiply the gunk that builds up in the arteries and veins over a good 50-80 years of a person's life in both the heart and the brain and is it any wonder that heart attack and stroke are still in the top leading 3 causes of death (in the U.S.....I'm not sure of the statistics in Australia).

Medications to help control cholesterol should always be offered to patients who have made honest efforts at getting things under control by diet and exercise but who have been simply unsuccessful. But these medications have their down sides as well and must be used with extreme caution in people above age 65.

6. MEDICATIONS like Plavix YOU ASK? Ahhhh.....well, to tell you the truth, I hope I haven't disappointed you too much with this answer by keeping it as topic #6. I did so for a reason....it's likely the least important factor in the equation of stroke prevention compared to everything else I've mentioned. Now, let's be fair...the fact that you're taking Plavix (and I prescribe it all the time by the time to patients) means that you MUST BE COMPLIANT and not take the pills with other medications which may interact or knock it out of commission. But in terms of anything BETTER? There's nothing in terms of medication I know of which is really any good compared to living healthy lifestyles.

Other antiplatelet agents are either similar or slightly less efficacious than Plavix and so if you have been successful in taking Plavix I would advise you against changing it for anything else at this time.

Well, young lady I hope the information I've provided has given a few additional insights into the world of stroke prevention that you may've not known about or believed were that important compared to the DRUGS....but in point in fact, I believe the non-pharmacological approaches and interventions are so much more important with longer duration and efficacious impact that they deserve our undivided attention.

If this information in fact, is something useful that I hope you and others can use...don't be shy, print it out and pass it out among your friends and relatives, would you mind terribly a written commentary and criticism of my responses to your question? I would very much appreciate that.

Also, if there are no other questions on this topic could I ask that you CLOSE THE QUERY on your end so that the network recognizes the fact that I've attended to your concerns adequately and that the case can be filed and cataloged.

I wish you all the best Down Under. Hope to one day visit the continent!

This query required 58 min. for review, research, and final documentation for envoy.

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