STROKE
INTEGRATIVE HEALTH
The 5th Leading Cause of Death in the United States
Howard F. Loomis
Jr., DC
This series of articles has discussed the ten (10) leading causes of death in the United States as documented by government statistics. I have attempted to discuss how chiropractors may be useful in early recognition and perhaps even prevention of these disease processes. This article discusses the 5th leading cause, Stroke. Like Alzheimer’s disease, stroke could arguably be excluded from the series for chiropractors, as I did with suicide and accidents.
But every year more than 795,000 people in the U.S. have a stroke. Chances are you will see one or more of patients who are already developing cerebrovascular problems that may lead to a stroke. While it is not possible to prove a negative, that is to have prevented a stroke, it is possible to recognize the warning signs and bring
those to the patients’ attention. With that in mind I will focus my remarks on the most important early warning signs of potential stroke that I believe are relevant to our profession.
Stroke (cerebrovascular diseases)
Cerebrovascular conditions result from problems with the blood vessels that supply the brain. There are four common types:
• Stroke
• Transient ischemic attack (TIA)
• Subarachnoid hemorrhage
• Vascular dementia
Risk of having a stroke varies with race, ethnicity, and geography; it also increases with age. However, in 2009, 24 percent of people hospitalized for stroke were younger than 65 years. Highest death rates from stroke in the U.S. occur in the southeast.
High blood pressure, high cholesterol, and smoking are considered the major risk factors for stroke. Several other medical conditions and unhealthy lifestyle choices can increase your risk for stroke.
That description sounds similar to the occurrence of type II diabetes that we wrote about in my last article when we discussed metabolic syndrome in depth. Before we briefly review those signs and symptoms I would like to outline a series of physical signs that I have found consistent with those who develop metabolic syndrome and the head forward posture.
The Head Forward Posture
This is a posture problem that is easily recognized by viewing the standing patient from the side. The head can be seen forward of a vertical line from the ears down through the acetabulum. There are many possible factors responsible for this condition, but all lead to development of chronic symptoms. It is common for the patient to experience tingling and numbness in the arms, and a burning pain between the shoulder blades.
Another way of identifying this condition is with the patient laying supine. Ask patient to look at their feet. It is normal for the chin to tuck first. The test is positive if the eyes move toward the ceiling before the head flexes on the neck. This happens if the SCM muscle is firing first, before the anterior scalene muscles.
This combination of postural
deviation and compensatory involuntary muscle contractions is often found with limited chest expansion and shallow upper chest breathing. Clearly the movement of the diaphragm is reduced. The diaphragm receives its spinal innervation from T4 to T9, but also C3 to C5 from the phrenic nerve. Both spinal areas will be involved in this condition.
Seated Patient Exam
Involuntary muscle contractions between T4 or 5 and T9 account for loss of the normal thoracic kyphotic curve and the concavity is referred to as Pottenger’s saucer. This has been proven to be a transitory condition until the cause becomes chronic. My experience has been that it is often involved with the occurrence of chronic headaches. Pottenger’s saucer and the head forward posture causes a rounding of the shoulders and posterior movement of the upper ribs forcing lateral movement of the scapulae away from the spine. Palpation of the angle of the posterior ribs and weakening of the levator scapula and rhomboid muscles is quite pronounced.
Metabolic Syndrome
Metabolic syndrome is not a specific diagnosis, but a combination of several separate physiological dysfunctions related to metabolism. In 1977 it was suggested there was a group of factors responsible for the development of cardiovascular disease. It was hypothesized that oxidative stress (energy production) could produce a variety of problems, even sex hormone imbalances. Elevated blood glucose, triglycerides, and cholesterol are the signature blood tests.
Also, elevated blood pressure and pulse pressure are significant. Do you routinely check blood pressure on your patients? Clearly it is indicated on those with a head forward posture. Elevated blood pressure Systolic = 130 mm Hg or higher and Diastolic = 85 mm Hg or higher or patient is receiving treatment for high blood
pressure.
Elevated pulse pressure
Do you take every patient’s blood pressure and check their pulse pressure and rate on every visit? You should, because that is often the earliest and easiest indication of metabolic stress you can perform.
Recent studies suggest that a high pulse pressure is an important risk factor for heart disease. A study which combined the results of several studies of 8,000 elderly patients, found that a 10 mm Hg increase in pulse pressure increased the risk of major cardiovascular complications and mortality by nearly 20%.
Elasticity in the aorta decreases with age due to structural changes, thereby producing age-dependent increases in pulse pressure. Pulse pressure of 60 or above in patients 60 years old or older is a poor sign as it increases intracranial pressure and increased chances for a stroke.
How can stroke be prevented?
When you encounter a patient with the above postural and physical findings as well as elevated blood pressure, especially those with elevated pulse pressure, it is a good
idea to acquaint them with your findings. Remind them about the following habits they might use to remain healthy even if they are being treated medically.
Stroke prevention measures include:
• Eating a balanced diet
• Maintaining a healthy weight
• Getting enough exercise
• Not smoking
• Limiting alcohol use
• Staying hydrated
If they are not under medical care acquaint them with the need to:
• Manage cholesterol levels
• Control blood pressure
• Manage diabetes
Signs and symptoms of stroke
It might be a good idea to end this article by reviewing signs that a patient has had or is having a stroke. Remember fast treatment can reduce the brain damage that stroke can cause. Some treatments for stroke only work if given within the first 3 hours after symptoms appear.
"Recent studies suggest that a high pulse pressure is an important risk factor for heart disease."
• Numbness or weakness in the face, arm, or leg, especially on one side of the body.
• Confusion, trouble speaking or difficulty understanding speech.
• Trouble seeing in one or both eyes.
• Trouble walking, dizziness, loss of balance, or lack of coordination.
• Severe headache with no known cause
If you think someone may be having a stroke, act F.A.S.T. and do the following simple test:
• F - Face: Ask the person to smile. Does one side of the face droop?
• A - Arms: Ask the person to raise both arms. Does one arm drift downward?
• S - Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
• T - Time: If you observe any of these signs, call 9-1-1 immediately.
The next article in this series will discuss chronic lower respiratory disease which includes COPD.
HowardF. Loomis, Jr., DC, has an extensive background in enzymes and enzyme suppleHe is the founder and president of the Food Enzyme Institute. His extensive knowledge of physiology, biochemistry, and enzymology has made him a sought-after speaker and a prolific writer. The Food Enzyme Institute offers seminars to healthcare practitioners around the country.
Dr. Loomis published ENZYMES: The Key to Health in 1999. He also co-authored and published The Enzyme Advantage: For Healthcare Providers and People Who Care About Their Health in 2015, and The Enzyme Advantage for Women in 2016, with respected medical journalist Arnold Mann.
Contact info: 6421 Enterprise Lane, Madison, WI53719 customer service@foodenzymeinstitute. com, 800-662-2630.
