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By Joshua S. Yamamoto, M.D., F.A.C.C. and Kristin E. Thomas, M.D.

Excerpt from Chapter 1: “Prevent is an Active Verb”

When I was in high school, I always liked to look in the back of the textbook to get the answers

first. That way, I would know if I was on the right track in solving a problem. So, I will try to give the answers first.

To keep your brain (and yourself as a whole) healthy, know the answers to the questions:

1. What is the health of my heart and circulation?
2. What can I do, or what can I do differently, to keep my circulation working as SAFELY and EFFICIENTLY as possible?

Fundamentally, these are the only questions I ever get asked. The questions are simple, but

the answers are different for all of us. A few definitions are in order. First of all, what is a stroke? Technically speaking, we call a stroke a cerebrovascular accident. (As you can see, doctors love to confuse things by using Latin and Greek. I supposed lawyers are just as bad.) Cerebro means “brain.” Vascular means “blood vessel,” or refers to circulation. And accident, well, that always means something bad.

A stroke is damage to the brain caused by a problem with blood flow to the brain.

This is why cardiovascular doctors (also known as cardiologists) have always been responsible for preventing strokes, although they are not the doctors called when you have a stroke. The doctors called when you have a stroke are neurologists (brain specialists). They should not be the first doctor you see to prevent a stroke. Hopefully, you will never need to see one. You should see your primary care doctor or a cardiologist first.

A stroke is not a heart attack. Sometime in the past 50 years, our medical vocabulary became even more confusing than it already was. The terms stroke and heart attack became interchangeable. They have a lot in common, but they are different things. A stroke is brain

damage. A heart attack is heart damage.

Cardiologists prevent both. Historically we just have not been very aggressive about preventing strokes. Having a stroke means you have had brain damage, which means a neurologist (a brain specialist) will need to help you. Preventing a stroke means keeping your circulation healthy, which is not a job for a brain specialist. It’s a job for a circulation specialist (that is, a cardiologist).

Biologically speaking, there are several types of strokes, but most of them are caused by a clot jamming up the blood flow to the brain. Those clots tend to come from the heart or the big blood vessels leading to the brain (the carotid arteries), or they can form in the smaller blood vessels within the brain. No matter what, you don’t want blood clots in your brain. That’s a stroke.

There are also “bleeding strokes,” but they are not the common ones. In fact, many bleeds

in the brain start as a clot. We tend to fear bleeding, but in fact, clots are a much, much bigger problem.

Clots can be prevented. That’s part of how we prevent strokes.

A common question is what are the signs of a stroke? Well, the whole goal is to not have a stroke in the first place, but it is worth knowing what happens when you do clot off part of your brain. Remember, a stroke is brain damage. So, whatever part of the brain you damage may not

work quite right again. It may not work at all. Pick a function that your brain controls. If you

clot off the part of the brain that controls that function, it won’t work. Just about anything related

to brain function can be lost by a stroke.

For example, you may lose the ability to speak, to understand words, to see, to swallow,

to move your arm or leg. You may not think right. You may be confused. Your face may droop. You may collapse. For better or worse, most strokes don’t kill you. They just take something away, usually forever.

            If you have a stroke, you will get to know a neurologist all too well. They are the experts

who can tell you just how much of your brain has been damaged and how likely you are to recover what you have lost.

            There are many books to help you understand how to recover from brain damage. This is

not one of them. I find them all a little depressing. If you do have a stroke, sometimes dramatic

things can be done to try to rescue your brain. Several new studies have been published about

some of these high-tech procedures (where tubes get stuck into your head to suck out clots,

or clots are melted with drugs). One of my favorite patients recently asked me about these

treatments. He wanted to know what was the best way to treat a stroke. The answer was really

quite simple.

The best way to treat a stroke is to not have one in the first place.

OLD SCHOOL: In medical school, we learned to wait for someone to have a stroke before

we did any investigation. The unfortunate patient would be admitted to the hospital

under the care of the neurologists. They would meticulously examine the patient to

determine what parts of the brain did not work, and correlate those findings with the

brain scans (CT scans, and later MRI scans). We would order all sorts of tests to look at

the heart and the blood vessels and monitor the heart rhythms to see if we could determine

why someone had a stroke. The idea was, once we understood why your stroke

happened, we just might do something to prevent the next one.

NEW SCHOOL: We know that strokes come from changes in how the heart and circulation

work. We actually look for ways to prevent your first stroke, not your second, by knowing the health of your heart and arteries.

What do we do to prevent strokes and vascular dementia?

• Establish a relationship with a physician.
• Know the health of your heart.
• Know the health of your arteries.
• Know the regularity of your heartbeat.
• Know if it’s time to take a medicine to prevent plaque in your arteries and whether you need a pill to prevent a blood clot.

You Can Prevent A Stroke is available now. https://amzn.to/2SWVNhI

Dr. Joshua S. Yamamoto attended Dartmouth Medical School. He trained on the Osler Medical Service at The Johns Hopkins Hospital, and then completed cardiology training at the National Naval Medical Center and Georgetown University. He was the cardiology consultant to the US Congress, Director of Cardiac Imaging, and held a faculty appointment at the Uniformed Services University. In 2005, he was lent to the Army and served in Kuwait as the theater cardiologist for the ongoing wars in Iraq and Afghanistan. Upon his return, he joined his wife in private practice.

Dr. Kristin Thomas graduated with honors from the University of Michigan and then completed her medical degree at Michigan. She finished residency training at Johns Hopkins Hospital and then was appointed one of Hopkins first hospitalists in 1997, serving for one year in this faculty position. In 1998 she served a year on faculty at Hopkins as Chief Resident. She completed six months of fellowship training at Hopkins in Rheumatology in 1999 prior to moving to Washington DC where she joined Foxhall Internists, P.C., in December 1999. She is a Board Certified Internist. She is on the clinical staff at Georgetown University Hospital and Sibley Memorial Hospital. She and her husband reside with their family in Maryland.

 Published July 31, 2019