Stroke or migraine?

Firstly, apologies for having been away for so long - the article below explains most of what happened and may, I hope, be of help to some.

Secondly, an introduction. I am Nick Anderson, caretaker of this page, editor of Green Health Watch Magazine and, since very recently, founder of The OsteoTrace Shop webshop. 

Over Christmas 2016 I had a ‘biological event’ which was diagnosed as a ‘transient ischaemic attack’ (TIA, aka ‘mini-stroke’). A TIA is defined as ‘a short-term disruption of the blood supply to part of the brain’. It can last from a few minutes to 24 hours (after which it is re-diagnosed as a (full-blown) stroke). This disruption of the blood supply to the brain is usually caused by an abnormal blood clot that has formed elsewhere in the body and travelled to and blocked a blood vessel supplying the brain. Abnormal clots can also be formed from pieces of fatty material or air bubbles. 

The disruption in the blood supply results in a lack of oxygen (amongst other things) to the brain. This can cause sudden symptoms similar to those caused by full-blown strokes, e.g. speech disturbances (like slurring, garbling, drop in voice register), visual disturbances (like flashing lights), numbness or weakness in the hands, arms and face (particularly the mouth (1))

N.B. TIAs/ministrokes are still strokes and must be treated as seriously. An ambulance must be called immediately, even if the symptoms are already subsiding. (The hours following a TIA/mini-stroke are high risk for a full-blown (possibly fatal) stroke.)

The treatment I was given ...

Tests and scans

I was given the following routine tests and scans: blood pressure, blood cholesterol, blood sugar, strength and co-ordination of the limbs, feet and hands (grip), mouth drooping on one side, wonky smile, balance and straightness of walking, heart function.

I was given two computed tomography (CT) scans - one of the head and one of the neck - which together exposed me to the ionising radiation equivalent of (e.g.) 500 days of natural background, or more than 200 X-rays, but found no evidence of any blockage or seriously narrowed artery or vein - see Edi).

Aspirin, Simvastatin and Clopidogrel

I was initially prescribed two medications: aspirin (75 grams a day) and the statin Simvastatin (40 grams a day). The aspirin is given in order to reduce the ability of my blood platelets and white blood cells to:

• penetrate the endothelium (a one-cell thick lining of the artery walls

• attach to the artery wall and begin the process of plaque development, slowly increasing the risk of a clot or clots forming (thrombosis)

The best time of day to take aspirin is immediately after a large meal. Lots of food in the stomach protects the stomach wall from damage by the drug (e.g. stomach ulcers, stomach pain).

The Simvastatin is given in order to:

• reduce my liver’s natural and beneficial production of cholesterol (see Edi)
• lower my blood levels of “bad” low density lipoprotein-transported cholesterol (LDLC)
• lower my blood levels of triglyceride fats

(Blood tests had found that both my blood Total Cholesterol level and my blood LDLC level were a little high (6.3 and 3.0 respectively.))

According to Bristol Laboratories Ltd., Simvastatin’s manufacturer (2) the best time to take Simvastatin is with your evening meal because the liver produces cholesterol mainly during the night.After a few weeks the aspirin was replaced by the anti-platelet medicine Clopidogrel (75 milligrams a day). Clopidogrel may be taken with or without food. I stuck to ‘with food’. 

And by the way, although nicknamed ‘blood thinners’, neither aspirin nor Clopidogrel thins the blood (which would be disastrous). See ‘Aspirin, Simvastatin and Clopidogrel’ above.

My GP recommended a daily, 40-minute, vigorous walk, wished me luck and suggested that we review my progress in six months. At that time I took this as the usual advice about (e.g.) ‘reducing sedentary lifestyles’, ‘getting the blood going round’ and ‘raising heart rate’. Now I know how key exercise several times a day is to boosting nitric oxide levels in the blood vessels.

What next?

During the next four months I had five or so similar ‘biological events’, triggering ambulance rides to the nearest Accident and Emergency, the same full array of routine tests recording the same results and leading to the same diagnoses of TIA. It was a time-consuming, distracting and depressing experience. The repeated diagnoses of TIA seemed to suggest (at least to me) that it was only a matter of time before I had a full-blown stroke causing serious damage, even death.

None of the many routine tests carried out during this period by the doctors appeared to cause them any concern, suggesting (again, at least to me) that my brain, neck and heart arteries were generally in good shape, but told none of us anything about the atherosclerosis status of my arms and legs. I wanted to find out if there was:

• anything other I could do than adopt a low-cholesterol diet and vigorous daily exercise to reduce my risk of a full-blown stroke or heart attack

• any ways of:
• estimating the general stiffness of my artery walls and their level of atherosclerosis
• restoring any significantly stiffened artery walls to the elastic, smooth, non-stick state of my childhood
• removing/reducing any plaque that had accumulated on my artery/vein walls body-wide over the last sixty years

The answer to all of the above is ‘Yes’, but they may not be available on the NHS in your area, and may be expensive:

• Commission a Pulse Wave Velocity test to predict my likely general artery wall stiffness level
• Commission a blood ADMA level test in order to predict my overall level of atherosclerosis
• Commission a blood nitric oxide level test. A low blood nitric oxide level indicates the need for activities to raise body-wide nitric oxide production by the endothelial cells in order to restore any stiffened arteries by:


• making dietary and lifestyle changes in order to ensure (i) good levels of L-Arginine (LA), L-Citrulline (LC), protein and folate (B9) in my diet, and (ii) good levels of daily exercise in my life
  
  
• treating my body to a Combined LA/LC dietary supplement

• Commission a blood vitamin D3 level test and, if low, raise my the dose of my daily D3 supplement to 5,000IU in order to soften any stiffened artery walls

and, given my borderline osteoporosis status and the important role of organic silica in the blood vessel walls and the rebuilding of bone ...

• Commission a blood organic silicon level test and, if low, treat my body to an organic silicon dietary supplement

Editorial

(i) The current medical orthodoxy in most more industrially developed countries (MIDCs) is that a combination of excessive production of cholesterol by the liver and diets rich in “bad” low density lipoprotein-transported cholesterol (LDLC) leads to ...

• high blood LDLC levels, contributing to ...
• atherosclerosis, where the thickening, hardening and stiffening of artery walls are due primarily to the build up of white blood cells and tunica intima smooth muscle cells (the innermost layer of the artery wall) creating ‘atheromatous’ (fibro-fatty) deposits of ‘plaque’ (3)

The process:

• progressively restricts bloodflow (and therefore the flow of oxygen and nutrients to organs and tissues body-wide
• increases the risk of (e.g.) high blood pressure, TIAs/mini-strokes, strokes and heart attacks

(ii) Several research studies have suggested that diet can be more effective than statins at reducing blood cholesterol levels.

References

1. UK National Health Service. Https://www.nhs.uk/conditions/transient-ischaemic-attack
2. Simvastatin Patient Information Leaflet. Bristol Laboratories Ltd.,
   Unit 3, Canalside, Northbridge Road, Berkhamsted HP4 1EG
3. https://en.wikipedia.org/wiki/tunica_intima
4. Heart UK. https://heartuk.org.uk/press/press-kit/key-facts-figures

Not a TIA/mini-stroke after all

In April 2017 I was busy learning all about atherosclerosis and how to counter it (on the basis of my TIA/ministroke diagnosis), when I received a phone call out of the blue telling me that (i) a new consultant had reviewed my case and (ii) an appointment had been set up for further tests and a review of my diagnosis. I attended, undertook the same tests, got the same results, but was provisionally re-diagnosed. The new consultant felt it likely that I had never had a TIA) at all, but rather attacks of a form of migraine called ‘silent migraine’ (see the article ‘’Silent migraines’ below). Just this news was sufficient to instantly raise my mood from slightly depressed to walking on air!
Five confirmatory tests (including yet another CT scan and a magnetic resonance imaging (MRI) scan) upgraded her  ‘silent migraine’ re-diagnosis from hypothesis to medical probability, and I was summoned again, informed that my brain-neck-heart vascular system was an “enviable …  picture of health”, and waved off to enjoy the rest of my life!

This article was published in edition 52 of Green Health Watch Magazine
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