Stress and Stroke

Picture this: It’s a typical Tuesday. Marci gets up, makes breakfast for her husband and grandkids while watching the news. She gets the grandkids off to school (Marci’s daughter is going through a divorce and she’s moved herself and three young kids back in with mom). She takes her husband to the doctors office (he’s on the last round of treatment for prostate cancer). Her son calls- he just got laid off. Bills are piling up, Marci wonders if she needs to get a part time job to help balance the budget, but wonders if anybody would even hire her at her age.

Around 11am Marci notices a tingling on the right side of her face and right arm. Marci ignores it, it’s just a tingling. She still has to go grocery shopping and vacuum the house before the kids get home. At the grocery store, Marci has difficulty checking out- she fumbles the credit card and just can’t push the buttons correctly. The next day Marci isn’t any better, her arm is weaker and she can’t hold a coffee cup. She calls her doctor to get an appointment since she knows something isn’t right. The doctor immediately tells her to hang up and call 911- she thinks Marci is having a stroke. Marci thinks ‘ambulances are expensive’ and calls a taxi instead to take her to the hospital. Tests confirm- Marci has had a stroke. Since Marci waited too long to seek help, the ER couldn’t give Marci the clot-busting medicine used to treat acute strokes. As Marci quietly absorbs the multitude of information she’s being told, she wonders “did stress cause my stroke?”

Scenarios such as these are altogether very common. One of the most frequent questions the stroke team is asked is some variation on “did stress cause this”? The short answer is- maybe.

We know stress is a risk factor for cardiovascular disease. There is a lot of ongoing research on stress and the physiologic affects it has on the body. Stress is also subjective, everybody tolerates it differently, and it isn’t quantifiable. We do know that stress causes us to produce cortisol and adrenaline. In a stressful situation, when these chemicals are released, our fight-or-flight response kicks in. Adrenaline causes our heart to beat faster and our blood pressure to rise. A sudden increase in blood pressure can cause the wall of a blood vessel to break, causing a hemorrhage in your brain. Chronic stress can mean the body isn’t getting a break from these chemicals. Cortisol can cause BP to be consistently elevated, it raises cholesterol, and creates higher level of blood sugar (all three of these increase your risk of stroke). Cortisol is associated with the immune system and sleep habits. Long term effects of these can increase inflammation and damage the heart. Inflammation increases your risk of stroke.

People tend to eat more (and unhealthier) when stressed, and therefore increases the risk of obesity. And lastly we make poor choices when stressed- food, alcohol, smoking, drugs. We exercise poorly (if at all) when stressed, we spend more time on the internet (which increasing amount of studies are showing has a negative impact on our psyche). We essentially can fail to care for ourselves properly. People forget to refill prescriptions, take their meds, or if budgets are tight, simply don’t fill the medication at all. All of this is of course cyclical, the worse it gets, the more stressed you become.

How can we reduce stress? Obviously, nobody likes being stressed out and it’s easier said than done. Here is a list of commonly cited tips on reducing stress.

1. Keep a positive attitude. Try to see the bright side of a situation. Every challenge is an opportunity for someone to learn something new or develop a new skill.
2. Avoid or limit time spent with people who consistently add to your stress, if possible.
3. Set reasonable goals and expectations for yourself. This helps with time management. Learn how to say “no” if you recognize you are overstretched in commitments.
4. Be clear about your expectations of others.
5. If you feel tension/stress developing, take a break from the provoking factor, if at all possible.
6. Take a few minutes each day for private time to relax. Consider meditation, focusing on positive thoughts such as “I can do this”, “I’m happy with my effort”, etc.
7. Concentrate on breathing deeply for a 5 minute period of time with good posture and eyes closed. This has positive effects on heart rate and blood pressure.
8. Exercise regularly.
9. Avoid excess alcohol and recreational drugs – the aftermath never pays off and generally contributes to subsequent stress.
10. Eat healthy and carry healthy snacks. Current recommendations encourage the Mediterranean Diet or Anti-Inflammatory Diet as preferred choices of diets. Avoid processed foods.
11. Listen to music that is soothing or carries positive messages – or songs that get your body moving!
12. Maximize your time for sleep and reduce disruptions. Before bedtime, consider investing in a neck pillow which can be heated and then applied to your neck and upper shoulders. But don’t oversleep.
13. Access your support system regularly to maintain the connection. Being there for someone else will help ensure someone is there for you when you need it. Withdrawing from friends and family because you don’t want them to know you are having trouble or don’t want to bother them is counterproductive.
14. Remember to be grateful for the family, friends, talents, knowledge, and health that you have.
15. Accept that you cannot control everything. Forgive yourself for your imperfections. Try to laugh at yourself for mistakes without serious consequences.

It’s important to understand what role stress plays in our overall health, but it’s also important to recognize low stress does not equal ‘good’ health. By following the tips above, including taking medications as prescribed and getting regular check-ups by your healthcare provider, your risk for a stroke/ cardiovascular event will decrease.

Lastly, remember the common signs and symptoms of stroke- and call 911 immediately for anybody showing these!

Sudden onset/ wakes up with:

• Balance problems
• Eye issues- loss of vision, double/blurry vision
• Facial droop
• Arm or leg weakness/ heaviness or numbness
• Speech difficulty
• Terrible headache (worst headache of life)