Jonathan L.

Ventigan Stroke Risk Factors, Coping, DM Foot Screening Reaction Paper

Block 10A

Thursday was spent with the stroke support group PARAISO and their family members and friends on a lay forum on the risk factors for stroke. Most of the people present already had a stroke; they were dragging their feet, their arms in corticate flexion or simply they were sitting on wheelchairs. Some were surprisingly young to have had a stroke. In the lay forum, the usual suspects or risk factors for ischemic stroke were enumerated: smoking, high blood pressure, dyslipidemia especially hypercholesterolemia (which can lead to plaque formations that can directly block brain blood vessels or cause thrombosis), obesity, heart disease and vascular diseases (which can cause irregular blood flow in the heart or blood vessels, predisposing to thrombus formation), physical inactivity, hypertension (which predisposes to hemorrhagic stroke), etc. Most important for most of them, a previous bout of stroke can predispose them to have another stroke in the future. Stroke is referred to as a lifestyle disease or a disease of old age and looking at most of the members of PARAISO really brings out this fact. It is fortunate that the support group and the department have come together to bring this lecture to them. Lifestyle diseases are preventable with early intervention, close follow-up and lifestyle modifications. There were also free medications given that day, emphasizing the role of pharmaceutical interventions. Metformin, the first line drug of diabetes, was prescribed that day. People seemed to have the impression that the FBS was diagnostic but for those with established diabetes, HbA1c testing needed to be done. I had no idea if they were compliant with this. Metformin may no longer be enough and polydrug therapy or even insulin may be needed already for some. Also available was amlodipine, a CCB that may be used for monotherapy. It is recommended in some guidelines (like the ESC, ESH 2007 guideline on the management of arterial hypertension) however that dual therapy be the initial treatment as monotherapy has a high failure rate. In that case, it may be safe to combine it with thiazide diuretics, ARBs and ACEis. Simvastatin, a statin, was also available that day. This is the drug recommended by the 2005 Philippine dyslipidemia guideline as the drug for hypercholesterolemia or high LDL as safe and cost effective. Unfortunately, talking to some of the people there, it was clear that not all were compliant and only took their drugs as needed. Diabetes was also discussed in the forum as it, and other lifestyle diseases, come together. Obesity predisposes to stroke, diabetes, heart disease, etc. FBS was also done and almost all the patients there had pre-diabetes on screening, not surprisingly. DM foot screening was also done with the monofilament test, currently the best screening method for DM neuropathy. To be honest, I had only read about the test before and had not done it yet in an actual clinical setting so it was quite an experience for me.