I had an ischemic stroke in May and I’m not sure why. My speech has returned, but my mind is still blank, causing significant anxiety and depression. I’m 73 and I also looked after my wife who was shielding. Could stress have caused the stroke?
John Prentice, Causewayhead, Stirling.
Being unwell for eight months while being your wife’s caregiver must have been a tremendous burden. But you won’t feel this way forever, and there are treatments out there that will help.
An ischemic stroke occurs when the blood in an artery in the brain stops flowing and the tissue that supplies the vessel becomes damaged. This could be due to a clot coming from the heart or from a blood vessel that supplies the head.
Your current symptoms suggest post-stroke depression. At least 30 percent of people suffer from a depressive illness after a stroke. An important sign is fatigue, which is not relieved by rest [File photo]
You have had scans of your brain and carotid arteries in your neck. If they were clear, the stroke could instead have been the result of a blood clot in an artery in the brain.
This is called atheroma and can be caused by deposits of fat that narrow blood vessels.
They say you are now taking three medicines: clopidogrel, to reduce the risk of blood clots; Amlodipine, to control your blood pressure; and atorvastatin, to help keep blood cholesterol down.
These are vital to your treatment, and none are responsible for your ongoing symptoms (including the dislocated disc in your neck that you mention in your longer letter).
Keep taking them until asked to stop. At this point I should add that stress can increase blood pressure, affect blood vessel walls, and increase the likelihood of clotting.
Your current symptoms suggest post-stroke depression. At least 30 percent of people suffer from a depressive illness after a stroke. An important sign is fatigue, which is not relieved by rest. Irritability, anxiety, insomnia, and memory problems are also typical symptoms.
You will need confirmation of this diagnosis and medical assistance, including antidepressant and cognitive behavioral therapy – talk therapy that aims to change behavior and thinking.
With the right drug and a good psychotherapist, you will recover.
I’ve had a cough for almost two years and my GP doesn’t have any solutions. It starts with a tickling sensation and turns into an embarrassing fit of coughing. I was referred to a hospital for tests, but the results came back fine. I also tried medications that didn’t work. I would appreciate suggestions.
Jane Trotter, Stoke-on-Trent.
A cough that lasts longer than two months is defined as a chronic cough and is understandably frustrating.
First, let me explain how a cough works. It begins as a nerve reflex that is triggered by cough receptors in the airways.
There are two types of receptors: chemicals that are sensitive to temperature, acid, and other irritants; and mechanically, triggered by contact. When one is stimulated, impulses travel to the cough center of the brain. The responses migrate back to stimulate the muscles involved in a cough. In this way, the body can get rid of an irritant.
First, let me explain how a cough works. It begins as a nerve reflex that is triggered by cough receptors in the airways [File photo]
The most common causes of chronic cough – post-nasal drip (when mucus drips from your nose down your throat), asthma, and acid reflux – have been ruled out, as you suggest in your longer letter.
It could be bronchiectasis, where the airways have become permanently widened and inflamed, often as a result of whooping cough years ago.
The only sure way to diagnose is with a CT scan, which will give a detailed picture of the lungs. Talk to your GP to see if more tests are needed.
Write to Dr. Scurr
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In my opinion … GPs need funding for key treatments
When it comes to medical care, the government seems to know the price of everything but the value of nothing. Recently, a neighbor told me that his GP was unwilling to remove the hard wax that is causing the problem when his hearing aids didn’t seem to be working.
It’s been a year since I wrote about this change in policy that said general practitioners could no longer provide many services because someone at headquarters said the NHS would not fund them.
In the past, such services were provided on the basis of goodwill, but the increasing workload and scarcity of money have put an end to it. According to the British Medical Association, more than 80 services are no longer reimbursed.
The Covid-19 vaccines are a case in point. General practitioners receive £ 12.58 per dose. This is not enough to cover the 12 hours a day, seven days a week costs necessary for a quick absorption.
The general practice is not a dump that can take on work that is not considered a province of the hospital service. Aspects of health care that are not reimbursed also seem to be no longer valued – unless you might be the injecting man.