Stroke Archive

Ask the doctor

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Q. My doctor said I "almost" have an underactive thyroid, which puzzled me. Then she said I might benefit from treatment, which puzzled me more. How can you "almost" have a disease, and how can treatment be useful if you don't have the disease?

A. I can see how that might have been confusing. In fairness, it's a confusing situation, even for doctors. Let's take this in two parts. First, what's an "underactive thyroid"? The thyroid gland in our neck makes a hormone, called thyroid hormone, that travels throughout the body and affects every cell. If it is making the right amount of the hormone — if the blood levels are normal — then there's no problem. If it's making too much (an overactive thyroid), or if it's making too little (an underactive thyroid), those are problems that require treatment.

Symptoms of dry skin, eczema, contact dermatitis, and psoriasis can overlap.

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It's easy to overlook dry skin during the winter, when indoor heating and dry air pull moisture from the skin. But sometimes it's tough to tell if dry skin is a consequence of the season or a sign of a serious condition. "I see a fair number of people who come in with psoriasis or eczema and had just assumed it was dry skin," says Dr. Jason Frangos, a dermatologist at Harvard-affiliated Brigham and Women's Hospital.

Why does skin dry out?

It's not just winter conditions that lead to dry skin; it's also a change in our skin's top layer, or epidermis. This layer is normally thick with naturally occurring fats and oils that act as a barrier to help retain moisture and prevent irritants from entering the skin.

There's an upswing in cases of chlamydia, gonorrhea, and syphilis in the United States, and it includes older adults.

For as long as humans have engaged in sex, there have been sexually transmitted diseases (STDs). The term STD (which has replaced the older "venereal disease") generally refers to infections that can be transmitted by vaginal, anal, or oral sex. Among them are genital herpes, human papillomavirus, chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV). The CDC estimates there are about 20 million new STD cases every year, but only a fraction of them get reported.

STDs are on the rise in people of all ages. There were more than two million reported cases of chlamydia, gonorrhea, and syphilis in 2016. While the vast majority occurred in teenagers and young adults, there also were significant increases in cases among middle-aged and older adults (see "STDs reported among older adults").

Research we're watching

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Adding a little extra spice to your food may help you eat less salt, according to a study in the December 2017 issue of Hypertension. A salty diet may raise your risk of high blood pressure, leaving you more prone to heart attack and stroke.

For the study, Chinese researchers recruited 606 people and determined their preferences for salty and spicy foods, in part by asking how often they ate foods such as salted fried pork and pickled Chinese cabbage.

In the journals

Some antidepressants may not offer much relief for people who battle both depression and a chronic disease, according to research in the Nov. 21, 2017, Journal of the American Medical Association.

Nearly half of Americans live with a chronic condition, according to the CDC, and many also suffer from depression, including more than half of Parkinson's disease patients, 41% of cancer patients, and more than 25% of those with diabetes.

Ask the doctors

Q. I have a family history of macular degeneration. Is there any way I can prevent it?

A. Macular degeneration is a common eye condition that typically manifests in people over age 50. It damages the macula of the eye, which is located near the center of the retina, and can lead to vision loss. The macula is the part of the eye that helps you see objects that are right in front of you. When this area is damaged, you may see spots or your vision may get blurry or dark. These changes might make it more difficult for you to drive or perform other everyday activities.

Research we're watching

Scientists are getting some bright ideas on how to protect people from brain damage related to stroke by looking at the brains of hibernating squirrels.

When squirrels hibernate, blood flow to their brain slows dramatically — similar to the reduced blood flow to a human brain that occurs with an ischemic stroke (one caused by a blocked blood vessel in the brain). But unlike the nearly 800,000 people who experience ischemic strokes each year, the hibernating squirrels don't suffer any harmful consequences from this reduction in blood flow to the brain. Scientists say this difference reflects cellular changes in the squirrel brains that protect them from damage. The scientists for the NIH-funded study, who published the results in the Federation of American Societies for Experimental Biology's FASEB Journal, say they have found a potential drug that might mimic this protective hibernation process and could, one day, protect human brains from stroke-related damage.

Most people drink less as they grow older. However, some maintain heavy drinking patterns throughout life, and some develop problems with alcohol for the first time during their later years. The many challenges that can arise at this stage of life — reduced income, failing health, loneliness, and the loss of friends and loved ones — may cause some people to drink to escape their feelings.

Several factors combine to make drinking — even at normal levels — an increasingly risky behavior as you age. Your ability to metabolize alcohol declines. After drinking the same amount of alcohol, older people have higher blood alcohol concentrations than younger people because of such changes as a lower volume of total body water and slower rates of elimination of alcohol from the body. That means the beer or two you could drink without consequence in your 30s or 40s has more impact in your 60s or 70s.

Identifying and treating a stroke as quickly as possible can save brain cells, function, and lives. Everyone should know the warning signs of a stroke and when to get help fast.

The warning signs of a stroke can begin anywhere from a few minutes to days before a stroke actually occurs. The National Stroke Association has devised the FAST checklist to help determine whether a person is having a stroke.