Stroke Archive

Ask the doctor

Q. My doctor told me I should get a home monitor to keep tabs on my blood pressure. Which number is most important in the reading, the top or the bottom one?

A. This question comes up often, perhaps because doctors and patients alike tend to pay more attention to the top (first) number, known as systolic pressure. It reflects the amount of pressure inside the arteries as the heart contracts. The bottom (second) number, diastolic pressure, is always lower since it reflects the pressure inside the arteries during the resting phase between heartbeats.

In the journals

Blood pressure readings are usually done on only one arm, but a new analysis makes the case for checking both arms, as the difference between them may suggest an elevated risk for heart disease. The findings were published in the February 2021 issue of Hypertension.

Researchers examined 24 studies that measured blood pressure in both arms in 53,827 adults without high blood pressure. They found that a difference of more than five points between the left and right arm systolic readings (the top number) was linked with a 9% higher risk for a first-time heart attack or stroke and a 6% increase in cardiovascular death within 10 years. The greater the difference between the two readings, the higher the risk.

Can adopting a healthier diet help fight prostate cancer? That's a question men newly diagnosed with prostate cancer often ask their doctors.

Several studies have shown that in countries where men eat a typical "Western" diet containing a large amount of meat, the incidence of prostate cancer, especially aggressive prostate cancer, is higher than in countries where plant-based foods are a primary part of the diet. Unfortunately, these studies weren't designed to prove cause and effect. So for now, definitive answers about prostate cancer and diet aren't yet in — although researchers are actively studying this topic.

Ask the doctors

 Image: © scyther5/Thinkstock

Q. I've read that getting the flu shot annually will weaken my immune system over time. Is this true?

A. A study published in the March 1, 2017, issue of The Journal of Infectious Diseases investigated whether getting an annual vaccination against influenza (flu) can weaken your body's natural ability to protect itself from the disease. Past studies have raised similar concerns. Researchers at the University of Bergen in Norway followed 250 health care workers. Some of them got a flu vaccination every year from 2009 through 2013. The others only received the vaccine once in 2009 and not in the years from 2010 to 2013. The researchers then took blood samples before the influenza season (and before people were vaccinated that season), from the members of both groups and looked at different markers to gauge how well their immune systems would respond to the influenza virus. They found that getting an annual flu vaccination did not weaken the immune system. As a group, the people who got the flu shot annually appeared to have a better immune response to influenza than those vaccinated only once.

Listening to music may boost exercise ability, ease stress and anxiety, and enhance recovery from strokes.

 Image: © shironosov/Getty Images

Whether you prefer Stravinsky's symphonies or the Beatles' ballads, you probably listen mostly because you simply like how they sound. You might not realize that music engages not only your auditory system but many other parts of your brain as well, including areas responsible for movement, language, attention, memory, and emotion.

"There is no other stimulus on earth that simultaneously engages our brains as widely as music does," says Brian Harris, certified neurologic music therapist at Harvard-affiliated Spaulding Rehabilitation Hospital. This global activation happens whether you listen to music, play an instrument, or sing — even informally in the car or the shower, he says. And it helps to explain how and why music therapy works (see "Singing — and striding — stroke survivors").

On call

Q. What is the significance of mild narrowing of the carotid artery detected by an ultrasound? I have never had any symptoms of stroke.

A. "Mild" narrowing ranges from 15% to 49% blockage of the artery. Over time, this narrowing can progress and lead to a stroke. Even if it doesn't progress, mild narrowing is a sign of early blood vessel disease and calls for preventive measures.

On call

Q. I have just recovered from the flu. How soon can I resume exercise again and can I go straight back to my previous routine?

A. The recommendations about when to return to exercise after respiratory infections, such as the flu, colds, or bronchitis, are vague. One major reason is that each person's response to illness is so variable. But here is my general advice.