Chat Moderator: Welcome, Dr. Morgan. It's good to have you with us.

Dr. Morgan: Thank you for asking me to be here. I always enjoy a chance to try to take Oklahoma out of the "stroke belt."

Peggy: My doctor told me that the top number on my blood pressure really doesn't matter. It's the bottom number that causes stroke. Is that right?

Dr. Morgan: Peggy -- Interesting question. Men are more likely to have a stroke, but women are more likely to die of a stroke.

Patches: What are the main symptoms of stoke?

Dr. Morgan: The symptoms that should alert a person that he or she may be having a stroke include: the sudden onset of one-sided weakness or one-sided numbness or one-sided visual loss or loss of speech fluency. If you have one of these, there is hope that we can reverse it because of a new treatment called TPA, "clot buster." But it can only be given if the patient gets to the emergency room quickly.

Peggy: Who is more at risk, men or women?

Dr. Morgan: Peggy -- Interesting question. Men are more likely to have a stroke, but women are more likely to die of a stroke. This is particularly true of young women under 40. A stroke is a very dangerous thing for young women.

Frank: How effective is aspirin in preventing a stroke?

Dr. Morgan: Frank -- That's been well studied for 20 years. It's very clear that in patients who have risk factors for stroke, aspirin can reduce the risk of stroke about 20 percent. And, importantly, reduce the risk of vascular death 18 to 20 percent (dying of any blood vessel-related problem.)

Patches: When you say, "get to the emergency room quickly"... how fast is that?

Dr. Morgan: Patches -- The National Institute of Health (NIH) recommends five minutes from first symptom to emergency room door. If everyone did that, we could do a lot better job of helping patients who are victims of stroke.

Peggy: My doctor told me that the top number on my blood pressure doesn't really matter. It's the bottom number that causes stroke. Is that correct?

Dr. Morgan: Peggy -- That's incorrect. Both numbers are important. The best studies reveal that 6 points of elevation of the systolic blood pressure (top number) increases stroke risk 30 percent. Five points of elevation of the bottom number (diastolic) increases stroke risk by 30 percent. Normal is 140 over 90.

Patches: I have a friend who recently had a stroke. He is a heavy smoker. How important is it not to smoke (or drink, or be overweight, etc.) for the prevention of stroke?

Dr. Morgan: Patches -- It's critically important to not smoke to prevent the first stroke and the second and third. An elegant study done at the Mayo Clinic by Whisenhunt shows convincingly that smokers' carotid arteries start narrowing earlier and faster and more severely than non-smokers'. The day you quit smoking your rate of narrowing returns to the rate of non-smokers, but you never really regain that lost ground. So it's like my friend the Baptist preacher said, "you can be forgiven, but you always pay a price for dancing with the devil." Tell your kids to not smoke.

Peggy: Another aspirin questions. Does it matter how much aspirin? Should I take a regular adult aspirin or baby aspirin?

Dr. Morgan: Peggy -- That's a matter of some debate. Most neurologists in the United States recommend an adult sized aspirin (325 mg), but most European neurologists recommend 81 mg and a few as low as 50 mg. Although the effective range is said to be 50 to 325 mg, most of us are still using 81 or 325 mg.

Patches: What about second-hand smoke? How does that affect my risk for a stroke?

Dr. Morgan: Patches -- Good question. That's a hard scientific study to do. But the very best evidence is that it is an important risk factor for a lot of disease including stroke, heart attack, emphysema and cancer. A trick question is: What percentage of Oklahomans are smokers? The answer is: Nearly all of us because when we go to restaurants in Oklahoma or go to buy a car tag, we're exposed to other people's smoke.

Patches: Thanks for the information!

Trinna: Dr. Morgan, I was a patient of yours from 9/5/00 to 11/13/01. I would like to take this time thank you for your help, which was in the form of writing letters to my insurance company, on the subject of the insurance companies disposition of being very frugal towards their clients pain medications. As I said, I was a patient of yours from 9/5/00 to 11/13/01. You were treating me for my migraines. You put me on Neurontin and told my husband and I, at our first visit to your office on 9/5/00, that if this medicine didn't work, you had a few others that you could put me on to try to control my migraines. However, on 11/13/01, I had an appointment with you about the problem of my migraines not being controlled Neurontin and what would be the next step. As I recall, you informed me that my taking Amerge and Zomig for more than 4 days in a row, or more in a seven-day period, would prompt rebound migraines. You informed at that time, that I should not continue to do so, keeping it to 4 days a week, no more.

Dr. Morgan: Trinna -- All of the newer migraine medicines (Tryptans) probably can cause rebound. It's a strange thing. A little of it helps, but too much of it causes a recurrence of chronic daily headache in migraine patients.

Frank: I've heard people refer to having a TIA, but have never been sure what it is. Could you please explain? Thanks.

Dr. Morgan: Frank -- A TIA is a transient ischemic attack in which an artery supplying fresh oxygen carrying blood to the brain is temporarily blocked off. Usually this is from a clot. The body tries to dissolve the clot and if the clot is dissolved quickly enough and blood flow is re-established, then the symptoms resolve. If it is blocked for too long then the damage is permanent.

Sandy: Do you have any suggestions for preventing strokes?

Dr. Morgan: Sandy -- Great question! By far the most important way to prevent stroke is to know what your blood pressure is. If your blood pressure is up it is essential that you get it down and keep it down. Untreated high blood pressure is a more powerful cause of stroke than cigarette smoking or being overweight or lack of exercise or irregular heartbeat or prior heart disease.

Peggy: I am 25 pound over weight. I quit smoking 8 years ago. I am a 53 y/o female. My blood pressure was normally 110/70 but recently, about 6 months ago, it has been 138/90 on average. My doctor said if I lost weight, my blood pressure would go back to normal. My cholesterol also jumped from 186 to 236. He said the weight loss would help that too. Both of these changes were about the same time but my weight has not changed. I have always been about 25 pounds over weight. Will weight loss help my BP and cholesterol number drop and reduce my risk for stroke?

Dr. Morgan: Peggy -- The answer is yes. Weight loss does help blood pressure control and does help lower cholesterol. The problem is that eating right and exercising is easy to say and hard to do, isn't it? If it were easy, we'd all be thin. My advice is to give yourself six weeks of really absolutely sticking to a diet and exercise program. At the end of that time, if your cholesterol numbers do not improve, it's time to consider medication.

Sandy: What age is the youngest person you've seen who suffered a stroke?

Dr. Morgan: Sandy -- I've seen it in teenagers. More commonly it's a disease in the 40s, 50s, 60s, 70s. But anyone can have a stroke.

Fred: Does Gingko Baloba protect against stroke?

Dr. Morgan: Fred -- Gingko Baloba is an ancient remedy from Asia that is said to have a lot of healing properties. The best study on this came in the archives of neurology a couple of years ago. It probably is a weak "free radical" scavenger, which may protect against damage in a lot of settings. There are other "free radical" scavengers that are more potent, less expensive and not as likely to increase bleeding time. Vitamin E is one of those. So I tell my patients if they want to try a "free radical" scavenger, I would try Vitamin E.

Sandy: Dr. Morgan - I am approaching 40, am 5'6" and about 140 pounds. Even though high blood pressure runs in my family, mine is always normal. However, the past few times I've donated blood, my cholesterol has gone from the 160 - 180 range, to the low 200's (under 225). I haven't changed my eating habits, exercise (or lack thereof); I do not smoke and drink occasionally. Any idea as to why my cholesterol would go up when I am not doing anything differently?

Dr. Morgan: Sandy -- There are a number of reasons why your cholesterol might be going up. The most likely is that you inherited the tendency of your own liver to make higher levels. Often, this gene doesn't "kick in" until your age. Other possibilities would include an under active thyroid or early diabetes. Your levels are not terribly high and at this point I would favor getting on a regular exercise program to try to get it back into that wonderful range you were in previously, 160 to 180. In terms of stress, it can indirectly affect you if it drives your blood pressure up or if you smoke because of stress or overeat because of stress. The literature suggesting that emotional stress itself causes stroke is pretty weak. But stress can cause some lifestyle changes that put you at risk.

Sandy: Thank you very much!

Dr. Morgan: Sandy -- You're welcome!

Fred: Are people with migraine headaches more at risk for a stroke?

Dr. Morgan: Fred -- Slightly. This is not a very powerful risk predictor, but it does put you at some increased risk. This is particularly true for young females. It is especially an important risk factor for young female smokers and even more important for young female smokers taking birth control pills. This group is at extraordinarily high risk.

Brett: Do you recommend blood thinners to reduce stroke?

Dr. Morgan: Brett -- Good question. There have been five large studies in patients who have not previously had a stroke or heart attack to see if taking aspirin would protect them from stroke. The two largest of these including the nurses' study in North America and the physicians' study, neither one showed that aspirin reduced risk in patients who had not previously had stroke or heart attack. Preventing the first stroke is called primary prevention and that includes blood pressure management, cholesterol lowering, stopping smoking, and regular exercise. Preventing a second stroke is called secondary prevention. Aspirin works here very well. There are other alternative medications, as well.

Brett: Can a heart attack and a stroke happen at the same time?

Dr. Morgan: Brett -- Yes. Usually the heart attack is the first event. Then the body forms a clot on the wall of the heart at the site of the heart attack. And a portion of that clot breaks loose and travels to the brain. This is called an embolic stroke. It can also occur from irregular heartbeat at the time of a heart attack or even years later. An irregular heartbeat is a very important risk factor for stroke. Patients who have atrial fibrillation (the most common irregular heartbeat) need powerful blood thinners (Heparin and/or Coumadin) to prevent stroke. It's not that strokes are hereditary, it's that the risk factors for stroke are hereditary. Particularly high blood pressure and high cholesterol. The good news is that these hereditary factors are not controllable with medication and lifestyle changes so you don't have to inherit your parents' and grandparents' stroke or heart attack. We now have ways of intervening.

Brett: Thank you!

Dr. Morgan: Brett -- You're welcome!

Peggy: How much exercise is recommended per week to help reduce the risk of stroke?

Dr. Morgan: Peggy -- Good question. Authorities vary in their opinions. But a consensus is at least 30 minutes in the aerobic range three times a week.

Eddie: Thanks for the information

Dr. Morgan: Eddie -- You're welcome!

Jill: I have heard about "stroke screenings"... what are those?

Dr. Morgan: Jill -- The Stroke Center of Oklahoma frequently sponsors stroke screenings in which volunteers from the Integris Health system that are trained will take your blood pressure, check total cholesterol and HDL and you fill out a questionnaire assessing other risk factors. There's no charge for this and we move it around from place to place in the city -- usually at churches. You can watch for that on our website www.integris-health.com.

Jill: Great - I will do that! Any idea when the next one will be held?

Dr. Morgan: Our most recent stroke screening was at Cherokee Hills Baptist Church last Sunday. Previously, we had done a stroke presentation at that church and were so impressed by the quality of their potluck dinner put on by the Baptist women we had to go back. If I had known the food was that good, they might have converted me from Methodist.

Dr. Morgan: The next stroke screening is on May 9. We're not sure of the location, but watch the website for details.

Jill: Thank you for your time!

Dr. Morgan: Jill -- You're welcome!

Peggy: Thank you Dr. Morgan.

Chat Moderator: Thank you, Dr. Morgan. That's all for today.