Participants: Don Mackintosh, Phil Mils
Series Code: HFAL
Program Code: HFAL000034
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00:51 Hello and welcome to Health for a Lifetime.
00:54 I'm your host Don Mackintosh and today we're joined with 00:57 Dr. Phillip Mills from Wichita, Kansas. 00:59 Welcome, Doctor. 01:01 Today we're going to be talking about a very interesting subject 01:05 that is strokes. 01:06 You've titled our interview today... 01:09 This is for the golfers! 01:10 Making Par on Strokes. 01:13 I think that's a clever name, but what does it mean exactly? 01:17 What I want to talk about here is proper treatment 01:20 so that the people who have had strokes get the maximum 01:25 recovery that science can bring today in the Lord. 01:28 What is a stroke? 01:30 A stroke is a problem where there is a blood supply loss 01:36 to a certain portion of the brain. 01:37 There are several areas of the brain with many different 01:42 blood vessels. 01:44 Any of a number of problems can result from a stroke 01:52 because that part of the brain is damaged. 01:55 It didn't have sufficient oxygen because it didn't get blood. 01:59 I assume that not having oxygen probably can be caused from 02:03 different reasons. 02:05 Well, if you don't get blood to a cell 02:08 it has no way to breathe. 02:11 Then it can either get very sick if it lasts only a short time 02:17 or it can actually die. 02:19 Unfortunately in the brain if you have brain tissue that dies 02:23 there is no way for your body to regenerate brain tissue 02:28 and we don't have any mechanism, any surgery, any medicines to 02:33 regenerate brain tissue. 02:34 So what you want to do is make sure that you have as short 02:40 a time, with oxygen loss, as possible. 02:43 That's what the treatment is designed to cut down 02:46 on the injury to that area of the brain 02:49 that lost the blood supply. 02:51 Now if you look at the types of strokes that you can have 02:56 we could basically divide it into two categories. 03:01 There is several ways to divide it. 03:02 But there is the category in which there is bleeding and 03:07 there's the category in which there isn't any bleeding 03:10 with the stroke. 03:11 Immediately when a person begins to have symptoms of a stroke 03:16 either sudden loss of memory, have sudden blindness, even if 03:21 it doesn't last a long period of time, sudden loss of speech, 03:25 confusion perhaps, or sudden loss of the use of one side 03:30 of the body, left or right side, that person should have an 03:35 immediate evaluation in acute care and they can 03:40 determine whether or not there is bleeding. 03:42 If there is bleeding then they will have one type of treatment. 03:48 If there is not bleeding there's actually some new techniques 03:52 to try to take care of clots. 03:55 Now once the patient has been stabilized then there are 04:01 several areas that need to be looked at so that you can 04:06 maximize the person's abilities and minimize their disabilities. 04:14 That's actually my area of specialty in rehabilitation. 04:19 I look at Jesus, He was a rehab doctor. 04:22 In the book of Revelation He gives the great 04:26 instruction to rehab. 04:29 He says strengthen what remains. 04:32 We take a person that may have lost some function 04:35 and we strengthen what remains. 04:38 I would like to go over some of those details with our audience. 04:42 Before you get to those details which I know probably most 04:46 people that are with us today either know someone who has 04:50 had a stroke or perhaps they've had one themselves because 04:53 it's so prevalent, but is it something that just happens with 04:56 older people or should everyone be interested in this subject? 04:59 It is something that can happen at any age. 05:03 But as a young person we can develop habits of life that 05:10 decrease our risk of stroke. 05:12 Let me give you some examples. 05:15 Back well over 100 years ago there were a lot of strokes. 05:21 It wasn't because they had the high fat diet. 05:24 It was because they had a high salt diet. 05:27 They had a slightly different kind of stroke in the 1800's 05:31 then we have today. 05:32 But it was their lifestyle. 05:34 As they changed from the high salt - your salt pork, 05:38 your salt meat, preserved salt foods - pickles and those, 05:43 As society changed from that we still had strokes but now we 05:47 have a different kind of cause of strokes. 05:52 Today a common cause of strokes is atherosclerosis. 05:57 If we want to live so that we can avoid strokes we will 06:03 try to avoid the breaking of the natural law in our youth 06:09 so that we can decrease the risk of stroke as we grow older. 06:15 So we won't smoke, drink, won't eat bad foods, make sure we 06:20 get enough water, all these different kind of things. 06:22 Correct. 06:23 Well, let's go on. 06:25 The people that have had strokes or know people that have had 06:28 strokes, are going to be most interested I think in some of 06:32 the things you have to share. 06:33 What are some common problems that arise? 06:35 Maybe we can talk about those and then we can go through 06:38 and what should we do about the common problems that arise 06:41 if someone has a stroke. 06:42 One of the things that people forget is that you're not just 06:48 arm and leg when it comes to muscles. 06:50 The musculoskeletal system involves muscles everywhere. 06:54 One of the most important muscles that we just don't even 06:59 give a second thought to is our swallow muscles. 07:01 If I am paralyzed on the right side of my arm and I'm paralyzed 07:09 on the right side of my leg guess where else I'm probably 07:12 paralyzed or maybe paralyzed? 07:15 I may have some paralysis, possibly could include 07:19 the tongue, it may also include the throat. 07:22 Now we would think of that because a person has 07:25 with a right sided paralysis may have difficulty with speech. 07:29 But the truth of the matter is a person that is paralyzed on 07:33 the left side may also have problems with swallowing 07:36 and a high percentage do. 07:37 Not only do they have problems swallowing but they may not 07:41 be aware of it. 07:42 They go to the hospital and they're eating. 07:45 And when you eat food it was designed a very meticulous 07:50 structure with a lot of complication in it to make 07:58 the food you eat go into your stomach and not into your lungs. 08:03 There's a common pathway here in my mouth when I open my 08:08 mouth and I breath in, why is it not going into my stomach? 08:13 Whereas if I took and drank a glass of water, it would go into 08:17 that mouth, but without any thinking on my part, it goes 08:20 into my stomach not into my lungs. 08:23 How does that take place? 08:25 It takes place in the throat. 08:28 These muscles may be paralyzed 08:30 and they may be sensorial loss. 08:32 So a person is eating and swallowing the food into 08:36 their lungs and they don't even know it - not coughing, 08:40 no problems. 08:41 So they could get pneumonia and all these different things. 08:44 They get pneumonia and one of the first things that needs to 08:47 be evaluated, once a patient is stable, is to determine 08:53 how safe their throat is for swallowing food to make sure 08:59 it's going into the stomach and not the lungs. 09:00 So swallowing food is one big thing. 09:04 What is another thing? 09:05 Well, let me state more about that. 09:07 We often times will think a speech therapist should see 09:11 somebody if they've had a stroke and can't talk. 09:13 But a speech therapist should also see a patient if they've 09:16 had a stroke - period - just to evaluate the swallow. 09:20 They will put some food and then they will watch. 09:24 Depending on the results of that evaluation we may need to 09:32 get special x-rays to work with the swallowing 09:37 Another problem that you have to consider is the problem with 09:42 the bowel bladder. 09:43 If I am paralyzed on one side of the body the bladder muscles 09:50 and the bowel muscles may also have a paralysis 09:54 on a portion on one side. 09:56 So they're just weak on that one side? 09:58 Yes, the sphincters that control that. 10:00 And so a person may have incontinence. 10:04 Now those two areas - eating and incontinence - if we can't get 10:10 a person independent and safe in eating and if we cannot get a 10:14 person independent and safe in their bowel bladder control, 10:17 then those people seldom will be able to go home. 10:21 They will have to go to a nursing home where they can have 10:24 more attended care. 10:27 Some people might not understand the word - incontinence. 10:30 I remember taking care of some people in the hospital and 10:33 I told them that their relative was incontinent. 10:37 And they said, "Do you have a map so we can find out 10:39 where continents is?" 10:40 What does incontinence mean? 10:43 That means a person has lost control voluntarily of their 10:49 bladder or of their bowel. 10:52 So, swallowing, bowel, and bladder problems. 10:56 Are there any other problems? 10:57 Yes. 10:58 We want to make sure that the skin is protected 11:03 during this time. 11:04 If, for example, they have problems with bowel bladder 11:08 continence that may mean, or control, there is some 11:15 fluid around their skin in the hip area and they may develop 11:21 skin breakdown. 11:22 So we want to look at that and it will need meticulous 11:26 nursing care to make sure that those problems 11:29 are being addressed. 11:31 Ok, so we've got swallowing, bowel and bladder, the hazards 11:37 of being immobilized, anything else? 11:39 Yes. 11:40 As we move on from some of the acute problems then we 11:48 have to move into the chronic kinds of problems that a 11:55 patient has. 11:56 Here we are going to need a full, comprehensive rehab 12:04 program because if a person has some visual deficits 12:09 they may not be able to see how they're putting their 12:13 clothes on. 12:15 They will put their clothes on backward or they'll put one 12:19 side of their shirt on and not another side of the shirt. 12:22 And yet they will think they are dressed. 12:24 One of the very interesting aspects of stroke is if a person 12:33 has lost the realization they have, let's say a left side, 12:38 we call that left sided neglect, now that doesn't mean they're 12:42 being neglectful of their left side, but what it does mean 12:46 is that they are not aware of their left side. 12:49 You'll ask them, "Does your left side work?" 12:54 and they will say, "Yes," but they can't move their left side. 12:56 If you have them draw a picture of themselves they'll draw half 13:00 a picture and they will think it's the whole picture. 13:01 Because it may not only involve the left side in sensation 13:06 on the left side and motor control on the left side 13:09 but it may involve visual on the left side. 13:13 Here it's very fascinating because it's not the left 13:18 eye that doesn't see, it's not the right eye that doesn't see, 13:22 but it's both eyes - just the way it's wired - may not see 13:28 to the left and yet they are not aware that they don't see. 13:33 So we've got swallowing disorders, bowel and bladder 13:38 problems, problems with the extremities, visual problems, 13:41 and there are probably some more problems. 13:43 We've been talking with Dr. Mills from Wichita, Kansas 13:47 about strokes. 13:48 He's been talking about what happens when we have a stroke. 13:51 When we come back we're going to talk a little bit more about 13:54 some of the problems, but then we're going to talk 13:56 about the solutions. 13:58 We hope that you will join us. 14:12 Have you found yourself wishing that you could 14:14 shed a few pounds? 14:15 Have you been on a diet for most of your life, 14:17 but not found anything that will really keep the weight off? 14:20 If you've answered yes to any of these questions, then we 14:24 have a solution for you that works. 14:26 Dr. Hans Diehl and Dr. Aileen Ludington 14:29 have written a marvelous booklet called, 14:31 Reversing Obesity Naturally, and we'd like to send it to you 14:34 free of charge. 14:36 Here's a medically sound approach successfully used 14:38 by thousands who are able to eat more 14:41 and loose weight permanently 14:43 without feeling guilty or hungry through lifestyle medicine. 14:46 Dr. Diehl and Dr. Ludington have been featured on 3ABN 14:50 and in this booklet they present a sensible approach to eating, 14:53 nutrition, and lifestyle changes that can help you prevent 14:56 heart disease, diabetes, and even cancer. 14:59 Call or write today for your free copy: 15:23 Welcome back. 15:25 We've been talking with Dr. Phillip Mills from 15:28 Wichita, Kansas. 15:29 He's a specialist in physical medicine. 15:32 That's taking care of people who have had strokes. 15:34 Perhaps you've had a stroke or know someone that has. 15:36 We're happy you're with us if you're just joining us. 15:39 Is there hope for those that have had strokes? 15:41 Yes, as a matter of fact the person who has had a stroke 15:46 has very good odds for doing certain things. 15:49 Virtually all of the stroke patients, somewhere between 15:54 80-95 percent of people with appropriate rehabilitation 15:58 will be able to walk. 16:00 Many of them, the majority, will be completely independent again. 16:08 Now some of those that walk will be assisted with 16:13 physical therapy learning how to have appropriate canes or 16:21 perhaps even a walker in some cases, but the vast majority 16:28 will be able to walk again. 16:31 The stroke generally will not leave a person dependent 16:39 but with appropriate vigorous rehabilitation typically they 16:44 can become independent. 16:46 Can they see again? 16:47 We've talked about visual problems before, those blind 16:51 spots ever go away? 16:53 Not all stroke patients, obviously, have problems with 16:57 blindness in a portion of the eye. 17:00 Those that do that is a problem if it doesn't come back because 17:05 if a person doesn't see, let's say they don't see in the left 17:09 part of their visual field and that's on both sides the left 17:14 part is absent, if that doesn't come back obviously they 17:20 couldn't drive safely. 17:22 And in fact they may not be able to read 17:28 without some retraining. 17:29 From a rehab standpoint you begin to try to teach them 17:33 that they have lost the vision in that portion of their body. 17:38 There are various techniques that we use. 17:40 It does remind me how often we think we see and we 17:45 ourselves may have some blind spots and they might be big 17:49 blind spots. 17:50 In the case of a patient, he has to learn to depend on 17:53 someone else to tell him that he has this blind area. 17:59 Then they learn to compensate for it by moving their neck 18:05 and if possible moving their eyes and scanning into 18:08 that area of blindness. 18:09 You're a pastor, you would appreciate this, when I see 18:13 patients like that it reminds me of my spiritual blind spots 18:16 and the importance of I have to rely on God to keep me looking 18:23 in those areas that I would miss otherwise. 18:25 You mentioned some other things that trouble people 18:31 that had strokes. 18:32 You mentioned the bowel and the bladder and different things. 18:35 You've told us that they can start walking again. 18:38 But what about those things that are very troubling. 18:42 You normally can control your bowels and bladder but then 18:45 you loose that control. 18:46 Is there hope there? 18:47 Yes. 18:48 There are special exercises and some retraining that's done in 18:52 rehab centers. 18:53 And again, we are not always successful but often can be 18:56 successful and those are some major areas of emphasis 19:00 in rehabilitation. 19:02 Now in the area of the weakness of an arm or a leg, it's very 19:08 interesting if you look at how the brain is anatomically 19:14 made so that the leg has less area in the brain then the 19:22 arm. 19:23 I used to wonder how come elephants aren't 19:27 smarter than humans because their brain is so much bigger. 19:30 Good question. 19:31 Their brain isn't big in the area of thinking. 19:37 It's big in the area of controlling their trunk. 19:39 The nose. 19:41 So all of that goes into the thousands of muscles and 19:46 movements of the trunk of the elephant. 19:49 Well, the area that makes us humans, this forepart of our 19:54 brain, the front of our brain, that is larger 19:58 in humans than any other animal. 20:00 Now the representation in the brain for the leg is much 20:04 smaller than the arm or the thumb. 20:08 I like to tell the women that in the brain the women have a 20:15 great big area for the tongue - it's also true 20:18 for the men as well! - laughter - 20:21 But, of course, the bigger the area of the brain the more apt 20:28 it is to be affected if you have a stroke. 20:32 For example if you have a big target you're more apt to 20:36 hit it than if it's a small target. 20:38 That means that the arms which have relatively large area 20:43 in the brain are more apt to be affected by a stroke 20:46 and more apt to have long term effects from a stroke 20:50 then the leg. 20:51 So the patients that have had a significant stroke are very 20:56 seldom happy with the residual of the arm but they may be 21:00 satisfied with the way their legs work. 21:04 So the 85% that will walk again they're happy with the fact 21:07 that they're walking and like that but in using their arms 21:11 they don't have that fine ability that they used to have 21:15 or they don't sense that they do. 21:16 Yes. 21:17 Now when you look at how a stroke begins to recover 21:19 it's very interesting because early on a stroke may have a 21:24 problem with what we call flaccidity. 21:31 Flaccidity is the hand and arm or leg 21:38 just are completely relaxed. 21:41 Now that's a problem with the shoulder because the arm 21:45 is attached to the body by muscles and if I have no muscle 21:53 the arm just falls down. 21:55 Gravity pulls it down. 21:56 If you examine a patient you can stick your fingers in their 22:02 shoulder joint and you can feel a finger-breadth of space 22:06 there. 22:07 If that isn't properly treated over time, over maybe a year, 22:11 I've seen it drop down an inch and it just keeps getting longer 22:14 and longer. 22:15 The arm pulls farther and farther away from the body. 22:19 So it's very important that they have the proper treatment 22:24 to keep that arm up or you can develop some long-term 22:28 problems with what we call the supluxation there. 22:34 The shoulder is moving away out of the socket. 22:38 Now as the stroke begins to change, to heal, generally this 22:47 flaccid portion becomes spasticity and so it begins 22:51 to get tight. 22:52 And in the spastic portion we begin to have problems with 22:56 the muscles being tight and the joints then 23:00 getting contractured. 23:02 If that is improperly treated you may have difficulty in 23:07 hygiene - washing between the fingers, washing in the elbows, 23:12 washing underneath the arms, washing in the knees, the toes, 23:17 those sorts of problems. 23:20 So we want to make sure in a rehab setting that we get proper 23:26 range of motion techniques and ways to relax, if possible, 23:31 or at least keep the joints from freezing up. 23:37 Let me ask this question and see if I'm on to anything here. 23:43 If the problem is that some part of the brain has been damaged 23:47 through not having enough oxygen and you're just moving the arm 23:51 and different things, does that really help? 23:52 Well, we have patients that will come to me and they've had 23:56 a severe stroke and the family is very concerned about it. 23:59 It might be 2 or 3 years before and they still can't move 24:03 their arm. 24:04 So they'll want to have some sort of exercise program so 24:09 that the arm will move again. 24:10 But the problem is not in the arm. 24:13 The problem is in the brain that controls the arm. 24:18 If a person is moving the arm all day it will help the joints 24:25 but it's not going to bring back the brain. 24:28 It reminds me of people who are trying to work their way 24:31 into heaven. 24:33 The problem is not the works they do. 24:35 The problem is the heart that motivates the works. 24:39 Until we have the healing in the heart we'll never have the 24:45 proper works. 24:47 So likewise, unless the nerves in the brain is healed, all 24:51 of the movement down here at the arm is not going to 24:55 change the arm. 24:56 Now there are some things that can be helpful. 24:59 Some studies have shown some bio feedback techniques can be 25:03 useful in the hand in developing different pathways of movement. 25:09 But that is some limited types of treatments. 25:14 So there is hope. 25:15 I want to ask a question. 25:17 We've got about 2.5 minutes left here and I want to touch 25:20 on two things. 25:21 One is, can we really damage someone by helping 25:25 them too much if they've had a stroke? 25:27 Number two, what about all the psychological pain and anxiety 25:32 that comes with a stroke, what would you say about that? 25:35 But first of all, can we help someone too much? 25:37 Yes, well you can't help them too much but you can help 25:41 them and not help them. 25:43 You can help them best by allowing them to do for 25:48 themselves what they're capable of doing for themselves. 25:51 We can damage people by doing too much for them. 25:54 One of the problems that sometimes we'll have in a rehab 25:58 setting, is the family wants to feed the patient, the family 26:01 wants to dress the patient, the family want to do everything 26:05 for the patient. 26:06 In fact, part of the process of recovery from a stroke is 26:12 learning to do for yourself feeding, dressing, and moving 26:19 around. 26:20 God does a rehab program for us and He is very careful 26:25 in giving us opportunities to do what we can do 26:33 as part of the recovery process from our spiritual stroke 26:38 shall we say. 26:39 So I suppose if someone has had a relative they should 26:41 they should really counsel with a specialist like yourself 26:44 and ask, "Is this helpful or not?" 26:46 Let's go to that second question. 26:47 You've seen probably thousands of strokes. 26:50 Is there ever any good news that comes from a stroke? 26:54 Along with that how can people deal with the real 26:57 anxiety which is a big life change, what would you say 26:59 about that? 27:00 One of the problems that strokes cause is depression. 27:05 Whenever we have a loss of function, we become depressed 27:09 typically and I wouldn't say that a stroke is a good thing, 27:15 but even a stroke can be part of a process that can result in 27:20 good to us. 27:22 All things work together for good to those that love God. 27:26 The patients that I have, that have had strokes, 27:32 that know the Lord are happy 27:35 even in the midst of this loss. 27:39 It's amazing. 27:40 They'll come in and tell the blessings that God has given 27:43 them in sustaining them through their problems. 27:47 Thank you so much for being with us, Dr. Mills. 27:51 We hope that you have found blessing to the program today 27:54 and that as a result you or someone you love will have 27:58 health that lasts for a lifetime. |
Revised 2014-12-17