Stroke Patient

Education Workbook
A Guide to Understanding Stroke
This workbook is designed to help you become a well-informed participant in
your health care decisions regarding your stroke. We hope this will help you better
understand stroke and guide you through your recovery and rehabilitation.

www.hoag.org/stroke
Forward
A Guide to Understanding
Stroke
It is our sincere hope that this stroke patient
education workbook will provide you and your loved
ones with helpful information. This is designed to
be your personal workbook during your stages of
recovery. Understanding what happens when a
stroke occurs and being a knowledgeable participant
in your treatment plan are essential for your recovery
and rehabilitation.
This workbook is organized to help you understand
the general and specific information regarding your
stroke. If you or a family member have questions
after reading this material or at any time, please
contact the Neuroscience Stroke Nurse Navigator
at 949-764-8273.
Some of the enclosed materials were selected from
publications of The National Stroke Association,
The American Heart Association/American Stroke
Association, Brain Aneurysm Foundation,
The American Academy of Sleep Medicine, and
The Brain Attack Coalition.

Hoag Stroke Program Team

Pickup Family Neurosciences Institute
949-764-6066

iii
Table of Contents –
A Guide to Understanding Stroke
Introduction Life After Stroke
Welcome to Hoag’s Stroke Program . . . . . . . . . . . 1 Job Retraining/Volunteering. . . . . . . . . . . . . . . . . 46
Meet the Team Members. . . . . . . . . . . . . . . . . . . . 1 Driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
What to Expect During Your Hospital Stay. . . . . . . 3 Sexuality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
All About Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Warning Signs of Stroke . . . . . . . . . . . . . . . . . . . . 5 Lifestyle Modification
More Stroke Facts. . . . . . . . . . . . . . . . . . . . . . . . . 6 Smoking Cessation. . . . . . . . . . . . . . . . . . . . . . . 49
Frequently Asked Questions . . . . . . . . . . . . . . . . . 6 Stop Smoking Directory. . . . . . . . . . . . . . . . . . . . 49
Take These Step to Prevent a Second Stroke. . . . . 7 Stress Management . . . . . . . . . . . . . . . . . . . . . . 50

Risk Factors and Prevention Family Involvement

Risk Factors and Prevention . . . . . . . . . . . . . . . . . 8 The Caregiver’s Role. . . . . . . . . . . . . . . . . . . . . . 51
Uncontrollable Stroke Risk Factors . . . . . . . . . . . . 9 Taking Care of Yourself . . . . . . . . . . . . . . . . . . . . 52
Controllable Stroke Risk Factors . . . . . . . . . . . . . . 9 Working Together . . . . . . . . . . . . . . . . . . . . . . . . 54

Effects of Stroke Community Resources

Your Brain and You. . . . . . . . . . . . . . . . . . . . . . . 11 Caregiver’s Bill of Rights . . . . . . . . . . . . . . . . . . . 55
Right-Brain vs. Left-Brain Stroke. . . . . . . . . . . . . 13 A Caregiver’s Resource Guide. . . . . . . . . . . . . . . 55
Characteristics Based on Location of Stroke . . . . 14 Where To Turn For Help. . . . . . . . . . . . . . . . . . . . 56
Physical Effects. . . . . . . . . . . . . . . . . . . . . . . . . . 14 Palliative Care Medicine Consult Service
at Hoag Hospital. . . . . . . . . . . . . . . . . . . . . . . . . 58
Medications
Medications To Help Manage and Prevent Stroke. 17 Appendix
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Rehabilitation
Your Rehabilitation Program. . . . . . . . . . . . . . . . . 21
Personal Care. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Mobility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Home Safety Tips. . . . . . . . . . . . . . . . . . . . . . . . 28
No Such Word As “Can’t” . . . . . . . . . . . . . . . . . . 29

Nutrition
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Healthy Eating After A Stroke. . . . . . . . . . . . . . . . 30
Dysphagia Diet Summary. . . . . . . . . . . . . . . . . . . 32
Fat Facts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Healthy Substitutions to Reduce Fat . . . . . . . . . . 35
Sodium-Controlled Diet. . . . . . . . . . . . . . . . . . . . 38
Understanding Food Labels. . . . . . . . . . . . . . . . . 41
Eating Out. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Recommended Books/Cookbooks . . . . . . . . . . . 45

iv
 Introduction
Welcome to Hoag’s Meet the Team
Stroke Program Members
Hoag Stroke Program Helping you to maximize your recovery is a multi-
disciplinary team effort. The stroke team includes
Mission Statement doctors, nurses, nursing aides, respiratory therapists,
Stroke patients at Hoag receive the highest level physical therapists, occupational therapists, speech/
of care through a patient-centered, integrated, language pathologists, care managers, social
multidisciplinary team approach, using the best in workers, dietitians, your family, friends, and YOU.
evidence-based practice, state-of-the-art technology Your physician will determine which members of
and advanced research. the multi-disciplinary team will assist you in your
Pickup Family Neurosciences Institute’s Stroke recovery. Although these professionals have different
Program is DNVGL certified as a Comprehensive specialties, they share a common goal of helping you
Stroke Center at its Newport Beach campus, and to recover.
a Primary Stroke Center at its Irvine campus. Hoag
Stroke Program has received the American Stroke Primary Care Physician
Association’s “Get With the Guidelines” – Stroke Your primary care physician or hospitalist directs and
Gold Plus Performance Achievement Award and the plans your medical care in cooperation with your
Target Stroke Honor Roll Elite Award. neurologist and neurosurgeon.
Our Stroke Program is patient-centered with an
advanced approach to caring for our patients. The
Neurohospitalist
Stroke Team is multidisciplinary involving nurses, Your neurohospitalist is a hospital-based
therapists, care managers, social workers as well as neurologist who diagnoses and treats diseases
physicians from other specialties to assure optimal of the nervous system.
medical management and therapies are provided to
each of our stroke patients. Stroke Program Medical Director
The Stroke Program Medical Director is a
Hoag Newport Beach is designated a Stroke
Neurohospitalist who is fellowship trained in stroke
Neurology Receiving Center with Orange County EMS.
and cerebrovascular disease. He oversees and
directs the care of the stroke patient in conjunction
with the other physicians, nurses and staff that
make up the stroke team. He also ensures that
patients receive consistent, state-of-the-art care in
accordance with the latest scientific research.

Registered Nurse
Your registered nurse (RN) will assist your progress,
monitor your recovery and administer your
medications. Throughout your hospitalization, your
RN will assess your neurological function, level of
pain, signs and symptoms of any complications.
Your RN will educate you regarding prevention of
complications and help communicate any concerns
that you and your family may have to your physicians
and other healthcare members.

Patient Care Assistant

Your patient care assistant will help you with
personalized care and daily needs. He or she may
also perform procedures such as blood pressure,
temperature and drawing of blood.

1
Introduction

Stroke Program Nurse Navigator strength, and function of the arms, and may utilize
Your stroke program nurse navigator works modified techniques and/or adaptive equipment.
collaboratively with the physicians, nurses and OTs will also address problems related to vision,
multidisciplinary team to oversee your care and perception, problem-solving, safety, reasoning,
manage quality improvement. Your navigator will decreased sensory awareness, sitting balance/
also assist with your education regarding stroke endurance and positioning. One of the important
signs and symptoms, treatment and prevention aspects of therapy is the education and training for
of complications, and will meet with you and your the patient and caregiver.
family to assess your individual needs. At 30 days
and 90 days after discharge, you will receive a phone Physical Therapist
call from your navigator to assess your progress and Physical therapists (PT) will help you regain the ability
reinforce any education. Hoag’s nurse navigator also to be mobile again. They focus on deficits in your
coordinates the monthly support group meetings strength, balance, stamina, coordination and safety
and educational flyers mailed to your home. to help you regain bed mobility along with the ability
to stand up, balance, walk, and navigate stairs.
Respiratory Therapist Your PT will also assess the need for any equipment
Your respiratory therapist (RT) works with the such as a cane or walker, address any safety issues
healthcare team to help maintain and/or improve for returning home, and provide training for you
the health of your lungs. He or she will assist you and your family that will assist you through a safe
with breathing exercises, breathing medications, transition back to self sufficiency.
ventilator care and coughing techniques.
Care Manager
Speech/Language Pathologist Your care manager is an RN or social worker who
Your speech/language pathologist (SLP) will work assesses your status and evaluates your treatment
with you and your family to evaluate and treat plans throughout your hospital stay. He or she works
any problems you may have in your ability to use closely with your primary physician, healthcare
language. If needed, the SLP will assess your ability professionals and family to develop a quality
to swallow. Following this assessment, he or she discharge plan and coordinate all options for post-
may make recommendations to your physician to hospital continued care, including transition
ensure safety in swallowing, adequate nutritional to a lower level of care, alternative medical services,
intake and prevention of aspiration. durable medical equipment and supplies.

Dysphagia/Dietary Team Social Worker

Your physician may initially order no liquids or food The clinical social worker is a licensed professional
by mouth (NPO) until your swallowing ability has (LCSW) who will help provide you and your family
been evaluated. The dysphagia team will evaluate if with emotional counseling, crisis intervention,
you have difficulty swallowing (dysphagia). After the support groups and community resource
evaluation, the dysphagia team will recommend an information.
appropriate diet.
Dietitian
The primary goals of the dysphagia evaluation are
The dietitian works with your doctor to meet your
to ensure that swallowing is safe (no food or liquid
nutritional needs. He or she may check your eating
going down the airway), and that intake of food/liquid
habits and teach you about your diet. He or she will
is efficient and sufficient.
make sure that meals are healthy and tasty.
Occupational Therapist Chaplain
Occupational therapists (OT) will assist you in
The hospital chaplain is available to provide
managing activities of daily living (ADL) such as
spiritual guidance and emotional support for
self-feeding, bathing, dressing, home management
you and your family.
skills and community re-entry. These tasks are
accomplished by working to improve coordination,

2
 Introduction
What to Expect During
Your Hospital Stay All About Stroke
Hoag Stroke Program follows evidence-based What is a Stroke?
state-of-the-art stroke treatment protocols. Once
your stroke is diagnosed via clinical assessment Stated simply, a stroke is an injury to the brain
and brain imaging, treatment begins to help stabilize caused by an interruption of the blood supply. Brain
your symptoms. Then additional assessment is cells must have a continuous supply of blood. When
initiated to identify the reason for your stroke and a person has a stroke, this continuous supply is cut
the risk factors involved. The treatment of your off and the brain cells suffer damage.
stroke entails a through cerebrovascular and cardiac The brain also must receive oxygen and nutrients
diagnostic evaluation. (such as glucose) from the blood vessels. When
At the bedside, you will be evaluated daily by brain cells do not function, neither do the parts
the Stroke Team to update you and your family on of the body controlled by those brain cells.
diagnostic results, medications and rehabilitation The extent and location of the injury to the brain
needs. A key component once the assessment is dictates which brain functions are affected by
complete and you are medically stable, is to initiate the stroke.
rehabilitation evaluations by the physical therapist, A stroke is a sudden unexpected happening with
occupational therapist and speech therapist. diverse results. Some stroke patients recover to a
Aggressive rehabilitation is an essential part of your degree that normal life can be resumed. Some stroke
physical and cognitive recovery. A care manager will patients have residual damage (loss of function)
also visit you routinely to assist you and your family that is not recoverable. No two stroke patients have
with discharge and other social needs. exactly the same injuries or disablements.
This Stroke Patient Education Workbook will be Disability from stroke can take many forms
reviewed with you and your caregivers to help you depending on the area of the brain that is damaged.
understand the type of stroke you suffered and The stroke’s effect may be slight and temporary or it
the cause of the stroke. In addition, important may be serious, even fatal. A typical stroke survivor
educational topics such as the signs and symptoms may not be able to use his or her right or left side
of stroke, calling 9-1-1 at the first signs of of the body, or may have communication problems
symptoms, your risk factors and recommendations such as not being able to speak or read. Every
for stroke risk reduction. stroke is different.
You are the most important individual of your stroke Because a stroke patient’s recovery is both medical
recovery and our goal is to practice a holistic and rehabilitative, the recovery continues over a
approach addressing your physical, emotional, period of time, which can be weeks, months, or even
spiritual and social needs to maximize your recovery. years. Sometimes the damage done to the brain
cells cannot be overcome. Only time can tell the
optimum recovery for each patient.
If you or your loved one has had a stroke, you are
not alone. Every 40 seconds someone in the United
States will experience a stroke. This amounts to
approximately 795,000 people a year. Currently, about
610,000 people suffer first strokes each year. These
numbers are expected to increase significantly as a
result of an increase in the country’s aging population.

3
Introduction

Types of Stroke
There are two types of stroke: ischemic and hemorrhagic. The majority (87 percent) of all strokes are ischemic,
while the remaining 13 percent are hemorrhagic.

Ischemic Strokes Hemorrhagic Strokes

clot causing burst aneurysm causing

embolic stroke subarachnoid hemorrhage

plaque causing torn artery causing

thrombotic stroke intracerebral hemorrhage

Ischemic Stroke Hemorrhagic Stroke

The most common type of stroke, an ischemic stroke, Strokes caused by a bursting blood vessel in the brain
occurs when a blood clot blocks an artery cutting off that spills blood into the brain are called hemorrhagic
the flow of blood to the brain. Without enough oxygen strokes. High blood pressure and brain aneurysms
being delivered to the affected area, brain cells will can both cause the wall of a brain artery to become
begin to die and stroke survivors will start to have weak, and possibly result in this type of stroke.
problems using certain parts of their bodies. There are two types of hemorrhagic stroke:
There are two types of ischemic strokes: embolic intracerebral and subarachnoid. An intracerebral
and thrombotic. During an embolic stroke, a blood hemorrhage is caused when a ruptured blood
clot (embolus) or other undissolved piece of material vessel bleeds into the tissue deep within the brain.
moves through the body and lodges in a brain artery The bleeding causes brain cells to die, and that
cutting off the supply of blood. A thrombotic stroke, part of the brain no longer functions correctly. In a
a blood clot (thrombus) forms in the brain artery and subarachnoid hemorrhage, a blood vessel bursts
blocks the flow of blood. near the surface of the brain and bleeds into the area
between the brain and the skull. This bleeding may
increase pressure in the brain, injuring brain cells.

4
 Introduction
What is a Transient Ischemic Attack (TIA)? MECHANICAL TREATMENT TO PHYSICALLY
If an artery leading to the brain, or inside the brain, REMOVE THE CLOT
becomes blocked for a short period of time, the • Physical removal of a blood clot in a large blood
blood flow to an area of the brain slows or stops. vessel in the brain causing the stroke is called a
This lack of blood and oxygen can cause temporary mechanical thrombectomy.
symptoms that are similar to a stroke. These • This procedure has been clinically proven to
symptoms usually last 5 minutes or less and leave prevent or reduce disability in many patients
no permanent injury to the brain. suffering from a stroke due to occlusion of a large
TIAs are a serious warning sign of stroke and should brain artery, regardless of whether IV Alteplase
not be ignored. As many as 20 to 40 percent of (tPA) is given or not.
people who experience a TIA go on to have a stroke. • To remove the clot, a specially trained doctor
threads a long tube, called a catheter, through an
artery in the groin up to the blocked artery in the
Acute Stroke Treatment brain using image guidance.
• Two different devices may be used to remove
Management of Ischemic and
the clot: Stent retrievers grab the clot, which is
Hemorrhagic Stroke then removed with the stent; Aspiration catheters
• The first step is determining if the stroke is caused remove the clot with suction. These devices may
by the interruption of blood flow (ischemic) or by also be used together.
bleeding from an abnormal vessel (hemorrhagic) • Patients must meet strict criteria to be eligible
with rapid brain imaging. for this procedure, so that the potential benefit
outweighs the risks of the procedure.
Clot Dissolving or Clot Removal
• Some patients will meet criteria for both
for Ischemic Stroke Medication Treatment with IV Alteplase (tPA) and
MEDICATION TREATMENT WITH ALTEPLASE – Mechanical Thrombectomy.
INTRAVENOUS (IV) TPA TO DISSOLVE THE CLOT RISKS OF IV ALTEPLASE (TPA)
• Tissue plasminogen activator (tPA) or Alteplase • The main risk of IV Alteplase (tPA) is that it can
is the only FDA-approved medication for the cause serious bleeding in the head or body.
treatment of acute ischemic strokes. • If bleeding happens in the brain, it can cause
• When promptly administered, it can save lives and
worse stroke symptoms or even death.
reduce the long-term effects of stroke. • Doctors are very careful about using IV Alteplase
• Alteplase (tPA), is given through an IV in the arm. It
(tPA). For example, a brain scan is done before
works by dissolving the clot and improving blood TPA treatment to make sure you have no signs of
flow to the affected part of the brain. bleeding.
• Alteplase (tPA) needs to be given within 4.5 hours • After treatment, you are closely watched for the first
of having a stroke in eligible patients. 24 hours in an Intensive Care Unit to make sure you
• Many people miss this key brain-saving treatment have no internal bleeding or allergic reactions.
because they don’t arrive at the hospital in time • If you notice any headache, tongue swelling,
for Alteplase (tPA) treatment. This is why it’s so bleeding gums, nose bleeding, bloody urine or
important to identify a stroke and seek treatment stool; notify your nurse immediately.
immediately for the best possible chance at a full
recovery.

5
 Warning Signs
of Stroke
RISKS OF MECHANICAL THROMBECTOMY Stroke is a 911 Emergency
• The risks of thrombectomy are mainly related to
Learning the symptoms of stroke could save a life. It is
the procedure itself. Risks include bleeding where
critical to seek medical attention as quickly as possible
the catheter was put in and a tear or sudden
after the first sign of stroke. Call 911 immediately.
closure of a blood vessel.
• Doctors are very careful about using thrombectomy. The most common warning signs of stroke include:
• Sudden numbness, weakness or paralysis in your
They will make sure it is the right procedure.
• After treatment, you are closely watched for the
face, arm or leg, especially one side of your body.
• Sudden confusion, trouble speaking, or
first 24 hours in an Intensive Care Unit.
• If you notice any headache or bleeding at the
understanding speech.
• Sudden trouble walking, dizziness, loss of balance
puncture site, let your nurse know immediately.
or coordination.
Management of Hemorrhagic Stroke • Sudden trouble seeing in one or both eyes.
• ICH Management • Sudden severe headache with no known cause.
Treatment goal is to avoid further hemorrhage.
Neurosurgical consult and blood pressure
management are key to best patient outcomes.
Time of Symptom Onset
• SAH Management If symptoms are witnessed, it is very important to
Due to rupture of a brain aneurysm, treatment identify the time the patient was last seen in their
can include minimally invasive neurointerventional usual state of health. It is very important for family
placement of material, such as coils, to clog the or caregivers to accompany the patient to provide
aneurysm from within, or neurosurgical placement important information that will guide medical treatment.
of a metal clip at the base of the aneurysm.
• AVM Management STROKE is an Emergency – Every minute counts
Treatment can include neurointerventional
embolization, Gamma Knife radiosurgery, or
neurosurgery to remove the abnormal blood vessels.
ACT F.A.S.T!
FACE DROOPING
F Does one side of the face droop or is it
numb? Ask the person to smile. Is the
person's smile uneven or lopsided?

ARM WEAKNESS
A Is one arm weak or numb? Ask the
person to raise both arms. Does one
arm drift downward?

SPEECH DIFFICULTY

S Is speech slurred? Is the person unable

to speak or hard to understand? Is the
person able to correctly repeat the words?

TIME TO CALL 9-1-1

T If someone shows any of these

symptoms, even if the symptoms
go away, call 9-1-1.

Have the ambulance go to the nearest certified stroke center

6
 Introduction
Frequently Asked
Stroke Facts Questions
• Approximately 795,000 people suffer strokes each What is the likelihood that someone
year. It is the major cause of disability among adults. who has had a stroke will have another?
• Stroke kills nearly 130,000 people each year,
Anyone who has had a stroke is at increased risk
and is the fifth leading cause of death, ranking for another. This risk varies with each individual,
only behind heart attack, cancer, chronic lower depending on a variety of factors, including the
respiratory diseases, and unintentional injuries. type of stroke initially experienced. The risk can be
• The risk of stroke more than doubles with each reduced through medications and lifestyle changes.
decade after age 55. The aging of the U.S.
population suggests that the number of people What can I do to prevent a second
who have strokes could increase significantly in stroke?
coming years.
Up to 80% of second ischemic strokes may be
• People with diabetes, especially those who have
preventable. A combination of dietary modification,
high blood pressure, are at increased risk for stroke. exercise, a statin, antithrombotic, and blood pressure
• A person who has had a stroke is much more likely control can reduce your risk of another stroke. Work
to have another than a person who has never had with your doctor to create a prevention plan.
a stroke.
• Everyone has some stroke risk, but making simple How long will it take for me to recover
lifestyle changes may reduce risk of a first or from a stroke?
recurrent stroke. The most dramatic recovery from a stroke usually
• Stroke is preventable. Up to 80 percent of strokes comes in the first 3-4 months, but recovery can occur
can be prevented. well into the first or second year after the acute event.
• Stroke is treatable. Learn to recognize stroke
symptoms, realize that stroke is an emergency, How long does a person continue with
and get to the nearest certified stroke center rehabilitation after a stroke?
immediately. Rehabilitation begins in the hospital, soon after the
stroke, and is most intensive within the first few
months. In some cases, it continues with a variety of
approaches for years.

How is a TIA different from a stroke?

Unlike strokes, these attacks are brief and
temporary, lasting less than 24 hours. Additionally,
TIAs do not result in permanent brain damage.

7
Introduction

Take These Steps to

Prevent a Second Stroke
What’s the difference between “good”
cholesterol and “bad” cholesterol?
Manage high blood pressure
Cholesterol is a fatty substance that can deposit
itself in the arteries. It hardens over time, eventually
narrowing the arteries and restricting blood flow.
HDLs are considered the “good” cholesterol because
they contain the greatest amount of protein and the
Control cholesterol
smallest amount of cholesterol. They are believed
to remove cholesterol from the cells and transport it
back to the liver for processing and removal.
LDLs are considered the “bad” cholesterol because Reduce blood sugar
they contain the greatest percentage of cholesterol
and may contribute to other atherosclerosis.

Why do I have to take a statin even if my Be active

cholesterol level is normal?
Clinical practice guidelines recommend the use of
statin therapy to reduce the risk of recurrent stroke
in patients who have had a stroke or TIA. In addition Eat better
to reducing cholesterol levels, statins have an
antiinflammatory property that protects the brain.

When can I drive after a stroke?

Driving is often a major concern after a stroke. Maintain a healthy weight
Safety behind the wheel is extremely important after
a stroke. Before you drive, talk to your doctor. He
or she can tell you if your stroke has changed your
ability to drive. You can also get a driving evaluation Quit smoking
to see if you are safe to drive. See page 46 for more
information.

Discuss your medication

regimen with your doctor

8
 Risk Factors and Prevention
Risk Factors and Prevention

High blood
pressure Hormonal
Diabetes contraception
& HRT

High
Obesity
cholesterol

Heart
disease Inactivity
& AFib
Risk
Family
Factors Binge
drinking &
history or substance
ethnicity misuse

Smoking
Age & vaping

Dehydration Previous
stroke & TIA
Sleep apnea

9
Risk Factors and Prevention

Uncontrollable Controllable Stroke

Stroke Risk Factors Risk Factors
Are you at risk for stroke? Identify the risk factors Lifestyle Factors that Increase
that apply to you to find out.
Stroke Risk
Age
The chances of someone having a stroke increase Smoking
with age. Two-thirds of all strokes happen to people Cigarette smoking is a strong risk factor for stroke.
who are over age 55. Stroke risk doubles with each The nicotine and carbon monoxide in cigarette
decade past age 55. smoke damage the cardiovascular system and pave
the way for stroke to occur. Quit smoking now and
Gender lower risks.
More women than men have strokes each year, in
part because women generally live longer. Alcohol Use
Excessive consumption of alcohol, including binge
Family History drinking, is associated with stroke. The American
Although actual risk varies, people with a family Stroke Association advises consuming no more
history of stroke are at risk for stroke themselves. than two drinks per day for men and no more than
one drink per day for non-pregnant women to lower
Personal History of Diabetes stroke risk. Talk to your doctor if you need help
Having diabetes more than doubles stroke risk. This overcoming addiction to alcohol.
may be due to circulation problems that diabetes
can cause. While diabetes is treatable, having the Weight
disease increases your risk for stroke. Work with Excess body weight and obesity are linked with an
your doctor to manage diabetes and lower your risk. increased risk of high blood pressure, diabetes, heart
disease and stroke. Losing weight can significantly
Race reduce your risks.
African-Americans have a higher risk of death and
disability from stroke than whites. Latinos and Exercise
Asians also are at increased risk. This may be due Consult with your physician about an exercise
to a greater incidence and severity of high blood program that involves 30 minutes of exercise five
pressure. times per week.

Having one or more uncontrollable risk factor(s)

does not mean you will have a stroke. It does mean Treatable Medical Conditions
that you should pay special attention to the lifestyle That Increase Stroke Risk
factors and treatable medical conditions that you are
able to control to lessen your overall risk.
High Blood Pressure
High blood pressure is the single most important
risk factor for stroke because it is the leading cause
of stroke. High blood pressure adds to your heart’s
workload and damages your arteries and organs
over time. Normal blood pressure is below 120/180
for adults. Talk to your doctor about ways to control
your blood pressure.

10
 Risk Factors and Prevention
Atrial Fibrillation (AFib) Previous Stroke
Having atrial fibrillation can increase stroke risk up to You cannot control the fact that you have had a
five times. That is because AFib causes the heart’s stroke, but you can control the lifestyle and medical
upper chamber to beat incorrectly. This can allow risk factors that contributed to your stroke. Having
blood to pool and form clots that can travel to the one stroke increases your chances of having another
brain and cause a stroke. Work with your doctor to one. A transient ischemic attack (TIA), or temporary
know your risk for stroke related to AFib and develop stroke symptoms, is another strong indicator of
a treatment plan to lower your risks. stroke. One-third of all people who experience a TIA
go on to have a stroke within five years.
High Cholesterol
People with high cholesterol have an increased risk Prevention is Your Key
for stroke. Large amounts of cholesterol in the blood to a Stroke-Free Life
can build up in the arteries and lead to decreased Detection and management of stroke risk factors is
blood flow and the formation of clots. This can lead the best way to lower your personal risk for stroke.
to a stroke. Work with your doctor to develop a plan If any of the controllable risk factors listed apply to
to lower your cholesterol. See page 33 for more you, the National Stroke Association recommends a
information. visit to your doctor to discuss your individual risk and
develop a treatment plan.
Obstructive Sleep Apnea (OSA)
Regular doctor’s visits can help diagnose these
A person is considered at risk for OSA if two or more
problems and help prevent a stroke before it
of the following occurs:
happens. Stroke risk factors can be managed by
• Witnessed apneas or pauses in breathing
lifestyle changes and/or medical care.
during sleep
• Obesity, defined as:
– BMI > 35 (Weight in kg/Height in meters)
• Neck circumference > 40 cm (about 16 inches)
• Male gender
• Age > 50
• Excessive daytime sleepiness
• Snoring loudly

The more items you identify with, the higher the risk.
According to the National Stroke Association, sleep
apnea can be an after effect of stroke or the cause
of a first-time or recurrent stroke. OSA causes low
oxygen levels and high blood pressure, both of
which can increase the risk of stroke. Your doctor
can refer you to a sleep specialist to determine if you
have OSA.

11
 Your Brain and You
The brain is the control center of your entire body. Each part of the brain is responsible for controlling a
different function of the body, such as breathing, language or emotions. The diagram below outlines the parts
of the brain and functions for which they are responsible.
Effects of Stroke

Frontal Lobe Parietal Lobe

• Movement • Intelligence
• Intelligence • Reasoning
• Reasoning • Telling
right from left
• Behavior • Language
• Memory • Sensation
• Personality • Reading

Temporal Lobe Occipital Lobe

• Speech • Vision
• Behavior
• Memory Cerebellum
• Hearing • Balance

• Vision • Coordination

• Emotions • Fine muscle control

Pituitary Gland Brain Stem

• Hormones • Breathing

• Growth • Bloodpressure
• Fertility • Heartbeat
• Swallowing

Types of Stroke
There are two types of stroke: ischemic and hemorrhagic.

Ischemic stroke
The most common type of stroke, an ischemic stroke occurs when a blood clot blocks an artery,
cutting off the flow of blood to the brain. There are two types of ischemic strokes: embolic and
thrombotic.
• Embolic: a blood clot (embolus) or other undissolved piece of material moves through the body
and lodges in a brain artery cutting off the supply of blood.
• Thrombotic: a blood clot (thrombus) forms in the brain artery and blocks the flow of blood.

12
Hemorrhagic Stroke
Strokes caused by a bursting blood vessel in the brain that spills blood into the brain are called hemorrhagic
strokes. There are two types of hemorrhagic stroke: intracerebral and subarachnoid.

Effects of Stroke
• Intracerebral: when a ruptured blood vessel bleeds into the tissue deep within the brain.
• Subarachnoid: a blood vessel bursts near the surface of the brain and bleeds into the area between the
brain and the skull.
Your stroke was a __________________________________________________________ stroke;
caused by _____________________________________________________________ ; located in the
_____________________________________________________________ of the brain.

Anatomy of the Cerebral Vasculature – CEREBRAL ARTERIES

Right anterior Left anterior

cerebral cerebral (A2)

Anterior Left anterior

communicating cerebral (A1)

Middle
cerebral

Internal
carotid

Posterior
communicating

Posterior
cerebral

13
 Right-Brain vs. Left-Brain Stroke
Effects of Stroke

RIGHT BRAIN DAMAGE LEFT BRAIN DAMAGE

Weak or paralyzed left side
Weak or paralyzed right side
Visual-perceptual deficits
Speech-language deficits
Unaware of deficits
Memory deficits
One-sided neglect
Visual-perceptual deficits
Memory deficits
Impaired thinking
processes (impulsive)

14
Characteristics Based
on Location of Stroke Physical Effects
The brain is a complex organ that controls multiple The effects of a stroke will depend on several factors
body functions. When a stroke occurs and blood is – how widespread the damage is, the type of stroke,
unable to reach the region of the brain that controls which brain cells have been damaged, and how

Effects of Stroke
a specific body function, that part of the body quickly other areas of the brain tissue take over the
cannot work properly. damaged cells. No two patients will have the same
For example, if the stroke occurs toward the back of physical changes.
the brain, it is likely to affect the individual’s vision. The most common effects of a stroke include the
The effects of a stroke depend mainly on the location following: weakness, loss of sensation, difficulty with
of the obstruction and the extent to which brain speech or language, disruption to vision,
tissue is affected. depression and/or problems with memory.

Right Brain Weakness

The effects of a stroke depend on many factors, Weakness after stroke may involve one side of the
such as the location of the obstruction and the body, the entire arm and leg, just the arm, or just
amount of brain tissue affected. Since the brain the leg. The face and mouth may also be involved,
controls the opposite side of the body, a stroke and may cause difficulty swallowing, slurred speech
affecting one side will result in neurological or drooling. Patients may experience lack of
complications on the other side. For example, a coordination of the face, arm or leg.
stroke that occurs on the brain’s right side will affect
the left side of the face and body. This could bring Visual Changes
on any of the following effects: Patients may have problems with double vision or
• Paralysis on the left side of the body loss of one side of their vision, experience one-sided
• Issues with vision neglect or have a blind spot.
• Quick, inquisitive behavior
• Loss of memory
Sensation
Changes to sensation may include numbness to the
Left Brain affected area, pain and inability to recognize objects
by touch.
A stroke that occurs on the left side of the brain
affects the right side of the body, resulting in any
Changes to Muscle Tone
or all of the following effects:
• Paralysis on the right side of the body The muscles of the affected arm or leg may
experience a change after a stroke. Flaccid muscles
• Speech/language issues
are very loose, relaxed and cannot be moved by the
• Slow, cautious behavior
patient themselves. The opposite of this is a spastic
• Loss of memory muscle that is tight at all times. The arm or leg may
be held in a rigid position, such as a tight clenched
Brain Stem fist. Often the movement seen may be related to
When a stroke occurs in the brain stem, it can affect the abnormal tone when the affected arm or leg is
both sides of the body – depending on the severity stimulated.
of the injury – and may leave the individual in what’s
referred to as a “locked-in” state. In this case,
the patient is usually unable to speak or have any
movement below the neck.

Cerebellum
If the stroke occurs in the cerebellum, it can lead to
problems with balance and coordination, dizziness,
nausea, vomiting, and sometimes visual changes.

15
 Fatigue disorders. Signs of dysphagia may include coughing
After a stroke, almost all stroke survivors feel tired or or choking during or shortly after swallowing,
some type of fatigue at some point. Stroke survivors increased drooling or chewing, pocketing of food
Effects of Stroke

often must work harder to make up for the loss of in the mouth, inability to clear throat and pain with
normal functions (such as being unable to use an swallowing. Patients who have this difficulty are
arm or hand). You’ll probably start to feel less tired at risk for food or liquids to enter the windpipe
after a few months. Some ways to increase your (trachea), which can lead to pneumonia. The oral
energy are to get plenty of sleep, eat a healthy intake of food or liquid may be restricted initially until
diet, take rest periods throughout the day, learn to the ability to swallow is evaluated.
relax – being relaxed lets you use your energy more
efficiently, talk about your emotions – coping with Behavioral and Emotional Changes
frustration, anxiety and anger can be draining. Talk After a stroke, people often experience emotional or
to your doctor about your fatigue. He or she can behavioral changes. This is because stroke affects
evaluate any medical reasons for your tiredness such the brain and our brain controls our emotions and
as depression or medication side effects. behaviors. Many changes resulting from a stroke
can improve with time, including behavioral and
Neglect emotional changes. Talk to your doctor if you notice
Some stroke patient’s lose the awareness of one any of these changes.
side of the body. This may involve ignoring the side
of the body, not looking to the affected side or Memory Loss
pocketing food in one side of the mouth. Patients may experience subtle changes to their
memory. They may have difficulty following directions,
Communication Disorders keeping track of the day or time, identifying familiar
If a stroke causes damage to the language center objects or sequencing normal activities.
of the brain, there may be language difficulties.
Aphasia is a term used to describe a collection Loss of Emotional Control
of communication difficulties, including problems (Pseudobulbar Affect)
with speaking, understanding, reading and writing. Stroke patients may display emotions for no
Intelligence is not altered, although the inability to apparent reason or have difficulty controlling their
communicate may leave the impression that the emotions. This may result in sudden laughing, crying
patient is less intelligent than they were before. or displays of anger. Episodes may come and go
Stroke can also lead to challenges with reading, quickly, and are often associated with the patient’s
writing and math. inability to communicate. This can make social
interactions difficult and unpredictable.
Swallowing Disorders
When a stroke affects the face, mouth or throat,
patients may experience difficulties swallowing.
Dysphagia is the term used to describe swallowing

16
Managing Depression Depression Symptoms
After Stroke EMOTIONS

Effects of Stroke
• Sadness
Depression – mild or major – is the most common
emotional reaction faced by stroke survivors. • Anxiety
Following a stroke, it is important for family and • Guilt
friends to show patience and compassion to help • Anger
survivors recover. Each survivor needs to respond • Mood swings
in his/her own way, without pressure to meet the
• Irratability
expectations of others who have not experienced
a brain injury. It may be impossible for family and THOUGHTS
friends to understand how they feel. • Self-criticism

If your symptoms are severe and last more than two • Impaired memory
weeks, you may have clinical depression – a medical • Indecisiveness
condition that is painful and can slow the progress of • Confusion
your therapy. • Thoughts of death or suicide
PHYSICAL
Facts About Post-Stroke Depression
• Chronic fatigue
• It can start at any time – immediately following a
• Lack of energy
stroke, during rehabilitation, or after the patient
returns home. • Sleeping too much or too little

• It is extremely common. Studies show that • Weight gain or loss

between one-third and one-half of stroke survivors • Loss of motivation

experience depression. • Substance abuse
• It is not a character flaw or moral failing.
BEHAVIOR
• It can slow recovery, preventing survivors from • Withdrawal from others
participating in therapy. • Neglectof responsibilities
• It increases risk of another stroke.
• Changes in personal appearance
• It generally responds well to treatment.
• It is unlikely to go away on its own. Thoughts You May Be Having
Feeling sad about your losses is a normal reaction • “I don’t have the words to express how I feel.”
experienced by virtually every stroke survivor. • “I hate losing control and my independence.”
However, when that sadness turns to depression, • “I feel like a burden.”
it’s time to take action. Your treatment may • “I feel unlovable.”
include therapy with a psychiatrist or psychologist,
• “Life will never go back to the way it was.”
medication, or a combination of both.
How Family/Friends Can Help
Family and friends can help by showing compassion
and understanding, and being an emotional support
rather than having the expectation that everything
should be better. Hoag offers a Stroke Support
Group that can help survivors and family members
adjust to the new normal. For more information, call
949-764-6066. (See page 60.)
Tell your doctor about your symptoms for help
coming up with a plan to treat your depression.

17
 Medications To Help
Manage and Prevent Stroke
Stroke is one of the leading causes of serious long-term disability in the United States. To reduce your risk
of recurrent stroke, it is important to modify your “risk factor profile.” This includes reducing your cholesterol,
abstaining from smoking and excessive alcohol consumption, and treating your high blood pressure. Eating
healthy and exercising regularly can also reduce the risk of cardiovascular complications.
There are many different medications that can help to reduce these risk factors. HMG-CoA Reductase
Inhibitors and Niacin can help reduce your cholesterol. ACE Inhibitors as well as Beta Blockers can assist in
reducing high blood pressure. And because the clumping together of platelets are integral processes in stroke,
antiplatelet drugs are key pharmacologic therapies to prevent stroke recurrence.
With the right treatment and some changes in daily life, most people with stroke feel better and can lead
happier, healthier lives. Everyone’s situation is different—certain treatments that fit one person’s situation won’t
be right for another’s. Patients and their families should talk with their physician about the most appropriate
Medications

treatment options. This section reviews some of the medications used to treat this condition.

Medication Information

Antiplatelet What they do

Medications Antiplatelet medications are used to inhibit the formation of blood clots by
preventing platelets from sticking together.
P Aspirin
P Enteric Coated Aspirin Benefits
P Clopidogrel (Plavix) Antiplatelet medications are effective in reducing the risk of stroke by preventing
the formation of blood clots and also offer a protective effect against heart
P Aspirin/Dipyridamole attacks and strokes.
(Aggrenox)
Things to watch for:
• Easy bruising
• Persistent stomach pain.
• Signs of bleeding, such as blood in vomit, urine or stool.
• Aggrenox can also cause side effects such as headache, flushing, and
occasionally yellowing of the eyes or skin – notify your doctor right away if you
have this side effect.

18
Medication Information

Anticoagulation What they do

Medications Anticoagulant Medications (Blood Thinners) work in the body to slow blood clot
“Blood Thinners” formation.
Warfarin competes with Vitamin K to slow clot formation by reducing the action
P Warfarin (Coumadin) of blood clotting factors II, VII, and IX.
P Apixaban (Eliquis) Another class of anticoagulant medications has been approved by the
P Rivaroxaban (Xarelto) FDA. Apixaban, Rivaroxaban, Edoxaban, and Dabigatran are in this class of
medications. They work by reducing the circulation of blood clotting factors X,
P Edoxaban (Savaysa) Xa, and Thrombin.

Medications
P Dabigatran (Pradaxa) Enoxaparin is a Low Molecular Weight Heparin that prevents and treats clots in
P Enoxaparin (Lovenox) blood vessels. It is given by an injection under the skin, usually on the front side
of the stomach area.

Benefits
Reduces the potential for blood clot formation and therefore reduces the risk of
stroke recurrence.

Things to watch for:

• Unusual bruising or bleeding.
• Signs of bleeding, such as blood in vomit, urine or stool.
• Maintain a steady diet and avoid heavy alcohol consumption
• Check with your doctor or pharmacist for any drug interactions with
Anticoagulant Medications, even over-the-counter and “herbal” non-
prescription products.

Vitamin K and Warfarin (Coumadin)

The Vitamin K content of foods you consume may have an important effect
upon your therapy with Coumadin. It is important to avoid or limit foods that
are high in Vitamin K while taking Coumadin. Discuss specifics of your diet with
your doctor or dietitian.

Food sources that are high in Vitamin K: Turnip greens, soybeans, soybean oil,
Brussels sprouts, lettuce, cauliflower, cabbage, broccoli, spinach, liver, and
green tea.
Food sources that have a moderate amount of Vitamin K: Asparagus, corn oil,
watercress, tomatoes, cheese, oats, butter, potatoes, bacon, egg yolks, whole
wheat, coffee

19
 Medication Information

Ace Inhibitors What they do

P Benazepril (Lotensin) ACE Inhibitors prevent the body from forming angiotensin, a substance in the blood
that causes vessels to narrow and raises blood pressure. By preventing the formation
P Captopril (Capoten) of angiotensin, your blood pressure is lowered, your heart’s workload is reduced and
P Enalapril (Vasotec) the development of plaques
is blocked.
P Fosinopril (Monopril)
P Lisinopril (Prinivil, Benefits
Zestril)
They help you by decreasing the formation of plaque, thereby allowing
Medications

P Moexipril (Univasc) blood to flow easier. They can also reduce high blood pressure, which also
lowers stroke risk. In studies, ACE Inhibitors have been shown to reduce
P Perindopril (Aceon) mortality, heart attacks, strokes, heart failure, as well as diabetes-associated
P Quinapril (Accupril) complications.
P Ramipril (Altace)
Things to watch for:
P Trandolapril (Mavik) • Dizziness tends to occur with the first or second dose, and then goes away by
itself.
• If you experience a persistent dry cough, which gets worse or becomes
bothersome while taking ACE Inhibitors, contact your doctor.
• Swelling of the face or tongue; call your doctor if this occurs.
• Can be taken without regard to meals.

Angiotensin II What they do

Receptor Blockers ARBs work by blocking the effect of angiotensin II, a chemical that narrows
(ARB) blood vessels and raises blood pressure. This effect helps to widen blood
vessels allowing blood to flow more easily to lower blood pressure. ARBs are
P Atacand (candesartan) sometimes prescribed for people who cannot tolerate ACE inhibitors.
P Avapro (irbesartan)
Benefits
P Benicar (olmesartan) ARBs are used to treat high blood pressure, heart failure, kidney failure
P Cozaar (losartan) associated with diabetes, and chronic kidney diseases. Lowering blood
P Diovan (valsartan) pressure can reduce your risk of stroke.
P Micardis (telmisartan) Things to watch for:
• Dizziness or lightheadedness upon standing. This effect is usually strongest
with the first dose, especially if you are taking a diuretic (water pill). Call your
doctor if it is persistent or severe.
• If you experience a persistent dry cough, which gets worse or becomes
bothersome while taking ARBs, contact your doctor.
• Elevated potassium levels (hyperkalemia) follow your doctor’s
recommendations for lab monitoring.
• Swelling of the face or tongue, call your doctor if this occurs.
• Do not take ARBs if you are pregnant or plan to become pregnant.

20
Medication Information

Beta-Blockers What they do

P Atenolol (Tenormin) Beta-blockers reduce the heart’s tendency to beat faster. They block the effects of
chemical messengers in the body that cause the heart to work harder and increase
P Bisoprolol (Zebeta) blood pressure. This allows your heart to maintain a slower rate and helps keep it
P Carvedilol (Coreg) from getting weaker over time.
P Metoprolol (Toprol XL, Benefits
Lopressor)
Beta-blockers may reduce the energy needs of the heart, and when tolerated
over a long time, may actually reduce heart size and improve the function of

Medications
the heart.

Things to watch for:

• Dizziness.It usually occurs early in the treatment course, but goes away
once your body adjusts.
• Do not use beta-blockers if you have severe asthma or COPD, symptomatic
bradycardia or advanced heart block without
a pacemaker.

HMG-CoA What they do

Reductase HMG-CoA Reductase Inhibitors, otherwise known as the “statins,” reduce the
Inhibitors amount of cholesterol in the body. This is done by inhibiting the HMG-CoA
reductase enzyme, which is an important step in producing cholesterol.
P Atorvastatin (Lipitor)
P Fluvastatin (Lescol) Benefits
P Lovastatin (Mevacor) HMG-CoA Reductase Inhibitors lower cholesterol and fats in the blood to
help prevent heart attacks and strokes. They have an anti-inflammatory effect
P Pravastatin as well as an anti-atherosclerotic effect, which reduces plaque build-up and
(Pravachol)
stabilizes plaque in the arteries.
P Simvastatin (Zocor)
P Rosuvastin (Crestor) Things to watch for:
• Muscle weakness. If you experience unusual muscle weakness, contact your
P Ezetimibe/Simvastatin physician immediately.
(Vytorin)
• Do not eat grapefruit or drink grapefruit juice when taking
these medications.
• Limit alcohol intake as it can damage your liver and cause increased side
effects.

21
 Medication Information

Niacin Cholesterol-Lowering Drugs

(Nicotinic Acid) What they do
P Niacin (Nicobid, Niacin decreases the amount of LDL, the “bad cholesterol,” by blocking its
Niaspan) production. Niacin also decreases Triglycerides (TG) and increases the amount
of HDL, otherwise known as “good cholesterol.”

Things to watch for:

• Flushing. This may be reduced by taking niacin with meals and avoiding hot
Medications

liquids or alcohol immediately after a dose.

• Taking aspirin or Tylenol 30 minutes prior to niacin may also reduce the
flushing.
• Itching usually goes away after several weeks of therapy.

22
Your Rehabilitation Program
Your rehabilitation program for continued recovery will be:

PROGRAMS SERVICES SETTING FREQUENCY LIKELY CANDIDATES

Acute care 24-hour Hospital or special Several Survivors who have

(inpatient) medical rehab unit of a hours each many medical issues
care and a hospital day (most and may develop
and rehab full range demanding) problems without
hospitals of rehab continued medical
resources treatment

Sub-acute Provide daily Rehab center, rehab Less Survivors who have
facilities nursing care unit of a hospital, demanding serious disabilities but
and a fairly skilled nursing facility than acute are unable to handle
wide range (short-term nursing programs, but the demands of acute
of rehab care) or skilled nursing continue for programs in a hospital
services home (long-term), longer periods

Rehabilitation
skilled nursing unit in of time
a hospital

Long-term One or more Nursing home, skilled 2-3 days per Survivors who have their
care facilities treatment nursing facility week medical problems under
areas control but still need 24-
hour nursing care

Outpatient One or more Doctor’s office, 2-3 days per Survivors who have their
facilities treatment outpatient center week medical problems under
areas of a hospital, other control enough to live
outpatient centers, in their own homes and
and some adult day can travel to get their
centers treatment

Home health Specific In the home As needed Survivors who live at

agencies rehab home but are unable
services in to travel to get their
one or more treatment
treatment
areas

Rehabilitation:

Phone number:

23
 Therapies:
P Physical therapy P Occupational therapy P Speech therapy
Durable Medical Equipment:
P Front-wheeled walker P Bedside commode P 3-in-1 (shower chair/over toilet/bedside commode)
P Hospital bed P Other
Notes:
Rehabilitation

24
Personal Care
Hospital staff help patients re-learn activities of daily Activities
living through strengthening, coordination, use of During hospitalization, your therapist may discuss
assistive equipment and compensatory techniques your skills, abilities and interests with you and
if needed. After a stroke, patients may experience your family. They may provide treatment that will
difficulty using their arms to perform familiar tasks improve specific skills, assist you in developing new
such as eating, grooming, bathing and dressing. leisure interests/hobbies, and provide resources to
Specifically, the occupational therapist will assist you promote your self-sufficiency and independence.
in re-learning self care techniques, possibly adapting Staying active and involved in pleasurable pursuits
clothing attire, and/or obtaining special devices for following a stroke in critical. Recreational activities
self-management assistance. can improve perception, coordination, strength, shift
your attention from disability to ability, enhance your
Eating/Chewing/Swallowing self-esteem and confidence, promote relaxation and
The ability to feed oneself after a stroke may be distraction from pain, and facilitate socialization with
impaired. You may have difficulty cutting food, others in society.
using utensils or opening containers. This may be
related to weakness, decreased coordination or Discharge Planning
paralysis. The occupational therapist will assist you Prior to your discharge from the hospital, the case

Rehabilitation
in developing strength, coordination, and learning to manager will obtain information from your physician
use assistive devices. and therapist on your discharge therapy needs.
Dysphagia is a term used to describe difficulty with Depending on your status, home environment, social
swallowing. A patient may lack feeling or sensation support and available transportation, a decision will
in one or both sides of their mouth or have weak be made whether you will have home therapy, be
muscles in the throat, mouth or face. Your physician referred to outpatient therapy, go to a skilled nursing
may order the dysphagia team to evaluate and facility or acute rehab facility.
make recommendations regarding the proper type
of diet for you. Remember: Many times, clear liquids
are difficult to swallow and using thickening may
be beneficial. Consult with your therapist before
discharge.

Dental Care
Due to the loss of muscle control and sensation,
stroke patients are at high risk for dental problems.
Risk factors may include food accumulation on
affected side, accidental cheek or tongue biting,
burns from hot food, dry mouth due to medications,
loose or unclean dentures, and poor nutritional
status. A thorough dental program may include
frequent rinsing with water or use of an irrigating
device, testing temperature of food before eating,
adjusting and daily cleaning of dentures, and regular
check-ups by dental professionals.

25
 Mobility
Improving mobility can be a large focus of • Visual/perceptual alignment, facial and scanning
rehabilitation and this begins as soon as possible exercises at a mirror
following a stroke. The treatment team will involve • Standing activities: weight shifting exercises,
you and your family in setting realistic treatment standing at sink for grooming and hygiene
goals in the areas of mobility. Goals are designed to activities.
meet your specific needs based on your prior level • Gait training/walking: walking on different floor
of independence, present level of impairment, home/ surfaces with or without assistive devices, i.e.,
community environment, help available for return walker, cane, ankle brace.
home, and motivation for active participation in the
• Stair training: walking up and down different size
therapy program.
steps using rail(s), with or without assistive device.
Both physical therapists and occupational therapists
will work with you in the areas of mobility, and family
and/or caregiver training sessions will be arranged
Bed Positioning
as need. All of the following activities may be
modified to meet your unique needs: Why Bed Positioning is Important
• Bed
1. Minimizes pain on your affected side
mobility training and bed positioning: rolling,
2. Protects the joints on your affected side
Rehabilitation

using bedpan, getting in and out of bed.

• Transfer training: scooting, moving from bed
3. Minimizes edema (swelling) in your affected arm
or leg
to and from wheelchair/commode/chair, car
4. Prevents contractures on affected side
transfers, sitting and standing to and from various
heights and surfaces. 5. Prevents skin breakdown

Positioning: Lying on Affected Side Positioning: Lying on Unaffected Side

ELEVATE AFFECTED ARM

• Shoulder is positioned forward
• Elbow out and palm turned upward
POSITION AFFECTED LEG
• Hip and knee slightly bent
• Place other leg on pillow to support weight ELEVATE AFFECTED ARM
MAY PLACE PILLOW BEHIND BACK • Shoulder is positioned forward
• Elbow straightened as able
• Hand with palm down

POSITION AFFECTED LEG

• Hip and knee slightly bent
• Toes pointing forward

MAY PLACE ANOTHER PILLOW BEHIND BACK

TO SUPPORT TRUNK POSITION

26
Positioning: Lying on Back
ELEVATE AFFECTED ARM
• Shoulder is positioned forward,
arm out to side
• Palm is turned upward as able

POSITION AFFECTED LEG

• Hip and knee slightly bent
• Toes pointing up as able
• Avoid tight tucking sheets
• May use footboard or cradle

Getting In and Out of Bed: Log Roll

Rehabilitation
Lying on back, bend left knee and place left arm across chest. Roll all in one movement to right. Reverse for
rolling to left. Always move as one unit.
PRECAUTIONS FOR THE
AFFECTED ARM
Do:
• Keep affected arm across the
body when rolling the patient
from side to side.
• Keep the arm on a pillow with
elbow slightly bent and palm at
neutral when the patient is lying
on their back in bed.
• When sitting, keep affected arm
supported on a pillow. Encourage
use of affected arm for support
if able.
• Keep hand elevated to reduce
swelling and increase awareness.
Do not:
• Pull from any part of the affected
arm when rolling or turning the
patient back to bed.
• Let affected arm hang at side
without support during sitting and
standing activities. Your therapist
will evaluate the need for an arm
sling.
• Let affected arm lay across the
body when patient is resting in
bed on their back for prolonged
period of time.

27
 Exercises Active Exercises: These exercises are appropriate
when you have some movement of the affected side.
Your therapist will give you an individual exercise
program and determine what exercises are Some Tips to Remember
appropriate for you. You may receive additional • Never try to progress too rapidly.
instruction at another facility, at home or as an
• Do not hold your breath during
outpatient. Appropriate exercises should begin as
soon as possible to prevent joint contractures, pain, exercise movements.
swelling, skin breakdown, and to reduce stiffness • Exercise on a regular basis. Keep a log of your

in the muscles and maintain/improve neurological exercises, include amount of exercise, date, time,
connection between brain and muscle. and note any responses to exercises.
• Do not drink alcoholic beverages
Passive Exercises: If you cannot move your
affected limbs or can only move them a little, your before exercising.
• Consult a physician if you experience any
therapist will instruct you, your family member or
caregiver to move your limbs with you. new symptoms.
Rehabilitation

Ankle Pumps Bridging

Relax leg. Gently bend and straighten ankle Slowly raise buttocks off bed. Return to starting
while pulling toes upward. Move through full position. Do not hold your breath.
range of motion.

Trunk Rotation
Slowly rock knees from
side to side, allow back
to rotate slightly.

28
Gait Training/Walking
Your therapist will determine if you need an assistive device to walk safely. He or she will instruct
you on how to use it.

Rehabilitation
Walker Quad Cane Hemi-Walker Standard Cane

Bracing • Abnormal posture

• Hyperexcitable reflexes
You may need to use an ankle-foot orthosis (AFO)
with walking to prevent your toes from dragging on Methods to Decrease Spasticity
the floor (if your ankle is weak) or to help stabilize
• Proper positioning of the arm or leg
your knee (if your thigh muscles are weak) and/or
a hand splint for a front wheel walker to include • Stretching

affected arm and more normal movement and • Weight bearing through affected arm or leg
facilitation. Your therapist will communicate • Splinting
with your physician if you need a brace or splint. • Medications (possible medications: Baclofen
(Lioresal), Zanaflex, Valium, Danthuim)
Spasticity Management
Spasticity is uncontrollable muscle tightness in an
arm or leg that can cause pain and affect movement.
The involuntary muscle contraction of spasticity
is a common physical response to the brain injury
caused by a stroke. If the brain injury resolves and
voluntary movement returns, spasticity may diminish,
restoring the usefulness of the limb. Spasticity
usually coexists with weakness.

Symptoms of Spasticity
• Stiffness in the arms, fingers or legs
• Painful muscle spasms
• A series of involuntary rhythmic contractions and
relaxations in a muscle or group of muscles that
leads to uncontrollable movement or jerking, called
clonus
• Increased muscle “tone”

29
 Home Safety Tips
Flooring Furniture
• Remove rugs that can be easily tripped on, • Sit in chairs with arm rests to help you get in
especially at top and bottom of stairways. and out of the chair.
• Make sure rugs have non-skid backings. • Place firm cushion or pillow on seat of chair or
• Make sure rugs and carpets are free of curled couch to elevate.
edges, worn spots and rips. • Use a sturdy step stool to reach items in high
• Secure electrical cords out of the way. Consider cupboards or closet shelves.
using a cordless phone. • If you are not confident using a step stool or
• Eliminate uneven surfaces and obstacles from ladder, DO NOT use them. Get help.
pathways both outside and inside the home. • If you must use a ladder, make sure the ladder is
• Have mats at doorways for people to dry their feet in good condition, fully opened and on a firm, level
on to prevent slipping. surface. Place each foot securely on the step. Do
not stand on top of the ladder.
Bathroom
• Make sure grab bars or safety rails are securely Stairs
anchored over the tub, in the shower and near the • Make sure handrails are securely fastened. If you
Rehabilitation

toilet. have a large flight of stairs separated by a landing,

• Use a nonskid rug on the bathroom floor. place a chair with arm rests there to allow you to
rest half way up.
• Use of a raised toilet seat or commode with arms
• Mark the top and bottom of stairs with contrasting
may be necessary.
tape.
• Keep toiletries in an easy to reach receptacle.

Footwear
Lighting
• Selectfootwear that stays securely on feet, with
• Maintain adequate lighting in all areas, eliminate
soles that are not slippery.
shadowy areas.
• Use night-lights in bathrooms or in hallways. Assistive Devices
• Motion-sensored lights eliminate need to remove • Make sure the equipment is in proper working
hand from assistive device. condition.
• Check to make sure light switches are within easy • Make sure the rubber tips of the crutches, canes
reach, at proper height, and may be illuminated for and walkers are in good condition.
nighttime. • Do not try to carry anything in your hands while
you are using a walker. Consider the use of a
walker bag or pockets.

30
 No Such Word
As “Can’t”
Energy Conservation As a stroke survivor, I know the value of listening to
• Store frequently used items at waist level or within one’s therapists and following their instructions. I arrived
arm’s reach. at rehabilitation unable to speak and with my right side
• Store commonly used items on upper shelves
paralyzed. Since I had been a writer, photographer,
lecturer, college instructor and wildlife rehabilitator for
of refrigerator.
over 20 years, you can imagine how frustrated I was!
• Use a lazy Susan, or adaptive equipment
(reachers) for easier reach. Instead of lifting heavy First came an evaluation, which tested everything from
items, slide them across the counter. sight and hearing to balance and movement. Then
• Allow yourself extra time to get ready and spread
came concentrated work on what I could do, followed
later by what I might be able to do with extra effort
out tasks throughout the day.
and work.
• Take several rest breaks and sit when necessary.
Each stroke survivor is different. No two are quite
Personal Precautions alike. Our rates of progress will vary; some slower,
• Ifyou live alone, have daily contact with a family some faster. Many of us will not be able to achieve as
member, friend or neighbor. much as we’d like. But the most important thing for us
is to try!
• Keep your glasses prescription up-to-date.

Rehabilitation
• Be alert for unexpected hazards, including We will make gains only if we are willing to work at it. If
children, pets, out of place furniture and toys. you will not heed your therapist’s advice...if you refuse
to attempt the necessary movements...if you turn a
• Avoid rushing to answer the phone or doorbell.
deaf ear and sit or lie practically comatose...you hurt
• When carrying bulky objects, make sure your
yourself most of all, but you also hurt your family, friends
vision is not obstructed. and all those who care about you.
• Do not carry items that are too heavy; check the
Therapy can hurt or be repetitious and sometimes
weight of the item first.
boring, and our gains may seem minuscule or even
• Do not turn or twist your back to reach or lift an
nonexistent, but without the effort, we shall certainly
object. It is much easier to move closer or turn have no gains at all.
your whole body and feet towards a wanted
object, rather than risk losing your balance. Through the guidance of all the therapists:
• Take time to regain your balance and reduce
occupational, physical, speech, cognitive, retraining,
pool, recreation, and psychology, I have come a long
dizziness when you change positions, i.e., going
way and am, I feel, productive again.
from lying down to sitting and sitting to standing.
• Be aware of medications, their interactions and There must be no place for the word “can’t” in your
side effects. vocabulary. Perhaps you “don’t want to right this
minute” or you wonder, “How can I accomplish this
task?” But keep trying. FIND A WAY. The therapists will
guide you.
Try aiming for small goals, ones that you and your
therapists feel are attainable. With each little success,
your confidence will build.
When you eventually reach a plateau from which
your rate of improvement is considerably reduced,
you must then accept the hand (pun intended) that
fate has dealt. To deny your limitations, to refuse
to accept the fact that you are no longer quite the
same person, may be condemning yourself to a life
of bitterness and negativism. Never forget that life
is a precious commodity...treasure it, whatever your
limitations may be.
Rosemary K. Collett
Stroke Survivor

31
 Introduction
This nutrition section was specially prepared for you with a great deal of thought and care to provide you
with the most up-to-date source of information about healthy eating for your heart. We hope you find the
information useful to help you make healthy adjustments in your diet. You are invited to call any of our dietitians
to ask specific questions about your needs including food purchasing, eating out at restaurants, or even food
preparation. Remember, we are here to help YOU! Best wishes and healthy eating!

Healthy Eating After A Stroke

• Control meat/poultry/fish portions to no more than
1. Food Texture
6 oz. per day.
Choose foods according to the textures that you can
• Bake, broil, BBQ, or boil foods to reduce fat.
chew and swallow. After some strokes, swallowing
may be difficult. The term “dysphagia” means • Trim the fat from your meat and take the skin off
difficulty swallowing. The purpose of the “dysphagia your chicken, before cooking.
diet” is to help the individual learn to swallow again • For vegetables: Try steaming or grilling directly on
by starting with foods that are easiest to manage. the grate or in foil.
In the brief description below, foods are grouped – Spray with a non-stick pan spray.
from the easiest to control in the mouth (pureed and – Pan fry using a non-stick spray.
thicker liquids) to the most difficult (thin liquids).
SOLID FOODS 3. Decrease Cholesterol and Saturated Fat
• Dysphagia I: pureed foods that have little need of • Eggs: Limit your egg intake to three egg yolks per
chewing week.
Nutrition

• Dysphagia II: ground meats, fish and poultry, and • Meat: Eat more lean fish and poultry and less red
finely chopped foods meat. Try eating more meatless meals, which are
• Dysphagia III: finely chopped meats, fish and usually lower in fat and calories and higher in fiber.
poultry, soft vegetables • Decrease Saturated and Hydrogenated Transfats:
Choose soft butter/oil spreads or margarine
LIQUIDS – THE THICKNESS OF THE LIQUID MAY without hydrogenated oils to reduce your intake of
VARY ACCORDING TO THE FOLLOWING:
saturated fat and cholesterol.
• Pudding-like texture • Choose vegetable oils over animal fats, such as
• Honey texture canola oil and olive oil.
• Nectar or syrup texture
• Thin liquids (no thickening required) 4. Increase Complex Carbohydrates
For additional information, see the “Dysphagia Diet Increase complex carbohydrates, which are rich in
Summary” on page 55. fiber, vitamins and minerals, and relatively low in fat
and calories.
2. Decrease Total Fat • Whole Grains: Use whole wheat or grain flour
Most Americans currently eat more than 40 percent and bread, bran bread/cereal, oatmeal/oat bran,
of their calories from fat. The goal is to decrease that brown rice, barley, corn meal, rye, buckwheat, and
level to 30 percent or less of your total calories. experiment with any other whole grains.
• Use non-fat or 1% milk in place of whole • Fruits and Vegetables: Choose those especially
milk and limit the use of high fat cheeses and ice- with an edible peel or seeds, such as: apples,
cream. berries, broccoli, green leaf lettuce, melons,
• Cut down on the amount of fat you add to food, oranges and potatoes. Eat the whole fruit rather
such as: butter, margarine, lard, oils, salad than drinking the juice.
dressing, sour cream, whipped cream, etc.

32
• Legumes: Try dried beans, peas and lentils. 8. Maintain Normal Blood Pressure
• Limit your intake of simple carbohydrates, such
DECREASE ALCOHOL
as sweets and sugar. These foods contain few
nutrients and are high in calories. • Alcohol consumption has been shown to elevate
blood pressure, and it is often difficult to achieve
5. Maintain Desirable Weight control in persons with a high alcohol intake. If
you have high blood pressure or are taking blood
EXERCISE IS KEY pressure medications, you should discuss your
• Choose your favorite daily exercise, such as alcohol consumption with your physician.
walking, bicycling or swimming as approved by
AVOID CAFFEINE
your physician. Experts recommend 30 minutes a
• Caffeinemay raise blood pressure for
day, 3-5 times per week.
NOTE: Consult with your physician before starting approximately two hours after it is consumed.
any exercise program. Excessive caffeine may cause prolonged elevation
in blood pressure.
If overweight, follow these guidelines:
• Decrease
INCREASE CALCIUM
sugar
• Many studies have shown that individuals with
• Decrease fat
hypertension consume inadequate amounts of
• Decrease portions
calcium. Therefore, blood pressure may improve by
• Decrease alcohol
increasing dietary calcium.
• The following foods are rich in calcium and should
6. Reduce Salt/Sodium Intake be eaten daily:
Americans eat an average of 5000-8000 milligrams • Milk (Nonfat or 1% lowfat milk is slightly higher in
of sodium each day. The American Heart Association
calcium than whole milk)
recommends an intake of 2,000 milligrams of sodium
• Yogurt
each day. Follow these tips to reduce the amount of

Nutrition
salt in your diet. • Cheese (choose those with less than 6 grams

• Eliminate the salt shaker from the table. of fat/oz.)

• Salmon (canned with bones)
• Omit salt and high sodium containing food
products when preparing foods. • Broccoli

• Decrease use of convenience foods containing • Tofu

excessive sodium. Sodium compounds are often
used to extend shelf life, improve taste or color,
and speed up cooking time. This may include
frozen dinners, canned soups, hot dogs, and
instant or processed foods.

7. Increase Potassium
Increasing the level of serum potassium has been
shown to increase sodium excretion. The following
are good sources of potassium and should be
included daily:
• Oranges • Tomato products
• Broccoli • Melons
• Potatoes • Dried fruit
• Spinach/Greens • Pumpkin
• Asparagus • Bananas
• Beans

33
 Dysphagia Diet Summary
Dysphagia means difficulty swallowing. The purpose of the Dysphagia Diet is to help the individual learn to
swallow again by starting with foods that are easiest to manage. In the Dysphagia Diet levels listed below, foods
are grouped from the easiest to control in the mouth (pureed and thicker liquids) to the most difficult (thin liquids)

DYSPHAGIA I DYSPHAGIA II DYSPHAGIA III

Milk Products Pudding (diet or regular) Pudding (diet/regular) Milk

Baked custard Baked custard Pudding (diet/regular), custard
Plain/flavored yogurt without Plain/flavored yogurt without fruit/seeds Plain/flavored yogurt without fruit/seeds
fruit/seeds Milkshake, ice-cream, sherbert Milkshake, ice-cream, sherbert
Milkshake, ice-cream, sherbert Small curd cottage cheese, Ricotta cheese, Small curd cottage cheese, Ricotta
Pureed cottage cheese American cheese, finely grated cheese cheese, American cheese, finely grated
cheese

Soups Blended and strained soups Blended and strained soups Soups with allowed ingredients

Meat/Poultry/ Pureed meat/poultry Ground meat/poultry (w/gravy) Finely chopped meat/poultry (w/gravy)
Fish/Eggs Finely flaked fish, baked/broiled Meatloaf (w/gravy)
Scrambled/poached egg Finely flaked fish, baked/broiled
Plain tuna, chicken, turkey salad
Scrambled/poached egg

Vegetables Pureed vegetables Finely chopped vegetables Cooked only: beets, carrots, green beans
(NO corn, peas) (chopped), sliced mushrooms, peas,
Tomato/vegetable juice chopped spinach, squash
No raw vegetables (NO raw vegetables)

Fruits Pureed fruits Finely chopped canned fruits (NO seeds/ Fresh fruit (i.e. prunes, cherries, figs,
Applesauce, nectar skins) raisins), chopped
Applesauce, ripe banana NO pineapple
Nutrition

Cereals Thickened cooked refined Cooked cereals Cooked cereal

cereals without texture, pureed Cold cereals that become soft in milk
oatmeal

Potatoes Mashed potatoes (w/extra Mashed potatoes (w/gravy) Mashed potatoes (w/ gravy)
gravy) Baked potato w/o skin

Starches Pureed breads Moist soft bread stuffing Rice, pasta

Pureed rice Macaroni & cheese (no hard crust/stringy Macaroni & cheese, spaghetti w/sauce
cheese) Moist soft bread
Pasta (drained) w/sauce or gravy Soft breads without seeds

Fats Butter, margarine, mayonnaise Butter, margarine, mayonnaise Butter, margarine, mayonnaise
Sour cream Sour cream Sour cream

Miscellaneous Salt, finely ground pepper, Salt, finely ground pepper, catsup, mustard, Salt, finely ground pepper, catsup,
catsup, mustard, jelly, gelatin, jelly, gravy mustard, jelly, gelatin, gravy
mousse gravy Fruit ice, popsicles, ice chips

Desserts Pudding, ice cream Fruit ice, popsicles Cream pies, pudding, pie filling, cake w/
Cream pies (no crust), pudding, (NO nuts, allowed ingredients
seeds, raisins, coconut) (NO nuts, seeds, raisins, coconut)

Liquids All – Thickness depends on All – Thickness depends on individual needs All – Thickness depends on individual
individual needs needs

*This summary is only a guide; other foods may be acceptable according to appropriate texture.
When in doubt, ask the speech therapist or registered dietitian.

34
Fat Facts
Fat is one of the three major energy sources in Saturated Fat and Trans Fat
food. A concentrated source of calories – about
nine calories per gram – fat is found in foods from THE DIETARY EFFECTS
the fat and meat categories of foods. Some kinds • Tends to increase total blood cholesterol levels
of milk products and starch/bread categories also • Usually found in animal products (i.e. dairy, meat),
contain fat. but also found in some plant products (i.e. palm
oil, coconut oil, cocoa butter)
Types Of Fat HYDROGENATED FAT (A TYPE OF SATURATED
OR PARTIALLY-SATURATED FAT)
• Hydrogenation is a food production process that
Cholesterol
changes a liquid (or unsaturated fat) into a solid
IN THE BLOOD fat (or saturated fat), often for the purpose of
• This is a wax-like substance, which is extending shelf life of the product fat.
manufactured by the liver and needed for the • Examples: shortening, stick margarine
normal function of all systems in the body. A high
level (above 200 mg/dl—some studies show above Polyunsaturated Fat
180 mg/dl) has been shown to be a major risk • Tends to lower total cholesterol (LDL and
factor in developing heart disease (including high HDL cholesterol)
blood pressure, obstruction of the heart or brain • Only found in plant foods
vessels, and hardening of the arteries). There are
• Generally liquid at room temperature. Examples
different forms of cholesterol, of which, there is
include corn oil, safflower oil, cottonseed oil,
one that is considered “good.” The others are
sunflower oil, and some other vegetable oils.
considered “bad.”
The primary two we monitor: Monounsaturated Fat
• HDL cholesterol – “good” cholesterol, acts as a • Tends to lower the “bad” (LDL) cholesterol and

Nutrition
scrubbing bubble of the arteries to remove the have no effect on the “good” (HDL) cholesterol
plaques that are forming • Only found in plant foods
• LDL cholesterol – “bad” cholesterol, lays down the
• Examples include canola oil, olive oil, avocados,
plaques that cause the blockages
and nuts
What causes the blood values to be elevated?
• Eating foods high in saturated fat, trans fat, Triglyceride
and cholesterol • A triglyceride is a fat found in food and
• Weight above desirable level manufactured by the body from excess sugar, fat,
• Lack of exercise alcohol, or excess quantities of food at one meal.
• Hereditary factors

IN THE DIET
• Only found in animal products. Limit intake of
the following foods: egg yolks, chicken, turkey,
beef, pork, lamb, duck, sausage, cold cuts, organ
meats, etc.

35
 Analysis of Lipid Profile
The following is a comparison of your cardiac lipid (fat) profile to accepted, desirable ranges. Attaining lipid
profiles, as close to desirable levels as possible, should help decrease your chances of coronary heart disease.
For every:
one percent decrease in blood cholesterol, there is a...
two percent reduction in coronary artery disease risk.

Your levels on (indicate dates below)...

Date: Date: Date: Date: Lipid Categories: Desirable Level

Cholesterol: less than 200 mg/dl

(Some studies show <180 mg/dl)

Low Density Lipoprotein (LDL): less than 100 mg/dl

High Density Lipoprotein (HDL): 40-60 mg/dl

Triglycerides: less than 150 mg/dl

Nutrition

Total Cholesterol/HDL Ratio: less than 3.5

36
Healthy Substitutions to Reduce Fat
How to Reduce Your Fats: The Hit-’n‘-Switch List
INSTEAD OF CHOOSE THESE INSTEAD OF CHOOSE THESE

Whole • Nonfat milk Buttermilk Recipe: For each cup of buttermilk,

milk • Lowfat milk (1% or extra light place 1 Tbsp. lemon juice or vinegar
preferred) in a measuring cup. Fill to 1 cup level
• Evaporated skim milk–diluted with nonfat milk. Let stand for about 5
minutes. Stir.
• Reconstituted nonfat milk
Butter, • Light spread (tub only)
Cream • Evaporated nonfat milk–undiluted margarine • Margarine without hydrogenated oil
• Nonfat milk
• Butter/oil spreads
Whipped Whipped Evaporated Milk
1 whole • 2 egg whites or 1/4 cup commercial
cream Place undiluted evaporated skim milk
egg cholesterol-free egg substitute or
in an ice cube tray. Place in the freezer
1/4 cup homemade egg substitute
until ice crystals form around the
edges. Chill bowl and beaters. Place Egg Substitute
milk in chilled bowl and beat to desired 1 dozen egg whites
consistency. 1/2 cup nonfat dry milk powder
2 or 3 drops of yellow coloring (if desired)
Whipped Topping
Mix together in a covered jar and store
1/2 cup water
in the refrigerator. Good for omelettes,
1 Tbsp. lemon juice
scrambled eggs, french toast, etc. To
1/3 cup dry nonfat milk powder

Nutrition
use for baking, add 1 tsp. oil for each
2 Tbsp. sugar (or sugar substitute
1/4 cup of mix. 1/4 cup of mix is equal
equivalent)
to 1 large egg.
1/2 tsp. vanilla
Place all ingredients in a bowl. Place in
Sour • Commercial non-fat sour cream
refrigerator until well chilled. Beat until
cream Sour Cream Substitute
stiff peaks form.
2 Tbsp. nonfat dry milk powder
Cream • Commercial fat-free cream cheese 1 Tbsp. lemon juice
cheese • Neufchatel cream cheese (limited 1 cup large curd cottage cheese
amount) Wash cheese in strainer and let drain
well to remove all cream. Combine
Cream Cheese Substitute ingredients. Whirl in blender until smooth.
Line a colander or sieve with cheese
cloth. Pour in low-fat yogurt. Cover Mock Sour Cream
loosely and let drip in the refrigerator Blend equal parts of low-fat cottage
for 12 to 24 hours. This works well in cheese and low-fat yogurt in a food
cheesecake and other recipes calling processor until smooth and thick.
for cream cheese. Yogurt Sour Cream
Plain low-fat yogurt works well as a
Baking Try this substitution: substitute for sour cream on such
chocolate 3 Tbsp. cocoa + 1 Tbsp. oil things as baked potatoes. To use
(1 ounce) yogurt as a sour cream substitute in
sauces, add 2 Tbsp. of flour for each
cup of yogurt so the sauce will thicken
properly and not curdle.

37
 How to Reduce Your Fats: The Hit-’n‘-Switch List
INSTEAD OF CHOOSE THESE INSTEAD OF CHOOSE THESE

Hot • Commercial cocoa mix (read labels) Crackers •L

 ow fat rice crackers, melba toast, rye
chocolate Hot Cocoa Mix crackers
1 cup nonfat dry milk powder Tortilla Triangles
1/3 cup unsweetened cocoa powder Cut corn tortillas into 8 triangles. Place on
3 Tbsp. sugar baking sheet and bake at 425 degrees until
Mix ingredients and store in an airtight crisp and dry. Great with salsa!
container. To use, put 2 heaping
teaspoonfuls of mix into a cup and add White White sauce
hot water. Stir well. If desired, add a dash 1 cup nonfat milk, 2 Tbsp. flour
of vanilla. sauce
Pour nonfat milk into a jar with a lid.
Add flour, cover and shake vigorously
Ice cream • Frozen low-fat or nonfat yogurt, fruit until smooth. Pour into a pan and cook
ices, sherbet, sorbet over low heat until thickened, stirring
constantly. Add pepper and a dash of
salt. This makes a medium sauce. For a
Cheese Use low fat (or fat free) cheese such as thinner version use just 1 Tbsp. of flour.
mozzarella, farmers, ricotta, parmesan, For a thicker sauce add 3 Tbsp. of flour
port du salut, or other low fat for each 1 cup nonfat milk. To add more
cheeses with 2 to 6 gms fat/ounce flavor, use onion or garlic powder, thyme,
or any other appropriate seasoning.
Soy • Low sodium soy sauce (read label)
sauce Gravy Gravy
Use about 1 Tbsp. flour for every 1/2 cup
liquid. You may use fat-free beef, chicken
Nutrition

Ground • Ground turkey, chicken or veal or turkey broth. Meat drippings may be
beef used for added flavor. Add ice cubes to
the drippings to harden any fat; remove
Baked • Home baked goods using egg the fat and use only the remaining liquid.
Put half of the liquid you are using for
goods substitute, egg whites, canola oil, your gravy in a jar with the flour. Cover
reduced sugar and salt and shake until mixture is smooth. Pour
• Use commercially baked fat-free into a pan with the remaining liquid. Bring
goods to a simmer and cook for a few minutes,
stirring constantly. Season to taste. Gravy
may be made with browned flour (for
Cream • Use nonfat milk and thicken as color) or brown gravy coloring may be
soup with white sauce recipe (See “white added.
sauce”). Browned flour
Place flour in a shallow baking pan,
Oil- • Water-packed tuna spreading it out evenly to a depth of
packed about 3/4”. Cook in a very low oven,
stirring occasionally, until lightly browned.
tuna Store in a covered jar in the refrigerator.
Keeps indefinitely.
Peanut • Use the “old-fashioned” style of
butter peanut butter and pour off the oil
• Natural, reduced-fat peanut butter

White rice • Brown rice

• Barley
• Quinoa

38
How to Reduce Your Fats: The Hit-’n‘-Switch List
INSTEAD OF CHOOSE THESE INSTEAD OF CHOOSE THESE

Salad • Fat free or low-fat commercial French • Baked potato

dressings dressings fries
Oven Baked “French Fries”
French Dressing Cut 2 lbs. well scrubbed potatoes as for
6 Tbsp. garlic flavored wine vinegar french fries. Put 1 tsp oil in a large pan or
4 Tbsp. cold water bowl and add potatoes. Cover and shake
¼ tsp. each of pepper and dry mustard to coat potatoes with oil. Place potatoes
¼ cup canola oil on a foil-lined baking pan that has been
Put all ingredients in a covered jar. Shake sprayed with a non-stick spray. Place
well. Chill. Makes about 12 servings. in a 475 degree oven. Bake 15 to 25
minutes or until well browned. Turn once
Red French Dressing during baking. Sprinkle very lightly with
½ cup canola oil salt, parmesan cheese, or any favorite
2 Tbsp. vinegar flavoring. Serves 4.
2 Tbsp. lemon juice
½ tsp. each of dry mustard and paprika
few grains coarse pepper Salt/ • Mrs. Dash Seasonings
¼ cup mayonnaise seasoned
Parsley Patch Seasonings
¼ cup catsup or tomato paste salt All purpose spice mix
¼ tsp. Worcestershire sauce ¼ cup paprika
Mix all ingredients together and shake 1 Tbsp. onion powder
well. Chill before using. This is especially 1 Tbsp. garlic powder
good on plain lettuce or on a vegetable ½ tsp. thyme
salad. Makes 1¼ cups. 1 Tbsp. pepper
Dressing “Ranch Style” ½ tsp. oregano

Nutrition
One package commercial “ranch style” dash of cayenne pepper (optional)
dressing mix Special Salad Blend
Use plain lowfat/nonfat yogurt as a Mix 4 parts each of marjoram, basil,
substitute for the mayonnaise, sour cream, tarragon, parsley, celery seed and chives,
or buttermilk called for on the package. with 1 part each of thyme and grated
(This is still high in sodium, but the fat, lemon peel.
calories and cholesterol are reduced.)
Savory Vegetable Blend
Cottage cheese dressing Mix 1 part each of marjoram, basil
1 cup cottage cheese parsley, and chives with ¼ part thyme.
1
/3 cup buttermilk
Place cottage cheese in a sieve and Succulent Egg Seasoning Blend
wash lightly in cold water. Let drain Mix 3 parts of parsley with 1 part each of
thoroughly. Combine cottage cheese and tarragon, basil, marjoram and chives.
buttermilk. Whirl in blender. Add more
buttermilk if a thinner dressing is desired. Surprising Italian Blend
Mix 2 parts each of oregano, marjoram,
Variations: thyme, and basil with 1 part each of
Bleu Cheese: Add 1 Tbsp. bleu cheese rosemary and sage.
and some pepper to taste.
Italian: Add oregano, garlic powder
and onion powder to taste.
Mock Thousand Island: Add 2 Tbsp.
chopped green pepper and 1 Tbsp.
tomato paste.
Pepper Dill: Add 1/2 to 1 tsp. dried
dillweed and 1/4 tsp. pepper.

39
 Sodium-Controlled Diet
Why Follow a Sodium-controlled Diet? Sample Menu for a
A sodium-controlled diet may help you manage your Sodium-controlled Diet
high blood pressure (hypertension). This diet will also
BREAKFAST
help prevent water retention. Even if you are taking
• Orange juice (1 cup)
medication, it’s still important to follow a sodium-
controlled diet to help the medication work more • Shredded wheat cereal (1 cup)
effectively. • Banana (1)
• Whole wheat toast (2 slices) with margarine
Important Points To Keep In Mind (2 tsp.) and jam (1 Tbsp.)
• Shake the sodium from your diet. Stop adding salt • Milk (1 cup)
to your food while it’s cooking • Coffee or tea
or at the table.
• Many non-prescription medications contain LUNCH
sodium. Make sure you read the label or ask your • Low-sodium vegetable soup (1 cup)
doctor or pharmacist. • Unsalted crackers (4)
• When dining out, ask that your order be prepared • Hamburger (3 oz.) on a bun with sliced tomato(1)
without salt. Most airlines offer low-sodium meals and lettuce (2 oz.)
with 24-hour notice. • Mustard and low-sodium mayonnaise
• Other actions you can take to help control your (1 tsp. each)
blood pressure include maintaining a healthy body • Fresh fruit salad (1 cup)
weight, limiting alcohol and exercising regularly. • Iced tea with lemon
• Scan food labels for sodium claims. If a product
SNACK
states it’s sodium-free, it has less than 5 mg per
• Graham crackers (2)
serving.
• Fresh apple (1)
• Beware of "light" or "reduced" sodium. This just
Nutrition

means less than the original product. It may still • Milk (1 cup)

contain high amounts of sodium. DINNER

• Tossed salad (3 oz.) with salt-free vinegar and oil
dressing (1 Tbsp.)
• Broiled skinless chicken breast (3 oz.)
• Herbed brown rice (1 cup)
• Steamed broccoli (1 cup)
• Whole grain roll (1) with margarine (2 tsp.)
• Italian fruit ice (1 cup)
• Coffee or tea

Source: American Dietetic Association

40
Sodium-Controlled Diet
FOOD CATEGORIES FOODS RECOMMENDED FOODS TO OMIT TIPS

BREADS, CEREALS, RICE AND PASTA (6-11 SERVINGS EACH DAY)

Serving size = - Breads and rolls without - Breads, rolls and Cook cereals, rice and
- 1 slice bread salted tops, muffins crackers with salted tops pasta without adding any
- 1 cup ready-to-eat cereal - Most ready-to-eat and - Quick breads, self-rising salt.
- ½ cup cooked cereal, rice cooked cereals flour, and biscuit mixes Salt can be omitted or
or pasta - Unsalted crackers and - Regular breadcrumbs decreased in most recipes
- ½ bun, bagel or English breadsticks - Instant hot cereals for baked goods.
muffin - Low-sodium or - Commercially prepared
homemade breadcrumbs rice, pasta or stuffing
or stuffing mixes
- All rice and pastas

VEGETABLES (3-5 SERVINGS EACH DAY)

Serving size = - Most fresh, frozen and - Regular canned Season vegetables with
- 1 cup raw leafy low-sodium canned vegetables and juices, herbs, spices or lemon
- ½ cup cooked vegetables including sauerkraut and juice, instead of ham,
- ¾ cup juice - Low-sodium and salt- pickled vegetables bacon or salt pork.
free vegetable juices - Frozen vegetables with
sauces
- Commercially prepared
potato and vegetable
mixes

Nutrition
FRUITS (2-4 SERVINGS EACH DAY)

Serving size = - Most fresh, frozen and - Fruits processed with

1 medium, ½ cup canned, canned fruits salt or sodium
¾ cup juice, ¼ cup dried - All fruit juices

MILK, YOGURT AND CHEESE (2-3 SERVINGS EACH DAY)

Serving size = - All milk, but limit to a - Malted and chocolate Dairy foods have moderate
- 1 cup milk or yogurt total of 2 cups daily milk amounts of sodium. Keep
- 1 ½ oz. natural cheese - All yogurt - Regular and processed in mind that milk and
- 2 oz. processed cheese - Most low-sodium cheese, cheese spreads yogurt are lower in sodium
cheeses, including and sauces than most cheeses.
ricotta, cream cheese - Limit buttermilk to 1 cup
and cottage cheese per week

41
  EATS, POULTRY, FISH, DRIED BEANS AND PEAS, EGGS AND NUTS
M
(2-3 SERVINGS OR TOTAL OF 6 OZ. DAILY)

Serving size = - Any fresh or frozen beef, - Any smoked, cured, Use convenience foods
- 2-3 oz. cooked lamb, pork, poultry, fish salted or canned and processed meats
- 1 egg and some shellfish meat, fish or poultry, sparingly or buy low-
- ½ cup cooked beans - Egg and egg substitutes including bacon, chipped sodium, reduced-sodium
- 2 Tbsp peanut butter or - Low-sodium peanut beef, cold cuts, ham, or salt-free varieties.
1
/3 cup nuts as 1 oz. of butter frankfurters, sausage, Choose frozen dinners with
meat - Dried peas and beans sardines and anchovies less than 500 mg sodium
- Frozen breaded meats per serving.
- Salted nuts

FATS, SNACKS, SWEETS, CONDIMENTS AND BEVERAGES

- Low-sodium or unsalted - Salad dressings, soups, Read food labels carefully

versions of butter, gravies and sauces searching for high-sodium
margarine, salad made from instant mixes ingredients, such as
dressings, soups, soy or other high–sodium salt, sodium chloride,
sauce, condiments and ingredients monosodium glutamate,
snack foods - Salted snack foods, brine or broth.
- Pepper, herbs and olives
spices, vinegar, lemon or - Meat tenderizers,
lime juice seasoning salt and most
- Low-sodium carbonated flavored vinegars
beverages - Commercially softened
water
Nutrition

42
Understanding Food Labels
A new type of food label can be found on food packages. Reading the label tells more about the food and
what you are getting. The information you see on the food label—the nutrition and ingredient details – is
required by the government. Some food labels may display a “short label format,” that is, when the food has
only a few of the nutrients required on the standard label. What’s on the label depends on what’s in the food.
Small-and medium-sized packages with very little label space can also use a short label. If the information is
not displayed, there must be an address and/or phone number for the consumer to contact for a copy of the
information. The table below shows what the new label looks like and explains some of its new features.

SERVING SIZE
Similar food products
now have similar serving
sizes. Serving sizes Nutrition Facts
are based on amounts Serving Size 16 Crackers (31 g)
people actually eat. Servings Per Container About 9

Amount Per Serving

Calories 150 Calories from Fat 50
% DAILY VALUE
% Daily Value* % Daily Value shows
Total Fat 6g 9% how a food fits into
a 2,000 calorie diet.
NEW LABEL Saturated Fat 1g 6%
INFORMATION Trans Fat 1g

Nutrition
This section contains Polyunsaturated Fat 2g
information about the
nutrient content for Monounsaturated Fat 2g
each serving. Cholesterol 0mg 0%
Sodium 270mg 11%
Total Carbohydrate 21g 7%
Dietary Fiber 1g 4%
Sugars 3g
Protein 2g

VITAMINS AND DAILY VALUES

Vitamin A 0% Vitamin C 0% FOOTNOTE
MINERALS
Calcium 2% Iron 6% These reference
Only two vitamins, A &
C, and two minerals, * Percent Daily Values are based on a 2,000 calorie numbers are set
calcium and iron, are diet. Your daily values may be higher or lower by the government
depending on your calorie needs: and are based on
required on the food
label. Calories: 2,000 2,500 current nutrition
Total Fat Less than 65g 80g recommendations.
Sat Fat Less than 20g 25g The values are based
Cholesterol Less than 300mg 300mg on a daily diet of 2,000
Sodium Less than 2,400mg 2,400mg and 2,500 calories;
Total Carbohydrate 300g 375g your own nutrients
Dietary Fiber 25g 30g may be less or more.

SOURCE: Food and Drug Administration, 2006

43
 Eating Out
“Don’t Cook Tonight... PIZZA SPOTS
Call Your Favorite Restaurant” • Choose smaller portions (i.e., one slice instead of
Hints for selecting low fat, low salt foods two) and select a salad with “lite” dressing on the
when eating out side.
MEXICAN SPOTS
Fast Food • Choose soft shell tacos or fajitas instead of hard
If you don’t always have time to sit down for a shell to reduce fat and calories. Choose tostada
leisurely meal, you may wonder about eating in salads but avoid eating the shell.
fast-food restaurants. The good news is fast food is PLEASE NOTE:
changing. Look for salad bars where you can make
Specific information on the nutritional breakdown
your own meal. Beware of salad bars with pre-mixed
for each fast-food restaurant may be obtained from
“specialty” salads (such as macaroni salad, pasta
various sources such as the fast-food restaurant you
salad, potato salad, carrot raisin salad, etc.), as they
visit or your local dietitian.
usually contain high amounts of fat, sodium, and
occasionally, sugar. Instead, add fresh vegetables to
Italian Food
your salad and eat with whole grain bread. Try baked
potatoes with vegetable or yogurt toppings. To many diners, Italian food says pasta. And pastas
are a good choice for those on low-fat calorie
SPECIAL ORDERS controlled diets, as long as they are not filled with
• Another healthy fast-food technique is a “special cheese or fatty meat or tossed with butter or cream
order.” Ask to leave off fatty and calorie-heavy sauces. Linguine with white or red clam sauce is
ingredients. For example, a Burger King Whopper a fine pasta selection. Acceptable sauces include
without mayonnaise cuts out 150 calories and 16 marsala, made with wine, or marinara, made with
grams of fat. tomatoes, onion and garlic (no meat). If you’re
HAMBURGER SPOTS concerned about salt, try pasta primavera, with a
small amount of oil and fresh vegetables. Consider
Nutrition

• Choose simply prepared items, such as

fresh fruit and smaller portions of meat. ordering the appetizer portion of pasta as your
When available, choose the grilled chicken breast entrée, often the portions are large enough to be
items (avoid fried chicken patties), filling. Among other selections in Italian restaurants,
the regular (2 oz.) hamburger or the “lean simply prepared chicken and fish dishes are your
burger” on a bun (whole wheat preferred) best bet. To control fats, calories and sodium, select
with lettuce, tomato and onion (such as items that are fixed to order. Avoid dishes like veal
McDonald’s McLean Deluxe with only scallopine or parmigiana, since they are usually
10 grams of fat). Beware of fried foods prepared by adding fats. Fresh fruit is an excellent
and double-decker burgers. dessert choice.
SALADS Japanese Food
• Salads are a great choice at any style restaurant. Although many dishes are high in sodium, Japanese
Choose grilled meats and ask for the dressing on cuisine is, overall, a boon to those on low-fat
the side. Dip your fork in the dressing, then pierce diets. Pickled vegetables are low in cholesterol,
food to control fat, sodium and calories. saturated fat and calories and a lovely introduction
FRIED CHICKEN SPOTS to traditional Japanese entree fare like sashimi (raw
• Peel the skin and breading off to reduce the fish), which is an ideal choice. Beware of sushi (as
calories by half and the fat by two thirds. the rice has very little fiber and has sugar and rice
wine added, causing a rapid rise in blood sugar),
deep fried dishes such as tempura, and high sodium
soups and sauces (or sauces with sugar added). Ask

44
your waiter to serve sauces on the side and keep Steakhouse Food
them to a minimum. Look for the word “yakimono,” Those on calorie controlled, reduced fat and
which means broiled. Dishes that feature tofu, a cholesterol diets may feel it necessary to avoid
soybean curd protein without cholesterol that is high steakhouses altogether. In fact, steakhouses, like
in calcium and extremely low in fat and calories, are seafood restaurants, may be a good choice, since
especially recommended. Steamed rice makes a food is most often prepared to order. Be sure to
good accompaniment. order your beef broiled without additional fat or
salt. Choose lean varieties, like London broil, filet
Chinese Food mignon, round and flank steaks, and ask that all
When eating Chinese food, skip high-sodium soups visible fat be trimmed. If you’re having a baked
and the crisp noodles, which are high in fat and potato, eat it plain or with controlled amount of
calories. If the noodles are on the table, ask the margarine or low-fat yogurt. Enjoy a green salad
waiter to remove them. Choose dishes that are (with dressing on the side) and fresh steamed
boiled, steamed or lightly stir-fried in vegetable oil, vegetables as accompaniments. The plainer your
rather than sauteed. Although many Chinese dishes choices, the better.
are high in sodium, you can ask that sauces, such
as soy, be served on the side and that MSG and salt Middle Eastern Food
be eliminated in the preparation. If you have high Middle Eastern dishes rely greatly on meat, but
cholesterol, avoid dishes like Egg Foo Young and just as heavily on vegetables, grains and spices.
any menu listing that is made with lobster sauce, Appetizers may include midya dolma, mussels
since it contains egg yolks. Hunan and Szechuan- stuffed with rice, pine nuts and currants, yalanji
style food is high in calories when the meat is first yaprak, grape leaves filled with a similar mixture, and
fried in hot oil. Be cautious and avoid all dishes that imam bayildi, baked eggplant stuffed with a variety
are deep fried. Enjoy the steamed rice but remember of vegetables. All are acceptable and a selection
to control the portions. of these appetizers might make a tasty and exotic

Nutrition
meal. If you wish to order an entree, shish kabob,
Mexican Food when not basted with butter, is a good choice and
Many feel that Mexican food is off limits, but that’s manter kabob, small portions of pot-roasted lamb
not necessarily so. Whole grains are staples of smothered in mushrooms, green peppers and
Mexican dishes, and tortillas, made with corn and onions, may be acceptable as long as it’s not too
baked rather than fried, can be a welcome addition oily. Ask that visible fat be trimmed from the meat
to your diet. However, avoid the flour tortillas, made before cooking. Vegetarians might try couscous,
with lard and fried. A fine beginning to your meal steamed bulgur wheat, topped with vegetables.
might include salsa, a favorite appetizer on Mexican Couscous may also be topped with chicken.
menus. Tomato, onion and avocado salads with Accompaniments to main courses in Middle Eastern
fresh lemon squeezed over the top are refreshing. A restaurants often include rice or bulgur (cracked
real treat is seviche, fish marinated for hours in lime wheat) and pickled vegetables, both of which are
juice then drained and mixed with spices. Together acceptable. Fresh fruit, especially melons and
these introductions might make a complete meal grapes, make an authentic close to your meal.
for you. If you’re still hungry, try shrimp or chicken
tostadas on a cornmeal tortilla (not fried). Forget the
refried beans (as they are cooked in lard), although
some restaurants have boiled beans (a good
source of fiber) with onions and spices. In Mexican
restaurants, be sure to ask that garnishes, such as
cheese and sour cream, be served on the side.

45
 French Food shish kabob, broiled on a spit and made with baby
A good rule for dining out in French restaurants is lamb, tomatoes, onions and peppers. Have your
“keep it simple.” Steamed mussels or a salad (with entree with rice. As for pitfalls, lamb, often found
dressing on the side) are fine starters, but avoid on Greek menus, has more saturated fat than beef;
French onion soup, which is high in calories and phyllo dough, used in some entrees and desserts, is
salt. Be wary of sauces, the heart of classic French very high in fat; caviar, used in some appetizers, is
cuisine. Hollandaise sauce, made with egg yolks high in cholesterol; and babaganoosh, an eggplant
and butter; bechamel, with milk, butter and flour; appetizer, is frequently prepared with fat, keeping it
and bernaise sauce, an expanded hollandaise, are high in calories.
poor choices. The alternatives are French wine
sauces, such as bordelaise; tasty and usually not Health Food/Vegetarian
as high in fat or cholesterol. “Nouvelles” sauces, Nutrition-conscious diners have prompted
lighter because flour is eliminated in preparation, still a proliferation of health food and vegetarian
may contain cream, egg yolks, butter and plenty of restaurants. Most offer an array of salads, lots of
calories. All sauces tend to be high in sodium. To yogurt based dishes, food prepared in soybean oil
be safe, ask if your entree is in sauce and how that (a polyunsaturate) and many selections made with
sauce is prepared. Perhaps you can order it on the beans and grains, nuts and seeds. Unfortunately for
side. Avoid dishes labeled “au gratin,” as these often calorie watchers, some of these dishes may be high
come with toppings of cheese and butter. in fat especially if made with large quantities of oils,
high-fat dairy products or even nuts and seeds. If on
Greek Food a low cholesterol, low-fat regimen, you should note
If you’re counting calories, you may worry that Greek whether or not eggs or whole-milk cheeses have
food is too oily. Seek dishes prepared with limited been used in the preparation and if yogurt is made
amounts of olive oil, and you’ll find many acceptable from whole or skim milk.
choices. Tzatziki, an appetizer made with yogurt and
Indian Food
Nutrition

cucumbers, is safe to order, especially if the yogurt is

the low-fat type. Pita bread is very low in fat. Greek The tastiness of Indian food, which is generally low
salads are filling and delicious. The feta cheese is in saturated fat, cholesterol or calories, is a tribute to
slightly lower in fat than hard cheeses, but high in the creative use of spices. Many of the dishes offered
sodium. (Remember, that anchovies and olives are use a yogurt-based curry sauce, a good choice
also high in salt. If you are on a low-sodium regimen, for those on special diets–especially if the yogurt
have the cheese, anchovies and olives removed is the low-fat type. You’ll enjoy the salads, often a
before serving.) Order dressing on the side. For a refreshing combination of yogurt with chopped or
main course, stick with dishes like plaki, fish that’s shredded vegetables (raita). Tandoori chicken and
been cooked with tomatoes, onions and garlic; or fish dishes, which are marinated in Indian spices and

46
 Recommended
Books/Cookbooks
roasted in a clay pot, make a delicious and authentic There are many good books on cooking and nutrition
meal. Often, however, butter is used to baste the available at the bookstore or in your local library.
tandoori preparations. Ask if margarine can be used These are only a few and we encourage to you to
instead. Seekh kabob, marinated ground lamb that experiment. Look for those that list calories, fat, and
is cooked over coals, is another choice as long as sodium with recipes.
the lamb is lean. Vegetables are an important part of
Indian meals. Lentils or dal, are high in protein and The New American Heart Association
fiber and low in fat. Always check to see if ghee, Cookbook, 9th Edition
which is clarified butter, is used in the preparation of American Heart Association
vegetables. Indian dishes are often served with plain June 2017
rice, a cooling accompaniment. Try the delicious
breads, like dry pulkas (unleavened wheat bread) or American Heart Association Low-Salt
naan (without butter). Cookbook, 4th Edition
American Heart Association
March 2013
Remember: When in doubt,
ask your waiter or waitress Cooking Light
Magazine published 6 times per year
Cookbook published annually
Adapted from: “Dining Out - A Guide To Restaurant Dining,” The Complete Mediterranean
American Heart Association, 1984.
Diet Cookbook
The Editors at America's Test Kitchen
December 2016

Nutrition
The Spectrum: A Scientifically Proven
Program to Feel Better, Live Longer,
Lose Weight, and Gain Health
Dean Ornish, M.D.
December 2008

Other free publications are available through your

local chapter of the American Heart Association.

47
 Job Retraining/
Volunteering Driving
After your stroke, you may or may not be able to Driving is a major concern after a stroke. It’s not
return to the job you had before. All states have unusual to want to drive after a stroke; being able to
vocational rehabilitation programs to retrain people get around after experiencing one is important. But
with disabilities who can still work and to help them while safety is always an issue when a person gets
find jobs. behind the wheel, it’s even more important after a
If you think retraining would help you, contact your stroke. The reason is that a stroke may change how
California Department of Rehabilitation, Laguna you do things. Before you drive again, think carefully
Hills Branch at 949-598-7942. A counselor will about how these changes may affect your own and
help determine if you are qualified for the program. other people’s safety.
Eligibility depends on two criteria:
How does a Stroke Affect Driving?
1. The existence of a disability that prevents you
from working Stroke affects different people in different ways. If
you have any of these effects, they could seriously
2. Financial need
impact your ability to drive safely.
• Changes in mobility. Paralysis (weakness) in your
Helpful Tips from People Who
arm or leg affects how you steer, brake
Have Had Strokes, and Are Now
and accelerate. Your reaction time also may
Employed or Volunteering be slowed.
• Be flexible, think of new ways to make changes in • Changes in vision. Loss of vision in one or both
the way you work, i.e., work shorter hours, fewer eyes affects your ability to see in the rear view
days, and so on. mirrors and outside windows. Visual perceptual
• Pace yourself, take time to rest. Stick to regular problems may change how well you judge
consistent hours, without extending them to distance, or speed, and maintain your lane
overtime. position.
• Take your medications on time, especially if you • Changes in thinking skills. Impulsive behavior,
are busy. Keep a back-up supply of medications at impaired judgment and difficulty problem solving
work. Make taking care of yourself a priority. also may influence your driving behavior. May
• Communicate what you need at work. If there cause difficulty in focusing, attention, and the
Life After Stroke

are any helpful adaptive devices that could make ability to handle multiple distractions on the road.
your job easier and help you work more efficiently, • Changes in communication. Being unable to
discuss them with your employer. follow directions, difficulty following road or traffic
• Some people will treat you differently when signs, read a map, ask for help or explain events
you return to work. Make every effort to be a are secondary aspects of driving, but they’re also
part of the activities at work. Expressing your safety concerns.
interest in people you work with promotes a For additional driving information, visit www.aded.net
sense of belonging. Use humor or a light attitude
when dealing with a person who seems newly How do I Know if I can Drive?
uncomfortable in your presence. • Talk to your doctor. He or she can tell you about
• Take short breaks. Take time to rest and renew
your stroke and how it might influence your driving.
yourself. Learn some relaxation techniques. Talk to You’ll also get a professional opinion based on
yourself in a positive, encouraging way. experience.
• Consider professional psychological or vocational • Contact the State Department of Motor Vehicles in
counseling. It may put into perspective some of your area. Ask for the Office of Driver Safety. Ask
your concerns about work. Appropriate support what requirements apply to people who’ve had a
groups may also offer tools to cope with work- stroke.
related problems.
See section 8, “Community Resources” for more
information.

48
 Sexuality
• Enrollin a Driver’s Rehabilitation Program. For Sexual intimacy for the stroke survivor maybe a
a fee, you may receive a driving assessment, difficult and sensitive topic to discuss. You may have
classroom instruction and suggestions for many questions and concerns about sexuality and
modifying your vehicle (if necessary). This program may even be afraid to discuss them. Some questions
is available at Hoag Rehabilitation Services in include: Can I have sex again? Will my medications
Newport Beach. interfere with my ability to have sex? Will sex cause
See page 57 under “Community Resources” for another stroke?
driving re-training programs. It’s important to know that many men and women
A driver rehabilitation specialist is specifically trained who have had strokes continue to enjoy an active
in both driver education and medical aspects related and healthy intimate life with their partners.
to stroke to address your special needs. Your feelings about your body may have changed as
To ensure safety for the stroke survivor who drives, a result of your stroke. Coping with these changes
driver rehabilitation specialists have developed some in your body can affect how you feel about your
helpful hints: sexuality. First, realize that accepting these changes
takes time and effort. You may experience anger,
• Drive in familiar areas.
grief, depression and denial. But by dealing with
• Drive on less congested roadways.
these feelings, you can begin to accept the way your
• Use clearly marked lanes. body has changed. It is important to remember that
• Use uncomplicated intersections. sexuality is not just the act of sexual intercourse, it
• Combine trips to minimize driving. involves much more than that.
• Clean windshield to maximize visibility. Sometimes, simply being able to take care of
• Avoid clutter on the dashboard. yourself in personal matters, such as bowel and
• Eliminate distractions (phone, ratio, etc.). bladder functions enhances self-esteem. This, in
turn, increases feelings of sexual attractiveness.
Stroke survivors are also advised to avoid certain Getting dressed every day and trying to look your
conditions that make driving more dangerous, such best may boost your feelings and the feelings of
as night driving, rush-hour traffic, bad weather and those around you.
unprotected left turns.

Life After Stroke

It is also important to discuss with your mate
What if I Can’t Drive? how you both are feeling about physical changes.
Remember that in all partnerships it takes effort to
If you can’t drive, you can still feel good about
maintain what is good and correct what is not. This
yourself. You’ve made the responsible choice and
is true whether or not it involves people
have considered both your safety and the safety
with disabilities.
of others. Even though it may feel like it at first, life
isn’t over. There are other forms of transportation, Professional help is always available, including your
including: doctor, nurse psychologist and social worker. They can
• Public transportation. Many cities offer reduced also refer you to someone who is trained to do so.
fare passages and have wheelchair lifts on buses. Sexual health is a combination of sexual anatomy or
• Specialized transportation vans or taxis. Some sexual functioning that sometimes can be helped by
places have transportation systems specifically a sexual medicine evaluation. There are specialized
designed for people who need help. sexual medicine health care providers who specialize
• Friends and family. Ask for a ride from family in the diagnosis and treatment of sexual concerns.
members and friends when you need to go These professionals are trained to help men and
somewhere. And when you’re offered a ride, women who have had a stroke.
accept it. Because sex is often a sensitive topic, your doctor or
• Check on community resources, such as senior your mate may not discuss it with you unless you ask.
citizen’s groups and local volunteer agencies. Resuming intimate relations with your partner can
be a scary situation, especially when you haven’t
had the interest or desire to be together for some

49
 time. Take your time and do not feel pressured to • Pillows can be used to prop up the affected side.
resume sexual intercourse right away. Each person’s • To control a spastic limb during lovemaking, lie on
experience is different and everyone will resume the affected limb and bend it slightly.
intimacy at their own pace. • If thrusting movements are difficult for the stroke
If it is a concern, please speak with your health survivor, the mate may want to perform that part of
care provider and request a referral to an intimacy the lovemaking.
specialist. A sexual health concern should not be • If intercourse is difficult, remember that other
ignored. forms of sexuality and intimacy can provide a
If you were sexually active before your stroke, you great deal of pleasure, including touching and
probably can be sexually active again. But this caressing, massages, oral sex, self stimulation,
requires time, patience and the loving support of and lovemaking with vibrators.
your mate. If you were not particularly interested
in sex before your stroke, this will not necessarily Other suggestions:
change. In any case, don’t measure success or • Discuss your medications with your health care
disappointments by past performance. provider; sometimes medication schedules can be
adjusted. Never stop or change medication without
Begin slowly. Start with being close to your mate by
first discussing it with your health
touching and caressing each other. Begin to explore
care provider.
what feels good to you now that sensation on one
• Planned sexual activity right before a meal is often
side of your body may be different. Do not feel that
you need to have sexual intercourse to feel good best. Decreased foods and alcohol intake before
about being with your mate. Add intercourse only if sexual activity reduces excess cardiovascular strain.
and when you both feel ready. The goal is to enjoy • Set the stage: remember that the setting is also
each other. important. Dim the lights, play soft romantic music,
maybe light scented candles to help enhance the
The focus should be on pleasure rather than
sensual mood.
performance. Focus on physical intimacy and spend
• If you have a catheter, check it before intimacy.
quality time together; share emotions and thoughts.
Also, it’s important to be sensual in an non-sexual If incontinence is an issue or loss of urine, keep
towels handy for easy clean up.
Life After Stroke

way: holding hands, cuddling and even massage can

be a pleasurable experience. • Communicate: Even if your speech is impaired,
touch can be the best form of communication.
Tips for intimacy after a stroke: Desire and connectedness is an important
• Remember if you had a stroke, your body and component of your sexual health.
appearance may have changed. You and your Remember that you are not alone. Sexuality
mate may need time to get used to this and other concerns are very common, especially in men and
changes related to the stroke. women with chronic medical illnesses. There is
• Time intercourse when you are the most rested professional help available to address your concerns
and relaxed and have enough time to enjoy in a private and confidential manner.
each other.
• If the stroke survivor lacks sensation on
half of the body, stay away from that side during
intimacy.
• If the stroke survivor has limited vision on
one side, try to stay where you can be seen during
intimacy.
• If one side of the stroke survivor’s body is weak,
he may want to lie on his affected side, or his mate
might want to take the position on top.

50
Smoking Cessation
It is a well-known fact that smoking is a risk factor California Smokers’ Helpline
for many health problems. Recent studies have www.nobutts.org
confirmed that cigarette smoking is a risk factor English 800-NO-Butts (662-8887)
for stroke. The nicotine and carbon monoxide Spanish 800-45-NO-FUME (456-6386)
in cigarette smoke damage the cardiovascular Korean 800-556-5564
system and pave the way for stroke to occur. Since Vietnamese 800-778-8440
e-cigarettes also contain nicotine – some contain as Chinese 800-838-8917
much as a pack of cigarettes – it is a concern that TDD 800-933-4833
vaping or using e-cigarettes can also be a risk factor CHEW 800-844-CHEW
for stroke.
Services: One-on-one telephone counseling, and
Below is a stop smoking directory with resources self-help materials. Teens – most of the above
to help you quit smoking or vaping. Many of the helplines have specialized counseling for teens 14
resources are free and include telephone support, and older.
online resources, or local meetings for support as Cost: Free
you quit smoking.
County of Orange Health Care Agency –
Stop Smoking Directory Tobacco Use Prevention Program
Provided by: American Lung Association® of Orange County (TUPP)
405 E. 5th Street
American Cancer Society Santa Ana, CA 92701
1940 E. Deere Avenue, Suite 100 866-NEW-LUNG (English)
Santa Ana, CA 92705 866-639-5864 (Spanish, Vietnamese, Korean, Farsi)
949-261-9446 www.ochealthinfo.com/tupp
Services: Literature, referrals and self-help materials Services: Phone counseling and self-help materials,
information on policy and local activities to decrease
American Lung Association access of tobacco to youth, materials and referrals.
of Orange County Cost: Varies
513 E. 1st Street, Ste. B Free quit smoking or vaping classes.
Tustin, CA 92780 Free supply of nicotine patches for adults and teens.
714-332-3273
Services: Literature and in-home materials on Hoag Hospital
smoking and health, how to help a friend quit, One Hoag Drive

Lifestyle Modification
smoking and teens, and referrals Newport Beach, CA 92663
Cost: Varies 949-764-5511
FREEDOM FROM SMOKING ONLINE www.hoag.org/education
www.lungusa.org Services: Freedom From Smoking; Mondays &
Interactive course designed to educate and modify Thursdays, 7pm to 9pm, January – November
the behavior patterns of a smoker Hoag Conference Center, Lower Campus
Cost: Free Cost: free

51
 Stress Management
What is Stress? Guidelines for Preventing Stress
Stress is one’s physical and emotional response to 1.  Slow down.
change. Plan ahead and allow enough time to get the
• 
Positive Stress: May improve one’s concentration, most important things done without having to
performance and motivational drive to achieve rush.
goals “under pressure” 2.  Sleep more.
• 
Negative Stress: Environmental factors that cause Try to get at least six to eight hours of sleep per
a non-specific chain of reactions that keep you night. To ward off insomnia, be more active and
“geared up” in a constant ongoing debilitating cycle. mindful.
• 
Causes of Stress: 3. Worry less.
– People The world will keep going if you don't get
– Environment everything done. Give yourself a break.
– Feelings 4. Laugh.
– Relationships
Laugh often and out loud, even when you're
alone.
– Thought process
5.  Stay connected.
– Physical illness
Friendship and family connections are great
medicine. Prioritize calling friends and family to
Symptoms of Stress catch up.
• 
Physical: Headaches; muscle tension; difficulty
sleeping; sweating; back pain; irregular heart rate;
fatigue; frequent colds or flu; sexual dysfunction;
skin problems; upset stomach
• 
Psychological: Anxiety; impatience; depression;
irritability; anger; feelings of helplessness
• 
Behavioral: Eating too much or too little; difficult
communication; lack of concentration; excess
smoking; alcohol and drug use.
Lifestyle Modification

52
6.  Get organized. Stop Stress in its Tracks with these Tips
Create to-do lists to help you prioritize important 1. Count to 10 before speaking or reacting.
tasks, and handle big projects one step at a time.
2. Take slow, deep breaths until you feel your body
7.  Give back. relax.
Helping others helps you feel good. Volunteer
3. Taking a walk, even just to the restroom and
your time at a local charity or help out a friend.
back, can help break the tension and give you a
8. Stay active. chance to think things through.
Exercise relieves both mental and physical
4. Try a quick meditation or prayer to gain
tension. Find something you enjoy and do it every
perspective.
day.
5. If it’s not urgent, sleep on it and respond the next
9.  Give up bad habits.
day – especially with stressful emails and social
Excessive alcohol, tobacco or caffeine can
media trolls.
increase blood pressure. Cut back or quit to
reduce anxiety. 6. Walk away from the situation for a while, and wait
to handle it until things have calmed down.
10. Change what you can.
Put your energy into learning a new skill, working 7. Break big problems down into smaller parts.
toward a goal, or helping others. Take one step at a time instead of trying to tackle
everything at once.
8. Relax with music or an inspirational podcast to
help decrease road rage.
9. Take a break to pet your dog/cat, hug a loved
one or help someone out.
10. Do something active – exercise is one of the best
stress relievers.

Lifestyle Modification

53
 The Caregiver’s Role
When a stroke survivor can’t do everything Goals and Limits
independently, “caring for” someone has another Caregiving isn’t well defined. At an extreme, a
meaning. It means providing care for the person caregiver sometimes seems to be doing everything
who’s had a stroke. Caring in this sense goes for someone, with no limits. Though caregiving
beyond personal feelings and includes what we do can be difficult, setting goals helps. Remember, a
for the person who needs help. caregiver’s basic goal is to assure the care receiver’s
People who provide help for stroke survivors are physical comfort and safety. When you assist in
called caregivers. Everyone involved in helping rehabilitation or recovery, you help that person
a stroke survivor is a caregiver – the spouse, function at the best possible level. And with your
family members and friends. There’s no one “job help and personal care, the stroke survivor preserves
description” that explains what all caregivers do. The dignity and self-esteem. Whether you’ve just started
responsibilities of each caregiver vary according to or you’re an experienced caregiver, you may need
the unique needs of the stroke survivor. All people help organizing your time and resources and getting
who will provide care must determine for themselves answers to many questions.
the type and amount of care they can offer. This may It’s important to know about the stroke and the
require a number of adjustments as roles change deficits affecting your family member. Doctors
and new skills may need to be learned. Common and other health professionals can tell you the
responsibilities of caregiving include: medical and behavioral signs. Don’t be afraid to
• Physical help with life’s daily activities ask healthcare professionals about what your care
• Managing financial, legal and business affairs receiver’s condition, feelings and actions mean for
• Monitoring behavior to assure safety
you. The amount and type of care or supervision you
provide may change as the condition changes.
• Coordinating medical and rehabilitative care
• Providing emotional support for your stroke It will be helpful for you to learn as much as you
survivor and family members can and how best to help, as well as participate
The role of caregiver may vary from having full in education offered for you and your loved one.
responsibility for all these areas to only having Participate in some rehabilitation sessions. This is a
minimal responsibility. “Caregiving” can develop good way to learn how rehabilitation works and how
slowly or happen suddenly. There’s no real training to help. Find out what the person can do with help,
for the job. It’s something you may never have and what the person can’t do.
expected.
Family Involvement

54
Taking Care of Yourself
Caregiving can be a satisfying experience. It Defining your Need
involves helping someone you care for continue As in other caregiving responsibilities, you must be
living independently in the community as much as organized. You must know what type of help or relief
possible. You, the caregiver, are incredibly important. you need or want most. Do you need occasional
As the caregiver, you’ve also accepted a special respite or a regularly scheduled helping arrangement
responsibility to take care of yourself, physically, you can rely on, or both? Ask relatives, friends, clergy,
emotionally, mentally, spiritually, interpersonally, or social workers for suggestions of other people who
and financially. Finding an opportunity to break the might help. Try to involve these others with giving care
routine, to leave your caregiving responsibilities in early. Keep them involved! You need their assistance
other competent hands is essential. Taking a break is for an occasional break. Neighbors and friends may
considered by many to be the most important thing be glad to help when asked, despite hesitating to
a caregiver can do to sustain the ability and desire to offer. Often word of mouth is a good way to locate
care for an individual. It’s called respite care, or taking dependable, suitable assistance. Local colleges,
time out. You will be able to continue providing care churches and senior centers can also be sources of
when you are rested, refreshed, and invigorated, after referrals or help. Family and friends can and should
engaging in other activities and interacting with other play major roles in caring for a disabled or impaired
people. You need time for yourself, to spend with person. This is true even if most of the care has
friends or alone, relaxing, on a vacation, or engaging obviously been taken on by one person, you!
in a favorite hobby or sport. Respite care almost
always works with proper planning. Physical Health
• Rest: Physical health is a key caregiver concern.
Assembling the Pieces Adequate rest every night is imperative. Beyond
Who has time for all this? It’s a reasonable daily rest, most likely you will also need an
question. It may be difficult to change your lifestyle occasional “major” rest. That means planning a
immediately to achieve real health in every area at period of respite such as a long weekend or a week
once. But get started. Select at least one or two of vacation.
areas to work on right away. In other words, set a • Exercise: Regular exercise is extremely important
realistic goal for yourself to improve your life in these
and will strengthen you for the rigors of helping
areas of health, and regularly check your progress
someone who’s unable to walk alone to move from
toward that goal. Remember, these are important
place to place. It will also help you rest better.
health activities to regaining a sense of control over
• Diet: A well balanced diet is, of course, also linked
your time and your life.
to overall physical health. Though you may not
Preparation always feel like eating, do so anyway. A proper diet
can help establish the cycle of good health.
Especially if you’ve always been available, your care
receiver will need to be prepared when you do leave
for a break. Reassure all involved that you will return
at a particular time. The helpers will need to know
the schedule and routine in the home, exactly what
they’re expected to do, and how to reach you if a

Family Involvement
problem arises.

55
 Emotional and Mental Health Benefits for Both
Almost every caregiver needs to talk about Be specific in your requests for help. Consider small
emotions stirred up by the job of caring for a frail things that individuals might easily provide, like
or handicapped person. You may feel anger, guilt, spending a few hours a week playing cards, watching
impatience, helplessness, love, and dislike all at the TV with a family member, or just staying in the house
same time. Admit that such feelings exist. Accept while you’re gone.
them! Don’t waste effort trying to talk yourself out of
having a certain feeling. And realize that your situation Tips for Family Caregivers
is not unique. Many other people are also caregivers • Caregiving is a job and respite is your earned right.
and have these same feelings about their situations. Reward yourself with respite breaks often.
In some areas there may also be a volunteer phone • Watch for signs of depression, and don’t delay in
reassurance program or caregiver support groups getting professional help when you need it.
to bring together people like you. Even finding one • When people offer help, accept the offer and
other caregiver to talk with occasionally may help.
suggest specific things that they can do.
Social workers, clergy, or counselors may also be
• Educate yourself about your loved one’s condition
able to help you talk about your situation and feelings.
Keeping up with current events and local news will and how to communicate effectively with doctors.
broaden your sights beyond your own home situation. • There’s a difference between caring and doing. Be

Reading, music, and other mental “exercises” will also open to technologies and ideas that promote your
provide welcome diversion and pleasure. Laughter loved one’s independence.
is an important habit to cultivate. It can ease tension • Trust your instincts. Most of the time they’ll lead you
and frustration and can help you enjoy small moments in the right direction.
of success. • Grieve your losses, and then allow yourself to dream
new dreams.
Spiritual Support • Seek support from other caregivers. There is great
Spiritual health goes by many names. But basically, strength in knowing you are not alone.
the term refers to the peace and strength we carry • Caregivers often do a lot of lifting, pushing and
within us. pulling. Be good to your back.
Interpersonal Well-Being
Affection is necessary for human survival. Just as
the person you care for needs it, so do you. Friends,
family members, counselors, or clergy can support
you. Remember, we each need to receive our share of
affection in order to give it to others.

Financial Health
Caring for another person can be costly. You should
seriously consider the financial consequences for you,
Family Involvement

your plans, your family, and your future.

56
Working Together
The family is the most important source of long-term Organizing Details
support during the recovery of a stroke patient. The There is usually one primary caregiver. That person
multi-disciplinary healthcare team needs your help usually becomes the in-home case manager and
to accomplish the most effective treatment plan for switchboard for information. Unless otherwise
your loved one. Family members are a significant arranged, that person coordinates the care plans
part of the treatment plan and the healthcare team decided on by the family. Family members need
invites you to share your observations and feelings to decide how to share responsibility for meeting
with us. We are here to answer your questions and these needs. There are many ways to divide tasks:
to help you and your loved one through the acute by specific need, by interval of time, by ability to
hospital phase by developing the best discharge provide. Assigning each person the responsibility for
plan possible. Our goal is to assist the patient in meeting one specific care need can be an effective
regaining as much independence as possible, within way to divide responsibilities.
his or her limitations.
Giving care to a disabled family member brings Changing Relationships
stress into the family. It changes the family system. It The caregiver, family member and the care receiver
changes how each family member relates to all other will all encounter new situations in their new roles.
family members. Working together as a family usually will be the best
way to plan and work for changes that will be most
Family Conference beneficial for all.
Sometimes clear-cut family roles can help everyone
sort out the expectations of each family member,
including the caregiver, knowing what they should
do for the disabled family member. These are good
times for everyone to talk and make long-term plans
for the disabled family member, share information
and feelings, and plan emergency or vacation back-
up for the primary caregiver.
If you accept the role of caregiver, you should feel
free to request significant help from family members
inside and outside the household. The success of
a caregiving plan increases when family members
are able to express their feelings and help shape the
caregiving plan.

Family Involvement

57
 Caregiver’s A Caregiver’s
Bill of Rights Resource Guide
I have the right... Most stroke survivors want to continue living in their
1. To take care of myself. This is not an act of own homes and communities. But while most of
selfishness. It will give me the capability to take us would want to support that desire and keep our
better care of my relative. family member at home, illness or disability may
make it difficult. A variety of community services has
2. To seek help from others even though my relatives
been developed to help stroke survivors and their
may object. I recognize the limits of my own
families remain at home. Many of these services
endurance and strength.
provide vital assistance with the daily activities of
3. To maintain facets of my own life that do not independent living, including needs of safety, health,
include the person I care for, just as I would if he mobility and nutrition. A range of services available
or she were healthy. I know that I do everything is briefly described below. Some of these programs
that I reasonably can for this person, and I have require fees, which are often calculated on a sliding
the right to do some things just for myself. fee scale determined by your ability to pay.
4. To occasionally get angry, be depressed and
Adult Day Care – specialized program for those who
express other difficult feelings.
are not physically and/or mentally capable of full-time
5. To reject any attempts by my relative (either independent living and need professional protective
conscious or unconscious) to manipulate me supervision in a social setting during the day.
through guilt.
Counseling – assisting the client and his or her
6. To receive consideration, affection, forgiveness
family to cope with social, mental, emotional, and
and acceptance for what I do from my loved one
sometimes medical factors affecting their total
for as long as I offer these qualities in return.
well-being. The aim of counseling for the client
7. To take pride in what I am accomplishing and to usually is to reduce stress, make decisions, improve
applaud the courage it has sometimes taken to communication skills, and spur personal growth.
meet the needs of my relative.
8. To protect my individuality and my right to make a Day Treatment – structured services operating less
life for myself both now and when my relative no than 24 hours per day, which teach independent
longer needs my full-time help. living skills and socialization skills, and offer
psychosocial rehabilitation and psychotherapy to
9. To expect and demand that as new strides increase independent and effective functioning.
are made in finding resources to aid physically
and mentally impaired persons in our country, Home-Delivered Meal (Meals-on-Wheels) –
similar strides will be made towards aiding and a federally-sponsored meal program for homebound
supporting caregivers. or disabled persons 60 and older (and their spouses
regardless of age). Meals on Wheels are hot meals
This “Bill of Rights” is adapted from Caregiving: Helping an Aging prepared by churches, or other local volunteer
Loved One by Jo Horne, AARP Books, 1985
groups off-site and delivered directly to client homes.
Home Health Aide Services – in-home personal
care assistance with bathing, eating, toileting,
mobility, etc. or the training of the client to perform
these procedures as appropriate.
Homemaker Assistance – supervised trained
personnel assisting with light cleaning, shopping,
laundry, some food preparation, and other
household duties.
Community Resources

Respite Care – supervision and assistance by

individuals who come into the home for a limited time
to provide family members a break in responsibility for
a frail, handicapped, ill or disabled person.
Transportation Services – assistance with travel
to and from community resources and facilities for
routine and/or scheduled needs (i.e., medical, social,
nutritional).
58
Palliative Care Medicine Consult Service
at Hoag Hospital
What is Palliative Care? The Palliative Care Consult Service works closely
The term palliative is derived from the original Greek with the attending physician to control pain and
root word pallios meaning “to cloak.” Palliative care symptoms, and allow individuals to focus on
is different from hospice in that patients can receive regaining control and quality of life.
aggressive alleviation of suffering while continuing to Palliative care may be right for you if you
receive disease-focused treatments – whatever the suffer from:
prognosis. • Pain
At Hoag, our Palliative Care Program is called the • Nausea
"CARES Program" and focuses on: • Breathlessness
• Complete pain and symptom management • Anxiety
• Supportive counseling • Other symptoms due to a serious illness
• Emotional and spiritual support
Serious illnesses may include cancer, advanced
• Goals of care discussions
heart disease, advanced lung disease, kidney failure,
• Education regarding community palliative care Alzheimer’s disease, and advanced liver disease.
services Palliative care can be provided at any stage of illness
and along with treatments intended for cure of the
Who can Benefit from Palliative Care? disease.
The World Health Organization defines palliative For more information on Hoag’s CARES Program,
care as a treatment approach that improves the call 949-764-8585.
quality of life of patients and their families facing the
problems associated with life-limiting illness. This is
accomplished through the prevention and relief of
suffering by means of early identification and careful
assessment and treatment of pain and other needs
that can be physical, psychosocial and/or spiritual.

Community Resources

59
 Where To Turn For Help
Following is a list of several local and national Sleep Disorders
community resources that can offer assistance with
a variety of issues. HOAG SLEEP HEALTH PROGRAM
Judy & Richard Voltmer Sleep Center -
Information and Emotional Support Newport Beach
510 Superior Avenue, Suite 200A
PICKUP FAMILY NEUROSCIENCES INSTITUTE Newport Beach, CA 92663
AT HOAG 949/764-8070
One Hoag Drive www.hoag.org/sleep
Newport Beach, CA 92663
949-764-6066 Hoag Sleep Center Irvine
www.hoaghospital.org/neuroscience 16305 Sand Canyon Ave., Suite 230
Irvine, CA 92618
HOAG COMMUNITY EDUCATION SERIES 949-557-0130
Hoag offers free education classes to the community www.hoag.org/sleep
on a variety of health care topics, including stroke.
For a list of classes and to register, please visit: Smoking Cessation
www.hoaghospital.org/information and click on
“Community Education” FREEDOM FROM SMOKING
Or call 949-764-HOAG (4624) Hoag Hospital Conference Center (lower campus)
949-764-5511
AMERICAN STROKE ASSOCIATION
800-553-6321 Employment
www.strokeassociation.org
DEPARTMENT OF REHABILITATION
• Caregiver Action
(Employment and independence for Californians
• Caregiver Resource with disabilities)
• Family Care Alliance 949-598-7942
• Family Care Support
Support Groups
NATIONAL STROKE ASSOCIATION
800-STROKES/800-787-6537 HOAG HOSPITAL STROKE SUPPORT GROUP
www.stroke.org Hoag Hospital Stroke Support Group offers a stroke
support group for caregivers and survivors. The
CAREGIVER ACTION NETWORK group meets on the fourth Thursday of each month,
202-454-3970 from 2 p.m. to 3:30 p.m. at Hoag Conference
www.caregiveraction.org Center. Refreshments are served.
For more information, call 949-764-1454.
FAMILY CAREGIVER SUPPORT PROGRAM
OC Office on Aging HOAG BRAIN ANEURYSM/AVM SUPPORT GROUP
800-510-2020 Hoag Hospital offers a support group for
714-480-6450 those diagnosed or treated for an aneurysm or
www.officeonaging.ocgov.com/services/fcsp arteriovenous malformations (AVM) of the brain. For
more information call 949-764-5942
FAMILY CAREGIVER ALLIANCE
800-445-8106 ORANGE COUNTY STROKE REHABILITATION
www.caregiver.org NETWORK
www.ocsrn.com
Community Resources

CAREGIVER RESOURCE CENTER ORANGE

COUNTY
800-543-8312
714-446-5030
www.caregiveroc.org

60
REHABILITATION INSTITUTE OF SOUTHERN Driving Re-Training Programs
CALIFORNIA
714-633-7400 HOAG REHABILITATION SERVICES
Stroke support group every Monday at 1 p.m. Hoag Health Center Newport Beach
520 Superior Ave., Ste. 100
STROKE FAMILY WARM LINE Newport Beach, CA 92663
888-4-STROKE 949-764-5645
Hours of operation: Monday - Friday,
6 a.m. - 3 p.m. ST JUDE CENTER FOR REHABILITATION AND
WELLNESS
Financial Support 2767 E. Imperial Hwy.
Brea, CA 92821
MEDI-CAL 714-578-8706, ext. 2327
ORANGE COUNTY SOCIAL SERVICES AGENCY
1928 South Grand Ave. Additional Resources
Santa Ana, CA
800-281-9799 HOAG REHABILITATION SERVICES
714-541-4895 24-hour automated assistance Hoag Health Center Newport Beach
Hours of operation: Monday - Friday, 520 Superior Ave., Ste. 100
7 a.m. - 5 p.m. Newport Beach, CA 92663
949-764-5645
HICAP www.hoag.org/rehab
HEALTH INSURANCE COUNSELING AND
ADVOCACY PROGRAM 16300 Sand Canyon Ave., Ste. 100
714-560-0424 Irvine, CA 92618
800-434-0222 949-557-0630
www.hoag.org/rehab
MEDICARE
800-MEDICARE (800-633-4227) MARY & DICK ALLEN DIABETES CENTER
www.medicare.gov AT HOAG HOSPITAL
520 Superior Ave, Suite 150
Information on Aphasia Newport Beach, CA 92663
949-764-8065
HOAG COMMUNICATION RECOVERY GROUP www.hoag.org/diabetes
520 Superior Ave.
1st floor exercise room 4870 Barranca Pkwy., Ste. 110
Newport Beach, CA 92663 Irvine, CA 92604
Fridays, 1:15-2:30 p.m. AMERICAN DIABETES ASSOCIATION
Cost: $28 per month 611 Wilshire Blvd., Ste. 900
949-764-1918 Los Angeles, CA 90017
NATIONAL APHASIA ASSOCIATION 323-966-2890
400 East 34th St. 800-DIABETES (800-342-2383)
New York, NY 10016 www.diabetes.org
800-922-4622 AARP
www.aphasia.org 888-OUR-AARP (888-687-2277)
AMERICAN SPEECH–LANGUAGE HEARING Spanish 877-342-2277
ASSOCIATION www.aarp.org
800-638-8255
Community Resources

TTY 301-296-5650
www.asha.org

61
Appendix

Glossary
ADL CVA
Activities of daily living, including dressing, bathing, Cerebral Vascular Accident. See “Ischemic Stroke.”
grooming, eating and homemaking.
Denial
Ambulate Inability to understand the nature and extent of the
To walk. patient’s cognitive, behavioral and functional deficits.
This difficulty often is due to both cognitive and
Angiogram psychological factors.
A procedure done to visualize the blood vessels in
the brain. Disorientation
Confusion about one’s identity, location, or the
Aphasia current date.
A language problem that involves difficulty in
understanding, talking, reading and writing. Dysarthria
Unclear, slurred speech resulting from weakness
Apraxia and/or incoordination of the muscles used to
Difficulty performing planned movements or produce speech and voice.
sequences of movement (including muscular
control of the tongue), which are not the result of Dysphagia
paralysis, incoordination, or loss of sensation or A disorder of swallowing due to neurological injury,
comprehension. structural abnormality or surgical alteration of the
muscles of swallowing.
Aspiration
Food or liquid that has gone into the lungs rather Edema
than the stomach. A condition in which the body tissues contain an
excessive amount of fluid. This may be a localized
Assistive Device problem, such as in brain or extremity swelling.
A device used to assist in ambulation or to improve
activities of daily living (i.e. cane, walker). Fine Motor Activities
Activities that include hand coordination, such as
Ataxia writing and buttoning.
Inability to coordinate muscle groups for smooth
movement. Flaccid
Total lack of muscle tone or activity in a muscle or
Atrial Fibrillation muscle group.
Rapid, irregular contraction of the atria of the heart
that produces an irregular and often rapid ventricular Hemianopsia
rate. Defective vision or blindness in half of the visual field
of one or both eyes.
Attention
The ability to concentrate on information. Hemiparesis
Muscular weakness or partial paralysis of one side of
Carotid Artery the body.
A major artery in the neck that supplies blood to the
head and brain. Hemorrhagic Stroke
A stroke caused by a bursting blood vessel in the
Cognition brain that spills blood into the brain (see page 7).
The activities involved in thinking, reasoning and
problem solving. Incontinence
Lack of control over excretory functions (urination,
CT Scan bowels).
CAT Scan (Computerized Axial Tomography) – A
series of X-rays taken and analyzed with a computer
to determine the level and type of damage to the
whole body and/or specific area.

62
 Appendix
Ischemic Stroke Prognosis
A stroke caused by insufficient supply of blood and Prediction of the course and outcome of a disability
oxygen to a part of the brain. Also referred to as or disease.
CVA.
Range of Motion (ROM)
Magnetic Resonance Imaging (MRI) The amount of movement possible in a joint,
A technique used to obtain images of the brain and measured in degrees.
blood flow to the brain using a magnetic field.
Sensation
Nasogastric Tube (NG Tube) Information received by the brain through the senses
A tube that is inserted through the nostrils and of sight, touch, smell, taste, hearing and movement.
passed into the stomach, through which food and
liquids are given. Spasm
An involuntary muscular contraction.
Neglect
A condition in which the individual is unable to sense Spasticity
some part of his or her world, usually on either the Increased resistance or contraction in the muscle,
right or left side of the brain. usually caused by damage to a part of the brain that
controls movement.
NPO
Nothing by mouth, a diet restriction sometimes Stenosis
ordered by the physician. Reduction in size of a vessel or other opening.

Orientation Stroke
Accurate awareness of one’s identity, location and See “Ischemic Stroke” and “Hemorrhagic stroke”.
the current date. Thrombectomy
Occupational Therapy (O.T.) A procedure to physically remove a blood clot from
Therapy that assists the patient in managing a large blood vessel in the brain, causing a stroke.
activities of daily living. Transfers
Paralysis Methods of getting into and out of a wheelchair or
Inability to move a muscle or a group of muscles a chair, or moving from standing to a bed, toilet, car,
voluntarily. tub, shower or floor and back again.

Paresis Thrombolytics
Weakness of a muscle or a group of muscles. Thrombolytic (fibrinolytic) drugs help reestablish
cerebral circulation by dissolving (lysing) the clots
Patent that obstruct blood flow. Most thrombolytics are
Term used to describe a small hole in the heart plasminogen activators - they activate the factors
between the left and right atrium. in the blood that ultimately break up a blood clot.
To be effective, thrombolytic therapy should be
PEG administered as quickly as possible after the onset of
A feeding tube inserted through the skin into the stroke symptoms.
stomach.
Perseverance
Uncontrolled, involuntary repetition of speech or of
an activity.
Physical Therapy (P.T.)
Therapy that helps patients regain the ability to be
mobile.

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One Hoag Drive
PO Box 6100
Newport Beach, CA 92658-6100
1/19-LAD-2M-AT

949-764-HOAG (4624)
www.hoag.org