Stroke is a medical emergency which occurs when blood flow to the brain is disrupted, denying brain tissues oxygen and nutrients. In this situation, brain cells begin to die in a few minutes. It is important to take immediate action when stroke occurs so as to reduce brain damage and associated possible complications. This is because the longer stroke goes untreated, the greater the potential for brain damage and disability.

Thankfully, stroke is both preventable and treatable. Some symptoms associated with stroke include:
• Slurring of speech, difficulties communicating and comprehending
• Paralysis on one side of the body including face and some body parts
• Blurred vision in one or both eyes
• Sudden severe headache accompanied by vomiting and dizziness
• Loss of balance or coordination.

Causes of stroke include blockage of an artery and leakage or bursting of a blood vessel. In addition, some people experience a temporary disruption of blood flow to the brain which does not cause permanent brain damage.

Types of stroke depend on the causes and they include:
Ischemic stroke: Most strokes- up to 80%, fall into this category. They occur when the arteries to the brain become narrowed or blocked, causing severely reduced blood flow (ischemia). Forms of Ischemic stroke include Thrombotic and Embolic strokes.
Hemorrhagic stroke: This type of stroke occurs when a blood vessel in the brain leaks or ruptures. Brain hemorrhages result from many conditions that affect the blood vessels including hypertension, blood thinning and aneurysm. Form of hemorrhagic stroke include Intracerebral hemorrhage and Subarachnoid hemorrhage.
Transient ischemic attack (TIA): TIA- sometimes referred to as a mini-stroke, is caused by a brief decrease in blood supply to the brain lasting as short as five minutes. Similar to ischemic stroke, TIA occurs when a clot or debris blocks blood flow to part of the nervous system but there is no permanent tissue damage and no lasting symptoms. Having a TIA increases the risk of having a full-blown stroke, causing permanent damage later.

Risk factors for stroke include:
• Lifestyle factors such as physical inactivity, smoking, obesity, alcohol and drug abuse.
• Medical factors such as hypertension, high cholesterol, diabetes, sleep apnea, heart problems and personal or family history of stroke.
• Other factors such as age, race and gender.

Stroke prevention strategies focus on general, healthy lifestyle recommendations which include:
• Controlling high blood pressure (hypertension)
• Lowering the amount of cholesterol and saturated fat in your diet
• Quitting tobacco use
• Controlling diabetes
• Maintaining a healthy weight
• Eating a diet rich in fruits and vegetables
• Exercising regularly
• Drinking alcohol in moderation, if at all
• Treating obstructive sleep apnea (OSA)
• Avoiding illicit drugs

Preventive medications such as anti-platelets and anti- coagulants may be recommended and prescribed by a doctor to prevent the recurrence of a stroke.

According to World Health Organization, there are about 32.4 million myocardial infarctions and strokes worldwide every year. People who have had a previous episode of myocardial infarction (MI) or stroke are at the highest risk of having another episode. MI survivors are at increased risk of recurrent infarctions and have an annual death rate of 5 percent- 6 times that of people of the same age who do not have a history of MI. In the United States, someone suffers a heart attack every 40 seconds. A total of about 790,000 Americans suffer a heart attack yearly, and of these cases, 580,000 are a first heart attack while up to 210,000 are recurrent.

By definition, Myocardial infarction (MI), also known as heart attack is the irreversible death (necrosis) of heart muscle due to prolonged lack of oxygen supply (ischemia). MI is a medical emergency that occurs when a part of the heart muscle does not receive sufficient blood flow such that the heart muscle is unable to receive oxygen. The more the time that elapses before treatment to restore the blood flow, the greater the damage that will be done to the heart muscle- in severe cases, the affected section of the heart begins to die and this can be fatal. The major cause of heart attack is Coronary artery disease (CAD). Other causes include severe spasm which may be caused by tobacco and illicit drug use or sudden contraction of a coronary artery that can interfere with blood flow to the heart muscle. A heart attack occurs when one or more of the coronary arteries are blocked due to narrowing from the buildup of various substances, including cholesterol in a condition called atherosclerosis.

Risk factors for heart attack are those factors that contribute to atherosclerosis. They may include:

• Age
• Tobacco
• High blood pressure
• Obesity
• Diabetes
• High levels of low-density lipoprotein (LDL) blood cholesterol or triglyceride levels
• Metabolic syndrome
• Family history of heart attack
• Lack of exercise and Stress
• Use of Illicit drugs such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack.
• History of preeclampsia or an autoimmune condition

There are two types of heat attack; the first is STEMI (ST-elevation myocardial infarction) where there is a complete obstruction of blood flow in a coronary artery supplying the heart with oxygen-rich blood. This results in damage to the width of the heart wall. The second type of heart attack is the Non-STEMI (Non-ST-elevation myocardial infarction) in which there is a partial obstruction of blood flow in a major coronary artery supplying the heart with oxygen-rich blood. In this case, only part of the heart wall thickness is damaged.

Medications can reduce the risk of a subsequent heart attack and help damaged heart function better. In addition, lifestyle changes such as maintaining a healthy weight, eating heart-healthy foods, quitting smoking, exercising regularly, managing stress and controlling conditions that can lead to heart attack, such as high blood pressure, high cholesterol and diabetes can prevent heart attack or its recurrence.

Arteries are blood vessels that carry blood from the heart, they are lined by a thin layer of cells called endothelium, which keep them smooth and allow blood to flow easily. Arteriosclerosis is a situation where these blood vessels that carry blood-containing oxygen and nutrients, from the heart to other parts of the body thicken and become stiff, causing restrictions in blood flow to body organs and tissues. Usually, the structure of arteries allows them to be flexible and elastic; however, the arterial walls can harden and become narrow in another condition commonly known as Atherosclerosis. In this condition, the arteries become narrowed and hardened due to a buildup of plaque around the artery wall; it is also known as arteriosclerotic vascular disease.

Similar to Atherosclerosis, Arteriosclerosis disrupts blood flow around the body, posing the risk of serious complications. It occurs when the endothelium becomes damaged, allowing harmful cholesterol to build up in walls of the artery. To fight this problem, the body sends white blood cell to flush out the cholesterol, however, these cells may become stuck at the affected site building up plaque. In extreme cases, the plaque may break open, cause blood clots and result in life-threatening complications, such as stroke and heart attack.

Risk factors for arteriosclerosis (Arteriosclerosis is the stiffening or hardening of the artery walls) and Atherosclerosis (narrowing of the artery because of plaque build-up- a specific type of arteriosclerosis) include high blood pressure, high levels of cholesterol, smoking, diabetes, air pollution, genetics,  and high levels of sugar in the blood. Symptoms of these conditions depend on whether it’s the carotid, coronary or renal arteries that are affected. General symptoms include weakness, difficulty breathing, headache, facial numbness, paralysis, vomiting, anxiety, chest pain, coughing, loss of appetite, swelling of the hands and feet and difficulty concentrating

Diagnosis and treatment of atherosclerosis are important to prevent complications. Common methods of diagnosis include:

• Blood tests which measure sugar, fat and protein content in the blood
• Physical exams used to detect plaques, weak pulse, low blood pressure, aneurysm and wounds that don’t heal properly
• Ultrasound scanner can be used to check blood pressure at distinct parts of the body- pressure changes may indicate arteries that have an obstructed blood flow.
• CT scan is used to find arteries that are hardened and narrowed.

Treatment options include lifestyle changes including maintaining a healthy weight, medications that have antiplatelet capacity and surgical interventions such as angioplasty or coronary artery bypass grafting (CABG). However, it is important that atherosclerosis is accurately diagnosed, and on time, to ensure the functions of the arteries are returned to full capability. It is always better to prevent the development of by eating a good diet, frequent exercise and not smoking.

Pruritus, also known as itchy skin, is an uncomfortable, tingling and irritating sensation that stimulates an individual to scratch. Pruritus or itchy skin can be associated with some disorders, including dry skin, skin disease, pregnancy, and rarely, cancer. It is also more common in older adults because the skin has a tendency to become drier with age. Itchy skin may appear normal, red, rough or bumpy depending on the cause or trigger. It may occur on certain small areas, such as on some parts of the arm or leg, or it can occur over the whole body. It can also occur with or without any other noticeable changes on the skin. In some cases, itchiness can last for a long time and can be intense- the more the itchy area is rubbed or scratched, the itchier it gets; And the more it itches, the more it is scratched causing an itch-scratch cycle can be very difficult to discontinue. Continuous itching can result in inflamed or swollen areas on the skin leading to wounds or infection.

Self-care and homemade measures such as moisturizing frequently, use of gentle cleansers and warm water bath can bring temporary relief. Permanent relief requires a diagnosis and treatment of the factor underlying the itchiness. The major characteristic of Pruritus is a continued urge to itch some or most parts of the body. Identified and common symptoms include redness, bumps or blisters, dry cracked skin and scaly skin.

Pruritus can be caused by pruritogens and several factors; however, it is sometimes difficult to determine the exact cause. Skin conditions such as dry skin (xerosis), eczema (dermatitis), psoriasis, scabies, insect bites, atopic dermatitis, urticaria, mastocytosis, dermatitis herpetiformis, pemphigoid and hives result in itchiness. Other factors include:

• Internal diseases: Liver disease, kidney failure, iron deficiency anemia, thyroid problems and certain cancers
• Nerve disorder: Multiple sclerosis, diabetes, pinched nerves and shingles
• Psychiatric problems: Anxiety, obsessive-compulsive disorder and depression
• Irritants and allergies: Poison ivy, parasites, cosmetics, opioids, wool, chemicals and some soap

It is important to see a dermatologist if:

• Itchy skin persists for over two weeks
• Doesn’t improve with self-care measures
• Doesn’t improve despite treatment
• Is severe and distracting
• Starts suddenly without cause
• Causes sleep interruptions
• Affects the whole body
• Is accompanied by signs and symptoms such as extreme tiredness, weight loss, changes in bowel habits, or urinary frequency, fever or redness of the skin

A physical examination and inquiries about a patient’s medical history are essential to diagnosing and treating Pruritus. Blood tests, x-rays, thyroid, liver and kidney function tests are important for diagnosis. Itchy skin treatment focuses on determining the underlying the cause of the itch and treating it. If self-care and homemade remedies don’t ease itchiness, medications may be used as prescribed by a doctor. Some medications include corticosteroid creams; ointments such as tacrolimus, pimecrolimus, capsaicin, doxepin and oral medications such as fluoxetine and sertraline. In addition to medications, light therapy (phototherapy) which involves exposing the skin to a specific type of light at several times may be used to treat Pruritus.

Insomnia is a sleep disorder characterized by difficulty falling and staying asleep, sleep interruptions at night, waking up earlier than necessary and feeling exhausted when awake. According to Centers for Disease Control and Prevention, about 50 to 70 million Americans experience some form of sleep disorder. Insomnia can sometimes lead to depression by influencing the mood and attentiveness of people who it affects. Lack of sleep can also lead to household injuries, car accidents, problems at work, marital issues, social problems, alcohol abuse and poor health. Symptoms of Insomnia include sleepiness during the day, general tiredness, irritability and problems with concentration and memory. Insomnia is caused by several factors and may include one or more of the following:

• Health problems such as pain, sleep apnea and restless legs syndrome
• Lack of sufficient physical activity
• Substance abuse
• Reactions to bad nights of sleep
• Shift work and Jet lag
• Insufficient exposure to sunlight
• Overheating the bedroom
• Emotional conditions such as stress, depression, worry and anxiety
• Poor sleep habits, such as watching TV in bed
• Lack of a regular bedtime schedule or significant physical discomfort
• Changes in sleep habits or surroundings including noise, light, or bed change
• Tobacco, alcohol, drugs, caffeine and certain medicines

There are two major types of insomnia; primary and secondary insomnia. Primary insomnia occurs when a person suffers sleep problems that are not directly associated with any other health condition. On the other hand, secondary insomnia is a situation where a person experiences sleep problems because of an underlying problem such as a health condition or factor.

Insomnia can also be categorized based on how often it occurs and how long it lasts when it occurs; these are acute and chronic Insomnia. Acute Insomnia may or may not occur frequently but lasts for a short time while chronic Insomnia occurs more frequently and lasts for a long time. Additionally, acute insomnia can last from one night to a few weeks; it can also come and go with periods of no sleep problems. Chronic Insomnia, on the other hand lasts at least three nights a week for three months or longer. Treating Insomnia focuses on the reasons and factors underlying one’s inability to sleep well. Certain personal and lifestyle changes may relieve Insomnia. These include:

• Going to bed and waking up at the same time
• Avoiding caffeine, nicotine and alcohol use hours before bedtime
• Exercising regularly
• Avoiding prolonged use of phones or devices that give off light before bed,
• Making the bedroom comfortable
• Avoiding naps at daytime

Prescription drugs and counseling can also be used, however, it is important to note that medication doesn’t work as well over time as lifestyle and behavior changes do.