Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
A stroke occurs when blood flow to a part of the brain is impaired, either because the arteries have become constricted due to atherosclerosis or because of bleeding in the brain. Within minutes, the nerve cells in the affected area of the brain become damaged and die.
If you, or someone you are with, experience symptoms of stroke, call 911 and seek care immediately at the closest emergency room.
Stroke is the third leading cause of death in the United States and the primary cause of adult disability. Up to 80 percent of strokes are preventable. In recent years, fewer people have died of stroke because we have more sophisticated means of identifying and controlling your risk factors. We can work closely with you to help reduce risk factors associated with stroke.
If you are with someone who may be having a stroke, follow these steps:
If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast. Brain cells are dying.
There are 2 major types of stroke. The first is known as ischemic stroke and is caused by insufficient blood flow due to a clot. The second is caused by bleeding in the brain and is known as a hemorrhagic stroke. Ischemic strokes are more common, accounting for approximately 80 percent of all cases. Hemorrhagic strokes can be more dangerous, however. There are some additional basic facts about the 2 types of strokes:
Stroke symptoms begin suddenly and can include:
A transient ischemic attack (TIA) is a serious emergency condition, because it can be a warning sign of a future stroke. TIAs occur when hardening of the arteries (atherosclerosis) temporarily interferes with blood flow to a part of the brain. TIAs are often called ministrokes, which is inaccurate. Unlike ministrokes, the symptoms of TIAs do not usually leave permanent damage.
Here are some things to remember about a TIA:
Stroke is an emergency condition. If you have symptoms, call 911 or go to the nearest Emergency Room.
Treatment depends on the severity and cause of the stroke, although most people who have a stroke will be admitted to the hospital. Many of our hospitals in Northern California are certified by the Joint Commission as "Primary Stroke Centers," meaning that they have undergone and passed rigorous evaluations by a national agency to ensure the highest quality of care.
There are a range of surgical options available for treating a stroke:
Anticlotting medications are used to reduce the chances of blood clots forming and thus reduce the risk of stroke. These include:
|Drug Name||Used For||Drug Type|
|Tissue Plasminogen Activator||Acute stroke treatment||Thrombolytic|
Some stroke medications should not be taken by women who are trying to get pregnant or are at risk for pregnancy because they can cause birth defects. If you are a woman of childbearing age (15 to 49) and are not planning to get pregnant, use an effective form of birth control. You must be using a highly reliable birth control method if you are taking certain medications to prevent stroke.
Everyone can be at risk of stroke. Some risk factors are outside of your control. Others are associated with medical conditions or lifestyle habits. Some of these risk factors can be controlled. If you have one or more modifiable risk factors, we will work closely with you to minimize your risk and prevent a stroke.
If you have suffered a stroke, we will work with you to control or minimize your modifiable risk factors. These controllable risk factors include the following:
Women with a history of stroke may be at higher risk for another stroke if they become pregnant. If you are a woman of childbearing age (15 to 49) and have had a stroke, use a highly reliable form of birth control and discuss any plans for pregnancy with us before trying to conceive.
There are a number of steps you can take to prevent a stroke, or a further stroke, from occurring:
If your blood pressure is high (more than 140/90), we will work with you to help you eat better and maintain a healthy weight, take medication, stop smoking, and get more exercise.
We treat elevated cholesterol, especially elevated LDL (known as bad cholesterol) with statin type drugs that have been shown to reduce the risk of subsequent stroke. The target LDL cholesterol for patients who have had a previous ischemic stroke or TIA is less than 100. If you have diabetes and have had a TIA or ischemic stroke, then your LDL should be less than 70.
Stopping smoking reduces the relative risk of stroke by about 30 percent immediately. Within just a few years after quitting, your stroke risk will be the same as for nonsmokers.
A variety of medications are commonly used to reduce the chances of blood clots forming and thus reduce the risk of ischemic stroke. These include:
If you or someone you are with has symptoms of stroke, call 911 and seek care immediately at the closest emergency room. Don't wait. Stroke is an emergency, just like a heart attack. The sooner you are treated, the better your outcome is likely to be.
When you come in to our Emergency Department, you will be evaluated by a member of our stroke team, which will oversee your care. Our stroke team consists of emergency room physicians, neurologists, and internists who specialize in hospital-based medicine (called “hospitalists”).
If you are able to recover fully in the Emergency Department, you may be able to go home. Before we discharge you, we will schedule an appointment with your personal physician. He or she will assess your risk factors for stroke, perform a physical examination, review the tests done in the Emergency Department, and decide whether to order additional brain imaging studies and lab work to assess your risk for transient ischemic attacks (TIAs) or strokes in the future.
If you had a stroke, depending on your symptoms, we will consult with a number of clinicians who specialize in helping patients recover. Speech therapists will assess your ability to swallow foods and liquids safely, physical therapists will evaluate you to plan or begin your rehabilitation, and nurses will monitor you for any changes or complications. We will prescribe the most appropriate anticlotting medication for you to take and educate you about how to take it. To prevent further strokes, we may order diagnostic imaging tests. Depending on the results, we may recommend surgery to prevent further strokes. We may perform the surgery while you are still in the hospital, or we may schedule it for a later date.
When you are ready to be discharged from the hospital, we will schedule a follow-up appointment with your personal physician. We may also schedule appointments with other specialists and clinical providers, depending on your specific needs. These may include continued physical therapy and speech therapy appointments. Your personal physician will manage your care once you are discharged.
If there are questions about your symptoms or the results of the tests that were done in the hospital or the Emergency Room, you may be referred for outpatient consultations with me or someone in the Neurology department. Personal physicians work closely with neurologists to ensure that patients who are recovering from stroke, or at risk of stroke, are monitored closely. Your personal physician will schedule a referral appointment for you while you are still in the office, or if that is not possible, we will call you to make arrangements.
In some cases, your personal physician may call me or one of my colleagues while you’re in the office so we can all discuss your care together. If we decide you need an appointment with me after our discussion by phone, we can usually schedule it the same day.
During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.
If we decide that surgery is an appropriate option, I will refer you to a vascular surgeon, who will evaluate you to see whether you are a candidate for surgery. If you and your surgeon decide to proceed, he or she will discuss the procedure with you, including how to prepare, what to expect on the day of the surgery, and how long it is likely to take you to recover.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.