How Well Can Coumadin Prevent Transient Ischemic Attacks?
Coumadin is a potent blood thinner, so how effective is it at preventing a transient ischemic attack, also known as a TIA?
“The only time that I would recommend Coumadin for TIA or stroke prevention would be if the patient has atrial fibrillation, which is a cardiac rhythm abnormality,” says Rob Lapporte, MD, who is board certified in emergency medicine.
Dr. Lapporte continues, “Studies show that in most other instances, the risks of hemorrhage while on Coumadin outweigh the benefits. Antiplatelet drugs like aspirin, Plavix and Aggrenox are better choices.”
But risks aside, from the standpoint of preventing a TIA, just how effective is Coumadin (also known as warfarin)?
The verdict isn’t clear-cut on this. Some studies show that Coumadin is more effective than aspirin at preventing a stroke, and other studies indicate that aspirin is the winner here.
Bottom line, nobody really knows the answer to this question.
The standard of medical practice is that in elderly people with atrial fibrillation, they are often (not always) prescribed Coumadin.
In these patients, the benefits of this blood thinner outweigh the risks (internal bleeding).
That’s because when old age is combined with atrial fibrillation, the risk of stroke or its forerunner, TIA, is greatly amplified.
Transient Ischemic Attack Symptoms
- Vision problems including double or blurry
- Slurred speech or trouble forming words
- One-sided weakness in an arm or leg
- One-sided facial or limb paralysis or weakness
- One side of the face drooping
- Confusion, cognitive change, difficulty understanding speech
- Clumsiness, feeling off-balance or a heaviness on one side of the body
- Severe headache
- These symptoms are all sudden-onset
A-fib can cause pooling of blood in the heart, leading to clots that then travel by way of carotid arteries into the brain, where they can lodge in a blood vessel and shut off oxygen to the part of the brain that the vessel supplies: anything from a 10-second TIA to a massive stroke.
Coumadin thins the blood and hence reduces its ability to form clots.
Dr. Lapporte has been practicing evidence-based clinical medicine in emergency rooms and urgent care centers for 25+ years. His experience includes that of medical director for Legacy ER and Urgent Care.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Monkey Business Images
Can an MRI Show a Transient Ischemic Attack?
Just how effective is an MRI at detecting a transient ischemic attack or TIA?
Well, when compared to a CT scan, an MRI “is more sensitive when evaluating someone for a TIA or stroke,” says Rob Lapporte, MD, who is board certified in emergency medicine.
But neither the MRI nor CT scan can literally show that a transient ischemic attack occurred, continues Dr. Lapporte.
However, an MRI “can be helpful in a TIA workup in two ways,” he says.
“One, if the MRI shows evidence of an infarct [tissue death from blocked blood supply] or hemorrhage, then it rules out a TIA. This patient would now be diagnosed with a stroke.
“Two, if the MRI does not show any evidence of acute infarct or hemorrhage, and the symptoms are consistent with a TIA, the diagnosis can be made.”
A transient ischemic attack, due to its temporary nature, will not result in tissue death.
The clot that transiently blocks blood supply dissolves before an infarct can happen.
A hemorrhage results from a hemorrhagic type of stroke, and a TIA is not related to this kind of stroke.
A TIA is sometimes called a mini-stroke, and it is the transient or temporary version of an ischemic stroke. Ischemia refers to insufficient supply of blood.
Though an MRI is more sensitive than a CT scan at revealing signs that a TIA probably occurred (due to ruling out signs of a stroke or brain bleed, in combination with evaluating symptom descriptors from the patient), Dr. Lapporte points out that the MRI “is more time consuming and labor intensive.”
Conclusion
“There is no test for TIA,” states a report in Practical Neurology (2014 Feb; 14(1): 23-31).
The report adds that “the gold standard remains assessment as soon as possible by a clinical expert.”
Dr. Lapporte has been practicing evidence-based clinical medicine in emergency rooms and urgent care centers for 25+ years. His experience includes that of medical director for Legacy ER and Urgent Care.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Duet PandG
Source: ncbi.nlm.nih.gov/pmc/articles/PMC3913122/
Can a CT Scan Detect a Recent Transient Ischemic Attack?
Is it possible for a CT scan to show a recent TIA (transient ischemic attack)?
Wouldn’t it be great if a TIA could leave “footprints” that can be seen on a CT scan?
This way, a doctor can point to the “footprints” and tell the patient with conviction, “Yes, you had a transient ischemic attack,” or, “You did NOT have a TIA.”
The answer to whether a CT scan can detect a recent TIA is “Yes and no,” says Rob Lapporte, MD, who is board certified in emergency medicine.
“A CT scan is useful in the workup for TIA in two ways,” explains Dr. Lapporte.
First if all is “if the CT scan shows evidence of an infarct or hemorrhage, then it rules out a TIA.”
An infarct refers to a localized area of tissue that has died from lack of blood (oxygen).
So in scenario #1, the patient is then diagnosed with a stroke. In the second way that a CT scan can help in diagnosing a TIA, the scan does not show evidence of an acute infarct or hemorrhage, continues Dr. Lapporte.
In addition to that, the symptoms of the patient “are consistent with a TIA,” and the diagnosis of transient ischemic attack is made.
Dr. Lapporte adds, “If you’re asking if you can ‘see’ a TIA on a CT scan, the answer is no. It’s a clinical diagnosis.”
Summary
“There is no test for TIA,” states a study appearing in Practical Neurology (2014 Feb; 14(1): 23–31).
The paper adds that “the gold standard remains assessment as soon as possible by a clinical expert.”
Dr. Lapporte has been practicing evidence-based clinical medicine in emergency rooms and urgent care centers for 25+ years. His experience includes that of medical director for Legacy ER and Urgent Care.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Freepik
Source: ncbi.nlm.nih.gov/pmc/articles/PMC3913122/
Can a TIA Cause Disorientation or Loss of Consciousness?
Can sudden-onset unawareness be caused by a transient ischemic attack?
A sudden experience of mental fog or what seems like unawareness to an observer can be quite unsettling — especially to anyone who knows what a transient ischemic attack is.
“Yes, a TIA can cause disorientation, amnesia or even loss of consciousness,” says Rob Lapporte, MD, who is board certified in emergency medicine.
This means that a person can drop to the floor as a result of a TIA, sustaining injury from the fall.
Such an injury could involve the brain from head trauma, or a broken hip from the impact.
Transient ischemic attacks are associated with the following symptoms, all sudden-onset:
- Weakness or a heavy feeling on one side of the body or in a limb
- Numbness or paralysis in a limb, especially on one side
- Clumsy or off-balance gait
- Facial drooping, especially on one side
- Slurred or nonsensical speech
- Difficulty forming words
- Difficulty understanding speech
- Dizziness
- Blurry vision
- Double vision or a partially obstructed visual field
- Mental confusion or trouble with memory
Dr. Lapporte explains, “Think of it this way. The brain has many functions, and every part of the brain requires blood flow to stay functional.
“If any portion of the brain is deprived of blood (therefore, oxygen), it will cease to function properly.
“While this [loss of consciousness, disorientation or unawareness] may not be the most common presentation of a patient with a TIA, it’s certainly possible.”
How possible is unawareness or loss of consciousness from a TIA?
“Loss of consciousness is extremely rare in TIAs (but not impossible),” states a report in Practical Neurology (2014 Feb; 14(1): 23–31).
Much more likely than not, a seemingly sudden loss of consciousness is caused by something other than a TIA, such as a rapid and big drop in blood pressure, or an abnormal heart rhythm.
When a TIA actually does cause a loss of consciousness (and remember, this is very rare), it’s when the blood clot is located in the brainstem or thalamus.
A sudden bout of mental fog, unawareness or some other altered state of consciousness is never normal — even if it is brief — and it may even be a small seizure. A prompt medical evaluation is warranted.
Dr. Lapporte has been practicing evidence-based clinical medicine in emergency rooms and urgent care centers for 25+ years. His experience includes that of medical director for Legacy ER and Urgent Care.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/forma82
Source ncbi.nlm.nih.gov/pmc/articles/PMC3913122/
Can a Headache Be a TIA’s ONLY Symptom?
Is it possible that a headache can be the only symptom of a transient ischemic attack (TIA, mini-stroke)?
Let’s say the headache even lasts just a few minutes.
What are the odds that this could have been a TIA (transient ischemic attack), especially if you have risk factors for one of these mini-strokes?
Headaches and TIAs
“Approximately 25% of all TIAs present with headache as a prominent complaint, and yes, it can be the only symptom of a TIA,” begins Rob Lapporte, MD, who is board certified in emergency medicine.
“However, this is rare. Usually there is a speech deficit or a motor deficit, such as weakness or facial droop.”
So for instance, a sudden-onset headache that comes at the same time as double vision, in a person who has risks for a transient ischemic attack, are very worrisome symptoms.
This individual should go to the ER as soon as possible, even if the headache and visual disturbance last for only 10 seconds!
Very short duration of TIA symptoms is NOT related to the seriousness of the underlying cause.
So whether that headache, coupled with some other neurological symptom such as one-sided heaviness, lasts only 10 seconds or 30 minutes, the urgency to get to an ER is the same.
A sudden headache that’s full force, like a thunderclap, is a warning to get to the ER as soon as possible—and by ambulance.
This is far more likely to be the immediately life-threatening burst blood vessel in the brain (ruptured aneurysm or hemorrhagic stroke), than a transient ischemic attack or ischemic stroke.
Risk factors and ways to reduce the possibility of having a TIA are the same as that for a stroke, such as controlling blood pressure, structured exercise and not smoking.
And remember, headaches can have many causes.
Dr. Lapporte has been practicing evidence-based clinical medicine in emergency rooms and urgent care centers for 25+ years. His experience includes that of medical director for Legacy ER and Urgent Care.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: Shutterstock/Ruslan Huzau
Can Strength Training Prevent Sciatica?
If you’re worried about developing the painful condition of sciatica, and you haven’t been strength training — it’s time to hit the gym and lift those weights.
It’s yet one more benefit to weight workouts: lowering the risk of ever ending up with a nerve problem.
“Some ways to prevent sciatic pain definitely includes strength training of core muscles to help increase stability,” explains Dr. Jeff Langmaid, DC, founder/owner of The Evidence Based Chiropractor, LLC, in Tampa, FLA, a research-based marketing and practice growth company that serves thousands of chiropractors across the globe.
Dr. Langmaid continues, “It’s also important to incorporate flexibility exercises into your routine.
“Strengthening your core muscles can help support your lumbar spine. Core stability and support can decrease the likelihood of an episode of sciatic pain.
“Strength training and core muscles are extremely important, but don’t forget also to temper that with flexibility.
“Our body functions at its optimal potential when we are able to have proper strength and flexibility.”
Strength Training Recommendations for Sciatica Pain Prevention
“Regarding weightlifting and sciatic pain, I recommend a focus more on repetition rather than excessive load,” says Dr. Langmaid.
This means 25 reps with a medium-weight kettlebell, for example, instead of eight reps with a super heavy giant kettlebell.
“You don’t want to perform max load exercise – rather, perform strength training exercises with light weights and more repetitions.”
Another example is a 15 rep deadlift routine. Fifteen reps would be done with a medium or light load of weight.
As with the kettlebell swing, proper form is very important with the deadlift.
Shutterstock/Maridav
Dr. Langmaid continues, “Increasing repetition of strength training exercises goes hand-in-hand with core stability.
“This can help prevent sciatic pain. Strength training with maximum load can increase the likelihood of sciatic injury.”
Among the best strength training exercises for preventing sciatica pain are the following: deadlift, bent-over dumbbell row, seated row, kettlebell swing, corner row, pushup, pushup-row and squat.
Freepik.com/fxquadro
Though these are classic weight training moves, every one of them strengthens the core. Your sciatic nerve will thank you!
Jeff Langmaid, DC
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Zennis Se/Pexels
Can Stabbing Sciatica Pain Come on Suddenly?
You can be simply bending over to tie a shoe when suddenly a sharp pain rips down your leg and takes your breath away. Sciatica can be the cause of this.
“Yes, stabbing sciatic pain can come on suddenly, most commonly due to injury,” says Dr. Jeff Langmaid, DC, founder/owner of The Evidence Based Chiropractor, LLC, in Tampa, FLA, a research-based marketing and practice growth company that serves thousands of chiropractors across the globe.
“Many patients will report bending over to tie shoes or pick up a newspaper and feel the pain,” adds Dr. Langmaid.
Other Passive Actions that Can Bring on Sudden Stabbing Pain Due to Sciatic Nerve Irritation
- Leaning over to put something in or take something out of the dishwasher
- Bending over to fill the dog bowl with food
- Bending over to pet the dog
- Leaning over to shave the lower leg
In fact, any similar motion of trunk/spinal flexion, in which the lower back is bending so that you can reach for something, can induce a sudden stabbing pain — thanks to sciatica.
Yet these are such seemingly very innocuous activities.
Imagine what a more taxing movement might do, such as bowling, picking up a toddler, loading groceries into the trunk of a car, and heavier work such as pulling a sofa closer to the edge of a wall or picking up a box of books.
How can a small, light movement trigger intense sciatica pain?
Dr. Langmaid explains, “Often, decades of repetitive micro-trauma can leave a lumbar disc on the verge of herniating.
“Then, a simple, benign motion such as tying your shoes can cause the disc to herniate [bulge out] and put pressure on the sciatic nerve.
“But don’t forget, sciatic pain can come on acutely or build slowly throughout time.”
The sciatic nerve runs the length of the leg. Shutterstock/Nathan Devery
If you’ve been plagued by periodic bouts of sudden stabs of pain down your leg or in your butt due to sciatica — it’s time to revisit the concept of aggressive conservative treatment and management of the condition.
This includes sticking to a physical therapy and stretching regimen that a physiotherapist can prescribe for you.
Jeff Langmaid, DC
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Freepik.com/8photo
Can Stabbing Sciatica Pain Affect only the Butt?
If you have a stabbing butt pain only, can this be caused by sciatic nerve problems?
Imagine walking around in the house or at a store, or standing in line, when suddenly a stabbing pain surges through your rear-end.
This happens from time to time, and there are no other symptoms. The pain occurs only in your buttocks.
“Stabbing-type sciatic pain indicates the sciatic nerve has been pinched, which can be caused by acute injury or repetitive micro-trauma,” says Dr. Jeff Langmaid, DC, founder/owner of The Evidence Based Chiropractor, LLC, in Tampa, FLA, a research-based marketing and practice growth company that serves thousands of chiropractors across the world.
“It doesn’t have to be limited to the buttocks,” continues Dr. Langmaid.
“It can carry down to the leg, then calf and down to the foot. Sciatic pain can run across through the entire sciatic nerve, although some patients only feel it in one or two places.
“It doesn’t have to just be pain, but can include burning, tingling and the electric leg shock. Sciatic nerve pain is often felt as a result of a lumbar disc herniation.”
A stabbing type of pain that comes on suddenly, whether it is only in your behind, only down a leg and especially both in the butt and leg, is highly suspicious for a pinched or compressed nerve.
This includes the sciatic nerve — a major nerve that runs down the butt and leg, all the way to the foot.
As mentioned, a lumbar disc herniation is the usual cause. The disc bulges out and compresses or “pinches” a nerve that comes out of the spine. The affected nerve is not necessarily the sciatic one.
As for sciatic nerve compression, this can also be caused a little further down in the buttocks by a tight piriformis muscle.
If this muscle presses upon the nerve, it can induce pain, tingling or numbness.
Stretching and strengthening exercises (see below) can help relieve the condition.
Hip extension for the butt.
Stretch for the piriformis muscle. Shutterstock/Maridav
Jeff Langmaid, DC
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Miss Ty
Can Specific Exercises Increase the Risk of a Herniated Disc?
If a spinal disc might easily tear in some people, could certain exercises raise the risk of a herniation?
A herniated disc is when disc material bulges (herniates) out from the spinal column. This puts pressure on nerves.
“At times, our discs can withstand tremendous load and at other times, they can tear like tissue paper,” says Dr. Jeff Langmaid, DC, founder/owner of The Evidence Based Chiropractor, LLC, in Florida, a research-based marketing and practice growth company that serves thousands of chiropractors across the globe.
“They are very strong in some planes of motion and very weak in other planes of motion.
“Exercises that have both twisting and loading are very challenging to a disc and can increase the likelihood of an injury to the disc.
“Some of these exercises may include straight leg raises, deep knee bends or the wood chop, to name a few.”
Exercises that Simultaneously Involve Some Degree of Twisting plus Loading
- Walking lunge while holding a weight and twisting to one side with each step.
- Renegade row (pushups alternating with a dumbbell row)
- Bent-over dumbbell row (most people do twist somewhat when doing this).
- Any oblique-twisting exercise against resistance
- Some yoga routines
If you’re doing something at the gym that involves simultaneously twisting and loading, you may want to rethink your perceived need to do this particular exercise if you’re concerned about a disc herniation.
There actually is no need to simultaneously bare heavy loads and twist, whether your goal is to lose weight, gain muscle or achieve a certain appearance to your physique.
Unless you’re training for a wood chopping competition (and yes, “timber sports” have wood chopping events), do not combine twisting with load bearing.
Also be mindful of what seems to be linear movements that are heavily loaded, such as the leg press.
I knew a fitness director at a gym who “blew out a disc” (herniated it) when he went down very deep in the leg press apparatus, causing his lumbar area to leave contact with the apparatus, while attempting to press up a very heavy load.
Jeff Langmaid, DC
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: BruceBlaus/CreativeCommons
Can Cardio Exercise Prevent Sciatica?
Sciatica is a cause of sudden attacks of severe pain that can shoot down the leg, often starting in the butt.
Cardio exercise is something that you should strongly consider if you’re determined to knock down your chances of ever developing sciatica.
This disorder is very common and involves pressure at some point along the higher portion of the sciatic nerve.
This major nerve extends down the buttocks, continuing down the upper leg and then lower leg.
Cardio Exercise and Sciatica
“Cardio exercise has the potential to indirectly limit or prevent sciatica,” says Dr. Jeff Langmaid, DC, founder/owner of The Evidence Based Chiropractor, LLC, in Tampa, FLA, a research-based marketing and practice growth company that serves thousands of chiropractors all over the world.
He continues: “If you have good cardiovascular fitness, chances are you are maintaining a healthy weight and are staying active.
“Both of those are key contributors to not only preventing sciatica, but overall health and wellness.”
Sciatica does not just happen.
The key is consistent, structured exercise, not irregular or inconsistent bouts of physical activity.
- This means that the periodic pickup basketball games do not count.
- Neither does housework.
Dr. Langmaid continues, “Additionally, many cardiovascular exercises can contribute to core strength and stability.
“For instance, a seated rowing machine is a cardiovascular activity, but provides a strength training component with it that can go a long way towards preventing sciatic pain.
“There are also certain cardio exercises and activities that can increase our flexibility, and the combination of core strength, flexibility and cardiovascular endurance is best together for preventing or limiting sciatica.”
Proper Use of a Treadmill
Walking is a form of aerobic exercise — when done with enough intensity to get the heart rate elevated.
If you use a treadmill, do not hold on. This interferes with natural spinal alignment when walking.
Shutterstock/Khakimullin Aleksandr
When the spine is concerned, you do not want anything less than correct biomechanics when conducting cardiovascular exercise.
If you feel you’re going to fall off unless you hold on, then slow the speed or lower the incline.
Swing your arms so that your upper and lower body move the way nature intended.
In addition to doing consistent cardio activity to help prevent sciatica, you should employ the exercises depicted below.
Freepik.com/yanalya
