EIGHT MONTHS AGO during a routine follow-up visit, a patient of mine surprised me when she started tearing up after I asked her a simple question: "How have you been doing?"

Her life has not been the same since she suffered a stroke 10 months ago, a stroke that made her speech slurred and left side weak. "My memory and focus are betraying me," she lamented.

She could not use her left arm as well as she used to, and worse, she could no longer drive. Overall, she felt like a burden on her family. She missed her job as a receptionist at a local company, but mostly, she missed the people she worked with.

She was a lively lady in her early 60s and enjoyed her friends and family--especially her grandchildren. However, now, with the consequences of the stroke, her social and emotional life was taking a toll. She felt physically disabled, but it was the emotional part that was the hardest on her, as is the case with many stroke patients.

She felt that she was losing her will and drive to carry on the activities that she enjoyed in the past. And it became more difficult to go back to the routines she had gotten used to at home and in the community.

I thought about all the medical reasons to treat her, as I do with all my patients. She is a stroke survivor, as we call them, and therefore it was my responsibility to make sure that all her risk factors were addressed and managed adequately. This is in order to ensure that a second stroke does not occur.

It is what we call secondary stroke risk factors modifications or reductions. We make sure that the patient has:

Optimal blood pressure control

Optimal diabetes control

Optimal weight and lipids (cholesterol and fat) profile

Smoking cessation plan, if the patient smokes

Daily exercise (walking for 30 minutes a few days a week).

This plan also includes evaluating and treating obstructive sleep apnea and cardiac disease, to name a few other risk factors that are relevant to some patients.

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