N. Tom. Indiana University - Purdue University, Indianapolis.

The addition of the handle to the shaft makes it versatile purchase 50 mcg flonase, with more than 30 blocking and striking techniques available to the officer buy flonase 50 mcg overnight delivery. Correct use in stressful and challenging situ- ations requires extensive and ongoing training flonase 50mcg without prescription. It is carried unobtrusively on the belt and does not impede the general movement of the officer. This gives more weight distally, but it is prone to becoming flattened and rough over time because the baton is closed by striking this end against the ground. The acrylic patrol baton has a solid or hollow nylon shaft with a ring of rubber separating the shaft and handle. It is broader than the friction lock type and, therefore, less likely to cause injury because the imparted energy is spread over a larger area. The heavier weights of these types of batons are used in public order disturbances. In the United States, a 26-in hickory (wooden) straight baton is used (similar to group 3 in the previous list). The situation throughout the Austra- lian states is variable, with intrastate differences relating to specific police staff; for example, plain clothes staff may use an Asp-type baton, whereas uniformed officers are equipped with straight or side-handled batons. Strikes are made from an officer’s strong (dominant) or weak (nondominant) side, and clearly the potential for injury varies with the baton mass and velocity at impact, the target area, and to how much of the surface area the force is applied. Although no body area is absolutely forbidden to strike, an officer must use a proportionate response to the situation he or she faces knowing the potential to injure. Although target areas are divided into low-, medium-, and high-risk areas, maintaining a distinction between them can be difficult because strikes are made in dynamic situations where an initial target area may change as the potential detainee moves. Target areas with a low injury potential are the areas of the common peroneal, femoral, and tibial nerves on the legs and those of the radial and median nerves on the arms. There is a low probability of permanent injury, with the main effects being seen as short-lived motor nerve dysfunction, as in a “dead leg” and bruising. The medium injury potential areas involve bones and joints, including the knees and ankles, wrist, elbow, hands, upper arms, and clavicle. In these cases fractures, dislocations, and more extensive soft tissue injuries would be expected. Finally, those areas with the highest risk of injury include the head, neck and throat, spine, kidneys, and solar plexus. The most common injury is bruising, and this is often in the pattern of so-called “tramline bruising,” where two parallel lines of bruising are sepa- rated by a paler area. This is not unique to a baton injury but reflects an injury caused by any cylindrical hard object. The absence of bruising or other find- 200 Page ings does not mean that a baton was not used because, for example, a degree of cushioning can occur from clothing. It is possible for a detainee to have signs but minimal symptoms or even be unaware of being struck. Fractures need to be considered where there are the traditional clinical signs of local pain, swelling, and loss of function. Considering the forces that can be applied when necessary, there is the potential for significant injury with bruising and rupture of internal organs, including the heart, liver, spleen, or kidneys or a head injury. The forensic physician should refer suspected cases for hospital review without delay, es- pecially if a confirmatory history for events is unavailable. Particular care is needed in those who are intoxicated because they are difficult to assess. Because they cannot be released them- selves, snips to cut them are always available at the same time. Although quick and easy to apply, they have no way of being locked in position, so they can tighten in an uncontrolled manner, resulting in direct compression injuries. At least two ties are used on each detainee; one is placed on each wrist and then interlocked with the other. These plastic constraints are used in preplanned operations, where numerous arrests are expected or in special- ized operations. Excessive force, either directly applied by the officer or from a detainee continuing to move, can result in strains to joints, such as the wrist, elbow, and shoulder. Officers in the United Kingdom are not trained in any neck holds because of the high risk of serious injury or death as a result of large blood vessel or airway compression. Fatalities can occur quickly, and if a detainee complains of such holds being used, the neck should be examined carefully. Petechial bruising should be looked for in the face, particularly in and around the eyes, on the cheeks, and behind the ears. It is common for clothing to be held in a struggle to restrain, which may tighten it around the neck. Linear bruising Medical Issues of Restraint 201 may be seen at the site of tightening, as well as petechial bruising on the neck and above on the face. Clearly, the tactical firearms units are often required in these situations, but there is an increasing trend to look for other “nonlethal” options, which will incapacitate with a lower risk of serious injury. In the United Kingdom, the investigation of firearm inci- dents under the auspices of the Police Complaints Authority with its attendant recommendations is a major influence when looking at developments in this area (7). Different countries use different restraint equipment, such as water cannon or the firing of different projectiles (e. They were first introduced in Northern Ireland in 1970; 125,000 rounds have been fired, and 17 fatalities have resulted, the last one occurring in 1989. With time, the delivery systems have improved, and this is reflected in the mortality figures. In June 2001, the L21A1 baton round was introduced to replace the “plastic bullet” in combina- tion with a new baton gun and optical sight (L104 baton gun). This gives much better accuracy, both decreasing the chances of dangerous inaccurate direct impacts and avoiding hitting unintended persons. When used in situations of public order, they are fired at ranges between 20 and 40 m, with the target being the belt buckle area. The aim is to hit the individual directly and not bounce the baton around before this, because this will both cause the projectile to tumble around its axes, making injury more likely, and decrease the accuracy of the shot. Injuries are mainly bruises and abrasions, with fewer lacerations, depending on how and where the body is hit. More serious injuries are possible, with occasional fractures and contu- sions to internal organs. Although intra-abdominal injury is unusual, impacts to the chest can give rib fractures and pulmonary contusions. As an alternative to using armed response against those who may use firearms or where there is major risk to life, the baton round can be used within a 1-m range. This system has a projectile with a tail and is smaller and faster than the baton round. The injury pattern will be similar, but if the projectile becomes unstable in flight so that the surface area striking the target is smaller (because of altered orientation), then the potential for injury is increased. Swift’s Electri- cal Rifle,” or Taser (8–10), is a small hand-held, battery-powered device allowing the transmission of pulsed high-voltage shocks to a person along fine wires fired from the front of the unit. Onset is almost instant, providing the circuit is com- pleted from Taser to target with an accurate weapon discharge. Either com- pressed nitrogen or a rifle primer acts as a propellant to fire two barbs from the front of the unit to the skin or clothing of the individual requiring restraint. The barbs remain attached to the unit by lengths of wire to a maximum range in some units of 6. This increased separation gives more effect from the 50,000-V shocks as more muscle groups are affected. The barbs are not barbed like a fish hook but only have small projections on them. The generalized involuntary muscular contractions produced by the Taser result in victims falling in a semicontrolled fashion. There is a poten- tial for injuries depending on the exact nature of the fall, but normally, recovery is prompt and uneventful. In the target areas of the torso and legs, there are few complications, but a direct hit on the eye could cause a pen- etrating injury, requiring urgent specialist assessment, and superficial blood vessels elsewhere could be punctured. Taser usage has been associated with fatalities, although the exact cause is not known. Nearly all who died in one study either had taken drugs (phen- cyclidine, amphetamine, or cocaine), had heart disease (that may only be found postmortem) or had other contributing injuries.

The top of the throat con- sists of these key parts: Chapter 8: Oxygenating the Machine: The Respiratory System 135 Pharynx: The pharynx is an oval buy generic flonase 50 mcg line, fibromuscular sac about 5 inches long and tapering to 1⁄2 inch in diameter at its anteroposterior end discount flonase 50mcg amex, which is a fancy biology term meaning “front to back buy cheap flonase 50mcg on-line. On the back wall of the pharynx is a mass of lymphoid tissue called the pharyngeal tonsil, or adenoids. Larynx: Connecting the pharynx with the trachea, this collection of nine carti- lages is what makes a man’s prominent Adam’s apple. Also called the voice box, the larynx looks like a triangular box flattened dorsally and at the sides that becomes narrow and cylindrical toward the base (see Figure 8-3). Ligaments con- nect the cartilages controlled by several muscles; the inside of the larynx is lined with a mucous membrane that continues into the trachea. Three of the larynx’s nine cartilages go solo — the thyroid, the cricoid, and the epiglottis — while three more come in pairs — the arytenoids, the corniculates, and the cuneiforms. The thyroid cartilage (thyroid in Greek means “shield-shaped) is largest and consists of two plates called laminae that are fused just beneath the skin to form a shield-shaped process, the Adam’s apple. Immediately above the Adam’s apple, the laminae are separated by a V-shaped notch called the superior thyroid notch. The ring- shaped cricoid cartilage is smaller but thicker and stronger, with shallow notches at the top of its broad back that connect, or articulate, with the base of the arytenoid car- tilages. The arytenoid cartilages both are shaped like pyramids, with the vocal folds attached at the back and the controlling muscles that move the arytenoids attached at the sides, moving the vocal cords. On top of the arytenoids are the corniculate carti- lages, small conical structures for attachment of muscles regulating tension on the vocal cords. Nestled in front of these and inside the aryepiglottic fold, the cuneiform cartilages stiffen the soft tissues in the vicinity. The epiglottis, sometimes called the lid on the voice box, is a leaf-shaped cartilage that projects upward behind the root of the tongue. Attached at its stem end, the epiglottis opens during respiration and reflex- ively closes during swallowing to keep food and liquids from getting into the respira- tory tract. When talking, the folds stretch for high sounds or slacken for low sounds, causing the opening into the glottis — the opening in the larynx — to form an oval. Just above these folds are the ventricular vocal folds, also known as vestibular or false folds, that don’t produce sounds. Use the terms that follow to identify the structures of the larynx shown in Figure 8-3. Corniculate cartilage Going deep inside the lungs After the pharynx and larynx comes the trachea, more popularly known as the wind- pipe. Roughly 6 inches long in adults, it’s a tube connected to the larynx in front of the esophagus that’s made up of C-shaped rings of hyaline cartilage and fibrous connec- tive tissue that strengthen it and keep it open. Just above the heart, the trachea splits into two bronchi divided by a sharp ridge called the carina, with each leading to a lung. But they’re not identical: The right primary bronchus is shorter and wider than the left pri- mary bronchus. Each primary bronchus divides into secondary bronchi with a branch going to each lobe of the lung; the right side gets three secondary bronchi while the left gets only two. Once inside a designated lobe, the bronchus divides again into terti- ary bronchi. The right lung has ten such branches: three in the superior (or upper) lobe, two in the middle lobe, and five in the inferior (or lower) lobe. The left lung has only four tertiary bronchi: two in the upper lobe and two in the lower lobe. Each tertiary bronchi subdivides one more time into smaller tubes called bronchioles (see Figure 8-4), which lack the supporting cartilage of the larger structures. Each bronchiole ends in an elongated sac called the atrium (also known as an alveolar duct or alveolar sac). Alveoli (or air cells) surround the atria, as do small capillaries that pick up oxygen for delivery elsewhere in the body and dump off carbon dioxide fetched from elsewhere. Overall, there are 23 branches in the respiratory system, with a combined surface area (counting the alveoli) the size of a tennis court! Knowing that the bronchi aren’t evenly distributed, you may have guessed that the lungs aren’t identical either. They’re both spongy and porous because of the air in the sacs, but the right lung is larger, wider, and shorter than the left lung and has three lobes. The left lung divides into only two lobes and is both narrower and longer to make room for the heart because two-thirds of that organ lies to the left of the body’s midline. Each lobe is made up of many lobules, each with a bronchiole ending in an atrium inside. Covering each lung is a thin serous membrane called the visceral pleura that folds back on itself to form a second outer layer, the parietal pleura, with a pleural cavity between the two layers. These two layers secrete a watery fluid into the cavity to lubricate the surfaces that rub against each other as you breathe. When the pleural membrane becomes inflamed in a condition called pleurisy, a sticky discharge roughens the pleura, causing painful irritation. An accompanying bacterial infection means that pus accumulates in the pleural cavity in a condition known as empyema. The pulmonary trunk comes from the right ventricle of the heart and then branches into the two pulmonary arteries carrying venous blood (the only arteries that contain blood loaded with carbon dioxide from various parts of the body) to the lungs. That blood goes through capillaries in the lungs where the carbon dioxide leaves the blood and enters the alveoli to be expelled during exhalation; oxygen leaves the alveoli through the capillaries to enter the bloodstream. After that, oxygenated arterial blood returns to the left atrium through the pulmonary veins (the only veins that contain oxygenated blood), completing the cycle. Bronchial arteries branch off the thoracic aorta of the heart, supplying the lung tissue with nutrients and oxygen. Fill in the blanks to complete the following sentences: The trachea divides into two 55. If a pin were to pierce the body from the outside in the thoracic region, the third structure it would reach would be the a. Use the terms that follow to identify the structures of the bronchiole shown in Figure 8-4. Inhaling metal and mineral dust can be particularly harmful because the particles cut into and embed themselves in delicate lung tissue, leaving nonfunctional and less pliable scar tissue. Specific lung conditions include Silicosis, commonly found among construction workers, is caused by deposits of sand particles in the lungs. Rhinitis, or the common cold, can be caused by several different kinds of viral infections. Undue exposure may activate the virus or cause the body to become more susceptible to the virus. Inflammation of the pleura membrane Chapter 8: Oxygenating the Machine: The Respiratory System 141 Answers to Questions on the Respiratory System The following are answers to the practice questions presented in this chapter. Yes, the human body’s two greatest needs are to inhale oxygen and to exhale carbon dioxide. Remember that the Latin root for blood is hemo; none of the other answer options incorporate that root. The rates in the other answer options are more akin to pulse rates or blood pressures than to average respirations per minute. Gaseous exchange in lungs m Which of the following statements about the mucous membranes of the nasal cavity is not true? Left lung F The vocal folds change position by the movement of the cartilage known as c. These sacs are the smallest parts of the lungs, so it makes sense that molecular exchange would take place here. Note that the question asks you to choose from the list provided, not from the entire structure of the body. Chapter 9 Fueling the Functions: The Digestive System In This Chapter Getting down and dirty with digestion basics Examining the mouth Spending time in the stomach Passing through the intestines and other organs for enzyme digestion t’s time to feed your hunger for knowledge about how nutrients fuel the whole package Ithat is the human body. In this chapter, we help you swallow the basics about getting food into the system and digest the details about how nutrients move into the rest of the body.

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It may be that other unresolved issues are interfering with successful ad- aptation to the relocation cheap flonase 50mcg without prescription. The individual no longer exhibits signs of anxiety order flonase 50 mcg line, depres- sion order flonase 50mcg mastercard, or somatic symptoms. The individual willingly participates in social and vocational activities within his or her new environment. Many of the behaviors have adverse or even destruc- tive consequences for the individuals affected, and seldom do these individuals know why they do what they do or why it is pleasurable. The individual is unable to resist an impulse, drive, or temptation to act in a way that is harmful to the person or others. The individual experiences an increasing sense of tension or arousal before committing the act and pleasure, gratification, or relief at the time of committing the act. Some clients report changes in sensorium, such as confusion during an episode or amnesia for events that occurred during an episode. Symptoms usu- ally appear suddenly without apparent provocation and ter- minate abruptly, lasting only minutes to a few hours, followed by feelings of genuine remorse and self-reproach about the behavior. Often the stolen items (for which the individual usually has enough money to pay) are given away, discarded, returned, or kept and hidden. The individual with kleptomania steals purely for the sake of stealing and for the sense of relief and gratification that follows an episode. The preoccupation with gambling, and the impulse to gamble, in- tensifies when the individual is under stress. Many pathological gamblers exhibit characteristics associated with narcissism and grandiosity and often have difficulties with intimacy, empathy, and trust. Motivation for the behavior is self- gratification, and even though some individuals with pyromania may take precautions to avoid apprehension, many are totally indifferent to the consequences of their behavior. The impulse is preceded by an increasing sense of tension, and the individual experiences a sense of release or gratification from pulling out the hair. A familial tendency appears to be a factor in some cases of intermittent explosive disorder and patho- logical gambling. Brain trauma or dysfunction and mental retardation have also been implicated in the predisposi- tion to impulse control disorders. Various dysfunctional family patterns have been suggested as contributors in the predisposition to impulse control disorders. These include the following: • Child abuse or neglect • Parental rejection or abandonment • Harsh or inconsistent discipline • Emotional deprivation • Parental substance abuse • Parental unpredictability Symptomatology (Subjective and Objective Data) 1. Increasing tension before committing the theft, followed by pleasure or relief during and following the act 6. The need to gamble or loss of money interferes with social and occupational functioning 11. Increasing tension followed by a sense of release or gratifica- tion from pulling out the hair 15. Impulse Control Disorders ● 259 Related/Risk Factors (“related to”) [Possible familial tendency] [Dysfunctional family system, resulting in behaviors such as the following: Child abuse or neglect Parental rejection or abandonment Harsh or inconsistent discipline Emotional deprivation Parental substance abuse Parental unpredictability] Body language (e. Long-term Goal Client will not harm others or the property of others (time dimension to be individually determined). Be honest, keep all promises, and con- vey the message that it is not the person but the behavior that is unacceptable. Maintain low level of stimuli in client’s environment (low lighting, few people, simple decor, low noise level). A stimu- lating environment may increase agitation and promote aggressive behavior. Make the client’s environment as safe as possible by removing all potentially dangerous objects. Because of weak ego development, client may be unable to use ego defense mechanisms correctly. Helping him or her recognize this in a nonthreatening manner may help reveal unresolved issues so that they may be confronted. Help client recognize the signs that tension is increasing and ways in which violence can be averted. Activities that require physical exertion are helpful in relieving pent-up tension. Explain to the client that should explosive behavior occur, staff will intervene in whatever way is required (e. This conveys to the client evidence of control over the situation and provides a feeling of safety and security. The client is able to verbalize the symptoms of increasing tension and adaptive ways of coping with it. Related/Risk Factors (“related to”) [Central nervous system trauma] [Mental retardation] [Early emotional deprivation] [Parental rejection or abandonment] [Child abuse or neglect] [History of self-mutilative behaviors in response to increasing anxiety: hair-pulling, biting, head-banging, scratching] Goals/Objectives Short-term Goals 1. Client will cooperate with plan of behavior modification in an effort to respond more adaptively to stress (time dimen- sion ongoing). Intervene to protect client when self-mutilative behaviors, such as head-banging or hair-pulling, become evident. A helmet may be used to protect against head-banging, hand mittsto prevent hair-pulling, and appropriate padding to pro- tect extremities from injury during hysterical movements. Try to determine if self-mutilative behaviors occur in re- sponse to increasing anxiety, and if so, to what the anxiety may be attributed. Assist with plan for behavior modification in an effort to teach the client more adaptive ways of responding to stress. Encourage client to discuss feelings, particularly anger, in an effort to confront unresolved issues and expose internalized rage that may be triggering self-mutilative behaviors. Offer self to client during times of increasing anxiety, to pro- vide feelings of security and decrease need for self-mutilative behaviors. Anxiety is maintained at a level at which client feels no need for self-mutilation. Client demonstrates ability to use adaptive coping strategies in the face of stressful situations. Long-term Goal Client will be able to delay gratification and use adaptive coping strategies in response to stress (time dimension to be individu- ally determined). Often these individuals rationalize to such an extent that they deny that what they have done is wrong. Client must come to under- stand that certain behaviors will not be tolerated within the society and that severe consequences will be imposed on those individuals who refuse to comply. Encourage client to explore how he or she would feel if the circumstances were reversed. An attempt may be made to enlighten the client to the sensitivity of others by promoting self-awareness in an effort to assist the client gain insight into his or her own behavior. Throughout relationship with client, maintain attitude of “It is not you, but your behavior, that is unacceptable. Rewards and positive feedback enhance self-esteem and encourage repetition of desirable behaviors. Help client identify and practice more adaptive strategies for coping with stressful life situations. The impulse to perform the maladaptive behavior may be so great that the client is unable to see any other alternatives to relieve stress. Client is able to demonstrate techniques that may be used in response to stress to prevent resorting to maladaptive impul- sive behaviors. Client verbalizes understanding that behavior is unaccept- able and accepts responsibility for own behavior. This category differs from somatoform disorders and conversion disorders in that there is evidence of either de- monstrable organic pathology (e. Selye (1956) believed that psychophysi- ological disorders can occur when the body is exposed to prolonged stress, producing a number of physiological effects under direct control of the pituitary-adrenal axis. He also suggests that genetic predisposition influences which organ system will be affected and determines the type of psychophysiological disorder the individual will develop. It has been hypothesized that individuals exhibit specific physiological responses to certain emotions. For example, in response to the emo- tion of anger, one person may experience peripheral va- soconstriction, resulting in an increase in blood pressure.

Wean off caffeine slowly to avoid with- drawal symptoms discount flonase 50mcg fast delivery, which can worsen anxiety buy 50 mcg flonase. Lifestyle Suggestions • Develop a positive attitude toward life’s many challenges and work on managing anger and hostility purchase flonase 50 mcg fast delivery. Many smokers light up when they are stressed, but smoking actually wors- ens stress and causes nervous system damage. Top Recommended Supplements B-vitamins: Essential for nervous system and adrenal function; a deficiency can cause anxi- ety and worsen the response to stress. Dosage: Look for a product that provides 50–100 mg of the B-vitamins and take daily. Calcium and Magnesium: Promote calming and relaxation, and support muscle and nerve function. Lactium: A milk protein that contains bioactive peptide with anti-stress properties. Several studies have shown that Lactium can help reduce the physical and mental effects and symp- toms of stress. Complementary Supplements Panax ginseng: An adaptogenic herb that helps reduce the response to stress. It also sup- ports physical and mental performance, immune function, and adrenal gland function, all of which can be hampered by stress. Relora: A combination of magnolia and phellodendron, which reduces stress without caus- ing drowsiness. It also helps in the production of important neurotransmitters that are required for mood and proper sleep, and it provides support for cardiovascular and immune function. Eat a healthy diet that is rich in vegetables, fruits, legumes, nuts, and seeds, and choose lean protein and healthy fats. Reduce or eliminate processed fast foods, caffeine, refined starches, sugar, alcohol, and tobacco. Areas of the brain commonly affected by stroke are those that control movement, speech, vision, and sensation. Stroke is a medical emergency that requires immediate treat- ment to minimize damage to the brain and disability. They occur when blood clots or other particles block arter- ies to your brain and cause severely reduced blood flow (ischemia). This deprives your brain cells of oxygen and nutrients, and cells may begin to die within minutes. This can result from a number of conditions that affect your blood vessels, such as uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). S Stroke is a major cause of death in Canada, but your chance of surviving a stroke today is much greater than it was a few decades ago. About half of all people who have a stroke recover to some degree, although about one-third of first strokes are fatal, so early detection and prevention are critical. It causes the same signs and symptoms as a stroke, but it lasts for a short time (few minutes to hours) and then disappears. Weakness: Sudden loss of strength or sudden numbness in the face, arm, or leg, even if temporary. Trouble speaking: Sudden difficulty speaking or understanding or sudden confusion, even if temporary. This drug can improve your chances of a full recovery, but it is effective only if given within three hours of initial symptoms. This drug does not work for hemorrhagic stroke, and can actually worsen the problem. If you are at risk of ischemic stroke, your doctor may give you anti-coagulant drugs, such as warfarin (Coumadin) or anti-platelet drugs such as aspirin, clopidogrel (Plavix), or ticlopidine (Ticlid). A carotid endarterectomy involves an incision in your neck to expose your carotid artery and remove the plaques. This involves insertion of a balloon-tipped catheter into the obstructed artery to open it up. Surgical procedures can be done for the treatment and prevention of hemorrhagic S stroke. Aneurysm clipping involves placing a tiny clamp at the base of the aneurysm to keep it from bursting. Dietary Recommendations Foods to include: • Boost fibre intake by eating lots of whole grains, vegetables, fruits, beans, nuts, and seeds, which will help lower cholesterol levels, improve blood sugar control (essential to prevent diabetes), and help with weight management. Colourful fruits and vegetables contain an- tioxidants that help reduce the risk of atherosclerosis and heart disease. Apples, oranges, tomatoes, and bananas are a particularly good source of potassium, which can help lower blood pressure. Try to eat three servings per week of fresh cold-water fish such as salmon, trout, herring, mackerel, and tuna. Nuts contain fibre and nutrients such as vitamin E, alpha-linolenic acid, magnesium, potassium, and arginine, which are important for heart health. Although nuts are high in calories, some studies have found that increasing nut consumption by several hundred calories per day does not cause weight gain. Substituting as little as 20 g per day of soy protein for animal protein can significantly lower cholesterol. Foods to avoid: • Foods high in cholesterol should be minimized (organ meats, egg yolks, and whole milk products). S • High-glycemic foods (white bread and refined starches) raise blood sugar levels and in- crease the risk of diabetes. Avoid adding salt to foods and minimize eating processed and fast foods such as deli meats, snacks (chips, pretzels), french fries, and burgers. Conversely high potassium intakes have been associated with a lower risk of stroke. Some of the protective effects of potassium lie in its ability to lower blood pres- sure. Foods high in potassium include bananas, potatoes, oranges, raisins, artichokes, avocados, spinach, nuts, seeds, lima beans, cod, chicken, and salmon. Smoking contributes to atherosclerosis, increases the risk of blood clots, reduces the oxygen in your blood, increases your blood pressure, and makes your heart work harder. Losing even 5–10 percent of excess weight can lower cholesterol and blood pressure. Moderate-intensity activities, such as brisk walking, biking, or swim- ming, can reduce cholesterol and blood pressure and help with weight management. If you have diabetes or are at risk for diabetes, work on improving your blood sugar levels with exercise and a low-glycemic diet. Top Recommended Supplements Citicoline: A form of the B-vitamin choline that has neuroprotective properties, citicoline prevents brain damage due to lack of oxygen, helps restore key membrane components called phospholipids, and counteracts the effects of membrane-injuring molecules known as free radicals. Seven studies have shown that treatment with choline within 14 days of onset of ischemic or hemorrhagic stroke can significantly reduce death and disability. This is a specialty supplement that is available through natural health care practitioners. Policosanol: Several studies have shown that it can significantly reduce blood clotting (com- parable to aspirin). Do not combine with other blood thinners such as aspirin unless advised by your health care provider. B-vitamins: Lower levels of homocysteine, an amino acid linked to increased risk of stroke in many studies. Folic acid, vitamin B6, and vitamin B12 can lower homocysteine levels, but studies have not yet demonstrated whether this will result in a decreased risk of stroke. Con- sider a B-complex or take a multivitamin that provides 50–100 mg of the B-vitamins. It may be helpful for both the prevention and treatment of stroke (improving recovery). Dosage: 120– 240 mg daily, standardized to 6 percent terpene lactones and 24 percent flavone glycosides. Know the warning signs and seek immediate medical attention if you suspect a stroke. Eat lots of fruits, vegetables, whole grains, beans, nuts, fish, soy, garlic, and yogurt, and drink green tea.

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