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Treatments to Prevent Yet Another Stroke

Dear Dr. Roach: I’m a 66-year-old man who has had two strokes in two years. The surgeon said that what caused the strokes both times is that arteries that supply blood to my brain are too small. The surgeon said brain surgery was too dangerous. All he did was change my meds. My concern is whether this treatment is enough to prevent another stroke. I’m afraid I may have a third and final stroke! Dr. Roach, are there any other treatments available? Can this problem be helped with stents or stem cells? — J.B.

Answer: A stroke is very similar to a heart attack. Not enough blood flows to the brain, and some of the brain cells die, and the brain forms a scar. Depending on how much and what part of the brain is affected, the effect can be anywhere from unnoticeable to devastating. A TIA (transient ischemic attack) is similar to a stroke, except that symptoms last less than 24 hours, and it is thought to be from poor blood flow but without the resulting death of the brain cells.

Treatment for an acute stroke, like a heart attack, should be done as quickly as possible in the hospital. Many people permanently lose brain function by not calling an ambulance right away when experiencing stroke symptoms, such as sudden weakness or difficulty speaking.

As for treatment to prevent stroke in someone who has had a previous stroke or TIA, both medications and surgery sometimes are used. However, medications are used more and more, so there are fewer people getting surgery. If your surgeon says surgery isn’t for you, then you are left with medications. Fortunately, these are much better at preventing stroke than they used to be. Stents have been tried but have not been successful. I have read preliminary data on stem cells being used for acute stroke, but I don’t know of any results from using stem cells to prevent stroke.

Dear Dr. Roach: Every time I fly, my ears bother me terribly for weeks. It seems that in the first part of the trip, my ears pop for about an hour after landing but then clear up. On the return trip, as soon as the plane begins to descend, the pressure builds despite swallowing, yawning, etc., and then they plug horribly for two to three weeks, popping on and off and affecting my hearing. I saw an ENT doctor, who just recommended a decongestant, but that didn’t help the one time I tried it.

This spoils any vacation I want to take. Please help. I really want to enjoy life and take a trip. What can I do, and why does this happen? — J.H.

Answer: The Eustachian tube connects the middle ear with the back of the throat. It regulates the pressure inside the air-filled middle ear so that you can hear properly across a range of pressures. If it doesn’t work properly, you can feel discomfort as the tympanic membrane (eardrum) bulges out (when, for example you are going up in a plane and the pressure outside the ear is less than inside) or bulges inward (if you are taking a dive underwater).

Yours isn’t working properly. This can happen due to infections, allergies, while pregnant or with a variety of medical conditions. Some people’s Eustachian tubes just don’t work well because of their anatomy.

I do agree with your ENT doctor that a decongestant is helpful. However, in my experience, a decongestant spray is more effective. This is the one situation in which I prescribe Afrin (I have seen too many people use it longer than the three days it should be). But one spray 12 hours before flying and another right before boarding the plane works very well for most people.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to or write to P.O. Box 536475, Orlando, FL 32853-6475.