What is a stroke .......................................................................1
Types of stroke...............................................................................1
What is a transient ischemic attack (TIA)?.................................2
Warning Signs of Stroke or TIA...............................................2
Why is Stroke an Emergency? Call 911 ....................................3
Stroke Testing and Monitoring..................................................3
Acute Stroke Treatment ...........................................................6
Stroke Recovery and Rehabilitation..........................................8
Cognition (thinking) and Communication .................................9
Coping with Emotions ................................................................10
Eating and Swallowing................................................................11
Recurrent Stroke and Stroke Prevention.................................20
Personal Modifiable Risk Factor Reduction...............................20
Follow up after discharge ............................................................25
This guidebook was written to give you and your family some information about stroke and
help you to prepare for recovery. Please keep in mind that each person has different causes and
kinds of stroke as well as needs and pathways to recovery. The guidebook will help you learn or
better understand what a stroke is, what the warning signs are, what to do when one occurs,
tests and treatment options, risk factor reduction, rehabilitation and, and resources for support.
Please let us know if you have any questions or concerns.
What is a stroke?
A stroke, or a brain attack, is a type of blood vessel disease which affects the blood vessels
leading to and inside the brain. A stroke occurs when a blood vessel which carries oxygen and
nutrients to the brain, is blocked or bursts. This may result in brain cell death affecting body
functions and is a medical emergency. Stroke is the third leading cause of death and a leading
cause of disability in the United States.
Types of stroke
• Ischemic strokes are caused by blockage of an artery that supplies blood to
• Hemorrhagic (bleeding) strokes are caused by ruptured blood vessels.
What is an ischemic stroke?
Ischemic stroke accounts for about eighty-three percent of all cases. Ischemic strokes happen as
a result of a blockage within a blood vessel supplying blood to the brain. The reason for this
type of blockage is the development of fatty deposits lining the vessel walls. This condition is
called atherosclerosis which can contribute to a heart attack or stroke. These fatty deposits can
cause two types of blood flow blockages to the brain.
There are generally two causes of ischemic strokes.
• Cerebral thrombosis refers to a thrombus (blood clot) that develops and clogs
• Cerebral embolism is a blood clot that forms in the bloodstream usually in the heart and
large arteries of the upper chest and neck. A part of the blood clot breaks loose, enters
the bloodstream and travels through the brains blood vessels until it reaches vessels too
small to let it pass. A second important cause of embolism is an irregular heartbeat,
known as atrial fibrillation. It creates conditions where clots can form in the heart and
travel to the brain.
What is a hemorrhagic (bleeding) stroke?
Seventeen percent of all strokes are hemorrhagic. This happens when a blood vessel bursts and
stops the oxygen supply to the surrounding areas of the brain.
Hemorrhagic strokes are different from ischemic strokes in several ways.
• The death rate is higher and the overall prognosis is worse.
• Usually affects younger people.
• Symptoms often include a sudden severe headache, nausea, and vomiting.
• May not see a TIA (mini-stroke) or other stroke warning sign first.
There are two kinds of bleeding strokes.
• Subarachnoid hemorrhage occurs when a blood vessel on the surface of the brain bursts
and bleeds into the space between the brain and the skull. The most common cause is a
busted aneurysm (blood filled pouch that balloons out from an artery wall) most often
caused by high blood pressure.
• Intracerebral hemorrhage occurs when a blood vessel bleeds into the tissue deep within
the brain and is most often caused by high blood pressure or aging, causing about 10-20
percent of all strokes.
Treatment for bleeding strokes.
Because hemorrhages can be life threatening, hospital care is required in an intensive care unit.
Medication can control further bleeding, control high blood pressure, or decrease brain swelling.
Surgery may be needed depending on the cause of the bleeding.
What is a TIA?
A transient ischemic attack (TIA), sometimes called a mini-stroke, is caused by blockage of
blood flow in the brain that occurs briefly and goes away on its own. A TIA can happen days,
weeks or months before a major stroke and can be a sign that a major stroke may occur. The
symptoms of a TIA are the same as the warning signs of a stroke, but usually last less than one
hour but may last up to 24 hours. Once you have had a stroke your risk of another is higher. It
is very important to recognize the warning signs of stroke.The first step to treat a stroke is to
recognize the symptoms as soon as they happen.
Warning Signs of Stroke or TIA
• Sudden numbness or weakness of the face, arm, or leg, especially on one side of
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance, or coordination
• Sudden severe headache with no known cause2
Why is stroke an Emergency?
Every minute counts. The longer blood flow is cut off to the brain, the greater the damage.
Treatments are available to greatly reduce the damage caused by a stroke. The most common
kind of stroke, ischemic stroke, can be treated with a drug that dissolves clots blocking the
What should you do?
To receive the drug that dissolves clots you need to arrive at the hospital as soon as symptoms start.
• Know stroke symptoms
• Call 911 right away
• Get to a hospital that is expert in caring for stroke patients.
Do not wait for the symptoms to go away and do not ignore them. If you have any of these
warning signs or symptoms call 911 and get help right away.
If possible, know the time the symptoms started. Because stroke injures the brain, you may not
realize that you are having a stroke. The people around you might not know it either. Your
family, friends, or neighbors may think you are confused. You may not be able to call 911.
That is why everyone should know the signs of stroke and know how to act fast.
Stroke Testing and Monitoring
Finding a stroke while it is happening is important
because the treatment depends on the type, cause, and
location. Your doctors and nurses will ask questions about
your medical history and symptoms. Tests will be
performed to correctly diagnose a stroke. If you have had
a stroke or stroke warning signs, your doctor will need
additional information to fully understand your specific
problem and plan the best treatment. In addition to blood
tests, you will need testing to examine your brain, heart
and blood vessels. Here are the tests most often used in
stroke diagnosis and treatment planning.
Blood Tests and Procedures Used for
Stroke cannot be determined by a blood test alone. However, these tests can provide
information about stroke risk factors and other medical problems that may be important.
CBC (complete blood count)
This is a routine test and shows the number of red blood cells, white blood cells, and platelets
in your blood. Hematocrit and hemoglobin show of the number of red blood cells. A complete
blood count might be used to tell if you are anemic (too little blood) or have an infection
(shown by too many white blood cells).
Coagulation (clotting) tests
PT (Prothrombin time)
PTT (Partial thromboplastin time)
INR (International normalized ratio)
These tests measure how quickly your blood clots. An
abnormality could result in excessive bleeding or excessive
clotting. If you are taking blood-thinning medicine such as
warfarin (Coumadin or similar drugs), the INR blood test is
used to be sure that you receive the correct dose. It is very
important that you obtain regular checks. If you are taking
heparin, the PTT test is used to determine the correct dose.
Blood chemistry tests
These tests measure the levels of normal chemical
substances in your blood. An important test in emergency
stroke evaluation is to measure glucose (blood sugar) levels.
Blood sugar levels which are too high or too low can cause
symptoms which may be mistaken for stroke. Fasting blood glucose is used to help in the
diagnosis of diabetes, which is a risk factor for stroke. Controlling blood sugar after a stroke can
improve stroke recovery. Other blood chemistry tests measure serum electrolytes, the normal
chemicals in your blood (sodium, potassium, calcium) or check the function of your liver or
Blood lipid (fat) tests
These tests measure cholesterol, triglycerides, HDL (high density lipoprotein), and LDL (low
density lipoprotein). Cholesterol is a natural substance found in all living tissue, but when too
much of it builds up in the arteries, either because of heredity or dietary factors, it can be
dangerous. Cholesterol is a wax-like substance that is found in the body. It is a lipid, or a type
of fat. Cholesterol is made in your body by your liver. You also get cholesterol by eating foods
that come from animals. Examples of foods that come from animals include meats, eggs, and
whole-fat dairy (milk) products.
Your health care provider may take a blood sample from you to see if you have too much
cholesterol in your blood. You may need to fast for 9-12 hours before your blood is drawn.
Fasting (going without eating) helps to make sure that the test shows your actual cholesterol or
blood sugar level. When fasting, you may drink water. Food and other drinks (such as coffee or
tea) consumed during this time may affect your cholesterol or blood sugar reading.
Acceptable blood cholesterol levels are specific to each individual and for that reason your
health care provider should have those numbers and work with you on a therapeutic plan.
Normal Total Cholesterol is below 200.
Normal LDL is below 100.
Normal HDL is above 40 for men and 50 for women.
What are triglycerides?
Triglycerides are another class of fat found in the blood stream. Elevated triglyceride levels may
be caused by medical conditions such as diabetes, hypothyroidism, kidney disease, or liver
disease. Dietary causes of elevated triglyceride levels may include obesity and high intakes of
fat, alcohol, and concentrated sweets. A healthy triglyceride level is generally less than
Tests that check the brain, heart, and arteries
CAT Scan (Computed axial tomography, CT) is an important diagnostic test of the brain. It
uses x-rays to produce a 3-dimensional image of your head and is usually one of the first tests
given to a patient with stroke symptoms.
MRI (Magnetic resonance imaging, MR) like a CT scan, it shows the location and extent of
brain injury. The image is sharper and more detailed than a CT scan. It uses magnetic fields to
also produce a 3-dimensional image.
Tests that view the blood vessels
Carotid Doppler is a test that uses ultrasound waves and can show if the artery in your neck
that supplies blood to the brain is narrowed by atherosclerosis (cholesterol deposits).
MRA (Magnetic resonance angiogram/arteriogram) is a special type of MRI scans. In this test,
special substances are injected into the blood vessels and an x-ray is taken to show the blood
flow through the blood vessels leading to and into the brain.
This allows the size and location of blockages to be evaluated. This test is especially valuable
in diagnosing aneurysms and malformed blood vessels and providing information before surgery.
Tests that check the heart
Electrocardiogram (EKG) is a standard test of the electrical activity of the heart. Electrical
sensors are attached to your chests, arms, and legs. Some strokes are caused by an irregular
Echocardiogram (2-D echo, TTE, TEE) ultrasound waves are used to take a picture of your
heart and the circulating blood. The ultrasound probe may be placed on your chest (trans-
thoracic echocardiogram, TTE) or through a tube put down your throat (trans-esophageal
echocardiogram, TEE). A TEE is more accurate and can be used when problems with the chest
make TTE hard to do. Before a TEE you will be given medicine through your veins to relax
and allow for the procedure.
Acute Stroke Treatment
Treatment depends on the type and cause of stroke.
Surgery, medications, acute hospital care and
rehabilitation are all accepted stroke treatments.
When a neck artery is partially blocked by a fatty
buildup, surgery might be used to remove the plaque.
This surgery is called a carotid endarterectomy.
Cerebral angioplasty is a new, experimental technique.
Balloons, stents and coils are used to improve blood flow
and treat some types of problems with the brain’s blood
vessels. The widespread use will require more study of its
safety and effectiveness.
Sometimes treating a stroke means treating the heart.
The reason is that various kinds of heart disease can contribute to the risk of stroke. For
example, damaged heart valves may need to be treated surgically or with anti-clotting drugs to
reduce the chance of clots forming around them. Blood clots also can form in the hearts of
people with atrial fibrillation. Atrial fibrillation (A-fib) is a type of abnormal heart rhythm. If
clots form, there is a chance they could travel to the brain and cause a stroke.
Strokes caused by a blood clot are often treated with medications that work to prevent the
blood’s ability to clot. These include:
• Blood clot-busting medications
• Antiplatelet medications
In 1996, the Food and Drug Administration approved the clot-busting drug tissue
plasminogen activator (t-PA) to treat stroke. This has had a positive impact on the
treatment of ischemic strokes.
Not every stroke patient should be treated with t-PA, particularly those having a bleeding
stroke. Use of t-PA can cause bleeding. Tissue plasminogin activator is effective only if given
very soon after a stroke begins. For maximum benefit, it must be started within three hours
of the onset of stroke symptoms. That is why it is so important to see stroke as a medical
emergency and respond immediately.
If you do not receive t-PA, you may receive other medicines that improve blood flow. Both
anticoagulants and antiplatelets are medicines that decrease blood clotting.
What should I know if I am taking anticoagulants?
Anticoagulants are medicines given to prevent your blood from clotting or preventing clots
that already exist from getting larger. They can keep harmful clots from forming in your heart,
veins or arteries. Clots can block blood flow and cause a heart attack or stroke. Common
names for anticoagulants are warfarin (Coumadin) and heparin.
• You must tell all of your doctors and dentists that you are taking the anticoagulant
• You must take the medication exactly the way your doctor tells you.
• Have blood tests taken regularly so your doctor can see how the medication is working.
• Know the level of your target Prothrombin time and International Normalizing Ratio
• Tell your family you are take anticoagulant medicine and wear emergency medical
identification (i.e. bracelet).
• Always check with your doctor before taking other medications or supplements such as
aspirin, vitamins, cold medicine, sleeping pills or antibiotics. These can alter the
effectiveness and safety of anticoagulants by strengthening or weakening them.
• Avoid big changes in how much vitamin K you eat. Vitamin K can inactivate some
blood thinners. Limit foods high in vitamin K content, broccoli, brussel sprouts,
cabbage, kale, parsley, spinach, and turnip/collard/mustard greens, to ? cup cooked or
1 cup raw vegetables daily. Discuss your diet with your doctor, dietitian, or pharmacist.
• You may bleed more easily while you are using this medication so avoid activities that
can increase the chance of traumatic injury. Let your doctor know if you have had
• Watch for signs of internal bleeding (i.e. excessive bruising, blood in stools).
What should I know about antiplatelet medications?
Antiplatelet medications keep blood clots from forming. They keep blood platelets from
sticking together. They are used to treat atherosclerosis or if someone has an increased risk of
blood clots. Atherosclerosis occurs when cholesterol builds up on inner walls of blood vessels
and increases the chance that blood clots will form. Antiplatelet medicine helps prevent
strokes. Common names for antiplatelets include aspirin, clopidogrel (Plavix), and
• Antiplatelets should not be taken with anticoagulants unless your doctor tells you to do so.
• You might receive directions not to take antiplatelets or anticoagulants when you are
going to have surgery.
Stroke Recovery and Rehabilitation
Stroke is the leading cause of adult disability in the United States.
There are more than 5 million stroke survivors in the United States.
Rehabilitation is an important part of recovering from stroke. Through
rehabilitation, you can relearn or regain basic skills such as speaking,
eating, dressing, and walking.
When the immediate crisis of a stroke has passed and you are medically
stable, it is time to consider rehabilitation therapy. Therapy begins in the
hospital and often continues after being discharged from the hospital.
The goal of rehabilitation is to restore as much independence as possible
by improving physical, mental, and cognitive (thinking) abilities. Not all
of the negative effects of a stroke are permanent.
Appropriate and adequate rehabilitation can help you work toward the
goal of restoring your daily activities. Your rehabilitation may include
Occupational, Physical and Speech-Language Therapy.
Occupational Therapy focuses on helping stroke survivors rebuild skills
that are needed for daily living activities such as bathing, dressing, and
cooking. The Occupational Therapist also works on improving skills in
memory, judgment, and problem solving, which are necessary to perform
daily living activities.
Physical Therapy works to improve stroke survivor’s movement, strength, and problems with
sensation (feeling). The Physical Therapist focuses on restoring skills needed to get around
more independently, to improve transfers, balance, coordination, and walking.
Speech-Language Therapy focuses on improving the function and safety of swallowing, which
is often affected by a stroke. The speech-language pathologist helps improve communication
skills, such as listening and understanding, talking, saying words clearly, reading and writing.
Therapy may also work toward improving problem solving, memory, and reasoning skills.
Because the effects of stroke vary, it is important to have an individualized therapy program
to best meet your needs. You should consult a therapist who can help in selecting specific
exercises that will benefit you and provide instruction for both you and your caregiver. As
with any exercise program, consult your doctor and/or therapist first.
For additional information on inpatient or outpatient Stroke Rehabilitation, please call Baptist
Health Rehabilitation Services at the following locations:
Baptist Medical Center Downtown: 904-202-9750
Baptist Medical Center South: 904-821-6575
Baptist Medical Center Beaches: 904-627-2980
Baptist Medical Center Nassau: 904-277-9677
Cognition (thinking) and
Stroke can cause physical problems. It can also affect
cognition, or thinking abilities. Cognition is what helps
people use their brains to talk, read, write, learn,
understand, reason, and remember. Difficulty with
cognition may affect how you manage your everyday
tasks, your ability to participate in rehabilitation, and
even to live on your own following a stroke.
Memory Loss and Communicating
Every stroke is unique. The effect that stroke has on your thinking abilities depends on where
and how the stroke injured the brain and your overall health.
1. Memory loss
After stroke memory loss is common, but not the same for everyone. For example, depending
on where the stroke occurred in the brain you may have short-term memory loss.
What may help?
• Try to form a daily routine—doing certain tasks at regular times during the day.
• Try not to tackle too many things at once. Break tasks down into small steps.
• If a task needs to be done, make a note of it or do it right away.
• Make a habit of always putting things away in the same place where they can easily be
seen or found.
After a stroke, one of the most common problems people experience is trouble with
communication. Stroke survivors may experience a type of communication disorder called
aphasia, which means “without language.” About one million people in the United States have
aphasia. Most cases are due to the results of a stroke. There are several types of aphasia,
depending on what part of the brain has been damaged.
People with aphasia have a partial or total loss of their ability to talk, to understand what people
say, and to read and write. One or a combination of these skills may be affected. For example, you
may have trouble remembering the names of objects or putting words together to make sentences.
You may recover from aphasia without treatment. But most people benefit from therapy by a speech-
language therapist. The goal is to improve your ability to communicate. This is done by helping you
get back some of your language skills and learning new ways to get your message across.
• Try using your hands to gesture, or nod your head, if you are unable to say words.
• Draw or write things on paper.
• Create a communication book that includes words, pictures and symbols that are
meaningful to you.
• Take your time. Try talking to people when you have plenty of time.
• Show people what works best for you.
Coping with Emotions
Dealing with a flood of emotions can be hard for stroke survivors. It is common to be tired,
frustrated, depressed, and unmotivated. Some emotions are normal responses to the changes in
your life after a stroke. If you suffer from depression, anxiety or emotions that are not in line
with the situation, seek help. You may be treated with medication,
counseling, therapy, or all three. Joining a local stroke support group
may also help.
Dealing with Depression
Grieving for what you lost is normal. If sadness becomes depression,
talk to your doctor. Depression can surface right after a stroke, during
rehabilitation, or after you go home. It can be, but not always, caused
by brain damage from the stroke. Mild or major depression is the
most common emotional problem faced by survivors.
Symptoms of depression include:
• Feeling sad most of the time.
• Feeling worthless or helpless.
• Crying all the time.
• Loss of interest or pleasure in ordinary activities.
• A change in how easily you are annoyed.
• Sudden trouble sleeping or oversleeping.
• Sudden loss or increase of appetite.
• Being unable to concentrate, remember or make decisions like you used to.
• Ongoing thoughts of death or suicide.
Socializing with family and friends is an important part of
stroke recovery. As a stroke survivor, you may have trouble
doing the things that allow you to connect with other people
such as talking on the phone, writing letters, shopping, or
eating out. This can make you feel disconnected and alone at
a time when you need more social support that ever before.
Getting the Support You Need
Stroke survivors and stroke caregivers need support. There are
many ways to get the support you need.
A support group allows you to interact with other stroke survivors and caregivers who know
what you are going through. People in a support group can:
• Help you find ways to solve problems related to stroke.
• Share information about products that may help recovery.
• Encourage you to try new things.
• Listen to your concerns and frustrations.
• Give you a chance to get out of the house.
Healthy Eating and Swallowing
You should eat nutritious food to get better. Many stroke survivors are malnourished. This means
they are not getting enough vitamins and minerals because they are not eating enough healthy
foods. You need to eat healthy so you can have energy for exercise, therapy, and your favorite
activities. Healthy eating will be easier once you learn to deal with new challenges you might
have from a stroke.
Choosing Healthy Foods
Healthy eating is good for you. It will help you manage your weight and blood pressure as well
as diabetes and high cholesterol. These things are all crucial to prevent another stroke and stay
healthy. Most foods in the grocery store must now have a nutrition label and an ingredient list.
If you are still unsure, ask your doctor to arrange a visit with a licensed dietitian. The dietitian
will teach you how to plan meals and snacks to improve your health.
A diet high in saturated fat and cholesterol has been linked to chronic diseases such as heart
disease and stroke. The goal of a heart healthy eating is to decrease your risk of heart disease
and stroke. Research shows that the amount and type of fat you eat can affect your overall
health. A heart healthy diet low in sodium, saturated and trans fats, and cholesterol can help
reduce the risk and/or complications of heart disease and stroke. Eating fiber (ie. whole wheat
bread, fresh vegetables) may help you decrease your cholesterol. Decreasing your fat intake will
decrease your calorie intake. Decreasing the amount of sodium (salt) that you eat and drink
may help to control your blood pressure. You may also lose weight on this diet because
decreasing your fat intake will decrease your calorie intake. Decreasing calories in your diet can
help you to lose weight.
Nutrition Guidelines for Your Health
• Plan to eat a variety of foods of a variety of colors each day.
• Eat at least five servings of fruits and vegetables per day.
• Reduce Sodium. Try cooking from scratch instead of using pre-prepared
foods from a box or bag. Do not use salt during cooking and at the table.
• Read food labels for the amount of sodium. Keep the sodium content of a
complete meal to between 500-600mg. Keep single food items less than 240mg.
• Limit Saturated Fat. Saturated fats can increase cholesterol levels, especially
low-density lipoprotein or LDL (bad cholesterol). Saturated fats are found in
meat, milk products, and in some vegetable fats such as coconut, palm, and
palm kernel oils. To lower your saturated fat intake, choose low fat meats
without the skin and limit your daily intake to 6 ounces (3 ounces = the size
of a deck of cards); choose low-fat or fat-free milk products.
• Avoid Trans Fat. Trans fat raises LDL levels (bad cholesterol) and lowers high-density
lipoprotein or HDL levels (good cholesterol). Trans fat can be found in vegetable
shortening, some margarine, crackers, cookies, chips, cakes, doughnuts and other foods
made with or fried in partially. hydrogenated oils. A small amount of trans fat is also
found naturally in milk products, some meat and other foods made with animal fats.
• Reduce Cholesterol. Cholesterol can be found in animal products such as meat, egg yolks,
and milk products.
• Increase Fiber and Antioxidants. Try for a minimum of 25 grams of fiber each day. Eat a
diet high fiber with foods such as vegetables, fruits and whole grains such as oats, whole
wheat, brown rice, whole bran and barley.
• Maintain a Healthy Weight. Lose weight if you are overweight or maintain a healthy
weight. Talk with your doctor or registered dietician to determine a healthy weight for
you. Be more physically active every day to help control weight. Pay attention to
serving size and eat only enough for your height and body type. Avoid foods and
beverages with added sugars, which can easily add too many calories with little
Heart-Healthy Food Choices
Food Group: Lean Meat, Poultry, Seafood, Eggs & Other Protein Foods
(5-6oz. per day/3oz. = deck of cards)
Choose Most Often Avoid or Choose Less Often
Beef: USDA Select or Choice grades of lean
beef (trim visible fat) such as eye & top round,
sirloin, flank, tenderloin, round tip, top loin,
bottom round, rib, chuck & rump roast, T-bone,
porterhouse, cube steak, ground round, lean &
extra lean ground beef (>90% lean); lean veal
chop, roast or leg; low-sodium roast beef deli meat
Beef: Prime grades of beef, prime rib, heavily
marbled & meats with lots of visible fat, regular
ground beef; ground or processed veal cutlets
Poultry: Skinless chicken & turkey, Cornish
hen, duck or goose (drained of fat); low-sodium
chicken or turkey deli meat
Poultry: Fried chicken, chicken & turkey with
Fish: Include 2 or more servings per week of
fresh, frozen or canned fish & shellfish (watch
sodium content of canned items)
Fish: Fried fish or shellfish, commercially
breaded or processed fish
Pork: Lean & choice cuts such as fresh ham,
tenderloin, center loin chop, Canadian bacon
Pork: Spare ribs, ground pork, pork sausage,
Lamb: Lean & choice cuts such as chop, leg &
Lamb: Rib roast, ground lamb, organ meats
Game: Duck, goose or pheasant (without skin
& drained of fat), venison, buffalo, ostrich,
Game: Duck, goose or pheasant with skin
Processed Meats: Choose processed & deli
meats with <3g fat per oz.
Processed Meats: Bologna, pimento loaf,
salami, sausage, bratwurst, knockwurst, hot
Eggs: Limit egg yolks to 2-4 per week, egg
whites (2 whites can be used in place of 1
whole egg in most recipes), cholesterol-free egg
Eggs: More than 2-4 whole eggs per week
(include those used in baking)
Food Group: Low-Fat Dairy Products
(2-3servings per day)
Food Group: Breads, Cereals, Rice & Pasta
(6-11servings per day/1 serving = 1oz.)
Choose Most Often Avoid or Choose Less Often
Milk: Fat-free/skim or 1% milk (liquid,
powdered & evaporated), fat-free or low-fat
buttermilk, soy milk
Milk: Whole or 2% milk (liquid, powdered &
Yogurt: Fat-free or low-fat yogurt, yogurt
drinks, soy yogurt
Yogurt: Whole-milk yogurt or yogurt drinks
Cheese: Low-fat natural or processed cheeses
such as mozzarella, parmesan, cottage cheese,
Cheese: Regular cheeses high in saturated fat,
whole-milk cottage cheese
Ice Cream: Low-fat or fat-free ice cream &
Ice Cream: Regular ice cream
Sour Cream: Low-fat or fat-free sour cream Sour Cream: Regular sour cream
Coffee Creamer: Low-fat coffee creamer Coffee Creamer: Cream, half & half, whipping
cream, nondairy creamer, whipped topping
Choose Most Often Avoid or Choose Less Often
Breads: Whole-grain bread, buns, bagels &
pita; English muffins, corn or flour tortillas,
homemade corn muffins & other homemade
baked goods using unsaturated oils, low-fat
milk & egg substitute
Breads: Croissants, biscuits, pastries, processed
white bread, high-fat bakery bagels,
commercially prepared muffins & other bakery
Rice: Brown rice & whole grains such as
barley, quinoa, millet, oats
Rice: Instant rice & rice mixes high in sodium
Cereals: Whole-grain wheat, rice, bran, oats
cereals, low-fat granola
Cereals: Processed cereals not made from
whole grain, most granolas
Food Group: Vegetables
(3-5servings per day)
Food Group: Fruit
(2-4servings per day)
Food Group: Fats & Oils
(6-8tsp. per day)
Choose Most Often Avoid or Choose Less Often
Fresh, frozen or canned without added fat or
Canned with sodium/salt, fried or prepared
with butter, cheese or cream
Choose Most Often Avoid or Choose Less Often
Fresh, frozen, dried or canned in own juice;
100% fruit juice
Fruit in heavy syrup or served with butter or
Choose Most Often Avoid or Choose Less Often
Monounsaturated Fats: Canola, olive &
peanut oils; avocado, almonds, cashews,
pecans, peanut butter & other nut butters;
olives, sesame seeds, Tahini paste
Butter, lard, shortening, bacon grease, stick
margarine, ghee; coconut, palm & palm kernel
oils; macadamia & Brazil nuts, pistachios, pine
nuts; salad dressings made with egg yolk,
cheese, sour cream or whole milk; coconut;
Polyunsaturated Fats: margarines (tub or
spray) made from heart-healthy oils; corn,
sunflower, safflower, sesame & soybean oils;
salad dressings made from heart-healthy oils;
walnuts, sunflower & pumpkin seeds
Too Tired to Eat or Cook?
Meal planning, grocery shopping and cooking require a lot of energy. But, being tired does not
mean you should give up on healthy eating. Planning ahead can help you get the nutrition you
need for your stroke recovery.
• Eat your biggest meal early in the day when you have the most energy. The last meal of
the day can be simple, such as a sandwich or cereal.
• Look for pre-washed, pre-cut fruits and vegetables at the grocery store. Most places offer
apple slices, baby carrots, broccoli florets, celery sticks, mixed vegetables, salad greens,
• If preparing and eating three meals a day takes too long or takes too much energy, eat
six small meals per day instead.
• Many communities offer a “Meals on Wheels” program. Check with your local social
services to see how you can get healthy meals delivered to your home through this program.
• Seniors can often get healthy, low-cost meals at senior center. Check your local
newspaper for locations, times and menus.
Have you Lost Your Appetite?
Many survivors do not feel as hungry as they used to and forget to eat during the day.
• Try eating smaller healthy meals throughout the day.
• Be sure to plan three meals a day plus snacks to maintain your health and energy—even
when you are not so hungry.
• Eat high-calorie foods in your meal first.
• Sometimes, poor appetite is caused by depression. Your appetite is likely to improve
after depression is treated.
• Walk or do some light exercise to stimulate your appetite.
Challenges When Eating
It is hard to eat healthy when you have trouble swallowing, chewing, or using eating utensils.
Swallowing and Chewing Problems
A stroke can weaken or paralyze muscles that help you swallow or chew. About 40-60% of
stroke survivors have dysphagia (swallowing difficulties). Dysphagia can lead to serious medical
problems such as dehydration (not enough water), malnutrition (not enough vitamins and
minerals), choking or coughing, aspiration (when food or liquid goes into the lungs) and
pneumonia. The speech-language therapist can test for dysphagia and make suggestions to
improve swallowing and eating.
Talk to your doctor if you have any of these signs of dysphagia:
• Coughing, choking, or sputtering when eating or drinking.
• An unusually hoarse voice or the need to clear your throat often.
• Food, liquids, or saliva escape from your mouth or nose when you try to eat or drink.
What can help?
If the speech-language pathologist says you are safe to eat by mouth:
• Cut foods into smaller pieces before chewing.
• Use a blender or food processor to puree foods to the texture of baby food.
• Choose soft foods such as cooked cereal, mashed potatoes, eggs, cottage cheese,
applesauce, canned fruits and soups.
• Thicken liquids so you can control them better in order to keep from going down the
wrong way. Natural thickeners include cornstarch, tapioca, flour, instant potato flakes,
oats, and matzo meal.
• Keep your mouth moist with ice chips and small sips of water.
• Place foods and liquids on the stronger side of the mouth (the opposite of the drooping side).
• If you wear dentures, see your dentist to check how they fit. Loose dentures can interfere
with chewing and swallowing. Dentures that do not fit well can also cause pain, which
can decrease your appetite. Medicines, mouth dryness and other medical changes can
affect denture fit. Have your dentist check them at least once a year.
After your stroke, you may have trouble grasping or holding utensils. Take advantage of special
products that can help you:
• Flatware with larger handles or Velcro straps can be easier to grasp.
• Knives with curved blades can help you cut food with one hand.
• Plate guards can help keep food on the plate when using one hand.
• Rubberized pads under the plate can keep it from sliding around.
Meals and Social Outings
Eating out is common in the United States. It can also be good for your recovery. Eating out on
occasion relieves you of many household duties. It also can help you
connect socially with others. But, many stroke survivors shy away
from restaurants and social outings because they have problems
getting around, filtering out noises, or have difficulty eating and
swallowing. Some of the following tips may help:
• Call ahead to see if the place has parking, entry ramps, eating
space and bathrooms needed to host guests in wheelchairs.
• Avoid busy times and noisy places.
• Request a booth or table where you can sit across from others
but face a wall; this can reduce distractions in the restaurant.
• Go to a familiar restaurant where you know the menu.
• Mentally rehearse what you want to order.
• Have family and friends help you order items that are safe.
• Bring a card that says, “I have aphasia” and show it to the restaurant staff.
For more information, go to www.aphasia.org. 17
Most stroke survivors are able to return home and continue doing what you were involved in
before the stroke. You may need intensive therapy and may be discharged to a rehabilitation
facility; or therapy can be completed from home. The rehabilitation process will be determined
by the severity of your stroke. Some survivors need few services, while others need months of
rehabilitation. Social workers and other hospital staff can help prepare you for the move home
or to a rehabilitation facility upon leaving the hospital.
For those who have had a more severe stroke, going home depends on many factors:
• Ability to care for oneself.
• Ability to follow medical advice .
• Mobility and speech (Stroke survivors not independent in these
areas may be at risk in an emergency or feel isolated.)
• Availability of a caregiver.
Managing life at home is an important part of stroke recovery. Stroke
affects each survivor differently. To live well after stroke, you may need
to make some changes in your home and daily routine.
What changes do I need to make at home?
Living at home successfully also depends on how well the home can be
adapted to meet your needs.
• Safety – Take a good look around and get rid of anything that might
be dangerous. This might be as simple as taking up throw rugs,
testing the bath water temperature prior to getting in or wearing
rubber-soled shoes to prevent slipping. You may have to get handrails
in the bath or shower.
• Accessibility – You need to be able to move freely within your home.
You may have to rearrange the furniture or build a ramp to go
• Independence – Your home should be modified so that you can be as
independent as possible. Often this means adding adaptive equipment,
such as grab bars or transfer benches.
Preparing to Go Home
• If needed, ask your doctor to help you plan a home visit by an occupational therapist
(OT). They are trained to help you manage daily activities and regain you
independence. The OT will check your home and may suggest simple changes to make
everyday living easier and safer.
• A social worker can help you make decisions about your rehabilitation plan.
Getting out is good for you. It gives you a chance to be with
other people. Each time you successfully go places, you build
your confidence to do it again. Getting out of the house allows
stroke survivors a chance to regain a sense of freedom, control
and independence. Going to the places you want to go, doing
the things you enjoy, and spending time with other people will
help the recovery process. Accept that your body has changed
and realize you can still be active, productive, and have a good
quality of life.
How Do I Know if I Can Drive Safely?
Driving involves many skills that can be affected by a stroke. Fortunately, most stroke survivors
can regain the ability to drive safely.
• Talk to your doctor or occupational therapist for a professional opinion.
• Contact the State Department of Motor Vehicles. Ask for the Office of Driver Safety
and find out requirements for people who have had a stroke.
• Have your driving tested.
• Enroll in a drivers training program.
Signs of Unsafe Driving
• Drives too fast or too slow for the road conditions or posted speed.
• Needs help or instructions from passengers.
• Does not observe sign or signals.
• Often gets lost, even in familiar areas.
• Has accidents or close calls.
• Gets easily frustrated or confused.
Tips for Safe Driving
• Always make sure you and your passengers wear seatbelts.
• Drive in familiar areas.
• Drive on roads that are not busy.
• Combine trips. Plan your errands and appointments.
• Turn off the radio, phone, and other things that can take your attention away from driving.
• Avoid driving at night.
• Plan your travel so that you are off the road during rush-hour traffic or during bad weather.
Recurrent Stroke and Stroke Prevention
After stroke, survivors tend to focus on rehabilitation and recovery. But preventing another (or
recurring) stroke should be a key concern. Of the 750,000 Americans who have a stroke each
year 5-14 percent will have a second stroke within one year.
Stroke prevention is also important for those who have had transient ischemic attacks (TIAs)
or mini-strokes. TIAs are brief episodes of stroke-like symptoms that last from a few minutes to
24 hours. TIAs usually do not cause permanent damage or disability. But TIAs can be a serious
warning sign of impending stroke. Up to one third of people who have a TIA are expected to
have a stroke. Strokes and TIAs can be prevented through lifestyle changes, surgery, medicine,
or a mix of all three.
Your Personal Modifiable Risk Factors/Lifestyle Changes
There are two types of stroke risk factors. One type you cannot control, the other you can.
Stroke risk factors you cannot control include:
• Being over the age 55.
• Being a man.
• Being African American.
• Someone in your family has had a stroke.
• Having diabetes.
Having one or more of these factors doesn’t mean you will have a
stroke. By making simple lifestyle changes, (listed below), you may be
able to reduce the risk of a first or recurrent stroke.
These simple lifestyle changes can greatly reduce your chance of
having a stroke. You can control these risk factors:
1. Quit smoking.
2. Control your blood pressure.
3. Maintain a healthy weight.
4. Eat foods low in sodium (salt) and fat.
5. Avoid excessive alcohol.
6. Exercise often.
7. Stay hydrated.
8. Monitor your cholesterol levels.
9. Manage your diabetes.
10. Control atrial fibrillation (if present).
1. Quit smoking
Smoking and tobacco use are the most preventable cause of serious
How do I quit and free myself?
• Quitting takes hard work and a lot of effort, but you can
• Millions of people quit smoking every year and most quit on
• Quit when you are ready to quit.
• List your reasons for wanting to quit.
• Consider the benefits of quitting, better physical health and energy, peace of mind and
control, better social life, preventing harm to those around you and saving money.
• Talk to your health care provider about how to stop smoking and set a quit date.
• Plan the way you will quit—do not leave it to chance. There is no “best” way to quit.
“Cold turkey,” Cutting down gradually, Nicotine gums or patches are some options. Do
what you and your health care provider think will work best for you.
• If you can not stop right now, cut down on the number of cigarettes you smoke each day.
• Seek support and encouragement from you friends and family.
• Use stress management techniques.
Here are some suggestions to stay smoke free.
• Plan how you will deal with tempting situations such as: Social situations that involve
alcohol, relaxing after a meal, emotional upsets, loneliness, boredom, depression, anger
or anxiety at work, conflicts with people.
• Avoid old activities that trigger the urge to smoke.
• If coffee is a trigger, change to juice or tea. Hold
your cup in the opposite hand.
• Review the list of reasons you want to quit often.
• Clean out and put away ashtrays. Throw out
lighters, matches, and cigarettes.
• Become more active in your leisure time. Exercise.
• Keep healthy cigarette substitutes around like carrot
or celery sticks, sunflower seeds, etc.
• Reinvest in yourself. You will have 5-10 percent more
time. Develop new skills, hobbies, or ways to relax.
• Mark your success on the calendar and reward yourself.
• Start saving the cash you would have spent on cigarettes. Buy something special.
Talk to your doctor about smoking cessation programs or products that might work for you.
Baptist Health has resources that can help. The Quit Smart Program is an individualized,
multi-method program based on research conducted at Duke University Medical Center. For
more information, call 904.202.7069.
2. Control your blood pressure
High blood pressure is one of the most important and easily controlled stroke risk factors. Know
your blood pressure and control it. Because there are no symptoms, many people do not know
that they have high blood pressure.
Blood pressure is given two numbers, for example 120/80.
The top number, the systolic blood pressure, is a measurement of the forces your blood puts on
blood vessel walls as your heart pumps. The bottom number, diastolic blood pressure is a
measurement of the force your blood puts on the blood vessel walls when your heart is at rest.
• For people over age 18, normal blood pressure is lower than 120/80. A blood pressure
reading consistently 120/80-139/89 is pre-hypertension. If yours is in this range, you are
more likely to develop high blood pressure. Also called hypertension, high blood
pressure is a reading of 140/90 or higher.
• Have your blood pressure checked at least once each year—more often if you have
high blood pressure, have had a heart attack, stroke, are diabetic, have kidney disease,
have high cholesterol or are overweight. For blood pressure readings check the
pharmacy/drug/grocery store or fire station.
• If you are at risk for high blood pressure, ask your doctor how to manage it more
Many times blood pressure can be controlled through diet and exercise. Even light exercise—a
fast walk, bicycle ride, swim or yard work—can make a difference. Adults should do some form
of moderate physical activity for at least 30 minutes five or more
days per week, according to the Centers for Disease Control and
Prevention. Regular exercise may reduce your risk of stroke.
Before you start an exercise program, check with your doctor.
For some people who have high blood pressure, losing weight,
reducing sodium or other lifestyle changes will not lower high
blood pressure as much as needed. These people will probably
need to take medication.
3. Maintain a healthy weight
If you are overweight, especially if you carry a lot of weight around
your waist, you are at higher risk for health problems such as high
blood pressure, high blood cholesterol, diabetes, heart disease, and
stroke. If you are overweight, start eating a healthy diet and exercise regularly. Quick-weight loss
diets do not work. Body Mass Index (BMI) looks at height-to-weight ratio. It can tell if you are
obese. Discuss it with your doctor. For more information and to calculate your BMI online visit
the American Heart Association’s website www.americanheart.org and search BMI.
4. Eat foods low in sodium (salt).
Too much sodium (salt) in the diet can cause high blood pressure, which can lead to stroke.
Foods high in saturated fat and cholesterol can cause fatty deposits on the walls of your arteries
(blood vessels). This causes atherosclerosis (hardening of the arteries). Atherosclerosis can cause
poor blood flow in certain areas of your body, and put you at higher risk for health problems
such as stroke and heart disease. For more information on eating right and for some tasty
healthy recipes visit the American Heart Association’s Web site www.deliciousdecisions.org.
5. Avoid excessive alcohol.
One or two drinks a day may help increase HDL (“good”) cholesterol, but more than that can
contribute to high blood pressure, heart disease, and stroke. Alcohol can also increase dehydration.
6. Exercise often.
Be physically active. Exercise can help with blood pressure
control, reduce cholesterol levels, reduce risk of developing diabetes,
and aid in weight control.
7. Stay hydrated.
It is very important to keep blood liquid and flowing. A general
rule of thumb is to drink enough to keep from getting thirsty. This is
especially important when exercising and during the summer or early
winter when dehydration is the most likely.
8. Manage your cholesterol levels.
High amounts of dietary cholesterol may increase blood cholesterol in some people. Eat less
than 300 milligrams (mg) of cholesterol per day. The body needs some cholesterol to stay
healthy. The body needs cholesterol to build cell walls and make hormones. However, too
much cholesterol in your body may be bad for your health.
Elevated cholesterol (particularly “bad” cholesterol, or LDL) is a risk factor for heart disease
Cholesterol readings are divided into two types.
Low-density lipoprotein (LDL) cholesterol is commonly called the “bad” cholesterol, and is a
type of fat in the blood that contains the most cholesterol. It can contribute to the formation
of plaque (or fatty deposits) buildup in the arteries, known as atherosclerosis.
You want your LDL to be low, generally less than 130 milligrams/per deciliter (mg/dL), but if
you have had a stroke/TIA or heart attack your goal is less than 100 and if you have diabetes
you want your LDL to be less than 70.
High-density lipoprotein (HDL) is known as the “good” cholesterol, and is a type of fat in the
blood that helps to remove cholesterol from the blood, preventing the fatty buildup and
formation of plaque.
You want your HDL to be as high as possible, generally higher than 40 mg/dL for men and
above 50 for women.
Some ways to raise HDL and lower LDL are:
• Decreasing body weight.
• Avoiding foods high in saturated fat, dietary cholesterol, and excess calories.
• Exercising for at least 20 minutes three times a week.
• Stop smoking.
• Taking appropriate medications.
9. Manage your diabetes
Some people are more likely to develop diabetes.
Diabetes increases the risk of heart disease and
stroke. During regular check ups your doctor
should screen for diabetes. If you have diabetes,
you can manage it by carefully following your
doctor’s recommendations. A blood test called
Hemoglobin A1c should be done every three
months and should be below 7mg/dL. Hemoglobin
A1c is used to determine your average blood sugar
levels over the last three months.
10. Controlling atrial fibrillation
Many forms of heart disease can increase your stroke risk. Atrial fibrillation (Afib) is an
irregular heartbeat. Afib is when the top chambers of the heart fibrillate (quiver) and do not
empty effectively. This fibrillation can cause blood clots to form. The clot can travel from the
heart to the brain and cause a stroke. Warfarin (Coumadin) and aspirin are often prescribed to
treat atrial fibrillation. You and your doctor should monitor taking warfarin carefully. Work
with your doctor to manage atrial fibrillation.
Following up after discharge
Be sure to follow your personal discharge
instructions. Make sure you understand and
agree with them. Know your personal
modifiable risk factors from the list above. It
is very important to have regular checkups
and work with your doctor to reduce or
control your personal modifiable risk factors.
Your doctor can monitor your risk factors
and suggest treatments.
American Stroke Association,
a division of the
American Heart Association
Ask for the Stroke Family Warmline to talk
with a stroke survivor or caregiver, get a list of
stroke support groups in your area or ask for
Stroke Connection magazine
National Stroke Association
Information on stroke, including prevention,
treatment, rehabilitation, and support for
stroke survivors and their families or subscribe
to Stroke Smart magazine.
National Institute of Neurological
Disorders and Stroke
Government information available on a
variety of stroke-related topics.
First Call, a division of the
904.632.0600 or 211
Can refer you to community resources.
Independent Living Resource
Center of Northeast Florida
Advice, information, and referrals for disabled
Jewish Family and
Multiple services, including counseling
Baptist Behavior Health
Psychological and psychiatric counseling services
Resources for stroke survivors and their families*
*This information is provided by Baptist Health as a resource and should not be considered
Compiled by Michelle Silver,
MSN, ARNP, FNP-BC
Clinical Outcome Specialist Stroke
Nursing Clinical Practice Division
The Stroke Center Team
The Neuroscience Nurses
The Clinical Practice Division
Note: This guide was compiled from medical information that is available to the general public.
It should not be considered recommended treatment for any particular individual. Stroke
survivors should check with their doctors about any personal medical concerns.
The information in this patient guide was gathered from the following resources:
American Heart Association National Stroke Association
American Stroke Association The Centers for Disease Control
community.e-baptisthealth.com Thompson MICROMEDEX
National Institute of Neurological Disorders
800 Prudential Drive
Jacksonville, Florida 32207
BAPTIST MEDICAL CENTER DOWNTOWN
800 Prudential Drive
Jacksonville, Florida 32207
BAPTIST MEDICAL CENTER BEACHES
1350 13th Avenue South
Jacksonville Beach, Florida 32250
BAPTIST MEDICAL CENTER NASSAU
1250 South 18th Street
Fernandina Beach, Florida 32034
BAPTIST MEDICAL CENTER SOUTH
14550 Old St. Augustine Road
Jacksonville, Florida 32258
WOLFSON CHILDREN’S HOSPITAL
800 Prudential Drive
Jacksonville, Florida 32207