DEAR DR. ROACH: I had a small stroke in September. What probably brought it on was a fall backward downstairs in the dark. I hit the back of my head on the basement floor, which was carpeted, as were the stairs. I was stunned for a few minutes, but did not lose consciousness.
Four weeks later while I was tilling my garden, my whole left arm and hand went numb. I couldn’t walk in a straight line. My speech was slurred, but my face was okay. I laid down, and the numbness went away after 20 or 30 minutes.
Now, two months later, it hasn’t recurred, and I feel fine and haven’t had headaches. I’m 86 and in good health. I never saw a doctor about this. Do you think I should do anything special? — J.H.H.
ANSWER: You have two concerning issues, which I am not sure are related. The first is the fall. Odds are, this is nothing to worry about, and without loss of consciousness, many people don’t even alert their physician. However, at age 86, there is a significant risk of damage to the delicate blood vessels in the head.
A condition called subdural hematoma, involving bleeding below the dura mater (the protective connective tissue around the brain), may result. Very slow bleeding may continue into the subdural space until a person develops symptoms, which may resemble dementia, a stroke or a seizure. A CT scan of the head is recommended to check for bleeding.
The second is the episode you are calling a stroke, but what medical experts would call a transient ischemic attack (TIA). It’s similar to a stroke, except that its effects are not permanent and last less than 24 hours. Because a TIA may herald a stroke with potentially permanent and catastrophic effects, we take these very seriously and comprehensively review the person’s condition, looking for ways to reduce stroke risk, including blood pressure and sugar control if appropriate or medication.
I am not sure that your fall has anything to do with your symptoms of sensory loss and slurred speech. A subdural hematoma can resemble a stroke, but I expect that the symptoms are permanent, at least until the pressure is relieved by draining the blood. Nevertheless, the event that you had deserves urgent evaluation. Start with your regular doctor or a neurologist.
DEAR DR. ROACH: I wonder why doctors don’t suggest lentils for constipation? Why is it always another drug? A small bowl of lentils is a magic elixir for that particular issue, and the only side effects are increased protein and a happy outcome, so to speak. — D.T.
ANSWER: First-line treatment for constipation should always be a lifestyle change, not a drug. Increased fiber (lentils are an excellent source), plenty of water intake and regular to moderate exercise are effective for most people. I often recommend prunes because they have naturally occurring substances that help promote movement in the intestines, in addition to providing fiber.
I have recently received several letters from people who made lifestyle changes and still had severe symptoms of constipation, in which case medication is reasonable.
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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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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