In 2011, Congress was tasked with trying to find a way to either decrease the deficit or raise the federal debt ceiling limit. Whether it was by tax increases or spending cuts to areas such as defense and other domestic programs, there was political stalemate between Democrats and Republicans. In the end, it was agreed upon to raise the debt ceiling by way of the Budget Control Act of 2011. Outlined in the act are a set of laws and regulations that will expire at midnight on December 31, 2012 and have gained popularity in being labeled as the “Fiscal Cliff”. If these laws and regulations are left to expire, we will see increased tax rates and deep spending cuts. More money will be coming out of citizen’s paychecks but the upside is that the deficit as a percentage of Gross Domestic Product (GDP) will decrease significantly. If tax policies are allowed to expire, the United States economy could slip back into recession according to the Congressional Budget Office. This would extend the amount of time it would take for the economy to get back on stable footing and start growing at a steady pace again. To put the situation simply, when deciding what to do with the impending tax hikes and spending cuts, House and Senate members are placed with the responsibility of choosing between the short and long term impacts on the US economy. Depending on what decisions are reached we could slip back into recession or continue on our path of growth.

There are three scenarios’ that can be reached on December 31 – each with much different economic ramifications:

(1) The first is for Congress to do nothing and let the Budget Control Act of 2011’s tax increases and spending reductions occur. In the near term this will harm the U.S. and could force it back into recession but would position the US better for the future.

(2) The second scenario would be extending some tax cuts and letting others terminate while at the same time reducing only part of future spending. While this is better in the near term, it will increase the deficit as part of GDP and put the US in a comparable situation to Europe and a possible credit rating downgrade.

(3) The final scenario would be a compromise within Congress on all budget issues and would have less impact on GDP and avoid another recession. The optimal scenario would be a compromise on both sides but with political gridlock in Congress this could be difficult.

With a little more than a month to go, there is a sense of urgency for Congress to come up with concessions on both sides of the table. Republicans and Democrats continue to express progress in negotiations and are hopeful to have a proposal in place within the next couple  weeks. Whether or not a deal is reached on Capital Hill will depend on perpetual support from Republican and Democratic leaders to come up with a compromise.

Kevin Alexander
Medical Registrar
Austin Health: Melbourne, Australia

Q: What is a stroke?

A: A stroke is an acute neurological injury that occurs as a result of a disturbance in the blood flow to the brain.  This reduction in blood flow can result from blockage of an artery that supplies a part of the brain, or by rupture of an artery supplying a part of the brain.

Q: How do strokes affect people?

A: The effect of a stroke may vary and depends on a few factors.  These include the actual part of the brain affected as well as how quickly the stroke is treated.  Some people may have a stroke with no lasting effects, while others may lose significant brain functions such as the ability to speak, movement of one or more limbs, co-ordination, balance among others.

Q: Is there any way of telling if someone is having a stroke?

A: There are some features to look for that can help in determining if someone is having  a stroke.  These can be remembered using the acronym FAST.  Each letter represents a particular feature.

F – Face: Does the person’s face appear uneven or droopy to one side?

A – Arm: is there weakness or numbness in one or both arms? Or does one arm drift down if the person tries to hold it out straight?

S – Speech: Is the person having difficulty speaking? Does the speech sound strange?

T – Time: If any of these features are present, FAST action is required! The person may be having a stroke and the sooner that person can be treated, the better the chance of recovery.  The emergency response number (9-1-1) should be activated ASAP!

Q: So how is a stroke treated?

A:  Strokes can be very debilitating and can even cause death.  However, whereas in the past it may have been perceived as a death sentence, today’s treatment options offer much hope.  In some cases, early treatment can save lives and recover some of the deficits lost from the early insult.  In addition, rehabilitation programs can help improve function in areas that were affected so that persons can resume a good quality of life.

The actual treatment received depends on the type of stroke.  Strokes caused by blockage of the arteries can be treated by giving medications that “break up” the clots.  These medicines can help reopen the arteries.  Additionally, medicines can also be given to prevent new blood clots from forming and so prevent future strokes. Strokes caused by bleeding from the arteries are treated differently.  Here, treatment is aimed at reducing the damage caused by the bleeding in and around the brain.  It may involve stopping or reducing the doses of medicines that have the potential to cause or worsen bleeding.  In some cases, surgery can be performed to repair the artery or stop the bleeding.  This, however, is not always possible.

Because of the difference in the methods of treatment for the different types of strokes, it is very important to get to hospital as quickly as possible to facilitate prompt assessment so that effective treatment can be had.

Q: Can strokes be prevented?

A: Yes they can. There are certain risk factors for getting a stroke.  These include:

• High blood pressure
• Diabetes
• High cholesterol
• Cigarette smoking
• Overweight

Managing these risk factors helps reduce the risk of having a stroke.  The following provides some brief tips to help manage these risk factors:

• If your blood pressure is high, try to lower it.
• If you’re diabetic, aim to have your blood sugar as near normal as possible.
• If you’re a smoker, quit smoking.
• Exercise or physical activity for at least 30 minutes a day, most days of the week.
• If overweight, lose weight.
• Have a diet rich in fruits, vegetables and low-fat dairy products but low in sweets and refined grains such as white bread or white rice.
• Low salt diet
• Limit alcohol intake
• Less than one drink per day for women; less than two drinks per day for men
• Medicines should be taken as directed. Medicines that are especially important in preventing strokes include:
• Blood pressure medicines
• Medicines to prevent blood clots, such as daily aspirin, warfarin (brand name: Coumadin®), and dabigatran (brand name: Pradaxa®)
• Medicines called statins, which lower cholesterol

In addition to these measures, a small proportion of people may benefit from surgery that reopens clogged arteries in the neck.  This can help prevent strokes but as stated before, only a small group of people may be appropriate for this type of surgery.