Stress tsar Tony Rudd: 'A little bit of stress is good for you' Stroke is the third most common cause of death after heart disease and cancer and the most common cause of adult disability. People are now aware of the importance of controlling blood pressure and cholesterol levels, but less is known about the dangers of very vigorous exercise - although TV presenter Andrew Marr's stroke after a spell on a rowing machine has hopefully changed this. Activities such as weightlifting should be avoided, says Rudd; and osteopaths should not be allowed "anywhere near the neck." "You'd be mad to let someone pull your neck around," he says. There is a real risk of arterial dissection [a torn artery]. The same thing can also happen to people being spun round violently on fairground rides. He also urges stroke survivors not to lose hope. For far too long, there has been a fallacious belief that if someone hasn't recovered in three months, they are not going to recover at all. It's nonsense. People carry on recovering for years afterwards. Certainly, with language, recovery starts off later and tends to go on longer," he says. How will stroke care do under the NHS reforms? One of Rudd's biggest challenges is to encourage the new Clinical Commissioning Groups (CCGs), who will decide how money is spent locally, to look at the bigger picture so that the same standards can be enforced everywhere. "I firmly believe that the clinical commissioners have their hearts in the right place," he says. It's still early days, and the CCGs are unlikely to take risks around transforming services. I am optimistic that as they gain experience they will have the courage to be more radical. The idea of being a stroke tsar is unlikely to turn Rudd's head - indeed, he hates the expression. He began his career some 30 years ago, choosing one of the least sexy specialisms - geriatric medicine. While working as a geriatrician at St George's Hospital, London, in the Eighties, he realised how "appalling" stroke care was. "The assumption was that stroke was a pretty much untreatable disease, with patients left languishing on different wards," he recalls. Three of us physicians said 'Let's sort this out. We set up a dedicated stroke unit and the rest is history. The initiative, the first of its kind in the country, became the model for stroke services nationally. Rudd is no shrinking violet when it comes to speaking out about Government policy. He once called the health reforms nonsensical and wanted them to be reversed. These days he is more pragmatic, citing "opportunities which exist now which were not there before." On funding, he comments: "We know that the days of huge growth within the health service are at an end, but there is plenty we can do within the existing budget." One beef that Rudd does have with the Government is that it has not taken enough action on smoking and alcohol. It's very disappointing that the Government has decided not to encourage plain packaging for cigarettes and minimum pricing for alcohol. I think these are extremely important measures to prevent stroke. When it comes to his own health, like many medics Rudd has no idea of his own cholesterol levels and has not had his blood pressure checked for years. But, then, he does run up and down nine flights of stairs every day. In his line of work, surely he must feel a sense of mortality? I know I've been incredibly fortunate so far, touch wood. It is a stressful job, but not all stress is bad. Working with people that you can't stand or who are incompetent or unpleasant is a situation that causes your blood pressure to go up. That's bad stress. A job that keeps you alert and stimulated is good stress. I would be far more likely to have a stroke from twiddling my thumbs and not having enough to do than I would do from buzzing around.