Tuesday, April 15, 2014

Too often, strokes are missed in ERs

Clearly, more training is needed. A recent study showed that strokes are often missed in ERs:
Every year, tens of thousands of Americans with symptoms such as dizziness or headache are misdiagnosed in the ER in the days or weeks before they suffer a stroke, according to the researchers.
Women, minorities and those under age 45 are the most likely to be misdiagnosed, according to the study published online April 3 in the journal Diagnosis.
"It's clear that ER physicians need to be more discerning and vigilant in ruling out stroke, even in younger people," study leader Dr. David Newman-Toker, an associate professor of neurology at the Johns Hopkins University School of Medicine in Baltimore, said in a Hopkins news release.
That's a scary thought - people under 45, women and minorities are too often misdiagnosed. My own stroke came at age 39, so I feel incredibly fortunate that the right doctors and other professionals were at the right time and right place.

Of course, if a stroke diagnosed is missed or even delayed, it could mean more consequences for the stroke patient: Possibly more likely to suffer more profound disability, or even death.

If you see someone with stroke signs, make sure you make that known to the health professionals. You might save a life that way.

Thursday, April 10, 2014

Stem cell story worth reading

Whenever I see "stem cells," I put up my skepticism shield. There's been a lot of hyperbole out there about stem cells.

However, this recent story shows a small light of good news without overselling. It's how stem cells helped some stroke patients recover:
All the patients saw some improvement in weakness or paralysis within six months of their procedures. Although three people developed complications related to the surgery, they all recovered. There were no adverse reactions to the transplanted stem cells themselves, the study authors said.
What's more, the researchers said, two patients experienced dramatic recoveries almost immediately after the treatments. ...
"It's a small, early human study. It takes multiple steps to get to something clinically useful, and this is a nice, early step," said Dr. Steven Cramer, clinical director of the Stem Cell Research Center at the University of California, Irvine.
Again, as the researcher says, it's a small study. Still, worth watching.

Tuesday, April 08, 2014

An update one week out

Be joyful in hope, patient in affliction, faithful in prayer.

This is my week anniversary of surgery, and while I can tell my knee problem was fixed, it's still sore and swollen. In other words, fairly normal recovery.

Now, it's a matter of patience. I am not patient person in many ways. I want instant relief, instant fix, instant recovery.

Of course, the world seldom operates that way. Instead, we wait for relief, we sit and try to fill our time for fixes, we spent hours, days, weeks, months and more for recovery. But Paul gave some great advice to his fellow believers in Rome.

We don't always have control - indeed, we seldom have control - over time and recovery. Certainly, there are often - not always, but often - ways to smooth our path for recovery. There are many, many well-trained health professionals who can help. And in many instances, using patience will bring about more lasting recuperation.

So in my recovery, I do pray that I can be joyful in hope, patient in my affliction, and faithful to pray.

Thursday, April 03, 2014

Having the hard discussions

Photo from the U.S. Department of Veterans Affairs
We all want to recover completely - the alternatives are unpleasant, and we're tempted to shy away from even thinking about these alternatives.

But the truth is, stroke is the most common cause of disability in the United States, and it's the fourth leading cause of death. Of course, the medical community needs to continue its efforts to find better ways to prevent and treat strokes to improve these numbers.

It's sometimes hard to talk about the type of care that some stroke patients need. And I'm not 100 percent in agreement with the tone and implication of the American Heart Association/American Stroke Association statement that "the majority" stroke patients need palliative care - that is, care with the emphasis on comfort rather than dealing with the underlying problem.

Still, the ASA did come up with some potential discussion points between stroke survivors, caregivers and health professionals:
As a stroke survivor or family member, you should expect your healthcare provider to:
  • Talk about your preferences, needs and values as a guide to medical decisions.
  • Discuss what aspects of recovery are most important to you.
  • Have effective, sensitive discussions about your prognosis, how to deal with physical or mental losses from a stroke, and if necessary, of dying, among  other serious topics.
  • Guide you through choices about life-sustaining treatment options. Providers should address pros and cons of CPR, ventilators, feeding tubes, surgery, do-not-resuscitate orders (DNR), do-not-intubate (DNI) orders and natural feeding.
  • Know the best treatment options for common post-stroke symptoms, including pain, other physical symptoms and psychological problems like depression and anxiety.
  • Engage a palliative care specialist if complex issues arise.
  • Help preserve dignity and maximize comfort throughout the course of a stroke, including during the dying process and when nearing death.
Understandably, these might be very hard conversations. But avoiding these conversations might cause increased and needless suffering.

Tuesday, April 01, 2014

Most women miss most stroke signs

Stroke signs - too few people recognize them.

I'm guessing that men and women pretty much equally miss the signs in general. However, a recent study focused on just one sex and found that most stroke signs are unrecognized by most women:
Slightly more than half of the participants (51%) identified sudden one-sided weakness or numbness of the face or a limb as a stroke warning sign, but the rest of the warning signs were tagged by fewer than half, according to Heidi Mochari-Greenberger, PhD, MPH, of Columbia University Medical Center in New York City.
Those included difficulty speaking or understanding speech (identified by 44% overall but by a lower percentage in Hispanic versus white women), sudden severe headache (23%), unexplained dizziness (20%), and sudden loss of at least some vision (18%), she reported at the American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity, and Metabolism meeting in San Francisco.
I'd add that not every stroke has every sign. I never had a headache, for example. So even if one sign appears, get to help fast!

Thursday, March 27, 2014

Delays to stroke treatment can be costly

I was fortunate enough to get help quickly on the day my stroke happened. Now, recently published research casts this in a different way - stroke patients lose a month for each 15-minute delay:
Diane Barbeler had a stroke on Monday last week. The next day, she walked out of the hospital with only minor sensory changes in her right hand and foot.
Barbeler owes her quick recovery to the tissue plasminogen activator, or tPA, that she received within 3 hours of losing strength and control in her lower limb, says Atte Meretoja, a neurologist who helped diagnose her stroke at Australia’s Royal Melbourne Hospital. Patients like Barbeler, 66, gain a month of disability-free life for every 15 minutes saved in getting the clot-busting drug, according to research by Meretoja and colleagues published today in the journal Stroke. ...
“The main delay in stroke is due to people not calling for help,” said Meretoja, the lead author of the study and an associate professor of medicine at the University of Melbourne. “We have now demonstrated that this is very harmful, and people lose on average a month of life for every 15 minutes they wait at home hoping that the symptoms will go away.”
That's a sobering number. Wait 15 more minutes, and you lose a month. Know the signs of a stroke and get help - for yourself or someone you care about - quickly.

From the American Stroke Association

Tuesday, March 25, 2014

Watch your blood pressure - now more than ever

Hypertension - high blood pressure - is the leading cause of strokes in the United States. So it makes sense to keep up with your own numbers and, if directed by a physician, do something about them.

Now, the latest news is that even slightly higher blood pressure may raise stroke risk:
The sweeping review analyzed data from 760,000 study participants who were followed for up to 36 years. The researchers found that people with "prehypertension" - higher-than-optimal blood pressure not officially defined as high blood pressure - were 66 percent more likely to experience a stroke than those with normal blood pressure.
"This meta-analysis confirms evidence from many studies, and I think it continues to warn physicians and the public that more vigorous control of blood pressure is important for reducing stroke risk," said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine, who was not involved in the research. "The findings confirm that even mild to moderate levels of elevated blood pressure are important for determining stroke risk."