Thursday, December 30, 2010

Bad news and good news....from Kansas

Health offical warns of secondhand-smoke dangers
“Even brief exposure to tobacco smoke causes serious disease,” said Dr. Jason Eberhardt-Phillips, state health officer and director of the Division of Health at the Kansas Department of Health and Environment. “In seconds, these chemicals reach every organ in the body where they cause inflammation, put stress on the body, and cause damage to delicate tissues like those that line your blood vessels."

And for those who quit smoking, stroke risk drops...

“The benefits of quitting are remarkable,” Eberhardt-Phillips said, noting that after two to five years, a former smoker’s risk of suffering a stroke “...drops to the level of a ‘never smoker.’”

Tuesday, December 28, 2010

'Teachable moment' can help stroke prevention

Not really thought about it, but this makes some sense...

Emergency docs on call for stroke primary prevention:

The recommendations also urged emergency physicians to identify patients at high risk for stroke and to consider making referrals, conducting screenings, and beginning preventive therapy.

The American Academy of Neurology endorsed the guidelines for neurologists as well.

Emergency department visits may be a "teachable moment" for patients, agreed Roger Bonomo, MD, director of stroke care at Lenox Hill Hospital in New York City.

Although "a busy ER is not the best place to provide such education," he said in a statement sent to reporters, "it is a good enough place to start."

Friday, December 24, 2010

The world gets the 'Lazarus effect'

[This was originally posted Dec. 24, 2009]

Jesus, once more deeply moved, came to the tomb. It was a cave with a stone laid across the entrance. "Take away the stone," he said.

"But, Lord," said Martha, the sister of the dead man, "by this time there is a bad odor, for he has been there four days."

Then Jesus said, "Did I not tell you that if you believed, you would see the glory of God?"

So they took away the stone. Then Jesus looked up and said, "Father, I thank you that you have heard me. I knew that you always hear me, but I said this for the benefit of the people standing here, that they may believe that you sent me."

When he had said this, Jesus called in a loud voice, "Lazarus, come out!" The dead man came out, his hands and feet wrapped with strips of linen, and a cloth around his face.

Jesus said to them, "Take off the grave clothes and let him go."

Not long ago, I heard a presentation by one of the doctors responsible for making tPA (tissue plasminogen activator) available to stroke patients.

In my own experience, I could not speak, I could not move my right arm or leg - but after the clot-busting tPA, I regained those abilities. It was a dramatic experience. The doctor called it "the Lazarus effect."

It made me think of the story of Lazarus - see above - in John's gospel. There, a dead man regained his life. Once there was no hope. His sisters, relatives and friends knew they lost him. Jesus entered. Hope returned. Lazarus lived.

How about this world? On a cold night so long ago, a world needed this Lazarus effect. Today, this world needs it as well. On that first Christmas, God gave the world the Lazarus effect: a new beginning, a new covenant, a new life. Today, you can receive your own Lazarus effect.

Thursday, December 23, 2010

More evidence: We need better stroke care

Study gives 'striking' snapshot of stroke prognosis

Nearly two-thirds of Medicare patients who are discharged after having a stroke will die or be readmitted to the hospital within a year, according to a new study in the journal Stroke.

The findings are “striking,” says study author Gregg C. Fonarow, MD, the Eliot Corday Professor of Cardiovascular Medicine and Science and the director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles.

Fonarow and colleagues analyzed the death and hospital readmission rates for more than 91,000 Medicare beneficiaries treated for ischemic stroke at 625 hospitals from April 2003 and December 2006. The most common type of stroke, ischemic strokes occur when blood flow to the brain is blocked.

Tuesday, December 21, 2010

Time for more people to know about tPA

Like most people in 1998, I'd never heard of a drug called tPA (tissue plasminogen activator).

Sadly, too many people still don't know about it.

I recently became aware of a new book, "tPA for Stroke: The Story of a Controversial Drug" that digs into  why it's still largely unknown. The authors - Dr. Justin Zivin, a professor of neurosciences at the University of California San Diego who performed some of the earliest experiments that showed tPA could be used to treat stroke patients, and science writer John Galbraith Simmons - describe in detail the drug's controversial history.

In 1998, it had only been approved for stroke patients for a couple of years (1996) by the U.S. Food and Drug Administration. TPA acts to clear blood clots lodged in the brain - the main cause of stokes - allowing blood flow to resume to the brain. I am convinced that without the drug, at best, I would currently be disabled or, at worst, would have died that day. But because a willing neurologist happened to be available in a small-town hospital just two years after the drug was approved, I'm alive and well.

Thanks be to God.

Zivin recently talked with the San Diego Union Tribune not long about about the little-used drug that can minimize stroke damage:

Every 40 seconds, it happens to someone, somewhere in the United States. Stroke. It’s the third leading cause of death after heart disease and cancer, killing the victim in roughly three out of 10 cases while leaving many survivors with permanent brain damage and paralysis.

There is a drug, however, that can, if taken soon enough, minimize the consequences of a stroke, even produce a recovery so remarkable that it’s difficult to believe the patient ever even had a stroke. The drug is called tPA. Most stroke victims never get it.
And that's a shame. People need to know the stroke signs, call 911 and get the stroke victim to a stroke center - fast.

Friday, December 17, 2010

'I will give you rest'

“Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.”

Weary and burdened can often describe the struggles of a stroke survivor.

In this season - celebrating the birth of Jesus - we can celebrate his words of comfort for those in need.

Wednesday, December 15, 2010

Weekend admissions worse for stroke victims

An interesting followup on recent news about stroke victims in Wales should keep banker's hours came from MedlinePlus about how weekend admissions worse for stroke victims:

Canadian researchers analyzed data from almost 21,000 stroke patients admitted to 11 stroke centers in the province of Ontario. Only patients with their first stroke were included in the study.

Seven days after a stroke, patients admitted on weekends had an 8.1 percent risk of dying, compared to a 7 percent risk for those admitted on weekdays. The findings were the same regardless of age, gender, stroke severity, other medical conditions, and the use of blood clot-busting drugs.
Of course, we can't choose when a stroke occurs. However, we can know the signs, get help promptly and speak out on behalf of the stroke victim when, so often, he can't speak for himself.

Monday, December 13, 2010

New stroke prevention guidelines

For any patient, anywhere, a stroke prevented is better by far than a stroke treated. If you've got a brain, read the new guidelines on primary stroke prevention:
In 1999, AHA [American Heart Association] set a goal for 2010 of decreasing mortality from heart disease and stroke by 25%, Dr. Goldstein [Larry B. Goldstein, professor of medicine (neurology) and director of the Duke Stroke Center at Duke University Medical Center in Durham, N.C., who chaired the writing group for the new document] told Medscape Medical News. That goal was achieved early, in 2008, probably due to better prevention strategies, he said.

Of more than 790,000 strokes that occur each year, 75% of those are first events, "so prevention is particularly important." Because risk factors for both ischemic and hemorrhagic strokes largely overlap, he said, "in this guideline we address primary prevention of stroke, not just ischemic stroke, so that's one significant change."

The article details the prevention guidelines - something worth reading. Because the brain you save might be your own.

Thursday, December 09, 2010

Message from Kansas...but applicable anywhere

Even as a Missouri resident, I'd take advice from this Kansan. Jason Eberhart-Phillips, M.D., is the Kansas state health officer. He wrote an opinion piece about how stroke prevention starts with you:

Here is the bottom line: After a stroke hits, every minute counts. Time lost is brain lost.

To reduce the chances of being hit by a stroke at all, everyone can take proven steps to lower their risk – starting today. These steps include:

Keeping your blood pressure under control. High blood pressure doubles a person’s chances of stroke compared to having normal blood pressure. Roughly a third of Kansas adults have high blood pressure, and many don’t even know it.

Watching your cholesterol level. About a third of Kansas adults have cholesterol levels that are too high. High cholesterol is associated with blocked arteries in the brain, just as it is linked to blockages in blood flow to the heart.

Being physically active. Moderate activity, like walking for half an hour most days of the week, can have a dramatic effect on lowering stroke risk.

Limiting alcohol consumption. More than one or two drinks a day increases the risk of a stroke, along with heart and liver disease.

Avoiding cigarette smoke. Smoking reduces the amount of oxygen in the blood, allowing clots to form more easily.

Tuesday, December 07, 2010

No age barrier to thrombolysis in stroke?

This blog references a lot of stories about the under-50 (or even 40!) folks who have had strokes. But a reverse story, from Glasgow, Scotland, was published not long ago, based on a study for older patients treated with clotbusters for stroke:
Patients over age 80 with acute ischemic stroke fare better when treated with intravenous thrombolytic therapy than when left untreated, a new analysis shows. They derive benefits from thrombolytic therapy similar to younger patients, are not at significantly greater risk for intracranial bleeding, and, therefore, should not be denied this treatment based on age alone, investigators conclude. ...

"For most stroke physicians, the findings will confirm their suspicions and reinforce their practice," senior study investigator Dr Kennedy R Lees (University of Glasgow, Scotland) noted. "The unfortunate truth is that many older patients will have missed an opportunity for treatment and are now living with the consequences, if they even survived. We hope that now age will not be a barrier to treatment."
More important than ever for all stroke patients - young or old - to get to a stroke center as soon as possible.

Wednesday, December 01, 2010

New stroke prevention pill might be safer

More news on potentially better stroke prevention medication. Downside: Might be considerably more expensive. Given its safety vs. warfarin (also known as Coumadin), however, if you or someone you know is currently taking the major blood-thinner, it's a good idea to keep track of the progress on this medication. A recent one from USA Today:

New pill prevents strokes with less bleeding risk for atrial fib patients
The study of 14,000 patients found that a new one-a-day pill, rivaroxaban, prevents strokes as effectively as the current mainstay of treatment, Coumadin, without the need for routine testing to monitor patients' ability to make blood clots and avoid unwanted bleeding, says Robert Califf, of the Duke Clinical Research Institute in Durham, N.C.

Atrial fibrillation affects approximately 2.3 million people in the USA, and has been linked to a five-fold increase in the risk of lethal strokes. The reason: when a heart goes into atrial fibrillation, its upper chambers quiver rather than contract 60 to 90 times a minute as they're supposed to, moving blood through the heart and blood vessels.