Tuesday, October 30, 2012

Plugging holes in the heart good for you? Maybe. Maybe not.

So ... for stroke prevention, do plugging holes in the heart serve better than taking blood thinner medications? The resounding answer: Maybe not. But maybe so.

A recent paper outlined the results of research of the effects of plugging a patent foramen ovale (click here for details about that term) in terms of preventing strokes. My 1998 cryptogenic stroke - that is, a stroke with no clear reason - was finally attributed to a hole between two heart chambers. (Click here for my own story about what happened.)

For this post, let's go through two articles and one press release (which you should read in their entirety) with a few snippets included. First, here's one headlined that Plugging PFOs no help for stroke -- maybe:
He said physicians should consider the following:
  • First, we're talking about a stroke risk reduction that, if it plays out over time in a 46-year-old, is important.
  • Second, for patients who are in the midst of their lives regarding career or family, they are looking for the best strategy to reduce the risk of having another stroke with all those consequences. So, what may be a small difference [in absolute risk reduction to an observer], is a huge difference to these patients
  • And third, when we review pharmacologic studies that look at the risk reduction of secondary stroke prevention, we are not dealing with the same magnitude. These magnitudes of risk reduction [in RESPECT] are really substantial. That's what you must keep in mind when dealing with this patient population.
So, the story is that decisions need to be made on a patient-by-patient basis. I agree with that idea. The next item is a little more positive on the closure side.

PFO closure may be superior to medical therapy in preventing stroke:
"In contrast to a previously reported randomized trial for the treatment of cryptogenic stroke, the RESPECT trial enrolled only patients with documented cryptogenic embolic strokes and excluded patients with other potential causes of stroke and/or TIA. The period of follow-up approached nine years and was not restricted to only events within the initial two years of follow-up," said Richard Smalling, M.D., Ph.D., James D. Wood Distinguished Chair in Cardiovascular Medicine at The University of Texas Health Science Center at Houston (UTHealth), who served on the steering committee and as a principal investigator of the trial.
"As a result, the trial enrolled patients at high-risk for recurrent events and followed them for a long period of time, enabling the detection of relatively infrequent recurrent stroke," said Smalling, who is director of interventional cardiovascular medicine at the Memorial Hermann Heart and Vascular Institute. "The totality of evidence in the RESPECT trial clearly demonstrates the superiority of device closure using the Amplatzer PFO Occluder in patients with the above entry criteria compared to standard medical therapy."
Finally a story with a decided negative bent is headlined how St. Jude device to close heart holes fails to stop stroke:
The results won’t change medical practice very much, with some high-risk patients still likely to get treated even without formal FDA approval, Ajay Kirtane, director of the interventional cardiology fellowship program at Columbia University Medical Center/New York-Presbyterian Hospital in New York, said at the meeting.
“I would like as a physician to have the option to discuss it with the patient and be able to use it if the patient elects to do so,” he said. “That would be the ideal scenario. To use it in everybody, I don’t think you can do that on the basis of this data.” ...
“These are healthy people, and the results are something a 46-year-old stroke patient wants to know,” said lead researcher John Carroll, director of interventional cardiology at the University of Colorado. “It works. What we are debating is how superior it is to medical therapy. Any benefit that could potentially cut the risks down the road has a big impact.”
So my own bottom line hasn't changed on this: It's very much a decision that needs to be informed and made carefully between doctor(s) and patient. A single answer won't fit everybody, in this case.

I am convinced mine has prevented further strokes or mini-strokes. That being said, I was an active relatively young man when mine happened. Everyone has his or her own circumstances, and those have to be taken into account in any serious medical decision.

Monday, October 29, 2012

‘Hercules’ urges stroke awareness

Today is World Stroke Day, a day to push for awareness of stroke signs and know what to do when you see these signs.

Even ‘Hercules’ star and stroke survivor Kevin Sorbo urges stroke awareness:
On World Stroke Day, Oct. 29, he’s joining forces with the American Stroke Association, a division of the American Heart Association, to spread the word about something else he’s learned about stroke: In many circumstances, it is beatable.
Kevin Sorbo, star of the television series “Hercules,” was only 38 when he suffered three strokes.  That was how he learned anyone can have a stroke.
"Like my character, Hercules, I thought I was invincible," said Sorbo, author of True Strength: My Journey from Hercules to Mere Mortal and How Nearly Dying Saved My Life. “There are many myths and misconceptions about stroke. As a survivor, I have learned that stroke is largely preventable, treatable and beatable."

Thursday, October 25, 2012

New treatments for those going through aphasia

Catching up on news about aphasia, which I went through after my stroke some years ago. Check out the story on how new treatments may help restore speech lost to aphasia:
But technology, Riedel said, has introduced new language-improvement techniques into the mix over the last few years that are both exciting and fun. Several apps available for iPhone or iPad involve synthetic speech that helps engage those with aphasia in yet another realm of communication.
"Our patients have much more access to different kinds of programs that are computer-based," she said. "There's always something new around the corner."
What remains a constant concern, however, is the misunderstanding many people have of those with language difficulties and how to treat them, Ganzfried and Riedel agreed.
"Many people with aphasia will become socially isolated because of their communication difficulties, which can lead to depression," Ganzfried said. "There are also many misconceptions about aphasia, including that the person is mentally unstable or under the influence of drugs or alcohol. It's also extremely frustrating. Imagine knowing what you want to say in your head but you can't get the words out."
This problem can indeed by frustrating. It doesn't affect your level of intelligence - just getting those thoughts out in the form of language.

Tuesday, October 23, 2012

Video demonstrates role of exercise in stroke recovery

Through the new use of Twitter (click there to follow Stroke of Faith!) I found this video about the role of exercise in stroke recovery:
To recover from her TIA and head off a full-blown stroke, Helen enrolled in a year-long study of exercise and stroke recovery run by the Heart and Stroke Foundation Centre for Stroke Recovery. This video tells her story, and explains how exercise can help people recover from stroke.
A good video to share ...

And a second find from the same Centre for Stroke Recovery talks about the the importance of research into stroke recovery:
The best thing is to prevent stroke before it happens. The next best thing is to treat stroke quickly, before it can seriously damage the brain. This is easier said than done. Brain cells die quickly after stroke (which is why we often say “time is brain”). One effective treatment does exist – but most stroke patients don’t get to hospital soon enough to benefit from it. Even those who get the drug in time are often left with deficits.The vast majority of stroke patients rely on rehabilitation to provide them with an improved quality of life after stroke. This is why we urgently need to find better ways to help stroke survivors recover more quickly and more completely.

Saturday, October 20, 2012

Tomatoes for stroke prevention?

I'm not a big fan of raw tomatoes, and turns out cooked tomatoes might be even better in terms of tomatoes for stroke prevention:
"This study supports the recommendation of eating [more] servings of fruits and vegetables a day," said Nancy Copperman, MS, RD, director of public health initiatives at the North Shore-Long Island Jewish Health System in Great Neck, N.Y.
"Foods such as tomatoes, guava, watermelon, and grapefruit are good sources of lycopene," she said in a statement. "When a tomato is cooked, the heat processing actually increases the levels of cis-lycopene, which is easily absorbed by the body."
(Photo from the Arkansas Secretary of State) 

Thursday, October 18, 2012

Stroke recovery - someday an app for that?

From across the pond, comes news about university students launching a new app in hopes of helping stroke victims:
StrokeLink, a free app that uses a patient-focused interface, empowers stroke survivors by providing them with the necessary tools to regain their independence. The app’s toolkit of health reference material and its powerful tool for rehabilitation was created to guide and actively engage stroke patients as they recover, using accessible design and rich media content.
These self-care tools include rehabilitation programs with exercises ranging from fine motor skills to full body movements, and are presented as text, pictures, or videos, accompanied by audio cues.
We've seen other technologies - video games, for one - being adapted as tools for stroke recovery. Hope this one comes to fruition, too.

Tuesday, October 16, 2012

Resources about stroke effects

Simple resources for stroke survivors and loved ones are all over the Web. I stumbled across this one recently, a Web tool to explore the effects of a stroke, courtesy of the National Stroke Association:
Stroke affects physical, cognitive and emotional functioning, but there are things that can be done to reduce the impact of post-stroke effects. Each patient’s stroke experience is different and depends on the type of stroke and which areas of the brain are damaged.
Effects can be experienced at varying degrees at any phase of recovery. Understanding the nature of the effects of stroke and what can be done about them is the first step to recovery.
Just follow the link to explore.

Thursday, October 11, 2012

Aphasia advocate's story

I'll never forget one stroke story I heard some years ago - long before my own stroke.

The newspaper editor was at a meeting and was leaving when he turned and spoke to someone. He - and everyone else within earshot - heard nothing but gibberish. Classic aphasia for a stroke patient.

My good old Google alert found a story of another stroke survivor recovering from aphasia:
The first month after my stroke I was told I would never walk again or be able to use my left arm. I sat in my wheelchair and cried. Today, I would say I am 99 percent of the woman I was before my stroke due to the therapy I was able to receive. Because of that, it’s important that I stand and fight to help others just like me.
Click on the link and read her entire story, but one phrase stands out for me - "due to the therapy I was able to receive."

In my own recovery, I'm convinced that speech therapy was an important part of bringing back my abilities to read, write and speak. So if you've recovered some abilities - even if it's below her 99 percent - look for ways to support others who are in their own struggle. You can make a serious difference in someone's life.

Tuesday, October 09, 2012

'Be our strength every morning'

Lord, be gracious to us;
    we long for you.
Be our strength every morning,
    our salvation in time of distress.

Somewhere along the way, I became a morning person. Most days when I run, I wake up before dawn, quietly prepare, and run. Not fast, to be certain, but run.

Because of this, I've seen lot of sunrises. Yet I'm never tired of them. A new day, new strength, new hope - all because of God's grace and love.

We often equate night - darkness - with times of distress. Yet God is waiting for us with a sunrise. We long for God, as the verse in Isaiah says. But in his time, morning is coming, with salvation, despite all the distress we face.

(Photo from National Center for Atmospheric Research)

Thursday, October 04, 2012

Minor isn't so minor...

What's a "minor" stroke?

Turns out, we might have to redefine that term. Recent research, as reported by heart.org, notes that minor stroke can cause major disability:
"We found that patients with blocked or narrowed blood vessels were at the highest risk of disability," she added. "These patients need to have brain and blood-vessel imaging quickly to decide what interventions are needed to prevent disability."
Their findings build on previous work that has shown that patients with stroke considered "too mild for thrombolysis don't do as well as we might think," Coutts said.
The study was published online September 13, 2012 in Stroke.
Reached for comment on the study, Dr Pooja Khatri (University of Cincinnati Academic Health Center, OH) said: "Dr Coutts and her colleagues have once again demonstrated that so-called mild strokes are not always so mild. Even in this particularly mild cohort, consisting of both TIAs and the mildest strokes, they saw a substantial amount of disability at 90 days.

All the more reason for this blog's constant refrain: Know stroke signs. Act quickly. Be an advocate for someone.

Tuesday, October 02, 2012

Diet part 3: Yogurt might help blood pressure

Last post talked about raising blood pressure via salt intake. Today, the news is a little more positive - about yogurt. I've been a fan of yogurt for years - and especially, lately, Greek yogurt, which generally contains more protein. So here's a link how yogurt is linked to lower blood pressure:
People who ate at least the equivalent of one serving every three days were 31% less likely to develop high blood pressure than those who ate no yogurt at all, Huifen Wang, PhD, of Tufts University in Boston, and colleagues found.
An even stronger effect was seen among individuals who were not taking antihypertensive drugs, according to their analysis of the Framingham Heart Study Offspring Cohort reported at the American Heart Association's High Blood Pressure Research meeting in Washington, D.C.
"Yogurt is a nutrient-dense, low-fat dairy product," the group noted. "Higher yogurt intake, as part of a healthy diet pattern, may be beneficial for blood pressure control and hypertension prevention.

High blood pressure, of course, is a leading stroke risk factor. So any reasonable way to maintain a normal blood pressure puts you ahead in the game!