Aphasia treatment can be costly

Aphasia - language problems that can often be the result of a stroke - can be costly. But I'm grateful that despite aphasia after my own stroke, I was allowed to have speech therapy to bring back my language abilities to stay a productive member of society.

So when you read about how post-stroke speech problems inflate cost of treatment, remember that (1) preventing strokes can save lives and health care dollars and (2) the cost of speech therapy is small compared to the cost of doing nothing.

Help in regaining lost speech drive up medical bills, the researchers found. Medicare payments averaged over $20,700 for those with aphasia compared to about $18,700 for those without these language difficulties, an 8.5 percent difference.

The researchers also found that patients with aphasia were older and suffered more severe strokes, stayed in health care facilities 6.5 percent longer than those without impaired language, and had higher rates of illness and death.

The study appears Feb. 16 in the journal Stroke.

Each year in the United States, strokes leave about 100,000 people with language impairment.

"These findings are important because dramatic changes are occurring in health care reimbursement, specifically imposed caps on Medicare reimbursement for outpatient speech language pathology and physical therapy," study lead author Charles Ellis Jr., an associate professor of health sciences and research at the Medical University of South Carolina in Charleston, said in a journal news release.

Combo therapy may ease fatigue after stroke

I certainly relate to the chronic fatigue that happens after a stroke. It seemed to sap energy for quite some time. I was convinced at the time that going back to running helped greatly to help get past chronic fatigue.

And now, researchers have found that combo therapy may ease fatigue after stroke, as reported by Reuters Health:

The researchers recruited 83 patients who were suffering from chronic fatigue an average of four years after having a stroke.

Half were randomly assigned to 12 weeks of cognitive therapy alone, and half had cognitive therapy plus the exercise training. ...

After 12 weeks, the study found, 58 percent of patients receiving both therapies had a "clinically relevant" improvement in their fatigue, based on questionnaires. That compared with 24 percent of patients who'd had only cognitive therapy.

A clinically relevant improvement meant that patients had noticeable changes in their daily activities, [lead researcher Aglaia] Zedlitz said.

The findings, reported in the journal Stroke, suggest that a combination of cognitive therapy and exercise might help post-stroke fatigue.

(Photo from the National Institutes of Health)

Separate us? Never

For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.

-Romans 8:38-39

After a stroke, it's easy to feel separated. In my own experience, with a difficulty to read and speak, I spent time seemingly apart - even in a crowded place.

Paul's words serve as a reminder that despite what life throws at any of us, we can't be separated from God. His love is always with you.

Does that mean that post-stroke life is rosy and always ideal, always easy? Certainly not. Life will not stop giving out  challenges on a daily basis, large and small. But through at all, no matter the outcome on this life and on this earth, that love abides. Always.

More links between stroke risk, air pollution

Researchers have found more links between stroke risk and air pollution:

After reviewing the medical records of more than 1,700 stroke patients in the Boston area over 10 years, the researchers found a 34 percent increase in the risk of ischemic strokes on days with moderate air quality compared with days when the air was rated good by the U.S. Environmental Protection Agency. Ischemic strokes occur when a clot blocks blood flow to part of the brain.

On days with moderate air quality, levels of fine particulate matter is higher but within allowable limits.

“This is a significant study because we have documentation that the risk of stroke can be elevated when the air quality is still within the guidelines set by the current EPA regulations,” said Dr. Murray A. Mittleman, an author of the study who teaches at Harvard Medical School and works in the CardioVascular Institute at Beth Israel Deaconess. “This implies that the current regulations can be strengthened further to prevent these catastrophic health events.”

Problem lingers: Too many don't get help soon enough

I've posted who-knows-how-many times about the importance of getting help quickly for stroke patients.

Even as the time window for treatment for many stroke patient has expanded over the last several years, researchers have still found that many stroke victims still don't get treated fast enough:

An analysis of about 115,000 patients who had strokes between 2005 and 2010 found that almost 44 percent didn't get to the hospital until more than 4.5 hours after the time they were known to first show symptoms. That's a sign of trouble: it's actually up from 39 percent in 2005.

Meanwhile, the percentage who got to the hospital within two hours fell from 40 percent in 2005 to 35 percent in 2010, another sign that more patients may be in danger from not getting prompt care.

Also, many patients chose to get themselves to the hospital instead of calling an ambulance, "boosting the risk that they won't get there in time to be able to take a clot-busting drug," said study co-author Dr. Mary George, a medical officer with the division for heart disease and stroke prevention at the U.S. Centers for Disease Control and Prevention.

Strokes don’t just threaten the old

Mine happened at the "young" age of 39 to a longtime distance runner, non-smoker - everyone needs to know about the signs and symptoms and know what to do.

A recent Washington Post story about how strokes don’t just threaten the old; strokes among younger people are on the rise

"Nobody’s invincible,” warns Dr. Ralph Sacco, a University of Miami neurologist and past president of the American Heart Association.

Every year, about 795,000 people in the U.S. have a stroke. While some strokes are caused by bleeding in the brain, most are like a clogged pipe. Called ischemic strokes, a clot blocks blood flow, starving brain cells to death unless that circulation is restored fast.

Make no mistake, the vast majority of strokes do occur in older adults. But up to a quarter of them strike people younger than 65, Sacco says.

In the so-called stroke belt in the Southeast, that figure can be markedly worse. At Wake Forest Baptist Medical Center in North Carolina, a stunning 45 percent of stroke patients are young or middle-aged, says stroke center director Dr. Cheryl Bushnell."

Behavior (and red meat) affects health

Gulp! I plead guilty for enjoying red meat.

I do, however, generally don't have two servings a day. Maybe one. And in all kidding aside, this article showing that frequent red meat eaters at higher risk of stroke provides some guidance in how your behavior can affect your health. An excerpt:

To see what influence different types of dietary protein have on stroke risk, the researchers divided up the people in the study based on how much red meat, poultry, fish, dairy and other sources of protein they typically ate each day.

Men who ate more than two servings of red meat each day -- which was at the high end of the meat eaters -- had a 28 percent increased risk of stroke compared to men who averaged about a third of a serving of red meat each day, the low end of the red meat eaters.

The researchers considered a serving of red meat as four to six ounces of beef or a hamburger patty.

Women who ate nearly two servings of red meat a day had a 19 percent higher risk of stroke than women who ate less than half a serving each day.

A 19 percent increase in stroke risk means that instead of 26 out of every 1,000 people having a stroke, 31 out of every 1,000 people would have one.

Medicare shortchanges hospitals on stroke therapy

Interesting look on an issue that will eventually have to be reconciled. Reuters reported that Medicare shortchanges hospitals on stroke therapy:

They found that between 2001 and 2008, it typically cost U.S. hospitals $14,100 (in 2008 dollars) to care for a tPA patient who had a "good outcome." If the patient suffered serious complications from the stroke or died, the typical cost was around $19,000.

But the average Medicare payment for patients with a good outcome was $10,000, and just over $13,800 for patients who had disabling strokes.

In an earlier study, the same researchers had found that hospitals generally lose money on Medicare reimbursements for another stroke treatment - endovascular embolectomy, in which doctors go in and extract the blood clot causing the stroke.

... But over the long term, some hospitals might decide they don't want to invest in being stroke treatment centers.

"It could affect availability (of tPA) if some hospitals lose interest in treating a disease they are losing money on," Cloft said.

A state that needs help...

Being born in Arkansas, I am always drawn to news in that state. A recent story combines my home state with some serious news: saving stroke patients in a state with a high stroke death rate.

Doctor says telemedicine helps save stroke patients:

Arkansas is ranked No. 1 for stroke deaths in the country.

"A physicians shortage is a big part of it," said Northwest Medical Center Emergency Medical Director Dr. Katherine Barton. "Unfortunately, some parts of our state are very poor. There's just not always enough access to physicians like people need. There's not education about strokes that we need to have out there. And there's a lot of cardiovascular disease in our state because of a lot of obesity and smoking."

When it comes to strokes, time is everything.

"The more time that passes, the more damage that's done, the more brain cells that die and the more of your function you cannot get back," said Barton.

(Map from the U.S. Centers for Disease Control and Prevention)

Speed and skill - a stroke-fighting combination

A great story - and a reminder that quick response can make a huge difference for stroke patients - comes form Oregon, where a man's quick-acting wife and skilled doctors affected his recovery. Here's a snipped, but you should read the whole thing:

Around 7:15 a.m., 75 minutes after the first stroke symptoms, tPA began dripping into a vein in Steve's right arm. Within 15 minutes, his "word salad" disappeared. He could speak clearly.

As the intravenous drip continued, an ambulance drove Steve to Providence St. Vincent, so neurologists could observe him, and try to determine what caused the stroke.

About 48 hours later, on Thursday, Steve still wore blue pajama pants and a less-than-cozy hospital gown. But his shoes stood nearby as he waited to be discharged. Even doctors were stunned by his swift recovery, his speech and memory restored.