Hole elevates stroke risk of older patients, too

An article recently published by The New England Journal of Medicine shows that like the not-so-old set, people over 55 face a higher risk of stroke if a patent foramen ovale (or PFO, a hole between the two upper chambers of the heart) is present.

The article cites a study of 503 patients and reports that a "patent foramen ovale was more than twice as common in older patients with a crytogenic stroke" -- that is, a stroke with no obvious cause -- "as it was with a group of patients with stroke of known origin," according to a MedPage Today article.

"Consistent with previous studies," the article says, "cryptogenic stroke patients younger than 55 had a threefold greater prevalence of patent foramen ovale than did the patients with stroke of known cause."

Should those patients have those PFOs closed? Studies are ongoing. So if you fall into that category, stay in contact with a neurologist or cardiologist and keep tabs on new developments.

Another hole-in-the-heart resource

My trusty Google alert flagged another information resource about a common heart defect that is suspected to lead to strokes under certain conditions.

The defect -- called a patent foramen ovale -- is a hole between the upper chambers of the heart. Everybody is born with the hole, which normally is closed shortly after birth. For previous entries on my own experience, you can click here, here or here.

The latest one is from iVillage Total Health (click here to read the article) and covers the basic facts about the defect, symptoms (which are usually nonexistent) and diagnosis, treatment and good questions for your doctor.

The site is limited but has some video and other explanatory content that might help in your search for information.

Clues to a living treasure

Can you be a clue?

In the movie “National Treasure,” the character played by Nicholas Cage had spent his adult life seeking a fabulous, secret treasure. Early on, he discovers an important clue about the location of the treasure, hidden in a beautiful carved pipe hidden in the hold of a long-lost ship. Most of the rest of the movie revolves around his constant search to follow one clue, which leads to another clue to another clue – until finally the treasure is revealed. And no other order of events would have worked.

If he skipped any step, the treasure would never have been found. If he went out of order, somehow stumbling across certain clues before the proper time, he would have been hopelessly lost. Instead, step by step, in the proper order, in the proper time, the key was found, the treasure was won.

Consider people like prophet Jeremiah and Apostle Paul. Each stood at their points of time and became living clues to a living treasure. Those clues were and are ready to be followed by any eager seeker of this treasure. And the treasure was – and can be again and again – won.

Like Jeremiah, like Paul – to whatever degree – can the rest of us serve as clues to that treasure? There are plenty of people who are lost, desperately seeking that one piece of information, that one remark, that one example of behavior. Am I necessarily the clue that unlocks the treasure? Maybe. Or maybe I’m the clue that sends the person to you, and you keep the sequence going. Next time, maybe it’s reversed, because best of all, unlike the movie, we’re not the clues for just one person, but potentially for anyone we encounter any place.

This blog is designed as a series of clues to that living treasure, especially for those whose lives have been impacted by stroke. So the next time someone asks about your faith, or simply is in need of an act of kindness or friendliness – can you be a clue?

Good news, bad news

Interesting article appeared on a Web site called MedPage Today (more on that later) recently about poor advice from hospital "healthline" operators concerning stroke symptoms.

The article, titled "Stroke Patients May Get Faulty Advice from Hospital Healthlines," details how investigators called various hospitals, described stroke symptoms, and too often received bad advice such as:

• Call your own doctor
• Wait to see if your symptoms improve
• Drive the patient for medical care

The correct answer, of course, is to call 911 for an ambulance. Don't wait.

Here's a good description of stroke symptoms, plus other great advice, from the American Stroke Association:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

The good news is the source of the article cited, which seems to be a good resource for other medical information. MedPage Today is described as a "medical news service" for physicians, but this article is a pretty easy read even for a non-doctor. It works with the University of Pennsylvania School of Medicine for some of its content, including the article linked. Click here for its entire Stroke section.

Heart of the matter

This video, obtained from the incredibly nice people at Barnes-Jewish Hospital of St. Louis, is an actual series of images showing part of the procedure described in the previous two posts.

The post-procedure posting shows an animated version of this device. The previous one described the procedure, which is designed to close a hole between the upper chambers of the heart, a common birth defect called a patent foramen ovale.

The image is fairly faint, but it does show the outlines of two connected metal mesh discs and the two catheters, one for imaging and the other for deploying the device.

Again, I hope it might become helpful for anyone who is researching this procedure. It was not that painful and after three weeks (as of Monday, July 16), so far so good. Thanks be to God.

Hole replaced by hope

 As mentioned in the previous post, on Monday, June 25, 2007, my patent foramen ovale (hole between the two upper chambers of the heart) was closed via cardiac catheter.

The hole was plugged with an Amplatzer "Cribriform" device, which places two nickel-titanium alloy discs of metal mesh and polyester fabric, just under an inch across, on each side of the hole, shutting off the flow from vein side to arterial side. The video above, which is a depiction of how the device would be placed, came from the Web site www.amplatzer.com, owned by the AGA Medical Corp., the manufacturer.

And the placement of this device, of course, brings hope of preventing future strokes.

For anyone who is considering a similar procedure, the catheterization procedure itself was almost painless and took about 45 minutes. I was vaguely awake most of the time, watching quite a bit of the process on a monitor mounted to my left. But afterward, you'll have some sore legs for several days and restrictions for several weeks. Follow them to the letter. It's hard for a distance runner to be sidelined, but some things can't be rushed. Even hope.

Speaking of hope, my hope is that this experience might give hope to someone in similar circumstance. So here' s to hope, gifted to us by God.

There's a hole in my heart

A word to the around-40-year-old set: It can happen to you, too. Strokes are not always confined to the elderly.

I post this not to encourage pity, but rather to issue a warning: Be aware of stroke symptoms, even if you're young and in the best of health. A lurking birth defect can cause trouble, and it's important to act promptly when you even suspect stroke symptoms.

The above video is an experiment, so please forgive my amateur presentation. But considering the information below, it might save the life of someone you love -- or your own.

For nine years, I've had the nagging information that there is a small hole in my heart (more information to follow) that, in all likelihood, contributed to my stroke in 1998. A minor transient ischemic attack in April 2007, though, put that hole back on my radar. And with it, a hope to drastically reduce my stroke risk. Permanently.

Thus the video. It's from a transesophageal echocardiogram, big words to describe a camera that goes down your gullet to capture images of your moving heart. It was conducted at the Missouri Heart Center in Columbia, Mo. This is one snippet and it's my best guess of the location of the hole. At one point of the video, you see no color, then a burst of blue then red, appearing to pass through a small hole. If it's wrong, I'll correct the video. Again, it's my amateur's best guess.

The hole is between the two top chambers of my heart. This is a common birth defect. There are a few complicating physical factors -- based on the characteristics of the wall between the two chambers -- that places me at relatively high risk of stroke. So a doctor in St. Louis will snake a tube through some arteries to the heart and apply a patch device, comprised of two quarter-size pieces of nickel-titanium mesh. This is the same procedure done on Tedy Bruschi, a current New England Patriots linebacker.

The heart procedure is set for Monday, June 25. Dr. John LaSala will conduct this procedure at Barnes-Jewish Hospital.

Warning: This is written by a non-doctor. So please, don't take this as actual medical expertise. It's the best I can do, and it's probably 'way too simplified. If you think you're having or have had stroke or TIA symptoms, see a doctor. Now.

I offer these details to illustrate how it can happen to a relatively young, relatively fit person.

The small hole between the two atrial chambers is called a patent foramen ovale. Everyone is born with the hole and, depending on who you ask, somewhere between 75 and 80 percent of the time, it seals up shortly after birth. That means about 1 out of 4 or 5 people actually have a foramen ovale, which is not a huge problem. For most.

There are exceptions to that statement, though; my particular problem centers on the muscular wall between the two chambers, called the atrial septum. It should be smooth and flat. If so, the vast majority of people with a foramen ovale never know and no problems ever develop. In some instances, though, the atrial septum is misshaped, called an atrial septal aneurysm. That's where the problem arises.

Normally, the right atrium receives blood from the vein side of the circulatory system, then passes it along to the lungs. In addition to processing oxygen for the blood supply, the lungs also use a filtering mechanism to remove debris, such as clots. From the lungs, the blood is moved back to the other side of the heart and pumped out to the arterial system, supplying oxygen-rich filtered blood to the body. However, if the atrial septum has a divot, if you will, then debris can collect. When pressure builds up in the chest -- say, from coughing or sneezing -- then blood and debris can move through the foramen ovale from the right atrium to the left atrium, circumventing the lung's filtering system. Unfiltered blood is pumped out into the body, including the brain.

Because of this, nine years ago I experienced a cryptogenic stroke -- that is, a stroke with no obvious cause. Last April, a much more minor episode occurred, which triggered a round of tests recently completed. As long as the current conditions remain, my risk of stroke is several percentage points higher than the rest of the population, despite the fact that I don't smoke, have low cholesterol levels, excellent blood pressure readings and, being a distance runner going on 20 years, am generally quite fit.

Dr. LaSala will use an arterial catheter to insert a metal-mesh object that, once in place, will expand into shapes that look like two small umbrellas and cover the hole, one on one side and one on the other. Over time, scar tissue should cover the patch and permanently seal it against the atrial septum.

The final result: My stroke risk will fall dramatically and should actually be lower than the general population. I anticipate a complete recovery and, in fact, to be in better health than ever.

That, at least, is the plan. What will happen? It's not up to me. But I trust the one who is in charge.

Living with imperfection – for now

In these post-Easter days, some notes to consider about our all-too human condition. From Luke 24:1-12:

On the first day of the week, very early in the morning, the women took the spices they had prepared and went to the tomb. They found the stone rolled away from the tomb, but when they entered, they did not find the body of the Lord Jesus. While they were wondering about this, suddenly two men in clothes that gleamed like lightning stood beside them. In their fright the women bowed down with their faces to the ground, but the men said to them, "Why do you look for the living among the dead? He is not here; he has risen! Remember how he told you, while he was still with you in Galilee: 'The Son of Man must be delivered into the hands of sinful men, be crucified and on the third day be raised again.' " Then they remembered his words.

When they came back from the tomb, they told all these things to the Eleven and to all the others. It was Mary Magdalene, Joanna, Mary the mother of James, and the thers with them who told this to the apostles. But they did not believe the women, because their words seemed to them like nonsense. Peter, however, got up and ran to the tomb. Bending over, he saw the strips of linen lying by themselves, and he went away, wondering to himself what had happened.

Perfection required?

Thank God – and I mean God – the answer is no.

Consider some of the witnesses of the first Resurrection Day, the greatest day in human history, the day Christ rose from the grave, and the day he redeemed us all: Mary Magdalene and Joanna were among those described as afflicted with evil spirits and disease (Luke 8:1-2). Peter denied Christ to witnesses before the Crucifixion (Luke 22:60).

They were imperfect,flawed sinners. As are we all. What did these sinners do? Mary and Joanna, and others, delivered the news. Peter ran to the tomb. In Acts, he becomes the Rock of a faith that we follow to this day. The other followers finally came to understand Jesus' words in Galilee: "the Son of Man must be handed over to sinners, and be crucified, and on the third day rise again." (Luke 24:7)

Like Jesus came to the cross in the face of death, those early followers came to faith in the face of their own imperfection. Consider that day, that Resurrection Day. It began as a day of bitterness and misery for a small band of people who might have been quickly forgotten. The day turned bright indeed, though, for the women who visited the empty tomb, for Peter, and, thank God, for all of us who celebrate that day.

A stroke can be a physical sign of imperfection. For the moment. In his own time, God prepares perfection for us. That is our hope and strength.

Faith and strokes: Interesting study

A recent article reports what the faithful already knew.

The article, "Scientific American: Religious faith may help stroke victims: study," is based on an article in newsletter Stroke, published by the American Heart Association. Researchers at the San Raffaele Pisana Rehabilitation Center in Rome interviewed 132 stroke survivors about their religious beliefs and spirituality.

"The analysis showed higher scores on the anxiety and depression scale correlated significantly with lower scores on the religious and spirituality questionnaire," said the American Heart Association, which publishes Stroke.

In English: Chances are, if you have faith, your stress levels are lower after a stroke.

One more note from the article: "The reasons for this possible link between faith and post-stroke emotional distress are hard to pin down, though the researchers gave tentative explanations."

Hard to pin down? How about this: God, through your faith, gives you strength.