Stroke sign and prevention tips

Another Web site with some stroke prevention tips: Signs and tips for prevention from familydoctor.org. A snippet:

Risk factors for a stroke

* Atherosclerosis (hardening of the arteries)
* Uncontrolled diabetes
* High blood pressure
* High cholesterol level
* Smoking
* Previous transient ischemic attack (TIA)
* Heart disease
* Carotid artery disease (the artery that carries blood to your brain)

Many of these risk factors are treatable - so if this list sounds like you or one of your loved ones, get to a doctor if you haven't already!

Anniversary of hole repaired

Close to the end of the day today, June 25, 2008, remembered that this is the first anniversary of the procedure that plugged a hole in my heart.

My 1998 stroke was likely caused by a small hole between the two atrial chambers, called a patent foramen ovale. Everyone is born with the hole and most of the time, it seals up shortly after birth. And add another defect: The wall between the two chambers, called the atrial septum, should be smooth and flat. If so, even a patent foramen ovale is unlikely to cause a problem. In some instances, though, the atrial septum is misshaped, called an atrial septal aneurysm. The hole and the aneurysm combination increases the chances of a problem.

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 patent 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, 10 years ago I experienced a cryptogenic stroke -- that is, a stroke with no obvious cause. In April 2007, a much more minor episode occurred, which triggered a round of tests. As long as the conditions remained, my risk of stroke was 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.

Thus, a year ago, I went through a procedure, in which a doctor snaked a couple of tubes through some arteries and deployed a device that plugged the hole. Within six weeks, I was back to normal. After six months, I received a final OK that the hole was completely sealed. No more restrictions, no more prescription blood-thinner, no higher stroke risk than the rest of the population.

Found a video about the procedure, including the very same doctor who did the work at Barnes-Jewish Hospital in St. Louis. If nothing else, I hope this gives someone reassurance that even a hole in the heart can be defeated.

Stroke Doc - slightly off-beat but well-thought resource

A blog with the straightforward name - Stroke Doc - is a resource offering original postings and numerous links.

It categorizes resources aimed at everyone, then another set aimed toward experts.

Every now and again, it's good to remind ourselves a caveat the blog mentions: "The site contains general information only and is not intended to replace a physician's advice. Please consult a physician to address your specific health care questions."

Same is true for every Web site or blog. The Internet can't replace your own doctor(s). And for matters of faith, it can't replace a church home or pastor.

Stroke signs: Remember the first three letters, S. T. R.

One more way to remember stroke symptoms, recently from The HealthCentral Network - STROKE: Remember the First Three Letters, S. T. R.

The simple test, according to the article:

S: Ask the individual to SMILE.
T: Ask the person to TALK and SPEAK A SIMPLE SENTENCE (coherently) i.e., "It is sunny out today").
R: Ask him or her to RAISE BOTH ARMS.

So as you try to remind and teach people about stroke symptoms, another mnemonic device to help.

Beliefnet: Health and Healing

A Web resource worth checking out, especially the particular entry on stroke information on the Web site Beliefnet: Health and Healing.

Lots of other material that can be related to stroke survivors, family members and caregivers, including weight loss, fatigue, stress and depression, can be found on the main Health and Healing page.

All about stroke resources

An often-updated Web resource for stroke survivors, caregivers, loved ones and families: All About Stroke.

One good, educational article is about blood thinner medication - which clot-type stroke survivors often take - and the side effects. It covers aspirin, Aggrenox, warfarin, Plavix, heparin and enoxaparin, a particular form of heparin.

With the exception of enoxaparin (as far as I know), I've used them all and glad they're available to help with stroke prevention. The article does a good job of going quickly through the primary side effects to watch out for. Click on the drug names (or the photo of the pills) for additional links.

You can also sign up for an e-mail newsletter about stroke-related news from the site.

(Image from National Library of Medicine)

Growing African American awareness

A blog devoted to African American-oriented issues, including health, posted an important item recently, with a title at home even here: Would you know if you were having a STROKE?

The article brings out some key points to ponder, quoting National Stroke Association statistics:

• Half all black women will die from stroke or heart disease.
• Blacks are twice as likely to die from stroke than whites.
• In the 45-54 age group, black males have a three times greater risk than white males of having an ischemic stroke.
  

The blog links to a public service announcement video and gives some vital stroke facts. Plus, the National Stroke Association has lots of additional links and educational material focusing on the African American population and preventing strokes.

What's aphasia? Many stroke survivors know

This month (June) is Aphasia Awareness Month - and if you're like me, you weren't aware of aphasia until it hit close to home. Or maybe you're still unfamiliar.

So what is aphasia?

The National Aphasia Association defines it this way:

Aphasia is an acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence. Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty reading and writing.
... The most common cause of aphasia is stroke (about 25-40 percent of stroke survivors acquire aphasia). It can also result from head injury, brain tumor or other neurological causes.
... Aphasia affects about 1 million Americans - or 1 in 250 people - and is more common than Parkinson's Disease, cerebral palsy or muscular dystrophy. More than 100,000 Americans acquire the disorder each year. However, most people have never heard of it.

I was hit by aphasia with my stroke, and through speech therapy, was able to regain my speaking, reading and writing ability. I suspect most people in similar circumstances wonder, from time to time, about a forgotten or misused word or a need to re-read a sentence: Would I have made that mistake if the stroke never happened? Another one of those unanswerable questions.

So if you know a stroke survivor, you might well know someone impaired - temporarily or permanently - with aphasia. Visit the National Aphasia Association Web site and review the resources. And share awareness of aphasia with others.

Awareness - Christ and his followers

Last Sunday, the revised common lectionary Gospel reading came from Matthew 9:9-13, 18-26, words you might have heard before.

Jesus called for Matthew, a man of poor reputation, to follow him. He responded to a woman's touch to his garment by healing her infliction. He knew what a funeral crowd needed to hear and witness:

"Go away. The girl is not dead but asleep." But they laughed at him. After the crowd had been put outside, he went in and took the girl by the hand, and she got up.

A constant theme through this reading: awareness. Jesus was aware of the struggle within Matthew, the faith of the woman, the need of the funeral crowd. And among stroke survivors, family members, loved one and caregivers, awareness is also a big deal.

Stroke is the third leading cause of death and the leading cause of permanent disability in the United States. Part of the reason is that people are generally not aware of stroke signs or symptoms, and we’re trying to change that, to make sure there’s stroke awareness. The more people who know, the better chance of survival and success and the better chance of fewer disabilities.

If someone’s face seems to droop on one side, that’s something to be aware of.

If someone has sudden weakness in an arm or leg, that’s something to be aware of.

If someone’s speech is suddenly slurred, that’s something to be aware of.

There’s no time to lose – the faster the person gets help, the more likelihood of better a outcome.

Awareness was a constant theme of Jesus’ ministry. Consider all those times that he was aware of a need for a word, for guidance, for calling to follow, for an action. Jesus didn’t do this in a random way, in a careless way. His word and action came through his perfect awareness.

In the Scripture reading above, we first have Matthew. As a tax collector, he’s got three strikes against him: an underling of the Roman government, constantly in contact with Gentiles and therefore unclean, and in a profession regarded, at the time, to be dishonest.

But Jesus was aware that Matthew was ready to follow. Just like those doctors who saved my life, Jesus used awareness to diagnose Matthew’s symptoms and acted to supply a cure. What an example for humankind: be aware of the signs and symptoms, and act.

Then there’s the woman, too afraid to approach Jesus face to face, reaching down to touch his garment in a crowd. But despite the crowd and confusion, Jesus was aware of that light touch, was aware of the woman’s faith. Jesus used awareness to diagnose the woman’s needs and acted to supply a cure.

And the story of the death of the daughter – when he arrives at the house, no one else has the faith that the synagogue’s leader showed when he asked Jesus to bring back his daughter. A funeral was taking place. Here, too, Jesus used awareness to know what the leader and the others needed and acted.

Let's take two ideas away from the story of Jesus’ awareness.

First, how can we use our own gift of awareness? Consider that question in even simple ways:

• Attention to those around us
• Using our faith and reasoning to gauge when it looks like someone has a need
• Willing to act or call out for help in that time of need

Second, let’s look at our relationship with Jesus Christ and his awareness:

• He has complete awareness of our needs; he is our ultimate physician
• His awareness gives us an open invitation to prayer and communion with Christ
• With that relationship of awareness and understanding, we can strengthen our bond with Christ every passing day

Because at the end of the day, we are all in need. Sometimes, I think back to the day of my stroke in 1998 and shudder and ponder the unanswerable questions: What if I was alone? What if I couldn’t get anyone’s awareness?

But the word today assures us with answers: In our relationship with Christ, we are never alone. And in Christ, we always have a friend with awareness.

Always.

A friend.

Who is aware.

And that is indeed good news.

Need for speed: Those three hours

An article in the magazine Innovate, published by Barnes-Jewish Hospital and Washington University Physicians, explains how tissue plasminogen activator (tPA) has dramatically changed the treatment of clot-type strokes.

And it emphasizes the need to get stroke victims - even suspected stroke victims - to a properly equipped hospital right away. The clot-busting medication tPA is know to be effective, in carefully managed cases, within three hours of the onset of an ischemic stroke.

It also goes to the need for preparation and the availability of the right health professionals. Not every stroke victim is a candidate for tPA, and there's a limited amount of time to make that determination.

“In the wrong hands, tPA can be deadly,” the article quotes Dr. Jin-Moo Lee, Washington University neurologist at Barnes-Jewish. “Studies have shown that hospitals without a lot of experience actually end up causing more harm than good.”

That's important to know - especially if you have to speak on behalf of a stroke victim. Call 9-1-1. Be insistent that the victim is transported to a hospital with the correct expertise.

Stroke survivor resources

If you've already lived through a stroke, you don't want another. A good Web resource on a project called Steps Against Recurrent Stroke (S.T.A.R.).

Just a few facts that demand your attention:

• Three-quarters of a million Americans experience a stroke each year, and at least 1 in four (25%-35%) will have another stroke within their lifetime.
• Within 5 years of your first stroke, your risk for another stroke can increase more than 40%.
• Recurrent strokes often have a higher rate of death and disability because parts of the brain already injured by the original stroke may not be as resilient.
• Within five years of a stroke, 24 percent of women and 42 percent of men will experience a recurrent stroke.

And some recommendations that make a great deal of sense:

• Stop smoking
• Keep blood pressure, cholesterol and diabetes under control
• If you have an irregular heartbeat work with your doctor to control it
• Eat a healthy diet
• Increase physical activity

This advice won't cover everyone in specific terms of stroke causes (see this link about cryptogenic strokes, which describes my own stroke history). Still, it's good general advice for one and all.

Detecting danger: Stroke survivor says free screening saved her live

A story worth reading was recently in The Daily News Tribune (Waltham, Mass) and tells the story of Massachusetts General Hospital employee and, on a whim, stopped in a corridor for a free ultrasound carotid artery screening, just happened to be offered at the hospital Feb. 13.

Turns out she had 90 percent blockage in her right carotid artery, putting her in high risk for a stroke. Doctor's at the hospital's vascular center did a procedure and cleared the blockage, drastically reducing the risk.

Now, some experts say you shouldn't just have a screening on a whim. A good article from About.com makes some good points about false readings. However, the About.com writer does suggest that some people - those with a family history or those with known vascular disease - might be good candidates.

With Stroke Awareness Month just behind us, a good suggestion: Consider your own history and act accordingly. Keep in mind that this is from a non-doctor. Why not ask your own doctor for advice?

More details on the snake venom research

Last posting linked to a news article about research in using snake venom to treat stroke patients. A more technical and detailed link can be found with the Internet Stroke Center's Stroke Trials Registry.

The page describes the efforts to learn about the results of an intravenous infusion of ancrod - pit viper venom - within six hours of a stroke. The study looks at patient status three months afterward.

The study is still recruiting facilities and patients to take part in the study.