This Christ-centered blog is designed to serve stroke survivors, families and friends, through sharing experience and faith. My own stroke came on May 8, 1998. God provided medical professionals, friends, fellow believers, and strength to get me through some struggling recovery times.
“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.’”
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."
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.
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.
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.
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.
“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.”
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.
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.
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 howstroke 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.
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.
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:
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.
After a long Thanksgiving weekend, I'm thankful for my own recovery those years ago. Sometimes, it's hard to find something to give thanks for. Health, money and other struggles interfere with being thankful.
But there are blessings. Despite the darkness of any situation, Christ is with you and beside you. He will not abandon you. Let his peace rule your heart. Consider the blessings. Give thanks.
A recent study brings into question whether stroke survivors with a hole between the two upper chambers of the heart - called a patent foramen ovale - should have the hole patched:
Full final results from the first randomized controlled trial of patent foramen ovale (PFO) closure for stroke/transient ischemic attack (TIA) to reach completion have found no differences in the primary end point of stroke or TIA at two years, all-cause mortality at 30 days, and neurological mortality between 31 days and two years.
[Dr Anthony] Furlan [University Hospitals Case Medical Center, Cleveland] said it's "too soon to say" what impact the results will have on PFO-closure procedures: several trials are still ongoing, and while the devices are investigational in the U.S., they are market-approved in Europe and elsewhere.
"Ultimately I think CLOSURE I, if the other ongoing trials show similar results, will obviously ratchet down the number of endovascular PFO closures [performed]," he said.
"The challenge now, in my view, for the endovascular community is to refine the selection criteria and not so liberally be closing these holes in cryptogenic-stroke patients."
I have an interest in this because I had my PFO closed in 2007 and no longer take blood-thinners. Before that, I had been on both warfarin and Plavix, plus aspirin.
My understanding of my own case is that the PFO was just one of two factors; the other was an atrial septal aneurysm. That's when the wall between the two upper chambers of the heart - which normally should be fairly straight and smooth - is bulging. Basically, I was told, it had a divot, where blood clots could gather. Then, when chest pressure increases by something as simple as a sneeze, a clot could go from one side of the heart to another, through the hole, to the brain, causing a stroke.
This research points out the need to have intelligent conversations with your doctor(s) about any medical procedure, including discussion of possible outcomes, factors in your particular case, risks and alternative treatements.
Never thought of this, but this could be a weighty matter - for real. Often, stroke patients have trouble speaking or can't speak at all. But also often, it's important for physicians to know the weight of the patient.
Stroke patients are frequently unable to communicate their weight due to aphasia or decreased consciousness. tPA is given on a milligram per kilogram basis, but there often is not the time or the equipment in the emergency department to verify a patient's weight and determine the correct drug dose. Physicians therefore often rely on "eyeballing" or visual estimation.
"Dosing itself is really crucial for the activity of tPA, and overdosing may be not as useful as the correct dose, and underdosing may cause harm to the patient," said Dr. [Martin] Köhrmann [associate professor of neurology at the University of Erlangen-Nuremberg, Germany]. "This, together with the situation where we don't have the correct weight information, is really concerning."
While my Missouri driver's license displays my weight, not sure that (a) those are always accurate and (b) that's a universal standard for driver's licenses across the globe or even in the U.S. Another good argument for keeping better electronic health records.
Today is the Great American Smokeout today - and I hope someone you know stops smoking. Smoking is a known stroke risk and is bad for you in so many ways.
The new labels. . .are part of a proposed rule-making. The FDA will accept public comment on the 36 proposed labels, and expects to choose nine of them by June to make final. By Oct. 22, 2012, manufacturers will no longer be allowed to distribute cigarettes for sale in the United States that do not display new graphic health warnings.
Public health officials are hoping that the new labels will re-energize the nation’s anti-smoking efforts, which have stalled in recent years. About 20.6 percent of the nation’s adults, or 46.6 million people, and about 19.5 percent of high school students, or 3.4 million teenagers, are smokers. Every day, roughly 1,000 teenagers and children become regular smokers, and 4,000 try smoking for the first time. About 400,000 people die every year from smoking-related health problems, and the cost to treat such problems exceeds $96 billion a year.
“When the rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes,” said Dr. Margaret Hamburg, the commissioner of the Food and Drug Administration.
As graphic as the suggested labels are, they can't compare to the lives that cigarettes and other tobacco products have destroyed. A puff on a cigarette isn't worth permanent disability or death.
Waiting is hard. In my own recovery, it was hard to wait for improvement in reading, writing and speaking skills. My own mother is having a hard time in recovery from surgery.
Waiting is hard. Often, it's unclear how long your wait will last. People often don't know what exactly will happen after the wait is over.
But wait we must, so often. But take heart - you are in God' hands. For whatever reason you must wait, remember the words from this Psalm. Take heart. Wait for God.
The findings, reported in the journal Stroke, do not prove that alcohol and infections act as stroke "triggers" in some people, but they "strongly support" the notion that they do, the researchers say.
On the other hand, there is insufficient evidence on whether other suspected triggers -- like extreme stress or physical exertion -- do in fact contribute to stroke, lead researcher Dr. Vincent Guiraud, of Hopital Sainte-Anne in Paris, told Reuters Health in an e-mail.
Researchers found that MRI data could accurately determine if patients had experienced stroke symptoms within a three-hour period or less, which would allow the use of a clot-busting drug that works best if administered within that window of time. Tissue plasminogen activator, known as tPA, can dramatically reverse stroke symptoms in those whose strokes are caused by blood clots and blockages, which account for an estimated 85 percent of all strokes.
Strokes strike about 795,000 Americans each year, killing 137,000, according to the U.S. Centers for Disease Control and Prevention. The condition is a leading cause of serious, long-term disability in the United States.
"A tool that can estimate the age of stroke would be of great value in cases of unknown stroke onset time," said lead researcher Dr. Catherine Oppenheim, professor of radiology at Universite Paris Descartes in France. "This concerns as many as a quarter of all stroke patients who cannot be given tPA because they wake up with stroke symptoms or are unable to say when their stroke began."
Kind if a sad story - from the recent World Stroke Day - about a civilized country that only offers one particular type of stroke treatment during business hours only. So if you plan to have a stroke in Wales, be sure to have it during weekdays, 9 to 5.
About 11,500 people in Wales suffer a stroke or TIA each year and medical professionals say quick treatment means a better outcome and recovery for the patient. Approximately 11% of all deaths in the UK are caused by strokes.
Under the plans, access to a clot-busting drug, thrombolysis, currently offered only during weekday office hours will be expanded to 24 hours a day, every day, across all of Wales by 2011.
The drug is given to patients who suffer certain types of stroke and can limit the long term brain damage. However, to be effective it has to be carried out within three hours of the stroke happening.
Announced on World Stroke Awareness Day, health boards will from next year will offer "specialist assessment, preventative treatment and lifestyle advice in a single hospital visit."
I've seen similar stories before, but the idea of checking blood pressure at barbershops is not a bad idea at all. In fact, it's a great idea. This particular story is from Texas....
In a unique randomized trial, African American men who were patrons of black-owned barbershops in Dallas County, where they had their BP regularly measured and were encouraged to contact a physician when it was elevated, showed a mean 7.8-mm-Hg drop in systolic pressure over 10 months.
That was only 2.5-mm-Hg more of a drop (p=0.08) than seen in a comparator group of men who had received standard educational pamphlets on high BP in African Americans, but no BP checks or other encouragement to assess blood pressure, at the barbershops.
"That doesn't sound like much of a blood-pressure fall for any one person, but at the population level it's a very large effect," lead author Dr Ronald G Victor (Cedars-Sinai Heart Institute, Los Angeles, CA) observed for heartwire.
A joint committee representing the American Heart Association and the American Stroke Association has published updated evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack; the statement has been published online Oct. 21 in Stroke. ...
"The recommendations in this statement are organized to help the clinician who has arrived at a potential explanation of the cause of ischemic stroke in an individual patient and is embarking on selection of a therapy to reduce the risk of a recurrent event and other vascular outcomes," the authors write. "Our intention is to update these statements every three years, with additional interval updates as needed, to reflect the changing state of knowledge on the approaches to prevent a recurrent stroke."
Stroke recovery can be a lengthy and heavy burden. Stroke is the leading cause of permanent disability in the United States.
Also carrying a burden: those who provide care of stroke survivors. Today, pray for those who carrying burdens for others - literally fulfilling the law of Christ. There is no higher calling.
Atrial fibrillation is a common cause of stroke, as mentioned before. The U.S. Food and Drug Administration just approved a new drug for stroke prevention for those patients. Stroke is the third leading cause of death in the United States and is the leading cause of permanent disability.
The U.S. Food and Drug Administration today approved Pradaxa capsules (dabigatran etexilate) for the prevention of stroke and blood clots in patients with abnormal heart rhythm (atrial fibrillation).
Atrial fibrillation, which affects more than 2 million Americans, involves very fast and uncoordinated contractions of the heart’s two upper heart chambers (atria) and is one of the most common types of abnormal heart rhythm.
“People with atrial fibrillation are at a higher risk of developing blood clots, which can cause a disabling stroke if the clots travel to the brain,” said Norman Stockbridge, M.D., Ph.D., director of the Division of Cardiovascular and Renal Products in the FDA’s Center for Drug Evaluation and Research.
The rate declined to 92 deaths per 1,000 stroke patients in 2007, from 125 deaths per 1,000 seven years earlier, according to data released today by the U.S. Agency for Healthcare Research and Quality. The rate for men fell 29 percent compared with 24 percent for women, the figures showed. Fatality figures also receded for heart attack, heart failure and pneumonia, the agency reported.
The numbers reflect advances in the care that patients receive at the hospitals, said Roxanne Andrews, a senior researcher at the agency, part of the federal Department of Health and Human Services.
“Patients are getting to the hospital earlier and maybe patients are a little healthier than they used to be,” Andrews said in a telephone interview. “But the decline does show that patients are getting better treatment partly because the technology for treating patients is getting better.”
Words that once came naturally for even simple objects before the stroke—such as a chair, a pen, or an apple—are suddenly difficult if not impossible to retrieve. Although some people may recover their language skills in time, for others, the effects can be chronically debilitating.
Such differences in patient outcomes have scientists from the University of South Carolina delving deeper into this language disorder—called aphasia—which results when language centers of the brain are damaged by stroke, head injury, or other causes. In new NIDCD-funded research, they’ve demonstrated not only how important the location of the brain damage is in predicting how well a person will respond to aphasia therapy, they are also investigating a new method for stimulating brain-damaged regions in people with aphasia, in hopes of increasing brain plasticity and perhaps improving word recall.
These words were delivered to exiles in Babylon. Words of hope and promise for the future.
Plans are important. But people often don't like making plans. They often require dull and tedious work. They can be thwarted by outside influence. Even the best plans can go awry. They are, after all, a product of people. Those imperfect people.
God loves those imperfect people so much, though, that he has plans for those people. The plans were promised those many years ago to those in exile. Does God have plans for you? I'm convinced that he does. He loves you like he loved his exiles.
As a longtime runner, I've been thirsty. Very thirsty.
More important than physical thirst, though, is quenching the thirst for something beyond ourselves. We've all been there - a dry and weary place in our lives, where it seems there is no water.
Better than water, though, is our ultimate thirst quencher, our ultimate electrolyte. God is with you, even in those lands and in those times.
Oct. 29 is World Stroke Day - marking attention for the third leading cause of death in the United States.
The numbers are sobering. In the U.S., more than 795,000 strokes occur each year, according to the Centers for Disease Control and Prevention. The cost in dollars: $73 million. The cost of death and disability is uncountable. It is the leading cause of permanent disability in the United States. Every six seconds, someone in the world dies from a stroke.
But it's not just numbers. World Stroke Day campaign also highlights the fact that stroke can be prevented and that stroke survivors can recover and regain their quality of life with care and support: To quote the CDC:
The campaign is asking people to commit to six ways to reduce their likelihood of having a stroke.
1. Know one's personal risk factors, including diagnosed high blood pressure, diabetes, or high cholesterol.
2. Be physically active and exercise regularly.
3. Avoid obesity by eating a healthy diet with lots of fresh fruits and vegetables.
4. Limit alcohol consumption.
5. Avoid cigarette smoke. People who smoke should seek help to stop now.
6. Learn to recognize the warning signs of a stroke and call 9-1-1 right away if someone is suspected of having a stroke.
The links on this list will lead you to other resources and previous postings. Preventing a stroke can prevent the loss of a life or a life of disability.
If you or someone you care of is a stroke patient, you want the best plan of care you can get. This recent article, from MedlinePlus, reports another tool that could help better these plans.
A new Internet-based tool can more accurately predict stroke patients' risk of dying in the hospital and help their doctors develop better care plans, according to a new Canadian study.
Hospitals also can use the prediction tool to evaluate and improve their patient outcomes, said study author Dr. Eric Smith, assistant professor of neurology at the University of Calgary in Alberta, Canada.
My own struggle with aphasia and recovery included some serious brain re-wiring, speech therapy and simple time.
Now, new research gives some voice to stroke survivors struggling with language issues. The brain is more resilient, more capable of recovery, than previously thought.
Julius Fridriksson, a researcher at the University of South Carolina's Arnold School of Public Health, said the findings offer hope to patients of “chronic stroke,” characterized by the death of cells in a specific area of the brain. The damage results in long-term or permanent disability.
“For years, we heard little about stroke recovery because it was believed that very little could be done,” Fridriksson said. “But this study shows that the adult brain is quite capable of changing, and we are able to see those images now. This will substantially change the treatment for chronic-stroke patients.”
The study, reported in the Sept. 15 issue of the Journal of Neuroscience, involved 26 patients with aphasia, a communication disorder caused by damage to the language regions in the brain’s left hemisphere. Aphasia impairs a person’s ability to process language and formulate speech.
"Our meta-analysis of data from rigorous randomized sham-controlled trials did not show a positive effect of acupuncture as a treatment for functional recovery after stroke," Dr. Jae Cheol Kong of Wonkwang University in Iksan, South Korea, and colleagues conclude in the Canadian Medical Association Journal (CMAJ).
Some recent studies have found no benefit for acupuncture when it is compared to sham acupuncture, a placebo version of the traditional Chinese medicine technique that can involve needling non-acupuncture points, penetrating the skin shallowly, or not penetrating the skin at all.
From the U.S. National Library of Medicine, part of the National Institutes of Health, a service called MedlinePlus offers a great stream of good, updated information about strokes.
Welcome to the human condition. If you or someone you know has struggled with stroke recovery, you know the stress. And the burden of frustration. The weariness and worries.
Lift up your burden to Christ. Rest in Christ, with Christ, secured by Christ.
Not all hospitals have the most up-to-date technology for evaluating people who may be having a stroke. But emergency rooms with access to a rapid-response stroke center via a consultation system known as “telestroke” can minimize brain damage caused by stroke, according to Stroke: Preventing and Treating “Brain Attack,” a new report from Harvard Medical School.
When stroke symptoms occur, quick action is vital. Getting to a hospital emergency room, preferably one that specializes in treating stroke, is crucial. To prevent brain cell death, treatment is most effective if it starts within an hour of the start of the stroke. One of the main clot-dissolving drugs, tPA, must be given within a few hours after symptoms appear.
Everyone should know the stroke signs and symptoms. And now, one more reason: There is growing suspicion - no proof yet - that certain migraines might be stroke-related.
The two new studies, both published in BMJ, add to the evidence of a suspected migraine-disease link. But both research teams say the findings should not alarm those who suffer migraine with aura because the risk is still low.
''We don't want to scare people at all," researcher Tobias Kurth, M.D., Sc.D., director of research at INSERM at the Hospital del la Pitie Salpetriere in Paris, tells WebMD. The vast majority of migraine sufferers, he says, will not get a stroke because of their migraines.
Much of New Zealand is beautiful with friendly, smart people.
So it's good to know that country uses a campaign to increase stroke awareness, a topic that is near and dear to me. And the theme of "Act Fast" is key. Time = brain, as this blog has stated before. Know stroke signs and get help quickly. It could save a life or prevent permanent disability.
The article - from the Otago Daily Times - gives the sobering facts, too, about the how "young" stroke patients can be:
A quarter of New Zealanders who experience a stroke each year are aged under 65, the Stroke Foundation says, before Stroke Awareness Week begins on Monday.
The non-profit organisation is promoting the message "Act Fast" to help everyone spot the symptoms of the third-largest killer in the country and how acting fast can save lives.
If you know someone who went through a stroke or heart-related ailment, you might know someone who takes the drug warfarin, also knows as Coumadin. Another wide use of the same chemical, and I kid you not: rat poison.
This isn't designed to scare people off taking warfarin. I was on it for years and while it's exceedingly difficult to prove a negative, it very well could have prevented multiple strokes or mini-strokes. If your doctor prescribes this medication, follow the instructions to the letter.
That being said, the medication requires frequent blood draws and can result in excessive bleeding. It plays badly with several other medications and even some foods. So medical experts have been working on replacements for years.
Industry analysts estimate the warfarin-replacement market at more than $10 billion a year and possibly up to $20 billion.
Medical experts have cheered the arrival of a new generation of anti-clotting drugs, since it is hard to maintain the right balance of warfarin in patients and the drug also interacts badly with certain foods and other medicines.
"Patients and physicians have been begging for a warfarin replacement," according to Ralph Brindis, president of the American College of Cardiology.
(Image from the National Institutes of Health; not a real photo of warfarin, by the way)
People who read this blog have heard references to my own experience with aphasia, an impairment of language which occurs when someone suffers injury to the language areas of the brain.
This language from Psalm triggers thoughts about those days. When no one else could understand me, God could. He turned his ear to me. When I struggled with words, God turned his ear to me. When I said one word but meant another, God turned his ear to me. He understood every word. Every phrase. Every thought.
If you or a loved one is struggle with aphasia, God is listening - with perfect understanding.
The readings from Psalm are so often comforting and supportive. When we slip (both in spirit and physically), when we suffer, when we seem lost.
The words in Psalm are here for us. So for the next few postings, you'll see some favorite Psalm passages. Use them to remind you of God's presence and support. Share these words to those who need them.
Back in the spring and summer of 1998, I spent a lot of time rebuilding my speaking and writing abilities. One of the effects of my stroke, I learned, was something called aphasia, an impairment of language which occurs when someone suffers injury to the language areas of the brain.
Often, as in my case, this accompanies a stroke.
In addition to speech therapy, I spent quite a bit of time playing on a child's education toy called the GeoSafari, originally bought for our daughters to use. The toy helped me get my words/grammar back in order, or at least to an acceptable degree. We actually sold the GeoSafari at a yard sale not long ago and thought about those days as it left with an eager parent.
Motion sensing technologies, such as the Nintendo Wii Remote, could be used in the rehabilitation of people with aphasia - a language impairment, commonly caused by a stroke, that affects around 250,000 people in the UK. ...
"Gesture tracking and recognition technologies are becoming a ubiquitous part of new computing and gaming environments, ranging from Apple's touch-screen iPad through the hand-held Nintendo Wii Remote to Microsoft's forthcoming Kinect for the Xbox 360, which will track users' movements without the need for a handheld controller," says Stephanie Wilson, Senior Lecturer in HCID at City University London. "Whilst popular in gaming, we will evaluate the suitability of such technologies in aphasia rehabilitation."
We've already seen articles about how the Wii Fit can help the physical consequences of a stroke. Now, perhaps similar technology can help conquer other issues. Aphasia was the most frustrating part of my recovery. Here's hoping that technology will ease some of that frustration.
The quick takeaway from this story: If you are diagnosed with this condition, get a reason for the specific treatment your doctor recommends. Each has its own set of risks, benefits. Have your doctor spell out each.
Carotid artery disease occurs when plaque fills up major arteries supplying blood to the brain, greatly raising stroke risk.
There are three common treatments for the condition: an artery-scraping surgery called endarterectomy; the placement of a stent to keep the artery open; or the use of cholesterol and antihypertensive medications to help lower stroke risk.
The new report finds that patients can expect to be offered different treatments depending on where in the United States they live - a sign that there's no consensus on the best way to treat the condition, according to Duke University researchers.
Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your body.
A couple of thoughts on the idea of your body as a temple - in stroke prevention and for fellow stroke survivors.
Paul was specifically writing here about sexual immorality, but the concept of your body as a temple for God is something you can carry in every aspect. Here's a couple:
Stroke prevention - If your body is a temple, maintain it well. One recent posting about stroke prevention listed the top risk factors:
History of high blood pressure
Current smoking
Abdominal obesity
Diabetes
Lack of physical activity
Poor diet
More than 30 drinks per month or binge drinking
Ratio of blood fats known as apolipoprotein B (apo B) to apolipoprotein AI (apo AI)
Heart disease
Psychosocial stress/depression
So many of these are at least partially in our control. Watch the numbers. Listen to your doctor. Be as active as you can be. Watch what you eat. You don't have to be unreasonable - just maintain that temple.
And for stroke survivors - My imperfect, flawed, damaged body is a temple. God loves me so much, despite my flaws, that he considers my body as a temple. Your body is a temple because of God's love for you.
In one report, researchers found that 25 percent of stroke patients stopped taking one or more of their stroke prevention medications within three months after their stroke.
"Providers should spend more time teaching stroke patients and caregivers when new risk factors are diagnosed and new medications are prescribed, such as blood pressure or cholesterol medications prior to discharge, while keeping the regimen as streamlined as possible," said lead researcher Dr. Cheryl D. Bushnell, an associate professor of neurology and associate director of the Women's Health Center of Excellence at Wake Forest University Health Sciences.
While not in every instance, so many strokes can be prevented - often if the patients would follow a doctor's instructions. I'm as stubborn as the next patient, so it's taken me years to concede that 99 percent of the time, the doctor knows best.
"So I say to you: Ask and it will be given to you; seek and you will find; knock and the door will be opened to you. For everyone who asks receives; he who seeks finds; and to him who knocks, the door will be opened.
"Which of you fathers, if your son asks for a fish, will give him a snake instead? Or if he asks for an egg, will give him a scorpion? If you then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give the Holy Spirit to those who ask him!"
It seems, so often, that the gifts of life are passing us by. Think about material gifts - a bigger house, a new car, expensive clothes. We see people ask and ask and ask for these gifts. I've done it myself, in my unguarded moments.
The question is, what are we supposed to be asking for? What are we seeking? Why are we knocking? The Scripture above, the words of Christ Jesus, is about asking for his gift, seeking his gift, knocking on the door for his gift.
The gift of all gifts - a relationship with God, a discipleship with Christ. Comforting for those afflicted. Rest of those who are fatigued. The confident knowledge that with Christ, you are never alone.
All of this world's material gifts will turn to dust. The gift of all gifts, though, never ends.
Up to three in four stroke survivors fall within six months of their stroke, and these falls can lead to serious injuries, including broken bones.
"Although research has shown that fall prevention programs including exercise are effective for older people, it was unclear whether these, or any other interventions, work for people with stroke," lead researcher Dr. Francis Batchelor of the University of Melbourne, in Australia, told Reuters Health by email.
So Batchelor and his colleagues carefully reviewed the relevant research to date and pooled together the results of 13 studies that enlisted a total of nearly 1,500 people.
The studies analyzed a wide range of interventions to prevent falls after strokes, from strength training to medications, report the researchers in the journal Stroke.
Clearly, there's a need to find a solution for these falls. A fall can lead to painful injuries and disability.
Another strong reason to make yourself aware of stroke signs and symptoms, plus what to do if it happens to yourself or someone you know. Even if you get to the right place in time, proper treatment is still not a guarantee, as this article illustrated.
While a growing number of hospitals boast that they are equipped to use the clot-dissolving drug, they don't always do so, a Journal Sentinel investigation found. And the organization that certifies those hospitals as stroke centers doesn't require that they actually offer the drug to eligible patients.
The clot-dissolving agent, known as tissue plasminogen activator, or t-PA, is the only approved drug for treating a stroke by stopping it and significantly reducing the risk of disability.
Yet the number of patients who get t-PA has remained dismally low, about 5% of all stroke patients, ever since the drug was approved 14 years ago. Much of that is because patients fail to recognize their symptoms and get to the hospital within the 4 ½ -hour window during which the drug can be administered.
It is not all the fault of patients.
This is a great and informative article about stroke centers and stroke treatment, or, too often, the lack thereof.
Is every stroke patient a candidate for this drug?. No. That's why we want training of health professionals so they'll do the best job they can do. It's also illustrates the importance of the need for advocates for patients. Often, the patient can't speak clearly or isn't completely lucid after a stroke. That's why it's so important for someone to be able to speak on the patient's behalf.
Take this story as a valuable lesson on those two points.
I"m a fan of the BBC television show Doctor Who - and a fan of efforts to help people hit by a condition called aphasia, which affects the speech of many stroke patients.
So I had to include a link to a story about a recurring Doctor Who character - the Dalek - and its use in an event to raise money to serve aphasia sufferers:
A Dalek was the menacing attraction as the Ewell Village Fair became the first fund-raising event this year for the chosen charities of the borough's new mayor.
The fair, held at Ewell Castle School, was in aid of Dyscover, the Samaritans and Meru, and Councillor Clive Smitheram, mayor of Epsom & Ewell, has plenty more in the pipeline. ...
Based in Walton-on-the-Hill, Dyscover provides specially designed speech and language programmes for those suffering with a brain condition called aphasia, helping them to adjust on a long-term basis.
Aphasia is an impairment of language which occurs when someone suffers injury to the language areas of the brain. Aphasia can affect language in many ways including its production (ability to speak), and its comprehension (ability to understand others when they speak), as well as other related abilities such as reading and writing. Over 20% of all people who suffer a stroke develop some form of aphasia.
This month, the Heart and Stroke Foundation of B.C. [British Columbia] and Yukon launched a two-year campaign to familiarize people with the five signs of stroke -- rapid onset of weakness, speech impairment, vision problems, severe headache and dizziness -- and the urgency of immediate treatment.
The stroke awareness campaign is needed, according to statistics from the foundation.
- A survey in 2007 found fewer than 54 per cent of British Columbians could name just two of the five stroke warning signs.
- About 1,500 people (roughly one-third of stroke victims) in B.C. die within a year of their stroke.
- A conservative estimate pegs the annual cost of strokes in B.C. at more than $330 million.
Using data from 2,587 young adults — men aged 20 to 35 years; women aged 20 to 45 years — from the 1999-2006 National Health and Nutrition Examination Surveys, Dr. Elena Kuklina and colleagues tested to see whether the frequency of cholesterol screenings was higher for patients who had one or more risk factors for coronary heart disease, which include smoking, high blood pressure, obesity or family history of heart disease before age 50.
Rates of heart disease and related conditions as well as risk factors were high among the adults in the study — consisting of 59% of the sample. So were the rates of elevated "bad," or LDL, cholesterol. Elevated levels of LDL cholesterol were present in 7% of young adults with no risk factors, 12% with one risk factor, 26% with two or more risk factors and 65% of those with heart disease or related conditions.
"This is worrisome," said Kuklina, a fellow at the CDC's division of heart disease and stroke prevention. "Not only do a lot of young adults have [coronary heart disease] or its equivalents, but a large majority have high cholesterol too."
I always pay special attention to news from my home state, Arkansas. A recent article from a newspaper called the Paragould Daily Press illustrates a life reclaimed thanks to clot-busting tPA and lists some statistics showing the need for stroke awareness and prevention in Arkansas:
According to the U.S. Centers for Disease Control and Prevention (CDC), Arkansas had 1,875 stroke-related deaths in 2005, the most recent year for which data is available. Arkansas also ranks third highest among all states in stroke deaths, with 61 per 100,000, according to the CDC. The nationwide direct and indirect cost of medical and institutional care of permanently disabled stroke victims was more than $70 billion in 2009.
Since the program began Nov. 1, 2008, 99 stroke patients have been treated by Arkansas SAVES neurologists and 15 have received the t-PA.
(Map from the Centers for Disease Control and Prevention)
Comforting words from Jeremiah for those who are struggling. Have faith. Look at all what God has done. You are important to him - and nothing is too hard for him to accomplish.
Yes, it might or might not take the form you expect. But he is there beside you. With his outstretched arm.
[B]ut those who hope in the LORD will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint.
These words in Isaiah can be powerful reminders that with God, your strength is not just your own, your source of strength is beyond your own. God renews that strength.
I run, and I can tell you, this human body does grow weary. But Isaiah isn't talking about the mere human condition, the human body. He is not talking about strength that can be counted by the pound. No - he's talking about strength in faith. It's about strength in faith that will carry stroke survivors and caregivers and yes, they will soar on wings like eagles.
Ran across this short video featuring great entertainer Della Reese. She suffered a stroke when she was at the height of her entertaining career. She was on set of NBC's "The Tonight Show."
The video was her response after recognition from the National Stroke Association:
... {S]alt is so pervasive in the food supply it's difficult for most people to consume less. Too much salt can increase your blood pressure, which is major risk factor for heart disease and stroke.
"Nine in 10 American adults consume more salt than is recommended," said report co-author Dr. Elena V. Kuklina, an epidemiologist in the Division of Heart Disease and Stroke Prevention at the U.S. Centers for Diseases Control and Prevention.
Kuklina noted that most of the salt Americans consume comes from processed foods, not from the salt shaker on the table. You can control the salt in the shaker, but not the sodium added to processed foods, she said.
The new study compared risk factors among 3,000 people who had a stroke to those of 3,000 age- and sex-matched individuals who did not have a stroke. Study participants came from 22 countries.
The 10 risk factors that account for 90% of stroke risk are:
History of high blood pressure
Current smoking
Abdominal obesity
Diabetes
Lack of physical activity
Poor diet
More than 30 drinks per month or binge drinking
Ratio of blood fats known as apolipoprotein B (apo B) to apolipoprotein AI (apo AI)
Heart disease
Psychosocial stress/depression
Now, for some of these, genetics might play a part. But for all of these, people with these risk factors can at least attempt to at least semi-control them. And it's worth the effort - a brain is at stake.
Engel had suffered a stroke. It had damaged the part of his brain we use when we read, so he couldn't make sense of letters or words. He was suffering from what the French neuroscientist Stanislas Dehaene calls "word blindness." His eyes worked. He could see shapes on a page, but they made no sense to him. And because Engel writes detective stories for a living (he authored the Benny Cooperman mystery series, tales of a mild-mannered Toronto private eye), this was an extra-terrible blow. "I thought, well I'm done as a writer. I'm finished."
Nearly 80 percent of the population (250 million residents) lives within an hours drive of a stroke center and nearly 211 million residents lives within a 30-minute drive.
Companies' research announcements should almost always be taken with a grain of salt, so don't hold your breath for exciting news about this next week.
But atrial fibrillation is a common problem and known stroke-causing ailment. So look for more news and perhaps answers on this in the months ahead.
The trial is intended to evaluate the safety and efficacy of the plug in preventing blood clots in the heart that can lead to strokes. The trial will be conducted with patients suffering from atrial fibrillation, a condition in which the heart quivers and doesn’t pump blood properly. That can cause clots that travel to the brain and result in strokes, according to a statement from the company.
The finding stems from Canadian research involving 103 people who'd had a stroke and were receiving standard follow-up care in a hospital. About half were then enrolled in an additional experimental effort called the Graded Repetitive Arm Supplementary Program (GRASP).
The GRASP group spent 35 minutes four times a week doing such non-intense arm exercises as buttoning a shirt, pouring water into a glass and playing speed and accuracy games. The functioning of arms and hands that had been affected by the stroke improved, on average, 33 percent for these participants, the study found. The amount that people used their arms and hands increased as well.
Every find news that sounds good but you know it must get better? Recent stories reported just that kind of news.
On one hand, almost 30 percent of stroke patients showed up an an emergency room within the first hour. That's good. But that means more than 70 percent don't show up within the first hour. That's the downside. The downside means fewer treatment options, and, the study shows, fewer people who show up after the first hour receive a clot-busting drug.
There are two other interesting findings: If the stroke is more obviously serious or the patient shows up in an ambulance, then you get a much higher percentage of those arriving at an ER with in the first. Now, the first item is out of your control. However, the second item - how an ambulance can get someone to help quicker - is advice that anyone can follow.
A substantial portion of ischemic stroke patients present to emergency departments within an hour of onset, and they are more likely to receive thrombolytic therapy than those who arrive later, but both factors present room for improvement, according to research published online June 3 in Stroke. ...
The researchers found that onset-to-door time was 60 minutes or less in 28.3 percent of patients, 61 to 180 minutes in 31.7 percent, and more than 180 minutes in 40.1 percent. Characteristics most strongly associated with early arrival included severe neurologic deficit and arrival by ambulance versus private vehicle. Patients arriving in the first 60 minutes more frequently received intravenous thrombolytic therapy than those arriving in 61 to 180 minutes (27.1 versus 12.9 percent), but their door-to-needle time was longer (90.6 versus 76.7 minutes).
...[T]he increase did not appear to come at the expense of the number of patients treated in the earlier period up to 3 hours after onset, something investigators had feared would happen once physicians knew they had more time to decide whether to treat.
Patients treated later had similar functional outcomes to the earlier window, the researchers found; there was a small increase in symptomatic intracerebral hemorrhage (ICH) and death but not enough to prevent use of the treatment, the researchers conclude.
"Women need to be treated for stroke as soon as possible. We found that women who weren't treated had a worse quality of life after stroke than men. However, the good news is that women who were treated responded just as well as men to the treatment," study author Dr. Michael D. Hill, of the University of Calgary in Canada, said in a news release from the journal's publisher.
Hill and his colleagues analyzed data on more than 2,100 stroke patients. Of the 232 patients treated with tPA within three hours after their stroke, 44 percent were women.
Only 58 percent of women who didn't receive tPA had a good outcome six months after their stroke, compared with 70 percent of men who weren't given the drug. Women and men treated with tPA after their stroke had similar outcomes.
From entertainer Bret Michaels and Delaware Attorney General Beau Biden to countless others, story after story of late shows that strokes can often happen to the under-50 crowd:
Dr. Irene Katzan, director of the Primary Stroke Care Center at the Cleveland Clinic, told Newsweek that given Biden's quick recovery, he likely suffered an ischemic stroke, in which an artery to the brain somehow becomes blocked, cutting off blood flow and oxygen supply. (A more serious form of stroke occurs when a blood vessel breaks completely, and blood seeps into the brain.)
At 41, the Delaware attorney general doesn't seem like someone who is at high risk of a stroke: according to the American Heart Association, more than 75 percent of stroke victims in the U.S. are 65 or older. But Katzan says it's not unheard of in a younger man.
"There's a common misconception that stroke is a condition only of the elderly," said Matarese, also the medical director of the stroke center at St. Mary Medical Center in Langhorne, Pa. "In fact, it can affect anyone, including young adults. There are young, otherwise seemingly healthy adults who have had them and, in many times, the cause of their stroke is not the more commonly seen problems that we see in older individuals."
There were 1,163 men between 35 and 44 who died of stroke in 2006, the most recent year in which data is available, according to the federal National Center for Health Statistics.
"Quite literally, the more time you waste or lose trying to treat a stroke, the more brain cells die," says Dr. Nasser Razack, director of neurosciences at Northside Hospital in St. Petersburg. "It's critically important that if you think you are having a stroke, or someone you know might be having a stroke, to dial 911 immediately and get help."
Time determines the treatment available to the estimated 780,000 Americans affected by stroke each year; one of the first questions doctors must answer when a patient arrives at a hospital emergency room is how much time has passed. It's especially critical as stroke remains the third leading cause of death in the country today, killing 187,000 people a year, the Centers for Disease Control and Prevention says.
So what exactly is a patent foramen ovale, and how common is it? We spoke with Dr. Jonathan Tobis, clinical professor of cardiology and director of interventional cardiology at the Ronald Reagan UCLA Medical Center, who explained that this is a congenital condition. Fetuses normally have a hole, or flap, between the left and right atria of the heart that allows blood to flow in between, bypassing the lungs. Once the baby is born and taking in oxygen to the lungs, that flap seals up -- or it's supposed to. In about 20% to 25% of people it stays open, leaving a small to large hole that still allows some blood to flow between the atria.
Most people never know they have this condition. But it may cause strokes, although rarely, Tobis said: "A blood clot can form and travel a pathway from the right to the left atrium and up to the brain, causing a stroke." It’s typically corrected these days with a catheter-based method that "is sort of like closing a button hole," he said. "It's a relatively simple procedure done as an outpatient."
Tobis said people shouldn't go running to their doctors demanding an echocardiogram to see whether they have this condition, because most remain asymptomatic throughout their lives.
Michaels, 47, has had a few struggles in his life but on appearance, seems healthy enough. His story, though, can serve as a cautionary tale. He's not old. Not puny or weak-looking. Active. So was I. So have countless others.
So even if someone seems healthy, know and pay attention to the signs and symptoms of a stroke.
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
However, people might miss the not-so-fine print, also on the association's Web site:
If you notice one or more of these signs, don't wait. Stroke is a medical emergency. Call 9-1-1 or your emergency medical services. Get to a hospital right away!
Notice the association doesn't say get if if someone has all the signs. Just once would suffice.
I did not have a headache associated with my stroke. Most of the people I've spoken with who have gone through having a stroke tell me that he or she did not have a headache. While a sudden, severe headache is a clear warning sign, especially of a hemorrhagic stroke. But it's only one sign, and you should pay attention to all of them.
All of them were filled with the Holy Spirit and began to speak in other tongues as the Spirit enabled them.
-Acts 2:4
Pivotal events in history. When something occurs that changes the direction of a people, a nation, the world. Books upon books have been written about pivotal events. There’s a whole cable channel devoted to history. We study those events in colleges and universities, in elementary and high schools. We are all students of history because we all witness history, and our lives are intertwined with history.
And characters in those stories – pivotal people in pivotal events.
And this is one of reasons why Acts is one of my favorite books of the Bible. It constantly talks about the precise timing and planning of God that created the Christian church and spread its message throughout the world. It gives me comfort to know that no matter how chaotic this world seems to be, God is truly in control.
The verse above is from the pivotal event of the day of Pentecost that launched the Christian church. Read the entire story in Acts. And even further back, explore the beginning of the festival that brought all those people who heard Peter's message to Jerusalem.
Now, are all Christians challenged to stand up and preach in a language we suddenly can speak? Maybe. Maybe not. But I’m certain we can – in some way – be pivotal people in lives that God created.
I will never forget the pivotal people of the day I had a stroke - the colleague who got me some help; the people who transported me to a hospital; the fact that, in 1998 at a small hospital in a small town, there happened to be a neurologist capable of using tissue plasminogen activator for the "Lazarus effect."
You can be a pivotal person in the life of a stroke victim by simply calling 911 and getting some help. Be willing and stand ready to be that pivotal person if that time comes.
