'And be thankful'

Let the peace of Christ rule in your hearts, since as members of one body you were called to peace. And be thankful.

-Colossians 3:15

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.

(Image from Heartlight)

Is closing the hole in the heart really best idea?

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.

Weight and tPA - potentially critical combination

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.

Ran across this story about how faulty estimates of patient weight affect tPA dose:

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.

Time to stop smoking - now

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.

And just in time, the U.S. Food and Drug Administration has unveiled graphic warning labels for cigarettes:

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.

(Image from FDA)

'Wait for the LORD...'

Wait for the LORD;
be strong and take heart
and wait for the LORD.

-Psalm 27:14

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.

Finding stroke 'triggers' might help prevention

 Read on about recent research about a study identifying potential stroke triggers:

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.

Time is important - so some good news....

MRI images may pinpoint time of stroke:

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."

Be sure to schedule your stroke carefully...

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.

'Faster care' for stroke victims across health boards:

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."

Checking blood pressure at barbershops

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....

Haircuts, hypertension, and black-owned barbershops:

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.

Preventing recurring strokes - new guidance

One stroke risk factor: having a previous stroke. Now, new guidelines for recurrent stroke prevention:

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."