Hopeful research for stroke patients

More Lazarus-related news - Australian researchers have seen promising results using a second clot-busting drug vs. the now-standard Alteplase, also called tissue plasminogen activator or tPA..

Researchers with the University of Newcastle's School of Medicine and Public Health compared Alteplase with Tenecteplase, now used in heart attack patients. The results showed a rapid recovery for stroke patients:

Associate Professor [Mark] Parsons said there was often a "Lazarus-like" effect among the Tenecteplase patients as they appeared to rise up off the bed. Lazarus, in the Bible, was raised from the dead.

"The results were quite dramatic and a bit surprising for us in that in the new drug Tenecteplase, more than two-thirds of patients had this dramatic response within 24 hours where they almost fully recovered," Associate Professor Parsons said.

"With the standard drug it's about a third."

I've always enjoyed the Lazarus reference - including my own Lazarus-effect moment in 1998. With more research, here's to more Lazarus experiences for stroke patients.

The thing to do: Call 911

Just a couple of postings ago, this blog noted that research showed that there is still often a time issue for stroke patients - they are too often not getting to help in time.

Now, more news along those lines: Stroke patients don't call 911:

Nationwide, only about half of stroke patients arrived at the emergency department via ambulance and that figure hasn't changed over a 10-year period, Hooman Kamel, MD, of Weill Cornell Medical College in New York City, and colleagues found.

"Our findings suggest that national efforts to address barriers to ambulance use among patients with stroke need to be intensified or adjusted," they reported in a research letter in the March 14 issue of the Journal of the American Medical Association.

Thrombolytic therapy improves outcomes after ischemic stroke, but most patients don't present to the hospital in time, which is typically within 4.5 hours of symptom onset. That's despite numerous educational efforts to encourage people to call 911 at the earliest signs of stroke, especially because being transported via ambulance results in quicker arrival at the emergency department."

Thank God - and I mean thank God - someone had the presence of mind to summon an ambulance on the day my stroke occurred. But too often, that doesn't happen.

Now, does calling for ambulance guarantee an ideal outcome? No. Nothing can. But does failing to call 911 reduce your chances of a good outcome? Absolutely.

(Image from Alexander County (N.C.) Health Department)

A follow-up about holes in the heart

Almost five years ago - how time does fly - the hole between my two upper chambers were closed by a catheterization procedure.

Doctors had guessed since 1998 that my stroke at that time was caused by a series of actions:

• A hole in the heart we're all born with - patent foramen ovale - never closed.
• The wall between the two chambers was not a nice straight, smooth surface, but was more wavy with a divot, also called an atrial septal aneurysm.
• Normally, blood pumps into the vein side of the heart, then out the lungs to get oxygen and get filtered for clots and debris, the back into the arterial side and eventually out to the brain and body,
• However, clots and debris could collect in the divot and with a little extra chest pressure - even a sneeze - could push that from vein side to arterial side, bypassing the filtering process.
• The clot or debris is pumped out to the brain.
• Stroke happens.

So, after a transient ischemic attack, or a TIA mini-stroke, in 2007, I decided to take an offer to close that hole. (See video below.) It went great. A little over a year later, I finished a marathon.

Now, however, a new study stirred questions about whether the procedure works any better than medication. I was on a blood-thinner called warfarin, or Coumadin.

I think, though, one important takeaway from this research came from an ABC News quote:

Dr. Anthony Furlan, the study's lead author and chairman of neurology at University Hospitals Case Medical Center in Cleveland, said the evidence just isn't there to support a PFO closure procedure over simply giving patients medication.

"We're not saying there are no patients who should have the hole closed, but we are saying the selection criteria have to be radically refined," he said. Ideally, a patient would be under age 45, have a very large hole in their heart and a heart defect called an atrial septal aneurysm.

When my stroke occurred, I was a "young" 39. Plus, the atrial septal aneurysm was - now much more solid thanks to the device implanted - present.

Did I really want to be on a sometimes-dangerous blood thinner for the rest of my life? No. For me, I think the closure was the best choice. Is it  for everyone? The real answer, like many medical answers, is not so clear. Each individual's circumstances should be considered.

Time is still an issue

Time, as I've written for this blog time and time again, is key to stroke recovery.

Yet, we get depressing news about how stroke victims arrive to hospital late for drug therapy:

The CDC researchers found that almost 44 percent of patients who had strokes between 2005 and 2010 took more than 4.5 hours to get to the emergency room after their first symptoms.

That's up from the almost 40 percent who hesitated before going to the hospital in 2005.
At the same time, the percentage of stroke victims who got to the hospital within two hours also decreased — from 40 percent in 2005 to 35 percent in 2010 — another sign that people may not understand the need to get prompt medical care.

About 795,000 Americans suffer a stroke each year, according to the CDC. The most common type (87 percent of all strokes) is ischemic stroke, caused by a blockage in the blood flow to the brain.

You must get to help. Is that a guarantee? No. But it certainly increases your chance of positive outcome.

For mice - or for this man

Here's a no-brainer - even for mice.

A recent story about stroke research indicated that mice kept in solitary generally do worse than mice with partners. Now, mice aren't people. But I can tell you in my own experience that friends, fellow believers and family made a huge difference in my own recovery.

Mice that were socially isolated tended to have greater ischemic infarct volumes relative to mice paired with a stroke partner or a healthy partner. In addition, the solitary mice had significantly decreased levels of brain-derived neurotrophic factor (BDNF), a protein that helps support the survival of existing neurons.

(Generic mouse photo from the National Institutes of Health) 

Oranges? Can't hurt, really

Watch out for stories about medical research. Just because things seem connected, it doesn't follow that one causes the other. Maybe. Maybe not.

That being said, recent news about the potential connection between an orange a day and stroke prevention is interesting:

Women with the highest levels of flavanone in their diet were 19% less likely to have an ischemic stroke during 14 years of follow-up than those with the least flavanone intake (P=0.04), Aedín Cassidy, Ph.D., of the University of East Anglia in Norwich, England, and colleagues found. ...

Most of the flavanones consumed by women in the study came from orange and grapefruit juice (63%). But eating the whole fruit would likely be a better way to boost intake, the researchers suggested.

"Given the higher flavanone content of citrus fruits and the sugar content of commercial fruit juices, public health recommendations should focus on increasing citrus fruit intake," they recommended in the paper.

Unless you've got a health reason not to eat an orange a day, this isn't a bad idea at all. This research doesn't prove the link, however. (Photo from U.S. Department of Agriculture)