Battle strokes with ultrasound?

Lately, we've seen news about better stroke outcomes. But there's still so much room for improvement. Now, check out this future-looking article from Popular Mechanics about ultrasounds and the fight against stroke:

To date, the most effective treatment is the clot-dissolving thrombolysis drug tissue plasminogen activator, tPA. But tPA is a far-from-perfect solution, says Andrew Barreto, a neurologist at the University of Texas Health Science Center in Houston. “IV-tPA will help about 30 of 100 patients who receive it within the first 4.5 hours after stroke symptom onset,” Barreto says. “But, many patients are still disabled, so we need better treatments.”

Barreto and some of his colleagues think that ultrasound could be one of those treatments. Ultrasound has been a valuable tool for diagnosing and tracking strokes in the brain for years. Now, a wide variety of new technologies are making it possible for neurosurgeons to use ultrasound waves, which travel at frequencies too high for the human ear to pick up, to not only identify the signs of stroke such as blood clots in the brain but also to help treat them.

I was one of the fortunate who benefited from tPA - with minimal remaining effects of my stroke. It's great to hear that researchers are out there seeking more and better tools to battle strokes.

Could warfarin temporarily raise stroke risks?

Warfarin might be phased out for many patients - maybe - with some unpleasant or worse side effects. And perhaps that is a good thing. From a few days ago, here's a snippet  of a story titled "Start Warfarin, Have a Stroke?":

Starting warfarin for preventing stroke in patients with atrial fibrillation appeared to be associated with a transiently increased risk of ischemic stroke before the preventive effects kicked in, a large case-control study showed.

Compared with not taking any antithrombotics, initiating warfarin was associated with a greater risk of ischemic stroke in the first 30 days ... , with a peak at 3 days, according to Samy Suissa, PhD, of McGill University in Montreal, and colleagues.

But after that, the well-known stroke-cutting effects were seen ... .

I've always been told that warfarin takes three days to take effect, which fits at least part of the story. Click on the story link to read more.

'The Lazarus effect'

[This was originally posted Dec. 24, 2009]

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."

-John 11:38-44

Not long ago (2008), I heard a presentation by one of the doctors responsible for making tPA (tissue plasminogen activator) available to stroke patients.

In my own 1998 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. Once there was no hope. A man's sisters, relatives and friends knew they lost him. Jesus entered. Hope returned.

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.

No closing times for strokes

Ever been in a hospital over a weekend? Hospitals are famous for making people show up before dawn during weekdays for a medical procedure so they can sit and wait for hours - and virtually shutting down on Saturdays and Sundays.

Now, from England, is a story on how an elderly man was turned away from King’s Mill Hospital because stroke unit shut at 6 p.m.:

Elderly stroke victim John Mallalieu was turned away by a Nottinghamshire hospital because it was too late on a Friday afternoon.

The ambulance carrying the 89-year-old from Caunton to King’s Mill Hospital in Sutton-in-Ashfield was diverted to City Hospital in Nottingham, where he remains in intensive care.

The incident was a timely reminder of the additional problems facing patients who need attention at weekends.

Did this patient choose to have a stroke so close to 6 p.m.? Certainly not.

'The word of our God endures forever'

The grass withers and the flowers fall, but the word of our God endures forever.

-Isaiah 40:8

It's cold with snow lingering in spots where I'm located at this writing, here in the middle of Missouri in December. Much of the grass has indeed withered, and flowers are gone.

Sounds like a bummer. Summer has vanished. Fall is almost complete. Winter is already here in spirit if not by the calendar. Not quite yet - still a couple of days away.

But this is not unexpected. I can read a calendar - for the next few months, I know that the grasses and flowers are waiting for spring. I know that outside, cold winds will blow. Our family pets will linger by the fireplace. No surprises there. The information imparted by a simple calendar, it seems, endures.

So much greater is the word of God. Study the word and know that it - and with it, God's love - endures.

(Photo from the National Oceanic and Atmospheric Administration, with text added by author)

Brain therapy might help stroke rehab

Stroke is the leading cause of permanent disability in the United States. So many people need physical, occupational and speech therapy to recover. I recently read about research that might lead to better tools to help stroke patients to recover.

This article describes how brain therapy helps rehabilitate stroke patients:

A new interventional therapy that uses a brain–computer interface appears to change brain activity in patients with stroke, new research has shown.

The therapy alters specific areas of the brain that correlate with both the affected and unaffected hands. The activation of these areas of the brain appears to correspond to executed and imagined tasks of the affected hand, and may represent neuroplastic recovery.

"Brain activity fed back to the patient is key for the therapy," explained Vivek Prabhakaran, MD, director of functional neuroimaging in radiology at the University of Wisconsin in Madison.

(Photo from the University of Wisconsin School of Medicine and Public Health) 

600 blog postings - and, God willing, more to come

God is our refuge and strength, an ever-present help in trouble.

-Psalm 46:1

This is the 600th blog posting for Stroke of Faith, which began eight years ago this coming Saturday. Click here for the first posting.

For several years, the blog was updated only sporadically. Then, in 2008, I decided to either abandon the blog or update more often. So, since then, it's been updated generally two or three times a week.

I also recently re-read the verse in Psalm 46, and I think it makes a statement about one of the reasons for this blog:. When I needed help, God was my refuge. When I had no strength, God was my strength. And even to this day, when trouble invades, God is my ever-present help.

Still too high - but stroke deaths are falling

Even though stroke is the leading cause of permanent disability in the United States, stroke deaths have been declining.

Not to say that stroke rates are still too high - especially with the young. And strokes - often preventable - still claim too many lives.

Still, this article showed at least a glimmer of good news about how U.S. stroke deaths fell 30 percent over the past decade:

It is possible that the most important reason for the decline is the success in lowering Americans' blood pressure, which is the biggest stroke risk factor, he said. Other reasons for the decline may include reductions in smoking, improved cholesterol levels and better treatments for stroke patients.

"We don't know how much all of the sources are contributing," Howard said. "Certainly, we want it to keep going down. But if we don't understand why the numbers are decreasing, we can't work toward that trend."

Howard said the 30 percent decline in stroke deaths in the last 11 years is "a big deal, so you could argue that our battle is won. But I think [there's still] a lot to be accomplished in this area."

Yes. A lot remains to be accomplished.

Pot and stroke research and rats

This blog has seen postings about various research on preventing or treating strokes. I always try not to make rash promises about how something - coffee or chocolate or tea or bat spit (honest!) or snake venom - will prevent a stroke or treat a stroke.

So I was fascinated to read the many articles about how "stroke survivors" could be given cannabis to reduce brain damage:

The “exciting” research has been compiled by researchers at the University of Nottingham, who have pulled together research from around the world to suggest that ‘cannabinoids’ – chemicals related to those found in cannabis, some of which also occur naturally in the body – could reduce the size of stroke and improve neurological function.

The research – so far which has only been done on rats – indicates that all three classes of cannabinoid could be effective in shrinking the area of the brain affected by stroke and in recovering neurological function.

I put "stroke survivors" in quotes because of the second paragraph's note that the research was done on rats - not people. So the "stroke survivors" so far have been rats.

Always watch out for stories that call research "exciting" when it's done on rats. Would cannabinoids work the same on humans? Nobody knows. Keep that in mind when you read about the weed. It'll be time to be excited when it works on people.

(Photo from the National Institutes of Health)

'Give thanks to the Lord'

Praise the Lord. Give thanks to the Lord, for he is good; his love endures forever.

-Psalm 106:1

Here in the United States, today is Thanksgiving Day.

Today, I am thankful for:

• Being alive.
• The notes and feedback from readers of this blog.
• A church home.
• The ability to work and exercise.
• Family and friends.
• And so much more.

Thankful to ...? Many people deserve thanks. But God is the ultimate source of all the blessings I've received, all the people who have come into my life.

And for that, especially on this day, I give thanks to the Lord.

What are you thankful for?

'Will become perfect'

Last Friday, people in the United States and around the world marked the 50th anniversary of the tragic death of President John Kennedy.

Another great figure died the exact same day - great Christian apologist C.S. Lewis.

Recently, I received an email from The Ranch with this great C.S. Lewis quote:

Those who put themselves in His hands will become perfect, as He is perfect - perfect in love, wisdom, joy, beauty, health, and immortality. The change will not be completed in this life, for death is an important part of the treatment. How far the change will have gone before death in any particular Christian is uncertain.

As a stroke survivor, I'm damaged goods in this imperfect body. Indeed, you can't find any perfect human being. Not on this side of the great divide. But as Lewis reminded his readers, perfection awaits all who accept it.

(Photo from Wikimedia Commons)

Developing new class of blood thinners continue

For a few years, I took warfarin (also known as Coumadin) daily. I had to be careful in diet, in the timing of the medication and getting blood tests monthly to make sure my blood was not too thick, not too thin, but rather, to paraphrase Goldilocks, "just right."

The drug, also famously used as rat poison, has been in use to prevent clot-type strokes for decades. You might have seen the TV commercials lately for new drugs coming on the market to replace warfarin. Now, new blood thinner edoxaban was found safer, as effective as warfarin:

"Personally, I think it will be used. We know this drug is safer than warfarin," said the study's lead investigator, Dr. Robert Giugliano, a cardiologist at Brigham and Women's Hospital in Boston.

But it will enter a market that already has three other new medicines vying to displace cheap, decades-old warfarin. 

It aims to compete with Xarelto, sold by Bayer AG and Johnson & Johnson, and Eliquis sold by Bristol-Myers Squibb Co. and Pfizer Inc., which belong to the same class of drugs as edoxaban, as well as a similar medicine from Boehringer Ingelheim called Pradaxa. ...

"If you look at the four new drugs, they're more similar than different," said Dr. Mark Link, a professor at Tufts University Medical Center in Boston, who was not involved in the trial. "All these drugs are safer than warfarin."

Warfarin, of course, can cause bleeding, bruising and other medical problems. On the downside of the new drugs, costs will be far greater than the cheap generic warfarin. Still, worth discussing with your doctor.

(Photo from the National Library of Medicine)

Men: Walk to reduce your stroke risk

You've seen references to exercise before, but here's more info that to reduce stroke risk, take a hike:

Men who walked eight to 14 hours each week had about a one-third lower risk of stroke compared to men who walked no more than three hours a week or did not walk at all, and the risk was about two-thirds lower for men who walked more than 22 hours a week.

"Compared to walking at a slow pace, the men who walked faster had about a one-third reduction in stroke risk, but this was entirely explained by the fact that they walked further than men who walked slower," Jefferis told MedPage Today. "On balance it seemed that time spent walking, rather than walking pace, was more important in our study."

Walking is the predominant form of physical activity in older adults, and it is important to understand its impact on stroke risk in this population, the researchers wrote.

Walking is cheap exercise and cheap "medication" for stroke prevention. Most people can start at their own pace and time, and slowly improve as ability increases. Of course, it's always advisable to check with a health professional before starting an exercise program.

Not long ago, this blog highlighted a study focusing on women and walking. Now, it's time for men to "take a hike!"

(Photo from U.S. Department of Health and Human Services)

'Lead me on level ground'

Teach me to do your will, for you are my God; may your good Spirit lead me on level ground.

-Psalm 143:10

This past weekend, I ran 10 miles into and around Branson, Mo. If you've ever been there, you know it's a very hilly place.

As a result, my time was slower than normal, and I had some sore leg muscles! 

Several months before, I fell. Pretty hard. I was running down a sidewalk I've run on numerous times before. A small unlevel spot caught me, and the next thing I knew, I was rolling onto the concrete and grass nearby. Fortunately, I wasn't seriously injured.

In both cases, though, I didn't regret my running at all. Running is my time to reflect, time to challenge myself, time to pray and praise.

Figuratively - if not literally - we've all encountered hills and even small rough spots that become obstacles. While taking on obstacles might strengthen us, our spirits often need some distraction-free level ground when we are ready to connect with God.

Follow him to that level ground.

(Photo midway through a hill I ran in Branson, Mo., from Google Maps)

Stroke, tPA and physician decision-making

A brief but thought-provoking article in the Neurology journal spells out recent survey results about the use of tissue plasminogen activator, the clot-busting drug used to treat certain stroke patients.

When is it right, when is it wrong, to apply the medication? Not in the cold scientific sense, but in the practical and ethical sense? If the patient would face devastating effects of the stroke no matter what? If the patient is in the throes of incurable dementia, such as Alzheimer's?

A snippet of the Stroke, tPA and physician decision-making article:

Studies like this one help to highlight and clarify the rationale behind the treatment of acute stroke. They allow us to understand the individual approaches that different physicians take to identical clinical problems. This study suggests that neurologists' decisions about tPA are based on many factors. Some of these factors include their own opinions about the quality of life a person might have after a severe stroke. For instance, Dr. Shamy discovered that most of the surveyed neurologists were less likely to give tPA to patients with dementia (like Alzheimer disease). This is in contrast to recent studies that have shown that there is no greater risk to tPA in people with dementia. Further supporting this finding was the observation that the physicians were less likely to treat patients with more severe strokes or those who might require assisted living.

Interesting results, interesting reading about decisions people face every day.

(Image from the National Institute of Neurological Disorders and Stroke)

Low-T therapy may boost stroke risk

Unless you've been disconnected from television for the last five years, you've seen the marketing term: "low T" and countless commercials pitching testosterone therapy to men.

Recent research, though, might put a pause in deciding to start taking the medication, as testosterone medication may boost risk of heart attack, stroke, death:

The new research found that among 8,709 older men who were assessed for the possibility of blocked arteries, those taking testosterone were 30% more likely to suffer an adverse event -- a stroke, a heart attack or death.

"Our findings raise some uncertainty regarding the potential safety of testosterone use in men," concluded the authors, a group of physicians and epidemiologists in Colorado and Texas. While patients taking testosterone should not abandon the medication willy-nilly, they added, "it is important to inform patients that long-term risks are unknown and there is a possibility that testosterone therapy might be harmful."

At least, this raises questions to your doctor if you are considering testosterone therapy.

'Come to me, all you who are weary'

“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.”

-Matthew 11:28-30

I've heard many stories of people in stroke recovery who tire easily. Personally, I became weary, too. Things eventually improved, which, as a distance runner with a busy work schedule, I'm grateful for.

But sometimes, life can make anyone feel weary and burdened.

Physical weariness and heavy burdens are one thing. But Jesus, in this passage, is using that metaphor for the wearied and burdened spirit. The burdens can sap strength and hope.

Remember the promise, though: "I will give you rest." Find your hope, strength and rest.

Happy Halloween

Be strong and courageous. Do not be afraid or terrified because of them, for the Lord your God goes with you; he will never leave you nor forsake you.

-Deuteronomy 31:6

Life can be scary - I know.

Today, I take a little comfort in the "scary" Halloween events, people and decorations. You see, it's not scary at all. While we'll see the occasional Halloween Grinch who goes past the fun on this day and night, Halloween is mostly harmless.

But in real life - even when we're confronting the not-so-harmless - it's comforting to know that we don't need to fear. In the verses above, Moses is about to step down after leading God's people for decades. He reassures these people with these words. The words echo still. Be strong. Do not be afraid. God goes with you. He will never leave you.

So this day, with its fake scariness, know that God will never leave you when the real world closes in!

Medication/lifestyle vs. angioplasty for stroke prevention

Preventing a stroke can prevent disability. Preventing a stroke can save a life.

So I thought a recent story on how a recent study found that medication, lifestyle changes are safer than an angioplasty procedure for some stroke patients:

In this study, patients with narrowed brain arteries took medication to reduce blood clots, and to lower blood pressure and cholesterol ― all risk factors for stroke.

They were encouraged to exercise, improve their diets and stop smoking.

Half of the study participants also underwent a surgical procedure known as stenting, in which a metal mesh tube is used to prop open the damaged artery.

The result: Those who used medication and lifestyle change combo fared better than those who had the angioplasty/stenting procedure. That means fewer strokes, fewer changes of disability, fewer risks of premature death.

As anyone who's read this blog knows, despite the fact that I had my own medical procedure, I'm a believer that exercise and managing known stroke risks are some of the keys to stroke prevention.

Worldwide, strokes hit more people, many younger

One of the missions of this blog is to highlight stroke prevention. Every stroke prevented is a win. However, recent numbers show that stroke prevention has actually lost some ground - in the global perspective, at least.

A recent report shows that stroke numbers are up worldwide:

In 2010, there were 16.9 million people who had a first stroke, 33 million stroke survivors, and 5.9 million people who died from a stroke -- increases of 68%, 84%, and 26% respectively since 1990, according to Valery Feigin, MD, of the Auckland University of Technology in New Zealand, and colleagues. ...

What's more, there was a 25% ... increased incidence of stroke in those ages 20 to 64. At the end of the study period, 31% of first strokes occurred in people younger than 65, up from 25% in 1990. ...

Feigin and colleagues wrote that "these findings suggest that stroke should no longer be regarded as a disease of old age."

Read the entire article for more details. One comment especially touches on good common sense: reduce hypertension and unhealthy lifestyle.

'The Lord gives strength to his people'

The Lord gives strength to his people; the Lord blesses his people with peace.

-Psalm 29:11

Strength and peace.

In human history, those two terms have been at odds at times - you could easily cite examples of those in power with strength who have been anything but peaceful.

But we're not talking about human examples. Strength from God - that inner strength - is the perfect complement to God's inner peace.

So many times, I've needed strength and peace. It's difficult - and I'd say impossible in the final analysis - to find those things in the quality of God's strength and peace.

How does he provide this? Note the words - God "gives" strength; he "blesses" people with peace. We don't purchase or earn these things. God freely gives them. To you. To all.

Ambulance still best choice for stroke transport

This is not a big surprise - ambulance still best choice for stroke transport:

If "time is brain," then patients with ischemic stroke should get to the emergency department by ambulance rather than private vehicle, one study suggested.

Arrival times of 3 hours or less were more likely in an ambulance than in a private vehicle ..., according to Sheryl Martin-Schild, MD, PhD, of Tulane University in New Orleans, and colleagues.

If you read the entire article, you'll see that ambulance patients are more likely to show up within three hours of stroke onset, which means better chances with the only current treatment available for clot-type strokes.

The final outcomes at discharge, interestingly, of both ambulance-driven and private transportation patients are about the same. However, it's also the case that generally more severe stroke patients arrive by ambulance, while the generally less severe arrive by private transportation. So the ambulance-arriving patients generally start out worse but wind up about the same.

The takeaway on this - know stroke signs, and if you think someone is having a stroke, call an ambulance!

Exercise: Stroke prevention medicine

I'm convinced that being a longtime distance runner helped me survive and recover from my stroke in 1998. Fifteen years later, I'm still doing it.

Not to say that running is for everyone. Some people can't stand it or aren't ready for it. Even starting a walking program, though, could reap benefits, according to a recent article how exercise can be a powerful medicine:

Exercise may be as effective as medication in preventing early death in people who've had heart attacks or strokes, a new study suggests.

"Doctors should give their patients advice about the lifesaving benefits of exercise, and when possible they should refer patients to rehabilitation programs with exercise programs," says the study's lead author, Huseyin Naci, a fellow at Harvard Medical School and a graduate student at the London School of Economics.

Preventing a stroke is far better than trying to recover from one (or another one). Exercise, I'm convinced, can be a huge help.

(Photo from the U.S. Centers for Disease Control and Prevention)

Fascinating look at stroke results, recovery

A fascinating article - complete with videos - comes from a Canadian media outlet, how stroke survivors can experience 'bizarre' syndromes:

Every 10 minutes in Canada, someone suffers a stroke, and while the physical impacts are often obvious and familiar – a limp, or a paralyzed arm – equally devastating are the hidden, cognitive disabilities that can convince some people they’re losing their minds.

After decades of neglect, science is beginning to unravel the strange, but fascinating, neuropsychological syndromes that can occur when neurons die and the brain tries frantically to rewire lost connections – conditions that will increase as the population ages, because one of the single biggest drivers of stroke risk is age.

The articles runs through a half-dozen less common - but very real - stroke results that can change how people perceive our world and how they speak.

And it speaks to the real need for long-term therapy for stroke survivors. It quotes Dr. Dale Corbett, scientific director and chief executive officer of the Heart and Stroke Foundation’s Centre for Stroke Recovery in Ottawa.

“The brain is so fascinating, and so complicated,” said Corbett.

With the right therapy, people will often continue to recover “long past what we would have normally expected.”

Brain stimulation might be viable post-stroke

Stroke recovery can be a challenge - many, many know that better than I - but it's good to see research on possible ways to improve that recovery.

A recent study discussed how brain stimulation is viable in post-stroke rehab:

Repeated noninvasive transcranial magnetic stimulation (nTMS) helped treat spasticity, motor symptoms, and post-stroke pain in a small population of stroke patients, researchers reported here.

Check out the link for the whole story, and keep in mind the research included a small number of people. Still, this bears watching.

(Image from the National Institutes of Health)

Stroke recovery with an iPad

Back about 15 years ago, I used a educational toy called a Geo Safari to help me bring back some language skills after my stroke, in addition to speech therapy.

Now, moving 15 years to the present, current stroke survivors can use even cooler technology. I ran across one story how a support group uses iPads to help stroke survivors regain function:

"The applications are on my laptop," [Suzanne] Hill said. "I'm on it most of the time. There are 15 applications that I can use. I just enjoy it so much. There's no chore to any of this for me."

Indeed, some of the apps are games, such as Scrabble or connect-the-dots. Some resemble putting the user back in an elementary school classroom, such as viewing a picture of a dog, then selecting the letters from an alphabet jumble to spell d-o-g.

"I have limitations on my right side," Hill acknowledged. "My right hand is not so flexible, (but) my typing skills are coming back."

'Clot Picker' can improve outcome - sometimes

I've been reading about research results as reported in the World Congress of Neurology, and ran across an example of both good news and not-so-good news.

First, there's the item how a 'Clot Picker' rescues tPA stroke failures:

Treating ischemic stroke patients with endovascular therapy when initial tPA thrombolysis was unsuccessful led to good 3-month outcomes in most cases, a researcher said here.

Then, though, the not-so-good news - how endovascular therapy had poor outcomes in the elderly:

Only about one-quarter of stroke patients 80 and older who underwent endovascular treatment after thrombolysis had good functional recovery, according to a single-center study reported here.

A couple of notes - first, all this research involved a relatively small number of people. Something to keep in mind. Also, I think these results can show the need for qualified expertise in treating stroke patients.

Could a trip to the ER with a headache mean a stroke?

While not every stroke will bring on a headache, a sudden headache could be an important sign. Saw this recent article from Everyday Health:

Sometimes a headache is just a headache, but sometimes it's a sign that you're having a type of stroke called subarachnoid hemorrhage (SAH). What happens when emergency room doctors don't recognize this possibility?

A large number of misdiagnosed stroke cases occur every year, particularly for stroke from hemorrhage, in which 20 percent of cases may go undiagnosed. Subarachnoid hemorrhage (SAH) is the kind of stroke with the highest rate of under-diagnosis.

Read the entire article for good tips.

(Photo from U.S. Department of Health and Human Services)

Good neighbors, fewer strokes, study shows

How does a neighborhood cut stroke risk?

Environment, we're learning, is a key element of good health. Places to walk safely. Access to healthy food. Quiet. Clean air. There are all kinds of local, state and federal policies about where people live that can impact health.

Now, recent research shows that good neighbors can mean fewer strokes:

"If future work consistently shows that neighborhood-level constructs provide a protective effect against stroke," they continued, "this line of research may further justify policy changes and neighborhood-level public health approaches to stroke prevention."

Numerous studies have examined the relationship between negative neighborhood factors -- including violence, noise, traffic, cleanliness, and air quality -- and poor health outcomes, but not many have explored the associations between positive neighborhood characteristics and health.

In three Chicago neighborhoods, a previous study showed that an increase in perceived social cohesion within the neighborhood -- a measure of  "connectedness between and among neighbors and their willingness to intervene for the common good" -- was associated with a reduced risk of fatal stroke.

'Will never walk in darkness'

When Jesus spoke again to the people, he said, "I am the light of the world. Whoever follows me will never walk in darkness, but will have the light of life."

-John 8:12

Yes, you might have seen this particular Bible verse here before.

However, I couldn't resist keeping on the "light" theme this week (see previous post here). Fall is coming fast and with it, days are slowly shortening. Soon, daylight savings time will end, and when I leave my workplace, it'll be dark. Just recently, I've started to use a little headlamp when I run in the early morning hours.

But dark can be more than just a matter of day or night. Just as Jesus talked about the light of life, life also has its dark times. Struggles with pain and tribulation. Stroke recovery frustration. Times of being lost in a world that is often dimly lit.

We've all been in the dark. But the light is available for us - when we begin - or just remember - to follow the light of the world.

'A light on my path'

Your word is a lamp for my feet, a light on my path.

-Psalm 119:105

Ever feel lost? In a strange town? Or a strange situation?

It's happened to me - literally AND figuratively.

Not long after I moved to Missouri several years ago, during a long run on a Saturday, I got turned around and two hours later finally figured out where I was. I got to a phone, called home and my wife was kind enough to come get me.

It was bright sunlight, but I might has well been lost in the dark.

When my stroke occurred a few years before my lost-while-running episode, I felt lost in a different kind of dark. Thanks to many people who helped, I found light and, once again, home.

We all run into patches of darkness, times that seem dreary and hopeless. But we can look toward our relationships with God to find that light -and home.

'Polypill' approach might help in stroke prevention

I don't take many pills and grateful for that. Still, I forget one from time to time. I could see that for someone with a more complicated medication schedule, it's more critical to stay on schedule. I managed my mother's medications for a couple of years and, to a degree, can understand the concern.

Ran across an interesting story about the "polypill" approach - multiple heart disease medications rolled into one dose, and how heart patients more likely to take medication when in single pill:

One study shows that a number of stroke patients stop taking their pills within three months after having a stroke. A new study in Britain finds that if patients with heart disease can take a single pill instead of several pills, they are more likely to stay on their medication.

Of  course, stroke patients who stop taking their pills generally have a higher stroke risk. So perhaps the polypill will help prevent more strokes. And for an individual, one is too many.

CDC: Thousands of strokes are preventable

Many strokes - especially striking the "younger" set - are preventable. The U.S. Centers for Disease Control and Prevention recently released new figures about those deaths.

You might have read about stroke risk factors here before - especially smoking and high blood pressure. Controlling those factors can add years of healthy living to many lives. Read the article about how 200,000 heart disease, stroke deaths could be prevented:

"As a doctor, I find it heartbreaking to know that the vast majority of people who are having a heart attack or stroke, under the age of 65 in particular, and dying from it didn't have to have that happen," CDC director Dr. Tom Frieden said during a noon press conference. ...

Each year in the United States nearly 800,000 people die from heart disease or stroke, many of which could have been prevented by proper medical management and lifestyle changes to control risk factors, Frieden said.

Click here to read a summary from the CDC.

Stroke risk and smoking

Smoking: a known stroke risk. And recent research shows that women are particularly at risk for the deadliest type of stroke. Read more on how stroke risk is similar among men and women smokers worldwide:

Smoking cigarettes may cause similar stroke risks for men and women, but women smokers may be at greater risk for a more deadly and uncommon type of stroke, according to new research in the American Heart Association journal Stroke.

When compared to non-smokers of the same gender, smoking increases the risk of having any type of stroke by 60 to 80 percent in women and men.

'Straining toward what is ahead'

Brothers and sisters, I do not consider myself yet to have taken hold of it. But one thing I do: Forgetting what is behind and straining toward what is ahead, I press on toward the goal to win the prize for which God has called me heavenward in Christ Jesus.

-Philippians 3:13-14

"Forgetting what is behind..."

I must admit, sometimes I look backward. Decisions made. Events that I had no control over. Tragedies and disappointments. Thrills and accomplishments.

And yet, those backward glances change nothing that is ahead. Yes, remembering lessons are important. But learning lessons and reliving the past are not the same thing.

Paul, in his letter to the Philippians, got it right: Strain toward what is ahead, and "press on toward the goal... ."

Quicker treatment, better outcomes

A couple of days ago, I posted a note about how hospitals increasingly give powerful clot-buster for stroke. A related item, showing the importance of early treatment shows that the quicker the treatment, the better chances of a better outcome.

A study indicates that ultra-early treatment reduces disability after stroke:

... [T]he new study found that when these clot-busting drugs were administered even sooner -- within 90 minutes of the appearance of stroke symptoms -- patients had little or no disability after three months compared with patients who got the drugs later.

"Despite the time window of 4.5 hours to give clot-busting drugs, there are clear differences between patients treated ultra-early -- within 90 minutes -- and those treated later," said lead researcher Dr. Daniel Strbian, an associate professor of neurology at Helsinki University Central Hospital in Finland."

Stroke is the leading cause of disability in the United States, so quicker treatment to reduce these outcomes should be a high priority. I'll end this with the same note I ended the last posting: It's vital that a stroke patient get help quickly. Recognize the signs of a stroke and don't hesitate in getting aid!

Hospitals increasingly give powerful clot-buster for stroke

In the good news front, more clot-caused stroke patients are receiving the powerful treatment tissue plasminogen activator, or tPA. This is especially true for those who arrive at a hospital quickly and assessed for safe use.

The numbers, to be sure, could be better. But now, you've got better odds of proper treatment than you might have had a decade ago. Check out the story on how hospitals are increasingly giving powerful clot-buster for stroke:

At these hospitals, use of tPA increased from 4 percent to 7 percent during the nine-year study period. Among patients who were quickly brought to hospital and did not have any medical conditions that would prevent safe use of the drug, tPA administration increased from 43 percent to 77 percent. ...

"Hospitals have put tremendous efforts in the past decade into increasing the number of patients who can be treated with intravenous tPA, and this paper suggests those efforts are paying off," study corresponding author Dr. Lee Schwamm, executive vice chair of neurology and director of stroke services at Massachusetts General Hospital, and a professor of neurology at Harvard Medical School, said in a hospital news release.

"Today, more than three-quarters of stroke patients who are eligible for IV tPA are getting this treatment at the more than 1,600 U.S. hospitals we studied," he added.

It's vital that a stroke patient get help quickly. Recognize the signs of a stroke and don't hesitate in getting aid!

Mediterranean diet: Possible stroke prevention

Diet plays into stroke risk factors - both good and bad ways. A new study (click on the link to read the entire story) reports that a Mediterranean diet may counter the genetic risk of stroke:

Mediterranean diets heavy in two foods -- olive oil and nuts -- are linked to a lower rate of strokes in older people whose genetic makeup boosts their risk of diabetes, according to a new study.

The research suggests but doesn't conclusively prove that the diet lowers or even eliminates the extra risk of stroke, perhaps by lowering the rate of diabetes. Still, "our work has placed a solid step on the ladder of personalized nutrition and successful health," said study co-author Jose Ordovas, director of the nutrition and genomics laboratory at Tufts University's USDA Human Nutrition Research Center on Aging.

Ethnic disparity in stroke rates persists

Strokes can cross the boundaries of race, ethnicity, sex, age, and income. However, some groups do have higher stroke rates. A recent story shows that ethnic disparity in stroke rates persists:

Ischemic stroke rates declined over an 11-year period in Corpus Christi, Texas, but rates remained elevated in Mexican Americans relative to their non-Hispanic white neighbors, researchers found. ...

"Although the declining ischemic stroke incidence in Mexican Americans and non-Hispanic whites is encouraging, the persistent disparity in young stroke patients, who suffer the longest from post-stroke disability, indicates a need for additional prevention efforts targeting young Mexican Americans and communities with large minority populations," they wrote.

"The U.S. Department of Health and Human Services recently published goals and objectives for reducing health disparities, although specific action plans remain elusive," they added.

Fighting aphasia to communicate

I lost the ability to speak during my stroke - and struggled to regain the ability to speak coherently.

A recent story about how another stroke survivor fought to communicate:

However, last year, everything came to an abrupt halt when Alster suffered a stroke while traveling in his car. He awoke from a coma after three weeks in the hospital and was discharged to Morse Geriatric Center for rehabilitation. He could not speak, had no mobility and could not feed himself.

Alster entered the aphasia program at Morse, and with the help of his rehab team, led by Debbie Trontz, along with his own fighting spirit and motivation from his wife, he eventually learned to speak once again, eat and walk.

'His love endures forever'

Praise the Lord. Give thanks to the Lord, for he is good; his love endures forever."

-Psalm 106:1

Here's the last of a three-part set of postings drawn from Bible verses. The last one told us that nothing "will be able to separate us from the love of God that is in Christ Jesus our Lord."

Today's verse reminds us that love - the love that cannot be separated - endures. Endures through all trials, big or small. Forever.

Trials confront us all  - you, me, everybody.Those trials testing of your faith produce perseverance. And those trials cannot separate us from God's love. And "his love endures forever."

'The love of God'

For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.

-Romans 8:38-39

Last Thursday's posting was about life's trials - big and small - that can produce perseverance in faith.

Today, I re-read these verses from Paul's letter to the Romans and saw they fit that message, too. Trials are in the present and test us for the future. But despite these trials, they cannot separate us from God's love.

The trial I wrote about last week - harassment and tomato-throwing - is small compared to the trial of stroke recovery. But God's love is large - bigger than any trial, love that cannot be separated from you.

You might have seen these words on this blog before, but they're so worth repeating.

'Testing of your faith produces perseverance'

Consider it pure joy, my brothers and sisters, whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance.

-James 1:2-3

Trials come in lots of varieties and sizes. Recently, our home has been hit by harassment and vandalism by unknown people. It started with late-night doorbell ringing and escalated to tomato-throwing at our garage and front doors a few days ago. It happens off and on, sometimes as long as two weeks without incident.

Especially after we cleaned up smashed tomatoes off our doors in the middle of the night, I've had a lot of uncharitable thoughts about the culprits and have sat up late more than once.

After reading these verses from James, perhaps I need to adjust my attitude. So I've pledged myself that I will pray daily for the vandals.

Will it stop? I don't know. Will I still stay up late occasionally? Probably. Should they still held accountable? Yes.

Will testing my faith help me produce perseverance? Yes. And that's what it's about.

Women trail men in clot-busting treatment

Ran across an interesting report about a disparity between men and women and stroke treatment. The article cites why women trail men in clot-busting treatment:

Among patients presenting with an acute stroke, women were less likely than men to receive intravenous thrombolytic therapy, which could have to do with delayed arrival at the hospital, researchers found.

Read through the entire article; another argument that speedy response to stroke signs are vital.

Moving more may lower stroke risk

A regular visitor to this blog won't be surprised - exercise is good for you!

I regularly run 4-10 miles - occasionally longer - and now, a study funded by the National Institutes of Health suggests that moving more may lower stroke risk:

The findings revealed that regular, moderately vigorous exercise, enough to break a sweat, was linked to reduced risk of stroke. Part of the protective effect was due to lower rates of known stroke risk factors such as hypertension, diabetes, obesity and smoking.

“Our results confirm other research findings but our study has the distinct advantage of including larger numbers, especially larger numbers of women as well as blacks, in a national population sample so these provide somewhat more generalizable results than other studies,” said Virginia Howard, Ph.D., senior author of the study from the School of Public Health, University of Alabama at Birmingham.

"Enough to break a sweat" is a good measure for exercise, at least in my experience. And it makes sense that exercise will help address high blood pressure and help with other key stroke risk factors.

Walking is a good start - cheap exercise most people can do.

(Photo from the Centers for Disease Control and Prevention)

Blood pressure pills can reduce stroke risk

High blood pressure is a top stroke risk - a factor that can, at least to a degree, be controlled. A large study shows one way to decrease your stroke risk is to take your blood pressure pills:

A large new observational study demonstrates that people who don’t take their antihypertensive medications are much more likely to have a stroke. The new study, published in the European Heart Journal, used nationwide prescription, hospital and mortality records from 73,527 hypertensive patients in Finland.

The Finnish investigators compared 26,704 patients who were hospitalized or died of stroke with 46,823 patients who did not have an event. The stroke patients were older, less educated, had lower income, and were more likely to have diabetes or cancer than controls.

'Your consolation brought me joy'

 When anxiety was great within me, your consolation brought me joy.

-Psalm 94:19

I try not to worry. A lot. When I am thinking right, I remember to bring my anxiety to God.

A few months ago, God allowed me to stumble across a quote from someone I'd never heard of before. Her name was Mary C. Crowley. I did some research and found that she was many things, but she was also someone who COULD have been weighed down with anxiety. Lost her parents at an early age. Went to work during the Great Depression to keep her children from starving. Battled cancer twice.

Here's her quote I found: “Every evening I turn my worries over to God. He's going to be up all night anyway.”

The words from Psalm 94 - echoed in this wise woman's words - remind us that in our worries or anxiety, God is there to console us.

Herbal stroke remedy no better than dummy pill

I've never tried herbal remedies, and here's another reason to be wary. Note the ingredients and cost in the Reuters Health article on how a herbal stroke remedy is no better than a dummy pill:

A Chinese herbal remedy marketed to improve stroke recovery failed to exceed the benefits of a placebo in a large, three-month clinical trial.

"There's no evidence of efficacy," said Dr. James Brorson, medical director of the University of Chicago Stroke Center, who was not involved in the study. ...

NeuroAiD is a blend of extracts from plants, leeches, beetles, scorpions and antelope horn. ...

It is currently not available through U.S.-based vendors, although consumers can buy it online. A three month regimen costs about $1,500.

Speech recovery can continue for years

I've been convinced that stroke recovery doesn't all happen in the short term - a year or less. In my own  experience with aphasia, it can take years to recover.

Now, I see a Wall Street Journal article about how new therapies help stroke survivors recover language years after injury:

Encouraging new evidence is emerging to suggest the brain’s plasticity, or its ability to change and heal, may last many years after injury—far longer than the commonly assumed plateau for speech recovery of about six months to a year after stroke. Insurers, for example, may only cover the cost of one-on-one speech therapy sessions for the first few months.

“The conventional wisdom has long been that after a year post-stroke, you aren’t going to get any better,” says Cynthia Thompson, director of the Center for the Neurobiology of Language Recovery at Northwestern University. “But the brain continues to change until you die."

Certainly, in my case, rapid change took place in the first few months after my stroke in 1998 - starting with complete lack of speech back to a career in journalism.

But later, even years later, I would catch incremental improvements. Now, I still have some lasting effects (in my opinion) in the speech department, but I refuse to rule out even additional improvements.

'Wait for the Lord; be strong and take heart'

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

-Psalm 27:14

My guess is most people don't like to wait. We're living in a cell phone-microwave-Internet world, and waiting doesn't sell.

Still, sometimes we are forced to wait. If you're in those circumstances, remember these words from Psalm 27. We're not always on a human schedule - but in God's schedule. So be strong and take heart.

Study shows Chicago policy may help stroke patients

You've seen postings before about using accredited stroke centers when possible. Now, a recent study shows a link to those centers and better treatment. You can follow this link and read about how a study shows citywide policy may help stroke patients recover:

A citywide policy enacted in 2011 — involving Chicago ambulance crews taking suspected stroke patients directly to accredited hospitals with accredited stroke centers — was associated with increased usage of a therapy that can reverse the effects of a stroke if received in time, according to a study published in the journal JAMA Neurology on Monday.

Before the change, rates of stroke patients getting what’s known as intravenous tPA [tissue plasminogen activator] was 3.8 percent of all patients. After, it improved to 10.1 percent.

 

Drug combo may reduce risk of second stroke

I was on aspirin and Plavix for several years to prevent a second stroke. I eventually had a mini-stroke (or a transient ischemic attack) anyway. Still, more info to discuss with your own doctor. Check out this article about how a study shows this drug combo may reduce risk of second stroke:

After suffering a stroke or a mini-stroke, patients are usually given aspirin to prevent clots that can cause another stroke. Now a new study suggests that adding the drug Plavix (clopidogrel) to the mix can reduce the risk of a second stroke by nearly a third over aspirin alone. ...

"Giving two drugs that block platelets works a lot better than aspirin alone in people who have had a minor stroke or TIA," said researcher Dr. S. Claiborne Johnston, a professor of neurology at the University of California, San Francisco.

The trial was done in China, so whether the results would be the same in the United States isn't known. "They probably are, but we would like to see them confirmed," Johnston said.

Nearly 1 in 4 stroke survivors develop PTSD, study shows

I must agree with the study author, quoted here: "Strokes are among the most terrifying life-threatening events."

Read about a study showing that nearly 1 in 4 stroke survivors develop PTSD:

A stroke may leave some survivors with post-traumatic stress disorder, which may hinder their recovery, according to a study released... .

About 23% of patients who survive a stroke or transient ischemic attack, a brief interruption of blood flow to the brain, have PTSD symptoms within a year, the study finds. About 11% have chronic PTSD, in which symptoms last three months or longer, more than a year later. The study, led by Columbia University Medical Center researchers, was published online ... in the journal PLOS ONE.

"Strokes are among the most terrifying life-threatening events," says lead author Donald Edmondson."

For stroke patients, every minute counts

A study recently showed the power of time - in 15 minute increments. For clot-type strokes, every quarter-hour delay getting to help can mean more likelihood of a poorer outcome.

While the clot-busting drug tissue plasminogen (tPA) has its limitations, getting to a hospital too late has its own ramifications.

Click on the link to read how every minute counts for stroke victims, study confirms:

Rapid treatment with a clot-dissolving drug reduces stroke patients' risk of in-hospital death and increases their chances of being able to walk and return home when they leave the hospital, according to the study, published in the June 19 issue of the Journal of the American Medical Association. ...

For every 15-minute faster start of tPA therapy, patients were less likely to die or have an intracranial hemorrhage, and were more likely to walk and be sent home when discharged from the hospital, according to the study.

Better heart health brings lower stroke risk

Left from last week, here's one more take about reducing stroke risks with this emphasis: "...small changes in lifestyle can have a huge impact in reducing stroke burden."

Read more about how better heart health brings lower stroke risk:

The risk of incident stroke was significantly lower for individuals who had average or optimum cardiovascular health compared with those who had poor cardiovascular health based on the organizations' Life's Simple 7 (LS7) score, which incorporates three health factors and four lifestyle factors, according to Ambar Kulshreshtha, MD, MPH, of Emory University in Atlanta, and colleagues.

"Our study supports this idea that making small changes in lifestyle can have a huge impact in reducing stroke burden," Kulshreshtha said in an interview, adding, however, that it remains to be tested which multidisciplinary interventions will work at the population level to reduce the burden of stroke.

The AHA/ASA released the framework that would become Life's Simple 7 in 2010. The score incorporates information on blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet to provide an assessment of cardiovascular health.

The big three stroke risk factors

Another way to look at stroke risk factors and prevention takes a look at the three biggest risk factors for a stroke:

As we've done in recent months by examining the risk factors and treatments associated with the most common types of cancer and diabetes, I propose to more closely examine the three biggest risk factors that can cause a stroke, discuss what treatment options exist, if any, to help mitigate that risk, and as always, discuss what investment potential these top treatments may have for your portfolio.

According to the CDC, there are three big factors that can lead to stroke:

Medical conditions.
Behavioral factors.
Hereditary factors.

And again - it's important to pay attention and take control where you can. The life you save might be your own.

Stroke prevention factors

So many people can reduce their stroke risk - preventing events that can cause disability or death. Check out this recent article on how your stroke risk can shrink with 7 lifestyle changes:

Certain lifestyle changes could greatly reduce your stroke risk, according to a new study.

Researchers calculated stroke risk among nearly 23,000 black and white Americans aged 45 and older. Their risk was assessed using the American Heart Association's Life's Simple 7 health factors: be active, control cholesterol, eat a healthy diet, manage blood pressure, maintain a healthy weight, control blood sugar and don't smoke. ...

"Compared to those with poor blood pressure status, those who were ideal had a 60 percent lower risk of future stroke," study senior author Dr. Mary Cushman, a professor of medicine at the University of Vermont in Burlington, said in a journal news release.

Note that many of the risk factors cited can be at least partially controlled. Not every stroke can be prevented. But many are preventable.

Stroke network leads to better outcomes

A story worth following - a stroke network leads to better outcomes:

Stroke care networks save lives and reduce the need for long-term care, a study of one of the largest and longest operating networks confirmed.

The networks are designed to integrate the delivery of stroke treatment across regions to optimize the chances that patients will receive timely, evidence-based therapies even if they don't live near a designated stroke center.

"After the stroke network was introduced there were clear improvements in the quality of stroke care," Kapral told MedPage Today. "More patients were treated with optimal stroke care interventions, such as thrombolysis, including clot-busting drugs, and stroke-unit care."

Here in the U.S., I've seen too many examples of uncoordinated care.

'For everything in heaven and earth is yours'

Yours, Lord, is the greatness and the power
    and the glory and the majesty and the splendor,
    for everything in heaven and earth is yours.
Yours, Lord, is the kingdom;
    you are exalted as head over all.

-1 Chronicles 29:11

This verse from Chronicles happens to be today's verse on the blog (June 4, 2013).

It speaks to me of God's greatness and power, but also that God shares this world with us, with its glory, majesty and splendor.

On some days, those things are harder to see - we've all been in situations where we don't see the glory, majesty and splendor. Know that God is there to help you through those times, with his power and love.

(Photo from NASA; text added by author)

Hospitalized stroke patients receive worse care

I've written before about the value of showing up in an ambulance for better care. And you'd hope that once you're in the hospital, you'd be in excellent care. Now, some recently released statistics indicate that stroke patients already in the hospital receive worse care:

Stroke patients receive better care if they have their stroke outside the hospital than in the hospital. These worrisome findings come from a study based on data from the American Heart Association's Get With the Guidelines program.

"Maybe the emergencies we are least prepared for are the emergencies that happen in our very own backyard," Ethan Cumbler, MD, said here at Hospital Medicine 2013. ...

Defect-free care, defined as the proportion of patients who received all of the achievement-measure interventions for which they were eligible, was significantly worse for in-hospital stroke than for community-onset stroke... .

"The gap in defect-free care was larger than I expected," Dr. Cumbler told Medscape Medical News.

This also might show the value of being an advocate for someone in the hospital.

Rising costs - yet another reason to prevent strokes

We already now that stroke is the largest cause of disability in the United States and fourth leading cause of death. Now, there's another reason to emphasize stroke prevention. MedPage Today reports that stroke costs to double by 2030, groups say:

Annual stroke-related medical costs are projected to jump from $71.6 billion in 2012 to $183.1 billion in 2030, according to a statement from the organizations in the August issue of Stroke.

Total annual costs, including the price of lost productivity, were estimated to rise 129% to $240.67 billion by 2030, Bruce Ovbiagele, MD, MSc, of the Medical University of South Carolina in Charleston, and colleagues reported in the statement. ...

"The biggest bang for buck would be primary prevention," he [Bruce Ovbiagele, MD, MSc, of the Medical University of South Carolina in Charleston] told MedPage Today in an interview. "We know it works but we know we have a lot of room for improvement. We could do more."

Click here for more about stroke prevention - money aside, it can save a life.

Spotting stroke signs quickly

May is Stroke Awareness Month, and I hope you will see this information multiple times - it's very important. But through my trusty Google alerts, I found a nice presentation of  signs of stroke:

"When someone has a stroke, they may show either slight or extremely noticeable physical changes," Dr. Randolph Marshall, chief of the stroke division at New York-Presbyterian Hospital/Columbia University Medical Center, said in a hospital news release. "The most effective way to prevent the permanent damage associated with stroke is to recognize the signs of an attack and to seek medical attention immediately."

Dizziness and trouble walking, loss of vision in one or both eyes and a severe headache that comes on suddenly for no apparent reason are other signs that someone is having a stroke. Early treatment, however, can prevent or possibly reverse the damage caused by strokes. The experts advised remembering the acronym "FAST" to help people recognize a stroke sooner and reduce any long-term damage:

• F for Face: Does someone's face look uneven?
• A for Arm: Do you notice one arm hanging down?
• S for Speech: Check for slurred speech or other signs of trouble speaking.
• T for Time: Call 911 and seek immediate medical attention.

Please click on the link above and read all of it. Stroke is the leading cause of disability in the United States, and the country's fourth largest cause of death. Taking quick action might make a huge difference.