Christmas: '...and for love of us came to us ...'

When we celebrate Christmas we are celebrating that amazing time when the Word that shouted all the galaxies into being, limited all power, and for love of us came to us in the powerless body of a human baby.

-Madeleine L'Engle

As the season of Christmas is still with us - until Epiphany on Jan. 6 - I wanted to add this quote from Madeleine L'Engle, best know as the author of "A Wrinkle in Time."

These are words to ponder. Celebrating the birth of, from outward appearances, a human baby - but knowing that this baby was the embodiment of the one who created you and loves you. What am amazing time that must have been.

So today, as people are so tempted to move past Christmas as if we can just put it away, keep Ms. L'Engle's quote in mind. Before that first Christmas, God first "shouted all the galaxies in being" and made humanity.

Yes, we celebrate that birth during this time of year. But that love is more than a day, a season. God's love for you was your gift on Dec. 25, today, tomorrow and as the New Year dawns. Every and all days, God's love is present and accessible for you.

'Lazarus effect' - then and now

[This was originally posted Dec. 24, 2009; revised in 2014]

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

A few years 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."

Another study shows possible stroke treatment outcomes

As the year gets close to an end, we've lately seen two pieces of news that might - might - lead to better outcomes for stroke patients in hospitals.

A few days ago, there was research showing that a clot removal technique might be the next step in certain stroke treatment. Click here to read about it.

One of the concerns about tissue plasminogen activator clotbuster - tPA - is a risk of bleeding. Now, though, research indicates the possibility that another drug might counters tPA risks:

Positive news for new stroke treatment - clot removal

There's promising news that there's more than one way to battle a clot-related stroke. Maybe, in some circumstances, better than current medical treatment.

Read here about a study showing how clot removal proves mettle in large-vessel strokes:

Headlines can hit or miss the story

Photo from the
National Institute on Aging

I'm a journalist by trade, and I've seen some great - and not so great - stories about strokes, research and treatment.

For instance, over the last few days, I've seen stories about a recent study about memory loss and stroke risk. The study included a portion saying that people who complain about memory loss have a higher risk of stroke. But then it gets muddy.

The researchers included three groups, by level of medication - low, medium and high. And the high group members seemed to have had a higher stroke risk. Or did they?

Post-TIA brain scans might yield vital information

Nobody likes to hear bad news - but sometimes, bad news might save a life.

Many people have transient ischemic attacks, or mini-strokes, before a larger stroke occurs. Now, imaging after a mini-stroke can help map a plan of treatment and, potentially, preventing a more serious stroke.

You can read here about how brain scans yield clues to future stroke risk:

Brain scans taken shortly after a mild stroke can help identify patients at risk of suffering another stroke within three months, a new study suggests.

Ignorance about stroke can kill or disable

If you're here, chances are you've had a stroke or know someone who had a stroke. That means you're likely more educated than most people about stroke risks, signs and the potential outcomes, both good and bad.

I ran across a couple of articles about the lack of knowledge in the United States - where this blog is based - and halfway across the globe. One article reports that more than half of Americans don’t know if they are at risk for:

Despite the prevalence and potential severity of stroke, many Americans still don’t know the risk factors or signs of a stroke. About one third of Americans are unable to recall the warning signs of a stroke, according to the American Heart Association (AHA). Nearly 60 percent of Americans don’t know if they are at risk for the disease, the American Stroke Association (ASA) said.

Post 700: '...there is no failure'

Inside the will of God there is no failure. Outside the will of God there is no success.

-Bernard Edinger

I ran across this quote not long ago. Now, I don't pretend to know all there is to know about God's will. Yet, this quote strikes me as true.

Today's posting is No. 700 on this blog. And I would hazard a guess that at least a time or two, I've had some success. Those times with positive responses, both public and private. The posts that were personally therapeutic.

My personal prayer with Post 700 is to move upward to success - not necessarily as people see it, but as God sees it.

Better speed to stroke treatment

More evidence that mobile stroke treatment can result in better outcomes. Just read about a recent study indicating that a mobile unit speeds access to tPA:

Nearly one-third of (32.6%) ischemic stroke patients who were transported in the special ambulance received thrombolysis, compared with 22% of patients who received conventional care ..., reported researcher Martin Ebinger, MD, of the Charite-Universitatsmedizin in Berlin, and colleagues.

Hospital transport ... increased the number of tissue plasminogen activator (tPA) treatments within the critical window of 1 hour (the "golden hour") from symptom onset almost 10-fold, they wrote online in JAMA Neurology.

Golden-hour thrombolysis was associated with better short-term outcomes in the study population, they added.

Read the whole article for details for a way to improve the application of this treatment and improved versions in the future.

'... Only God is here.'

Here then I am, far from the busy ways of men. I sit down alone; only God is here.

-John Wesley (1703-1791)

Happy Thanksgiving, everyone.

Today, I'm thankful of my times alone with God. Much of mine don't involving sitting, but rather running. In most places, there are lots of opportunities to run in groups. As a longtime runner, though, I like to run alone.

But not really alone. That's the time when I am away from the "busy ways of men" and find myself with God. When I pray, when I praise, when I worship. There are other times I do all these things, but today, I give thanks for those times when I'm alone with God.

 Have you found your times when you can sit down alone with only God? If so, when is that time? And if not - try it!

Right combo of aspirin and blood thinners found safe

I stopped taking blood-thinners seven years ago, after a heart procedure removed my extra-high stroke risk.

However, I always took them when ordered, despite the trouble of tests, diet-watching and bruising/bleeding risk.

Turns out, that's what you're supposed to do. Experts reported earlier this month that long-term use of aspirin plus blood thinner is safe:

The blood-thinning combination won't increase a patient's risk of early death, according to a new study presented Sunday at the annual meeting of the American Heart Association in Chicago. The report was also published online Nov. 16 in The Lancet.

Today - actually any day - is a good time to quit smoking

Today is the Great American Smokeout - a day to quit smoking.

Actually, any date is a good day to quit smoking. It's a leading cause of strokes. Here's some basic information from the U.S. Centers for Disease Control and Prevention about smoking and stroke:

How are smoking and exposure to secondhand smoke related to heart disease and stroke?

Smoking is a leading cause of heart disease. Smoking can:

• Raise triglycerides (a type of fat in your blood)
• Lower "good" cholesterol (HDL)
• Damage cells that line the blood vessels
• Cause thickening and narrowing of blood vessels
• Cause clots to form, blocking blood flow to the heart

So, listen to this former smoker in the video below:

Note to self: If you're going to have a stroke, schedule it

This week, I took a friend to a hospital's emergency room after normal business hours. This isn't the only visit that confirmed my belief that health care suffers after hours.

Now, from Denmark, a new study looks at that weekend effect:

Overall, death within 30 days was 15% more common among patients presenting to Danish hospitals on weekend, evening, or night-time hours compared with those admitted during regular business hours, Nina Sahlertz Kristiansen, MHSc, of the Centre for Quality in Middelfart, Denmark, and colleagues found.

Off-hours admissions were associated with a lower likelihood of meeting even eight out of 10 performance measures, but that difference diminished over time, particularly from 2003 to 2011 after a national quality improvement program, the group reported online in Stroke.

The key factor in the mortality difference appeared to be stroke severity, they noted.

If only strokes followed a calendar and time clock - only Monday through Friday, 9 to 5.

Watch out for that easy road

The safest road to hell is a gradual one. This is safe road has a gentle slope, without turns, without milestones, without signposts, without warnings.

-C.S. Lewis

First and foremost: I am not a theologian.

Neither, by the way, was C.S. Lewis.

However, that aside, and no matter what you or yours think about hell, his quote carries a lot of meaning in life in general. How much in life leads to bad results by a supposed easy path?

We roll along, perhaps not paying close attention to certain diet, exercise, smoking or other choices we make. Things seem to be going over life's paths that appear to be safe, without warnings.

You know what can happen. A stroke can come at young, old or in between, without warning.

A different road - more thinking through diet selections, deciding how to exercise, making conscious choices about smoking - seems harder. Not necessarily perfect, but at least considered. And with better possible outcomes. Not guaranteed, but more likely.

Again, I'm not here to debate the existence or characteristics of hell. But just be careful what road your life is taking. It might make a difference here on earth.

'My strength and my defense'

    I will trust and not be afraid.
The Lord, the Lord himself, is my strength and my defense;
    he has become my salvation.

-Isaiah 12:2

Truth be told, I was afraid on May 8, 1998.

But even on that day, God was my strength and my defense. And because of that, I trust God more. Will I ever be afraid again? That's an unanswerable question. I would like to say no - and as I continue building up my faith, I hope to one day give that answer honestly: No.

Everyone has - or will have - a day with threat, a day that could be filled with fear. Here's to all our faith journeys continuing to reach higher and higher levels of trust in God so that fear - like death - can be conquered.

Reducing time can improve outcomes

You've heard here and elsewhere that time is so critical in stroke treatment. Even though stroke treatment is far from ideal, speed can often improve the outcome.

I ran across an interesting article that laid out ideas that experts propose to reduce time in treating strokes:

Because the absence of blood flow to the brain results in the ongoing death of brain cells and continued loss of functionality, “every minute of delay in administering t-PA is worth 1.8 days of disability-free life,” he said. “Years ago, we were treating 4 percent of patients nationwide with t-PA, which has grown to 8 percent and even 10 percent in New Jersey thanks to greater awareness by both hospitals and patients. But with a theoretical goal of administering it to 30-40 percent of all stroke patients someday,” he said, “we’ve got a long way to go.”

To help close that gap, Gizzi advocates further streamlining the process by which stroke victims are treated during transport to the hospital through a series of new practices, many of which require a physician’s greater trust in, reliance on, and collaboration with the emergency medical services personnel and paramedics who are first on the scene.

Most of us have seen delays in treatment of all kinds of ailments in hospitals and other locations. For stroke patients, delays can mean death or disability. The need for speed must be taken seriously.

What's important: Stories of survival

Today is World Stroke Day. Now, that doesn't mean a lot to me. Strokes don't keep a calendar, This blog is not part of a non-profit trying to raise profile or raise funding (both of which are needed and important, by the way).

But I did run across a Tampa Bay Times piece about the most important part of stroke awareness - people. Check out the link to read three stories of survival:

"I was having a perfect day and felt completely fine the second before my left side went out," she said.

Bedinghaus is like many Americans who have suffered a stroke and didn't see it coming.

Wednesday is World Stroke Day, and the American Heart Association and American Stroke Association of Tampa Bay use the day as an opportunity to encourage everyone to learn the warning signs of a stroke by using the acronym FAST:

Face drooping; Arm weakness; Slurred speech; and Time to call 911.

'... He heard my voice ...'

In my distress I called to the Lord;

    I cried to my God for help.

From his temple he heard my voice;

    my cry came before him, into his ears.

-Psalm 18:6

Could you talk during and after your stroke? I couldn't that day. To this day, I feel that my thoughts are sometimes bottled up while I try to get them out. Writing is much easier for talking. The delete key is my friend.

It especially comes through during times of stress, when I'm tired, when I'm not familiar with the topic, or when I'm given little time to think about what I'm supposed to say.

The words in this passage gives me some comfort. God hears your voice. In times of stress. When you're tired. Any circumstances. And if your voice has been silenced or stifled by a stroke, God still hears you perfectly, even if you are in a silent struggle.

Distress? Call for God. He stands ready to hear your voice - even if impaired of silent. Your cry comes before him loud and clear.

Preventing a stroke might prevent a death

We all need to encourage better treatment for better outcomes for stroke patients.

BUT, just as important are ways to prevent strokes. For every stroke we prevent, we prevent a possible death or disability. A recent study combined some key methods to reduce stroke risk and, not surprisingly, that healthy lifestyle choices may cut women's stroke risk:

After being followed an average of 10 years, women who ate a healthy diet, drank alcohol moderately, never smoked, remained physically active and had a healthy body weight were 54 percent less likely to have a stroke than women with none of these factors, said study author Susanna Larsson, a researcher at the Karolinska Institute in Stockholm, Sweden.

While other studies have looked at single risk factors, "only a few studies have examined the combined effects of a healthy lifestyle on stroke risk," Larsson said.

"We observed that the risk of stroke decreased steadily with an increasing number of healthy lifestyle habits," she said.

While the study found an association between healthy habits and stroke risk, a causal link was not proven.

Take this seriously - the life you save may be your own.

'To learn to be alone with God ...'

I have found silence to be a powerful element in prayer. To learn to be alone with God even in the presence of others is something we Christians should try to do. There are innumerable times during the day when we can turn our thoughts, even for a moment, from business affairs and center them on God’s goodness, Christ’s love, our fellow man’s needs.

-J. C. Penney

Not long ago, I received this quote from a ministry called The Ranch. an interesting take on a relationship with God from, of all people, the founder of the J.C. Penney Co.

Now, he's long gone, and the chain of stores has certainly has its ups and downs. But still, the quote speaks to me. We live in a hurry-up world that is full of noise, images, bright lights and so many other distractions. It's so easy to forget to find time to be alone with God.

But it's so important. One reason that I enjoy running and cycling is that it gets me away from so many distractions and gives me time to be alone with God.

Not into such things? Find your own time and place, as Penney said, in the middle of our bustling world.

Now, enjoy the Penney's reference in the video below - part of the second-funniest movie ever made - then make plans to have time alone with God!

Do stroke patients already in hospital get less treatment?

You'd think that if you're already a hospital patient, you'd get quicker care for an in-hospital stroke vs. having a stroke elsewhere.

Not necessarily, sadly. After years of visiting and sitting with hospital patients, I can see why. You see delays in almost everything. And in a recent Canadian study, it was found that in-hospital stroke patients wait longer for care:

The study results showed that in-hospital patients waited an average of 4.5 hours from the time symptoms were recognized to undergo computed tomography compared with 1.3 hours for patients brought to the ED.

"To me that's a shocking difference," said Dr Saltman.

About 29% of in-hospital stroke patients met the "benchmark" best practice of getting thrombolysis within 90 minutes of symptom onset compared with 72% of patients coming from the community, said Dr Saltman.

In addition, the in-hospital group was less likely to receive thrombolysis (12%) than the group admitted after having a stroke outside the hospital (19%), even if they were eligible for this intervention, she added.

In-hospital patients stayed longer in the hospital (17 days vs 8 days), were more likely to be discharged to a rehabilitation facility (40% vs 32%), and were less likely to be sent home (35% vs 44%).

This speaks volumes for the need for advocates for stroke patients, especially if they are having speech or physical difficulties while in the hospital.

Is it true in the United States? Add your own experiences below.

Health risks can linger long after a stroke

After a stroke, after leaving the hospital, after a few months, memories fade and, human nature being human nature, people tend to relax their guards.

However, a few months might not long enough to assure health risks are adequately addressed after a stroke. A recent study indicates health risks after a stroke may linger for at least five years:

In the study, Swartz's team analyzed data from about 24,000 patients in Canada who suffered a stroke or mini-stroke, clinically known as a "transient ischemic attack" (TIA).

All of the patients had already survived the "high-danger" period, which is typically thought to be the 90 days after hospital discharge.

However, within the first year after this high-risk period, 9.3 percent of the patients died, had a repeat stroke, mini-stroke, heart attack or were admitted to long-term care. Death was the most common of these events, affecting more than 5 percent of patients in the first year.

Among patients who were still alive after a year, the rate of these events remained at 5 percent in each of the following four years, according to the study to be presented Tuesday at the Canadian Stroke Congress in Vancouver.

"We now need to identify ways to determine which people, among those who have made it through the riskiest period, remain most at risk for serious events so we can develop appropriate preventive interventions," Swartz said.

The last quote is the important point - preventing those bad outcomes that come even years after a stroke. Even while the search Swartz describes is going on, it highlights the need for you to keep a watch on your own health.

Weird Al: 'I go to church'

This summer, Weird Al Yankovic came out with a new album. I've always enjoyed his work - funny, clever, entertaining.

Now, I have very little knowledge of Weird Al's set of personal beliefs but got a small and positive glimpse about his typical Sunday a few days ago in Parade magazine:

Generally, I get up and pour myself a bowl of cereal with some soy milk on it. I quickly check the Internet. I go to church, and then I might pick up a burrito or food for the whole family. Maybe we’ll go to the park, watch a movie on TV, or camp out in the backyard.

"... I go to church, ..."

That small, unpreachy statement says something. It says that it's OK to tell people you go to church. It might lead to great things for someone who hears you.

Now, is Weird Al perfect in everything because he goes to church? Of course not. No one is. But perfection is not required. God loves you just the way you are.

Now, from Al's latest album ...

Dr. Groucho got it right

Groucho Marx might have said it best: "I intend to live forever, or die trying."

I can connect with Groucho after a hole in my heart was closed back in 2007. Click on this link for info about my patent foramen ovale (PFO) closure and why.

The short story version is that the hole between the upper two chambers in my heart apparently allowed a blood clot to circumvent the clot-filtering mechanism in the lung, leading to a stroke in 1998 and a mini-stroke in 2007.

Since then, I've seen lots of studies indicating that this procedure might or might not be the best way to treat stroke survivors, looking at procedure vs. blood-thinning medication. My concern about warfarin (also known as Coumadin) was that as a fairly active person, taking pills that make you bleed easier might not be a good idea. Plus, pills and the related monthly blood tests cost money. I ditched the pills six months after the procedure.

That's more of a long-term concern instead of the relatively short-term outcomes in most studies. However, a recent study suggests that PFO closure may be cost-effective over long term:

PFO closure reached the incremental cost-effectiveness threshold of  < $50,000 per quality-adjusted life-year (QALY) gained in 2.6 years. Moreover, the treatment met the threshold of < $50,000 per life-year gained in 4.9 years. The per-patient mean cost of medical therapy surpassed that of PFO closure after 30.2 years of follow-up.

Now, I was in my 40s when my PFO closure occurred, so I plan to live 30.2 years (and more, I hope!) afterward.

Cholesterol-lowering drugs and stroke recovery

One of those interesting-but-we're-not-sure-how-this-works studies comes from recent research about cholesterol drugs and stroke recovery.

Read how these drugs may help after certain strokes:

People taking the commonly used drugs known as statins were also 2.5 times more likely to be discharged home or to a rehabilitation facility, the study reports.

When it comes to the best treatment for hemorrhagic stroke, there hasn't been a standard treatment recommendation, according to the study's lead author, Dr. Alexander Flint, the medical director of neuroscience quality at Kaiser Permanente in Redwood City, Calif. Now, he said, physicians should know that taking patients off statin treatment in the hospital "may carry a risk of substantially worse outcome."

The findings from this study aren't considered definitive because it wasn't designed to prove that the statin treatment directly caused the lower risk of death.

'I will never be shaken'

Truly my soul finds rest in God;
    my salvation comes from him.
Truly he is my rock and my salvation;
    he is my fortress, I will never be shaken.

-Psalm 62:1-2

The older I get, the more I enjoy the book of Psalms.

The verses above hits home: Haven't you needed rest? Support? Have you ever felt events started to shake - figuratively or literally - around you?

We've all experienced these things. You or someone you love might have had a stroke. Perhaps still struggling through recovery, with physical disability, speech difficulty, or both.

God's got your back. While the world seems to shake around you, God provides the support you need to stand firm - figuratively or literally. These verses don't say that troubles will stay away. But you know God will be your rock and fortress.

Stroke signs and stroke centers

Knowing stroke signs is important - but what to do next is also vital.

A recent article in the Philadelphia Inquirer offered a resource on finding stroke care. A primary stroke center must meet a certification standard that elevates patient care:

A primary stroke center is an acute-care hospital that meets certain criteria for delivering stroke care and adheres to practice guidelines designed to improve outcomes for patients with warning signs or symptoms of stroke.

If you or a loved one may be having a stroke, call 911 immediately and ask for transport to the nearest primary stroke center.

Click here for a map of stroke centers across the United States - sadly, only updated as of 2010. It's not the most user-friendly map. To see a map of stroke centers, click on the button labeled Map Options, choose the tab called Layers and choose the latest-available year of primary stroke centers.

You'll get a map similar to the image, and you can zoom in for more detail. As you can see, west of the Mississippi, they become sparse.

Earlier hospital release: Good news, bad news

I can't decide whether this story is good news or bad news - Ireland could free up 24,000 hospital beds by letting stroke patients out early:

The report found that 54% of stroke survivors, or more than 3,000 people each year, could benefit from a policy of ‘early supported discharge’.

This approach to rehabilitation allows patients to return to their own homes more quickly and intensive treatment is given in the home for a number of weeks. According to today’s report, this approach would require a substantial increase in the resourcing of community therapists (physiotherapists, occupational therapists, and speech and language therapists), community nurses and other community care above current levels in Ireland.

However, savings from the reduced cost of acute bed days could fund this increase in resourcing.

On one hand, hospitals are not healthy places. Lots of sick people and germs are present. You might or might not sleep well in a hospital. Family members are strained.

Yet, hospital is the place to be if you need it. Health professionals, equipment, treatment options are in the same place.

So I could see if this plan is executed well for people who would benefit more out of the hospital, AND services become available in the patient's own home: Good idea.

If executed not-so-well, releasing people who still need the services of the hospital just to save money in short terms (but would increase cost in long terms): Not a good idea.

I could see this sort of effort happen in the United States, too, with the ongoing debate about health care costs. So worthy of watching.

Too much salt can threaten the young

Salt can lead to high blood pressure. Which is the leading stroke cause.

So, it's disturbing that that children consume too much salt:

About two-thirds of that sodium came from prepared or ready to eat “store foods,” 13 percent from fast food, 9 percent from school cafeterias and 5 percent from other restaurants, according to the report. More than 40 percent came from 10 food categories, headed by pizza and bread and including cheeseburgers, chicken nuggets, tacos and soup.

“Some of these foods may not taste salty, but they are top contributors because they do have significant sodium content and children eat a lot of them,” said Dr. Ileana Arias, the deputy principal director of the CDC. “A poor diet in childhood can help lay the foundation for future health problems. And the fact that young kids and teens are consuming so much sodium these days and adopting increasingly bad dietary habits is certainly a cause for concern.”

This is particularly disturbing in light of the fact that one in six children already has elevated blood pressure, a risk for high blood pressure as adults and increasing the risk of heart disease and stroke, she said.

We owe children better chances in avoiding strokes and heart disease.

Listen and learn, young people ...

A cautionary tale ... .

Young people - that is, people under 45 - can have strokes, too. In fact, it happens too often. Mine happened at age 39.

Ran across a recent story quoting an expert saying that patients under 45 years of age often miss stroke symptoms:

Neil Schwartz, M.D., Ph.D., says strokes are not uncommon in younger patients.

"We do see 10 or more percent of strokes occurring in younger patients under the age of 45," says Schwartz.

In fact, a new nationwide study found that while the incidences of stroke has dropped by nearly half over the last two decades, most of that improvement was in patients over 65 years old. Researchers believe some younger patients may not have seen the improvement because of an increase in risk factors like obesity and diabetes.

So even if you're young and active, know the stroke signs and don't be afraid to act!

Potassium linked to reduced stroke risk

Like the old song says, "I Like Bananas Because They Have No Bones."

Now, another reason. Recent research shows that potassium is tied to lower stroke risk:

An analysis of data from the Women's Health Initiative (WHI) found an inverse relationship between self-reported dietary potassium intake and stroke in postmenopausal women.

Women (mean age 63.6) who consumed the most potassium each day ... had a 12% lower overall risk of all stroke ... and a 16% lower risk of ischemic stroke ... when compared with women consuming very little potassium ..., reported Sylvia Wassertheil-Smoller, PhD, of Albert Einstein College of Medicine in New York City, and colleagues.

In addition, among women without hypertension, those in the highest quartile of reported potassium consumption had a 27% lower risk of ischemic stroke than those in the lowest quartile, they wrote in the journal Stroke.

All kidding aside, there are other potassium sources other than bananas. So enjoy your favorite!

They know what they want to say ...

My words: towrith, rithe, rice.

And I was trying to say "Jonesboro."

That's what happened as a result of my stroke in 1998. My wife had asked me to say the word Jonesboro, a northeast Arkansas city I'd recently visited, and that's how it came out: towrith, rithe, rice. I knew what I wanted to say, but just couldn't say it. Intelligent wasn't affected - just the connection between thought and actual speech.

Thus began my education about aphasia and stroke results. And many, many stroke patients have language difficulties.

So, I watch out for news about aphasia and ran across a recent article about recovering language after a stroke:

“People refer to it as kind of being in a prison because they have the words. They retain their knowledge and intellect,” says Ellayne Ganzfried, executive director of the National Aphasia Association in New York. “They know what it is they want to say, but they can’t access it the way they used to.”

Ganzfried estimates that between 25 and 40 percent of stroke victims suffer from aphasia, a condition that can also result from brain tumors or other neurological disorders. With stroke victims, various levels of communication can be affected, depending on what part of the brain was most damaged and how significant the stroke was, adds Michelle Troche, director of clinical science research at the University of Florida Health Upper Airway Dysfunction Lab.

“Aphasia is when someone has trouble coming up with words, grammar, comprehension … There can also be the speech problem,” Ganzfried adds. “It’s not as crisp because of weakness in the muscles.”

A good article that might help others understand the problem - when the thought process is still intact but the speech process is interrupted.

Fascinating research about learning brains

We know so little about the human brain. And for a lot of reasons - including improving stroke recovery results - this knowledge is so important.

Interesting item about research - admittedly, just monkeys - in which scientists are plugging into a learning brain:

“We looked into the brain and may have seen why it’s so hard to think outside the box,” said Aaron Batista, Ph.D., an assistant professor at the University of Pittsburgh and a senior author of the study published in Nature, with Byron Yu, Ph.D., assistant professor at Carnegie Mellon University, Pittsburgh.

The human brain contains nearly 86 billion neurons, which communicate through intricate networks of connections. Understanding how they work together during learning can be challenging. Dr. Batista and his colleagues combined two innovative technologies, brain-computer interfaces and machine learning, to study patterns of activity among neurons in monkey brains as the animals learned to use their thoughts to move a computer cursor.

“This is a fundamental advance in understanding the neurobiological patterns that underlie the learning process,” said Theresa Cruz, Ph.D., a program official at the National Center for Medical Rehabilitations Research at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “The findings may eventually lead to new treatments for stroke as well as other neurological disorders.”

As we all know, monkeys aren't people. However, this kind of research might well lead to advances. Worthy of watching.

It's global: Telemedicine can make a difference

Telemedicine is important in rural America. I've been through lots of small towns with few or no specialists who can make the difference between proper treatment and permanent disability or death.

Now, a study in Germany shows the impact telemedicine in that country:

During the same interval, the proportion of patients receiving thrombolytic therapy rose from 2.6% to 15.5%.

"The main findings of 10-year experience of TEMPiS showed that this type of telemedical stroke unit network is sustaining, offers state-of-the-art acute stroke care by increasing access to stroke units and improving thrombolysis service, and is associated with long-term improvement in terms of quality indicators of acute hospital care," Muller-Barna and colleagues wrote.

Telemedicine -- the use of modern teleconferencing technology to evaluate patients remotely and to recommend treatment strategies -- has increasingly been adopted in developed countries as a way to bring specialist care to rural areas where it is otherwise scarce or unavailable.

In the stroke setting, it involves putting stroke neurologists located mainly in urban tertiary care centers on call to evaluate patients brought into community hospitals in distant towns.

Time, as mentioned in this blog before, is key in stroke response. Using the combination of technology and medicine can decrease that time and improve outcomes.

Less education and smoking: Deadly combination?

There's  been lots of studies and stories about disparities among more vulnerable populations. People with less education are no exception, especially those who smoke. One recent study found that less educated smokers are at greatest risk for stroke:

"The combined effect of low educational level and smoking on the risk of stroke is the most surprising finding of our paper," said study author Helene Nordahl, an epidemiologist in the department of public health at the University of Copenhagen.

She added that reducing smoking among those with the least education could potentially reduce strokes more than targeting smoking in those with the most schooling.

Although the study included Danish participants, Nordahl believes her findings are applicable to other countries.

"Since the most disadvantaged groups are often exposed to a wide number of stroke risk factors, it seems plausible that these people are at increased risk of stroke, not only in Denmark but also in the U.S.," Nordahl said.

The second paragraph of this excerpt hits home - for public health education, it's important connect with the right people to reduce stroke risk.

And EVERYONE is important...

Time for younger set to start taking care

Once again, we're seeing more concerns about young people and stroke risk. for older people, the rate of stroke is declining. For people younger, there seems to be trouble. Read this article how stroke incidence is down and survival up -- for some:

These stroke incidence data appear to reflect both positive and negative trends in stroke prevention and treatment over the last few decades, Koton said.

Photo from U.S. Centers for
Disease Control and Prevention

On the plus side, increased use of statins and hypertension medications and a dramatic decline in smoking may largely explain the lower stroke rate among people over the age of 65, while the rise in obesity and diabetes in younger adults could explain the lack of progress in reducing stroke incidence in younger adults, Koton told MedPage Today.

"More younger adults are obese, and when obesity increases so does hypertension and diabetes," she said. "Hypertension is the main risk factor for stroke. I think this is a warning sign for us to take these risk factors as seriously in younger people as we do in older people."

Yes - time for ALL ages to take stroke risk factors SERIOUSLY.

Mental decline concern? Time to take action

A scary thought: Mental decline often precedes a stroke, study finds:

"Low cognitive function is generally associated with poor neurological health and brain function. Worsening of neurological health can lead to several health problems with stroke being one of them," he explained.

Photo from the National
Institute on Aging

Previous research has shown that poor cardiovascular health can increase the risk of mental decline, but the researchers say this is the first study to show that mental decline can increase the risk of stroke.

The findings suggest that assessing seniors' memory and thinking skills could help identify those at risk for stroke, though the study only found an association between memory and stroke risk, without proving cause-and-effect.

I don't like to post scary stories that show no hope. And in the last paragraph in the above quite, there's some hope. It shows a need for "help identify those at risk for stroke." Identify those at risk, and you've got a chance to take some preventive action.

So, scary thought, but a chance to take action.

'Turns my darkness into light'

You, Lord, are my lamp; the Lord turns my darkness into light.

-2 Samuel 22:29

As summer starts its final weeks, days are getting shorter. In several more weeks, that'll be even more pronounced.

The Old Testament's David had his dark days, too. He was hunted by Saul. Had his own failings.

But this verse is part of David's praise to God, acknowledging God's strength and perfection. You can read the entire chapter here.

When dark days come, God is present to turn your darkness into light.

Young stroke outcomes: A key reason for stroke prevention

This is one reason why stroke prevention is so important: Strokes subtract years from lives. Tragically, that's especially critical among the younger stroke survivors (mine was at 39).

Read about recent research showing that mortality is high after an early stroke:

The mortality rate of people who survived at least a month after having a stroke at age 15 to 49 was 15.7% over a mean 10 years of follow-up and 23.0% cumulatively with up to 17 years of follow-up, Karoliina Aarnio, MD, of the Helsinki University Central Hospital, and colleagues found.

That rate was seven-fold higher than that of the age- and sex-matched general population, they reported in the September issue of Stroke. ...

"The high mortality rates and the striking impact of recurrent stroke on the risk of death should lead to development of more robust primary and secondary prevention strategies for young patients with stroke," they argued.

Reduce disability risks - get help immediately for stroke patients

Among adults in the United States, stroke is the leading cause of permanent disability. And too many times, those disabilities came about because of delay in treatment.

Even more research makes it even clearer - know the stroke signs and get help. Immediately. Share this information with family, friends, loved ones, colleagues, acquaintances - anyone and everyone.

British researchers found (again!) that speedy delivery of a clot-busting drug helps stroke patients avoid disability:

Prompt treatment with tissue plasminogen activator (tPA, also known as alteplase) "is a very effective means of limiting the degree of disability in stroke patients," study co-author Dr. Jonathan Emberson, of University of Oxford in the U.K., said in a news release from the journal The Lancet.

The study, published in the journal on Aug. 5, also reinforces the idea that the quicker that patients can get tPA, the better.

One U.S. expert agreed. "The analysis reiterates the importance of patients going to the ER immediately at the time of developing acute neurological symptoms that could be due to a stroke," said Dr. Rafael Alexander Ortiz, director of interventional neuroradiology and stroke at Lenox Hill Hospital in New York City.

Simple pulse check: Potential tool for stroke survivor care

I've seen a lot of needles, scalpels, and other tools that are at least somewhat invasive. Most of them did a lot more good than harm, and if I had to do it all over, I'd probably say yes again in the great majority of the time.

Indeed, today, I had a knee injection (virtually painless) that made good sense in my medical care.

Still, "noninvasive" is a term I like, so I was interested in hearing that a simple routine pulse check may detect the possibility of a second stroke, study says:

"Screening pulse is the method of choice for checking for irregular heartbeat for people over age 65 who have never had a stroke. Our study shows it may be a safe, effective, noninvasive and easy way to identify people who might need more thorough monitoring to prevent a second stroke," said study author Dr. Bernd Kallmunzer, of Erlangen University in Germany.

The study included more than 250 people who survived an ischemic stroke (blocked blood flow to the brain). Either the patients or their relatives were taught how to monitor the pulse to detect an irregular heartbeat.

Pulse checks taken by patients and relatives were nearly as accurate as those taken by health care workers, according to the study published online July 23 in the journal Neurology.

'Who gives me strength'

I am not saying this because I am in need, for I have learned to be content whatever the circumstances. I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do all this through him who gives me strength.

-Philippians 4:11-13

Ever felt weak? I certainly have.

Does anyone like that? Certainly not.

Paul had his own hardships - beaten up, locked up, etc. In his letter to the Philippians, he tells of his remarkable ability to handle all those situations.

Now, note that Paul didn't just stop when he found a way to be content with his circumstances. No, he kept going in his mission that still resonates today. But he did find that God's strength is the world's greatest coping tool for those in stress.

Stressed out? Weak? Use the same coping tool that brought Paul through his worst days.

Could dementia drug help stroke patients?

We see ads for the drug Namenda (or memantine) for treating Alzheimer's. Now, would it be possible for the same dementia drug work for stroke recovery?:

"We know that it's tolerated fairly well in patients with Alzheimer's, so if it can be shown to be useful in promoting stroke recovery that could be a significant event," Seemant Chaturvedi, MD, a neurologist at Wayne State University in Detroit, told MedPage Today.

"The findings are very interesting because for several decades we've been trying to identify whether any medication can help with stroke recovery, and thus far there hasn't been any definitely proven medication to help," added Chaturvedi, who was not involved in the study.

Read the whole story following the link above. To the non-health professional mind, this makes some sense - potentially, a "significant event" for stroke survivors.

Stress, depression may boost stroke risk

Don't ignore stress and depression - it's already serious, and it could become even more serious. Check out this recent study how stress and depression may boost stroke risk:

The study found that depression seemed to raise the risk of a stroke or a transient ischemic attack (TIA) by 86 percent. It also found that stress apparently raised stroke or TIA risk by 59 percent. And hostility doubled the risk, the researchers said. A TIA is a mini-stroke caused by a temporary blockage of blood flow to the brain.

However, it's important to note that the study only found an association between the risk of stroke and negative emotions. It wasn't designed to prove that negative emotions can cause strokes.

Still, "chronic stress and negative emotions are important psychological factors that affect one's health, and findings from this study link these factors to brain health in particular," said the study's lead author, Susan Everson-Rose, an associate professor of medicine at the University of Minnesota.

"Patients and their health care providers should be aware that experiences of chronic stress and negative emotional states can increase risk for stroke," she noted.

Good news but still work in progress

Better results - but miles to go.

Recent released numbers show some good news about the rate of strokes overall and avoiding deaths as a result of a stroke. Still, strokes are the greatest cause of adult disability in the United States, and we still have a problem in this country with smoking, high blood pressure and diabetes.

Still, a new report shows that in the U.S., strokes and stroke deaths have decreased over past decades:

The chance of dying after having a stroke also fell during the study. Over a 10-year period, the number of deaths per 100 strokes dropped by eight. That decrease was particularly prevalent among the youngest study participants and was similar for both sexes and races.

Coresh said the decline in strokes and improvement in survival may be attributable to better control of risk factors - particularly high blood pressure, also known as hypertension - as well as increased smoking cessation and diabetes control.

“I think we’ve been working on hypertension awareness, treatment and control for 40 years now,” he said. “Largely it’s a story of success but as (with) many things in health it’s never done. We need to keep doing better and better.”

Photo from the National Institute of Neurological Disorders and Stroke

Routine screening - careful decision-making

Medical screenings often seem benign things to do. But there's a line between smart preventive decisions and bad decisions.

Interesting article about how experts have rejected routine screening for narrowed neck arteries:

Image from the
National Heart, Lung and Blood Institute

"Screening for carotid artery stenosis often leads to follow-up testing and surgeries that can cause serious harms, including stroke, heart attack, or death," task force member Dr. Jessica Herzstein said in a news release from the group. She explained that this type of blocked artery "is uncommon in the general adult population, so screening everyone would lead to many false-positive results."

A false-positive result is when a test shows that a person has a condition that he or she actually does not have.

The new recommendation does not apply to adults with a history of stroke, mini-stroke, or signs and symptoms of stroke. These people should consult with their doctors about getting tested, the task force advised.

"The best way to prevent a stroke, and other cardiovascular diseases, is to focus on the things we know work," task force chair Dr. Michael LeFevre said in the news release. "This includes controlling high blood pressure and cholesterol, not smoking, being physically active, maintaining a healthy weight, and eating a healthful diet."

Note that rejecting this routine screening does NOT apply to people who have known risks.

As mentioned, there's a line - sometimes, a thin line - between screen vs. not screen. Carry pro-screen to an extreme, and we'd all have once-a-month colonoscopies. Not a pretty picture. Carry no-screen to an extreme, and we wouldn't know our own blood pressure.

You can find the details about the U.S. Preventive Services Task Force's recommendation here.

Don't just shrug off a mini-stroke

TIAs - or transient ischemic attacks - are too often shrugged off as unimportant. However, that's wrong.

Even if the person can move and speak with no difficulty after a mini-stroke, that doesn't mean the patient and professionals should walk away and do nothing. A recent study showed that many patients with TIA have long-term cognitive impairment:

"Our findings confirm what we experience in daily practice: While motor and language disturbances recover within 24 hours after a TIA, long-lasting cognitive complaints are a problem for many patients. There needs to be more clinical awareness of this issue," lead investigator Ewoud J van Dijk, MD, from the Radboud University Nijmegen Medical Centre, the Netherlands, told Medscape Medical News.

He suggested that a TIA affects complex networks that are involved in cognitive functioning. "These networks are likely more vulnerable than those involved in motor and language function. Further study is needed to confirm this, but physicians should be aware of these cognitive dysfunctions because it potentially affects quality of professional and daily living," he said.

'My rock, my fortress and my deliverer'

The Lord is my rock, my fortress and my deliverer; my God is my rock, in whom I take refuge, my shield and the horn of my salvation, my stronghold.

-Psalm 18:2

Re-reading the other Psalm verses featured here, you can see several references of taking refuge in God.

Do you have a refuge - I mean by that, a physical place you go, retreat to - when trouble comes your way? I find it a couple of ways - I have a workshop in the basement of my house, where I do very amateur woodworking, and three mornings a week, I run outdoors when I can.

Can I live in those refuges indefinitely? No. Sooner or later, I need to leave my workshop or my running route and join the rest of the world.

So, in Psalm, is the writer suggesting that we simply take refuge and never leave? I don't think so. God provides refuge when life's storms hit. But when those storms subside, God sends us to join the rest of the world. A world where you can make a difference in the lives of others.

So when you need that refuge - regardless of the physical place you might go - take your troubles to God. Not to keep it to yourself, though, but rest and strengthen, then share that hope of refuge with others.

   

Avoiding more strokes: Longer heart monitoring

It's well-established that atrial fibrillation is a stroke risk. We know that sometimes, people aren't aware they have that condition until after a stroke. We know that condition might take time to detect. And finally, there are some strokes that defy explanation.

So it makes good sense, as researchers found, that a study supports longer heart monitoring for stroke patients:

In both studies, the longer monitoring periods resulted in significantly more patients being prescribed anticoagulants to lower their risk of another stroke.

Photo from U.S. Centers for Disease
Control and Prevention

“If more patients with atrial fibrillation can be detected, then more patients can receive appropriate stroke prevention therapy, and the hope is that more strokes, deaths, disability and dementia can be avoided,” said Dr. David Gladstone, an associate professor in the department of medicine at the University of Toronto and the lead author of the Embrace trial.

Some medical centers monitor patients beyond the usual 24 hours, and in May the American Heart Association updated its guidelines to say it was “reasonable” for patients with unexplained strokes to be monitored for 30 days.

The main point is in the quote: "...the hope is that more strokes, deaths, disability and dementia can be avoided."

Stroke prevention, racial disparities and younger patients

Stroke prevention is important! If a stroke doesn't happen, then treatment is not necessary. Therapy for recovery is not necessary. And quality of life remains.

So a recent story highlighted not just one, but two issues - racial disparities and strokes for those under 65. The story is about how rising stroke rate for blacks in South Carolina, study finds:

Photo from U.S. Centers for
Disease Control and Prevention

They found that stroke hospitalizations among blacks younger than 65 jumped by more than 17 percent, but remained stable for whites younger than 65.

Blacks appeared more vulnerable to stroke at younger ages, too. According to the study, slightly more than half of the blacks hospitalized with stroke were younger than 65, compared with 30 percent of whites.

The study was published June 19 in the journal Stroke.

"Excess strokes among blacks, as well as the lingering racial disparity in the younger groups, represent a serious public health issue," lead author Dr. Wayne Feng, a stroke neurologist at the Medical University of South Carolina Stroke Center in Charleston, said in a journal news release.

'Stop and consider'

Listen to this, Job; stop and consider God’s wonders.

-Job 37:14

 Stop and consider.

That's something I do too seldom. God has placed all of these wonders - the quiet countryside, mighty rivers, oceans' deep, the animal kingdom, and, most importantly, us. Yet like many people, I rush here and there, taking in so little of what God offers.

And beyond the physical world's beauty, God offers us love. God offers us a deep relationship.

Stop and consider. If you can read this, there is one of God's wonder to consider. Find it. Stop. Consider.

More evidence about smoking

Doing healthy things make you less of a stroke risk - that just makes sense.

So a recently story about more such research didn't contain any big surprises.

But I did want to highlight one element in the story about how healthy habits linked to lower stroke risk:

“Being a former smoker was not associated with stroke risk, showing that cessation of smoking is effective in stroke prevention,” the researchers write in the journal Stroke.

So - stop smoking now, and you could wind up lowering your stroke risk! Better yet, if you've never started, just don't do it.