Walking - yes, it can lower stroke risk

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

As you might know, I'm a believer in exercise.

Here's the latest research that shows moderate exercise cuts stroke risk as much as strenuous activity:

The women who reported engaging in moderate physical activity in the 3 years before enrollment in the study were 20% less likely to suffer a stroke, compared with women who reported no activity.

Prof. Wang says she was surprised that the link to reduced stroke risk was strongest with moderate physical activity.

More strenuous activity such as running didn't further reduce women's stroke risk," she adds. "Moderate activity, such as brisk walking appeared to be ideal in this scenario."

Clot-busting tPA: Good news and bad news

I was fortunate enough to benefit from a drug called tissue plasminogen activator, or tPA, on the day of my stroke. Click here to read more about that experience.

The drug has made news in recent days. First, more patients are getting help faster, according to an article about how the "Target Stroke" initiative cuts time to tPA:

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

The percentage of patients with a door-to-needle time of 60 minutes or less was 29.6% just before the "Target: Stroke" initiative was implemented at the beginning of 2010 and 53.3% in the third quarter of 2013 ...,  a clinically relevant improvement, according to Gregg Fonarow, MD, of the University of California Los Angeles.

At the same time, clinical outcomes improved and complications from the use of tissue plasminogen activator (tPA) fell, he reported at the International Stroke Conference here.

Speaking of tPA, more recent research confirms that the drug is clearly associated with less long-term disability. Stroke is the leading cause of permanent disability in the United States. You can read through this link how thrombolysis limits stroke regardless of age, severity:

A new meta-analysis confirms that regardless of patient age or stroke severity, thrombolytic treatment of ischemic stroke is associated with less long-term disability.

Although earlier treatment was associated with better outcomes, patients in every subgroup of age and stroke severity receiving tissue plasminogen activator (tPA) within 4.5 hours of symptom onset benefited from treatment, with more patients left with little or no disability, including patients over 80 years of age.

Now, the not-so-good news. Still, another study reveals, few stroke patients get the clot-busting drug:

"We are not making a great deal of progress," says the study's lead author, Opeolu Adeoye, an associate professor of emergency medicine and neurosurgery at the University of Cincinnati.

The medication, called tPA, or tissue plasminogen activator, can dissolve the blood clots that cause most strokes, often sparing patients from devastating brain damage. The drug increases the chance that a stroke patient will be able to regain normal functions and return home by about 30%, Adeoye says.

But tPA, approved for strokes in 1996, only works if given within 4.5 hours of a stroke. Hospitals have worked to streamline their systems to get patients care as quickly as possible, says Victor Urrutia, medical director of the comprehensive stroke center at Johns Hopkins Hospital in Baltimore, who wasn't involved in the new study. Yet, he says, "It's really striking that this number hasn't increased much over the years."

So there's more work to accomplish so that this drug - even with its imperfection - can benefit so many and prevent or curtail serious disabilities.

Driving tests for stroke survivors?

I did wonder about driving after my stroke - could I remember where to go and how to get there? Turns out, my fleeting worries about this didn't pan out. However, for many, many stroke survivors, these concerns are too real.

I never took any sort of driving test to make sure my abilities were intact. In fact, a recent study highlighted that many stroke survivors resume driving without testing:

From U.S. Department of Transportation

Researchers from the Medical University of South Carolina found that more than half of the 162 stroke survivors in their study returned to driving following their stroke, with 59 percent of those returning within one month. Less than 6 percent of all stroke survivors received any formal driving evaluation before getting behind the wheel again.

"It's been my experience that even though one of the very first questions stroke patients ask is when they can go back to driving, very few will actually go and get a formal driving evaluation," said study author Dr. Shelly Ozark, an assistant professor of neurology.

"Some of that is the nature of stroke itself," she said. "Even though it can be a devastating illness, some people think if they have no problem walking or seeing, they're not affected. People don't necessarily recognize they have deficits."

For stroke survivors: Was this a concern of yours? And would you be OK taking a test?

Gout-causing uric acid might help in stroke treatment

Gout is painful, bad news. Gout is caused by uric acid, which can turn into crystals lodged in joints.

Now, though, the uric acid that causes gout might help stroke treatment. Recent research indicates that the gout culprit might help in stroke treatment:

Uric acid given along with thrombolytics in the first hours after an ischemic stroke showed a signal for improved recovery, a Spanish proof-of-concept trial showed.

The rate of near full recovery at 90 days was 39.3% with the powerful antioxidant compared with 33% on placebo instead, Angel Chamorro, MD, PhD, of the Hospital Clinic in Barcelona, Spain, and colleagues reported here at the International Stroke Conference. ...

Uric acid has gotten a bad reputation as the culprit in gout, but it only causes problems when high concentrations crystallize out into joints over the longer term, Chamorro told MedPage Today.

Read the entire article for more info. I was a tPA recipient, which I believe improved my stroke outcome somewhat. Not everyone has the same outcome. If this development will improve more stroke outcomes, that's needed progress.

Early treatment for depression: Stroke prevention?

Depression can be serious and needs to be taken seriously. With seriousness comes treatment, which, according to this article, could actually prevent a stroke or heart attack:

Patients who had no evidence of heart disease at the study start who received antidepressants and therapy for their depression almost halved their risk of a heart attack or stroke during the eight years of the study, compared with the standard care group, the researchers found.

"Ultimately, this line of research could produce a new approach to preventing cardiovascular disease," said study author Jesse Stewart, an associate professor of psychology at Indiana University-Purdue University Indianapolis."

There's a great temptation to look away of the problem of depression, to avoid treatment. This article can open your eyes to the importance of early treatment.

Women and stroke prevention guidelines

Women and men are different - in case you're wondering.

That is, there are specific differences that can mean strokes can impact those populations differently.

Check out this article on how women got their own stroke guidelines:

"It is very important that there is a specific stroke prevention guideline for women because we're not the same as 50% of the population," Dolora Wisco, MD, a neurologist at the Cleveland Clinic, told MedPage Today. "We have our own risk factors on top of the ones that are commonly seen out there."

Women are disproportionately affected by stroke; of an estimated 6.8 million people living in the U.S. after surviving a stroke, 3.8 million are women. In addition, stroke is the fifth leading cause of death for men, but third for women.

Read the article for some of the differences and review the guidelines, which focuses on stroke prevention.

'Dangerously uninformed about stroke'

The link (below) tells the story of a stroke survivor and points out a sad - but obvious - fact. Stroke risk factors and stroke symptoms are not well know.

Read the story about the survivor and the cold facts about stroke prevention and symptoms:

Stroke, which strikes some 795,000 Americans each year and kills about 130,000, is the fourth leading cause of death in the U.S. and a leading cause of disability, according to the Centers for Disease Control and Prevention. There are roughly 6.8 million stroke survivors in the U.S. And yet it is largely misunderstood.

"The public is dangerously uninformed about stroke," said Jim Baranski, CEO of the National Stroke Association, a nonprofit advocacy group based in Englewood, Colo.

Strokes happen in the brain, but the underlying causes often begin in the cardiovascular system. The good news is that 80 percent of strokes can be prevented, Baranski said, if people control the risk factors that make them more susceptible and recognize early stroke signs.

Check out the stroke signs with this video:

'In whom I trust'

I will say of the Lord, “He is my refuge and my fortress, my God, in whom I trust.”

-Psalm 91:2

I've been injured. First, nagging pain in the upper part of my left calf. That subsided. A few days later came serious swelling and pain above my left knee. At this writing, I'm wearing a splint designed to immobilize my left knee, with crutches leaning nearby and an ice bag on my knee.

Also as of this writing, I don't have a precise diagnosis. However, when offices open, I plan to call for the earliest possible appointment with a specialist.

What will happen? I don't know.

For someone like me, that's annoying. As a longtime runner, I can't run at the moment, which bothers me intensely. Even routine tasks around the house are difficult and slow.

Thus the verse above - "...my God, in whom I trust."

What should I do while I wait to know what's wrong with my knee, while I wait to know about the future of my running, while I wait... ?

Remember that verse in Psalm - "...my God, in whom I trust."

I might know more before this is posted - that is my intention. I'm writing this to pledge that I will trust in God no matter what, before I know the outcome. That's not necessarily easy. It's much easier to trust my own judgment. I pledge to trust in God no matter what is before me.

God is present for you, too, to place yourself in his trust.