More numbers on getting good results by fast treatment

Faster quality stroke treatment: Better chance you'll go home, not to a nursing home. More likely you'll be able to walk. And less likely you'll die after arrival.

There are some encouraging numbers in a recent study about hospitals pushing faster stroke care get better results:

The study is "more evidence that for stroke, every minute counts," says lead author Gregg Fonarow, a heart specialist at the University of California-Los Angeles.

Researchers looked at 71,169 patients with ischemic strokes, the kind caused by blood clots. They compared those treated in the years 2003-2009 with those treated in 2010-2013 after the hospitals adopted an improvement program developed by groups including the American Stroke Association.

Result: The share of tPA-treated patients who got the drug within an hour of arriving rose from 26% to 41% and reached 53% by the last months of the study. The median time elapsed fell from 77 minutes to 67 minutes.

In-hospital deaths among the treated patients fell from 9.9% to 8.2%. More of them left the hospital able to walk (45.4% vs. 42.2%), and more went home to recover (42.7% vs. 37.6%). A possible complication, bleeding in the brain, affected fewer patients (4.6% vs. 5.6%).

Of course, much more work is needed to get these numbers even better. But at least some providers are getting the message.

Running and stroke recovery, prevention

I'm now in my 27th year of running, and I broke a personal record recently. For the 27th time, I did not run in the Boston Marathon. Next year, I'll have a chance to break that record again with 28.

However, fellow stroke survivor Tedy Bruschi has completed the Boston Marathon.

A recent interview with Runner's World magazine touched on running and stroke:

Studies have suggested that running might help lower stroke risk. Did that factor into the formation of this team—and your decision to take up running after retiring from football?

Absolutely. One of the top ways to fight stroke—in addition to knowing the warning signs—is to keep yourself in the best physical shape you can. The doctors told me that one of the reasons why I was able to overcome and recover from my stroke was that I was probably in the best shape of my life. I was 31 years old, a professional athlete."

Good advice - event if you're never a professional football player. Stay in the best shape you can be. Might save your life.

Sleep may avert stroke risk

As some of you know, I had knee surgery recently. One of my priorities to improve my recovery is getting enough sleep.

That just makes sense.

But the lack of enough sleep might well bring about even more serious consequences, even among the young. A recent article details how insomnia may raise stroke risk:

Over the course of four years, researchers found that insomnia seemed to raise the likelihood that a person will be hospitalized due to stroke by 54 percent.

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

That risk skyrocketed for people between the ages of 18 and 34, who were eight times more likely to suffer strokes if they had insomnia when compared to their peers who got good sleep, the study found.

"We pay a lot of attention to high blood pressure, to obesity, to issues related to cholesterol. Those are known risk factors," said Dr. Demetrius Lopes, director of the Interventional Cerebrovascular Center at Rush University in Chicago and a spokesman for the American Heart Association. "But I think what is underrated is if you don't have a good sleep routine, how much it can harm you, especially at a young age."

Unfortunately, we live in a noisy, distracting, 24/7 world. And that makes it harder to get a good night's sleep. And that's on top of the difficulty many people have getting a good night's sleep even with ideal circumstances.

I love a good night's sleep. And now more than ever it seems, getting a good night's sleep is a serious matter.

Too often, strokes are missed in ERs

Clearly, more training is needed. A recent study showed that strokes are often missed in ERs:

Every year, tens of thousands of Americans with symptoms such as dizziness or headache are misdiagnosed in the ER in the days or weeks before they suffer a stroke, according to the researchers.

Women, minorities and those under age 45 are the most likely to be misdiagnosed, according to the study published online April 3 in the journal Diagnosis.

"It's clear that ER physicians need to be more discerning and vigilant in ruling out stroke, even in younger people," study leader Dr. David Newman-Toker, an associate professor of neurology at the Johns Hopkins University School of Medicine in Baltimore, said in a Hopkins news release.

That's a scary thought - people under 45, women and minorities are too often misdiagnosed. My own stroke came at age 39, so I feel incredibly fortunate that the right doctors and other professionals were at the right time and right place.

Of course, if a stroke diagnosed is missed or even delayed, it could mean more consequences for the stroke patient: Possibly more likely to suffer more profound disability, or even death.

If you see someone with stroke signs, make sure you make that known to the health professionals. You might save a life that way.

Stem cell story worth reading

Whenever I see "stem cells," I put up my skepticism shield. There's been a lot of hyperbole out there about stem cells.

However, this recent story shows a small light of good news without overselling. It's how stem cells helped some stroke patients recover:

All the patients saw some improvement in weakness or paralysis within six months of their procedures. Although three people developed complications related to the surgery, they all recovered. There were no adverse reactions to the transplanted stem cells themselves, the study authors said.

What's more, the researchers said, two patients experienced dramatic recoveries almost immediately after the treatments. ...

"It's a small, early human study. It takes multiple steps to get to something clinically useful, and this is a nice, early step," said Dr. Steven Cramer, clinical director of the Stem Cell Research Center at the University of California, Irvine.

Again, as the researcher says, it's a small study. Still, worth watching.

An update one week out

Be joyful in hope, patient in affliction, faithful in prayer.

-Romans 12:12

A few weeks ago, I posted a note about arthroscopic knee surgery scheduled for April 1.

This is my week anniversary of surgery, and while I can tell my knee problem was fixed, it's still sore and swollen. In other words, fairly normal recovery.

Now, it's a matter of patience. I am not patient person in many ways. I want instant relief, instant fix, instant recovery.

Of course, the world seldom operates that way. Instead, we wait for relief, we sit and try to fill our time for fixes, we spent hours, days, weeks, months and more for recovery. But Paul gave some great advice to his fellow believers in Rome.

We don't always have control - indeed, we seldom have control - over time and recovery. Certainly, there are often - not always, but often - ways to smooth our path for recovery. There are many, many well-trained health professionals who can help. And in many instances, using patience will bring about more lasting recuperation.

So in my recovery, I do pray that I can be joyful in hope, patient in my affliction, and faithful to pray.

Having the hard discussions

Photo from the U.S. Department of Veterans Affairs

We all want to recover completely - the alternatives are unpleasant, and we're tempted to shy away from even thinking about these alternatives.

But the truth is, stroke is the most common cause of disability in the United States, and it's the fourth leading cause of death. Of course, the medical community needs to continue its efforts to find better ways to prevent and treat strokes to improve these numbers.

It's sometimes hard to talk about the type of care that some stroke patients need. And I'm not 100 percent in agreement with the tone and implication of the American Heart Association/American Stroke Association statement that "the majority" stroke patients need palliative care - that is, care with the emphasis on comfort rather than dealing with the underlying problem.

Still, the ASA did come up with some potential discussion points between stroke survivors, caregivers and health professionals:

As a stroke survivor or family member, you should expect your healthcare provider to:

• Talk about your preferences, needs and values as a guide to medical decisions.

• Discuss what aspects of recovery are most important to you.

• Have effective, sensitive discussions about your prognosis, how to deal with physical or mental losses from a stroke, and if necessary, of dying, among  other serious topics.

• Guide you through choices about life-sustaining treatment options. Providers should address pros and cons of CPR, ventilators, feeding tubes, surgery, do-not-resuscitate orders (DNR), do-not-intubate (DNI) orders and natural feeding.

• Know the best treatment options for common post-stroke symptoms, including pain, other physical symptoms and psychological problems like depression and anxiety.

• Engage a palliative care specialist if complex issues arise.

• Help preserve dignity and maximize comfort throughout the course of a stroke, including during the dying process and when nearing death.

Understandably, these might be very hard conversations. But avoiding these conversations might cause increased and needless suffering.

Most women miss most stroke signs

Stroke signs - too few people recognize them.

I'm guessing that men and women pretty much equally miss the signs in general. However, a recent study focused on just one sex and found that most stroke signs are unrecognized by most women:

Slightly more than half of the participants (51%) identified sudden one-sided weakness or numbness of the face or a limb as a stroke warning sign, but the rest of the warning signs were tagged by fewer than half, according to Heidi Mochari-Greenberger, PhD, MPH, of Columbia University Medical Center in New York City.

Those included difficulty speaking or understanding speech (identified by 44% overall but by a lower percentage in Hispanic versus white women), sudden severe headache (23%), unexplained dizziness (20%), and sudden loss of at least some vision (18%), she reported at the American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity, and Metabolism meeting in San Francisco.

I'd add that not every stroke has every sign. I never had a headache, for example. So even if one sign appears, get to help fast!