'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.