'Therefore we will not fear ...'

God is our refuge and strength, an ever-present help in trouble. Therefore we will not fear, though the earth give way and the mountains fall into the heart of the sea, though its waters roar and foam and the mountains quake with their surging.

-Psalm 46:1-3

I recently became aware of a friend who is in a real struggle right now - betrayed and abused.

Now think - anyone in your life who currently faces trouble or fear? Yourself?

I know many stroke survivors face trouble on a daily basis. I've been there - feeling vulnerable and weak. Some feel it physically. Others struggle with speech problems, memory, vision and more.

Vulnerable? God is your refuge, a safe place in a storm. Weak (physically, mentally or, most important, spiritually)? God is your strength.

Reach out to God. He is with you, through those times of trouble. If you struggle how, reach out to friends of faith until you find ways to relate to God.

Singing for stroke patients - aphasia therapy

I've previously told my story about how singing seemed to help in my recovery from aphasia, an effect of my 1998 stroke.

Now, here's another story of how singing does stroke patients good:

Photo from Scott W. Vincent via Flickr

In a hospital atrium at Mount Sinai Beth Israel this week, a choir gave its first public performance. Wearing light-up necklaces and accompanied by drums and guitar, the performers rang bells and sang such holiday classics as “Silver Bells” and “Joy to the World,” occasionally breaking out in harmony.

Dead to hope? Jesus offers you his own 'Lazarus effect'

[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."

'Be strong and take heart'

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

-Psalm 27:14

Impatience - the story of my life.

I'm better than I used to be but still struggle with impatience. I avoid some things because of it - golf, for example. As an amateur woodworker, I use my hobby as a tool to teach myself patience. It's working, but slowly.

Impatience is a special challenge for many stroke survivors. I know it was (and is) mine. Struggling to read. Struggling for proper speech. Struggling to write clearly.

The best way I've found to conquer impatience is to read verses like this selection from Psalm. Timing is not always ours - often, timing is in God's time.

So think about that when you struggle with impatience. Use this time to build your inner strength - take heart and wait for the Lord.

Preventable strokes and treatment - finding answers, saving lives

Photo from Pete via Flickr

I'm sold on stroke prevention. It saves lives and it gives society more resources to battle health problems.

An interesting research take about 'preventable' strokes and treatment:

Three out of four strokes could be avoided, and one in four are "highly avoidable," according to a study assessing stroke preventability. It also found that strokes considered the most treatable were the most preventable.

Those were the findings when a 10-point stroke preventability scale -- incorporating key measures such as treatment for hypertension, high cholesterol, and atrial fibrillation -- was applied to 274 consecutive ischemic stroke patients treated at a single institution. ...

One more way to potentially speed treatment

Speed, as you know, is key in treating stroke patients.

Recent news about telemedicine shortening door-to-needle time:

A mobile stroke treatment unit (MSTU) operated by Cleveland Clinic which uses telemedicine to connect emergency team members to a hospital-based vascular neurologist, reduced time to tPA treatment by more than 25 minutes in an analysis of the first 100 patients transported. ...

'I will hope in him'

... his compassion never ends. It is only the Lord’s mercies that have kept us from complete destruction. Great is his faithfulness; his loving-kindness begins afresh each day. My soul claims the Lord as my inheritance; therefore

-Lamentations 3:22-24

Lamentations is not a great marketing book name, is it? It's attributed to the prophet Jeremiah after the Babylonians destroyed Jerusalem.

But in these verses, Jeremiah reminds us that as bad as things can get, God is with us. He knows us. He loves us. He will not leave us.

In the days and years after my stroke, I've leaned on God for hope. And it's available to all of us.

Long-term stroke risk - stroke prevention must continue

You can't give up stroke prevention - even in the long run.

Some recent research showing that young women are at risk long after a stroke long after an initial stroke:

The study is among the first to examine long-term outcomes in younger women who are heart attack or stroke survivors, co-author Bob Siegerink, PhD, of Leiden and the Center for Stroke Research Berlin, told MedPage Today in an email exchange.

Hospitals hiring weight-guessers? Or is there a better solution?

Image from Wellness Corporate Solutions via Flickr

Ever seen someone offering to guess your weight at a carnival? It's been a while for me.

Maybe we need to hire some of those folks for hospital work - when knowing someone's weight means administering the correct amount of a drug that could bring you back from a stroke, or put you in danger - at least partly depending on how the accuracy of your weight in its calculation.

Recently, some research shows that weight guesses for stroke treatment are often wrong:

"Relying on our ability to 'guess' the weight of a patient in the acute setting is no longer acceptable and potentially dangerous," Pankaj Sharma, MD, PhD, from the Institute for Cardiovascular Research at the University of London, told Reuters Health.

The recommended dose of alteplase (recombinant tissue-type plasminogen activator [r-tPA]) is 0.9 mg/kg, up to a maximum dose of 90 mg. In the interest of time, clinicians often estimate patients' weights to determine the r-tPA dose. ...

Language skills and aphasia recovery - connected?

Should have taken those French classes in high school.

Turns out that for stroke patients suffering from aphasia, a language problem that affects thousands a year, bilingual brains sustain less stroke damage:

Compared to patients who spoke only one language, bilingual stroke patients were more than twice as likely to have normal cognition following their stroke and they also performed better on tests measuring post-stroke attention and function.

But the two groups had similar frequencies of aphasia, at 11.8% among monolinguals and 10.5% among bilinguals (P=0.354), which might be explained by a higher level of cognitive control in patients speaking two or more languages, Suvarna Alladi, DM, of Nizam's Institute of Medical Sciences in Hyderabad, India, and colleagues wrote online in Stroke.

Link between depression, stroke risk among black Americans

Racial disparity is a longstanding issue in health care. A study showing the need for more research and action linked depression among black Americans and stroke risk:

The study, based on the ongoing Jackson Heart Study in Jackson, Miss., included more than 3,300 blacks between 21 and 94 years old who were screened for depression. None of the participants had a history of heart attack or stroke.

But more than 22 percent had major depression at the start of the study, and over the course of 10 years, they had a higher risk of heart disease (5.6 percent vs. 3.6 percent) and stroke (3.7 percent vs. 2.6 percent) than those without depression, the researchers found.

Participants with depression were more likely to be women, have chronic health problems, get less exercise, have lower incomes, smoke, and have a higher body mass index (BMI), an estimate of body fat based on height and weight.

You've seen other news about depression as related to stroke risk, too. It's a series issue for all of us. And, perhaps, particularly an issue for some populations.

Feel like you're on a high wire for your health?

Photo by Morgan via Flickr

During a discussion of the health care of my mother in the last few years of her life, a smart doctor told us that as someone ages, much of health care becomes a balancing act.

Or maybe it's not just about aging, but blood pressure in any age. Check out recent research about how blood pressure control can cut stroke risk but might result in trade-offs

And the rate of all cardiovascular events, including heart attack, stroke, and cardiovascular death, was 25 percent lower in the group that received aggressive treatment: 243 events in those 4,678 patients, compared with 319 events in the 4,683 that got less medicine.

Adding more research on alcoholic drinks and stroke prevention

Photo by Graham Hills via Flickr

I've had a drink of soju more than once, first with colleagues from South Korea visiting the United States a few years ago and during trips to that country.

I enjoyed it at the time, and now feel even better about it! Check out the story about soju might lower stroke risk:

Research results suggest that three to four glasses of the drink a day lower males’ stroke risk. Compared to those who do not drink, one glass of soju (10g of alcohol), two glasses of soju, and three to four glasses of soju can scale down stroke risk by 62 percent, 55 percent and 46 percent, respectively. Drink-based stroke prevention effects were the highest when a person drinks one glass or less of soju.

Pot: Stroke related? Researchers seeking answers

For the complex human brain, there are few simple answers out there. This includes answers about stroke causes and risks, depending on type of stroke, age and other factors.

Now, there's more research on marijuana use, specific type of stroke and age:

Photo from National Library of Medicine

A team led by Dr. Valerie Wolff, at the University Hospital of Strasbourg in France, examined 334 patients younger than 45 who suffered an ischemic stroke -- an attack caused by blocked blood flow to the brain. Fifty-eight of the patients were marijuana users.

The study couldn't prove that marijuana caused strokes, but Wolff's team did find some differences in stroke characteristics between pot users and non-users.

Hole in the heart - patching or not patching?

My own stroke was blamed on a hole in my heart - a patent foramen ovale, or an opening between the two upper chambers of the heart. The opening was closed in 2007. To read more about that, you can follow this link.

Researchers have been back and forth on whether closing the hole is a good idea or not. The most recent discussion made more sense - to this layman - and how for some, the closure makes sense. For others, not as much.

For example, relatively young people with a combination of the hole and an atrial septal aneurysm - that's when the wall between the two upper chambers of the heart is bulging - might benefit more. That was my case.

So follow this link to read more about the results of PFO closure in the long term:

While patent foramen ovale (PFO) closure still doesn't pan out for overall outcomes in long-term follow-up, the procedure does what it is supposed to in terms of reducing recurrent cryptogenic strokes, particularly for younger adults, the RESPECT trial showed.

Stressed out? Then watch out - this might happen to you

Photo by bottled_void from Flickr

I was in a stressful situation - by my own making and ambition - when my stroke happened. Did that increase my risk?

A bit of an unanswerable question at this late date, but there's some research that might indicate a link that a high strain job increases stroke risk:

The association between exposure to high job strain and an increased risk of stroke was particularly pronounced in ischemic stroke and in women but not in hemorrhagic stroke or in men, according to Dingli Xu, MD, of Southern Medical University, Guangzhou, China, and colleagues. ...

The story of the unknown unknowns

The famous quote about the "unknown unknowns" is back. Check out the video for some background, then read on.

My stroke was an "unknown" - unexplained at the time. It was later explained as a hole between the two upper chambers of my heart, also known as a patent foramen ovale. Click here to read more about PFO, strokes and heart repair.

Recently, experts had an interesting discussion about finding out the causes of unexplained - or cryptogenic - strokes.

'My hope is in you'

But now, Lord, what do I look for? My hope is in you.

-Psalm 39:7

We're all coached to pin our hopes to something human-made.

Buy this, and you'll be good-looking. Purchase that, and you'll be popular. Drink this, you'll have more friends. Eat that, and you'll lose all the weight you want. Subscribe to this, and all your problems are resolved.

Too often, people pin their hopes on hollow dreams, as directed by entertainment and advertising. I certainly have fallen into this trap.

Consider this Psalm verse. We've looked and looked for hope. Time to place our hope is in God.

Time to up the game for stroke treatment

Photo by Chris Violette via Flickr

During the last couple of decades, we've seen some upgrade in care for stroke patients.

But this can't stop. Treatment could be so much better.

Check out the story on how experts call for care upgrade:

Patients suspected of having a stroke should be transported to an accredited comprehensive stroke center (CSC) when it is reasonable to do so, they wrote. When a CSC is too far away, patients should be taken to the nearest primary stroke center (PSC) that is linked to a CSC by telemedicine. They also called for the expansion of telemedicine networks linking smaller, non-PSC hospitals in very rural communities to accredited stroke centers.

"The qualifications for these PSCs and CSCs should be upgraded so that imaging technology and the availability of neurologists to see patients 24/7 should be requisites," the editorialists wrote. "Systems for rapid imaging and throughput should be in place at these centers."

'Let him have all your worries and cares'

Let him have all your worries and cares, for he is always thinking about you and watching everything that concerns you.

-1 Peter 5:7

Lately, this blog has featured a lot of Bible verses - with the theme of troubles and worries.

Why? I am not certain. I seem to have been led down this route. Perhaps these were written for a particular person out there in Internetland. Perhaps for something in my own life that has yet to develop. Perhaps for a reason yet to be determined.

For whatever reason, we can all consider these verses - we will all face worries sooner or later. Let God have those worries.

Vaccinations and stroke prevention

Got your flu shot?

Photo from futureatlast.com via Flickr

That's important, especially for children. Now, it's seems that child vaccinations might lower stroke risk:

Although respiratory tract infection may act as a trigger for childhood arterial ischemic stroke (AIS), routine vaccinations appear protective, a large, international case-control study has shown.

"Our findings provide reassurance that vaccinations do not increase stroke risk, and may even reduce risk," Heather Fullerton, MD, MAS, of the University of California San Francisco and colleagues reported online in Neurology.

A childhood stroke must be devastating. Now, here's one possibility to reduce those chances.

'Do not worry about tomorrow'

Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.

-Matthew 6:34

Famous words from a famous event. This comes from the Sermon on the Mount. Jesus was addressing a crowd on a hillside. This is one of many, many often-references words.

And boy, do I need these words.

Do you ever had stress in your life? At the end of a day, say, your head is already filled with what is likely facing you tomorrow? It's hard to break that routine, isn't it?

So read the entire sermon - Matthews 5 through 7 - to get a real feel of what Jesus was saying.

Whenever I read it, I come away with a new thought. So before I wrote this, this thought came to me: Jesus isn't saying that worry is a sin. Instead, he's trying to comfort a crowd of people who, like those of today, can be worry-ridden. Comfort we should all heed and take to heart.

What are your thoughts?

'We get knocked down, but we get up again'

We are pressed on every side by troubles, but not crushed and broken. We are perplexed because we don’t know why things happen as they do, but we don’t give up and quit. We are hunted down, but God never abandons us. We get knocked down, but we get up again and keep going.

-2 Corinthians 4:8-9

What do the words "crushed" or "broken" mean to you?

Physically, grapes are crushed to make wine; a window can be broken by a baseball. But what about people?

Paul wrote to the Corinthians about the human condition - you can't ignore that troubles abound. Good, decent people can have health problems. Hard workers can find themselves unemployed. Those seeking friends might find themselves - in human terms - alone.

But we are not really alone. God never abandons us.

Does that mean all the world is just rainbows and flowers? Of course not. Humans - with both good intentions and bad intentions - have made many, many messes in this world. We get through this precisely because God never abandons us.

'In his word I put my hope'

I wait for the Lord, my whole being waits, and in his word I put my hope.

-Psalm 130:5

Hope. My hope. Your hope.

We've all been there, haven't we - waiting, even reluctantly, in hope? Maybe you're waiting now in hope.

Lately, I've had some disappointments and concerns. Knee still bothers me. Other strange, unexplained lower leg pains, twinges and cramps. A friend seems to be having serious personal issues - yet to be explained. And more.

There's only so much I alone can do about any of these or others. Instead, I wait; my whole being waits. In hope.

This must be a high priority item - to save lives

Photo from Doug McCaughan via Flickr

Chances are, you have high blood pressure or you know someone with high blood pressure.

Chances are, you know that high blood pressure is the leading cause of strokes.

Now, it's even clearer that even tighter control of high blood pressure is a key to stroke prevention:

"Our results provide important evidence that treating blood pressure to a lower goal in older or high-risk patients can be beneficial and yield better health results overall," said Dr. Lawrence Fine, chief of the Clinical Applications and Prevention Branch at the U.S. National Heart, Lung, and Blood Institute. "But patients should talk to their doctor to determine whether this lower goal is best for their individual care."

And the answer to the aspirin question is ...

Photo from Open Knowledge via Flickr

Those who are trying to prevent a stroke might feel like a ping pong ball.

There's been a bit of back and forth about who should take an aspirin every day to prevent strokes or heart attacks. Now, it seems we're now told that adults in their 50s should take aspirin daily:

Updated guidelines issued by the US Preventive Services Task Force recommend daily low-dose aspirin for the prevention of heart attack and stroke among adults aged 50-59 who are at high risk for cardiovascular disease. ...

What people can't see can still be real

Photo by Allan Ajifo

I can relate to this. I have no physical signs from my stroke. But I certainly felt the affects of aphasia (click here to read more about aphasia). Most are now gone, but for some these "hidden disabilities" are more long term.

Here's a relevant look at “hidden” disabilities after stroke:

Williams said she thinks that her disabilities aren’t taken as seriously as physical challenges.

'Our dwelling place' - but so much more

Lord, you have been our dwelling place throughout all generations.

-Psalm 90:1

A dwelling place. I've been thinking of dwelling places a lot these days:

• With my wife, planning and considering some home projects to protect the investment we've already made in our home.
• Been helping to prepare a home for one of my daughters.
• Feeling proud of the accomplishments of my eldest daughter in improving the dwelling of her family.

But "dwelling" is so much more. This Psalm excerpt isn't talking about buildings. There's so much more.

When we feel lost from shelter, when we feel out in the open when the world's storms hit - God is our dwelling place. There, we find shelter. There, we can find peace and security.

Find your dwelling place - not the physical one, but the one that is so much more.

Cold is not cool - but winter is coming...

As a born Southerner, I am not a cold weather person. Cool is cool. Cold, however, is not.

And as cool weather is on the horizon now that it's September, it's good to know about recent research about the link between cold weather and stroke risk. While the studies don't prove that cold weather causes strokes, it's worth it to stay mindful about staying warm this winter and be sure you stick to your prescribed medications.

Here's a link and a snippet of the story about how cold weather may up risk of stroke, severe heart attack for some:

Stroke and the aging brain

Photo by Allan Ajifo via Flickr

I'm a runner and occasionally refer to the book "Running Until You're 100" by Jeff Galloway.

But that sort of assumes I'll be around and can find my way around a running course at that age. That might be a challenge - one recent study suggests that a stroke ages a brain by eight years:

University of Michigan researchers analyzed national data from more than 4,900 black and white Americans aged 65 and older who underwent tests of memory and thinking speed between 1998 and 2012.

Do you work hard? Too hard? What might follow ...

Photo by hiroo yamagata via Flickr

I work. A lot. As in gathering unused vacation time and such. Technology makes that so much more tempting.

But I might take advantage of more time off after hearing the news about how long work hours may increase risk for stroke:

As technology now allows us to work anywhere and anytime, thereby extending our normal working hours, it becomes more important to maintain a balance in life.

The phone number is easy to remember - but who's calling it?

A few posts ago, we looked at the hospital behavior after a stroke patient is hospitalized. And you have seen postings about how hospitals often take patients more seriously if they arrive via ambulance.

But who's calling for an ambulance ride? Here's an interesting look at how race and sex may influence who calls an ambulance for stroke symptoms:

With an average age of 71, half of the stroke patients were women and almost 70 percent were white. Almost 20 percent were black, 8 percent were Hispanic and 3 percent identified as Asian.

Aging with migraine? Smoking seems to add a major stroke risk

Smoking, as mentioned here before, is bad for you. Really bad for you.

So check out this news about smoking, migraines and strokes - older smokers with migraines may face added stroke risk:

Photo: free photos via Flickr

The researchers did not find an association between migraine and the risk of either heart attack or stroke in nonsmokers. But among smokers, migraine was associated with a threefold increased risk of stroke.

However, even though the study found an association between migraine and stroke risk in smokers, it did not prove a cause-and-effect relationship.

Pass the fried catfish - but only once in a while

Photo: Patrick Woodward via Flickr

This isn't the first time we've seen the warning that Southern diets are linked to stroke risk.

Being a born Southerner - and a lover of fried catfish, fried hush puppies and fried okra - it's hard to admit that the food I grew up on was perhaps not the healthiest. These days, living in the Midwest, I am sparing in consumption of these things.

Check out the latest article that Southern-style diet is least healthy:

Individuals eating foods typical to the Southern region -- think fried chicken, fried okra, sweet tea, buttered biscuits, and lots of gravy -- showed a 56% increase in cardiovascular disease, compared with those rarely eating such foods, in the national, population-based, observational Reasons for Geographic and Racial Differences in Stroke (REGARDS) trial.

Got a few minutes? Could be that this is all you'll need

You don't have to do Olympic-level exercises to reduce your stroke risk.

Which is good news for me, since I'm past that.

I still run (relatively slowly) but according to some recent research, even a little exercise goes a long way for older adults:

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

The reduction in all-cause mortality was stronger for men than for women, Hupin's group noted, adding that there was a possibility that men may have overestimated their activity, or that women might have underestimated theirs.

"This protective effect appears dose-dependent and is already significant for a low dose of moderate to vigorous physical activity (or about 15 min per day), which is below current recommendations for older adults," they stated. "These results can guide future recommendations for older adults and may improve adherence to regular physical activity programs and thus their global health."

Exercise has previously been shown to offer a wide array of benefits to older adults.

Fifteen minutes of moderate activity a day is within reach for almost anyone. Check out the entire article, then go do your 15 minutes!

Chew your food, or this might happen!

I had the greatest hug last week. But the lead-in event started out deadly.

One evening, after grilling some beef kabobs, I enjoyed one chunk too much – and began to choke. My wife Laura came to my rescue, put her arms around me from behind and squeezed. And at least six more times. The chunk remained, but her moves gave me a tiny bit of an airway. She called 911 while I went to the floor, hacking like a cat with a hairball.

We're supposed to go F.A.S.T. - but are those preaching it do the same?

Second round in this week's theme: Taking stroke patients seriously.

We're all told to get possible stroke patients to medical help fast - there's even a program with the acronym F.A.S.T. We're all told brain = time.

But, according to a recent study, it seems that many hospitals overestimate their adherence to stroke guidelines:

Researchers surveyed staff in 141 hospitals across the United States who treated more than 48,000 stroke patients in 2009 and 2010, and compared their responses with patient data. The results revealed significant differences between staff perception and reality.

How much priority will you get when it comes to saving your life?

This week's theme: Taking stroke patients seriously. Sadly, we are not always taken seriously.

This is written in kindness - my life was saved by health professionals in a hospital. But we've all seen the other side in hospitals - the hurry-up-and-wait phenomenon. And in my own personal observations, transportation is a big issue for hospitals.

So it's not a big surprise that in those cases in which a stroke patient needs to move to a stroke center, the transfer is actually no faster than driving yourself:

Aspirin today? You are not alone - and maybe Missouri could do better

(Credit below)

You know, aspirin is good for headaches, too.

I ran across some numbers the other day about aspirin use - high numbers of users who want to avoid stroke or heart disease.

Within the heart patients surveyed, a fairly tiny number take aspirin for pain relief. It is actually a pretty good non-steroid anti-inflammatory, too, if you can stomach it.

One down note for my current state of residence - Missouri. Read about this and from a story running down the numbers on aspirin's common use:

Secondhand smoke: Does it have a deadly link to stroke risk?

Photo by Global Panorama via Flickr.

We know smoking is linked to increased stroke risk - among many other dangers.

It's possible that even being around smokers might bump up your risk. Check out this recent study how secondhand smoke is tied to raised stroke risk:

"Our findings suggest the possibility for adverse health outcomes such as stroke among nonsmokers exposed to secondhand smoke and add to the body of evidence supporting stricter smoking regulations," said lead author Angela Malek, of the Medical University of South Carolina in Charleston.

'Those who wait upon God ...'

Photo by Frank Kovalchek via Flickr

For even young people tire and drop out, young folk in their prime stumble and fall. But those who wait upon God get fresh strength. They spread their wings and soar like eagles, they run and don’t get tired, they walk and don’t lag behind.

-Isaiah 40:30-31 (The Message)

A couple of postings ago, I complained about nagging back pain. And even though I'm not so young these days, I understand how, as Isaiah says, young people can get tired, drop out, stumble and fall.

Ever feel that way?

As this is being written, I'm waiting for word that my health insurance will cover a shot in the back that, I hope, will help. Complaints about employee-based health insurance delays - thus reducing their own employees' productivity - could take up an entire posting and then some.

But today, it's about waiting. It seems we live in a hurry-up world today. If there's nothing I can do but wait, I need to wait. Not necessarily on human timetables, but on God's timetable. Follow God's timetable will give me fresh strength, as Isaiah told so eloquently so long ago.

Now, will I always get exactly what I want by waiting? Not necessarily. But God's strength comes in many ways, many sizes, many shapes. I must refresh my trust in that.

Was your stroke an emergency? Not all that long ago...

Photo by Chris Violette via Flickr

We've gone a long way.

Twenty years ago, a stroke wasn't considered an emergency. No treatment to reverse or limit a stroke's brain damage.

In 1996, the clot-busting drug tissue plasminogen activator was approved to treat strokes. That also caused a great deal of rethinking how health care providers responded to strokes. What was not an emergency suddenly became one. That meant a lot of rethinking of roles and actions of health professionals when a stroke happens.

An interesting take on that history and more ideas evolving, focusing on when stroke care is a statewide effort:

'You have done so many things!'

Lord, you have done so many things! You made them all so wisely! The earth is full of your creations!

-Psalm 104:24 (Common English Bible)

One of those creations, of course, would be ... you!

When you're having one of those days - frustration, perhaps, or without obvious progress - remember that you are one of God's creations.

I've had some particularly trying days lately with an old back injury flaring up, which happens every few years. Yesterday, I stayed close to home, laying flat on the floor with an ice bag and living on muscle relaxers.

So I pondered this yesterday. Every day is important, of course, but it is only a day. Today, I'm much better. I feel hope for tomorrow.

Guaranteed?

Only this: I am one of God's creation. That's all I need to know.

Get moving after a stroke?

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

Hanging around in a hospital bed is seldom good for you. Everybody knows that - and now we've got a little evidence for stroke patients.

Mine affected my speech, not so much my physical abilities. I was a little unsteady for a while and, in my way of thinking, lost a little of my fine motor skills. But so many people have more profound physical issues after a stroke.

And part of the answer, it seems is that people with brain injuries heal faster if they get up and get moving:

For women, PTSD seems linked to stroke risk

Stroke prevention becomes even more important when an additional risk factor looms. Recent research about post-traumatic stress disorder reveals that PTSD and trauma may raise women's stroke risks:

For women with severe PTSD, the study found a 60 percent higher risk of heart attack or stroke compared to women who hadn't experienced any trauma. The risk was increased 45 percent for women who experienced a traumatic event but didn't develop PTSD, the researchers added.

"Our study is the first to look at trauma exposure and PTSD symptoms and new cases of cardiovascular disease in a general population sample of women," said lead researcher Jennifer Sumner, an epidemiologist at Columbia University's Mailman School of Public Health in New York City.

It's important to note, however, that while this study found an association between trauma and a higher risk of stroke and heart attack, it wasn't designed to prove a cause-and-effect relationship. It's possible that other factors may explain the increased risk.

Where are you? And why should that matter for stroke treatment?

Place can have a lot to do with your health. That's been demonstrated, and experts have talked about diet, access to providers, lifestyles and more.

But a recent study has its own author puzzled about baffling disparities in stroke treatment across the United States:

In the bottom one-fifth of the hospital markets patients received no tPA. In the top one-fifth of markets 9% of patients received clot-busting drugs. In Asheville, NC and Stanford, CA as many as 14% of patients received IV tPA or an intra-arterial treatment using tPA or another drugs.

There were only minor improvements in treatment levels for patients in regions with certified primary stroke centers, or where emergency medical services drove patients further to get stroke treatment. Older patients, minorities, and women were less likely to get tPA regardless of where they lived, the study showed.

Assigning homework for aphasia recovery patients

As you might have seen before, I used some technology myself in recovering from aphasia - a borrowed child's toy called GeoSafari. It was a teaching toy, and I was able to use it as a language-building tool.

Fast-forward 17 years, and we're more sophisticated now - snazzier video games, education toys, tablets - offering even more possibilities for aphasia recovery.

Plus, it gives a chance to study this on your own timetable. Check out the recent story how self-delivered speech therapy is feasible for aphasia patients:

Aphasia frustration - maybe spread-out therapy could help with recovery

It took a long time for my language skills to come back adequately - at least, under my definition of "adequately." One thing that persists over the last 17 years, though, is that when I am tired or stressed, speaking becomes harder.

So, this study makes a certain amount of sense to me - work too hard, you'll tire out. And initially, my stroke left me easily tired. This study looked at the time involved in speech therapy and recovering speech skills and found that aphasia recovery better when therapy is spread out:

Training stroke patients for the just-in-case scenario

Photo from Thomas Hawk via Flickr

Learning is generally a good thing.

Ever been hospitalized? If so, it's likely you went through a discharge process, received some instructions and signed some papers. In my experience, most instructions are semi-helpful at best. Now, here's an idea that might be an upgrade for in-hospital instructions - educating stroke survivors helps them spot another stroke faster:

Stroke survivors who receive extensive stroke education are much more likely to recognize symptoms of another stroke and seek immediate treatment, a new study shows. ...

Legislation about stroke centers can make a real difference

Where do you live? Where's the closest stroke center?

We've all seen lots of evidence that where you live has a lot to do with your health. Local diet. Cultural expectations about exercise. Access to healthy food choices. Access to places where you can safely take a walk.

And access to stroke centers, according to recent research showing how state stroke center laws have a real impact:

States with some of the highest percentage of acute care hospitals with designated stroke centers were Delaware (100%), Massachusetts (97%), New Jersey (96%), and Rhode Island (90%).

'Now faith is the assurance of ... "

Now faith is the assurance of things hoped for, the conviction of things not seen.

-Hebrews 11:1

What is faith to you?

The writer of the New Testament book Hebrews - and we don't know with certainty who wrote it - knew his or her own answer.

So what do you hope for? Ultimately. In the short term, I hope to keep up this blog, to spend time with my family, to keep connected to my church, to ... . You get the idea.

But what do I really hope for? How about this: I hope to retain my conviction of things not seen. Faith gives the assurance that one day, those convictions will be seen.

'Keeps body and soul together'

Watch this: God’s eye is on those who respect him, the ones who are looking for his love. He’s ready to come to their rescue in bad times; in lean times he keeps body and soul together.

-Psalm 33:18 (The Message)

Ever seen bad times? If not, just wait - everyone sees them sooner or later.

In the bad times of my life, God was my lifeboat. He gave me health professionals, other experts, friends, colleagues, fellow believers - the list can go on and on. With these resources, he kept my body and soul together time and time again.

Notice that the Psalm writer didn't say you won't face bad times; just that God is with you even during those times.

Another compelling part of the verses from The Message, kind of a combo commentary and Bible reference,  talks about people who are looking for God's love. We're hard-wired, it seems, in our search for love.

Know that God's love is always there for you, coming to your rescue, keeping body and soul together.

Too soon for certainty, but a potential way to recover stroke patients' limbs

Photo from Belén Rubio Ballester

Appears to be good news, with a large grain of salt.

I've seen several references how the use of virtual reality technology could help stroke patients recover the use of a limb. The idea is to have the limb represented on a computer screen, performing better than it performs in real life, which then makes the limb's functions improved in real life.

The grain of salt: It's from a study of just 20 people. Worth more research, but still a "maybe" at this stage.

You can read more through this link to a story about virtual reality and stroke patients:

In the study of 20 stroke patients, researchers sometimes enhanced the virtual representation of the patient's affected limb, making it seem faster and more accurate, but without the patient's knowledge.

After the episodes in which the limbs were made to seem more effective, the patients then went on to use them more, according to lead researcher Belen Rubio.

"Surprisingly, only 10 minutes of enhancement was enough to induce significant changes in the amount of spontaneous use of the affected limb," said Mrs Rubio from the Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems at Pompeu Fabra University in Spain.

Stroke risk rises for those with untreated apnea

Photo from flickr by Tony Webster

I don't have a real frame of reference about apnea. But I know a lot of people who face this sleeping disorder.

Now, another reason to investigate and, if necessary, treat this problem. In a study involving millions of people, it seems that untreated sleep apnea boosts risk of heart disease, stroke:

Obstructive sleep apnea (OSA) may increase the risks of death, heart disease, stroke, and kidney disease, as well as hasten kidney function decline, according to a study of more than 3 million U.S. veterans.

Compared with OSA-negative patients, untreated OSA was associated with an 86% higher mortality risk ... , and treated OSA was associated with a 35% higher mortality risk ... , wrote Miklos Z. Molnar, MD, PhD, of the University of Tennessee Health Science Center in Memphis, and colleagues, in the journal Thorax.

What sleep apnea? Follow this link to find out more about its causes and symptoms. And if this might - just might - explain why you often feel tired and sleepy, there's now one more reason to seek treatment.

What's the next phase of stroke treatment?

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I was fortunate enough to be in the right place, right time in 1998 - just two years after approval of clot-buster tissue plasminogen activator, also known as tPA or alteplase.

However, it's true that little has changed since then. Researchers have looked at different windows of time for the drug, which can quickly dissolve a clot to prevent further stroke damage, but new, safer and more effective drugs have not come to pass.

I have little right to complain about tPA, but I'm just one guy who benefited. It has its dangers, too. And while there are some good signs related to using devices to remove clots, much more research and work are needed to improve treatment and stroke outcomes.

You can read a recent article summarizing the need for the next phase in stroke treatment:

From biblical times to modern hospitals, timing can make all the difference

From Flickr by Sean MacEntee

Starting out in left field here. One of my favorite books in the Bible is Acts. Why? Because a lot of important events are happening quickly, and timing is critical. The order of events is part of a grand plan there.

I like timing things in life, too. I'm not as good as God with timing, but when my sequence of actions works, it gives me a great deal of satisfaction.

So, I'm interested in this recent story about how workflow processes can be a success, showing how clot busters can be delivered in an hour, even with an MRI:

Two centers -- one academic, one community -- that use MRI as part of an NIH study dropped their median DTN [Jeff's note: DTN stands for door-to-needle, or the time between the patient enters the hospital to the time of stroke treatment] time from 93 to 55 minutes after focusing their workflow processes, Amie Hsia, MD, of MedStar Washington Hospital Stroke Center, and colleagues reported online in Neurology.

Cholesterol and risk - drugs might help you prevent a stroke

More tools for lowering stroke risk - but let's make sure.

Check out the recent story how cholesterol drugs may lower stroke risk for healthy older adults:

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www.flaticon.com is licensed by CC BY 3.0

The study found that when people took medications called statins or fibrates, their risk of stroke over almost a decade went down by about one-third.

But, lead researcher Dr. Christophe Tzourio, a professor of epidemiology at the University of Bordeaux and Inserm in France, doesn't think older people should start taking these drugs solely for stroke prevention.

"Our results should not be interpreted as an indication for prescribing statins or fibrates to elderly individuals. We wouldn't recommend changing medications based on the results of only one study," he said.

"The next step is to see whether we can replicate our findings or not," he added.

I'd second the doctor's notion of waiting. If you're a "healthy older adult," you might question the need of adding a drug that might have some unsettling side effects. Yet, if cholesterol numbers indicate a problem, be sure to work with your doctor to decrease your risk.

'You have done wonderful things, planned long ago ...'

Lord, you are my God. I will exalt you; I will praise your name, for you have done wonderful things, planned long ago, faithful and sure.

-Isaiah 25:1

Sometimes, not often, I think of what might have been. If my stroke never happened, my language never affected, this life nearly snatched away from me.

A rather pointless exercise, I must say.

When those thoughts show up, I should consider words such as the ones from Isaiah - God has done wonderful things, planned long ago, faithful and sure.

Now, certainly, this life is not a rosy walk in the park all the time. Still, consider wonderful things. Beautiful mountains, streams and forests. People who play a positive influence in your life. Wonderful things can be small - even a moment of peace. Or can be large - positive, life-changing events or revelations.

We often pray to God when bad things happen. And we should. But consider exalting God, too, when we recognize his wonderful things. God is faithful and sure.