Best stroke outcome still comes down to speed, it seems

When the drug tissue plasminogen activator (tPA) came along, we've heard time and again that speed is vital for improved outcomes for stroke patients.

Now, with other tools becoming available, it seems that the rule of speed still applies. The most recent example comes from an article about three keys to blazing fast thrombectomy:

Reduced disability with mechanical clot removal for large-vessel ischemic strokes -- as consistently seen across recent trials -- gave a clear mandate for use but also re-emphasized the need for speed.

"It's all about timing," said Patrick Lyden, MD, director of the stroke program at Cedars-Sinai in Los Angeles.

Read the whole story about the three keys. And remember - if you or someone you care about exhibit stroke signs, get to care. Fast.

'And the Lord hears them' - even with aphasia

The righteous cry out, and the Lord hears them; he delivers them from all their troubles. The Lord is close to the brokenhearted and saves those who are crushed in spirit.

-Psalm 34:17-18

"Righteous" can be a scary word. In this context, David was talking about those who were following God. And God loves and accepts even those imperfect followers like me. (And you!)

The last post was about aphasia, a language problem that can be the result of a stroke. It's often misunderstood - as anyone afflicted with aphasia would know.

So the best part of the verse: "...the Lord hears... ." I'm convinced that God hears one despite language problems, even despite one's silence or those who are struggling for words to speak. God hears you. When you are frustrated, God is close, ready to save "those who are crushed in spirit."

Don't confuse 'Game of Thrones' character with reality

I'm not a fan of the HBO series "Game of Thrones," but apparently, I'm in a distinct minority.

So I was surprised when I started reading that one character supposedly has aphasia, a language condition that affected me during and after my stroke, and many, many others. Maybe even you.

Now, aphasia does NOT diminish one's intelligence. You've got all those thoughts in there, and aphasia is often a barrier to get those thoughts out through speech.

So I did a little research, and instead of this being an instance to educate the public about aphasia, the talk that the character Hodor has aphasia - which is incorrect - has bolstered the mistaken impression that aphasia effects intelligence. Again, it does not.

Here's a good rundown on why this idea is wrong, highlighting that Hodor does not have aphasia:

Researchers are still puzzling through clot-buster's best timing and use

So, should we use tissue plasminogen activator more, or less?

Depends on where you read it.

The general rule is that the clot-busting drug (click here to read more about tPA) should be given within 3 and 4.5 hours, depending on who you ask.

One recent article leans toward the three hours:

"From analyzing all the available data, tPA [tissue plasminogen activator] after 3 hours for stroke patients may not be of any benefit but has a definite risk of fatal bleeding," Dr Alper told Medscape Medical News.

He pointed out that most guidelines on tPA in stroke recommend its use up to 4.5 hours after symptom onset, including those by the American Heart Association/American Stroke Association (AHA/ASA), which give tPA a Class 1 recommendation in this time window, but he says the data do not justify such recommendations.

"Other societies give weaker recommendations but the latest guidelines of the Canadian Association of Emergency Physicians give a weak recommendation against use of tPA after 3 hours. They are recognizing the uncertainty of the benefit and the greater consistency in harm," he added.

"Unless and until there are data showing unequivocal benefits to outweigh known harms, we believe that there should not be any strong recommendation or encouragement for the use of alteplase beyond 3 hours after stroke," Dr Alper and colleagues conclude in the BMJ paper.

But, on a different tack from a different story and a different study, you can find the suggestion for widening the use of tPA - not by time, but by type of patient. The article suggests that tPA could be used more widely for stroke patients:

Could this lead to save money and, more importantly, lives?

Lately, we've seen discussions, debates and heated arguments about health care costs.

And we've know, too, that atrial fibrillation is a major stroke risk.

Now, those two problems merge as a study shows that hospital costs of stroke patients rise in presence of afib:

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

"Overall, Afib increased the hospital costs of patients with ischemic stroke substantially across all age and sex groups," medical economist Guijing Wang, PhD, and colleagues from the CDC's Division for Heart Disease and Stroke Prevention wrote online in Stroke.

The findings suggest the need for studies evaluating the cost effectiveness of interventions to reduce the incidence of Afib, which is associated with a four- to five-fold increased risk for stroke, Wang told MedPage Today.

"We know that in older populations it may be too late to prevent Afib, so these interventions should start in younger adults," he said, adding that his research team plans to study the cost impact of such interventions.

So, interventions early for afib could not only reduce stroke risk, but reduce costs, which eventually benefits everyone. This research bears watching.

One more connection between heart and stroke

You see a lot of news about atrial fibrillation stroke risk. And my own stroke was ascribed to a hole in my heart combined with a divot along the atrial wall.

Now, one more connection, how a study findings suggest that a pouch in the heart may trigger unexplained strokes:

A pouch-like structure in the heart may be the source of some strokes that have no other known cause, a new study suggests.

This pouch in the heart's left atrial chamber -- called a left atrial septal pouch -- was first discovered in 2010 by cardiologists at the University of California, Irvine.

"The cul-de-sac nature of this heart pouch may promote stagnation of the blood, forming clots that can travel into the brain and cause a stroke," Dr. Mark Fisher, a professor of neurology and pathology and laboratory medicine, said in a UC Irvine news release.

Heart health and stroke risk - pay attentio
n to both.

Is something right happening in health care?

Something right might be happening.

In catching up on stroke-related news of late, I was reminded about a story showing that emergency departments are seeing fewer strokes and TIAs:

The rate of adult emergency department (ED) visits for ischemic stroke or TIA fell 35%, from 40 to 26 per 10,000 persons from 2001 to 2011 in the National Hospital Ambulatory Medical Care Survey (NHAMCS) data. The rates fell across age groups -- a relative 51% in the 55-to-74 range and 26% for those ages 75 and older, Anjali Talwalkar, MD, MPH, and Sayeedha Uddin, MD, MPH, both of the CDC's National Center for Health Statistics in Silver Spring, Md., reported in the March issue of NCHS Data Brief.

But among younger people who came to the ED for ischemic stroke or TIA, fewer were arriving by ambulance.

Strokes are generally preventable, with fairly common-sense diet, exercise and medication use leading those methods of prevention. I've put links under each of those categories, where you can read more about stroke prevention.

Stroke treatment is still vitally important, and improving stroke treatment through better medication, better therapy techniques and tools are key elements of stroke treatment. But preventing a stroke is the best treatment of all. So do what you can - the life you save could be your own.

'... Patient in affliction ...'

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

-Romans 12:12

I'm intentionally repeating these words from Paul today. In April 2014, I posted about my then-recent knee surgery and my need for patience.

Today marks one year plus a day after the arthroscopic knee surgery. I'm still not quite there, but getting closer.

And I'm still thinking about patience today. And, I hope, tomorrow. And so on.

A few months ago, I made an intentional decision to change the way I prayed about my knee. With more confidence. With more patience. It has made those months much easier for me to accept that sometimes, recovery is slow. Today, I feel that I'm a more patient patient.

And more confident, too, that God will take care of me. Do I get everything I want in the deal? Not necessarily. But God will put me in a place where he can use me, all of me, knee and all.