Basic facts about strokes -- they might save a life

May is Stroke Awareness Month. And here's a quick rundown on basic stroke facts, including signs and symptoms. Here's some of what you need to know about strokes:

During a stroke, nearly 120 million brain cells die every hour. Compared with the normal rate of brain aging, the brain ages 3.6 years each hour during a stroke. The sooner a patient receives care, the better the chances of recovery.

About 66 percent of strokes are spotted by a bystander, but less than half of Americans know the common warning signs and symptoms of stroke, which can be remembered using the acronym FAST -- (F) face drooping, (A) arm weakness, (S) speech difficulty, (T) time to call 911.

Other stroke symptoms include sudden numbness, sudden trouble seeing in one or both eyes, sudden severe headache with no known cause and sudden trouble walking.

The fastest way for stroke patients to receive treatment is by calling 911. Driving to the hospital is a common mistake people make, and it can result in longer wait times before the patient receives care.

Today is the 20th anniversary of my own stroke

It was 20 years ago today – the day I nearly died.

You can click here to read some details about my stroke on May 8, 1998, or here to read more about my treatment.

To this day, I thank God for everyone who helped me survive that day.

I always approach my stroke’s anniversary with mixed feelings. As I’ve said before, this blog isn’t about me, but about faith and stroke awareness. So I try not to dwell on that anniversary every year.

I even gave a great deal of thought about retiring this blog today. I certainly have slowed down in my posts here. Life has the habit of getting in the way.

But instead, I’ve decided keep this blog around, at least for a time. No promises on how frequently I’ll post.

And again, it’s not really about me. So I invite you to share your own story in the comments.

Saunas seem to help lower blood pressure, might prevent strokes

Now, here's some news I can appreciate - saunas might lower stroke risk:

Middle-aged and elderly men and women who had four to seven hot, dry sauna bathing sessions a week were 60% less likely to have a stroke over a 15-year period than those who had one weekly session, reported Setor Kunutsor, PhD, of the University of Bristol, U.K., and colleagues online in Neurology.

These results "are very strong and consistent, given that we have previously shown that sauna use reduces the risk of cardiovascular mortality," Kunutsor told MedPage Today.
Saunas -- which are found in nearly every home in Finland -- have been linked to lower cardiovascular disease and overall mortality, but have not been studied in stroke until now.

"Sauna appears to have a blood pressure-lowering effect," Kunutsor said. "Since the majority of strokes can be attributed to hypertension, sauna use may reduce the risk of stroke via reduction in blood pressure." Sauna also may stimulate the immune system, stabilize the autonomic nervous system, and reduce inflammation, oxidative stress, arterial stiffness, and vascular resistance, he noted 

Everywhere in the world, time is critical for stroke care

It's not just in the United States where stroke patients aren't getting to the emergency department in time. Check out the story from Ireland how over 60pc of stroke patients not arriving on time:

More than 60pc of people who suffer a stroke are not making it to hospital emergency departments in the ideal time frame, specialists warned yesterday.

The success of acute treatment of stroke is extremely time-dependent, the Oireachtas Health Committee was told.

The doctors called for a relaunch of the Act-FAST campaign, which raised awareness among the public about being aware of the symptoms of a stroke.

Prof Rónán Collins, Dr Diarmuid O'Shea and Prof Ken McDonald were appearing before the committee.

The doctors said that a "third to a half of all strokes may be prevented through lifestyle change, management of blood pressure and identification of an irregular heart rhythm".

A "nationwide approach to cardiovascular disease prevention is needed", they said.
Admission to a stroke unit is the foundation of all stroke care and reduces death and disability by 25pc.

"To achieve optimum patient outcomes, all acute stroke patients should be managed in an acute stroke unit," they said.

(Photo from leppre via Flickr)

'Don't be afraid, for I am with you'

Don’t be afraid, for I am with you. Don’t be discouraged, for I am your God. I will strengthen you and help you. I will hold you up with my victorious right hand.

-Isaiah 41:10

Fear, discouragement, weakness - we've all had those feelings.

If you've followed the last couple of postings (click here for the first one, here for the second), you'll know that I'm recovering from eye surgery, with the likelihood that I'm going to have one or two more procedures on my left eye.

As mentioned before, the vision in that eye is blurry. Slowly improving, but blurry. That makes it a little slow to write blog postings (please excuse any typos), emails and other computer tasks. So I need words - like those from Isaiah - to bring encouragement and hope.

And I hope these words help in your own struggles.

'Wait patiently for the Lord'

Wait patiently for the Lord. Be brave and courageous. Yes, wait patiently for the Lord.

-Psalm 27:14

A followup from the last posting - about dealing with worries. I'm also needing some patience.

I'm currently waiting for my left eye to heal from surgery. As this is being written, it's blurry and not really focused.

So I  could use a dose of patience. I want my vision to be stable now. But the healing process requires time, potentially months. So in addition to bring my worries to God in prayer, I need to wait patiently as my eye heals.

How do you wait patiently for the Lord?

'Do not be anxious about anything'

Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.

-Philippians 4:6-7

Lately, it's been hard not to be anxious.

Back in January, I learned that I had a detached retina in my left eye. By Jan. 15, I had the first of two procedures to correct the problem.

That seemed to fix it, but it erupted in a different spot in the same eye, so in late January I had surgery. Now, my left eye's vision is blurry, as expected after surgery. It's slowly improving. Slowly. And it's likely I'll need to have one or two more procedures for the same eye.

It's easy to fall into anxiety and worry about that vision as it slowly returns. But I'm trying - sometimes successfully - to place those worries in God's hands through prayer.

Paul offered these words to the Philippians to ease anxiety. How do you handle your own worries?

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."

Get a flu shot - and perhaps decrease your stroke risk

Have you had your flu shot yet?

Especially if you're an older adult, the flu increases your risk of stroke or heart attack. Flu can have a dangerous domino effect on older adults:

"Not as well known: In the two weeks to a month after you recover from influenza, you have a three to five times increased risk of having a heart attack," Schaffner said in a university news release. "You have a two to three times increased risk of having a stroke.

"Nobody wants a heart attack or a stroke, so by preventing flu, you prevent this inflammatory response and you can help prevent those strokes and heart attacks," Schaffner said.

Seniors account for more than half of flu-related hospitalizations caused by influenza and more than 80 percent of flu-related deaths, he said, so it's especially important for seniors to get a flu shot.

Strokes and holes in the heart - a solid explanation

A good explanation of what likely happened to me almost 20 years ago - a hole in the heart causing a stroke. A trusty Google alert found this good, simple explanation how after a stroke with no clear cause, a heart repair may be in order:

A still from the video of my PFO closure.
Click here to watch the video.

Most strokes occur when a clot blocks blood flow to part of the brain. Often, doctors can tell what caused the clot to form. But about a quarter of the time — especially in people younger than 60 — there is no obvious reason. These types of strokes are known as cryptogenic (meaning "of hidden origin").

One possible cause underlying a cryptogenic stroke is an opening in the wall that separates the heart's right and left upper chambers (atria). Known as a patent foramen ovale, or PFO, this flaplike opening is quite common. About one-quarter of all adults have a PFO (see "What is a patent foramen ovale?").

"But about 45% of people who have cryptogenic strokes have a PFO, which suggests the two conditions are related," says Dr. John Jarcho, a cardiologist at Harvard-affiliated Brigham and Women's Hospital. Yet for years, the question of whether closing a PFO could prevent additional strokes has been hard to answer.

Click on the link above for the entire article. And you can click here to read more about my own experience, including a heart repair in 2007.

'He guides me along the right paths'

He makes me lie down in green pastures, he leads me beside quiet waters, he refreshes my soul. He guides me along the right paths for his name’s sake.

-Psalm 23:2-3

It's been months since this blog has featured a posting based on Scripture. Why?

My life has been increasingly busy - work, home, etc - and the Scripture-based postings require me to think differently. I don't want to just throw out random thoughts to accompany Bible verses. It's been easier lately to just quote a recent article about stroke research or prevention.

I ran across the verses above several weeks ago, waiting for inspiration. I don't know if I have inspiration or not, but I feel compelled to include these verses today, especially the last sentence.

Modifiable stroke risks still rising across all ages, races

Most - not all, but most - strokes are preventable. Experts have been know for years that risk factors include high blood pressure, smoking and high cholesterol. All addressable issues. Yet, as NPR reported not long ago, modifiable stroke risks are still rising across all ages and races:

For years, doctors have been warning us that high cholesterol, cigarette smoking, illegal drug use and diabetes increase our chances of having a potentially fatal stroke.

And yet, most of the stroke patients showing up at hospitals from 2004 to 2014 had one or more of these risk factors. And the numbers of people at risk in this way tended to grow among all age groups and ethnicities in that time period. 

TIAs: Don't call them ministrokes

I've called them ministrokes before, but this article from U.S. News makes me re-think that phrase. It contends that you shouldn't call transient ischemic attacks ministrokes:

Yet, while 35 percent of adults in the U.S. have had symptoms suggestive of a TIA, only 3 percent of them called 911 for help, according to a recent online survey of more than 2,000 people by the American Heart Association and American Stroke Association. That’s a mistake, experts say. If you have symptoms of a stroke or TIA, “don't wait it out,” advises Dr. Dion F. Graybeal, medical director of stroke at the Baylor University Medical Center in Dallas. “Take these symptoms seriously and call 911.” If it’s a real stroke, every minute counts in terms of getting treatment and reducing the risk of permanent disability. And if it’s a TIA, “it’s an opportunity to intervene and hopefully stop a process or condition that could cause a stroke with disability in the future,” Graybeal says.

It’s better to be safe than sorry because if you have stroke-like symptoms, it’s difficult to tell immediately if you’re having a TIA or a full-blown stroke, says Dr. Nieca Goldberg, a cardiologist and medical director of the Joan H. Tisch Center for Women’s Health at the NYU Langone Medical Center in New York City. So it’s important to get to the hospital as soon as possible, There, you will most likely have a CT scan, a CT angiogram, an MRI or an MR angiogram of your brain and the blood vessels in your head to look for a blood clot and evidence of damage to the brain. If damage isn’t apparent and the symptoms have resolved, the episode will be deemed a TIA. But if there is evidence of damage to areas of the brain, the event will be diagnosed as a stroke, even if the symptoms have gone away, Goldstein says.

Stopping aspirin therapy may raise heart attack, stroke risk

Aspirin - cheap and perhaps lifesaving. So read how stopping aspirin therapy may raise heart attack, stroke risk:

Stopping low-dose aspirin therapy without good reason raises the likelihood of heart attack or stroke by nearly 40 percent, a large Swedish study suggests.

Doctors commonly prescribe daily low-dose aspirin after a heart attack to reduce the risk of having a second cardiovascular event. But about one in six patients stop taking their aspirin within three years, the study authors note in Circulation.

Closure of hole in the heart reduces stroke recurrence

A still from the video of my PFO being closed.
Click here to view the video.

If you've read this blog before, you might know that my hole-in-the-heart was closed 10 years ago. Click here to read details.

The hole is called a patent foramen ovale, or PFO. It's an opening between the upper chambers of the heart. We're all born with one, but it's normally closed shortly after birth. For some, though, it remains. For some people, blood clots can pass from one side to the other, getting pumped out to the arteries and eventually in the brain, causing a stroke.

Drug prices especially hit hard in rural America

Which is more valuable - the life of someone who lives in Mountain View, Ark., (population 2,860) or someone who lives just one county over?

That's the question from a good NPR piece about how high drug prices hit rural hospitals extra hard, a story beginning with the story of a stroke patient coming in to a small, rural hospital needing an expensive drug:

For example, Langston's 25-bed hospital pays $8,010 for a single dose of Activase — up nearly 200 percent from $2,708 a decade ago. Yet, just 36 miles down the road, a bigger regional hospital gets an 80 percent discount on the same drug. White River Medical Center, a 235-bed facility in Batesville, Ark., buys Activase for about $1,600 per dose.

White River participates in a federal drug discount program Congress approved in the early 1990s. The program offers significant price breaks on thousands of drugs to hospitals that primarily serve low-income patients. One federal report found the average discount ranged from 20 to 50 percent, though as illustrated with Activase, it can be much higher.

After years of decline, South sees rise in stroke deaths

Even though the South is also know as the Stroke Belt, we've seen a decline in stroke deaths - until now. In the most recent numbers, stroke deaths are rising in the South:

In its monthly Vital Signs report, the Centers for Disease Control and Prevention reported that stroke deaths are on the rise in the South in recent years after decades of decline, and rates are stagnant in other states. While stroke deaths have declined more than 76 percent since 1968 among adults 35 and older, and 38 percent since 2000, that decline has roughly leveled off or even increased in most states since 2013, according to the report. That includes an overall 4 percent increase in the South, with a 3 percent increase in Georgia and a whopping 10.8 percent increase in Florida.

“This is an important wake-up call,” said Dr. Brenda Fitzgerald, director of the CDC and a former Commissioner of the Georgia Department of Public Health. It is particularly alarming among those ages 35-64, which made up a third of the more than 32,000 “excess stroke deaths,” those who died from stroke who might not have had the death rates continued their decline.

Meth could up stroke risk in younger users

Methamphetamine's dangers are well known - and now, it looks like that the drug could up stroke risk in younger users:

With use of the stimulant increasing, particularly in more potent forms, doctors in many countries are seeing more meth-related disease and harms, the Australian study authors said. This is especially true among younger people, who are the major users of the drug.

"It is likely that methamphetamine abuse is making a disproportionate contribution to the increased incidence of stroke among young people observed over recent years," said researchers led by Julia Lappin. She's with the National Drug and Alcohol Research Center at the University of New South Wales in Sydney.

These strokes can lead to disabilities or death, she and her colleagues pointed out.

(Photo from MedlinePlus)

Men are seeing a decline in stroke risk - but women?

You might have seen postings about the disturbing numbers about younger people having strokes. Now, while stroke risk is declining among some groups, a recent study suggests that stroke risk is declining in men but not women:

The incidence of stroke has declined in recent years, but only in men.

Researchers studied stroke incidence in four periods from 1993 to 2010 in five counties in Ohio and Kentucky. There were 7,710 strokes all together, 57.2 percent of them in women. ...

No one knows why there has been no improvement in women, but the lead author, Dr. Tracy E. Madsen, an assistant professor of emergency medicine at Brown, said that some risk factors have a stronger effect in women than in men. Risk factors for stroke include high blood pressure, heart disease, diabetes and smoking.

Where did your stroke happen? Geography might impact treatment

Photo from David Kessler via Flickr

Last week, the posting was about people born in the "stroke belt" region.

So for a related item, a look at cholesterol-treating drugs seem less likely to be prescribed in the stroke belt, with no statin prescribed for half of stroke survivors:

But inside the so-called Stroke Belt region, seniors were 47% less likely to be discharged on a statin, and men were 31% less likely to get a prescription for the lipid-lowering drugs than women. Neither association was seen outside the Stroke Belt.

"All survivors of ischemic stroke should be evaluated to determine whether they could benefit from a statin, regardless of the patient's age, race, sex, or geographic residence," lead author Karen Albright, PhD, DO, MPH, of the Birmingham VA Medical Center, said in a press release.