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.

Ambulance still best choice for stroke transport

This is not a big surprise - ambulance still best choice for stroke transport:

If "time is brain," then patients with ischemic stroke should get to the emergency department by ambulance rather than private vehicle, one study suggested.

Arrival times of 3 hours or less were more likely in an ambulance than in a private vehicle ..., according to Sheryl Martin-Schild, MD, PhD, of Tulane University in New Orleans, and colleagues.

If you read the entire article, you'll see that ambulance patients are more likely to show up within three hours of stroke onset, which means better chances with the only current treatment available for clot-type strokes.

The final outcomes at discharge, interestingly, of both ambulance-driven and private transportation patients are about the same. However, it's also the case that generally more severe stroke patients arrive by ambulance, while the generally less severe arrive by private transportation. So the ambulance-arriving patients generally start out worse but wind up about the same.

The takeaway on this - know stroke signs, and if you think someone is having a stroke, call an ambulance!

Avoiding an ambulance can be tragic

Too often, people wind up at a hospital too late for the best stroke treatment. Another story made the rounds, this time how a third of stroke victims delay action by avoiding ambulance:

When patients were taken by ambulance, 79 percent of them got to the hospital within two hours after they first started to notice symptoms. That’s crucial, said Wallace, who has specialized in stroke treatment since the mid-1990s. The most common form of stroke can be treated in most cases with a clot-busting drug. But it must be injected within a maximum of 4½ hours from the onset of symptoms, and it’s better if injected within three hours, she said.

“That means a person has to have symptoms, recognize it, get into the hospital, be seen by us, get a CAT scan of the brain, IV started and a decision made, all within 180 minutes,” Wallace said."

Look tomorrow for another - very personal - story showing the importance of getting to help in time.

The thing to do: Call 911

Just a couple of postings ago, this blog noted that research showed that there is still often a time issue for stroke patients - they are too often not getting to help in time.

Now, more news along those lines: Stroke patients don't call 911:

Nationwide, only about half of stroke patients arrived at the emergency department via ambulance and that figure hasn't changed over a 10-year period, Hooman Kamel, MD, of Weill Cornell Medical College in New York City, and colleagues found.

"Our findings suggest that national efforts to address barriers to ambulance use among patients with stroke need to be intensified or adjusted," they reported in a research letter in the March 14 issue of the Journal of the American Medical Association.

Thrombolytic therapy improves outcomes after ischemic stroke, but most patients don't present to the hospital in time, which is typically within 4.5 hours of symptom onset. That's despite numerous educational efforts to encourage people to call 911 at the earliest signs of stroke, especially because being transported via ambulance results in quicker arrival at the emergency department."

Thank God - and I mean thank God - someone had the presence of mind to summon an ambulance on the day my stroke occurred. But too often, that doesn't happen.

Now, does calling for ambulance guarantee an ideal outcome? No. Nothing can. But does failing to call 911 reduce your chances of a good outcome? Absolutely.

(Image from Alexander County (N.C.) Health Department)

It's really OK to call for help

During Stroke Awareness Month, a good reminder...

Many say they'd call 911 for stroke signs, but most don't:

In a survey of 253 predominantly African American community volunteers in Washington, DC, 89% said they would call 911 at the first sign of stroke symptoms. However, in structured interviews with 100 hospitalized stroke patients (or proxy respondents) in the same city, only 12% reported actually calling 911 immediately at symptom onset.

The disconnect was "striking" when comparing what healthy participants said they would do hypothetically and what most actually did when faced with stroke symptoms, first study author Amie W. Hsia, MD, director of the Washington Hospital Center Stroke Center in Washington, DC, noted in a statement.

"The failure to act promptly contributes to delayed presentation, reduced opportunity for acute therapy, and greater stroke morbidity," Dr. Hsia and colleagues note in their report. They say further research is needed to "determine and conquer the barriers between behavioral intent and actual behavior to call 911."

(Image from State of Montana 9-1-1 Home Page)

Time for more people to know about tPA

Like most people in 1998, I'd never heard of a drug called tPA (tissue plasminogen activator).

Sadly, too many people still don't know about it.

I recently became aware of a new book, "tPA for Stroke: The Story of a Controversial Drug" that digs into  why it's still largely unknown. The authors - Dr. Justin Zivin, a professor of neurosciences at the University of California San Diego who performed some of the earliest experiments that showed tPA could be used to treat stroke patients, and science writer John Galbraith Simmons - describe in detail the drug's controversial history.

In 1998, it had only been approved for stroke patients for a couple of years (1996) by the U.S. Food and Drug Administration. TPA acts to clear blood clots lodged in the brain - the main cause of stokes - allowing blood flow to resume to the brain. I am convinced that without the drug, at best, I would currently be disabled or, at worst, would have died that day. But because a willing neurologist happened to be available in a small-town hospital just two years after the drug was approved, I'm alive and well.

Thanks be to God.

Zivin recently talked with the San Diego Union Tribune not long about about the little-used drug that can minimize stroke damage:

Every 40 seconds, it happens to someone, somewhere in the United States. Stroke. It’s the third leading cause of death after heart disease and cancer, killing the victim in roughly three out of 10 cases while leaving many survivors with permanent brain damage and paralysis.

There is a drug, however, that can, if taken soon enough, minimize the consequences of a stroke, even produce a recovery so remarkable that it’s difficult to believe the patient ever even had a stroke. The drug is called tPA. Most stroke victims never get it.

And that's a shame. People need to know the stroke signs, call 911 and get the stroke victim to a stroke center - fast.

World Stroke Day: Oct. 29

Oct. 29 is World Stroke Day - marking attention for the third leading cause of death in the United States.

The numbers are sobering. In the U.S., more than 795,000 strokes occur each year, according to the Centers for Disease Control and Prevention. The cost in dollars: $73 million. The cost of death and disability is uncountable. It is the leading cause of permanent disability in the United States.  Every six seconds, someone in the world dies from a stroke.

But it's not just numbers. World Stroke Day campaign also highlights the fact that stroke can be prevented and that stroke survivors can recover and regain their quality of life with care and support: To quote the CDC:

The campaign is asking people to commit to six ways to reduce their likelihood of having a stroke.

1. Know one's personal risk factors, including diagnosed high blood pressure, diabetes, or high cholesterol.
2. Be physically active and exercise regularly.

3. Avoid obesity by eating a healthy diet with lots of fresh fruits and vegetables.
4. Limit alcohol consumption.
5. Avoid cigarette smoke. People who smoke should seek help to stop now.
6. Learn to recognize the warning signs of a stroke and call 9-1-1 right away if someone is suspected of having a stroke.

The links on this list will lead you to other resources and previous postings. Preventing a stroke can prevent the loss of a life or a life of disability.

Stroke Awareness Month is over, but....

Time is critical in treating stroke victims:

"Quite literally, the more time you waste or lose trying to treat a stroke, the more brain cells die," says Dr. Nasser Razack, director of neurosciences at Northside Hospital in St. Petersburg. "It's critically important that if you think you are having a stroke, or someone you know might be having a stroke, to dial 911 immediately and get help."

Time determines the treatment available to the estimated 780,000 Americans affected by stroke each year; one of the first questions doctors must answer when a patient arrives at a hospital emergency room is how much time has passed. It's especially critical as stroke remains the third leading cause of death in the country today, killing 187,000 people a year, the Centers for Disease Control and Prevention says.

Myth: Headaches always accompany strokes

This is a cautionary note about a myth that might make you hesitate to get some help if you or someone you care about might be having a stroke.

People might remember the following stroke symptoms, as the American Stroke Association lays out:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

However, people might miss the not-so-fine print, also on the association's Web site:

If you notice one or more of these signs, don't wait. Stroke is a medical emergency. Call 9-1-1 or your emergency medical services. Get to a hospital right away!

Notice the association doesn't say get if if someone has all the signs. Just once would suffice.

I did not have a headache associated with my stroke. Most of the people I've spoken with who have gone through having a stroke tell me that he or she did not have a headache. While a sudden, severe headache is a clear warning sign, especially of a hemorrhagic stroke. But it's only one sign, and you should pay attention to all of them.

Pivotal events, pivotal people

All of them were filled with the Holy Spirit and began to speak in other tongues as the Spirit enabled them.

-Acts 2:4

Pivotal events in history. When something occurs that changes the direction of a people, a nation, the world. Books upon books have been written about pivotal events. There’s a whole cable channel devoted to history. We study those events in colleges and universities, in elementary and high schools. We are all students of history because we all witness history, and our lives are intertwined with history.

And characters in those stories – pivotal people in pivotal events.

And this is one of reasons why Acts is one of my favorite books of the Bible. It constantly talks about the precise timing and planning of God that created the Christian church and spread its message throughout the world. It gives me comfort to know that no matter how chaotic this world seems to be, God is truly in control.

The verse above is from the pivotal event of the day of Pentecost that launched the Christian church. Read the entire story in Acts. And even further back, explore the beginning of the festival that brought all those people who heard Peter's message to Jerusalem.

Now, are all Christians challenged to stand up and preach in a language we suddenly can speak? Maybe. Maybe not. But I’m certain we can – in some way – be pivotal people in lives that God created.

I will never forget the pivotal people of the day I had a stroke - the colleague who got me some help; the people who transported me to a hospital; the fact that, in 1998 at a small hospital in a small town, there happened to be a neurologist capable of using tissue plasminogen activator for the "Lazarus effect."

You can be a pivotal person in the life of a stroke victim by simply calling 911 and getting some help. Be willing and stand ready to be that pivotal person if that time comes.

Myth: There's nothing you can do

In keeping of our series of stroke myths for Stroke Awareness Month, here's another one, and it happens too many times: Someone has a stroke, but it's assumed that the best thing to do is wait, that nothing can really be done.

A recent study showed that friends of stroke victims are reluctant to call 911:

a new study shows that most people who realize stroke warning signs are occurring in a friend or family member may not call 911, thereby delaying potentially lifesaving treatment.

This is alarming, Michigan researchers suggest, because people who suffer strokes need immediate assessment and treatment.

But people who would call 911 if they thought a friend or loved one was having a heart attack don't seem to realize that strokes are deadly, too, the researchers write; strokes are the No. 3 killer in the U.S. ...

"Calling 911 gets you to the hospital fast and allows the paramedics to communicate with the hospital so staff are prepared for your arrival," says study researcher Chris Fussman, MS, an epidemiologist with the Michigan Department of Community Health in Lansing, in a news release.

Yes, treat a stroke like a heart attack. Call 911 immediately. If the victim gets into an emergency room soon enough, there are potential treatment options available. But time is critical - every second is critical. Know the signs and symptoms, as described by the National Stroke Association:

F = Face
• Ask the person to smile. Does one side of the face droop?

A = Arms
• Ask the person to raise both arms. Does one arm drift downward?

S = Speech
• Ask the person to repeat a simple sentence. Are the words slurred? Can the person repeat the sentence correctly?

T = Time
• If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast. Brain cells are dying.

After spotting signs: It's about time

Now you know the signs - face, arms (or legs) and speech.

And please remember - don't wait for all of those signs. One is enough to follow the next important word:

Time. If you even think someone might be having a stroke, it's crucial to get help now. No waiting to see if things will get better on their own. No calling a well-intentioned friend or neighbor for advice. No amateur diagnosing. One call to make: 911.

Wise words from the National Institute of Neurological Disorders and Stroke:

Stroke is a medical emergency. Every minute counts when someone is having a stroke. The longer blood flow is cut off to the brain, the greater the damage. Immediate treatment can save people's lives and enhance their chances for successful recovery.

Ischemic strokes, the most common type of strokes, can be treated with a drug called t-PA, that dissolves blood clots obstructing blood flow to the brain. The window of opportunity to start treating stroke patients is three hours, but to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes.

(Image from the Missouri Department of Health and Senior Services)

Time = brain

As one more report shows, call 911 at first sign of stroke:

In a report released Friday by the Centers for Disease Control and Prevention, a national registry of patients who suffered a stroke between 2005 and 2007 has found that nearly 40 percent used private transportation to get to a hospital emergency room rather than calling 911.

Bad decision, because as every neurologist will tell you: Time is brain.

ER crowds can keep you waiting

With H1N1 making news, with seasonal flu coming to an ER near you soon, this story about ER crowds and longer waits from ABC News makes sense - unfortunately:

Wait time for the very sickest patients, those would die without being treated promptly (for example, someone whose heart had stopped or who wasn't breathing) was not affected by crowding. But patients who were in the next tier down, for example someone with chest pain or signs of stroke, did have to wait longer in crowded conditions.

In my own experience and observation, people who arrive via ambulance get shorter wait time - even more evidence that if you're wise, you'll call 911 if you or someone near you is showing stroke symptoms. Life, or lifelong disability, could hang in the balance.

Take warnings signs seriously

It's too easy to ignore a mini-stroke or transient ischemic attack - TIA - instead of acting and taking the event seriously.

After all, you get over it, with no lingering effect, right?

Wrong. A recent story, based on recent research, reporting that one in eight strokes are preceded by a TIA:

Mini-strokes, or TIAs, have the same symptoms as a full blown stroke, including sudden weakness, slurred speech and difficulty walking. The symptoms last only minutes or hours and since people recover within a day, many don't take them seriously.

But doctors say patients who suffer mini-strokes should seek immediate medical treatment, because intensive treatment can prevent a larger stroke.

For the study, researchers looked at 16,400 patients who went to Ontario hospitals after having a stroke over four years. Among the patients, 2,032, or 12.4 per cent, reported having the symptoms of a TIA prior to a major stroke.

This is a case where common sense prevails. Take action on a TIA, and you could avoid a deadly or severely damaging stroke. So take that action if you think you or someone you care about is having a TIA. Make sure you know the signs.

Get to an emergency room - or better still, a local stroke center if available - as soon as possible. Best bet: Call 911.

Fast thinking helps stroke victim survive

Always great to hear a story about stroke awareness and quick action, this one from the U.K.:

A grandfather is hoping to say a special thank you to two strangers whose prompt action may have saved his life when he suffered a massive stroke.

Dave Brint, 67, was walking along Cleveland Street when he collapsed against a wall unable to move down one side or speak.

Fortunately, two women passers-by went to his aid and asked an on-looker to call 999 (editor note: of course, in the U.S., that would be 911) immediately.

Just because you're young ...

Recent Reuters article shows that even health professionals can misdiagnose a stroke - for those who don't fit the mold.

Because the typical stroke victim is age 55 or older, an emergency room's staff may not suspect a stroke when a patient under 45 arrives with telltale symptoms, the researchers said.

They urged doctors to be vigilant for signs of a stroke even if the patient is young, noting the importance of quick treatment to prevent lasting damage.

"Accurate diagnosis of stroke on initial presentation in young adults can reduce the number of patients who have continued paralysis and continued speech problems," Dr. Seemant Chaturvedi of Wayne State University in Detroit, one of the researchers, said in a statement.

As other blog entries have noted, the move to get stroke patients to the right location for proper treatment is a great step forward. Another important move is to make sure the people who deal with emergencies - those who answer 911 calls, those who respond to those calls, ER staff, etc. - are aware of the signs and can help make life-saving decisions.

That includes you - even if you're under 40, it can still happen to you. Believe me, I know.

Need for speed: Those three hours

An article in the magazine Innovate, published by Barnes-Jewish Hospital and Washington University Physicians, explains how tissue plasminogen activator (tPA) has dramatically changed the treatment of clot-type strokes.

And it emphasizes the need to get stroke victims - even suspected stroke victims - to a properly equipped hospital right away. The clot-busting medication tPA is know to be effective, in carefully managed cases, within three hours of the onset of an ischemic stroke.

It also goes to the need for preparation and the availability of the right health professionals. Not every stroke victim is a candidate for tPA, and there's a limited amount of time to make that determination.

“In the wrong hands, tPA can be deadly,” the article quotes Dr. Jin-Moo Lee, Washington University neurologist at Barnes-Jewish. “Studies have shown that hospitals without a lot of experience actually end up causing more harm than good.”

That's important to know - especially if you have to speak on behalf of a stroke victim. Call 9-1-1. Be insistent that the victim is transported to a hospital with the correct expertise.

Anniversary and awareness

Stroke Awareness Month stories will come and go, with phrases to help you recognize stroke symptoms. We should all pay attention.

But any month, any day, any time, the bottom line: If things don’t seem right, don’t hesitate. If speech is slurred, get some help. If someone’s face becomes off kilter, call 9-1-1. If a limb gets weak or numb, stop what you’re doing and get to an Emergency Room. Vision blurred or sudden confusion? Don’t take a chance. Quick onset of a severe headache? Don’t take two aspirin and call the doctor in the morning. Get to the doctor now.

I was certainly blessed to receive help 10 years ago today, May 8, 1998, when my stroke occurred. Details are here.

My personal – and apparently final – resolution came last summer. In April, I had a mini-stroke, what doctors call a transient ischemic attack. A trip to the emergency room – hey, I learned my lesson - led me to some Columbia, Mo., specialists. A test involving a camera dropped down my throat to get an echo image of my heart confirmed what I was told 10 years ago, that the apparent cause was a misshapen wall and a hole between the two upper chambers of my heart.

With the combination of those heart defects, blood comes in on the vein side laden with clots and other debris - as normal - and instead of being pumped through the lungs and get filtered, sometimes debris collected along the wall, then shunted through the hole and pumped out, unfiltered, into the arterial system, a stroke waiting to happen.

Last June, a doctor in St. Louis snaked a tube through an artery and placed a quarter-size patch, made of nickel-titanium, over the hole. Six months later, my risk of a stroke became no more than the rest of the population in general. To celebrate my 10 years, I plan to run 10 miles, as usual, on Saturday morning.

Many stroke survivors do not have such an outcome, I know. But more awareness and faster treatment can save or improve a life. Perhaps even yours.

Stroke Awareness Month

Those three little words: Towrith. Rice. Torithe.

Or at least, that’s how my wife wrote them down 10 years ago, on May 8, 1998. Those were my three attempts to say the name of a city I’d visited often: “Jonesboro.”

That was the day that stroke awareness became personal.

A colleague and I, newspaper reporters, were digging through boxes of documents at a semi-hostile government office in Arkansas. Almost straight up noon, a tiny blood clot became lodged in an artery on the left side of my brain, toward the front. The results were profound: I could not speak or make a sound. My right arm and leg were useless and limp. A strange, dazed feeling came over me. The rest of the day became a series of blurred images – an ambulance ride, doctors and nurses, needles and tubes.

Death, a doctor and friend told me later, came close.

And slowly, jumbled speech and the use of my arm and leg returned. My wife asked me to repeat the name of a city where I’d been a few weeks earlier. Jonesboro is in east Arkansas, rice country, so with short-circuited wiring in my brain, the city name made me think of rice. The words she scribbled on a scratch pad are at a spot in my office where I can see them daily.

May is Stroke Awareness Month, and if nothing else, my personal account can bust a couple of stroke myths. Do they always happen to elderly people? No – I wasn’t even 40. Are you at risk only you smoke, or if you have high blood pressure or high cholesterol? Wrong. As a non-smoker and a longtime distance runner, my numbers were excellent.

That’s why it’s so important to recognize stroke symptoms and act quickly – a stroke can happen to anyone, anywhere, anytime. Somewhere in American a stroke happens on the average of every 40 seconds, according to the American Stroke Association. Every three of four minutes, a stroke kills someone.

Major organizations – the American Stroke Association and National Stroke Association are two big ones – have acronyms and catchphrases to help you remember and recognize the signs of a stroke. For the former, you’re supposed to “Give Me 5.” It offers a quick stroke check using five short words: Walk, Talk, Reach, See, Feel, as in:

• Walk – Is his balance off?
• Talk – Is her speech slurred or face droopy?
• Reach - Is one side weak or numb?
• See - Is his vision all or partly lost?
• Feel - Is her headache severe?

The latter calls its campaign “Act F.A.S.T.,” standing for:

• F = FACE – Ask the person to smile. Does one side of the face droop?
• A = ARM – Ask the person to raise both arms. Does one arm drift downward?
• S = SPEECH – Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?
• T = TIME –If you observe any of these signs, it’s time to call 9-1-1.

The last item is the most important. Because my colleague was alert, help came fast enough. Help came fast enough, so the doctors and nurses could bust the clot with a medication called tissue plasminogen activator, or tPA. The sooner after the stroke develops, the more effective the treatment. Most strokes are caused by a blood clot, but about 20 percent of the time, it’s caused by a ruptured blood vessel. Those cases are even more likely to be fatal.

So just don’t wait. Don’t wait for the symptoms to subside. Don’t wait until you are certain. Don’t wait until you can get someone to drive you to your doctor’s office. Get to the Emergency Room now. Preferably, call 9-1-1.

A false alarm is far better than a funeral.