Alexa - tell me how to save a life

Alexa has moved into our home.

That is, a couple of Amazon Echo Dots occupy the place where I live. So far, I've told Alexa (the name of the voice) to tell me jokes, give me news and weather information, play radio stations, play music and more.

Very handy devices, all voice-controlled.

And now, Alexa can tell you the steps for CPR and warning signs of heart attack and stroke:

Alexa, the friendly voice of the Amazon Echo, will for the first time offer CPR instructions and describe the warning signs of heart attack and stroke.

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.

Having the hard discussions

Photo from the U.S. Department of Veterans Affairs

We all want to recover completely - the alternatives are unpleasant, and we're tempted to shy away from even thinking about these alternatives.

But the truth is, stroke is the most common cause of disability in the United States, and it's the fourth leading cause of death. Of course, the medical community needs to continue its efforts to find better ways to prevent and treat strokes to improve these numbers.

It's sometimes hard to talk about the type of care that some stroke patients need. And I'm not 100 percent in agreement with the tone and implication of the American Heart Association/American Stroke Association statement that "the majority" stroke patients need palliative care - that is, care with the emphasis on comfort rather than dealing with the underlying problem.

Still, the ASA did come up with some potential discussion points between stroke survivors, caregivers and health professionals:

As a stroke survivor or family member, you should expect your healthcare provider to:

• Talk about your preferences, needs and values as a guide to medical decisions.

• Discuss what aspects of recovery are most important to you.

• Have effective, sensitive discussions about your prognosis, how to deal with physical or mental losses from a stroke, and if necessary, of dying, among  other serious topics.

• Guide you through choices about life-sustaining treatment options. Providers should address pros and cons of CPR, ventilators, feeding tubes, surgery, do-not-resuscitate orders (DNR), do-not-intubate (DNI) orders and natural feeding.

• Know the best treatment options for common post-stroke symptoms, including pain, other physical symptoms and psychological problems like depression and anxiety.

• Engage a palliative care specialist if complex issues arise.

• Help preserve dignity and maximize comfort throughout the course of a stroke, including during the dying process and when nearing death.

Understandably, these might be very hard conversations. But avoiding these conversations might cause increased and needless suffering.

A quiz for Stroke Awareness Month

Many - even most - strokes are preventable by reducing the stroke risk factors.

For Stroke Awareness Month, check out this quiz from the American Heart Association:

Test your stroke I.Q. by answering these six questions. By knowing the stroke risk factors and symptoms, you can make a difference in your life or someone else's.

Appropriate blood thinner use is on the rise

From the Good News Department, via Reuters Health,  more stroke patients get clot-busting drugs:

As many as 95 percent of stroke patients with atrial fibrillation, a common heart rhythm disturbance, got blood thinners in 2010, researchers found. That's up from 88 percent in 2003.

The findings are based on nearly 1,400 U.S. hospitals in the "Get With The Guidelines -- Stroke" program, created by the American Heart Association and the American Stroke Association to make sure doctors are following up-to-date practices.

"Hospitals participating in this program improved their ability to deliver appropriate stroke care," said lead researcher Dr. William Lewis, a heart specialist at Case Western Reserve University School of Medicine in Cleveland, Ohio.

About 800,000 Americans suffer a stroke each year, according to the American Heart Association.

Live TV lesson about stroke signs

The chilling video of  Los Angeles TV reporter Serene Branson was played over and over the last few days. She began stumbling over slurred words on live television. Her face appeared not quite symmetric - class stroke signs.

Turns out, as U.S. News and World Report reported, her severe migraine mimicked a stroke:

Doctors at the University of California, Los Angeles, who performed a brain scan and blood work on Branson, said she suffered a type of migraine - often called a complex or complicated migraine - that can mimic symptoms of a stroke, the Associated Press reported Friday.

Dr. Ralph L. Sacco, president of the American Heart Association and chairman of neurology at the University of Miami Miller School of Medicine, explained that "a complicated migraine can often masquerade as a stroke or TIA (transient ischemic attack, sometimes called a mini-stroke)."

The symptoms can look just like a stroke, Sacco said, including loss of vision, blurry vision, paralysis on one side of the body, trouble speaking and trouble walking. "All kinds of things we associate with a TIA or stroke can be part of a complicated migraine," he said.

For people whose first experience with a migraine is a complex migraine, Sacco advises that they assume it is a stroke, however.

"If people have these classic symptoms, we should treat them as the emergency we think they are, which is a possible stroke," he said.

Branson did the right thing: Even though her symptoms subsided, she sought follow-up care. Too often, people don't see a doctor after a mini-stroke, setting themselves up for full-blown strokes. The lesson we can all take away: When you detect these signs, get help right away. It might just save a life.

From ABC News, a video of a good discussion of stroke signs:

Tracking stroke care can improvement care

What's best for stroke victims?

Important question. Most of us know someone who have suffered a stroke. Everyone knows who someone who is especially at risk. Not long ago, the American Heart Association released new guidelines for stroke care:

The updated standards include:

• Specifically tracking the percentage of ischemic stroke patients identified as eligible for tissue plasminogen activator (tPA) and appropriately treated within a 60-minute door-to-needle time. According to the guidelines, tPA is the only clot-busting drug approved for treating ischemic strokes and is effective only when given within a few hours after the onset of a stroke.

• Tracking the time from hospitalization to treatment to repair blood vessels for patients with a ruptured aneurysm.

• Performing 90-day follow-up of ischemic stroke patients to assess their outcomes after acute interventions, including treatment with tPA.

Standards like this will help find ways to make better decisions that will improve treatment for people who are often helpless when they arrive at a hospital.

Approaching your mid-40s or beyond? Watch out

As Stroke Awareness Month approaches, another article illustrating the need for awareness, Stroke: Journal of the American Heart Association:

Rates of the most common form of stroke begin to increase sharply after age 44, particularly in men, researchers reported ... .

In a Finnish study of 1,008 ischemic stroke patients less than 50 years old, researchers also found:

• a high frequency of stroke risk factors in young patients;
• a high percentage of “silent” and multiple strokes;
• the pattern of stroke-causing events begins changing in midlife to resemble that of the elderly.

My stroke occurred at age 39 - and I suspect a pretty serious TIA about 10 years earlier. So do a favor for a friend: Remind them of stroke signs.

Faith and strokes: Interesting study

A recent article reports what the faithful already knew.

The article, "Scientific American: Religious faith may help stroke victims: study," is based on an article in newsletter Stroke, published by the American Heart Association. Researchers at the San Raffaele Pisana Rehabilitation Center in Rome interviewed 132 stroke survivors about their religious beliefs and spirituality.

"The analysis showed higher scores on the anxiety and depression scale correlated significantly with lower scores on the religious and spirituality questionnaire," said the American Heart Association, which publishes Stroke.

In English: Chances are, if you have faith, your stress levels are lower after a stroke.

One more note from the article: "The reasons for this possible link between faith and post-stroke emotional distress are hard to pin down, though the researchers gave tentative explanations."

Hard to pin down? How about this: God, through your faith, gives you strength.