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| Photo from the U.S. Department of Veterans Affairs |
As a stroke survivor or family member, you should expect your healthcare provider to:Understandably, these might be very hard conversations. But avoiding these conversations might cause increased and needless suffering.
- 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.
Stroke treatment within 60 minutes, telestroke networks, and expanded eligibility for clot-buster therapy are among the topics outlined in the new stroke guidelines from the American Stroke Association published in Stroke: Journal of the American Heart Association.
Many of the so-called new guidelines are a simple statement of accepted clinical practice, such as treating eligible stroke patients with IV tissue plasminogen activator (tPA) within 60 minutes of arriving at the hospital, Edward C. Jauch, MD, lead author of the document, told MedPage Today.Read the entire article for a full report.
On World Stroke Day, Oct. 29, he’s joining forces with the American Stroke Association, a division of the American Heart Association, to spread the word about something else he’s learned about stroke: In many circumstances, it is beatable.
Kevin Sorbo, star of the television series “Hercules,” was only 38 when he suffered three strokes. That was how he learned anyone can have a stroke.
"Like my character, Hercules, I thought I was invincible," said Sorbo, author of True Strength: My Journey from Hercules to Mere Mortal and How Nearly Dying Saved My Life. “There are many myths and misconceptions about stroke. As a survivor, I have learned that stroke is largely preventable, treatable and beatable."
More young people and adults in their 30s and 40s are being hospitalized for stroke, even as stroke rates are dropping in older people, new data show.While the reasons are still up in the air, it is clear that the young and old need to know the stroke signs and symptoms, and we all need to improve stroke prevention.
The findings, reported ... at the American Stroke Association conference in Dallas, may be a sign that that rising rates of obesity, diabetes and high blood pressure among teenagers and young adults are taking a toll.
Or it may simply be that physicians have improved their diagnosis and reporting of stroke in young people during the past decade.
A joint committee representing the American Heart Association and the American Stroke Association has published updated evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack; the statement has been published online Oct. 21 in Stroke. ...
"The recommendations in this statement are organized to help the clinician who has arrived at a potential explanation of the cause of ischemic stroke in an individual patient and is embarking on selection of a therapy to reduce the risk of a recurrent event and other vascular outcomes," the authors write. "Our intention is to update these statements every three years, with additional interval updates as needed, to reflect the changing state of knowledge on the approaches to prevent a recurrent stroke."
However, people might miss the not-so-fine print, also on the association's Web site:
- 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
He points out that, according the American Stroke Association, up to 80 percent of all strokes are preventable. But that’s easier said than done, right? After all, it takes more than good intentions to make lasting changes.
"I think there is a big disconnect with stroke," he says. "It’s the third leading killer and the number one leading cause of long-term disability, yet it’s 80 percent preventable. The question is: where’s the disconnect? I have friends with good insurance who won’t see the doctor on a regular basis."
Nu-Image, Just the Way You Like It and Sly's each offered free blood pressure checks and educational materials to African Americans, who are twice as likely to have a stroke as white Americans.
Janelle Holder-Williams of the American Stroke Association said the idea of reaching out to black men in barber shops is simple: "We wanted to reach the men where they are. Historically, the barber shop was also a hospital for the black community, because there was little else. ..."
Holder-Williams said after the age of 35, black men are four times more likely to suffer a stroke than white men.
An issue to consider during May, which is Stroke Awareness Month.
Researchers zeroed in on a region of Texas, analyzed neighborhoods for the number of fast food restaurants, and found a 13% elevated risk of ischemic stroke in neighborhoods with the highest number of fast food restaurants. Ischemic strokes are caused by blood clots.
For every fast food restaurant in a designated neighborhood, the relative stroke riskincreased 1%, according to research presented at the American Stroke Association’s International Stroke Conference 2009.
“The data show a true association,” says Lewis B. Morgenstern, MD, director of the University of Michigan’s stroke program and lead author of the study. “What we don’t know is whether fast food actually increased the risk because of its contents or whether fast food restaurants are a marker of unhealthy neighborhoods.”
Fewer than two in five people surveyed knew all five warning signs and knew to call 911, the survey found. The results were to be presented ... at the International Stroke Conference in San Diego.
"We have to make sure that people know the signs and symptoms of stroke because the patient would need to get to the hospital as soon as possible to have a much higher chance of survival and avoiding potential disabilities," the survey's lead author, Dr. Jing Fang, an epidemiologist in the division for heart disease and stroke prevention at the U.S. Centers for Disease Control and Prevention in Atlanta, said in a news release issued by the American Stroke Association, which is sponsoring the conference.
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:
The latter calls its campaign “Act F.A.S.T.,” standing for:
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.
He works with the American Stroke Association to help raise stroke awareness and raise funds for this important organization, and he and recently finished a book, "Never Give Up: My Stroke, My Recovery & My Return to the NFL." Like myself, he's interested in running, and for those living in the Boston area, there's an opportunity to join his team to run marathons or half-marathons to raise money for the Stroke Association.
