It's not just money - it's affecting lives

Earlier this week, there was a posting about young people and strokes. Today, it's about the cost of care for elderly stroke survivors.

Now, cost is not a pleasant topic. It smacks of talk about death squads, rationing and other politically divisive terms.

But, how about we do agree on this: Preventing a stroke can save lives and resources that can always be used elsewhere. So, keep in mind stroke prevention in reading how caring for elderly stroke survivors costs an estimated $40 billion per year:

Using data from a national survey of Medicare beneficiaries, the team compared 892 elderly self-reported stroke survivors to 892 non-stroke controls, accounting for demographics and other health conditions, like hypertension, coronary heart disease or dementia.

Know someone who is ... Caregiver? Spouse? Stressed? That person is not alone

Stress is your enemy.

Photo from bottled_void
via Flickr

Stress is especially an enemy for caregivers - and those people are often prime targets for stress.

The needs of caregivers can be woefully ignored, including their own health care, which includes mental care. You should take note from this story on how stressed spouse caregivers race a higher stroke risk:

Spousal caregivers who reported being under moderate or severe strain had a 5.1% rate of incident stroke, compared with 2.6% among propensity-matched people who were not caregivers ... , Sindhu Lakkur, PhD, of the University of Alabama at Birmingham, and colleagues found. ...

The researchers suggested there could be a public health implication for targeting stroke prevention efforts to this higher risk group of struggling spouse caregivers. Exactly how this might be done needs further study, Lakkur told MedPage Today.

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.

'Carry each others' burdens'

Carry each others' burdens, and in this way you will fulfill the law of Christ.

-Galatians 6:2

Stroke recovery can be a lengthy and heavy burden. Stroke is the leading cause of permanent disability in the United States.

Also carrying a burden: those who provide care of stroke survivors. Today, pray for those who carrying burdens for others - literally fulfilling the law of Christ. There is no higher calling.

God loves you - with love that cannot be separated

Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or nakedness or danger or sword? ... No, in all these things we are more than conquerors through him who loved us. For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.

-Romans 8:35,37-39

Ever had trying times? If you're reading this as a stroke survivor or a caregiver, the answer is likely a resounding yes. Even if you haven't had that experience, the human condition dictates that we will face some hardship. In this world, it's unavoidable.

Paul's great, comforting words here, though, can remind you, even in your hours of suffering, that God loves you. A speaker I recently heard phrased it like this: "God desperately loves you."

Paul had his own difficulties - just read Acts starting at Chapter 9 sometime if you're unfamiliar - but had the courage to write these words.

When you need some words of prayer and strength, remember these words of Paul. And remember, too, that God desperately loves you.

'My salvation comes from him'

My soul finds rest in God alone; my salvation comes from him.

-Psalm 62:1

What is "rest" for a stroke survivor or caregiver?

I think of it as finding peace, as finding a place without constant turmoil, as finding how life's priorities.

As we begin to celebrate Advent this year, may God help you find your rest.

Depression can follow a stroke

Caregivers are important for stroke survivors, especially those who suffer depression post-stroke. According to this recent study, this effects women more than men:

Brittany Poynter, M.D., and colleagues from the University of Toronto looked at 56 studies on stroke and depression comprising more than 75,000 people, about 12,000 of them women. The time between the stroke and onset of depression ranged from less than two weeks to 15 years.

In women, rates of post-stroke depression ranged from about 6 percent to 78 percent, while in men depression rates ranged from 4.7 percent to about 65 percent.

These findings are important, Poynter said, because women who have had a stroke generally do more poorly than men. They tend to have higher rates of disability and longer hospitalization times. The authors say this might be due in part to higher rates of depression. In addition, “women may have less access to care,” Poynter said.

'A ransom for many'

Instead, whoever wants to become great among you must be your servant, and whoever wants to be first must be slave of all. For even the Son of Man did not come to be served, but to serve, and to give his life as a ransom for many.

-Mark 10:43-45

What better way to describe those people who care for those who lived through a stroke - as they survive, struggle and recover.

God bless the caregivers, the servants - like Christ, they do not come to be served, but serve. Today, pray for a caregiver you know.

Women need care, too

One of my news alerts pointed me to this disturbing article: Women less likely to receive critical care after a stroke, MSU researchers find.

Women are 30 percent less likely than men to receive a critical clot-busting drug than can limit brain damage after a stroke, according to a Michigan State University study.

The study findings were presented Feb. 19 in San Diego at the International Stroke Conference, organized by the American Heart Association and American Stroke Association.

Tissue plasminogen activator, or tPA, first approved as a treatment in the mid-1990s, is a potent blood thinner used to dissolve artery-clogging clots, which cause most strokes. As part of its study, a team of MSU researchers reviewed all stroke studies published between 1995 and March 2008 that presented data on tPA treatment rates. Eighteen studies provided data on more than 2.3 million patients.

A recent posting mentioned that stroke symptoms are often missed for the under-55 crowd. My stroke occurred at age 39 and fortunately, it was recognized. Still, it's clear that people who do not fit in the mold of a classic stroke patient - elderly male - need help, too.

This shows further evidence that if you even think you might be having a stroke, call 911, get somewhere and get a satisfactory answer. And if you are getting someone else to an emergency room, you might have to be that person's advocate for proper care.

So learn stroke signs. Don't hesitate. Waiting might be fatal.

This world can be tough - but not tough enough

For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.

-Romans 8:38-39

No separation. Nothing "in all creation" can separate us from the love of God.

Consider illness. Consider suffering. Consider post-stroke trials and tribulations, for the survivors, for the caregivers, for the loved ones. This is not to make light of those conditions - instead, it is a message for the ultimate hope for those suffering.

None of these conditions, as Paul reminds us, "will be able to separate us from the love of God that is in Christ Jesus our Lord." Comforting love. Unconditional love. All-encompassing love.

Amen to that, and thank God.

Beliefnet: Health and Healing

A Web resource worth checking out, especially the particular entry on stroke information on the Web site Beliefnet: Health and Healing.

Lots of other material that can be related to stroke survivors, family members and caregivers, including weight loss, fatigue, stress and depression, can be found on the main Health and Healing page.

Stroke Awareness and Recovery blog

My Google alert for news and blogs found a Web site devoted to "Sharing ideas on caring and independence for stroke survivors and their families." The site, Stroke Awareness and Recovery, has a good entry about Stroke Awareness Month.

Lots of good resources from another blogger who is a stroke survivor.