Too many rehab patients suffer harm, not help

And this is why everyone needs an advocate.

I ran across this article showing that while stroke rehabilitation services can provide a great deal of help, they can do harm as well. This is a great illustration that every stroke patient in a facility needs someone watching, and the facility personnel need to know that someone is watching.

So read how nearly 30% of rehab facility patients suffer care-related harm:

The Department of Health and Human Services' Office of Inspector General found that nearly 29% of Medicare beneficiaries admitted to inpatient rehab facilities experience an adverse event during their stay including healthcare-acquired infections, medication errors and pressure ulcers.

We're supposed to go F.A.S.T. - but are those preaching it do the same?

Second round in this week's theme: Taking stroke patients seriously.

We're all told to get possible stroke patients to medical help fast - there's even a program with the acronym F.A.S.T. We're all told brain = time.

But, according to a recent study, it seems that many hospitals overestimate their adherence to stroke guidelines:

Researchers surveyed staff in 141 hospitals across the United States who treated more than 48,000 stroke patients in 2009 and 2010, and compared their responses with patient data. The results revealed significant differences between staff perception and reality.

How much priority will you get when it comes to saving your life?

This week's theme: Taking stroke patients seriously. Sadly, we are not always taken seriously.

This is written in kindness - my life was saved by health professionals in a hospital. But we've all seen the other side in hospitals - the hurry-up-and-wait phenomenon. And in my own personal observations, transportation is a big issue for hospitals.

So it's not a big surprise that in those cases in which a stroke patient needs to move to a stroke center, the transfer is actually no faster than driving yourself:

'Cast all your anxiety on him'

Humble yourselves, therefore, under God’s mighty hand, that he may lift you up in due time. Cast all your anxiety on him because he cares for you.

-1 Peter 5:6-7

We've all experienced it - anxiety. Work. Marriage. Health. Children. Parents. The list goes on and on.

Stroke patients, too, can become consumed with anxiety. It's often uncertain exactly what the future will bring. Each human brain is unique, and therefore an individual's response to treatment, therapy and surgery is not guaranteed.

That being said, we have a place where we can place our anxiety, our fears and our worries. Take your issues to the one who has seen it all and can help remove your anxiety and fill you with hope.

Accept his love and hope. He will see you through.

Sometimes, systems fail stroke patients

An exasperating story - to many times, in any country, stroke patients don't get the attention needed. This story came from England, where too many stroke patients are too often waiting too long.

It's critical, critical that stroke patients get to a hospital soon. In the United States, ideally, it should be a hospital designated as a stroke center. But as BBC reported,  post-hospital stroke care "needs to improve":

Patients often faced delays in being seen, while some areas were failing to provide services altogether, the official health regulator said.

Immediate improvement was needed, it added.

The findings comes after a major focus on hospital stroke services in recent years. This has led to improvements in testing and treatment in the immediate aftermath of a stroke.

This in turn has increased the numbers surviving and, as a result, there are now 50,000 people a year who are left with disabilities following a stroke.

Weight and tPA - potentially critical combination

Never thought of this, but this could be a weighty matter - for real. Often, stroke patients have trouble speaking or can't speak at all. But also often, it's important for physicians to know the weight of the patient.

Ran across this story about how faulty estimates of patient weight affect tPA dose:

Stroke patients are frequently unable to communicate their weight due to aphasia or decreased consciousness. tPA is given on a milligram per kilogram basis, but there often is not the time or the equipment in the emergency department to verify a patient's weight and determine the correct drug dose. Physicians therefore often rely on "eyeballing" or visual estimation.

"Dosing itself is really crucial for the activity of tPA, and overdosing may be not as useful as the correct dose, and underdosing may cause harm to the patient," said Dr. [Martin] Köhrmann [associate professor of neurology at the University of Erlangen-Nuremberg, Germany]. "This, together with the situation where we don't have the correct weight information, is really concerning."

While my Missouri driver's license displays my weight, not sure that (a) those are always accurate and (b) that's a universal standard for driver's licenses across the globe or even in the U.S. Another good argument for keeping better electronic health records.

Could music help regain post-stroke speech?

Singing therapy helps stroke patients regain language:

"Music, and music-making, is really a very special form of a tool or an intervention that can be used to treat neurological disorders, said Dr. Gottfried Schlaug, associate professor of neurology at Beth Israel and Harvard University. "There's rarely any other activity that could really activate or engage this many regions of the brain that is experienced as being a joyous activity."

There are between 750,000 and 800,000 strokes per year in the United States, and about 200,000 of them result in a kind of language disorder called aphasia, he said. About one-third of those patients have aphasia so severe that they become non-fluent, meaning about 60,000 to 70,000 patients per year could benefit from the music therapy.

Again, battling stroke myths and misunderstandings

Here's another slant on taking down some misconceptions about strokes and survivors - in an article titled "Ex-scientist's stroke opens minds to recovery."

When Jill Bolte Taylor had a stroke in 1996, it didn't just change her life. ...

"I've actually had people write me, 'I'm apologizing to you for how I treated stroke patients,'" says Taylor, 50.

Her experience and book has changed how some health professionals have treated survivors.

'Joyful ... patient ... faithful'

Love must be sincere. Hate what is evil; cling to what is good. Be devoted to one another in brotherly love. Honor one another above yourselves. Never be lacking in zeal, but keep your spiritual fervor, serving the Lord. Be joyful in hope, patient in affliction, faithful in prayer.

-Romans 12:9-12

"Be joyful in hope ... ."

Paul went through some dreadful, awful, torturous experiences during his ministry. But again and again, he wrote about hope.

I can't imagine the life Paul had - he turned turned from society's "in" crowd and took the path of the often persecuted. Perfect? No. But that was not required for Paul and it's certainly not required for Christ followers.

So when human afflictions seem overwhelming, I hope you can find comfort in Paul's writings. He, too, was afflicted but found peace.

Avoiding a second stroke - efforts needed

A recent article in U.S. News and World Report:

After suffering a stroke, the chances of having another are high, but a new report shows many patients aren't getting the interventions they need to reduce that risk.

Those interventions include lifestyle changes, such as smoking cessation and exercise, and medical treatments, such as aspirin, blood pressure medications and cholesterol-lowering drugs.

We need more and better strategies for these patients - rehab, counseling, medication, among other things. This Stroke Awareness Month is a good time to start.

Another study about clot-busting developments

Not long ago, researchers from Johns Hopkins University released a study about the use of an aggressive clot-busting treatment for stroke patients.

New results from a multicenter study led by Johns Hopkins show that patients who got an experimental clot-busting treatment for a particularly lethal form of stroke were not only dramatically more likely to survive but also continued to shed lingering disabilities six months later. The findings, announced Feb. 19 at the International Stroke Conference in San Diego, are likely to build support for the use of tissue plasminogen activator, or tPA, in patients with intracerebral hemorrhage, a treatment-resistant form of stroke marked by brain bleeding.

There's been some disagreement about tPA, so new studies are important to get some clear answers.

From the No Kidding Department...

A recent headline from U.S. News and World Report:

Specialized stroke care improves outcomes. From the article of Nov. 20, 2008:

Stroke patients treated at community hospitals with specialized stroke care and telemedicine support from major stroke centers are more likely to survive and live independently than patients treated at hospitals without stroke units, a German study finds.

It's vital to get stroke patients to the right place or in communication with the right people. Ideally both. This can be crucial in the outcome of a stroke.

As Thanksgiving Day gets closer, I give the Lord thanks that I was able to get into the hands of people who knew exactly what to do.

More details on the snake venom research

Last posting linked to a news article about research in using snake venom to treat stroke patients. A more technical and detailed link can be found with the Internet Stroke Center's Stroke Trials Registry.

The page describes the efforts to learn about the results of an intravenous infusion of ancrod - pit viper venom - within six hours of a stroke. The study looks at patient status three months afterward.

The study is still recruiting facilities and patients to take part in the study.

In the future, stroke survivors might thank snakes

Stories about snake venom treating stroke victims have appeared from time to time, so it's high time to link to one for Stroke Awareness Month.

This one is from the Tallahassee Democrat. A particular study, in which the Tallahassee Memorial Hospital's Stroke Center is taking part, focuses on the use of Malayan pit viper venom. According to the article, the venom might work up to six hours after a stroke; a drug derived from the venom "is believed to have anti-coagulation and anti-clotting effects, which may improve blood flow to the brain."

The worldwide study started in 2005, and it bears watching.

Can a needle save the life of a stroke victim? Not this kind

A strange, weird and funny myth came up on my Google alert about stroke news.

From the urban legend department from about.com: Can a Needle Save the Life of a Stroke Victim?

Surprise answer (at least as the needle is described in the story): No.

A doctor used a needle to use tissue plasminogen activator (tPA) that helped save my life. Different needle, different location.

Internet Stroke Center at Washington University

Yesterday's post mentioned the Internet Stroke Center at Washington University in St. Louis. It's also connected with Barnes-Jewish Hospital, which is next door to the university's medical school.

The Internet Stroke Center offers resources for patients and families, including basics on recognizing stroke symptoms, caring for stroke survivors and reducing stroke risk. There's a link to the latest stroke news. It's a good Web site to note during Stroke Awareness Month.

One of the more disappointed stories, from MedWire News, starts this way: "Only a fifth of people who suffer a stroke recognize the event as an emergency and go urgently to hospital, research reveals." That means, of course, four out of five people who suffer a stroke do not recognize the event as an emergency and go urgently to a hospital. We need to do better. Much better.

Here are the symptoms:

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

Even if you suspect that's going on - to you or someone else - get to some help fast. As stated before, a false alarm is better than a funeral.

Being several days out of my effort to post to this blog almost every day and keep it active, I've found it gets easier every day and discovered some fascinating people and additional resources. And on that note, thanks be to God.