Stroke of Faith

Problem lingers: Too many don't get help soon enough

noreply@blogger.com (Jeff Porter) — Fri, 10 Feb 2012 00:50:00 +0000

I've posted who-knows-how-many times about the importance of getting help quickly for stroke patients.

Even as the time window for treatment for many stroke patient has expanded over the last several years, researchers have still found that many stroke victims still don't get treated fast enough:

An analysis of about 115,000 patients who had strokes between 2005 and 2010 found that almost 44 percent didn't get to the hospital until more than 4.5 hours after the time they were known to first show symptoms. That's a sign of trouble: it's actually up from 39 percent in 2005.

Meanwhile, the percentage who got to the hospital within two hours fell from 40 percent in 2005 to 35 percent in 2010, another sign that more patients may be in danger from not getting prompt care.

Also, many patients chose to get themselves to the hospital instead of calling an ambulance, "boosting the risk that they won't get there in time to be able to take a clot-busting drug," said study co-author Dr. Mary George, a medical officer with the division for heart disease and stroke prevention at the U.S. Centers for Disease Control and Prevention.

Strokes don’t just threaten the old

noreply@blogger.com (Jeff Porter) — Wed, 08 Feb 2012 01:38:00 +0000

Mine happened at the "young" age of 39 to a longtime distance runner, non-smoker - everyone needs to know about the signs and symptoms and know what to do.

A recent Washington Post story about how strokes don’t just threaten the old; strokes among younger people are on the rise

"Nobody’s invincible,” warns Dr. Ralph Sacco, a University of Miami neurologist and past president of the American Heart Association.

Every year, about 795,000 people in the U.S. have a stroke. While some strokes are caused by bleeding in the brain, most are like a clogged pipe. Called ischemic strokes, a clot blocks blood flow, starving brain cells to death unless that circulation is restored fast.

Make no mistake, the vast majority of strokes do occur in older adults. But up to a quarter of them strike people younger than 65, Sacco says.

In the so-called stroke belt in the Southeast, that figure can be markedly worse. At Wake Forest Baptist Medical Center in North Carolina, a stunning 45 percent of stroke patients are young or middle-aged, says stroke center director Dr. Cheryl Bushnell."

Behavior (and red meat) affects health

noreply@blogger.com (Jeff Porter) — Thu, 02 Feb 2012 13:58:00 +0000

Gulp! I plead guilty for enjoying red meat.

I do, however, generally don't have two servings a day. Maybe one. And in all kidding aside, this article showing that frequent red meat eaters at higher risk of stroke provides some guidance in how your behavior can affect your health. An excerpt:

To see what influence different types of dietary protein have on stroke risk, the researchers divided up the people in the study based on how much red meat, poultry, fish, dairy and other sources of protein they typically ate each day.

Men who ate more than two servings of red meat each day -- which was at the high end of the meat eaters -- had a 28 percent increased risk of stroke compared to men who averaged about a third of a serving of red meat each day, the low end of the red meat eaters.

The researchers considered a serving of red meat as four to six ounces of beef or a hamburger patty.

Women who ate nearly two servings of red meat a day had a 19 percent higher risk of stroke than women who ate less than half a serving each day.

A 19 percent increase in stroke risk means that instead of 26 out of every 1,000 people having a stroke, 31 out of every 1,000 people would have one.

Medicare shortchanges hospitals on stroke therapy

noreply@blogger.com (Jeff Porter) — Tue, 31 Jan 2012 14:46:00 +0000

Interesting look on an issue that will eventually have to be reconciled. Reuters reported that Medicare shortchanges hospitals on stroke therapy:

They found that between 2001 and 2008, it typically cost U.S. hospitals $14,100 (in 2008 dollars) to care for a tPA patient who had a "good outcome." If the patient suffered serious complications from the stroke or died, the typical cost was around $19,000.

But the average Medicare payment for patients with a good outcome was $10,000, and just over $13,800 for patients who had disabling strokes.

In an earlier study, the same researchers had found that hospitals generally lose money on Medicare reimbursements for another stroke treatment - endovascular embolectomy, in which doctors go in and extract the blood clot causing the stroke.

... But over the long term, some hospitals might decide they don't want to invest in being stroke treatment centers.

"It could affect availability (of tPA) if some hospitals lose interest in treating a disease they are losing money on," Cloft said.

A state that needs help...

noreply@blogger.com (Jeff Porter) — Thu, 26 Jan 2012 14:36:00 +0000

Being born in Arkansas, I am always drawn to news in that state. A recent story combines my home state with some serious news: saving stroke patients in a state with a high stroke death rate.

Doctor says telemedicine helps save stroke patients:

Arkansas is ranked No. 1 for stroke deaths in the country.

"A physicians shortage is a big part of it," said Northwest Medical Center Emergency Medical Director Dr. Katherine Barton. "Unfortunately, some parts of our state are very poor. There's just not always enough access to physicians like people need. There's not education about strokes that we need to have out there. And there's a lot of cardiovascular disease in our state because of a lot of obesity and smoking."

When it comes to strokes, time is everything.

"The more time that passes, the more damage that's done, the more brain cells that die and the more of your function you cannot get back," said Barton.

(Map from the U.S. Centers for Disease Control and Prevention)

Speed and skill - a stroke-fighting combination

noreply@blogger.com (Jeff Porter) — Tue, 24 Jan 2012 14:12:00 +0000

A great story - and a reminder that quick response can make a huge difference for stroke patients - comes form Oregon, where a man's quick-acting wife and skilled doctors affected his recovery. Here's a snipped, but you should read the whole thing:

Around 7:15 a.m., 75 minutes after the first stroke symptoms, tPA began dripping into a vein in Steve's right arm. Within 15 minutes, his "word salad" disappeared. He could speak clearly.

As the intravenous drip continued, an ambulance drove Steve to Providence St. Vincent, so neurologists could observe him, and try to determine what caused the stroke.

About 48 hours later, on Thursday, Steve still wore blue pajama pants and a less-than-cozy hospital gown. But his shoes stood nearby as he waited to be discharged. Even doctors were stunned by his swift recovery, his speech and memory restored.

Finding the 'hidden' disabilities

noreply@blogger.com (Jeff Porter) — Tue, 17 Jan 2012 13:41:00 +0000

Not all post-stroke disabilities are easy to detect - sometimes adding to recovery difficulties. One recent article discussed how better detection of the "hidden" disabilities can help stroke survivors get help they need:

Health workers detecting the condition after a stroke could make cognitive intervention to improve the patient’s function and prevent chronic disability, according to Anna Barrett, M.D.. She is the director of Stroke Rehabilitation at the [Kessler] Foundation.

"Early detection of spatial neglect after stroke could enable cognitive interventions to improve function, and might prevent chronic disability."

Study confirms common sense link

noreply@blogger.com (Jeff Porter) — Thu, 12 Jan 2012 14:42:00 +0000

It makes sense that obesity can be a factor in stroke risk. So it also makes sense that fighting obesity would mean fighting stroke risk.

That common sense is somewhat confirmed as a study showed weight-loss surgery can cut deaths from strokes:

The study appears in the latest issue of the Journal of the American Medical Association.

The researchers checked the health and body weight of the participants at 2, 10, 15 and 20 years. ...

During the follow up, which lasted an average of 14.7 years, the researchers found patients who didn't have surgery suffered more heart disease and more fatal heart attacks and strokes.

Stroke prevention tips

noreply@blogger.com (Jeff Porter) — Tue, 10 Jan 2012 14:41:00 +0000

Not all strokes can be prevented - but most are preventable.

Recently found this link to top 10 stroke prevention tips:

Did you know that 80% of all strokes can be prevented? Strokes have the reputation of randomly striking out of nowhere. But you have more control to prevent strokes from happening than you might think. Here are our top ten prevention tips.

Regular readers of this blog will know some if not all of these, but this list is a good set of reminders.

Compilation of aphasia info...

noreply@blogger.com (Jeff Porter) — Tue, 03 Jan 2012 13:58:00 +0000

My Google alerts sent me a link about a topic that is close to me: aphasia.

I struggled with language - even still, to a degree - after my 1998 stroke. A link listing 10 things to know about aphasia:

If a stroke has left you with lingering language problems, called aphasia, you might recover some limited abilities on your own. However, you'll probably need speech-language therapy for the best possible improvement. Fortunately, experts know more today than ever before about treating aphasia effectively. Here are 10 essential facts about the most up-to-date treatment strategies.

I watched, once again, Dick Clark struggle with aphasia as 2012 began over last weekend. More power to him!

God's love: Open for all

noreply@blogger.com (Jeff Porter) — Tue, 27 Dec 2011 15:00:00 +0000

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

Responding to a Stroke of Faith posting on Christmas Eve, an intelligent blogger commented that a particular medication does not work with complete effectiveness for every person.

My response included the phrase that "the results are very much case by case." That's true for any medication you can buy, use or receive. People are unique, so results are case by case.

Later, during Christmas Eve church services, I thought about that phrase in a different context: Unlike medications, God's love is NOT a case-by-case basis. As Paul wrote, God's love is for all and cannot be undone. Cannot be removed from us.

In this world, so much of life is case-by-case. God's love is not one of these. His love is offered to us all.

The world receives the 'Lazarus effect'

noreply@blogger.com (Jeff Porter) — Sat, 24 Dec 2011 18:00:00 +0000

[This was originally posted Dec. 24, 2009]

Jesus, once more deeply moved, came to the tomb. It was a cave with a stone laid across the entrance. "Take away the stone," he said.

"But, Lord," said Martha, the sister of the dead man, "by this time there is a bad odor, for he has been there four days."

Then Jesus said, "Did I not tell you that if you believed, you would see the glory of God?"

So they took away the stone. Then Jesus looked up and said, "Father, I thank you that you have heard me. I knew that you always hear me, but I said this for the benefit of the people standing here, that they may believe that you sent me."

When he had said this, Jesus called in a loud voice, "Lazarus, come out!" The dead man came out, his hands and feet wrapped with strips of linen, and a cloth around his face.

Jesus said to them, "Take off the grave clothes and let him go."

-John 11:38-44

Not long ago (2008), I heard a presentation by one of the doctors responsible for making tPA (tissue plasminogen activator) available to stroke patients.

In my own 1998 experience, I could not speak, I could not move my right arm or leg - but after the clot-busting tPA, I regained those abilities. It was a dramatic experience. The doctor called it "the Lazarus effect."

It made me think of the story of Lazarus - see above - in John's gospel. Once there was no hope. A man's sisters, relatives and friends knew they lost him. Jesus entered. Hope returned.

How about this world? On a cold night so long ago, a world needed this Lazarus effect. Today, this world needs it as well. On that first Christmas, God gave the world the Lazarus effect: a new beginning, a new covenant, a new life. Today, you can receive your own Lazarus effect.

Research points to new walking therapy

noreply@blogger.com (Jeff Porter) — Thu, 22 Dec 2011 14:00:00 +0000

For many, walking means freedom - the ability to move freely and safely. Walking is part of some recent news on the stroke recovery front - robotic assist gets stroke patients walking:

For patients who are unable to walk following a stroke, robot-assisted gait training results in greater long-term gains in mobility than conventional therapy for those with the most severe deficits, researchers found.

In a small randomized trial, the robot-assisted therapy was better at improving walking capacity through two years, but only among those with high motor impairment, according to Giovanni Morone, MD, of the Santa Lucia Foundation in Rome, and colleagues.

It was also superior to conventional therapy for improving patients' mobility and ability to perform basic activities of daily living, the researchers reported online in Stroke: Journal of the American Heart Association.

Fascinating development in stroke therapy

noreply@blogger.com (Jeff Porter) — Tue, 20 Dec 2011 14:00:00 +0000

As most survivors know, much of the time, one post-stroke struggle involves one side of the body hampered. In my case, my stroke happened on the left side of my brain, losing movement in the right arm and leg. While those movements came back thanks to some quick-thinking health professionals, this is not always the case.

Now, Reuters Health reported last week, researchers have found some interesting results about how brain stimulation may help some stroke patients:

Treating stroke patients who have lost control and awareness of one side of their body with magnetic stimulation to the brain may improve their symptoms, researchers said today.

In a new, small study published in the journal Neurology, patients who were given quick bursts of stimulation over a couple of weeks improved by about 20 percent on tests of vision and attention, while those who got a fake stimulation treatment didn't improve significantly.

But researchers said it's still unclear what types of patients might benefit from the treatment and by how much.

It might be worth our while to read the whole story. And while this is merely research and not all the answers are in, this has some positive possibilities for improving therapy for stroke patients.

Another set of stroke prevention stories

noreply@blogger.com (Jeff Porter) — Wed, 14 Dec 2011 00:54:00 +0000

I've been running across more and more stroke prevention stories. Here are two recent ones:

Vitamin, diet link to stroke risk assessed

In a review, neither antioxidant vitamins nor B-vitamins were associated with stroke prevention, but a healthy diet, such as the Mediterranean diet, did appear to diminish risk, Graeme Hankey, MD, of Royal Perth Hospital in Australia, reported in The Lancet.

"The overall quality of an individual's diet and balance between energy intake and expenditure seem to be more important determinants of stroke risk than individual nutrients and foods," he wrote.

Hankey reviewed the literature on individual vitamins, nutrients, foods, and overall diets and their effects on stroke risk.

Stroke risk reduced with treatment of prehypertension

Patients with prehypertension who take blood-pressure-lowering therapy have a highly statistically significant 22% reduced risk of stroke, a new meta-analysis shows. The study is published online December 8, 2011, in Stroke.

The reduction in stroke risk observed in the study was "clear-cut," "clinically meaningful," and evident among all classes of antihypertensive drugs studied, said lead author Dr Ilke Sipahi (Case Western Reserve University, Cleveland, OH).

"We saw it with ACE inhibitors, we saw it with calcium-channel blockers [CCBs], and we saw it with angiotensin-receptor blockers [ARBs] to a certain extent," Sipahi said in an interview. "So this is a true finding; the risk is truly reduced."

But the study results should not change current recommendations regarding blood-pressure-lowering therapy, said Sipahi. "It's not realistic to go ahead and recommend antihypertensive therapy to every single patient with prehypertensive blood-pressure levels, but I think our findings have to be discussed extensively within the medical community."

Let Jesus light your world

noreply@blogger.com (Jeff Porter) — Thu, 08 Dec 2011 14:30:00 +0000

When Jesus spoke again to the people, he said, “I am the light of the world. Whoever follows me will never walk in darkness, but will have the light of life.”

-John 8:12

This time of year, it's getting darker and darker early in the day, when, three times at week, I'm out running.

So most of the time, I'm wearing a headlamp to somewhat dimly light my path. Otherwise, I'd likely stumble and fall. And most of the time, I'm on a fairly popular running, walking and bicycling venue, a trail close to my house, so I see headlamps all along my route - so people won't walk, run or bike in the darkness.

Now, things can still go wrong. Headlamps provide only so much light. Outside of its fairly small area, there's darkness. And they are run on batteries and human technology. Batteries eventually expire, and human technology can fail. I've gone through two headlamps and now working on No. 3 in my almost 25 years of running. And No. 3 will eventually be discarded.

Unlike my headlamp, Jesus is not a light exclusive to me and will never fail. He is my light, can be your light - the light of the world. Let him light your world.

Stroke prevention news

noreply@blogger.com (Jeff Porter) — Tue, 06 Dec 2011 14:04:00 +0000

Two different recent stories about stroke prevention...

Diet rich in antioxidants may cut stroke riskheheart.org

Women who eat an antioxidant-rich diet may significantly cut their stroke risk, particularly for those without a history of CVD, new research suggests.

The prospective study found that women with no history of CVD who consumed the highest amount of antioxidants in foods such as fruit, vegetables, tea, whole grains, and chocolate had 17% fewer strokes than those who ate the least amount. Among women with a history of CVD, those who consumed the most antioxidants had 45% fewer hemorrhagic strokes.

"This study suggests that eating a diet rich in antioxidants, especially from fruits and vegetables, may be of importance for stroke prevention," the study's lead author, Susanne Rautiainen (Karolinska Institutet, Sweden), said in an interview.

(Chart from U.S. Department of Agriculture)

Stroke's teachable moment - NBC-2.com

It was his one and only stroke. To lower his chances of a second one, Al was forced to change his life.

"I was smoking the first time and then once you have the stroke you quit smoking. It's a drastic change and there's a lot of things that cause damage in your life and I've been fortunate enough that I've only had one stroke and one is enough."

About 25% of stroke victims will have another stroke within five years. But studies show following a set of established guidelines, aimed at prevention, can change the odds.

'His love endures forever'

noreply@blogger.com (Jeff Porter) — Thu, 01 Dec 2011 14:44:00 +0000

Give thanks to the LORD, for he is good.
His love endures forever. ...

Give thanks to the God of heaven.
His love endures forever.

-Psalm 136:1,26

Who doesn't need love?

It's the human condition. We want love. We desire it. We need it. There's a human tendency to take it for granted when things are good. But, say, when those of us have struggled with stroke recovery or other challenges, we recognize our hunger for love.

And we are loved. Take in the words in the Psalm - God's love endures forever. Past human struggles. Forever.

Aphasia: A struggle for words

noreply@blogger.com (Jeff Porter) — Tue, 29 Nov 2011 14:36:00 +0000

U.S. Rep. Gabrielle Giffords made news not long ago by sitting through an interview about her lengthy struggle with brain injury after a shooting that nearly killed her. She clearly struggles with words - a problem called aphasia.

Many stroke survivors struggle with aphasia, too. While the cause of Giffords' aphasia is different than mine, I certainly feel for her as she faces this communication challenge. As a newspaper reporter at the time, I was concerned that my language problems would endanger my livelihood. I'm sure that as a public official who runs for office every two years, she has some of the same concerns. Words are powerful tools for political candidates.

Her first television interview occurred not long ago on ABC News.

Aphasia is a silent-like problem - people who have it have trouble talking about it. I know that at one time, I had trouble getting words out. But the word "aphasia" is a word that needs to become more known.

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One more reason for dental cleanings: Potential stroke prevention

noreply@blogger.com (Jeff Porter) — Tue, 22 Nov 2011 14:15:00 +0000

More and more, it's clear that oral health is important to overall health. A recent article discusses how professional dental cleanings may reduce risk of heart attack, stroke:

The study included more than 51,000 adults who had received at least one full or partial tooth scaling and a similar number of people matched with gender and health conditions who had no tooth scaling. None of the participants had a history of heart attack or stroke at the beginning of the study.

The study didn’t adjust for heart attack and stroke risk factors — such as weight, smoking and race — that weren’t included in the Taiwan National Health insurance data base, the source of the information used in the analysis.

“Protection from heart disease and stroke was more pronounced in participants who got tooth scaling at least once a year,” said Emily (Zu-Yin) Chen, M.D., cardiology fellow at the Veterans General Hospital in Taipei, Taiwan.

Professional tooth scaling appears to reduce inflammation-causing bacterial growth that can lead to heart disease or stroke, she said.

(Image from Centers for Disease Control and Prevention)

Important: Even mini-stroke prevention

noreply@blogger.com (Jeff Porter) — Thu, 17 Nov 2011 14:36:00 +0000

A somber story from USA Today and reported elsewhere: 'Mini-strokes' can shorten life expectancy.

The study calculated life expectancy by comparing mortality rates among people who had TIAs with other people of the same age and sex. Life expectancy declined steadily each year. After nine years, almost half of the TIA patients had died — 20% more than in the general population, according to the study of 22,000 people published Thursday in Stroke: Journal of the American Heart Association.

While having a TIA didn't substantially increase the risk of death in people younger than age 50, the attacks did increase mortality for those older than age 65. About 5 million Americans have had a TIA, according to the heart association.

TIAs are "very bad harbingers," says Nehal Mehta of the University of Pennsylvania's School of Medicine, who wasn't involved in the new study. Up to 10% of TIA patients have a major stroke within 48 hours, the American Heart Association says.

This is not a scare tactic, but a reminder that stroke prevention is clearly important, especially those people older than 65.

Appropriate blood thinner use is on the rise

noreply@blogger.com (Jeff Porter) — Tue, 15 Nov 2011 14:35:00 +0000

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.

Stroke and memory: Connected?

noreply@blogger.com (Jeff Porter) — Tue, 08 Nov 2011 14:38:00 +0000

An interesting article about the possible connection of stroke risk and predicting memory problems. Some details about the research on how stroke risk profile may also predict odds of memory problems:

"Overall, it appears that the total Stroke Risk Profile score, while initially created to predict stroke, is also useful in determining the risk of cognitive problems," study researcher Frederick Unverzagt, PhD, says in a news release. He is a professor of psychiatry at the Indiana University School of Medicine in Indianapolis.

After taking into account complicating factors, getting older and having thickened heart muscle were both independently linked with future memory problems. High systolic blood pressure (the first number in a reading) also appeared to raise a person's odds of memory decline, even in the absence of heart muscle thickening.

“Our findings suggest that elevated blood pressure and thickening of the heart muscle may provide a simple way for doctors to identify people at risk for memory and thinking problems,” Unverzagt said.

You can't change every potential stroke risk factor, but some - blood pressure, as cited above, for example - can be addressed through exercise, diet or medication. Now, it seems, you might be able to steer away from memory problems, too.

(Photo from the Centers for Disease Control and Prevention)

'Grant me a willing spirit'

noreply@blogger.com (Jeff Porter) — Tue, 01 Nov 2011 13:16:00 +0000

Restore to me the joy of your salvation
and grant me a willing spirit, to sustain me.

-Psalm 51:12

David was in trouble and troubled when he made this plea to God.

While our own troubles and travails might be different than David's, we, too, can find joy of salvation in one who can sustain us. God can help us find that willing spirit, that willingness to seek out a restoration, the prayers to sustain us.

Does this mean all troubles will cease? No, David still had his challenges. So do we. But God can sustain us through our own challenges.

Watching out for the details may help

noreply@blogger.com (Jeff Porter) — Tue, 25 Oct 2011 13:31:00 +0000

The right treatment might be the key to success. A recent story gave the results of Australian research showing that certain after-stroke treatments may boost outcome:

"Clinical leaders of stroke services can adopt this strategy with confidence that their outcomes will improve," Sandy Middleton, a professor at the Nursing Research Institute at St. Vincent's & Mater Health in Sydney, Australia, and colleagues wrote in the report in the Oct. 12 online edition of The Lancet.

The researchers noted that patients who recover in units devoted to stroke care often experience fever (20 to 50 percent of patients), high blood sugar (up to half of patients) and problems swallowing (37 to 78 percent of patients) within the first few days of a stroke. These conditions "are not yet universally well managed," the study authors indicated.

In the study, Middleton and colleagues randomly assigned patients at 19 stroke units in New South Wales, Australia, to different types of treatment. Some followed existing guidelines, while others adopted new protocols involving monitoring of fever and high blood sugar plus treatment for the conditions. Nurses also underwent special training to treat swallowing problems in the patients.

Within 90 days, 42 percent of the 558 patients in the group that received the special treatment were dead or considered to be dependent, compared with 58 percent of the 449 patients who received the existing treatment, the investigators reported.

Patients who received the special treatment also scored better on a test of their physical functioning, the results showed.

This also shows the value of an advocate for every stroke patient to help manage these conditions - fever, blood sugar and problems with swallowing. My wife was my advocate after my stroke, when I could not, literally, speak for myself. I'm convinced that her efforts greatly improved my outcome. Thank God for my advocate.

(Photo from the National Institutes of Health)