No…not these blockages….


New Stroke Guidelines Will Change Stroke Treatment in the U.S.

Each year, more than 690,000 Americans have strokes caused by blood clots blocking vessels in the brain, called ischemic strokes. Some of the clots can grow large and may require intense therapy to treat.

However, widely celebrated new research reaffirms that large blood clots in the brain are less likely to result in disability or death, if the blockage is removed in the crucial early hours of having a stroke.

Right now the standard treatment is a clot-dissolving drug called tPA. But it must be given intravenously within 4.5 hours to be effective. For people with larger brain clots, tPA only works about a third of the time.

New studies recommend doctors to use modernized -retrievable stents, to open and trap the clot, allowing doctors to extract the clot and reopen the artery nearly every time when used with tPA.

Clot-removing devices provide better outcomes for stroke survivors

0213-News-Removing clots_BlogStrokes caused by large blood clots in the brain are less likely to result in disability or death if the blockage is removed in the crucial early hours, according to reaffirming new research widely celebrated Wednesday.

Doctors quickly lauded the findings as instantly changing the way certain stroke sufferers are treated. The reason is because the results are not new, but validating: Dutch researchers in October had reached the same conclusion for the first time in a trial known as MR CLEAN.

Three new studies reported at the American Stroke Association’s International Stroke Conference reinforced those results from the Netherlands. The trials had been halted early because their results were so positive. Clot-grabbing devices used alongside a standard drug that dissolves clots, researchers said, can greatly improve the outcomes for people having the worst and most disabling strokes.

“This is a watershed moment in the management of acute stroke,” said Lee Schwamm, M.D., an American Heart Association volunteer and director of acute stroke services at Massachusetts General Hospital who was not involved in the studies. “Stroke is now a treatable disease in its earliest hours, and we can offer hope and promise to patients that early treatment can lead to dramatic reductions in disability and death.”

Each year, more than 690,000 Americans have strokes caused by blood clots blocking vessels in the brain, called ischemic stroke. The standard treatment is a clot-dissolving drug called tPA. But it must be given intravenously within 4.5 hours to be effective. For people with large clots it only works about a third of the time.

Doctors can see an image to detect the blockage

Solitaire_credit Covidien








Less sophisticated devices tested previously produced disappointing results in clinical trials. But the new studies tested more modern devices such as a retrievable stent, a tiny wire cage attached to a catheter that is threaded through an artery in the groin to the blocked artery in the brain. The stent opens and traps the clot, allowing doctors to extract the clot and reopen the artery nearly every time.

Among the new research is a Canadian study known as ESCAPE that involved 315 stroke patients. Most were given the clot-busting medicine tPA, and about half of them were also treated with a clot removal device.

Three months after their strokes, 53 percent of patients whose treatment included clot removal were functionally independent and able to take care of themselves compared with about 29 percent given tPA alone. The treatment also improved the odds of survival. In the clot-removal group, about 90 percent of patients were still alive after three months compared with 81 percent in the tPA-alone group. The results were published simultaneously in the New England Journal of Medicine.

Results were similar in a smaller Australian study called EXTEND-IA, also published simultaneously in the New England Journal of Medicine: 71 percent of stroke patients given both treatments were functionally independent after three months compared with 40 percent of those given tPA alone.

Bruce Campbell, M.D., a neurologist at the Royal Melbourne Hospital, led the Australian study and said clinical guidelines will now change.

“It’s a difference for patients between having paralysis down one side and not being able to talk compared to getting home and back to all their usual activities,” Campbell said.

Another study, dubbed SWIFT PRIME, involved 196 stroke patients in the United States and Europe. Researchers found that 60 percent given both treatments achieved functional independence three months later compared with about 36 percent given tPA alone. There were also fewer deaths among patients who had their clots removed: 9.2 percent versus 12.4 percent.

The next step will be to make sure stroke patients are taken to hospitals where specialists are on-hand to perform the clot-removing procedure, said Jeffrey Saver, M.D., a director at the UCLA Stroke Center and lead investigator of the SWIFT PRIME study. “We need to change the medical system,” he said.

Saver added that about 60,000 American stroke patients each year may be eligible for the new therapy.

In all three studies, the clot was removed from the blocked artery within six to 12 hours after stroke symptoms started. Researchers used simple imaging to quickly assess whether a stroke patient had a large clot.

Stroke and Depression

By , senior editor
A stroke can trigger depression.

For most people, the word “stroke” brings to mind a constellation of problems, including paralysis and difficulty with speech. But if someone has recently had a stroke, you’re probably well aware that the effects go well beyond the physical. The emotional aftermath can be just as overwhelming and far more difficult to sort out.

Although depression can strike anyone, those who’ve suffered a catastrophic illness may be more susceptible than other people. And when you throw a brain injury into the mix, the risk of developing a mood disorder becomes even greater. As many as half of stroke survivors will become depressed, according to James Castle, a neurologist at Stanford University.

Depression isn’t just miserable, it may also make a stoke survivor more susceptible to pain and fatigue and may even delay his recovery.

  • In a study published in the journal   Stroke,   researchers reported that stroke survivors who were treated for depression demonstrated improved recovery in regular daily activities compared with those whose depression went untreated.
  • People who are depressed also tend to be less compliant with rehabilitation and more resistant to making lifestyle changes to prevent a second stroke.

Fortunately, depression can be treated. With the appropriate care, a patient will lead a happier life — and life will be easier for you, too. Here are some practical things you can do if you think the person you’re caring for is depressed after a stroke.

Be alert to warning signs of depression after a stroke

It’s not always easy to recognize depression. In the case of someone who’s had a stroke, the situation can be even more complicated. If a patient has trouble talking or understanding language, it might be especially difficult to recognize depression. Increased   emotional liability   — sudden and extreme mood swings, common after a stroke — may also hide symptoms of depression.

You may also think he has good reason to feel depressed. After all, he’s just had a stroke and can’t do the things he used to be able to do. But there’s a difference between the normal   grieving   process and depression. The warning signs of depression include:

  • Frequent crying episodes
  • Feelings of hopelessness or worthlessness
  • Poor appetite or increased appetite
  • Sleeping too much or not enough
  • Increased agitation and restlessness
  • Loss of interest in life
  • Expressing thoughts of dying or suicide

A stroke survivor should be evaluated for depression if he has had several of these symptoms for more than two weeks.

Encourage a stroke survivor to be tested for depression

If you believe a patient is depressed, the first step is to talk to him about his feelings. This isn’t always easy, especially if he isn’t used to expressing emotions. Ask him if he’s feeling sad or hopeless. Try to get an idea if it’s really depression or just a temporary case of the blues.

The next step is to schedule an evaluation. His primary care physician may want to talk to him first, or she may refer him to a psychiatrist or counselor. In any case, the evaluating doctor will talk to him and assess his mood. She may also order screening tests to rule out other medical conditions that can mimic depression, such as a thyroid disorder or infection.

If he resists the idea of testing because he’s embarrassed or afraid, help him understand that a diagnosis of depression isn’t the shameful secret it once may have been. It doesn’t mean he’s “crazy” or is going to be taken away to a   nursing home   . And his test results are private, so no one b ut he and his doctor needs to know.

If he absolutely refuses to see a doctor, there’s not a whole lot you can do. “There’s no way to force the issue unless there are severe circumstances,” says Castle. If he has become psychotic or suicidal, or if his depression has progressed to the point where he can no longer care for himself, Castle recommends that you notify his doctor or emergency medical services immediately. Otherwise, your best bet is to enlist family members and friends to try to persuade him to seek help.

Support a stroke survivor during treatment for depression

If a patient is diagnosed with depression, the doctor may prescribe antidepressant medications and/or recommend psychotherapy. “Most doctors take a multidirected approach toward battling depression,” says Castle. “Medicines can be highly effective, but often there’s a role for psychotherapy and lifestyle changes.”

Even if a primary care doctor diagnosed depression, a patient may still benefit from seeing a mental health professional, says Castle. “Some primary care physicians feel comfortable treating this disorder, but many would prefer the assistance of a psychiatrist or psychologist.” Castle says this can be difficult for people who associate a stigma with mental health treatment. “It’s important for the family to support the patient over that barrier.”

The person in your care may also be nervous about taking antidepressants, but Castle points out that they present very little risk: “If anything, there’s some evidence to suggest that these medicines might actually decrease the chance of having another stroke.” Some of the common side effects, such as loss of libido or excessive sweating, can be annoying, but they’re nothing compared to the misery of depression. And the doctor can work with the patient to find the most effective medication with the fewest side effects.

Other ways you can help a stroke survivor with depression

Simply supporting the patient as he struggles with depression can help him a great deal. Here are some other things you can do:

  • Help him stay as physically active as possible.   Talk to the doctor and rehabilitation team about what exercises are appropriate. Find activities you can do together, such as a morning walk around the neighborhood.
  • Depressed people often want to sleep during the day.   “As much as possible, don’t allow a patient to slip into a depressed routine,” says Castle. “Break the cycle by encouraging him to be awake during the day with exposure to sunlight.” A simple walk outdoors or some time in the garden can really help.
  • Structure the day around activities that give him pleasure and a sense of purpose.   For example, meet friends for lunch or enjoy a leisurely walk through the mall.
  • Try to stay positive and upbeat, but don’t foster unrealistic expectations.   Instead of saying, “You’ll be hiking again in no time,” you might say, “If we keep walking together every day, you’ll notice that it gets a lot easier.”
  • Join a support group — for either or both of you.   Talking to other people who’re struggling with similar issues can be enormously comforting and helpful. It’s also a great way to connect with other stroke survivors and caregivers . Remember that it’s not all up to you

In the end, it’s really up to the stroke survivor to get help for depression. If he won’t talk to his doctor or comply with treatment, you can’t make him — and you shouldn’t blame yourself. Keep offering support and provide positive reinforcement when he takes those difficult steps toward recovery.

But there’s only so much you can do. If feelings of guilt and sadness overwhelm you, you may need help coming to terms with the fact that he isn’t going to get help. Ask his doctor for information about support groups and other resources to help you manage your own feelings.

Source:       E. Chemerinski et al. “Improved recovery in activities of daily living associated with remission of post stroke depression.”   Stroke   32, 2001. 

7 Cognitive Biases That Are Holding You Back

The brain is surprisingly resource intensive, making up about 2 percent of your body weight, but consuming 20 percent of your calories. Because of this, the human brain has evolved with numerous mechanisms in place to reduce energy consumption wherever possible.

Thanks to two of those mechanisms, latent inhibition (a part of your brain’s sensory filter) and cognitive biases (decision-making shortcuts), most of what you think of as conscious decisions are being made with filtered data and a heavily biased mindset. While this is great for biological efficiency, it’s not so great for thriving in a fast-paced, modern world.

While there are literally hundreds of cognitive biases, these seven play a significant role in preventing you from achieving your full potential:

1. Confirmation Bias. This occurs when you warp data to fit or support your existing beliefs or expectations. The effects are often found in religion, politics, and even science.

Why does that matter? Because an inability to look outside of your existing belief systems will vastly limit your ability to grow and improve, both in business and in life. We need to consider more possibilities, and be more open to alternatives.

2. Loss Aversion. Also known as the endowment effect, loss aversion is a principle in behavioral economics whereby someone will work harder to keep something than they will to acquire it in the first place. This is also closely related to the sunk cost fallacy, where one is inclined to pump more resources into something based solely on the resources already expended.

If you need an example, being hesitant to fire a bad employee is a common one. You might think, “Well, I’ve already put so much time into training them, paying them, insuring them, and their performance isn’t really THAT bad…I should see if I can salvage this.”

Don’t make this mistake. When time or money is gone, it’s gone, and you need to consider the future without attachment to the past. Speaking of past and future…

3. Gambler’s Fallacy. The human brain has difficulty understanding probability and large numbers, so you are naturally inclined to believe that past events can somehow change or impact future probabilities.

For example, there are many people who try to analyze the past performance of the stock market in order to pick future stocks that should be winners, usually with terrible results (there’s a reason why very few money managers outperform the S&P 500). This is a product of the Gambler’s Fallacy, and it can get you, your clients, and your businesses into a great deal of trouble.

How does this hold you back? In most cases, past events don’t change the future unless you let them, so you need to take great care when attempting to learn from the past. It’s fine to look to the past for insights, but don’t fall into the “past performance dictates future performance” trap.

4. Availability Cascade. Just because you hear something frequently does not make it true, though the brain sure likes to believe otherwise. For example:

  • You don’t use just 10 percent of your brains (you actually use 100 percent).
  • Gum doesn’t take seven years to digest (it doesn’t digest at all; it just passes right through in about the same time as everything else).
  • Bats aren’t blind (they see quite well, and have amazing hearing to boot).

Surprised? Bad information seems to spread as fast, if not faster, than the truth, so you need to fact-check frequently before you make decisions based on bad information. If you notice something coming up again and again, dig into the facts and determine for yourself what is or isn’t true.

5. Framing Effect. This one is fascinating, and I take advantage of it regularly as a marketer. In a nutshell, how something is framed, positively or negatively, has an enormous impact on how the information is processed…even if the information is fundamentally identical.

For example, let’s say you’ve been diagnosed with a terminal illness, and two different doctors come to tell you what happens next:

  • Doctor A: “With proper treatment, you have an 80 percent chance of a full recovery.”
  • Doctor B: “There’s a 20 percent chance that you’ll die after being treated for this illness.”

Which doctor would you want to work with? Even though both are exactly the same, most people will pick Doctor A, because an 80 percent chance of recovery sounds way better than a 20 percent chance of death.

It’s important to carefully consider how you present information in all walks of life, because your method of presentation can make or break the outcome.

6. Bandwagon Effect. Just because many people believe something doesn’t make it true…though it does make it much easier for the brain to accept. In many ways, humans behave like herd animals, blindly accepting whatever they encounter as long as there seems to be some social proof.

One of my favorite quotes is attributed to Mark Twain, and says:

“Whenever you find yourself on the side of the majority, it is time to pause and reflect.”

It’s important not to allow the beliefs of others to sway you without careful thought and research on your part. Don’t accept things at face value.

7. Dunning-Kruger Effect. Last but not least, this cognitive bias is at play behind arrogance and egotism. People have a psychological tendency to assess their abilities as much greater than they really are.

How do you conquer this? I personally have a four-step approach:

  1. Keep a journal
  2. Meditate
  3. Pause before you act
  4. Self-analyze

As you go through this process, you’ll find yourself better equipped to assess your skills without bias. I’ve written a more detailed blog post about self-awareness, if you want to check it out.

Becoming aware of cognitive biases and the role they play in your life is one of the most critical steps to conquering, or at least mitigating, their negative effects.

The opinions expressed here by columnists are their own, not those of

When Doctors Say No, Find a New Doctor

Posted by Emily Shearing

Renee Burnett never took no for an answer. When her husband’s doctors and therapists told him he’d never walk again after his stroke, she recruited another team of medical professionals.

Two and a half years later, Harold Burnett, 44, walks without a cane. “I see more and more improvement in him every day,” Renee Burnett says. “They say whatever you get back in a year after the stroke, that’s it, but that is so false.”

Impervious to Pessimism

In the weeks after his stroke, Harold Burnett gained back some of the movement in his left leg, thanks to a physical therapist, who also taught Renee Burnett how to stretch and manipulate her husband’s leg at home to improve his mobility. A month later, the neurologist told Burnett he was amazed by his recovery.

But six months after daily physical therapy and major advancements in his leg, there was little improvement in his left arm. One occupational therapist even told Burnett after a visit that continuing therapy on his left arm “was a waste of time.” Renee Burnett saw the therapist’s snub as a blessing in disguise. “I’m such a stubborn person that I tried to prove her wrong,” she says.

Expanding the Care Corridor

The couple from New Jersey traveled to Philadelphia to seek out a new team of specialists for Harold Burnett’s care. Doctors assured the Burnetts they could have him walking normally again, and in a year they could shift the focus of recovery onto his arm.

With the help of Botox, Burnett is resuming normal functions in his left arm. “He can raise his arm, grasp objects, move his arm out to the side, and he is actually trying to go back to work,” Renee Burnett says. “And this is the man they said would never get out of a wheelchair.”

That’s proof, Burnett says, that the minute you hear anything is impossible from a doctor or therapist, move on. “That [therapist] did all they could for you and now it’s time to find someone else to help you get further along,” she says. “Don’t ever listen to the word no. If we would’ve listened to the first doctor, the first therapist just saying we should be grateful he’s alive, my husband wouldn’t be walking.”

What to do AFTER you had a stroke

Posted by Lisa O’Neill Hill

You’re watching television and a commercial comes on. It’s one you’ve seen before, but this time you burst into tears. You can’t stop crying. Later, you spill something and you become angrier than you should. You’re frustrated because you can’t control your emotions.

If this sounds familiar, you’re not alone. Dealing with the emotional and psychological aspect of stroke can sometimes be just as challenging as dealing with the physical recovery. Changes in your emotions or behavior can be caused by the physical damage to your brain or from the effects of coping with the trauma and its aftermath.

It’s not unusual to be frustrated or angry that you can’t do all the things you could do before. You may be grieving the life and the identify you had before your stroke. It’s also normal to be depressed or sad. In fact, more than a third of stroke survivors are affected by depression. And some people struggle with lack of motivation or not caring what happens.

Many survivors also worry about having another stroke or transient ischemic attack (TIA), especially if they’re out in public or while sleeping. Others become so worried that they can’t sleep or become anxious when they’re left alone.

These tips may help you deal with the emotional aspects of recovery:

• Don’t feel guilty about your feelings. They’re not good or bad. They’re a normal part of the recovery process.

• Talk to someone. Talking about the stroke and your feelings about it will help you come to terms with them.

• Join a support group. Other survivors will understand what you’re dealing with and can offer insight.

• Know when to ask for help. Talk to your doctor if you think you could benefit from counseling or from an antidepressant.

• Exercise. It’s a natural mood booster and will help you feel better.

• Find time to relax. Listen to music you enjoy, meditate, or practice deep-breathing exercises. These can be particularly helpful if you feel anxious. Writing your worries on a piece of paper also can help.

• Do something you enjoy, whether that’s watching a silly television show, spending time with your family, or savoring a good cup of coffee.

• Give yourself credit. It’s important to celebrate your progress and it’s OK to make mistakes.

• Tell people how you’d like them to treat you if you become emotional. You might get more upset if someone dismisses your feelings or tells you not to cry.

For more information, go to StrokeSmart

Has someone suddenly gone to the hospital? Then you should read this!

I was told that Josie King Foundation had as link you can use in case you are or a family member is in the hospital.

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Being a patient or having a loved one in the hospital can be stressful and confusing. You are in a new environment with lots of information being given to you. There is so much to think about and to process- the names of the doctors and nurses, new medications, scheduled procedures, questions to ask, and so much more. It can be a bit daunting.

The Josie King Foundation has created a Patient Journal app. Patients and families can use this app to easily record vital medical information, stay organized, keep a permanent medical record, and share the notes with doctors or anybody else via email.

The Patient Journal app is now available for free download on the Apple iTunes App Store link:

Using the Patient Journal app is easy. The app opens a list of prompts about information that should be tracked during a hospital stay.

To enter notes, click on a category to learn more about it and type away.

You can review the information you have entered, and can even scroll through the daily entries to get an overall view of a patient’s changing condition.

At any point, you can email the journal to a doctor, a loved one, or yourself to keep as a permanent record of the hospital stay.

The Patient Journal app can be reused for subsequent hospital stays.

If you have any questions or comments about the app, we would love to hear them. You can email, and we will get back to you quickly.  Go to the Josie King Foundation for more information.

Fact or Myth……




MYTH: Stroke cannot be prevented. FACT: Up to 80 percent of strokes are preventable.
MYTH: There is no treatment for stroke. FACT: At any sign of stroke call 9-1-1- immediately. Treatment may be available.
MYTH: Stroke only affects the elderly. FACT: Stroke can happen to anyone at any time.
MYTH: Stroke happens in the heart. FACT: Stroke is a “brain attack”.
MYTH: Stroke recovery only happens for the first few months after a stroke. FACT: Stroke recovery is a lifelong process.
MYTH: Strokes are rare. FACT: There are nearly 7 million stroke survivors in the U.S. Stroke is the 4th leading cause of death in the U.S.
MYTH: Strokes are not hereditary. FACT: Family history of stroke increases your chance for stroke.
MYTH: If stroke symptoms go away, you don’t have to see a doctor. FACT: Temporary stroke symptoms are called transient ischemic attacks (TIA). They are warning signs prior to actual stroke and need to be taken seriously.

Source: National Stroke Association