Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 438 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Friday, May 22, 2015

When every second counts - MGH and MNH become specialized stroke centres

I know  hospitals like this chest-thumping display of accreditation. But that is all it is. It talks about access and procedures, NOT RESULTS and GOALS. 30day deaths and 100% recovery?
Big f*cking whoopee.
 https://muhc.ca/newsroom/article/when-every-second-counts-mgh-and-mnh-become-specialized-stroke-centres

Two McGill University Health Centre (MUHC) hospitals have recently received new accreditations: the Montreal General Hospital (MGH) was designated a secondary stroke centre and the Montreal Neurological Hospital (MNH), a tertiary stroke centre. The accreditations were granted after a successful reorganization of services that has optimized speed and quality of care for stroke patients. So, it was with great pride that around 40 members of the MUHC Stroke Program and MUHC administrators celebrated the news.
“The MUHC is the only medical institution in Quebec to have a tertiary and a secondary stroke centre,” says Neurologist Dr. Robert Côté, medical director of the MUHC Stroke Program. “Both units are ultra-specialized and provide rapid assessment, diagnostics and treatment for any type of stroke intervention. The only difference between them is that the MNH has interventional neuroradiology (INR), a procedure used to retrieve clots inside the arteries.”
The transformation of services is part of a stroke strategy put in place by the Ministry of Health in 2013 to improve stroke prevention and healthcare services offered to the more than 12,000 Quebeckers who experience a stroke every year. For every one of them, time is of essence. 
“Time is brain,” says Dr. Côté. “For every minute a stroke is left untreated, 2 million brain cells are destroyed. So, the sooner we treat patients the higher the chances of survival with fewer disabilities. That’s better for patients and their families, of course, but it’s also cost effective.”
In the last two years, a Stroke Coordinating Committee, with representatives from the MGH and MNH, worked diligently to fulfill the ministry’s long list of criteria and receive the accreditation. One important requirement was that each unit have a dedicated stroke team. 
“That means that the same professionals will follow a patient from admission until discharge,” explains Rosa Sourial, clinical nurse specialist in the MUHC Stroke Program. “Furthermore, a nurse clinician facilitates continuity of care throughout the hospitalization and collaborates with patients, families and the stroke team in planning the next phase of recovery which involves rehabilitation and follow up in the MUHC Stroke Prevention Clinic.” (Please see : Upgraded Stroke Prevention Clinic improves health services offered by the MUHC)
The two centres also reviewed and improved their procedures to fulfil three other requirements:  improve access to diagnostic testing, decrease the length of stay of patients and engage patients and families in the plan of care. (Maybe results of 60 minute delivery of tPA?)
“Although patient experience hasn’t been formally tested, a survey carried out by nurse managers in both units indicated that patients and families feel they are better informed about stroke care,” says Sourial. 
The improvements in access, continuity and quality of care in both units also benefit patients who were not initially targeted by the stroke program, such as those with transient ischemic attacks (TIA). The success in the transformation is even more meaningful because it was achieved during a challenging time. 
“We underwent the rigorous process of accreditation in a context of budget constraints and in the middle of the transition of the Royal Victoria Hospital, which was the entry point for our stroke patients, to the Glen,” says Dr. Côté. 
As Rosa Sourial puts it, the whole process has been “a lot of work, but a fun ride”.
“Our teams joined forces to improve the health of the population and we can see the results,” she says. “This is not about us, but about our patients. I hope the two stroke centres will get even better in the future.”

Upgraded Stroke Prevention Clinic improves health services offered by the MUHC
The accreditation work at the two stroke centres had another major positive result.  For the past year, the MUHC Stroke Prevention Clinic (SPC) located at the Montreal General Hospital (MGH) has been offering enhanced acute evaluation services to patients with a transient ischemic attack (TIA).
“A TIA produces similar symptoms to those of a stroke such as sudden weakness on one side of the body, face droopiness or difficulties finding words, says Heather Perkins, nurse clinician in the Stroke Prevention Clinic. “It usually lasts only a few minutes and often causes no permanent damage, but should be taken seriously, because these patients are at higher risk of having a stroke.”
The clinic accepts referrals from emergency departments and general practitioners in the community. It   has the same access to radiology and ultrasound equipment as the Emergency Department so that all exams can be done as soon as is needed. It also follows up on patients recovering from a stroke and quickly refers them to rehab specialists.
Along with the new services, the clinic pursues its main vocation: to educate healthcare workers and patients about TIAs and strokes. As Neurologist and Medical Director of the MUHC Stroke Program Dr. Robert Côté explains, “The Stroke Prevention Clinic is extremely important. We can treat patients for acute stroke and send them to rehabilitation, but we don’t want them to come back with another stroke.”


Mr. Lopez, Dr. Stephen Davis, Dr. Mariel Jessup "What evidence would you need to see to change your mind about how to solve the stroke problem?"

Stroke survivors are not getting anywhere with help for us, so we need to change the conversation from F.A.S.T. and prevention to something more useful.
A great description from Seth Godin;

Seth's Blog : How to win an argument with a scientist

The person you're arguing with now (who might be a scientist during the day, even, but is merely being a person right now) is not going to be swayed from a firmly held opinion by your work to make better science. It's more likely that it will take cultural pressure, shame, passion, humor, connection and a host of unreliable levers to make your point.

How Neurotic Are You? One-Minute Personality Test

I scored 0 out of 40.

Very low neuroticism

You personality is more emotionally stable than at least 93% of people -- even more than that if you scored lower than a 3.

Have at it. I'm sure there is some correlation with happiness and ability to handle setbacks. Your doctor probably should know this in order to treat you better.

Investigation of the effects of solid lipid curcumin on cognition and mood in a healthy older population

Curcumin has been touted for its wonderful properties. What does this research tell your doctor about updating your stroke diet protocol?  I've only written 12 posts on curcumin.
YOU DO HAVE A STROKE DIET PROTOCOL? DON'T YOU?
http://jop.sagepub.com/content/29/5/642.abstract?&
  1. Katherine HM Cox
  2. Andrew Pipingas
  3. Andrew B Scholey
  1. Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
  1. Andrew B Scholey, Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, 3122, Australia. Email: andrew@scholeylab.com

Abstract

Curcumin possesses many properties which may prevent or ameliorate pathological processes underlying age-related cognitive decline, dementia or mood disorders. These benefits in preclinical studies have not been established in humans. This randomized, double-blind, placebo-controlled trial examined the acute (1 and 3 h after a single dose), chronic (4 weeks) and acute-on-chronic (1 and 3 h after single dose following chronic treatment) effects of solid lipid curcumin formulation (400 mg as Longvida®) on cognitive function, mood and blood biomarkers in 60 healthy adults aged 60–85. One hour after administration curcumin significantly improved performance on sustained attention and working memory tasks, compared with placebo. Working memory and mood (general fatigue and change in state calmness, contentedness and fatigue induced by psychological stress) were significantly better following chronic treatment. A significant acute-on-chronic treatment effect on alertness and contentedness was also observed. Curcumin was associated with significantly reduced total and LDL cholesterol and had no effect on hematological safety measures. To our knowledge this is the first study to examine the effects of curcumin on cognition and mood in a healthy older population or to examine any acute behavioral effects in humans. Results highlight the need for further investigation of the potential psychological and cognitive benefits of curcumin in an older population.

Lesion Characteristics of Individuals With Upper Limb Spasticity After Stroke

This starts to address the f*ckingly simple but stupid question. 'Exactly what leads to spasticity in some 40% of patients?' ' Why do the other 60% not exhibit spasticity?'
Whom is putting this into the strategy plan and whom is assigned to find the answer? A great stroke association would tackle and solve this problem. But NO, everyone will just sit on their ass waiting for SOMEONE ELSE TO SOLVE THE PROBLEM.
So how do you fix the putamen? Ask your doctor and not politely. 
The solution to this could lead to much easier recoveries. Contrary to the pronouncements of Dr. William M. Landau;

Spasticity After Stroke: Why Bother?

He really needs to relook at whatever research he is citing and talk to some intelligent survivors. 

At least these scientists didn't listen to his Dr. Landaus' call for stopping research on spasticity;

However, the perseverative preoccupation of professional neurologists and therapists with the purpose of overpowering the spasticity ogre seems to be an endemic, intractably-taught delusion that afflicts both academic scholars and clinicians.1 

 Lesion Characteristics of Individuals With Upper Limb Spasticity After Stroke

  1. Daniel K. Cheung1,2,3
  2. Seth A. Climans4
  3. Sandra E. Black, MD, FRCP1,2,3,5
  4. Fuqiang Gao, MD2
  5. Gregory M. Szilagyi2,3
  6. George Mochizuki, PhD1,2,3
  1. 1Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
  2. 2Sunnybrook Research Institute, Toronto, Ontario, Canada
  3. 3University of Toronto, Toronto, Ontario, Canada
  4. 4Western University, London, Ontario, Canada
  5. 5Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. George Mochizuki, Sunnybrook Research Institute, 2075 Bayview Avenue, Rm M6-178, Toronto, Ontario, Canada M4N3M5. Email: george.mochizuki@sunnybrook.ca

Abstract

This study explores the relationship between lesion location and volume and upper limb spasticity after stroke. Ninety-seven stroke patients (51 with spasticity) were included in the analysis (age = 67.5 ± 13.3 years, 57 males). Lesions were traced from computed tomography and magnetic resonance images and coregistered to a symmetrical brain template. Lesion overlays from the nonspastic group were subtracted from the spastic group to determine the regions of the brain more commonly lesioned in spastic patients. Similar analysis was performed across groups of participants whose upper limb (elbow or wrist) Modified Ashworth Scale (MAS) score ranged from 1 (mild) to 4 (severe). Following subtraction analysis and Fisher’s exact test, the putamen was identified as the area most frequently lesioned in individuals with spasticity. More severe spasticity was associated with a higher lesion volume. This study establishes the neuroanatomical correlates of poststroke spasticity and describes the relationship between lesion characteristics and the severity of spasticity using mixed brain imaging modalities, including computed tomography imaging, which is more readily available to clinicians. Understanding the association between lesion location and volume with the development and severity of spasticity is an important first step toward predicting the development of spasticity after stroke. Such information could inform the implementation of intervention strategies during the recovery process to minimize the extent of impairment.

 

New athletic shoes needed

After the problems on the cruise and Barcelona I need a lot tighter shoes. For work I'm wearing one of the Italian shoes I bought last year. It has the curly laces and since my left foot is still swollen my foot doesn't slide and jostle my detached big toenail.  Part of the problem is that my current athletic shoes were bought a size larger - 13 - to accommodate an AFO

Coffee rehab and lever handles

For the two weeks I was in Tampa the office had free coffee with Keurig machines. This was only a problem in getting out of the breakroom. It had a stiff lever handle and I had to resort to putting the coffee cup on the floor, opening the door, picking up the coffee and then walking the long way around thru rows of cubicles so I didn't have to go thru two more doors. My left hand is so useless, can't even open it enough to get it around the lever sideways. And if I did succeed in that I would need my right hand to yank it off the lever. The past two weeks here in Sacramento, the lever handles aren't as stiff so I can get them opened with a coffee cup in my right hand. So far I've only spilled on myself twice through the drink hole in the cover. Free coffee here also, hotel also has 24 hour coffee. I'm in heaven.

Thursday, May 21, 2015

Study questions beneficial effects of a Nordic diet on cardiovascular events

What is your post-stroke diet protocol from your doctor? Paleo, Mediterranean, Nordic? Do you even have one? Specifics, not just general crap like eat healthy.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=152951&CultureCode=en
A new study led from Sweden’s Karolinska Institutet shows that although individual components of a healthy so-called Nordic diet previously have been linked to beneficial effects on cardiovascular health, as well as to other health effects, there is no evidence of an association with cardiovascular events in a general population. The study, which was conducted in in over 40,000 Swedish women, is being published in the Journal of Internal Medicine.
Cardiovascular disease, such as heart attack and stroke, is a leading cause of death worldwide, and it has long been known that dietary factors have an important influence on cardiovascular health. Previous studies have shown beneficial effects of a healthy Nordic diet − comprising whole grain bread and oatmeal, fruit (apples/pears), vegetables (root vegetables and cabbage) and fish − on short-term markers of cardiovascular health, for example lower blood pressure and weight loss. Several studies have also showed beneficial effects of individual components included in the Nordic diet on cardiovascular events. However, the current study is the first to investigate the overall, long-term association between a healthy Nordic diet and the incidence of cardiovascular disease in the general population.
The study was conducted in 43,310 middle-aged Swedish women. The participants answered questions in 1991/92 about their food intake, and the incidence of cardiovascular disease was recorded through the Swedish registries over approximately 20 years until the end of 2012. During the follow-up period, nearly 20% of the women developed cardiovascular disease. However, unexpectedly given the results of previous studies, the beneficial effect of a healthy Nordic diet did not register when looking at the incidence of concrete, cardiovascular events in the general population.
“The reason for this for this discrepancy could be that previous studies showing effect of a healthy Nordic diet were intervention trials, which means participants had a very high adherence to this particular diet and also were selected, high-risk persons in relation to developing cardiovascular disease, whereas the present study expected a lesser degree of adherence, and looked and a group of overall healthy women”, says first author Nina Roswall, PhD, at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
An additional goal for the research team was to determine whether any relationship between the healthy Nordic diet and cardiovascular disease is modified by age, weight, alcohol consumption or smoking. Their results show that alcohol intake, weight (BMI) and age did not have any significant affect.
“We did manage to show a beneficial effect of this diet among former smokers”, says Professor Elisabete Weiderpass, PhD, who supervised the study. “However, this may be due to the fact that smoking cessation is associated with dietary changes towards a healthier lifestyle, which may have affected the results. It is also important to point out that further investigation is required to confirm these findings.”
Research organizations involved in this study, other than Karolinska Institutet, were the Danish Cancer Society Research Center, University of Auckland, New Zealand, Harvard School of Public Health, USA, Folkhälsan Research Center, Finland, The Cancer Registry of Norway, The Arctic University of Norway, and University of Tromsö, also in Norway. The investigation was supported by a grant from the Swedish Research Council.
Karolinska Institutet − a medical university: ki.se/english

Liraglutide is neurotrophic and neuroprotective in neuronal cultures and mitigates mild traumatic brain injury in mice

Is this enough evidence to create clinical trials in humans? Whom can we ask that question of? There is no one because no one is in charge of stroke. . Because every stroke professional in the world is waiting for SOMEONE ELSE TO SOLVE THE PROBLEM.
Three years ago this was reported;

GLP-1R Agonist Liraglutide Activates Cytoprotective Pathways and Improves Outcomes After Experimental Myocardial Infarction in Mice

yet we are no farther along in this because why?

http://onlinelibrary.wiley.com/doi/10.1111/jnc.13169/abstract 
  1. Yazhou Li1,†,*,
  2. Miaad Bader2,†,
  3. Ian Tamargo1,
  4. Vardit Rubovitch2,
  5. David Tweedie1,
  6. Chaim G. Pick2,3,‡ and
  7. Nigel H. Greig1,‡,*
DOI: 10.1111/jnc.13169



Abstract

Traumatic brain injury (TBI), a brain dysfunction for which there is no present effective treatment, is often caused by a concussive impact to the head and affects an estimated 1.7 million Americans annually. Our laboratory previously demonstrated that exendin-4, a long-lasting glucagon-like peptide 1 receptor (GLP-1R) agonist, has neuroprotective effects in cellular and animal models of TBI. Here, we demonstrate neurotrophic and neuroprotective effects of a different GLP-1R agonist, liraglutide, in neuronal cultures and a mouse model of mild TBI (mTBI). Liraglutide promoted dose-dependent proliferation in SH-SY5Y cells and in a GLP-1R over-expressing cell line at reduced concentrations. Pretreatment with liraglutide rescued neuronal cells from oxidative stress- and glutamate excitotoxicity-induced cell death. Liraglutide produced neurotrophic and neuroprotective effects similar to those of exendin-4 in vitro. The cAMP/PKA/pCREB pathway appears to play an important role in this neuroprotective activity of liraglutide. Furthermore, our findings in cell culture were well-translated in a weight-drop mTBI mouse model. Post-treatment with a clinically relevant dose of liraglutide for 7 days in mice ameliorated memory impairments caused by mTBI when evaluated 7 and 30 days post trauma. These data cross-validate former studies of exendin-4 and suggest that liraglutide holds therapeutic potential for the treatment of mTBI.



Tracking of Administered Progenitor Cells in Brain Injury and Stroke by Magnetic Resonance Imaging

If your stem cell provider isn't tracking the cells they inject then they have no f*cking idea if they survived and are doing any good at all. This is why I don't trust any statements about Gordie Howe. They have absolutely no idea if the stem cells even lived. Any clinical research that doesn't include tracking should never even get funded.
http://link.springer.com/chapter/10.1007/978-3-319-15063-5_12
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Abstract

Traumatic brain injury and stroke remain important causes of chronic neurologic morbidity due to the lack of vasculature in injured brain. Promising data from preclinical and clinical studies suggest that transplantation of exogenous hematopoietic stem cells (HSCs) and neural progenitor cells (NPCs) has therapeutic potential for boosting brain repair. This neuroregeneration could be achieved by HSCs/NPCs migration, differentiation, enhanced endogenous angiogenesis and neurogenesis, and the secretion of trophic factors by these cells in injured tissue and stroke. The neuroregeneration is achieved by significant decrease in graft-versus-host disease and improved functional behavior of damaged brain. Importantly, these stem cells are derived from peripheral blood, umbilical cord blood (UCB), bone marrow (BM), and embryonic sources. A subpopulation of CD34+ human HSCs identified by the cell-surface molecule AC133 (CD133) has been shown to be more specific for endothelial differentiation and vascular repair. Similarly, NPCs have shown to induced angiogenesis and neurogenesis in stroke. Several studies have been exploited in vivo imaging modalities, importantly magnetic resonance imaging (MRI) to monitor the migration and engraftment efficacy of administered cells for cell-based therapies. This chapter covers the characterization of contrast agents, cell-labeling methods for MRI, use of endothelial progenitor cells (EPCs) and NPCs in vascular integrity and neuroregeneration, and molecular mechanisms of their homing to the injured or stroke site, such as their interaction with brain endothelium as depicted by MRI.

WITHDRAWN: Haemostatic drugs for traumatic brain injury

I wonder if this applies to hemorrhages also. If we had publicly available stroke protocols maintained by our stroke associations we could look it up. But we have jackshit. Stroke survivors are just all around screwed.
http://europepmc.org/abstract/med/25970597
, , , , ,
Department of Population Health, London School of Hygiene & Tropical Medicine, Room 134b Keppel Street, London, UK, WC1E 7HT.
Highlight Terms
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial bleeding is a common complication of TBI, and intracranial bleeding can develop or worsen after hospital admission. Haemostatic drugs may reduce the occurrence or size of intracranial bleeds and consequently lower the morbidity and mortality associated with TBI.

OBJECTIVES: To assess the effects of haemostatic drugs on mortality, disability and thrombotic complications in patients with traumatic brain injury.

SEARCH METHODS: We searched the electronic databases: Cochrane Injuries Group Specialised Register (3 February 2009), CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (1950 to Week 3 2009), PubMed (searched 3 February 2009 (last 180 days)), EMBASE (1980 to Week 4 2009), CINAHL (1982 to January 2009), ISI Web of

Science: Science Citation Index Expanded (SCI-EXPANDED) (1970 to January 2009), ISI Web of

Science: Conference Proceedings Citation Index - Science (CPCI-S) (1990 to January 2009).

SELECTION CRITERIA: We included published and unpublished randomised controlled trials comparing haemostatic drugs (antifibrinolytics: aprotinin, tranexamic acid (TXA), aminocaproic acid or recombined activated factor VIIa (rFVIIa)) with placebo, no treatment, or other treatment in patients with acute traumatic brain injury.

DATA COLLECTION AND ANALYSIS: Two review authors independently examined all electronic records, and extracted the data. We judged that there was clinical heterogeneity between trials so we did not attempt to pool the results of the included trials. The results are reported separately.

MAIN RESULTS: We included two trials. One was a post-hoc analysis of 30 TBI patients from a randomised controlled trial of rFVIIa in blunt trauma patients. The risk ratio for mortality at 30 days was 0.64 (95% CI 0.25 to 1.63) for rFVIIa compared to placebo. This result should be considered with caution as the subgroup analysis was not pre-specified for the trial. The other trial evaluated the effect of rFVIIa in 97 TBI patients with evidence of intracerebral bleeding in a computed tomography (CT) scan. The corresponding risk ratio for mortality at the last follow up was 1.08 (95% CI 0.44 to 2.68). The quality of the reporting of both trials was poor so it was difficult to assess the risk of bias. AUTHORS'

CONCLUSIONS: There is no reliable evidence from randomised controlled trials to support the effectiveness of haemostatic drugs in reducing mortality or disability in patients with TBI. New randomised controlled trials assessing the effects of haemostatic drugs in TBI patients should be conducted. These trials should be large enough to detect clinically plausible treatment effects.

Does your doctor know who the thought leaders are in stroke?

I have no clue who they might be. When your neurologist has a stroke whom will they be going to to get 100% recovered? It's a simple question, demand an answer. But I would suggest some;
Dr. Michael Tymianski, of the Toronto Western Hospital Research Institute in Canada.
Dr. Michael A. Moskowitz in 2010 had some great ideas needing followup.
I'm sure our stroke associations have not called these people together to establish a strategy to solve all the f*cking problems in stroke. Because everyone in the world is waiting for SOMEONE ELSE TO SOLVE THE PROBLEM.

Seth Godin has a good discussion on this;

You don't know Lefsetz? 

I was talking to someone dedicating his career to working in newspapers. I asked him what he thought of the work of Jeff Jarvis. He had no idea what I was talking about.
I met a musician the other day, and asked her how her work without a label was going, and referenced something by Bob Lefsetz. She didn't know who I meant.
The last time I was at an event for librarians, I mentioned Maria Popova. Blank stares.
A podcaster asked me a question, and I wondered if he admired the path Krista Tippett had taken. He had no clue.
A colleague was explaining his work in memetics to me. I asked about Dawkins and Blackmore. You guessed it...
Or Kenji on food, Cader on publishing, Underhill on retail, Lewis on direct mail copywriting and on and on...
We would never consent to surgery from a surgeon who hadn't been to medical school, and perhaps even more important, from someone who hadn't kept up on the latest medical journals and training. And yet there are people who take pride in doing their profession from a place of naivete, unaware or unlearned in the most important voices in their field.
The line between an amateur and professional keeps blurring, but for me, the posture of understanding both the pioneers and the state of the art is essential. An economist doesn't have to agree with Keynes, but she better know who he is.
If you don't know who the must-reads in your field are, find out before your customers and competitors do.
Too much doing, not enough knowing.


Day of the week and ischemic stroke: is it Monday high or Sunday low?

Well mine was on Sunday morning but my socioeconomic status was average.
http://www.ncbi.nlm.nih.gov/pubmed/15272128

Abstract

BACKGROUND AND PURPOSE:

The study aim was to examine the incidence of ischemic stroke (IS) by day of the week and its relationship with age, sex, and socioeconomic status (SES).

METHODS:

A total of 12,801 IS events in men and women aged 25 to 99 years was recorded in a population-based stroke register (FINMONICA), which was functioning in Finland from 1982 to 1992. We analyzed the weekly variation in IS incidence by pooling the data and stratifying by sex and age. Taxable income and level of education were used as indicators of SES.

RESULTS:

We observed a significant weekly variation in IS occurrence, but the analysis by age group demonstrated a difference by weekday only in the age group 60 to 74, both in men and women (P<0.001 and P=0.02, respectively). The increase in the number of IS events from Sunday to Monday was pronounced in men (29.2% increase from Sunday to Monday). When stratifying by age, Monday excess in IS incidence was associated with lower SES among persons >59 years of age. No Monday excess was observed in persons with high SES.

CONCLUSIONS:

Because the incidence of IS is much higher in persons with low SES than in those with high SES, the Monday excess in persons with low SES is of substantial public health interest. This finding may suggest reasons for the higher IS incidence in persons with low socioeconomic positions and open up some possibilities for prevention.

Usual dose of caffeine has a positive effect on somatosensory related postural stability in hemiparetic stroke patients

So coffee improves postural stability. The next test should by to perturb your stability by drinking red wine and see if coffee can stabilize it after that.

Can Wine Protect You From Having a Stroke?

 Usual dose of caffeine has a positive effect on somatosensory related postural stability in hemiparetic stroke patients

Abstract

OBJECTIVE:

To evaluate the effect of caffeine on balance control of hemiparetic stroke patients, we investigated the difference in postural stability before and after drinking coffee by observing changes in stability index (SI) from posturography.

METHODS:

Thirty patients with history of stroke and 15 age-matched healthy subjects participated in this study. Effect of group factor (of the control and stroke groups) and treatment factor (pre- and post-drinking of coffee) on SI were tested in three conditions: with eyes opened, with eyes closed, and with a pillow support. The effects of these factors on visual deprivation and somatosensory change of subjects were also tested.

RESULTS:

Under all conditions, SI was higher in the stroke group than in the control group. Under eyes-open condition, the treatment factor was not statistically significant. Under eyes-closed condition, the interaction between group and treatment factor was statistically significant. After the subjects drank coffee, SI in the control group was increased. However, SI in the stroke group was decreased. Under pillow-supported condition, the interaction between group and treatment factor appeared marginally significant. For visual deprivation effect, the interaction between treatment and group factor was statistically significant. After caffeine consumption, the visual deprivation effect was increased in control group but decreased in the stroke group. For somatosensory change effect, the interaction between group and treatment factor was not statistically significant.

CONCLUSION:

Postural stability of hemiparetic stroke patients related to somatosensory information was improved after intake of usual dose of caffeine.

 

New hospital ratings evaluate delivery of “typical care”

Right now we have no f*cking clue how good our stroke hospitals are, this new rating doesn't cover stroke. Our stroke associations don't have enough balls to analyze and publicly publish such ratings. Get With the Guidelines and Joint Commission certification tell us nothing about the results of stroke patients. A great stroke association would tackle such a project because its mission is to help survivors not doctors or hospitals.
New hospital ratings evaluate delivery of “typical care”

Wednesday, May 20, 2015

Floyd Medical Center receives award from American Heart Association/American Stroke Association - Rome, GA

These are NOT result awards so they don't tell you anything about how good the program is. Call that hospital president(Kurt Stuenkel) and demand to know what the RESULTS are; 30 day deaths, 100% recovery.
There is absolutely nothing in here that tells me that the RESULTS are better in this hospital than other hospitals. I don't give a crap about how well you do processes.
Big f*cking whoopee.
Guidelines here: You can see how this is nothing to be impressed about. This is all indirect action, not results.
http://www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelinesHFStrokeResus/GetWithTheGuidelinesStrokeHomePage/Get-With-The-Guidelines-Stroke-Overview_UCM_308021_Article.jsp


But the puffery article here;
http://www.northwestgeorgianews.com/rome/business/floyd-medical-center-receives-award-from-american-heart-association-american/article_b12cf68e-fe58-11e4-b29c-9ba239b88fbc.html

Floyd Medical Center has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award with Target: StrokeSM Honor Roll. The award recognizes the hospital’s commitment and success ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.
To receive the Gold Plus Quality Achievement Award, hospitals must adhere to Get With The Guidelines-Stroke achievement indicators for two or more consecutive 12-month periods and comply with Get With The Guidelines-Stroke Quality measures.
“With a stroke, every second is critical, and this award demonstrates our commitment to ensuring patients receive excellent care as quickly and efficiently as possible,” said Dr. Joseph Biuso, Executive Vice President and Chief Medical Officer at Floyd. “Our award-winning stroke team is dedicated to improving the quality of care patients receive and these guidelines help us achieve that goal.”
The Get With The Guidelines® program establishes quality measures that are designed to help hospital teams provide the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. (Nothing on Results)

My standard reply to all these articles extolling the virtues of getting to a hospital fast for stroke

The first 24 hours may be critical but you didn't mention that maybe 10% of those eligible for tPA actually get it. And of those getting it it only works to completely reverse the stroke 12% of the time. http://wrkf.org/post/more-stroke-patients-now-get-clot-busting-drug

All they ever do is parrot the messages from the stroke associations. And those messages are lying by omission.

The PIED Piper of Nootropics

An analysis of nootropics by Science Based Medicine. I had earlier written about this here;
http://www.oc1dean.blogspot.com/search/label/Nootropics
Pre-condition the physiological system to withstand trauma. Fascinating idea but I can't quite see saying, 'I'm going to have a stroke in 3 months, run my brain thru this pre-conditioning'. But maybe we could repurpose some into neuroprotection strategies.

But maybe not useful yet.
The PIED Piper of Nootropics

New York Academy of Sciences Podcasts on Dementia

Just in case your doctors aren't providing you stuff on your 33% dementia chance post-stroke from an Australian study.

http://www.nyas.org/whatwedo/scpodcasts.aspx 
4 right now a 5th coming soon.

MRI screening helps in accurate and rapid stroke treatment

A 60 minute treatment goal is way too slow, you need to have this delivered in the ambulance. Scanning is way too slow, expensive and requires a neurologist on duty.  When are we going to fund researchers to test out these 17 possibilities to find out which one is the best?  Or maybe the Qualcomm Xprize for the tricorder?  
http://www.news-medical.net/news/20150514/MRI-screening-helps-in-accurate-and-rapid-stroke-treatment.aspx 
Time is critical when it comes to stroke, and early treatment is associated with better outcomes. According to the Screening with MRI for Accurate and Rapid stroke Treatment (SMART) study, small changes in quality improvement procedures enabled clinicians to use MRI scans to diagnose stroke patients before giving acute treatment, within 60 minutes of hospital arrival. MRI scans provide detailed images but take longer to complete than CT scans, which are commonly used in most centers. The findings, published in Neurology, were supported in part by the National Institutes of Health's National Institute of Neurological Disorders and Stroke (NINDS).
"By making small changes to our processes, we were able to scan suspected stroke patients with MRI and appropriately treat patients within a goal time of 60 minutes. This is an important finding for hospitals, healthcare providers and the public," said Amie Hsia, M.D., medical director of the Comprehensive Stroke Center at MedStar Washington Hospital Center, Washington D.C., and senior author of the study. "Not only does MRI provide more precise and complete information than the traditionally used CT scan, now we've also demonstrated that it is feasible to use from a time perspective."
National guidelines suggest that stroke patients should receive treatment within 60 minutes of arriving at the hospital. (Why so slow?)The majority of hospitals rely on rapid CT scans to determine if an individual is eligible for intravenous tPA, the only FDA-approved treatment for ischemic strokes, those caused by blood clots in the brain. If a CT scan shows the patient is having a bleeding, or hemorrhagic, type of stroke, tPA cannot be used as treatment. For many years CT scans were the only imaging tool available in most hospitals, but now MRIs are becoming more widely available.
Clinicians at MedStar Washington Hospital Center and Suburban Hospital, Bethesda, Maryland, routinely work with physician-scientists from NIH and have access to their cutting-edge medical protocols and technologies. The two hospitals use MRI instead of CT scans to screen stroke patients. Although MRI scans can take up to 15 minutes longer than CT scans, they provide clinicians with more detailed information about what is happening in a patient's brain. Using MRI, clinicians can see early changes taking place during the stroke. In this way, they can see what tissue is at risk and identify blocked blood vessels or subtle bleeding that cannot be picked up by CT.
To reduce the door to treatment time, multidisciplinary teams at both hospitals carefully examined the existing processes to identify time-consuming bottlenecks or duplicative methods. By using "lean process interventions," they found a number of steps that could be eliminated or changed. For example, at MedStar Washington Hospital Center, a lengthy MRI screening form was simplified to three questions; at Suburban Hospital, tPA was put into the medication cart in the MRI suite so that it could be given immediately to patients after scanning instead of returning them to the Emergency Department for treatment.
Once the changes were implemented, Dr. Hsia's team examined whether they had an impact on treatment times for patients. The results indicated that door to treatment time was reduced from 93 to 55 minutes, a difference of 40 percent. Over a two year period, the percentage of patients treated within 60 minutes increased from 13 to 61.5 percent. Further analysis revealed that these changes were due to faster MRI start times.
"There was no difference in the patient characteristics. It was clear the improvements were due to the changes we made in the processes at these two hospitals," said Dr. Hsia.
"A number of the changes that Dr. Hsia's team assessed were not specific for MRI scans, but were related to general procedures of getting patients ready for imaging as quickly as possible. This suggests that these findings are relevant even in hospitals that do not have emergency access to MRI scanners," said Walter Koroshetz, M.D., acting director of NINDS. "We will persist in evaluating best practices for acute stroke care to ensure that the greatest number of patients receive treatment as early as possible following stroke."
Dr. Hsia and her colleagues will continue to monitor the door to treatment times, to ensure they are sustainable. In addition, they plan to continue to evaluate best practices for acute stroke care and look for other improvements to further decrease door-to-treatment times for patients.
Source:
NIH/National Institute of Neurological Disorders and Stroke

Novel computer-aided system developed for acute stroke detection

This barely helps at all in reducing the time to treatment. It still requires a time consuming and expensive scan. But has this been tested for those cases where prior strokes have occurred?  When are we going to fund researchers to test out these 17 possibilities to find out which one is the best?  Or maybe the Qualcomm Xprize for the tricorder?  Does no one have a clue that we need to be following a strategy rather than this stupid scattershot approach? If our stroke associations actually wanted to be useful they would use some of the brainpower of their employees and create a strategy to solve all the problems in stroke. But no, it is more important to put out press releases.
http://www.news-medical.net/news/20150514/Novel-computer-aided-system-developed-for-acute-stroke-detection.aspx 

The Hong Kong Polytechnic University (PolyU) has developed a novel computer-aided detection system for acute stroke using computer intelligence technology. Reading 80-100 computer images, the system is able to detect if the patient was struck by ischemic stroke or haemorrhagic stroke. The detection accuracy is 90%, which is as high as that conducted by specialists, but at a much reduced time from 10-15 minutes to 3 minutes. The new system serves as a second opinion for frontline medical doctors, enabling timely and appropriate treatment for stroke patients.
Providing treatment to acute stroke patients within the golden hours of stroke treatment, i.e., 3 hours of stroke onset, is vital to saving lives. However, stroke specialists do not work around the clock, increasing the risk of misdiagnosis and delayed diagnosis of acute stroke. This novel system which analyses brain scans could help save lives by assisting non-specialists in diagnosis by providing them a second opinion. Timely diagnosis and treatment within 3 hours of stroke onset also minimise damage.
Developed by experts from the Department of Health Technology and Informatics at PolyU, the computer-aided detection for stroke (CAD stroke) technology combines sophisticated calculations, artificial intelligence and pathology to help medical professionals achieve speedy and accurate diagnosis.
The first part of the system is an algorithm for automatic extraction of areas of suspected region of interest. A computed tomography (CT) scan uses X-rays to take pictures of the brain in slices. When blood flow to the brain is blocked, an area of the brain turns softer or decreases in density due to insufficient blood flow, pointing to an ischemic stroke.
The second part is an artificial neural network to classify region of interest for stroke. The CAD stroke computer "learns" the defining features of stroke, and performs automated reasoning. CT scans are fed into the CAD stroke computer, which will make sophisticated calculations and comparisons to locate areas suspected of insufficient blood flow. It detects where the images look "abnormal", and will be highlighted for doctors' review. Early changes including loss of insular ribbon, loss of sulcus and dense MCA signs will appear as "abnormalities", helping doctors determine if blood clots are present. As our system is able to detect subtle change in density, our system is also able to detect haemorrhagic stroke which is presented as increase in tissue density.
Equipped with the built-in artificial intelligence feature, the CAD stroke technology can learn by experience. With every scan passing through, along with feedback from stroke specialists, the application will improve its accuracy over time.
The life-saving application can also detect subtle and minute changes in the brain that would escape the eye of even an experienced specialist, slashing the chances of missed diagnosis. False-positive and false-negative cases, and other less serious conditions that mimic a stroke can also be ruled out, allowing a fully-informed decision to be made.

Omega-3 fatty acids enhance cognitive flexibility in at-risk older adults

I'm assuming this is in food not supplements. Ask your doctor for clarification. And see how long it takes for your hospital to create a dementia prevention diet protocol.
http://medicalxpress.com/news/2015-05-omega-fatty-acids-cognitive-flexibility.html
A study of older adults at risk of late-onset Alzheimer's disease found that those who consumed more omega-3 fatty acids did better than their peers on tests of cognitive flexibility—the ability to efficiently switch between tasks—and had a bigger anterior cingulate cortex, a brain region known to contribute to cognitive flexibility.
The analysis suggests, but does not prove, that consuming DHA and EPA, two omega-3 found in fish, enhanced in these adults in part by beefing up the anterior cingulate cortex, the researchers report in the journal Frontiers in Aging Neuroscience.
"Recent research suggests that there is a critical link between nutritional deficiencies and the incidence of both and degenerative neurological disorders, such as Alzheimer's disease," said University of Illinois neuroscience, psychology, and speech and hearing science professor Aron Barbey, who led the study with M.D./Ph.D. student Marta Zamroziewicz. "Our findings add to the evidence that optimal nutrition helps preserve cognitive function, slow the progression of aging and reduce the incidence of debilitating diseases in healthy aging populations."

More at link

Fetal stem cells and the sports heroes they revitalized

A special report by USA TODAY Sports reveals how a stem-cell manufacturer averted controversy in the treatments of Gordie Howe and John Brodie.
There is absolutely no way to determine if the stem cells that were injected had anything at all to do with their supposed recoveries I wouldn't go down this line until real research is done. Not just anecdotal reports.
http://www.usatoday.com/longform/sports/2015/05/18/fetal-stem-cells-gordie-howe-john-brodie-tijuana-stroke-stemedica/27501717/  

Tuesday, May 19, 2015

You need to surround yourself with 'Freaks' not 'Squares'

An excellent lesson from gapingvoid art. Our stroke associations need lots of freaks to throw out all the deadwood.
http://us1.campaign-archive2.com/?u=028de8672d5f9a229f15e9edf&id=d3e607734a&e=74020f8000
Every large organization will have its “squares”…the guys who do everything right, say everything right, go to all the right meetings, and know how to wield a golf club properly - especially in the presence of an important client.
As impressive as these people can be, few of them will end up changing the world.

The way I see it is, the really great moves forward are made from the really great ideas.

And those ideas are found not on the golf course, but on the intellectual outskirts of the business, from the people hanging out in left field i.e. The Freaks.

The more freaks you have tinkering away productively on their mad ideas, protected from the short-term minutiae of running a business, the more interesting your company will become.


The poster art for this can be purchased at the site. In case you need to visibly hang  the poster in a squares' office. 

Cognition Improves After Supplemented Mediterranean Diet, Finds a Rare Trial

Do you really think this is enough for your hospital to hire a nutritionist to create a diet protocol for stroke survivors? I'm betting 30 years unless that great stroke association president starts calling up every single stroke hospital and starts asking why they haven't changed a single stroke intervention in the last 20 years.  If your stroke association is not doing that you need to replace the board of directors.
http://www.biosciencetechnology.com/articles/2015/05/cognition-improves-after-supplemented-mediterranean-diet-finds-rare-trial?
Cognition improves in older people who eat a plant-based Mediterranean diet with antioxidant-rich extra virgin olive oil or mixed nuts, according to rare clinical trial research published by JAMA Internal Medicine.
“This is a significant pioneering study,” Nikolaos Scarmeas, M.D., M.Sc., Ph.D., told Bioscience Technology. Scarmeas, a Columbia University Associate Professor of Neurology, was not involved with the work. “There are a lot of observational studies suggesting association between a Mediterranean-type diet and a series of medical conditions and diseases. But there are few experimental interventional studies, i.e. clinical trials, securing and providing high level of evidence for such an association. This is in particular for neurological diseases. The parent study of the current one, the PREDIMED, very convincingly demonstrated a protection of a Mediterranean-type diet particularly for stroke. This small sub-study suggests a protective effect for cognitive decline too.”
Said senior author Emilio Ros, M.D., Ph.D., of the Institut d'Investigacions Biomediques August Pi Sunyer, Hospital Clinic, Barcelona: “The major surprise was the great power of foods and dietary patterns to beneficially influence health.”

More at link.

Electricity generating nano-wizards - for ER stroke use

We could get together a few smart people and come up with solutions to removing blood clots with nano-robots or repairing broken aneurysms. Coiling and tPA are so outdated, why aren't we thinking grand ideas?  They most certainly won't come from any of our existing stroke associations.
http://www.rdmag.com/news/2015/05/electricity-generating-nano-wizards-quantum-dots-are-ideal-nanolab?
Just as alchemists always dreamed of turning common metal into gold, their 19th century physicist counterparts dreamed of efficiently turning heat into electricity, a field called thermoelectrics. Such scientists had long known that, in conducting materials, the flow of energy in the form of heat is accompanied by a flow of electrons. What they did not know at the time is that it takes nanometric-scale systems for the flow of charge and heat to reach a level of efficiency that cannot be achieved with larger scale systems. Now, in a paper published in EPJ B Barbara Szukiewicz and Karol Wysokiński from Marie Curie-Skłodowska University, in Lublin, Poland have demonstrated the importance of thermoelectric effects, which are not easily modelled, in nanostructures.
Since the 1990s, scientists have looked into developing efficient energy generation from nanostructures such as quantum dots. Their advantage: they display a greater energy conversion efficiency leading to the emergence of nanoscale thermoelectrics. The authors evaluate the thermoelectric performance of models made of two quantum dots—which are coupled electrostatically—connected to two electrodes kept at a different temperature and a single quantum dot with two levels. First, they using the theoretical approach based on approximations to calculate the so-called thermoelectric figure of merit, expected to be high for systems with high energy conversion efficiency. Then, they calculated the charge and heat fluxes as a means to define the efficiency of the system.
They found that the outcomes of the direct calculations giving the actual—as opposed to theoretical—performance of the system were less optimistic. For most parameters with an excellent performance, calculated predictions turned out to be surprisingly poor. These findings reveal that effects that are not easily formalized using equations are important at the nanoscale. This, in turn, calls for new ways to optimize the structures before they can be used for nanoscale energy harvesting.

Comprehensive stroke centers may be associated with improved survival in hemorrhagic stroke

The key word here is MAY, they never give useable statistics that you can use to rate hospitals to see if they are any good. Why 90 days when 30 days is the standard reporting timeframe? This is so simple to prove, you take MRIs at admission and then at the 30 or 90 day mark and compare dead areas. That would be objective although I guess death is objective also.
http://www.docguide.com/comprehensive-stroke-centers-may-be-associated-improved-survival-hemorrhagic-stroke?

Data Acquisition System (MIDAS 22) Study Group ; Journal of the American Heart Association 4 (5), (2015)

BACKGROUND Comprehensive stroke centers (CSCs) provide a full spectrum of neurological and neurosurgical services to treat complex stroke patients. CSCs have been shown to improve clinical outcomes and mitigate disparities in ischemic stroke patients. It is believed that CSCs also improve outcomes in hemorrhagic stroke.
METHODS AND RESULTS We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes data on patients discharged with a primary diagnosis of intracerebral hemorrhage (ICH; International Classification of Diseases, Ninth Revision [ICD-9] 431) and subarachnoid hemorrhage (SAH; ICD-9 430) from all nonfederal acute care hospitals in New Jersey (NJ) between 1996 and 2012. Out-of-hospital deaths were assessed by matching MIDAS records with NJ death registration files. The primary outcome variable was 90-day all-cause mortality. The primary independent variable was CSC versus primary stroke center (PSC) and nonstroke center (NSC) admission. Multivariate logistic models were used to measure the effects of available covariates. Overall, 36 981 patients were admitted with a primary diagnosis of ICH or SAH during the study period, of which 40% were admitted to a CSC. Patients admitted to CSCs were more likely to have neurosurgical or endovascular interventions than those admitted to a PSC/NSC (18.9% vs. 4.7%; P<0.0001). CSC admission was associated with lower adjusted 90-day mortality (35.0% vs. 40.3%; odds ratio, 0.93; 95% confidence interval, 0.89 to 0.97) for hemorrhagic stroke. This was particularly true for those admitted with SAH.
CONCLUSIONS Hemorrhagic stroke patients admitted to CSCs are more likely to receive neurosurgical and endovascular treatments and be alive at 90 days than patients admitted to other hospitals.


Cosmin Mihaiu: Physical therapy is boring -- play a game instead

You shouldn't follow this, that would be practicing medicine on yourself.
http://www.ted.com/talks/cosmin_mihaiu_physical_therapy_is_boring_play_a_game_instead?
You’ve just been injured, and you’re on the way home from an hour of physical therapy. The last thing you want to do on your own is confusing exercises that take too long to show results. TED Fellow Cosmin Mihaiu demos a fun, cheap solution that turns boring physical therapy exercises into a video game with crystal-clear instructions.

Rethinking Stimulation of the Brain in Stroke Rehabilitation Why Higher Motor Areas Might Be Better Alternatives for Patients with Greater Impairments

Going after the pre-motor cortex wouldn't help me at all, most of mine is dead. I wish someone would tackle the extremely difficult problem of moving functions that were in dead areas to new locations. Now that would be worthy of a Nobel prize. You will need to send your doctor after exactly how they are stimulating the PMAs.
http://nro.sagepub.com/content/21/3/225?etoc
  1. Ela B. Plow1,2
  2. David A. Cunningham1,3
  3. Nicole Varnerin1
  4. Andre Machado4
  1. 1Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
  2. 2Department of Physical Medicine & Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
  3. 3School of Biomedical Sciences, Kent State University, Kent, OH, USA
  4. 4Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
  1. Ela B. Plow, Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH 44195, USA. Email: plowe2@ccf.org

Abstract

Stimulating the brain to drive its adaptive plastic potential is promising to accelerate rehabilitative outcomes in stroke. The ipsilesional primary motor cortex (M1) is invariably facilitated. However, evidence supporting its efficacy is divided, indicating that we may have overgeneralized its potential. Since the M1 and its corticospinal output are frequently damaged in patients with serious lesions and impairments, ipsilesional premotor areas (PMAs) could be useful alternates instead. We base our premise on their higher probability of survival, greater descending projections, and adaptive potential, which is causal for recovery across the seriously impaired. Using a conceptual model, we describe how chronically stimulating PMAs would strongly affect key mechanisms of stroke motor recovery, such as facilitating the plasticity of alternate descending output, restoring interhemispheric balance, and establishing widespread connectivity. Although at this time it is difficult to predict whether PMAs would be “better,” it is important to at least investigate whether they are reasonable substitutes for the M1. Even if the stimulation of the M1 may benefit those with maximum recovery potential, while that of PMAs may only help the more disadvantaged, it may still be reasonable to achieve some recovery across the majority rather than stimulate a single locus fated to be inconsistently effective across all.


Stem cell clinics peddle a lot of snake oil – but the market’s growing fast

Nothing in here on neurons but you'll need to read this if you have any inclination to try stem cells. I'm guessing at least 50 years before any proof is found.
http://medcitynews.com/2015/05/stem-cell-clinics-regulation/?

'Home-brew' morphine/opiods from brewer's yeast now possible - study

This is just for informational purposes only. Do not do this.
There is one study suggesting that opiods are useful. But that was 30 years ago and I'm sure we have made zero progress in further study. And this was only in cats.

Treatment of stroke with opiate antagonists — Effects of exogenous antagonists and dynorphin 1–13

 'Home-brew' morphine/opiods from brewer's yeast now possible - study

Negative effect of a low-carbohydrate, high-protein, high-fat diet on small peripheral artery reactivity in patients with increased cardiovascular risk

You probably need your doctor to truly evaluate this. It seems to say that a low carb diet stiffens your arteries.
http://www.ncbi.nlm.nih.gov/pubmed/22850317

Abstract

Low-carbohydrate diets have become increasingly popular for weight loss. Although they may improve some metabolic markers, particularly in type 2 diabetes mellitus (T2D) or the metabolic syndrome (MS), their net effect on arterial wall function remains unclear. The objective was to evaluate the relation between dietary macronutrient composition and the small artery reactive hyperaemia index (saRHI), a marker of small artery endothelial function, in a cohort of patients at increased cardiovascular (CV) risk. The present cross-sectional study included 247 patients. Diet was evaluated by a 3-d food-intake register and reduced to a novel low-carbohydrate diet score (LCDS). Physical examination, demographic, biochemical and anthropometry parameters were recorded, and the saRHI was measured in each patient. Individuals in the lowest LCDS quartile (Q1, 45 % carbohydrate; 20 % protein; 32 % fat) had higher saRHI values than those in the top quartile (Q4, 29 % carbohydrate, 24 % protein, 40 % fat; 1.66 (sd 0.41) v. 1.52 (sd 0.22), P= 0.037). These results were particularly strong in patients with the MS (Q1 = 1.82 (sd 0.32) v. Q4 = 1.61 (sd 027); P= 0.021) and T2D (Q1 = 1.78 (sd 0.31) v. Q4 = 1.62 (sd 0.35); P= 0.011). Multivariate analysis demonstrated that individuals in the highest LCDS quartile had a significantly negative coefficient of saRHI, which was independent of confounders (OR -0.85; 95 % CI 0.19, 0.92; P= 0.031). These findings suggest that a dietary pattern characterised by a low amount of carbohydrate, but high amounts of protein and fat, is associated with a poorer small artery vascular reactivity in patients with increased CV risk.

Feasibility of Early Functional Rehabilitation in Acute Stroke Survivors using the Balance-Bed–A Technology that Emulates Microgravity

You'll have to send your doctor after this because I have no understanding of what this is.
Feasibility of Early Functional Rehabilitation in Acute Stroke Survivors using the Balance-Bed–A Technology that Emulates Microgravity
Lars I.E. Oddsson
1,2
,3
*,
Marsha Finkelstein
4
,
Sarah Meissner
4
 
1
Department of Physical Medicine and Rehabilitation, Program in Rehabilitation Science, University of
 
Minnesota, Minneapolis, MN, USA
 
2
Technological Leadership Institute, College of Science and Engineering, University of Minnesota, Minneapolis, MN, USA
 
3
Recanati School for Community Health Professions, Ben-
Gurion University of the Negev, Israel
 
4
Courage Kenny Rehabilitation Institute,Allina Health,Minneapolis,MN, USA
 
*
Correspondence:Lars
IE
Oddsson
,
Department of Physical Medicine and Rehabilitation, Program in
 
Rehabilitation Science, University of Minnesota, Minneapolis, MN, 55455, USA
.
 
Keywords:
Acute Stroke
,
Balance Function,
Body Weight Support,
Countermeasure
,
Microgravity
,
Rehabilitation.
 
Abstract
Evidence-based guidelines recommend early functional rehabilitation of stroke patients when risk of patient harm can be managed.
Current tools do not allow balance training under load conditions
sufficiently lowfor acute stroke patients
.
This single-arm pilot study tested feasibility and safety for acute stroke survivors to use “Balance-Bed”, a technology for balance exercises in supine initially developed to emulate microgravity effects on balance.
Nine acute stroke patients (50-79 yrs.) participated in 3-10 sessions over 16-46 days as part of their rehabilitation in a hospital inpatient setting.
Standard inpatient measures of outcome were monitored where lack of progress from admission to discharge might indicate possible harm.
Total FIM scores at admission (median 40, range 22-53) changed
to (74, 50-96),Motor FIM scores from(23,13-32) to (50,32-68) and
Berg Balance scores from(3, 0-6) to (19, 7-43) at discharge.
Changes reached Minimal Clinical Important Difference
for a sufficient proportion (<0.6) of the patients to indicate no harm to the patients.
In addition, therapists reported the technology was safe,provided a positive experience for the patient and fit within the rehabilitation program. They reported the device should be easier to set up and exit.
We conclude acute stroke patients tolerated Balance-Bed exercises
such as standing on one or two legs, squats, stepping in place as well as
balance perturbations provided by the therapist. We believe
this is the first time it has been demonstrated that acute stroke patients
can safely perform whole body balance training including
balance perturbations as part of their rehabilitation program. Future
studies should include a control group and compare outcomes from
best practices to interventions using the Balance-Bed. In addition
, the technology is relevant for countermeasure development for
spaceflight and as a test-bed of balance function under microgravity
like conditions