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 493 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

Saturday, June 25, 2016

Prospective, open-label safety study of intravenous rtPA in wake-up stroke

They don't bother to tell us the full recovery rate at all to see if it is any better than the current tPA only fully working 12% of the time?
http://www.ncbi.nlm.nih.gov/pubmed/27273860

Abstract

OBJECTIVE:

It is estimated that 1 of 4 ischemic strokes are noticed upon awakening and are not candidates for intravenous recombinant tissue plasminogen activator (rtPA) because their symptoms are >3 hours from last seen normal (LSN). We tested the safety of rtPA in a multicenter, single-arm, prospective, open-label study (NCT01183533) in patients with wake-up stroke (WUS).

METHODS:

We aimed to enroll 40 WUS patients with disabling deficits. Patients were 18-80; NIHSS ≤25; and selected only on the appearance of non-contrast CT (i.e., <1 90-day="" and="" asymptomatic="" awakening.="" be="" board="" clinical="" data="" dose="" endpoints="" had="" hemorrhage="" hours="" hypodensity="" ich="" improvement="" in="" included:="" intracerebral="" intravenous="" kg="" mca="" mg="" modified="" mrs="" nihss="" of="" other="" outcome="" oversight.="" p="" patient="" pre-planned="" primary="" rankin="" rtpa="" rules="" safety="" scale="" score="" sich="" standard="" started="" stopping="" symptomatic="" territory="" the="" to="" was="" with="">

RESULTS:

Between 10/2010 and 10/2013, all 40 pre-planned patients were enrolled (50% men) at 5 stroke centers. Four patients (10%) were subsequently determined to be mimics. Patients had a mean age of 60.8, median NIHSS of 6.5 (2-24 range) and received thrombolysis at a mean time of 10.3 ± 2.6 LSN and 2.6 ± 0.6 hours from awakening with deficits. No sICH or parenchymal hematomas occurred. At 3-months, 20 of 38 (52.6%) patients achieved excellent recovery with modified Rankin scale scores of 0 or 1 (2 patients were lost to follow-up).

INTERPRETATION:

Intravenous thrombolysis was safe in this prospective WUS study of patients selected by non-contrast CT. A randomized effectiveness trial appears feasible using a similar, pragmatic design.

CLINICAL TRIAL REGISTRATION INFORMATION:

www.clinicaltrials.gov Identifier: NCT01183533 This article is protected by copyright. All rights reserved.
© 2016 American Neurological Association.

KEYWORDS:

acute ischemic stroke; clinical trials; thrombolysis; wake-up stroke
PMID:
27273860
[PubMed - as supplied by publisher]

New devices causing 'paradigm shift' in stroke care

There is nothing here that tells me they have done one goddamn thing to solve the neuronal cascade of death by these 5 causes.in the first week. This is all just deflection for all the failures in solving all the fucking problems in stroke.
http://medicalxpress.com/news/2016-06-devices-paradigm-shift.html
New devices called stent retrievers, which effectively reverse strokes, have revolutionized the treatment of certain stroke patients, according to an article in the journal Expert Review of Neurotherapeutics.
"Stent retrievers are a major advance in acute ischemic stroke care and will have significant impact on the evolution of stroke systems of care," according to the article by Loyola Medicine neurologists Rick Gill, MD and Michael J. Schneck, MD. Dr. Gill is the outgoing chief resident and Dr. Schneck is a professor in the Department of Neurology of Loyola University Chicago Stritch School of Medicine.
Eighty-seven percent of strokes are ischemic, meaning they are caused by clots that block to a portion of the brain. In selected patients, stent retrievers can be used to remove such clots. Loyola used stent retrievers on 34 patients in 2015, and 21 patients during the first six months of 2016.
A stent retriever is a self-expanding mesh tube attached to a wire, which is guided through a catheter (thin tube). The endovascular specialist inserts the catheter in an artery in the groin and guides the catheter through various blood vessels all the way up to the brain.
Once the stent retriever reaches the blockage, the endovascular specialist deploys it. The device pushes the gelatinous blood clot against the wall of the blood vessel, immediately restoring blood flow. The stent retriever then is used to grab the clot, which is pulled out when the surgeon removes the catheter.
"With the advent of stent retriever devices, there has been a paradigm shift in the utilization of endovascular therapies for acute ischemic stroke," Drs. Gill and Schneck write. (Endovascular refers to catheter-based surgery.)
Drs. Gill and Schneck describe how the current generation of stent retrievers, including the TREVO and Solitaire devices, are a remarkable improvement over earlier devices such as MERCI and Penumbra that employed different technology. Studies of these earlier devices showed results that were equivocal at best. But more recent trials of stent retrievers consistently show the newer devices are clearly superior to the intravenous drug tissue plasminogen activator (tPA) alone in reducing disability from strokes.
The clot-busting drug tPA can restore blood flow and limit stroke damage, if it is given within 4.5 hours of the onset of the stroke and the clot is small enough. (If the patient is older than 80, the cutoff time is three hours.) But in many patients, tPA either would not be safe to take, or would not be sufficient by itself to restore blood flow. In such patients, stent retrievers often can be used to remove the clot.
Drs. Gill and Schneck foresee future device improvements that will do an even better job of restoring blood flow and increasing the number of patients who could benefit.
Stent retrievers also will affect where stroke patients are treated. Paramedics will play an important role in routing higher severity , who could benefit from stent retrievers, to centers that have the capability to perform neuroendovascular procedures, Drs. Gill and Schneck write.
More information: Rick Gill et al, The use of stent retrievers in acute ischemic stroke, Expert Review of Neurotherapeutics (2016). DOI: 10.1080/14737175.2016.1193007

Journal reference: Expert Review of Neurotherapeutics search and more info website

Friday, June 24, 2016

7 Steps to Stroke Recovery Stroke Recovery Association of BC

You will notice that your doctor has not one damn thing to do with your recovery. Your recovery would be so much easier if your doctor had collaborated with researchers to solve the neuronal cascade of death by these 5 causes.
The doctor in there uses the stupid quote; 'All strokes are different, all stroke recoveries are different'.
https://www.youtube.com/watch?v=GHJL42xFuz8&t=0s

Innovations in the Treatment of Stroke - Health Matters

No discussion of the Circle of Willis, two MDs that supposedly are experts. Wrong discussion that blockage of carotid artery directly causes a stroke. No discussion of the neuronal cascade of death. Or any interventions that stop the 5 causes of that. Yes, this was a neurosurgeon but it left a lot to be desired.
https://youtu.be/2oN_qb7U6Co

A new method of curing the apoplexy. With an appendix, containing some observations upon the use and abuse of physick. By John Catherwood, M.D. - 1715

https://www.amazon.com/containing-observations-concerning-Bezoar-Stone-Catherwood/dp/B009JLO80Y/ref=sr_1_1?s=books&ie=UTF8&qid=1466645650&sr=1-1&keywords=a+new+method+of+curing+the+apoplexy.
He spent the first 17 pages arguing that bleeding via arteriotomy vs. phlebotomy was better. I.E. Cut open arteries vs. veins.
He does not believe in using emetics

Why was this use discontinued? It didn't work. Why hasn't tPA use been discontinued since it only fully works 12% of the time?

22 Signs of PTSD

With a  23% chance of stroke survivors getting PTSD, your doctor should be testing for that possibility and providing solutions to PTSD.
In case you need to diagnose yourself., I've put them into text form instead of paging through each one.
https://www.domesticshelters.org/domestic-violence-lists/signs-of-ptsd#.V23m73qvGR4

# 1   Flashbacks or nightmares of the abuse.
# 2   Intense physical reactions to reminders (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating).
# 3   Avoiding places or situations that serve as reminders.
 # 4  Thinking the world is more dangerous than it is.
# 5   Trouble concentrating.
# 6   Any signs of depression.
# 7   Overwhelming feelings of sadness, fear, despair, guilt or self-hatred.
# 8   Not seeking help to avoid discussing or thinking about the abuse.
# 9   Physical pain that migrates throughout the body.
# 10  An inability to imagine a positive future.
# 11  Lack of interest in activities once enjoyed.
# 12  Outbursts of anger.
# 13  Loss of interest in other people and the outside world.
# 14  Difficulty sleeping.
# 15  Forgetting parts of traumatic events.
# 16  Not being able to trust others.
# 17  Jittery or always on alert for danger.
# 18  Agitation or irritability.
# 19  Emotional numbness.
# 20  See, hear or smell something that triggers memory.
# 21  Being startled by loud noises or surprises.
# 22  Feelings of intense distress when reminded of the trauma.




















The problem with complaining about the stroke system ...is that the system can't hear you.

Another insightful post from Seth Godin. If we apply this to stroke, there has to be thousands of the 10 million stroke survivors a year that know employees of the stroke associations that can be influenced to speak about all the problems in stroke and what exactly those stroke associations are doing to solve them. 10 million survivors a year plus relatives and friends could make a deafening call to action. But it is up to YOU to do this, our stroke medical professionals seem not to be able to get anything accomplished that directly helps stroke survivors. Awareness be damned.
http://sethgodin.typepad.com/seths_blog/2016/06/the-problem-with-complaining-about-the-system.html

The problem with complaining about the system

...is that the system can't hear you. Only people can.
And the problem is that people in the system are too often swayed to believe that they have no power over the system, that they are merely victims of it, pawns, cogs in a machine bigger than themselves.
Alas, when the system can't hear you, and those who can believe they have no power, nothing improves.
Systems don't mistreat us, misrepresent us, waste our resources, govern poorly, support an unfair status quo and generally screw things up--people do.
If we care enough, we can make it change.

PAY IT FORWARD

World Stroke Organization and Medtronic Collaborate to Increase Stroke Awareness

AWARENESS!!! WHAT A PILE OF FUCKING SHIT.
This is why our stroke leadership needs to be replaced, they don't even try to solve any of the problems in stroke, much less any BHAGs(Big Hairy Audacious Goals) 
Real leaders tackle the hard problems instead of running away from them like scared chickens.
http://www.erienewsnow.com/story/32296316/world-stroke-organization-and-medtronic-collaborate-to-increase-stroke-awareness
SOURCE World Stroke Organization; Medtronic
GENEVA and DUBLIN, June 23, 2016 /PRNewswire-USNewswire/ -- The World Stroke Organization (WSO) today announced a global partnership with Medtronic plc (NYSE:MDT) to increase stroke awareness through several initiatives. The two organizations will work together to educate, raise awareness and support effective management of patients who have strokes.
The partnership, announced at the 2016 Annual Scientific Session of the Chinese Stroke Association (CSA) and Tiantan International Stroke Conference (TISC) in Beijing, will focus on continued growth of stroke awareness through the Stroke is Treatable World Stroke Day campaign; implementation of the WSO's new global stroke services guidelines: The Roadmap to Delivering Quality Stroke Care; and, supporting WSO's global clinical educational programs including the World Stroke Academy and teaching courses.
Every year, approximately 15 million people worldwide have a stroke. Of these, nearly five million die and another five million are left permanently disabled. Fortunately, the prospects for preventing and treating stroke are far better today than even five years ago. Technologies such as the stent retriever are making huge strides in treating stroke, while insertable cardiac monitors are helping physicians detect atrial fibrillation in cryptogenic stroke patients, enabling them to provide treatment to potentially prevent a recurrent stroke.
"Recognizing the signs of stroke early, treating it as a medical emergency with admission to a specialized stroke unit, and providing access to the best professional care can substantially improve outcomes," said WSO President, Professor Stephen Davis. "We are calling for everyone to take action, drive awareness and push for better access to stroke treatments, and we are delighted to have Medtronic join us in the fight against stroke."
WSO's teaching courses are clinical education courses tailored to individual countries' needs. This year's programs will address evidence-based approaches to stroke prevention, treatment and rehabilitation and will focus on improving stroke services specifically in Beijing, the Philippines and Hyderabad, India. In addition, the World Stroke Academy provides a digital teaching option to reach all member countries with educational programming on stroke.
"Medtronic is committed to fighting stroke across the globe and an important step in that direction is ensuring that the proper clinical education tools are available," said Stacey Pugh, vice president and general manager of the Neurovascular business at Medtronic. "WSO provides dynamic education programs utilizing various mediums to reach a broad swath of caregivers in the stroke field. We're proud to help bring these targeted courses to countries working to improve stroke care."
In 2016, the World Stroke Campaign will focus on the treatability of stroke, recognizing that although stroke is a complex medical issue, there are ways to significantly reduce its impact. In addition, awareness of stroke signs and symptoms plays a critical role and is a focus of the partnership's efforts.
"Medtronic and WSO share the commitment of improving care for patients who have experienced stroke," said Nina Goodheart, vice president and general manager of the Diagnostics and Monitoring business at Medtronic. "We recognize the importance of advancing care for these patients and will work together with the WSO to continue to make this a priority."
About the WSO
The World Stroke Organization (world-stroke.org) is the world's leading organization in the fight against stroke. Established in October 2006, WSO's mission is to reduce the global burden of stroke through prevention, treatment and long-term care. With individual and organizational members worldwide, including stroke support groups, WSO is the global voice for stroke and the only international stroke NGO in official relations with the World Health Organization (WHO).
About MedtronicMedtronic plc (www.medtronic.com), headquartered in Dublin, Ireland, is among the world's largest medical technology, services and solutions companies - alleviating pain, restoring health and extending life for millions of people around the world. Medtronic employs more than 85,000 people worldwide, serving physicians, hospitals and patients in approximately 160 countries. The company is focused on collaborating with stakeholders around the world to take healthcare Further, Together.
Any forward-looking statements are subject to risks and uncertainties such as those described in Medtronic's periodic reports on file with the Securities and Exchange Commission. Actual results may differ materially from anticipated results.

Systemic infusion and local irrigation with argatroban effective in preventing clot formation during carotid endarterectomy in a patient with heparin-induced thrombocytopenia.

What I don't understand is why with that blockage the solution isn't just to completely close it up as long as the Circle of Willis is complete rather than go through the risks of endarterectomy? But I have no medical training so someone with that could explain why I'm wrong.
http://dgcases.docguide.com/systemic-infusion-and-local-irrigation-argatroban-effective-preventing-clot-formation-during-carotid?overlay=2&
A therapeutic dilemma exists when patients with symptomatic carotid stenosis and concomitant heparin-induced thrombocytopenia (HIT) are advised to urgently undergo carotid endarterectomy (CEA) with heparin therapy. After a 63-year-old man with HIT and multiple medical comorbidities underwent emergent coronary artery bypass grafting, postoperative imaging revealed plaque at the origin of the left internal carotid artery with 80%-99% stenosis and minimal contralateral internal carotid artery disease. During the patient's evaluation to undergo CEA for symptomatic high-grade carotid stenosis, enzyme-linked immunosorbent assay revealed persistent platelet factor 4 antibodies. The endarterectomy was successfully performed while the patient received argatroban, both as a continuous infusion and intermittent irrigation during dissection of the plaque. Postoperatively, the drip was continued for 24 hours, and the patient was discharged day 2 on a daily dose of 325 mg of aspirin. At the 6-month examination, Doppler ultrasound revealed normal anterograde velocities with no evidence of stenosis, and the patient noted no subsequent ischemic events. We now recommend systemic intravenous and local argatroban irrigation to prevent thromboembolic complications in CEA cases with HIT and renal insufficiency. Bivalirudin for both systemic intravenous use and local irrigation may be safer in patients without renal insufficiency because of its shorter half-life.
from: Department of Neurosurgery, University of Cincinnati College of Medicine and Comprehensive Stroke Center at University of Cincinnati Neuroscience Institute, Cincinnati, Ohio, USA.
as reported in: Serrone JC, Andaluz N, Brink V, Zuccarello M, Ware SL. World Neurosurg. 2013 Jul-Aug:80(1-2):222.e15-8. doi: 10.1016/j.wneu.2013.01.037.

Hypertension: Top Natural Supplements for Treatment

Worthless because no amounts are given. You are expected to guess on your own.
http://www.newsmax.com/fastfeatures/hypertension-natural-supplements/2016/06/22/id/735176/

Thursday, June 23, 2016

6 Types Of Depression And What Makes Them Different

Since depression is quite common post stroke, your doctor should know the difference and be treating it correctly.
http://www.medicaldaily.com/types-depression-mental-illness-bipolar-disorder-390077

Mixed reality serious games for post-stroke rehabilitation

Ask your doctor what existing games they have already put into use in the stroke department. These have been out there for years so there is no fucking excuse for not having some already in the department, except for incompetence or laziness.  The answer to that proves how badly your stroke department is run.
http://s3.amazonaws.com/academia.edu.documents/46577039/Mixed_reality_serious_games_for_post-str20160617-28819-tgc533.pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1466704758&Signature=jWWdTZu9M7VHY5kRfdALDvYE%2B1Q%3D&response-content-disposition=inline%3B%20filename%3DMixed_reality_serious_games_for_post-str.pdf

Di Loreto Ines, Gouaich Abdelkader, Nadia Hocine
Lirmm - Université Montpellier 2
{diloreto,gouaich,hocine}@lirmm.fr
Abstract
— In this paper we propose a mixed reality system
(MRS) and an adaptation module for rehabilitation of the upper
limb after stroke through serious games. Aim of the system is to
increase intensity and number of training session using the fun
factor as driver. Although our system is targeting post stroke
patient it is necessary to validate and test our approach with valid
users at the first stage to provide patients with stable system to
use. These studies and their results are described in this paper.

The Role of Spasticity in Functional Neurorehabilitation- Part I: The Pathophysiology of Spasticity, the Relationship with the Neuroplasticity, Spinal Shock and Clinical Signs

While a great explanation of what spasticity is I could get nothing out of this to alleviate spasticity.
http://www.archivesofmedicine.com/medicine/the-role-of-spasticity-in-functional-neurorehabilitation-part-i-the-pathophysiology-of-spasticity-the-relationship-with-the-neurop.pdf

Angela Martins
*
Department of Veterinary Science, Lusophone University of Humanities and Technology, Hospital Veterinário da Arrábida, Portugal
*
Corresponding author:
Angela
Martins,
Department of Veterinary Science, Lusophone University of Humanities and Technology, Hospital
Veterinário da Arrábida, Portugal, Tel: 212181441; E-mail: vetarrabida.lda@gmail.com
Rec date:
Feb 29, 2016;
Acc date:
Apr 05, 2016;
Pub date:
April 12, 2016
Copyright:
© 2016
Martins
A. This is an open-access article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Martins
A. The Role of Spasticity in Functional Neurorehabilitation-
Part I: The Pathophysiology of Spasticity, the Relationship with the Neuroplasticity,
Spinal Shock and Clinical Signs. Arch Med. 2016, 8:3
Abstract
The symptom/clinical sign of spasticity is extremely important in functional neurorehabilitation, since it reduces the functional independence both in the
quadruped animal as in the human biped.  This clinical sign/symptom manifests itself alongside with pain, muscle weakness, impaired coordination and poor motor planning, leading to a spastic movement disorder.
To perform a correct FNR protocol an understanding of its pathophysiology is required. In
addition FNR often stimulates the property of the central nervous system,
which is neuroplasticity, which may potentiate the spastic movement disorder.
In this regard, especially in the human biped, we must take into account the appearance of spinal shock and its development into spastic movement disorder, and therefore, a
tight and constant monitoring of clinical signs is essential in order to choose the adequate methods and modalities of FNR

He went abroad for stem cell treatment. Now he’s a cautionary tale. Stroke patient Jim Gass

Right now I would have to say stem cell therapy is complete quackery. I have seen nothing that even comes close to proving that it works or even if the stem cells survived.
http://www.bostonglobe.com/metro/2016/06/22/went-abroad-for-stem-cell-treatment-now-cautionary-tale/wH8d9uLejaDvSwWRt91w5L/story.html
When Jim Gass suffered a stroke in 2009, it soon was clear that standard rehabilitation would not repair the damage. Unwilling to accept life in a wheelchair, Gass decided his only option was to fly overseas for experimental stem cell treatment.
At clinics in Argentina, China, and Mexico, doctors injected Gass with what they described as stem cells from several sources, including fetal tissue, in attempts to reverse his partial paralysis. Clinics tout the treatments online as cutting edge and curative.
What happened to Gass next is a cautionary tale for other desperate patients seeking unproven and unregulated treatments in the murky world of “stem cell tourism,’’ warned a group of Brigham and Women’s Hospital doctors in a letter to the New England Journal of Medicine, published online Wednesday.
After scans showed something unfamiliar on Gass’s spine, where the latest round of stem cells had been injected, a Brigham doctor discovered a strange sticky fibrous growth there.
“It looked like nothing I had ever seen,’’ said Dr. John Chi, director of the neurosurgical spine cancer at the Brigham, who co-wrote the letter to the journal. “It was stuck onto the nerves and had an odd consistency.’’
Gass, 67, the former general counsel for Osram Sylvania in Wilmington, had chosen a particular clinic in Mexico in part because former San Francisco 49ers quarterback John Brodie had stroke treatment there that he considered successful.
But in the year after he returned from Mexico in September 2014, when he had his last treatment, he began experiencing extreme back pain and additional paralysis in his right leg, which had not been affected by the stroke, he said in an interview. That was what led him to the Brigham doctors for surgery last year.
Now Gass is more disabled than he was prior to stem cell therapy.
Brigham pathologists tested the tissue taken from Gass’s spine and determined it was a tumor-like growth but did not have mutations associated with cancer and therefore could not be treated with chemotherapy. Most of the cells were not Gass’s but from another source.
“It’s hard to know what to call it,’’ Chi said.
Doctors have treated Gass with radiation to shrink the mass, which has helped somewhat, but they are also searching for other solutions.
Doctors have been increasingly warning that stem cell clinics are proliferating around the world with little oversight. They are promoting their methods to patients suffering from strokes, amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease), Alzheimer’s, and other conditions for which there are few good options. Professional athletes have helped popularize the clinics by seeking out stem cell therapy for strokes and shoulder and knee injuries.
Hockey legend Gordie Howe received experimental stem cell treatments in Tijuana, Mexico, in December 2014 — treatments that his family credited with helping prolong his life after a debilitating stroke about two months earlier. He died early this month at age 88.
Yet, bone marrow transplant, a treatment for leukemia, is the only approved stem cell therapy in the United States.
In the months after his stroke, Gass researched potential treatments constantly.
“I couldn’t accept where I was. A life lying down in bed is not the place to be,’’ he said. “The consensus was stem cell therapy was going to be the future of treatment for stroke. I read all the cautionary tales even though I didn’t believe them.
“I thought it would work,’’ he added.
Dr. Aaron Berkowitz, director of global neurology at the Brigham and the letter’s lead author, said it is hard to know how many people undergo unproven stem cell therapy.
A paper published in 2014 in the journal Travel Medicine and Infectious Disease identified 224 websites advertising stem cell clinics in 21 countries. They most often pushed treatments for multiple sclerosis, antiaging, Parkinson’s disease, stroke, and spinal cord injury — diseases and conditions for which there is no evidence that stem cell therapy is effective, though some are being studied.
In the United States, dozens of clinics have sprung up in recent years, largely avoiding regulation because they use cells extracted from a patient’s own body. But the US Food and Drug Administration signaled earlier this year that it planned to crack down on these clinics and issued draft guidelines explaining that even procedures using a patient’s own cells require approval by the agency.
Clinics overseas have more leeway and use stem cells from donors as well as fetal tissue.
“Even though there are probably hundreds of clinics in the US, when people go abroad the risk goes way up,’’ said Paul Knoepfler, a professor at the University of California Davis School of Medicine, who runs a popular stem cell research blog. “In Mexico you can treat someone with stem cells . . . and if you took the same procedure across the border, to do it legally, you’d have to get FDA approval.’’
Medical journals are increasingly writing about the phenomenon of stem cell tourism and have published reports of at least two other cases involving tumors, Berkowitz said.
“This is very risky,’’ he said. “It looks exciting that professional football players do it. But these are private clinics and they may be having a lot more complications that are not being disclosed. We don't know whether it’s working or not.’’
But some people may feel there is little other hope. As a result, the number of patients getting treatment outside the medical system is far higher than the number of patients enrolling in studies, Berkowitz said. Patients who might eventually get into experimental trials in a hospital don’t want to wait that long.
Gass, who is in the process of moving to San Diego, said his case is not only a warning to patients considering overseas treatment. He also hopes that discussing his experience publicly will light a fire under the federal government to quickly fund research into what could bea promising area of medicine.
For now, patients are relying on what they read online and athletes’ anecdotal accounts. Gass said he picked clinics that had positive or neutral reviews. But in some cases those testimonials came from doctors, speaking for patients. He did not want to name the clinics because he is worried they will sue him.
He tried several clinics because they each claimed to use slightly different approaches, he said. At the clinics, which operate like small private hospitals, doctors were careful not to promise positive results but said they expected Gass to show significant improvement. In Argentina, doctors said they injected him with his own stem cells. He did not getter better. He stayed three months in China, where physicians claimed to use fetal tissue cells.
“Every week they come by and tested you and the doctor says to his team ‘look how much better he is doing.’ I wasn’t doing better,’’ Gass said.
In the end, his body grew weaker after treatment and his wallet grew lighter. He estimates he spent $150,000 to $200,000 on the therapies alone. And while he lost most of the movement in his left arm and foot after the stroke, nerve damage from the tumor has left him with paralysis in his right leg, too.
“I still think it will work someday,’’ he said. “I just don’t know when.’’
Liz Kowalczyk can be reached at kowalczyk@globe.com.

Wednesday, June 22, 2016

NEW STROKE TREATMENT: FULL STORY - etanercept

A news station fell for this quackery. A great stroke association president should have confronted them and demanded an on air retraction.
https://www.facebook.com/7NewsTownsville/videos/1098820933497325/

An inaugural dissertation on apoplexy. By Thomas Triplett, of Alexandria, honorary member of the Philadelphia Medical Society - May 1798

You can test whether your doctor has advanced in stroke in the past 218 years. Dr. Cullen is referred to numerous times. Have your doctor explain why the current treatment is better than this.
https://www.amazon.com/inaugural-dissertation-apoplexy-Alexandria-Philadelphia/dp/1170871135?ie=UTF8&*Version*=1&*entries*=0
Selected lines.

Common subjects of this disorder;
1. Very corpulent people, especially those who have indulged too liberally in the pernicious use of spirituous liquors.
2.  Peculiar constitutions; short necks and large heads with irritable habits.
3.  Indolence and excess in eating and drinking, produce a plethoric state of the system, and by distending the stomach and interrupting the function of respiration, prevent the free return of blood to the heart,
4.  Long and constant application of the mind on one subject, by increasing the determination to the brain, predisposes to apoplexy.
5.  Old age.  May be ascribed to a venous plethora, and also an accumulation of their excitability.
6.  A large undigested meal, may be considered the most frequent., for by distending the stomach, preventing in great measure the expansion of the lungs and pressing upon the aorta, it accumulates blood in the vessels of the brain and proves a very frequent source of this disease.
7.  Violent exercise, by increasing the general circulation and accelerating the flow of blood to the brain will often have the same effect.
8. Vomiting.
9.  Hot bathing is a frequent cause of apoplexy.
Diagnosis:
Many of the appearances which drunkenness exhibits are so similar to the apoplexy that it is extremely difficult to ascertain the difference. So in 218 years the stroke world still hasn't solved this problem.
The method of Cure:
1. It is of the utmost importance in the commencement of the fit, immediately to diminish the excitement of the vessels of the brain. With this intention copious bleeding is employed. Some have advised opening the temporal and carotid arteries, the vessels under the tongue. etc.  Others have thought that every advantage might be derived by drawing it from the jugular veins, or from both arms at once.
2. Purging; The bowels should always be kept regularly open. We should make use of such medicines for this purpose that will act briskly, although the more dramatic purges are not to be preferred.
3. Cold Water; When this disease has been brought on by breathing carbonic acid gas or by exposure to heat. The remedy seems particularly serviceable.
4. Cool and fresh air; When the apoplexy has been brought on by breathing impure air in crowded assembles, we should immediately expose the patient to pure cool air.
5. Blisters should be applied to the head and neck, the head already having been shaved.
6. Here we must have recourse to the most stimulating applications; as cataplasms composed of garlic and mustard to the arms and feet. 
7.  Electricity and frictions ought to be tried and certain acrid substances, as garlic, to be held in the mouth.
8. Ardent spirits and volatile salts should be given internally.

The first study to ever show Alzheimers can be reversed has just been published

A great stroke association president would make sure this was publicly available to all survivors so they can have their doctors supervise the implementation. Remember your chances of dementia/Alzheimers post stroke.
A documented 33% dementia chance post-stroke from an Australian study?   May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.
3. A 20% chance in this research.   July 2013.

Is your doctor even testing you for dementia/MCI post-stroke?
http://www.dailykos.com/stories/2016/6/21/1540972/-The-first-study-to-ever-show-Alzheimers-can-be-reversed-has-just-been-published?


Aspirin Still Wrongly Given to Lower Afib Stroke Risk

For your doctor.
http://www.medpagetoday.com/Cardiology/Arrhythmias/58683?

Nearly 40% of patients on aspirin instead of oral anticoagulant



  • by Salynn Boyles
    Contributing Writer

  • This article is a collaboration between MedPage Today® and:
    Medpage Today

Action Points

  • About 40% of cardiac outpatients with atrial fibrillation (AF) with a moderate to high risk of stroke were treated with aspirin alone without an oral anticoagulant (OAC), according to data from the large, real-world ACC PINNACLE Registry.
  • Note that there is now good evidence that aspirin is not an anticoagulant, and that it does not prevent stroke due to atrial fibrillation.
Well over one-third of atrial fibrillation patients who have a moderate to high risk for stroke are prescribed aspirin to lower this risk instead of oral anticoagulants, even though aspirin has no benefit for the prevention of Afib-related thromboembolism, researchers reported.
Their newly published analysis of data from the American College of Cardiology's PINNACLE registry involving Afib patients found that close to 40% of patients were treated with aspirin alone instead of an oral anticoagulant.
After multivariable adjustment, it was determined that patients prescribed aspirin were also more likely to have other risk factors for cardiovascular disease than those prescribed an oral anticoagulant, Jonathan C. Hsu, MD, of the University of California San Diego, and colleagues wrote in the Journal of the American College of Cardiology.
"These data indicate a gap in care, most prominent in patients with or at risk for coronary artery disease, and it should draw attention to a high rate of prescription of aspirin therapy in atrial fibrillation patients at risk for stroke, despite previous data that show aspirin to be inferior to oral anticoagulants in this population," the researchers wrote.
Cardiologist Samuel Wann, MD, of St. Mary's Hospital in Milwaukee, said the finding is especially concerning because the PINNACLE registry includes highly motivated patients and cardiologists. Wann co-wrote an editorial published with the study.
"There is good evidence now that aspirin is not an anticoagulant, and that it does not prevent stroke due to atrial fibrillation," he told MedPage Today. "We may have thought that years ago, but not anymore."
The study included two cohorts of atrial fibrillation outpatients with a moderate to high thromboembolic risk (CHADS2 score ≥2 and CHA2D2-VASc ≥2) enrolled in the PINNACLE registry between 2008 and 2012.
In one cohort of close to 210,400 patients with CHADS2 scores ≥2 on antithrombotic therapy, 38.2% were treated with aspirin alone and 61.8% were treated with warfarin or a non-vitamin K antagonist oral anticoagulant. In a second cohort of close to 300,000 patients, with CHA2DS2-VASc scores ≥2, 40.2% were treated with aspirin alone and 59.8% were treated with an oral anticoagulant.
After multivariable adjustment, hypertension, dyslipidemia, coronary artery disease, prior heart attack, unstable and stable angina, recent coronary artery bypass graft, and peripheral arterial disease were all associated with a higher incidence of aspirin prescriptions.
Male sex, higher body mass index, prior stroke/transient ischemic attack, embolism history, and congestive heart failure were associated with more frequent prescription of an oral anticoagulant.
"The specific patient characteristics associated with (aspirin prescribing), including those related to coronary artery disease, highlight opportunities to improve appropriate prescription of oral anticoagulants in atrial fibrillation, including identifying knowledge gaps that might be informed by future studies," the researchers wrote.
In their editorial, Wann and St. Mary's Hospital colleague Sanjay Deshpande, MD, wrote that while the American College of Cardiology/American Heart Association still "give tepid support" to the use of aspirin in patients with a low risk for stroke (CHA2DS2-VASc ≤1), other guidelines, including those from the European Society of Cardiology and NICE in the United Kingdom, no longer recommend aspirin for Afib-related thromboembolism prevention.
"This variance from guidelines does not appear to be related to true contraindication to anticoagulation, but may reflect a lack of appreciation that aspirin administration places a patient at significant risk for bleeding, while offering virtually no protection from stroke," they wrote.
They concluded that greater awareness of aspirin's lack of benefit for reducing Afib-related stroke risk is needed among both physicians and patients.
"'Take two aspirin and call me in the morning' is not appropriate treatment for a patient with atrial fibrillation at risk for thromboembolism," they wrote. "The clot only thickens."

Complying With the National Institutes of Health Guidelines and Principles for Rigor and Reproducibility

Our fucking failures of stroke associations should have enough employees that can monitor that stroke research meets these guidelines. But they won't, it would be too much like hard work. They would have to keep track of all research and do a better job than I can. If they were my minions they would accomplish that with no questions asked.
http://atvb.ahajournals.org/content/36/7/1303.extract?etoc
  1. Christian Weber
+ Author Affiliations
  1. From the Saha Cardiovascular Research Center and Department of Physiology, University of Kentucky, Lexington (A.D.); Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (R.A.H.); Department of Medicine, University of North Carolina at Chapel Hill (N.M.); Departments of Medicine and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.); Diabetes Research Program, Division of Endocrinology, Department of Medicine, New York University Langone Medical Center (A.M.S.); and Institute for Cardiovascular Prevention, and Department of Medicine, Ludwig-Maximilians-Universität (LMU) and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany (C.W.).
  1. Correspondence to Alan Daugherty, University of Kentucky, Saha Cardiovascular Research Center, 741 S Limestone - BBSRB Room 243, Lexington, KY 40536. E-mail Alan.Daugherty@uky.edu

In 2014, the National Institutes of Health (NIH) delivered a document that described the principles and guidelines for reporting preclinical research (https://www.nih.gov/research-training/rigor-reproducibility/principles-guidelines-reporting-preclinical-research). These principles and guidelines were developed in a workshop that addressed the concern of reproducibility of preclinical research and were built on previous NIH recommendations for transparency in reporting data.1 A major driving force behind this effort stemmed from concerns voiced by the pharmaceutical industry that described their failure to replicate studies performed in academic laboratories2,3 These issues have also attracted attention through commentaries in both scientific journals4 and the lay press.5
As guardians of a large investment of public funds, the NIH aspires to promote confidence in science through enhanced reporting of protocols and data in journals, focusing in particular on reproducibility of results of similar experiments performed in different laboratories. A wide spectrum of scientific leaders, including many journal editors, attended the meeting at which this document was developed. The consequent report emphasized the need for journals to modify their editorial processes in several respects. These included requirement that authors document a detailed description of statistical analyses and data reporting with the aim of increasing transparency, sharing of data and materials, and establishing best practices for reagent verification. An additional requirement was for journals to establish a standard mechanism for the reporting of refutations of published work. All American Heart Association journals, including ATVB, have endorsed these NIH guidelines.
The NIH guidelines state specifically that “the journal assumes responsibility …

The Outlook Linked To Better Judgement, Memory And Health

But what about the research that says that pessimists live longer?  Is your doctor pushing you to optimism because you'll have fewer heart attacks and strokes and better cognition? Or does s/he want you to live longer and push you to pessimism? You should make the choice, I'm an optimist.
http://www.spring.org.uk/2016/06/outlook-linked-better-judgement-memory.php?omhide=true
Psychological exercises can help to improve this beneficial outlook.
Being optimistic about the future is linked to fewer memory problems and better problem solving and judgement.
The new research on people aged over 65 is the latest scientific endorsement of an optimistic outlook.
Optimism has already been linked to eating better and exercising more.
People who are more optimistic are also less likely to suffer heart attacks and strokes.
One way to increase optimism is to try writing about your ‘best possible self’.
This exercise has been shown to increase optimism.
The conclusions come from a national survey by the US National Institute of Aging.
Ms Katerina Gawronski, the study’s first author, said:
“We felt like this was an important topic to investigate and to our knowledge, it’s the first study to examine the link between optimism and cognitive impairment in older adults.
We found that optimism was indeed associated with better cognitive health over time.”
Mr Eric Kim, the study’s co-author, said:
“Therefore, optimism may be a novel and promising target for prevention and intervention strategies aimed at improving cognitive health,”
The study was published in the journal Psychosomatic Medicine (Gawronski et al., 2016).

Care pathways and healthcare use of stroke survivors six months after admission to an acute-care hospital in France in 2012

Of course our fucking failures of stroke associations will not follow the recommendation here and create a database of stroke care, treatments and results. If you don't know what didn't work you can NEVER fix your problems. Since 90% of survivors do not fully recover there is an abundance of information to be collected as to why they didn't recover.With 10 million survivors a year there is vast amounts of data waiting to be analyzed. Only lazy and stupid people don't want to correct that failure.
Has your stroke hospital analyzed why all of their patients did not fully recover? WHY THE HELL NOT? STUPIDITY? LAZINESS? NOT INTERESTED?
http://www.ncbi.nlm.nih.gov/pubmed/27038535

Abstract

INTRODUCTION:

Care pathways and healthcare management are not well described for patients hospitalized for stroke.

METHODS:

Among the 51 million beneficiaries of the French national health insurance general scheme (77% of the French population), patients hospitalized for a first stroke in 2012 and still alive six months after discharge were included using data from the national health insurance information system (Sniiram). Patient characteristics were described by discharge destination-home or rehabilitation center (for < 3 months)-and were followed during their first three months back home.

RESULTS:

A total of 61,055 patients had a first admission to a public or private hospital for stroke (mean age; 72 years, 52% female), 13% died during their stay and 37% were admitted to a stroke management unit. Overall, 40,981 patients were still alive at six months: 33% of them were admitted to a rehabilitation center (mean age: 73 years) and 54% were discharged directly to their home (mean age 67 years). For each group, 45 and 62% had been previously admitted to a stroke unit. Patients discharged to rehabilitation centers had more often comorbidities, 39% were highly physically dependent and 44% were managed in specialized neurology centers. For patients with a cerebral infarction who were directly discharged to their home 76% received at least one antihypertensive drug, 96% an antithrombotic drug and 76% a lipid-lowering drug during the following month. For those with a cerebral hemorrhage, these frequencies were respectively 46, 33 and 28%. For those admitted to a rehabilitation center, more than half had at least one visit with a physiotherapist or a nurse, 15% a speech therapist, 10% a neurologist or a cardiologist and 15% a psychiatrist during the following three months back home (average numbers of visits for those with at least one visit: 23 for physiotherapists and 100 for nurses). Patients who returned directly back home had fewer physiotherapist (30%) or nurse (47%) visits but more medical consultations. The 3-month re-hospitalization rate for patients who were discharged directly to their home was 23% for those who had been admitted to a stroke unit and 25% for the others. In rehabilitation centers, this rate was 10% for patients who stayed < 3 months.

CONCLUSIONS:

These results illustrate the value of administrative databases to study stroke management, care pathways and ambulatory care. These data should be used to improve care pathways, organization, discharge planning and treatments.

Tuesday, June 21, 2016

Tai Chi for stroke rehabilitation: protocol for a systematic review

Have your doctor and therapists follow the results of this research. If YOU don't tell them about this it will not be followed up.
http://bmjopen.bmj.com/content/6/6/e010866.full

  1. Zongheng Li1
+ Author Affiliations
  1. 1Department of Rehabilitation, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
  2. 2National Institute of Complementary Medicine, Western Sydney University, Sydney, New South Wales, Australia
  3. 3Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
  4. 4Department of International Communications, Beijing University of Chinese Medicine, Beijing, China
  1. Correspondence to Dr Zongheng Li; lee_zongheng@163.com
  • Received 14 December 2015
  • Revised 7 May 2016
  • Accepted 23 May 2016
  • Published 16 June 2016

Abstract

Introduction Stroke is a major cause of death and disability, and imposes a huge burden and significant workload for patients, their families and society. As a special form of physical activity, Tai Chi is may be useful for stroke rehabilitation. The objective of this review is to systematically evaluate the efficacy and safety of Tai Chi for rehabilitation in stroke patients.
Methods and analysis We will conduct a systematic search of the following electronic databases from their inception to 31 October 2015: MEDLINE, EMBASE, the Cochrane Library, the Chinese BioMedical Literature Database (CBM), the Chinese National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP), Wanfang and the Chinese Dissertation Database. All relevant randomised controlled trials (RCTs) in English and Chinese will be included. The main outcomes will be changes in the neurological function of patients and in independence in activities of daily living. Adverse events, adherence, costs and the cost effectiveness of Tai Chi will also be assessed. Two independent reviewers will select studies, extract data and assess quality. Review Manager 5.3 will be used for assessment of risk of bias, data synthesis and subgroup analysis.
Ethics and dissemination This systematic review does not require formal ethical approval because all data will be analysed anonymously. Results will provide a general overview and evidence concerning the efficacy and safety of Tai Chi for stroke rehabilitation. Findings will be disseminated through peer-reviewed publications.
Trial registration number CRD42015026999.

The potential power of robotics for upper extremity stroke rehabilitation

Who the fuck gives a shit about potential? Write up and publicize a stroke protocol to see if others can repeat your results. A great stroke leader would be forcing stroke protocols to be written. This milquetoast attempt  just chaps my ass. Try to fix all the fucking problems in stroke instead.

  1. Sean P Dukelow
  1. Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
  1. Sean P Dukelow, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8 Canada. Email: spdukelo@ucalgary.ca

Abstract

Two decades of research on robots and upper extremity rehabilitation has resulted in recommendations from systematic reviews and guidelines on their use in stroke. Robotics are often cited for their ability to encourage mass practice as a means to enhance recovery of movement. Yet, stroke recovery is a complex process occurring across many aspects of neurologic function beyond movement. As newer devices are developed and enhanced assessments are integrated into treatment protocols, the potential of robotics to advance rehabilitation will continue to grow.