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:

Saturday, January 31, 2015

Northern Ireland hospitals are ready to act FAST

But the real question is, What percentage of time does tPA administration 100% resolve the stroke effects?  Being prepared means nothing if what you are treating them with barely works.  Are they better than the appalling efficacy rate of 12% for tPA.

Technology helps elderly with mild dementia

I know this wouldn't work for my parents at all even before they would have dementia. They are making an incredibly giant assumption that technology can be dumbed down enough that anyone can work it. They better have a massive user evaluation test.
Blekinge Institute of Technology in Sweden will receive 10 million SEK to develop new technologies that will increase the quality of life for elderly people with mild dementia. The technology, IT support via e-readers, will also facilitate for the relatives.
It is from Horizon 2020, the EU Framework Programme for Research and Innovation, that the project Medical Intelligence for Assistive Management Interface - Mild Dementia received the funds. The project will last for four years.

In the project, new specially adapted technology that can help elderly people suffering from mild dementia will be developed. This may involve, for example reminders so they do not forget to take their medication or an appointment. In addition to raising the quality of life for these elderly people the new technologies will make it easier for relatives and healthcare professionals.
Today, up to 9 percent of the population over 60 years suffer from mild dementia, so there are a great number of people who will have use of the new technology.
The first step is to develop a customized technology that is user friendly. Then the technology will be tested on 2,000 people in Europe. The new technology is expected to be ready for operation in 2020.
The work will be conducted within the research environments sustainable active aging and health and technology at BTH. Responsible for the project is Johan Berglund, professor of public health sciences. The senior project SNAC-Blekinge, which enabled this EU project, has been underway at BTH since 2000.
- With this technology, we hope to support and develop nursing care, increase the elderly persons and their family members’ quality of life while also reducing health care costs, says Professor Johan Berglund.

Luging therapy

Went luging today at the Muskegon Winter Sports Complex. 4 runs down. 850 foot track.
Run 1.  The first run was pretty much totally out of control, It took forever to get my legs controlled and on the kufens, the track is fairly bumpy. After the 5th curve on the straightaway I spent the entire time rubbing my left shoulder against the wall. 19.3 seconds
Run 2. Coming out the the fifth turn  I slammed into the wall and overturned the sled. The sled made it down ok, I had to get helped out of the chute, only my pride was hurt.
Run 3. Finally was able to be under control all the way down. 18.3 seconds.
Run 4. Totally slammed into the wall coming out of turn 5, not sure how I stayed on the sled. In the pictures you can see the goose egg sized swelling on the inside of my left elbow. I think my left arm drifted down slightly until it was no longer on top of my waist and thus when I slammed into the wall the arm was between the frame of the sled and the wall. 24 seconds.
Carrying a 40-50 lb. sled up the steps to the start each time made my legs feel like jelly. And with no use of my left arm/hand I couldn't even help pull myself up the steps.I teetered on the brink of falling a few times.
Don't even consider this unless you are insanely stupid. This is not an approved therapy for anyone.
These videos are of other people going down the Muskegon track to give you some flavor of what it is like.
Deans' bump

The line at the start

He's off

Notice the motorcycle helmet

The elbow pads were mainly to protect your coat from getting ripped as you contacted thewooden walls

The steps to the top

The womens' winners

The womens' winners

The goose egg

The goose egg

Increasing Neurogenesis with Fluoxetine, Simvastatin and Ascorbic Acid Leads to Functional Recovery in Ischemic Stroke

How soon can your doctor ramp up clinical trials on this?
, , , , , ,
Department of Neuroscience, Cell Biology and Physiology, Wright State University, 3640 Colonel Glenn Highway, Dayton, Ohio 45435.
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Department of Neuroscience, Cell Biology and Physiology, Wright State University, 3640 Colonel Glenn Highway, Dayton, Ohio 45435.
Highlight Terms
Less than 8.5% of ischemic stroke patients receive clot-busting drugs within the narrow time needed to reduce injury. Thus, there is need for an easily-accessible delayed post-stroke drug treatment to improve functional recovery. Various combinations of fluoxetine, simvastatin, and ascorbic acid were given to healthy rats to assess impact on neurogenesis versus controls. Fluoxetine combined with simvastatin and ascorbic acid produced a 19-fold increase in neurogenesis versus controls in healthy rats; fluoxetine alone produced 10-fold increase. We next tried a couple of drug combinations versus control in endothelin-induced stroked rats. Combined fluoxetine/simvastatin/ascorbic acid treatment, given to stroked rats 20-26 hours after stroke induction and continued for 31 days, produced strong recovery as measured by Montoya staircase test (mean recovery to 85% of pre-stroke function) and Forelimb Asymmetry test (mean recovery to 90% of pre-stroke function) . Fluoxetine and ascorbic acid without simvastatin only produced ~50% of recovery produced by the 3-drug combination. Our results indicate that combined treatment of Fluoxetine, simvastatin and ascorbic acid represents a promising delayed stroke treatment that greatly improves functional recovery in rats and warrants further study in human patient populations. This work formed the basis for a patent submission (US20130065924A1) Composition and method for treatment of neurodegeneration.

Friday, January 30, 2015

Negative communication between doctor and patient could make symptoms worse

Since your doctor does not do an objective diagnosis and has no written stroke protocols there is no chance of getting any good feelings from any encounter with your doctor. But you can meet your doctors' expectations by being in the 90% that don't get to a full recovery or become a 30 day death statistic..
Doctors who unintentionally communicate to patients that they don't believe or understand them could actually make symptoms worse, a new study suggests.
The research by the Universities of Southampton and Exeter indicates that a type of 'nocebo' response, where patients perceive a lack of understanding or acceptance from their doctor, could create anger and distress - physiological conditions that can worsen illness.
"Our work indicates that the effects of patients feeling that their doctor doesn't believe or understand them can be damaging both emotionally and physiologically," says lead author Dr Maddy Greville-Harris, from the University of Southampton. "This could lead to worsening of illness, known as the 'nocebo response'.
"Patients bring certain beliefs and expectations to their health care professional, which are moulded by the culture they live in and their previous experiences. Their expectations will undoubtedly affect the outcome but improving communication in consultations could make a big difference to patient care. This is a small study and more research is needed on a larger scale."
Published in the American Journal of Medicine, the researchers recorded and analysed consultations at a pain management clinic involving five women with chronic wide-spread pain. During subsequent interviews, patients reported feeling dismissed and disbelieved by healthcare providers, encountering providers who did not invest in them or show insight into their condition.
Patients described feeling hopeless and angry after invalidating consultations, feeling an increased need to justify their condition or to avoid particular doctors or treatment altogether.

More at link.

Latest Sentinel Stroke National Audit Programme (SSNAP) results show world class stroke care is achievable - UK

I'm sorry but this is not world class care. Quality of RESULTS was not measured so this is f*cking worthless. I know the bar is set extremely low for reporting about supposedly good news about stroke but we need some realism. And the realism is that;

If you just had a stroke, You are F*cking screwed
The seventh report from the Sentinel Stroke National Audit Programme (SSNAP) data shows that 13 stroke services scored an ‘A’ overall for the quality of care (What about RESULTS?)they provide for patients. This is a substantial increase from the 6 services that achieved an ‘A’ in the previous report. Reaching this level is a considerable achievement, suggesting a world class service.
SSNAP is the first national stroke register in the world to collect information about the entire stroke pathway, from being admitted to hospital to the six month follow-up appointment.  SSNAP aims to improve stroke care by measuring the quality of stroke services against evidence based standards and supporting staff to make improvements. SSNAP results are updated every three months, and cover all hospitals treating stroke patients in England and Wales, together with two hospitals in Northern Ireland. It is the most comprehensive and reliable source of information about the performance of stroke services.
The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP)*, as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).
The report published today relates to patients admitted between July and September 2014 and includes named hospital results for the entire inpatient care pathway (where the numbers of patients entered in SSNAP for this quarter make this viable). The results are available online at the SSNAP Results Portal.
Congratulations to the 13 services which have scored an ‘A’ overall. Several more would have scored an ‘A’ if they had not been marked down because of issues of case ascertainment and data compliance, both of which are problems that should be fairly easily solvable. What these latest results show is that, although the audit has set the bar very high to achieve the top score, it is achievable and we hope will encourage others to strive to improve.
As in the sixth report, it is encouraging to see some improvements in the national results for stroke care both the first 72 hours of care and in the standards and processes of care by discharge, since data collection began. The quality of data submitted to SSNAP is also improving each quarter.
The National Clinical Director for Stroke, Professor Tony Rudd, reports that SSNAP should prove invaluable in helping to shape future developments in stroke care in England, Wales and Northern Ireland. Without high quality data, improvement in clinical care is unlikely to occur.
Professor Rudd said:
Measuring the quality of care is an essential component for quality improvement. The SSNAP audit provides very high quality information that could help professionals, patients, and commissioners use and develop their services for the future.
Professor Rudd is also chair of the Intercollegiate Stroke Working Party which oversees the SSNAP.
The quality of data submitted to SSNAP, measured in terms of audit compliance, has also improved each quarter, which is essential in providing meaningful audit results. However, there remains unacceptable variation across the country. SSNAP has moved to absolute measurement of results which means that all teams are capable of showing improvement.

Blood Test for Brain Injury May Not Be Feasible

I had high hopes for this possibility.
Complications involving the brain’s unique waste removal system – the existence of which has only recently been brought to light – may thwart efforts to identify biomarkers that detect traumatic brain injury (TBI). That is because proteins that are triggered by brain damage are prevented from reaching the blood system in levels necessary for a precise diagnosis.
Tens of millions of dollars have been invested by the U.S. government and the private sector in recent years in an effort to develop a simple blood test that can help physicians quickly and accurately gauge the extent of neurological damage after a blow to the head. However, a new study conducted in mice and published today in the Journal of Neuroscience appears to indicate that these efforts may face significant hurdles.
“These findings show that a blood-based biomarker for TBI is unlikely to be effective for routine clinical use,” said Maiken Nedergaard, M.D., D.M.Sc., co-director of the University of Rochester Medical Center (URMC) Center for Translational Neuromedicine and lead author of the study. “Both the injury itself and the clinical approach to TBI can impair the ability of the brain to remove waste, resulting in variable and – for the purpose of detection and diagnosis – unreliable protein levels in the blood.”
More than 1.5 million Americans, both children and adults, suffer concussions every year. Furthermore, it is estimated that more than 300,000 U.S. military personal have been victims of TBI since 2000. Readily visible symptoms – such as headache, nausea, dizziness, and sleep problems – don’t reflect the extent of the injury. Consequently, there is an urgent and compelling public health need to develop a method that can determine the severity of TBI and help predict which of these individuals may be at risk for long-term cognitive problems.
It is only within the last few years that researchers have begun to understand how the brain deals with waste. In 2012, scientists at the University of Rochester revealed that the brain possesses its own unique waste removal system, which has been dubbed the glymphatic system.
The glymphatic system consists of a plumbing network that piggybacks on the brain’s blood vessels and pumps cerebral spinal fluid through brain tissue to flush away waste. The waste flows out of the brain, into the lymph nodes, and eventually makes its way to the general blood circulation system and, ultimately, the liver.
It is known that during the shock of brain injury, certain proteins are shaken free from the brain’s cells. This has led to the speculation that by measuring the levels of these proteins after they have made their way into the blood system, physicians may be able to ascertain the existence and severity of injury.
The Rochester team of researchers performed a series of experiments on mice with TBI and tested the animal’s blood for three proteins (S100 beta, glial fibrillary acidic protein, and neuron specific enolase) that are considered strong candidates for a blood-based biomarker for TBI.
It turns out that the glymphatic system is very delicate and small alterations can disrupt function, impairing the ability to remove waste products, such as the proteins associated with TBI, from the brain. An earlier study showed that the blows to the head themselves can disrupt the function of the glymphatic system.
The current study shows that treatments for these conditions may also impair the brain’s ability to remove waste. Just like a water pump, the glymphatic system requires pressure to function properly. Efforts to relieve the stress on the brain from swelling after an injury by using drugs like acetazolamide or employing a surgical procedure that drains CSF can “depressurize” the system and impair clearance of waste.
Furthermore, people under observation in hospitals for TBI are often subjected to frequent neurological evaluation by physicians, disrupting their sleep. In other instances, patients are given sedatives to induce sleep after TBI. Because the glymphatic system primarily functions while we sleep, these variations in clinical care can skew protein levels found in the blood.
During experiments that replicated these conditions in mice with TBI, the researchers were not able to detect reliable changes in protein levels in the blood.
“This study shows that even small changes can modulate the brain’s ability to clear waste,” said Benjamin Plog, an M.D./Ph.D. student in Nedergaard’s lab and a co-author of the study. “Consequently, we need to recalibrate our efforts and begin to think about measuring brain damage in a manner that takes into account the level of impairment to the glymphatic system. “

New members selected for National Advisory Neurological Disorders and Stroke Council

If you know these people ask them which problems in stroke are going to be their focus. And what is the strategy to address all these problems.
Five prominent individuals from the neuroscience community have joined the National Advisory Neurological Disorders and Stroke Council, the principal advisory body to the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.
The council, which includes scientists, physicians and public representatives, meets three times each year to review scientific applications and to advise the institute’s leadership on activities and policies affecting research programs.
“We are pleased to welcome these individuals to the NINDS’ council. Their extensive experience and diverse backgrounds will enrich the NINDS’ work to advance basic, translational and clinical research in the neurosciences,” said NINDS Acting Director Walter Koroshetz, M.D.
Brief biographies of the new council members are below.
Amy Brooks-Kayal, M.D., is a professor in the Departments of Pediatrics and Neurology at the University of Colorado, School of Medicine, Aurora, and in the Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego. She is also chief and Ponzio Family Chair in Pediatric Neurology at the Children’s Hospital Colorado in Denver. Dr. Brooks-Kayal is internationally recognized for her research in the mechanisms of and new therapies for epilepsy and her expertise in clinical care for people with epilepsy. She is a member of the board of directors and incoming president of the American Epilepsy Society. She earned her M.D. from Johns Hopkins University, Baltimore, and completed residencies in pediatrics and child neurology at Children’s Hospital in Philadelphia.
Karen S. Chen, Ph.D., is the chief scientific officer and chief operating officer of the Spinal Muscular Atrophy (SMA) Foundation in New York City. She is responsible for overseeing the full range of scientific and drug discovery programs, as well as managing the activities at the SMA Foundation. Dr. Chen has more than 25 years of experience planning, directing, and conducting preclinical research as a senior research scientist and manager.  She has headed a variety of departments and groups working on the discovery and development of novel therapeutics for neurological disorders. Prior to joining the SMA Foundation, Dr. Chen worked at Roche and Elan Pharmaceuticals, where she focused on therapy development for Alzheimer’s and Parkinson’s diseases. She earned her Ph.D. in neurosciences at the University of California, San Diego.
Timothy Coetzee, Ph.D., is the chief advocacy, services and research officer at the National Multiple Sclerosis Society (NMMS) in New York. Dr. Coetzee has been engaged in multiple sclerosis advocacy work throughout his career. He leads the society’s federal and state activism programs and manages its investment in basic, clinical and commercial research. He has also helped launch and served as president of Fast Forward, an initiative of the NMMS to speed the commercial development of new treatments for multiple sclerosis. He earned his Ph.D. at Albany Medical College in New York.
Beverly L. Davidson, Ph.D., is the director of the Center for Cellular and Molecular Therapeutics and holds the Arthur V. Meigs Chair in Pediatrics at the Children’s Hospital of Philadelphia. She is also a professor in the Department of Pathology and Laboratory Medicine at the Perelman School of Medicine at the University of Pennsylvania. Prior to her move to the Keystone State, Dr. Davidson was the Roy J. Carver Chair in Biomedical Research at the University of Iowa Carver College of Medicine, Iowa City, and vice chair for research in internal medicine. Her research focuses on inherited brain disorders and the development of novel therapies. She has received numerous awards including a University of Iowa Carver Research Program of Excellence. In 2014, she served on the first Blue Ribbon Panel to review the NINDS Intramural Research Program. She earned her Ph.D. in biological chemistry from the University of Michigan in Ann Arbor.
S. Lawrence Zipursky, Ph.D., is a professor in the Department of Biological Chemistry at the University of California, Los Angeles, David Geffen School of Medicine. He is also an investigator for the Howard Hughes Medical Institute. As a developmental neurobiologist, Dr. Zipursky researches the cellular rules and underlying molecular mechanisms by which neurons establish specific patterns of synaptic connections during development. Dr. Zipursky is a member of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative Multi-Council Working Group. He has received numerous honors including election to the National Academy of Sciences. Dr. Zipursky earned his M.Sc. and Ph.D. degrees in molecular biology from Albert Einstein College of Medicine in New York City.
NINDS ( is the nation’s leading funder of research on the brain and nervous system. The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

Thursday, January 29, 2015

After heart attacks, most don’t get enough statins

Even heart docs are stupid and obviously do not keep up with news/research. So our doctors are not the only ones who know nothing.
The reason why you don't prescribe high dose statins:
FDA announces new safety recommendations for high-dose simvastatin

Ischemic Stroke Activates Hematopoietic Bone Marrow Stem Cells

Impossible for me to tell what this means, so ask your doctor.

  1. Matthias Nahrendorf
+ Author Affiliations
  1. From the Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston (G.C., H.B.S., T.H., Y.Y., Y.S., P.D., J.S., R.W., F.K.S., M.N.); Stroke and Neurovascular Regulation Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown (F.H., Y.W., M.A.M.); Center for Regenerative Medicine, Massachusetts General Hospital, Boston (N.S., D.T.S.); and Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.).
  1. Correspondence to Matthias Nahrendorf, Center for Systems Biology, 185 Cambridge St, Boston, MA 02114. E-mail
  1. * These authors contributed equally to this article.


Rationale: The mechanisms leading to an expanded neutrophil and monocyte supply after stroke are incompletely understood.
Objective: To test the hypothesis that transient middle cerebral artery occlusion (tMCAO) in mice leads to activation of hematopoietic bone marrow stem cells.
Methods and Results: Serial in vivo bioluminescence reporter gene imaging in mice with tMCAO revealed that bone marrow cell cycling peaked 4 days after stroke (P<0.05 versus pre tMCAO). Flow cytometry and cell cycle analysis showed activation of the entire hematopoietic tree, including myeloid progenitors. The cycling fraction of the most upstream hematopoietic stem cells increased from 3.34%±0.19% to 7.32%±0.52% after tMCAO (P<0.05). In vivo microscopy corroborated proliferation of adoptively transferred hematopoietic progenitors in the bone marrow of mice with stroke. The hematopoietic system’s myeloid bias was reflected by increased expression of myeloid transcription factors, including PU.1 (P<0.05), and by a decline in lymphocyte precursors. In mice after tMCAO, tyrosine hydroxylase levels in sympathetic fibers and bone marrow noradrenaline levels rose (P<0.05, respectively), associated with a decrease of hematopoietic niche factors that promote stem cell quiescence. In mice with genetic deficiency of the β3 adrenergic receptor, hematopoietic stem cells did not enter the cell cycle in increased numbers after tMCAO (naive control, 3.23±0.22; tMCAO, 3.74±0.33, P=0.51).
Conclusions: Ischemic stroke activates hematopoietic stem cells via increased sympathetic tone, leading to a myeloid bias of hematopoiesis and higher bone marrow output of inflammatory Ly6Chigh monocytes and neutrophils.

St. Catherine receives stroke care certification - Garden City, KS

The arrogance of those involved in assuming that readers will think this is important rather than being worthless because it doesn't refer to results. Call the hospital president and demand better stroke results than this crap.
Big f*cking whoopee.
You can check out Joint Commission standards here:
 I saw absolutely nothing about what should be done the first week or anything about measuring 30-day deaths and 100% recovery.  God, these people are worse than worthless. Complacent good-for-nothings.  
“A hospital must demonstrate strict adherence to guidelines and quality improvement, which includes rapid patient evaluation and treatment,” said Dr. Matt Byrnes, a general surgeon at the hospital. “The Joint Commission is the premiere accrediting agency nationwide, and we have its gold seal of approval. It has rigorous standards, which is why we chose this path to accreditation.” 

This statement is what is so f*cking bad about this. Guidelines NOT RESULTS.
You could probably meet all the guidelines and still have every patient die and that would be counted as a success.