Clot Busting With tPA to Improve Outcomes

As you may know, stroke is the leading cause of long term disability in the United States and many other countries around the world. In fact, although stroke has dropped from the 3rd leading cause of death in the U.S. to the 5th in less than a decade, it still remains the 2nd world-wide. Although national organizations such as the American Stroke Association and the National Stroke Association have make great strides through initiatives to spread stroke awareness, we still have a long way to go to decrease the occurrence of stroke.

Some individuals are lucky enough to have very mild residual deficits from stroke thanks to life-saving medical advances such as tPA and thrombectomy. However, this is not the case for the majority. In fact, as of 2011, only 7% of patients presenting to hospitals nationwide with stroke symptoms were treated with tPA. This is largely due
to delays in seeking treatment. One main factor that makes ischemic stroke patients ineligible for tPA is hospital arrival past the window of opportunity. This window is generally within 3 hours although for some cases the window can be extended up to 4.5 hours. For this reason it is crucial that 911 is called for EMS transport to speed up the process once a potential stroke victim reaches the hospital.

Another difficulty in the consistent administration of tPA is some apprehension on the part of providers to administer the medication as there are risks involved. By being aware of these possible treatments as well as stroke symptoms to watch out for, you become your own advocate for discussing all possibilities in stroke care as well as requesting transfer to a primary stroke center if needed. One new release from Mass. General reported that only 75% of eligible individuals are getting tPA at 1600 hospitals studied. Although this seems like a large percentage, it ideally should be higher. If a patient is eligible for tPA, prompt and thorough education on the magnitude of success from this treatment as well as potential risks should be provided. Once informed consent is obtained the medication should be administered ASAP. Studies show the greatest benefit from tPA is seen when it is started within 90 minutes from the start of symptoms.

As a result of initiatives to improve “door to needle times” (the time between arrival to the hospital and start of tPA), hospitals have made great strides in improving the outcomes of stroke patients. However, the struggle of getting people through the door on time still remains. Appropriate use of tPA can sometimes eliminate long term effects of stroke. I’ve seen many patients after tPA with little to no deficit. When these patients are compared to the individuals who come in after having impairments for an extended period of time, it is evident how instrumental this treatment is in stroke care. Awareness efforts are unable to reach everyone and unfortunately the highest risk individuals are often the hardest to reach. Therefore, stroke advocates like ourselves rely on individuals like you to spread knowledge and be aware of what to look for. Stay informed and remember that time is brain!

Education, Support

Tackling The Most Common Complication Of Stroke

If suffering a stroke weren’t difficult enough, survivors often face physical complications such as pneumonia, bed sores, falls and blood clots in the extremities. You may be surprised that none of these examples are even the most common complication of stroke. What is you may ask? Depression. Some sources report the incidence of post-stroke depression as high as 30-40%. At least one out of three survivors! As a society we often say, times are tough and things will get better; keep your chin up; or it’s just the blues, it will go away with time. But what about when it doesn’t?

The social stigma of mental illness in our world is a huge barrier to psychiatric care. The National Alliance on Mental Illness reports that of the 450 million people who suffer from mental illnesses globally, almost 60% do not obtain care. For a stroke survivor this not only affects psychological well-being, but also physical and cognitive recovery from stroke. Despite global efforts by the World Health Organization that stress the importance of mental wellness, post-stroke depression often goes untreated. It is crucial for the individual, the caregiver and others involved in the stroke survivor’s recovery to advocate for management if symptoms arise.

What are the symptoms of depression?
Persistent sadness
Pessimism, hopelessness, guilt, worthlessness
Loss of pleasure or interest in activities that were once enjoyed
Decreased energy, slowed activity
Restlessness of irritability
Difficulty concentrating, remembering or making decisions
Inability to sleep or oversleeping
Appetite or weight changes
Thoughts of death or suicide

The general rule is if five or more of these symptoms exist for greater than two weeks, they may be caused by depression. Depression after stroke is commonly attributed to losses associated with the stroke. However, there also may be biochemical changes in the brain that increase the chances of this happening. For this reason some people require medical treatment of their depression. Don’t tackle it on your own. Symptoms of depression are serious and need to be discussed with a physician to prevent setbacks in physical and cognitive recovery from stroke.

For more information visit:

American Stroke Association

National Stroke Association


Reduce Your Risk With This Low Effort Method: Sleep.

You may already be aware of the importance of sleep, but did you know that even small shifts in your circadian rhythm can negatively affect your health? In light of this past weekend’s time shift, let’s take a look at the effect of sleep on your body and your risk of stroke.

As overnight employees and swing shift workers know all too well, the body’s circadian rhythm plays an important role in our health and well-being. When sleep is irregular or inadequate your body is put under stress. This increases the risk of certain health conditions including heart attack and stroke. This widely accepted risk factor led researchers to study the effect of daylight savings time (DST) on stroke risk and it was found that overall stroke risk increases by 8% in the two days following DST. For adults over 65, the risk of stroke was found to increase by 20% due to the time change. This small schedule shift may not be noticeable for shift workers who are used to the frequent changes in sleep, however it may have a much greater effect on those who keep a strict sleep regimen.

Sleep affects your stroke risk in the long run as well. Sleep plays a role in healing and repair of the body: specifically the heart and blood vessels. For this reason insufficient sleep has been linked to cardiovascular diseases. Sleep also affects the release of hormones that make you feel hungry and affects the way our bodies use insulin. This causes blood sugar levels to increase. Therefore, when you are sleep deprived, the hunger hormone levels increase which makes you eat more even though your blood glucose is already higher from insulin resistance. The result is comparable to a pre-diabetic state! This as you can imagine increases the risk of developing both obesity and diabetes (which further increase the risk of stroke).

So I’m sure you get it, we need sleep. But how much is enough? Research found that out of 300,000 Americans who reported seven to eight hours of sleep per night were 25% less likely to have a stroke. But before you get too excited, the same research showed those that slept more than eight hours had the highest stroke risk. So I suppose it takes more of a Goldilocks method to maximize the reduction in stroke risk you get from sleeping.

Not only does adequate sleep reduce your risk of stroke, but it also improves your mood, your decision making skills and your memory. So make it this week’s goal to get a little more exercise and the proper amount of sleep to make a surprisingly big difference in your health and well-being.


Links to full articles used for this week’s blog:

Daylight savings time increases stroke risk, scientists find

Sufficient sleep and exercise may keep stroke at bay



We Won’t Sugar Coat It: Diabetes and Heart Disease

Happy Leap Day! As February comes to a close, we would like to leave you with some information about another major risk factor for heart disease and stroke. We talked about salt, now let’s talk about sugar! We told you high blood pressure is the leading risk factor for heart disease and stroke, but did you know that diabetes is also an independent risk factor as well? According to the American Diabetes Association (ADA), at least 68% of people with diabetes die from heart disease. The ADA also reports that adults with diabetes are 2 to 4 times more likely to develop heart disease than those without. The sweet news is that there are steps you can take to prevent it. So let’s begin.

What is diabetes?
Diabetes is a disorder of glucose metabolism, the basic sugar molecule that carbohydrates are broken down into. Although that sounds fancy, it really just means that the body is unable to use its main energy source properly. The body needs a hormone called insulin in order to let glucose into cells and be used as energy. With diabetes there is either no insulin produced (Type 1) or the insulin that is produced is not as effective (Type 2). Between 90-95% of diabetics are classified as Type 2. This is mostly linked to physical inactivity and increased body weight, though family history plays a role as well.

How do you know if you have it?
Nearly 7 million Americans have diabetes and don’t know it. Years before diabetes is diagnosed, certain cells in the body become less responsive to insulin when obesity is present and activity level is low. At first the pancreas, the organ that produces insulin, is able to keep up, but as time goes on production slows and blood sugar levels rise above the normal range. Symptoms of high blood sugar include excessive thirst and increased urination, fatigue, weight loss, blurred vision and slow wound healing or frequent infections. Talk to your doctor about your concerns and have your blood sugar checked.

What can you do to control it?
The National Diabetes Education Program (NDEP) encourages diabetics to follow the “ABC’s”: keep your A1C less than 7%; maintain blood pressure less than 130/80 mmHg; and control cholesterol by keeping LDL levels less than 100mg/dL. The A1C is a measure of blood glucose over a 3 month period. This is important because tight control of blood sugar reduces the risk of heart attack, stroke of death from cerebrovascular disease by 57% according to the NDEP. According to the American Heart Association, high blood pressure is twice as likely in individuals with diabetes as in those without. Although for the rest of the population blood pressure should be kept less than 140/90, diabetics should be lower due to the combined effect of high blood pressure and diabetes on heart disease and stroke risk. For the majority of diabetics, keeping LDLs lower than 100mg/dL is enough, however, if you already have been diagnosed with heart disease your doctor may want your LDL to be less 70mg/dL to further lower your risk of heart attack and stroke. In addition to medication therapy, regular exercise decreases these bad fats and increases levels of good fats in your bloodstream.

Why are diabetics at such an increased risk?
Some explanations are more complicated than others. For starters, over time when blood sugar remains high, damage occurs to the inside lining of blood vessels. This damage puts the individual at a higher risk of a process called atherosclerosis, or plaque build up in arteries. Some research also points to increased inflammation in the vessels as a cause of this according to Joslin Diabetes Center. Diabetics also have greater rates of a process called platelet aggregation. Platelets are the sticky substance in your blood that allows your blood to clot when blood vessels are damaged. So although they have an important function, they cause problems when they stick to damaged artery walls and  narrow the artery where blood passes through. These processes are both worsened by and result in high blood pressure. This is the start of the vicious cycle of heart disease.

It is recommended that you reduce your risk through modest weight reduction and regular exercise. Getting 30 minutes of exercise 5 days a week is ideal, but talk to your doctor about what’s right for you. You may have to start small with 5-10 minutes of walking per day and work up to your goal if you experience shortness of breath or feel over-exerted.
If you smoke: set a quit date today! Visit our education page for resources on smoking cessation. This is the single most important step you can take to lower your risk of diabetes, heart disease and stroke.

Thank you all for checking in for this month’s blog series on heart disease. We hope you gained some insight into America’s leading cause of death and learned how you can reduce your risk. Make small changes today for a healthier tomorrow. You can do it, we believe in you!


Let’s Get To The Heart Of The Matter: What You Need To Know About Heart Failure.

Feeling broken-hearted after being spared Cupid’s arrow this Valentine’s Day? Keep your chin up, it’s Heart Failure Awareness Week! So let’s take a look at the basics of a truly broken heart.


Heart failure is a condition affecting 6 million Americans. It is usually a result of other heart conditions such as coronary artery disease, high blood pressure or previous heart attack. Although we are at higher risk of developing heart failure simply by getting older, managing these other heart conditions first is very important to reduce our risk.
Although some believe the heart is the source of emotions and the soul (and years ago scholars would agree), it’s most importantly a pump. The heart pumps blood throughout the body to deliver fresh oxygen from the lungs and to remove carbon dioxide and wastes from the body. When the heart is unable to pump as effectively as the body demands, this is called heart failure. Heart failure does not mean that the heart is not working at all, rather that it’s not meeting the body’s expectations. When this starts to happen, the heart muscle gets bigger to increase its power, and it begins to pump faster. This is called compensation. When these methods are no longer effective, symptoms will start to show.
Symptoms of heart failure include:
  • Shortness of breath
  • Chronic coughing or wheezing
  • Swelling of the feet or ankles
  • High heart rate
  • Fatigue
  • Nausea or loss of appetite
  • Confusion
Although heart failure is often thought of as a condition affecting older adults, children and young adults can develop heart failure as well due to structural heart defects or certain infections. Symptoms of heart failure in infants or children can be trouble breathing, poor feeding or growth or excessive sweating.
Heart failure is divided into 4 functional classes: Class I-Mild, Class II-Mild, Class III-Moderate and Class IV-Severe. In early mild heart failure there is no limitation in physical activity. In Class II mild heart failure, the individual will begin to experience fatigue, palpitations, difficulty breathing or chest pain during ordinary activity. Moderate heart failure, Class III, results in the same symptoms with less than ordinary activity. Lastly, in Severe Class IV heart failure, symptoms may be present at rest and the individual is unable to carry out any physical activity without discomfort.
The process of heart failure begins before symptoms start to show, but by following a low sodium diet, taking prescribed medications and following your specific recommendations, the progression of the condition can be slowed. To monitor for a worsening, or exacerbation, of heart failure it is important to obtain a daily weight. This will monitor for fluid build up in the body. Weight should be taken at the same time, on the same scale, usually before breakfast. For a weight increase of 2-3 pounds over 24 hours, or 5 pounds or more in a week, be sure to call your doctor. Also watch for increased swelling in the legs or belly, increased fatigue or shortness of breath and decreased urinary output.
Unfortunately there is no cure for heart failure. Treatment is focused on management with a healthy lifestyle and consistent use of any prescribed medications. By working toward a healthier lifestyle you can slow the progression of heart failure by preventing further damage. Check out this helpful link from the American Heart Association to find out ways to adopt a healthy lifestyle.
As always, thanks for checking in! Stop by next week to close out American Heart Month with a look at Diabetes and its effect on the risk for heart disease.