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dr_evazan22
08-15-2006, 06:30 PM
Tonight I got an email that my Mom had forwarded to me. One of the people I thought of while reading it was Tycho. I also thought you all might want to know this in case to help a family member or friend.


STROKE: Remember The 1st Three Letters...S.T.R.

My friend sent this to me and encouraged me to post it and spread the word. I agree. If everyone can remember something this simple, we could save some folks. Seriously.. Please read:

STROKE IDENTIFICATION:
During a BBQ, a friend stumbled and took a little fall - she assured everyone that she was fine (they offered to call paramedics) and just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm, Ingrid passed away.) She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some don't die. They end up in a helpless, hopeless condition instead.
It only takes a minute to read this...

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.

RECOGNIZING A STROKE
Thank God for the sense to remember the "3" steps, STR . Read and Learn!
Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke.
Now doctors say a bystander can recognize a stroke by asking three simple questions:

S * Ask the individual to SMILE.
T * Ask the person to TALK to SPEAK A SIMPLE SENTENCE
(Coherently) (i.e. It is sunny out today)
R * Ask him or her to RAISE BOTH ARMS.

NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out their
tongue. If the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke. If he or she has trouble with
ANY ONE of these tasks, call 911 immediately !! and describe the
symptoms to the dispatcher.

A cardiologist says if everyone who gets this e-mail sends it to
10 people; you can bet that at least one life will be saved.

InsaneJediGirl
08-15-2006, 10:41 PM
Nice facts. Thanks Dr.evanzan :)

JimJamBonds
08-15-2006, 10:45 PM
Yes good stuff there Doc, about 2-3 years ago a had a few of those symptoms. But my stupid male "I'm fine" ego overulled my better judgement and I didn't seek any medical attention. Luckily nothing came of it.

JediTricks
08-16-2006, 04:03 PM
I thought this was going to be about that program that supposedly can identify a specific individual based on his keystroke pattern, which I think is complete bunk.

This is good to know though.

Bel-Cam Jos
08-16-2006, 05:25 PM
I heard you can do this for concussions or head injuries. In fact, when I was in my car accident (hit from behind, spun around and flipped over onto the side grass incline), one of the first things I thought of was after I made it out of the car, was this email someone had forwarded to me. So I smiled, spoke clearly, and lifted my arms. People thought I was weird [people still do] :D

Darth Instigator
08-16-2006, 07:06 PM
this is very good info, all too often people, especially older folks, tend to ignore or diminish the importance of symptoms that seem vague or they just don't want to spoil the event at hand. Unfortunately the time frame to possibly reverse the effects of a brain attack or stroke is a small window around the 4-6 hour mark, as well as the time frame for similar symptoms for the heart. When vague and small symptoms appear these are warning signs, by the time people call for the ambulance there is nothing we can do for them to help try and turn around what has occured. Its a shame and more people need to know what to look for. When I teach community based CPR I wish more people would come out and learn about it, especially the people from the elderly communities that are prevalent in the area I work, they could certainly benefit from a little knowledge.

dr_evazan22
08-16-2006, 08:22 PM
Thinking back over my EMT training in the mid-90's, asking questions to determine mental clarity were pretty standard (name, date, what day of week it was) for any head trauma. Something that the email above didn't really go into too much was / is that there are physical symptoms to make you ask the STR questions. In this particular case the lady 'tripped'. Try to remember the questions if there is a fall, maybe a loss of balance, the cause of an (car) accident. When you ask the STR questions be observant of the left side vs the right side (smile, raised arms) and of slurred speech.

Darth Instigator
08-16-2006, 09:51 PM
I took my paramedic class almost 10 years ago now, and have been in EMS for 13. We use the signs you pointed out and it is referred to as the cincinnati Stroke scale, it has recently become the standard for helping to determine any deficits suggesting a stroke. What you say is right, looking for unilateral weakness and signs and symptoms that are specific to the particular affected side of the brain.

2-1B
08-16-2006, 10:38 PM
I only take tips on this matter from Billy Squier.

darthvyn
08-18-2006, 11:26 AM
i don't know if "reverse" the effects of the stroke is the right thing to say, however... damage done is damage done. the quicker you respond to symptoms is the less damage that's done, which can then IN TIME be assuaged by rehabilitation. i doubt there's anything that can reverse the damage instantaneously, or over time for that matter. stroke rehabilitation is about re-routing the brain's functions to new areas that aren't damaged by the stroke. the brain is an amazing system of redundant backups which are put to the ultimate test when faced with something as destructive as a stroke.

read me! (http://www.hindu.com/mag/2004/04/18/stories/2004041800400600.htm)

me too! (http://www.mgh.harvard.edu/news/releases/100605smith.html)

and me!!! (http://www.patienthealthinternational.com/article/501828.aspx)

Darth Instigator
08-18-2006, 12:07 PM
no reverse is exactly right, as long as you reoxygenate the area before it becomes necrotic then the affects will in fact reverse. The brain has a vessel structure called the circle of willis which is similar to collateral circulation in the heart, which can allow for "re-routing" of the blood supply but once the time frame passes for tissue death no matter how much you reroute it wont help. With a stroke caused by an embolism or clot drugs called "clot-busters" can be used to break up the clot and reoxygenate the affected areas, drugs such as TPA and TNK.

Darth Instigator
08-18-2006, 12:10 PM
note this section of your link


A person who has a stroke may suffer little or no brain damage and disability, especially if treated promptly. But it can lead to severe brain damage and disability, or even death. The type of disability depends on the extent of brain damage and what part of the brain is damaged. Stroke may cause paralysis or weakness of one side the of the body, memory problems, mood changes, trouble speaking or understanding speech, problems with eating and swallowing, pain and depression. Rehabilitation and medical treatment can help a person recover from the effects of stroke and prevent another stroke from occurring.


A stroke is a medical emergency. Every minute counts when someone is having a stroke. The longer blood flow is cut off to the brain, the greater the damage. Immediate treatment can save people's lives and enhance their chances for successful recovery.

darthvyn
08-18-2006, 03:04 PM
neither of those passages claim that the damage can be reversed which is the word that was used before. recovery is not reversal. you can recover from frostbite after losing a finger - doesn't mean you're going to grow the finger back. the rest of the hand that didn't suffer as severe frostbite can recover, but will probably have a modicum of nerve damage.

any amount of lack of blood to the brain creates some amount of damage. it depends on how severe and widespread the lack of blood is and for how long.

in reference to a stroke, sometimes the nerve damage is equal to an all-night bender (beer kills brain cells, too...) however, recovery sometimes means learning how walk and talk again. sometimes it means learning how to deal with major nerve damage to an entire side of your body. rehabilitation in these cases is basically learning how to deal with this new state of being. that can't be reversed.

human nerve cells don't regernerate. until stem cell research is used to grow new nerve cells, nerve damage is irreversible, plain and simple. irreversible, meaning "can't be reversed." you can recover from it, however.

2-1B
08-19-2006, 12:06 AM
all this debating is gonna give me a stroke. :(

Darth Instigator
08-19-2006, 04:36 AM
ok since you are so all knowing can we count the hours and hours of time I have spent in front of doctors who have lectured about the ability to restore function as opposed to your belief of it not, as alittle bit of real world proof. I don't know to what extent your medical training is, if there even is any, but your suppositions are not really backed up anywhere.

darthvyn
08-20-2006, 11:45 AM
no reverse is exactly right, as long as you reoxygenate the area before it becomes necrotic then the affects will in fact reverse.

that's prevention of pre-stroke symptoms. an actual stroke is when the necrotizing has actually occured. click here (http://www.strokeassociation.org/presenter.jhtml?identifier=3030066) for the page "what is a stroke?" here's the text:



Stroke is a type of cardiovascular disease. It affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die.


The brain has a vessel structure called the circle of willis which is similar to collateral circulation in the heart, which can allow for "re-routing" of the blood supply but once the time frame passes for tissue death no matter how much you reroute it wont help. With a stroke caused by an embolism or clot drugs called "clot-busters" can be used to break up the clot and reoxygenate the affected areas, drugs such as TPA and TNK.

once again, that's only to reoxygenate portions that haven't died - that's a prevented stroke, not a reversed one.


ok since you are so all knowing can we count the hours and hours of time I have spent in front of doctors who have lectured about the ability to restore function as opposed to your belief of it not, as alittle bit of real world proof. I don't know to what extent your medical training is, if there even is any, but your suppositions are not really backed up anywhere.

i never claimed to be all knowing. childish exaggeration aside, i don't really see anything backing you up. i've provided links and facts. you've just claimed that you've spent hours being lectured by doctors.

i have had experience with my grandfather's stroke. it was quite severe, to the point where he will never be the same again. that's not to say he hasn't recovered and learned to deal with the damage it caused. he's easily confused and at first couldn't remember what iced tea is - which was his favorite drink. he calls it "the brown stuff" now. that was serious at first (he really didn't know what it was called,) but he's re-learned what iced tea is, and now just calls it that as a joke. but other confusions remain, especially in situations where he's presented with new things... he has a hard time making decisions on things he's never encountered before.

i don't know that you went to the doctors for hours and hours getting lectured about the ability to restore function. and i still don't. i'll take your word for it, but i wouldn't put it in there as "cold hard fact" seeing as how i wasn't there. do you have video? i would take that as proof.

anyway, my "supposition" was never that abilities can't be restored - my entire problem with the email (and many of it's kind...) is that it uses incorrect words like "reversed" when nerve damage can't be reversed at this time. (in the future when/if stem cell research is allowed, we may be able to cure nerve damage/diseases. until such time, it's remains irreversible.)

that's not to say you one can't RECOVER from that damage, and re-route the processes dictated by the damaged area to an undamaged area, but that only works for certain things. a stroke that causes paralysis of an entire side of the body, or even partial paralysis is not going to re-route itself. that's why my high school guidance counselor looked like half of his face was melting off. he had a stroke that caused partial paralysis to the left side of his body. at first he couldn't move the entire left side. with physical therapy and determination, he was able to get mobility back in his arm and leg. however, the nerve damage that couldn't be re-routed was evidenced in his tactile sense (he had little to no sensation in that side of his body from touch) and the permanently relaxed muscles in the left side of his face. he was able to re-learn how to talk with half the muscles as normal. that's recovery, not reversal.

anyway, i think i've made my point (over and over again) so i'm done. you can continue to argue, but i won't be there.

Darth Instigator
08-20-2006, 06:54 PM
someone who has a stroke and exhibits symptoms of such has Legally and medically had a stroke, now if they have function restored due to getting to the proper treatment faster than your grandfather doesn't take away the fact that they actually had a stroke. Your grandfather suffered from the debilitating inability to reverse the effects of a stroke but others don't. I guess the part here not getting through is that a stroke is a stroke whether you recover completely or not. You see it one way and I see it the right way, lol.

No I don't have videos but I have CME (continuing medical edication) certificates that I could post up if you are that in need of viewing my extensive experience with the second leading cause of having paramedics like me out there. But I would just think that my time and training is proof enough.

So you are done and I can't retort? Thats a good way to learn, I see how you work and I know you think you are right and thats the shame in things like this, is that you have proven that people like you don't want to learn what is new out there about old stuff. Medicine is a practice and rules and protocols change all the time. New findings and new "cures" for conditions are discovered everyday.

Based on your beliefs someone who has recovered from Cancer and no longer has cancer has never really had cancer. It doesn't compute and sorry if you see my postings in opposition as arguing but I am trying to educate you from propagating inaccurate information, not argue. Have a good day. If you would like to "argue" back I will be here to back up my points and anytime you want to view the American Heart Associations website related to Strokes feel free.

Darth Instigator
08-20-2006, 06:57 PM
follow-up*

if a person who suffers from a stroke reaches the proper medical facility within a certain timeframe (approx 3 hours) can have all finction and sensation restored with the use of Thrombolytic drugs in an obstructive stroke, hemorrhagic stroke is different and does not have the same fate.

darthvyn
08-21-2006, 07:34 AM
seriously, i think we're arguing the same side different ways. i understand fully that someone who has a cerebral thrombosis that caused some exhaustion of oxygen to a portion of the brain no matter how small has had a stroke, and that the quicker that person gets treatment the quicker the symptoms of the stroke can be assuaged. but millions of oxygen deprived brain cells die every minute it isn't treated, and i think 3 hours is over-estimating how much time you have to "reverse" (i still disagree with the use of that word) the effects of said thrombosis.

basically, we both agree that the quicker you get a person exhibiting symptoms of a stroke to the emergency room means the less chance of major debilitation. but to say that there's no damage if you get them there within 3 hours to be given the clot buster drugs is highly suspect. SOME modicum of damage is done, no matter how minute, which can't be reversed. it may or may not present itself as a change in lifestyle for the victim - meaning perhaps the damage was to a part of the brain that is rarely used, or perhaps just used every-so-often. but if it it affected a more active area of the brain, it could have certain effects which may just be chalked up to personality quirks.

anyway, you're busy talking about the outward appearance of the victim after treatment, whereas you are ignoring my assertions that the brain has been damaged. at the onset of oxygen deprivation to the brain about 36,000 brain cells die instantaneously, and a million die every minute following. multiply that by three hours. (180 million brain cells dead in three hours.)

for the most part our argument is about the semantics of the word "reversed." plenty of people make a "full recovery" without the damage being "reversed." i just think it's the wrong use of the word. that's all i've really been saying all along. the rest of the email i agree with.

Darth Instigator
08-21-2006, 03:34 PM
ok you are still defying my assertation that a stroke can be "cured" and I have done a small google search for you to find some answers so that you will believe someone more certified than me as I can't seem to convince you all though you assure me you aren't all knowing. Here are a few sites of interest

NSA (National Stroke Association) (http://www.stroke-tia.org/focus_article.asp?f=stroke_experts&c=stroke_fayad&b=stroke-tia_prof)

specifically notice this doctors assertation with reference to "curing"


PIERRE FAYAD, MD: Gene, itís been four to five years now since TPA has been approved for the treatment of ischemic stroke. Of course, this is the first treatment, and the only treatment so far approved for ischemic stroke. As you know, the approval has been based on the results of the NIH sponsored trial that demonstrated that patients who get TPA and satisfy certain criteria to receive TPA within three hours from the onset, will have an increased odds of 30% of being essentially cured from their deficits. So, [they are] without any deficits left at the end of three months.


but realize this;


Now of course, we talk about the benefits and risks of TPA, but we donít talk about how few patients still get it. There is, of course, a problem in delivery of a treatment that is so effective because of the narrow window in which it has to be given. Still less than 5% of all patients with ischemic stroke come within the three hours in order to be able to get TPA, which makes a beneficial therapy really not reaching all the patients that need to get it.
Its about people realizing the signs and symptoms stated in the very first post that make it so important to get this treatment and essentially a CURE.

Also read more here at the American Stroke Associations (http://www.strokeassociation.org/presenter.jhtml?identifier=3030387) website, they are an affiliate of the American Heart Association.



Also FYI, I discussed this very topic with my Mother-in-law, who has been an Advanced Cardiac Life Support certified Emergency room RN for the last 26 years who is currently active int he EMS community also and explained this debate to her and she concurs my assertation that strokes can be cured and that she too has learned through her continued and extensive training that the window of o0pportunity is around 3 hours time frame from ONSET of symptoms. You gotta believe man! Just believe me and read that literature I have posted, it is very informative.

darthvyn
08-21-2006, 09:36 PM
ok you are still defying my assertation that a stroke can be "cured" and I have done a small google search for you to find some answers so that you will believe someone more certified than me as I can't seem to convince you all though you assure me you aren't all knowing.

yes, i assure you i'm not all knowing. i'm just not all believing. i like to question everything. sorry, i'm just inquisitive like that.



NSA (National Stroke Association) (http://www.stroke-tia.org/focus_article.asp?f=stroke_experts&c=stroke_fayad&b=stroke-tia_prof)

specifically notice this doctors assertation with reference to "curing"


interesting read. i like this part



patients who get TPA and satisfy certain criteria to receive TPA within three hours from the onset, will have an increased odds of 30% of being essentially cured from their deficits. So, [they are] without any deficits left at the end of three months.


30% doesn't sound like a miracle to me. sure, it's better than 0%, but i wouldn't go around saying it's a "cure." it's a treatment that can reduce the risk of debilitation. that's great! but to guarantee a full recovery with numbers like that is just foolhardy.


Its about people realizing the signs and symptoms stated in the very first post...

already said, i'm totally on board with that...


... that make it so important to get this treatment and essentially a CURE.

THERE'S the interesting word - "essentially" - this is another (widely) misused word. in this instance it has the connotation that it acts LIKE a cure, but isn't really... the absence of this word would have gone a long way to lend creedence to the word "cure."


Also read more here at the American Stroke Associations (http://www.strokeassociation.org/presenter.jhtml?identifier=3030387) website, they are an affiliate of the American Heart Association.

already been there... this (http://www.strokeassociation.org/presenter.jhtml?identifier=3036010) article is interesting... it's where i got the numbers of brain cells that die each minute they are deprived of oxygen. you're still ignoring those statements of mine. i don't know why.

unfortunately, the doctor being interviewed in that article (Jeffrey L. Saver) uses the term "reverse" as well. i still disagree with the use of that word, as it's just plain wrong. i would have prefered "relief" or "alleviation" of symptoms, but the rest of the article bascially sums up my stance on nerve damage during a stroke.



Also FYI, I discussed this very topic with my Mother-in-law, who has been an Advanced Cardiac Life Support certified Emergency room RN for the last 26 years who is currently active int he EMS community also and explained this debate to her and she concurs my assertation that strokes can be cured and that she too has learned through her continued and extensive training that the window of o0pportunity is around 3 hours time frame from ONSET of symptoms. You gotta believe man! Just believe me and read that literature I have posted, it is very informative.

my ONLY problem with the entire thing is the use of the words "reverse" and now "cure" - otherwise i'm RIGHT there with ya - three hours is the window for 30% of stroke victims to recover from the debilitating effects, and 3 to 5 percent of those who suffer a stroke reach the hospital in time to be considered for this treatment. (http://www.strokeassociation.org/presenter.jhtml?identifier=2532)

so basically 30% of 5% of victims can come out unscathed. that's like, one person. hooray for that guy. hopefully people can diagnose these symptoms sooner and get that number higher, but in the meantime to laud this as a miracle "cure" is going quite overboard.

i will concede that they claimed a 30% "increased odds" of being "essentially cured" of their symptoms. i don't know what the base odds are, but they must be pretty low. even if the base odds are 10-20% (pure conjecture, they could be as low as 2% or as high as 80% - i don't know. is there some data on this somewhere?) taking the higher end of both percentages, that's still a 50/50 shot that the 5% that get there in time will come out without debilitation. i'm still not overly impressed. it's better, but not by much.

anyway, i'm not arguing that getting there in a timely manner can abate debilitation. basically, just stop using the words "reverse" and "cure" and i'm all good. but i'm a stickler for proper word usage. (just not capitalization, obviously. it's a weird quirk, i know...) i'm the son of an english major. it's in the blood.

Darth Instigator
08-21-2006, 09:50 PM
Nope this is absolutely a cure and reversal of prior symptoms, you need to get over your disagreement with these words. And the 30% stems from, as clearly explained but seemingly ignored by you, that not enough patients receive the treatment in the time frame stated thus only 30% of cases are reversed but so many more people would be candidates for this "CURE" and the numbers would surely rise, thus the original post here is accurate in that it is trying to get more people like you who don't believe in progress to realize signs and symptoms and to act more assertively to prevent what happened to your grandfather. Thats all, let the words soak in, they are in fact the truth and accurate and nerve damage occurs after muscular death which occurs after the 3 hours time frame that you previously debated but not accept. I too am a stickler for English and feel the definition of these words as well as the use by professionals is quite appropriate in this case.

with regards to this;


so basically 30% of 5% of victims can come out unscathed. that's like, one person. hooray for that guy. hopefully people can diagnose these symptoms sooner and get that number higher, but in the meantime to laud this as a miracle "cure" is going quite overboard.

The point is that, like I said before, if more people, say 100%, presented to the emergency room what then would that number be? even 30% of 100% has to be acceptable even to you.

darthvyn
08-21-2006, 10:29 PM
And the 30% stems from, as clearly explained but seemingly ignored by you, that not enough patients receive the treatment in the time frame stated thus only 30% of cases are reversed but so many more people would be candidates for this "CURE" and the numbers would surely rise,

i fully understand the statistics stated. i think you're confusing the issue. it's 30% of those that get there in time for the treatment and are deemed responsive to it. if more people get there in time for treatment, yes that percentage may go up, but it may not. until i get further proof, it will remain that only 30% of the people that get there in time for and are approved for the treatment will come out of it with a full recovery. the other 70% will have some modicum of debilitation from mild to severe.


thus the original post here is accurate in that it is trying to get more people like you who don't believe in progress to realize signs and symptoms and to act more assertively to prevent what happened to your grandfather.

i don't really know what you're trying to get at here... if you're asserting that i somehow failed to diagnose my grandfather's condition, it's probably that i was in new york and he was in florida.

but you're right about one thing. i hate progress. let's all get horse drawn carriages again. that would be awesome. :whip: <-- buggy whip


Thats all, let the words soak in, they are in fact the truth and accurate and nerve damage occurs after muscular death which occurs after the 3 hours time frame that you previously debated but not accept.

did you read the article about brain cells dying? 32,000 cells die the first second of a stroke.

For every minuteís delay, the brain loses:

* 1.9 million neurons;
* 14 billion synapses;
* 7.5 miles of myelinated fibers.

here it is again. (http://www.americanheart.org/presenter.jhtml?identifier=3036010)

is there a quantitative study somewhere about your claim of nerve damage in relation to muscular death? i don't see how that can be accurate when i see that 1.9 million neurons die in the first minute of oxygen deprivation.


The point is that, like I said before, if more people, say 100%, presented to the emergency room what then would that number be? even 30% of 100% has to be acceptable even to you.

any percentage of people saved from debilitation is more than acceptable to me. it's great! i just don't want to get people's hopes up that everyone comes out fine and it will be sunny every day and butterflies will follow them wherever they go - the cold hard facts is that 30% of those that get immediate treatment come out with a full recovery.

anyway, i think we've kept this argument going on long enough. time to pull the plug.

timmae
08-21-2006, 10:47 PM
very interesting thread. it caught my eye as something bad happened to me wed. i've been feeling crappy since. no insurance though. what about treatment/prevention?:sad:

Darth Instigator
08-22-2006, 12:18 PM
I'm not accusing you of anything darth, I am too tired to further discuss this, I said my peace.

darthvyn
08-22-2006, 07:05 PM
i feel the same way, we'll have to agree to disagree on ceratain things. but i think we both agree that the best thing to do in any emergency situation is get someone to the hospital right away. :shake hands:

2-1B
08-22-2006, 11:47 PM
:billysquier:

seanmcfripp
08-23-2006, 11:26 AM
:billysquier:

Use the bullhorn so we can hear you.


my ONLY problem with the entire thing is the use of the words "reverse" and now "cure..."

The semantics of "cure" and "reverse" are correctly laid out here. Where's the confusion? You can serve burnt toast to someone after scraping off the black stuff and smothering it in jam, and they'd probably say "Hey, this toast is pretty good." But going so far as to say you've found a "cure" for burnt toast is a bit of a stretch. To say you've found a way to "reverse" the burning of toast would be even more of an exaggeration.