National Emergency Medicine Assoc. (NEMA)

Stroke Lines is published by the National Stroke Council, a special program of National Emergency Medicine Association

It is that time of year when we all seem to be reflective and aware of the many blessings we have enjoyed over the past year. It is a time for closeness with family and friends, a time to take stock of our lives and our relationships. In this season of giving, we want to express our sincere appreciation to our friends who support the critical work of The National Stroke Council.

This has been a very successful year as many exciting new treatment options are being researched and approved. Our prevention education efforts are far reaching. As always, we stress prevention and recognition of the symptoms of heart attack.

As we move rapidly toward the 21st century, The National Stroke Council under the auspices of NEMA, is making plans to ensure that this critical heart research and technological development continue. To strengthen our ability to carry our mission and programs into the next millennium, we have partnered with financial advisors across the country to establish a legacy program. The advantage of this program is that can benefit both The National Stroke Council and the donor. A Life Income Gift (Charitable Remainder Trust) enables one to make a substantial gift to The National Stroke Council now, but continue to receive income from the asset throughout your lifetime or that of a loved one, while still being entitled to a current tax deduction for the gift

One of the things that has always made America special is the tradition of sharing with others. Without your generosity, many life-saving programs would not exist. I want to wish everyone good health and happiness during the coming year.

Howard H. Farrington

President

According to a follow-up study of the body mass and weight change in 116,759 women 30-55 years old, researchers discovered that women who gained more than 44 pounds since they were 18 years old are about two and a half times more likely to suffer a common type of stroke than women who have not gained as much weight. American Medical Association, May 21, 1997.

Researchers from the University of California, San Francisco estimate that a 1-time reduction of smokers by 1% would save $44 million dollars in health costs during the first year. There would be 34,000 fewer people going to the hospital because of stroke. Circulation - American Heart Association, August 1997.

Listeners who have tuned into "The Heart of The Matter" have heard some interesting information on stroke issues during the past few months.

Dr. Susan Fagan, Henry Ford Health System, Wayne State Univ., Detroit MI is an investigator who studied the cost effectiveness of hospitals using the enzyme called alterphase or t-PA (tissue plasminogen activator). Approved by the FDA last year for stroke, t-PA significantly improves the outlook for patients. If administered within 3 hours of the onset of stroke symptoms, 30% more patients recover without great disability. There is a risk of hemorrhage, however, and t-PA is expensive, nearly $2000 per treatment. Dr. Fagan and her colleagues examined the data from the original clinical trial of 624 stroke patients including length of stay during initial hospitalization, cost of treatment and rehabilitation at 3 month intervals during the first year after the patient's stroke.

Findings indicated that the benefits of t-PA far outweigh its high initial costs when compared to the long term care and rehabilitation costs of stroke. Projected over 30 years, Fagan estimated that the savings would amount to million dollars per thousand stroke patients.

Fagan emphasized the need for the general public as well as emergency room staff to recognize the stroke symptoms and to seek/give treatment as soon as possible.

Dr. Harold Adams, Neurology Department of the University of Iowa is adamant about people seeking treatment immediately if they have symptoms that could be a stroke. He describes the signs of stroke.

1. The sudden onset of numbness, weakness, heaviness . . .part of the body being clumsy.

2. An episode where part of the body is heavy or dead, usually involving the right or left side..

3. An episode where there's incoordination or trouble with balance or staggering

4. An episode where the speech is slurred or thick or having trouble understanding language.

5. An episode where there's a sudden loss of vision . . . painless involving one eye.

6. Or, the sudden onset of a very severe headache . . sometimes described as the worst ever.

Dr. Adams also says that if you have a precursor to stroke (known as a transient ischemic attack), that is C the symptoms subside after several minutes, that's your chance to get to the doctor immediately and get checked out.

Other topics heard on The Heart of The Matter covered by host Steve Girard include

Heart healthy recipes from Don Maurer, author of Lean and Lovin' It

The new nasal flu vaccine, Dr. Dominick Iacuzio, NIH

Medicare Reform efforts with Aaron Cohen, Health on the Hill reporter.

This is just a sampling of the variety "The Heart of The Matter" offers. For information on the station nearest you, or if you want your local station to carry "The Heart of The Matter," let us know. Transcripts are free (up to 4 per order) and cassette copies of all programs are available at a minimum charge for postage and handling.

To change the perception of both health care providers and the public that medical care for stroke is hopeless, the National Stroke Association (NSA) launched a PR program to accelerate clinical trials of new stroke treatment options including t-PA. Since there are many new stroke drugs in the research pipeline awaiting FDA approval, NSA links hospitals with 11 pharmaceutical companies to increase clinical trial enrollment for these new drugs. NSA also works with physicians, nurses and emergency room personnel to put a stroke team in place as well informing the public on the provider's stroke programs. C The National Stroke Council, through your contributions, has funded NSA's efforts in this important acceleration program so that stroke victims and their families can get the help they need as soon as they need it.C

With awards to organizations nationwide, the National Stroke Council has allocated monies which will affect the health of hundreds of Americans. Grant recipients have demonstrated their need for funding and have outlined benefits both for the public and for research endeavors.

"Jaws of Life" C Blackfeet Tribal Emergency Medical Services, Browning, Montana. This life-saving equipment is used to extricate and access injured individuals trapped at the scene of an accident. Prior to the grant award, the EMS personnel had to relay on outside assistance for the AJaws of Life" equipment, which extended the time to reach the injured victim.. In Montana, where winter storms are severe, having this equipment close-at-hand is critical to saving lives..

Cardiac ultrasound machine C Franklin Square Hospital Center, Baltimore, Maryland. The upgraded cardiac ultrasound machine enhances the staff'>s ability to effectively assess and treat patients and to better respond to patient needs relating to cardiovascular disease and failure. The hospital reports that the quality of patient exams has improved dramatically while the overall exam time has decreased by one quarter. Patient conditions are able to be treated sooner.

NEMA encourages organizations or institutions to apply for a grant. Because cardiac and trauma issues are a major focus, proposals which address these needs are welcome. Guidelines may be obtained by contacting National Emergency Medical Association, 306 W. Joppa Road, Towson, MD 21204 or 410/494-0300.

When a person has a stroke, it is often accompanied by aphasia, that is, the inability to articulate ideas in any form. Some people cannot speak intelligibly or understand what is being said to them. Some can not read or write.

Family members often recognize the expressive language difficulties that the person who has aphasia experiencesCdifficulty thinking of the correct word to use, using an incorrect or "made-up" words, making grammar mistakes or unintentionally using profanity. Persons with aphasia may tire easily and show extreme emotional fluctuations and inappropriate emotionsClaughing when something isn't funny or crying for no apparent reason.

A speech language pathologist is part of the team who can complete a comprehensive evaluation of speech and language and provide information to the family about the communication abilities and needs of the patient. Susan Glasgow, Executive Director, The Hearing & Speech Agency recommends the following steps to help support and communicate with the person who has aphasia:

1. Involve the person in family discussions and decision making as much as possible.

2. Give the person a longer amount of time to talk. Don't speak too soon for him or her.

3. Simplify sentence structure and reduce your own rate of speech.

4. Use natural gestures to help the person understand.

5. Communicate through touch.

6. Acknowledge and verbalize the frustration your loved one probably feels at not being able to communicate effectively.

7. If necessary, make more comments and responses rather than asking frequent questions and making too many demands. When a misunderstanding occurs, paraphrase or repeat more simply.

8.Be actively involved in the patient's treatment. Inform the speech-language pathologist about strategies that work at home.

9. Continue to talk to the family member who has aphasia.

10. Talk to the person as an adult and not as a child.