Act fast

Re­search on ed­u­ca­tion and aware­ness at the com­mu­nity level aims to cut dis­par­i­ties in stroke care.

The Star Malaysia - Star2 - - HEALTH - By LAURAN NEERGAARD

EDNA Wooten some­how stopped her car when her stroke hit. Then her grown daugh­ter ig­nored her slurred protests and raced her to the hos­pi­tal – just in time for a drug to dis­solve the blood clot that had caused her stroke.

Wooten was lucky. Too few stroke suf­fer­ers get that clot-bust­ing treat­ment, es­pe­cially black and His­panic pa­tients who are at the high­est risk of hav­ing a stroke, and also may be par­tic­u­larly hes­i­tant to seek fast care. New re­search is tar­get­ing those un­der­served pop­u­la­tions to bet­ter spread the word that “time is brain” – the faster you move, the more brain you save.

“We ba­si­cally scare peo­ple so much about stroke, it mo­ti­vates them to de­nial,” says Uni­ver­sity of Michi­gan re­searcher Dr Lewis Mor­ganstern, an ex­pert on stroke dis­par­i­ties.

“What we haven’t done a good job of, is telling peo­ple there is an ef­fec­tive treat­ment, that peo­ple are in con­trol of their own destiny.”

That was the mes­sage stroke ed­u­ca­tor Shauna St Clair of Ge­orge­town Uni­ver­sity took to a

A St John Am­bu­lance Malaysia vol­un­teer an­swer­ing a call at the con­trol cen­tre in Kuala Lumpur. Hes­i­ta­tion to call emer­gency ser­vices while you are hav­ing a stroke means more brain dam­age. se­nior cen­tre in a pre­dom­i­nantly black neigh­bour­hood in Washington DC last week, as part of a project funded by the US Na­tional In­sti­tutes of Health (NIH). Most strokes are like a clogged pipe, St Clair ex­plained. Break up the clog, and blood can re­sume feed­ing the starv­ing brain cells on the other side, like what hap­pened when Wooten, 61, was treated at a nearby hos­pi­tal.

“Dam­aged brain cells we can fix. That’s why we want you to get treat­ment as soon as pos­si­ble,” St Clair told the rapt group. “If they stay dam­aged, they die.”

About 795,000 Amer­i­cans have a stroke ev­ery year. It is the nation’s lead­ing cause of dis­abil­ity and the num­ber three killer.

Symp­toms in­clude sud­den numb­ness or weak­ness in the face, arm or leg, es­pe­cially on one side; sud­den trou­ble speak­ing, un­der­stand­ing speech, see­ing or walk­ing; and a sud­den ex­tremely se­vere headache.

While some strokes are caused by bleed­ing in the brain, the vast ma­jor­ity are is­chemic strokes – the clot kind that the drug TPA (tis­sue plas­mino­gen ac­ti­va­tor) can help treat, but only if it is given within a few hours of the first symp­tom.

Yet 14 years af­ter TPA hit the mar­ket, over­all only about 5% of US pa­tients get it.

That is due partly to prob­lems within the US health care sys­tem, and partly be­cause only about a third of stroke suf­fer­ers get to the hos­pi­tal in time for test­ing to tell if they are good can­di­dates for it.

Ev­ery­one needs to know to act fast if they ex­pe­ri­ence or wit­ness stroke symp­toms. But the new re­search comes be­cause black Amer­i­cans have strokes at twice the rate of whites, and are more likely to die. His­pan­ics are at an in­creased risk of stroke as well. Worse, both pop­u­la­tions tend to have strokes at much younger ages than whites.

Ge­orge­town re­searchers tracked is­chemic strokes for a year in Washington DC, and found black pa­tients re­ceived TPA less of­ten than whites, in part be­cause of slower hos­pi­tal ar­rival, de­spite com­mu­nity sur­veys that found wide­spread knowl­edge about stroke symp­toms.

“No, you can’t wait to see if your symp­toms go away,” says Dr Chelsea Kidwell, a Ge­orge­town neu­rol­o­gist who heads the project.

“No, you should not call your rel­a­tive or friend. You’ve got to call 911.”

The find­ings echo a ma­jor study that Dr Mor­ganstern leads in Cor­pus Christi, Texas, where Mex­i­canAmer­i­cans were 40% less likely than whites to call 911 for treat­ment of a stroke. The dis­con­nect is not sur­pris­ing, says NIH Na­tional In­sti­tute of Neu­ro­log­i­cal Dis­or­ders and Stroke deputy di­rec­tor Dr Wal­ter Koroshetz. The most com­mon mis­take among all pop­u­la­tions when feel­ing a stroke symp­tom is to take a rest.

Adding to the con­fu­sion are so­called min­istrokes – a TIA or tran­sient is­chemic at­tack – in which an artery is blocked for a few min­utes, but suf­fers no per­ma­nent dam­age.

It is a warn­ing sign, how­ever, that a ma­jor stroke may be im­mi­nent, which prompt care to treat risk fac­tors like high blood pres­sure might avert.

Other stud­ies have found that half of those who have had a TIA never tell a health provider.

It takes com­mu­nity-spe­cific re­search to learn what act-fast mes­sages work, Dr Mor­ganstern says.

His Cor­pus Christi project re­cently taught mid­dle-school stu­dents to call 911 if they wit­ness some­one hav­ing stroke symp­toms. He also gave them home­work as­sign­ments to teach their par­ents, thus reach­ing a hard-to-tar­get pop­u­la­tion.

The project is also de­sign­ing ways that lo­cal Ro­man Catholic churches can help with stroke ed­u­ca­tion.

In Washington DC, Dr Kidwell is work­ing with am­bu­lance com­pa­nies to have their units by­pass the clos­est hos­pi­tal for one of three cer­ti­fied stroke cen­tres – hos­pi­tals with 24hour spe­cial ca­pa­bil­i­ties to give TPA.

The com­mu­nity ed­u­ca­tion will tar­get not only se­niors, but younger peo­ple who may wit­ness a stroke – like the woman who told St Clair she had no­ticed her mother leav­ing church look­ing drunk, a loss of bal­ance caused by a stroke.

It also will stress happy end­ings such as Wooten’s. She slept off a TIA two weeks ear­lier and cred­its her daugh­ter’s love of TV hos­pi­tal shows for recog­nis­ing the ma­jor stroke.

About an hour af­ter get­ting the clot-buster, “it was like it never hap­pened,” says Wooten, who says her only lin­ger­ing prob­lem is a slight shake when her right hand holds some­thing heavy.

“I’m driv­ing my car, I’m mess­ing with my grand­kids. Thank God, I’m do­ing ok.” – AP


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