Reducing your stroke risk…because I care

With all the upcoming excitement about Halloween, you may have overlooked the fact that yesterday was World Stroke Day.

This year, the global campaign to tackle stroke was highlighted with the slogan “Because I care…”.

The phrase showcases the role of caregivers in supporting people who have suffered a stroke and aims to correct misinformation about the disease, such as the misconception that stroke only happens later in life.

Every other second, stroke attacks a person, regardless of age or gender. Of the 15 million people who experience a stroke each year, six million do not survive. Worldwide about 30 million people have had a stroke and most have residual disabilities.

Overall approximately 55 000 more women have strokes than men each year, mainly because stroke occurs more frequently at older ages and women generally live longer than men. Of note, women are twice as likely to die from a stroke than breast cancer each year.

And recent data published in the Lancet, shows a striking 25% worldwide increase in the number of stroke cases in people aged between 20 and 64. This younger age group now accounts for a shocking 31% of strokes.

But, with greater awareness, these figures don’t have to continue their alarming trend.  Stroke can be prevented, treated and managed in the long term. The campaign theme “Because I care” emphasizes these areas.

The slogan was chosen as it can easily be adapted to all cultures and in any setting. It attempts to address prevailing misinformation about the disease, e.g., stroke only happens later in life. The campaign also celebrates the important contributions of caregivers and the role they play as conduits between the stroke community and the general public in correcting misinformation.

Because I care…

• I want you to know the facts about stroke
• I will work to break down the myths surrounding stroke
• I want you to learn how to minimize your risk of stroke
• I want you to have access to the best possible treatment
• I will ensure that you receive quality treatment, care and support
• I will be with you every step of the way towards your full recovery

Research presented at the recent European Society of Cardiology [ESC] Congress  showed that there are plenty of steps young obese women can take to reduce their risk of stroke. In young women without metabolic disorders such as high blood pressure, high cholesterol and high blood sugar  or abnormal glucose metabolism being overweight did not increase the chance of having a stroke compared to normal weight women without metabolic disorders. However, the risk of stroke increased by 3.5 times in women who were overweight and had metabolic disorders.

Study author, Dr Michelle Schmiegelow said: “Obesity puts young women at a major risk of developing high blood pressure, diabetes or high cholesterol, which dramatically increases their likelihood of having a stroke. Young women who are overweight or obese probably have a window of opportunity to lose weight and keep a healthy lifestyle so that they reduce their risk of getting high blood pressure, diabetes and high cholesterol. In this way they can protect themselves from having a stroke or heart attack.”

Awareness of important risk factors, such as atrial fibrillation  and hypertension, is crucial.

Professor Joep Perk, MD, a Swedish Cardiologist and spokesperson for the ESC says: “Women are at the same risk of stroke as men, and the level of risk is completely steered by the underlying risk factor pattern they have. The majority of people who have a stroke are disabled for the rest of their lives and may be paralyzed or lose their ability to speak. The devastating consequences of this disease for patients and their loved ones make prevention even more important.”

He adds: “Prevention for all cardiovascular disease follows the same pattern, be it stroke, heart attack, or peripheral arterial disease. Step one for women is absolutely to stop smoking – that beats everything. The second most important thing is to know your blood pressure to see if you are at risk. And finally, adopt healthy behaviors like eating heart healthy food and keeping the amount of salt you eat under control.”

The global campaign against stroke asks people to commit to six stroke challenges:
•    Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol
•    Be physically active and exercise regularly
•    Maintain a healthy diet high in fruit and vegetable and low in salt and keep blood pressure low
•    Limit alcohol consumption
•    Avoid cigarette smoke. If you smoke, seek help to stop now
•    Learn to recognize the warning signs of a stroke and how to take action.

Check, check, check, check, check and check!  I’m feeling up to the stroke challenge.  Are you?

A Diabetics Best Friend

Guide dogs, watch dogs, hearing dogs, mobility assist dogs,  lap dogs, big dogs, small dogs – SRxA’s Word on Health readily admits to a fondness for them all.

So it’s hardly surprising that we were drawn to a story about Early Alert Canines, a non-profit group in California that is training man’s best friend to detect the subtle scents of low blood sugars and matching them with Type 1 diabetics.

These diabetic alert dogs are trained to recognize the biochemical scent that a diabetic’s body gives off as his or her blood glucose begins to change. The dogs learn that this biochemical scent is a command to the dogs for them to carry out an “alert” action – an early warning that can help their human partners avoid acutely dangerous hypoglycemia, and hyperglycemia.

Because hypoglycemia (low blood sugar) can cause severe problems including coma and death, and because hyperglycemia can contribute to long-term diabetes complications, these early warnings, allow diabetics to check their blood glucose levels and treat themselves appropriately. Thus, these amazing dogs are a not only a diabetic’s best friend, they also become life-changers and life-savers.

Although medical technology makes it possible for diabetics to regularly their own blood sugar levels, there are many times when such checks are problematic or even impossible; during sleep or during intense exercise, school work, or business meetings. Early Alert Canines, on the other hand, are always on alert for their insulin-dependent partners, ready to warn them about critical changes in their blood sugar levels.

“We can’t smell it … It gets down to a molecular level,” says organization executive director Carol Edwards, noting the detection of a “cocktail of chemicals,” such as acetone, adrenaline and endorphins, which are released into the bloodstream as a diabetic’s glucose is dropping.

One person benefitting from the program is Nancy Harrison from California. Over a period of 17 years, paramedics have been dispatched on numerous occasions to revive her during hypoglycemic episodes. Instead of being woken by strangers in blue, wielding an IV and bag of dextrose 50%, when her glucose level starts to plummet.
she now finds an 80-pound yellow Labrador on her chest, alerting her the fact.
“He gets in my face … he’ll plow me down to get me to pay attention to him,” says Harrison, about her dog Kade.

Trained initially by Guide Dogs for the Blind, Kade preferred to eat paper towels, socks and dryer sheets making him unsuitable for the sight-impaired. But when it comes to alerting Harrison, he is all business. When he  commutes with her to work he will put his head on her shoulder and start licking her face if her blood sugar starts to drop.

Early Alert Canines (EAC) trains two main classes of diabetic alert dogs: full-access service dogs and skilled companion dogs.

Full Access Service Dogs are trained and placed with diabetic adults and children age 12 and older. These dogs are fully trained diabetic alert dogs and attend work, school, extracurricular activities, errands, etc., with their diabetic partners. These dogs are accredited service dogs and can legally accompany their diabetic partners anywhere the general public is allowed. Full Access Service Dogs are perfect for people who can commit to having a dog with them all hours of the day.

Skilled Companion Alert Dogs are trained and placed with diabetic children, families with multiple diabetics, and some adults who find a service dog won’t fit into their lifestyle. Skilled Companion Alert Dogs are fully trained in hypoglycemic alerting, and do most of their work in the diabetic’s home, but do not have public access rights.

In order to qualify for the program potential dog owners must be insulin-dependent diabetes who have been using insulin for at least one year and diligently manage their diabetes. EAC is keen to point out that their dogs are not for people who are not attempting to closely control their diabetes. The application process involves an online application, paper applications, a phone interview, a home visit and orientation. There is an application fee of $100.

If approved, the diabetic attends Team Training, during which the diabetic may be matched up with a dog that the staff determines to be a good fit for the individual’s needs. Diabetics seeking placement with a skilled companion attend a one-week course, and diabetics seeking full access service dogs attend a two-week course.

For more information about these very special dogs and the Early Alert Canine program click here.

Hospital errors affect 1:3 patients

How common are hospital errors?

A shocking new study suggests that the number of “adverse events” befalling patients in U.S. hospitals may be 10 times higher than previous estimates.

If the authors are correct, this would mean that medical mistakes affect one in three people hospitalized  in the US. The study, published in the journal Health Affairs involved a review of almost 800 patient charts at three U.S. hospitals. Using a review technique known as the “global trigger tool,”  researchers detected a whopping 354 adverse events. Scarier still,  that figure might actually understate the enormity of the problem as it was based on potentially incomplete medical records rather than on direct observation in real time.

Dr. David C. Classen of the University of Utah believes his study gives a more reliable tally of hospital errors than other studies, including a 1999 landmark study from the Institute of Medicine entitled To Err is Human showing that hospital errors caused up to 98,000 Americans each year.

So what sorts of events were uncovered in the new review? According to Classen, there were three big ones:

• Medication errors, including getting the wrong drug the wrong dose of the right drug
• Surgical errors, such as having an operation done on the wrong site or gaffes that result in bleeding or infection;
• Hospital-acquired infections

The question many are now asking: is the new estimate accurate?

“It is hard to know that to make of the trigger tool,” admits Dr. Peter J. Pronovost, a Professor in the Johns Hopkins University School of Medicine (Departments of Anesthesiology and Critical Care Medicine, and Surgery) and Medical Director for the Center for Innovation in Quality Patient Care.

However, “Far too many patients suffer preventable harm in the U.S.” he added.

Other recent studies appear to confirm Classen’s findings.

Earlier this month the US government released data for the first time, showing how often patients are injured by certain medical errors in hospitals.  However, only eight types of serious, preventable errors were included in the comparison.

They were: air in the bloodstream, falls, bedsores, transfusions with the wrong blood type, urinary tract infections, blood infections, uncontrolled blood-sugar levels and foreign objects left in the body after surgery.

Other serious events, including wrong-site surgeries and medication errors, were not included.

And late last year, the Office of Inspector General for the U.S. Department of Health and Human Services said 180,000 Medicare recipients die each year from hospital mistakes. That’s more people than are killed every year in car crashes, or from diabetes or pneumonia.

Without doubt, health care has improved over the past decade, but it’s clear that there is still a great deal of work to do in order to achieve a health care system that safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity.

Until then, SRxA’s Word on Health advises that if you think something is amiss or wrong with your hospital care, speak up.