Two Things You Can Do To Improve Stroke Survival Chances
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Dr. Andrew’s Stroke Survival Guide
This is Dr. Nadine Andrew. She’s a Senior Research Fellow in the Department of Medicine at Monash University. She’s the Research Data Lead for the National Center of Healthy Aging. She is lead investigator on the NHMRC-funded PRECISE project… The most comprehensive stroke data linkage study to date! In short, she knows her stuff.
We’ve talked before about how sample size is important when it comes to scientific studies. It’s frustrating; sometimes we see what looks like a great study until we notice it has a sample size of 17 or something.
Dr. Andrew didn’t mess around in this regard, and the 12,386 participants in her Australian study of stroke patients provided a huge amount of data!
With a 95% confidence interval because of the huge dataset, she found that there was one factor that reduced mortality by 26%.
And the difference was…
Whether or not patients had a chronic disease management plan set up with their GP (General Practitioner, or “family doctor”, in US terms), after their initial stroke treatment.
45% of patients had this; the other 55% did not, so again the sample size was big for both groups.
Why this is important:
After a stroke, often a patient is discharged as early as it seems safe to do so, and there’s a common view that “it just takes time” and “now we wait”. After all, no medical technology we currently have can outright repair that damage—the body must repair itself! Medications—while critical*—can only support that and help avoid recurrence.
*How critical? VERY critical. Critical critical. Dr. Andrew found, some years previously, that greater levels of medication adherence (ie, taking the correct dose on time and not missing any) significantly improved survival outcomes. No surprise, right? But what may surprise is that this held true even for patients with near-perfect adherence. In other words: miss a dose at your peril. It’s that important.
But, as Dr. Andrew’s critical research shows, that’s no reason to simply prescribe ongoing meds and otherwise cut a patient loose… or, if you or a loved one are the patient, to allow yourself/them to be left without a doctor’s ongoing active support in the form of a chronic disease management plan.
What does a chronic disease management plan look like?
First, what it’s not:
- “Yes yes, I’m here if you need me, just make an appointment if something changes”
- “Let’s pencil in a check-up in three months”
- Etc
What it actually looks like:
It looks like a plan. A personal care plan, built around that person’s individual needs, risks, liabilities… and potential complications.
Because who amongst us, especially at the age where strokes are more likely, has an uncomplicated medical record? There will always be comorbidities and confounding factors, so a one-size-fits-all plan will not do.
Dr. Andrew’s work took place in Australia, so she had the Australian healthcare system in mind… We know many of our subscribers are from North America and other places. But read this, and you’ll see how this could go just as much for the US or Canada:
❝The evidence shows the importance of Medicare financially supporting primary care physicians to provide structured chronic disease management after a stroke.
We also provide a strong case for the ongoing provision of these plans within a universal healthcare system. Strategies to improve uptake at the GP level could include greater financial incentives and mandates, education for patients and healthcare professionals.❞
See her groundbreaking study for yourself here!
The Bottom Line:
If you or a loved one has a stroke, be prepared to make sure you get a chronic health management plan in place. Note that if it’s you who has the stroke, you might forget this or be unable to advocate for yourself. So, we recommend to discuss this with a partner or close friend sooner rather than later!
“But I’m quite young and healthy and a stroke is very unlikely for me”
Good for you! And the median age of Dr. Andrew’s gargantuan study was 70 years. But:
- do you have older relatives? Be aware for them, too.
- strokes can happen earlier in life too! You don’t want to be an interesting statistic.
Some stroke-related quick facts:
Stroke is the No. 5 cause of death and a leading cause of disability in the U.S.
Stroke can happen to anyone—any age, any time—and everyone needs to know the warning signs.
On average, 1.9 million brain cells die every minute that a stroke goes untreated.
Stroke is an EMERGENCY. Call 911 immediately.
Early treatment leads to higher survival rates and lower disability rates. Calling 911 lets first responders start treatment on someone experiencing stroke symptoms before arriving at the hospital.
Source: https://www.stroke.org/en/about-stroke
What are the warning signs for stroke?
Use the letters F.A.S.T. to spot a stroke and act quickly:
- F = Face Drooping—does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
- A = Arm Weakness—is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
- S = Speech Difficulty—is speech slurred?
- T = Time to call 911
Source: https://www.stroke.org/en/about-stroke/stroke-symptoms
Last but not least, while we’re sharing resources:
Download the PDF Checklist: 8 Ways To Help Prevent a Second Stroke
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The Unchaste Berry
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A Chasteberry, By Any Other Name…
Vitex agnus castus, literally “chaste lamb vine”, hence its modern common English name “chasteberry”, gets its name from its traditional use as an anaphrodisiac for monks (indeed, it’s also called “monk’s pepper”), which traditional use is not in the slightest backed up by modern science.
Nor is its second most popular traditional use (the increase in production of milk) well-supported by science either:
❝Its traditional use as a galactagogue (i.e., a substance that enhances breast milk production) is not well supported in the literature and should be discouraged. There are no clinical data to support the use of chasteberry for reducing sexual desire, which has been a traditional application❞
Source: American Family Physician | Chasteberry
Both of those supposed effects of the chasteberry go against the fact that it has a prolactin-lowering effect:
❝It appears that [chasteberry] may represent a potentially useful and safe phytotherapic option for the management of selected patients with mild hyperprolactinaemia who wish to be treated with phytotherapy.❞
Source: Vitex agnus castus effects on hyperprolactinaemia
Prolactin, by the way, is the hormone that (as the name suggests) stimulates milk production, and also reduces sexual desire (and motivation in general)
- In most women, it spikes during breastfeeding
- In most men, it spikes after orgasm
- In both, it can promote anhedonic depression, as it antagonizes dopamine
In other words, the actual pharmacological effect of chasteberry, when it comes to prolactin, is the opposite of what we would expect from its traditional use.
Ok, so it’s an unchaste berry after all…. Does it have any other claims to examine?
Yes! It genuinely does help relieve PMS, for those who have it, and reduce menopause symptoms, for those who have those, for example:
❝Dry extract of agnus castus fruit is an effective and well tolerated treatment for the relief of symptoms of the premenstrual syndrome.❞
❝That [Vitex agnus castus] trial indicated strong symptomatic relief of common menopausal symptoms❞
Source: Vitex agnus castus essential oil and menopausal balance: a research update
Is it safe?
Generally speaking, yes. It has been described as “well-tolerated” in the studies we mentioned above, which means it has a good safety profile.
However, it may interfere with some antipsychotic medications, certain kinds of hormone replacement therapy, or hormonal birth control.
As ever, speak with your doctor/pharmacist if unsure!
Where can I get some?
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
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Eggcellent News Against Dementia?
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It’s that time of the week again… We hope all our readers have had a great and healthy week! Here are some selections from health news from around the world:
Moderation remains key
Eggs have come under the spotlight for their protective potential against dementia, largely due to their content of omega-3 fatty acids, choline, and other nutrients.
Nevertheless, the study had some limitations (including not measuring the quantity of eggs consumed, just the frequency), and while eating eggs daily showed the lowest rates of dementia, not eating them at all did not significantly alter the risk.
Eating more than 2 eggs per day is still not recommended, however, for reasons of increasing the risk of other health issues, such as heart disease.
Read in full: Could eating eggs prevent dementia?
Related: Eggs: Nutritional Powerhouse or Heart-Health Timebomb?
More than suitable
It’s common for a lot of things to come with the warning “not suitable for those who are pregnant or nursing”, with such frequency that it can be hard to know what one can safely do/take while pregnant or nursing.
In the case of COVID vaccines, though, nearly 90% of babies who had to be hospitalized with COVID-19 had mothers who didn’t get the vaccine while they were pregnant.
And as for how common that is: babies too young to be vaccinated (so, under 6 months) had the highest covid hospitalization rate of any age group except people over 75.
Read in full: Here’s why getting a covid shot during pregnancy is important
Related: The Truth About Vaccines
Positive dieting
Adding things into one’s diet is a lot more fun than taking things out, is generally easier to sustain, and (as a general rule of thumb; there are exceptions of course) give the greatest differences in health outcomes.
This is perhaps most true of beans and pulses, which add many valuable vitamins, minerals, protein, and perhaps most importantly of all (single biggest factor in reducing heart disease risk), fiber.
Read in full: Adding beans and pulses can lead to improved shortfall nutrient intakes and a higher diet quality in American adults
Related: Intuitive Eating Might Not Be What You Think
Clearing out disordered thinking
Hoarding is largely driven by fear of loss, and this radical therapy tackles that at the root, by such means as rehearsing alternative outcomes of discarding through imagery rescripting, and examining the barriers to throwing things away—to break down those barriers one at a time.
Read in full: Hoarding disorder: sensory CBT treatment strategy shows promise
Related: When You Know What You “Should” Do (But Knowing Isn’t The Problem)
Superfluous
Fluoridated water may not be as helpful for the teeth as it used to be prior to about 1975. Not because it became any less effective per se, but because of the modern prevalence of fluoride-containing toothpastes, mouthwashes, etc rendering it redundant in more recent decades.
Read in full: Dental health benefits of fluoride in water may have declined, study finds
Related: Water Fluoridation, Atheroma, & More
Off-label?
With rising costs of living including rising healthcare costs, and increasing barriers to accessing in-person healthcare, it’s little wonder that many are turning to the gray market online to get their medications.
These websites typically use legal loopholes to sell prescription drugs to the public, by employing morally flexible doctors who are content to expediently rubber-stamp prescriptions upon request, on the basis of the patient having filled out a web form and checked boxes for their symptoms (and of course also having waived all rights of complaint or legal recourse).
However, some less scrupulous sorts are exploiting this market, to sell outright fake medications, using a setup that looks like a “legitimate” gray market website. Caveat emptor indeed.
Read in full: CDC warns of fake drug dangers from online pharmacies
Related: Are You Taking PIMs? Getting Off The Overmedication Train
A rising threat
In 2021 (we promise the paper was published only a few days ago!), the leading causes of death were:
- COVID-19
- Heart disease
- Stroke
…which latter represented a rising threat, likely in part due to the increase in the aging population.
Read in full: Stroke remains a leading cause of death globally, with increased risk linked to lifestyle factors
Related: 6 Signs Of Stroke (One Month In Advance)
Take care!
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Can We Do Fat Redistribution?
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The famous answer: no
The truthful answer: yes, and we are doing it all the time whether we want to or not, so we might as well know what things affect our fat distribution in various body parts.
There’s a kernel of truth in the “no”, though, and where that comes from is that we cannot exclusively put fat on in a certain area only, and nor can we do “spot reduction”, i.e., intentionally lose fat from only one place.
How, then, do we do fat redistribution?
Your body is a living organism, not a statue
It’s easy to think “I’ve been carrying this fat in this place for 20 years”, but during that time the fat has been replaced several times and moved often; in fact, the cells containing the fat have even been replaced. Because: fat can seem like a substance that’s alien to your body because it doesn’t respond like muscles, isn’t controllable like muscles, doesn’t have the same sensibility as muscles, etc. But, every bit of fat stored in your body is stored inside a fat cell; it’s not one big unit of fat; it’s lots of tiny ones.
In reality, any given bit of fat on your body has probably been there for 18–24 months at most:
Fat turnover in obese slower than average
…and there are assorted factors that can modify the rate at which our body deals with fat storage:
Human white adipose tissue: A highly dynamic metabolic organ
So, how do I get rid of this tummy?
There are plenty of stories of people who try to lose weight from one part of their body, and lose it from somewhere else instead. Say, a person wants to lose weight from her hips, and with careful diet and exercise, she loses weight—by dropping a couple of bra cup sizes while keeping the hips.
So, we must figure out: why is fat stored in certain places? And the main driving factors are:
- hormones
- metabolic health
- stress
Hormones affect fat distribution insofar as estrogen and progesterone will favor the hips, thighs, butt, breasts, and testosterone will favor a more central (but still subcutaneous, not visceral) distribution. Additionally, estrogen and progesterone will favor a higher body fat percentage, while testosterone will favor a lower one.
This is particularly relevant later in life, when suddenly the hormone(s) you’ve been relying on to keep your shape, are now declining, meaning your shape does too. This goes for everyone regardless of sex.
See:
- What You Should Have Been Told About The Menopause Beforehand
- The BAT-pause! ← this is about the conversion of white adipose tissue to brown adipose tissue, and how estrogen helps this happen
- Topping Up Testosterone?
Metabolic health affects fat distribution insofar as poor metabolic health will result in more fat being stored in the viscera, rather than in the usual subcutaneous places. This is a serious health risk.
See: Visceral Belly Fat & How To Lose It
Stress affects fat distribution insofar as chronically elevated cortisol levels see more fat sent to the stomach, face, and neck. This fat redistribution isn’t dangerous itself, but it can be indicative of the chronic stress, which does pose more of a general threat to health.
See: Lower Your Cortisol! (Here’s Why & How)
What this means in practical terms
Assuming that you would like the fat distribution that says “this is a healthy woman” or “this is a healthy man”, respectively, then you might want to:
- Check your sex hormone levels and get them adjusted if appropriate
- Improve your overall metabolic health—without necessarily trying to lose weight, just, take care of your blood sugars for example, and they will take care of you in terms of fat storage.
- Manage your stress (which includes any stress you are experiencing about your body not being how you’d like it to be).
If you are doing these things, and you don’t have any major untreated medical abnormalities that affect these things, then your fat will go to the places generally considered healthiest.
Can we speed it up?
Yes, we can! Firstly, we can speed up our overall metabolism:
Let’s Burn! Metabolic Tweaks And Hacks
Secondly, we can encourage our body to “move” fat by intentionally “yo-yoing”, something usually considered bad in dieting when people just want to lose weight and instead are going up and down, but: if you lose weight healthily, it comes off everywhere evenly, and if you gain weight healthily, it goes mostly to the places where it should be.
So, a sequence of lose-gain-lose-gain might look like “lose a bit from everywhere, put it back in the good place, lose a bit more from everywhere, put it back in the good place”, etc.
So, you might want to gently cycle these a few months apart, for example:
How To Lose Fat (Healthily!) | How To Gain Fat (Healthily!)
You can also cheat a little, if it suits your purpose! By this we mean: if you’d like a little extra where you already have a little fat, then you can put muscle on underneath it, it will pad it up, and (because of the layer of actual fat on top) nobody will know the difference unless you flex it with their hand on it.
Let’s put it this way: people doing squats for a bubble-butt aren’t doing it to put on fat; they’re putting muscle on under the fat they have.
So, check out: How To Gain Muscle (Healthily!)
And finally, for all your body-sculpting needs, we present these excellent books:
Women’s Strength Training Anatomy Workouts – by Frédéric Delavier
Strength Training Anatomy (For Men) – by Frédéric Delavier
Enjoy!
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Terminal lucidity: why do loved ones with dementia sometimes ‘come back’ before death?
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Dementia is often described as “the long goodbye”. Although the person is still alive, dementia slowly and irreversibly chips away at their memories and the qualities that make someone “them”.
Dementia eventually takes away the person’s ability to communicate, eat and drink on their own, understand where they are, and recognise family members.
Since as early as the 19th century, stories from loved ones, caregivers and health-care workers have described some people with dementia suddenly becoming lucid. They have described the person engaging in meaningful conversation, sharing memories that were assumed to have been lost, making jokes, and even requesting meals.
It is estimated 43% of people who experience this brief lucidity die within 24 hours, and 84% within a week.
Why does this happen?
Terminal lucidity or paradoxical lucidity?
In 2009, researchers Michael Nahm and Bruce Greyson coined the term “terminal lucidity”, since these lucid episodes often occurred shortly before death.
But not all lucid episodes indicate death is imminent. One study found many people with advanced dementia will show brief glimmers of their old selves more than six months before death.
Lucidity has also been reported in other conditions that affect the brain or thinking skills, such as meningitis, schizophrenia, and in people with brain tumours or who have sustained a brain injury.
Moments of lucidity that do not necessarily indicate death are sometimes called paradoxical lucidity. It is considered paradoxical as it defies the expected course of neurodegenerative diseases such as dementia.
But it’s important to note these episodes of lucidity are temporary and sadly do not represent a reversal of neurodegenerative disease.
Sadly, these episodes of lucidity are only temporary. Pexels/Kampus Production Why does terminal lucidity happen?
Scientists have struggled to explain why terminal lucidity happens. Some episodes of lucidity have been reported to occur in the presence of loved ones. Others have reported that music can sometimes improve lucidity. But many episodes of lucidity do not have a distinct trigger.
A research team from New York University speculated that changes in brain activity before death may cause terminal lucidity. But this doesn’t fully explain why people suddenly recover abilities that were assumed to be lost.
Paradoxical and terminal lucidity are also very difficult to study. Not everyone with advanced dementia will experience episodes of lucidity before death. Lucid episodes are also unpredictable and typically occur without a particular trigger.
And as terminal lucidity can be a joyous time for those who witness the episode, it would be unethical for scientists to use that time to conduct their research. At the time of death, it’s also difficult for scientists to interview caregivers about any lucid moments that may have occurred.
Explanations for terminal lucidity extend beyond science. These moments of mental clarity may be a way for the dying person to say final goodbyes, gain closure before death, and reconnect with family and friends. Some believe episodes of terminal lucidity are representative of the person connecting with an afterlife.
Why is it important to know about terminal lucidity?
People can have a variety of reactions to seeing terminal lucidity in a person with advanced dementia. While some will experience it as being peaceful and bittersweet, others may find it deeply confusing and upsetting. There may also be an urge to modify care plans and request lifesaving measures for the dying person.
Being aware of terminal lucidity can help loved ones understand it is part of the dying process, acknowledge the person with dementia will not recover, and allow them to make the most of the time they have with the lucid person.
For those who witness it, terminal lucidity can be a final, precious opportunity to reconnect with the person that existed before dementia took hold and the “long goodbye” began.
Yen Ying Lim, Associate Professor, Turner Institute for Brain and Mental Health, Monash University and Diny Thomson, PhD (Clinical Neuropsychology) Candidate and Provisional Psychologist, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Don’t Forget…
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Learn to Age Gracefully
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Aging with Grace – by Dr. David Snowdon
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First, what this book is not: a book about Christianity. Don’t worry, we didn’t suddenly change the theme of 10almonds.
Rather, what this book is: a book about a famous large (n=678) study into the biology of aging, that took a population sample of women who had many factors already controlled-for, e.g. they ate the same food, had the same schedule, did the same activities, etc—for many years on end. In other words, a convent of nuns.
This allowed for a lot more to be learned about other factors that influence aging, such as:
- Heredity / genetics in general
- Speaking more than one language
- Supplementing with vitamins or not
- Key adverse events (e.g. stroke)
- Key chronic conditions (e.g. depression)
The book does also cover (as one might expect) the role that community and faith can play in healthy longevity, but since the subjects were 678 communally-dwelling people of faith (thus: no control group of faithless loners), this aspect is discussed only in anecdote, or in reference to other studies.
The author of this book, by the way, was the lead researcher of the study, and he is a well-recognised expert in the field of Alzheimer’s in particular (and Alzheimer’s does feature quite a bit throughout).
The writing style is largely narrative, and/but with a lot of clinical detail and specific data; this is by no means a wishy-washy book.
Bottom line: if you’d like to know what nuns were doing in the 1980s to disproportionally live into three-figure ages, then this book will answer those questions.
Click here to check out Aging with Grace, and indeed age with grace!
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Break the Cycle – by Dr. Mariel Buqué
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Intergenerational trauma comes in two main varieties: epigenetic, and behavioral.
This book covers both. There’s a lot more we can do about the behavioral side than the epigenetic, but that’s not to say that Dr. Buqué doesn’t have useful input in the latter kind too.
If you’ve read other books on epigenetic trauma, then there’s nothing new here—though the refresher is always welcome.
On the behavioral side, Dr. Buqué gives a strong focus on practical techniques, such as specific methods of journaling to isolate trauma-generated beliefs and resultant behaviors, with a view to creating one’s own trauma-informed care, cutting through the cycle, and stopping it there.
Which, of course, will not only be better for you, but also for anyone who will be affected by how you are (e.g. now/soon, hopefully better).
As a bonus, if you see the mistakes your parents made and are pretty sure you didn’t pass them on, this book can help you troubleshoot for things you missed, and also to improve your relationship with your own childhood.
Bottom line: if you lament how things were, and do wish/hope to do better in terms of mental health for yourself now and generations down the line, this book is a great starting point.
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