Author Topic: Health: let's talk about stroke.  (Read 1950 times)

Re: Health: let's talk about stroke.
« Reply #25 on: March 26, 2021, 08:48:26 pm »
Subsequent investigation showed inefficient heart, Helly (therefore pooling or stagnation): my carotids were fine and the knife came out as easily as it went in!  But they still prescribed the aspirin on probability alone, I think.  Though, thinking further about it, I may be doing them a complete disservice: if I had a bust vessel, wouldn't I just keep deteriorating?

Peter

hellymedic

  • Just do it!
Re: Health: let's talk about stroke.
« Reply #26 on: March 26, 2021, 09:25:11 pm »
Aspirin and similar stop platelets aggregating but don't prevent blood clotting totally.

Although you might ooze a bit longer if you take aspirin for toothache, you are unlikely to bleed to death after a tooth extraction.

ian

  • feat. Undead Jess & Finestre, Queen of Hell
Re: Health: let's talk about stroke.
« Reply #27 on: March 26, 2021, 09:26:21 pm »
Unless they do it with dynamite.
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hellymedic

  • Just do it!
Re: Health: let's talk about stroke.
« Reply #28 on: March 26, 2021, 09:29:35 pm »
Aspirin is seldom used for pain nowadays.
Around 50 years ago, it was in common use and there were more dental extractions.
Few folk bled to death...

Re: Health: let's talk about stroke.
« Reply #29 on: March 26, 2021, 09:49:32 pm »
But they still prescribed the aspirin on probability alone, I think. 

There are well-established evidence-based guidelines for TIAs.

https://cks.nice.org.uk/topics/stroke-tia/management/secondary-prevention-following-stroke-tia/
https://pathways.nice.org.uk/pathways/stroke

Though, thinking further about it, I may be doing them a complete disservice: if I had a bust vessel, wouldn't I just keep deteriorating?

Indeed.
TIA - transient - symptoms usually lasting < 1 hour.
Haemorrhagic stroke (relatively rare, 15% ish of all strokes, with blockages, temporary or otherwise, being predominant): ain’t going to get better by itself.

Re: Health: let's talk about stroke.
« Reply #30 on: March 27, 2021, 08:10:59 am »
A TIA is not usually considered an emergency. The usual pathway is to give aspirin (or similar) immediately, an ultrasound of the carotid arteries within a few days to look for the plaques that cause these platelet emboli and a CT scan of the brain to see if there has been any permanent damage. If surgery is indicated then it’s carried out within 6 weeks of the initial TIA. The purpose of surgery is to reduce the chances of a fully blown stroke.

A stroke is an emergency. A CT of the brain will show if the cause is a clot r a bleed and if the former then clot busting drugs are given. 
I am often asked, what does YOAV stand for? It stands for Yoav On A Velo

citoyen

  • Occasionally rides a bike
Re: Health: let's talk about stroke.
« Reply #31 on: March 27, 2021, 08:18:43 am »
Unless they do it with dynamite.

<makes mental note never to ask ian to recommend a dentist>
"The future's all yours, you lousy bicycles."

citoyen

  • Occasionally rides a bike
Re: Health: let's talk about stroke.
« Reply #32 on: March 27, 2021, 08:28:23 am »
Cycling does not protect against strokes as well as it does against heart disease.

Going back about 15 years, my club mate Geoff had a stroke while out on the Sunday ride. For some reason, I’d left the ride early that day, can’t remember why, so I missed it happening. They were going up a hill at the time and he just keeled over. Of course, it was in an area with poor phone signal so it took ages to get the ambulance out, which can’t have helped.

You wouldn’t have had him down as a stroke risk to look at him - he was ostensibly a fit and healthy 50-something.

I’ve lost touch with most of that group now but as far as I know, he’s never ridden a bike again since then. Sad.
"The future's all yours, you lousy bicycles."

T42

  • *** fool in a hurry
Re: Health: let's talk about stroke.
« Reply #33 on: March 27, 2021, 09:04:44 am »
If I had to choose I'd rather have a clot than an aneurysm.  A chum of mine went out one morning to push his wife's car, popped an aneurysm and died within a minute.  Another was a keen climber. His left eye felt a bit funny when he was watching TV, and when he tried to tell his wife it came out very slowly. She called the emergency services and they had him on clot-busters within the hour.  His speech was slurred for a few months and it was still a bit slow years later, but last I heard he was back to climbing.
I've dusted all those old bottles and set them up straight.

Re: Health: let's talk about stroke.
« Reply #34 on: March 27, 2021, 09:32:44 am »
If I had to choose I'd rather have a clot than an aneurysm.  A chum of mine went out one morning to push his wife's car, popped an aneurysm and died within a minute.  Another was a keen climber. His left eye felt a bit funny when he was watching TV, and when he tried to tell his wife it came out very slowly. She called the emergency services and they had him on clot-busters within the hour.  His speech was slurred for a few months and it was still a bit slow years later, but last I heard he was back to climbing.
Your friend was lucky.  I will take the sudden total death over the possibility of being successfully resuscitated.  Stroke medicine is still in the stage of trying to keep people alive in my view.  The chances of being able to climb, ride a bike or un independently after a stroke is very low.  You are far more likely to end up needing permanent care.

quixoticgeek

  • Mostly Harmless
Re: Health: let's talk about stroke.
« Reply #35 on: March 27, 2021, 10:34:12 am »
Your friend was lucky.  I will take the sudden total death over the possibility of being successfully resuscitated.  Stroke medicine is still in the stage of trying to keep people alive in my view.  The chances of being able to climb, ride a bike or un independently after a stroke is very low.  You are far more likely to end up needing permanent care.

It depends a lot on how fast you're treated. We're seeing survival and recovery rates that would be un heard of 10 years ago. Emergency medicine is amazing!

J
--
Beer, bikes, and backpacking
http://b.42q.eu/

Re: Health: let's talk about stroke.
« Reply #36 on: March 27, 2021, 11:51:45 am »
I agree completely but even so I would put stroke therapy where hip replacement was 15 years ago.

Re: Health: let's talk about stroke.
« Reply #37 on: March 28, 2021, 12:16:26 am »
I agree completely but even so I would put stroke therapy where hip replacement was 15 years ago.

Depends on the level of the stroke, surely? A work friend/colleague had a stroke about 3 years ago and physically appears largely fine, though has difficulty with fine motor coordination and has lost speech, so communication is more than frustrating.

My aunt's hip replacement at least 35 years ago was wholly successful, at any rate as far as I was aware at the time and subsequently.

Re: Health: let's talk about stroke.
« Reply #38 on: March 28, 2021, 09:07:19 am »
I agree completely but even so I would put stroke therapy where hip replacement was 15 years ago.

Depends on the level of the stroke, surely? A work friend/colleague had a stroke about 3 years ago and physically appears largely fine, though has difficulty with fine motor coordination and has lost speech, so communication is more than frustrating.

My aunt's hip replacement at least 35 years ago was wholly successful, at any rate as far as I was aware at the time and subsequently.

I think that proves my point.  After a hip replacement you can go back to running, cycling whatever, your work colleague is still suffering problems

IJL

Re: Health: let's talk about stroke.
« Reply #39 on: March 28, 2021, 11:52:35 am »
The leading cause of stroke is Atrial Fibrillation (AF) much AF is asymptomatic and goes unnoticed, feeling more pulses would find more AF and avoid more strokes. 

Also a bit of a pedantic point but TIA is a retrospective diagnosis, ie it means there have been neurological changes that have fully resolved within 24 hours (without another cause of the changes).  If the changes are still being seen it's a  CVA until proven otherwise.


Re: Health: let's talk about stroke.
« Reply #40 on: March 28, 2021, 12:08:52 pm »
One of Brucey's relations has just posed some details on the cycling UK forum. Apparently he's only 8 months older than me, so not quite 57.   :jurek:


As a chap who lives on his own, I'm now looking at Apple Watches for their heart monitoring, fall detection & ability to call emergency services.  Not a cheap option though. 
Not fast & rarely furious

tweeting occasional in(s)anities as andrewxclark

T42

  • *** fool in a hurry
Re: Health: let's talk about stroke.
« Reply #41 on: March 28, 2021, 02:44:31 pm »
One of Brucey's relations has just posed some details on the cycling UK forum. Apparently he's only 8 months older than me, so not quite 57.   :jurek:


As a chap who lives on his own, I'm now looking at Apple Watches for their heart monitoring, fall detection & ability to call emergency services.  Not a cheap option though.

FWIW, 10 days ago my "clinically certified" ECG-capable watch - the one my cardiologist had recommended, not an Apple - warned me that it had detected signs of AFIB.  I printed out the trace and showed it to him: "too noisy to see anything" he said.

The trouble with such devices is that they don't monitor the heart continuously, you have to start the ECG function yourself, i.e. if you feel symptoms. Even then the signal conducted through your arms is so faint that unless you remain absolutely motionless and don't talk, other muscles firing inject a storm of interference. The recommendation with my gadget is to sit down and rest your arms on a table, which of course you have along on every ride.

IMO the best way of monitoring AFIB is probably an implantable device, which is not really available to the casual user. Short of that, getting a cardiologist to fit you with a 24-hour holter is next best (but of course you might not have AFIB during that time - it tends to come and go).  AFIB watches come a poor third.
I've dusted all those old bottles and set them up straight.

Re: Health: let's talk about stroke.
« Reply #42 on: March 28, 2021, 05:15:59 pm »
Old school, but checking your pulse (manually) remains a highly sensitive method for detecting AF. Specificity not good but as a method of ruling out AF, it’s pretty good.

Why bother? There is a strong association between AF and stroke. Roughly 1 in 6 strokes is due to blood clots caused by AF itself and by other factors that predispose to AF. Someone with AF is about 5 times more likely to have a stroke than someone who doesn’t. 1 in 4 people over 40 (North American numbers) will develop AF. Optimal management of AF reduces stroke risk, but you need to identify it first.

A couple of useful videos here:

https://www.heartrhythmalliance.org/aa/uk/know-your-pulse

There is an app mentioned in one of those videos called Fibricheck which uses the phone camera as a way to measure pulse rate and rhythm. I have tried it just now, on behalf of you all  :P It’s all right I suppose. You need to sign up and get an account. I suspect at some point, money will be asked for. When you use it, it tells you within seconds that “a medical expert has reviewed your measurement to guarantee a detailed and medical grade diagnosis”. which I find rather unlikely. Yet, when I click on the bit where it reports my pulse rate and rhythm, the small print says “this is not a diagnosis”.

There may be better apps that also use the tech that is already present in most phones. I see Dr. Fibricheck has just emailed me to say it is only free for 24 hours, which isn’t a lot of good, and they will now be unsubscribed from.

Anyway, getting back to my original point, manual pulse checks, with the Mk1 finger, are useful and it could be worth becoming familiar with the method and what the pulse normally feels like. An easy way to reassure yourself that you are not in AF.

Re: Health: let's talk about stroke.
« Reply #43 on: March 28, 2021, 10:36:43 pm »
Or that you are, in my case.....

Re: Health: let's talk about stroke.
« Reply #44 on: March 29, 2021, 06:43:58 am »
I'm familiar with what AF feels like with mk1 finger, or ear to chest. MrsC gets them relatively frequently.

AF is really obvious. Heart beat sounds like a broken flutter.

(probably a good thing that scotland is obsessed with defrib machines and our nearest one is about 60 yards away)
<i>Marmite slave</i>

arabella

  • no se porque yo no lo se
Re: Health: let's talk about stroke.
« Reply #45 on: March 29, 2021, 11:32:18 am »
Stupid question time: doesn't stroke* present differently in women?
If so, how does it present?

*or do I mean heart attack?  But again, where do I find the info?
In the dark, all views are the same.

IJL

Re: Health: let's talk about stroke.
« Reply #46 on: March 29, 2021, 12:33:14 pm »
I'm familiar with what AF feels like with mk1 finger, or ear to chest. MrsC gets them relatively frequently.

AF is really obvious. Heart beat sounds like a broken flutter.

(probably a good thing that scotland is obsessed with defrib machines and our nearest one is about 60 yards away)

AF can cause palpitations but not all palpitations are AF

Is she on warfarin or similar?

Re: Health: let's talk about stroke.
« Reply #47 on: March 29, 2021, 12:51:09 pm »
I'm familiar with what AF feels like with mk1 finger, or ear to chest. MrsC gets them relatively frequently.

AF is really obvious. Heart beat sounds like a broken flutter.

(probably a good thing that scotland is obsessed with defrib machines and our nearest one is about 60 yards away)

AF can cause palpitations but not all palpitations are AF

Is she on warfarin or similar?
Correct correction.

She gets palpitations.

No, not on any medication, other than the shovel-full of vitamins and supplements she swallows daily.

(note, never argue with a menopausal woman).
<i>Marmite slave</i>

citoyen

  • Occasionally rides a bike
Re: Health: let's talk about stroke.
« Reply #48 on: March 29, 2021, 01:06:05 pm »
Stupid question time: doesn't stroke* present differently in women?
If so, how does it present?

*or do I mean heart attack?  But again, where do I find the info?

Don't know about stroke, but AIUI it's a common misconception that women are at lower risk of heart attack than men, and symptoms are often ignored or misdiagnosed.

More here:
https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women/misdiagnosis-of-heart-attacks-in-women
"The future's all yours, you lousy bicycles."

Wowbagger

  • Sylph
    • Musings of a Gentleman Cyclist
Re: Health: let's talk about stroke.
« Reply #49 on: March 29, 2021, 01:15:25 pm »
I was diagnosed with AF in July last year. It was quite weird. My normal resting pulse rate was about 50 bpm. Those 50 "strong" beats were still present, but there was an odd fluttering going on between times. I went to A & E and the machine said my pulse rate was 150ish per minute. They brought it down with some sort of intravenous drug. Since then I've been on bisoprolol (beta blocker) and edoxaban (blood thinner). Those two are for life, apparently. I've cut down massively on booze and lost weight, and I've averaged about 9300 paces or equivalent per day so far this year. I haven't noticed the AF return.

Raphael Behr wrote a good description of his heart attack from just over a year ago. https://www.theguardian.com/commentisfree/2020/jan/29/heart-attack-brexit-politics

Bach without a doubt.