2021-01-21

Ep 120 -- How COVID-19 Causes Stroke with Dr. Jason Hinman


 

Click here for a machine-generated transcript.

We know that COVID-19 causes stroke in many cases. You can recover from the disease and then still have a stroke caused by the virus. Sometimes the only way you find out you have a COVID-19 infection is that you go to the hospital with a stroke and they tell you. In the US, about 1500 strokes a week are caused by COVID-19.

But why is this happening?

We're starting to get some answer about how COVID-19 causes stroke thanks to the work of Dr. Jason Hinman and his colleagues at the University of California Los Angeles (UCLA). In this episode Jason and I talk about his research and the relationship between Stroke and COVID-19.

Bio

Dr. Jason Hinman poses for a professional headshot in his white coat.

Jason Hinman, M.D., Ph.D. - Dr. Hinman is Assistant Professor of Neurology at the David Geffen School of Medicine and Interim Director of the Stroke Program at the West Los Angeles VA Medical Center. Dr. Hinman received his MD/PhD degrees from Boston University School of Medicine.

He completed adult neurology residency training at Ronald Reagan UCLA Medical Center with fellowship training in vascular neurology and stroke rehabilitation also at UCLA. His NIH-funded research laboratory focuses on the molecular pathways at the interface of stroke and Alzheimer's dementia using basic and translational models of stroke and cerebrovascular disease. 

The Model

The technology Jason, Dr. Naoki Kaneko,  and their colleagues use is fascinating. They've taken scans (MRIs, CT scans, Angiograms, etc.) of patients' brains and used those scans to build a physical, 3-D model of the networks of veins and arteries in the brain. This allows them to see just how blood flows and where it struggles.

It also means neurosurgeons who may be planning to fix a patient's aneurysms with a stent or coil could practice on an actual model before going into the patient's brain.

With Jason's research, they line the fake vessels in their model with human epithelial cells. These cells are the same ones that line our real blood vessels. As a result, they were able to observe the way the virus interacts with the blood vessels. Then they learn how that interaction can lead to clots and other blood vessel damage, which, in turn, causes a stroke.

Here's a link to the study: https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.032764

And here's a link to the press release about the study: https:/newsroom.ucla.edu/releases/covid-19-increased-stroke-risk

The Solution

If you've survived a COVID-19 infection, how can you reduce your chances of having a stroke? Right now, the best research says to eat right, exercise, hydrate, and get good sleep.

In other words, do the things the medical establishment has been telling us to do for years. There's no magic solution. We just have to do the hard work of doing the right thing. Which, of course, is also how you reduce your chances of having a stroke even if you haven't had COVID.

I know. It sucks. But at least it's cheap.

BEFAST

More people are having stroke due to COVID-19. Younger people are having strokes. Many of these strokes can be treated and result in minimal disability if the person gets to the right hospital quickly enough.

So make sure everyone you know can recognize a stroke. Teach them to BEFAST.

Sudden loss or change in Balance, Eyesight, Facial droop, Arm control, Speech or language means that it is Time to call an ambulance.

Stroke symptom graphic

The Important Takeaway

Don't catch COVID-19.

The impacts are long lasting. Even if you survive (and most people will) it still damages your blood vessels, your heart, your kidneys, your lungs, and more. If you survive, the Grim Reaper gets another bite at that apple through COVID inspired stroke and other conditions.

Mask up when you go outside. The mask isn't to protect you. It's to protect anyone else that you see and their families. The fact is there is no way to know for sure if you are infected right now. You could be. I could be. Since symptoms may not show up for a couple weeks, we can't know. Mask up so you don't kill someone or give them a stroke.

Minimize social contact. When you do have that contact, keep your distance. Avoid crowded indoor spaces. If you see someone without a mask, stay away from them. If they get offended, so what? Let them. Afterall they're the ones trying to infect and kill you.

Take advantage of delivery and curbside pickup. Work from home if you can.

Not everyone has those options. Respect people who do have to go out to work by respecting rules intended to reduce transmission.

Many of us don't have to stay locked up 24-7 for months on end. We can go out on occasion, but we have to be responsible about it.

Hack of the Week

It's winter, my Dysport (Botox alternative) is wearing off, and we've had a stressful start to 2021. All that adds up to my tone and spasticity getting stronger and tighter.

When I want to undo that fist I make by default, I could just forcefully  open my fingers, but that just encourages more resistance.

What's for effective is to bend my wrist down (flexion) in the direction the wrist tone want to go anyway. When you bend your wrist down, that naturally encourages your fingers to open up.

The reason for that is that the finger extensors -- the muscles that open your fingers run from your forearm over the top of your wrist and the back of your hand. Bending your wrist down causes them to pull on your fingers, opening your fist.

Give it a try.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2021-01-14

Ep 119 -- Stem Cells and Thrombectomy with Dr. Dileep Yavagal


 

Click here for a machine generated transcript.

Mission Thrombectomy 2020+ is an initiative to double the number of mechanical thrombectomies around the world. This initiative, driven by Dr. Dileep Yavagal, aims to help more stroke survivors, communities, and economies in the developed and developing world by reduces the level of disability cause by stroke.

We talk about that initiative this week, but first we get an update on Stem Cells.

Dr. Yavagal was a guest on Strokecast back in episode 42. We talked his work in stem cell research to treat acute stroke patients. The work was promising but still experimental.

It still is.

Dileep gives us an update on the progress and research protocols involving the treatment. The bottom line is there is NO approved stem cell therapy in the US today. Research has not sufficiently demonstrated safety and effectiveness. But they're working on it.

The only stem cell therapy available for stroke is experimental in research studies. If you choose to participate in those studies, great! Research studies provide the treatment for free.

If someone tries to charge you or collect a fee for stem cell therapy, run, hobble, or wheel away as fast as you can. It is not a legitimate therapy at this time.

Bio

Dr. Yavagal headshot

Dr. Dileep R. Yavagal, MD, FAHA, FAAN, FSVIN is the Director of Interventional Neurology and Co-Director of Neuroendovascular Surgery at the University of Miami & Jackson Memorial Hospitals and Clinical Professor of Neurology and Neurosurgery at the University of Miami School of Medicine. He has recently been appointed to lead the Neurological Cell Therapy Platform at the Interdisciplinary Stem Cell Institute at the University.

Dr. Yavagal is an international thought leader in endovascular therapy for ischemic and hemorrhagic stroke as well as a pioneer in the translation of intra-arterial delivery of cell therapy for stroke. He was the national Co-PI of the first US multicenter clinical trial of Intra-arterial delivery of autologous bone marrow stem cells for ischemic stroke: RECOVER Stroke. He was on the on the steering committee of the SWIFT-Prime and MR RESCUE, both landmark randomized clinical trials of endovascular stroke therapy. He co-authored the landmark 2015 AHA Endovascular Stroke Therapy Guidelines as well as the recent groundbreaking DAWN stroke trial in the New England Journal of Medicine. He is the founder and Past-President of the Society for Vascular and Interventional Neurology (SVIN). He has also co-authored the AHA Policy statement on Stroke Systems of Care.

Dr. Yavagal has received several state and federal research grants to study endovascular stem cell therapies for ischemic stroke using small and large animal models of stroke in his research laboratory. He is considered a pioneering researcher the field of intra-arterial delivery of stem cells in stroke therapy.

Dr. Yavagal is Chair of the Society of Vascular and Interventional Neurology’s (SVIN) global campaign called Mission Thrombectomy 2020+ (MT2020+) and is leading a no-holds-barred charge to accelerate access and remove geographic disparities to mechanical thrombectomy (MT), an interventional treatment for a common type of disabling stroke.

MT2020+ is calling on public health policymakers to increase physical, financial and diagnostic access to MT for patients with disabling strokes.

Stem Cell Updates

Dr. Yavagal's research is about the use of stem cell therapy to treat stroke patients in the first few days of their stroke -- the acute phase. The process his team is exploring involves placing the donor stem cell at the point of injury by using a catheter through the groin or wrist. This method is similar to his other key projects around mechanical thrombectomy. Both involving similar equipment -- a catheter the surgeon navigates through the patient's arteries to remove or deliver a payload. And it takes place in an angio suite, which is an operating room with special imaging equipment.

In a study with the patients' own cells, his team has demonstrated safety, and they have seen results indicating effectiveness, too, even though the study wasn't designed for it.

Recent large animal studies have demonstrated that the process is safe. The next step is to do studies to demonstrate the safety of donor stem cells with humans. Then they can explore effectiveness.

At this point (January 2021) there are no FDA approved stem cell therapies for stroke patients. But we're getting there.

Mission Thrombectomy 2020+

Mechanical Thrombectomy is the gold standard for the treatment of large vessel ischemic stroke, especially when combined with tPA.

In mechanical thrombectomy, a surgeon runs a catheter from the femoral artery in the groin or radial artery in the wrist. They navigate to a clot in the brain and drag it out to restore blood flow.

tPA is a clot busting medicine that works to break up clots in the body to restore blood flow.

When both treatments are used, patients experience much better outcomes.

The challenge is they have to be used quickly. Patients have only 90-minutes to 24 hours to get treatment. The actual window varies widely based on the details of the patient's stroke, MRI, general health, and the specifics f the hospital they get to.

Most of the time, the window is 3 hours That window has been growing though.

When I had my stroke in June of 2017, the window was much smaller. I woke up with symptoms so I had my stroke sometime between 1:00 AM and 7:00 AM. That put me outside the window for the interventions at the time. Six months later the window expanded, and it continues to get better.

Would my right MCA at the basal ganglia thrombus been eligible for removal a few months or a year later if my stroke had just held off a little longer? I'm not sure I want to know.

Mission Thrombectomy 2020+ is an initiative led by Dr. Yavagal to double the number of thrombectomies performed around the world in both developed and developing countries.

A large part of the work involves creating national and regional committees to work with local health ministries. The committees educate politicians, government officials, administrators, and health care influencers on the benefits of mechanical thrombectomy for patients and society.

Disability and shortened life is expensive for a community. It's expensive from the loss of the inherent value of human life and quality of life for many survivors. But it's also expensive in sheer economic impact.

Long term treatment costs money. Loss of worker productivity costs money. Loss of productivity from caregivers costs money. The opportunity cost from untreated stroke is enormous.

In many cases. Prompt mechanical thrombectomy can save lives, reverse some stroke damage, and dramatically reduce the number and severity of disabilities a survivor will live with.

When you can make a case for reducing both human and economic costs, you've got a pretty compelling case.

That's the case Mission Thrombectomy 2020+ makes around the world.

The Jet Plane Comparison

Thrombectomy isn't cheap to start up. You need Angio Suites -- specialized emergency room with specialized imaging equipment. It requires super tiny catheters to go through the blood vessels to retrieve the clots. And it requires expert training for neurosurgeons, nurses, and all the other folks who make hospitals work.

How can developing nations or less prosperous communities in developed nations afford all that?

If they see the value, they'll find a way.

Dr. Yavagal compares it to jet travel. Smaller communities or developing nations still often have air service. That's expensive, too. Airport runways aren't just blacktop highways. Airport infrastructure is much more complex and expensive than it looks. Airplanes are expensive. Maintenance on aircraft is expensive. Staff to fly and repair planes require specialized skill.

How can so many places afford it?

Because the see the value air travel brings. It's critical infrastructure to develop and prosper. And it brings tremendous benefits in both human and economic capital.

They find the money because they see the value.

And that's the goal of Mission Thrombectomy 2020+.

Mission Thrombectomy 2020+ has produced a whitepaper talking about the importance of Thrombectomy and why a community needs to make the treatment available. You can read it here: Mechanical Thrombectomy for Acute Stroke-Building Stroke Thrombectomy Systems of Care in Your Region: Why & How?

Hack of the week

Find your ducks.

We talked with Sarah Parsloe in Episode 111 and Bill Torres in Episode 110.

Sarah tells the story of how Bill feeds the ducks every day. Many stroke survivors struggle with being the recipient of care. This is especially true for those of us who were always trying to take care of others before our strokes. When we're not able to do that anymore, it can be tough.

Bill found the ducks that needed help after his stroke. Even as he worked to recover, each day he fed the ducks at a local pond. He still does. Taking care of the ducks is a great way to help out after stroke -- it's a way to feel needed and to put value back into the world. Being able to contribute -- to make a difference -- is something we all need.

So find your metaphorical or literal ducks and go feed them.

Links

Where do we go from here?


Here is the latest episode of The Strokecast

2021-01-02

Ep 118 -- Surprise Brain Tumor and as Post-partum Stroke With Ruth Carroll


 

A machine generated transcript is available here

A 20+ year old hidden brain tumor made itself known just before Ruth Carroll gave birth. A stroke followed the birth of her son and set Ruth on an unexpected journey as a new mother and young stroke survivor.

It's been a few years since all that happened, and I'm delighted to speak with Ruth in this episode. There is something so calming in her demeanor -- even when she's talking about horrific ICU hallucinations. We talk about that, hydrotherapy, family, and more.

Bio

Ruth Carrol stands in a field holding a bouquet of flowers and a glass of wine.

Ruth Carroll is 36 years old. She's from County Cork in Ireland but live in County Dublin as she married a Dub! They have a son who is 3 & half years old called Bobby. 

Prior to this sudden shift in her life direction, Ruth worked in marketing as a brand manager at McDonalds in Ireland

Ruth was diagnosed with a brain tumor a week before Bobby was born. Her pregnancy hormones caused the tumor to grow very quickly & suddenly & this unfortunately caused her stroke the very next day after Bobby was born.  (left side affected)

Ruth has made a good recovery but still has a long way to go. Ruth's neuro surgeon told her he thought she would be bed bound for the rest of her life. She showed him! Ruth is now walking independently. Her left arm & hand is still paralyzed but Ruth  continues working hard on getting them back!  

Ischemic does not mean clot

Most ischemic strokes are due to a clot forming in a blood vessel, so most people think that's what ischemic means. It's not quite true, though.

Ischemia actually refers to a lack of oxygen getting to the cells. Most of the time that's due to a clot, but not always. In fact, it's sometimes therapeutic, like in Remote Ischemic Conditioning which we talked about in episode 55.

In Ruth's case, her stroke was ischemic, but there was no clot. Instead, her brain tumor wrapped around an artery from the outside, cutting off the flow of blood to that part of her brain.

Most treatments for ischemic stroke involve clot busting medications like TPA or clot removal via mechanical thrombectomy. Neither of those therapies would have helped Ruth because there was no clot to break or remove.

They had to pursue surgery to remove the tumor and restore the flow of blood.

Hydrotherapy

Hydrotherapy is an important part of Ruth's recovery program.

Hydrotherapy typically takes place in a special heated pool with a therapist who can help the survivor safely complete the exercise program.

The warm water helps the muscles relax and relieve tone and spasticity. The buoyancy helps reduce balance issue so the survivor can focus on their movement. The water resistance ensure the muscles still get a good work out. And the water reduces the risk of injury from a fall. Finally, a hydrotherapy pool will typically have the accessibility equipment to make it safe for a person with disabilities to enter and leave the pool.

Special pools and specially trained therapists help survivors get special results.

Hack of the week.

Mirroring what Kristen Aguirre said in episode 114 (http://Strokecast.com/GratefulKristen), Ruth suggests looking for shampoo and related products that have a pump.

When you're already living with paralysis and working hard in the shower to, you know, not fall, opening bottles and pouring soap without spilling the product or yourself is exhausting. So don't do it.

When you choose your product, look for bottles that come with pumps. They make it much easier to dispense the product.

If your favorite product doesn't come with a pump option, add one yourself. You can find generic bottle pumps on line.

Here's one example (affiliate link):

amzn_assoc_tracking_id = "currentlybill-20";
amzn_assoc_ad_mode = "manual";
amzn_assoc_ad_type = "smart";
amzn_assoc_marketplace = "amazon";
amzn_assoc_region = "US";
amzn_assoc_design = "enhanced_links";
amzn_assoc_asins = "B00B8XWI7G";
amzn_assoc_placement = "adunit";
amzn_assoc_linkid = "30419a8da470bac355e5e10f93659817";

//z-na.amazon-adsystem.com/widgets/onejs?MarketPlace=US

Links

Where do we go from here?

  • Follow Ruth on Instagram at Ruthie_Carroll84 to join her on her journey and see adorable pictures of her family.
  • For more stroke related books, gadgets, gizmos, and bottle pumps, visit the Strokecast Gift Guide at http://Strokecast.com/GiftGuide
  • Share this episode with a friend, colleague, or relative by giving them the link http://Strokecast.com/Ruth
  • Mask up and stay safe in 2021
  • Don't get best…get better.


Here is the latest episode of The Strokecast