bof fri fleu
May 11, 2010 2:13 PM   Subscribe

Given the news that Joe Biden's son Beau had a mild stroke today, perhaps it would be helpful to know the warning sides. FAST was a series of public service announcements from the Massachusetts Department of Health. You could be a hero! HBCH!
posted by Potomac Avenue (29 comments total) 6 users marked this as a favorite
Is the "FAST" link supposed to link to the same news article as the first link?
posted by Hairy Lobster at 2:15 PM on May 11, 2010

See also.
posted by Nothing... and like it at 2:20 PM on May 11, 2010

perhaps it would be helpful to know the warning signs

Sinbad agrees.

Not to make light of an awful medical issue; it is very important to recognize how a stroke manifests itself. Good post.
posted by The Winsome Parker Lewis at 2:22 PM on May 11, 2010

Oh gosh, I heard he was in the hospital but didn't know it was a stroke until seeing this post. 41 seems awfully young for that kind of thing, I wish him a speedy and complete recovery. Considering how just about everyone on my father's side of my family has died of a stroke, this is a huge fear of mine so thanks for the links.
posted by Shesthefastest at 2:28 PM on May 11, 2010

When my grandfather had a stroke, we didn't realize it for several hours. He'd driven over and was hanging out at our house as usual, though he seemed unusually concerned about getting in touch with his friend Jerry. He eventually picked up the television remote and tried to call him on that--that's when we realized that something wasn't right.

He was 86, and lived about two years after that, though his health declined pretty rapidly. Apparently the fact that he'd stopped taking his blood pressure medicine (unbeknownst to all of us) about five years before was a major contributor.

Take care of your pop-pops, mefites.
posted by PhoBWanKenobi at 2:29 PM on May 11, 2010

Darn it, no the second link is supposed to be to this catchy number.
posted by Potomac Avenue at 2:49 PM on May 11, 2010

I found this helpful image on a noticeboard at work a few weeks back.

Face - is one side droopy?
Arms - can't raise both arms equally
Speech - slurred speech, muteness
Time - lost time could be lost brain

I recommend everyone memorise those, and also check out the Stroke Foundation image.

It could save your life.

Because if you fail to spot a zombie in time, it will kill you dead.
posted by Wataki at 2:50 PM on May 11, 2010 [5 favorites]

I have helped to treat many strokes in my time as an EMT. This is one of the cases where fast response makes a difference. (Heart attacks are often too fast for the fastest response, many other diseases aren't so fast that emergency treatment is needed.)

If you can get to clot busters in the first hour, you can prevent almost all of the damage in many cases. The brain starts to really die in places after that. Even after a few hours, getting to treatment can make a difference, though.

Following these links really brought back all the times I have seen a brain go away, bit by bit, over the course of 20 minutes. I'm actually kinda crying at my desk. This strong emotional response is why I'm not an EMT any more.
posted by poe at 2:50 PM on May 11, 2010 [4 favorites]

Fun Fact: one of the best phrases to use for testing for stroke addled speech is "The sky is blue in Cincinnati." It seems to hit all the right sounds, and detects partial paralysis every time.

Almost any phrase will work, though, so don't waste time trying to remember that one.
posted by poe at 2:55 PM on May 11, 2010 [3 favorites]

I JUST finished reading My Stroke of Insight: A Brain Scientist's Personal Journey by Jill Bolte Taylor yesterday. (previously on MeFi).

When my mother called me late last night, babbling rather incoherently, not able to think of the correct words for something - my first thought was "Stroke?" - then I realized she'd just taken her Ambien and was just out of it. When I called this morning she didn't remember calling me at all (long distance even) and we laughed about it. She thanked me for calling to check on her anyway.
posted by mrbill at 2:59 PM on May 11, 2010

How many of the FAST symptoms are you supposed to have before you should worry? Because I once, about a year ago, had some weird stuff going on with my face, one half of it was numb and kind of tingly, and my vision was blurred on that side, although I don't think my mouth was dropping, and I didn't have any of the other symptoms. It went away after about half an hour, just when I was starting to worry.
posted by Joakim Ziegler at 3:31 PM on May 11, 2010

How many of the FAST symptoms are you supposed to have before you should worry?

Any one of these symptoms is serious enough to get checked out, mainly because the risks are great, the treatments are simple and time is of the essence.

Should you worry about it now? I'm not a doctor, so I don't really know. I do know that most of the stroke victims I had to deal with were unaware of or confused by their symptoms. They would even continue to get up and try to walk even though half of their body wasn't working.
posted by poe at 3:58 PM on May 11, 2010

I've heard... read... that ice water bath might be the best place to wait for treatment/first response.
posted by bz at 4:04 PM on May 11, 2010

I knew you would make "bof fri fleu" the post title. It seemed like I sat across from those words on the commute every day for a year.
posted by Countess Elena at 4:05 PM on May 11, 2010 [2 favorites]

Here's to Beau's speedy recovery. The ability to speak coherently would be a terrible loss. We need look no further than his father.
posted by hal9k at 4:07 PM on May 11, 2010

TPA for stroke remains controversial. Many practicing emerg docs (and associations) feel trials are not very convincing, and the medication has a big risk. So if an emerg doc tells you he's going to give you tpa, ask him to outline the controversy for you. You're not going to get tpa in any case if your symptoms are mild, like "weird stuff going on with your face". A skeptic might question whether these sort of campaigns are funded by pharma in order to get more customers for their pricey 'clotbusters' (which have a 6% chance of giving you a cerebral hemorrhage and may not have any actual benefit).

More info here.
posted by kevinsp8 at 4:28 PM on May 11, 2010

Not so much "bof fri fleu" as Word Salad. Whole words would come out, but they had nothing to do with each other or what I was trying to say (and I am otherwise never at a loss for words). I was 41. Scary the first time, frustrating in the few subsequent occurrences. Turns out it was hemorrhagic (bleeding in the brain) rather than ischemic (blockage in the brain) in my case, so a clot-buster would have been the wrong thing for me. That was seven years ago, and except for some memory impairment all seems well.
posted by squalor at 4:49 PM on May 11, 2010

I just recently discovered that I had a mild stroke some time in the past. What was interesting is that I discovered it via a CT scan doing a check for the cause of my Restless Leg Syndrome (when can we have a real name for this, BTW?). I don't know when it happened or what the effects of it are/were. I've always been fairly clumsy and a bit forgetful, so at least now I can blame it on something :)
posted by swimming naked when the tide goes out at 4:56 PM on May 11, 2010

I had an ischemic stroke the day after Thanksgiving last year. We live near a hospital, and I have a history of atrial fibrillation, so when I started going south we suspected a stroke. I got to the hospital within 20 minutes of symptom onset and was given TPA. Boys and girls, I am typing this today at my normal speed because the TPA -- and a quick trip to the ER -- saved my cookies. And as I type this, I am in the hospital once more, having my meds adjusted because Multaq isn't sufficiently controlling my heart rate.

Because my wife and I knew a bit about the risks of stroke, we did not sit around the shack debating what was happening -- we flew to the hospital. Contrary to what kevinsp8 says above, and no offense to him, I say -- let the doctors do their thing. Debating with a doctor whether or not you are having a stroke may just mean the difference between walking out a week later or years of rehab.

And had I known in advance (I know it now) about the 6% chance of a greater bleed (less likely in the case of my stroke, as it was ischemic, as I said above), I would have said, "Give me the fucking TPA anyway! Give it to me now!"
posted by Guy_Inamonkeysuit at 5:18 PM on May 11, 2010 [2 favorites]

Man, strokes have to be my biggest irrational fear. Good to have some reliable info to put my irrational concern that I'll have a stroke at 21 to the test.
posted by mccarty.tim at 6:11 PM on May 11, 2010 [1 favorite]

By irrational, I mean irrational for a person my age. Every time I feel a tingle go up my spine or feel a bit dizzy, there's always a part of my brain that screams "ARE YOU SURE YOU AREN'T HAVING A STROKE?" And I try to discretely do the FAST test, just to put myself at ease.
posted by mccarty.tim at 6:13 PM on May 11, 2010

I dunno about the states but in Australia you have to meet strict guidelines to get TPA. It has to be an ischemic stroke (which we tell by giving you the world's fastest CT), you have to have presented within 4 hours of onset, and there's a bunch of minor stuff too. In the event that you're in the position of needing it, stopping to argue with your doctor's probably the stupidest thing you can do - for one, you'll likely not be in a position to argue what with just having had a stroke, and for two the longer you put it off, the higher the chances it won't work.

Sure there's side effects, potentially nasty ones. It's a very potent anticoagulant. But if you've got a clot in your brain that's preventing brain tissue from getting a blood supply do you even need medical training to realize that getting rid of the clot asap is the best thing for you?
posted by Silentgoldfish at 7:15 PM on May 11, 2010

The interesting thing about bof fri fleu is that, in Massachusetts at least, stroke victims say it the same in Spanish and Portuguese.
posted by adamg at 7:34 PM on May 11, 2010

Are typos and getting links wrong also warning signs? That was unintentionally funny, Potomac Avenue.

Three nuns at a park. Flasher flashes them. Two had a stroke. The other couldn't reach.
posted by uncanny hengeman at 8:56 PM on May 11, 2010 [2 favorites]

Guy_Inamonkeysuit: this sounds like the reasoning fans use. Many strokes resolve on their own ("mini-strokes"). Even the 2 out of 10 studies that showed a benefit for tpa only saw a marginal benefit at the 30 day point when comparing the placebo group versus the tpa group (and as per my link the groups likely weren't comparable to start with).

I wasn't saying debate the diagnosis, I was saying ask about the pros and cons of the treatment. Doctors feel pressure to 'do something' and frankly fear being sued if they don't give this treatment. But stakes are high and after hearing and an honest and informed ER doc explain this treatment I'm not sure as many people would choose it. I'm not sure I would, and I'm an ER doc. And knowing that companies stand to make big money by promoting this treatment to docs and patients, doesn't ease my skepticism.
posted by kevinsp8 at 9:44 PM on May 11, 2010

Tissue plasminogen activator (tPA) is most definitely not controversial for stroke treatment. In the appropriate patient cohort, it is proven to reduce disability at three months. It is not a miracle cure, and should never be represented as such. It does carry a risk of bleeding in the brain, but there is also an intrinsic risk of conversion from ischemic stroke to hemorrhage for a variety of reasons.

Clot-busting drugs like tPA had been used for several years in heart attacks before they were found to be useful in stroke.

In large strokes, or larger strokes which have gone on longer than the three-hour limit for tPA, there are other interventions, including a procedure using a shape-memory alloy, the MERCI retrieval device which goes into the blood clot as a straight wire, and is then induced into a corkscrew shape to withdraw the clot. There are studies going on looking at the use of removable stents as well to at least temporarily restart blood flow around the clot while the interventionalist plans to remove it.

If you have sudden onset of any focal neurologic symptom, which includes numbness or tingling, muscle weakness, hand incoordination, inability to walk, inability to talk, facial droop, or loss of vision, especially if on one side of the body or face, you should go immediately to the emergency room. Especially if you are over 50, smoke, have diabetes, high blood pressure, and/or high cholesterol.

(I am not an advocate for diagnosis at a distance, but given Beau Biden has "full motor and speech" capability, one wonders if he had a pure hemisensory stroke or maybe a transient ischemic attack—a temporary stroke that is often a harbinger of a real one.)
posted by adoarns at 4:50 AM on May 12, 2010

Kevinsp8, in the ER there is often not enough time to reasonably discuss the pros and cons of administering TPA (or doing any procedure, I would think), and most at-risk people probably don't do it ahead of time for obvious reasons. What if I had gotten to the hospital an hour later? As it was, the full stroke hit me as I was in the ER, before I received TPA. As a doctor, you know that such occasions are emotionally fraught. People having a stroke (and/or those accompanying them) may find clear-headedness somewhat beyond them. My wife was watching my eyes roll independently as they administered TPA. I came back -- I was (am) very very lucky. Neither she nor I could have cared less about drug company profits at that moment.

I just hope you never find yourself in my position. I'm still dealing with the psychological after-effects -- and I am also still in the hospital, being monitored as my meds are changed. Do I give a damn about drug company profits right now? I do not. And I don't give a damn what the alt. med people think or say, either, frankly.

I did not have a mini-stroke or a TIA... I had what the doctor described to me as "not a small" stroke. I repeat: I was very very lucky. If my ER gambled on my behalf, they were lucky too. Hell, I'd never even heard of TPA. And new stuff is coming along all the time... who knows what options will be available at any given moment?
posted by Guy_Inamonkeysuit at 6:11 AM on May 12, 2010

Guy_Inamonkeysuit: I think we're pretty much obliged to obtain informed consent before administering any treatment, especially this. Informed consent involves a discussion of the risks, benefits, and alternatives. I can do it in a minute or two. It's not an easy decision... but it's really the patient's decision. Larger strokes also have more risk of converting to a bleed, which is why too severe an ischemic stroke is a contraindication to this medication. I'm glad your outcome is good... now make sure you're taking aspirin and you're pressure is good etc... prevention saves many more lives than tpa.

This chart (scroll to page 2, pdf file) is one way to explain it simply. But this chart only applies if you believe the study, which as per my above link, there is good reason to doubt. I like what this ER nurse says:

"...I have seen or read material distributed or articles in the local newspaper or directly heard reference to getting to the hospital early to get the 'miracle clot busting drug'. Is this information helpful? accurate? The education on lifestyle changes and symptom recognition is very helpful but I have big concerns about the promotion of TPA and minimization of risks... So are Stroke Centers good medicine or marketing? My opinion, some good medicine (the education and rehab portion) and a lot of marketing and optimistic claims. The whole thing kinds of smells bad to me. As a Nurse when tasked to give TPA for stroke I make sure that the patient and family are fully informed, repeated several times, that while the treatment may eventually reduce disability it also might kill you. As far as the Stroke Center cheer leading, I just hold my nose."

adoarns: You're simply wrong that tpa isn't controversial. For example, the American Academy of Emergency Physician's current position statement on tpa is:

"It is the position of the American Academy of Emergency Medicine that objective evidence regarding the efficacy, safety, and applicability of tPA for acute ischemic stroke is insufficient to warrant its classification as standard of care. Until additional evidence clarifies such controversies, physicians are advised to use their discretion when considering its use. Given the cited absence of definitive evidence, AAEM believes it is inappropriate to claim that either use or non-use of intravenous thrombolytic therapy constitutes a standard of care issue in the treatment of stroke."

And this article in the journal Stroke (published by the American Heart Association) says "No issue has caused greater controversy than the view that intravenous tPA should be a standard form of therapy for acute stroke."

Two studies out of ten showed some modest benefit (treat 8 patients to get one that benefits) but in only one of many measures of stroke outcome, and there have been serious questions raised about the methodology. That's not exactly a slam-dunk.
posted by kevinsp8 at 8:22 AM on May 12, 2010

Good info, kevinsp8 -- I don't want to seem oppositional. I still think that making an on-the-spot decision while in extremis is not necessarily the best way, but damned if I can see an alternative. My wife had to sign for me, as I was headed south by the time the TPA bolus was ready. Additionally, a friend who is a nurse (and has worked ER) was with us, having met us at the hospital in response to her call. He urged us to have the TPA, but as I say I was unresponsive at that time. I know my wife was extremely distraught and perhaps not capable of making a well-informed decision.

All in all, my outcome was the best possible one. I can easily see that it could have been otherwise.

(And I have just come back from an echo treadmill stress test, and all seems well -- the new meds seem to be doing their job -- so I am doubly happy!)
posted by Guy_Inamonkeysuit at 9:16 AM on May 12, 2010

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