Posts Tagged ‘Dealing with having a stroke,’

May 27, 6:05 PM (ET)

By MARIA CHEN

LONDON (AP) – Special stockings commonly given to stroke patients to prevent blood clots don’t work, a new study reported Wednesday.

Doctors often prescribe the tight, thigh-high stockings to patients who have suffered a stroke, seeking to prevent blood clots in patients’ legs – which could prove fatal if they break off and reach the heart or lungs.

About two-thirds of stroke patients can’t walk when admitted to hospital, and up to 20 percent of those patients develop a blood clot in their legs. The stockings squash the legs and force the blood to circulate better, and can be used in place of, or alongside, anti-clotting drugs like heparin.

But in a study of more than 2,500 stroke patients in Australia, Britain and Italy, doctors found the stockings did nothing to reduce the chances of a clot. Not only that, but they caused problems like skin ulcers and blisters.

The results were simultaneously published in the Lancet medical journal and presented at the European Stroke Conference in Stockholm on Wednesday.

Some experts were surprised by the findings.

“We have used these stockings because we assume they work,” said Dr. Ralph Sacco, president-elect of the American Heart Association, who was not linked to the study. “But sometimes you’re surprised when you find out the truth with a randomized trial.”

The stockings have been proven to reduce clots in surgery patients, so experts had long thought the low-cost solution might also help stroke patients.

In the study, about half of the patients got standard care in addition to the stockings. The other half just got standard care. Experts took an ultrasound of patients’ legs after about 7 to 10 days, and then again after 25 to 30 days. About 10 percent of patients in both groups developed blood clots.

In the group wearing stockings, 5 percent reported side effects like skin problems and blisters. That compares to 1 percent in the group not given the stockings.

The study was paid for by Britain’s Medical Research Council, the Scottish government, the health charity Heart and Stroke Scotland, Tyco Healthcare in the United States and the U.K. Stroke Research Network.

In Britain, draft guidelines recommend patients wear the stockings and they are used to treat an estimated 80,000 patients per year. Martin Dennis, of the University of Edinburgh and one of the study authors, said he has contacted British officials to suggest they reconsider their advice.

“This should cause a big change in how patients are treated,” Dennis said, noting that in 2002, 90 percent of stroke units in Britain used the stockings.

In the United States, stockings for stroke patients are far less popular than in the U.K.

Dr. Marc Mayberg, co-director of the Seattle Neuroscience Institute, said he hadn’t recommended the stockings for patients in about 20 years. He said the stockings were cumbersome and difficult for many patients, whose legs were paralyzed, to put on and take off.

Recommendations from the American Heart Association published in 2005 advised doctors to consider using the stockings in addition to an anti-clotting drug, or for patients who can’t take such drugs.

Sacco said American doctors were more likely to use drugs instead of stockings to prevent clots. He thought the guidelines promoting stockings might now have to be revised.

“With this lack of effect, doctors may be much less inclined to use them,” he said.

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On the Net:

The Lancet http://www.lancet.com

By JOHN TIERNEY

Imagine that you have ditched your laptop and turned off your smartphone. You are beyond the reach of YouTube, Facebook, e-mail, text messages. You are in a Twitter-free zone, sitting in a taxicab with a copy of “Rapt,” a guide by Winifred Gallagher to the science of paying attention.

The book’s theme, which Ms. Gallagher chose after she learned she had an especially nasty form of cancer, is borrowed from the psychologist William James: “My experience is what I agree to attend to.” You can lead a miserable life by obsessing on problems. You can drive yourself crazy trying to multitask and answer every e-mail message instantly.

Or you can recognize your brain’s finite capacity for processing information, accentuate the positive and achieve the satisfactions of what Ms. Gallagher calls the focused life. It can sound wonderfully appealing, except that as you sit in the cab reading about the science of paying attention, you realize that … you’re not paying attention to a word on the page.

The taxi’s television, which can’t be turned off, is showing a commercial of a guy in a taxi working on a laptop — and as long as he’s jabbering about how his new wireless card has made him so productive during his cab ride, you can’t do anything productive during yours.

Why can’t you concentrate on anything except your desire to shut him up? And even if you flee the cab, is there any realistic refuge anymore from the Age of Distraction?

I put these questions to Ms. Gallagher and to one of the experts in her book, Robert Desimone, a neuroscientist at M.I.T. who has been doing experiments somewhat similar to my taxicab TV experience. He has been tracking the brain waves of macaque monkeys and humans as they stare at video screens looking for certain flashing patterns.

When something bright or novel flashes, it tends to automatically win the competition for the brain’s attention, but that involuntary bottom-up impulse can be voluntarily overridden through a top-down process that Dr. Desimone calls “biased competition.” He and colleagues have found that neurons in the prefrontal cortex — the brain’s planning center — start oscillating in unison and send signals directing the visual cortex to heed something else.

These oscillations, called gamma waves, are created by neurons’ firing on and off at the same time — a feat of neural coordination a bit like getting strangers in one section of a stadium to start clapping in unison, thereby sending a signal that induces people on the other side of the stadium to clap along. But these signals can have trouble getting through in a noisy environment.

“It takes a lot of your prefrontal brain power to force yourself not to process a strong input like a television commercial,” said Dr. Desimone, the director of the McGovern Institute for Brain Research at M.I.T. “If you’re trying to read a book at the same time, you may not have the resources left to focus on the words.”

Now that neuroscientists have identified the brain’s synchronizing mechanism, they’ve started work on therapies to strengthen attention. In the current issue of Nature, researchers from M.I.T., Penn and Stanford report that they directly induced gamma waves in mice by shining pulses of laser light through tiny optical fibers onto genetically engineered neurons. In the current issue of Neuron, Dr. Desimone and colleagues report progress in using this “optogenetic” technique in monkeys.

Ultimately, Dr. Desimone said, it may be possible to improve your attention by using pulses of light to directly synchronize your neurons, a form of direct therapy that could help people with schizophrenia and attention-deficit problems (and might have fewer side effects than drugs). If it could be done with low-wavelength light that penetrates the skull, you could simply put on (or take off) a tiny wirelessly controlled device that would be a bit like a hearing aid.

In the nearer future, neuroscientists might also help you focus by observing your brain activity and providing biofeedback as you practice strengthening your concentration. Researchers have already observed higher levels of synchrony in the brains of people who regularly meditate.

Ms. Gallagher advocates meditation to increase your focus, but she says there are also simpler ways to put the lessons of attention researchers to use. Once she learned how hard it was for the brain to avoid paying attention to sounds, particularly other people’s voices, she began carrying ear plugs with her. When you’re trapped in a noisy subway car or a taxi with a TV that won’t turn off, she says you have to build your own “stimulus shelter.”

She recommends starting your work day concentrating on your most important task for 90 minutes. At that point your prefrontal cortex probably needs a rest, and you can answer e-mail, return phone calls and sip caffeine (which does help attention) before focusing again. But until that first break, don’t get distracted by anything else, because it can take the brain 20 minutes to do the equivalent of rebooting after an interruption. (For more advice, go to nytimes.com/tierneylab.)

“Multitasking is a myth,” Ms. Gallagher said. “You cannot do two things at once. The mechanism of attention is selection: it’s either this or it’s that.” She points to calculations that the typical person’s brain can process 173 billion bits of information over the course of a lifetime.

“People don’t understand that attention is a finite resource, like money,” she said. “Do you want to invest your cognitive cash on endless Twittering or Net surfing or couch potatoing? You’re constantly making choices, and your choices determine your experience, just as William James said.”

During her cancer treatment several years ago, Ms. Gallagher said, she managed to remain relatively cheerful by keeping in mind James’s mantra as well as a line from Milton: “The mind is its own place, and in itself/ Can make a heav’n of hell, a hell of heav’n.”

“When I woke up in the morning,” Ms. Gallagher said, “I’d ask myself: Do you want to lie here paying attention to the very good chance you’ll die and leave your children motherless, or do you want to get up and wash your face and pay attention to your work and your family and your friends? Hell or heaven — it’s your choice.”

Sat Apr 11, 2009 8:55PM EDT