Here are some developments/news items that managed to escape treatment in the popular press.

A stroke is a stroke

When I trained in the 1970s, the concept of “transient ischemic attack” (TIA) reigned.  This term referred to sudden symptoms of a stroke that resolved in minutes to hours to one day and were associated with no evidence of brain tissue injury by cerebral imaging available at the time.  The idea was that rapid resolution of symptoms produced no permanent brain injury.

As magnetic resonance imaging (MRI) came into common use in the 1990s, it became clear that many patients who suffered TIAs had evidence of brain injury with the more detailed brain imaging.

The National Institutes of Health Stroke Scale now grades cerebral ischemia (reduced blood flow to the brain causing stroke symptoms) on a continuum, with TIAs classified as minor strokes.

So…minor or not, if you experience signs of a stroke such as sudden 

weakness/paralysis on one side of your body, even if it resolves quickly, you should seek medical assistance ASAP.  There are acute interventions that are effective in proportion to how soon therapy is instituted.

Speaking of Strokes…

If you have had a stroke, all is not lost.  A Canadian study spanning four years in Canada found that stroke victims who followed recommended levels of physical activity had a 50 percent reduction in mortality compared to sedentary victims.  The beneficial effect of exercise was more prominent in those younger than 75 (79 percent reduction in mortality), but still significant for people 75 and older (32 percent reduction in mortality).

The more exercise, the better, but the amount necessary to achieve benefit was startlingly modest: 10 MET-hours/week.  The optimum was 20 MET-hours/week.  A MET is a ratio of your working metabolic rate relative to your resting metabolic rate.  Cleaning your house , for instance, wins you 3.5 METS.  Other MET values are available on Healthline (go to the internet).

The benefit of exercise, which also decreases sedentary time, is also apparent in preventing strokes altogether.  So keep on truckin’.

E-cigs to quit smoking… maybe not

One of the benefits touted for the use of e-cigarettes (i.e., “vaping”) is that it can help cigarette smokers quit the habit.  In a recent large study, however, smokers who wanted to quit (quitting was defined as abstinence from smoking cigarettes for 12 months) had less success with using e-cigarettes as a aide to quit smoking compared to pharmaceutical cessation aids (e.g., Nicorette, either gum or lozenges) or behavioral therapy.  The combination of the latter two was the most effective.  

This finding, in addition to the fact that we still do not know the long term effects of e-cigarette use, leads experts in the field of smoking control to believe that vaping should not be recommended to those who want to quit smoking.

Vaping industry advocates point out that the study cited above lacked the power of the gold standard for medical research.  It was observational, that is, there was no randomization of participants that corrects for biases that are not obvious.  On the other hand, an expert in the field points out that, if public health limited itself to this kind of evidence, we would not know that smoking causes cancer.

In the study cited, the smokers who had the most success in quitting used none of the available aids to quit smoking.  Personal motivation and old fashioned will power carried the day.

If you doubt the addictiveness of nicotine, read on

Quitting smoking is an unquestioned health benefit: cigarette smokers who beat the habit enjoy up to a decade of greater life expectancy.  But what about quitting after getting diagnosed with lung cancer?  

In a large study from Russia, only 43 percent quit smoking after the diagnosis of lung cancer.  In an average of seven years of follow-up, however, smoking cessation was associated with a 33 percent reduction in mortality compared to those who  continued to smoke.

Editorialists in the Annals of Internal Medicine opined that smoking cessation therapy, in contrast to the current practice, should be a routine component of treating patients with lung cancer.

1 Comment

  1. Helen says:

    As I read this comment on the newly-discovered seriousness of a TIA, I realized again the importance of a primary care doctor for directing a patient’s thinking. I had seen this article in the April 9 issue of the New York Times. While I registered the message, I missed the listing of common symptoms, led by weakness in half the body. I noted only the symptoms of the two patients profiled, those of slurred speech and fluttering eyelids. Jim had an earlier note on the underrated value of these front-line doctors and the need to bring their compensation closer to specialists’ incomes. Absolutely.

Leave a Reply