Families and social networks don’t always help stroke victims

A recent study in Nature Communications shows that when stroke patients are surrounded by close connections like their immediate family, they are less likely to get to the hospital in time for treatment, compared to patients with looser social connections.

Amar Dhand is a neurologist at Harvard Medical School with a PhD in sociology from Oxford who studies the relationship between social connections and health. His team surveyed 175 stroke patients in Boston and St. Louis, and mapped their social networks against the time it took them to arrive at the hospital. The 67 patients who took more than six hours to arrive had both smaller and tighter-knit social networks than the 108 who arrived in under six hours…

“This is the biggest problem in stroke therapy today,” Dhand says. “The delay that is caused by patients and the caregivers. The social context is the largest part of the delay, hands down, in stroke patients arriving in hospital in time.” There’s a predictable sequence of events for stroke patients in close networks, he notes. Initially, a patient may delay telling their family about their symptoms, not wanting them to worry.  “Secondly, they [the family] over-negotiate the symptoms, and perhaps even argue about them,” Dhand says. “Then they all validate each others opinion to watch and wait.”

He calls it an”echo chamber,” where family members, hoping for the best, minimize the gravity of the situation and conflate it with previous, less severe illnesses.

In contrast, when patients with only loose social networks have a stroke, there isn’t as much dithering. Patients who suffer strokes in a public place may be sent to the emergency room out of an abundance of caution by employees of the mall, store, or restaurant where they are afflicted. In some cases, an ambulance may be called by someone who doesn’t want the responsibility of caring for the sick person.

Here is the full article.

Comments

Death by Dithering

Donald Trump is exonerated. You libs can't handle it. #trump2020

It's worse when the patient gets home. Someone learning to walk, talk, remember or even think rationally is beholden to stonewalling insurance companies and family members who quickly loose patience with the shortcomings of a once able bodied person.

If you're lucky, the stroke will kill you. If not, you're forced to deal with an indifferent, largely predatory world, without cognitive access to what made you whole. The isolation becomes acute.

A chilly view but I suppose it may be all too accurate. It reminded me that those who have low IQs may also face "an indifferent, largely predatory world, without cognitive access to" useful defence mechanisms. As we age we'll all become more vulnerable.

And let’s not forget the most American problem of them all: Going to an emergency room will often cost up to a couple thousand, with insurance! Quite the penalty if it happens to be nothing important.

It's a $50 co-pay with insurance, but thanks for the hysterical shrieking.

Well, apparently 15.5% of Americans don't have health insurance (over 50 million people). This is not the case in every other Western country.

https://www.forbes.com/sites/joshuacohen/2018/07/06/troublesome-news-numbers-of-uninsured-on-the-rise/#57097b674309

Depends on your insurance. My daughter and son-in-law have an $8000 deductible policy (which still costs them a lot per month). A trip to the ER isn't $50 unless they make a lot of them.

Let's give free lunches to all! Feel the Bern!

Of course even without free lunches, survival rates for Americans who have strokes are comparable to other western countries: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329668/

https://www.reuters.com/article/us-health-spending/u-s-health-spending-twice-other-countries-with-worse-results-idUSKCN1GP2YN

All the more reason to spend less. Medicare for no one!

Assume not replicable.

The study actually finds a result 100% opposite of how the quartz article (and the study's authors) are pitching it. People who arrived at the hospital later had FEWER social connections on average. It's right there in the excerpt: "both smaller and tighter-knit social networks". The person with the "tightest" social network, as measured by the study, was the one person who had no connections at all. The two next tightest networks were the people who had exactly one connection. Etc. All this study is finding is that larger networks tend to be less tight, and then spinning a fake-counterintuitive result out of the latter misleading fact.

(Not that I trust the study methodology regardless of the results -- interviewing people who *made it* to the hospital about their networks isn't necessarily any better than asking lottery winners about their secret to success. If a close friend convinces you, ten hours later, to go to the hospital, this study would have reported that as "close friends are correlated with showing up at the hospital late, which is bad".)

Your relatives

Will

Kill you.

No one gets outta here alive.

"... in stroke patients arriving in hospital in time."

The window for arriving on time has recently increased from 6 hours to over 16 hours.

Transtromer was one of the few authors whose books were actually fun to read, as opposed to interesting to read and full of the kind of meaning that makes us think that reading such books makes us smarter.

All of us can easily become smarter than the best of authors, simply by seeking Wisdom ( I recommend reading the Book of Proverbs and accepting, as a given, the fact that we live in a world that was created by a God that loves us.....).

Transtromer suffered a stroke when he was fairly young (mid-50s, I think). Not sure if anyone was at fault for the fact that he never fully recovered his health ---probably he was just the victim of an unfortunate medical event. Even great poets suffer such things, sometimes.

When I was in my 20s, back in the 80s, I used to wonder where all the iconic hippies and culturally cool young folks of the 60s had wound up. By the early 1990s, some taught law at Ivy League law schools, some were unloved old dudes or dudettes on sad communes, some tried to be stand-up comics, some had actually gone into politics, or made cash on the "oldies circuit" or in a few cases, like the Byrds and CSNY, had garnered millions of dollars off record sales and concert tours.

Later in life, I wondered what may have happened to the thousands of guys who were temporarily confined to mental hospitals, with what we would now call extreme PTSD, after their campaigns in places like Guadalcanal and the Ardennes.
Let's say you could follow up on a thousand such guys - all but 20 or 30 out of every thousand of whom have since died ---- there are a few, like Salinger, who achieved an eccentric sort of success ---- but probably there are lots who died without any friends, after a few years in jail for some unrelated offense (fighting a cop in 1948, that sort of thing) --- and probably a few who just barely scraped by, married some sort of fat woman who did not mind the PTSD symptoms, because fat women take what they can get if they want to get married, and God bless them for that, and had a few kids, every once in a while one of the kids would be the drummer or vocalist on some horrible lousy top 40 or 'deep vinyl' song from the peak years of lousy music (1958 until the present).....

these are the things I think about when listening to "oldies radio"

someday nobody will think such things

but

God loves us all.

I remember.
God remembers.

No matter how difficult your life has been, remember this ----

I think you are fascinating, and I want you to know that God loves you, not because I find you fascinating, but because
God loves you, and loves everybody who ever loved you.

(by the way, I am not gifted in any real way, but I will say this ----- I can go to a flower stand, or one of those 'garden department' places at the Home Depot, and in less than a tenth of a second I can see, amongst the flowers or the potted plant, the most beautiful thereof.

And I never buy the most beautiful, I may buy the second most beautiful, I do not like to take advantage of my gifts, I like to let someone else come by and bring home the most beautiful petunia plant from the petunia plant selection at Home Depot, or at Walmarts.
I love this world.

Don Colacho said: Our ability to love something other than God proves our indelible mediocrity: but: I say:

Don, you are wrong there.
I have made dogs laugh, I have made cats laugh, I once or twice or a thousand times (who can tell with such subtle creatures) made an insect laugh, and of course I have made men and women laugh, and one day I said to myself:

maybe I should try to make God laugh.

But how, my poor young friend, could I do such a thing if I did not love something other than God?

There are no real prizes for being smart, there are only prizes for being kind and brave, or for making those we love happier (making them laugh).

Enty if you are reading this and I know you are -
endomeotrosis is a real thing.
And Ben Stiller is a cancer survivor.
Stop pretending you don't know that.
Pray for those who suffer, if you can't directly help them, at least pray for them.

There are Billions of people in this world and if you wanna know how many real doctors and real faith healers there are ---

not many.
People get all giddy thinking ooh Harvard Medical School or

ooh Fields Prize

but when the rubber hits the runway

not many of us are any good at helping the sick.

I try.

You should try too.

In 1966 my next door neighbor, who claimed to be a veteran of the Spanish American War of 1898 (alas I now think he was only a 'Spanish-American War "Era" Veteran', I have no reason to think he ever heard, as I have often heard, a shot fired in anger) answered, when I asked a question which I now cannot completely accurately remember, sadly ----
he said, because it was a good question that he did not want to answer: children should be seen and not heard.

I still like the guy (who was a friendly neighbor, and who had a little bit of a crush on my older sister - born in the early 50s of the century before this one, just as he had been born in the early 80s of the century before that - well work it out, it makes sense, sort of)....

I still like the guy, but he was rude to me, and although he was born a couple centuries ago, that does not take away the stench of rudeness from what he said to me that day.

I am in a good mood tonight but I am not in such a good mood that I am going to say what the question that I, in my youth, asked the Spanish American war veteran, and to which he replied so rudely, and in such a way that I no longer automatically respect someone simply because they are a Spanish American war veteran.

God loves us all.

God wants you to be a faith healer.

All those years ago when I felt righteous indignation at the lack of politeness from my neighbor who was a Spanish American war veteran, I said to myself ....

well God loves him of course ....

what I did not say to myself was this:

years from now I, an expert on stroke victim protocols, would write a few random words on the internet, NOT DESCRIBING EVERYTHING I KNOW ABOUT HOW TO AVOID STROKES (med.com sites are full of such information) but saying....

God wants you to be a faith healer.

Maybe you too were born in the 1880s and maybe you too were once rude to somebody much younger than you. If that is the case, I forgive you.

If that is not the case, please tell me why you do not want to be a faith healer?
Those who suffer need your prayers, my young friends.

ok so some guy writes on the internet about some long ago argument he had with a veteran of the Spanish American war and he mentions that he would like other people to try to be faith healers and your reaction is

(A) dude nobody reads comments on blogs anymore this is not 2009

(B) fuck this guy he is full of it, he is some loser just angry because HE DID NOT WIN A FIELDS MEDAL and because NOBODY ASKED HIM TO BE A PROFESSOR AT HARVARD

(C) well that was trivial, anyone can say anything;

or

(D) hey maybe God wants me to be a faith healer.

(A) and (C) are acceptable answers, albeit wrong, (B) is absolutely and terribly wrong, and (D) is correct.

Read, reread, and memorize, Proverbs 8, and try to remember that moment in your life when you thought "oh my goodness life would be paradisiacal if I really cared about other people"

when the rubber hits the runway

do what you need to do.

maybe you are brilliant, and your teachers at Harvard law said your answers on the finals were brilliant.

No they weren't

I will tell you what you need to do to be brilliant.

Fight against sickness, help someone who is sick.

God has promised me many descendants -
that is a given -
and if I forgot to ask, when asking for God's promise, that they might all be faith healers ---

well that would have been sad.

(I remembered, but this is 2019, and ...
well, this is 2019. I apologize for having, for a moment, forgotten that )

but I remembered.

and yes I really did argue, back in the day, with a guy who claimed to be a veteran of the Spanish American war, about whether me or him were right on the issue we argued about.

I was right and he was wrong.

I still respect him, but I was right and he was wrong.

God loves us all.
Not some of us, all of us.

Possibly some kind of range restriction and survivor bias here?

Consider we know that there are "married men live longer" and "Contribution of extended family networks to Hispanic longevity advantage in the USA" effects.

So possibly the set of people with larger family networks tend to be older and in worse health, but "kept going" by family networks?

Having a wide social network is also probably a signal of being mobile and employed, and in better health, while a small and tight-knit network is probably a signal of being older and restricted to the home, and cared for by relatives.

Despite some public health education efforts, most Americans are woefully unaware of the symptoms of a stroke and the value in getting rapid treatment at a properly equipped hospital.

Most of us are aware of the symptoms of a heart attack and the need to get to a hospital immediately. A stroke is an equally urgent situation; if it's an ischemic stroke (which the majority are) there are drugs that can dissolve the blood clot and prevent most of the devastating brain damage from a stroke. But the drugs have to be administered quickly.

My father did everything right, except that his health care provider didn't have a modern up-to-date hospital. He felt strange, told my mother "I think I'm having a stroke" and they went to the hospital right away. They put him under observation but didn't administer the drug (TPA) because they weren't trained in how to use it. So he suffered massive brain damage and was disabled for the rest of his life.

Just as any emergency room should have defibrillators for people who are having a heart attack, they should be equipped and trained to treat stroke victims. I'm guessing that nowadays most do, but the hospital that my father went to did not (this was about 20 years ago).

"But the drugs have to be administered quickly."

There have been recent breakthroughs: "The key finding is that there is often more time than doctors realized in which brain cells can still be rescued by a procedure to remove the clot. Traditional guidelines have set a limit of six hours after stroke symptoms begin, and said after that it would be too late to help. The study showed that the time window could be expanded to 16 hours. " (NY Times, 2018)

There is also a new Japanese drug that supposedly gives a 36 hour window.

Prompt treatment greatly increases the prospects for recovery and to minimize permanent damage. But even stroke victims taken promptly to a hospital are no better off if it’s the wrong hospital (I.e., without quality staff with the necessary training). My neighbor had a stroke while driving her car and crashed, so she was immediately transported to the hospital. Fortunately her husband realized the staff at that hospital were not competent to treat her, and he had his wife transported by helicopter to the right hospital, but only after a shouting match with the staff at the wrong hospital. The hospital is not a bad hospital, it’s just the wrong hospital for someone suffering a stroke. How many people consider such things before the medical crisis. Know your local, or not so local, hospitals in case of a stroke, heart attack, etc.

Comments for this post are closed