Stroke and Gut: There's a Connection, aka I Had a Stroke Before They Really Knew

I have a sensitive stomach, and ever since my stroke, more sensitive, which I didn't think was possible. With the holiday season upon us, I wanted to know WHY! In other words, is there a connection between stroke and gut?

Harvard researchers found stomach problems could be linked to after-stroke stress. In fact, the gastrointestinal (GI) tract is sensitive to anxiety, anger, depression, and sadness, too (all of which I've had post-stroke), and it can trigger symptoms in the gut. Therefore, the brain reflects what the GI system feels. Stress is the worst, the researchers concluded. (Fun fact: I used to consider giving a stressful TED talk about stroke; I'm not anymore). 

In an article called "A Hidden Factor in Stroke Severity: The Microbes in Your Gut" by Jordana Cepelewicz, she talks about a new study in mice which demonstrates that manipulating the microbiome [the genetic material of all the microbes - bacteria, fungi, protozoa and viruses - that live on and inside the human body] can influence the extent of brain damage caused by a stroke. 

A study involving mice, published this week in Nature Medicine, argues that striking the correct microbial balance could prompt changes in the immune system that would be likely to reduce brain damage after a stroke.

Researchers at Weill Cornell Medical College and Memorial Sloan Kettering Cancer Center wanted to find out whether they could shift the balance of these cells to favor beneficial cells by meddling with the mouse bacteria. 

So one group’s intestinal makeup was resistant to antibiotics and the other group bacteria was susceptible to treatment. When the latter group was given a combination of antibiotics over the course of two weeks, the microbes underwent change. Then the researchers obstructed the cerebral arteries, inducing an ischemic stroke [the most common type of stroke]. They discovered that the resultant brain damage was 60 percent smaller in the drug-susceptible mice.

Finally and painstakingly, the researchers took the colons of mice that had ischemic stroke and transplanted to new mice with no antibiotics, thus establishing a group with finagled gut bacteria but no drug exposure, and discovering that these mice had also acquired protection against stroke. 

“These cells determine what kind of inflammatory immune response the brain is going to experience after stroke,” says neurologist Constantino Iadecola, director of the Brain and Mind Research Institute at Weill Cornell and one of the study’s authors. “Immune cells end up helping out instead of contributing to the damage that occurs."

A mouse’s genetic material is quite different from that of a human, and researchers will need clinical data, but at least they're trying.

"This is just the beginning,” says Ulrich Dirnagl, a neurologist at the Center for Stroke Research Berlin who read the results. “The study links the microbiota and the immune system and the brain in stroke—an acute brain disorder—in one story. That’s really novel." 

That it is, Dr. Dirnagl. That it is.

From the Journal of Digestive Diseases Foundation, a study was done to emphasize the GI problems that happen with stroke survivors which is directly associated with their quality of life. 

Stroke patients were evaluated for common gastrointestinal symptoms including type and site of stroke admitted over an 18-month period with symptoms of vomiting, dysphagia (difficulty swallowing), constipation, masticatory difficulties (including the muscles of the lips and tongue and the vascular and nervous systems supplying these tissues), and sialorrhea (drooling or excessive salivation), among others. 

There was no significant difference in GI symptoms in either sex, site or type of stroke, except that constipation and incomplete evacuation were commoner in ischemic stroke. 

The American Academy of Neurology says that people who have GI bleeding after stroke are more likely to die or become severely disabled than stroke survivors with no GI bleeding.

“This is an important finding since there are effective medications to reduce gastric acid that can lead to upper gastrointestinal bleeding,” said study author Martin O’Donnell, MB, of McMaster University in Hamilton, Ontario. “More research will be needed to determine whether this is a viable strategy to improve outcomes after stroke in high-risk patients.”

The study focused on 6,853 people who had ischemic strokes, and of those, 829 people died during their hospital stay and 1,374 died within six months after the stroke.

A total of 100 people had gastrointestinal bleeding while they were in the hospital. In more than half of the cases, the GI bleeding occurred in people who had less severe strokes. Of those with GI bleeding, 46 percent had died within six months, compared to 20 percent of those without GI bleeding. 

The study was supported by the Canadian Stroke Network, the Ontario Ministry of Health and Long-term Care, the Canadian Institutes of Health Research, the Institute for Clinical Evaluative Sciences, and the University Health Network Women’s Health Program in Toronto.

Patients with ischemic or hemorrhagic stroke are at risk for systemic complications, says the National Institutes of Health. No study to date has addressed causes of gastrointestinal hemorrhage in stroke, but the researchers intuitively assign the bleeding to stress ulcers. The study focused on 17 patients with gastrointestinal bleeding after stroke which is rarely severe and may not contribute significantly to mortality. 

Hmm. So the two latter studies contradict each other on mortality, but studies are like that: if you want to prove a point, do a study. But one thing is for sure: GI bleeding, or any other bleeding, for that matter, is not good. And when you have a stroke, it's really not good. 

In my mind, I wonder whether for the ones that died abused their bodies through excessive alcohol use or they ate cholesterol-rich fast food pre-stroke or it was a case of hospital errors. Who knows. Neither of the studies addressed that issue. Whatever the case, if you're a sufferer of GI bleeding, depending on the origin of the bleed, and if there's no other option, surgical intervention may be appropriate.

I'm reminded of the famous quote:

Into each life some rain must fall. 

Henry Wadsworth Longfellow

And this is my quote:

Sometimes, life is a torrential downpour. With a stroke, life becomes a never-ending tsunami. 

Stroke Survivors: Stay Away--Mayhem, Mishaps, and Murder on Black Friday

I usually write a post about Black Friday this time of year, the marked up and then seemingly discounted products that everyone goes searching for in the malls and stand-alone stores. People are trampled to death, with their bodies stepped on repeatedly that happens in the prodigious crowd. The workers lose any semblance of their "thanksgiving" and the shopping frenzy makes the greedy buyers do what they wouldn't do at any other time of year--mayhem, mishaps, and murder. 

Look at this chart from The Hustle dating from 2006 to 2018:

We don't have this year's numbers, but I bet it follows the same trend, with Walmart having the most notorious amounts of injuries and deaths. 

Cyber Monday doesn't have those problems. This year, more holiday shopping will be done online than in the store. The injury and death count for Cyber Monday? Zero. Fuck Jeff Bezos who doesn't pay a decent living wage to his workers, but as a handicapped person, I'm a hypocritical fan of Amazon Prime.  

Black Friday is no place for the disabled. If you've already gone to stand in those inordinate lines and came out alive and are disabled, good for you. You got lucky. 

Hey! I've got an idea. If you like confrontation which Black Friday already is, why don't you go to a protest instead. Stand up for the Green New Deal, climate change, free college, Medicare for all, healthy drinking water, and there's always somebody who thinks the opposite. At least, if you obey the cops and stay on your side of the "line," everybody wins. 

Warfarin: A Blood Thinner and Rat Poison Shouldn't Be in the Same Sentence

I got a brain bleed 13 years ago and I wasn't supposed to live. I had Protein S Deficiency that gave me blood clots and didn't know it for over half my lifetime until I was diagnosed with a hemorrhagic stroke. The neurosurgeon didn't operate because the chance that I would have survived the operation was zero, having thick and plentiful clots in every extremity. Instead, I was put on Warfarin, another name for Coumadin, and here I am, a decade later.  

A little background first. The only restrictions with Warfarin are too much Vitamin K intake, like lots of kale, broccoli, or leafy green vegetables. The most important thing with Warfarin is to stay consistent. By staying consistent, the doctor knows how much Warfarin to give me through a prothrombin time (PT), a test used to detect a bleeding or clotting disorder and the international normalized ratio (INR) used to monitor how well the blood-thinning medication called anticoagulant is working. I take blood tests frequently and I am stable. 

So how could Warfarin, the wonder drug, and Warfarin, the rodent poison, be related? 

A long time ago, in the late 1920s, the cattle and sheep in North America and Canada were dying from fatal bleeding, blamed on mouldy silage, (a method used to maintain the pasture for cows and sheep to eat later and stored in the silos when natural pasture isn't beneficial, like in the dry season).

The cattle and sheep had grazed on sweet clover, a kind of hay. Hemorrhaging occurred usually when the climate was damp and the hay had become moldy. Tough times in the 1920s meant that farmers could not afford a replacement, so the hemorrhagic disease became known as "sweet clover disease."

There were only 2 solutions, according to veterinary surgeons: destroying the moldy hay and having a replacement or transfusing fresh blood into the bleeding animals which was called "plasma prothrombin defect."  

But everything comes down to money, and even though the farmers were told not to feed the moldy hay, they did not follow the recommendation, and sweet clover disease remained, even a decade later. 

By 1940, Karl Link, a biochemist, and his colleagues came upon a natural substance called coumarin, better known as dicoumarol from the sweet clover and was used as an anticoagulant, albeit an iffy one. The work was fully financed by the Wisconsin Alumni Research Foundation (WARF), who were given the patent for dicoumarol in 1941. 

But in 1945, knowing that dicoumarol was a lengthy process in thinning the blood, Link considered using the coumarin derivative Warfarin as a rodenticide which had the reverse effect--slow bleeding until the little suckers bit the dust. Bleeding in who-cares-about-rodents fit the bill, and the compound was named Warfarin after the funding agency. It was marketed in 1948 as a rodenticide, and warfarin still exists today as both a rodent killer and a blood thinner. 

In 1954, Warfarin became known as the go-to anticoagulant under the trade name Coumadin, and was approved for use in humans and, of course, rodents. But in humans, when there was still too much bleeding, Vitamin K foods reversed the effect. And too much Vitamin K led to clots. That is why I have to stay in the INR range of 2 to 3 when I get tested--above 3 could lead to bleeding and I have to take more Vitamin K; under 2 could lead to blood clots so I have to decrease my Vitamin  K. Thus, I get tested every other week.

The mechanism of Warfarin was not discovered until 1978, when John W. Suttie and colleagues, in an "Aha moment," proved that Warfarin alters Vitamin K by slowing down the enzyme epoxide reductase, known as VKOR, which is highly sensitive to Warfarin, the most commonly prescribed anticoagulant. 

There it is, folks, as easily as I could say it. My trademark is, Know a little bit about a lot of stuff and you'll get by fine.