Luke Perry and Strokes

Actor Luke Perry Died today after suffering a “massive stroke” on February 27. I was alerted by Megan, my 39-year-old niece. She enjoys reading her local Crime Blotter (and posting funny entries she sees), and she, her dad, and I have a text group where we try to scoop each other on reporting about someone interesting who died. Now and then, I even get a good Honorary Unsubscribe out of it.

Perry in a 1990 publicity shot, when he scored a leading role on Beverly Hills 90210. He is also known for the show Riverdale.

When I saw it was a stroke, and that the former teen heartthrob Perry was only 52, I commented back, “Keep tabs on your blood pressure! Even at your age.” I don’t know if hypertension was behind Perry’s stroke, but that’s by far the most common risk factor.

Her reply surprised me: “I’m already on meds for it!” We chatted about it, and she said she’s been on such drugs for several years, at a very low dose. Her doctor tried taking her off the drugs and her BP popped up again, so back to it.

Yes, someone who is only 52 (or even 39) can have a stroke. In fact, even young children can and do have them too. It’s tragic, and mostly preventable: stroke is the #1 preventable cause of disability.

I asked Megan if she monitored her blood pressure at home. No… and could I recommend a worthy monitor? She mentioned the kind that go around your wrist, rather than the upper arm. Yes, those actually do work, but I’m a little dubious as to how accurate they are. In fact, I’m a little dubious about the accuracy of all of the automatic ones. Me, I use the tried-and-true manual cuff and my Littmann stethoscope, but yeah, they can be a hassle to use, especially on yourself. But either automatic type is probably “accurate enough” for home use. If you wonder, just take it with you next time you go to the doctor, and have the automatic one take your BP on one arm while the nurse takes it on the other, and see how close it is.

Diagnosing in the Field

Of course, this reminds me of one of my ambulance calls.

We were paged out to a house near us just after breakfast, and when I arrived I realized I knew the patient, which quickly put him at ease. “What’s going on, Bob?” Well, he said, as he was getting dressed, he noticed his hand wasn’t working. He couldn’t move his fingers, grip anything, etc. It’s almost all cleared up now, though….

He held up his hand and wiggled his fingers, and they all worked, except two were not as agile. As I checked him out, one clearly improved. It was a few years ago and I have no recollection of his blood pressure, but he was perplexed by this symptom. I wasn’t: I did stroke tests on him, and everything was negative except for his hand. My intuition still said “stroke,” though, so I told him I did think it was, and I strongly advised him to go to the hospital. He trusted my experience and agreed. I found out later that he had been admitted, so clearly something was wrong.

The next morning Kit and I happened to be scheduled to donate blood at that same hospital, so we went a little bit early and stopped in to visit him. Bob said I was right: scans showed it was a stroke, and by the time he got to the hospital, other stroke symptoms were starting to appear. Thanks to him getting to the hospital in the early stages, they were able to not only stop it, but completely reversed all of his symptoms. So much so that he was just finishing getting dressed because he had been discharged, and he was able to walk out, perfectly normal. He was extremely grateful for my advice.

They used tPA on him: tissue plasminogen activator. It’s a natural enzyme that breaks down blood clots, and they can make it in the lab and use it as a drug for strokes. Get rid of the clot, and blood flow resumes to the oxygen-starved parts of your brain, hopefully before permanent damage sets in.

Not all strokes can benefit from tPA; giving it to someone having a hemorrhagic stroke (bleeding into the brain, vs an ischemic stroke, where a blood vessel in the brain is blocked) can kill them, so it’s not likely medics will be carrying it in ambulances anytime soon. But when it does work, it works best if it’s given very quickly, before the stroke has time to do permanent damage. Second best: reducing the damage, so recovery is much faster.

“Brain Attack”

In 1990 the American Stroke Association proposed renaming strokes (or “cerebrovascular accidents” — CVA) to “brain attack” to emphasize how serious they are (just like a heart attack), and that quick care can save lives and reduce disability (just like a heart attack). It hasn’t caught on, but the medical profession takes them much more seriously now than when I was a young medic in the late 1970s.

How to Spot a Stroke FAST, from the American Heart Association. Click to make larger, then drag it to your desktop so you can read it all in full size.

That’s likely because there is now a way to treat them: tPA, but it only really helps in the first few hours after “last normal.” But the urgency has led to some good public education, promoting “FAST” — a mnemonic for Facial droop, Arm weakness, Speech difficulty, and, if you see any of those things, Time to call 911 for an ambulance. (For medics, we use T to mean two things: what was the last Time they were seen to be normal, to help decide if tPA can be used, and that Time is of the essence: don’t screw around once you’ve diagnosed a CVA, get going!)

Another one tries to one-up that: FASTER changes the T to Talking (can they, as usual?), adding the E to look at the Eyes (do they look normal?), and then the R is React — call 911. Either way, read up on it before you need to use it! If in doubt, just call 911 and let us do it. We have training for more sophisticated tests if there are doubts.

Prevention is Better

Just like heart attacks, prevention is a lot better than trying to treat a stroke after the damage is done. Hence the emphasis on the primary risk factor, hypertension — high blood pressure — and keeping it down. Which, by the way, also helps prevent heart attacks.

In 2017, the American College of Cardiology, in association with the American Heart Association, put out new guidelines urging doctors to treat blood pressure higher than 130/80, rather than the previous starting point of 140/90. The higher it goes, the greater the risk of heart and brain attacks.

That’s why I directly tell my patients with high blood pressure that they need to act: since they can’t feel high blood pressure, they tend to ignore it. “Trust me,” I tell them. “You really don’t want to have a stroke.” According to those new guidelines, nearly half of all Americans have hypertension. It’s a big deal — and no wonder we have so many CVAs and myocardial infarctions (aka, heart attacks).

Recommendations

Which loops us back to Megan realizing that she should have a blood pressure monitor at home, so she can keep an eye on it. I looked at Amazon to see what is highly rated.

A typical home automatic blood pressure monitor. Make sure the cuff is snug, but not super-tight, before you push the button.

You have to be careful when looking at ratings. One had the perfect 5 stars! That consisted of ten 5-star ratings, and every one of them looked suspicious to me, like maybe the seller had gotten a bunch of friends or employees to buy one and put in a “Verified Purchase” review gushing about how great it was. They just didn’t strike me as genuine, so that one was dropped out of my search.

Amazon’s best-seller, the Omron 5 (which goes around the upper arm), has as of now 8,136 customer reviews, with an average rating of 4.2 stars. That’s more like it! It’s $40, and as I write this there’s a 10% off coupon.

For wrist-based monitoring, the leader on Amazon seems to be iProven, which comes in two main versions: stand-alone ($28), and one that talks to an app on your smartphone (slightly higher), presumably keeping a record of measurements that you can show to your doctor. Together, they have 380 ratings (probably enough) averaging 4.3 and 4.4 stars, respectively.

Don’t Screw Around with high blood pressure. Get it checked no matter how old you are. Ask any medic, or a friend with a monitor, if you don’t have one and aren’t already seeing a doctor soon. If it’s higher than 130/80, get an appointment and get it treated. Trust me: you really don’t want to have a stroke!

24 March Update

In the comments, several (including my niece, who is the one that got me started on this topic) noted that “newer models” of the wrist-based monitors are indeed accurate. I went ahead and ordered the one I linked to, and yep, I’m convinced it’s reasonably accurate. Funny thing, though: I linked to a “regular” one, and also another slightly more expensive model that has Bluetooth to link to a smartphone app. Amazon says the latter is “currently unavailable” …but that’s the one they sent. Go figure!


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25 Comments on “Luke Perry and Strokes

  1. For what it’s worth, I had a visit this afternoon to my doc, and she said she has done a ton of tests with a wrist cuff and hasn’t seen any discernible difference between it and her usual stethoscope check, especially with the newer models.

    I’ll bet the key is “newer models” — I’m sure they’ve improved over the years. -rc

  2. I had 5 ischemic strokes after an angiogram through the wrist 3 years ago. It has been long road but I’m still hanging in there. I had high blood pressure under control but I had to find a new cardiologist because my old one disappeared with all my records, I had 2 stents from earlier.

    So that is why he did an angiogram to see what he was up against, but this was the first time he went through the wrist … And 3 days later 5 strokes, I am still alive and getting around so that’s good, just that the foot droop is tough. Do not take high blood pressure or family history for granted. Okay my arm’s tired … Thanks for letting me vent.

    Sounds like you got more than your share! -rc

  3. Consumer Reports gives their highest rating (85) to the Omron 10. They don’t rate the Omron 5 as high giving it a 70 and it’s not on their list of recommended models. But hey, 8,000 users probably are not wrong.

    I often see fake reviews on Amazon. Often they can be spotted because they just paraphrase the company promo paragraph. Sometimes they don’t even bother to paraphrase and just use copy and paste.

    I lost a lot of respect for Consumer Reports (I was a long-time subscriber) when I bought a number of things on their recommendation …and thought they were terrible. I do better with carefully checking the reviews on Amazon. But yeah, Amazon really needs to do something not only about fake reviews, but fake (counterfeit) products. -rc

  4. I’m an occasional shopper on NewEgg.com to buy computer equipment. They use a similar five star review system and one thing I really like about their web site is you can sort items by *number* of reviews. That tends to put the most popular one on the top and you can see which one gets better ratings and choose that way. I wish Amazon would set up sorting like that.

    With Amazon, I like to look for the “best seller” tag and sometimes if you click on that tag you can get a list of all the best sellers in that category which can be helpful.

  5. There is an extension you can download called Fakespot that will let you know the “fakeness” of ratings on any site. Works great and is fast. Add the extension to your browser and you are ready.

  6. I have an Omron 10 series (BP786N) and it has bluetooth connectivity to my smartphone and the Omron app. I like how it will graph the readings for the last week, month or even year. It is twice the cost of the 5 series, but very convenient when at the doctor’s to pull up the history.

  7. I have an Omron 3 (I think it’s the 3 – model #BP710N), another upper arm model with fewer bells and whistles, which works fine also. It replaced my previous Omron, which I had bought in the 1980s, and was still working, but was substantially slower and noisier than more modern machines.

    I didn’t have much luck with the wrist machine I tried, but that might have been just as long ago, and they probably have improved a lot. I know people who have very large upper arms and have trouble with the arm units, and use the wrist ones successfully.

  8. It also pays to check with your health insurer. If you have high blood pressure (as I do — marginally high, controlled with drugs), some will actually give you a blood pressure monitor. Mine is an Omron BP742N — it doesn’t say, but it is apparently in the Omron 5 series. Works just fine.

    Good tip! -rc

  9. Regarding fake-looking reviews, check out reviewmeta.com and fakespot.com. Both will take a link from places like amazon and analyze the reliability of the reviews, giving you an adjusted score (reviewmeta) or a grade on the ratings (fakespot).

  10. Hi from the U.K.

    My GP actually recommend the Omron. I have been using it daily since diagnosed with high BP.

    After mucking around for a few months with various treatments we settled on Valsartan as it is not a Beta Blocker and would allow me to continue SCUBA.

    Early diagnosis, early treatment… Normal life!

    It would have been simple to ignore the symptoms as I just didn’t feel “quite right” but was bullied into seeing the doctor. Very glad I did.

  11. Nearly six years ago, I had a brain bleed. I had no idea I had high blood pressure. I was lucky that it occurred in the cerebellum. It’s left me with permanent vertigo and I walk like a “drunken sailor!” Twelve days in the hospital. I feel blessed that I can function normally and continue to work. Plus, no more expensive theme parks — just look down and turn around and spin better than any roller coaster!

    • Love your look down and turn around comment. I’ve been on a batch of heart meds for a couple of years and now I am a bit dizzy with needing to drink a pint or two. Vertigo is on the list of expected side effects and it’s so nice to know it’s expected and not some kind of medical mystery. I don’t really miss beer, wine, or whiskey all that much… oh hell; yes I do.

  12. Thank you so much for the info. I too have had HBP for years and take meds, but don’t take it very seriously like I should. I take the meds every day but just not that worried about it. I need to get a monitor and these two on here are good to know. I have been wondering what kind to get.

  13. I bought the Omron 5 a year ago when my BP shot up due to stress ~ which included the medical community not dealing with the basic cause (allergic response to new environment) but getting caught on my BP. I’m still on the edge, so monitor diet and exercise. No meds yet. Your into is priceless, based on experience and alertness. Thanks, Randy!

    Hey, if nothing else I have to keep my readers healthy so they can keep reading! 😀 -rc

  14. My older brother had a stroke when he was a teenager. It was not diagnosed as such at the time and went untreated. No hospital or doctor checked him out, he just got home from where he was and went to bed for about a week. It wasn’t until he had a massive stroke 5 or 10 years later that the docs determined it had happened before. He was not expected to live but pulled through with some loss of vision and speech. All this was back in the mid to late 1960s. I don’t know if there is any earliest age limit on being susceptible for a stroke.

    Strokes can happen in infancy, but happily that’s quite rare. -rc

  15. Strokes are very serious indeed. My Mother had one on a Saturday morning. A big one. I recognized it immediately and called 911 instantly. She got tPa too, but unfortunately, it did not save her life. She lost her speech and later her cognizance. She had apparently been having small strokes for some time, unbeknownst to her, me or her doctor. She continued to have them and I lost her 4 years later. The worst 4 years of my, or her life. I miss her still.

    She was on HPB meds all along and I made sure she took all her meds every day.

    Yep, tPA can’t save them all, even if administered quickly. Strokes really suck, especially the bad ones. That’s why I emphasize “you don’t want one” to my patients when they’re hypertensive. Thanks for telling your story. -rc

  16. Please explain how a stroke differs from a TIA. I worked with a lady who kept having TIAs. As far as I know, nothing was ever done about them, even though she’d already had an untreated stroke that wasn’t recognized as such until weeks later. We also had a hard time convincing caregivers that she was having TIAs as they showed up as nonsensical talk. They weren’t English speakers & didn’t realize what was going on.

    A transient ischemic attack is essentially defined as a small stroke that fully resolves within 24 hours. The loss of blood flow (ischemia) is “transient” (enough short-termed) so that it doesn’t create tissue loss (an infarct). They are often seen before and after full-blown strokes, and are a sign that something is wrong and treatment(s) should be considered. Like what? Blood pressure medications, sometimes blood thinners, and more. That said, some patients ignore them even knowing the possible outcome — typically older and/or less healthy folks that feel like they’ve lived long enough. I do know people like that, and respect their wishes. (And if they feel that way, I suggest they have a “Do Not Resuscitate” order not only signed, but immediately available to medics when they arrive if someone calls 911. Too many forget that second part!) -rc

  17. As always, thank you for the insight and in this case the recommendations for testing apparatus. As a person with high blood pressure I will definitely be looking into the options you listed (though a quick glance at the wrist one that connects to bluetooth indicates they might not be getting that one again, which is a bummer because I liked the connectivity concept). I certainly don’t want to end up in the “dead too soon” category, especially over something I could potentially control.

  18. There are other reasons for strokes, one of them is blood clots. I knew that there was a family history of blood clots and strokes on my maternal side — my grandfather had massive strokes (was totally paralized at age 61 and died after the second one at age 65), and my mother had heart attacks caused by blood clots at age 68 (she died when blood clots hit her lungs at age 69), but I did not know the extent of my own danger. (I actually have rather low BP as a general rule.)

    In Oct 2018, I noticed dark spots in my field of vision in my right eye, which turned out to be blood from leakages caused by blood clots in my retina. Surprise!!! Early that same week, I had a complete physical with my internist who found nothing wrong with my blood work. The retina specialist sent me immediately to a hematologist who took one look at my recent blood work and found a major issue with an anti-clotting factor. Turns out I have Antithrombin III Deficiency, which is a genetic defect that probably caused the deaths of my mother, grandfather, uncles, and several cousins. I had blood tests for 63 years before someone finally noticed that there was a problem. I am now on blood thinners (for life), and am still being treated for the bleeding in my right eye. That retinal bleeding was a well disguised blessing for me because it did uncover what could have been a very damaging or fatal condition.

    I did indeed indicate there are other causes: “I don’t know if hypertension was behind Perry’s stroke, but that’s by far the most common risk factor.” There are certainly more.

    My guess is that tests for Antithrombin III Deficiency are fairly recently available — at least at a cost where they can be done routinely. I checked my blood work (I keep a spreadsheet so I — and my doctor — can see trends over time), and don’t see a test for it, so it may not be routine even today. But clearly someone was smart enough to order one for you …but not attentive enough to look at the test results! Glad someone caught it before you had worse problems. -rc

  19. I use a wrist cuff. It’s important to take it along to the doctor (actually it’s important to do this with any new BP monitor) when you go. They take your blood pressure, then you get yours out and take your blood pressure again. Compare! My doctor was delighted when I did this and wished everybody did.

    I’m told that there is often a five point difference when you take your pressure at the wrist. This was true in my case, with two different wrist cuffs. If my pressure reads 95/65 at the wrist, then it is really 100/70. (yes, at 68 that’s really my blood pressure)

    Definitely a good BP to live with. Still, the only way to know whether your cuff is accurate or (say) 5mm off is to test it. It is smart that you did, so now you know. -rc

  20. My wife had strokes and it had nothing to do with blood pressure. She was a smoker.

    Definitely another significant risk factor. -rc

  21. Sugar and wheat are 2 things in the standard American diet that lead to inflammation, causing strokes in individuals with that propensity. You can see a drastic reduction in pressure by eliminating them.

  22. As a Respiratory Therapist for 45 years I have taken a lot of blood pressure readings in a lot of different settings from hospital to clinic to patient homes. For on the road in home use I found the wrist BP monitor to be really convenient. It was compact, easy to carry, and one device fit anybody with arms except infants and small children. When I used the traditional upper arm model I carried 3 cuff sizes and still had a few patients with too large or too small arms. At first I was skeptical of accuracy and did many comparisons of the wrist model to the traditional cuff but soon left the cuffs in the office. It is important to hold the wrist model at the level of the heart or readings can be inaccurate. Many models have an indicator light when held at the correct height. I used an Omron BP652 Wrist Blood Pressure Monitor on the job for a few years before I retired. I think it was $70 several years ago but I have since seen it on sale for $50. If used correctly, which is easy to do, there is no concern about accuracy.

  23. In my (limited) research, I was looking for a BP monitor that had associated computer software with which I could keep a running record over time without the need to connect to the “cloud” (I don’t do “cloud” and I don’t have a “smart” phone). I’m referring to years rather than just a couple months or less. The only one I could find is the MicroLife, available online and at most local drug stores. (I got mine at Costco.) It’s not expensive and it’s fairly accurate, and it allows one to bring a long-term chart printout to one’s doctor to discuss trends. And I’ve never had it overinflate and cause discomfort. In contrast, the ones I have been hooked up to at the ER have gotten uncomfortably, almost painfully, tight, more so than any doctor using the old fashioned manual type.

    And IMO, there’s no reason for that. They can “hear” the pulse going up, and “know” when it stops — that’s the systolic. Go up a little more to ensure there is no fluke, and done. That’s how the wrist cuff I got works. -rc

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