Nils in S:t Petersburg 2005 (Photo T. Kharitonova)

Who am I? |  Links to my activities | Submit a comment to Nils' blog | Message to Nils

2008, 3rd August

Here I am again after one year, a bit surprised to see that my blog now appears as one of the first hits when I Google on my name. Obviously someone is reading it, which makes my abscence quite embarrassing. My promise today, to myself, is to restart my blog and write a note at least weekly. Lets see if this works. There are many competing obligations. With one 2-year and one 4-year old boy at home my time is divided between work and family (my 10-year old daughter also needs some of my time, checking homework is one daily activity) so reduction of the amount of sleep is the only way out. Many of my email contact will note that my emails are posted between 1 and 2 a.m., a wonderfully silent part of the day.

Right now I am entering the last week of my summer holiday, and I have enjoyed some fine weeks (last week was a break when I was preparing the programme of the Karolinska Stroke Update meeting in November). So when I decided to take some time to look back on my blog, and saw the picture above from S:t Petersburg, my mind went to the new book I just started to read, and its author. I have previously read two books on Stalin (Young Stalin and Stalin- the court of the Red Tsar) by Simon Sebag Montefiore, the productive British historian. The book - by the same author - I am reading now is about Potemkin, the lover, friend and co-ruler of Empress Catherine the Great of Russia. It was in St Petersburg, during Catherine's coups d'état 28th June 1762, one of the famous white nights, Catherine became aware of Potemkin. He came to her help when she was looking for a dragonne, a lanyard, for the sword she had received from a member of the guard when she appeared at the entrance of the Winter Palace. When he was about to return to his position, his horse refused for a short while, and stayed close to the empress, while Potemkin got an opportunity to exchange a few words with the new ruler. If you have not read the book yet, its worth doing.

In November, 16th-18th, the 7th Karolinska Stroke Update meeting will take place in Stockholm. We started the meeting in 1996 for consensus discussions on how recent new research on treatment of stroke should be implemented into clinical practice. From 2008 this meeting is coordinated with the Guidelines Committee of the European Stroke Organisation, ESO. I hope that the programme can be published this week after it has been approved by the Programme Committee.

2007, 10th June

Pain is something you would not wish any fellow human being. But there are situations when this statement is not at all true. Pain can be an important warning signal of a serious problem in your body. And if this signal is lacking, we may underestimate its severity. Let me give an example.

A myocardial infarction, a heart attack, is a very serious condition. Usually (but not always!) it generates severe pain and the victim, or a family member, calls an ambulance immediately. In these situations, there is usually no hesitation. The victim is brought to hospital urgently and diagnosis and treatment starts already during the transport.

A brain infarction, a brain attack, is also a very serious condition. It is unusual, however, that is generates severe pain, and consequently it is common that the person who experiences symptoms does not call an ambulance immediately. Symptoms like sudden difficulty to move an arm and a leg, to speak fluently, a visual disturbance, a a facial asymmetry are often misinterpreted as  a benign condition. In these situations, I would wish that pain was present and sufficiently strong so the victim of the brain attack calls an ambulance at once. If she or he did, we would have a chance to cure the attack, or at least to reduce its consequences. A short period of pain could make the difference between a future life with a disability and to continue life as before.

Since there is no pain, and will be no pain, in most brain attacks, we have a tough challenge to inform and inform again about the warning signs. It is not easy to reach out with a message to the public. We have tried many methods, sometimes with success, sometimes our message is drowning in the media flow.

Some year ago, an email circulated in Sweden, and maybe also other countries, and suddenly I heard that almost every person around me had received this email. All recipients were asked to forward the message to all persons in their mailing lists, and within short it had reached almost every owner of an email account. This was excellent. Only one hook. Many within the risk population of a stroke do not have an email account, so they were missing the information. But their children did, and they can have received the message this way.

The message told that a person suddenly got ill during a dinner, and the other guests called an ambulance. It was later found that the person had a brain attack and the outcome was serious. Obviously the other guests did not understand the symptoms, and wanted to tell others in a similar situation how to identify a brain attack, or a stroke. The talked to an expert (not me) who adviced them to perform the following diagnostic procedure:

If you suspect a stroke, ask the person to hold his both arms straight out in front of her/him. If one of the arms can not be kept in that position, it may be a stroke. Ask then the person to smile. If the smile is not symmetric, it may be a stroke. Finally, ask the person to repeat a sentence, such as 'It as a nice weather today'. If the person cannot repeat this sentence, it can be a stroke.

This diagnostic procedure is of cource not perfect. But we will never find the perfect way of informing and this message is quite OK in my mind. More ideas of this kind are welcome.

2007, 8th June

Summer came early this year, and today the temperature is 31 degrees in Stockholm. In two years time from now, May 26-29, 2009, Stockholm will host the European Stroke Conference. I hope we will be able to greet the participants as warmly.

Last week this conference was held in Glasgow, Scotland, under Chairmanship of Professors Kennedy Lees and Martin Brown, and as usual under close supervision of the Chairman of the Programme Committee, Prof Michael Hennerici, Mannheim. It was an excellent meeting, plenty of very important data was presented and there were rich opportunities to meet with colleagues for informal discussions.

Unfortunately, again two important randomised trials in acute stroke were unable to report positive outcomes. The FAST study, of activated Factor VII for brain haemorrhage, and the DIAS2 study, of desmoteplase, for lysis of blood clots. For both studies, there was an unpleasant (or, rather pleasant) feeling that the neutral outcomes were hiding important effects. Factor VIIa significantly reduced the bleedings, but the study was unable to show that this reduction also resulted in a functional improvement for the patients at long-term follow up. For DIAS2 the control group may have had too mild symptoms and consequently too good prognosis to show a differerence with the treated group.

Lots of investigators and stroke professionals naturally feel a growing disappointment with all these trials which fail to prove a treatment effect. But many forget that we would be able to achieve substantial benefit to stroke patients if we implemented the knowledge accumulated from earlier research. The use of stroke units and thrombolysis are evidence based treatments which are yet only marginally set into practice. We need more research into the mechanisms which accelerate implementation of evidence based interventions.

2007, 7th June

Someone would probably ask me: do you still have time to spend on editing a blog on a daily basis, or almost daily? Of course not. Or - it depends on how you see things.

I recently read a column in one of the free journals they distribute in the Metro. A man complained that too many people were complaining about lack of time. He himself was the CEO of a large company (>1000 employed), he worked 60 hours per week, he fixed breakfast for two kids in the morning, he did the cleaning of the house himself (he said he had a rather big house), he did his part of the cooking. Furthermore he made five training sessions at the gym a week, read a few books and wrote columns (obviously) for a daily journal.

I wonder if all this was true. But if I look at my own agenda, although it cannot compare, I also sometimes wonder if it is true. I also fix breakfast for my three youngest kids every morning, and I put at least two of them to bed in the evening (including reading, washing, put on the pyjama, etc.), I work 60 hours a week, I have only two training sessions at the gym (but I also do some jogging inbetween), I read 3-4 books in parallel, and I usually have a movie ready in my laptop in case there will be a dead moment. So logging in to the blog, and giving an update about the current perspectives could work. But this is only day 3 on this blog's lifetime, and we will see where it ends.

2007, 6th June

Well, I am back. I have to work most of today at home although it is a holiday, the Swedish National Day, June 6. This day has been a holiday only since 2005, and the official national day since 1983. Since 1916 the day has been celebrated as the Day of the Swedish Flag, and I remember as a child and boy scout, when I was parading under the flag in front on His Majesty the King.

What are we celebrating? The coronation of King Gustav Vasa (Gustav I) on June 6, 1523, an event which corroborated the formation of the Swedish nation. Another important event is the approval of the Government Act, a part of the Swedish constitution, which occurred on June 6th, 1809 and ended the Era of the Gustavians (i.e. Gustav III and his less talanted son Gustav IV:s Adolf).

Do we, the Swedes, really need a National Day? We have never been enslaved and there is no great liberation event that fills our emotions.swiss replica watches Is this day only a day for the right wing xenophobic and homophobic extremist groups who wants to distance themselves and the rest of us from all which do not follow their narrow view on what is Swedish? My answer is no. It is important that the National Day is a day we celebrate the good sides of Sweden: Freedom, democracy, tolerance. And our joy to live in such a beautiful country.

2007, 5th June

I start my blog here. I have no idea if this is going to work or not, but anyway, I'll try. Maybe it will help me keep track on what I am doing, for myself.

I am starting this on June 5, a gordious day, my windows are open, its close to midnight, my kids are sleeping. If I come back tomorrow with a few lines, this blog may have a chance. Let's see.