Surgery more ef­fec­tive than drugs for stroke

Large study showed bet­ter re­sults than the use of TPA

The Guardian (Charlottetown) - - HEALTH - Dr. Gif­ford Jones

How would you feel if you suf­fered a stroke and were left par­a­lyzed and then later dis­cov­ered that if you had been aware of early signs of stroke, paral­y­sis could have been avoided?

This col­umn might help to pre­vent this tragedy. More­over, the good news is that surgery is su­pe­rior to anti-clot­ting drugs for treat­ment of this dev­as­tat­ing event.

A re­port in the New Eng­land Jour­nal of Medicine shows that surgery, rather than TPA, a clot dis­solv­ing drug that works like house­hold Drano, pro­duces a bet­ter out­come.

There are two kinds of stroke. Eighty per cent of the time “block­age strokes” are caused by a clot that pre­vents oxy­genated blood from reach­ing the brain. The other type of stroke hap­pens when an artery rup­tures de­stroy­ing brain tis­sue.

The time-hon­oured treat­ment of blocked strokes has been to in­ject TPA im­me­di­ately in the hope that this will dis­solve the clot. But stud­ies show it works in only one third of cases.

In an at­tempt to im­prove re­sults, 500 Dutch pa­tients were treated by surgery. This seems like a good idea as most of us know that in­sert­ing a flex­i­ble snake into a blocked kitchen sink may some­times work bet­ter than Drano.

This wasn’t the first time surgery was used, but this large study showed bet­ter re­sults than the use of TPA. Ninety days af­ter surgery 32.6 per cent of pa­tients were func­tion­ally in­de­pen­dently com­pared to 19.5 per cent of those treated with TPA. This is due to the fact that sur­gi­cal clot ex­tract­ing in­stru­ments have im­proved over the years.

But can med­i­cal con­sumers help doc­tors im­prove the re­sults even fur­ther?

First, we must get rid of the myth that strokes oc­cur only in the el­derly. Prof. Valery Fei­gin, di­rec­tor of the Na­tional In­sti­tute for Stroke at Auck­land Univer­sity in New Zealand, re­ports in the jour­nal, The Lancet, that ev­ery year over 80,000 chil­dren and youths are af­fected by this sud­den med­i­cal cri­sis.

Next, re­mem­ber that the first three hours fol­low­ing a stroke are of vi­tal im­por­tance to pre­vent per­ma­nent brain dam­age. So whether you’re treated by TPA or surgery, tim­ing is es­sen­tial, just as it is for treat­ment of heart at­tack.

The next im­por­tant way to pre­vent ma­jor stroke is to un­der­stand that im­pend­ing stroke can some­times be di­ag­nosed be­fore it hap­pens. The warn­ing sig­nal that flashes is called a tran­sient is­chemic at­tack (TIA). It is set off by a de­crease in blood sup­ply to the brain.

Some pa­tients com­plain of a sud­den tem­po­rary loss of vi­sion or dizzi­ness. Oth­ers may no­tice numb­ness of the face, arms or leg. Nor­mally, th­ese symp­toms last from a few min­utes to an hour. This is the time to see the doc­tor so a test can be done to de­ter­mine the cause.

How a ma­jor stroke af­fects pa­tients de­pends on where the stroke oc­curs in the brain and the ex­tent of brain in­jury. In some cases, the di­ag­no­sis is ob­vi­ous when there’s im­me­di­ate paral­y­sis on one side of the body or the per­son is un­able to speak. In such cases, few need to be told to call 911.

In less dra­matic sit­u­a­tions, when un­sure of what is hap­pen­ing to a pa­tient, keep th­ese points in mind. Ask the per­son to stick out his or her tongue to see if it flops to one side. See if he can re­spond to a sim­ple re­quest such as rais­ing an arm. Or can he speak a sim­ple sen­tence? If a per­son fails any one of th­ese re­quests, call 911.

What I find dis­tress­ing about stroke re­ports is that there is never any men­tion that high doses of vi­ta­min C and ly­sine can help pre­vent many of th­ese dis­as­ters. See www.docgiff.com to see the dra­matic change in ar­ter­ies af­ter the use of this nat­u­ral rem­edy avail­able in health food stores.

It’s tragic that the med­i­cal es­tab­lish­ment ig­nores this med­i­cal dis­cov­ery, par­tic­u­larly when the epi­demic of obe­sity and type 2 di­a­betes is caus­ing so many blocked ar­ter­ies.

His­tory may even­tu­ally show this nat­u­ral rem­edy has col­lected dust while doc­tors con­tinue to pre­scribe choles­terol-low­er­ing drugs associated with so many trou­bling com­pli­ca­tions.

Dr. W. Gif­ford-Jones is a syn­di­cated colum­nist whose med­i­cal col­umn ap­pears in The Guardian ev­ery Tues­day. Check out his web­site, www.docgiff.com, which pro­vides easy ac­cess to past col­umns and med­i­cal tips. For com­ments, read­ers are in­vited to email him at info@ docgiff.com. He can also be found on Twit­ter @Gif­fordJonesMD.

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