Wholly Healthy: Stroke

Among the many things that we all fear, stroke has to be one of the worst. Stroke, or cerebrovascular accident (CVA), is one of those medical events that can fundamentally change the way we live. It can affect our speech, our ability to use our hands or to walk, our vision or balance, our comprehension — or any other function that our brains provide.

Around the country we now see myriad billboards and television commercials about stroke. The message seems to be that if you have a stroke and you get to the hospital in time, there is a magic drug that will invariably fix the problem. So I want to briefly explain the ups and downs of that drug. The drug most often used is called TPA (for tissue plasminogen activator), and the class of drugs to which it belongs is called “thrombolytics.”

The idea is that if you have a stroke that appears to come from a clot in a blood vessel in your brain, the drug will dissolve that clot and lead to resolution of your symptoms. We have done this for years in heart attacks, and it works well. It’s medicine mixed with plumbing. Drano for the heart. Or in this case, “Drano for the Braino.” In theory, it makes so much sense that it’s difficult to see the downside. Have a “brain attack”? Go to your nearest hospital and have the pipes cleaned out! (Mind you, it has to be given in three to four-and-a-half hours, depending on the protocol of the hospital where you are treated.)

Nevertheless, for several years this has been a source of great controversy in medicine. A lot of ink has been spilled in the debate, and a lot of research and analysis of the research has taken place. And the answer is that, just like so many questions in theology, it varies with who you read and what you want to believe.

The bottom line is this: Some people in the studies completely recovered from their stroke symptoms. I’ve seen it happen, and it’s grand! However, the research also shows that 1) not everyone recovers from their stroke, 2) some people have dangerous bleeding due to the side effects of the drug, and 3) some people die from the bleeding caused by the drug. Remember, the drug dissolves clots everywhere, not just at the stroke. You can imagine that you might have a leaking blood vessel in your brain, or might already have an ulcer or mild nosebleed. In those instances, serious bleeding can occur with thrombolytics. However, for many patients, the risk is worth the chance to recover their normal lives or to keep from being bedridden or otherwise disabled.

I hope that you, dear reader, never face a stroke. You can reduce your risk by eating a healthy diet, exercising and controlling your cholesterol, triglycerides, blood pressure and blood sugar. But if you do have symptoms, don’t wait around at home. Go to the hospital. Once there, you may well be offered thrombolytic drugs. Talk to the doctor and assess the benefits and the risks of the drug. But go into it knowing that no drug is a magic drug, and that every drug therapy, however wonderful and promising, has inherent risks. And it’s nowhere more true than in the treatment of stroke.

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