Too late
It's been a while since I posted something medical, so I thought I'd share a tidbit.
A few weeks ago I saw a patient who was coming in for an urgent visit. There was a phone note from the morning stating that the patient had troubles moving her hand two days ago and could we see her in clinic today. I looked at the chart and saw that this was an 80-something year old woman with high blood pressure and only one thought crossed my mind... STROKE!
A lovely elderly lady walked in with her daughter-in-law translating. She had some trouble with her arm two days ago. It felt numb, and she wondered if she had slept on it wrong. Now there was something wrong with her hand and she couldn't hold a pencil or turn a page. When I checked, sure enough she had a very mild facial droop, her tongue deviated slightly to one side when stuck out, and her grip strength was shot. She most likely had what is descriptively called the "dysarthria/clumsy hand" pattern of stroke because the mechanical aspects of speech and hand control happen to be adjacent in the brain. It was of course too late to change the course of events, but with occupational (fine motor) therapy she might recover some function so I got the ball rolling to have her admitted, confirm the stroke on MRI, medically manage the factors that caused the stroke (her blood pressure), and get her hooked up with therapy.
The daughter-in-law felt understandably terrible and said "if only I'd brought her in yesterday!" and I had to tell her that that too would have been too late. There is a drug that can sometimes clear the clot causing a stroke, a sort of heavy duty brain Drano, but you can only get it within 4.5 hours of the event or the risk of bleeding into the brain is too great. Which is to say -- and I've said it before -- if you or someone you love has a body part that suddenly stops working, please, please PLEASE get to a doctor in time for them to do something about it! Do not drive yourself there. Do not wait in the ER waiting room. Call 911 and take the fast track to the nearest hospital. Time is brain.
My work here is done. Carry on as you were!
A few weeks ago I saw a patient who was coming in for an urgent visit. There was a phone note from the morning stating that the patient had troubles moving her hand two days ago and could we see her in clinic today. I looked at the chart and saw that this was an 80-something year old woman with high blood pressure and only one thought crossed my mind... STROKE!
A lovely elderly lady walked in with her daughter-in-law translating. She had some trouble with her arm two days ago. It felt numb, and she wondered if she had slept on it wrong. Now there was something wrong with her hand and she couldn't hold a pencil or turn a page. When I checked, sure enough she had a very mild facial droop, her tongue deviated slightly to one side when stuck out, and her grip strength was shot. She most likely had what is descriptively called the "dysarthria/clumsy hand" pattern of stroke because the mechanical aspects of speech and hand control happen to be adjacent in the brain. It was of course too late to change the course of events, but with occupational (fine motor) therapy she might recover some function so I got the ball rolling to have her admitted, confirm the stroke on MRI, medically manage the factors that caused the stroke (her blood pressure), and get her hooked up with therapy.
The daughter-in-law felt understandably terrible and said "if only I'd brought her in yesterday!" and I had to tell her that that too would have been too late. There is a drug that can sometimes clear the clot causing a stroke, a sort of heavy duty brain Drano, but you can only get it within 4.5 hours of the event or the risk of bleeding into the brain is too great. Which is to say -- and I've said it before -- if you or someone you love has a body part that suddenly stops working, please, please PLEASE get to a doctor in time for them to do something about it! Do not drive yourself there. Do not wait in the ER waiting room. Call 911 and take the fast track to the nearest hospital. Time is brain.
My work here is done. Carry on as you were!