Baby Strokes

One of our favorite guilty pleasures is the tv show House because the program is about the unusual rather usual diseases. If House is your doctor he'll get to your problem and will save your life when all other doctor's will leave you for dead because it's not medical protocol. Dr. Gregory House looks for zebras when all the other doctors only look for horses, to paraphrase the old joke - when you hear hoof beats think horses not zebras! When we're sick we want a doctor who will find the answer regardless of standard medical protocol.

Number one (1) cause of death to children under the age of fifteen (15) in the nation from 2006 data is accidents. The number is four (4) times greater and any other causes. The number two (2) cause of death is assault (homicide) followed by heart diseases in the number three (3) position. According to the Center for Disease Control and Prevention (CDC).

Dr. Rebecca N. Ichord, director of the pediatric stroke program at Children’s Hospital of Philadelphia, who continues to be deeply involved in Jared’s care, said that while conditions like migraines and poisoning could cause similar symptoms, “front-line providers need to have stroke on their radar screen as a possible cause of sudden neurologic illness in children. Dr. Heather J. Fullerton, a leading pediatric stroke researcher at the University of California, San Francisco, was even more emphatic. “When a child comes into an emergency room with strokelike symptoms,” Dr. Fullerton said, “it should be considered a stroke unless proven otherwise.” (New York Times)

Every hospital isn't highly rated in healing strokes of any kind. We suggest a HOUSE type of hospital with a unit designed specifically to care of a patient suffering from a stroke.  In the District of Columbia if you're a resident or visitor you'll want to be take or have someone take you to one of the three hospitals that offers the best care available for you or your loved one. They are in no order of importance: Georgetown University Hospital, The George Washington University Hospital and/or Washington Hospital Center.

These all received the Joint Commission the Gold Seal of Approval. Their are a choice of seventeen (17) hospitals and medical centers for Maryland. Their are a choice of nineteen (19) hospitals and medical centers for North Carolina.  Their are a choice of eighteen (18) hospitals and medical centers for Virginia.

We know the warning signs. Unfortunately they seem so normal that unless you've experienced some major discomfort the signs are too easy to ignore. Hospitals often ignore the signs as well unless you're unlucky enough or rather lucky enough to suffer a stroke while on a monitor - to many times the indicators are missed.

Stroke Warning Signs
If you notice one or more of these signs, don't wait. Stroke is a medical emergency. Call 9-1-1 or your emergency medical services. Get to a hospital right away!
* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
* Sudden confusion, trouble speaking or understanding
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness, loss of balance or coordination
* Sudden, severe headache with no known cause (American Heart Association AHA)

One other thing the time you choose to go to the hospital could save your life.

"In two separate studies, one in the United States and the other in Australia, investigators found possible significant delays when doctors’ offices were called first. Calling an emergency number or an ambulance is the quickest way to reach a hospital within the three-hour window of opportunity for acute stroke treatment that can potentially avert serious post-stroke disability."(AHA)

While you're on your way to the hospital, and because you're reading this now instead of after the fact, keep some wild blueberry juice in your refrigerator. Not grape juice but the expensive variety of wild blueberry juice frozen if you've got it. Wild blueberries are available only from Maine or Canada. In animal trials since 2002 with rats wild blueberries appear to have health benefits being verified by research that now include human subjects. Yes, the studies have been small but consistent. As we always say - It couldn't hurt!

Death Attacks

Yesterday the stories(1)(2)(3) were on race and aftercare cardiac survival rates and how Blacks do worse than Whites according to the most recent research published in the Journal of American Medical Association (JAMA). HealthDay included a link to the American Heart Association on cardiac arrest which includes the information that: "No statistics are available for the exact number of cardiac arrests that occur each year. It's estimated that more than 95 percent of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden cardiac arrest is as high as 30–45 percent."

Twelve (12) percent of five (5) percent doesn't seem significantly important except if you beat the odds and make it to the hospital you're a part of the five (5) percent. However it ain't over and surviving to receive care isn't the end whether you're Black or White. You're still likely to perish as a result of what ever created your cardiac condition. The difference isn't in your color but in what hospital you select - which for many is a matter of your skin color.

"Racial Differences in Survival After In-Hospital Cardiac Arrest" When the article refers to the National Registry of CardioPulmonary Resuscitation (NRCR) for their research using hospitals affiliated with the registry we immediately sought to get a local lists. Unfortunately such a list isn't available from their website but what is listed is their original research on Cardiac arrest in the Emergency Department: A report from the National Registry of Cardiopulmonary Resuscitation which refers to a link to a second (PDF) two (2) page report also links to a third report which concludes: "What does this mean to your facility? Patients who suffer a cardiac arrest in the ED are a unique population having better survival to discharge compared to patients arresting in other hospital locations. As ED location was an independent positive predictor of survival, further analysis of process variable such as personnel, training, and frequency of practice may identify opportunities for improvement."

The linked research concludes: "ED CAs have unique characteristics, and better survival and neurologic outcomes compared to other hospital locations. Primary ED CAs have a better chance of survival to discharge than recurrent events. Traumatic ED CAs have worse outcomes than non-traumatic CA."

We included the video reports here for your own edification. Most edifying are the additional comments by Dr. Chan on the issue of race abd treatment excluded from the main report but a part of the official "B" roll. The comments follow one after the other.

Non Emergency Emergencies

When Aunt Pearlie complained of a backache we though maybe some Doan's pills and she'd be back on her feet and eating again. She knew the problem was much worse but we didn't so we delayed treatment. If the experience taught us one thing is that for family, including ourselves, who are afraid of hospitals and dread emergency rooms (ERs) and non-urgent care center in the mall or shopping center is a good send. Some are over crowded because of their limited hours and specialities but may are crowd free. Taking a family member there while out and about or in lieu of a hospital might be a better alternative. If the situation is at all serious an ambulance from their gets you far ahead of the line than a standard ER walk-in (this is only our anecdotal experience however). According to the latest report in the news (Bloomberg, Reuters, US News & World Report) which miss reads the facts "retail clinics" are a good choice for sore throats, earaches and urinary tract infection. Here's what they actually say according to the editors of Annals of Internal Medicine: "Little is known about retail clinics in the United States. Contribution - The investigators found that nearly all U.S. retail clinics offer care for common symptoms (such as sore throat and cough), immunizations, and routine screening tests (such as lipid and glucose levels). Most are in urban locations, and about half are in 4 states. The investigators estimate that one third of the U.S. population resides within a 10-minute driving distance of a retail clinic. Caution - The findings apply only to retail clinics operating in 2008. Implication - About one third of the U.S. population resides near a retail clinic that provides basic acute and preventive care."

While some Clinics use residents rather than interns physicians we are of the "doctor is a doctor is a doctor" school of medicine in that unless you can get in to see your doctor when you want to see your doctor without a substantial wait time you don't know what you're going to get from the ER or the hospital when you walk in. Again just using our own experience we've had ambulances called from clinics where the doctors live by the "don't sue us school of medicine" where over care is better than under care any day. Our own physicians have never called an ambulance for us (again our experiences are all anecdotal) so your mileage may vary.

Emergency Life

While searching for the same heart attack prevention drug we discovered from the same University of Sheffield their research on improving emergency room outcomes. "New research seeks to reduce patient deaths in UK emergency care services"

Great but isn't that what every emergency room should do and does do? We yes and no - the difference is according to U of S is that: "Current crude comparisons of outcomes like mortality ignore the construction of the system, the type of population the system serves and the way patients use the system. Any attempt to compare the performance of a system must use a robust and reliable method for adjusting for differences and the way the service is used".

We're going to keep our eyes focused on their website and research as their "Sheffied team to undertake research into Swine Flu that will contribute to the Government´s response to the virus in the coming months." It's the British government but better is better and currently regardless of what you've heard of TV the poorest brit is healthier than a much wealthier American.

When you see items like this at their website it impossible not to smile and feel comfort that someone is doing what needs to be done and that an answer is coming or being sought. Especially when you read this: "To improve older people's lives through better assessment and response to their health and care needs".

Their research is our raison d'etre (reason to exist).