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Source: Diana Marszalek
415-476-2557
29 May 1998
STROKE VICTIMS ARE NOT SEEKING HELP FAST ENOUGH TO IMPROVE SYMPTOMS
Though clot-busting drugs are available to treat strokes soon after they occur, the majority of stroke victims are not getting the treatment they need to limit the extent of brain damage caused by strokes because they don't seek help soon enough, UC San Francisco experts say.
"The most common reason why people don't get treatment for strokes is that they don't call 911 immediately and ask for help," says neurologist Wade Smith, MD, PhD, assistant director of the UCSF Stroke Service, part of UCSF Stanford Health Care.
In addition, not all hospitals have full-time staff with the expertise to administer the treatments. UCSF Medical Center, Stanford University Medical Center and UCSF-affiliated San Francisco General Hospital are among a few Bay Area emergency medical centers equipped to administer the drugs 24 hours a day. Though strokes hit suddenly, they are rarely painful, meaning people often wait to treat their symptoms in hopes they will go away. But people who don't seek immediate help lose the option of treatments that could reduce the damage caused by stroke, because some treatments are effective only within three hours after stroke occurs, experts say. Though relatively new, drugs that break up blood clots in the brain, which cause 75 percent of strokes, are widely available, says UCSF Stanford Health Care neurologist S. Claiborne Johnston, MD.
One drug, called Tissue Plasminogen Activator, or TPA, has the potential to reduce significantly the severity of stroke symptoms if administered within three hours after strokes occur, Johnston says. Other drugs currently under study - including other clot-busting drugs and brain-protecting drugs that paramedics could administer - also offer promise, experts say. In some cases, drugs such as TPA can make a big difference in a person's recovery, Johnston says.
Tom Lee (a pseudonym) is one such person. A 28-year-old San Franciscan, Lee suddenly lost his ability to speak clearly and stand on his own when he had a stroke while having lunch with a friend in March. He rushed to UCSF Medical Center, where he was treated immediately with a clot-busting drug called Urokinase. Today, Lee is walking well, has regained his ability to think clearly and is looking forward to going back to work as a consultant. Yet although Lee, and others like him, may be doing well, the clot-busting drugs are not widely used, Johnston says.
Many stroke victims simply wait too long to get treatment, even when they experience common stroke symptoms such as the sudden onset of weakness or numbness on one side, trouble speaking or understanding and balance problems, Johnston says.
That, Johnston says, is why it's essential that people learn to recognize the symptoms of a stroke, which is the third biggest killer and the No. 1 cause of disability in the United States. They also need to know where to get help should they need it. Though more than 70 percent of stroke victims are age 65 and over, anyone, at any age, who experiences a sudden change in the ability to speak or think clearly, no matter how subtle, may have had a stroke. Stroke victims also may experience a sudden change in the ability to walk or use one-half of their body.
About 550,00 patients experience a stroke each year. But there are steps people at-risk for strokes can take to prevent them, Johnston says. Controlling high blood pressure is the single biggest step people can take to reduce the risk of stroke, he says.
Exercise also can be a key factor in decreasing the risk of stroke, even for stroke survivors who want to avoid another one, says Gregory W. Albers, MD, a UCSF Stanford Health Care neurologist and director of the Stanford Stroke Center. Regular exercise can lower pressure, reduce cholesterol levels and promote weight loss, all of which increase the risk of stroke, he says.
But if a stroke does occur, getting treatment fast is an essential part of improving chances for recovery, experts say. "If a patient decides to try to sleep it off, they are not going to be eligible for any form of treatment," Smith says. "They need to call 911." May is Stroke Awareness Month.
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