Advances in the Treatment of Stroke
By Andrew Ellsworth, M.D.
Weakness on one side of the body, slurred speech, facial drooping, inability to find or understand words; these are symptoms of a stroke which are typically sudden in onset. The symptoms can be subtle, or they can be severe. Regardless, rapid diagnosis and treatment is the key to recovery.
Not long ago, not much could have been done for someone as they were having a stroke. Often, we could only wait and see how the patient recovered with rehabilitation. For years, prevention was the only tool we had to combat initial and recurring strokes. Preventative measures such as blood pressure control, aspirin or other blood thinners, cholesterol control, and of course, a healthy diet and exercise remain especially important today. Thankfully, we now have a few more options.
Clot-busting medications have been a great advancement in the treatment of strokes since the mid-1990s. If administered soon enough, sometimes these clot-busting medications can work to break up a clot that is blocking blood flow in an area of the brain thus restoring circulation. This can help to preserve or at least minimize the area of the brain that would be permanently damaged.
There are risks to these meds, such as bleeding, but the chance of improving the outcome usually justifies their use. To minimize risks, the clot-busting medication must be initiated within three to four- and one-half hours following the onset of symptoms. Physicians also consider other criteria before treating with clot-busting meds, including the patient’s medical history, blood test results, and they must rule out a hemorrhagic stroke using CT imaging of the brain. A hemorrhagic stroke is when damage is done by a ruptured blood vessel rather than from blockage.
More recently, technological developments have changed the emergent care offered for very severe strokes. It is now possible to manually restore blood flow to the brain using minimally invasive surgery. A surgeon inserts a system of catheters and wires into an artery in the arm or groin, advances this system up through the neck and into the brain. Then, at the location of the blood vessel blockage, the blood clot is removed and the circulation to the affected area is restored.
Highly specialized, this new procedure seems almost miraculous. It has been referred to as the “Lazarus” procedure as it literally brings people back to life and sometimes immediate improvement is noted as soon as during the procedure.
The keys are recognition and time. Know the signs and get help quickly. Think of the acronym FAST: Face drooping? Arm weakness? Speech difficulty? Time to call 9-1-1.
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.
Gout: An Ancient Malady
By Kelly Evans-Hullinger, M.D.
It is a classic presentation: The middle-aged man who develops a painful, swollen, great toe the morning after indulging in a steak dinner with a few beers. The savvy clinician will immediately identify this diagnosis, and I imagine much of the general public might recognize it as well. It’s “The Gout.”
Gout is a unique type of inflammatory arthritis in which a substance called uric acid, accumulating in too-high amounts in the bloodstream, forms crystals within a joint. The presence of those microscopic crystals causes the immune system to attack the “foreign” substance, and the result is excruciating pain. I have seen many a patient limp or be wheelchaired into the exam room when this process occurs in their toe, ankle, or knee. In the most severe cases, patients might be admitted to the hospital.
Gout has been recognized as a disease for many centuries, being described in ancient Egyptian texts in 2600 B.C. and later by the famed Greek physician Hippocrates around 400 B.C. It was once known as the “arthritis of the rich,” and the “disease of kings,” given its propensity to occur after consuming rich food and alcohol. Uric acid crystals were first visualized under a microscope in 1679, during the microscope’s early years, by another famous historical scientist, Antoni van Leeuwenhoek. The chemical composition of what he saw, however, was not known until more than a century later.
If you have had the agony of experiencing a gout attack, know that you are in excellent company. Both Benjamin Franklin and Thomas Jefferson were known to suffer from gout, and historians have speculated that their shared experience led to their strong connection at the time of the American Revolution. In fact, reports have stated that Franklin, unable to walk due to a gouty attack, was carried on a chair into the Constitutional Convention by convicts. Western history and literature are full of references to “The Gout.”
Today, gouty arthritis is a fairly common disease. It tends to affect men more than women, and generally occurs in middle-aged and older adults. Treatment of the acute episode is fairly simple; often we just use anti-inflammatory medication. In patients who have recurrent problems with gout we consider daily medication that lowers the level of uric acid in the bloodstream altogether, which is typically highly effective.
“The Gout” of ancient times was a life-altering condition and as such found its way into many historical texts and literature. Today, well, it’s just gout. And usually, we can treat it very effectively.
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.
When We Know Better
By Debra Johnston, M.D.
Early in the pandemic, I had occasion to page through photo albums my mother assembled during my childhood. Some of those happy images chilled my physician heart. There I was, two months old, sleeping peacefully on my stomach, in the middle of a sheepskin rug.
There I am, seven years later, seated with my siblings on lawn chairs in the bed of the pickup truck as my parents drove us home. We navigated that 15-mile trip multiple times a week for months.
There I am, age 12, grinning from my perch atop a wagon load of corn. On the way home from the co-op, I would ride standing on the wagon hitch while my siblings sat on the fenders.
Bear in mind, my parents seemed especially safety conscious for the time as evidenced by snapshots of us buckled into our primitive car seats. And, when sunscreen was introduced, I remember my classmates basking in baby-oil while I was slathering on the SPF4.
As the saying goes, when we know better, we can do better. That philosophy should apply to us all, throughout our lives.
During my years in medical school, we taught parents to lay their babies down for sleep on their backs or their sides. Now we know better…back sleeping on a firm mattress with a taut fitted sheet and no blankets or teddy bears, presents the lowest risk of SIDS. And, research continues.
Early in my career, we recommended children not be allowed to eat peanut products until at least age two to reduce allergy risk. Now we know better…early introduction to small amounts of peanut butter and other highly allergenic foods is the preferred strategy for most children. Still, research continues.
The history of medicine, and of science, is one of constant research and evolution. Some things we once thought we knew, did not hold up under further objective study. It is critically important that we challenge and examine our options and re-evaluate the way we have always done things. We must expect adjustments and be willing to change when healthier alternatives are revealed.
Obviously, I survived the dangerous situations of my childhood. However, too many children do not. We can never eliminate all risk, but we can, and must, continue to invest in the scientific process, using the best available data to determine the most effective solutions, even to old questions.
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.
Passing the Torch
By Jill Kruse, D.O.
When I was younger my parents would let me stay up late to watch “The Tonight Show” with Johnny Carson. I will never forget when it was announced that he would be leaving the show and Jay Leno would be the new host. I was shocked and upset. How could anyone possibly sit behind that desk and host the show as well as Johnny? My family begrudgingly started watching Jay Leno as he took the stage. The show was not the same, but over time we came to accept the new host and what he brought to the show that was different and new.
Change is difficult for everyone, but change is one of the few constants in this world. The Prairie Doc® organization is experiencing our own version of change after the death of our founder Dr. Richard Holm in March 2020. None of us will ever replace our Dr. Holm with his wisdom and charisma; however, we bring our own unique strengths and experiences to the programs to make them our own while supporting his mission. Dr. Holm embraced change as was evidenced in many of his writings:
“Change is something we all must face in life, and I have observed that those who embrace change seem to flourish,” wrote Holm.
“As the seasons turn, we are reminded that to survive in this life we must face change,” he wrote in his book Life’s Final Season. “Not too long ago, I attended two funerals in one month and wondered how both surviving eighty-year-old men were going to handle the loss of their spouses and all the changes that were about to occur. Usually people need about six months to mourn before they are expected to recover and move on. The standard teaching in medical school is to begin being concerned when mourning lasts longer than that, but every situation is different.”
Referring to the surviving spouses, Holm wrote, “When love is true, (the deceased) would want the one left alone to see change as an opportunity to continue in another way, to find fresh interests, to discover new joy.”
We invite you to join us in respecting Dr. Holm’s wishes as we continue his legacy and accept his challenge to embrace change. His message is clear, “I believe the ability to handle change is like working and stretching a muscle. If you don’t use it, you will lose it. Stagnation can cause rigidity, weakness, despondency and death; but movement can cause flexibility, strength, happiness and life.”
We hope that our loyal audience will continue to watch the show, listen to the radio program, and podcast, and read the newspaper articles or blog posts. The torch has been passed and I, along with the other Prairie Docs and our guests, accept it humbly and graciously. We hope you enjoy this new season as we honor Dr. Holm and continue to bring you useful information based on honest science, provided in a respectful and compassionate manner.
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.