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We are Number One!
Just at the height of the college football bowl season, January 1, 1999, when the nation was waiting to see who would end up as number one, there was a most disturbing front page headline in Post and Courier that morning.  The headline, "S.C. Leads in Stroke Fatalities," naturally caught my attention since this is the fourth column in a series on Stroke in the Seabrooker.  It seems that the timing and importance of this topic are especially relevant to the Palmetto State.

There was a subtlety to the Post and Courier story that actually came from data released by the American Heart Association.  The report deals with age-adjusted mortality, not the true incidence of stroke.  This, of course, is even more worrisome since it turns out that S.C. doesn't have the highest incidence of stroke, but we are more likely to die from it than any other state.  Why is this so?

The answer to this question is complex and truthfully probably unknown: are our strokes just more severe, are we slow to seek medical care, or is our medical care of stroke inferior to everyone else's?  Clearly, Seabrookers cannot answer these questions for the entire state, but there are some lessons here that we should learn that relate to us and our friends on this lovely island.
   
What you should do
The single most important thing that a stroke victim or his family can do is act swiftly. Time is of the essence.  You have three hours from the first onset of symptoms until the most innovative therapy is no longer helpful.  In the October Seabrooker we listed the signs and symptoms of a stroke or "brain attack."  The hallmark of a stroke is the sudden onset of one-sided neurologic dysfunction, slurring of speech or unexplained dizziness.  Headache and change of consciousness are not always, and often not, present. 
 
If these symptoms appear it is vital to call 911.  We are fortunate here on Seabrook to have a very rapid response time for the well-trained EMS personnel.  They will continue the so-called "seven-step stroke chain of survival and recovery"(see table) that you have initiated.  The aim is to accomplish all these steps in less than three hours.  Note that one step that the American Heart Association and other physician groups omits is "calling your own personal physician."  It has been shown in a number of clinical studies that trying to reach a doctor wastes precious time when dealing with a stroke.  Do not call your own doctor if you think you are having a stroke.
 
The EMS system alerts the hospital where diagnosticians will be mobilized to make a quick diagnosis.  This will almost always involve a CT scan to help determine the cause of the stroke, hemorrhage or arterial occlusion.  Definitive therapy depends on proper differentiation of these two causes.  The relatively new "clot buster, TPA," might be indicated in strokes caused by occlusion, but is only effective if given within three hours of the onset of symptoms.  Emergency surgery may be indicated in hemorrhagic stroke, and again, often the earlier the intervention the better the chance of recovery. 

Age alone is an enormous risk factor because for every decade you live beyond age 55 your stroke risk doubles!  Thus each of us has an increased risk of having a stroke the longer we live.  One unexplained and potentially mortal or debilitating mistake regarding stroke is that women tend to wait longer to get help and once they arrive in emergency rooms they aren't diagnosed as quickly.  This is thought to be a result of a public and even professional misperception that stroke afflicts men more than women.  The clear lesson is that male and female Seabrookers alike need to act promptly if they develop sudden symptoms of stroke.  We can do our part to get off the number one ranking!
 
Stroke Chain of Survival and Recovery (7D's):

1. Detection - note the onset of signs and symtoms
2. Dispatch - call  911 and have EMS dispatched immediately
3. Delivery - transport patient to hospital with assessment and care
4. Door - immediate emergency department triage
5. Data - prompt laboratory and CT diagnostic studies
6. Decision - diagnosis and decision about appropriate therapy
7. Drug - administration of appropriate drugs or other intervention

Source: American Heart Association - Acute Stroke

MUSCHealth.com Online Health Library Related Links:
Treatment for Stroke

Other Online Resources:
Medline plus Stroke Treatment Information
American Stroke Association

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