Sample Of One On TPA

We were surprised to see an Instapundit link to the continuing debate over tissue plasminogen activator (TPA) in the NYT.  Big organizations have made their decision:

Stroke treatment guidelines issued by the American Heart Association and the American Stroke Association strongly endorse T.P.A. for patients after they’ve been properly evaluated. But treatment must start within three hours (in some cases, four-and-a-half hours) of the stroke’s onset, and the sooner, the better.  [Emphasis added]

But individual doctors have dissented.  We are about individual rights so we have some sympathy for those doctors.  And TPA only works for certain types of strokes so the properly evaluated in the quote above is critical.  The NYT quotes an example of the dissenters:

At Sierra Vista Regional Medical Center in San Luis Obispo, Calif., Dr. Scott Bisheff, an emergency medical physician, tells patients there is great uncertainty about whether T.P.A. helps or harms. If it caused bleeding in a patient’s brain, the consequences could be catastrophic.

We think the last sentence is stating the obvious but the first is just wrong.  We have a sample of one, Lady deGloves.  About 15 years ago she suffered a stroke.  We got her to the hospital in a timely fashion where she was properly evaluated first by the emergency room physicians and then by a neurologist.  The neurologist came to ask us if we should try TPA.  They called it tPA then.  Our non-physician analysis was that she was 100% incapacitated on her left side with severe speech problems.  When then poked her with needles we jumped but she did not notice them.  The doctor said there were risks but TPA might help.  We thought what does she have to lose and approved the treatment.  They administered the treatment and told us that she would be moved from the emergency room to intensive care.  By the time we met her there our analysis was that she was 00.01% incapacitated.  The next day the physical therapist came in and said there was no need for her services.  The emergency room physicians came to see the miracle.  She needed surgery later to eliminate the arterial blockage.  Now, 15 years later and without any problems, it is beyond obvious that we made the right choice.

We know the dangers of small sample size.  We know that there are risks associated with TPA.  We know you need to get to the hospital FAST

Sidebar: FAST stands for Face drooping, Arm weakness, and Speech difficulties.  The T is for time.  If you are too late you can’t use TPA.  End Sidebar.

when a stoke happens.  Don’t wait or your options are limited.  If they offer TPA after  we would suggest that you take the risk.

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