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.
We just got back from a long weekend trip. When you are retired long weekends can show up whenever you feel like it. Here are four observations from the trip.
- We forget the bar’s name on US 75, but it has a tag line of, “We only look expensive.” We wish we had time to stop because the drinks might have been free to have the tag line balance out.
- We recently left Topeka. We are trying to decide if Brown v. The Board of Education is a great decision or the start of wandering away from the Constitution. It is not our area so you can discuss it among yourselves.
- In one day we crossed the following rivers: Iowa, Kansas, Mississippi, and Missouri. A nice day’s drive.
- Here are a few scenes from a mid-continent crossroad lunch. One pair, MWG and the Lady deGloves, had new Boston tour shirts (review in the next post). Another pair had new Tom Petty and the Heartbreakers shirts. A third group was talking about playing Carnoustie and the challenges of driving and talking on the cell when knees don’t reach the steering wheel. Fortunately, they are driving in opposite direction from us.
Road trips are a great opportunity to observe and take joy in the world.
Jay Nordlinger got a couple of columns out out The Greatest Room In The World. Here is part two. We were surprised that he only reported a couple of sports items. We would have expected Fenway and Wrigley to be nominated but we are shocked to find out that the Plaque Gallery at the National Baseball Hall of Fame was not the most popular choice. In fact, it wasn’t mentioned.
Another place we would nominate would be the Up-The-Hill Theatre at American Players Theatre in Spring Green, Wisconsin. Here is a picture:
It is hard to get better than Shakespeare under the stars. They are rebuilding it so that it will be even better.
The Lady deGloves and your humble scribe spend much of the weekend starting a project in the yard. We came to believe that squirrel behavior was much more pervasive than we thought. We have seen squirrels carrying rocks from those we use for landscaping. We have even found rocks when cleaning out the rain gutters but we did not know the extent of this behavior.
This weekend we were removing sod, lots of sod, for a combined garden and grandchildren play area. Removing the sod revealed how many rocks the squirrels buried in 800 square feet. We are in a part of the Midwest were rocks are not a natural occurrence. We did not count them but there must have been at least one thousand rock buried there. We did find one nut. So if somebody compares your behavior to a squirrel you have every right to feel insulted.
Fame come in many ways. We have seen it twice in two days. Yesterday, my nephew notes on Facebook that we were one of the sad sacks in Albany International Airport that did not get out of town. Today, in Impromptus, Jay Nordlinger says:
I think I have a favorite Web address — it’s for the University of Wisconsin at La Crosse: http://www.uwlax.edu. Isn’t that kind of cool? Although I also think of the airport in Los Angeles, known as LAX.
We are gobsmacked! Our old school is Jay’s favorite address. We think of the airport in California as the pretender.
Here is Ann Althouse on W:
He seems so gentle and modest. If he has any actual opinions on these subjects, he’s completely hiding them. And yet I’m sure many people think what he’s saying accords with what they think. He’s speaking the language of traditional American politics — the language Trump eschews. Me, I’m a proponent of clear speech. But Bush is being civil and diplomatic and continuing to follow his policy of not trying to cling to presidential power.
What a nice man. And yet they called him Bushitler.
He is a nice man. He was a good president and an even better ex-president. Like Truman and Ike he was able to walk away. His sucessor should take notice. So should the press.
We spent an hour at the Orthopaedic Center waiting for the Lady deGloves. She is recovering from hand surgery. Compared to many of the folks in the waiting room both of us should feel good about our health.
Sidebar: That is the way they spelled. We are not sure but don’t think there is any significant distinction between orthopaedic and orthopedic. End Sidebar.
Watching the folks come into orthopaedics is a humbling experience. There are all ages and all degree of problems. There was a 23 year old with a broken ankle that was charming all the workers while storming around on crutches but there were young and old with more serious problems. One middle age person was limping and had an arm caste. Many of them had chronic problems and often seemed interested in audible discussions. We sure it is not the only waiting room in the clinic that would be humbling but however you spell it, orthopaedics is one of them.