STROKE LECTURE By Arlyn M. Valencia, M.D. Associate Professor University Of Nevada School Of Medicine Diplomate, ABPN

This lecture may save your life.

STROKE LECTURE By Arlyn M. Valencia, M.D. Associate Professo University Of Nevada School Of Medicine, Diplomate American Board Of Psychiatry & Neurology

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"The Doctor-Show Phenomenon" By Arlyn M. Valencia, M.D.

I came across an article " An Injection Of Hard Science Boosts TV Shows' Prognosis" and I couldn't help but write my take on this doctor show phenomenon. I think ER is not believable as far as the physician's general attitude and behavior are concerned. (I will not even comment on the inferior doctor shows. ) Now, there may be rare physicians, medical professionals and paramedical personnel who have that kind of a make-up, and this may be obvious in certain situations. But not all situations. If that kind of drama is what prevails in emergency rooms (ER's) and wards, then patients' care and prognosis will definitely be compromised. ER is overly dramatized. The medical situations are turned into a bonanza of ill-reacting doctors, nurses, patients and janitors.


Don't get me wrong. I watched ER knowing that Michael Crichton, one of my favorite writers, wrote for the show.I very much value his work or whatever work he may be involved in even peripherally. Every time I see an ER episode, I try to see his imprint on the story twists. I read all his books (and I am beyond excited when I learned that the last novel he wrote, right before his death, was discovered in his PC and is now awaiting publication), admired his honesty, adored his wit, "sided" with his no-side, agenda-less take on the global warming issue. In this blog, I would just like to blurt out my humble opinion on the doctor show phenomenon.


As far as medical facts are concerned, I salute the consultants/researchers with coming up with the most esoteric, zebras of a diagnosis that even clinical experts would have a hard time blurting them out just like that. Although there may be the "ideal" ER's/wards manned by clinicians who are also academicians, rarely, would there be such a situation like that. This is more apparent in the series House, which I just happened to watch last night. Not only is this attending and residents not neurologists, rheumatologists, neuroradiologists,or endocrinologists (I still don't know what medical specialties they practice, or maybe I missed a very important episode when they revealed what they are, especially House), but the way they talk, argue, manage patients, and even perform the procedures they do, made me conclude they're specialists (and even subspecialists in some fields) in all the above mentioned disciplines. And all these in a community hospital setting.


This overlooked yet to-your-face aberration, may be due to the fact that a significant number of the show's consultants are researchers and "technically- minded" , and the necessary input from a long-time, experienced clinician is lacking. Or it may have been that if too much of a real clinician's input is considered, the over-all effect might be that the show would lack appeal and drama. If it would help soften the above comment, Dr. House's effect on me is, and I know the majority of the House-watching populace would agree: I, myself, wouldn't mind being assessed (but maybe not admitted) by the Vicodin-addicted Dr.House. He reminds me so much of the cocaine-using yet brilliant Sherlock Holmes.

Don't get me wrong; House is the only doctor show I really enjoy. But the episode I saw last night made me cringe. Not just because of the blurting of a mouthful of diagnoses that are "interconnected" but also concluding that there may already be a complication (vasculitic) that is confounding the over-all problematic picture. These only from plain deduction.

There's one aspect that I cherish, though, not just in that episode I recently watched but in almost all of House's episodes, and that is at the end it makes it all clear that the physicians' viurtues of "looking" at the patient, at the entire picture and addressing every aspect of patient care are the real "stars" of the show.

A Friday Visit With The Lagascas

Gemma Lagasca is growing up to be a beautiful lady. Intelligent and athletic, with a good heart, she is the pride of Emma and Aldo Lagasca.

Filipinos are well known for their gregarious nature. Sharing is not a task but a privilege. We share our love for the simple yet precious things in life: we share snippets of stories that delighted and touched our heart, laughter that seems to come from nowhere, food that nourishes the body and feed our soul, chores not to burden but to involve. And at the end of the day, the emotional yoke we carried prior to the visit, is lightened and seemed so small.

SAVING THE BRAIN AFTER A STROKE: Time Is Of The Essence

When Joe woke up that chilly night, he knew something was terribly wrong. He tried to stand up but instead, he suddenly slid to the floor as if his right body pulled him down. That’s when he realized the right side of his body had gone “dead” on him. He tried to verbalize, orient himself to his surroundings. He concluded his mind was still working. He tried “shaking off” the problem on his right side but it would not go away. “Maybe”, he sighed, “I’ll sleep it off. It should be OK by tomorrow.”

Joe just had a stroke which affected solely the motor pathway in his left brain. He got lucky that the speech center, which is also on the left side (on right-handed individuals) was spared, thus, his ability to talk and comprehend remained intact.

Stroke is a too-familiar word for everyone. It is unfortunate, however, that the majority of Americans do not know the symptoms of stroke or those who knew do not know the significance of early medical evaluation and intervention.

Stroke affects 750,000 Americans each year. It is the third leading cause of death and the leading cause of serious long-term disability. The cost of care for stroke victims approximates $40 billion a year and a significant proportion of this is spent on long-term rehabilitation and nursing home care.

A stroke occurs when the blood flow to a part of the brain is impeded due to sudden blockage of an artery supplying that area of the brain. The needed glucose and oxygen will not reach that particular brain tissue which eventually will suffer and die if the blood flow is not immediately restored. The result will be loss of function of the part of the body which that part of the brain controls. This is called ischemic stroke.

Another cause of stroke is sudden bleeding into the brain substance when a weakened wall of an artery ruptures. This is called a hemorrhagic stroke.

Stroke is also called “brain attack” to connote the necessity of seeking immediate medical attention, that is as soon as the symptoms occur. However, compared to heart attack in which the symptom seems universal (chest pain), a stroke can have different manifestations, depending on what part of the brain is ailing or dying. For example, if the verbal speech area on the dominant side of the brain (which is left on right-handed individuals) loses blood supply causing death to the brain cells, the patient will suddenly lose the ability to talk .

Some of the more common warning signs of stroke are: sudden weakness or numbness of the face, arm and leg on one side of the body, sudden blurring of vision or blindness in one or both eyes, sudden incoordination, trouble walking, dizziness, sudden confusion, trouble speaking or understanding or sudden severe headache with no known cause. Of course there are other less obvious signs of stroke like sudden-onset double vision, difficulty with swallowing, nausea and vomiting. These latter signs are more commonly seen in brainstem strokes.

There is a nationwide campaign to improve stroke awareness. Every stroke must be treated as a life-threatening emergency. The available stroke treatment modalities can only be administered if the patient is brought for evaluation and treatment within three hours of stroke onset for the intravenous clot-buster (tissue plasminogen activator, tPA) and within six hours of stroke onset for the intraarterial clot-buster. Not all stroke patients are candidates for these treatments. It is very important that the emergency room (ER) physician and the neurologist adhere to the protocol. If given appropriately to eligible patients, the treatment can decrease or even reverse theneurologic deficits that the patient had at the onset.

Better understanding of the causes of stroke and the changes that happen in the brain before, during and after stroke has led to better over-all patient management. Even if the patient is not a candidate for the clot-buster therapy, emergent medical intervention can easily be started that may protect or save the ailing brain. It may be as simple as maintaining a good diastolic blood pressure, controlling fever, treating concomitant infections as soon as recognized (the latter is considered a risk factor for stroke), normalizing the blood sugar, improving oxygenation especially on those with preexisting lung conditions. These measures may help “protect the ailing brain cells”. If these cells are not rescued, they will eventually die resulting in increasedneurologic deficits, thereby, increased disability.

Control of other risk factors should also be started acutely, such as treatment for high cholesterol, diabetes and homocysteinemia. Cessation of smoking, controlling other risk factors and compliance to stroke prevention treatment (taking the appropriate antiplatelet medications and blood thinners), can not be overemphasized.

Each stroke patient is different. Joe, the patient I mentioned earlier, is my father. He improved dramatically. It could be that the ailing part of the brain got rescued by blood supply from other territories.

Our brain, although gifted with the power toautoregulate its own blood flow, can be chronically challenged by several medical insults like hypertension, diabetes, heart disease, cigarette smoking. This power of the brain can get exhausted. We still have time to correct such things before our brain gives up on us.

Take care of our brain. Control the risk factors, help in disseminating information to improve awareness. And at the first sign of stroke, seek immediate medical attention (call 911). The faster we act the better chance we have of saving or protecting the brain from the effects of stroke.

Arlyn M. Valencia, M.D. is a Diplomate of the American Board of Psychiatry and Neurology, an Associate Professor of Neurology, Department of Medicine, University of Nevada School of Medicine, and a Fellowship-trained Stroke Neurologist.