FEATURE/'Three Hours to Save Your Life' New Drugs Can Fight Stroke — But Medical Care is Often Too Little, Too Late

Business Wire, May 11, 1999

PLEASANTVILLE, N.Y.--(BUSINESS WIRE FEATURES)--May 11, 1999--

Exciting new drugs and surgical techniques can mean full recovery from the horror of stroke -- if the proper help comes quickly. But as Reader's Digest magazine reveals, lives are being needlessly lost because of public ignorance and medical mismanagement.

Stroke is America's third-leading killer, claiming 160,000 lives a year. And 4 million survivors must struggle with problems ranging from impaired speech or vision to paralysis and shattered mental capability.

While there was once little doctors could do, today's revolutionary procedures can save lives -- and preserve the quality of life -- reports the magazine's May 1999 issue. Unfortunately, only a small fraction of stroke victims now get this help.

That's because the new therapies require that stroke victims be hospitalized, evaluated and treated as quickly as possible. The clotbuster drug t-PA, for example, is safe and effective only if administered within three hours of stroke's first symptoms. And a brain CAT-scan is needed before t-PA treatment to determine the type of stroke.

Patients who receive t-PA (tissue plasminogen activator) within this narrow window are at least 30 percent more likely to escape disabling damage -- and yet fewer than one in 20 now get this wonder drug. The window of opportunity slams shut because medical professionals, and stroke victims themselves, simply don't act fast enough.

"If America takes brain attack as seriously as it did heart attack in the `70s," says leading t-PA researcher Dr. John Marler, "we can save hundreds of thousands of people from death and disability in the coming years."

For that to happen, says Reader's Digest:

- EMS transport must improve. The emergency medical service goal

should be to deliver patients to hospitals within 20 minutes of

the alert (less than 10 percent of stroke victims currently reach

emergency rooms within three hours of symptom onset). And 911

dispatchers must give Priority One status to calls about possible

stroke.

- Hospitals must do more. Fewer than a quarter of our hospitals

have acute stroke teams, and stroke victims historically have

been assigned low emergency room priority.

Medical experts recommend that emergency rooms should have trained stroke-treatment specialists on duty. Dr. Mark Alberts, director of Duke University Medical Center's Stroke Acute Care Unit, suggests that doctors and HMOs create community-wide networks to provide smaller hospitals with standby specialists day and night.

But when Alberts urges doctors in smaller communities to take stroke treatment more seriously, the response is often lax. "I can't leave my busy practice to rush down to the hospital, read a CAT-scan and decide whether a patient needs t-PA," doctors often say. They would surely respond more aggressively in a cardiac arrest situation, Alberts complains.

- Potential victims must heed early warning signs. You, your

family, your co-workers -- everyone should know the sudden

symptoms of stroke, caused by blood clots or brain hemorrhage:

-- Trouble seeing in one or both eyes.

-- Severe, unexplained headache.

-- Numbness, weakness or paralysis of the face, arm or leg,

especially on one side of the body.

-- Trouble walking, loss of balance or coordination.

-- Confusion, difficulty speaking or understanding.

And remember: even brief, passing episodes can warn of a major attack to come.

"If people with a stroke like mine act quickly, they too may recover," says Baltimore resident Zanes Cypress, whose wife found him paralyzed on their family room floor. The fast-arriving EMS crew raced the couple to the local University of Maryland Medical Center, where Dr. Marian LaMonte, co-director of the center's brain-attack team, gave Cypress a dose of t-PA. Cypress was out of the hospital, in good condition, just days later.

The teamwork between the UM med center and Maryland's sophisticated statewide EMS network -- which can rush even isolated rural patients to the facility within an hour -- shows what can be done when stroke response is made a priority. "In 1996 it took us hours to evaluate and treat a stroke victim," said Dr. Ray Englander, at Sacred Heart Medical Center in Eugene, Ore. Today that treatment can begin in just 45 minutes.

One noted Sacred Heart survivor is Ken Kesey, author of "One Flew Over the Cuckoo's Nest." Kesey improved dramatically after his 1997 stroke, thanks to t-PA treatment. True to form, the irreverent writer dubbed the amazing new clotbuster "Drano for the Braino."

Many others could survive as well, Reader's Digest concludes, if the public and medical professionals realize there is new hope for stroke victims.

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