Tag: ER

Can a Superfit, Healthy, Vegan Triathlete Have a Stroke or Heart Attack?

Introduction

The sunset on December 30, 2015 in no way foreshadowed a dark and stormy night. A pity, for such might have sparked a premonition of perdition as I set off on a run around 5:30 p.m.

About ten minutes into it I found myself dazed and disoriented on the side of the road. Several strangers asked if I was OK, did I need any help. I brushed them off in a few words to the effect of I appreciate the offer but no worries. I’m fine – just resting a bit.

In fact, I wasn’t resting – I was wondering why I was on my knees, struggling to get up. I wanted to get on with my run. I had no idea how I got there, on the ground.

Other comments from Good Samaritans included:

* you don’t look so good.

* you’re bleeding – (I had no idea at the time).

* we saw you fall (still have no memory of that).

* shall we call an ambulance?

A new guy appeared, a tourist from Burlington, Vt. He first held my arm when I almost made it to my feet. Then he said, hearing my protests that I’d be fine – Listen to me. I’m a doctor – you’re having a stroke.

He called 911 and sat with me on the curb.

Until that point, I was in denial. (I’m fine. I’m fit – I must have just stumbled. Just help me up.) That was my mantra – until the doctor’s reality check. The fact that I could not stand seemed a bit worrisome.

While waiting for the ambulance, however, I kept hope alive, that this was merely a terrible and possibly expensive mistake (I had no time to shop around for ambulances, to compare prices and accommodations). I told the doctor that I was very fit, despite being somewhat mature (77) and that I had won national and world triathlon championships in recent years – and was about to describe my impressive body composition, vegan diet, low heart rate, how I take no meds, have no cavities and so on when he interrupted – Doesn’t matter. You’re having a stroke. Be quiet – the ambulance is here.

I was packed off to nearby Bayfront Hospital. Still, when wheeled into the ER, I felt pretty good and tried one more time, saying something like this: I really don’t think I should be here – you folks have seriously ill people to deal with – look after them. I’ll be just fine. I’m probably the healthiest person in this ER, though that may not be saying much. At this, I heard the person at my side, the EMT who drew my blood and otherwise looked over me on the way to the ER, say, in a bit of a sing-song fashion, No you’re not.

At that, I quieted down, resigned at last that the medicos would take it from there. Soon thereafter, the following transpired:

• Stroke confirmed in short order.

• Prodding and testing by many specialists.

• Loaded up with TPA – a powerful clot-buster which only works if administered within three hours of the incident, but the sooner, the better.

• Arrival of my wife Carol, who later attested that I failed the tests involving raising my left arm, left leg and touching my nose with my left index finger. (I thought I performed all these tasks brilliantly and still have no memory of not being able to do so).

• Taken to brain-related version of ICU.

• Prodded, tested, filled with IV saline solution and subjected to varied blood-letting procedures.

• Cat scanned, CETA’d and inserted into sundry machines that go ping. After the TPA was run through me, the paralysis abated and the rest of my two-day stay was devoted to observation and testing and evaluation. Was released at noon on New Year’s Day.

No evident problems weeks later (or immediately after the TPA injection in the ER), save what one doctor thought might be minor damage to the right frontal lobe (which I probably don’t use, anyway) – except now I have atrial fib – so must take a 20 mg pill (Xarelto) daily. At least for now, until something less powerful (aspirin?) might be found acceptable or safe.

How Can A Pain Management Doctor Help The Epidemic Of Opioid Overdosing?

Opiates or Opioids as they are more commonly known are and important prescription medication for any pain management doctor. However, in the last 10 years or so, they have become an abused, misused and overused medication that has sadly, been related to addiction and even death.

There Are Several Questions

When this epidemic is discussed among those in the medical industry, in particular, the pain management area, there are two questions that come to the surface: How is this happening? Who is letting it happen? What are can be done about it?

The biggest players in this epidemic are doctors and the pharmaceutical industry. So what responsibility should a pain management doctor take toward curbing and correcting this epidemic? What accountability should the pharmaceutical companies have? If there are any solutions, what are the best ones?

The CDC has recently issued the first set of guidelines for prescribing opioids. This guide is focused toward primary care physicians and has become the national standards for prescribing these painkillers. And while it is too late for millions, it is a positive step taken in the right direction.

What Are Opiates?

Derived from morphine, found as far back as the 3rd century B.C., they are a powerful painkiller. Common names for this drug are hydrocodone and oxycodone. It is believed that the Sumerians nurtured poppies and removed opium out of the seed capsules.

Opiates not only provide relief from pain, the sole intention of any pain management doctor, but they produce euphoria as well. It is that euphoric feeling that leads to abuse of the drug. Opioids are expensive and harder to acquire than the euphoric drug, heroin.

After years of using opioids, even months, a user will develop a tolerance to them. As such, they need a higher dosage in order to get the same level of relief. If their pain management doctor doesn’t approve a prescription for a higher dosage, they will resort to heroin. In fact, it is believed that 4 out of 5 opioid users have become heroin users.

The number of deaths from heroin overdose almost quadrupled between 2000 and 2013 in America. And when it comes to death from injury, opioids are the most common cause in this country.

Over 15,000 people die each year according to the CDC due to opioid medication overdoses. It is estimated that there are over 800 recreational users for each person that dies with over 30 ER visits due to opioids that result in 10 hospital admissions.

What Can Be Done?

One of the first steps is for every pain management doctor and other professions in the industry to question their patients thoroughly about any past or current alcohol or drug use. They should also check any prescription drug monitoring program that is available to them.

And the biggest step of all is to prescribe the lowest effective dose of any opioid to begin with and for only the amount that will most likely be needed. If a patient is complaining of pain after the prescription is finished, then a different type of pain management may be needed.

Every pain management doctor needs to be educated on opioids so that they can be better able to monitor their patient’s safety and recommend alternatives for pain management. The training of physicians should include the importance of developing a treatment plan in writing and create a medication agreement that the patient and them both sign, designating one physician as the sole prescribing doctor for pain medication.