medical

How Accurate Is Prenatal Testing?

nancyvalko abortion, disability, hospice, law, medical, medical ethics, palliative care, terminal/palliative sedation

I have written about the alleged accuracy of prenatal blood testing before as both a nurse and a mother in my blog “A Dark Side of Prenatal Testing” and “Two Wonderful Stories: A Prenatal Misdiagnosis; Man Saves Grandchild from Abortion”.

Now, ProPublica, a self-described nonprofit investigative newsroom, just published an article titled “They Trusted Their Prenatal Test. They Didn’t Know the Industry Is an Unregulated “Wild West.”

The authors tell the story of a mother who had an in vitro diagnostic test (IDT) that came back negative, meaning her baby did not have the serious conditions that were tested for.

However, when the mom delivered her daughter, the baby had serious problems and only lived 28 hours.

The autopsy showed that the baby had an extra 13th chromosome, a condition that was part of the testing. The chances that the baby would have not have this or two other serious conditions was “greater than 99%.”

The test was a simple blood draw designed to check for an array of genetic anomalies but the mother, a science researcher, read academic articles showing a higher risk of inaccurate results than she realized.

The mom found other women reporting problems with the tests also so she tried contacting the company that made the test, hoping she would help other families.

She was unsuccessful.

She found out that if she had taken other common commercial tests like some for Covid-19 or pregnancy, the company would have had to inform the US Food and Drug Administration about “reports of so-called adverse events.”

The mom found out that the test she took fell into a regulatory void:

“No federal agency checks to make sure these prenatal screenings work the way they claim before they’re sold to health care providers. The FDA doesn’t ensure that marketing claims are backed up by evidence before screenings reach patients. And companies aren’t required to publicly report instances of when the tests get it wrong — sometimes catastrophically.

The broader lab testing industry and its lobbyists have successfully fought for years to keep it this way, cowing regulators into staying on the sidelines.”

The stakes are high for families with the article stating:

 “Upwards of half of all pregnant people (sic) now receive one of these prenatal screenings.”

And that the companies stress that “ultimately, it’s the responsibility of health care providers, who order the tests, to inform patients about the limits of screenings.”

CONCLUSION

When I had my last child in 1985, I was offered but refused amniocentesis. In my case, it was offered because I had previously had Karen, my daughter with Down Syndrome.

Some people asked if I was brave or stupid. I told them that I was just well-informed after researching both amniocentesis and CVS.

I knew that both procedures carry a risk of miscarriage and that I would never abort a child because of a disability. I also knew that such procedures can only test for some of the thousands of known “birth defects” and I personally met families who were erroneously told that their child had a defect but were born healthy.

After that, I was remarkably worry-free during my last pregnancy and delivered a healthy girl.

But maternity care has changed a lot since 1985, especially since the American College of Obstetricians and Gynecologists (ACOG) now states that Abortion is Healthcare Abortion is Healthcare | ACOG

But despite the possible inaccuracies of prenatal test, there is help if a baby is diagnosed with an unexpected condition like Down Syndrome or Trisomy 13.

Thankfully, there are even programs like Perinatal Hospice & Palliative Care: Continuing Your Pregnancy that can help in the event of a prenatal diagnosis that indicates a baby may die before or after birth.

Where there is love, there is always hope!

CDC OVERHAULS IT’S COVID 19 GUIDELINES

nancyvalko Covid 19, medical, nursing, vaccines

This month the Centers for Disease Control and Prevention announced significant changes in its Covid 19 guidance in a press release. Author Geta Massetti, PhD, MPH, MMWR explained that:

“We’re in a stronger place today as a nation, with more tools—like vaccination, boosters, and treatments—to protect ourselves, and our communities, from severe illness from COVID-19. We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation.  This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”(Emphasis added)

Among the biggest changes are:

“The CDC’s COVID-19 prevention guidance will no longer differentiate by whether people are up-to-date on their vaccinations.

Testing to screen for COVID-19 will no longer be recommended in most places for people who do not have COVID symptoms. 

The CDC says people who have tested positive for COVID-19 can stop wearing masks if their symptoms have improved and they test negative twice in a row — initially on the sixth day after their infection began, and then again on the eighth day.

And the CDC says that “to limit social and economic impacts, quarantine of exposed persons is no longer recommended, regardless of vaccination status.” 

And there are also new changes to guidance for schools, including:

“-Removed the recommendation to cohort

-Changed recommendation to conduct screening testing to focus on high-risk activities during high COVID-19 Community Level or in response to an outbreak

-Removed the recommendation to quarantine, except in high-risk congregate settings

-Removed information about Test to Stay

-Added detailed information on when to wear a mask, managing cases and exposures, and responding to outbreaks”

Also and as of June 12, 2002, “CDC will no longer require air passengers traveling from a foreign country to the United States to show a negative COVID-19 viral test or documentation of recovery from COVID-19 before they board their flight” but must be “fully vaccinated”.

And, according to CBS News, “U.S. agents will begin to offer COVID-19 vaccines to migrants in Customs and Border Protection (CBP) custody who are processed under regular immigration procedures and can’t show proof of vaccination.” (Emphasis added)

CONCLUSION

This sounds like progress but there is still controversy and court cases about Covid 19 vaccination mandates and exemptions. Stay tuned for further developments.

A Light at the End of the (Covid 19)Tunnel?

nancyvalko Covid 19, law, medical

My husband and I just returned from a trip to Florida where we were happily surprised to find the closest place to normal since the Covid 19 pandemic started. Everyone wore masks (except one young man we saw at a distance) and everyone was careful about social distancing. Hand sanitizers were everywhere.

Best of all, people seemed happy and we saw very few stores closed.

When we returned home, we both finally received the first of our 2 Covid 19 vaccination doses.

Is it possible that there is a light at the end of the Covid tunnel?

I am cautiously optimistic but aware that Covid 19 may still be a problem in the long term, especially since some younger family members-including children-contracted Covid despite precautions. Thankfully, they all had mild cases with no hospitalizations. My husband and I will continue to follow Missouri’s guidelines of masks, social distancing, etc. even after we receive our next dose of vaccine.

IS FLORIDA A HARBINGER OF GOOD NEWS?

Florida was among the last states to go into lockdown and one of the first states to ease restrictions.

Florida’s Governor Ron DeSantis was vilified by many of the media for adopting something similar to Sweden’s strategy of protecting the vulnerable while keeping businesses and schools open but a year after the pandemic hit the US, that strategy seems to be working.

Despite having the second largest number of elderly people by state, Florida’s Covid death rate numbers are better than New York’s and California’s. And, unlike so many other states, Florida’s economy is thriving.

Now, Governor Abbott of Texas and Governor Reeves of Mississippi have announced that they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates.

WHAT HAPPENED?

It has been almost a year since the U.S. went on lockdown for Covid 19 when President Trump declared Covid 19 a national emergency on March 13, 2020.

At first, the lockdown was only supposed to be for a few weeks to “flatten the curve” of infections and prevent hospitals from being overwhelmed by Covid patients.

However, as the lockdowns wore on for months, some doctors and other experts started warning about the emotional and health damage occurring.

Although it received little media notice, a May 19, 2020 letter to President Trump signed by over 600 doctors detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-COVID patients. 

The doctors’ letter also stated that:

“Keeping schools and universities closed is incalculably detrimental for children, teenager and young adults for decades to come.”

Then on October 4, 2020, the Great Barrington Declaration was written and released and eventually signed by thousands of doctors and experts from around the world. The Declaration encouraged governments to lift lockdown restrictions on young and healthy people while focusing protection measures on the elderly, stating:

“Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. “

Unfortunately, Covid 19 rules and lockdowns have become a political football in many states, especially with school and small business reopenings.

CONCLUSION

We know a lot more about Covid 19 now than when the pandemic started, especially from watching U.S. states and other countries use various strategies to try to contain the virus. And now, of course, it appears we have several promising vaccines.

Although there is much more to learn, we indeed might be seeing a light at the end of the Covid 19 tunnel.

An Amazing Video of a Living, First Trimester Unborn Baby

nancyvalko abortion, grief, law, medical, Planned Parenthood

Recently, I saw an amazing video in a post on the Nurses&Midwives4Life Ireland Facebook page showing a living, first trimester baby on a surgical field. The baby was moving its’ tiny head and limbs remarkably like a newborn baby. The image was both beautiful and heartbreaking since this little one could not survive.

The Speak Life video is covered with a warning that “This video may be sensitive to some people” and posted by Jonathan Van Maren, communications director for the Canadian Centre for Bio-Ethical Reform, with the caption ”This 8-second video of a first-trimester baby tells you everything you need to know about how wrong abortion is.”

I investigated further and it seems that the that the unborn baby was about 8 weeks old and that he or she had been removed after an ectopic pregnancy in which the unborn baby develops outside the womb.

Ectopic pregnancies can be life-threatening to both mother and child when the unborn baby develops in one of the Fallopian tubes leading to the womb, although there have been some rare cases where a baby develops in the abdomen and survives. Several years ago, I had an elderly patient who told me how her unborn baby survived decades ago when the doctors did not know that the baby was in the abdomen during her uneventful pregnancy until labor began. That is unlikely today since ultrasound images are routine during pregnancy.

A PICTURE IS WORTH A THOUSAND WORDS

Although the baby in the video could not survive after he or she was removed, the video itself is powerful evidence that abortion takes the life of a real human person even in the first trimester.

Most abortions are performed in the first trimester when women and the public are often told by organizations like Planned Parenthood that the unborn baby is just a “clump of cells”.  In the first trimester, most babies are aborted by either vacuum suction which destroys the little person or by  medical abortion using pills to first disrupt the attachment of the unborn baby to the mother and then expel the baby. However, abortion reversal is possible after the first set of pills.

Women who have abortions rarely see their baby after a first trimester abortion but it has happened, especially with medical abortion. This can be very traumatic to the woman. Contrast the look of the deceased first trimester unborn baby in the article titled “She took the abortion pill, then saw her 7-week-old baby” with the living first trimester unborn baby in the video.

CONCLUSION

Years ago, my late daughter Marie became unexpectedly pregnant and found out that the unborn baby was growing in one of her Fallopian tubes rather than her womb. She had to have emergency surgery when the tube ruptured.

Afterwards, the surgeon showed me the picture he had taken (unasked) during the surgery to remove the then deceased baby, my grandchild. The picture was personally so sad to see but I was comforted that the surgeon cared enough to take a picture of this tiny person.

After so many years and so many experiences as a nurse and volunteer in the pro-life movement, I believe that all women should be given the opportunity to know the truth about their unborn baby’s humanity as part of informed consent before abortion.

And I believe the rest of us should also have the opportunity to learn the same truth before we support legalized abortion.

This video of a living, first trimester unborn baby speaks louder than mere words.

Talking to Patients

nancyvalko medical, mental health, nursing, ventilators/life support

As I have related before, back in the early 1970s when I was a new ICU nurse, I was teased for talking to comatose patients. I was even asked if I talked to my refrigerator. I explained that if hearing was truly the last sense to go, it made sense to talk to the patients and explain what we were doing just as we would for any other patient. The other nurses thought this was ridiculous-until “Mike”.

“Mike” was a 17-year old boy who was admitted to our intensive care unit in a deep coma with massive injuries caused by a terrible car crash. The neurosurgeon on duty pronounced, “He won’t live until morning and it’s a good thing, because he’d be a vegetable.” I was shocked that he said this in front of “Mike”!

But “Mike” didn’t die. I kept talking to him and eventually he could even move a finger on command. But he would not respond to the neurosurgeon, even with tests to see if he would move with pain stimuli.

Later on, when “Mike” was able to breathe on his own, he would even say “Hi” for me on command but it was only after I repeatedly begged that Mike finally said “Hi” to the neurosurgeon. The neurosurgeon called this a “miracle” but shortly after that, Mike was transferred to a nursing home. None of us ever expected to see him again.

However, about 2 years later, a handsome young man strode into our ICU and asked “Do you remember me?” It was Mike! He said he had driven 60 miles to tell us thanks for saving his life and we all dissolved in happy tears.

I told him that he wouldn’t remember this, but he would move and say “Hi” for us nurses but not for the neurosurgeon. Mike got very serious and said “I remember him calling me a vegetable and I wouldn’t move for him!”

After that, every nurse on our unit was told to talk to every comatose patient as if he or she was totally awake and soon we found more patients who unexpectedly woke up or improved.

And no one ever teased me about talking to “comatose” patients again.

Throughout the decades since, I have talked to other patients who were considered comatose or otherwise unconscious, not just to patients with a major brain injury but also to patients approaching death and to patients sedated while on a ventilator for breathing. I’ve always considered this talking and explaining just basic respect for every patient. I was pleasantly surprised when I followed up with patients and families after they left our ICU and found many who remembered and told me how much this had helped them.

“OBSERVATIONS FROM ICU PATIENTS WE THOUGHT WERE ASLEEP, BUT WERE NOT”

So I was thrilled to see this title for a new Journal of the American Medical Association (JAMA) learning audio for doctors with stories from patients about what they experienced in an ICU while their treating doctors and nurses thought they were “asleep”.

In the audio, most of the patients were on sedation while on a ventilator and assumed unaware. One such woman related how she became so angry at her doctor’s attitude that she wanted to throw something at him and was frustrated when she couldn’t. Another man related how painful it was when the electrodes checking for his level of sedation were used without explanation or warning. Another complained about hearing nurses talking about her mom and dad poorly and their lack of empathy.

But there were also good stories about nurses or doctors taking the time to explain what was happening, talking as if the patient could hear everything and helping patients communicate without words. One doctor told about how his own father was in a hospital for an extended time and his dad remembered hearing the doctor talking about all the things he couldn’t do instead of what he could do. This doctor says that his father’s discouraging experience made him a better doctor.

The audiotape also explains how difficult it can be to not over- or under-medicate people, especially when it comes to pain, confusion and anxiety. The audiotape recommends that health care professionals try to avoid long acting drugs with potential side effects and continuous medication infusions and to use simple tools to assess delirium, confusion and anxiety.

The audiotape also recommends that health care professionals “treat patients like real persons”, “take the time to explain”, “be careful to assess level of awareness”, “realize that every action and word have real consequences” and that the “human element” is the most important.

CONCLUSION

Being in an ICU can be especially stressful for patients and their families and I hope this information is helpful. Medicine can do wonders today but it is the human connection that provides the best environment for healing for both patients and their families.

Minding Your Medications, Especially When You are Older

nancyvalko medical

When I first started out as a nurse in the late 1960s, I saw several patients admitted to determine why they had “mental status changes”, such as confusion. One of my first duties on admission was to make a list of medications the patient was taking.

I was alarmed to find some of these patients, usually elderly, were taking a large number of medications and some were similar and/or had potential interactions with other medications. When I first brought this to the attention of a doctor, he was skeptical until he read one of the patients’ lists.

The result was that he reevaluated every medication and temporarily stopped all medications that were not crucial. When the patient rapidly improved and went home with a much reduced list of medications, he and I shared this with other doctors and many other such patients then rapidly improved.

However, according to a December 12, 2017 article from Kaiser Health News titled “An Overlooked Epidemic: Older Americans Taking Too Many Unneeded Drugs”, such problems with medications continue to exist in our fast-paced health care system and older people continue to be especially at risk.

As the article states:

“At least 15 percent of seniors seeking care annually from doctors or hospitals have suffered a medication problem; in half of these cases, the problem is believed to be potentially preventable. Studies have linked polypharmacy (multiple medications) to unnecessary death. Older patients, who have greater difficulty metabolizing medicines, are more likely to suffer dizziness, confusion and falls. And the side effects of drugs are frequently misinterpreted as a new problem, triggering more prescriptions, a process known as a prescribing cascade.

The glide path to overuse can be gradual: A patient taking a drug to lower blood pressure develops swollen ankles, so a doctor prescribes a diuretic. The diuretic causes a potassium deficiency, resulting in a medicine to treat low potassium. But that triggers nausea, which is treated with another drug, which causes confusion, which in turn is treated with more medication.

For many patients, problems arise when they are discharged from the hospital on a host of new medications, layered on top of old ones.” (Emphasis added)

Some doctors are now trying to combat the problem through education  about “deprescribing” — systematically discontinuing medicines that are inappropriate, duplicative or unnecessary.

I saw this problem recently in my own family when one of my older but still vigorous relatives in remission from cancer suddenly started to deteriorate. At first, her daughter thought the cancer had come back but the tests were negative.

The mystery was solved when it was discovered that my relative’s ophthalmologist (eye doctor) changed her eye drops for glaucoma but, unfortunately, the new medication also contained some of the same drug she was using for her heart condition.  When the medications were adjusted, my relative was back to normal within a short time.

MY RECOMMENDATIONS FOR MEDICATION USE AT ANY AGE

1. Keep an updated list of all medications you take-including supplements like vitamins and over the counter medications-with you or a family member. Make sure all of your doctors have this list.

2. Especially if you take several prescription medications, don’t be afraid to ask your doctor if you still need all your current medications. With pain medication, especially narcotics, ask about how long you should use them and if or when you should start using over the counter pain medicine instead.

3. Ask about all your medications’ intended purpose and side effects  so you can recognize a potential problem.

4. If possible, use one pharmacy so that all your medications will be listed in one place and possible interactions can potentially be picked up.

5. Feel free to ask the pharmacist questions about your medications, even after you have already filled and started the prescription. They are there to help and medication is their specialty. You can even ask them how to safely dispose of older or narcotic medications you no longer need. Personally, I use a pharmacy that is open 24 hours a day.

I hope these tips will be helpful to you and your loved ones!

 

Follow Up to “My Amazing Operation”: New Study Shows That The Diagnosis of Primary Hyperparathyroidism is Often Missed

nancyvalko medical

Last June, I wrote about my parathyroid surgery and how the crucial diagnosis of hyperparathyroidism can be missed.

The parathyroid glands are four small glands located behind the thyroid in the neck whose sole function is to control the amount of calcium in our bodies within a tight blood range of about 8.5-10.5 mg/dL, depending on a particular laboratory’s values.

If one or more of these small parathyroid glands starts growing (called an adenoma and rarely cancerous), this causes the parathyroid to release too much parathyroid hormone which causes abnormally high calcium in the bloodstream. This can cause serious health problems such as cardiovascular problems, osteoporosis (bone loss which can lead to fractures), depression and even premature death.

The surgery involved is now a minimally invasive procedure and, in my case, I was able to go home the same day after an early morning surgery.

Many symptoms of primary hyperparathyroidism can be unnoticed, mild or confused with other conditions like normal aging. The diagnosis is confirmed by a high amount of calcium in the blood (hypercalcemia) along with a high level of PTH (parathyroid hormone).

In my case, I asked for a PTH blood test when my calcium level rose and I researched all the causes of high blood calcium. I realized then that I had some mild symptoms of primary hyperparathyroidism that I attributed to other causes.  After my operation, my symptoms went away.

Now a study just came out July, 2017 in the medical journal Annals of Surgery titled “Failure to Diagnose Hyperparathyroidism in 10,432 Patients with Hypercalcemia: Opportunities for System-level Intervention to Increase Surgical Referrals and Cure”

that concludes:

“A significant proportion of patients with hyperparathyroidism do not undergo appropriate evaluation and surgical referral. System-level interventions which prompt further evaluation of hypercalcemia and raise physician awareness about hyperparathyroidism could improve outcomes and produce long-term cost savings.” (Emphasis added)

The study involved over 10,000 patients with blood calcium levels above the normal upper limit of 10.5 mg/dl and found that only 31% had a workup including a PTH level and of those patients with a high PTH level, only 22% were referred to a surgeon.

CONCLUSION

In my previous blog, I wrote that that the previous criteria for parathyroid surgery included a calcium level of  above 11.5 mg/dl but that my surgeon told me that the criteria may be changing to an even lower level. This new study may change that criteria.

Calcium levels are usually checked in annual exams including blood work. I would recommend that if your calcium level is above the normal high, you ask your doctor if further testing like a PTH blood test is warranted and especially if you notice any signs or symptoms of hyperparathyroidism.

Primary hyperparathyroidism has long been considered a relatively rare condition with 100,000 people diagnosed annually in the U.S.  but, according to this study, it might not actually be so rare.

The good news is that it can be treated.

The Catholic Church, Experimental Treatments and Charlie Gard

nancyvalko futility, law, medical, medical ethics

A disturbing statement made by Archbishop Vincenzo Paglia, head of the Vatican’s Pontifical Academy for life, appearing to support the European Court of Human Rights decision to reject Baby Charlie Gard’s parents’ request to go to the US for an experimental treatment for their critically ill son struck a nerve with many Catholics. And although Pope Francis quickly expressed his support for Baby Charlie and his parents shortly after the statement, the ethical issue of experimental treatment remains confusing to many people, Catholic or not.

But what has the Catholic Church really said about experimental means?

VATICAN STATEMENT ON EUTHANASIA

Perhaps the best guidance can be found in the 1980 Vatican Statement on Euthanasia that states:

“If there are no other sufficient remedies, it is permitted, with the patient’s consent, to have recourse to the means provided by the most advanced medical techniques, even if these means are still at the experimental stage and are not without a certain risk. By accepting them, the patient can even show generosity in the service of humanity. – It is also permitted, with the patient’s consent, to interrupt these means, where the results fall short of expectations.” (Emphasis added)

The document further explains that:

But for such a decision to be made, account will have to be taken of the reasonable wishes of the patient and the patient’s family, as also of the advice of the doctors who are specially competent in the matter. The latter may in particular judge that the investment in instruments and personnel is disproportionate to the results foreseen; they may also judge that the techniques applied impose on the patient strain or suffering out of proportion with the benefits which he or she may gain from such techniques. (Emphasis added)

This is a common sense and balanced approach that was not controversial in 1980 and should apply in Baby Charlie Gard’s situation, especially since there is apparently disagreement among doctors about the experimental treatment.

TWO CASES OF EXPERIMENTAL TREATMENT

When I worked with cancer patients in the 1980s and 1990s, I especially remember two patients who decided to try experimental treatments.

One was an older woman whose cancer had spread to her brain. A new drug had been developed that would have to be administered via an access implanted in her head. She desperately wanted to spend more time with her family and was willing to try the drug despite the potential side effects and poor chance that the drug would work.

Initially, the drug did make her worse and she was near death. Three times we called her family to come in because death was imminently expected and she was in a coma.

But she surprised us all by recovering and two years later was still doing well without any recurrence of the cancer. The doctors were astounded.

In another case, a man in his 40s with two sons also decided to be part of a clinical trial of a new drug for his cancer. Some of my colleagues questioned why he would take on such a challenge so I talked with him. He said that he accepted the fact that he was probably going to die of his cancer but he wanted to try the drug not only in the hope that it would benefit him or others like him but also because he wanted his sons to know that he fought to live and be with them.

Although this man died, he left a brave legacy of love to his boys.

CONCLUSION

It is important to understand that medical progress and technological marvels often happen because doctors, patients and family persist in trying.

For example, it wasn’t that long ago that AIDS was considered incurable. Experimental drugs did not work at first but later ones did and now AIDS is no longer an automatic death sentence.

Baby Charlie’s parents worked hard to find a potential treatment and even raised the money to transport their son to the US. The hospital’s decision to usurp the parents and unilaterally remove Baby Charlie’s life support has led to an outpouring of support for Baby Charlie and his parents.

Let us hope that this latest court appeal will reverse the hospital’s decision and help restore the rights of parents reasonably trying to help their children

How to Recognize Stroke Symptoms and New Study Shows More Hope for People with Strokes

nancyvalko medical

As a nurse and a relative, I have seen the devastating results of major strokes, medically called cerebrovascular accidents (CVA). Decades ago, there was little that could be done medically except rehab to help with the effects of a major stroke. Now we have new techniques and new hope. However, these techniques depend on the person having the stroke or the people around them recognizing the symptoms and getting immediate medical treatment.

WHAT IS A STROKE?

Strokes happen when some brain cells die due to a lack of oxygen when the blood flow to the brain is impaired by a blockage (ischemic CVA) or rupture of a blood vessel (hemorrhagic CVA).  Symptoms depend on the area of the brain affected.

In 1996, the FDA approved tissue plasminogen activator (tPA), an intravenous medication that can dissolve blood clots in the 80% of strokes caused by blockage of blood flow (ischemic CVA). It cannot be used with strokes caused by bleeding and tPA must be given within a 3-4 hours following the onset of symptoms. If given promptly, the Stroke Association estimates that1 in 3 patients will see their symptoms resolve or have major improvement.

For the less common strokes caused by bleeding (hemorrhagic CVA), surgery like clipping, coils or removal may help reduce long-term damage and relieve pressure on the brain.

In 2004, the FDA approved the first medical device that could actually remove blood clots from blocked brain arteries in ischemic CVAs and the window of opportunity to treat was eventually widened to 6 hours after the onset of symptoms. After 6 hours, experts thought the affected areas of the brain were dead or irreparably damaged.

Now, a new study shows that that window may be widened to 24 hours  and this would allow many more patients to benefit.

The researchers  “contended that many patients have a ‘mismatch’ between the dead tissue where a stroke started and the far larger territory of brain tissue that is threatened, but still alive”. The results of the study on 206 patients with serious strokes at 32 hospitals in the U.S., Spain, France and Australia are impressive and hopefully will be proven and replicated.

My point is that medical progress is made when we don’t give up on people.

In the meantime, there is much we can do to help people with strokes.

SYMPTOMS OF STROKE

As a nurse, I made sure that all my relatives, especially the older ones, could recognize the symptoms of stroke and the importance of immediate treatment. Everyone needs to know and pass along this information from webmd.com  to others:

“Sometimes a stroke develops gradually. But you’re more likely to have one or more sudden warning signs like these:

  • Numbness or weakness in your face, arm, or leg, especially on one side
  • Confusion or trouble understanding other people
  • Trouble speaking
  • Trouble seeing with one or both eyes
  • Trouble walking or staying balanced or coordinated
  • Dizziness
  • Severe headache that comes on for no reason

The FAST test is a quick way to check someone for symptoms.

Face: Smile! (Does one side of their face droop?)

Arms: Raise both arms. (Is one higher than the other? Do they have a hard time holding one up?)

Speech: Repeat a short, simple sentence, like “Mary had a little lamb.” (Do they slur their words? Is it hard to understand them?)

Time: If any of these are “yes,” call 911.”

Also, note the time when symptoms started. The hospital staff needs to know this.

The life and health you save may be your own!

My Amazing Operation

nancyvalko medical

Last week, I underwent a minimally invasive (small incision) operation that I hadn’t heard of before but which appears to be already making a big difference in my health. The operation is called a parathyroidectomy.

The parathyroid glands are four small glands located behind the thyroid in the neck whose sole function is to control the amount of calcium in our bodies within a tight blood range of about 8.5-10.5 mg/dL, depending on a particular laboratory’s values.

As the American Association of Endocrine Surgeons’ website notes:

“Every cell and organ in the body uses calcium as a signal to regulate their normal function. Therefore, it is crucial that calcium levels are tightly controlled. Abnormally high blood calcium levels can damage every organ in the body gradually over time.” (Emphasis added)

If one or more of these small parathyroid glands starts growing (called an adenoma and rarely cancerous), this causes the parathyroid to release too much parathyroid hormone which causes abnormally high calcium in the bloodstream. This can cause serious health problems like cardiovascular disease, osteoporosis (bone loss which can lead to fractures), depression , increased risk of cancer and even premature death.

In the US, about 100,000 people of all ages develop this condition called primary hyperparathyroidism each year which predominantly affects older “populations and women two to three times as often as men“.

The diagnosis of hyperparathyroidism is sometimes missed because the blood calcium is not especially high at first and symptoms can be unnoticed, mild or confused with other conditions like normal aging.  Also, doctors often take a wait and see approach if patients have no symptoms.

In primary hyperthyroidism, the diagnosis is usually made by discovering a high blood calcium level (often checked routinely at yearly visits) and a high parathyroid level in the blood (PTH) if other causes of high blood calcium have been ruled out. The PTH blood test is NOT a routine test and must be ordered separately.

In the 1990s, calcium levels above 12 mg/dL and age less than 50 were the National Institutes of criteria for parathyroidectomy when a patient did not have the classic symptoms of hyperparathyroidism, especially because the operation was such a big surgery.  However, now we have a minimally invasive parathyroid surgery that is usually low risk and only involves a small incision that can often even be done on an outpatient basis.  In the 2000s, the high calcium criteria for surgery on patients without symptoms was recommended to be reduced to just 1 mg/dL above the normal range (about 11.5 mg/dL).  However, my surgeon just told me last month that the criteria may be changing again down to an even lower level but that scientific paper will not be published until December.

MY EXPERIENCE

For the last few years, my blood calcium was at the upper end of normal and I had a diagnosis of borderline osteoporosis despite taking calcium pills daily and taking osteoporosis medication in the past.

When my blood calcium rose to 11.9, I researched the topic and I was alarmed by what I read. It was then that I realized that the symptoms of bone pain and increased fatigue that I never thought to mention to my doctor could actually be symptoms of an adenoma in my parathyroid.

I asked my doctor about getting a PTH test. That test turned out to be high and I was quickly referred to a surgeon well-experienced with hyperparathyroidism.

I underwent a short, minimally invasive surgery and I was one of the lucky ones who had this experience as described on the endocrineweb.com site:

Even though half of patients with this hyperparathyroidism (Parathyroid Disease) will state that they feel just fine, after a successful parathyroid operation more than 85 percent of these patients will claim to “feel much better”! Some say it’s like “someone turned the lights on”.

In my case, my bone pain was gone and I felt more energetic than I had in a long time.

I am happy that this operation is expected to start relieving my bone loss by returning the blood calcium to my bones. I am also relieved that I am avoiding long term damage to my body from high blood calcium.

I hope that this information will help others who may have this disease find better health!

CONCLUSION

There is still controversy over when and how to treat mild hyperparathyroidism without symptoms. Some experts have made extravagant claims about parathyroid surgery that make it sound like a miracle cure while others are more cautious about treatments and surgery. There is a tremendous amount of information available, especially on the internet, but I always recommend discussing health concerns with your doctor first.