by Virginia Hopkins
The phone rang at 5 a.m. on a Sunday, but I somehow incorporated it into a dream and didn’t wake up. It was my 84-year-old mother on the other side of the country, leaving a message that she’d probably had a stroke and was about to be put into an ambulance and taken to the emergency room. After hearing her message a few hours later my thought was, the good news is that she can still talk and understands what’s happening.
Over the past 30 years I’ve written many articles about the importance of having someone accompany you to the hospital, whether for an emergency or a scheduled procedure. The first thing I realized while trying to track down my mother was that she had been sent off to the emergency room at a large hospital, by herself. She lives in a wonderful retirement community, so I had assumed someone had gone with her, but no, they handed the EMT her chart and sent her on her way. When I finally spoke to her, some three hours later, she was still lying on a gurney in the emergency room, and her speech was a bit garbled. Her left side was numb and she couldn’t walk by herself. She was confused and scared. Fortunately she had long ago made me her medical power-of-attorney, so I could legally make medical decisions for her if she was unable to do so for herself.
My mother has had atrial fibrillation (afib), which is a rapid and irregular heartbeat, for over a decade. Upon diagnosis the first thing the doctor suggested was the blood thinner heparin, but she refused it. Those with afib have a higher risk of stroke because blood clots can form in an upper chamber of the heart and travel to the brain. Heparin can help prevent a stroke, but it’s a dangerous drug and she had heard horror stories about it from friends and relatives. She was prescribed various drugs to control the afib, with little success and unacceptable side effects. Next she had a pacemaker implanted to help regulate her heartbeat, followed by ablation, a procedure that burns tiny lesions into the heart tissue to block the overactive nerve impulses that cause the fibrillation. This type of ablation doesn’t cure afib, but calms it down significantly. Within days after the ablation my mother’s energy levels were better than they had been in years and she was able to return to an active lifestyle.
After seven years of good health, the afib had most likely caused this stroke. When I spoke to the emergency room doctor on the phone he began pressing me to agree to have her flown by medevac helicopter to a big city hospital with a special stroke unit, where she could have a procedure in which a wire is inserted into the carotid artery (the one on the side of the neck that goes into the brain) and threaded up into the brain to dislodge the clot. He said the procedure had to be done within a few hours of the stroke so I had to decide now. I asked if they had done anything to find out whether the stroke was caused by a clot or a bleed. They had not, but were assuming it was a clot. I asked if she had been given a neurological workup to determine the extent of the damage. She had not. They had decided she had some pre-existing dementia, which she most definitely did not. I told him her garbled speech and confusion were caused by the stroke, not dementia. I thought about what she would want, and told him we’d pass on the helicopter ride and invasive procedure.
An hour later a CT scan showed neither clot nor bleed and her blood work was normal except for raised levels of an enzyme that indicates an ischemic stroke has occurred, so it was classified as a mild ischemic stroke. She was admitted to the hospital around mid-afternoon. Remember, this ordeal began in the morning. She had been on a gurney the entire time, had not eaten since the night before, and had doctors pushing her to have an invasive procedure and take a drug she didn’t want.
Once my mother got to her room, the pressure from doctors and nurses to take heparin continued. They threatened, cajoled, joked and insisted. When she said she bruised easily they challenged her. When I said our family bruises easily they challenged me and cited research. I said, “Show me the research!” They named papers. I found them online, read them, called back and said, “The lead authors on these studies are drug company consultants. I don’t consider them credible.” I pointed out that an article published in the New England Journal of Medicine last January stated that almost half of emergency room visits by older people are due to bleeding caused by blood thinners. For details, read Drugs Most Likely to Send You to the ER. They finally gave her an aspirin, not to help dissolve a clot she was told, but because she said she was in pain.
Pills Pills Pills and More Pills
Then the personnel dance ensued. For the rest of the afternoon my mother had health professionals marching into her room to declare, “I am your ________ (fill in the blank) and I want you to take a pill for ________.” There were cardiologists, a neurologist, a psychiatrist, a physical therapist, a social worker, a patient advocate, and a variety of nurses and assistants. They variously wanted to give her drugs to lower her blood pressure, lower her cholesterol, improve her circulation, treat heartburn, treat dementia, relieve anxiety, relieve depression and help her sleep. She told them to call me. I asked who was in charge and coordinating the case. Nobody knew. I told them she would take aspirin and that was it. I told them to stop telling her to take drugs. I told them she did not have dementia, her cholesterol was fine, she did not have heartburn, and she was not depressed. She was anxious for good reason, and her blood pressure was high because she had been lying on a gurney all day arguing with doctors about heparin. And furthermore, there is good research showing that stroke patients who are given drugs for anxiety and depression take longer to recover. (See references below.)
A stroke is a brain injury, and in order to heal the brain needs sleep, rest, peace and quiet. A cool, dark room, quiet voices and minimal stress can make all the difference in recovery. Most hospitals are noisy, busy, brightly lit, and intensely stressful for all concerned, the opposite polarity of what an injured brain craves. The best testimonial to the importance of peace and quiet after a stroke is Jill Bolte Taylor’s amazing book, My Stroke of Insight. Taylor suffered a massive brain hemorrhage but vividly remembers much of her recovery process. It’s a book best read before a loved one has a brain injury.
Long after my mother was admitted and in her room, I spoke to a cardiologist and asked him why the pressure to take heparin was so intense. “Because that’s the standard of care and we have to do that or we can be fired and the hospital can be sued.”
I said, “But you understand that she emphatically does not want to take this drug and I agree with her?”
He said, “I do.”
I said, “Okay, you have done your job to the best of your ability and we now agree to disagree and would you please put a note in her chart that says, “Do not ask this patient to take any drugs, including blood thinners.” He agreed. I spoke to the nurse’s station and they agreed.
Multiple drug prescriptions are one of the leading causes of hospitalization and death in the elderly. As I’ve explained in detail in the book Prescription Alternatives, once you combine more than two prescription drugs, all bets are off as to their side effects. It’s a dangerous game to play, especially when multiple doctors are prescribing. According to the FDA, adverse drug reactions caused by properly prescribed and administered drugs cause approximately 106,000 deaths per year, making prescription drugs the fourth-leading cause of death in the U.S. Blood thinners are in the top five classes of drugs contributing to this death toll.
Elderly Hospitalized Patients as a Marketing Opportunity
On Monday the hospital marketing dance began. My mother was given drug pamphlets, paperwork for rehab centers, and glossy brochures for walkers, canes and wheel chairs. The following day was much the same, with marketing for adult diapers, laxatives, eyeglasses, and drugs, drugs, drugs. Fortunately her speech was back, her thinking was clearer and she could reasonably ignore all the geezer gear. Although they promised she could be discharged that day to the nursing facility at her retirement community, by mid-afternoon it had not happened. The nursing facility could not pick her up without an official discharge from the hospital. When her cousin called to wish her well she said, “Get me out of here!” He drove over and sprang her, but not before having an avalanche of slick, glossy product brochures dumped on him.
Make no mistake about it. Hospitals are corporations. They are no longer non-profits whose mission is to heal the sick. Today a hospital’s first mission is to make a profit. When you walk or are wheeled in the door you are a customer first and a patient second. You are a target for the sale of drugs, devices and procedures. The brands of drugs offered (pushed), have to do with Big Pharma power, money and influence, not with what’s best for the patient.
When my mother was able to check her email, she found one from a lawyer she’d never met, wondering how her stay in the hospital went and whether she’s like to sue anyone there for anything. The hospital had asked for her email address, then immediately turned around and sold it to someone whose job description is to sue them. If corporations are people too, this one is both venal and stupid.
Before the Ambulance Arrives
There is much that can be done for someone who has had a stroke, even before the ambulance arrives. The first step is to take one aspirin, and only one, because if it’s a stroke caused by bleeding rather than a clot, two aspirin could make it worse. Chewing it is better than swallowing.
Personally I would rub on some progesterone cream, which won’t thin the blood per se, but will help normalize clotting tendencies and will immediately boost the brain’s ability to heal itself (read Progesterone and Stroke for details).
If appropriate and the person having the stroke is still lucid, a small glass of red wine can help thin the blood and act as a muscle relaxant, and can also be used if aspirin is not available.
If I were having a stroke I would want 100 mg of nattokinase as soon as possible. Nattokinase is an extract of natto, a Japanese food made from fermented soybean paste. It is an enzyme that effectively helps the body dissolve fibrin, a substance involved in clot formation. In fact, it’s one of the most potent clot dissolving enzymes known, and does it without blocking the production of vitamin K, which the blood thinner warfarin does. Nattokinase is a natural substance and can’t be patented, so it’s unlikely to be used in mainstream medicine anytime soon.
Be forewarned, if you bring any of these items into a hospital and try to give them to a patient, they will be confiscated, which is reasonable as few if any hospitals have policies or procedures on how to incorporate safe, effective and natural alternatives to drugs into a treatment program.
For the elderly at risk for stroke it’s important to avoid straining during bowel movements. Straining can temporarily create very high blood pressure that can rupture blood vessels in the brain, and particularly in those with afib it can send a clot into the brain. One of the easiest ways to avoid straining is to eat a few prunes after dinner and wash them down with a cup of warm herbal tea. This keeps the stool soft and bulky, which makes straining unnecessary. For more details read Constipation Causes and Remedies which includes a list of drugs that can cause constipation.
Six weeks later, thanks to good physical and occupational therapy programs at the retirement community, a strong will to get better, and minimal drugs, my mother is doing well. She’s moving a little more slowly, and it’s a little harder to balance the checkbook, but she’s doing the New York Times crossword puzzle, communicating with her friends on Facebook, has a very active social life, and has started reading her book club’s next selection. Overall she’s in good health and spirits.
What haunts me is that as patient advocates go, I’m fairly knowledgeable about many of the issues that can arise during an emergency visit to the hospital, but during that long, long Sunday, separated from my mother by 2,700 miles, I repeatedly felt stymied, helpless and under-informed. I knew that my mother would want to avoid drugs in general and would not want to take heparin in particular, but the hospital staff made it pointedly clear that, in their opinion, I was putting my mother’s life at risk by agreeing with her. The decision not to take heparin was completely rational, especially in a family that has a tendency to bruise and bleed easily, but our refusal had thrown a wrench into the patient treatment gears and the hospital staff didn’t know how to back up and take a different approach. The pharmaceutical tools available in a hospital are more akin to a monkey wrench, when it would often be more appropriate to use tweezers.
We need alternative medicine health professionals in our hospitals, working with other hospital staff, to support patients who would justifiably prefer to use safer and gentler forms of medicine and healing whenever possible. Many hospitals have integrated acupuncture into their treatment options, but alternative medicines also have their place.
Although my mother encountered many wonderful people during her stay at the hospital, it was clear that corporate hospital priorities have more to do with profits than with patients, and that she needed an advocate there with her for protection.
Goldstein B, “Common drugs may influence motor recovery after stroke. The Sygen In Acute Stroke Study Investigators, Neurology 1995 May;45(5):865-71.
Goldstein LB, “Potential Effects of Common Drugs on Stroke Recovery,” Arch Neurol. 1998;55:454–546.