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Soe Soe Mar, M.D.

Soe Soe Mar, M.D., pediatric neurologist, finds it very rewarding to see children get better with the correct medicines and lifestyle changes.

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As the Ankle Turns

Washington University orthopedic surgeon, Sandra E. Klein, MD, is a specialist in foot and ankle problems. She says “A serious ankle injury, like a severe sprain, can take up to three months to heal.

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Time is Brain

A slight facial droop, arm weakness, slurred speech, sudden confusion or severe headache -- are all signs of a stroke. When a stroke happens, time is of the essence for effective treatment.

There is a window of about three hours from the time of the stroke to administer the clot-buster medication called tissue plasminogen activator (tPA) -- used to reverse the effects of a blood clot-caused ischemic stroke.

It is important to realize that not all strokes are caused by blood clots cutting off oxygen to the brain. Some strokes are from cerebral hemorrhages, or bleeding in the brain. Because clot busters should not be given to patients who have had a hemorrhagic stroke, part of that critical three-hour window must be devoted to assessing symptoms and performing diagnostic scans to tell the difference.

Washington University emergency medicine specialist at Barnes-Jewish Hospital, Peter Panagos, MD, is co-director of the BJH Stroke Network. He says, “People often seek medical care too late for reversal treatment due to the lack of symptom recognition or delays in getting to the Emergency Room. Time is brain. People have become much better at recognizing signs of a heart attack and calling 911 promptly, but stroke signs are more signs of exclusion.

Without pain, patients may be unaware that parts of their bodies are not working correctly or that they have less feeling in one arm than the other. It can be very difficult for an older person who lives alone or with an aging spouse who doesn’t grasp the seriousness of the situation.”

Comprehensive stroke centers are certified to provide fast and efficient evaluations of all types of stroke patients utilizing specialized teams and technology, such as CAT and MRI brain scans.

Dr. Panagos adds, “It is not possible for the family, EMT or physician to make the distinction between an ischemic or hemorrhagic stroke. They have to get to the ER quickly and have a CAT scan. We would not want to give a patient with bleeding in the brain a powerful blood thinner, such as tPA, since this would make the bleeding much worse.”

He recommends all families and caregivers know the FAST assessment:

F: Facial asymmetry or droopiness (Ask the person to smile)
A: Arm weakness (Ask the person to raise both arms to the side)
S: Speech (Ask the person to repeat a phrase and check for slurring)
T: Time (Get to the hospital FAST; tell EMS you need them immediately)

If you or someone you know is experiencing stroke symptoms,
DON’T drive to the hospital
DON’T take aspirin
DON’T call your primary care doctor
CALL 911 IMMEDIATELY and ask to be taken to a stroke center.

Barnes-Jewish Hospital is a Joint Commission-certified stroke center, one of only eight in Missouri

Peter Panagos, MD

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