Guest guest Posted January 8, 2006 Report Share Posted January 8, 2006 Sharon's stroke raises questions about treatment http://www.usatoday.com/news/world/2006-01-05-sharon-medical_x.htm JERUSALEM (AP) — Prime Minister Ariel Sharon suffered a massive stroke in the back of an ambulance while on an hourlong trip to a Jerusalem hospital, raising a host of questions about his treatment. Why wasn't he flown to the hospital or at least driven to one closer to his home? Did doctors take an unnecessary risk by treating him with blood thinners after he had a mild stroke two weeks ago? Did they wait too long to schedule a heart procedure designed to prevent another stroke? And perhaps most important: Could political pressures have colored his treatment? " There are problems when you treat a figure who is a political persona, or a VIP, " said Dr. Gabi Barabash, the director of Ichilov Hospital in Tel Aviv, who was not involved in treating Sharon. " Treatment of a VIP adds stress to the judgment system, and stress is unproductive. " Sharon was on a respirator under deep sedation at Hadassah Hospital in Jerusalem on Thursday after seven hours of emergency surgery to stop a cerebral hemorrhage, or bleeding stroke. Outside experts said prospects for recovery were slim. The stroke followed a mild stroke Sharon suffered Dec. 18 that was caused by a small blood clot. Doctors at Hadassah released him less than 48 hours after that stroke and gave the 77-year-old leader blood thinners to prevent future ones. His neurologist, Dr. Tamir Ben-Hur, said " chances are excellent that he won't have another one. " On Dec. 26, doctors said they found a small hole in Sharon's heart they said had led to his mild stroke. They planned to seal the hole in a procedure scheduled for Thursday to prevent another stroke. But on Wednesday night, Sharon complained of feeling ill and his sons and a paramedic loaded him into an ambulance that had been stationed at his ranch in the Negev Desert since the stroke. The closer Soroka Medical Center in Bersheeba was told to prepare for his arrival, but he was taken instead on the hourlong trip to Hadassah. " I don't think they made a mistake, " Barabash said. The two hospitals are just half an hour apart, the medical staff at Hadassah is familiar with his case, and Soroka doesn't have a magnetic resonance imager, which is used in brain scans, he said. Sharon was conscious for most of the drive, and didn't deteriorate badly until about 15 minutes before reaching the hospital. Some Israelis questioned whether the outcome could have been different if had he been airlifted. " If there is an ambulance that is available at the door to the house that can leave immediately and a helicopter that still takes time to arrive, it is preferable to get moving, " Dr. Zeev Feldman, a neurosurgeon at Tel Hashomer Hospital outside Tel Aviv, told Channel 2 TV. " Generally speaking, it's best to come faster, " said Dr. Itzhak Fried, a professor of neurosurgery at Ichilov and UCLA. " But I'm not sure that with such massive bleeding, and the time difference of 10 to 20 minutes (from the hospital) that they're talking about, that it would have been significant. " Surgery to stop the bleeding apparently had been complicated by blood thinners Sharon took following his initial stroke, and the medication may also have contributed to the severity of Wednesday's stroke. Still, his doctors should not be criticized for prescribing it, independent experts said. Blood thinners are commonly given after clot-related strokes. They reduce the risk of similar strokes, but raise the risk of bleeding. " The doctors were responding to that first stroke properly with the use of blood thinners. It is unfair to critique them based on the information we have, " said Dr. Keith Siller, medical director of the Comprehensive Stroke Care Center at New York University. Giving Sharon a blood thinner was a tough judgment call, and one that many of the best doctors would have made, Siller said. The bleeding risk is usually considered a long-term one, from use of the drugs over months, not a few weeks, he said. Dr. Shlomo Mor-Yosef, Hadassah's director general, defended the prescription of blood thinners Thursday. Asked about Ben-Hur's assertion that the risk of a repeat stroke was small, another Hadassah official said: " A small chance is still a chance. They knew it was possible. " He spoke on condition of anonymity because he wasn't authorized to speak to the media. Some doctors questioned the need to seal the hole in Sharon's heart, given that research has not proven that this common, minor birth defect really causes strokes or that repairing it would prevent further problems. Siller, who is studying the possible correlation between such holes and stroke, said closing it sooner wouldn't have prevented the second stroke. " The closure of the hole was not necessarily an emergency because the association of that being the actual cause is still not really known for sure. ... (But) the very fact that you have a fresh scar in the brain will make you vulnerable to hemorrhage, " he said. Sharon's public stature, and his desire to portray himself in command ahead of March 28 elections may have also led to some decisions that clashed with doctors' judgment. At the time he fell ill, Sharon was working on a list of candidates for his new Kadima Party, which he formed after quitting the Likud Party. " We would not have advised a regular person to return to the same intensity of activity, " Dr. Avi Cohen, a neurosurgeon at Soroka, told Channel 2. Quote Link to comment Share on other sites More sharing options...
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