Certain types of strokes are always fatal

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DEAR DR. DONOHUE: A few months ago, my husband passed away. He had been in reasonably good health, took care of himself, ate sensibly, watched his weight and exercised religiously. He had an irregular heartbeat and was on Coumadin, and he took high blood pressure medicine.

Out of nowhere, one day, he said something was wrong, and he asked me to call 911. I did. At the hospital, they told us he had a massive brain hemorrhage in the worst possible place. The doctor said his functions were gone. They inserted a breathing tube and then disconnected it to see if he could breathe on his own. He could take only two breaths in one minute. We let him go in peace.

He died just five months short of our 50th wedding anniversary. I am so devastated. Should I have insisted they leave the breathing tube in? I know he didn’t want to live in a vegetative state. Could something have been done? The death certificate says the cause of death was a pontine hemorrhage. – L.V.

ANSWER:
There are two major kinds of stroke: ischemic (is-KEY-mick) and hemorrhagic. Ischemic stroke is a blockage of the blood supply to the brain due to a clogged artery. It’s the common kind of stroke. A hemorrhagic stroke is due to a broken brain blood vessel.

Your husband’s broken vessel was in the pons, a part of the brain through which nerve cables, essential to life, pass.

Disruption of the pontine nerve cables produces a deep coma and paralysis of both right and left arms and legs. Such strokes result in death or severe impairment.

Your husband probably bled more rapidly because he had to take the blood thinner Coumadin. You made the right decision, one your husband would have wanted. It’s the decision I wish my relatives would make for me if I ever suffer the same fate as your husband.

You have my deepest sympathy. Sudden deaths are devastating, because they are so unexpected. Your husband didn’t suffer. You have suffered far more than he did. The booklet on strokes explains this destructive illness in detail. Readers can obtain a copy by writing: Dr. Donohue – No. 902, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Does taking a baby aspirin (81 mg) daily prevent a heart attack or a stroke for a person who has not had either? If yes, is bromelain a good substitute for aspirin? – R.C.

ANSWER:
If people have had a stroke or a heart attack, taking aspirin reduces their chance of having a second one.

If people have not had a heart attack (or possibly a stroke) but are at great risk of having one, then aspirin lowers their risk of ever having one.

Being at great risk means having diabetes, uncontrolled high blood pressure or having a family history of such illnesses.

For women who have not had either a stroke or a heart attack and who are not at risk for having either, daily aspirin appears to lessen the chances of stroke, but not of a heart attack.

For men in this category, it’s the opposite. Aspirin lowers the chances of a heart attack, but not of a stroke. I can’t explain why. Bromelain is a combination of many natural substances, and it’s found in pineapples. It is said to keep blood platelets (the blood cells that promote clot formation) from clinging to one another and, therefore, from plugging arteries. How great that effect is hasn’t been quantitated. It should not be used as an aspirin substitute.

DEAR DR. DONOHUE: I had a vasectomy in 1999. I am 48. My wife and I would have a difficult time if we found out we were having another child. Is there any way to check the effectiveness of a vasectomy? – R.R.

ANSWER:
The seminal fluid can be checked for sperm. If there is none, that proves that the vasectomy has done its job.

DEAR DR. DONOHUE: My daughter is 54. For the past three years, she has had trouble swallowing food and drink. She saw a number of doctors and tried a number of medicines, but none worked. Last week she saw a specialist who told her she has achalasia. I’d appreciate an explanation of it and how it’s treated. – R.H.

ANSWER:
Achalasia (ack-uh-LAY-zee-uh) is a problem that arises from a dysfunction of the muscle action of the esophagus, the long tube that stretches from throat to stomach and through which food passes. It is not a rigid tube. It’s a hollow passageway whose walls are muscles. The esophageal muscles contract in succession, starting at the top. They push food down. In achalasia, muscle action is weak and uncoordinated.

Furthermore, the sphincter muscle at the bottom of the esophagus is tightly contracted at all times. This sphincter is a gate. It opens when food arrives at the lowermost esophagus. It stays closed most of the time to keep stomach acid and digestive juices from squirting upward into the esophagus. Weak muscle contractions of the upper esophagus coupled with a chronically tightly contracted sphincter make swallowing food close to impossible.

Achalasia comes about from a hitch in the nerve control of the esophageal muscles. Why it happens hasn’t been explained.

Medicines used to control angina chest pain can sometimes work for achalasia. Nitroglycerin, for example, can be put under the tongue, and it often permits close to normal swallowing action.

However, a more successful treatment is dilation of the esophagus with balloons. Sometimes surgery is necessary to restore the passage of food down the esophagus. Part of the surgical procedure entails making an incision in the sphincter muscle so it doesn’t stay tightly closed all the time.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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