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At 88, doctor pursues a long-ignored treatment for strokes, heart attacks
- INTPnerd 9y agoThat's brilliant, using heart attacks to treat strokes
- learc83 9y agoThe article didn't mention anything about using heart attacks to treat strokes.
- giancarlostoro 9y agoAt first I thought oh I guess the symptoms aren't as awful then I realized you interpreted the title differently from me... Wow yeah I guess they hit the title length limit for HN and had to get creative.
- vanderZwan 9y agoCouldn't OP have replaced the last comma with an ampersand?
- stared 9y agoIt uses coma.
- notadoc 9y agoHere's an alternate and more informative headline for anyone who wants a bit more detail rather than clicking through and trying to skim for the needle in a digital haystack: >>> "At 88, doctor pursues clot-busting medication combination to aid in treatment of heart attacks and strokes"
- downrightmike 9y agoThis is a much better title. Considering that the now favored course of action is surgery, a potent drug combo would be my choice. Once you start cutting, Docs often want to keep cutting.
- projektfu 9y agoThe favored course of action is interventional radiology and those guys like to get done and move onto the next patient to rake in the dough.
- neuro_imager 9y agoActually, its interventional cardiology for heart attacks and neurointerventional surgery/interventional neuroradiology(NIR) for strokes. (Not IR which cover non-neurological and non-cardiological interventional procedures). I'm a NIR and most of us are not paid per surgery/intervention. Also these interventions tend to be loss leaders in terms of hospital reimbursements. Funding for stroke centres can be profitable but that's a very long discussion. In addition, at least 7 randomized clinical trials have shown the benefit of thrombectomy in acute stroke (actually something of a modern medical technological miracle).
- projektfu 9y agoI find that surprising. What's the typical compensation model? Salary or hourly?
- neuro_imager 9y ago
- helloworld 9y agoFor me, it was the persistence of the researcher -- well into his ninth decade -- that caught my eye, rather than the somewhat arcane details of the thrombolytic therapy that he's been pursuing. A strong sense of purpose seems to be a factor in health and longevity. Is it just good fortune that allows some people to develop that sense of purpose, or can it be consciously and effectively nurtured?
- baxtr 9y agoHell yeah. I wish I’ll be that persistent when I get old. But then again, relaxing and traveling the world might be nice, too. Well, we’ll see
- justherefortart 9y agoTravel the world now, it gets harder as you age.
- Avamander 9y agoWith what funds...
- ytwySXpMbS 9y agoIf you try it can be extremely cheap. For example, hitchhiking is free. Depends on the country of course in regards to safety. If you stay in youth hostels it's significantly cheaper than hotels, and you meet more people, etc.
- ams6110 9y agoTravel is overrated, and environmentally catastrophic. Enjoy where you live, or if you don't like it, move.
- hodl 9y agoUse a canoe
- lvs 9y ago>What if tPA worked like the starter motor that turns on a car, and urokinase was the gasoline that ran it? No comment on the underlying science, but I will express my continued frustration with popsci writers and their counterproductive analogies. It's especially unhelpful when it's wrong on the dumbed-down end. A starter motor does not run on gasoline. It's an electric motor that runs off the battery.
- twic 9y agoThat's the whole point of the analogy. From the next paragraph: > When a clot forms, tPA in the bloodstream is quickly recruited to the site to begin dissolving it. But too much of a clot-buster could lead to bleeds, so once the process is sparked, the body rapidly clears out tPA. Urokinase comes along, carried on the surface of platelets and certain white blood cells, to finish the job. tPA kicks off the process, and once it's started, urokinase does the rest. I don't know the biochemistry in enough detail to say whether this is a really good metaphor (can urokinase only be activated if tPA has acted? is urokinase consumed by this process?), but the author is not suggesting that a starter motor runs off gasoline.
- skosch 9y agoOP simply mis-parsed the last "it" of the sentence to refer to the starter motor, when the author intended for it to refer to the car.
- smallnamespace 9y agoThat's a strange mis-parse since the rule is that pronouns refer to their closest reasonable antecedent (in this case 'car' is closest to 'it').
- arkades 9y agoWhat this story leaves out is why we are moving away from thrombolytics - besides them kinda sucking. Once a clot has matured they tend to be useless, which is part of why there’s a solid upper cap on time to administration. You cross a line where any clot they’re likely to bust isn’t one you want to bust. So, a window of a couple of hours. Urokinase doesn’t change that, to my knowledge. Surgical removal of the clot, on the other hand, has recently been shown to offer enormous benefit to at-risk tissue (tissue not yet dead but in the watershed area) 24 hours later, without risk of hitting the wrong clot. It’s no miracle either, but evidence is piling up that it’s got more Pros and fewer Cons. Thus, no one really following armchair hypotheses (one old non RCT trial not withstanding) about combining two increasingly undesirable drugs. I respect the guy’s thought and effort, and have to admit he might be right about their combined effectiveness, but this article leaves out a lot of the context as to -why- this isn’t getting attention. Writing a hagiography-by-omission is below what I’ve come to expect from statnews.
- ntenenz 9y agoFor those interested, the DAWN Trial (http://www.nejm.org/doi/full/10.1056/NEJMoa1706442 http://www.nejm.org/doi/full/10.1056/NEJMoa1706442) provides more detail on the value of thrombectomy, especially in cases where the collateral circulation is strong.
- _0ffh 9y agoVery interesting, thank you! Unfortunately I don't quite know what to make of the recurring phrase "mismatch between clinical deficit and infarct". Could anyone enlighten me, please?
- arkades 9y agoWhen a clot blocks off blood flow to an area of the brain you expect that area to die and, as a result, lose its function (“clinical deficit”). The blockage is an infarct; the downstream area suffocating is infarcted. When you look at the area of brain that should be downstream of a clot and therefore nonfunctional, that’s the “infarct volume”. It’s the volume of brain that we believe is infarcted. The “mismatch” is when we do a CT, find that, say, the chunk of your brain that moves your right hand is downstream from the infarct, but your right hand is still working. This suggests that that part of your brain has enough blood coming to it from other, less salient, arteries that it’s dying slowly instead of fast. That “mismatch” area is the one that, if we can go in and surgically pull out the clot, we can save.
- ganashaw 9y agoDid anyone else read this title as implying that heart attacks were a potential treatment for strokes?
- sabujp 9y agouggh, i need to use summarizers. Several paragraphs in and it finally said the cocktail was a combination of tpa and urokinase precursor
- stuntkite 9y agoI seriously couldn't get past the first full page. Someone needed to give me an idea of what his treatment was. I love that he's old and still doing something. The comments here tell me it's somehow using heart attacks to treat strokes, but this thing had so much crap before giving me a detail I could process. I hope he saves more people and lives to 120, but yeah, summary... or at least slightly better writing.
- skookumchuck 9y agoI hope I'm still productive at my job at 88.