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A TRIP TO THE EMERGENCY ROOM

You know, as I was being wheeled out of my place of work the other day by paramedics, and my co-workers were mercilessly mocking me for having an allergic reaction (these macho guys can't really tell me they love me, right?), it struck me very strongly that going to the Emergency Department is a real pain.

I had things to do. What about the plants in my office? My computer was on. I had an appointment that evening. Somebody had to pick up my kids at soccer.

But after all, life is preferable to death, and sense is preferable to stubbornness. So I just did what I was told to do, and I dozed off intermittently, and did what I was told to do, and six hours later I got to go home.

This kind of inconvenience is the thing that keeps people from responding to clear medical emergencies. It's time consuming, and embarrassing, and especially if it turns out to be a false alarm.

Today, I'd like to suggest that in one area of our health, we probably need to rethink the cost-benefit equation of calling an ambulance. Not enough people get prompt medical attention when they're having a stroke.

People tend to know the warning signs of a heart attack, but a "brain attack" can hit you in a bunch of different ways. And it's important to be suspicious because, unlike the case in past decades, we can actually do something for people with strokes, especially if they show up within three hours.

Strokes come in two varieties: clotting and bleeding. Either an artery leading to your brain gets plugged, or an artery bleeds into your brain. The clotting type -- what we call "ischemic" -- is more common, representing 90 percent of strokes. And if you get that type and show up at a hospital fast enough, a clot-busting drug might make you better very quickly.

Now, to get straight to the point, here's what to look out for in the most common types of ischemic stroke. Keep in mind that the brain, like the rest of the body, has two sides, each with its own arteries, so each stroke syndrome tends to affect half of the body:

* If the clot affects the front of your brain, you'll get weakness and loss of sensation in one leg, difficulty walking, drowsiness and impaired judgment.

* If the clot affects the middle part of your brain, you'll get weakness and loss of sensation in an arm and a leg together with the face on one side. You won't be able to see things on the other side of your body -- your vision will be cut in two vertically, with nothing on one side. You also might not be able to talk. (That can be either a "Blubba blubba blubba" or a "I can't -- where is? -- you -- that over -- hi -- Is it?"

* If the clot affects the back of your brain, you'll have the problem with half of your vision as above, and you may not be able to figure out what things are when you look at them. You'll probably feel groggy.

* And if the clot affects the way, way, back part of your brain, where the brainstem and the cerebellum are, you can get all sorts of symptoms: severe dizziness, double vision, inability to talk, inability to swallow, fainting, and/or loss of pain and temperature sensations on various parts of your body.

Now keep in mind that these are just four "classic" stroke presentations. Your body may not have read the textbooks, as one of my teachers used to say.

The main point is that any time part of your body isn't working right, don't just sit there for a few hours and hope it goes away. Get on the phone to somebody fast -- an ambulance is absolutely the right thing to do in this situation. You may have only a narrow window of time to get help. The sooner a stroke is identified and treated, the better your long-term chances are.

It's probably especially important to you, I would think, because most people fear being a burden on their family and others -- people fear losing their independence and their ability to take care of themselves.

Time wasted is brain lost.

Dr. Mike Merrill is an internist practicing in Buffalo. His column appears every other week on this page. E-mail your comments to him at driconoclast@yahoo.com.

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