DEAR DR. GOTT: My wife, age 84, died last year of a stroke and pneumonia, the latter contracted in the hospital. She was in intensive care and died in hospice February 14. She was an insulin-dependent diabetic with the additional pain of osteoporosis. Her doctor had her scheduled for office visits at three month intervals.
In my opinion, this was too long an interval for a person in as poor health as she was. Could or should the doctor have known about an impending stroke if she was seen more often? And, perhaps he might have changed her treatment or increased her medication? And, warned her family? Was this negligence or ignorance on the part of the young doctor to whom my wife was assigned by our large hospital system here? Her long-time doctor quit his practice on very short notice and went to work for the hospital as a hospitalist.
There were matters I needed to discuss with my wife but didn’t get to because of the sudden stroke. Maybe doctors cannot know when a stroke is impending, I don’t know. Her mother, also a diabetic, died of a stroke but was 15 to 20 years younger. I was reminded after my wife’s death that diabetics often have strokes. There was no word of condolence or sympathy from the young doctor to our family.
DEAR READER: A stroke can occur when the blood supply to the brain is either reduced dramatically or interrupted because it deprives brain tissue from receiving the oxygen it needs. Strokes can sometimes be prevented and treated with varying success once they occur as long as immediate intervention occurs. The signs and symptoms can fluctuate or disappear altogether but that does not mean immediate medical intervention should be ignored since the longer a stroke remains untreated, the greater the potential for both permanent brain damage and disability. A general guideline is getting medical intervention and drugs no more than three hours after initial symptoms present; however, that does not assure an individual will not still suffer irreparable consequences. Symptoms, among other things, can include headache, sudden weakness or numbness of the face, arm or leg – commonly on one side of the body, difficulties walking, and visual disturbances.
There are a number of different types of strokes that range from a transient ischemic attack (TIA) to a subarachnoid hemorrhage. The TIA is temporary and the patient will almost always return to normal, while the subarachnoid hemorrhage is caused by a ruptured aneurysm and is of far greater consequence.
If your wife’s vital signs and lab work remained relatively normal, I cannot blame her physician, despite his age. However, in my opinion, if her blood pressure slowly spiked, her diabetes was climbing out of control, she was a smoker, didn’t exercise, was obese, had high cholesterol levels or other unusual symptoms, she should definitely have received closer attention more frequently than every three months. This is not to imply her doctor could have stopped the stroke from occurring but he could have brought some of her risk factors under tighter control, working toward prevention. She also had a family history, was in her 80s and was likely relatively compromised because of her osteoporosis. And, there’s the darned pneumonia (common in health care facilities) that likely cost the ultimate price. Those factors worked against her. Further, diabetics are definitely at increased risk for stroke. In fact, the risk of stroke is about 2 ½ times higher for diabetics than it is for individuals without diabetes. She had a lot of strikes against her.
You indicate her young doctor was assigned to her. If you both felt he was too young to be able to understand the complexities of an aging body, you should have requested from the get-go she be assigned to another physician. My guess is that you are both covered under Medicare and this should have been possible. She also should have been under the guidance of her physician for better management of her diabetes.
It’s extremely difficult when someone leaves our lives too soon. Questions remain unanswered. Things are left unsaid. We can’t tell a person one more time how much they mean to us. And, the scars last a lifetime. I’m truly sorry for your loss and hope you can be comforted by the memories of the wonderful years you shared together.
Readers who would like related information can order my Health Reports “Stroke” and “Diabetes” by sending a self-addressed, stamped number 10 envelope and a $2 per report US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
