Life and treatment in the 'stroke belt'

You will notice that they don't tell you one factual thing about results of their stroke program.

1. Nothing on 100% recovery statistics.

2. Nothing on 30-day deaths compared to other hospitals.

3. Nothing on the efficacy of their stroke rehab protocols.

4. Nothing on their misdiagnosis percentage of strokes, especially young strokes.

Big fucking whoopee.

Life and treatment in the 'stroke belt'

Tallahassee lies just within the area of the country stretching from East Texas to the Carolinas and from Tennessee to Leon County, where U.S. strokes most frequently occur. Three Southern states, “the buckle ”— North Carolina, South Carolina, Georgia — have stroke mortality figures that are twice as high as anywhere else in the country.
But anywhere within that compromised geographic quadrant known as the “stroke belt,” the risks are heightened for debility or mortality resulting from a sudden catastrophic cerebral event.
The reasons are complicated. Lower socioeconomic status associated with lower standards of living, decreased health care, diet and lifestyle choices, which include smoking, alcohol consumption, and regional preferences for salty, high-fat foods, all contribute and amplify the risk for stroke.
But just as how and where you live may contribute to your risks, where you live can also bode well for a positive outcome should you actually suffer a stroke.

Buy PhotoMedical Director of Tallahassee Memorial Stroke Program Dr. Siddharth Sehgal sits for an interview in his office May 1. (Photo: Hali Tauxe/Democrat)

Dr. Siddharth Sehgal is a neurologist and medical director of Tallahassee Memorial HealthCare’s Stroke Program. Tall and quiet, Sehgal becomes passionate when he talks about the strides in stroke treatment over the last few years.
“I came to TMH five years ago when we were considered a primary stroke center,” he says. “Since that time, the Agency for Health Care Administration has licensed us as a comprehensive center — the only one between New Orleans and Jacksonville — capable of providing state-of-the-art care with neurologists, neurosurgeons, nursing, and rehabilitation… all in one setting.”
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The TMH Stroke Program sees 600 to 700 patients a year, and the volume is growing.
“We have four neurologists, four neurosurgeons, and we will add another in a few months. Uniquely, we will then have three surgeons with an additional year of schooling who are stroke-trained … meaning, with the expertise to physically remove clots from the deep arteries of the brain,” Sehgal said.
Two of those physicians, endovascular neurosurgeons, Dr. Matthew Lawson and Dr. Adam Oliver, are youthfully energetic disciples of stroke prevention because of what they see every day — a vascular crochet of arteries inside a brain where one of those flowing pathways has come to an abrupt halt. Looking at a still photo, Lawson points to the place where the dark dye’s calligraphy ends.
“That’s the clot, right there. That’s what we have to go in and get.”
But before that moment, other medical professionals have been evaluating evidence to ensure they land on the right diagnosis… so vital in determining the next best step for treatment.
“As soon as someone at home sees the first signs of stroke, a facial droop, arms that can’t move normally, speech impairment, they will hopefully immediately call 911,” says Dr. Sehgal. “Time is of the essence in treating a stroke; each minute lost means the loss of brain cells and the potential for permanent disability.”
One particularly effective medication for acute strokes, which can "dissolve" a blockage in an artery, is called tPA. But it is only able to be given within four hours of the beginning of the stroke in appropriate patients.
Upon arrival in the emergency room, a suspected stroke patient is quickly evaluated for symptoms and to differentiate those signs from other causes. A CT scan will be ordered. This allows doctors to decide if there has been an ischemic stroke, where oxygen-filled blood is unable to be delivered through a vessel, or a hemorrhagic stroke, in which a ruptured vessel has spilled blood into the brain itself.
Because time is so important, the evaluated patient is then taken immediately to the “cath lab.” Dye outlines the area in the brain where the blockage has occurred. One of the neurosurgeons specializing in mechanical thrombectomies will thread a "hair-fine" catheter through a vessel in the groin, upwards to the carotid artery and into the brain.