Director, Emergency Services, Bikur Cholim Hospital
I received a letter complaining that many patients do not
receive the best stroke care, recently in the news because of
the situation with the prime minister. They are referring to
the clot-busting drug called TPA, and Dave Tanne, a
neurologist at Tel Hashomer, is wondering why this drug is
not in more use.
I agree that the Health Ministry has not done enough to make
stroke centers, but one must realize that this therapy
carries some dangers and those who are eligible for it are a
precious few. While you must get to the hospital immediately
to receive this therapy (waiting to see if it goes away may
be too late), even so you may not be eligible. I wrote an
article in the Israeli Journal of Emergency Medicine
requesting caution and I have spoken with Dr. Tanne. There
are other interventions that have shown good results that are
without danger. So I think the writers of the article that
blasted Israeli hospitals were not balanced.
What is Anorexia Nervosa? This is a disease we have written
on in the past where young people — most often girls
— have a pathological obsession with losing weight and
they starve themselves to do so. There are genetic causes to
this, but a lot has to do with pressures to excel,
depression, anxiety, cultural and family pressures. Weight
loss can be substantial, and these girls can die. They lose
their hair, have stunted growth, and other symptoms. Often
there are stress fractures which result from malnutrition and
heart and brain are adversely affected.
Most of this can return if their weight loss is reversed, but
some brain changes remain for life. Patients must be re- fed,
often in a hospital setting, and slowly, much like Holocaust
survivors. Prozac is a drug often used, along with
counselling. Family therapy should be done, not just the
person involved. Those who want more information should check
out the source for this information, the New England
Journal of Medicine, 6 Oct. 05, or contact the following
links:
www.aedweb.org (Academy for Eating Disorders);
www.nationaleatingdisorders.org (The National Eating
Disorders Association) www.anad.org (the National Association
of Anorexia Nervosa and Associated Disorders).
Heart murmurs are simply interrupted flow through the valves
of the heart. The valves may be too loose or too sticky. Many
young girls have murmurs of no consequence, but as one gets
older a stuck valve can severely reduce blood flow from the
heart, and so can a leaky one. The best test for this is an
ultrasound of the heart called an ECHO. Antibiotics are taken
if there is a possibility of bacteria reaching bad valves,
and the latest updates are available through the American
Heart Association. Your doctor should assess them.
Valves that need to be changed are changed in an operation
using native valves (made of pig or cow hide) or metal ones.
The latter hold up better, the former do not need thinning of
the blood like metal ones. Write me in care of the
Yated.
A message from GlaxoSmithKline, sponsor of this
column. We haven't spoken about Zinnat in a while. I do
not use antibiotics routinely, but there are some things
about Zinnat that make it stand out. Safety in pregnancy is
the first. Second, it can often save taking two antibiotics
since its coverage is enough very frequently for tough
diseases like infections of the skin. It is very useful for
the elderly in pneumonia. Best of all, the side effects are
few.
