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Frail person with recurrent TIA
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An_244919 posted:
My father has had frequent visits to the ER for what seem to be TIAs.
He is 83. He is frail. He has a history of heart disease and takes coumadin. He has diabetes which has become difficult to control in the past year.

The visits to the ER are taking a toll on his primary caretaker who is also 83 but in better health. Each time he has symptoms of a stroke, she is afraid to NOT take him to the ER in case this is the time it really is a stroke- where minutes matter.

Everything that can be done to lower his stroke risk is being done. His weight, blood pressure and cholesterol levels are all good. He walks 30 minutes or more most days. He has low stress and a healthy diet.

Is there any way some of these ER visits can be avoided? Is there any way to determine a TIA from a major stroke without a CAT scan/MRI or whatever test it is they use?

The last time he had an episode of weakness, trouble swallowing and a weakness in one side, the doctor told him to go to the ER but he decided to take an aspirin and a nap instead. He felt fine when he woke up.

Isn't it dangerous to take an aspirin if you are having a stroke? I know he did it to avoid the stress on his primary caretaker. Does anyone have other suggestions for how these many episodes might be better managed?
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cchornomud responded:
Try asking his primary treating physician or one of the ER doctors. I personally would err on the side of caution regarding something so serious. I'm sorry to hear about his health problems.
 
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Alicew234 replied to cchornomud's response:
Thank you. I think his doctor is in the same position as the primary caretaker. When consulted, she can't take the chance on NOT sending him to the ER- just in case.

I live too far away to be available to help out with an ER visit. Maybe I can convince his wife not to accompany him each time. At least during the ER visit he gets to lie down! She stands by and waits while they do whatever testing they do. It is stressful for her.

What I need is an in home diagnostic tool. How much is a CAT scan and can an 83 year old woman learn to operate one? (kidding)
 
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Richard C Senelick, MD replied to Alicew234's response:
Your father and his caregiver are in a difficult situation. As you stated , it appears they are doing evrything they can do to prevent another stroke. If he is already taking aspirin, then taking another one probably is not dangerous, but also will not help.

A key question to ask his doctor is, " If he is having another stroke, what will you differently in the hospital that will impact his outcome?" He is probably not a candidate for tPA ( clot buster) and it may be that they would just do supportive treatment at his age and with his medical complications. If this is the case, your father and his doctor need to set up guidelines for staying home and going to the hospital. On the other hand, if he is a candidate for aggressive treatemnt, he may have no choice but to go to the ER. Time is critical if he is a candidate for tPA. That would seem to be the key factor to establish with his doctor.

Good Luck.
After your stroke you may be experiencing a new normal, but remember what George Eliot said- It is never too late to be what you might have been. You still can achieve new goals.
 
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Alicew234 replied to Richard C Senelick, MD's response:
Thank you very much, Dr. Senelick, that's extremely helpful. I will ask if they would let me accompany them on their next visit to the doctor.


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