Health Matters: The ABCs of TIADr. Wynne answers questions about TIA and various screen procedures.
By: Dr. Joshua Wynne, Grand Forks Herald
Q. My grandmother developed weakness of her left arm that lasted for an hour and then resolved. Her doctor told her she had suffered a TIA. What is a TIA and how is it treated?
A. TIA stands for transient ischemic attack, meaning a temporary (usually lasting seconds to minutes to hours but less than 24 hours) neurologic problem that clears completely. It usually is caused by the combination of hardening and narrowing of an artery in the neck going to the brain with a superimposed blood clot, a part of which breaks off and lodges in a smaller artery in the brain.
The immediate treatment is with aspirin, which helps reduce the risk of a blood clot forming. Subsequent surgery or the placement of a stent in the neck artery often is performed as well. But, if nothing is done, the patient has a significant risk of developing a stroke in which there is permanent brain damage and often one-sided weakness or paralysis.
A recent large study in China found that the combination of aspirin and another medication called clopidogrel (Plavix is the brand name) reduces the chance of a blood clot forming even better than if just aspirin is used; patients so treated suffered about a third fewer strokes than those treated just with aspirin.
Importantly, the use of the dual therapy in the study caused no more bleeding complications than aspirin alone. So your grandmother probably should be treated with the combination of aspirin and clopidogrel and be evaluated regarding the need for surgery or a stent procedure.
Q. Dr. Wynne, in prior columns you have discussed the controversies surrounding various screening procedures such as mammography for women, looking for breast cancer, and prostate-specific antigen (PSA) tests for men, looking for prostate cancer. But through routine screening, my doctor just found that I have prostate cancer, and yet he says that my type of cancer doesn’t need to be treated because it is slow-growing and low-risk! I’m scared and don’t understand.
A. This is a complicated and controversial problem, but let me try to clarify the issues. Prostate cancer comes in several different forms, but we are able to identify one form—fortunately such as what you have — that is localized to one area of the prostate, hasn’t spread anywhere, is slow-growing, and usually doesn’t result in death. About 95 percent of men with this type of prostate cancer will not succumb to it over the next 15 years — even if they receive no treatment! Despite this, many men still opt for treatment in this setting, although the benefits are unclear.
Unfortunately, the side effects of treatment are not minor, and include impotence. So for low-risk prostate cancer like yours, a reasonable option is to forgo treatment and simply be observed. Observation often includes close monitoring, with serial PSA measurements, periodic examination of the prostate, and biopsies as needed, although in some cases — especially in the elderly — we simply watch the patient and intervene only if symptoms develop.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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