tPA and me


What would you do if you scrambled through that 3.5 hour window, only to find a colleague waiting with his foot stuck out?

Jim PlagakisThere were strokes waiting to happen sitting in the front row, I thought to myself. I was attending a presentation sponsored by my homeowners’ association and put on by the Stroke Association of Florida.

If obese and sedentary means stroke, that wasn’t me. I eat okay. No red meat at all. Rice and beans a favorite. I exercise moderately and practice light yoga every morning. There was a year of unmitigated stress, but I’ve gotten beyond that, I believe. I patted myself on the back. No stroke for you, Jimmy Boy. 

Three weeks later, in the middle of the night, I reached for my alarm clock and my left hand did not work. I tried to shout, Victoria, I’m having a stroke. Nothing came out but a croak. Finally, I woke her up and showed her the What-to-do-in-case-of-a-stroke refrigerator magnet. She broke all records calling 911. 

They got me to the ER while the window was still open for the clot-buster tPA (tissue plasminogen activator). The neurologist warned me, You could die. He also said that tPA is the best choice for a good outcome. As I gave him a thumbs up, I heard someone ask Victoria whether she was the next of kin. The he-could-die papers had to be signed.

Three hours later, I was able to say to Victoria, Look at this, as I raised my left arm with a floppy hand attached. She indicated What-a-good-boy-you-are and suggested that I sleep. What I got was some kind of strange twilight slumber. I suggested that V find something to eat and was amazingly relieved when she declined. I wanted here right there, beside me.

I have not been a religious man for a long time, yet it was as if my Christian DNA had been activated. I knew all the words from childhood prayers and found them surprisingly comforting. 



Can’t trust the caregivers

Then came the ICU nurse from hell. “You can’t have tramadol,” she said. “The doctor ordered Vicodin.”

“Nothing, then,” I slobbered. The pain was my usual post-polio discomfort and had nothing to do with stroke.

Eventually I got tramadol, but my brand took a hit with V. The nurse had tattled: “Jim was a bad boy.”

Day Two. A neurology floor nurse came in, saying cheerily, “I have your omeprazole.”

“I can’t take omeprazole with Plavix.” I answered his befuddled look with an explanation.

 He came back an hour later with an answer from a pharmacist with a very impressive title. “She said that the omeprazole-Plavix thing is outmoded. It isn’t valid anymore.”

That is just wrong. You know it and I know it. I refused the omeprazole. “Just call my PCP and tell him 300mg of ranitidine.”



Can’t trust the “highly trained”

When I got home, I went to It was up to date and could not be more unambiguous. The hospital pharmacist was wrong.

Is this where the ACPE is placing its bets? Pump up the years in pharmacy schools to get this?

I am a sophisticated patient. What about the regular guy who knows nothing? He has no choice but to trust his caregivers, and that includes the pharmacist. How can an important clinical type belittle this?  

The U.S. Food and Drug Administration (FDA) is reminding the public that it continues to warn against the concomitant use of Plavix (clopidogrel) and omeprazole because their co-administration can result in significant reductions in clopidogrel's active metabolite levels and antiplatelet activity.



Can’t trust our own

Why do I get the uneasy feeling that pharmacy is failing?

I knew very little about stroke before that presentation in November. How can that be? The rubber meets the road at the pharmacy counter. Would you be able to educate the average patient?

Oh, I forgot. Your job is the Prescription Mill and speed. Explaining about stroke warnings would screw up the metrics.

Something is wrong when the most important stroke information is a refrigerator magnet.

I was fortunate. Act Fast is the rule. Victoria did an impersonation of Speedburner.

 My left hand will be close to useless for a while. I use a cane because the occupational therapist told me to. Getting tPA in time means that my life is merely inconvenienced. No tPA, and I could have been disabled for months.

Our industry provided the drug. Is that enough?

My experience tells me that there is something missing. I know. Your DM says, Not your job, Missy. You need to pay attention to wait times.

Jim Plagakislives in Sarasota, Fla. You can e-mail him atjpgakis@hotmail.comand check out his website at

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