To Your Good Health: Sadly, some strokes are always fatal

Dear Dr. Donohue: A few months ago, my husband passed away. He had been in reasonably good health, took care of himself, ate sensibly, watched his weight and exercised religiously. He had an irregular heartbeat and was on Coumadin, and he took high blood pressure medicine.

Out of nowhere, one day, he said something was wrong, and he asked me to call 911. I did. At the hospital, they told us he had a massive brain hemorrhage in the worst possible place. The doctor said his functions were gone. They inserted a breathing tube and then disconnected it to see if he could breathe on his own. He could take only two breaths in one minute. We let him go in peace.

He died just five months short of our 50th wedding anniversary. I am so devastated. Should I have insisted they leave the breathing tube in? I know he didn’t want to live in a vegetative state. Could something have been done? The death certificate says the cause of death was a pontine hemorrhage. — L.V.

Answer: There are two major kinds of stroke: ischemic (is-KEY-mick) and hemorrhagic. Ischemic stroke is a blockage of the blood supply to the brain due to a clogged artery. It’s the common kind of stroke. A hemorrhagic stroke is due to a broken brain blood vessel. Your husband’s broken vessel was in the pons, a part of the brain through which nerve cables, essential to life, pass.

Disruption of the pontine nerve cables produces a deep coma and paralysis of both right and left arms and legs. Such strokes result in death or severe impairment. Your husband probably bled more rapidly because he had to take the blood thinner Coumadin.

You made the right decision, one your husband would have wanted. It’s the decision I wish my relatives would make for me if I ever suffer the same fate as your husband.

You have my deepest sympathy. Sudden deaths are devastating, because they are so unexpected. Your husband didn’t suffer. You have suffered far more than he did.

The booklet on strokes explains this destructive illness in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 902W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

Dear Dr. Donohue: I had a high PSA reading and had to have a prostate biopsy. The report says prostate cancer with a Gleason score of four. What is that? — W.W.

Answer: When examining the biopsy with a microscope, the pathologist identifies the two most numerous kinds of cells. He assigns a number from one to five for each of those cell populations. One is the least-aggressive-looking cell and five is the most-aggressive-looking. The two scores are added. Two, therefore, is the best Gleason number, and 10 the worst.

Your score of four indicates a fairly benign cancer. It indicates a good prognosis. Gleason score, however, is not the only factor involved in estimating the cancer’s threat. The extent of its spread is also important.