• FALL 1994 ISSUE
HealthNews
Neurology Team Uses Unified Approach
to Treat Stroke Patients
0
ne of the leading
causes of death in
the United States is
stroke. In most cas-
es, a blood clot either builds up
in a brain artery or travels
from another part of the body
to the brain. The clot disrupts
blood flow to the brain and is
the third leading cause of
death in the United States.
Neurologists at Sinai Hospi-
tal, however, have taken a
proactive approach to prevent
stroke by evaluating patients
for cerebral vascular disease,
the leading cause of stroke.
"Our goal is to focus on the
prevention of cerebral vascu-
lar disease and the reduction
of risk factors associated with
stroke," says Sinai Hospital's
Division Chief of Neurology
William Leuchter, M.D. "We
have the capacity to diagnose
cerebral vascular disease at a
very early stage with safe,
non-invasive tests."
The first step is to identi-
fy risk factors. Individuals at
high risk for cerebral vascular
disease are those who smoke,
have high blood pressure (hy-
pertension) and high blood
cholesterol. Someone meeting "Our goal is to focus on the prevention of cerebral vascular disease and the reduction of risk
these criteria should be eval- factors associated with stroke," says Sinai Hospital's Division Chief of Neurology William
uated by a neurologist.
At Sinai, neurologists lead Leuchter, M.D.
it with medication," says Dr.
a team that evaluates patients for
Once patients are stabilized on
Leuchter. 'There are several drugs
cerebral vascular disease. Because
the Neurology Unit, they are moved
that can attack a clot and reduce its
to the Physical Medicine and Re-
these patients are also at risk of de-
harmful effects."
habilitation Unit. Stroke patients
veloping heart disease, the Cardio-
Although prevention is the best
enroll in physical, occupational and
vascular Diseases Section is
medicine, immediate care following
recreational therapy to improve mo-
involved in the screening process.
a stroke is important to limit the
bility and regain strength. Patients
Sinai's nationally recognized Lipid
negative impact on the brain.
Analysis Laboratory examines
are also invited to join the Stroke
Stroke patients are admitted to
blood cholesterol and fat levels and
Club, a support group for stroke pa-
Sinai's Neurology Unit, where ex-
tients. Dr. Leuchter commends the
the Department of Diagnostic Imag-
perienced staff take an active role
multi-disciplinary stroke treatment
ing and Radiology uses its state-of-
in each patient's recovery. "We are
team for its efforts on behalf of pa-
the-art imaging services to accu-
very fortunate to have an excellent
tients. He says, "Our entire team is
rately locate clots in the body to aid
nursing staff trained in the evalu-
committed to helping stroke pa-
in neurological evaluation and sub-
ation, treatment and management
tients remain as functional as pos-
sequent treatment.
of stroke patients," says Dr.
sible and to live full lives."
"When a suspicious clot or block-
Leuchter.
age is identified, we can try to treat
SINAI HOSPITAL
Domestic Violence:
When Love Hurts
The scenario is familiar — a woman enters an emer-
gency room with bruises and broken bones from a phys-
ical attack. Scared and shaken, she describes an
argument that escalated into brutality. The attacker
is her husband, and this is probably not the first — or
last — violent incident of their relationship. She will
most likely be beaten again and at some point may lose
her life to domestic violence. According to FBI statis-
tics, 1,432 women in the United States were killed by
their intimate partners in 1992. With alarming figures
such as these, the question remains: "Why does she
stay?"
"To the surprise of many friends and family mem-
bers, couples maintain this violent relationship," says
Sinai Hospital Psychiatrist Gerald Shiener, M.D., an
expert in treating victims and aggressors of domestic
violence. "A violent relationship is just as binding as a
love relationship."
In cases of domestic violence, Dr. Shiener says, the
relationship takes on a life of its own with extreme high
and low points. "The volatile relationship meets some
need for both the man and the woman, so the couple
maintains the relationship at all costs," he notes.
"Violence plays a part in settling the types of conflicts
most other couples face."
According to Dr. Shiener, the cycle of violence be-
gins early in the relationship, and incidents are rarely
isolated. From the first occurrence, the victim makes
excuses or flatly denies that the beating ever happened.
"The first thing I ask a woman involved in a case of
domestic violence is, "When was the first time it hap-
pened?' Inevitably, it was before the marriage. Many
women falsely believe the abuse will stop with the wed-
ding and that is not the case," says Dr. Shiener.
Many women take the step to separate from the
abuser, but the separation is usually short-lived.
According to Dr. Shiener, separations generally last
no more than 72 hours before one of two things occurs.
"After he realizes the relationship is over, the man is
panic stricken and will either beg forgiveness or lash
-
out with even more violence," he says. In either case,
the cycle of the unhealthy relationship continues. "they
cannot live together, and they cannot live apart," Dr.
Shiener says.
To family and friends, the cyde of violence may seem
easy to break, but Dr. Shiener offers advice to concerned
loved ones about coping with the situation.
"The best thing to do is offer support and encour-
age counseling," he says. "Confronting either of them
is not the answer because in many cases it draws the
couple closer together if they feel others are interfer-
ing in their relationship."
According to Dr. Shiener, both the abuser and the
abused need professional help. "Both need treatment
because the relationship, however dysfunctional, is
meeting some need for both of them," he says. "With-
out professional care, the cycle will continue, and there
will be more cases of death due to domestic violence."
Human Drama
Reflected in the Media
says Psychiatrist and Vice Chief of Staff Gerald
Shiener, M.D., who directs the service. Physicians and
nurses throughout the hospital can call the service for
help with a patient who may need psychiatric care.
Sinai's talented psychiatric staff can treat 'a new moth-
er experiencing post-partum depression, a cardiac pa-
tient recovering from bypass surgery or a rehabilitation
patient undergoing rigorous physical therapy.
In addition to working directly with patients, the
staff of the Consultation Liaison Service may also ad-
vise other health professionals in the hospital. The
Service is Sinai's way of treating the "whole" patient.
'N I N - s I na!
T
he headlines scream from the front pages of
newspapers and magazines every day. Tabloid
TV and news at eleven. Wife beatings.
Murders. Assisted suicides. We hear the trag-
ic stories with macabre fascination, as if the newest
scandal is but the latest installment of a daily soap
opera. In truth, however, they are illustrations of some
of the most important psychological and psychosocial
issues of our time and a reflection of our understand-
ing — or misunderstanding — of the human drama they
represent.
ratNEMMAMIVIVII
Emotional Support Is Available
for All Sinai Patients
motional struggles often go hand-in-hand
with illness. While hospitalized patients are
- being treated for physical conditions, they of-
ten need help for mental difficulties they may
also be experiencing. That's why Sinai Hospital offers
a 24-hour psychiatric consulting service.
The Department of Psychiatry's Consultation
Liaison Service is staffed by psychiatrists, clinical
nurse specialists and psychiatric residents who pro-
vide bedside consultation and care to Sinai inpatients.
"We provide psychiatric evaluations and manage
patients as needed throughout their stay at Sinai,"
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