Hi Chandra,

I’m really sorry to hear about your grandfather. I am not sure if he would be a good candidate for the penumbra device or not, nor am I sure whether or not this treatment is available in India or Australia.

Typically, with regards to disolving clots with medicine, time is a big factor. Typically, a patient must receive this treatment within the first several hours of onset of symptoms. (Traditionally, the recomendation has been that the treatment must be started within the first 3 hours of symptom onset, but some recent research is pointing towards expanding this window a few hours, possibly up to 6).

I’m not sure about time frames for use of the Penumbra device and to be honest I haven’t done any reading about this device recently.

In a nutshell, probably the person most qualified to answer your questions will be the physician treating your grandfather in India.

I truly wish the best for you and your family and hope that my answer here has perhaps helped in some small way.

Sincerely,

Sam

Thanks for the great feedback!

You’re right. I try very hard to avoid using jargon without explaining it in “regular people” terms, but sometimes I fail in that.

That’s why I really like this comments ability in wordpress, so that when I blow it, folks can call me on it and give me a chance to better explain things.

I’ll try to answer your specific questions in a second, but first I’ll go off on a bit of a philosophical self-improvement tangent.

The point you bring up leads to a very important concept when it comes to reading and learning. A good habit folks should discipline themselves to pick up is one of never simply glossing over words they don’t know the definition of or understand.
Anytime you are reading something, especially a document where you are trying learn something new and you come across a word or phrase you are not familiar with, you should make it a personal policy to go no further with what you are reading until you find out just what that word or phrase means.

If you do what most folks do and simply go on with your reading, you are usually dooming yourself to not being able to gain a good understanding of the material you are reading.

Folks, make this a firm habit for the rest of your life. It will produce tremendous rewards. I guarantee it.
Anytime you are reading something (such as my blog, or a school textbook, or whatever) and you come across a word or phrase you don’t understand. STOP! Go no further until you find out what that means!

Open a dictionary, do a Google search, ask someone else…..whatever, but go not further until you resolve this issue.

Okay, enough pontification for now.

Now to answer the specific words you brought up.

Panacea basically is a term that means a “Cure all.” It has its origins in the Greek word “Panakeia.” In Greek mythology, Panacea (or more accurately Panakeia) was the name of the Goddess of healing. She was one of the daughters of Asclepius,
the God of Medicine.

That funny little stick wrapped by a serpent (snake in this parts) that you may have seen at times, used to represent medicine is “The Staff of Asclepius”.

Interestingly, in many cases, particularly in the U.S., the somewhat similar, but less correct symbol known as the “Caduceus” is used. This is the one that has a rod wrapped by two serpents (not one serpent like the Asclepius rod above) and has a pair of wings.

The Caduceus actually is the symbol of the Roman God Mercury (who is the same guy as Hermes in Greek mythology). Mercury/Hermes is not the god of medicine, but rather was the messenger of the Gods, and ruled more over the areas of commerce, travel, eloquence, magic and theft.

Although you may often seen the Caduceus linked with the medical profession, especially here in the U.S., the Staff of Asclepius is more proper.

Interestingly, the symbol used to represent veterinary medicine and the veterinary profession is the Staff of Asclepius with a large letter “V” superimposed upon it.

So anyway, that’s a longwinded way of saying that Panacea means “Cure All”

Your next question about reperfusion is quite frankly a big can of worms. This is a subject that is massively complex and is a big area of medical research.

In a nutshell, the answer to your question appears to be “Yes.” The restored blood flow does contribute to a big inflammatory reaction and plays a part in further cell death.

This subject is too complex for me to fully explain here, but basically, these cells that have been deprived of oxygen appear to form a bunch of chemicals known as free radicals. These are very damaging to proteins in the cell membranes and to the cells DNA. They seem to create an environment that is conducive to triggering an inflammatory response. When blood flow is returned it carries with it a bunch of white blood cells, which respond to this environment by releasing all sorts of inflammatory chemicals of their own.

All of this seems to create a sort of toxic soup and starts a chain reaction that starts killing cells. As these cells die, they release even more chemicals that perpetuate the reaction.

This phenomenon isn’t something that only occurs in the brain. It can occur in any tissues that are deprived of blood flow for a long enough period of time.

Again, this is a very superficial explanation and this is a big area of medical research.

The take home message isn’t so much about what reperfusion injury is but rather that it can and does occur, and is a potential bad consequence of Penumbra, or any other method of similarly restoring blood flow.

If you’re interested in a more detailed explanation, as well as one of the areas of research into ways to modify this reperfusion injury phenomenon, hit that “reperfusion injury” link in the original post above.

Finally, as mentioned in the post above, arteriosclerosis is basically hardening of the arteries. In fact this is a medical term, which like most medical terms, is simply created by combining other words from either Greek or Latin.

In this case, you have the Greek word “Arteria,” which means artery, combined with the Greek word “Sklerosis,” which means hardness. Combine them and you get Artery-Harness. Arteriosclerosis means hardening of the arteries.

There are actually several forms of arteriosclerosis, but the most common is atherosclerosis, which is a hardening, caused by formation of an atheromatous plaque in the artery wall.

Whoa!!! What the heck is an atheromatous plaque???

Again this is a somewhat complicated subject, and in spite of how absolute and confident most in the medical profession come across about this topic, I’m personally convinced that there is still a whole lot of stuff we just don’t know yet.

In a nutshell, what happens is that over time the walls of the artery can become damaged. This is particularly true in areas of arteries where there is increased pressure, and turbulence or damaging forces being exerted against the arterial wall.

In your bodies circulatory system there are two sides: the venous system and the arterial system. The venous system is a low-pressure system that carries blood to the heart from parts of the body. The walls of veins are relatively thin and flexible. Again this is a low-pressure system. Rather than having to “Push” blood against any sort of resistance, the veins are more passive. They essentially have their blood “Pulled” from them by the heart.

The other side, the arterial side, is basically the opposite. It is a high-pressure system. The heart has to “Push” blood through these arteries into all the tissues in the far-reaching parts of the body. The arteries have thick muscular walls that are much less flaccid and flexible as compared to the veins.

When we are born, these arteries are new and are in pretty good shape. Over the course of a lifetime however, they are subjected to years of high pressure and abuse, and eventually can start to show signs of wear.

Just like an old hose laying in your yard for years, exposed to the elements, the walls of the arteries over time can start to become increasingly stiff and brittle.

If you had a super powerful microscope and could look at the inside walls of these arteries, you’d see that small cracks start to form. Triglycerides, fats and bad cholesterol in your blood can leak through these cracks so that they are no longer in the blood stream, but rather become located within the wall of the artery.

Apparently the body doesn’t much like this. It seems to recognize this stuff in the arterial walls as foreign…as an enemy contaminant that must be dealt with.

Special white blood cells (there are several different types of white blood cells, but they are all sort of like your body’s army or police force…they go marching into bad places and deal with attackers such as bacteria, viruses, etc.) move into the area and start to gobble up all this fatty stuff. At this point they become known as “Foam Cells.” This is because they appear foamy when they are all filled with this fatty stuff.

Well over time, through a bit of a complex system of chemical reactions, these cells begin to become calcified and hard.

Another type of cell called a fibrocyte moves into the area and starts to build a fibrous cap over the foamy area. This is basically a thick hardening wall that walls off the foam cells. The resulting structure is known as a fibrous plaque, or atheromatous plaque.

Over time this process continues and expands for years and you end up with a situation where the arterial wall becomes increasingly hard, brittle and thickened. As it thickens, it can start to occlude the lumen of the artery (which is the hollow part inside through which the blood flows).

It’s sort of like the drainpipe from your kitchen sink. As years and years of grease, and soap, and coffee grounds, and rust, etc build up on the inside walls of the drain pipe, the lumen….the hollow part inside…becomes smaller and smaller, and eventually your drain starts draining pretty slowly and it’s time for some liquid plumber.

If something happens and causes one of these plaques to rupture…i.e. the fibrous cap breaks open….exposing the underlying inner layers, it can fool the body into thinking there is a wound that needs to be healed.

The first step of this healing, just like when you cut your finger, is the formation of a blood clot.

On your finger, this is a good thing as it stops the bleeding. On the inside of a small artery feeding a vital part of your body, such as part of the brain or heart for instance, this isn’t such a good thing.

The clot can cause the artery to become blocked…in the heart this is what typically causes a heart attack. In the brain, it causes an occlusive stroke. This same sort of thing can actually happen anywhere in the body however. It could kill part of your intestines, or a kidney, or your big toe.

Again, think of your kitchen sink. If you’ve got a drainpipe that is brand new, the lumen is nice and big. Water flows through it easy. If you drop some food scraps down there as you’re cleaning your dishes, it’ll probably just go right on down the drain.

If you’ve got an old drain pipe however that has a thick build-up of gunk on the inside and as a result a small lumen, well than that little bit of food scraps you try to flush down the drain, might just be enough to completely block it off.

A blood clot on the inside of your artery can do the same thing. This is not something you want to happen.

With your sink you can try some liquid plumber. With your artery, it’s not so easy. tPA and Penumbra are sort of an attempt to come up with a Liquid Plumber like solution.

As mentioned, this is still a big area of medical research and we don’t really know as much about this stuff as we’d like to think we do.

It used to be thought that the main culprits were the old mature plaques. Recent research however is starting to lead us to believe that it may in fact be the young immature plaques that are actually the most dangerous and prone to rupture and cause a blood clot to form.

In any case, there are a lot of things that seem to contribute to formation of these plaques and this hardening of the arteries. Age, Gender, and Heredity seem to play a big role. There’s not too much we can do about these things.

Other factors however, we can exert some control over. These include things like smoking, high blood pressure, high triglycerides and bad cholesterol, high blood sugar, sedentary lifestyle, etc.

So, eat right, exercise, and DON’T SMOKE! (Have I mentioned not smoking before in this blog???)

I know this was a bit longwinded, but I hope it helps.

Let me know if you have other questions, etc.

Cheers!