Stroke: The Critical Importance of Time

"While individuals with other illnesses can often -- by themselves -- seek medical care once symptoms manifest, stroke victims find themselves utterly helpless. It is what makes stroke a condition that profoundly impacts not only the patients but their entire families."

Our brain, an intricate marvel, harbors a chilling vulnerability. Even a minor constriction or rupture of its blood vessels can disrupt the vital flow of oxygen and nutrients to its cells, triggering a devastating cascade of events. This results in the demise of crucial brain cells, leading to the loss of bodily functions and eventual paralysis. Communication becomes an insurmountable challenge, leaving one confined to a bed, a mere spectator to their own body.

Within the pages of MedPark Stories, we proudly present a glimpse into the life and work of a remarkable neurologist who emerges as a guiding beacon for those on the precipice of cerebrovascular catastrophe or disability. Dr Udom Suthiponpaisan, a distinguished specialist in Stroke, Neurosonology, and Interventional Neuroradiology at MedPark Hospital, rekindles hope and offers a lifeline for patients yearning to reclaim their ordinary lives.

Excel at school and pastime diversion

Excelling both in academics and a personal pursuit has been a consistent theme in Dr. Udom life trajectory from a young age. Even in his formative years, his potential was evident as he was voted student council president during elementary school. In junior high, his interests expanded to include the realm of music. The mesmerizing tones of the alto saxophone captured his imagination, fueled in part by a compelling image of His Majesty the Late King Bhumibol Adulyadej playing the instrument. The profound inspiration led him to join the school marching band, where he thrived, even competing in the prestigious national marching band competitions.

Simultaneously, his academic prowess remained unmatched. His dedication and diligence translated into remarkable achievements, notably culminating in an award for attaining the highest score in a Physics examination. Bolstered by an unswerving commitment to his goals, Dr. Udom triumphantly navigated the rigorous admission process, securing his place at the esteemed Faculty of Medicine, Chulalongkorn University, a remarkable feat he accomplished during his eleventh-grade year.

"During my time at Triam Udom Suksa School, my routine involved perusing books and assiduous completion of homework on a daily basis. My intellectual pursuits extended beyond the confines of high school curriculum, encompassing college-level subject matters. Physics held a particular allure for me due to my penchant for calculations. While mathematics revolves around numbers, physics offers a tangible and visual dimension. It presents phenomena we can genuinely see and visualize."

Broadening his understanding of recently evolved treatment guidelines

Following his graduation from medical school in 1997, Dr. Udom embarked on a professional journey by enlisting in the military, assuming the role of a physician within the Royal Thai Navy. This tenure afforded him the opportunity to administer care to a diverse array of patients grappling with afflictions of the brain and nervous system. During this period, conventional approaches to stroke management encompassed antiplatelet interventions, blood pressure regulation, and management of risk factors.

Yet, within the backdrop of an ever-advancing medical landscape, Dr. Udom recognized the imperative of continuously sharpen his expertise. Fueled by an unwavering commitment to the well-being of his patients, he resolved to embark on further educational pursuits, endeavoring to remain abreast of cutting-edge advancements, ensuring his proficiency in delivering state-of-the-art medical interventions.

"Frequent encounters with stroke patients led me to pursue a Neurology residency at Chulalongkorn Hospital (Chulalongkorn University). After completing the program, I worked at Somdech Phar Nangchao Sirikit Hospital and later at Somdech Phra Pinklao Hospital. At the latter, I established a dedicated stroke treatment team. I treated an ischemic stroke case by administering the hospital first anticoagulant stroke treatment. 

As stroke treatments advanced to involve mechanical thrombectomy, I returned to Chulalongkorn Hospital for further training. Back at Somdech Phra Pinklao Hospital, I took on nearly daily on-call duties due to the patients frequently turning up outside regular hours.

With extensive experience, I have high confidence in mechanical thrombectomy. This approach enables swift recovery and minimal brain abnormalities. Successful treatment hinges on a robust healthcare system, rapid intervention, and dedicated patient care."

Upon Dr. Udom's decision to retire at a relatively young age of 47, MedPark Hospital commenced its operations. Recognizing a favorable prospect, he seized upon the opportunity to channel his accumulated knowledge and highly honed skills in stroke care towards the further treatment and restoration of individuals affected by strokes.

Effective treatment of stroke is attainable through prompt intervention.

The key message Dr. Udom wishes to convey is that prompt action is crucial in treating strokes. He emphasizes that strokes can acutely affect anyone, coming out of the blue, underscoring the importance of heightened vigilance among those at risk. A clear understanding of stroke, its symptoms, and readiness for potential emergencies is vital. Seeking immediate medical attention is paramount when encountering symptoms akin to paralysis, such as speech or mobility impairment. The rapid medical intervention significantly reduces the likelihood of permanent paralysis.

"When patients get to the hospital promptly, the potential for severe brain damage from stroke diminishes. I previously treated an individual who exhibited paralysis, eye deviation to the right, facial drooping on the left, left-sided weakness, and speech difficulties upon arrival. Swiftly ordering a CT scan, I identified a lack of blood flow to the right hemisphere due to blockage by a blood clot. Administering an anticoagulant on the spot, followed by an immediate CT angiogram, unveiled a significant block in a major cerebral blood vessel. Subsequently, I perform a mechanical thrombectomy to extract the clot."

As a specialist, he deems vital elements for patient survival encompass the type of ailment, preexisting medical conditions, and the constricted blood vessel. In cases of smaller blood vessels, patients may face the potential disability of hemiparesis. Conversely, stenosis within larger vessels can trigger cerebral edema, imposing a risk of compression on critical brain regions like the brainstem, leading to death.

Duration also plays a pivotal role. When stroke symptoms emerge, opting against treatment leads to evolving symptoms. Delayed hospital arrival, exceeding the optimal treatment window, necessitates palliative measures to prevent clinical worsening. Swift hospitalization, even for severe cases, facilitates optimal treatment and eventual recovery. Lastly, hospital readiness and capability matter, going to a hospital with an inadequate treatment facility squanders precious time with the referral to another hospital.

"Unlike many other illnesses where patients can independently seek medical attention upon symptom onset, stroke renders patients reliant on external help. This unique aspect places stroke as a condition that profoundly impacts entire families. When a stroke occurs, it falls on relatives to arrange hospitalization. If the patient's condition deteriorates or results in disability, relatives must allocate their time to provide care."

"Vigilance is essential for all, particularly the elderly or high-risk individuals with a history of stroke. Swift hospitalization is crucial, regardless of symptom severity, as early evaluation accelerates recovery. Families of stroke patients should prioritize regular medical checkups, treatments, and adherence to prescribed medications. Given the unpredictable nature of stroke recurrence, readiness for emergencies becomes imperative."

A medic who attended to war casualties

Recounting the captivating narratives from his participation in rescue missions on both land and sea during his stint of service to repay the medical student loan program at Somdech Phar Nangchao Sirikit Hospital in Sattahip, Chon Buri,

“When HTMS Chakri Naruebet first arrived in Thailand, I was assigned to rescue stranded flood victims in Chumphon, hopping in and out of a helicopter many times a day, screening patients with serious illnesses for treatment at the hospital. I also had opportunities to serve the public on many naval ships, such as HTMS Similan (871), HTMS Surin (722), HTMS Angthong (791), HTMS Chao Phraya, and HTMS Saiburi. In addition, I received military medicine and disaster relief training through the ADMM - Plus ASEAN Military Medicine - Humanitarian Assistance and Disaster Relief Joint Exercise 2016 (AM - HEx 2016).”

In addition to his domestic public service in Thailand, he took on a significant assignment as a member of the inaugural deployment of the Thai Joint Task Force 972 to East Timor. This overseas mission occurred under tense circumstances in East Timor, marked by its declaration of independence from Portugal and subsequent invasion by Indonesia.

"Following an UN-sponsored referendum, the people of East Timor decisively opted for self-governance, igniting a period of internal strife and turmoil. Responding to this critical juncture, military contingents from many nations converged upon East Timor to take on peacekeeping roles. My involvement as a medic is to provide essential care to the people of East Timor. This chapter remains etched in my memory as a unique, extraordinary encounter that continues to resonate."