Dr. Brian Domenic Wishart, DO

Most people with hemophilia have a family history of the disorder, though about 30% do not. The most common forms are hemophilia A (classic hemophilia) and hemophilia B (Christmas disease). Hemophilia A and B share certain characteristics, but different genes are involved. Acquired hemophilia is very rare and has been linked to autoimmune conditions, cancer, and multiple sclerosis.

Hemophilia may be diagnosed using a blood test. If there is family history of the disorder, testing may be done prenatally. Treatment involves regular intravenous replacement of clotting factors, which may be produced in a laboratory (recombinant) or come from blood donors. For people with milder forms of the disease, a hormone called desmopressin may stimulate the body to produce clotting factors. Other drug therapies include medications that help slow the breakdown of blood clots and medications that are applied directly to the wound to promote clotting.

Living with hemophilia can be challenging, but simple things may help prevent excessive bleeding. For example, choosing activities like walking or swimming over contact sports can prevent injuries and strengthen muscles while protecting the joints. Chances for bleeding may also be reduced by making sure that children wear helmets and elbow pads during activities like bicycle rides.

Spinal cord injury medicine seeks to stabilize the spine and to alleviate the symptoms of spine damage. Practitioners of spinal cord injury medicine are called spinal cord injury specialists. Spinal cord injury medicine is an interdisciplinary field, meaning physicians of various specialties may be trained to treat spinal cord injuries.

Damage to the spinal cord may initially be diagnosed through X-ray, MRI, or CT scans. Patients can also undergo spinal exams to evaluate their sensory ability and strength. Injuries to the spinal cord can be complete (no feeling or sensation) or incomplete (some feeling or sensation remains). Conditions spinal cord injury medicine specialists may treat include:

• Paralysis, such as paraplegia (loss of function in the legs), or quadriplegia (loss of function from the neck down)
• Spine fracture or trauma, which can lead to impairment and/or significant pain
• Spinal infections
• Myelopathies, such as herniated disks, spinal tumors, and rheumatoid arthritis
• Inflammatory diseases such as ankylosing spondylosis, and degenerative conditions like Lou Gehrig's disease (ALS)

Treatment for spinal cord injuries often involves surgery, either directly after an injury occurs or at a later date. Surgery for spine injuries is intended to ease spinal compression and stabilize the spine. Surgical procedures can involve shifting vertebrae, removing bone, or altering spinal placement with implantable devices. Patients with significant spinal trauma may require urgent surgical intervention.

Surgical treatments can be complemented by rehabilitative physical therapy to improve mobility. Spinal cord injury specialists also treat complications arising from a spinal injury, such as respiratory or bladder conditions. Some patients with spinal cord injuries may require lifelong treatment. Spinal cord injury specialists aim to help these patients successfully adjust and lead an improved quality of life. An emerging treatment for spinal cord injuries is neural prosthetics, which replicate patients' lost nerve function. Neural prostheses may be used as artificial body parts or assistive devices that patients may cognitively control. Other assistive devices include wheelchairs and scooters.

Spinal cord injury specialists may collaborate with physical therapists, radiologists, neurologists, urologists, and orthopedists.

There are two main types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs more commonly and is when a blood vessel in the brain becomes blocked. Blockages are caused by blood clots and built-up plaque (deposits of fat and cholesterol), which leads to atherosclerosis, a condition where the blood vessels narrow and harden. The resultant restricted blood flow may lead to an ischemic stroke by blocking essential oxygen to the brain, causing the heart to exert more effort to pump blood.

Hemorrhagic stroke occurs when a blood vessel in or around the brain ruptures. The burst vessel leaks blood into surrounding brain tissue, causing irreparable brain damage.

Hemorrhagic strokes are less common and may occur from head injuries, brain aneurysms, brain tumors, and bleeding disorders, amongst other conditions.

Both ischemic and hemorrhagic strokes require immediate medical treatment. Medical intervention can prevent severe and life-threatening brain damage. Signs of stroke include:

-Disorientation or confusion

-Difficulty speaking

-Difficulty walking

-Impaired vision

-Weakness in the face, legs, or arms

-Severe headaches

When someone suspected of having a stroke reaches the hospital, the patient will usually receive a CT or other scan that provides an image of the brain. The scan results can reveal clotted or leaking blood in the brain. Physical exams, neurological exams, and blood tests may also be used to check for blood clotting and sugar. Treatment begins generally immediately if a stroke is detected.

Medical treatment for ischemic strokes includes a thrombolytic medicine which breaks up and disperses blood clots. This medicine can greatly improve stroke recovery and long-term health. However, the thrombolytic medicine must be administered as soon as possible to achieve these results. Other treatments for ischemic strokes are blood thinners and thrombectomy, a surgical procedure to remove a blood clot in the brain. Thrombectomy is performed by inserting a catheter (thin needle) into the artery to reach the blood clot and mechanically remove it. With the clot removed, normal blood flow to the brain resumes. Thrombectomy is typically performed at most six hours after a patient shows signs of a stroke.

Hemorrhagic strokes are treated with blood-saving medication and surgery. For a hemorrhagic stroke caused by the rupture of an aneurysm (blood vessel bulges), surgery to stem the bleeding aneurysm and vessel may be used. One surgical technique is stent-assisted coiling, which adds a stent (small wire-meshed tube) into the blood vessel to block the leaking opening of the aneurysm. A non-surgical procedure is endovascular coiling, where a catheter (thin, hollow needle) places a platinum wire coil at the spot of the aneurysm. The coil blocks bleeding and prevents the aneurysm from continuing to leak blood. These procedures are usually combined with blood-thickening medications. Blood transfusions may be administered if substantial blood loss has occurred.

Since stroke patients may have lost some essential functions while the blood flow to their brains was obstructed, both ischemic stroke and hemorrhage stroke patients may receive post-stroke rehabilitation to rebuild their physical and mental abilities. Some restorative treatments include occupational, physical, and speech therapy. Patients may also receive care from neurologists, who can assist patients in recovering certain brain functions and cognitive abilities, and rehabilitation psychologists, who may help patients with their emotional, behavioral, and cognitive recovery. Some stroke patients require lengthy rehabilitation and may never fully regain function, while others may recover more quickly. While the fastest recovery improvements are usually seen in the first three or four months, stroke rehabilitation can last for years.

If someone begins to show signs of stroke, contact emergency services and call 9-1-1 immediately since blood flow must be restored as soon as possible to help avoid significant brain damage. If an ambulance takes the person to the hospital, paramedics can initiate stroke treatment as soon as the patient enters the ambulance, allowing for more prompt medical intervention and care.