Tuesday, October 23, 2018
Health

Stroke stories can have a happy ending: What you should know

Arto Woods and his wife, Syvilla, had a good flight from Baltimore to Tampa in early May. En route, they talked about how convenient it would have been to fly directly into Orlando, where the conference that brought them to Florida was being held, but it was considerably more expensive, so they planned instead to drive to Orlando.

But they never made it there, or to the reunion of employees of the Department of Veterans Affairs, where Mr. Woods worked for 36 years. While collecting their luggage at Tampa International Airport, Mrs. Woods noticed a change in her 72-year-old husband’s face.

"It looked different from moments earlier and I asked him, ‘What’s wrong?’?" said Mrs. Woods, also 72. "I saw that his mouth was drooping and he was drooling." When she and a couple of bystanders got him to a nearby chair, "he was drooping, leaning to the left," she said.

Mrs. Woods knew exactly what to do next. She summoned nearby security guards and asked them to call 911. She was sure her husband was having a stroke.

The ambulance arrived within five minutes and rushed the couple to nearby St. Joseph’s Hospital, a designated stroke center. As soon as he was in the door, Mr. Woods was evaluated by the stroke team, had a scan to confirm that he had a blood clot in his brain and began receiving treatment, the clot-dissolving drug tPA and a procedure to remove bits of clot from the blocked vessel. All this happened within one hour of the onset of his symptoms.

Two days later, the left side weakness and paralysis had lifted and Mr. Woods’ speech and comprehension had returned. Four days later he was up, walking the hospital and even dancing with his wife in the hall. By the end of the week, the couple was back at home in Baltimore with no more regrets about their choice to fly into Tampa rather than Orlando.

"St. Joe’s was so close to the airport," said Mrs. Woods, a retired teacher. "God was with us in directing us to Tampa."

Dr. Alonso Osorio-Giraldo took care of Mr. Woods in the St. Joseph’s Hospital emergency department that day. During any given 10-hour shift, Osorio-Giraldo and his team will respond to one to two stroke alerts. They consider Mr. Woods’ case a success story, one where just about everything went right. But not all stroke patients have similar experiences and outcomes.

Osorio-Giraldo spoke with the Tampa Bay Times about what went right for Mr. Woods and where many people go wrong when faced with the possibility of a stroke.

How was Mr. Woods when he arrived at the hospital?

His blood pressure was very high and he had elevated blood sugar. He was completely paralyzed on the left side of his body, his speech was slurred and he wasn’t able to understand us. We initiated our Level 1 stroke protocol beginning in the hallway of the hospital, then took him straight in for a CT scan. He was in very serious condition with a very profound stroke. But, he came in (to the hospital) within minutes of the onset of symptoms and his wife was knowledgeable about his medical history, which helped a lot. This isn’t usually the case.

Then what happened?

The CT scan told us that Mr. Woods had one specific clot blocking one specific vessel in the brain, which told us that he was having the type of stroke that would benefit from tPA. We administered the drug within 30 minutes of his arrival. Then the interventional radiologist was called to create a three-dimensional picture of the blood vessels in the brain, so we could clearly see the vessel where the blood flow was being cut off and that Mr. Woods would benefit from further treatment to remove the clot. The tPA was already breaking it apart, so the interventional radiologist went in through a vessel in Mr. Woods’ groin, threaded a catheter up to his brain and sucked the clot out with a high-tech clot removal device.

That initial CT scan gives you a lot of information.

It tells us whether the stroke is caused by a clot or bleeding in the brain. If it’s a bleeding or hemorrhagic stroke, we can’t give tPA. The patient could bleed to death.

We don’t know who’s going to benefit from each intervention until we do these tests. They also tell us where the stroke is, where tissue is dying, which also tells us whether tPA could benefit the patient or cause harm. We have to be very careful.

What went right for Mr. Woods?

First, the emergency response team got to Mr. Woods quickly and notified us that they were on their way with a patient who had classic stroke symptoms. Then, St. Joe’s is close to the airport and is a designated stroke center, so we had a stroke team standing by waiting for him. Our "door-to-needle time" — the time from his arrival to treatment — was about 20 minutes, which is faster than the national average. We have nurses, pharmacists, neurologists, radiologists, everyone standing by just for this patient, plus the high-tech equipment to deliver treatment immediately. You would not see this in the average community hospital. It’s a very costly system to have, but one case like this one makes it all worthwhile. Plus, we do this same protocol every day, several times a day. Repetition makes us better.

Where do people go wrong with stroke?

They are presenting at the hospital too late. The typical story is a middle-age or older man who complains that his vision has suddenly gotten blurry, his arm tingles, he has a bad headache, he just doesn’t feel right. So he decides to lie down and wait for the symptoms to pass. The wife checks on him hours later and can’t get him up because he’s paralyzed. Twelve hours ago, we could have done something for him. My message is this: Know the symptoms of stroke and don’t wait to call 911. Time is brain. Acting fast can prevent or limit disability.

Contact Irene Maher at [email protected]

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