Stroke of Luck
Raul G. Nogueira, M.D.
I apologize for using this tech platform to discuss something outside of mobile and wireless. I think when you read this week’s column, you’ll understand and, hopefully, agree with me that this diversion was justifiable and appropriate. WARNING! Reading the rest of this column will likely be very emotional.
Have you ever found a loved one in a critical, life-threatening situation? That happened to me on Tuesday, August 23rd. I had talked with my wife, Alicia, a little after 6:00 pm on the way home following a meeting. We agreed that I’d pick up dinner and bring it home. I then talked with her again around 6:30 pm saying that I had dinner and would be home in 15 minutes.
When I walked in at around 6:45 pm, I called out for her but didn’t hear a reply. I looked around and didn’t immediately see her. Then, I looked on our back porch, and she was sitting there not moving. Strange. She was sitting up normally but not moving. She didn’t respond when I said her name, and I thought, “What is going on here?”
I came over to the sofa and realized she was in a daze. I asked her if she was okay, and she just mumbled. I immediately knew something very serious had happened, although I wasn’t sure what it was. I called a family friend who’s a doctor, and he felt it was likely a stroke and told me to call 911 just a minute or two before 7:00 pm. I immediately did that and tried to stay level headed (I tend to be quite emotional), but I think, in the circumstance, I held together okay at that point. I gave them my address and code to get in our gated community. She could mumble in a whisper things like , “OK” or “Yes” or “No”, but she could just barely get out a single word.
I told her help was on the way. I made sure the door was unlocked and then could hear the ambulance sirens. A few minutes later, around 7:15 pm, the paramedics arrived and took over. They immediately put her on a transport stretcher and informed Northside Hospital (about a mile from our house) that we were on the way.
We got her into the Emergency Room at 7:30 pm. The attending physician looked her over and immediately ordered a CT scan to check to see if there was bleeding in the brain. That happened very quickly. She was back within 30 minutes. The CT scan didn’t show bleeding, so they suspected it was a clot that moved into the brain. That’s the predominant kind of stroke. The attending neurologist, Dr. Silverboard, ordered tPA (blood clot buster) be given at 8:25 pm. This acts against any clots that have formed or that could be the cause of the stroke.
Alicia started to respond, but she clearly was compromised on her left side with little sight and inability to move her left arm. Of course, that meant that she had a problem somewhere in the right hemisphere of her brain (which controls the left side of the body). Next up was an MRI/MRA to look at the tissue and circulation in the brain and carotid arteries. She was pulled to the front of the line at 10:00 pm and was back by 11:00 pm.
At first, the radiologist reported to Dr. Silverboard that he didn’t see any clots, but he called back a few minutes later to say that another view clearly showed a clot at the base of the right hemisphere of her brain. Dr. Matt Burrell, a friend and doctor, explained the situation to Alicia. This was about 11:30 pm. Dr. Silverboard then called Dr. Raul Nogueira, Director of the Neuroendovascular Division at the Marcus Stroke Center at Grady Hospital and Professor, Emory School of Medicine. Grady has one of the country’s leading stroke treatment facilities.
Dr. Nogueira said we should get Alicia there ASAP. The Emergency Room staff ordered an ambulance. They came around 11:30 pm, and we transported Alicia to Grady. We got there around 12:15 am.
I met with Dr. Nogueira along with Alicia’s son, Grant Mitchell, and our close friend, Linda Keefe, whose husband had suffered a stroke a number of years ago. This is where the entire story gets very interesting.
It turns out there are two devices approved by the FDA for removal of clots (called Transcatheter Embolus Retrieval): 1) an aspirator that uses suction to withdraw the materials and 2) a corkscrew devices that goes through the clot and pulls it out. There’s also a third device that is going through FDA approval: it works like a stent that is pushed through the clot, opened up, expanded with mesh-like material, and is then withdrawn. It’s approved in Europe but not yet approved in the U.S.
Dr. Nogueira said that it was a 50-50 chance he’d be allowed to use the new device on Alicia, but Alicia’s son, Grant Mitchell, and I signed the forms to be in the trial and take our chances. We also called Alicia’s daughter, Sandy Kinnett, to get concurrence on the decision.
Dr. Nogueira told me he’d had excellent results with the new device. He left us at 1:00 am. I sat there and wrote an 11-page letter to Alicia to document the events and to let her know how much I loved her. Dr. Nogueira came out of surgery at 4:19 am. He told me he was able to use the new device on Alicia and felt he had very good results. I literally broke down with joy and appreciation and cried.
He then showed me the angio photos on his iPhone: the ‘before’ image showed the right hemisphere of her brain totally white due to no circulation, while the ‘after’ image showed hundreds of working arteries. They were the most amazing images I’ve seen in my life. He also showed me a close-up image of the three clot segments that he had withdrawn.
I went home, got two hours of sleep and came back to the hospital. Alicia had just woken up from the anesthesia. Dr. Michael Frankel, Director of the Marcus Stroke Center and Professor, Emory School of Medicine, and the Neurology team then did an assessment. They asked her to move her left arm. She simply lifted it up. They checked, and she had already gained some sight in the left eye. She began to talk in short sentences. Again, I broke down and cried.
During the day, she continued to improve. It was like watching someone ‘wake up’ from anesthesia. It wasn’t like recovering from amnesia. She had her knowledge. She just had to work harder to pull thoughts together and then deliver them via speech.
By Thursday, Alicia had recovered more and could get out of bed and begin walking, so they moved her to a lower care level. On Friday, they did another MRI and CT scan. Dr. Dimitri Cassimatis, Assistant Professor of Cardiology led a team including observation by a number of Emory Medical School students that did a Transesophageal Echo (TEE) where they anesthetize the throat and insert a probe into the esophagus so they can look directly at the heart.
The TEE is one of main tests used in patients with unexplained stroke to make sure a clot or other abnormalities inside the heart were not the culprit. It produces amazing results, in part due to pioneering work of Alicia’s and my good friend, Dr. Randy Martin of the Piedmont Heart Institute who is also Past President of the American Society of Echocardiography and Professor of Medicine, Cardiology for 20 years at Emory. He had come by to see Alicia and recommended the TEE procedure. However, the TEE didn’t show any remaining clots.
Dr. Frankel came by to review the results of all the tests. He felt that the cause of the clot couldn’t be determined. It could have been from a random episode of atrial fibrillation where the upper chambers of the heart, the atria, beat at a very rapid chaotic rate potentially leading to clot formation inside the left atrium. Or, it could have been biochemical. As he said, “We know ‘something’ caused a clot to form. We’re just not exactly sure what it was.”
The Neurology team did another assessment late Friday and pronounced that she was doing so well that she would be allowed to go home on Saturday. Well, I lost it again – like a swelled-up feeling from everything that happened over the past three days.
She’s going to do physical therapy to refine re-learning of small motor skills, so the brain can ‘work around’ the damaged area near where the clot stopped as well as the stress made to the right hemisphere of the brain.
The parting comment to Alicia by Dr. Frankel was, “You’re very special to be walking out of here in a matter of days. We’d love for you to do some PR for us when you get your strength back. It’s so important for people to know the signs/symptoms of stroke and to contact 911 immediately as your husband did.”
Alicia is now back home and doing well. She must be recovering: she’s bossing me around like before.
You’ve heard the mantra before: pay attention to the signs of a stroke: droopy facial muscles, change in speech, confusion or erratic movements. Get help fast! It can make all the different in the world.
Also, realize that anyone can get a stroke – even people in their 20’s and 30’s. But, because Alicia was in such good shape (Can you do 150 crunches a day and ride a 1,500-pound horse over three-foot jumps?), it helped her in her recovery.
P.S. I want to thank the Emergency Room physicians and staff at Northside Hospital and the entire staff of the Marcus Stroke Center at Grady Memorial Hospital for their support and excellent care provided to Alicia. I want to also thank Alicia’s three children Grant Mitchell, Sandy Kinnett and Virginia Chambless and her brother Bruce Grant for spending time with Alicia and helping me make important decisions.
J. Gerry Purdy, Ph.D.
Mobile & Wireless