Wilbraham woman's recovery from stroke an incredible success story
Earlier this year on February 29, Paul Provost woke up around 6:30 am, then attempted to wake his wife, Erline, who had an appointment with an orthopedic surgeon about an ankle that was bothering her. But, she never made that appointment.
“When I tried to wake my wife to take her shower and get ready for her doctor’s appointment, she was totally unresponsive. Her eyes were open, but she couldn’t move or talk. So, I called 9-1-1 and told them I thought my wife had a stroke,” said Provost.
“I was quite frightened for her, because I knew there was about a three-hour window in which doctors could administer clot-dissolving drugs to her, yet I had no idea when the stoke occurred. When we arrived at Baystate Medical Center’s Emergency Room, there was a team waiting for us and by 7:30 am Erline was having a cat scan.
Time is crucial
“Time is crucial and the longer you wait, the more damage occurs to your brain cells,” said Dr. Edward Feldmann, vice president and medical director, Neurosciences and Rehabilitation, Baystate Health.
Two million brain cells die every minute during a stroke, increasing your risk of permanent brain damage, disability or death. That’s why it is extremely important to be able to recognize stroke symptoms, because the drug t-PA, or tissue plasminogen activator, may help reduce the impact of the stroke if it is administered within three hours of the initial stroke. Earlier is better, however, and the best results are within the first 90 minutes from stroke onset, noted Dr. Feldmann.
Provost and her husband – who traveled in the ambulance along with his wife since he is unable to drive due to a severe case of glaucoma – were met at the hospital’s ambulance bay by members of the comprehensive stroke services team, who move swiftly and collaboratively when a 9-1-1 call is received for someone suffering from a stroke or a burst aneurysm. Called the Brain Attack Team, this stroke specific rapid response team includes neurosurgeons who perform interventional and cranial surgeries, neurologists, emergency physicians, radiologists, physiatrists, and other support staff.
Too late to T-PA
After being wheeled directly into radiology for scans and undergoing other diagnostics, it was determined that Provost had an ischemic stroke, which is caused by a blood clot blocking a brain artery – this one about one-half inch long. Unfortunately, Provost was beyond the time window to administer the intravenous clot-busting drug t-PA, but hope was not lost as another treatment option existed.
Dr. Farhad Bahrassa, the neurosurgeon on duty at the time, deemed Provost as a candidate for a procedure called a mechanical thrombectomy, only performed in Western Massachusetts at Baystate’s state-of-the-art neurointerventional laboratory.
“I immediately ran down to the emergency room to evaluate Mrs. Provost after receiving a page from Dr. Feldmann about her condition. When I arrived at her bedside, she was awake, but could not understand me or follow my instructions. Her speech consisted of incomprehensible sounds with no real words coming out. I quickly explained to her husband how a mechanical thrombectomy could help her, and recommended to proceed immediately with the procedure in order to restore circulation to her brain and minimize any damage that could happen from the stroke,” said Dr. Bahrassa.
Mechanical thrombectomy involves anesthetizing the patient, then inserting a thin metallic stent-like device into an artery in the leg. The surgeon then threads the device up to the blockage in the brain, where it opens to immediately restore blood circulation, eventually grabbing onto the clot and pulling it out.
An innovative procedure
“The innovative procedure is a dramatically successful treatment for blocked brain arteries causing acute ischemic stroke, whether or not the patient receives intravenous t-PA. It has proven benefit and is low risk. As always, the faster the circulation is restored, the better the outcome,” said Dr. Bahrassa, noting it took less than 30 minutes from the time the procedure began on Provost to removal of the clot and restoration of circulation to the brain.
“I didn’t know what was happening to me from the time I was in the ambulance until I woke up after the procedure and found myself immediately able to talk and move my body once again. There wasn’t even a scar where the doctor had gone through my groin, not even a band aid. It was all done so quickly and efficiently by Dr. Bahrassa, and I was just so amazed afterwards by the remarkable speed at which I was treated,” said Provost, a longtime Springfield educator who is now retired.
“I am just so pleased to have returned to normal and that I am able to drive, since my husband’s glaucoma prevents him from getting behind the wheel,” she added.
Dr. Bahrassa called Provost’s stroke treatment “an incredible success story.”
“I checked on her every morning and every evening during her short time in the hospital, and both she and I could not stop smiling about her excellent recovery,” he said.
Why the stroke?
It was eventually determined that the Wilbraham woman’s stroke was the result of a condition called hyperthyroidism, for which 10-15% of patients develop atrial fibrillation which can further lead to a stroke.
“It’s funny, both of my sisters were diagnosed with hyperthyroidism and had their thyroids removed early in life, but I kept being tested over the years and showed no signs. My last test was in 2014, and I guess you might say it unknowingly crept up on me,” said Provost, who now sees Baystate Medical Center endocrinologist Dr. Chelsea Gordner for her thyroid, along with regular visits to her primary care physician for follow-up.
This year alone, some 795,000 people in the United States will suffer a stroke – which occurs when blood vessels carrying oxygen to the brain are either blocked by a blood clot or rupture – one every 40 seconds and resulting in death every four minutes. More women have strokes than men, and twice as many African Americans have strokes than whites. And, stroke is the leading cause of adult long-term disability.
Yet, few Americans know the signs of stoke.
Know the signs
The following simple test can help you detect your own or someone else’s stroke symptoms and to Act FAST:
Face – Smile. Does one side of the face droop?
Arms – Hold both arms up evenly. Does one arm drift downward?
Speech – Repeat a simple sentence. Are the words slurred or mixed up?
Time – If you or someone else exhibits any of these symptoms, call 9-1-1immediately.
Other common stroke symptoms include: sudden weakness in the legs or on one side of the body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; sudden severe headache with no known cause.
Stroke can happen to anyone regardless of age or gender, and is even increasing among more and more young people leading an unhealthy lifestyle. This younger group now comprises 31 percent of the total stroke population, compared with 25 percent prior to 1990.
“The good news is that 80 percent of strokes can be prevented by knowing your risk factors and leading a healthy lifestyle,” said Dr. Feldmann.
Stroke risk factors
Several factors that increase the risk of stroke can be treated, including: atrial fibrillation, carotid artery disease, tobacco use, high blood pressure, diabetes, elevated blood lipids, obesity, and drinking too much alcohol.
Excess weight strains the circulatory system. Exercising five times a week is recommended along with maintaining a diet low in calories, salt, saturated and trans fats and cholesterol. Eating five servings of fruits and vegetables daily is also recommended.
Risk factors that are beyond a person’s control include race, being over age 55, and having a previous stroke or family history of stroke.
Baystate Medical Center in Springfield, Baystate Noble Hospital in Westfield, Baystate Franklin Medical Center in Greenfield, Baystate Wing Hospital in Palmer, and Baystate Mary Lane Hospital in Ware, part of Baystate Health, are all “Designated Stroke Centers.” Stroke designation, the result of an extensive on-site survey by the Massachusetts Department of Public Health, is awarded to hospitals who demonstrate they have the medical expertise, diagnostic equipment and treatment protocols available around-the-clock to treat emergency stroke patients.
For more information on stroke, visit baystatehealth.org and click on Neurology under the Services tab, then follow Neurosciences to the Stroke page.