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Healthier Me: Perfect Mix of New & Old Technology

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From: Sanford Health

Emma Gravalin smelled burning toast as she lay motionless on the kitchen floor.

The 87-year-old tried to move but her right side was paralyzed. She tried to speak but no words came out. With her left arm, she reached up and pressed her medical alert button. Staff from her senior-living apartment in Detroit Lakes, Minn., arrived immediately and called 911.

"When I couldn't talk, I knew what it was," says Emma, recalling that morning of Aug. 17, 2012. "It's scary when you know you're having a stroke but you don't know how it's going to turn out. I was one of the lucky ones."

Emma's luck hinged on recognizing stroke symptoms, calling for help immediately and receiving advanced care at the right time.

Stroke is the fourth leading cause of death in the United States and the leading cause of serious, long-term disability.

Early treatment crucial

An ambulance whisked Emma to the Detroit Lakes emergency department. The initial assessment indicated an ischemic stroke, the type that responds to the clot-busting "tissue plasminogen activator," or t-Pa, which must be given within three hours of onset of stroke symptoms.

"I knew exactly when my symptoms began," says Emma. "It was 7 a.m. when I was at the counter fixing my breakfast. Suddenly my knees gave out and down I went."

Well within the time frame, Emma was able to receive t-PA. She continued on to Sanford in Fargo. A phone call from the Detroit Lakes ER alerted Sanford of Emma's impending arrival. The call set in motion the finely tuned process that defines Sanford's Stroke Program.

Every minute counts

Accredited in 2010 by the Joint Commission, Sanford's Stroke Program strictly follows national standards and recommendations for best possible stroke care. The program brings together every essential element:

  • Rapid evaluation, accurate diagnosis
  • Full range of scans and tests
  • Readily available advanced treatments
  • Specialists from several disciplines
  • Complete rehab team
  • Educaiton to prevent future strokes
  • Coordination among regional emergency responders and hospitals

    "Time is brain," says Molly Byrne, RN, Stroke Program coordinator. "We know that during a stroke, the patient loses brain cells with every passing minute. The faster we can diagnose and treat the patient, the better the outcome."

    Communication, teamwork

    Midway through the trip from Detroit Lakes to Fargo, the paramedics called Sanford with an update. Emma was regaining strength in her right side but still couldn't talk.

    "That was very concerning," says Molly. "That's when we activated our ‘stroke code.' We knew additional treatment might be needed."

    The stroke code ensured the team of specialists and services Emma needed would be readily available the moment she arrived. This included a neurologist, CT scanning, a neuroradiologist to read the scan, and an interventional radiologist with expertise in performing advanced stroke treatments.

    Completed by 11 a.m.

    Emma's brain scan indicated the clot was large, requiring a thrombectomy. Performed by Sanford interventional radiologist Dr. Corey Teigen, this minimally invasive, image-guided procedure successfully removed the clot, restoring blood flow to the brain. Afterwards Emma could talk.

    Similar to t-PA, a thrombectomy is time-sensitive. Dr. Teigen reiterates the importance of rapid response: "Our number one message is if you think you're having a stroke, get help immediately. Today's best stroke treatments must take place quickly for maximum effectiveness."

    By 11 a.m. that day, Emma was resting comfortably in Sanford's Intensive Care Unit. Her four-day hospital stay included occupational, physical and speech therapy. She continued rehabilitation at a Detroit Lakes nursing home. Twelve days later she returned home to her apartment.

    "My kids tell me I came out of this so well because I'm 100 percent Norwegian," Emma says. "I think teamwork might have helped. And I know I had a lot of prayers behind me."

    One clear message

    Fully recovered and lively as ever, Emma once again enjoys her crossword puzzles, card games, friends and family. But the stroke that easily could have killed or disabled her is never far from her mind. She shows a pad of paper with five pages of scribbles.

    "That morning when I couldn't talk, I tried to write ‘stroke' so my helpers would know what happened," she says. "I couldn't even do that."

    Today her message is crystal clear: Recognize stroke symptoms and call 911.

    Symptoms of stroke include:

  • Sudden weakness or numbness/tingling of face, arm, leg
  • Sudden vision problems
  • Sudden confusion or difficulty speaking
  • Sudden severe headache
  • Sudden coordination issues

  • "You don't have to be Norwegian to survive a stroke," says Emma. "Just know the symptoms and get help fast."

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