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A List of Healthcare Resources

Publish Date: 4/15/2005

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Everett Noble works at Blue Ribbon Farm in Longmont on Wednesday. Noble had a stroke on March 10 and because of quick medical treatment, he suffered no permanent disability. Times-Call/Richard M. Hackett
Health News Headlines

‘Time is brain’
Stroke Team at CU hospital saves local man from permanent damage


DENVER — It was just another day deicing planes at Denver International Airport when Everett Noble found himself puzzling over turning a door knob.

Then he slumped against the wall and slipped down the door jam into a heap on the floor.

“It was embarrassing,” the semi-retired Longmont resident said.

Luckily, a co-worker recognized Noble’s behavior as stroke-related and immediately called paramedics.

Paramedics called ahead to alert the University of Colorado’s newly assembled Stroke Team before hitting the cherry lights and the gas to zoom down Peńa Boulevard.

Like so many stroke victims, Noble experienced no pain and no symptoms other than confusion.

“But I knew it was serious because we were flying down the interstate in that ambulance,” he said, chuckling.

•••

When the emergency room doors flew open at University of Colorado Hospital that March afternoon, about a half-dozen stroke team physicians jumped on Noble’s case.

They cut off his blue jeans and launched their hair-raising, beat-the-clock effort to save their first patient’s life and abilities.

“Time is brain,” said Dr. Kerry Brega, the hospital’s director of stroke programs.

And that time is short.

People with the kind of stroke Noble suffered — a “huge stroke” involving a single obvious clot — have just three hours to get the kind of care that makes a difference.

Often, that care entails clot-busting drugs like the Food and Drug Administration-approved tPA.

But according to the American Stroke Association, only 3 percent to 5 percent of stroke victims make it to the hospital during the three-hour window to receive tPA treatment.

So, while stroke victims linger at work or home, the brain continues to die — a process that stealthily erases whole sections of cognition.

Speech, memory and movements are going, going, gone as time flies. And soon the clogged vessel can cause death or grave disability.

“Some are so disabled they end up in a nursing home, where many people dwindle,” said Dr. Robert Neumann, a stroke team member and director of the neurosurgical and neurological intensive care unit at the hospital. “That’s not a very scientific term, but they do. They just dwindle.”

•••

Stroke is the nations’s No. 3 killer and No. 1 cause of serious disability, according to the ASA.

But Noble beat the odds.

His wife, Janice, said that early on he confused dice for dominos.

“Some don’t know how to say fork or how to use it,” said Dr. James Kelly, visiting professor of rehabilitative medicine and neurosurgery at the hospital.

But Noble got back to speaking, gardening and working without any turtle-paced stroke therapy.

The miracle was a combination of speedy transport and coordinated stroke team effort, Brega said.

When Noble arrived, the team hustled to image his brain and begin busting the clot with drugs and a tiny wire.

Those images showed what they suspected — a hot dog-shaped clot about the size of three BBs lined up in a row in the middle cerebral artery.

The majority of strokes happen there, where a main vessel to the brain forks to feed the left and right hemispheres, Brega said.

Scans of Noble’s brain showed the vessels splitting.

But while one branched into a tree on the right, the vessel leading to the left hemisphere dead-ended.

•••

Brega assembled a skilled team of neurologists, nurses and technicians earlier this year to turn stroke victims such as Noble into success stories.

The team is on-call 24/7 and ready to boost a patient’s chances of surviving and thriving.

After locating Noble’s clot, they administered tPA after interventional radiologist Stephen Johnson inserted a tiny hollow tube with a lead wire through a groin artery.

With a white plastic torque device, he was able to twist the wire to make all the bends on the way up to the clot in Noble’s brain.

A technique called “road mapping” helped him navigate the circulatory system, one that’s perilous because of the chance of accidentally tearing a vessel, he said.

To roadmap, Johnson shot dye ahead of the wire segment by segment and followed the dye trail on a screen to find his way to the clot.

Once at the clot, the team tried to administer just the right amount of tPA to dissolve the clot while simultaneously trying to break it up mechanically.

“Twenty minutes later — blam! It just blew open,” Johnson said.

•••

In early April, less than a month after he survived the stroke, Noble returned to University of Colorado Hospital.

He walked in and thanked the team for the work they did that day. Neumann met Noble by pumping his arm vigorously, as if a baby had just been born.

Stroke survivors usually don’t escape the experience without some sign of it, he said.

“When we busted up the clot, we said, ‘Everett, how are you?’ And you lifted up your head and said, ‘I feel better,’” Neumann recalled, laughing.

Noble’s flawless recovery offers hope that strokes can be conquered by science and high-level teamwork.

But don’t be fooled. Not all stroke victims are receptive to treatment and not all make it to the hospital in time.

Neumann said the hospital’s emergency department treats two to four stroke patients a week without the same kind of success.

“They’re usually folks who made it in late. And unfortunately they’re not candidates for the type of treatment Everett received. ... Time is brain.”

Warning signs

• Sudden numbness or weakness of the face, arm or leg, especially 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

Source: The American Stroke Association

Risk factors

Controllable factors:

• High blood pressure

• Tobacco use

• Diabetes

• Carotid or other artery disease

• Atrial fibrillation, a heart rhythm disorder

• Transient ischemic attacks — “warning strokes” that produce stroke-like symptoms but no lasting damage

• Certain blood disorders

• Sickle cell disease, also called sickle cell anemia

• High blood cholesterol

• Physical inactivity and obesity

• Excessive alcohol

• Some illegal drugs

Uncontrollable factors:

• Increasing age

• Male gender

• Family history and race — African Americans have a much higher risk of death from a stroke than Caucasians

• Prior stroke or heart attack

Source: The American Stroke Association

More information

Visit the American Stroke Association at www.americanheart.org or call 1-888-4-STROKE (478-7653).

Pam Mellskog can be reached at 303-684-5224, or by e-mail at pmellskog@times-call.com.

 

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