How a vital chain of events allowed a stroke victim to walk away unharmed

 “Shotgun” Jackson and his wife Carol of Independence, Missouri, last year made a second home for themselves in Montrose, Missouri, a small community about twenty miles southwest of Clinton.  Jackson had retired from his semi trailer repair business in April, 2003, and looked forward to working on his new home in Montrose.

Then on October 23, 2003, as Jackson was stapling insulation to a wall in his home in Montrose, his next door neighbor stopped by to pay a visit.  Upon her arrival, she took a good look at Jackson and said, “Shotgun, I think you’re having a stroke.” 

Thus began the first step in a chain of events that would save Jackson’s life and restore his health completely. 

As Jackson attempted to deny anything was wrong, Carol could plainly see drooping on one side of the face, and Jackson’s speech was becoming slurred and incomprehensible.  Carol called 911.

“I just didn’t know anything was wrong at all,” Jackson said.  “Thankfully, my neighbor knew the signs of stroke.  I could tell my speech was slurring, but other than that, I had no pain.  Had she not known what to look for, I don’t know where I would be.”

The mystery of stroke has diminished significantly in recent years, allowing for a level of awareness that may be easily shared with entire communities.  Today, with about five minutes of education, the average citizen can identify the symptoms of stroke and start the chain of events that must occur to save the stroke victim’s life and hopefully erase the physical damage brought on by the lack of blood flow to the brain.  This type of stroke is called acute ischemic stroke (AIS) and represents 85% of all strokes.  AIS is the leading cause of adult disability in the United States.

The simple analogy anyone can understand is the clog in the drain pipe of the kitchen or bathroom sink.  We’ve all seen it time and again.  Somewhere in the house the pipe has been stopped up and depending on how bad the clog is, we either pour a little Drano in to break it up or, if need be, we call Roto-Rooter to drive a snaking device into the pipe to remove the clog.

Essentially, a stroke is no different than a common clog in a pipe only the plumbing system is in the brain.  Now imagine if a clogged pipe in your house could make a whole section of your house crumble to pieces.  No doubt, you would want to move quickly to fix the problem and prevent the damage.  Apply the same concept to your brain. 

The household plumbing example essentially describes how most strokes occur.  A blockage (or clog) forms in the artery (or pipe) in some area of the brain, cutting off vital blood flow to a section of the brain.  This is what happened to a portion of Jackson’s brain as he busily stapled insulation in his garage on October 23, 2003. 

This “basic plumbing problem” as Jackson refers to it, is the same cause for heart attacks.  A clot forms in an artery near the heart and stops blood flow and a portion of the heart muscle begins to die because of the lack of oxygen to the heart.  Some stroke reversal experts like Dr. Marilyn Rymer, director of the Mid America Brain and Stroke Institute at Saint Luke’s Hospital, refer to stroke as a brain attack. In fact, the Brain Attack Coalition (BAC) formed several years ago to establish criteria for Primary Stoke Centers like Saint Luke’s.  Much of the stroke intervention criteria are similar to trauma intervention.

"Stroke reversal treatment is time-dependent.  Just as there is the ‘golden hour’ for trauma treatment, strokes treated within the first three hours after onset have the best outcomes,” says Rymer.

Unlike many heart attacks, there is often little to no pain with a stroke.  Often, stroke victims don’t even know the problem is happening, which may be a leading reason why the average stroke victim shows up at the hospital twelve hours after the onset of a blockage.  This is why it is so important for the whole community to have an idea of what a stroke is and what it looks like, in order to begin the chain of events that ultimately results in removing the blockage from the artery inside a victim’s head, restoring life and health. 

“First and foremost is the community’s ability to identify a stroke and realize that everything from that point must move very quickly in order to correct the problem and save the victim,” says Rymer. 

What follows can be truly amazing.

For Jackson, everything fell into place in a perfectly coordinated sequence of events that eventually brought him home to continue his retirement rather than to live paralyzed in a nursing home for the rest of his life.

“I accidentally fell into the system in the right place and at the right time,” says Jackson.

The chain of events may vary for a given patient depending on the immediate environment, location and severity of the stroke.  But the entire process may be said to have a “first half” and a “second half” which must happen flawlessly in order to have a better chance at being completely effective.  Both are equally and vitally important, but logic dictates that the first half must happen first.

Consider Jackson’s case and observe that each necessary step in the “first half” of his chain of events did in fact happen flawlessly and was not accidental at all. 

Step 1:  Identifying a stroke – Jackson’s stroke was identified due to the effectiveness of basic stroke education.

Step 2:  Local EMS identification of the stroke and specific emergency action. 

Despite the fact that most stroke victims will go or be taken to the closest medical facility, Andrew Umland, then director of Ambulance Operations with Gold Valley Memorial Hospital and now a flight paramedic with LifeFlight Eagle, immediately knew that Jackson needed the Mid American Brain and Stroke Institute at Saint Luke’s Hospital, because Saint Luke’s is the regional stroke center that provides stroke reversal care 24-hours a day, 7 days a week.  And because Saint Luke’s is the nation’s leader in providing a new stroke reversal procedure that has given exceedingly positive results to hundreds of stroke patients around the nation.

Step 3:  Immediate Communication – Umland simultaneously notified LifeFlight Eagle that an emergency transport was needed.

“Within two minutes of our arrival to Mr. Jackson’s home, we knew what was going on,” says Umland.  “Golden Valley Memorial Hospital protocol allows its paramedics to determine on the spot what medical facility is appropriate for a patient based on our assessment.  Saint Luke’s was Jackson’s best possible chance for a positive outcome.  Additionally, getting Jackson there as quickly as possible meant LifeFlight Eagle.  We shaved at least forty five minutes off of the overall timeframe by bypassing the local hospital. LifeFlight Eagle saved another hour at least.”

Step 4:  Rapid transport to a stroke center – Several minutes after Umland’s call, Golden Valley Ambulance rendezvoused with LifeFlight Eagle in Deepwater, Missouri.  Jackson was moved into LifeFlight Eagle’s Bell 407 and whisked away to the Mid America Brian and Stroke Institute at Saint Luke’s Hospital. 

LifeFlight Eagle Crew members, Anne Marie Ondak (RN) and Kent Shutt (paramedic) continued Jackson’s treatment in the air while Jeff Meyer (pilot) transported him to Saint Luke’s at nearly 150 miles per hour. 

“Speed was the most important thing we could provide,” Ondak says.  “Mr. Jackson had a huge stroke.  Had it occurred five or ten years earlier in my career, he either would have died or would have spent the rest of his life incapacitated in a nursing home.”

Thus ends the “first half” of Jackson’s lifesaving chain of events. For the best possible outcome, these first four vital steps must happen within three hours of the first signs of a stroke. 

The arrival at Saint Luke’s via LifeFlight Eagle begins the “second half” and ultimately provides the reason for why Jackson did not die or end up incapacitated for life.

Steps 5 & 6:  Assemble stroke team and assess patient – The moment Saint Luke’s Hospital received the initial call from Umland, the stroke reversal team was assembled in less than thirty minutes, made preparations for Jackson’s arrival and stood ready to unload him at the Saint Luke’s helipad.  From there they would run a CAT Scan on his brain to determine the exact nature of his problem and move him to the interventional neuro-radiology suite.

It is worth mentioning that Jackson did indeed have a “huge” stroke as Ondak described.  The National Institute of Health Stroke Scale is a numeric scale used to determine the severity of a stroke.  The higher the patient’s score the more injurious the stroke. 

“Anything over a 16 generally lands a patient in a nursing home,” said Rymer.

When Jackson arrived at Saint Luke’s his severity score was between 17 and 21. The higher the score, the worse the stroke.

Step 7:  Remove the clot – Upon arrival to the interventional neuro-radiology suite, Naveed Akhtar, M.D, was ready to insert a catheter containing a Merci Retriever, through Jackson’s groin and thread it up into his brain to identify the blockage and miraculously remove it.  Despite the absolute necessity of all the previous steps, this last step is indeed the most incredible.

With the catheter poised in front of the clot in Jackson’s artery, Akhtar then extended a small wire from within the catheter to pierce the clot.  This small wire is not made of any ordinary material.  It is a combination of nickel and titanium and has a memory of its own as it is able to resume a shape it has been programmed to have.  While the wire sits inside the catheter tube, it is straight.  Once it is extended out of the tube it resumes the shape of a coil or cork screw. 

Having pierced the clot with the wire, Akhtar extended it out a bit further allowing it to resume the cork screw shape, enabling Akhtar to torque or twist the coil into the clot.  From there, Akhtar slowly but surely pulled the whole clot out of Jackson’ artery immediately restoring blood flow to the oxygen starved section of Jackson’s brain.  At this point, Jackson’s stroke severity score dropped to a 4.  Three days later it was zero which means he is normal.

The concept of removing a clog from a pipe is simple enough.  But as mentioned, the pipe was in “Shotgun” Jackson’s brain.  The process of “unclogging” it requires years of instrument development, intense medical study and training, natural talent and notable finesse.  After all, we’re not talking about half inch steel pipes one drives a Roto-Rooter snake into. Arterial blockages are found in very delicate arteries often no more than three millimeters in width.  Deadly blockages can be smaller than a pin head.

Incidentally, the stroke reversal team also happened to identify a hole in Jackson’s heart while treating his stroke.  It seems the hole, which had always been there, was the cause of the clotting problem which caused the stroke in his brain.  The next day, Saint Luke's Mid America Heart Institute cardiologist Kenneth Huber, M.D., sent a catheter to Jackson’s heart, released a small rubber sheath about the size of the fifty-cent piece, and covered the hole.  Jackson went home a new man.

“About twenty percent of us have a hole in our hearts that never closed from birth,” says Rymer.  This can cause clots to pass through the hole and into the blood stream, though no one is quite sure what suddenly causes a blockage to happen one day and not the day before.”

Several months later, LifeFlight Eagle began producing its documentary film, LifeFlight Eagle: Your’s For Life.  Jackson was asked to give an interview for the film.  Jackson did give the interview but initially replied that he was too busy with other things. 

“That’s about the best answer Mr. Jackson could have given,” said Ondak.  “It meant everything was back to normal for him.”

Know the signs and symptoms of stroke:

Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)

Sudden confusion, trouble speaking or understanding speech

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss of balance or coordination

Sudden severe headache with no known cause

The Stroke Test

If you suspect someone is having a stroke, call 911 immediately.  While you’re on the line with the 911 dispatcher or emergency medical technicians en route, ask the patient to:  Smile (look for a drooping on one side of the mouth or crooked smile) -- Raise both arms and keep them up (look for weakness in one arm) -- Speak a simple sentence coherently (listen for slurring of speech).  Report the results to emergency personnel on the phone.