Treatments

The Information Edge And Beating A Stroke

Our coverage on beating a stroke last week, about a Massachusetts woman's successful treatment with a clot-busting drug called t-PA, got a tremendous response, including this message from Erin Hastings of San Francisco:

Tanya Gill, stroke survivor

hide captionTanya Gill in her hospital bed at Northwestern Memorial Hospital, Chicago

Joe Hastings

"This story literally saved my sister-in-law's life. Thank you! Thank you! Thank you!"

We had to look into that one. Erin Hastings steered us to her brother-in-law Dr. Joe Hastings. He's a doctor in Los Angeles—and the brother of Tanya Gill, a 39-year-old art instructor in Chicago. She suffered a severe stroke last Monday evening while she was at a Nordstrom department store with her mother and 2-year-old son.

After hearing the story, we realized we can't take credit for saving Tanya's life. But her experience shows just how fast information travels these days.

When Joe Hastings told his wife about Tanya's stroke, she said: "Wow! That sounds just like a story I heard this morning on NPR."

Hastings pulled out his iPhone.

"We have the app where you press the button and it brings up all the NPR stories of the day and you can either read them or listen to them," Hastings says. "So we tracked down your story and listened to it. And then it has a button where you can email it to anyone...which we did."

Soon the family back in Chicago had the story. Meanwhile, Hastings dashed to catch a flight to be with his sister. On his way he called the emergency room in Chicago and got a doctor who was treating her.

They were already talking about giving Tanya the drug t-PA, which has to be administered within a few hours after stroke symptoms start.

"When I got on the phone with the doctors," Hastings says, "they started explaining and going into all the details and medico-legal issues" about t-PA, which has significant risks. "I said, 'Please, just give it now.'"

They did, and Gill made a complete recovery.

She says she might well have gotten the drug anyway, but having her doctor-brother give his strong endorsement probably moved things along faster. "I'm to the point of being able to reflect," Gill says. "You know, for a bad thing to happen...everything happened as it should so that I could have a recovery...so I'm feeling very, very fortunate."

Joe Hastings says the NPR story gave his family "a lot of comfort and hope" in the midst of a crisis. "As my mom said, to know that someone had walked down almost that exact same road before and had done so well was really encouraging," he says.

But not everybody liked our story. Several emergency room physicians complained that we gave short shrift to the controversy over t-PA.

Dr. David Wirtz of Cortland, N.Y., is one of them. "The question of which patients benefit from this costly and very dangerous treatment is hotly debated, and the story barely mentioned this controversy," he writes.

Patricia Cox, another physician, adds, "This story makes it sound like a miracle drug, which isn't supported by the data."

The critics have a point. T-PA doesn't help everybody, and it is potentially dangerous, sometimes causing serious bleeding.

The drug is FDA approved. And its use is promoted by major health groups, such as the Joint Commission, the American Stroke Association, and the American Academy of Neurology. Many state governments are setting up programs to encourage t-PA use in stroke treatment.

Studies show that about a third of patients who get the drug right away have a total recovery or major improvement, according to a statement put out by the American College of Emergency Physicians, the American Stroke Association and the American Academy of Neurology.

But in about 1 in 100 stroke cases treated with t-PA, the drug causes disabling or fatal brain hemorrhage. So there is controversy.

Nearly two-thirds of US hospitals did not give t-PA to stroke patients in one recent study involving Medicare patients. Only about five percent of US stroke patients get it, although an estimated 30 percent of them are eligible.

Is t-PA responsible for Tanya Gill's recovery? No question, says Dr. Mark Alberts, director of the stroke program at Northwestern Memorial Hospital in Chicago, where she was treated. "I think t-PA should get the credit," he says. "It's the one thing we gave her. She got t-PA and her signs and symptoms went away."

We also asked Joe Hastings if he thought t-PA rescued his sister from a disabling stroke. "You know, it's something that we'll never really know for sure — whether it was t-PA or whether it was time," he says. "I personally think it helped her. And I can say with certainty, though, that it didn't hurt her."

He's also certain that instant communication was a big help. Not only was he able to hear the NPR stroke story on his iPhone, but he called up t-PA studies on the fly.

And on the night of her stroke, Tanya Gill was able to text her husband's relatives in India from her hospital bed to tell them, "Don't worry. I'm fine."

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