RENEE MONTAGNE, host:
This is MORNING EDITION from NPR News. I'm Renee Montagne.
ARI SHAPIRO, host:
And I'm Ari Shapiro. Today in Your Health, we look at strokes. It's the third-leading cause of death in this country. Most survivors have permanent disability. There is a drug that studies say can stop a stroke in its tracks. But few victims get it in time. NPR's Richard Knox reports on one woman who did.
RICHARD KNOX: Beverly Sylvia was having a perfectly ordinary day.
Ms. BEVERLY SYLVIA: It was just like any other day.
KNOX: After work, she went for a routine checkup at her doctor's.
Ms. SYLVIA: Everything was fine.
KNOX: It was a Tuesday. Sylvia goes out with friends on Tuesday nights to shoot some pool.
Ms. SYLVIA: So I was getting ready.
KNOX: She took a bath.
Ms. SYLVIA: Then I got out of the tub and all of a sudden, my arm went kind of numb.
KNOX: She shrugged off the numbness as a pinched nerve, and drove six miles to the VFW club. Once she got there, she felt funny.
Ms. SYLVIA: They said, do you want to play? And I said, no, I'm just going to sit here. And I had gotten some soda, and I went to drink it with a straw and I couldn't drink. I couldn't swallow, you know. I said, OK, something's going on. And then when went I to talk, the words were not coming out.
KNOX: The awful thought dawned on her she was having a stroke at the age of 49.
Ms. SYLVIA: I remember when my father had a stroke and everything that happened to him.
KNOX: Her father spent the last 15 years of his life disabled and depressed.
Ms. SYLVIA: I'm like, thinking to myself, OK, now what am I going to do? And I finally got the word stroke out.
KNOX: But to her horror, her friends didn't believe her.
Ms. SYLVIA: They're saying, oh, you know, if you go to the hospital they're going to do all kinds of tests. They're going to check your blood. And I'm thinking to myself, oh, my God. They think I'm taking drugs. And it's just amazing what people think, you know. They - that's the last thing they think - you're having a stroke.
KNOX: Sylvia was beginning to feel desperate. She didn't want to call 911 because she didn't want to go to the nearest hospital. Nobody would know her there, and she wouldn't be able to tell them what was wrong. So she makes a decision that will turn out to be crucial. With her left hand, she fishes out her cell phone and speed dials her best friend, Linda Rose.
Ms. LINDA ROSE: I had just gone to bed when the phone rang. And I thought, who is calling me at this time of night? And I was like, should I answer it or shouldn't I?
KNOX: Since Sylvia can't speak, a friend takes the phone and explains that she thinks she's having a stroke. Put her on the phone, Rose says.
Ms. ROSE: I said, well, why don't you have them take you to the emergency room? And she's like, uh-uh. And I'm like, well, call the ambulance. And she's like, uh-uh. I'm like, you mean you want me to come and get you? She's like, mm-hmm. So I said, OK, I will be there as soon as I can.
KNOX: Sylvia manages to get Rose to understand she wants to go to St. Luke's Hospital, eight miles away in New Bedford, Massachusetts. It's where her father was treated. Stroke specialists say Sylvia couldn't have chosen a better place.
(Soundbite of machine sounds)
Unidentified Man #1: Well...
(Soundbite of beeping)
KNOX: That's because St. Luke's has a direct link to the stroke center at Massachusetts General Hospital in Boston, 75 miles away.
Unidentified Man #2: Hi.
KNOX: Within minutes, the St. Luke staff calls Mass General.
Unidentified Man #3: Can you hear me?
KNOX: They get Dr. Raphael Carandang on the phone. He's the neurology fellow on call. He promptly activates the video link. What you hear is an actual recording of the telemedicine link-up that night.
Unidentified Man #4: This is Mrs. Sylvia.
Dr. RAPHAEL CARANDANG (Neurologist): Hi, Mrs. Sylvia. This is Dr. Carandang at Mass General.
KNOX: On his computer screen, Carandang can see Sylvia lying on a gurney in the St. Luke's emergency department.
Dr. CARANDANG: Here.
KNOX: A clock above her head reads 11:38.
Dr. CARANDANG: OK.
KNOX: That'll turn out to be important.
Dr. CARANDANG: Any other relatives there?
KNOX: By now, it's pretty clear Sylvia's having a stroke.
Unidentified Man #5: Her friend is here.
KNOX: But what kind?
Dr. CARANDANG: OK.
KNOX: If it's caused by a blood clot, there's a medicine that can potentially halt the stroke and stop further damage. If it's a hemorrhage, she might need emergency brain surgery. The wrong decision could kill her.
Dr. CARANDANG: Do you mind if we do a real quick examine?
Unidentified Man #6: Yup.
KNOX: Through the video link, Carandang can see a CAT scan of Sylvia's brain.
Dr. CARANDANG: Thank you.
KNOX: It shows no evidence of hemorrhage.
Dr. CARANDANG: Good.
KNOX: So she might be a candidate for the clot-busting drug called t-PA.
Dr. CARANDANG: Can you ask her how old she is?
Ms. SYLVIA: I am (unintelligible)...
Dr. CARANDANG: If you ask the patient if they can tell you how they are, then it'll give you an idea about speech and thought process.
Unidentified Man #7: Yeah, she's trying.
Ms. SYLVIA: I could understand everything he was saying. But it just was not coming out of my mouth, the answers.
Dr. CARANDANG: Can she put her arms out in front of her?
KNOX: The doctor in Boston is putting together a picture of what's going on inside Sylvia's brain.
Dr. CARANDANG: When she tries to lift her right arm up, she can't, you know, she can barely get it off the bed, and it drifts down right away.
KNOX: Each symptom tells him what part of her brain is starved for blood flow and oxygen.
Dr. CARANDANG: I'm going to zoom in on her face a little bit here.
KNOX: By this point, a senior Mass General neurologist is online. Dr. Anand Viswanathan is watching on his computer at home.
Dr. ANAND VISWANATHAN (Neurologist): As you can see, her right side of her face droops, and her lip is drooping. This is indicative that she's having a stroke, which is affecting that side of her face.
KNOX: Viswanathan can tell that Sylvia's stoke is a major one.
Dr. VISWANATHAN: A lot of brain tissue stands to die.
KNOX: If the clot is not dissolved fast. So now, the doctors have to find out something critical.
Dr. VISWANATHAN: Ms. Sylvia, what time did this start? And you have to be very clear, because it's very important regarding the medication.
KNOX: The medication has to be given within three hours of the first symptom. Too late, and the drug can cause bleeding in the brain, devastating disability or death.
DR. Viswanathan: What time did this all start?
Ms. SYLVIA: Within, yeah...
I know at that time what time exactly this all started, and I was trying to say it because I knew it was crucial. And it wasn't coming out.
Dr. CARANDANG: It's all right. You're going to have trouble speaking. I'm going to give you some choices. Tell me when you think it started, OK? Did this start at 5 o'clock in the evening?
KAHN: Sylvia shakes her head no.
Dr. CARANDANG: Eight o'clock?
KAHN: No again.
Dr. CARANDANG: Nine o'clock?
KAHN: Yes. Sylvia nods vigorously.
Dr. CARANDANG: Nine o'clock? Uh.
KNOX: That uh is because Carandang realizes Sylvia's got to get the drug before midnight. That's less than 15 minutes away.
Dr. CARANDANG: It meant that we would have to speed things up very, very quickly and act very, very fast from this point on. I was hoping she had more time.
Can we have somebody start computing a dose? You said she's how many pounds?
KNOX: The person who starts computing that dose is nurse Barbara Davis.
Ms. BARBARA DAVIS (Nurse): I remember at the moment, we were kind of like, oh no. We're about out of the window and she's not going to be able to get it.
KNOX: Now, Dr. Carandang needs to get Sylvia's consent before he can tell the team down in New Bedford to start the clot-buster drug.
Dr. CARANDANG: The risk of the medicine is that it can make you bleed in your head, which could be potentially dangerous. Do you understand the risks of the medicine?
KNOX: Sylvia's lying there speechless and helpless and thinking about her father, how he ended his life unable to move and unable to speak. She doesn't want to end up that way.
Ms. SYLVIA: I was thinking that I was just going go for it because I wasn't going to be like this. I was going to try anything.
KNOX: So there wasn't any doubt in your mind?
Ms. SYLVIA: There was no doubt.
KNOX: After Sylvia gives her consent, everything speeds up.
Ms. DAVIS: I've got it ready to go. As soon as we get those (unintelligible) line, I can get it started.
Dr. CARANDANG: The time is running. We're running out of time, actually.
(Soundbite of machine)
Ms. DAVIS: Relax. Hang on; let me put this thing up.
Dr. CARANDANG: Relax. There you go.
Ms. DAVIS: You're going to give me a ...
KNOX: Just as the clock reaches midnight, nurses start the drug flowing into Sylvia's arm. Minutes later, she's aboard an ambulance for the hour-long ride to Boston.
(Soundbite of ambulance siren)
Ms. SYLVIA: So I remember, I was like, perfectly still all the way up. I mean, I didn't move. You know, I just like, was on my back, that was it, and they had to have the nurse and she says, I'm here for - all the way up to there.
KNOX: Nurse Barbara Davis says the whole way up, Sylvia couldn't talk, and her muscle weakness was unchanged until the very end.
Ms. DAVIS: We were literally pulling into Mass General. Then I said, Beverly, how are you? And she said, I'm fine.
(Soundbite of laughter)
Ms. DAVIS: And I was so shocked. I'll never forget that. It was like all the symptoms were gone.
Ms. SYLVIA: I was like, wow, I can talk.
(Soundbite of laughter)
Ms. SYLVIA: And that's a good thing and I'm saying to myself, wow, if it's that medicine, it really worked.
Ms. DAVIS: I see a lot of patients but she always stuck in my mind just because she had such a great outcome.
KNOX: She was in the ICU for a little while, and she got out by the end of the week. And on Saturday, she went dancing.
(Soundbite of laughter)
Ms. DAVIS: That's great. I did not know that.
KNOX: That's a recovery.
Ms. DAVIS: That is a total recovery.
Dr. CARANDANG: This is the kind of case that you want to see, where they recover completely to the point where they were before their stroke.
KNOX: But Dr. Carandang adds a note of caution.
Dr. CARANDANG: It's what you want, but it's not what you see in majority of cases. There are some cases that still have some deficits, will still have to get some physical therapy and rehab before they get to where they're going to be in terms of recovery.
KNOX: In fact, some doctors think patients like Beverly Sylvia are just lucky. They don't believe studies that claim this drug can abort a stroke. But they'd have a hard time convincing her of that.
Richard Knox, NPR News, Boston.
SHAPIRO: If you have questions about strokes, join us today in a live Web chat, at noon Eastern time at NPR.org. Our Web site can also help you find a hospital that provides the kind of treatment Beverly Sylvia received.
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