Every 40 seconds someone in this country suffers a stroke and the National Institutes of Health points out nearly three-quarters of those strokes occur in people over 65.
So it was great healthcare news for the older demographic living on the Treasure Coast when Lawnwood Regional Medical Center last week was awarded the highest level of stroke treatment certification available.
The Joint Commission and the Agency for Health Care Administration upgraded the Fort Pierce facility from a “primary stroke center” to a “comprehensive stroke center” last Wednesday, making Lawnwood one of only 20 such facilities in the state of Florida.
It is an important distinction that recognizes “significant differences in resources, staff and training that are necessary for the treatment of complex stroke cases,” according to the Joint Commission.
“Our physicians are stroke experts,” says fellowship-trained interventional neurologists Dr. Vikas Gupta. “Our neurosurgeons are stroke experts. Our physical therapists, our ancillary staff – they are all stroke experts. Each one has role to play within the continuum of care of patients,” at the only comprehensive stroke center in a five-county area, stretching from Brevard County to Martin and Okeechobee counties.
Gupta and Dr. Akram Shhadeh, also a fellowship-trained interventional neurologist, say they are excited to be a part of the Lawnwood team.
“There has been a lot of advancement in the field that allows us to better treat stroke,” says Shhadeh, adding that if a patient is taken to a comprehensive stroke center in time, strokes are not only treatable, they are now often “reversible.”
There are two common forms of stroke, both dangerous and potentially deadly. The most common form occurs when the arteries to the brain become blocked, reducing or stopping the flow of blood. These blockages, usually caused by blood clots or by the buildup of plaque in the arteries, are called “ischemic” strokes. They account for about 85 percent of all strokes.
The second common type – “hemorrhagic” strokes – are caused when blood vessels in the brain start leaking blood or burst open altogether. These ruptures can be caused by hypertension, blood-thinning medications, trauma or aneurysms (weaknesses within the vessel walls).
That bleeding puts intense pressure on brain tissue, and can severely damage or kill brain cells. “In both situations you have to re-establish the blood flow as soon as possible, otherwise there will be 2 million neurons dying every minute,” Shhadeh says. “With hemorrhagic stroke, you have to fix the leakage as soon as possible.
“I would compare what we do to something that you see in your life every day – well hopefully not every day – in your house. If you have any plumbing issues, whether it’s leakage or clogging in your pipes, you call the plumber to re-establish the flow through the drain or you call them to fix the leak.
“We do the same thing for brain vessels. If there is a blockage due to a clot that traveled from the heart all the way to the brain, we can go through the artery of the leg with a catheter all the way up to the clot and then pull the clot out using special devices.”
Burst blood vessels inside the brain, he adds, can also be re-sealed through a similar minimally invasive procedure.
Gupta says getting care for a stroke as quickly as possible is absolutely vital. “As time goes on, the probability of a good outcome decreases.”
Both interventional neurologists mince no words on this: At the first sign of a stroke, they say in unison, “Call 911.”
Do not, they warn, attempt to drive yourself or have a loved one drive you. And, above all, do not wait for symptoms to go away on their own.
“A lot of people,” Shhadeh says almost grimacing, “don’t call 911 right away because they think the symptoms will go away and maybe they’ve had similar symptoms in the past that did go away. We call that TIA or Transient Ischemic Attack but TIA is as important as stroke because it is a big warning sign for impending stroke.”
Lawnwood’s new designation may pose a something of a dilemma – at least initially – for area first responders. Will all stroke patients now be automatically taken to Fort Pierce? Under what circumstances might they be transported to closer primary stroke centers at other area hospitals?
Battalion chief Cory Richter of the Indian River County Fire and Rescue department says “it is more complicated” than simply issuing a blanket order to take all stroke patients to Lawnwood but he also says his department is actively “looking into” the situation.
Gupta, meanwhile, has no doubt as to where stroke patients should be taken. “By definition,” he says, primary stroke centers, “only have the capacity to give tissue plasminogen activator and have a limited role in the current day and age.”
Tissue plasminogen activator is a clot-dissolving drug the FDA approved 30 years ago and there is a relatively small time window of time – between two and four hours depending on the patient’s age – during which it can be administered effectively. It can only be used to treat ischemic strokes.
The National Institutes of Health lists symptoms of stroke as: 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; and sudden severe headache with no known cause often accompanied by vomiting.
Gupta flatly states that should any of those symptoms present themselves, Lawnwood should be the patient’s destination.
Equipped with the latest advanced imaging technology, a 24-hour on-duty staff trained in vascular neurology, neurosurgery and endovascular procedures, with the ability to effectively treat both ischemic and hemorrhagic strokes, comprehensive stroke centers such as Lawnwood are designated by the Joint Commission as the best place to go for stroke treatment.
To learn more about Lawnwood’s comprehensive stroke center, go to: http://lawnwoodmed.com/service/stroke-center
