Tele-Stroke saves lives through speed

Mary and Robert Phillips of West Yellowstone learned first-hand the benefit of the Tele-Stroke Program that links expert Kalispell neurologists by video to stroke victims in emergency rooms in Libby, Ronan and Whitefish.

They were visiting their daughter in Troy when Robert, 61, suddenly stumbled and fell against a wall after getting up from a table. As Mary asked him if he was okay, he responded in clipped short sentences.

She jumped up to help him but he was like dead weight. When Mary turned him over, her EMT training told her that Robert was in serious trouble.

“One side of his face was drooping,” she said. “I knew immediately that he had had a stroke.”

An ambulance arrived in a few minutes with a paramedic on board to take Robert to St. John’s Lutheran Hospital in Libby where the staff was standing by to send him for a CAT scan to see if the stroke was caused by a clot or if he had a bleed in his brain.

While he had imaging performed, a technician hooked up the hospital’s new Tele-Stroke equipment. The system used a video link to put Dr. Kurt Lindsay, medical director of the Northwest Healthcare Stroke Program in Kalispell, at Robert’s bedside.

 “I think it was the first time that they ever used it,” Mary said. “It was like having the doctor in the room.”

Lindsay, one of only two fellowship-trained stroke specialists in Montana, worked with urgent care specialist Dr. Jay Maloney in Libby to put the patient through diagnostic routines to determine if he was a candidate for the clot-busting drug called tissue plasminogen activator (TPA).

Once the radiologist provided a report back from the CAT scan, Lindsay recommended administering the drug. Mary said she felt much more confident signing the release form with a specialist consulting with the urgent care doctor.

The drug, administered to the wrong candidate, could  possibly lead to death. But in this case, the clot-buster worked its magic before Mary’s eyes.

“Within five minutes, I could see changes,” she said.

Since the stroke occurred in the right hemisphere of Robert’s brain, the left side of his body was affected. Mary said she had noticed that side of his body impacted as time passed after the stroke.

As the drug entered his body, she said she saw changes in his posturing and his left foot began to twitch. Robert received TPA a little over an hour and 15 minutes from the on-set of his symptoms.

“I believe using the camera system allowed them to give the drug to him in time to break the clot and lessen the brain injury,” Mary said.

Dr. Lindsay credited Mary’s recognition of the symptoms plus the Tele-Stroke equipment as key factors in allowing Robert to benefit from TPA. He said a very small percentage of stroke patients receive the drug in emergency rooms because of the short window of effectiveness.

“The tough part is that it only works for three and a half to four hours after the onset of symptoms,” he said. “We don’t get to them soon enough. A big barrier is educating people to the signs and symptoms of stroke.”

These include sudden weakness or numbness 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.

“It’s a natural instinct for people who have symptoms to hope they will go away,” Lindsay said.

Unfortunately, people who delay may pay a terrible price. Lindsay said that stroke represents the third leading cause of death and the leading cause of disability such as impaired speech, motor and cognitive skills.

The Northwest Healthcare Stroke Program was established to provide an integrated approach to treatment targeted to improving these statistics for people like Robert. Lindsay, a Kalispell native, moved back from Portland, Oregon in 2009 to guide the program as medical director and practice neurology with his brother Dr. Brett Lindsay and Dr. Donald Stone.

All three neurologists have fellowship subspecialty training.

“Kalispell is really lucky — we have incredible facilities and people here,” Dr. Kurt Lindsay said.

 He said he chose the stroke subspecialty because he enjoys helping people who are really sick and need decisions made urgently. He also likes the long-term relationship he has with patients as they go through rehabilitation.

Normally, people who complete stroke fellowship training work in large urban settings. But Lindsay, as well as his wife Dr. Justine Gavagan, a general surgeon at KRMC, wanted to live and practice in Northwest Montana.

Lindsay called the stroke program here “top notch” from the emergency room to patient rehabilitation.

“It’s really refreshing to come from an academic center like Portland and know that everything I could do there, I can do here,” he said. “We do have this really aggressive system in place and ready to help people.”

With the initiation of  the Tele-Stroke program, these capabilities have been extended to Libby, Ronan and Whitefish with one of the three neurologists available within 20 minutes at all times, via video hookups in their clinic and their homes.

The neurologists in Kalispell use a joystick to remotely move the camera over the patient at a distant emergency room.

“We log in here at the office or at home,” Lindsay said. “We can examine the patient and talk to the patient and family. That really helps the ER doctor make decisions about treatment.”

He said that 6 to 7 percent of patients can have bleeding from the clot-busting drug which can be devastating. Lindsay said that’s why some physicians hesitate to administer the drug without an evaluation from a specialist.

Lindsay said the state contributed tobacco tax dollars to expand the stroke program capabilities regionally. He said those dollars pay for the camera equipment while the hospital helps defray the costs of maintaining physicians on-call in Kalispell.

“It’s a neat sort of interaction,” he said.

By shortening the time continuum from onset of symptoms to diagnosis and treatment, the Tele-Stroke system gives patients like Robert Phillips the best shot at lessening their brain damage through treatment options like TPA which improves symptoms in about 40 percent of patients.

“Our motto is ‘time equals brain’,” Lindsay said.

Robert’s wife believes the time saved that allowed her husband to receive the drug made all the difference in his level of disability. After receiving the TPA drug, he was flown to Kalispell Regional Medical Center where the staff was geared up to care for him.

After initial recovery, Robert immediately entered rehabilitation in Kalispell, which Mary considered a big help. Now, after three months, she said he can get out of bed on his own and dress, comb his hair and shave himself.

He recently walked 200 feet in a pool on his own without holding on to the edge.

“He walked into this kitchen, got a bowl down and got cereal today,” she said. “That’s awesome to me.”

According to Mary, his speech is fine except when he becomes overly tired. Robert continues to work diligently each day on reading and math with their daughter who has come to West Yellowstone this summer to help out.

Robert, a retired wrecker operator, has a personal goal of regaining the ability to get down on the floor and play with their grandchildren as he loved to do before his stroke. Because Mary called 911 instantly, the ambulance and paramedic got him quickly to the ER in Libby and St. John’s had the Tele-Stroke system to access neurologists, Robert improve his odds for making a comeback. 

 “It was miraculous how all the things were in place and available to take care of him,” Mary said.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.