March 07, 2012
Among the physicians who were at John C. Lincoln North Mountain Hospital to provide sophisticated lifesaving medical care for Yolanda Jones are from left, anesthesiologist Joel Pavelonis, MD, neuro-intensivist Victor Zach, MD, and interventional radiologist David LoPresti, MD.
Yolanda Jones is not surprised that medical specialists just happened to be available at John C. Lincoln North Mountain Hospital when she needed them.
"God brought those doctors there," she said. Jones had a stroke so severe that if it happened before she got to the hospital, it could have killed her. If it happened during surgery, while she was anesthetized, she could have been paralyzed.
Instead, she's almost unscathed. "I have a little trouble lifting my foot," she said.
"I also have numbness in my hand. I need some physical therapy, which I'll get in the near future."
Her doctors were thrilled to hear that. But let's go back to the beginning, when heart palpitations brought Jones to see cardiologist Warren Breisblatt, MD.
Stroke survivor Yolanda Jones cuddles Misha, her much-loved little friend who was waiting for her to come home.
"An ultrasound and a carotid angiogram showed her left internal carotid artery was almost completely blocked," Dr. Breisblatt said.
That's not good. The carotid artery carries fresh blood to the head and neck. When it splits, the internal carotid supplies oxygen to the brain.
Dr. Breisblatt contacted cardiothoracic surgeon, Kevin Brady, MD, to schedule a carotid endarterectomy. That's a sophisticated surgery that clears out clots or plaque and allows blood to flow freely.
Jones was being prepped for surgery, chatting away with her anesthesiologist, Joel Pavelonis, MD, when everything froze.
"She stopped talking. Her eyes got glassy," Dr. Pavelonis said. "She was unresponsive."
He recalls the moment with a bit of awe. "Twenty years of medicine and I've never before watched a neurological event unfold in front of my eyes," he said. "I knew right away she needed help for a stroke."
Jones remembers the moment, clearly. "All of a sudden I could think but I couldn't talk. My right side, my hand, my arm went numb. I couldn't move.
"Then at the top of my right eye I could see a gray shield descending, closing down my vision," she said. "I was going blind. I thought I was dying.
Dr. Pavelonis paged for neurological assistance. Victor Zach, MD, one of the state's few neuro-intensivists, arrived at Jones' bedside in moments.
"Dr. Zach told me later I had three strokes in one, the perfect storm, that affected the front, the top and the back of my brain," Jones said.
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"Her stroke was clinically severe," Dr. Zach said. "She was completely mute, unable to understand any instructions, paralyzed on the right side of her body and unable to swallow. She had a 40 to 50 percent chance of dying. If she did survive, her chance of being severely disabled was 90 percent."
Immediately he ordered a special clot-busting drug.
"With the assistance of Pat Jordan, RN, our wonderful charge nurse from the ICU, we were able to administer medication just 40 minutes after onset of the stroke," Dr. Zach said.
That time is important. National guidelines say clot-busting drugs must be given less than three hours after a stroke in order to be effective. In this case, the speed of medication delivery "was remarkable," Dr. Zach said.
"But there was a problem," he added. "While the standard of care was met, it wasn't enough."
A brain scan revealed her arteries were still closed. So Dr. Zach reached out for more help, paging an interventional radiologist. David LoPresti, MD, arrived in less than five minutes.
Dr. LoPresti transported Jones to the interventional radiology suite, where he passed a catheter through the artery at the top of her leg up to the clogged carotid. Medical images revealed the artery had barely been reopened by the medication, and only a trickle of blood was getting through.
After a brief conference, the physicians decided to inject the lifesaving drug directly through the catheter.
"After only four milligrams, the patient began to get control of her arm," Dr. Zach said. "At that point, Dr. LoPresti pushed on and skillfully passed a microcatheter through the tight vessel. He slowly delivered four more milligrams to the clot. The patient began to speak."
The team was overjoyed. They had just witnessed a miracle.
Medical protocols required a seven-day wait before Jones could get the the surgery she'd originally come to the hospital to get. During that time, Dr. Zach monitored her with a special ultrasound procedure to make sure her carotid remained open.
A week later, Dr. Brady removed all the plaque and clotted material in her artery.
"She did very well and went home with no neuro deficits," Dr. Brady said.
All the physicians who teamed up to save Jones are thrilled with her recovery.
"Someone was definitely looking over her shoulder," Dr. Pavelonis marveled.
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