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Stroke Reversal in a 26 year old nursing student
By Robert Rymer, MD.
Saturday, August 18, 2007
Rated "G" by the Author.
Alicia was home alone - well two of her three children were also there - ages two and three but they could not help their Mom that much when her stroke occured.
ALICIA HUMPHREY 26 years old 8/12/2004
A solo hiker who is struck by a bolt of lightning is usually doomed. No one is there to help and the victim is usually unable to reason and act. The stroke victim who is “struck” by a stroke while alone often shares the solo hiker’s fate. Many of these stories demonstrate that the stroke victim is often unaware of his/her condition and cannot act to change the circumstances. Someone (an “advocate”) needs to be around to help initiate treatment. Alicia’s story shows us that even if alone, friends may save your life.
Alicia Humphrey was 26 years old when she had her stroke. She was at home alone on August 12, 2004- well not exactly alone. Two of her three children (ages 8, 3, and 2) were there too; the 3 and 2 year olds. There were no other adults present until they were summoned. Her project that day was cleaning out all the children’s drawers and closets:
Alicia: I go from top to bottom, take everything out of the drawers and the closets. I’ll go through and get rid of all the little McDonald’s toys, this, that and the other.
A friend from nursing school where Alicia was then enrolled called in the middle of this clean-up project with an enticing offer:
Alicia: My friend from nursing school, Lisa, called asking if I wanted to go to lunch. But I had already eaten lunch with my kids by then so I declined. But I thought better of it and called her back and asked her if she wanted to go for a walk instead, since we had already eaten. She agreed to that and said that she would get ready and call me back soon. The crazy thing about this is that I had not heard from Lisa for 3 months and this was the first day I had talked to her – this day of all days. So I started getting everybody ready to go down to the park. So I got everybody into and out of the bathroom: “Hurry up and go to the bathroom. Lisa is coming over and we are going for a walk.”
So I finally got to go into the bathroom after everyone else. After I had finished we would be ready by the time she finally got over here.
I noticed when I was sitting down that I drooled. And at most, the only thing that really crossed my mind about that was, “Hmm. That was weird.” And then I noticed some numbness in my left hand. I was trying to grab something with my left hand, and I just really couldn’t do it. It kind of felt like my left hand was like half dead. I did not have a headache at that point.
Lisa did not live that far away so I knew I had to hurry because she would be here soon. I remember sitting there for a while. I don’t even remember what I was trying to grab, but I ended up dropping it. And I remember thinking to myself, “Why am I having such a hard time?” And then I just kind of gave up whatever it was I was trying to do. And I remember feeling weak on the left side, because I was thinking about standing up and I just didn’t think I could do it.
While sitting, the weakness on her left side got worse:
Alicia: I didn’t know why I knew I was weak. When I sat down I noticed some weakness on the left side. Just sitting there and trying to stabilize my self it seemed that the left side was a little weaker. I think my first symptoms started in my face, went to my arm, and then went to my leg. I noticed that the left leg felt a little different. I was looking down. It was a half bath and it’s really small, so you’ve got to watch out when you sit down. Otherwise, your head will hit the sink. You never know what’s on the floor because the kids had already been in there. I started feeling increasingly weak on the left side. And I think I started to sway a little because I felt myself kind of losing my balance, going towards the left side. I knew I was going to fall off the toilet, so instead of fighting it, I just went with it. So I just rolled off the toilet. The door was open. It’s always open, because the kids don’t let me go to the bathroom with the door closed. We lived in a two story townhouse. We were on the bottom floor. I have it all baby-gated off so they can’t get to the front door and get out. And so, basically, when I rolled off the toilet, I was in the living room.
What a picture! A 26 year old nursing student rolled off the bathroom stool into her living room and is now flat on her back, helpless and unable to get up!
Alicia: I just laid there for a minute, trying to think of how to get up. It was the weirdest thing because getting up is something you just do, you just get up. You don’t think about it. I was lying on my back and eventually my kids came down. The phone began to ring and I couldn’t get to it. So I called my three-year-old daughter over and told her to get the phone. I had trained her to get stuff for me. So she got the phone for me. It was my girlfriend, Lisa, on the phone. She told me she was on her way over to go on the walk. And I think my first statement to her was, “I’ve fallen and I cannot get up!”
By then, my words were pretty slurred and I don’t think she could understand me very well. I think she was trying to figure it out. She asked me if I was hurt and I said, “No, I fell off the toilet.” I kept telling her I was okay. She was there in about 15 minutes. I had the front windows open, except our kitchen table was pushed up against those windows. The door was also locked. Lisa has really bad scoliosis with steel rods in her back so it was impossible for her to bend to get in the window where she could unlock the door and come inside. She could hear me but was unable to see me because I was still on the floor. I could hear her yelling in the window:
Lisa: Send the kids over and unlock the door!
Alicia: I was trying to tell her they couldn’t because the baby gates were up. They couldn’t get over them. But she said she could not understand anything I was saying at that point. I was slurring my words too badly.
I remember lying on the floor for a really long time and being really, really mad because I couldn’t figure out how to get up. And it was only after lying on the floor probably for about half an hour that the headache started. I was trying to rock from side to side and wriggling to get over onto my stomach.
Eventually I managed to do just that. But then I was tired and I told my son to get me a pillow so I could take a nap. It was nap time. Anyway, I felt so tired. So he got me a pillow and I began to rest next to that large wooden baby-gate. I was still upset that I couldn’t get up.
When Lisa arrived she determined quite quickly that Alicia was in real trouble and so she called her mother and Alicia’s husband. When Lisa’s mother arrived, the first responder cascade was initiated:
Alicia: Lisa’s Mom ripped out the screen so she could gain access to the back door and unlock it. And then she came in. She threw a towel over me. After I was covered, in came the first responders.
The 911 responders were able to penetrate the complicated screens and baby-gates to finally arrive at Alicia who was lying on her stomach with a pillow under her head and a towel over most of her torso. She was still confused and slurring her speech:
Alicia: They kept asking me if I had hit my head and I told them, no I had fallen off the stool. By then they could see that I couldn’t use my left side. Lisa’s mom told me that my arm was all folded up under me. I was laying on it and didn’t even know it. I couldn’t feel anything on my left side, although I remember I was still wiggling my left leg, or it hadn’t been very long since I had. And then they asked me two billion questions and told me to move this, move that, can you feel that and can you feel this.
So, sophisticated help has arrived and the diagnosis of stroke has been made. What next?
Alicia: Once we were in the ambulance they asked me where I wanted to be taken and I told them that I worked for a nearby hospital. And they said, no, that was not the best place because they really weren’t able to take care of the symptoms I had. I was a CNA in long-term care and so I guess they decided to take me out to Saint Lukes Stroke Center. They just said that my hospital was not a good option, so here is what we will do.
Alicia: In the ER I was blind in my left eye and I had left-sided neglect. They started an IV in my left hand and I was like: “What the heck? Where did that come from?” The headache was worse now and it was on the right side of my head. I had had a right MCA infarction (vascular anatomy chart). This was weird because one of my first patients in nursing school had the same thing. It took me until I had mine to be able to find out what MCA meant (middle cerebral artery). My patient with the MCA stroke went into a coma, and stayed in a coma until a month after we left that service.
She remembers her brief stay in the ER which was packed with activity:
Alicia: I remember they kept asking me to do stuff and I didn’t know how and my head hurt so bad I couldn’t think. They gave me something to sign about the procedure(s) they were suggesting and I thought: “You can’t do this. My brain is injured! It doesn’t count as informed consent.” Just the previous semester we had courses on legal and ethical aspects of care and I thought: “This doesn’t count. I know what you’re saying, but it still doesn’t count.” I understood it but I was drugged. I felt drugged. I felt really, really sleepy. The stroke team did explain the options of the clot retrieval process to my husband and mother. It did make perfect sense to me .It was just that I hurt so bad.
The procedure utilized the clot buster, tPA, and the Merci® Retrieval system.
Alicia: I don’t remember anything of the procedure. I don’t even remember going there. I do remember them telling me about it. Dr. Steve Arkin, the stroke neurologist, stood at my hip and asked me to move my foot. I did not know if I was doing it. I remember it was such a weird thing for someone to ask you to do something which seemed so natural. And then I remember moving my foot. I could only do it for a few seconds because it felt so heavy. Then he asked me to move my hand, he put his hand in my left hand and I squeezed it. I think it surprised him because he didn’t think I would get my left hand back at all. I remember my Mom saying something about I should have seen the look on his face when I moved that left hand!
After the reversal had been accomplished they searched for the clot’s origin:
Alicia: They found a PFO but they said it was really, really small and they didn’t think that it was the cause of it all. They thought that birth control pills might have contributed to the clot but I also have bad genetics. There are some bad arteries in the family.
Alicia knew her reversal cascade had been initiated by a friend she had not seen for 3 months and it still puzzles her how it happened that Lisa had called that day:
Alicia: Really, I had good luck. Most of it was just chance. Lisa called that day of all days and then she was on her way over to go walking. If she had not come and found me, I would have been on my back until 10 P.M. that night.
Alicia does have some residual deficits. She is unable to type easily with her left hand and her sensation is not back to normal.
Alicia: When I do an assessment on a patient using my left hand, I just can’t feel it as well as with the right. I don’t know if it is something that needs to be retrained or if it’s just gone. I am not sure. Also, lukewarm water burns the skin on my left side. It feels really hot. Just after the stroke reversal I became really depressed. I could not feel anything. I wasn’t happy. I wasn’t ever mad, which probably should’ve clued me in because I’m always mad about something. I just didn’t care. The kids would wreck the house. I’d be like, “So what? I don’t care.” I pretty much spent the next month sleeping, sleeping it off.
Despite all this Alicia returned to work in 2 weeks after her stroke reversal.
And soon she will graduate with her BSN (Bachelor’s of Science in Nursing).
Alicia was lucky to have Lisa as a friend who wanted to go to lunch that day. Without Lisa’s arrival on the scene, the calls to her mother and subsequent 911 call, Alicia, too, might have ended up in coma like the patient she cared for as a nursing student. Or, as Alicia noted, she might have been on her back until 10 pm that night with no chance for stroke reversal. The 911, first responder team, detected the acute stroke. They also had experience with the Saint Lukes Stroke Center and chose to bypass the nearby hospital for a stroke reversal attempt. The intricate pieces of the stroke reversal process fell into place quickly and reversal was effected. Her three children, now 9, 4 and 3, still have their mother.
Read more true stories of stroke reversal in the book 911Stroke.org
Visit the web site 911Stroke.org for more information about the St.
Luke’s Stroke Center in Kansas City , Missouri.
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