Telestroke brings expert to you Jetsons-style

Telestroke brings expert to you Jetsons-style

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Crumpled on the floor of his Tooele bathroom, Larry screamed for help. At least, he thought he was screaming. In truth, no words came out. The 58-year-old was having a stroke, and the clock was his worst enemy. How quickly he could get help would play a huge role in determining whether Larry would ever regain his pre-stroke level of independence.

It's been about a year since that terrifying day when Larry's quick-acting son-in-law heard him kicking against the wall, scooped him off the ground and called 911. Thanks in large part to swift access to stroke specialists via [University of Utah Health Care's telestroke system](< location= target=_blank rel=>), Larry is living on his own again and is feeling more like his old self every day.

"I remember talking to the doctor on the TV," Larry said in a steady voice, recalling his visit to a Tooele emergency room where he teleconferenced with University of Utah stroke [neurologist Dana DeWitt, M.D.](< location= target=_blank rel=>) in Salt Lake City. "It was like she was right there with me, working with me. She asked me to raise my left hand and wave it, and I thought I was raising my hand, but she said I wasn't. She just knew right away what to do."

Through the University of Utah's telestroke system, patients — even those who don't live an easy car ride away from University of Utah Hospital — are able to meet face-to-face with stroke specialists during those critical first hours when parts of the brain are deprived of oxygen and nutrients. They're given specific tests and evaluated on a standardized scale to identify the severity of their stroke. Basically, it's a Skype-type call with a stroke expert that is initiated by an emergency physician.

Telehealth visits are picking up steam in the world of medicine and are particularly beneficial to stroke patients. For starters, people who have had a stroke exhibit physical signs that are evident even when viewed on a screen, such as drooping face, arm weakness and trouble speaking. Moreover, major decisions that can impact the rest of a patient's life need to be made rapidly. You've heard "time is money." Stroke doctors use an even more urgent analogy: "Time is brain."

"Every minute a stroke goes untreated, you're losing 1.9 million brain cells," said [Peter Hannon, M.D.,](< location= target=_blank rel=>) a University of Utah neurologist and one of the physicians who treated Larry. "The telestroke system has just been an incredible tool to allow us to really get access to these patients and try to intervene more quickly in rural or underserved areas."

If caught in time, a clot-busting drug — called tissue plasminogen activator or tPA — can make all the difference for a stroke patient. tPA, which must be given within 3 to 4 ½ hours of the onset of symptoms, dissolves the clot and improves blood flow to the brain. Unfortunately, it's often not given to patients who could benefit.

"A lot of times when people are in rural settings or smaller towns, they either can't get to a facility that can give this medication or they get to facilities where practitioners don't feel comfortable giving this medication," Hannon said. "So, by using telestroke, it allows these smaller hospitals to directly hook up to a larger center like the University of Utah. We then go ahead and work with clinicians there to administer treatment in an acute setting."

Other interventions, including mechanically retrieving the clot, are also available in some cases. But no treatment is the answer for every patient. In Larry's case, doctors recommended tPA. He got the medicine at Mountain West Medical Center, his local hospital, before being flown by helicopter to University Hospital.

"He had a pretty substantial improvement in his symptoms even by the time that he got to our hospital," Hannon said. "He wasn't back to baseline, but he had had a very severe stroke and his symptoms had improved considerably. He initially had very limited movement in his left arm and leg, and by the time he got here, he was starting to move them better, which is what we often see when a patient gets treated quickly."

In addition to acute care, University of Utah Health Care is also branching out to use telestroke technology for follow-up visits. Larry's local clinic, Stansbury Health Center, offers check-ups with stroke doctors.

As for Larry's recovery, he's doing well. He has since relearned to speak, get dressed and bathe. He's still blind in his left eye and has trouble counting money and tying his shoes, but he's pleased with how his recovery is going, especially the progress he's made with his speech.

"I'm blessed, I can guarantee you that," Larry said. "Compared to where I could be, I'm doing great."

Want to be a hero like Larry's son-in-law and identify a stroke when you see it? Neurologists teach the acronym F.A.S.T., which stands for Face (does one side droop?), Arms (does one arm drift downward?), Speech (are words slurred or mispronounced?), and Time (time lost is brain lost). Be sure to call 911 immediately if you or someone else experiences one of these symptoms.

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