Fri, Jul 8, 2016 at 05:00 AM

Stroke victim saved from negative effects by teleneurology

Beverly Ann Ivey is living proof that a network linking hospitals to neurologists makes a huge difference in how much damage results from a stroke.

Ivey was the first patient at Marshall Medical Centers to use the telestroke network put in place in April to help stroke victims who live a distance from a neurologist.

“It was a miracle,” said Beverly’s husband Larry, who watched his wife begin moving her limbs soon after receiving a clot-busting drug that works only during a short window following a stroke. “Immediately after they gave her the shot she moved her arm and leg.”

When it was determined at Marshall South that Ivey had suffered a stroke and met the qualifying criteria for teleneurology, the emergency doctor initiated a ‘stroke alert,’ which relayed her vital information to the network,  and sent her for a CT scan. Upon arrival at the ER, patients with symptoms of stroke are first evaluated to determine if they are a candidate for the teleneurology system. 

Dr. Amit Arora, a Huntsville Hospital neurologist and director of the stroke network, assessed Ivey in the emergency room using a video-capable computer. Although he was on a computer screen, he could see Ivey along with all her family and ask them questions.

“It was just like he was personally there,” Larry Ivey said. “He was looking at her, looking at her records and scans. It was neat.”

Ivey’s daughter, Courtney Easterwood, is an OB nurse at Marshall South. She was very impressed to see the stroke network in action.

“It was very smooth,” she said. “There were no hiccups. We didn’t have to wait. He was right there. He could see and assess her. It was not just a phone call.”

Arora ordered the tissue plasminogen activator (tPA) be given to Ivey. The reaction was immediate. Larry Ivey said hospital staff members were gathering to witness the event and exclaimed as she was able to respond to commands to lift her arm and leg.

“Her right side was completely flaccid before,” Easterwood said. “I know her speech is affected but I hate to think how she would be without the tPA.”

“It’s not as bad as it could be,” Ivey, 69, said in her halting speech.

Dr. Scott Kelley was on duty in the South ER when Ivey came in.

“She was a really good candidate,” he recalled.

That’s because her family was with her and knew exactly when her symptoms started. Often a stroke strikes when a person is sleeping and may go on for hours before being noticed. Ivey had had no previous brain bleeds from her first stroke and that is a good sign. Also, her blood pressure was well controlled.

“It all went very smoothly,” Kelley said.

The neurologist was reached quickly and saw for himself the lack of movement in one side, affected speech and facial drooping. He recommended using tPA, and within 30 minutes she was moving her arm and leg with no difficulty.

Kelley said that is very important because loss of mobility is much more difficult to regain than speech.

“Speech will keep improving for six months to a year,” he said. “Mobility is the key.”

Kelley said the telestroke network worked very well for Ivey. Before, time was wasted trying to locate a neurologist. Most physicians will not administer tPA without a neurologist first recommending it.

“The issue really is time,” he said. “It helps having a conduit like this. It’s a good system.”

Ivey is in the unique position of being able to compare the effects of a stroke with and without the drug. She previously had a stroke in August 2015, before the stroke network was established. She did not receive tPA. After 10 days in the hospital, she couldn’t walk or talk. She went to rehab for 21 days to regain some mobility and speech. Larry Ivey said he began noticing improvements in her writing, talking, thinking and cooking in late January and February of this year.

The recent stroke, which occurred on May 6, was much less damaging. She regained mobility right away and her speech is gradually improving. She did not need rehab.

“I honestly believe if that first stroke had been treated like this one she would have hardly any deficits,” Easterwood said. “She would probably be at 90 to 95 percent.”

Ivey said she wants to speak out to urge people to get stroke victims to the hospital as fast as possible. She knows how much difference time makes.

“If you could see how I was and could see how I am now,” she said. “The ragged edge of my speech is the only thing lacking.”

Like her daughter, Ivey also worked as a nurse at the hospital when it was known as the ‘B&A.’ That was before she and Larry travelled and lived abroad during the 22 years he spent in the military. They built their dream home in Douglas 16 years ago, filling it with furniture they collected while living in Germany.

Easterwood, her son Bryce and her brother Matt, along with their Dad, were all at the house with Ivey when the recent stroke occurred. Easterwood had brought lunch and was feeding Bryce when Ivey started speaking gibberish.

“The little one looked at me like I had two heads,” Ivey recalled.

Easterwood asked her mother to move her arm. When she couldn’t, they knew it was another stroke. She called for her brother, who carried Ivey to the car.

“That’s how fast it happened,” Easterwood said. “I turned around and she couldn’t get her hand to her mouth.”

When they got Ivey to the hospital, her right arm and leg were dragging.

Easterwood was well aware how crucial the time factor is to a stroke victim. She knew her hospital had recently joined the stroke network and she was hopeful.

“Everything turned out good,” she said.