From HealthNewsDigest.com

Stroke Issues
Stroke Patient Makes Remarkable Recovery
By
Jun 2, 2015 - 12:57:49 PM

(HealthNewsDigest.com) - By the time Steve Sebby was wheeled into a Rush operating room, his entire left side had become paralyzed by a stroke.

By the time he was wheeled out of the OR about two hours later, Sebby already was able to move his left hand a little. "It was that fast getting better," the 32-year-old Crystal Lake resident remembers.

Stroke is the main cause of severe long-term disability in the U.S., and fewer than 40 percent of people who suffer a major stroke - as Sebby did - regain their functional independence if they receive the standard drug treatment alone. Sebby, however, was treated with both the drug and an innovative interventional procedure, a combination that's been found to improve outcomes for stroke patients greatly.

The treatment Sebby received for the stroke he suffered in January, and his remarkable recovery from it, provides a window into understanding stroke. His story also shows how stroke care is advancing and offering greater hope to the nearly 800,000 people in the U.S. who have a stroke every year, according to the U.S. Centers for Disease Control and Prevention.

Too much effort

It was a little before 7 in the morning on Jan. 22 when Sebby, a website videographer, and his wife Brittany, a chiropractor, were about to leave for work. Suddenly, he began to experience intense vertigo and couldn't stand. He started vomiting, and his arm became numb, but Sebby remained conscious.

His wife called 911, and the ambulance arrived quickly. At that point, Sebby was experiencing headaches, ringing in his ears, and double vision.

The paramedics took him to an area community hospital, where an MRI exam revealed he'd had an ischemic stroke - which result from clots in vessels supplying blood to the brain. While exercise usually helps prevent stroke, Sebby's paradoxically likely was brought on by strenuous efforts to stay in shape earlier in the month.

"I tore my left vertebral artery on a day I was working on front squats with as much weight as I possibly could try to lift," explains the former lance corporal in the U.S. Marines, who served during the war in Iraq. "I remember waking up the next day and feeling like I slept funny.

"From that day until my stroke, I had pain in my neck and head that wouldn't go away. Looking back with 20-20 hindsight, I was having TIAs the entire time." TIA stands for transient ischemic attack, a temporary stroke that lasts an average of about a minute and is a warning sign. About a third of people who experience TIAs later have a stroke, says the American Stroke Association.

"It is critically important to call 911 if you experience any signs of a stroke because our treatments are time dependent" says James Conners, MD, a vascular neurologist and the medical director of Rush's comprehensive stroke program. "For every minute that goes by with a stroke you can lose nearly two million neurons."

The MRI showed that the clot, which had formed  at the site of the tear, had broken off and lodged in Sebby's basilar artery, which forms where the two vertebral (neck) arteries connect at the base of the skull.

Cut, thread, grab and pull

Sebby's doctors sought advice from Rush University Medical Center, holding a videoconference with Sarah Song, MD, an assistant professor of neurology. Rush physicians are available 24 hours a day, every day, to provide these consultations to the 10 Chicago-area hospitals in the Rush TeleStroke Network.

"We talk to patients just as if we were in the room with them, view their scans and other medical information, and confer with the doctors on hand to decide what care to provide," Song says. The Rush TeleStroke Network was launched in 2011, and it's expected that doctors at Rush will have provided more than 2,300 consultations by the end of this year.

At Song's direction, Sebby received a medication commonly known as tPA (for tissue plasminogen activator), which dissolves blood clots. It's the standard treatment for stroke, but it's not always able to completely dissolve large clots in major arteries that a cause severe stroke.

Which is what Sebby was having. Song discussed the case with Conners, and they decided to transport him to Rush for additional treatment. He was airlifted by helicopter.

"By the time I got into the helicopter and started moving, my pain was intense, and I was mostly paralyzed on my left side from my toes to the top of my head," Sebby recalls. During the 20-minute and roughly 45-mile flight from Woodstock to Rush, he lost his ability to swallow.

Rush is one of a handful of hospitals in the Chicago area where patients can receive thrombectomy, a procedure that literally pulls the clot causing a stroke out of a patient. During thrombectomy, a neurovascular surgeon threads a catheter through an incision in the patient's groin, snaking it through the blood vessels and into the brain. The doctor then uses a device attached to the catheter to grab and dislodge the clot and pull it all the way out through the incision, a bit like an angler reeling in a fish.

Studies recently have found that for large blood clots, thrombectomy combined with tPA improves the restoration of blood flow to the brain and may result in better long term outcomes than tPA alone.

Thrombectomy is not without risks. Doctors at Rush told Sebby that he had about a 7 percent chance of complications from the procedure if he chose to receive it. "Seven percent seem huge going into surgery, but there never was any question," he recalls.

Sebby, who had spent a month in ferocious combat in Fallujah, Iraq, remained calm. "I didn't have any panic moments of thinking I'm going to die," he recalls. "I thought, ‘these people seem like they know what they're doing, so I'm going to take a nap, and when I wake up, I'll feel my hands again.'"

Life lessons relearned

The procedure went as Sebby expected, but it still was unknown how much of the physical function on his paralyzed right side he would recover. He spent the next 10 days recovering at Rush, receiving physical rehabilitation each weekday.

"In two days I could stand up," he says. "In three days, I could walk to the bathroom. In four days, I could use the bathroom."

He credits the Rush staff for making his lengthy time at Rush "a very pleasant experience. Day one (while he was having his stroke) was not so hot, but that wasn't anybody's fault. Everybody there was absolutely on their ‘A' game. It was a really incredible team of people."

When he first went home, though, Sebby struggled with poor balance, headaches and numbness in his arms and chest. "I functioned like a drunk guy," he says.

As he worked to regain his motor skills, Sebby had a partner in his 11-month-old son, Parker. "We learned how to walk in the same week. Two days after my homecoming, he took his first steps. It's like he was waiting for me to come home."

With continued physical therapy, his condition steadily improved, and Sebby went back to work in mid-February, less than a month after his stroke. Despite some lingering numbness in his hands, he also has resumed his side job as a musician, performing a pair of shows in mid-May (he has an acoustic rock trio of his own and also plays in a wedding band).

Conners has monitored his progress and recently took Sebby off his blood thinning medication. He's exercising - gently - with swimming and low impact aerobics. "With our treatment capabilities we were able to offer Steve the best chance at a good outcome, and with his dedication to rehabilitation he has made a remarkable recovery from a potentially devastating stroke," he says.

"Being in combat in Fallujah, I've seen plenty of near-death experiences," Sebby reflects. I've really been trying to appreciate life to the fullest the last 10 years, and now this happens. It's just renews that perspective."

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