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Fast Action and Clot Busting Drug Saves Physician from Serious Long-Term Disability
Alexander MacGillis' Story
Alexander MacGillis’ family had gathered for a long Fourth of July celebration last summer when the unexpected happened.
“I was working on fixing the dock,” says Alexander, an active 87-year-old who lives on Pewaukee Lake with his wife of 53 years, Mary. “As I bent and lifted a section of it, I dislodged a blood clot. I immediately saw stars, and it seemed like there was lightning in my head. My daughter Maggie rushed to help me. When she reached me, I told her what was happening.”
Alexander was having a stroke. The blood clot had blocked blood flow and oxygen to his brain and when brain cells are deprived of oxygen, they begin to die. When they die, memory and muscle control are lost. Fast action was needed.
Daughter Christine, a nurse practitioner, also was visiting and came to his aid. By that time, his left side was weak, and when he tried to talk, he made no sense.
“My daughters got me into the house and called 911 immediately,” he says. “The EMTs arrived so quickly that one of them was still buttoning his shirt. They got me to the hospital in 12 minutes.”
Alexander is precise in his observations, in part because he is a physician and he knows such things are important. He was in private practice for many years as a urologist and most recently has volunteered at the Veterans Administration Medical Center in Milwaukee.
When Alexander arrived at ProHealth Waukesha Memorial Hospital on July 1, the emergency department staff had been briefed by the EMTs and set right to work. It was determined the stroke was caused by a blood clot to the brain, known as an ischemic stroke.
“Dr. MacGillis had classic stroke symptoms,” says Brian Huckstorf, MD, the emergency medicine physician who treated him. “He couldn’t speak, but could understand what we were saying. And he had left-side weakness. We did an assessment and determined he was a good candidate for tPA.”
That decision to use the clot-dissolving drug would affect both his treatment and his future.
TPA, or tissue plasminogen activator, is called a clot buster. Administered through an IV, the medication travels to the obstruction in the brain and begins to dissolve the clot and restore blood flow. Considered the gold standard for stroke treatment, it can only be used within a limited period after the stroke is triggered.
“He had arrived at the ED well within three hours of the onset of symptoms,” Dr. Huckstorf says.
It soon was apparent the tPA was working.
“It’s a pretty amazing drug,” Dr. Huckstorf says. “It’s one of those things that can change the course of what’s happening and really improve the prognosis.”
Neurologist Genevieve Jones, MD, met with Dr. MacGillis within an hour or so of his arrival at Waukesha Memorial. “Without tPA, his quality of life could have been dramatically altered,” she says. “His chronological age was 86 at the time, but a very young 86,” she says. “He stays active and is physically and mentally healthy. TPA would give him the best possible outcome.”
On average, ProHealth Care sees 500 stroke patients a year between Waukesha Memorial Hospital and Oconomowoc Memorial Hospital. In 2014, more than half were individuals impacted by ischemic strokes. In 2013, ProHealth Care was the first system in Waukesha County to introduce mechanical thrombolysis, which uses a catheter to extract cerebral blood clots, thereby reducing the risk of brain damage in stroke patients. The program administers tPA and performs mechanical thrombolysis at a higher rate than other hospitals in the state, and nation.
Veronica Laak, ProHealth Care’s Stroke Program coordinator and nurse practitioner, met with Dr. MacGillis during the five days he was in the hospital, and afterward in the stroke and transient ischemic attack follow-up program.
“He had responded to the IV tPA, but still had aphasia,” says Laak, referring to a disorder caused by an injury to the part of the brain that controls the ability to speak.
Laak referred Dr. MacGillis to outpatient speech therapy, helped reconcile and coordinate his medications and helped address the irregular heart rhythm that led to the stroke. He returned to Waukesha Memorial in October and Vicken Vorperian, MD, an electrophysiologist with ProHealth Heart & Vascular Care, performed a cardiac ablation procedure to correct his arrhythmia.
“Dr. MacGillis is an excellent patient and is very eager to get back to his previous life,” Laak says.
And what a life it is.
A lifelong athlete, Dr. MacGillis trains and swims competitively in the U.S. and Wisconsin Masters Program. Less than two weeks before his stroke he competed in a major meet, swimming in both individual and relay events, winning most and even setting record times.
He stays busy professionally, too. After retiring from private practice, he worked at the VA as a urologist until 2014, and afterwards as a volunteer until his stroke. He now is on medical leave from the VA.
“Dr. MacGillis is a very determined man and wanted to take an active role in his recovery,” says Laak, who has a special interest in stroke patients – in part, because she is one.
Six years ago, when she was just 25 and the mother of a 4-month-old, she was working third shift as a nurse at Waukesha Memorial.
“I suddenly had left-side weakness and was speaking gibberish,” she explains. “My co-worker recognized what it was right away.”
“I, too, was a candidate for IV tPA and was given the medication,” she says. “My recovery went well. But like Dr. MacGillis, I still feel like I sometimes have trouble getting the words out.”
Laak says she has made it her goal to provide support and information for stroke patients and their families.
“With the right care, a stroke patient can go back to leading a full and rewarding life,” she says.
Dr. MacGillis is on that road right now.
With speech therapy, his aphasia has improved significantly.
“I’m told it might take a full year for it to go away completely, but it’s much better,” he says. He anticipates going back to helping out at the VA in early 2016.
With his doctors’ consent, he already has resumed swimming, but has started out slowly.
“I would say right now I am about 90 percent recovered,” he says. “It’s just the aphasia that keeps me from being 100 percent, and that’s a little frustrating.
“But, God willing, in no time I will be working and swimming just like before, as if it never happened.”
Procedure at Waukesha Memorial saves 35-year-old stroke victim’s life
Tracy Gerber's Story
By Sarah Pryor
Waukesha Freeman Staff
Tracy Gerber remembers everything about Oct. 14.
She remembers working on her laptop, making herself lunch and sitting back down on the couch in her family room. Then she remembers falling out of the chair and being caught between a chair and her ottoman – and not being able to get up.
“I thought I didn’t have traction on the bottom of my slippers because they were slick,” Gerber said. When her husband, Jeff, came home four hours later and she was still stuck, and the left side of her face had begun to droop, the Gerbers realized something was wrong.
Tracy Gerber couldn’t believe it when the 911 dispatcher told her she had probably had a stroke. With no family history of illness and a clean bill of health herself, 35-year-old Tracy Gerber didn’t seem like a likely candidate.
After a series of tests in the Emergency Room at Waukesha Memorial Hospital, neurologist Dr. Stanya Smithdetermined that Tracy Gerber had suffered a stroke on the right side of her brain, and that time was of the essence.
“If you suspect someone is having a stroke, the patient needs to come as soon as possible, within an hour would be best, because CT scans, blood work, those things take time,” Smith said. “The clock is ticking.”
Catheter to the brain
Smith said that since several hours had passed since Tracy Gerber’s stroke, the window for administering drugs had passed, and the only solution would be a procedure in which a tiny catheter is inserted through the groin and threaded all the way up to the brain where it basically vacuums out the clot.
“She had good evidence that there was a large amount of salvageable brain if we were able to clear the blood clot,” said Dr. Robert Lesniak, who performed the rare procedure. “She had a lot of good things going for her, not the least of which was her young age.”
Tracy Gerber said she really never felt like anything was wrong – she felt like she was moving parts of her body, but her left side was entirely paralyzed.
“Every stroke is different, and having the stroke on the right side of her brain, she didn’t realize how bad it was,” Smith said. “She’ll never realize how bad her symptoms were, but her family and I know.”
It only took five days in the hospital for Gerber to get well enough to go home, which included intensive therapy to re-teach her to walk and brush her teeth lefthanded.
Two months later, she has hardly any lingering residual effects from the stroke, aside from extreme difficulty multi-tasking.
“My physical therapist told me to walk while bouncing a balloon from my right hand to my left hand and saying the names of states. It was so hard,” she said. “But I think we all multi-task too much sometimes, anyway.”
Signs of a stroke
Now the Gerbers hope Tracy’s story can be used as a cautionary tale for others.
“It can happen to anyone,” she said.
Signs of stroke include speech problems, vision problems like not being able to see out of one eye, numbness, tingling or weakness on one side, weakness on one side, onset dizziness and balance problems, Smith said.
As for Tracy Gerber, she’ll continue to be monitored at least once a year moving forward, since it’s still unclear what caused her stroke.
“She had a great outcome,” Lesniak said. “For me, one of the most gratifying moments in my career was when she climbed out of bed a few days after the procedure walked over to me with a big smile on her face and gave me a hug.”