Collaborative Care Enables Strong Outcome
Teacher and volunteer deputy recovers quickly after stroke.
Terresa Roberts is used to putting others before herself.
As a mother of five, a reserve deputy and a teacher of troubled youth at the Franklin County Juvenile Detention Center, Terresa's nature entails giving of herself to many.
That's one reason why, in the summer of 2016, the then 51-year-old brushed aside illness and tried to continue going about her responsibilities. On a liquid diet in preparation for a routine colonoscopy, Terresa attributed dizziness and lightheadedness to low blood sugar and the lack of solid food. She made tea, but dropped her cup. While she was cleaning up the spill, her 18-year-old son asked what was wrong.
"I didn't recognize anything major was happening," Terresa said. "I told my son I would drink some juice and then take a nap. He didn't buy it. He was worried and went to our next-door neighbor for help."
The neighbor had lost his mother to a stroke, which made him especially sensitive to Terresa's condition. He called 911.
"When the EMTs arrived to check me out, they said my blood sugar was 89 (normal)," Terresa said. "Strangely, that is a detail I remember. I walked to the ambulance under my own power, but on the one-mile drive between my home and the hospital, I went from code green to code red."
Terresa had suffered a stroke. At the local hospital in Ottawa, Kansas, she underwent a CT scan and IV tPA in accordance with stroke care conditions. But she would require specialized expertise.
Effective specialty care
Terresa was transferred to The University of Kansas Health System. In its Comprehensive Stroke Center, one of the first in the nation to earn certification by The Joint Commission, imaging revealed a large vessel occlusion – a clot blocking a blood vessel. Neurologist Michael Rippee, MD, and neurointerventionalist Michael Abraham, MD, performed an embolectomy, a minimally invasive procedure in which the blood clot is removed through the groin.
"Terresa's was a challenging case because her stroke severity score was not particularly high, but if the obstructed artery were allowed to remain obstructed, the stroke could have become devastating," said Dr. Abraham. "We explored the risks and benefits and proceeded with endovascular therapy to retrieve the clot."
After the surgery, Terresa was transferred to the ICU. The next morning, occupational and speech therapists assessed her.
"They had me walk down the hall and down a flight of steps," Terresa recalled. "They joked with me, 'Are you sure you've had a stroke?' I was essentially symptom-free."
Terresa attributes her rapid recovery in part to her ongoing commitment to physical fitness. An avid walker and runner, Terresa completed a half marathon in 2012 and had placed second in her age group in a 5K run just a few months before the stroke.
She cites the exceptional care she received as critical to her outcome.
"Everyone here is amazing," she said. "Beyond the fantastic healthcare, they really make you feel like they care about you as a person, and your family members, too. It helped us feel at ease and meant a lot."
Collaboration across disciplines
Terresa also was impressed with the collaboration of physicians across disciplines. She had health concerns in her history long before she had the stroke. As a teenager, she was diagnosed with mitral valve prolapse, in which the two flaps of the heart's mitral valve do not close evenly. She was prescribed beta blockers. Later, as a reserve deputy, she had to experience the shock of a Taser stun gun as part of her training. Shortly after that shock, she temporarily lost vision in her left eye. When she explained her history to her eye doctor, she was encouraged to see a cardiologist. She did so, choosing a nearby provider in Lawrence, Kansas, who discovered a hole in Terresa's heart. She was advised to take a baby aspirin daily, but that no other treatment was necessary.
This became especially important following her stroke. Aware of her history, the stroke team involved cardiologist Matthew Earnest, MD, in Terresa's care. Dr. Earnest ordered a Zio Patch, a home heart monitor, followed by the insertable LINQ cardiac monitoring device. These tests revealed an atrial fibrillation, an irregular heart rhythm that is a common cause of strokes. This finding led Dr. Rippee to choose a different secondary stroke prevention medication.
"I really appreciate that my neurologists and cardiologists talk to each other," Teresa said. "There is a lot of great communication here, a lot of working together to decide what to do"
Dr. Rippee cited multidisciplinary collaboration as a crucial component to Terresa's successful outcome.
"Terresa's story is a perfect example of the team approach to stroke care," Dr. Rippee said. "It began with the team at her local ER – where the team called me to discuss her immediate treatment – and continued through her transfer to us. Dr. Abraham and I worked together to make the decision to remove the clot, and we collaborated with our cardiologists to determine the reason she developed the stroke. We together uncovered the heart arrhythmia, and this enabled me to adjust her medications to reduce her risk for future strokes."
A new understanding
Today, Terresa feels healthy and strong. She is pursuing a master's degree in education in learning technologies from Ottawa University. She has a new appreciation for health threats that can strike without warning.
"You need to listen to your body," she said. "We always want to believe we're OK, but sometimes, we need to pay closer attention. A stroke can happen to anyone."
To learn more, visit kansashealthsystem.com/stroke.