When Saundra Pichelman, left, was having a stroke, her husband, John, recognized the signs and took her to the hospital immediately. Six years later, Saundra suffers no impairment.

Quick action prevented stroke survivor from suffering permanent damage

Editor’s note: May is National Stroke Awareness Month.

By Mattie Carter, Lawrence Memorial Hospital

“Something funny is going on,” Saundra Pichelman, told her husband, John, on a November night six years ago. The Kansas Jayhawks men’s basketball team had just won a game in Maui, Hawaii. When Saundra tried to reach for the remote to turn off the TV, she couldn’t move her right hand.

“I knew right away that she was having a stroke,” John said.

Saundra was not so sure. She had heard that one of the most common signs of a stroke was not being able to smile, and she could smile just fine.

Still, John insisted she go to the hospital — just blocks from their house.

“I started to get up and realized I couldn’t move my leg,” Saundra said.

John wanted to call an ambulance, but when Saundra objected he managed to coax her into the car. Within minutes, they arrived at Lawrence Memorial Hospital, where Saundra said her thoughts were foggy.

“I remember being wheeled into the room and I said, ‘I hear a bird. Did you guys know you had a bird in here?’” Saundra recalled.

The bird was actually the sound of a CT scanner, which confirmed her immobility and confusion were both caused by an ischemic stroke. Ischemic strokes involve blockage of blood flow to a part of the brain. According to the American Heart Association, ischemic strokes account for 87 percent of all strokes.

Dr. Caleb Trent, a physician in the Emergency Department at LMH, says he and his colleagues see someone with a potential stroke every day. Typically, when someone arrives at the hospital with stroke-like symptoms, a Code Stroke is called to mobilize a specially trained medical team. Chances are, if you spend any part of your day in a hospital, you will hear a Code Stroke issued at least once.

Once a Code Stroke is called, a CT scan is ordered to rule out bleeding in the brain. Bleeding in the brain can be a sign of a hemorrhagic stroke, a less common but more severe type of stroke. A neurologist is consulted as doctors try to determine if they can administer a lifesaving clot-busting drug, tPA, which stands for tissue plasminogen activator, considered the gold standard treatment for ischemic strokes.

Dr. Sanjeev Kumar, a neurologist with Lawrence Neurology Specialists, explained, “When neurons don’t get blood flow, they tend to die. A stroke is death of neurons.”

Preventing further damage is something LMH has streamlined. LMH has earned The Joint Commission Advanced Certification for Primary Stroke Center, a standard set by the American Heart Association on best practices for stroke care. The hospital even holds monthly internal meetings about its treatment and areas where it can improve.

Following Saundra’s CT scan, Dr. John Clark, another neurologist with Lawrence Neurology Specialists who treated Saundra, recommended she receive tPA.

Administering the clot-busting tPA drug helps clear blockage and prevent nerve damage. Dr. Kumar said there is only a four-and-a-half-hour window of time from onset of symptoms to when you can receive the tPA without a high risk of bleeding in the brain. Dr. Trent said the sooner it is administered, the better the outcome.

Saundra, thanks to her husband, was inside the four-and-a-half-hour window. Within 30 minutes of receiving the tPA, she started to regain movement on her right side. She was hospitalized overnight for monitoring, but was up and walking by the next morning. 

“I just came out of it perfectly,” said Saundra, who is 76.

Dr. Kumar said only about 20 percent of stroke patients make it to the hospital within the vital four-and-a-half-hour period. Dr. Trent said he attributes this to most people not recognizing they are having a stroke or not thinking their symptoms are severe enough.

“People think: ‘Oh, well I’m young, and I can’t be having a stroke.’ But you could,” he said.

For those outside the four-and-a-half-hour timeframe or with a severe clot, a breakthrough procedure is offering new hope, according to Dr. Kumar.

The procedure, known as a mechanical thrombectomy, inserts a small catheter into the vessels in the brain to remove the clot. It’s now become standard treatment thanks to recent clinical trials.

“Before that, we didn’t really know whether a thrombectomy, as in going in through a catheter and pulling the clot out, was helpful or not,” said Dr. Kumar.

Under new guidelines, patients can qualify for this lifesaving procedure up to 24 hours after initial onset.

“If you do a thrombectomy, you save brain cells and you save lives,” Dr. Kumar said.

Despite this advancement, seeking help immediately still offers the highest chances of recovery, which is why Dr. Kumar said it is important to recognize stroke symptoms and to call 911 if you think you or your loved one might be having a stroke. Arriving at the emergency department via ambulance allows emergency responders to alert the hospital so you can be treated immediately.

“There’s increased survival and decreased disability,” said Dr. Kumar.

Saundra’s proximity to LMH as well as her husband’s quick recognition helped prevent any disability following her stroke. In the weeks after, she followed up with Dr. Clark for a consultation.

Many of the risk factors for stroke are similar to those for heart disease, including diabetes, high blood pressure and high cholesterol. One risk factor Dr. Trent said he tends to see among a lot of patients who have suffered severe strokes is smoking. According to Dr. Kumar, leading a healthy lifestyle can significantly help your odds.

“With a good lifestyle and exercise, your risk of stroke is low. If you have a stroke, it is more likely your recovery is better, your disability will be less and you will be discharged from the hospital quicker,” Dr. Kumar said.

Nearly six years later, Saundra has had no impairment from the stroke and said she is constantly reminded how lucky she is. After her stroke, Saundra started taking part in a senior strengthening exercise class twice a week.

She also has a constant reminder of what could have been. A neighbor had a stroke around the same time Saundra did, and now must use a wheelchair.

“I see him sitting out on the front porch in his wheelchair, and I think, ‘I am so blessed,’” Saundra said.

Mattie Carter is an intern in the Marketing and Communications Department at LMH, which is a major sponsor of Lawrence Journal-World’s health section.