At first glance, Kim Fagan doesn’t seem like a likely candidate for a stroke.
An occupational therapy assistant, Fagan exercises daily, watches what she eats and takes a holistic approach to her health. She incorporates essential oils, organic foods, yoga and meditation into her routine.
But on Wednesday, March 14, a series of strange symptoms prompted the then-57-year-old to seek medical care. That morning, she had difficulty finding the right words when she spoke, and felt weakness and sensory loss in the right side of her body.
“I didn’t feel like myself. I couldn’t say why I wasn’t myself—I just felt ‘off,’” she said.
When Fagan arrived at work that day, she told her concerned colleagues at the outpatient therapy center about the strange symptoms. As they took her blood pressure, it hit her.
I bet I’m having a stroke, she thought.
Stroke is the number-one cause of long-term disability in the United States, affecting nearly 800,000 people each year. An ischemic stroke happens when a blood clot blocks blood flow to a portion of the brain. Stroke symptoms include sudden numbness or weakness in the face, arm, or leg, particularly on one side; sudden confusion or trouble understanding things; sudden trouble speaking; or sudden vision problems. A stroke is a medical emergency. If you think you or a loved one might be having a stroke, call 911 right away. The best stroke treatments are only effective if treatment is administered within a few hours of the start of symptoms.
When Fagan realized that a stroke might be causing her symptoms, she did the right thing: She went to the emergency room of her local hospital, Grand Itasca Clinic & Hospital in Grand Rapids, Minn. Like many other small community hospitals serving rural areas, Grand Itasca does not have a stroke specialist on site. But unlike many other hospitals, Grand Itasca uses “Telestroke” technology to give patients quick access to expert stroke care from University of Minnesota Health specialists.
The hospital has also received an Acute Stroke Ready Hospital designation from the Minnesota Department of Health. This means Grand Itasca meets all the criteria set forth by MDH to be able to provide the best care possible to stroke patients. Criteria include a designated acute stroke team, 24/7 imaging and lab capabilities, established collaboration with EMS, written protocols for treatment and transfer of stroke patients, education for staff and other factors.
Telestroke technology allows stroke specialists immediate access to incoming stroke patients through emergency room video conferencing—even if the specialist is hundreds of miles away. In late 2017, University of Minnesota Health and Fairview Health Services partnered to provide Telestroke access at Grand Itasca and other hospitals in Minnesota, which means that stroke patients arriving at rural or suburban hospitals can be seen remotely by University of Minnesota Health stroke specialists.
“The technology allows stroke patients at any of our partner hospitals to get the same level of care they would get at a comprehensive stroke center,” said Neurologist Christopher Streib, MD, who directs the University of Minnesota Health Telestroke program.
Within five minutes of her arrival at Grand Itasca, Kim Fagan was on a bed with IVs started and the Telestroke video conferencing cart at her bedside.
“They said they were going to get a neurologist,” Fagan said. On the screen, she saw University of Minnesota Health Neurologist Mohammed Alkuwaiti, MD, a stoke specialist. At the time, Alkuwaiti was at University of Minnesota Medical Center in Minneapolis—roughly 175 miles away.
“Dr. Alkuwaiti was amazing. He explained that he was going to do a neurological exam to see whether I was having a stroke,” Fagan said.
Using the Telestroke system, Alkuwaiti assessed Fagan. He noted that she was experiencing expressive aphasia, or difficulty speaking. She also had right hand and arm sensory loss; Fagan felt as though her right arm was not connected to her body.
Alkuwaiti recommended that she receive tPA—a clot-busting drug. Then, she was then airlifted to University of Minnesota Medical Center. There, she met Alkuwaiti in person. Due to rapid recognition of her symptoms and immediate treatment, Fagan’s follow-up scans showed no trace of the clot that had caused her stroke, and she turned her focus to recovery.
“The partnership between Grand Itasca and University of Minnesota Health was fairly new at the time of Kim’s stroke. I was able to use Telestroke technology to evaluate her, take a history, do an examination, look at the images, and provide best-practice care for stroke—including administering tPA through an IV,” Alkuwaiti said. “For patients in remote areas, having access to rapid stroke care is a great advantage for the community.”
One month after her stroke, Fagan was back at work. She was cleared to drive a car a few weeks later. She still notices some short-term memory problems from time to time, but experiences no other significant effects.
“I’ve been working in the healthcare field since 1988, and I’ve seen a lot of changes during that time,” Fagan said. “The healthcare system worked perfectly in my case, and I’m so grateful.”
Christopher Streib, MD, agrees.
“When a patient like Kim goes to Grand Itasca Hospital and is immediately seen by a stroke neurologist and treated with tPA through an IV, it’s a testament to our teamwork and a perfect demonstration of the capability of Telestroke technology. Rather than being permanently disabled from her stroke, Kim has had a nearly complete recovery.”
Emergency Medicine Physician Paul Palecek, MD, the physician leader of Grand Itasca’s stroke program, attributed Fagan’s successful treatment to multidisciplinary collaboration.
“It took many dedicated professionals to achieve this great outcome,” Palecek said. “From the Grand Itasca desk registration personnel to the folks who prepped her room at University of Minnesota Medical Center, it’s literally a chain of care in which each link is critical.”