He did not immediately think “stroke.”
As his symptoms became more clear on that July morning last summer, 69-year-old Onondaga County Undersheriff Warren Darby began to realize he needed to hurry to the hospital. Not just any hospital. A designated stroke center: Upstate University Hospital.
Word spread quickly about Darby’s medical crisis. Friends feared the worst. Darby says, “The Lord had other ideas,” as he recalls that day and the months that followed into his recovery. As blood leaked from a tiny vessel in Darby’s brain, he was at the mercy of a system of medical care that he helped create, a system in which the state Department of Health designates certain hospitals as stroke centers to improve quick access to definitive care for anyone suffering what appears to be a stroke. Now Darby was dependent on that system.
Stroke is a leading cause of disability in the United States and the fourth most prevalent cause of death. It happens when a blood vessel carrying oxygen and nutrients to the brain ruptures or becomes blocked by a clot. High blood pressure is one of the leading causes of stroke and the most important controllable risk factor.
“For all strokes, the sooner you get to the hospital, the greater your chances that something can be done,” says Gene Latorre, MD, the associate professor of neurology at Upstate who took care of Darby.
The annual celebration known as Valley Men’s Field Days was under way at Meachem Park, on the southern end of Syracuse. Organizers opened the rides and games specifically for children with special needs that July 18 morning, and Darby looked forward to joining the other police, fire and emergency medical services professionals assisting the kids. Several decades earlier, his own daughter, Kimberly, who was born with Down syndrome, enjoyed the field days. Today Darby continues to volunteer helping children on and off the rides.
His day began as it usually did, with breakfast around 7 a.m. and the medication he has taken for 10 years to help control his blood pressure. Then he put on his uniform and drove to work.
Darby climbed out of his car about 8 a.m. He felt off balance. He steadied himself and carefully walked into his office at the sheriff’s headquarters in downtown Syracuse. He sat at his desk doing some paperwork before heading to the field days. About 45 minutes later, he stood and felt the same imbalanced sensation.
He called his wife, Joan, a nurse. He recognized something was wrong, and he did not believe he should drive. She drove into Syracuse and called his cell phone when she arrived. When Darby stood up a third time, he felt imbalanced, and his left leg felt asleep. “That made me think, this is possibly a stroke,” recalls Darby.
Joan drove him to his physician’s office. “Dr. Mitchell Brodey examined me, and the next thing I know, I was in an ambulance on the way to the stroke center.”
Darby’s 52-year career in public service includes leadership roles in emergency medical services, fire services and law enforcement. For 16 years he served as president of the Central New York Regional Emergency Medical Services Council, and represented the local council on the New York State Emergency Medical Services Council. That’s how he was involved in the New York State stroke center designations.
Upstate University Hospital was the first designated stroke center in Central New York, and its staff provide stroke care that is not available elsewhere. Darby felt confident as paramedics wheeled him into the downtown hospital.
A team of providers had already been mobilized and was ready for him. Quickly it was determined that Darby had a small bleed on the right side of his brain, which made sense, given the symptoms he experienced on his left side. Next, they searched for the cause. The neurologist, Latorre told Darby that a weakened capillary deep in his brain had burst. He was suffering a hemorrhagic stroke. It would take 6 to 8 weeks for his body to absorb the blood and reveal any lasting debilitation, but first the team had to get the bleeding to stop.
Typically, the larger blood vessel will shut off the bleeding capillary, as long as the blood pressure is brought under control and the swelling managed. This is done chiefly through medication.
“For the most part, unless the blood pressure is not controlled, it resolves on its own,” Latorre says.
He adds that “the size of the hemorrhage is not as important as the location.” Some patients have minimal symptoms despite large fist-sized collections of blood, and others are rendered comatose from a pea-sized bleed.
The worst spot to have a stroke is in the brain stem. Darby’s stroke was in the area above the brainstem known as “deep territory.” He reacted promptly to his symptoms and got to the right designated stroke center quickly.
He received medication to help bring his blood pressure down, and he was admitted to the Neuroscience Intensive Care Unit on the ninth floor. He had a headache and nausea his first night. He underwent many tests during his four-day stay as doctors monitored the bleeding and swelling. The stroke affected Darby’s left leg and threw his balance off, but he suffered no cognitive deficits.
“I still think with time, God willing, I may lose all of the debilitation that I have,” he says.
He was discharged with a walker. Through weeks of rehabilitation at the Upstate University Hospital Physical Medicine and Rehabilitation Center, under the care of physical therapist Sara Bullock, Darby weaned himself to a cane. Now he walks carefully on his own; most people cannot tell that he suffered a stroke.
He continues to deal with fatigue, which doctors say may be the longest lasting weakness from the stroke. When his body is over tired, Darby feels numbness in his left foot and up his lower leg. Doctors have told him to take a nap when that happens. “Sleep is the best way to let the body repair a brain injury,” Darby recalls. “Regaining stamina is usually the last thing to return, if it ever fully returns.”
He has even been fishing and hunting since the stroke.
“Doc, is fishing considered rehabilitation?” Darby recalls asking Latorre.
The doctor smiled, nodded yes and then instructed him to be careful getting in and out of the boat and not to lift anything greater than 10 pounds for the next two weeks.
“I haven’t caught a fish over 10 pounds in Oneida Lake for many years,” Darby replied, “and if I do, I will gladly hand the pole over to my fishing partners.”
From the first Saturday in May (walleye opening) until hunting season begins in November, Darby fishes with friends two or three times per week from the boat he keeps at his Brewerton home. Last year 2,364 fish were caught on his boat, including mostly walleye, perch, bass and lots of pan fish.
Darby was able to work a few hours a day starting in August, the month after his stroke, and that built up to half days in September. Since October he has been working full time with breaks for a nap when fatigue sets in. “Patience is required for recovery from a stroke, because it does not happen quickly,” he says.
Today he takes his blood pressure medicines at breakfast and after supper every night and charts his vitals with his wife/nurse, using the same detail he puts into the fish tally on his boat. He plans to retire later this year at the end of Sheriff Kevin Walsh’s last term – and, he says with a smile, to keep Oneida Lake from flooding by continuing to remove fish from the water.
Looking back on this experience, he counts his blessings: “The system worked.”