Upstate stroke neurologists care for patients in remote areas

Mary Green, shown with her husband, Marshall, was airlifted to Syracuse from Alexandria Bay for stroke treatment after a consultation through the Upstate Telestroke network. (PHOTO BY SUSAN KAHN)


This is a story about two women, living in different parts of rural Central New York.

Each suffered a stroke.

Each had a loved one who summoned help.

Each saw a stroke neurologist from Upstate University Hospital long before arriving at the academic medical center in Syracuse.

Upstate’s Telestroke partnership – which allows Upstate neurologists to provide clinical care from a distance — helped save the lives of both Amanda Peer of Watertown and Mary Green of Clayton.

A headache that wouldn’t stop

Green, 49, is a licensed practical nurse who has worked for 30 years at River Hospital in Alexandria Bay. She was supposed to work there Oct. 25, but at 5:15 a.m. she remained sound asleep, snoring. Her husband, Marshall Green, tried to wake her up, twice.

Elwaleed El Nour, MD

When he realized she was unresponsive, he called for their son, Dustin to help while they waited for the ambulance. They thought Mary Green might have overdosed on her medication.

The day before, Green had a headache that wouldn’t stop. She remembers going to bed early. That’s all she remembers. “I don’t remember anything for about 38 days. I kind of lost a month of my life.”

Her husband kept notes for her. At River Hospital, the doctors consulted with Upstate neurologist Elwaleed El Nour, MD, via Telestroke. His assessment allowed for a quick decision that Green needed prompt transport by helicopter for expert care in Syracuse.

At Upstate, Green immediately underwent an angiogram, showing the blood flow – and the blockages – in the vessels of her brain. She had what is called a bilateral occipital stroke, affecting the lower back part of her brain. This region that controls vision, coordination and balance, among other essential functions.

Carmen Martinez, MD

Green spent 38 days in Upstate’s specialized neuroscience intensive care unit for patients with neurological problems. Medications helped her recover from her stroke. After she was  stabilized, she was transferred to Upstate’s physical medicine and rehabilitation unit.

She went home Dec. 13. She continues to see neurologist Carmen Martinez, MD, who is trying to determine why Green had a stroke – although the reasons remain unknown for some stroke patients.

Green is not back to work yet. She can’t drive, but she can walk, and she’s hopeful her vision will continue to improve. She considers herself “a very fortunate, lucky lady.”

Debra Ezell and her daughter, Amanda Peer. After she suffered a stroke, Peer’s doctors in Watertown conferred remotely with the director of Upstate’s Comprehensive Stroke Center before deciding to transfer her to Syracuse. (PHOTO BY SUSAN KAHN)

A hand that went numb

Amanda Peer, 33, lay in her hospital bed Sunday, March 12, the day after her stroke. She watched doctors walk by her room. Then she saw him. “Mom! That’s the guy who was in the car.”

That guy was neurologist Gene Latorre, MD, medical director of Upstate’s Comprehensive Stroke Center.

Gene LaTorre, MD

The car he was in was his own. Thanks to telestroke technology, Latorre was in the back seat on his laptop computer, with his wife at the wheel, conferring by video with Peer’s  doctors at Samaritan Medical Center in Watertown.

Shortly before, Peer had been talking on the phone with her mother, Debra Ezell, who lives next door. She placed fish sticks in the oven, and her right hand went numb. She collapsed onto a fold-out bed in the adjacent room. Ezell came running when she got no response over the phone.

“My words weren’t coming to me,” Peer recalls. “I couldn’t think of the words I was trying to say.”

Hesham Masoud, MD

She was in and out of awareness. She remembers seeing Latorre on a monitor doing an assessment. Peer thought she lifted both feet when he asked, although only the left one moved. One minute she heard people talking about transferring her to Syracuse. The next, she was in Syracuse, and family members were pouring into her room.

Peer wound up receiving a dose of clot-busting medication called tPA before she arrived at Upstate. A scan revealed six clots in her brain. Upstate’s neurointerventionalist and stroke neurologist Hesham Masoud, MD, used a specialized clot retrieval device to remove the largest ones. The small ones were treated with medication.

Within 12 hours, Peer says she had her speech back. Four days later, she was well enough to go home. She credits God with helping the doctors help her recover.

Telestroke network hospitals

The Upstate Telestroke network includes nine outlying hospitals:

— Carthage Area Hospital

— Canton-Potsdam Hospital

— Claxton-Hepburn Medical Center in Ogdensburg

— Clifton-Fine Hospital in Star Lake

— Cortland Regional Medical Center

— Gouverneur Hospital

— Lewis County General Hospital in Lowville

— River Hospital in Alexandria Bay

— Samaritan Medical Center in Watertown.

This article appears in the summer 2017 issue of Upstate Health magazine. Click here to hear more about how to deal with a stroke if you suspect one is occurring, and also about Upstate’s outreach efforts in stroke care.



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