A remarkable recovery: His stroke care included fast-moving, coordinated efforts by his wife, ambulance crew and specialists at Upstate

Members of Upstate’s stroke team who had a role in caring for patient Dave Cartner include: seated from left, Claribel Wee, MD, neurology resident physician; Cartner; and Hesham Masoud, MD, stroke neurologist. Standing from left, nurse Lauren Kaul, emergency department; Grahame Gould, MD, neurosurgeon; Jessica Guido, X-ray technologist; nurse Michelle Vallelunga, stroke program data coordinator; Shirley Cartner, the patient’s wife; Shantel Henry, X-ray technologist; nurse Patricia Veinot, stroke data coordinator; nurse Josh Onyan, stroke program manager; and Theodore Albright, MD, emergency medicine resident physician. (photo by Robert Mescavage)

Members of Upstate’s stroke team who had a role in caring for patient Dave Cartner include: seated from left, Claribel Wee, MD, neurology resident physician; Cartner; and Hesham Masoud, MD, stroke neurologist. Standing from left, nurse Lauren Kaul, emergency department; Grahame Gould, MD, neurosurgeon; Jessica Guido, X-ray technologist; nurse Michelle Vallelunga, stroke program data coordinator; Shirley Cartner, the patient’s wife; Shantel Henry, X-ray technologist; nurse Patricia Veinot, stroke data coordinator; nurse Josh Onyan, stroke program manager; and Theodore Albright, MD, emergency medicine resident physician. (photo by Robert Mescavage)

BY JIM HOWE

Dave Cartner has a remarkable story to share.

The patient

Dave and Shirley Cartner (photo by Robert Mescavage)

Dave and Shirley Cartner (photo by Robert Mescavage)

The 50-year-old Marcellus resident had finished breakfast on Feb. 13 and was about to leave for his job as a meat supervisor for a local food chain. “As I was walking out to the kitchen to say goodbye to my wife, my left foot felt heavy as I was walking the three or four steps to the chair. Then I kind of slid into the chair, and as my wife was talking to me, she could notice my face was drooping a bit, and as I was trying to speak with her, my speech was very muffled. Then my whole left side — my arm down to my feet — was gone. I couldn’t feel it any longer, so she could tell something was wrong,” he said.

Cartner’s wife, Shirley, realized he was likely having a stroke and called 911, overruling his request to “just get me in the car” and drive him to the hospital.

“She’s the brains behind the whole thing. I can’t praise her enough,” her husband said of her insistence on an ambulance.

The ambulance team

A Marcellus Ambulance crew quickly arrived, did a preliminary evaluation and got him ready for transport, recalled Stephen Knapp, the ambulance service’s executive director, who took part in the call. “It was quite obvious he had had a stroke,” he said. Crew members took Cartner’s vital signs, ran an electrocardiogram to check for a possible heart attack and relayed their information ahead to Upstate University Hospital, so the stroke team would be ready to receive the patient without delay.

“The ambulance crew asked us what hospital we wanted to go to, and we picked Upstate, knowing it was the place to go for stroke, because of the specialists there,” Cartner said.

The emergency medical technicians explained to Cartner that a team of professionals trained in stroke care would be waiting to meet him at Upstate. There he would get an imaging scan of his brain to see where the problem was, and things would move quickly, since the clock is ticking when treating a stroke.

The paramedics were able to relay Cartner’s medical information to the hospital while en route, including the crucial detail that he had been taking a blood thinner for atrial fibrillation, a heart condition.

Jeff Elwood and Stephen Knapp of Marcellus Ambulance (photo by Susan Kahn)

Jeff Elwood and Stephen Knapp of Marcellus Ambulance (photo by Susan Kahn)

The resident physician

“It was pretty clear he was having a stroke, even before he opened his mouth, because one side was completely limp, his face was drooping, but his speech was intact, so he was able to answer questions,” recalled Claribel Wee, MD, the neurology resident who examined him.

Since the left side of the brain controls speech, his ability to talk signaled that the problem was likely on the right side.

The stroke turned out to be from a clot, not a bleed, which seems odd, since Cartner had been taking a blood thinner. Blood thinners, however, are not a guarantee against clots, Wee said.

Another type of blood thinner is often given in stroke cases, the “clot-buster” medicine tPA, but since an additional blood thinner could have caused heavy bleeding in his case, the doctors decided to try a different approach.

“We found the large vessel occluded (blocked) exactly where we thought,” Wee said. She summoned specialists Grahame Gould, MD, and Hesham Masoud, MD, who agreed on what to do next.

The specialists

Gould would perform a thrombectomy, or clot removal, through a process called interventional radiology. This means that, guided by an X-ray screen, he runs a slim tube up through an artery in the patient’s groin to an artery in his brain to ensnare the clot with a retrievable stent, then pull it out.

“Patients can make wonderful recoveries in a short time, even if they do not recover as fast as Dave did,” Gould said of the procedure.

Masoud oversaw Cartner’s care but stresses that resident physicians like Wee play a major role in initially evaluating the patient, determining where the stroke is and what to do about it.

“Kudos to the residents. They work very hard, and you can directly link outcomes to the speed of their diagnosis,” Masoud said.

He said the results could have been “devastating” if Cartner had not gotten to a stroke center quickly. He could easily have lost the use of his left arm or leg and had impaired vision and other problems.

Without removing the clot, the right half of his brain would have been lost. “To go from that to be able to walk home — that’s pretty incredible. But it’s kind of a typical story these days. You see a lot of these Lazarus effects,” Masoud said. The Lazarus effect, referring to a man in the Bible who was brought back from the dead, is the sudden, seemingly miraculous recovery a patient can experience in a case like this.

The outcome

After the thrombectomy, “Dr. Gould came in and checked on me. I was so glad, and he was really surprised I stood up and shook his hand,” Cartner said.

“I feel great now,” Cartner said several months after the stroke. His only lingering problem appears to be a dull feeling in his left arm that he is working to resolve.

Wee called Cartner’s recovery “pretty remarkable,” considering how fast and fully he recovered. He was discharged Feb. 14, one day after he was admitted to the hospital.

Cartner is thrilled with the outcome of his stroke and praised the EMTs, doctors and nurses who took care of him. His only regret was for his wife.

“I felt bad I ruined her Valentine’s Day,” he said.

Upstate Health magazine summer 2018 issueHealthLink on Air logoThis article appears in the summer 2018 issue of Upstate Health magazine. Listen to  Hesham Masoud, MD, and nurse Josh Onyan talk about what people need to know about strokes in this podcast/radio interview.

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