Lifesaving Teamwork

IN OCTOBER 2017, less than a year after starting to enjoy his retirement to Palm Desert from Saint Paul, Minnesota, Montreal-born plastic surgeon Dean Mann, MD, suffered a massive stroke at home. While he was sitting at his desk writing emails, his right arm suddenly went numb and tingly. Then it stopped moving. “I just kept sitting there in my chair,” recalls Dr. Mann, at the time just a month shy of his 64th birthday. “My mind was all messed up. I couldn’t find the letters on the keyboard. I was getting kind of frustrated. But there was no alarm at all in my mind. I was sitting within arm’s length of the phone. I didn’t think of calling 9-1-1. It was just, ‘Oh, this is happening to me.’”

Thankfully, Dr. Mann’s wife, Shelley Mann, PhD, happened to walk into the room. Hearing her husband utter no coherent words yet making moaning sounds, she immediately suspected a stroke and called paramedics. Within 20 minutes, the Manns were in the Eisenhower Tennity Emergency Department.

Concurring with Dr. Shelley Mann’s assessment that her husband had suffered a serious stroke, the emergency room staff called Stroke Program Nurse Practitioner Fnu (Al) Alfandy, BSN, RN, ANP-BC. Reviewing Dr. Mann’s CT scan, Alfandy ascertained that there was no bleeding in the brain, and that he could safely administer the clot-dissolving medication tPA (tissue plasminogen activator). “We have a scoring system for stroke patients called the National Institutes of Health Stroke Scale,” explains Alfandy. “The higher the number on the scale, the larger the deficit. The highest number is 42; Dr. Mann’s was 19. I saw that he had a clot located in one of the major blood vessels in his brain. However, sometimes tPA is not enough to break up the clot.”

Alfandy conferred by phone with Board Certified Vascular Neurologist Hamid Salari, MD, Medical Director, Eisenhower Stroke Program. They agreed Dr. Mann was a candidate for interventional neuroradiologist Brian Herman, MD, Board Certified in Interventional Neuroradiology.

“We reviewed the imaging,” says Dr. Herman. “We brought Dr. Mann to the Radiology Laboratory where I ran a catheter into his brain. It’s a very delicate procedure — like maneuvering through landmines. If you make a mistake, push too hard or go in the wrong direction, you can perforate a blood vessel. It’s easy when it goes clean and right and you have the skill to do it. But it can be rough territory.”

The procedure went exactly as Dr. Herman intended. “Once the catheter was in place, I used one of the new retrieval devices and pulled out the clot,” states Dr. Herman. “He became nearly normal on the table. Within a couple of hours, he was completely normal.”

Dr. Mann agrees.

“I remember Dr. Herman saying, ‘OK, we got the whole clot out now,’ and I started talking to him as though we’d just been having dinner together,” says Dr. Mann. “From the time I went to the hospital to the time he finished was maybe three hours total, and from that moment on, I did not have any deficit.” “The next day, when I saw him, indeed, he didn’t have any deficit,” concurs Dr. Salari. “Basically, he recovered very nicely. He didn’t even go to a rehabilitation center. He went home.”

Many factors contributed to Dr. Mann’s excellent outcome. “First, he was lucky that the stroke happened during the day and not when he was sleeping,” explains Dr. Salari, “and, he was brought to the hospital right away. Second, the structure of our program made it possible for us to address his problems immediately.”

Additionally, Alfandy stresses that Dr. Shelley Mann was wise enough to have her husband transported by ambulance as opposed to driving him to the hospital herself.

“As part of our Stroke Program, we collaborate with emergency medical services to educate them as to what needs to be done, how to recognize a stroke, and how to contact us when it’s identified in the field. Not a lot of hospitals have protocols for stroke services. Some stroke centers may have the capacity to administer tPA but may not have an interventional neuroradiologist like Dr. Herman who can come in if the patient needs a thrombectomy [the removal of a blood clot from inside an artery].”

The lifesaving treatment Dr. Mann received at Eisenhower is emblematic of the Stroke Program’s superlative teamwork. “Like a heart attack, stroke is a ‘brain attack,’ and is treated by a stroke care team with the same sense of urgency,” concludes Stroke Program Coordinator Maureen Reiley, MBA, BSN, RN, CPHQ. “Stroke team members contribute their expertise, enhance and elevate stroke care synergistically. They raise the bar for excellence in stroke care throughout the organization.”