Clot-Busting Drug Delivered in Time

Wayne credits his family’s quick action for helping him survive his stroke. With him from left, Scottie Senalik and Jeremy and Ryan Epperson with children Evan and Weber.

Wayne Senalik was feeling fit and relaxed on a balmy Sunday in May. He and his wife, Scottie, were looking forward to a family gathering at their daughter Ryan’s house in Rancho Solano, and spending time with the grandchildren.

Wayne, 71, was sitting in a chair when he bent down to play with his 2-year-old granddaughter. Suddenly, he felt extremely dizzy and was unable to lift his head. “Scottie, pull me up. I can’t get up,” he recalls saying. Scottie, sitting nearby, instinctively called for Ryan and reached to dial 9-1-1.

“The next thing I knew, I was still sitting in the chair, but paramedics were cutting my jacket off and asking me questions, as I floated in and out of consciousness.” His 3-year-old grandson, Weber, asked his mother what was wrong.

“Ryan told him I hurt my head,” Wayne recounts. “Weber said, ‘I have a great idea,’ and ran off to get a Band-Aid.” Despite the adorable— and tension-breaking—gesture, Wayne knew he was going to need much more help, because his speech was slurred and he couldn’t move anything on his left side.

Time is Brain

About 87 percent of all strokes are ischemic. These types are caused by a blood clot, which blocks the blood supply to the brain. The other 13 percent of strokes are hemorrhagic, when a blood vessel in the brain bursts. Either way, quick treatment is of the essence, ideally within hours, because “time is brain.”

Since Wayne’s family had summoned paramedics so quickly, his initial critical care easily fell within that golden window. In fact, only 35 minutes had passed between the 9-1-1 call and when Wayne arrived at NorthBay Medical Center, where a Code Stroke had been called.

The code activates a specially trained team of nurses, physicians, lab techs, and respiratory therapists, explains Emergency Department physician Kyle Holmes, M.D., who was on duty that day. The Code Stroke also alerts the Radiology Department to free up the CT scanner, because the exam would reveal if Wayne had suffered an ischemic or a hemorrhagic stroke.

“We were waiting at the ED doors for the ambulance and as soon as the lab tech took the blood sample, we rolled right through the ED to the CT scanner,” says Dr. Holmes.

The stroke team is under great time pressure, Dr. Holmes explains. “We want to get the blood draw done within a minute or two of the patient’s arrival, then into and out of the CT scanner within 10 minutes. We don’t take our eyes off the clock because the best outcomes occur when treatment begins within 90 minutes of the first symptoms.”

NorthBay Healthcare launched its stroke program in 2010 in collaboration with the Mercy Neurological Institute of Greater Sacramento. The partnership means Mercy’s neurologists are available around the clock. When a Code Stroke is activated and the patient arrives at NorthBay Medical Center, a teleconference is immediately established between NorthBay and Mercy staff via telephone and a robot.

Mercy neurologists, along with Dr. Holmes, reviewed Wayne’s initial lab and CT results, and assessed his cognitive and physical function. It was unanimous: Wayne was experiencing an ischemic stroke and should immediately receive an infusion of tPA, a clot-busting drug. “It’s an effective drug and the sooner you get it, the more effective it is.”

Wayne received the drug 61 minutes after 9-1-1 was called. “That’s a fantastic response,” Dr. Holmes notes. Just 15 minutes after the drug was given, Wayne reported some tingling in his fingers and then was able to squeeze his hand. “That was a very good sign,” Dr. Holmes says.

But, Wayne still couldn’t move his leg, and precious minutes were adding up. The team agreed he should be flown to Mercy via helicopter for additional treatment. Once at Mercy San Juan Hospital in Sacramento, Wayne had another CT scan, and since there was still no movement in his leg, preparations began for interventional surgery to break up the clot.

But suddenly, Wayne was able to lift up his foot. The clot-busting drug had finally done its magic.

Wayne, a retired executive and chairman of NorthBay Healthcare Foundation’s Board of Directors, spent just three days in the Mercy ICU where he was soon up and walking. From there he was discharged to an acute rehabilitation facility for a week of speech, physical and occupational therapy. He was sent home with a cane but never used it. Less than two months after his stroke, he reports only occasional tingling in his left foot, but otherwise has made a full recovery.

“That’s a great outcome,” says Dr. Holmes, “and there are two main reasons for it: His family recognized the signs and called 9-1-1 right away. And, our stroke team all came together and we were able to administer the tPA quickly. Obviously, it’s a team effort where so many people helped.”

In retrospect, Wayne is amazed how it all could have turned out so differently. “What if I had been alone or we took too long to call 9-1-1? I had no warning signs. My blood pressure and cholesterol levels were under control.”

In good physical health, the avid golfer also walks four miles a day and he and Scottie work out twice a week with a trainer. But, he lost his father to a massive stroke at age 75; his mother had one at age 80.

“I wouldn’t be here today without the excellent stroke program they have at NorthBay,” he says. “I had all the experts I needed around me at all times. Never did my life feel threatened, nor did it cross my mind that I would die. Everyone taking care of me knew exactly what they were doing and I knew I was in the hands of experts. I thank God I was there.”