With the first and only comprehensive stroke center in Charlotte County, Fawcett Memorial Hospital is bringing hope to countless stroke victims and their families.
“This is going to change lives,” predicted Stroke Coordinator Janet Riepenhoff.
Fawcett has been a primary stroke center since 2005, but adding “comprehensive” to the name takes it to the next level, with advanced diagnostic and treatment capabilities previously unavailable. It allows victims of severe stroke to remain at Fawcett rather than being sent to comprehensive centers in Sarasota or Lee counties.
“Your typical stroke patients who come in, they can get the clotbuster drug Activaze (trade name of alteplase) that dissolves the clot and helps them get back to their normal state,” said Riepenhoff, an RN with a bachelor’s degree in nursing.
“But some strokes are caused because there’s a clot in one of the major arteries in the brain. They can receive the clotbuster drug, but it doesn't always resolve the symptoms or dissolve the clot.”
The comprehensive stroke center is part of Fawcett’s $2-million-plus new interventional radiology suite that is equipped with the latest technology used to identify blockages or malformations in blood vessels. The center reflects the highest level of competence for the treatment of stroke and required a significant increase in resources, staff, and training.
A trio neuro-interventional-trained physicians has joined Fawcett’s medical staff. Neurosurgeon Douglas Hershkowitz, MD, is the comprehensive stroke program’s medical director. Nurses and radiology technicians were trained in advanced stroke care, and the hospital’s dedicated neurology team is on call 24-7.
“These doctors can go in just like they would for a heart procedure, through the groin and up into the brain, then deploy a stent or a catheter and remove the clot,” said Riepenhoff, whose enthusiasm for the new program is contagious. “I mean, isn’t that amazing?”
Aside from her professional commitment to the welfare of her patients, Riepenhoff has a personal reason to be excited about the new comprehensive stroke program. Her 60-year-old sister-in-law suffered a devastating stroke and was treated at a comprehensive stroke center in Ohio.
“She's doing very well, thankfully, because of the advances in technology that we have today,” Riepenhoff said.
When a patient comes to Fawcett presenting stroke symptoms, initial care includes a CAT scan of their brain to reveal any bleeding or other abnormalities that would prevent them from getting the clot-busting medication.
If the stroke is serious enough to require comprehensive care, the patient undergoes a more advanced CAT scan to determine if there are any blood clots within the major arteries in the brain. This procedure is called a CT Angiogram followed by a CT Perfusion Study. These tests allow the neuro-interventionalist to make the decision about advanced stroke treatment.
If the decision is made for advanced care, during the interventional procedure the neuro-interventional doctor uses state-of-the art biplane imaging, a digital X-ray technology that uses two mounted rotating cameras, one on each side of the patient, to take simultaneous pictures. The cameras reveal detailed vessel and soft tissue anatomy, identifying blockages or malformations in blood vessels.
“The patient is on the bed, and the machine rotates around the bed in a circle,” Riepenhoff noted. “It takes different actual pictures deep inside the brain.”
The two sets of images form a three-dimensional portrait to aid in the treatment of a stroke. Post care for these patients is an extension of the care Fawcett already provides and the patient is placed in the appropriate level of care.
The neurosurgical procedures take 45 minutes to 1½ hours, depending on the complexity of the case.
“It doesn’t take long, but it has to be done within 24 hours of the onset of symptoms,” Riepenhoff said. “So if a patient comes in and they’re within the 24-hour window and meet the criteria defined by the doctors, they can undergo the procedure.
“That's why it’s so important for people to know what the symptoms are and act on them immediately,” she added.
The American Stroke Association advises applying the acronym FAST to any symptoms:
F – Face drooping.
A – Arm weakness
S – Speech difficulty
T – Time to call 911
Additional symptoms Riepenhoff mentioned include dizziness, difficulty understanding or thinking clearly, and paralysis on one side of the body.
“There are many different kinds of strokes,” Riepenhoff said. “And if those symptoms are sudden or you simply don’t feel ‘right,’ it’s best to get checked as soon as possible.”
Riepenhoff stressed the importance of calling 911 instead of driving or being driven to the hospital. “Call 911 and let them come and get you because you put yourself at risk, and other people at risk, when you get behind the wheel.”
She pointed out another good reason to call 911. On route to the hospital, EMTs can perform stroke assessments that measure any disabilities in the patient’s neurological system, plus any weakness, visual changes, or difficulty speaking.
“The EMTs can call us ahead of time and say, ‘I’m bringing you a stroke patient.’ This allows us to be on stroke alert, get everything ready here on our end, so that as soon as the patient gets here, they roll from the Emergency Room bay straight to the CAT scan room for their first initial scan of the brain.
“The EMTs are vital to really making sure we have the best information we can have on that patient.”
Speed is vital. Every minute in which a stroke is untreated, the average patient loses 1.9 million neurons, the nerve cells in the brain that receive and send electrical signals over long distances within the body. For every hour in which treatment fails to occur, the brain loses as many neurons as it does in almost 3.6 years of normal aging.
Riepenhoff works closely with EMS, the neuro-interventionalists, Dr. Herskowitz, and Dr. Pam Miller, Fawcett’s Director of Emergency Services. As stroke coordinator, Riepenhoff monitors all cases to make sure the correct processes are followed.
”We have certain assessments we use for stroke patients and we work hard to make sure that’s all done,” she said. “We also make sure staff and the nurses have the education they need.
“Going comprehensive is such a huge blessing to this to this county,” she added, “because we will absolutely be able to do that much more.”
Riepenhoff plans to spread the news in the community, attending health fairs and visiting area assisted living facilities and nursing homes. She is currently doing a series of one-on-one stroke education classes at Charlotte State Bank & Trust and she’s visiting the Salvation Army in June to talk about the comprehensive care program and strokes in general.
“We’re doing as much as we can to get out into the community to make them aware,” she said.
For additional information, contact the hospital at 941-629-1181 or call the Stroke Coordinator’s office directly at 941-629-8084.