During a time when many people are delaying appropriate health care due to fear of COVID-19, Patricia Miata, 58, says timely treatment is ultimately what saved her life after suffering a stroke. She survived a left middle cerebral artery (MCA) ischemic stroke, one of the worst types that is known for leaving patients with severe disabilities.
Patricia couldn’t walk or speak after the stroke in February of 2018 – the only thing she could say was her dog’s name, Diesel. She also experienced some vision loss. But just eight months later, she was back to work and even back to her exercise routine, thanks to timely treatment from neurologists with The University of Texas Health Science Center at Houston (UTHealth).
On the day of the stroke, Patricia was home alone and Diesel, a rescue lab mix, rushed to her side after she suddenly found herself on the kitchen floor. She had been cooking, and thankfully decided to sit down because something felt off – that’s when the stroke hit.
“I just fell out of my chair,” Patricia said. “I had the sense to crawl to the oven to turn it off, then I army crawled out my front door, across the concrete, just yelling out into the neighborhood for help.”
Patricia’s neighbor heard her and called 911. She was immediately taken to Memorial Hermann Memorial City Medical Center, which was recently certified as a Comprehensive Stroke Center. There, stroke-trained physicians from McGovern Medical School at UTHealth quickly assessed and treated her to minimize the time it took to restore blood flow in her brain.
“We work with EMS crews to recognize the signs of large stroke, so they know to skip the small local hospital and go straight to a large hospital where the patient can immediately get clot-busting medication called tissue plasminogen activator (tPA) and an endovascular thrombectomy, the surgery to remove the clot, all in one place,” said Sunil Sheth, MD, a neurologist with McGovern Medical School at UTHealth who cares for patients at UTHealth Neurosciences. “Those interventions are time-sensitive and every minute counts to quickly remove the blockage keeping blood flow from the brain.” Sheth is also a member of the UTHealth Institute for Stroke and Cerebrovascular Disease.
Teleneurology assessment and endovascular thrombectomy
The stroke team utilized telemedicine to have Patricia assessed quickly by Tiffany (TC) Cossey, MD, a teleneurologist with McGovern Medical School and UTHealth Neurosciences.
“We had been taken into a room in the emergency department and I heard someone talking, but no one there,” said Patricia’s husband John Miata, who had met her there at the hospital. “I heard it again and realized there was a robotic computer rolling up to me and a doctor was on the screen trying to look at Trish. She was trying to assess whether to give her tPA.”
“UTHealth Teleneurology ensures that stroke patients can be cared for by stroke specialists in any emergency room, 24/7,” Cossey said. “We are able to quickly assess the patient, start treatment, facilitate advanced treatments such as thrombectomy, and expedite transfers when appropriate. Based on the neurological exam performed virtually, I could tell that Mrs. Miata had suffered one of the worst types of stroke and a sizable portion of her brain was affected.”
Through the virtual exam, Cossey noticed Patricia had vision loss, significant weakness in the right arm and leg, and difficulty both speaking and understanding. She ordered the tPA and called Sheth in to do the thrombectomy.
“I was stunned at how quickly everything was happening,” John said. “I asked one of the doctors if he would have the procedure done for his own wife and he said yes, so I said, ‘OK, let’s do it.’”
“Getting the tPA treatment so quickly – within 16 minutes of my arrival at the hospital – and the immediate thrombectomy made such a big difference for me being able to function like I am now. I was able to start physical, occupational, and speech therapy while I was still in the intensive care unit. They advised the sooner the better, which made a big difference for my recovery. Many people are worse off than what I have experienced because they were not treated as quickly,” Patricia said.
“Many people who suffer MCA strokes do not return to work, and their quality of life is poor due to the severe disabilities the stroke can leave behind. Patricia started to get some of her strength back and most of her sight in just a few days, making her a perfect candidate for rehabilitation,” Sheth said. “Not everyone gets enough strength back to take that next step.”
Post-stroke recovery and rehabilitation
“Right after the stroke, the only word she could say was Diesel. She could say the dog’s name, but not her husband’s name,” John said jokingly.
Patricia was dealing with aphasia, or the inability to speak, and loss of sensation and slight weakness on her right side from head to toe, which are both common residual deficits of stroke. She was referred to Reza Sadeghi, MD, a neurologist with McGovern Medical School and UTHealth Neurosciences, for post-stroke recovery to help gain back her speech and body movement.
“Dr. Sadeghi helped us work through all the different stages of Trish’s recovery,” John said. “His encouragement and his awe of Trish encouraged us to keep pushing through – of course with the aphasia and also when she was having headaches, cramps, or any other leftover symptoms. He was so easy to talk to, and told you like it was – he told us she may never get feeling back completely on the right side, which she hasn’t, but that’s okay because he helped us to figure out ways to make everything work in spite of that.”
In just eight months after the stroke, Patricia was able to return to her job as a registrar at a local high school. Sadeghi also referred her to different rehab programs – two local inpatient programs and a more advanced outpatient one at TIRR Memorial Hermann that helped her gain back even more strength, so she was also able to walk and run with Diesel.
“She blew them away at both rehab programs,” John said. “They would give her packets to practice her speech and exercise to help with movement and she was always asking for more. She has been active her whole life and was determined to get back to that. We even went hiking in Colorado just a little over a year after the stroke and she was doing great – right after the stroke she couldn’t walk at all and there she was walking the trails.”
Sadeghi recommended a software that would help her with typing – she can speak into it and it will type what she needs.
“I still struggle sometimes with spelling but the program helps me with that,” Patricia said.
Back to regular life
Now, Patricia still has partial loss of sensation in the right side of her body, but she’s back to normal in all other respects, even driving.
“Trish went to a local driving rehab facility in August 2018 and then actually had to take a driving test with a DPS officer to get her license renewed,” John said.
She went from monthly meetings with Sadeghi to yearly, and now simply on an as-needed basis.
“Attitude plays a big role in anyone’s recovery from stroke. A lot of people give up after experiencing disability, but having a strong will like Patricia helps a lot of people through,” Sadeghi said. “Patricia is proof that with timely treatment and a positive attitude, recovery is possible.”
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