Telemedicine stroke program provides woman a lifeline

Jun 24 2009

While suffering a major stroke at her home near Mena, Iva Sikes assumed the worst, not knowing that a University of Arkansas for Medical Sciences (UAMS) - led telemedicine program would provide her a complete recovery.

Sikes, who lives alone four miles outside of Mena, was about to tend her flower garden June 1 when the left side of her body went numb, causing her to fall.

Her only hope of recovery was to get the right diagnosis from a stroke neurologist so she could receive t-PA, the only FDA-approved drug that could break up the blood clot that was starving her brain of oxygen and nutrients.

And it had to be done within three hours.

Sikes, 89, was wearing a lifeline, a communication device that allowed her to summon her grandson and an ambulance.

"I was sinking fast," she said just 10 days after the stroke. "I told my grandson, 'I'll not be here long.' My body, my mind, everything was sinking."

Had her stroke occurred just nine months ago, her chance of recovery would have been slim, said Salah Keyrouz, M.D., Sikes' stroke neurologist at UAMS.

Starting Nov. 1, Mena Regional Hospital was among the first of now nine hospitals to join the Arkansas SAVES (Stroke Assistance Through Virtual Emergency Support) program, which links rural hospitals to stroke specialists at UAMS and Sparks Health System in Fort Smith. The program is administered by the UAMS Center for Distance Health, which was created by Curtis Lowery, M.D., chairman of the UAMS Department of Obstetrics and Gynecology.

Stroke neurologists are on call 24 hours a day, and remote hospitals participate at no cost.

Keyrouz, medical director of the SAVES program, took the call from the Mena hospital after Sikes arrived. He was able to communicate via real-time two-way video with the local hospital medical staff and Sikes. He also was able to view her high-definition brain CT images taken at the hospital.

"In addition to her left-side paralysis, she had lost peripheral vision on the left side, too," Keyrouz said. "I knew then that she had a large stroke."

Despite her advanced age, Keyrouz determined that she was a good candidate for the clot-busting t-PA. It was important that Sikes was able to tell him definitively that the stroke had occurred at 9:30 a.m., which meant the drug could be given within the critical three-hour window. Patients who wake up with a stroke, for example, and don't know when the stroke began are not eligible to receive t-PA.

"If you can intervene very early on, there's a chance that you can melt the blood clot by giving this very powerful medicine," Keyrouz said. "If you do it beyond three hours, there is potential that you're irrigating an area of the brain that's irreversibly dead. The risk of bleeding is also high."

Sikes and her family agreed to the t-PA treatment after Keyrouz informed them that it would give her roughly a 30 percent chance of improvement, but a 2 percent to 6 percent chance of bleeding in the brain.

"This is a lady who was independent, going about her activities and enjoying life," Keyrouz said. "Without the medication, there was a very big possibility that she would live the rest of her life paralyzed, not feeling anything on her left side and with slurred speech."

Twenty-four hours after receiving the t-PA, Keyrouz followed up with Sikes using telemedicine.

The exam showed that Sikes had almost completely recovered. The paralysis was gone, her peripheral vision had returned, and her speech was nearly back to normal.

"The nurse would touch her with a pin on the left and right, and she was feeling perfectly normal on both sides," Keyrouz said. "She just had mild weakness in the left arm and left leg. She had such a remarkable recovery."

Sikes said she was surprised by her recovery and grateful for the technology that helped save her.

"It's just so wonderful, I'd like to tell the world," she said of the SAVES program. "I'm here today because of my lifeline and the medication I didn't know anything about."

The SAVES program is made possible by partnerships between the UAMS Center for Distance Health, the state Department of Human Services Division of Medical Services and Sparks Health System in Fort Smith. The program was established with a one-year, $6.1 million DHS Medicaid contract. Since the program began in November, there have been 38 SAVES consults and four patients have received t-PA.

The nine hospitals participating in the SAVES program so far are: Baptist Health Medical Center - Arkadelphia, White River Medical Center in Batesville, Baxter Regional Medical Center in Mountain Home, Booneville Community Hospital, DeWitt Hospital, Johnson Regional Medical Center in Clarksville, McGehee-Desha County Hospital, Helena Regional Medical Center and Mena Regional Health System.

Additional hospitals across Arkansas will be added in the coming months, said Lowery, director of the UAMS Center for Distance Health.

The most recent statistics from the national Centers for Disease Control and Prevention show that Arkansas had 1,847 stroke-related deaths in 2005, which dwarfs Arkansas' other major causes of death. Arkansas ranks third highest among all states in stroke deaths, with 61 per 100,000 residents. Only Alabama and Tennessee had a higher number. The nationwide direct and indirect cost of medical and institutional care of permanently disabled stroke victims was $57.9 billion in 2006.