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Hospital certified for treating strokes

August 23, 2009 12:57 am

BY JIM HALL

The chaos inside Larry Adkinson's head after his stroke was so intense--and the relief so welcome--that it reminded him of being shot down over Vietnam.

Adkinson flew 681 combat missions in Vietnam. On one mission, his A-4 Skyhawk plane was hit, setting off a riot of noise and lights inside the cockpit.

Adkinson ejected and remembers the contrasting silence as he floated to earth with his parachute.

At Mary Washington Hospital last year, where he was taken after his stroke, Adkinson couldn't speak or move his left side. His head hurt, and he was barely conscious.

But he received a clot-dissolving drug called tPA, and slowly he began to get better. His brain began to quiet.

"He's an example of a patient with a massive stroke who improved over the next month. The reason he improved so well is because of the tPA," said Dr. Maha Alattar, neurologist and medical director of the new stroke center at Mary Washington.

Adkinson, 68, has since regained his speech and the use of his left side. He considers himself an example of what can happen when a stroke victim receives quick and effective help.

"I'm in synch again," he said.

THE LUCKY FEW

Not all stroke patients experience the recovery that Adkinson did.

Stroke is the third leading cause of death in the U.S. And many who survive can't move, speak or think as they once did.

At Mary Washington, only 20 of the 460 people treated for acute stroke last year received a clot-busting drug. And not all of those experienced the relief that Adkinson felt.

"Stroke is the No. 1 cause of disability in our community," said Eleanor Redmond, stroke coordinator for Mary Washington.

Still, there are recognized ways to treat stroke patients. And there are hospitals, called certified stroke centers, that practice those techniques.

Mary Washington last month became the 14th hospital in Virginia to be designated an Advanced Primary Stroke Center.

The certification came July 25 from the Joint Commission, the non-profit agency that accredits the nation's hospitals.

"When you have that, you don't need to go an hour in the ambulance north or to Richmond" for stroke care, Alattar said. "You have it right here."

That care extends from the patient's arrival in the emergency room through hospitalization and discharge, Alattar said.

The hospital now employs five neurologists to provide round-the-clock coverage of the emergency room. Their goal, Alattar said, is to give the clot-busting drug that Adkinson received to all appropriate patients within one hour of arrival.

In addition, when stroke patients are hospitalized, they are routinely screened for blood clots and swallowing problems. And they're discharged with drugs to thin their blood and reduce their cholesterol.

They also get referrals to rehab, if appropriate, and to their primary care doctors. The staff shows them a checklist of their behaviors, such as smoking, that put them at risk.

"When you follow these guidelines, research shows you have better outcomes for your patients," Redmond said.

As a stroke center, Mary Washington has formally adopted these guidelines and strives to follow them consistently.

"There were things that we were doing halfway or not doing completely. Now we're doing everything without missing any gaps," Alattar said.

A MAN DOWN

Adkinson received this type of care after his stroke last year.

He retired from the Marines in 1988, then returned to Quantico Marine Corps Base as a civilian contractor.

He is a member of the Golden Eagles, the association of elite naval aviators. He also was a two-time All American lacrosse player and a Little All American football player at Hobart College.

Yet he had a stroke while at work at Quantico on a Tuesday afternoon in May.

His right arm started shaking uncontrollably, and when he reached with his left hand to stop it, he could not move the left.

He tried to stand, but his left leg did not work and he collapsed to the floor.

"I remember spinning toward the floor. The next thing I knew guys were behind me talking to me," he said.

Adkinson said he remembers little of what happened after that. He credits the EMT workers with recognizing the symptoms of stroke and taking him to Mary Washington, where Alattar was on duty.

A CT scan showed that Adkinson's stroke was ischemic, created by a blockage, rather than hemorrhagic, from a bleed.

He arrived at the hospital within three hours of the onset of the symptoms, the window for administering tPA.

TPA, or tissue plasminogen activator, is an intravenous drug used to dissolve blood clots in patients with ischemic strokes. It is not given to patients with hemorrhagic strokes. It works in about 30 percent of the people who receive it, including Adkinson.

"He's somebody who could have been so disabled," Alattar said. "It could have been horrible for him and his family."

Adkinson began rehab sessions immediately, and returned to work about two months later.

He takes medications now to thin his blood and lower his blood pressure and cholesterol levels.

His recovery has been complete, he said, save for a few odd losses: He doesn't see color as well with his left eye, and he has no taste in the left portion of his tongue.

He believes that regular exercise helps him, so he works out 45 minutes a day.

As a result, the 6-foot-2-inch Adkinson weighs 224 pounds, down almost 50 pounds from when he had the stroke. He has also regained some of the strength he had during his playing days.

In October, a group of Marines doing a physical fitness test teased him about his conditioning.

Adkinson showed them his "guns," or biceps.

"Those are just popcorn muscles," the Marines replied.

Adkinson accepted the challenge and did 20 repetitions on the pull-up bar.

"I got down and I couldn't move for two days," he joked. "I hurt my neck."

Jim Hall: 540/374-5433
Email: jhall@freelancestar.com