Three years ago, Lawnae Hunter couldn’t refuse when her 10-year-old granddaughter asked to go down the water slide with her at a Caribbean vacation resort. By the time Hunter got to the bottom, she was choking. She could barely stand. She didn’t realize it at the time, but somewhere during the descent, she’d had a stroke.

Family and resort staff told her she needed to call an ambulance and go to the hospital, but Hunter went back to her room at the resort and took a private vehicle to the hospital an hour later.

“My brain had continued to be damaged by the stroke,” she recalls.

“I was probably still in denial, even though I had probably lost my left side, so I can understand why people don’t go in.”

The hospital on the island didn’t have the clot-busting stroke drug to treat the stroke. By the time her family was able to hire a jet and whisk her off to a Florida hospital 10 hours later, it was too late.

“There’s not a morning when I get dressed that I don’t think, ‘If I had been lucky enough to have this stroke in Bend, I would walk, I would be able to use my arm,’” Hunter, 68, said. “Every morning when I wake up, I think of what my old life was.”

Medical advances over the past couple of years offer stroke patients more effective treatment options than ever before. But doctors say many patients are waiting too long before seeking help, limiting their chance at a meaningful recovery. In Central Oregon, a group of doctors, stroke survivors and other volunteers have launched a public awareness campaign to urge people to learn the symptoms of a stroke and to seek care immediately.

“People are having strokes, and they’re sitting at home,” said Dr. Steve Goins, a stroke care specialist with Pacific Crest Neurology in Bend.

Hunter and Goins met at a stroke conference at St. Charles Bend last year. Hunter wanted Goins to speak to her stroke survivor’s support group, and Goins wanted Hunter’s help in getting the word out about stroke symptoms.

“Patients who have strokes, don’t know what hit them,” Goins said. “That’s part of the physiology of strokes. And then, their loved ones or companions don’t necessarily know what to do, because nobody’s taught them.”

The two started talking with others in the community and in January, formed the nonprofit Stroke Awareness Oregon. The group has three main goals: to raise awareness around stroke symptoms, to serve as a clearinghouse for stroke recovery information and to help support early notification by first responders, preparing the hospital’s stroke team for the patient’s arrival.

“Everybody knows what cardiac symptoms are,” said Dr. Jim Stone, an emergency physician and medical director at Mountain Medical Immediate Care in Bend. “Almost nobody recognizes what the signs and symptoms of stroke are.”

The group is promoting the acronym FAST, which stands for face, arms, speech and time. Strokes — when blood flow to an area in the brain is cut off, usually by a blood clot — can cause portions of the face to droop, especially when the patient is asked to smile. When a stroke patient tries to raise both arms, one arm may drift downward. And if asked to repeat a simple phrase, speech maybe slurred or strange. If any of those symptoms occur, there is no time to waste: call 911 immediately.

“The more time you waste,” Stone said, “the more brain tissue is being killed.”

Improved treatments

Until recently, doctors thought it was pointless to treat strokes that had occurred more than four to six hours before patients arrived at the hospital. After that point, they would manage their blood pressure and treat their symptoms, but care was mostly focused on getting patients into rehab and seeing how much they could recover. If patients arrived at the emergency room within six hours, they could be given tissue plasminogen activator, a clot-busting drug commonly known as tPA.

Then, in 2004, the Food and Drug Administration approved a corkscrew-like device that could be threaded into blocked vessels in the brain to capture the blood clot and remove it. The device worked for only about a third of patients and it could take hours to deploy.

But in the past few years, newer versions of retrieval devices improved the success rate to about 80 to 90 percent.

“And they’re fast. You can do the procedure within an hour,” said Dr. Raymond Tien, a neurosurgeon with The Center: Orthopedic & Neurosurgical Care & Research. “So that sort of changed the treatment. … We became much better at opening the blood vessel up.”

Still, the devices were approved for use only within six to eight hours after the onset of symptoms, and few patients arrived at the hospital within that time window. Then in January, two research studies changed the way acute stroke in the United States would be treated.

The studies looked at what doctors call wake-up strokes, when patients go to sleep feeling fine, but wake up with stroke symptoms. Doctors decide whether to try to clear the blockage based on the time at which the patient last felt normal. For those with wake-up strokes, however, that could have been 8 to 10 hours earlier. Doctors had no way of knowing whether the stroke had occurred an hour after going to bed, or just a few minutes before waking up.

The two studies looked at what would happen if doctors extended the time window for treating wake-up strokes to 24 hours. The results were “spectacular,” Tien said. One of the studies found such a large difference in outcomes, they stopped the trial early because it would have been unethical to continue denying patients treatment.

Based on the results of the trials, the American Heart Association and the American Stroke Association revised their guidelines for stroke care, expanding the treatment window from six hours to 24.

“This really changes the paradigm of acute stroke treatment,” Tien said.

New protocols

Based on the new guidelines, St. Charles Bend is implementing an acute stroke protocol. Previously, emergency medical technicians could activate the stroke protocol at the hospital when they encountered a patient whose symptoms emerged within the past 3.5 hours. The hospital is extending that time window to 6 hours, and under certain conditions, up to 24 hours.

The hospital has implemented a screening tool for paramedics, fire department and medical helicopter crews to assess whether the patient is likely to have a blockage in a large blood vessel and should be evaluated for treatment. The new protocols should launch in May, once training is completed,

The hospital has upgraded its imaging technologies so that radiologists can perform tests to see which patients could benefit from a clot retrieval procedure.

“This is a huge opportunity for people to get treated, where we used to say after 3.5 hours, there’s not much we can do except admit you and do rehabilitation,” said Beth Wiese, stroke coordinator at St. Charles Bend.

In 2017, only about 7 percent of the 248 St. Charles Bend patients presenting with blocked arteries were treated with tPA. Just 15 where able to undergo mechanical clot removal. Under the new protocols, the stroke team expects that number to quadruple.

That, however, poses additional challenges. Currently, only Tien is trained to perform clot retrievals.

“I take stroke call every night I’m here in town,” Tien said. “The hospital has kind of ignored it, because the volumes have been pretty low, because most people fall outside the window for acute stroke.”

But if the number of stroke patients increases as expected, that may be more than one doctor can handle. Tien is now training two other physicians on the clot retrieval procedures, and within a year, the three doctors could rotate taking stroke calls.

Extending the time window and treating more patients, Wiese said, has the potential to significantly reduce disability in the community. Recovery after a clot retrieval has been so dramatic that patients are often discharged after just a day in the hospital.

“Anyone treated for acute stroke goes into the ICU for at least 24 hours,” Wiese said. “Many of them are discharging straight from the ICU, because their outcomes have been very good.”

“The ICU nursing team doesn’t know how to discharge a patient,” Wiese said. “That’s a good problem to have.”

Those outcomes, however, are time-dependent. Even with the window extended to 24 hours, the sooner the blockage is cleared, the greater the chance for a good recovery.

Saving time

The stroke awareness group has also proposed raising money for an early notification system called Pulsara. The system allows first responders to activate the stroke team with a touch of a button on their phones. Other regions that have implemented the system have a seen a marked drop in the time needed to get blockages cleared.

The stroke awareness group had plans to raise $48,000 to purchase the system for the hospital, and to operate it for the first year. The system has an annual $32,000 cost, but could also be used for other notifications, including for heart attacks or trauma calls.

The hospital had previously implemented a similar system for notification of heart attacks. That helped the hospital reduce the time between the patient’s arrival and when a blockage in coronary artery could be cleared with a tiny balloon. Hospitals across the country have worked to reduce their door-to-balloon time. The strength of the new stroke research may now prompt hospitals to focus on reducing door-to-needle time for stroke treatment.

“Stroke specialists around the world think this is going to bring stroke care into the same realm that heart attack treatment was 15 years ago,” Goins said. “We’re seeing statistical support for inpatients. It seems like miraculous recoveries.”

Recovery resources

Stroke Awareness Oregon hopes to serve as a clearinghouse of resources available to stroke survivors once they’ve completed their inpatient rehab.

“I see a lot of patients who’ve had strokes, and they come back, and sometimes, they look like they’re lost. They’ve had an intensive inpatient recovery program, then they don’t know where to go after that,” Goins said. “They’re launched back in our community without a lot of guidance.”

Asa Pollard of Bend had a stroke at 39 on Jan. 1, 2016. He work up early in the morning thinking his arm was numb from sleeping on it funny. He rolled over and went back to sleep. When he woke again, he fell trying to get out of bed. He dragged himself to the bathroom, but realized something was definitely wrong. He called a friend but couldn’t form the words to say what had happened. His friend called an ambulance.

It wasn’t till much later, after a battery of tests, that doctors informed him it was a hemorrhagic stroke. A blood vessel had burst, leaking blood into his brain, paralyzing his right side and leaving him unable to speak.

“I’m a goal-setter,” Pollard says. “My first goal was to leave the hospital without a wheelchair.”

He stopped using the wheelchair 26 days after his stroke, two days before being discharged. While Pollard had undergone an intensive inpatient rehab program, including physical, occupational and speech therapy, once discharged, he felt there was little direction for how he could continue his rehab.

“I had to make my own way,” he said. “I had to get myself better.”

Pollard decided that anything he could do before the stroke, he would try again. That included rock climbing. He started going to the Bend Rock Gym, an indoor climbing facility. Wearing a helmet and wearing a harness clipped to a rope, he could practice pulling himself up by the holds without fear of falling.

Last February, he went skiing with Oregon Adaptive Sports. He had been an avid snowboarder, but decided to learn skiing for the additional challenge. When he walked out of the lodge and looked up at the mountain, he was overwhelmed by the beauty of the day and how far he had come.

“I just got tears in my eyes,” he recalls. “I stopped to breathe it all in.”

He’s gone kayaking and mountain biking, after having his bike altered to put all the brakes and shifters on the left side. He completed the Storm the Stairs race, a 2-mile course on the campus of Central Oregon Community College that includes more than 300 stairs, in less than 45 minutes. His goal for this summer is to run again.

Before the stroke, Pollard had planned to enroll at the University of Texas in Austin to complete a master’s degree in public health. With mounting medical bills, he decided to stay in Central Oregon, taking a few classes at Central Oregon Community College in the spring after his stroke, and eventually enrolling in a kinesiology program at Oregon State University-Cascades.

He credits the classwork for helping him regain his speech. He graduates this June.

“I want them to hand me a piece of paper as a stroke survivor,” he said. “And then everyone who comes after me as stroke survivors, I can say, if you take one class, two classes, I don’t care if it takes you 15 years, just keep going. Just keep doing it.”

His dream is to open a gym that will cater to able-bodied and adaptive clients.

“Some stroke survivors honestly go inside, hole up and don’t do anything,” he says. “That’s the thing I’m trying to affect the most. I’ve been put in this weird situation where I can impact some people.”

—Reporter: 541-633-2162, mhawryluk@bendbulletin.com