Glendale College's Student Magazine
Tuesday June 27th 2017

There are not enough medical facilities to handle stroke victims…

And the problem is getting worse.

In 2011, Lotje Sodderland was a healthy, 34-year-old advertising professional when one night she was jolted awake by a thundering headache. She flailed around her room knocking things over, and lumbered outside to the hotel next door for help. Workers found her on the floor of the hotel bathroom unconscious.

Three days later she woke up in a hospital. The vision out of her right eye was a psychedelic haze. The charts on the wall were in English, but as imperceptible as hieroglyphics. When she tried to speak, she struggled to utter a word every five seconds like someone just learning English. Her thoughts were a jumbled mess and she could barely finish a sentence. She covered her face and broke down sobbing. She’d had a hemorrhagic stroke.

When a stroke disrupts the brain’s blood flow, 1.9 million brain cells die every minute. The longer it takes a victim to get to a hospital, the higher the chance of debilitating injury or even death. To adequately care for LA’s baby boomers entering their golden years, the county needs adequate hospitals that are accessible to all of its far-flung communities. That is where LA is failing.

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In December 2016, the Joint Commission, a private organization that certifies hospital quality, will mandate that paramedics in California only take stroke victims to certified comprehensive stroke centers. LA only has three of these: UCLA in Westwood, Cedars Sinai in West Hollywood and Glendale Adventist. The rest of the county is out of luck.

“We have some big infrastructure problems here,” says Dr. Arun Amar, a neurosurgeon at Keck medical center at the University of Southern California and a national authority on stroke intervention. “We are not prepared to rout patients to just a few centers in this big city. Imagine someone who’s not in Beverly Hills or Westwood or Pasadena…what if someone in the San Fernando Valley needs to take the 405, it’s going to take them 45 minutes. That’s a problem.”

USC, where Dr. Amar works, however is well-equipped to provide high quality relief to stroke victims including a breakthrough technique called thrombectomy that can bust a clot in under 20 minutes. As Dr. Amar explains, “First step is to insert a catheter, a flexible tube that’s pretty long, about four feet, into the artery in the leg right at the crease of the thigh. All the arteries of the body are connected so once we’re in, we can steer that into any other artery we want…We navigate the tube all the way to the site of the blockage, then there are various devices we can use to remove the clot. The first is shaped like a corkscrew pushed into the middle of the clot to pull it out. It’s a very mechanical, almost vulgar procedure. You don’t always get it the first time.”

When a patient arrives at a hospital that lacks surgeons trained in these new methods, they need to be transferred, which wastes valuable time during which brain cells are quickly dying. Mandating paramedics bypass community hospitals and go straight to comprehensive stroke centers aims to eliminate that scenario. But having only three hospitals still guarantees victims will suffer on long drives in LA traffic.

Other methods of thrombectomy that suction out the clot (mechanical thrombectomy) and chemically dissolve the clot (pharmacological thrombectomy) have led to faster relief and less debilitating injuries for scores of stroke victims.

The Joint Commission’s mandate however requires comprehensive stroke centers have an emergency room. USC does not, and therefore, starting this December, will no longer be accepting stroke patients.

The reason for the mandate however is a benevolent one. When a patient arrives at a hospital that lacks surgeons trained in these new methods, they need to be transferred, which wastes valuable time during which brain cells are quickly dying. Mandating paramedics bypass community hospitals and go straight to comprehensive stroke centers aims to eliminate that scenario. But having only three hospitals still guarantees victims will suffer on long drives in LA traffic.

Progress is coming. Dr. Amar predicts LA will add six comprehensive stroke centers by 2017 and he himself is trying to certify County General Hospital in East Los Angeles where USC surgeons also operate. “County has a big ER but never committed the resources to actually reporting its data or doing all the other metrics needed to apply to become certified. County General will have to become a primary stroke center before becoming comprehensive, which will take at least a year.”

USC is also devising a program to move their stroke doctors to Good Samaritan hospital in downtown, which also has an ER. The Joint Commission’s policy will mean bureaucratic hurdles for USC but ultimately positive steps for stroke medicine in the largest county in the nation.

Each year about 800,000 people in the U.S. have a stroke. It’s the third leading cause of death behind heart disease and cancer, and the number one cause of disability. When we think of stroke we usually think of the elderly because they have the much more common “ischemic” stroke, involving a clot, typically caused by high blood pressure, smoking or diabetes.

Unlike an ischemic stroke, Lotje’s hemorrhagic stroke can attack anyone at any age, is less detectable and more destructive. Though advances in microsurgery offer a less invasive way to salvage brain tissue, thrombectomy would not have helped her. Doctors surmised Lotje was born with an arterial malformation (AVM), a weird tangle of blood vessels in her brain that are weaker than they should be. The AVM was imperceptible for decades, but a ticking time bomb. On that fateful night, without warning, it sprung a leak.

Blood squirted out and pooled in Lotje’s brain tissue. In more severe cases the ensuing cell death and tissue damage causes permanent impairment, paralysis and death. In that way Lotje was lucky to be alive and have normal use of her body. She had emergency brain surgery to relieve pressure, but the damage was already done to the parts of her brain that govern reading and word association. Hemorrhagic stroke like Lotje’s remain a frustrating scourge with less preventative procedure options than ischemic stroke.

Five years on, Lotje continues her rehabilitation (reading, writing and basic word games) to rewire her brain around the zones the stroke killed. Lucky for us, she filmed much of the first eight months of her ordeal. Award-winning producer David Lynch took that footage and turned it into a full-length documentary called “My Beautiful Broken Brain,” now available on Netflix.

Lotje joins a small league of now-famous stroke survivors including local Los Angeles reporter Serene Branson who in 2011 had a minor stroke on live TV while reporting at the Grammy Awards. In 1995 a massive stroke left now deceased French journalist Jean-Dominique Bauby with locked-in syndrome, unable to move except for one eyelid. He penned his memoirs, “The Diving Bell and the Butterfly,” by blinking to correspond to letters of the alphabet. His story inspired a 2007 film by the same name.

An obvious piece of LA’s stroke puzzle lies in public education. The American Heart Association is the nation’s most powerful lobby for combatting stroke and has publicized a program to teach lay people the signs someone is having a stroke. FAST stands for Face drooping, Arm weakness, Speech difficulty, and Time to call 911. The AHA has a 60-second instructional video on YouTube that explains these warning signs. The Stroke Association in the United Kingdom has a similar program and produced an excellent 10-minute YouTube video depicting a real-life scenario of a man having a stroke in a mall and bystander administering the FAST test effectively.

With luck LA will soon certify new centers and mandate new policies that will reduce stroke’s debilitating effects on Southland residents. LA doctors will rely on us, the LA population, to be able to identify symptoms and get stroke victims to help quickly. Those two forces can make LA a model for combating stroke nationwide, an effort we owe both to our aging relatives and to ourselves.

 

About Brent Giannotta
Brent Giannotta is a continuing student at GCC who is fascinated by issues of gender, race and relationships. He previously worked as a political analyst in Washington DC and is slowly building a career as a writer.

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