RURAL HEALTH NEWS
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Conquering stroke… and motherhood Stroke team saves young, pregnant woman through fast action, collaboration SuSan Skog, for uCHealtH
One day Suzannah Preisendorf ’s daughter will learn of the amazing obstacles her mother overcame to be able to hold her firstborn. “I am so thankful to have this special, healthy baby,” the 26-year-old woman said as she picked her daughter up off the floor and gave her a kiss — a simple mothering task, yet one that Preisendorf could have missed if it weren’t for the fast-acting Primary Stroke Center team at Medical Center of the Rockies in Loveland. “It started with a horrible headache, dizziness and complete numbness on my right side,” she remembered of that August 2015 day. Four days past her due date, Preisendorf was fortunate to have her husband, Scott, by her side. “When I grabbed a hold of her, Suzannah’s legs just buckled,” he recalled. The couple rushed to MCR, a nationally recognized Primary Stroke Center, where the stroke team, including neurologist Dr. Brian Kaiser, emergency physician Dr. Marc Breen
Thirty-six hours after having a stroke, Suzannah Preisendorf delivered her beautiful baby girl, Maisy, without complications. Thanks to the fast-acting stroke team at Medical Center of the Rockies, Preisendorf has recovered from her stroke and can now hold her firstborn. Photo by Joel Blocker, for UCHealth.
and obstetrician Dr. Eric Yeh, sprang to work to save Preisendorf and her baby. Though hard to believe for someone so young, a brain MRI confirmed Preisendorf was suffering from an ischemic stroke. An artery supplying oxygen-rich blood to her brain was blocked by a blood clot. That stunning discovery posed a difficult decision: Could a full-term pregnant patient be given the clotbusting drug that doctors knew would break down her clot? Tissue plasminogen activator, or tPA, is given through an arm IV and
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restores blood flow quickly to the brain to minimize permanent disability. Complications include bleeding, but most studies on the effects of the drug weren’t conducted on pregnant women, according to Kaiser. “I couldn’t find any other cases where they treated somebody (with tPA) at 40-plus weeks (pregnant),” he said. “My chief concern was if Suzannah went into labor after receiving the tPA, would bleeding complications occur? Kaiser consulted further with fellow neurologist Dr. Pearce Korb, of UCHealth in Metro Denver, and
decided that Preisendorf was indeed a good candidate for tPA, so they administered the drug. MCR stroke program medical director Dr. Gerald McIntosh joined the treatment team the next morning to assist in the continued care of the young, soon-tobe mother. “This was pretty rare,” McIntosh said. “We found nothing in the international literature like this case.” The team of UCHealth specialists continued through the next day researching and discussing the best next steps for the patient, including the risks involved with her pending delivery. That around-the-clock vigilance was incredibly reassuring, Preisendorf said. “Doctors were always in the hallway discussing what needed to be done from the moment I was in the emergency room,” she added. “They were phenomenal. Each puzzle piece that fell into place helped us make the final decision.” “I think they were personally invested in our story, which made us feel better,” Scott said. Because of Preisendorf ’s potential risk of bleeding, doctors felt a vaginal delivery wasn’t a good option because of the increased intracranial pressure when pushing. The health care team concluded that it would be safer for both the patient and baby if doctors delivered via cesarean section. “We were all rooting for this family,” said Leigh Anne Creighton, stroke coordinator for UCHealth in northern Colorado. “As a Primary Stroke Center,
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we have the expertise and resources to provide the collaborative care required to treat patients with strokes. And this collaboration that touched the lives of this young mother and her child was incredible. It involved neurology, OB, anesthesia, pharmacy, lactation nurses, a rehabilitation team, ICU nurses and case managers. We were committed to having a whole team behind this patient.” Thirty-six hours after receiving tPA, Preisendorf delivered her beautiful baby girl, Maisy, without complications. But Preisendorf ’s fight wasn’t over. Although tPA broke up her clot, deficits caused by the stroke needed time to resolve. Preisendorf could not sit, stand or walk on her own, and she wasn’t able to hold, bathe or feed Maisy with her weakened right arm. “I was driven by wanting to take care of Maisy. She is pure joy,” Preisendorf said while bouncing Maisy on her knee. “I started going to physical therapy and occupational therapy rehab on an outpatient basis, and I do exercises at home. It was a huge motivator for me to know that if I worked hard I could finally hold her. If that doesn’t motivate you, I don’t know what will.” Their experience also has motivated them to use their story to raise stroke awareness and the importance of acting fast when you suspect a loved one is having a stroke. “Even young, pregnant women can have strokes,” Scott said. “Suzannah is 26; we had an appointment that morning and all the tests were perfect. It can happen to anyone.”
»every minute matterS If you suspect someone is experiencing a stroke, call 911 immediately. Paramedics are trained to recognize stroke symptoms and can notify the emergency room so that the stroke team is ready when the patient arrives. Immediate evaluation of patients with stroke symptoms by the stroke team is critical to providing the best chance of reducing permanent disabilities and death. Medical Center of the Rockies and Poudre Valley Hospital are nationally accredited, Primary Stroke Centers, meaning they have a stroke team of physicians and nurses committed to rapid evaluation and treatment of stroke 24/7, 365 days of the year. Research shows that patients who arrive at the ER within four and a half hours of their first symptom are eligible to be treated with tPA. UCHealth focuses on a 45-minute window for treating stroke patients so patients like Preisendorf can return home to their families. time is Brain. QUICKLY IDENTIFY A STROKE USING THE ‘FAST’ TEST: F - FaCe: Ask the person to smile. Does one side of the face droop? a - arms: Ask the person to raise both arms. Does one arm drift downward? s - sPeeCh: Ask the person to repeat a simple phrase. Is their speech slurred or strange? t - time: If you observe any of these signs, write down the time and call 911 immediately.
Think F.A.S.T. Know the signs. FACE Ask the person to smile. Does one side of the face droop? ARMS Ask the person to raise both arms. Does one arm drift downward? SPEECH Ask the person to repeat a simple phrase. Is their speech slurred or strange? TIME Act fast. Every second, brain cells die. Call 911 if you think you or a loved one is having a stroke.
Dear caregiver: Are you caring for yourself, too? One in four adults will find themselves caring for an older adult at some time Kati BlocKer, UcHealtH
Lynn St. John looked fondly upon her husband, Randy, as he sat in a motorized wheelchair in their cozy Loveland home. “I think it’s the mutual love and respect we have for each other that gets us through,” she said. “But it is difficult, and I can’t imagine if I hadn’t already been trained for this.” Lynn cut back her hours as a certified nursing assistant to be the sole caregiver for her husband of 14 years, a 67-yearold veteran with stage four kidney cancer and peripheral artery disease, as well as for her 93-year-old father, who passed away in October 2015. Her training helps her handle common caregiving tasks, such as helping with a shower, which can be a source of anger, resentment or embarrassment in other caregiving relationships, she said. “As a CNA, I see the different dynamics of (caregiver) situations, and there is a lot to be said about the importance of taking care of yourself as well as your loved one,” Lynn added. “I use the analogy of the oxygen masks on an airplane,” said Victoria Jerome, a psychologist with UCHealth’s Mountain Crest Behavioral Health Center in Fort Collins. “You need to put your mask on first before you can assist others.” Ask for help “I see caregivers who are overly fatigued, depressed or resentful from providing care,” Jerome said. “They feel they are the only one who can help — that no one else can do it — but in reality, if they would just reach out, there often is that support.”
From left, Loveland residents Lynn and Randy St. John at their home on Nov. 25, 2015. AARP Colorado recognized Lynn with a Portrait of Care, an artist’s painting of her and Randy, as part of the AARP I Heart Caregivers campaign during National Family Caregivers month in November. Photo by Dick’s Photography, for UCHealth.
And be open-minded about the ways others can help, said UCHealth geriatric clinical nurse specialist Peggy Budai, who, along with being a nurse, also was a caregiver for her mother. “Everyone might not be a caregiver type of person, but that doesn’t mean they can’t help in other ways,” she said. Ask family members who might feel uncomfortable with the care aspect to help with transportation, cooking meals, cleaning the house or yardwork, she added. And not just one time, Budai stressed. “It’s important that caregivers make it clear that this help is needed on a regular basis.” “I try to help caregivers recognize the importance of asking for help and the importance of balancing work, play and rest,” Jerome said. “People tend to feel they don’t have time or can’t afford help. We look at all those roadblocks and figure out ways we can overcome them.” Find resources, education and training Powerful Tools for Caregivers is a six-week class offered several times a year through a community partnership that includes UCHealth’s Aspen Club. The class provides helpful strategies for current and future caregivers. UCHealth gives links to resources on its Aspen Club web page, uchealth. org/aspenclub. Another great source for finding resources is through the Larimer County Office on Aging. “Caregivers can call our program (Caregiver Support Program at 970.498.7758) as a first point of contact to help them get started on creating a plan that lifts some of the stress of caring for someone else. The program can also
offer respite assistance to encourage them to get an occasional break,” said Lynette McGowan, caregiver support coordinator with Larimer County Office on Aging. “Many caregivers feel isolated. They don’t know where to start and feel overwhelmed. They don’t have to do this alone. What they do is important, and they deserve to be supported by their community.” Improving to better serve the caregiver Family caregivers are the backbone of our long-term care system, and are truly our first-responders and need to be viewed as an integral part of the health care team, McGowan said. UCHealth’s hospitals in northern Colorado and metro Denver are Nurses Improving Care for Healthsystem Elders designated sites. NICHE sites implement a variety of best practices to address the special needs of older adult patients and their families. Patient’s Passport as a resource One initiative at UCHealth NICHE hospitals is the Patient’s Passport, Budai said. The Patient’s Passport program gives caregivers a plastic pouch containing a booklet in which the caregiver enters important health care information about the person they are caring for. Daily routines and communication preferences — essential information the caregiver has noted while caring for the person — is all in one place so health care providers and others have that information when helping with care. Eligibility for veteran services For Lynn and Randy, his veteran’s benefits have been a good resource, but
she said it wasn’t easy. She had to “keep at them,” asking several times over for the benefits she thought her husband deserved. To really understand eligibility for benefits through the VA system, a good starting point is Larimer County Veterans Service, McGowan said. Take a break and stay connected A caregiver should take at least 15 minutes a day to meditate, read a book or take a walk, Budai said. “Without taking breaks — just like working without breaks — it is very stressful and can lead to physical or mental debilitation, such as not sleeping, losing weight or neglecting your own personal health,” Jerome said. Find a motivating activity and a group of people who share your situation, such as other caregivers; or find that friend who will continue to motivate you to take a break from caregiving, she said. Lynn found her motivation with community service. “I work and am active on the I Love Loveland committee, so even when I think I’m not in the mood to do something for me, it gets me out of the house,” Lynn said. “It’s so easy to feel like you’re stuck in the home because your loved one might not be able to go with you. But that time away is important, and I’m lucky that Randy is wonderful and understands that.” For Budai, she said she feels caregivers need an outside friend persistently encouraging them to do things outside the home. “A caregiver will probably turn down a coffee date over and over because they feel they don’t have time or are guilty for the inconvenience they think it will create,” Budai said. “But keep asking because when you are in the middle of caregiving, you don’t see how you are isolating yourself. For me, it took a friend pressuring me.” “I had periods where I wasn’t taking care of myself, and I saw the care I provide suffered,” she added. “You need to reach out to friends and family or even counseling if you need to. There are resources for mental health or spiritual support. It’s not a one size fits all, but do what’s right for you.”
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signs of a HEART ATTACK? Time lost is muscle lost. Know the signs. » Chest discomfort, pressure, squeezing, fullness or actual pain » Discomfort in one or both arms, the back, neck or jaw » Shortness of breath » Sweating » Nausea » Lightheadedness
Call 911 if you think you’re having a heart attack. Minutes matter. Don’t wait. When you’re having a heart attack, UCHealth Heart Center is the team you want on your side.
uchealth.org/heart