‘I never thought I was at risk at all’ - Stroke patient

Overcoming is a series of stories about our patients and their remarkable healthcare journeys.

David Horton (left) suffered a stroke last November. His wife, Brenda, was able to call for help quickly because she recognized the FAST signs of stroke.

Brenda and David Horton were going through their usual bedtime routine one night last November when Brenda noticed something out of the ordinary about her husband.

David was struggling to roll over in bed and grunting with each attempt.

Brenda, who had been reading beside him, asked David if he was OK. His answer was garbled – “Like my mouth was full of cotton balls,” David recalls – but it told her all she needed to know.

“I knew right away we were in trouble,” recalls Brenda, a nurse practitioner, now retired from Niagara Health’s Addiction Recovery Services. “I knew when he was talking to me, he was having a stroke.”

Brenda wasted no time reacting. She ran for the phone to call 9-1-1.

Within 10 minutes, paramedics arrived at the couple’s rural home to transport David to the Niagara District Stroke Centre at the Niagara Falls hospital. Upon arrival, he was taken for a CT scan, the images from which were used by a neurologist via Telestroke, a 24/7 emergency telemedicine application, to order his treatment, which included the clot-busting drug tPA.

“Within minutes of the neurologist’s order, the nurse had the meds and started the IV,” Brenda says. “As the minutes passed, he was getting better.”

Movement became easier for David. His speech started normalizing. Within two hours of arriving at the hospital, he was largely himself again.

“Every 15 minutes, you could see an improvement in cognition,” Brenda says. “It was amazing to me how quickly he was responding to the medication.”

All the while, David says he had no idea what was happening. He remembers trying to roll over in bed. Everything he was used to doing, including moving with ease, he could no longer do. Nothing seemed logical.

Eventually, he just resigned himself to the situation.

“I have memories of it,” David says.

Among them is the care he received at the Stroke Centre, which leads stroke care best practices across all Niagara Health sites and admitted about 800 patients last year.

“They were all so kind and they were on the ball,” Brenda says. “There was no panic. There was just efficiency. They had a mission. He really received the best care.”

David was discharged from hospital three days later. “I walked out of there with Brenda,” he says.

He still wasn’t sure why he was there in first place, however. David understood he had a stroke. But he didn’t understand why. He was active and in good health. He didn’t smoke and rarely drank.

“I never thought I was at risk at all,” he says. “In that regard, it took me by surprise.”

Seven months later, life is mostly back to normal for David “with a little asterisk attached.” He sometimes has issues finding words and remembering names of people close to him. He tires more easily.

But he also walks the laneway at his farmhouse every day and is driving again. He accepts what happened and encourages other stroke survivors to do the same, especially when going through the stroke itself.

“You have to leave the denial stage and get to the acceptance stage that you are having a stroke,” David says. “Take action right away. The best thing to do is get to the hospital right then and there.”

What happens when you call 9-1-1 because of a stroke

Callers to 9-1-1 are asked a series of questions by Emergency Medical Services (EMS) dispatch to determine whether someone is having a stroke and how paramedics will respond, explains Dr. Andy Rust, Medical Director of Niagara EMS and a Niagara Health emergency physician.

Using the Medical Priority Dispatch System (MPDS), the dispatcher will ask about symptoms and go through the FAST signs. They will also ask a patient’s age, past stroke and transient ischemic attack (TIA) history. This will help determine the appropriate paramedic team to send to the call, whether they need lights and sirens, and what hospital the patient should be delivered to.

When MPDS determines a patient is having a stroke and paramedics arrive on scene to find symptoms are consistent with that, patients whose symptom onset is less than six hours will be taken to Niagara Health’s District Stroke Centre in Niagara Falls. If symptom onset is more than six hours, paramedics will transfer the patient to the nearest emergency department where the emergency physician will assess them to determine next steps in treatment.

In cases where the patient is taken to the District Stroke Centre first, a neurologist is notified and the patient is immediately taken for a CT angiogram of their head and neck.

These scan results are given priority reading by the on-duty radiologist and the neurologist, who guides treatment in person or via Telestroke, a 24/7 emergency telemedicine application, and notifies the emergency physician of the care plan.

The standard of care is for patients to receive the clot-busting drug, tPA, by intravenous, if they arrive at hospital within six hours of symptom onset and meet the criteria. Patients will be transported for treatment outside of Niagara if they have a large vessel occlusion, which is a blockage in one of the major arteries of the brain, or symptoms have gone on longer than six hours and the patient meets the criteria for surgical removal of the stroke-causing blood clot.

“There’s a lot of pressure, especially for paramedics,” Dr. Rust says. “It’s a time-sensitive approach, especially when it comes to treatment. Time is brain, they say.”