Technology, time saved Gypsum man
GYPSUM – When Gypsum resident Don Hanan suffered a debilitating stroke while starting out on an elk hunt from the base of Beaver Creek on Nov. 6, he was in the right place, at the right time. Emergency room doctors at Vail Valley Medical Center had recently completed a training course with Denver’s Swedish Medical Center, a nationally certified stroke center. Using their newly-gained knowledge, the emergency doctors administered a blood clot-busting drug to Hanan. Within 10 minutes, he could move the hand on the stricken right side of his body, and he was starting to talk again. Three weeks later, after treatment at Swedish, he was able to walk out of the hospital. The only remaining stroke symptoms are some stiffness in his right leg and fatigue. He anticipates a 100 percent recovery, and will go back to his regular work as a project superintendent for J.L. Viele Construction, and as the pastor of the Word of Life church in Gypsum this month.”If it had to happen, I’m glad it did, when it did. I couldn’t have picked a better time or circumstances,” says Hanan.Time is critical”Time is everything when you have a stroke. The kind of disability you will suffer is the direct result of what happens to you in those first hours,” says Kimberly Langston, spokeswoman for Swedish Medical Center.Hanan, 45, had none of the warning signs, or the risk factors, that would have signaled a pending stroke. He has normal blood pressure, doesn’t smoke, low cholesterol and maintains a healthy weight.What he didn’t know was he had a birth defect: a hole in his heart that doctors suspect allowed the damaging blood clot to pass through his artery and into his brain.Hanan felt fine early in the morning of Nov. 6, when he and his 19-year-old son, Caleb, set out for their annual elk hunt. They were near the Beaver Creek golf course’s driving range, getting ready to go their separate ways to hunt the mountain, when the elder Hanan collapsed.
“I knew it was stroke symptoms. I didn’t know the specifics. I couldn’t speak to my son,” Hanan says. Caleb immediately recognized that something was really wrong. He called 911. Within minutes, an ambulance arrived, and carried Hanan to the Vail Valley Medical Center. An MRI confirmed that he had suffered a stroke.Risky medicineThree months before, emergency room doctors had completed a training and community education program with Denver-based Swedish Medical Center. Swedish is currently one of 67 hospitals in the country to have earned national certification as a stroke center.A year ago, Vail Valley Medical Center and Swedish initiated a cooperative program. The larger hospital offers training and community education to other hospitals that educate physicians on the latest treatments. Swedish also agreed make space available in their stroke center for patients who had been started on the treatment in Vail.”We are always looking for opportunities to bring a higher level of sophistication to people here in the valley. We’re always keeping our eyes open, figuring out how we can give better care,” says Dr. Chip Woodland, medical director for Vail Valley Medical center and an emergency room doctor.”We approached (Swedish) about a cooperative effort to develop protocols that work for us, and allow us to kind of seamlessly interface,” Woodland adds. “We can start the initial steps, but we need somebody we can refer patients down to.”Part of that training was a presentation on a blood-clot-busting drug known as tPA. Langston says stroke center doctors use tPA in about 30 percent to 35 percent of cases. Nationwide, only 1 percent to 4 percent of stroke victims receive the drug.The Vail emergency room doctors, realizing that the tPA could be effective for Hanan, consulted with doctors from Swedish via telephone. The medicine was on hand.
Next they talked to Hanan, and his wife, Vickie, who by that time was at his side, about the very real risks involved in using the drug. Don Hanan recalls the warnings.”It could have made me worse. It could have killed me. It could not have worked,” he says. Vickie Hanan was initially hesitant. The doctors recommended that the drug be administered sooner rather than later.With a nod of his head, Don, unable to speak, indicated he wanted to try the drug.The drug was administered within an hour-and-a-half of the initial stroke.”We need to do it rapidly. We only have a window of opportunity of about four hours from the onset of the symptoms in which to infuse the medicine,” says Woodland. The drug immediately went to work breaking up two blood clots on the left side of Hanan’s brain. Within minutes the blood flow and oxygen flow were restored. Hanan could speak and use his previously paralyzed right arm and trunk.As the hospital staff prepared him for a Flight-for-Life helicopter ride to Denver, one of the elated emergency room doctors, Dr. Pam Smith, kissed him on the forehead, Hanan says.”This has been wonderful for him,” Woodland says. “In the old days there wasn’t much we could do for stroke patients: Get them to bed and hope it didn’t progress much further.”Road to recoveryThe only initial side effect Hanan suffered from the tPA was some severe nausea, particularly during the helicopter flight.
He spent two days in intensive care at Swedish. Within four days, he was in the rehabilitation wing of the hospital, with 80 percent use of his right arm and shoulder and adequate speech, although he initially struggled with his thought processes.Three and a half weeks later, using only a cane, he walked out of the hospital and was able to return home. “Without the medicine, I’m sure I would not have been walking out,” Hanan says. He estimates he would have been only 50 percent recovered without the tPA. Doctors at Swedish also repaired the hole in his heart wall.By the time he left the hospital, he had completed his speech therapy, a major concern for a preacher. He still goes to physical therapy twice a week because there is still some disconnect between the brain signals that his nerves are supposed to carry to his muscles.Part of the physical therapy involves training the brain to re-route the signals for some basic functions and skills around scarred tissue. For example, when he wants to walk, Hanan has to purposely remember to pick up his right foot, and balance himself.”I have to think about even the smallest things,” says Hanan, although he quickly adds that he has regained 95 percent to 98 percent of his thought processes. The extra effort is exhausting, both neurologically and physically.Before releasing him from Swedish, his therapists asked that Hanan demonstrate how much he had recovered by giving a 15-minute sermon to some friends and to hospital workers.He had no problem picking the topic: how faith begins and rests with humility.”There’s nothing more humbling than not being able to take care of yourself. Humility is going to figure into the rest of my life,” Hanan says.There are other medical partnerships in the making for Vail Valley Medical Center. Woodland says the hospital is working with Children’s Hospital in Denver on a program that will make it possible to perform urology surgery on pediatric patients that would otherwise require a trip to the Front Range”We’ll keep the radar screen out there, and hopefully find other opportunities in the future where we can do similar type things,” Woodland says.Vail Colorado
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