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Telemedicine program can help stroke victims avert disability

MILWAUKEE -- As he drove west along I-94 in Jefferson County, Michael Harrigan reached for his bottle of water, but he couldn't grip it. "My face was feeling odd, and my breath was getting short," he said. Harrigan thought he might be having a st...

MILWAUKEE -- As he drove west along I-94 in Jefferson County, Michael Harrigan reached for his bottle of water, but he couldn't grip it.

"My face was feeling odd, and my breath was getting short," he said.

Harrigan thought he might be having a stroke. What he didn't know was that he was about to become the first person in Wisconsin to be treated as part of a telemedicine program designed to allow doctors at smaller hospitals to consult with larger stroke centers.

The goal of the program is to treat more patients with a clot-dissolving drug that can substantially reduce the risk of serious disability. For years, the medication has been available, but for a variety of reasons, including the drug's limited three-hour treatment window, the vast majority of stroke patients don't get it.

But in March, the University of Wisconsin Hospital in Madison and Watertown Regional Medical Center began a groundbreaking program to treat people in rural areas with the dicey, but effective, drug. And the goal is to develop an even more extensive telemedicine network linking rural and smaller hospitals with certified stroke centers throughout the state.

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Better diagnosis

Last month, a second patient was treated successfully in Watertown using the program. The first patient, Harrigan, 58, was treated in April. Five other stroke patients also were evaluated under the program, although they did not get the clot-dissolving drug, mainly because they didn't get to the hospital in time.

The key to the program is a two-way, high-definition video camera that is set up in the emergency room at the Watertown hospital. The camera allows stroke specialists at UW Hospital to perform a visual and verbal stroke exam of the patients. They also receive a CT scan of the brain that is taken in Watertown. It is believed that the system will allow for better decision-making than a simple telephone consultation.

In a short period, a neurologist in Madison can make a determination to begin an IV treatment of the drug tPA, which can dissolve a clot in the brain and restore flow of blood to the artery.

Last month, the American Heart Association issued a policy statement recommending the use of telemedicine and aeromedical transport as a way to increase access to stroke treatment in underserved areas.

The report noted that in the United States, there are four neurologists for every 100,000 people, caring for more than 700,000 acute strokes a year.

Because other conditions can mimic stroke, doctors without neurological experience often can have a hard time quickly and accurately diagnosing a stroke, the report noted.

At the same time, there has been a reluctance to use tPA because of fears about side effects -- it can cause serious bleeding in the brain -- and liability, the report said. As many as 40 percent of ER doctors say they would not use the drug.

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But stroke specialists are more skilled at using the drug, which can have a substantial impact on restoring function if it is used properly.

If the drug is not used, the chance of a full recovery is 26 percent, said Justin Sattin, an assistant professor of neurology at UW and medical director of UW's stroke program. With the drug, the odds improve to 39 percent.

Sattin noted that roughly one-third of the people in Wisconsin live in areas that are not near a certified stroke center where they are likely to get the drug if they arrive in time.

"The camera can help bridge that gap," he said. "My hope is to have this spread beyond Madison."

Trend

A few other telemedicine stroke programs have been set up around the country.

A study last August in the journal Lancet Neurology found that the correct treatment decision was made 98 percent of the time in a group of 222 patients evaluated as part of telemedicine stroke program operated by the University of California, San Diego Medical Center.

If lots of stroke centers established such programs, "you could blanket the country," said Howard Kirshner, a professor of neurology at Vanderbilt University Medical Center, which set up its own program six months ago.

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Kirshner, director of Vanderbilt's stroke center, said deciding to use tPA can provoke anxiety for doctors who are not stroke specialists. Telemedicine can allow them to be more comfortable administering the drug, which, in turn, can lead to more people being treated.

At Watertown Regional Medical Center alone, three to four stroke patients come to the ER each month, said Jacklynn Lesniak, vice president of patient services.

"It's been a huge benefit to us," she said. "It has given our community access to the kind of specialists that we would just not normally have. More people will be treated in the future because of this system."

For Harrigan, a Whitefish Bay financial consultant, there is little doubt about the program's benefit.

As soon as his symptoms began, he pulled over along I-94 and called 911. Paramedics with the Johnson Creek Emergency Medical System took him to the hospital in Watertown where doctors had activated the telemedicine system.

After he was evaluated by video camera by a stroke specialist at UW Hospital, doctors in Watertown put in an IV and began to administer tPA. The drug was started just 90 minutes after the onset of his symptoms, well within the three-hour treatment window.

His symptoms already were clearing up as doctors prepared to transfer him by Med Flight to UW Hospital, which is about 20 minutes away, said Lesniak at the Watertown hospital.

"I'm a pretty darn lucky guy that I was in the right place at the right time," Harrigan said. "I could have died. I am certain that at a minimum, I would have a lot more disability."

Harrigan said he has recovered about 90 percent use of his left hand, and his speech is about 80 percent recovered. Over the next month or two, he said, he expects to recover even more.

Related Topics: HEALTH
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