Experimental Stroke Treatment Saves Grandmother’s Life

Podcast Transcript

Kyle: Hey everybody welcome to The Comeback. I’m your host Kyle Michael Miller. During this episode we're talking with Cathy and Mike Alexander who have been married for almost 40 years. Cathy suffered a stroke in 2017 and an innovative procedure helped save her life. We're also joined by Dr. Mark Bain, a Cleveland Clinic neurosurgeon who treated her, but first, here's Cathy in her own words.

Cathy: Hi, my name is Cathy Alexander. I’m from Westerville, OH and I’m 61 years old. I have four children and I have four of the loveliest, most beautiful grandchildren you’ve ever seen. About one and a half years ago I was visiting my mom in Cleveland, and I had what I thought was a stroke. I was carrying my dishes to the sink and I fell. She dialed 911 and an ambulance came. It turns out I was having a stroke. I don’t remember anything after the little part in the ambulance. I woke up in the ICU later, and I was paralyzed on my right side.

Kyle: Cathy, Mike, Dr. Bain thank you so much for being here today.

Dr. Bain: Thank you for having us. I appreciate it.

Cathy: Thanks for having us.

Mike: Thank you for the invitation.

Kyle: Cathy, you have such an incredible story. We’re so happy that you are feeling well today, you look great. What do you remember about that day that you had a stroke in 2017?

Cathy: I’ll tell you, not much! I remember the morning and my mom and I just had breakfast together. I was going to drive home to Columbus, Ohio. I got up from the breakfast table and I was carrying a plate, that and myself just fell to the floor. I got up and I fell to the floor again and I said “Gee mom, I hope I’m not having a stroke.” That kind of was it. I remember my sister being in the hall with me and I remember being in the ambulance a little bit. I think they were trying to get me to talk, but I maybe couldn’t. And then that’s all there was.

Kyle: So your mom called 911.

Cathy: Yes. She said, “I think she’s having a stroke” so the ambulance for the stroke came. Two ambulances came! It was pretty neat.

Kyle: Dr. Bain, how important was the stroke ambulance in Cathy’s case?

Dr. Bain: I’ve said this a lot of times to the Alexander’s, the stars just sort of aligned that day for Cathy. The mobile stroke unit, there is no question, got her to care quickly. I remember that day very specifically. She was picked up by the mobile stroke unit and because of the direct communication we have and they can get the CAT scan which diagnoses the brain bleed right on the machine. So we didn’t have to wait until she got to the hospital, then got into the ER, then got the CAT scan. We had that CAT scan on the truck as soon as they picked her up. Within minutes they were able to call in and say, “Listen, we have someone with a hemorrhage in their brain coming in to you guys.” We can plan. So before I even saw her I had the operating room notified. I was getting numbers to call Mr. Alexander to tell him what was going on. We could really prepare our team. There’s no question that this really, really helped her.

Kyle: Mike, you were on a business trip in Alabama and you got the call that nobody ever wants to get.

Mike: I remember we were in Mobile, Alabama for the national sales meeting and I was ten minutes from my presentation. I was reviewing my notes, just getting prepared and I noticed I was receiving a phone call from my sister-in-law, Evelyn, which I normally ignore anyway. (Laughter) And then within a few seconds she texted me to call her now. I walked out into the hallway, got ahold of her immediately and she basically said, “You need to come home now! Cathy’s in an ambulance headed to the Cleveland Clinic. We think she’s having a stroke.” I notified my managers that I was getting out of there as fast as I possibly could. I worked for a very generous company at the time who had one of the corporate jets parked down there. They made arrangements for me to fly to Cleveland from Mobile using that which probably saved me half a day.

Kyle: Dr. Bain, you got on the phone with Mike as he was flying to Cleveland to be with Cathy. What do you remember about that phone call?

Dr. Bain: Well I do remember. They usually are pretty dramatic phone calls that you have to make very quickly. I'm sure Mike remembers a lot more than I do because I'm sure it's a very, very big moment in his life when he got that phone call. But yeah, I remember I picked up the phone and called him and explained everything. Cathy was in the midst of having a major stroke. We had a new innovative treatment strategy that we could potentially offer her, and it was very hard for him because he had to make a split second decision, yes or no, to this procedure. To be honest, at that point we were still early in our experience and we didn't have a lot of data to guide us one way or the other. So he took a big leap of faith and put his trust in us. He said “Go for it! Let's do the procedure. I think that's what she would want.” And that's what we did.

Kyle: Were there any other options or was this the only option?

Dr. Bain: Yeah, there are. Classically what we've done for patients like Cathy is to do something called medical management or critical care management. That's when people who are having brain bleeds, or bleeds inside of their brain, we put them in the ICU and our ICU docs do an incredible job managing these patients and helping. But one of the things we've been seeing is that that blood clot stays in the brain and we can control blood pressure and use a lot of medications to help with swelling in the brain. But some of our recent data and some of our preliminary data show that maybe getting that blood clot out of the brain actually helps reduce the swelling and things like that. So certainly we could have just put her in the ICU and watched her and do what we do for the majority of patients. But a lot of us now in the medical field now think that that's maybe the wrong thing to do.

Kyle: What kind of stroke did Cathy have and how exactly did you treat it?

Dr. Bain: She had something called a hemorrhagic stroke and if you look at stroke in general the majority of strokes people have are something called ischemic strokes. That's what you hear about when people have a bunch of their brain die because they lose blood flow to the brain. So in Cathy’s stroke a blood vessel actually burst in her brain. And when that happens it causes bleeding that basically courses into the tissue of the brain. So you can imagine how devastating that is if you put basically a lemon sized blood clot into the middle of the brain. It's a rarer form of stroke as opposed to ischemic stroke but it's a really deadly stroke, and so that's why we're focusing a lot of efforts on how we can help people.

Kyle: Can you walk us through this procedure? Exactly how does it work?

Dr. Bain: Sure. So first I’d like to start by describing the old way we used to do things. So before we had these minimally invasive devices, we used to make large incisions on the head and big bony openings in the skull. And a lot of hemorrhages, including Cathy's, are hemorrhages or blood clots that are deep in the brain. In order for us to get to those surgically we had to physically go down through the brain and take the blood clot out. And so you can imagine we’d probably do some collateral damage to the tissue of the brain even with good planning and safe trajectories to get there. So this minimally invasive technique that's been developed uses a very small tube. The diameter of the tube is probably about as big as a quarter and using some complicated GPS equipment that we have in the operating room we can navigate that tube down through these little wrinkles in the brain. So instead of actually going through or injuring the brain tissue, it just sort of pushes the tissue to the side and then we can access that blood clot right through that tube. Then we bring in some lighting and optics that can magnify things so we can operate down that little tube. The tube protects the brain as we're operating and we can do what we have to do right at the blood clot.  Basically remove the blood clot, if there is any bleeding we can coagulate things and take care of any bleeding source that we have. And it's amazing. You remove that tube and you actually see the brain close up right around that tube and you take that out. It's just a really nice way of accessing these hemorrhages.

Kyle: It's incredible.

Dr. Bain: Yeah, it really is.

Kyle: And this procedure that you did, it's still in clinical trial now?

Dr. Bain: It is. So when we did Cathy's procedure the devices that we use for this are all approved, but the biggest thing is we didn't know is if the indication is the right indication for this. So we've had an initial experience here at the Cleveland Clinic where we did about 18 to 20 patients, and in our initial experience people were really doing well with this procedure. Certainly Cathy was on the upper 10 percent of people that do well. She really did well. It’s people like Cathy and some of the results that we got in her case that actually sparked this clinical trial. So it's a randomized trial where we're looking to show that people do better with this procedure.

Kyle: Cathy, what was your first memory after waking up from surgery?

Cathy: I remember waking up, I don’t remember any pain, no pain at all for some reason. I remember looking at Mike and saying, “Hi Mike”. (Laughter) I guess that’s how we knew I was going to talk or at least could talk. And then I didn’t say much those next three days, or at least I don’t remember saying much the next three days and that was in the ICU. Then when I was in the room itself I was saying little things here and there. I was not able to use the bathroom or anything so I had to rely on everyone, but I got it….eventually. (Laughs)

Kyle: You weren’t able to walk at that point.

Cathy: No. I just sat in a bed, sitting up usually. It was okay.

Kyle: What was that first moment like when you guys realized that things weren’t going to be the same as they were before? And how did you process that with everything coming at you at once?

Cathy: That would be more Mike’s question because I guess I wasn’t processing anything at the time.

Mike: It was difficult, obviously, because we did meet with Dr. Bain in the recovery room shortly after Cathy arrived and he explained in person what he did and why he had to do it. That helped a lot. When he went over to Cathy and squeezed her hand, asked her a question and she verbalized her answer, he had a big smile on his face. He made us feel so much better by how happy he was with the results of the procedure. That helped a lot. We knew, my son was there I don’t think my daughter was there yet, that everyone’s lives were going to be different moving forward. But at the same time, this tragedy could have ended a whole lot worse. It’s literally a miracle it happened in Cleveland because of the availability of the procedure. Probably within an hour she would have been driving south back to Columbus and this would have happened while she was driving a car.

Kyle: Cathy, how are you doing today compared to the first day you went into rehab?

Cathy: Oh, much different. I don’t walk as well as I would like, but I can walk. I am okay, let’s put it that way.

Mike: You can drive.

Cathy: I can drive. Yep, I’m a good driver around the neighborhood. (Laughter) I drive the freeway, I’m good with that. I haven’t come up to Cleveland yet. I’d like to do that but my mother and Mike stop me from doing that, they’re not ready for that.

Mike: Yeah, we’re not ready for that yet. (Laughs)

Kyle: Do you feel like you’re continuing to get better or is it at a standstill?

Cathy: It’s kind of a standstill. There’s little things that I notice but pretty much I think I’m at a standstill.

Kyle: What are some of your favorite things to do now? Are there things about life that you take in and soak in every day that maybe you didn’t beforehand?

Cathy: Watching my grandchildren is a joy. I have four of them and they don’t know what a blessing they are but they are a true blessing. I play with them. I try to sit on the couch and we do things together. And then, I don’t know, I go shopping. I’m a mall shopper.

(Laughter)

Kyle: Mike you’re laughing. Does she know how to shop?

Mike: Oh yeah, very well!

Cathy: And I go, I’ll take my cane and I go from one store to another. One end of the mall will be for one day and the other end of the mall is another day. I don’t buy that much. (Laughs)

Kyle: Dr. Bain, compared to most patients who have a stroke similar to Cathy's how is her recovery today?

Dr. Bain: Her recovery is amazing. There is a signal in these group of patients that we treat with this minimally invasive technique that is astounding and she's in that signal. I would say the majority of patients that I see with a hemorrhage like hers, she would be unable to talk and probably not moving the right side of her body or very minimally. We do see recoveries. It's not to say that people don't recover if we don't do surgery, but it takes months and months and months. And most of those patients don't get a full recovery. If you see Cathy today she's walking, she's talking and she even started talking minutes after the procedure was done right when she woke up from anesthesia.

Kyle: Is that surprising?

Dr. Bain: Yeah, very surprising. I mean I usually I don't even think about looking at a meaningful recovery until three to six months after a procedure like this. The fact that when we took that blood clot out and she recovered from the anesthesia minutes after that she started mouthing words and talking. She wasn't able to do that before. It was astounding.

Kyle: Cathy, what was the most difficult part of the journey for you? Was there a moment where it was just really, really tough?

Cathy: You know what’s tough? I have very little emotion. I don’t feel one way or another. This is about as close as I could get to crying. Nothing makes me cry and that makes me sad. And I don’t know why. But Mike says it’s okay.

Mike: But at the same time, you laugh a lot.

Cathy: I laugh. I do laugh a lot. (Laughter)

Mike: That’s a big difference.

Kyle: That’s important.

Cathy: I don’t cry, I don’t know why, I just don’t cry.

Kyle: Mike, what was the most difficult moment for you seeing your wife go through this?

Mike: I think it was more fear of the unknown. It was never easy. It is still a work in progress, but the initial couple weeks was very difficult day-by-day. Trying to see her eat, trying to see her swallow water…it was just hard.

Kyle: And Cathy I know this isn’t your first medical feat that you’ve come through, you’ve had many over the years.

Cathy: I’ve had many, yes I have.

Kyle: Did overcoming all those other medical obstacles help encourage you or give you hope that you could beat this one too?

Cathy: Yes, it definitely did. It did. And if I have another one I’ll just fight through that one too!

Mike: Cathy doesn’t give herself enough credit talking about that because she developed juvenile rheumatoid arthritis when she was twelve years old. Since then, she’s had 14, what are considered major, significant surgeries to address her joints pretty much most of them throughout her body.

Cathy: All over.

Mike: You know as far as knee replacement, hip replacement, neck fusion….she’s a fighter.

Kyle: Have you ever played Go Fish?

Cathy: Go Fish? Yeah.

Kyle: We’re going to play a quick game of Go Fish. So we have a fish bowl here on set. You can go ahead and take the lid off and Cathy reach in there. There are three questions. You can grab one question at a time, read it to us and then give us your answer.

Cathy: What’s one thing you cherish now? Well that’s easy…it’s Mike, my grandchildren and my children. It’s Andy, Ty, Tony, Karen and all the grandchildren. I wouldn’t be where I am without them.

Kyle: Alright. Question two. These are not hard questions so you don’t have to be nervous. (Laughs)

Cathy: What’s your favorite thing to do with your husband? Oh, I like going to the movies and out to dinner. I like going out with our friends, I really like that. And I like just sitting at home. We sit at home. We watch TV….just being with Mike.

Mike: Well that’s good to know because the last one doesn’t cost any money but the first three did. (Laughter)

Cathy: Oh well!

Kyle: Is there one more in there?

Cathy: What advice do you have for others? I guess my advice for others would be to take things slow. Things will come. Just take it slow and everything else is on other people’s shoulders.

Kyle: I think for you, you’ve overcome so many obstacles that you have experienced that things don’t always happen quickly. Things take time and you’re living proof that you can come through and you can come out on top.

Cathy: Yes. It is a miracle. It truly is and it will happen.

Kyle: Do you guys have any final thoughts before we close?

Dr. Bain: It takes a large team of people to take care of someone like Cathy. I'd like to give some well due respect to a lot of our team members including the ICU team that takes care of patients. One of the ways we have success in treating patients as complicated as Cathy is by having a collaborative effort. Having the mobile stroke unit, having neurosurgeons that are pioneering new types of technology in the field, having a great critical care team that can take care of her before and after, everybody in the operating room. You just think about all the nurses that she interacted with and all the rehab doctors and everything. So it's quite an amazing team that's put together. And that's what we have to assemble to get good patient outcomes. That's why patients like this need to come to places like the Cleveland Clinic and tertiary centers where we can really take care of people with the teams.

Kyle: That’s great. Cathy, Mike, Dr. Bain thank you for being here today.

Dr. Bain: Thank you. I appreciate it.

Cathy: Thank you.

Mike: Thank you, Kyle.

Kyle: And thanks everybody for listening. You can find additional podcast episodes on our website http://my.clevelandclinic.org/podcasts, iTunes, SoundCloud, Stitcher and Google Play. We’ll talk to you next time.