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Telemedicine Helps Stroke Patients At A Distance

OPB | Aug. 14, 2014 4:41 p.m. | Updated: Aug. 18, 2014 11:14 a.m. | Portland

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There are approximately 87,000 adult stroke survivors in Oregon. That’s according to a 2013 report from the Oregon Health Authority. This week, the Oregon Stroke-Care Committee convened its second meeting, with the aim of using data from hospitals throughout the state to improve the quality of stroke-care. This could include treating patients using telemedicine.

Tony Page recuperates at Providence St. Vincent Medical Center, less than 48 hours after his stroke.

Tony Page recuperates at Providence St. Vincent Medical Center, less than 48 hours after his stroke.

Aparna Vidyasagar/OPB

Tony Page has benefited from the technology.

For the Pendleton resident, the day began like any other. The 47-year old single father of five went to his job as a forklift operator. Then, he went to a meeting with a friend. There, events quickly took a turn.

“I just started feeling really lightheaded. And then my hands went numb. I dropped what I was carrying and I just couldn’t talk,” said Page, speaking from a Providence St. Vincent hospital bed less than 48 hours after his ordeal.

 Although he didn’t know it at the time he was having a stroke.

As Page lost blood supply to his brain, stroke specialists in Portland were able to closely examine him at his local emergency room via telemedicine. By using a robot with high power cameras, he was given the go-ahead to receive a crucial drug called TPA, or Tissue Plasminogen Activator. It’s a drug that works best if it’s administered within hours of a stroke.

Later, Page was flown to Portland to be monitored in intensive care.

Lisa Yanase is a stroke neurologist at Providence St. Vincent. She says that before she had telemedicine tools, she would have to make decisions about whether to give TPA, over the telephone. Now a robot makes her job easier. It allows her to examine patients remotely.

Dr. Archit Bhatt is the Physician Lead for Telehealth at Providence Brain and Spine Institute. He is seen here with OSCAR, one of the robots used to examine stroke patients in the emergency room, prior to administering TPA.

Dr. Archit Bhatt is the Physician Lead for Telehealth at Providence Brain and Spine Institute. He is seen here with OSCAR, one of the robots used to examine stroke patients in the emergency room, prior to administering TPA.

Courtesy: Providence St. Vincent Medical Center

“I can zoom in and see vital signs on the monitor. I can see the telemetry, to see their heart rhythms. I can zoom in on the patient with the sensitivity to be able to see their pupils react. So it’s very high-powered cameras. I call it ‘Skype on Steroids’,” Yanase joked.

But what happens when these patients go back to their homes hundreds of miles away?

Patients like 65-year old Mike Dickinson, who had a stroke more than a year ago. He lives near Medford.

“Immediately after the stroke, upon arriving back home, I was fairly clumsy. I had a weakness in my left side. And my balance wasn’t very good,” said Dickinson.

Dickinson’s doctors are at the Oregon Health and Science University. He says it would’ve been difficult for him to drive the 300 miles to Portland. So he was in favor of joining an OHSU study, called STEP-TO-IT. It is a pilot study designed to prevent future strokes in patients who have had an episode and live more than 75 miles away from specialized follow up care.

Darren Larsen, a registered nurse, designed the study. He says it’s a good way to make sure nobody falls through the cracks.

“A lot of patients return home and will go back to their primary care physician. You know, and unfortunately some patients choose that they may not want to follow up; they don’t need to. By using telemedicine, it’s one additional way that we might be able to make sure patients are being followed and we are managing risk factors,” said Larsen.

These risk factors include high blood pressure, high cholesterol and heavy smoking. Doctors also remotely monitor diet and exercise and conduct neurological tests of motor skills while their patients remain at home.

Mike Dickinson interacts with OHSU stroke neurologist Dr. Helmi Lutsep during a follow-up care session at his home near Medford, Ore.

Mike Dickinson interacts with OHSU stroke neurologist Dr. Helmi Lutsep during a follow-up care session at his home near Medford, Ore.

Courtesy: Ken Olsen, Oregon Health and Science University (OHSU)

A year after his stroke, Dickinson has completed the STEP-TO-IT study. He says his cholesterol and blood pressure levels are under control. And, he is able to continue his hobbies. He is a professional photographer. And he sails, bikes and raises horses.

OHSU researchers hope to complete the STEP-TO-IT study in the next couple of years.

Back at Providence St. Vincent, Tony Page is preparing to head home. He is optimistic.

 “I feel kind of, a little dizzy, kind of foggy in the mind. But other than that I feel OK. But my plans are to go home and take it easy until Monday and go back to work. I feel strong enough. I feel kind of fuzzy in the mind. But I feel pretty good though,” said Page.

“I know one thing, I’m going to quit smoking,” he adds, laughing gently.

Providence stroke neurologists in Portland have been remotely following up with patients in local clinics for the past six months. Their goal is to expand the number of virtual clinics in the future.

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