In treatment of stroke care, timing is everything. One of the first things a doctor or EMT has to determine in the case of suspected stroke is when the last time the patient was healthy and coherent.
For Marlene Grimes, 82, spending time on the computer one day in April 2016, playing card games and replying to Facebook posts, may have been what saved her life.
“I was sitting at computer playing card games, tried to get up and couldn’t get up. I knew I wanted to get up, but couldn’t,” says the Milford resident. She tried scooting out of the chair to put her weight on her legs, “and then I realized my hand was sliding. I just couldn’t move.”
She tried to call her son-in-law and thinks they answered the call but couldn’t understand her. Grimes still lives in her own home but with family close by to check in on her regularly.
“Well, I had put my emergency bracelet in my purse earlier and thought, ‘Maybe if I just call 911, they’ll send a lady to help me get up,’” says Grimes.
“Everything about what you do for stroke care is time, time, time, so you have a stopwatch going in your mind, sometimes quite literally counting minutes, when you’re talking about getting the best outcome for treating acute stroke,” says Julian Macedo, MD, who was on call for the University of Cincinnati Stroke Team that day. Macedo is an anesthesia critical care fellow at the UC College of Medicine, and attending neurocritical care emergency medicine physician at the UC Medical Center.
“When a stroke occurs, we want to work to get blood flow back to the brain as soon as possible. A blockage of blood flow to the brain can result in stroke symptoms, like difficulty talking, paralysis, sensation loss, imbalance and vision trouble, some of which can be extremely debilitating.”
While Grimes, described by both Macedo and her granddaughter, April Gorman, as a very independent woman, did not know exactly what was happening to her, she did have the wherewithal to call 911.
Trying to Decide the Next Course of Action
Macedo received a call from Bethesda North around 5:30 p.m. that evening.
“When I got the call from ER, they said they believed it was a stroke; (Grimes) had left sided weakness and difficulty talking,” he says.
“They were sending her to get a CAT scan, both to see if there were any changes to her brain and also to look at the vessel in her brain. A big problem, in her particular case, is she lives on her own, near family, but the last time anyone had seen her well was at noon, so there was a lot of time unaccounted for. Not knowing when this occurred, she could be already out of the window for treatment.”
The most common treatment for ischemic strokes is tissue plasminogen activator (tPA), usually given by IV to dissolve the clot and improve blood flow to the brain. If administered within 3 hours (up to 4.5 hours in some patients, according to the American Stroke Association), tPA may improve the chances of recovering from a stroke. A significant number of stroke victims don’t get to the hospital in time for tPA treatment which is why it’s so important to identify a stroke immediately.
Macedo says the ER physician promised to begin making phone calls to family members and researching who saw her last to help determine when the problem occurred.
While Grimes had very clear stroke symptoms, Macedo explained that giving the treatment without knowing when symptoms began could increase her risk of complications.
A phone call from the emergency department helped clarify this.
“Her granddaughter (Gorman) noticed she had been on Facebook that afternoon,” he says.
Patient’s Social Media Activity Reveals Important Clues
Gorman wanted to get to the hospital as soon as she heard her grandmother had left in an ambulance.
“I called my sister to meet her and head to hospital. At that point, we did not know who called 911; we just knew they were taking her to Bethesda North,” she says, adding that her grandmother is so independent. “It could have been 5, 6, 7 hours before anyone would have checked in on her.”
As she anxiously waited for her sister, Gorman started scrolling through Facebook to pass the time. She saw a posted comment by Grimes time stamped “About an hour ago.”
“Immediately I got chills,” says Gorman. “That felt weird to me, knowing she was on her way to the hospital, and here I am seeing her Facebook post from less than an hour ago.” It stayed on Gorman’s mind as she and her sister rushed to the hospital.
Facebook Saves a Life
Gorman shared the information about the Facebook status with the emergency room staff as soon as they arrived, which was when Macedo got the call.
“I found this completely intriguing—the fact that I was going to be able to treat someone based on a Facebook post,” he says. “The granddaughter was able to share a screenshot of the comment with me, and the time stamp showed 3:49 p.m. (less than an hour and a half before Macedo received the first call).
“She was well enough to type a comment in this Facebook post, suggesting that she was normal, and we had evidence. Once I knew this, I felt confident for treatment. Is it the perfect way of knowing the last known wellness of patient? No, seeing someone actually well is preferred, but it’s not always feasible. I don’t know many physicians who would have felt comfortable administering tPA treatment without this information provided by Facebook’s time stamp, but once you have a detail like that, the pendulum swings the other way, and you feel well about treating a person with the time-dependent therapy.”
The medical staff started tPA immediately. Because Grimes had a clot in a particular area of her brain, she was flown by Air Care to UC Medical Center for clot-removal treatment by Todd Abruzzo, MD, professor in the departments of Neurosurgery, Radiology, Biomedical Engineering and Pediatrics at the UC College of Medicine.
“I went to see her after the procedure and let her know that everything went great,” Macedo says. “She stayed overnight, and I went to see her the next day; she is a fairly rambunctious individual, was very alert and glad to be doing so well.”
Back to Living an Independent Life
Grimes was sent home soon thereafter and is back to her usual independent lifestyle. She says her determination and positive attitude, in part, help keep her active.
“For Ms. Grimes, I don’t think anything except independence would have been acceptable for her in her mind,” Macedo says. “She wanted to be home, and I think this is the only outcome she would have accepted. I think from that standpoint, it was very fulfilling to me to know that we got her treated and got her back home.”
Her family says she is the most active 82-year-old great-great-grandmother they know. At her home in Milford, Grimes has a large yard and two little dogs that keep her busy. She can still show off her favorite dance moves from when she used to go out dancing but says she can’t find many partners that will keep up with her.
Grimes, herself, admits she doesn’t fully understand Facebook but enjoys reading about and seeing photos of her family, usually replying through email.
“She’s made a lot of friends on social media too,” says Gorman, chuckling. “She’s very active on her computer.”
Gorman says she thinks it has helped though since her grandfather passed away.
Macedo says it certainly made the difference in Grimes’ care.
“As we are getting more and more married to technology, I think we’ll be able to find interesting new ways of recognizing time dependent change in human beings and can we be early adopters of incorporating this info into our decisions,” he says.
Grimes thinks it’s pretty funny she called 911 on herself.
“I was lucky— it was a fluke that I called just to have someone help me up,” she says.
And while she doesn’t remember too much about her hospital stay, she says she feels very fortunate she ended up at UC. “I was even born there, back when it was called General Hospital, but we know it’s always the best for research and for treatment,” she says, adding that after her successful clot removal, she awoke in her hospital room to see the faces of many caring family members, “I opened my eyes, to see so many people. So many people I couldn’t even count them when I woke up … that’s really special to me.”