WELLNESS Stroke patient’s quick thinking saves her brain.
Patricia “Trish” Miata was cooking at home when it hit her.
She felt odd — like a part of her brain had disconnected from the rest of her body. She didn’t feel right standing, so she tried to sit, but it was almost as if she forgot how to.
Then she fell off the chair. “I knew something was wrong. That’s not me, not being able to control myself,” said Trish, who is 58.
She didn’t know it yet, but she suffered a left middle cerebral artery ischemic stroke, one of the worst types, which is known for leaving patients with severe disabilities. And she was alone in the house except for the family dog, Diesel.
Two million brain cells die every minute after a stroke, so timing is critical to treatment, said Dr. Sunil Sheth, assistant professor of neurology at UTHealth McGovern Medical School.
While the risk of stroke doubles every decade after age 55, strokes and ministrokes occur in 10 percent of Americans younger than 45 and are rising in people between the ages of 50 and 65, according to the Texas Medical Center.
Trish didn’t know how precious the next hour would be as she lay on the kitchen floor hollering, in hopes a neighbor might hear her cries.
She tried army crawling to the front door; Diesel was with her the entire way, but Trish doesn’t know if he was trying to help or if he thought it was a game. She opened the screen door onto the front porch and kept screaming for help. Worried no one would hear her over the sound of school buses that regularly flow down her street, she crawled on the concrete path to her driveway. There, a few neighbors walked across the street to check on her.
“I couldn’t explain what was wrong with me, and I wouldn’t have thought about a stroke,” Trish said. “I thought, ‘Why couldn’t I do what I wanted to do or say what I wanted to say?’ ”
More than two years after her stroke, Trish still doesn’t know why she had one. She has no family history, and she never battled high blood pressure or heart problems. She’s not a smoker.
Trish’s husband, John Miata, was still at work 2 miles away. When a neighbor called with the news, he sped home, finding a group of people but no ambulance. By the time John arrived at Memorial Hermann Memorial City Medical Center, Trish was in a private emergency room looking like a “deer in headlights.” But John was sure he looked the same way.
Doctors rushed in and out and spoke about the likelihood of a stroke. They asked when the stroke likely occurred, and John guessed that it happened within 10-15 minutes of his neighbor’s phone call.
Long before the COVID19 pandemic, neurologists used telemedicine appointments to diagnose patients within an hour of their stroke, Sheth said. Stroke physicians are able to evaluate remotely while the patient is still at home or in the ambulance.
A computer monitor was wheeled in to Trish’s emergency room for a telemedicine appointment with Dr. Tiffany (TC) Cos
sey, who almost immediately diagnosed Trish with a stroke.
Trish was eligible for two treatments because of how quickly she was able to get help after the initial stroke: a tissue plasminogen activator (tPA), which is given intravenously to break up blood clots in the brain, and a thrombectomy, a surgical procedure that grabs blood clots and pulls them out of the body. When performed within 60-90 minutes of a stroke, these two procedures can save brain cells.
But not every brain cell can be saved, which leads to areas of “dead brain” after a stroke. In Trish’s case, rehabilitation was necessary to rewire the parts of her brain that did not function correctly anymore.
When she woke up after surgery, Trish couldn’t talk except to say “Diesel,” and the right side of her body felt stuck — like she’d forgotten it was even there.
Within a day or two,
Trish could say “I love you” and sing “The StarSpangled Banner” but nothing else. She had aphasia, the loss of ability to understand or express speech because of brain damage.
Two weeks after her stroke, Trish was discharged to a stroke rehabilitation facility where she met Dr. Reza Sadeghi, the neurologist with McGovern Medical School and UTHealth Neurosciences who structured her rehab.
“You can imagine the struggle she had at the beginning. In her case, she was very determined on what she could do to improve her speech,” Sadeghi asid. “I would have to give a lot of credit to her and her husband, as well. Part of the process of recovery is support from family.”
Being a naturally competitive person helped Trish on the road to recovery, she said, but that did not make rehabilitation any easier. Eventually, she had to find a new way to do almost everything.
She is right-handed but struggled to do anything with her right side. Rather than write left-handed, she found a new way to write with her right hand.
“I had to overcome and conquer,” she said. “I still have problems, but I find ways to work through them or find another way to do it.”
After four months at two rehabilitation facilities, Trish had regained her speech and can walk without assistance.
Rehabilitation after stroke retrains the parts of the brain that are healthy to take over the parts that are injured, Sheth said. Not everyone’s brain is wired the same, he said, which is why tailored rehab is important.
Six months after the stroke, Trish learned how to drive again and got her driver’s license back. She also returned to her job as a high school registrar that fall by using specialized software to dictate emails and documents.
While in rehab, she said she walked miles around the building in the morning and evening. Walking eventually turned into jogging, an activity she has enjoyed since high school.
Sometimes, she runs with Diesel, though she says he doesn’t have the stamina she has.
“I always like to be doing something,” she said.