Hospital seeks stroke center certification

Leroy Simmons huffs and puffs, putting one foot in front of the other and finding confidence with each deliberate step as his brain relearns the familiar gait.

VIDEO: Leroy Simmons goes through his daily workout and his therapist talks about the treatment

GRAPHIC: How a stroke occurs

The day’s work has just begun for Simmons, who suffered a stroke last month and joined the ranks of thousands in the Valley struggling to recover what their “brain attack” took away.

“Therapy is not what people think,” Simmons says with a crooked grin. “You have to earn it. They make you work.”

The stroke weakened his right side, but the 72-year-old Gilbert man is showing steady improvement, thanks to grueling rounds of daily occupational and physical therapy at the John J. Rhodes Rehabilitation Institute at Mesa’s Banner Baywood Medical Center.

The rehab center, launched in 1983 with leftover campaign funds from its namesake former Arizona congressman, moved this fall from its longtime home at the now-closed Banner Mesa to the new Baywood tower.

The move coincides with Banner Baywood’s effort to become the first nationally certified stroke center in the East Valley, where specialized emergency and intensive care can improve outcomes for acute stroke patients. It’s recently been recognized by the American Stroke Association for its program.

HIGHER PROFILE

And it comes as stroke treatments, prevention and research are getting a higher profile, with local and nationwide efforts to educate people about stroke warning signs and get them to emergency rooms sooner.

Stroke is the nation’s third leading killer and No. 1 cause of disability in the U.S. Two-thirds of stroke victims will recover with minor to severe impairment, but researchers say many of those strokes could have been prevented.

About 10,000 people suffer an ischemic stroke — the most common type — each year in Arizona. Last year, stroke was blamed for more than 2,100 deaths statewide and about 1,200 deaths in Maricopa County.

Only in recent years, with advances in medicine — namely a clot-busting drug and imaging — have strokes come to be viewed as treatable emergencies. Still, the public and even the medical community often have trouble recognizing symptoms and knowing what to do.

Valley hospitals were ahead of the national curve, coming together after criteria for stroke centers were developed in 2000 to form what’s now called the Phoenix Stroke Initiative. It included a key agreement with 911 responders to bring stroke victims to hospitals that met the criteria.

The East Valley has had no such hospitals. The closest stroke center is Scottsdale Health Care Osborn.

“There’s a black hole in the East Valley,” said Dr. Timothy Ingall, a stroke neurologist at Mayo Clinic in Scottsdale and co-chairman of the Phoenix Stroke Initiative. “That’s because the hospitals have not been ready.”

Dr. M. Asim Mahmood, a neurologist and director of the stroke program at Banner Baywood, hopes to change that.

He’ll apply to the Joint Commission, the national hospital accreditation agency, next month, after which the hospital’s stroke unit and staff will be scrutinized. Only Mayo Clinic Hospital and St. Joseph’s Medical Center are similarly certified.

Mahmood said a patient’s survival and long-term recovery depend on fast action and an integrated team that includes the patient, paramedics and emergency room staff, and a strong rehabilitation program.

There’s only one medicine approved to treat ischemic strokes — the clot-busting tissue plasminogen activator, or tPA, which is also used to treat heart attacks. But because it must be administered within three hours of the stroke, and there’s a risk of brain or other internal hemorrhage, fewer than 4 percent of patients get the drug.

“It’s a first step,” Mahmood said. “It’s not an ideal drug.”

Mahmood has been speaking to community and medical groups about stroke symptoms and Baywood’s program.

“We have been continuously educating the staff, not just the stroke unit,” Mahmood said. “Because there’s no time to waste. All the channels need to be set in motion.”

A recent local study showed that while it took an average of just 35 minutes for emergency medical personnel to respond to 911 calls and get stroke victims to an emergency room, it took patients nearly two hours after their symptoms began to call 911.

EARLY TREATMENT VITAL

Studies also show that, even if it’s too late for a patient to receive the clot-busting drug, they still do better if they’re treated in a specialized stroke unit.

Stroke victims are at greatest risk of having another stroke within the first two or three days, and early assessment and rehabilitation can reduce that risk. Rehab becomes a key part of a stroke patient’s recovery.

“The sooner we can start, the better they can recover.” Mahmood said.

“For all practical purposes, the area that gets damaged does not get regenerated. The other areas of the brain start to pick up the slack,” he said. “We can teach the brain new tricks.”

Despite the huge gains that stroke victims can make in rehab — learning how to walk and talk again and regain their independence — studies show just 10 percent to 20 percent of those eligible get rehabilitation therapy.

More than 80 percent of the patients at the 22-bed Rhodes Rehabilitation Institute at Banner Baywood are discharged to their homes. From there, they’re likely to have outpatient therapy and are expected to follow up with exercises at home.

“I try to emphasize early on in treatment here that this is Phase 1,” said Dr. Paul Blake, medical director for the rehab unit. “Most people don’t realize how much recovery from stroke is possible.”

The day before his stroke, Leroy Simmons’ daughter noticed he was slurring his speech.

But, as always, he just bucked up and went to his job as a Wal-Mart security guard.

“If I’d paid attention to it and gone to the doctor instead of going to work that day ...” Simmons says. “But it didn’t hit me until I got off work and went to sleep. I woke up and couldn’t move.”

Daughter Deborah Simmons is thrilled with the progress her father has made in just a few weeks. She’s making big plans for a turkey dinner in a special family room on the unit.

“They want to keep him a little while longer. Because they see his potential,” she said. “So we’re going to take Thanksgiving to him.”

Leroy Simmons’ bright outlook and hard work is paying off.

“Every day,” he says, “it’s a little better.”

Stroke by the numbers

• 750,000 people suffer a stroke each year; 200,000 of them have had a prior stroke.

• 15 percent will die, 10 percent will require long-term care, 40 percent will have moderate to severe impairment, 25 percent will recover with minor impairment.

• 85 percent of strokes are ischemic, where a blood vessel to the brain is blocked.

• 15 percent of strokes are hemorrhagic, where a blood vessel in the brain breaks, leaking blood into the brain. Hemorrhagic strokes are responsible for 30 percent of all stroke deaths.

• 2 million brain cells die every minute during a stroke.

• Up to 40 percent of stroke victims will suffer another stroke within five years.

For more information about the stroke program at Banner Baywood Medical Center, call (480) 321-2000. To learn about the John J. Rhodes Rehabilitation Institute, call (480) 321-4240 or go online to www.bannerhealth.com Information also can be found on the National Stroke Association’s website at www.stroke.org, or the American Stroke Association at www.strokeassociation.org.