Stroke Patient Says It Was No Accident Specialists Were There: Yolanda Jones is not a bit surprised that a wide variety of medical specialists just happened to be in John C. Lincoln North Mountain Hospital, available to respond exactly when she needed each of them to contribute to the team effort to save her life.

Above: Yolanda Jones and Misha, the little friend who was waiting for her to come home!

“If it weren’t for God, all those doctors would not have been there” to stop her from dying and to save her from paralysis, she said. “I love my doctors and I appreciate what they did. But glory should go to God where it belongs. There was no luck in my story. God is in control.”

Jones believes her experience is testimony to God’s grace. “If you have to have a major stroke that could easily kill you,” she says, “do it in the hospital when and where God has brought all of the expert physicians you need. I was so blessed.”

Indeed, say a whole team of doctors who worked together to save her. Her stroke was so severe that she easily could have died or been completely incapacitated. If it had happened before she got to the hospital, it could have killed her.  If it had happened an hour later, during surgery, while she was under anesthesia, she could have been paralyzed and dysfunctional.

Instead, she’s almost unscathed by the experience.

“I have a little trouble lifting my right foot to step up on a curb, for example,” she said recently from her son’s home in Colorado.  “I also have some numbness in my right hand. I probably need some physical therapy, which I’ll get in the near future.”

Her doctors were thrilled to hear that update. But let’s go back to the beginning, when Jones went to see cardiologist Warren Breisblatt, MD, in his North Phoenix Heart Center office on the John C. Lincoln North Mountain Hospital campus. She’d been bothered by some heart palpitations but didn’t think it was serious.

“I did an ultrasound and a carotid angiogram,” Dr. Breisblatt said. “The tests showed that her left internal carotid artery was almost completely blocked.”

That’s not good. The carotid artery is a major blood vessel that comes out of the heart and supplies the head and neck with fresh blood full of life-supporting oxygen. When it splits into external and internal arteries, it’s the internal carotid that supplies oxygen to the brain.

Dr. Breisblatt immediately contacted one of John C. Lincoln’s most talented cardiothoracic surgeons, Kevin Brady, MD, to schedule an operation called a carotid endarterectomy. It’s a delicate, sophisticated procedure that clears the blockage – blood clot or plaque – out of the artery and allows blood to resume free flow.

Jones, who’d never had any cardiac issues except for the irritating occasional irregular heartbeat, came into the hospital and was being prepped for surgery, chatting away with her anesthesiologist when everything froze.

“She just stopped talking. Her eyes got glassy,” said anesthesiologist, Joel Pavelonis, MD. “She was unresponsive. I knew right away she needed immediate help for a stroke.”

He recalls the moment with a bit of awe. “Twenty years of medicine and I’ve never before actually watched a neurological event like that unfold in front of my eyes,” he said.

Jones remembers the moment, clearly. “I was lying there looking at the doctor when all of a sudden I just couldn’t talk,” she said. “I could think but I couldn’t form the words. I tried to mumble. My right side, my hand, my arm went numb and I couldn’t move.

“Then at the top of my right eye I could see what looked like a gray shield descending,” she said. “The shield was closing down my vision; I was going blind. I thought I was dying.

“Then I heard my nurse yell ‘She’s having a stroke!’ I heard her tell someone that they needed to call my son, and then everything went black.”

Dr. Pavelonis immediately ordered an overhead page for stat neurological assistance. “It was so fortuitous that Dr. Zach was in the hospital,” Dr. Pavelonis said. “He arrived at the patient’s bedside in moments.”

"A large blood clot had closed off her left internal carotid artery, preventing blood flow to the left hemisphere of the patient's brain,” said Victor Zach, MD, one of the few specially trained neuro-intensivists in Arizona.

"Additionally,” Dr. Zach said, “a piece of the blood clot broke off and traveled downstream, clogging up her middle cerebral artery.” This is the blood vessel that supplies blood to the cerebrum, the part of the brain that controls all voluntary actions in the body.

“Dr. Zach told me later I had three strokes in one, the perfect storm, that affected the front, the top and the back of my brain,” Jones said.

“With this situation,” Dr. Zach continued, “Ms. Jones had a 40 to 50 percent chance of dying. Even if she did survive, her chance of being severely disabled was 90 percent.” To expedite treatment, he issued an order for a special clot busting drug that is given to stroke patients whose stroke is caused by a blood clot.

“Her stroke was clinically severe,” Dr. Zach said. “She was completely mute, unable to understand any instructions, paralyzed on the right side of her body and unable to swallow. With the assistance of Pat Jordan, RN, our wonderful charge nurse from the ICU, we were able to administer the initial dose of clot busting medication just 40 minutes after the onset of the stroke.”

 National guidelines say that clot busting medications must be administered less than three hours after a stroke in order to be effective. In this case, the speed of medication delivery “was remarkable,” Dr. Zack said.

“But there was a problem,” Dr. Zach said. “While the standard of care was met, I could see that this wasn’t going to be enough to save Ms. Jones.”

A CT of Jones’ brain revealed density in the middle cerebral artery and that her carotid artery was still completely closed. “This is an ominous sign that indicates the clot busting medication may not work well.”

So Dr. Zach reached out for more help, paging an interventional radiologist in hopes that one would be in the hospital. Amazingly, David LoPresti, MD, just happened to be in the house.

“Dr. LoPresti arrived in less than five minutes, and together we watched what normally is every vascular neurologist’s and stroke patient’s worst nightmare: We watched the clot busting medication failing to reverse the stroke.”

Although Jones did regain weak control of her leg and was able to understand basic words, she was still mute, unable to move her right arm, and unable to swallow.

“It was at this time that Dr. LoPresti took over,” Dr. Zach said. Jones was transported to the interventional radiology suite where Dr. LoPresti passed a catheter through her femoral artery at the top of her leg all the way up into the clogged carotid artery.

The first images revealed that the tight carotid had been barely reopened by the clot busting drug and that only a trickle of blood flow was getting through.

After a brief conference, the physicians decided to proceed with an intra-arterial injection of the lifesaving clot buster drug, directly through the catheter.

“After only four milligrams of the drug, the patient began to get control of her arm,” Dr. Zach said.  At that point, I contacted my mentors back in New York and was instructed to advance further into the artery and give an additional dose.

“Dr. LoPresti pushed on and skillfully passed a microcatheter through the tight vessel,” Dr. Zach said. “He slowly delivered four more milligrams of the life-saving medicine in the immediate vicinity of the clot. The patient began to speak.”

The team was awestruck and overjoyed.  They had just witnessed a miracle.

Medical protocols required a seven-day wait before Jones could get the surgery that she came to the hospital to receive in the first place. During that time, Dr. Zach monitored Jones’ condition with a special ultrasound procedure to make sure her carotid artery remained open.

A week later, Dr. Brady performed the carotid endarterectomy, removing all the plaque and clotted material in her artery. “She did very well after her surgery and went home with no neuro deficits,” Dr. Brady said.

All the physicians who teamed together to save Jones are incredibly happy about her virtually complete recovery. “Someone was definitely looking over her shoulder,” Dr. Pavelonis marveled. “I’m so glad she’s now doing so well.”

As for Jones, “God put everything in perspective for me,” she said. “I was so blessed to have all of my doctors when I needed them. Life is different now and I am happy. I give all the glory to Jesus Christ, my Lord.”