Early Thanksgiving morning in 2011, Sharon Adams woke up and couldn’t speak.
She couldn’t understand what her husband was saying, nor could she move her right side. Sometime overnight—after she had gone to bed thinking about her Thanksgiving plans with her family the next —she had suffered a stroke.
As precious seconds ticked by, an ambulance whisked Adams to Bon Secours Maryview Medical Center near her Portsmouth home. Early tests didn’t show anything amiss, but doctors quickly transferred her to Bon Secours DePaul Medical Center in Norfolk and to the capable hands of Dr. John R. Baker.
Since the fall of 2011, the Harvard-trained Baker and his clinical team have been performing intricate brain surgery procedures at the Bon Secours Neurovascular Center at DePaul, using minimally invasive procedures via catheters to diagnose and treat conditions such as stroke and brain aneurysms.
Baker’s presence in Hampton Roads, along with the creation of a $4 million technologically advanced neurovascular suite at the hospital, has given stroke patients a better chance at life.
In the past, procedures like the ones Baker is performing would have required open brain surgery. On average, according to the hospital, the minimally invasive procedures result in less damage to sensitive tissues, fewer complications and quicker recovery times.
That was welcome news to Adams’ family members, who were stunned that the seemingly healthy, 48-year-old mother of two could be having a stroke. An MRI gave doctors a closer look at her brain and revealed that her left cerebral artery—the main artery to the middle side of the brain—was clogged. Left untreated, the artery would swell and run out of room in Adams’ skull, putting pressure on her brain. Parts of her brain then would start to die.
“The next thing I knew, Dr. Baker was talking to my husband, and saying we had to get her into surgery right away,” Adams recalls a year later. Now 49, she has fully recovered except for a slight weakness on her right side.
Typically, once a suspected stroke victim arrives at an emergency room, medical personnel use a variety of tests to figure out what kind of stroke it was and where in the brain it occurred. Once those are determined, doctors decide how to treat the stroke, be it with medicine, surgery, or both.
In South Hampton Roads, two hospitals specialize in treating strokes—DePaul and Sentara Norfolk General Hospital in Norfolk. On the Peninsula, the Primary Stroke Center at Riverside Regional Medical Center in Newport News has a team dedicated to diagnosing and treating stroke victims.
Stroke is the nation’s third leading cause of death, with someone suffering one every 45 seconds. It’s the leading cause of adult disability in the country, according to Baker. There are two major categories of stroke: bleeding strokes, which account for about 20 percent of all strokes, and clotting strokes.
The first three to four hours after a stroke is crucial—after that, medication doesn’t do much good. That’s when doctors like Baker step in, using catheters to go up into the brain’s arteries and break up the clot or place tiny devices that can repair a damaged artery.
In Sharon Adams’ case, Baker threaded a catheter up from the femoral artery near her groin and traveled about four feet up into her neck and then her brain, using a tiny device to suck out the clot.
Adams was sedated, but awake. Baker says the patient needs to be awake so that their response can be better evaluated, allowing doctors to treat the patient and not just what they see in images on television monitors. Within a few minutes of Baker busting through the clot, Adams was talking and moving her right side.
“I remember going in [to the room], them getting me ready,” Adams says. “I thought I would be put to sleep, but they were doing it. It was one of the worst pains I’ve ever felt, when he was opening the clot. He was saying, ‘Just hold on, just hold on.’ I was glad when it was over.”
All told, it took about 90 minutes from the time Adams arrived at DePaul to getting the clot out. Within five days, she was out of the hospital in a rehab facility. Ten days after entering rehab, where she needed a little work on walking and handwriting, she was home.
“By Christmastime, she was making Christmas dinner for her family,” Baker says, who keeps a photograph of Adams doing just that. “I wish everyone turned out that way.”
Although 48 seems young to have a stroke, Baker says it’s really not. The average age for patients treated is 59 to 57 for women; 55 for men. Doctors do treat people in their 80s and 90s, but that can be more difficult, Baker says, because other health issues can cause complications.
While figuring out a diagnosis is challenging, sometimes figuring out what is best for the patient is just as complicated.
“We try and treat everybody in my practice as to what benefit they’ll have,” Baker says. “Is what they’re having [done] going to result in a major disability if they’re treated? If we do treat it, what kind of level of disability will they have?”
In the past, procedures like the ones Baker is performing would have required open brain surgery. On average, according to the hospital, the minimally invasive procedures result in less damage to sensitive tissues, fewer complications and quicker recovery times.
Catheter-based procedures are also used to treat a brain aneurysm, a balloon-like bulge in the wall of a brain artery that’s filled with blood. Between two and four percent of the U.S. population, or some 1.5 million people, have aneurysms of different sizes in their brains. Many are very tiny and don’t cause any problems, but about 30,000 rupture each year.
Another of Baker’s patients, 53-year-old Cynthia Winnings of Chesapeake, had both an aneurysm and an irregular artery. In her case, a blood clot dislodged from the aneurysm and traveled through an artery. With this type of aneurysm, called a pseudo-aneurysm, there’s a 50 percent chance of bleeding in the first year.
So on Oct. 26, a few days after Winnings starting have vision issues and an MRI found a bulge on an artery, she ended up in the neurovascular suite at DePaul. Baker used a catheter to install a tiny stent in the faulty artery, and then filled the aneurysm with miniscule platinum wires called coils. The coils fill an aneurysm sac, closing it off from the artery.
Five weeks later, Baker had Winnings back in the neurovascular suite to check on her progress. While nurses prepped her inside the room, Baker strapped himself into burgundy colored lead apron worn over his scrubs, then covered it with a blue surgical drape.
The apron protects Baker from rays from the giant X-ray machine that takes pictures of a patient’s brain and arteries, allowing him to watch on a screen as he maneuvers the catheter. Today, he would be doing an arteriogram—releasing contrast dye through an artery to take new pictures of Winnings’ brain.
As he worked, he talked to Winnings, asking her how she was doing and reassuring her at every step. Once the catheter was in place and the dye injected, he asked her to hold her breath to allow for the clearest picture.
“This is the money shot,” he told her, reminding her again and again to hold still as the camera snapped photos of the spot where the aneurysm was, the coils highlighted by the dye. “Nicely done. Good job.”
The procedure over, Baker left the room, walking up to a bank of computers in a windowed room that looks into the neurovascular suite to study the photos more closely.
“That looks very nice,” he said, noting that the bulge had not gotten any bigger, although there were still some blood vessel issues. “It’s healing. It’s a nice result so far. I think this is actually going to be OK.”
As for Adams, she got a clean bill of health during her last visit to Baker in October. She’s still not sure what caused her stroke, although a previously undetected hole in her heart could have played a part. She’d had headaches since she was a teenager, so it could have been a combination of things.
Strangely enough, since she had her stroke, Adams doesn’t get headaches much at all anymore. She was able to return to her job after two months, resuming her full duties as a paralegal last summer. More importantly, she’s still around to enjoy life with her husband, James, and daughters, Rachel and Abby.
“I thank God every day,” she says. “I thank God for Dr. Baker. He really is my saving grace. I’m very blessed.”