When the Pros Deny a Stroke

Olga and her husband were having the vacation of a lifetime. They hooked up a teardrop trailer to their Subaru in NJ and headed out west. The planned to explore the gorgeous landscapes of the Washington State parks before jumping on ferry to Alaska.

On July 19, 2021, at a campground in Deception Pass State Park on the Washington State Peninsula, things started to unravel.

Olga had a brain stem stroke. She felt tingling up and down one side of her body and could not stop vomiting. She felt it was a stroke. Her husband called 911 and they made it out of the woods to a fire house.

The EMT said she wasn't having a stroke.

The ambulance that arrived said she wasn't having a stroke.

The ER staff said she wasn't having a stroke.

The neurologist said she probable wasn't having a stroke and specifically discouraged the tPA that could have solved the problem

And no one sent her to the more advanced hospitals in Seattle for stroke treatment.

The window for tPA came and went.

This whole time, Olga was having a stroke.

Olga shares her story in this conversation.

If you don't see the audio player below, visit http://Strokecast.com/Olga


Who is Olga Wright?

Olga stands in the woods looking at the camera. Shea wears a brown puffy jacket.

Olga is a married mother, grandmother, and recently retired educator. She lives in central New Jersey, where she practices extreme gardening.

She and her husband recently returned from a six-month, 24,000-mile road trip to Alaska and back, with their ultra-light, solar-powered camper.

Her goal is to educate the public and medical professionals at all levels to recognize nausea, vomiting, and tingling as stroke symptoms so that no one else is misdiagnosed as she was.

Olga can be reached at olgawrightstrokestory@gmail.com

Deception Pass

Deception Pass State Park is a gorgeous corner of the state. It's filled with hiking trails (including accessible trails), lakes, salt water shoreline, and campgrounds.

It's also just an amazingly beautiful part of the state. It seems remote but it's also within just a couple hours of Seattle to the Southeast and 90 minutes from Canada to the north.

It's easy to see why Olga and her husband chose to camp there.

Zofran and the Brain

Zofran is a medication I was not familiar with, and it's what finally got Olga's vomiting under control.

It's typically used to help treat nausea associated with chemotherapy. In Olga's case, it was used to treat a malfunctioning brain that was sending the signal of, "OKAY! Everyone out the way you came in!" even though there was nothing left.

The brain tries to protect us in lots of ways. Sometimes those threats are real and sometimes they are not. In Olga's case, her dying brain stem knew something was wrong but didn't know what. It went to an early reflex for poison and just kept trying the expulsion solution because it didn't know what else to do. Meanwhile, Olga's higher level brain functions were still working and trying to seek medical treatment for the stroke.

And this conflict is an illustration that the brain is not one, cohesive unit. It's different parts grabbing different pieces of data and attempting to execute a solution based on the tools at its disposal. The brain does not always work as a single unit.

But back to Zofran. One of the interesting things I learned while reading about it is that Serotonin, one of the brain's "happy" chemicals is also responsible for the vomiting function/command. Zofran works by suppressing Serotonin.

And that makes me wonder how its use as an antiemetic impacts things like depression. I suppose that will be a future research project.

Swedish ARU

The reason Olga and I connected is that she spent her inpatient rehab time at Swedish Medical Center. It's the same place I lived for the month following my stroke. You can learn more about the Acute Rehab Unit here.

Olga was lucky enough to work with OT Emilee who told her about the Strokecast. Emilee was also one of my OTs 4 years before Olga made it there. I interviewed Emilee in episode 20. You can hear that conversation here: http://Strokecast.com/Emilee

I've stayed engaged with members of my rehab team over the years. I've also met other folks on the stroke team at Swedish. Here are some other interviews I've done with the team at Swedish: http://strokecast.com/Swedish

Licensing for PT and OT

The pandemic has brought a dramatic increase in the availability of telemedicine. This is great because a lot of follow up appointments really don't need to be in person. I'd much rather do a 15 minute video appointment versus a 15 minute in person appointment I have to travel to and back from.

In Olga's case, it almost worked out for Outpatient PT. She would be able to continue her travels after leaving the hospital and get therapy on the road via the internet!

It’s a great idea, but it didn't work. Not because of technology or willingness, but because of state level bureaucracy. A Washington licensed physical therapist cannot legally treat a patient who happens to be in Alaska or whatever other state Olga happened to be travelling through.

Hack of the week

Walking is one of the best ways to drive recovery. At certain points, walking 100 feet may be the most you can do. At other points, a mile or two may be achievable. Regardless of the distance, walking as much as you can helps to drive recovery.

The most important thing, though, is to do it safely. Olga uses traction cleats for all her hiking activities. Traction cleats are basically snow chains for your feet. Even if there's no snow, they help traverse the wilds with less slipping and falling. You can find an assortment on Amazon here: https://strokecast.com/Hack/TractionCleats *.

A walker or cane can be great in a city environment, but they are less usable on the trail. What is usable whether hiking in Alaska or going down to the corner bodega is a pair of trekking poles. These are much taller than a cane. As you use them they give many folks plenty of stability and an upper body work out. You can find them on Amazon at http://strokecast./com/Hack/TrekkingPoles *.


Where do we go from here?

Here is the latest episode of The Strokecast

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