‘Time is brain’

Being a breakfast regular at a downtown diner helped save Will Hille’s life. Hille, the retired longtime pastor of St. John’s Lutheran Church, felt fine as he drove his car down the South Hill to Molly’s Family Restaurant Jan. 20. He felt fine when he walked in, greeted the waitress and sat down at his table.

But then Hille, 71, started having trouble getting his arm out of his jacket sleeve. He couldn’t hold the menu.

By the time his friend joined him at the table a few minutes later, the right side of his face had started to droop. He couldn’t get words out.

Hille was having a stroke, a brain attack so massive that a scan would soon show its potential to wipe out his ability to think, to use language and to move his right side.

“His stroke was actually going to be devastating,” says Dr. Anthony Santiago, a Rockwood Clinic neurologist who treated Hille.

For Hille, like all people in the midst of a stroke, minutes lost before seeking treatment mean brain cells lost.

“Time is brain,” says Santiago.

But too many people, experts say, ignore the early symptoms of a stroke, excluding themselves from receiving potentially lifesaving treatment.

“They often come up with other things,” says Sherry Nash, a registered nurse who is Sacred Heart’s neuroscience/stroke coordinator. “I slept wrong. I overexercised yesterday. I’ve heard a lot of excuses. The first response is denial.”

Luckily for Hille, the waitress knew him well enough to know that he was symptom-free when he came through the door. That bit of information would be crucial to doctors later as they determined the onset of Hille’s stroke.

Hille’s friend drove him back up the hill to Sacred Heart Medical Center, one of only a handful of hospitals in the country certified as a primary stroke center.

Hille could barely speak, but he was aware what was happening around him.

“Once we got there, it was out of control,” he says. “All heck broke loose. People were ripping my clothes off. Sticking needles in me.”

Within 22 minutes, Hille had been evaluated by a doctor and whisked to the CT scan.

And in less than 50 minutes from the time he came to the emergency room, doctors had started him on an IV drip of t-PA, a clot-busting drug that can, in some patients, stop a stroke in its tracks.

But t-PA, which stands for tissue Plasminogen Activase, is no miracle cure. Only a small percentage of stroke patients meet the criteria to receive the drug, which was approved by the Food and Drug Administration in 1996.

The majority are disqualified because they are not treated within three hours of the start of symptoms. After three hours, the risk of bleeding in the brain increases. Some people ignore their symptoms and fail to seek treatment, but many others simply wake up with stroke symptoms and can’t pinpoint when they started.

The drug also cannot be used on people suffering a hemorrhagic stroke, one that causes bleeding in the brain. About 20 percent of strokes are of that variety.

Others have pre-existing conditions or take medications that make them ineligible to receive t-PA.

Then there are the side effects. The same properties that make the drug such an effective clot-buster can also cause massive bleeding in the brain, raising the chance of hemorrhage about 10 times, says Sacred Heart emergency physician Dr. David McClellan.

“There is controversy in the emergency medical literature about whether this is a great treatment or just an OK treatment,” McClellan says.

At Sacred Heart, about two dozen patients received t-PA in the past year, Nash says. It is used much less frequently at other area hospitals.

As for Hille, he was the model patient.

He kept a card listing all of his medications, including dosages and frequencies, in his wallet. And Hille and his wife, Sue, had discussed t-PA in the past. Sue knew that her husband would be willing to take a risk on the drug if a stroke would disable or kill him.

“We’re both ready to meet the Lord anytime,” she says.

Within 10 minutes of the start of the IV, Hille’s stroke symptoms started disappearing. He scratched his head with his right arm. His facial droop improved. He started talking coherently with friends and family.

Two weeks later, you would never know Hille had a stroke.

He gets tired more easily and has a slight tremor in his right hand.

But he credits the “grace of God and modern medicine” for his recovery.

Hille may not suffer any lingering effects from the stroke, but he will still be spending some more time at Sacred Heart.

During his CT scan, doctors discovered a large tumor on his pituitary gland. It’s likely that the tumor, pressing on an artery, caused the stroke.

But doctors say it’s highly unlikely the tumor is cancerous. Hille will undergo surgery to have it removed next month.

Despite t-PA’s risks, those in the medical community say it could be of benefit to many more people – if only they would recognize the signs of a stroke and seek help.

“If people got to the hospital, we could treat twice as many,” Nash says. “The reality is patients aren’t getting to the hospital quickly.”