After last year’s Labor Day concert, Spokane Symphony principal bass player Patrick McNally went home feeling as healthy as ever.
But the very next morning, a strange numbness ran down the left side of his body. He felt weak. So McNally sat down with his iPhone.
“I had never felt that way before and I knew something was wrong,” said McNally, 38, who has performed with the symphony for 11 seasons.
“I Googled the symptoms. It said I was probably having a stroke, and that I should call 911 as soon as possible, because time matters. Probably within five minutes, firefighters were at my door, followed soon after by an ambulance.
“It almost felt like my arm was asleep, but it was the whole left side, including my face. I was told I didn’t have drooping on the left side of my face. I did have weakness.”
At Providence Sacred Heart Medical Center, McNally received a clot-busting medicine called tPA, for tissue plasminogen activator, within two hours of initial symptoms. The shot must be given within a short window of time.
As with all stroke treatments now available, quick medical care is crucial. The American Heart Association and other health groups back a campaign to recognize stroke symptoms under the FAST acronym: Face drooping, arm weakness, speech difficulty and time to call 911.
“At Sacred Heart, they did an MRI of the brain to make sure I didn’t have a hemorrhage type of stroke,” McNally said. “I had a blood-clot type of stroke. I believe ischemic is what they call it.
“I had a vertebral artery dissection, which means the arteries going up the back of my neck started coming apart. The body tried to heal itself with clots.”
Health providers believe a major reason why he’s now mostly recovered – returning to symphony performances part-time by spring – is he received treatment so quickly after noticing symptoms. Also, lengthy physical and occupational therapy ushered a quicker return to normal functions.
Dr. Yi Mao, with Providence Spokane Neuroscience Institute, said the window of time for providers to give tPA is four and a half hours from when a patient was last known to feel normal.
“As you move beyond that time window, the benefit as far as improving stroke symptoms diminishes, and the risk of hemorrhage becomes greater,” Mao said.
“Mr. McNally as he looked up his symptoms, he was able to get himself to the hospital quickly. Even within that four-and-a-half hour window, the faster you get the treatment, the better.
“Neurologists will often quote that once the acute stroke starts, every minute that goes by you’re losing close to 2 million neurons in your brain.”
McNally’s family was home when he suffered those acute stroke symptoms. Wife Meredith, a teacher, was on maternity leave for a baby boy, Oliver, born in June. McNally had planned to take their 7-year-old son, Jack, to school. They also have a daughter, Alice, 4.
Emergency workers had to help him get downstairs because of weakness. Quick actions followed, from ambulance crews’ aid to a Sacred Heart team’s assessment.
Depending on the type of stroke, Mao said different treatment options are available, including recent researched effectiveness for patients who have large vessel blockage.
“We can potentially go into these vessels and do clot removal,” he said. “The time window for that was more recently extended to 24 hours. Mr. McNally didn’t have a large vessel blockage. He was only a candidate for the tPA medication.”
McNally admits in those early days after his stroke he wasn’t so sure about his return to daily living routines or even mastering his bass for complicated musical arrangements. He spent a week at Sacred Heart, including a few days in ICU.
“At that point, I could barely lift my left arm or my left leg,” he said. “I pretty much lost feeling in my leg and arm, even after getting the drug.”
Recovering at St. Luke’s Rehabilitation Institute, he kept a bass guitar in his room. Despite initial pain, he kept practicing finger movements.
For his larger bass, he’s right-handed for use of a bow, and presses down its fingerboard with his left hand. Carrying the heavy instrument, which he estimates at 45 pounds in a case, was another matter.
“When I got to St. Luke’s, I had people telling me I should be walking soon,” he said. “My doctor said, ‘I’ve worked with musicians before; you’ll be able to play again.’
“There were definite concerns about coordination in my hand, especially in my left hand because all these tiny movements you’ve got to use. It’s very refined.
“I’m still fighting that,” he added. “I feel like I’m not 100 percent yet as far as my playing goes.”
With occupational, physical and speech therapies, he regained skills. McNally continued St. Luke’s outpatient care until March.
He performed the first time for a Holiday Pops session and played in about half the concerts the remaining season.
The mental work came back faster than the physical.
“One of the strangest things to me was how tired I was and how I needed to sleep a lot,” he said. “I also wanted to make sure I was up and active and walking as much as I could.”
McNally hopes others hearing his story will act quickly if they experience similar symptoms. Doctors aren’t sure what caused his stroke. It was possibly from him hitting the back of his neck on a cabinet.
A week before the stroke, McNally completed a 24-mile hike in the Grand Canyon with a friend rim-to-rim. He’d trained for months.
“I was definitely not aware of the signs before it happened,” he said. “Now I know how common strokes are, and it’s not just older people.
“People also made a good point that it’s important to call 911, don’t go to the hospital, because you might sit there. Go through the ambulance.”
Mao agrees, because minutes count for faster assessment that often begins with emergency responders.
“We activate a stroke code, so we all go to meet with a patient as soon as they arrive, and try to rush to the appropriate therapy as fast as possible. There is some kind of imaging to rule out hemorrhaging.”
Today, McNally said he takes a blood thinner medicine and makes sure to eat greens. Life has returned to normal both at home and for the symphony.
“As far as I’m concerned I’m back full-time. I can play most of the music we’re doing now, so I plan to be there the whole time next year.”
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