Distance, time and a hard-to-spell road name didn’t help the odds for Dave Lohman. At his farm near Oakesdale in November, he suddenly lost all feeling on the left side of his body while operating a tractor.
What Lohman did have in his favor were two men who proved crucial to his survival after a stroke: Randy Robinson, his brother-in-law who called emergency crews, and Dr. Jayson Brower, Lohman’s friend of 16 years who also is an Inland Imaging doctor affiliated with Providence Sacred Heart Medical Center.
Brower, an interventional oncology and radiology specialist, eventually did a life-saving procedure on Lohman, 59, to remove a blood clot in the brain. Today, Lohman has no residual symptoms from his stroke.
“Randy asked for Life Flight because he knew I was having a stroke,” Lohman said on April 6, at the farm with Robinson to describe what happened in November. He and his wife, Tavi, who is Inland Imaging’s chief financial officer, plan to retire on the property he calls their “hobby farm.”
“The Sacred Heart stroke program, obviously that’s what saved me, and Dr. Brower,” said Lohman, who remembers he didn’t feel well for weeks before the stroke. “Without them, I wouldn’t be standing here.”
The Sacred Heart care providers discovered Lohman had atrial fibrillation, where the heart goes into rapid heart rhythm and the blood doesn’t pump throughout the body. It resulted in the clot in his brain, and then the stroke.
On that day, he and Robinson had been working to clear some stumps, and Lohman went to get on his tractor about 500 feet away when he lost feeling and wasn’t able to control the tractor. He crashed it into a barn wall, then managed to get it a short distance outside the barn.
Robinson had waited nearly 10 minutes where they’d been clearing land, and then went to check on him.
It was initially frustrating to try to spell Sienknecht Road, named for the farm’s original homesteaders, when Robinson called 911. When help arrived, it took three people to get Lohman out of the tractor.
“From the time I found Dave to when Life Flight came was probably an hour,” Robinson said. “I was never worried about David dying, but I was worried about him being paralyzed for the rest of his life. It could very well be life-threatening, but what entered my mind was getting help.
“I knew that the clot-busting drug is pretty time-sensitive.”
Because of the time factor, Robinson said at first he wasn’t sure.
“I would have given you a one-in-100 chance that Dave would be where he is today. I’m trained in first aid, so seeing that and seeing a stroke for at least the second time, it was pretty obvious he was having a stroke.”
Lohman said the last thing he remembered was Robinson trying to spell the road name. Brower was on call that day at the hospital, and when Lohman arrived, he said his friend received the drug that thins blood and breaks up clots, as a first-line treatment.
That medication is effective if given within roughly three hours from the onset of a stroke, Brower said, and Lohman got it in time.
Lohman initially improved with the drug but then started to decline. Brower said that is when, several hours later, the stroke team decided to call in the radiology-assisted procedure that uses a tiny net device and a suction device to remove the clot by entering through the blood vessel at the hip bone to the brain.
It was the atrial fibrillation itself that complicated Lohman’s case, Brower said.
“The one thing that makes atrial fibrillation and strokes related to it a little more challenging is, because as the blood sometimes sits around for longer periods of time, the clot can be very hard and organized,” Brower said. “That makes it often difficult to extract from the brain.
“In Dave’s case, it was a little more challenging. Sometimes, we make what we call a pass or pull with the net to pull the clot out. We pull out all the stops to try to get the blood clots out and get the blood flowing again.”
The procedure can take from about 15 to 20 minutes to a few hours, depending on factors such as the patient’s anatomy and other complications, he said.
“The type of clot he had, and this goes back to difficulties of atrial fibrillation-related strokes, is that the clot, because it was harder and more organized, almost more like a cork rather than a blob of gelatin, if you will, then the clot-busting medication doesn’t dissolve it completely, and that’s why his symptoms didn’t resolve.
“He probably started to develop an acute clot around that area, further narrowing his blood vessel down, and that’s why his symptoms progressed to the point there really is no other option than the procedure. You can’t give additional clot-busting medication.”
Dr. Brower and others at Inland Imaging regularly do such vascular and stroke interventions. Fortunately, the procedure and technology have improved drastically over the years, he said. They use live X-ray guidance and other tools.
“The patient lays on a special X-ray table and we have cameras where we can image in two different ways – from front to back and side to side in his brain simultaneously. The procedure is done under general anesthesia, so they’re completely still, which you can imagine is important when we’re working in 4 and 5 millimeter blood vessels in the brain.”
He said the team uses catheters, or “little IV tubing,” placed into the arteries to get to the vessels in the brain.
“We put in X-ray contrast, or dye it’s sometimes called, and that lets us see what the blood vessels are doing and using those things together – the live X-ray guidance and then the contrast inside the blood vessels, we know where the clot is and that’s how we’re able to deliver that net device and suction device directly to where the clot is, and then try to grab a hold of it and pull it out.
“Thankfully, in Dave’s case, it took either three or four passes to get it all out, but we managed to get it all out completely and restore normal blood flow to the brain.”
In about 18 years of experience, Brower said this one procedure was both the most stressful and most gratifying one he’d ever done, because of their friendship and knowing potential results if the procedure wasn’t successful. Now seeing how well Lohman is doing helps to pull together why he and other doctors do that work.
“I’ve done other types of procedures on peripheral acquaintances, but nothing that I’d consider life and death like this one,” he said.
“The ability to share in this success and great patient outcome in such a personal way helps put it in perspective.”