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Monday, March 29, 2021

Swift Action Saves a Young Stroke Victim

Posted By: Advancing Care
Brennan Fleming with his grandparents, Janice and Tom Scarey, at their Kingston home. Photo by Daniella Inzerilli

How two grandparents and two hospitals teamed up to help and treat one very special patient.

As seen in the May 2021 Issue of Advancing Care.
By Melissa F. Pheterson

Despite 2020’s numerous challenges, Brennan Fleming began last summer with the world at his feet.

The 23-year-old from Mechanicville, NY, had just received his master’s degree in science and exercise, as well as in sports science, and was embarking on a career as a personal trainer. Fleming would soon learn that life can change in an instant.

After having dinner with his grandparents in Kingston, they settled around a backyard firepit. But when Fleming got up to tend to the flames, he felt something odd: “It was like the head rush you get when you stand up too fast, only it didn’t go away,” he recalls. “I sat back down, and my grandmother was speaking to me, but if you’d been a fly on the wall, it would have looked like I was ignoring her.”

Perplexed by his silence, Fleming’s grandmother asked if he was all right. “I said, ‘I don’t know; I feel really weird,’” he remembers. His grandfather asked if he knew where he was. “I said ‘no,’” Fleming recalls. “I don’t know why. I knew where I was, but it came out of my mouth a different way.”

Within minutes, his speech became garbled. He called his mother but was not making sense. Alarmed, his grandparents decided he needed medical attention and drove him to nearby HealthAlliance Hospital in Kingston, a member of the Westchester Medical Center Health Network (WMCHealth).

ICU and an Investigation

At the hospital, front-desk personnel asked Fleming basic questions, such as “What day is your birthday?” Once again, “even though I knew the answers, I couldn’t say them,” he says. He was quickly admitted to the Emergency Department, where he underwent an evaluation by a neurologist.

Fleming had suffered a stroke, and a blood clot was lodged in his brain. He had a CT scan of his brain to rule out bleeding. Then, the medical team at HealthAlliance Hospital — a designated Primary Stroke Center — intravenously administered a drug called tissue plasminogen activator (tPA), which can dissolve stroke-producing clots.

“It’s like a miracle medicine,” says Fleming, who was transferred to the intensive care unit for three days. By the next morning, he noticed an improvement in his speech and began speech therapy and physical therapy. “The therapists did exercises with me to make sure everything was working physically and to help my speaking improve,” he recalls.

Fleming’s cousin, Heather Frascello, RN, a nurse at HealthAlliance Hospital, also helped him with his speech exercises, which was very comforting to him. “She was there when I first got to the hospital,” he notes, and she was able to be there for me and my parents and explain things to us.”

While at HealthAlliance Hospital, Fleming was seen by Ellis Lader, MD, a cardiology and critical-medicine physician with the WMCHealth Heart and Vascular Institute. “A stroke in a young fellow is uncommon, so you form a plan, based on your suspicions, to investigate,” Dr. Lader explains.

“Know the signs of a stroke,” Fleming advises. “I didn’t know much about strokes, and now, looking back, I wish I had. I didn’t really know what was happening. My grandparents saved my life, because I would’ve just gone to bed. I thought I just needed to sleep it off.”

Dr. Lader told Fleming his theory: The culprit for the stroke might be a small hole between the upper right and left chambers of his heart. All babies are born with this hole, which normally closes shortly after birth. When it doesn’t, it is called a patent foramen ovale, or PFO, and it can change how the body processes blood clots that form in veins. Usually, these clots pass through the heart’s right chamber to the lungs, where they are filtered. But in people with a PFO, a clot can pass to the heart’s left upper chamber, where it is pumped out to the body, travels to the brain and becomes lodged there, causing a stroke.

Fleming was impressed by Dr. Lader’s expertise. “He was very comforting, saying, ‘This is what we believe, and this is the next step,’” he says. “It was good knowing something could be done.”

To determine whether he had a PFO, Fleming underwent a test called a transesophageal echocardiogram (TEE), which produced a clear image of his heart. Dr. Lader’s suspicions were correct: The TEE showed a PFO to be present. “We thought it was very likely the cause of the stroke,” Dr. Lader says.

Lifesaving Surgery

Fleming was transferred by ambulance to Westchester Medical Center, the flagship of WMCHealth, in Valhalla, for the PFO repair. One thing remained unclear, though: whether he had a blood-clotting disorder in addition to a PFO. In that case, treatment with medication might be more effective than PFO closure.

Fleming had to undergo blood tests to check for a clotting problem, but these tests take time to process. When he was discharged to await the results, he opted to stay with his grandparents in Kingston to continue receiving medical care nearby. “My grandmother and grandfather and I grew closer than ever during that time,” he said.

After learning that his blood tests were negative for a clotting disorder, Fleming underwent the PFO closure. After a brief, overnight stay, he was discharged and returned home to Mechanicville.

Today, Fleming is back to his regular routine and working once again. He takes several medications, works with a speech therapist and has certain restrictions on physical activities, such as lifting heavy objects and running more than a mile or two a day — for now. Yet, “I’ve received a second chance at life,” he says.

He is grateful to his quick-thinking grandparents, as well as to Dr. Lader and the staff at HealthAlliance Hospital and Westchester Medical Center for their life-saving care. “They were always there, being supportive of me and telling me everything would be okay,” he says. “They did a great job.”

Call 911 immediately at the first signs of a stroke. To make a non-emergent appointment call 914.493.2363 (Valhalla), 845.368.5936 (Suffern), 845.331.3131 (Kingston), 845.483.5951 (Poughkeepsie) or 845.586.2631 (Margaretville).

WMCHealth Hospitals Recognized for Exceptional Stroke Treatment

Westchester Medical Center has been certified as a Comprehensive Stroke Center, a designation that represents the most advanced stroke treatment available in a given geographic area. With this certification, Westchester Medical Center, the flagship of the Westchester Medical Center Health Network (WMCHealth), is now the only hospital in New York’s Hudson Valley region recognized by the New York State Department of Health as a Comprehensive Stroke Center.

In addition, the American Heart Association/American Stroke Association awarded the Get With The Guidelines® Stroke Gold Plus Quality Achievement Award to four WMCHealth hospitals: Westchester Medical Center; MidHudson Regional Hospital; Good Samaritan Hospital; and HealthAlliance Hospital: Broadway Campus.

Additional accolades were awarded to Westchester Medical Center and HealthAlliance Hospital: Broadway Campus, which earned Target Stroke Honor Roll, and to Good Samaritan Hospital, which earned Target Stroke Honor Roll Elite Plus, for meeting separate quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment.
The awards recognize the hospitals’ commitment to ensuring that stroke patients receive the most appropriate treatment according to nationally recognized guidelines.