Ronald Paapke knew he was in rough shape by the time he arrived on the operating table at OHSU the evening of Sept. 19.
Stricken by a stroke at his home outside of Astoria, he had been rushed to Columbia Memorial Hospital by ambulance and then flown by Life Flight helicopter to the Portland hospital. There, interventionalist Hormozd Bozorgchami, M.D., discovered the biggest blood clot he had seen in six years at OHSU – a full 12 centimeters snaking through the carotid artery from Paapke’s neck to his brain.
“He says, ‘Oh my God,’ and that kind of worried me,” Paapke said, with deadpan humor. “Then they pulled it out like it was a big fish, and all of a sudden I could move my hand and talk.”
Bozorgchami, an assistant professor of neurology in the OHSU School of Medicine, credited Paapke’s wife, Jane Leino, for recognizing the signs of a stroke and calling 911 immediately. Without that quick action, doctors said Paapke could have easily ended up paralyzed or dead. Paapke readily agreed.
“That was the scariest feeling I ever had in my life,” he said. “If it weren’t for my wife, I would have just been hard-headed and probably died.”
Fortunately for him, Leino had worked in a hospital in Alaska and knew the basics of how to determine whether someone is having a stroke. “My instinct kicked in,” she said. She asked him to smile, and saw that the left side of his mouth drooped and his speech seemed muffled. He had trouble lifting his left leg and his left arm. Ten minutes after he had slumped on the couch, an ambulance crew arrived to whisk him away to the hospital.
“Thank God I was right there within those first couple of minutes when it started,” Leino said.
Besides underscoring the importance of early detection, Paapke also benefitted from Columbia Memorial’s participation in the OHSU Telemedicine Network. The network is a regional system that provides immediate access to pediatric, neonatal, and stroke patients at hospitals throughout Oregon and Southwest Washington, augmenting local health care with OHSU specialists who are on call day and night.
In Paapke’s case, it would turn out that he needed direct life-saving care both in Astoria and in Portland.
Upon arrival at Columbia Memorial, he was quickly assessed by through a video link with on-call vascular neurologist Stewart Weber, M.D. Weber promptly ordered the delivery of a clot-busting enzyme known as tPA, for tissue Plasminogen Activator. Weber said even though the tPA likely softened the clot, it was apparent that Paapke would need an emergency transfer to OHSU to have it surgically removed, a procedure called a thrombectomy.
“It was turning into what would become a massive stroke,” Weber said.
He arrived at OHSU within three hours of the initial onset of the stroke. Using a mechanical suction device inserted into the neck, Bozorgchami was quickly able to grasp the clot and pull it out. Paapke said the effect was immediate.
“The second they pulled it out, I got all my function back,” he said. “The doctor said, ‘You’re really fortunate.’”
Although OHSU handles more than 500 stroke patients annually, Paapke’s near-immediate recovery does stand out.
“We do a fair number of these at OHSU,” Bozorgchami said. “While his case was a little unusual, we do this 24/7.”