When Bev Marcue went to the emergency room with a stroke, she didn’t get a drug to dissolve the blockage in her brain because doctors weren’t sure if it was treatable.
Marcue, from Lancaster, southwest of Madison, couldn’t walk and talk for weeks, and she still struggles with daily life.
Mike Harrigan was driving west on Interstate 94 from Milwaukee when he had a stroke. He went to the nearest hospital — in Watertown, east of Madison — where a stroke specialist at UW Hospital evaluated him by video connection and approved the clot-busting drug.
Harrigan has almost no impairment today.
Telestroke, a form of telemedicine available at Watertown Regional Medical Center, is one of several ways technology can help solve rural health problems — including some of the challenges examined by the State Journal in a yearlong special reporting project that concludes with this installment.
In Wisconsin, a variety of telemedicine programs, along with home health devices and electronic medical records, are removing barriers to delivering top-notch care in rural communities — from pharmacy services and mental health care to emergency treatments.
But while technology can give rural areas better access to specialty care and other services, it can be costly. Broadband capacity isn’t available in some rural places, and finding workers to install and manage computer networks can be a challenge.
“Technology has great potential to improve health care in rural clinics and hospitals,” said Louis Wenzlow, health information technology director at the Rural Wisconsin Health Cooperative in Sauk City. “But it is expensive and doesn’t necessarily reduce costs, especially in small clinics and hospitals.”
Grant Regional Medical Center in Lancaster plans to apply for a state grant to set up a telestroke connection with UW Hospital, said Sara Blum, an emergency room nurse who helped treat Marcue. Having the service might have allowed Marcue to get the stroke drug, called tPA, Blum said.
Telestroke “could have helped her tremendously,” she said. “With strokes, timing is everything.”
Telemedicine networks
Many of Wisconsin’s regional health systems have set up telemedicine networks.
Gundersen Lutheran in La Crosse, Luther Midelfort in Eau Claire, Aspirus in Wausau, Bellin Health in Green Bay and Aurora Health Care in Milwaukee are among the systems with video connections in rural areas.
Marshfield Clinic, which serves most of northern Wisconsin, was one of the first to implement telemedicine, in 1997, in two small towns: Ladysmith and Park Falls.
The multisite clinic now makes doctors in 45 specialties available by two-way, broadband video connection at 60 locations, said Nina Antoniotti, Marshfield Clinic’s telehealth director.
Nurses at the rural sites use digital stethoscopes on patients while doctors in Marshfield or other hubs hear the patients’ heart and lung sounds, ask questions and prescribe medicines or recommend other treatments. The specialties used most are neurology, pain management and endocrinology, or hormone medicine, which includes treatment of diabetes.
Telemedicine equipment costs about $8,000 per room, Antoniotti said. The service keeps patients from going to larger hospitals for some tests and procedures, so more revenue stays at rural facilities, she said.
“It pushes health care out to where people need it,” Antoniotti said.
Lou Marchiol, of Marquette, Mich., used a telemedicine connection in Rhinelander to Marshfield Clinic instead of traveling to Marshfield for check-ups after surgery on his foot.
“The pictures were so clear, it was just like being in Marshfield,” the 74-year-old retired teacher said.
Telestroke can improve care
Telestroke can improve rural emergency care for strokes by helping doctors determine if patients qualify for the only treatment available, the clot buster tPA.
The drug, given intravenously, can reverse or greatly reduce stroke symptoms such as paralysis and loss of vision or speech. But it must be started within four and a half hours after symptoms begin, and CT scans must verify that the strokes are caused by clots, not by broken blood vessels. Otherwise, tPA can cause bleeding.
Some rural hospitals don’t stock tPA. At others, general practice doctors don’t feel comfortable administering the drug and neurologists who specialize in strokes aren’t readily available, said Dr. Justin Sattin, a neurologist at UW Health.
Those factors contribute to a treatment gap: Patients at large hospitals are nine times more likely to get the drug than patients at small hospitals, according to a study last year in the journal Stroke.
With telestroke, neurologists in larger cities evaluate patients at rural emergency rooms and decide if tPA is appropriate, said Sattin, who helped set up telestroke at Watertown Regional. UW Hospital plans to expand the service soon to more hospitals, including in Beaver Dam and Belvidere, Ill.
Marshfield Clinic will soon launch telestroke at several hospitals, Antoniotti said.
Just in time
In Watertown, telestroke arrived just in time for Harrigan.
A financial adviser from Whitefish Bay, he was driving to a meeting in Waunakee in April 2009 when he reached for a bottle of water.
“I couldn’t grip it,” said Harrigan, 60. “The water was flipping all over the car.”
He pulled over and called 911, noticing that his speech was slurred. By the time an ambulance got him to Watertown Regional, his face was drooping and his arm was limp.
Telestroke had started the month before. Dr. Ross Levine, a UW Hospital neurologist, assessed Harrigan by video screen and told doctors in Watertown to begin tPA. Harrigan then was taken by helicopter to UW Hospital.
His arm and hand were weak at first, and his speech was a bit slow. But after physical therapy, he’s 95 percent normal, he said.
“Without tPA, I’m pretty convinced I would have had real, permanent damage,” he said.
Stroke still affecting Marcue
Marcue, 62, struggles to speak clearly and walk more than a few blocks two years after her stroke.
The former Piggly Wiggly deli worker woke up one night with a headache and a numb hand. Her husband drove her to the emergency room, where doctors couldn’t determine if her symptoms had started recently enough for tPA, said Blum, the nurse. By the time Marcue went to a neurologist in Dubuque, Iowa, it was definitely too late for the drug.
Marcue was hospitalized for three weeks. She couldn’t speak at first or move the right side of her body.
Through therapy, she gradually started walking and relearned how to talk. But some words remain unclear. She had to quit her job. She has little sensation in her right hand and had to give up hobbies: sewing, gardening, making handmade cards.
A second, more minor, stroke set her back this summer. But she has resumed physical therapy. She practices her speech every day and manages to help keep up the house.
“She cooks just as wonderful, it just takes her twice as long,” said her husband of 43 years, Francis, a school custodian.
Marcue said she hopes Grant Regional gets telestroke soon.
“Hopefully other people won’t have to go through this,” she said.
Source : madison.com