Fla. Man Survives Stroke with Subtle Warning Signs, Thanks to Teleneurology
July 10—PALM COAST—The evening of May 13 should have been a happy time for Chris and Colleen Conklin. They had just returned home from the MayDay Memorial Surf Classic in Flagler Beach and were expecting to meet friends and family a couple of hours later for an after-party.
In addition, they were planning to leave three days later for an Alaskan cruise to celebrate their 20th wedding anniversary.
But at about 5:30 p.m. that Saturday, something happened that would demand all of their attention. Before the night was out, they would learn firsthand what it means to have a stroke.
"When we got home, I took a nap, which I never do," said Chris Conklin. "Ever."
His memory of the ensuing hours is incomplete, but the woman who has been at his side for two decades recalls the details.
When her husband awoke, he seemed confused.
"It was almost like he was dreaming," said Colleen Conklin, a Flagler County School Board member since 2000. "Like he was still sleeping, but talking about the dream."
When she suggested that he was still dreaming, he grew irritable and insisted he wasn't sleeping.
"I asked him, 'Are you feeling OK?'" she said. "Because his behavior was just odd. And he said, 'Yes, I feel fine. There's nothing wrong with me.'"
In fact, for most of the rest of the evening Chris remained argumentative, which wasn't normal for him. (A doctor would later explain that it's not unusual for stroke sufferers to exhibit a personality change.) His condition deteriorated before her eyes. His movements grew awkward and he had difficulty dressing. When he reached out to pick up his eyeglasses, he couldn't quite connect with them. Grasping them at last, he looked at them as though he didn't know what they were for.
"I asked him to look up at me, and that's when I saw that his face—just very slightly—his smile was just a little off," she recalled. "I said, 'I think you're having a stroke.'"
Her guess turned out to be correct, but the experience was not what she would have expected.
"I thought a stroke was like an event," Colleen Conklin said. "Like, boom, it happens. All of a sudden your face is sloped and slanted and you can't speak, or you fall down. It was nothing like that. It was this slow and gradual process."
In fact, her husband doesn't have any obvious health risks that a layman might associate with stroke. There's no family history of it that he knows of and at 49 years old he's not overweight, not a smoker and gets plenty of exercise with his painting and pressure-washing business. His lone health concern is high blood pressure.
Over Chris Conklin's objections, his wife and two teenage sons took him to the emergency room at Florida Hospital Flagler. Though the Conklins went by car, the ER doctor who treated Chris Conklin pointed out an advantage to calling an ambulance: paramedics can call ahead and help hospital staff prepare.
"So we're already aware of any symptoms before they arrive," said Dr. Paul Jarczyk.
Jarczyk said that going to the ER should not be a source of embarrassment. If the situation turns out to be serious, as it was in Chris Conklin's case, losing time could mean missing a critical window for treatment.
When they arrived at the crowded ER, Colleen Conklin ignored her husband's objections and went to the front desk to explain what was happening. Things moved quickly after that, but because the nurse was calm and worked efficiently, Chris Conklin's worried spouse did not become alarmed.
"She was amazing," Colleen Conklin said of the nurse.
After some preliminary steps, hospital staff wheeled her husband into a room and brought in a large screen so that the neurologist could conduct tests remotely with the aid of an on-site therapist.
Teleneurology allows faster response from a neurologist, who might otherwise have to be summoned to the hospital. Critical time could therefore be lost. An alternative strategy could involve bringing an intensivist from the ICU to offer input.
By this time, Chris Conklin had lost strength along his left side as well as his left peripheral vision. He performed some hand-eye coordination tests and was asked to identify images or words on flash cards.
"He couldn't identify a palm tree," his wife said, her voice cracking at the memory.
That's when the neurologist said her husband was in the process of having a stroke—and they had an immediate decision to make.
The doctor told them about tPA, which stands for tissue plasminogen activator, the only FDA-approved treatment for ischemic strokes. It breaks up blood clots but must be administered within three to four hours from the start of first symptoms.
The Conklins were now three-and-a-half hours into the stroke.
But, as a major blood thinner, there was a risk. The neurologist told them that there was a 6 percent chance that the patient could bleed out and die.
Initially, Chris Conklin refused to have the injection. However, at his wife's insistence, he finally agreed.
"But they weren't kidding," Colleen Conklin said. "He started bleeding, you know, if he had a little scab or a little nick from shaving."
She credits the tPA with saving her husband's life.
He was taken to the intensive care unit, where he would be given a CAT scan and MRI to determine if there had been any permanent damage. The good news came back Monday: No damage.
Throughout the ordeal, Chris Conklin insisted that he and Colleen would not miss their Alaskan cruise. Now, though his blood pressure and glucose levels were fluctuating, improvements over the previous day and the positive MRI results renewed his determination.
It wasn't a popular idea among staff members but his brother, who is a doctor, said the cruise might help him relax. Not going, however, might boost his blood pressure.
So that day, with Chris Conklin's health on the mend and his business in the capable hands of his crew, the couple left for Orlando and their flight to Alaska.
Having so recently come through such an ordeal, they discovered a new appreciation for their anniversary cruise.
"It was magic," Colleen Conklin said. "It was an awesome trip."
Today, Chris Conklin is on the mend and undergoing regular physical therapy. The couple praises the doctors, nurses and staff of the hospital, calling them "amazing."
Looking back over their experience, Colleen Conklin encourages people to get to the emergency room whenever there are symptoms of a stroke.
"They know what they're doing here," she said. "They know the signs and symptoms. They will get you through very, very quickly."
Her husband's advice was more succinct.
"Listen to your wife," he said.
The News-Journal, Daytona Beach, Fla.