Judith Betten's Story

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Swedish TeleStroke Program

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“I needed my arms and legs to take care of my clients.”

Something wasn’t quite right as she drove home from the store, but 58-year-old Judith Betten couldn’t put her finger on what was wrong. She always drove with two hands on the steering wheel, especially when driving up the winding road she and her neighbors nicknamed snake road. Why, then, was her left hand resting limply on her thigh? Why did she hit the curb when she turned onto her street? And, why did she fall when she got out of her car? Nothing was registering, except for the vague knowledge that various parts of her body weren’t working.

Instead of lying down, which is what Judith really wanted to do, she called Maria, a good friend and registered nurse. Without hesitation, Maria told Judith to hang up and call a neighbor to come over immediately. Judith lives in a closely knit neighborhood in Sammamish, Wash. Within minutes, three of Judith’s neighbors arrived, took her blood pressure and called 9-1-1.

The fog in Judith’s brain kept her from understanding she was having a stroke and that people were urgently trying to save her life. Dr. Joel Wassermann and the emergency room staff at the Swedish Issaquah Emergency Department knew Judith immediately needed a neurologic evaluation to determine if she was a good candidate for tissue plasminogen activator (tPA), the clot-buster medication that can lead to significant improvement in some people if given within three hours of stroke onset.

The treatment window was closing rapidly. Even a transfer to Swedish Cherry Hill, home of Swedish’s nationally-recognized stroke program, would delay treatment. Instead, the ER staff enlisted the aid of the newest state-of-the-art technology. They rolled a TV screen in front of Judith and introduced her to two members of the stroke team at Cherry Hill — Dr. Will Berg, a neurologist, and Dennis O’Brien, a physician assistant.

“It was kind of strange to begin with,” says Judith. “But, Dr. Berg was very calm. I told him I didn’t have a headache and didn’t feel any pain. He asked me to move my arms. It was like talking with someone who was standing next to me.”

On the other side of the technology link, Berg evaluated Judith with the help of data provided by the Issaquah ER team.

“If I had only listened to a description of her exam findings,” says Dr. Berg. “I probably would not have given her tPA. The initial report was mild weakness without other significant findings. Seeing the difficulty she was having using her hand led to my decision to use tPA. Despite the relatively mild weakness, I didn’t think she would be able to continue her occupation with that degree of hand dysfunction.”

For 38 years, Judith has provided hair replacement services to cancer and alopecia patients, and to men and women who have lost their hair due to severe burns, scars or male pattern baldness.

Dr. Berg explained she had only 10 minutes left to make a decision about treatment. For someone who had never had any heart problems, but knew friends and family members who had strokes, Dr. Berg’s words where chilling.

“It wasn’t a difficult decision,” says Judith. “I needed my arms and legs to take care of my clients.”

Her dedication to her clients, her overall feisty nature and the anticipation of bringing home her new Bernese Mountain puppy, was the kind of supplementary “medicine” medical personnel often hope for.

“I was so fortunate,” says Judith. “I received excellent care at Issaquah and had the added benefit of being diagnosed by experts at Cherry Hill. When Dr. Berg and Dennis first visited me in the Cherry Hill ICU, I felt as if I already knew them because I had talked with them through the TV monitor.”

Judith was indeed fortunate. Every passing minute for a stroke victim means greater risk, less success and a higher complication rate. Through the technology of stroke telemedicine, Judith had immediate access to a subspecialist who could quickly evaluate her condition and recommend the best treatment, even though they were physically separated. In Issaquah, Dr. Wassermann was able to collaborate with Cherry Hill stroke team specialists and administer the life-saving clot-buster medication.

The three-hour window didn’t close for Judith. Today she is as strong as ever and continues to care for the clients who depend on her.

Progress update

Judith responded very well to tPA and did not require ongoing physical therapy after discharge. Her medications include simvastatin, lisinopril and aspirin. Dr. Berg also prescribed Chantix to help her stop tobacco use and endorsed her efforts to lose weight.

According to Dr. Berg, it is not unusual to see patients lose weight and stop smoking after a stroke. Unfortunately, after a few months many fall back into their same bad habits. To reduce risk of future strokes and heart disease, these lifestyle changes must be permanent.