Advertisement John Schroeter, of Stoughton, left the hospital five days after his stroke. He promptly returned to work and the golf course.
Horne didn't get to a major hospital until almost eight hours after her stroke started — too late to prevent most damage.
Schroeter received a clot-busting drug in less than three hours, which restored the speech and movement he had lost.
Hospitals and emergency medical services in the Madison area and around Wisconsin are trying to improve stroke care so more patients end up like Schroeter and fewer like Horne.
Just as the medical system has sped up its response to heart attacks in recent years, doctors are trying to shave off precious minutes when treating strokes — blocks in blood flow to the brain, usually caused by clots. Strokes are sometimes called "brain attacks."
"We're trying to create the same kind of coordinated network of care for stroke patients as we have for heart-attack patients, so every patient gets to the right place at the right time," said Dana Richardson, vice president for quality at the Wisconsin Hospital Association.
It's not an easy task, said Dr. Justin Sattin, a neurologist at UW Hospital who specializes in strokes.
He said strokes aren't as well known as heart disease, even though both have the same underlying cause: a build up of plaque in the arteries.
Unlike a heart attack's trademark chest pain, stroke symptoms — numbness, dizziness, slurred speech, blurry vision — are diffuse and can signal other conditions.
For heart attacks, angioplasty and open-heart surgery have long been available. But while some new procedures are being introduced for strokes, just one treatment has been fully approved — a drug called tPA, which generally must be given within three hours after symptoms begin because it can otherwise cause bleeding.
"It's been slow in coming for stroke," Sattin said.
All aspects of care
The Wisconsin Stroke Committee, a coalition of health organizations, was created in 2004 to improve stroke care.
Dr. Jacqueline Carter, chair of the committee, said the group focuses on all aspects of care, from ambulances and emergency rooms to rehab and occupational therapy.
Some hospitals are seeking certification for their stroke programs from the Joint Commission, the country's health-care accreditation organization.
The recognition, first offered five years ago, means hospitals follow certain procedures — such as assessing whether stroke patients can swallow before giving them food and prescribing blood thinners to prevent future strokes.
St. Mary's Hospital was certified in October and UW Hospital in May. Meriter Hospital plans to apply this fall, said Petra Olsen, whose position as organizer of the hospital's stroke program was created in November.
At St. Mary's, the certification process helped standardize care for patients who arrive too late to receive tPA, said Jo Goffinet, coordinator of the hospital's stroke program.
Goffinet said the patients' temperature, blood pressure and blood sugar levels are closely monitored to minimize swelling in the brain that can exacerbate stroke damage. "Before, that wasn't always the case," she said.
Rural hospitals
Late last year, the hospital association launched the Rural Hospital Stroke Improvement Project. It is helping 19 small hospitals train staff and better define when they should treat patients and when they should transport them to larger hospitals, said Richardson, of the hospital association.
Paramedics are also helping to streamline stroke care, said Dr. Paul Stiegler, medical director of Dane County's Emergency Medical Services.
The rescue workers are performing a rapid test on each patient who has possible stroke symptoms. In the test, called the Cincinatti Stroke Scale, patients are asked to speak, smile and hold up their arms. Slurred speech, a droop on one side of the mouth or a numb or unsteady arm indicate a likely stroke.
While transporting the patients, paramedics report positive test results to the emergency room, where doctors can ready a CT scanner and prepare tPA if it's within the three-hour window.
New procedures
At UW Hospital, new procedures for stroke are being performed and experimental treatments are being studied, said Sattin, the neurologist.
If patients arrive too late to receive tPA intravenously — the typical route — the drug can still be administered directly in the brain if it's within six hours of the onset of a stroke. Doctors snake a catheter up a series of arteries and release the drug near the clot.
Two devices, also deployed with a catheter, can be used up to eight hours after stroke symptoms begin, Sattin said.
One device sucks blood from a clot. The other, shaped like a corkscrew, pulls out a clot like a cork from a wine bottle.
"We're putting our tool box right at the site of the stroke," Sattin said.
Benefits of quick care
Horne, 67, like most stroke patients, didn't get to a tPA-administering hospital quickly enough to receive the drug.
Minutes after her stroke began four years ago, her husband drove her to Divine Savior Hospital in Portage. She wasn't transferred to St. Mary's for several hours, she said.
Horne praised the care she received at St. Mary's and her rehab programs at Meriter and Divine Savior. But it took months of hard work just to walk again.
"One minute you're a vibrant, active person, and the next minute you've lost everything," she said.
Schroeter, 58, had his stroke this January. As he was going outside to blow snow, he started to tell his wife, Rose, about a cable television worker who had come to their house.
His words came out as gibberish. The left side of his mouth drooped. Soon, the entire left side of his body was numb.
"You're having a stroke, and I'm calling 911," Rose recalled saying.
A sheriff's deputy arrived with an oxygen mask, and an ambulance whisked Schroeter to Meriter. After a CT scan, he received tPA — just minutes before the three-hour window expired.
His story is such a good example of what should happen when a stroke occurs, Meriter has featured him in a recent ad campaign.
"Any delay at all, and who knows what I'd be like today," he said.
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