comprehensive strok e center * status … stroke center status report. ... expertise and...

COMPREHENSIVE

CENTER • STATUS REPORT

750 EAST ADAMS STREET I SYRACUSE, NY I WWW.UPSTATE.EDU/STROKE

STROKE

COMPREHENSIVE

CENTER • STATUS REPORTSTROKE

UPSTATE UNIVERSITY HOSPITAL- COMPREHENSIVE STROKE CENTER

TABLE OF CONTENTS

A Letter from our Stroke Director . . . . . . . . . 1

About our Stroke Center . . . . . . . . . . . . . . 2 - 3

Our Numbers . . . . . . . . . . . . . . . . . . . . . . . . 4 - 5

Reducing The Burden of Stroke . . . . . . . . . . . 6

Emergency Neurological Life Support . . . . 7

Support To The Region . . . . . . . . . . . . . . . 8 - 9

Our Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

We Serve Our Community. . . . . . . . . . . . . . . 11

Data Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

A Patient’s Story: Joan . . . . . . . . . . . . . . . . . . 13

Newest Stroke Team Members . . . . 14 - 15

Upstate’s Stroke Neurologists . . . . . . . . . . . 16

A Patient’s Story: Kyle . . . . . . . . . . . . . . . . . . . 17

STATUS REPORT 1

Dear Central New York,

We are pleased to present the UpstateComprehensive Stroke Center Status Report. Thisreport will highlight our achievements in patientcare, quality and clinical expertise.

In 2015, Central New Yorkers had one less thing toworry about – where to go if they or their loved oneshould suffer a stroke. That year, through the effortof the largest neuroscience team in the region andhundreds of hospital staff, Upstate UniversityHospital became the first and only Level 1Comprehensive Stroke Center in the region, thehighest level of stroke certification available. Whatthis means to our community is that stroke patientshave access to a team of stoke physicians with theclinical expertise to care for the most complicatedof stroke patients. This clinical expertise allows us toprovide the highest quality of stroke care.

Since our Comprehensive Stroke Center Designation,our program has continued to expand with threemain goals:

Goal 1: To continue to provide the highest qualityand most comprehensive care to stroke patients.

Goal 2: To reduce the stroke burden in CentralNew York using multiple approaches includingcommunity education, community awarenesscampaign, and community engagement in strokeand cardiovascular disease activities.

Goal 3: To support health care providers all overCentral New York by holding provider conferencestargeting local neurologists, emergency physicians,family doctors and other health care providers onstroke management; and by providing emergencysupport/consultation using advanced technolo-gies such as a telestroke system so thattime-sensitive intervention can be done regardlessof patient location.

We are proud to share our achievements and goalswith you and hope that you find the information inthis report beneficial. The Comprehensive StrokeCenter at Upstate University Hospital continues tofocus on the quality of our stroke care and remainscommitted to the region and our communities.

Sincerely,

Julius Gene Latorre, MD, MPH

Medical Director,

Upstate Comprehensive Stroke Program

OUR GOALS FORSTROKE CARE

Upstate developsdedicated Neuro-Inten-sive Care Unit, makingit one of the firstNeuro-ICUs in the US

1970’SFDA approvedAlteplase, the firstdrug proven totreat AcuteIschemic Stroke

1995Upstate telestrokenetwork begins toreach out tocommunity hospitalsto provide expertiseand assistance to localproviders for acutestroke treatment

2007Upstate receives BronzePerformance Award fromAmerican Heart/StrokeAssociation forconsistently providinghigh quality patient care

2008Upstate became thefirst NY StateDepartment ofHealth DesignatedPrimary Stroke Centerin Central New York

2006Upstate receives SilverPerformance Award fromAHA/ASA for consistentlyproviding high quality ofstroke care for at least 12consecutive months

2009Upstate becomesthe first hospitalin New York Stateto achievecertification as aDNV primaryStroke Center

2010

UPSTATE STROKE PROGRAM:YEARS OF EXPERIENCE FOR BETTER CARE

2 UPSTATE UNIVERSITY HOSPITAL- COMPREHENSIVE STROKE CENTER

Upstate's Comprehensive Stroke Centeris embedded within the framework of along history of dedicated service to theneuroscience patient. Our NeurosurgeryDepartment received its start largelythrough the efforts of a pioneeringneurosurgeon, Robert King, MD. Dr.King, an internationally renownedneuro-surgeon was the first chair of theneurosurgery department founded in1966 and served until 1988. During histenure, he established a seven-year resi-dency program with a two-year benchresearch component, one of the first inthe country. Many neurosurgery resi-dency programs followed suit, addingresearch years to their residency,enhancing the evidence for the care ofpatients with neurological insult anddisease. In the 1970s, Dr. King estab-lished the first Neurosurgical ICU in NYState with seven dedicated beds and a21-bed neurosurgical unit. In 1996, theNeurosurgical ICU became the Neuro-science ICU and relocated to the new

East Wing of the hospital and the Neuro-science Intermediate Care Unit wasestablished, increasing the number ofbeds devoted to neuroscience patients.

Stroke Leadership

The beginning of the ComprehensiveStroke Center can be traced to thecombined efforts of the community andmany dedicated staff. In 2003,Onondaga County had the secondhighest mortality rate in NY State andhad no standardized stroke care in thecommunity. Dr. Satish Krishnamurthyagreed to chair the newly created CNYRegional Stroke Task Force aimed atstandardizing the response to and treat-ment of stroke in the Syracusecommunity. In 2006, Upstate becamethe first area hospital to mobilize itsstroke response team and earn NYSDepartment of Health designation as aPrimary Stroke Center. This led to theDepartment of Health designatingUpstate as a Telemedicine Hub hospital.

First for Therapies

In 2008, the Neurocritical Care Servicewas established under the leadership ofDr. Gene Latorre, and a fellowshipprogram followed soon after. With theadvent of the Neurocritical Care Service,the Neuroscience ICU increased its useand expertise with cutting edge tech-nologies and treatments. Upstatebecame the first area hospital in 2008 toimplement Therapeutic Hypothermiaand Normothermia to preserve brainfunction after insult. These therapiescontinue to be used to preserve brainfunction after neurological insult for thearea's most complex neurologicalpatients and post-cardiac arrest patients.During this year, the use of brain tissueoxygenation monitoring via Licox andadvanced intracranial pressure moni-toring using fiber optic devicesexpanded, as did the use of seizuremonitoring, first begun in the 1990s. Allof these aforementioned therapies are

A Histery of Growth

Upstate received theGold Plus PerformanceAward from AHA/ ASAfor consistentlyproviding the highestquality of stroke carefor at least 12consecutive months

2011Upstate receives GoldPlus Performance Awardfrom AHA/ASA for twoconsecutive years

2012Upstate receives GoldPlus PerformanceAward for third yearand Target StrokeHonor Roll status forconsistently providingthrombolytic therapywithin 60 minutes

2013Upstate receives GoldPlus Performance Awardfor the fourth year andTarget Stroke honor Rollfrom AHA/ASA for twoconsecutive years

2014Upstate becomes thefirst comprehensiveStroke Center in CentralNew York and one ofsix in New York State

2015Upstate receivedaccreditation for twoconsecutive years asDNV ComprehensiveStroke Center

2016

STATUS REPORT 3

now commonplace interventions used inour care of the neuroscience patients.

In 2010 DNV awarded Upstate designationas a Primary Stroke Center adding to theDOH designation. The neuroscience unitsmoved to the new construction below theChildren's Hospital on the ninth floor,establishing 46 beds devoted to Neuro-sciences. The department continued togrow, requiring the expansion of theNeuroscience ICU from 11 beds to 14 in2013 due to the increased acuity broughtby the growth of the Neurocritical CareService.

The continued expansion of our Neurocrit-ical Care Service and the expertise andbreadth of our services led to our decisionin 2014 to validate our expertise by invitingDNV to evaluate our program for certifica-tion as a Comprehensive Stroke Center. Wewere awarded this designation in January2015 and completed our reevaluation assuch with DNV in January of 2016.

Expertise for Patients

Upstate has the combined expertise andbreadth of services that only an academicmedical center can provide. Our EmergencyDepartment personnel receives specialtytraining in stroke. Our team providesmedian door-to-tPA times that exceednational standards. Specialty trained nursesin neuro critical care respond to the ED toassist in the care of these patients. OurNeuroendovascular Service uses a multi-disciplinary approach that includes theexpertise and collaboration of neurology,neurosurgery and radiology, bringing clotbusting therapies and treatments that arestate of the art for the care of ischemicstroke patients and the repair of aneurysmsand other causes of hemorrhagic strokes.Most importantly, Upstate has the expertiseto care for these patients after theselifesaving procedures, and all along thespectrum of care that is needed. We havethree dedicated nursing units with threelevels of care: Neurosciences Medical-

Surgical Unit, Neuroscience IntermediateStep-Down Care Unit, and the NeuroscienceICU. The nurses on these units, many ofwhom are certified in Neuroscience Nursingand in Stroke, receive specialized training inthe care of neuroscience and strokepatients. Our hospital-level rehabilitationprogram, the only one regionally, providescomprehensive rehabilitation services andmedical management to our stroke patientsand is a large part of our ComprehensiveStroke Center's team. Our patients are ableto continue in our Outpatient RehabilitationStroke Program once discharged from thehospital or inpatient rehabilitation unit.

Our interdisciplinary team is the largestteam dedicated to the brain in Central NewYork. Our rich history, combined expertiseand breadth of services are what earnedUpstate its Comprehensive Stroke Centerdesignation. We are honored to care for ourregion's stroke patients and are committedto providing and improving the care andlives of our community.

AHA/ASA Gold PlusPerformance AwardTarget: Stroke HonorRoll Elite Plus

2016


GOAL #1QUALITY: VOLUME

Upstate treats more stroke patients than any otherhospital in Central New York Upstate Hospital A Hospital BAcute Ischemic Stroke 377 377 121Transient Ischemic Attack 64 25 33Intracerebral Hemorrhage 108 63 20Subarachnoid Hemorrhage 36 17 1(Source: Hospital Executive Council Jan.-Sept. 2015)

Upstate Stroke Patient Volume 2013 - 2015 2013 2014 2015Total Suspected Stroke admissions N/A 1381 1395Acute Ischemic Stroke 556 486 510Transient Ischemic Attack 149 97 144Intracerebral Hemorrhage 132 116 127Subarachnoid Hemorrhage 70 57 44

Upstate performs more routine and complex neuroendovascularprocedures than any other hospital in Central New York

Year Mechanical Coiling SAH Embo Unruptured Stenting2006 1 37 21 31 162007 35 40 27 41 282008 27 59 20 69 192009 36 33 35 36 312010 29 46 53 36 452011 25 36 31 37 602012 54 40 53 48 382013 51 39 39 37 452014 41 32 25 24 432015 37 25 11 18 13

Upstate performs more acute stroke interventionsincluding intravenous tPA and mechanical thrombectomies than any other hospitals in

Central New York. Upstate also has one of the highest acute stroke treatment rates in

the country (National Average = 6%, Academic center average = 15%)

Year IV-TPA <45 min <60 min Mech Any Recanalization thromb Recanalization Treatment rate2013 45 0 81.1% 47 109 19.6%2014 58 41.2% 100% 41 95 19.5%2015 72 67.4% 100% 37 94 18.7%

Upstate Comprehensive Stroke CenterOffers 24/7 access to the following:

• 23 neurologists

• 4 board-certified strokeneurologists

• 3 on-site neurosurgeons

• 3 endovascular interventionalists

• 2 neuro-intensivists

• 8 neurorehabilitationspecialist/physiatrists

• Approximately 150 nurses whohave special training in the care ofneurological patients, some ofwhom have dual certification instroke and neuroscience.

• An entire hospital floor dedicated tobrain care with three levels ofspecialized care: NeuroscienceIntensive Care Unit; SpecializedNeuroscience Unit; andNeuroscience Step-Down Unit.

Upstate offers: complete treatment for acute stroke and the highest quality care

STATUS REPORT 5

Median Time Door ToNeurologist Evaluation

By having a neurologist in the ED at all

times, stroke patients are evaluated

immediately for the best care possible.

Upstate has doubled the speed to

evaluation.

Median Time Door To CT:from arrival to start

of CT

With new protocols

in place, patients are

getting to CT

quicker, so that they

can get tPA quicker.

Median Time to tPA:

TIME IS BRAIN


OUR MISSIONReducing the burden of stroke throughCommunity education and publicawareness campaigns

• Treatment

Working in partnership with the patient, Upstate’sstroke program provides appropriate, timely andconsistent standards of neurological services ofthe highest competence achievable and that iscentered around the needs of the patient.

• Prevention and Education

Educating communities, patients and familiesabout prevention strategies and the challengesstroke can cause

• Support

Providing support and assistance to families,friends and survivors of stroke

Providing consultation to outlying hospitals inthe diagnosis and care of stroke patients

• Research

Searching for new knowledge, innovativetechniques and technologies related to stroke

GOAL #2REDUCING THE BURDENOF STROKE

Upstate is the only hospital in

Central New York with three levels

of specialized care just for the

brain. The specialized

Neuroscience floor includes the

Neuroscience Intensive Care and

Neuroscience step-down units. As

the area’s only Comprehensive

Stroke Center and medical

university, Upstate also offers

largest team with 24/7 board

certified stroke neurologists, on-

site neurosurgeons, specialists in

neurointerventional radiology,

neurocritical care specialists,

board certied emergency

physicians and neuro-certified

nurses.

What to do in the first criticalhour of a neurological emergencyThe ENLS course is designed to helphealthcare professionals improvepatient care and outcomes during thecritical first hours of a patient’sneurological emergency. ENLSdemonstrates a collaborative, multi-disciplinary approach and provides aconsistent set of protocols, practicalchecklists, decision points, andsuggested communication to useduring patient management.

ENLS benefits to participants:

• Advanced knowledge toparticipants

• Improved patient care andoutcomes

• Current information onadvancements in treatment

• A select set of topics directlyrelevant to neurocritical care

MDs, critical care nurses, and otherprofessionals who treat neurologicalemergencies benefit from ENLS's in-depth presentations of 13 criticaltopics including Ischemic Stroke,Subarachnoid Hemorrhage, TraumaticBrain Injury, and IntracranialHypertension and Herniation.

Instructors: Neurocritical CarePhysicians, Dr. Latorre & Dr. El Nour

Classes are held at: UpstateUniversity Hospital DowntownCampus, Syracuse NY

Classes are for MDs, PAs, NPs, Nursesand EMS Providers.

For information on classes and toregister email [email protected]

Dr. Latorre is a neurologist specializing

in the care of patients with all types of

stroke, both ischemic and

hemorrhagic. He also is a

specialist in critical care

neurology, caring for complex

and refractory seizure requiring

intensive care and all forms of

traumatic brain injuries. He

obtained his medical degree at

the University of the East-RMMC

in the Philippines and finished his

neurology training at Upstate Medical

University. He obtained his specialty

training in stroke and critical care

neurology at Massachussets General

Hospital/Brigham and Women’s

Hospital/Harvard Medical School in

Boston, MA, before joining the

Department of Neurology at Upstate in

2007. He is a diplomate and an active

member of the Neurocritical Care

Society. He was one of the first

physicians to have Emergency

Neurological Life Support (ENLS)

certificiation and has been an instructor

in the ENLS live course since 2014.

Dr. El Nour is a board certified

Neuro-intensivist specializing in

treating critical, acute, and

emergency neurological

disorders including ischemic and

all kind of hemorrhagic stroke.

He finished his residency

training in Internal medicine at

Mount Sinai School of Medicine and

completed his neuro-critical care training

at Upstate Medical University. He is a

diplomate of medicine and a member of

American Academy of Neurology, a

member of the Neuro Critical Care

Society and has been an ENLS trainer

since 2013.

ENLS: EMERGENCY NEUROLOGICAL LIFE SUPPORT

STATUS REPORT 7


GOAL #3PROVIDE SUPPORT TO THE REGION

Telemedicine: Because Time Is Brain

Rapid evaluation and treatment of patients isthe best way to minimize long term effects ofstroke. The Upstate Stroke Center uses state-of-the-art-technology to provide immediateaccess to advanced stroke care. Our StrokeTelemedicine Program supplies the expertiseand resources of board certified neurologiststo the region’s affiliated community hospitals24 hours a day, seven days a week.

Telemedicine allows a neurologist to performan exam on stroke patients and quickly decideif they are a candidate for time sensitivetreatment such as the clot buster drug, tissueplasminogen activator (tPA), which can helpsave brain cells and decrease chance ofdisability related to stroke. If the patient is noteligible for tPA via an IV line, the patient can betransferred for more advanced therapies suchas clot retrieval, interarterial tPA, or advancedneurosurgery.

Benefits to Participating Hospitals

Telemedicine Means Immediate Connectionto Stroke SpecialistsThe telemedicine program connects localproviders with stroke specialists at the UpstateComprehensive Stroke Center for a two-wayflow of information to facilitate emergencyevaluation and management of patientssuffering from acute stroke. With the increasingstroke incidence, more patients are seen incommunity hospitals. Because of thecomplexity of initial stroke evaluation, andconditions that mimic it, providers have accessto a collaborative consultation.

Timely Evaluation and Other Benefits ForPatients

The goal of the Upstate Stroke TelemedicineProgram is to improve the health of the stroke

patient. Patients will have access to urgentevaluation by our stroke experts, if a strokeexpert in your hospital is unavailable.

Patients with uncomplicated stroke may betreated locally. This avoids unnecessary transfer,which also increases patient satisfaction andallows for more convenient family visits.

Patients with acute or more complicated strokedisorders will receive immediate intervention,and intervention can continue during theprocess of transfer to higher level of care —avoiding potential gaps in provision of care asa result of geographic location.

Patients who cannot be treated with standardcare may be eligible for participation in themultiple clinical trials that are conducted at theUpstate Comprehensive Stroke Center. Thismay provide your patient with successfultreatment before it becomes available toothers.

Free Access to Leading Edge Therapiesand Training

A collaborative partnership with UpstateComprehensive Stroke Center enables acommunity hospital to provide time sensitivestroke consultation and intervention. Strokecare becomes another dimension of qualityand service provided by the hospital, furtherenhancing the hospital’s image in thecommunity as it offers innovative therapiesand can accommodate increases in servicevolume without additional capital cost,operating cost, or additional staff.

Regular and on-demand staff educationprovided by the collaboration can empowerhospital staff and care providers in taking careof uncomplicated patients on site, increasingproductivity and improving staff confidenceand work satisfaction.

Upstate’s Stroke Telemedicine Program is a community initiative of the Upstate Comprehensive Stroke Center to continuecollaborative relationships with community hospitals to provide time-sensitive stroke intervention regardless of patientlocation. There is no charge or cost to hospitals to participate and the service is free and non-binding.

Overview of the Upstate StrokeTelemedicine Program

Participants in the StrokeTelemedicine program receive:

• 24/7 stroke specialistconsultation service FORFREE;

• 24/7 transfer center supportfor patients requiringtransfer;

• Information technologysupport for enhancedpatient consultation,including but not limited toequipment needed forvideo-teleconference/consultation FOR FREE;

• Regular and on demand localstaff education/training onstroke care;

• Local hospital support forthe application to obtainprimary stroke centerdesignation;

• Local hospital support forstroke quality measurecollection and reporting.

Current Participating Hospitals:

Samaritan Medical Center

River Hospital

Carthage Area Hospital

Claxton-Hepburn MedicalCenter

STATUS REPORT 9

Upstate’s Stroke Telemedicine Program

is the first hub to provide acute stroke

care to community hospitals in the

Central NY region. Established in 2007,

the service has provided acute stroke

evaluation and treatment to more than

150 patients at five community

hospitals, with an overall intravenous

tPA rate of 9.2%. Without telemedicine,

these patients would otherwise not

have received treatment.

Primary Stroke Centers

Comprehensive StrokeCenters

Counties Served by the UpstateComprehensive Stroke Center

What is the difference between a Primary Stroke Center and a Comprehensive Stroke Center?


OUR MISSIONA COMMITMENT TO QUALITY CAREIt is the mission of our program to provide thehighest level of stroke care to the manycommunities we serve. We have a stroke team inplace that is over 300 strong, with 150 nurses in ourED, neuroscience ICU, stroke unit, neuro floor andinterventional radiology who have specialized stroketraining. Many of our nurses even hold dualcertification in neuro critical care and stroke.

As a nurse with over 20 years of critical care training,I can sincerely say that I am proud to be a memberof this team. Through time and experience withstroke patients, I can confidently say that you or yourloved one can expect a level of care at Upstate’sComprehensive Stroke Center that is unsurpassed.

We work tirelessly to not only meet nationalstandards for stroke care, but to consistently exceedthem.

We have a commitment to the communities that we serve – a commitment to provide communityeducation on stroke prevention; a commitment topartner with EMS to enhance first responder strokecare; and most of all, a commitment to our patientsand their families to continue to provide the highestquality of stroke care in this community.

Jennifer Schleier RN, BSN, CCRN

Stroke Program Manager

STATUS REPORT 11

WE SERVE OUR COMMUNITY:EDUCATION • SERVICE • VOLUNTEER

I’ve been witness to the multitude of accomplish-ments that the Upstate Stroke Team has achieved.The growth inspired me to become part of thisteam and since being in this role, I’ve come tounderstand the complexities, extreme motivationand teamwork that make Upstate’s stroke programstand above the rest.

Being the newest addition to the team, I hope tointegrate my nursing experience with the acutestroke patient in the hospital, with the post-strokepatient who is requiring continued support athome. I have gained a wealth of knowledge frommy intensive care, interventional radiology, andhome care nursing experience that I hope to sharewith my team and community.

I also plan to increase EMS pre-hospital notificationcalls, which will lead to a more rapid treatment ofthe stroke patient, in turn leading to better patientoutcomes. I will be assisting with the implementa-tion of the Telestroke programs establishing a vast

network of hospitals within a phone call away fromUpstate’s highly trained stroke physicians. The Tele-stroke program will not only provide quality care tothe residents of the North County, but assure thatthe soldiers and their families stationed at Ft. Drumwill also be given the best neurological care avail-able.

This is an exciting opportunity for me to both learnand teach, and I am excited to get out and informthe community of everything the Upstate StrokeTeam has to offer!

Joshua Onyan, RN, SCRN

Stroke Outreach Coordinator


We live in an automated world wheredata, whether we know or not, isbehind all of the things that we do andchoices that we make. Havingstandards and benchmarks allow us tomeasure our own performance andcreate goals to be even better at whatwe do. We are working through thisquality process every day, continuallyreviewing our data to ensure the bestpatient care.

As a bedside Neuro floor nurse forthe last 7 years, I was blessed to startmy nursing career here at anacademic medical center. It was thatconstant drive and overwhelmingpride that I saw in every Stroke teammember, without exception, thatpushed me to want to learn moreabout our specialty, helped me earnthe neuroscience certification innursing and into my current role ofdata coordinator.

I hope to continue to bring my ITtraining and customer supportexperience in improving our databaseand internal data collection. We willcontinue to strengthen our relationshipwith our accrediting agencies andthose who write the standards andguidelines for Stroke care.

I am thrilled to lead our StrokeCommunity Education Program. Weare eager to share our knowledge withthe hope of helping others make goodchoices should they encounter strokein their lives. Whether it is lecturing ata library or talking to a church group, Iwill pledge to all of you, if you meetone of us, you are getting our very best!

Michelle F. Vallelunga, RN, MS,

CNRN, SCRN

Stroke Data Coordinator

DATA UPDATE

STATUS REPORT 13

Syracuse, NY, May 26, 2016— It had been atypical day for Joan Izyk., 72, from Oswego.She had enjoyed a breakfast out and wasrelaxing in her living room with a coloringproject. When her husband arrived athome, she stood up to greet him in thekitchen, but she never made it there. Shecould hear her husband calling her, but wasunable to respond. Joan had suffered astroke.

“I just went down, and I could not get up, “Joan said. “I couldn’t talk, so I couldn’t yellto him. He thought it was a stroke rightaway.”

“Impaired speech is one of the symptomsoutlined in the FAST (Face, Arm,, Speech,Time) acronym,” said Josh Onyan, outreachcoordinator, Upstate ComprehensiveStroke Center. “Joan’s husband recognizedthat she was having a stroke, which helpedher get the treatment she needed quicklyand ultimately led to her positive outcome.”

FAST is an acronym to help detect signs ofstroke. F stands for facial drooping, A forarm weakness, S for speech difficulties andT for time; time is of the essence in gettingtreatment for stroke

The Stroke Team at Upstate’sComprehensive Stroke Center receivednotice that the 911 call had come in as a

possible stroke. This set the wheels inmotion immediately. Oswego Fire arrivedat Joan’s home and had her in theambulance within minutes. The EMS teamrecognized the right facial droop, rightupper extremity weakness and slurredspeech, consistent with the FASTsymptoms. Joan was rushed to UpstateUniversity Hospital.

Once at Upstate, Joan was greeted bydoctors from both the ComprehensiveStroke Center and EmergencyDepartments within five minutes of herarrival, and received her CT scan at fourminutes, 21 minutes faster than the NewYork state guidelines. The CT report fromthe radiologist was ready withinminutes, and indicated that there wasno head bleed. This allowed Joan toreceive her tPA in just 24 minutes. TheState recommendation for this treatmentis 60 minutes.

Joan underwent clot retrieval and wasresting at home just three days later, withonly mild facial weakness.

EMS providers at Oswego Fire and the teamat the Upstate Comprehensive StrokeCenter were essential to her positiveoutcome.

Joan is back home after two weeks in the

hospital. She has regular followup care in

her hometown and in Syracuse.

A PATIENT’S STORY:QUICK ACTION LEADS TO POSITIVEOUTCOME FOR STROKE PATIENT


Upstate’s new faculty members — Hesham Masoud, MD, and Grahame Gould, MD —

flank Amar Swarnkar, MD in the bi-plane angiography operating room at Upstate

University Hospital. Part of the intraoperative MRI surgical suite, surgeons can obtain 3-

Tesla MRI scans during procedures, improving patient outcomes.

Joining Upstate’s comprehensive

stroke center are two physicianswith expertise in interventional clotretrieval.

The addition of Grahame Gould, MD, andHesham Masoud, MD, strengthens the teamof professionals who provide round-the-clockstroke care at Upstate University Hospital.They join Amar Swarnkar, MD, in providingendovascular neurosurgery, includingmechanical thrombolysis. This is a crucialtherapy for patients suffering ischemicstrokes. Swiftly locating and removing a brainclot improves the patient’s odds of survivaland recovery.

Upstate’s stroke team earned “Honor Roll –Elite” status in U.S. News & World Report’sannual Best Hospitals publication for 2016.This designation is for hospitals whose door-to-needle time is less than an hour at least75 percent of the time, for at least fourconsecutive quarters. Door-to-needle timerefers to the time from a stroke patient’sarrival at the Emergency Department untilhe or she receives clot-busting tissue plas-minogen activator, or tPA, if appropriate.

Grahame Gould, a native of New Orleans,comes to Upstate from Thomas JeffersonMedical College in Philadelphia. He special-izes in endovascular and cerebrovascularneurosurgery.

His medical degree is from Yale UniversitySchool of Medicine. He was chief resident inhis 7th year of neurological surgery residencyat Yale-New Haven Hospital in Connecticut,and then he completed a fellowship inendovascular neurosurgery at ThomasJefferson.

Gould is the author of chapters in textbooksincluding “Operative Neurosurgical Tech-

niques” and “The Comprehensive Treatmentof the Aging Spine: Minimally Invasive andAdvanced Techniques” and has beenpublished in a variety of medical journals. Heand six other inventors hold a patent on anintraventricular brain-cooling catheter.

Hesham Masoud has expertise in endovas-cular surgical neuroradiology and vascularneurology. He comes to Upstate from BostonMedical Center and the Boston UniversitySchool of Medicine, where he was an assis-tant professor of neurology.

Masoud received his medical degree fromAin Shams University in Cairo. Hecompleted his internship and residency inneurology at Case Western Reserve Schoolof Medicine in Cleveland, where he wasselected to serve as chief resident his senioryear. He then went on to complete acombined fellowship in vascular neurologyand endovascular surgical neuroradiology atBoston Medical Center.

He lectures and writes about acute stroketherapy, intracranial stenting, endovascularmanagement of cerebral aneurysms,neuroimaging of intracerebral hemorrhageand other topics.

In addition to the clinical care they provide toadult patients, both physicians have facultyappointments and will be involved inresearch as well as teaching the next genera-tion of physicians and surgeons.

The presence of Gould, a neurosurgeon,Masoud, a stroke neurologist, and Swarnkar, aneuroradiologist — all three with expertise inacute stroke rescue therapy — highlights thethree-disciplinary approach to endovascularmanagement of stroke at Upstate.

WELCOME NEWEST STROKE TEAM MEMBERS

STATUS REPORT 15


Antonio Culebras, MDProfessor of Neurology

Education/TrainingMD: University of Madrid,Spain

Residency: ClevelandClinic Foundation

Fellowship: ClevelandClinic Foundation

Specialties/Certification:

NeurologySleep MedicineNeurophysiologyVascular Neurology

Treats: Adults

Treatment/Services:Acute Stroke CareCerebrovascular diseasesSleep disordersSleep ApneaNarcolepsyParasomniasSleep studiesEEGTissue plasminogenactivator treatment

Hesham Masoud, MDAssistant Professor ofNeurology, Neurosurgeryand Radiology

Education/TrainingMD: Ain Shams University,Egypt

Residency: Case WesternReserve University SOM,OH

Fellowship: BostonMedical Center, MA

Specialties/Certification:NeurologyVascular NeurologyEndovascularNeuroradiology

Treats: Adults

Treatment/Services:Acute Stroke InterventionAcute Stroke CareCerebrovascular diseasesTissue plasminogenactivator treatmentCarotid stenosisIntracranialatherosclerosisBrain aneurysmHead and neck tumorembolizationCerebral vasospasmWADA testCerebral angiogramMechanicalthrombectomy for stroke

Carmen Martinez, MDAssistant Professor ofNeurology

Education/TrainingMD: Universidad Libre deColombia, Colombia

Residency: New YorkMedical College, NY

Fellowship: AlbertEinstein/MontefioreMedical Center, NY

Specialties/Certification:NeurologyVascular Neurology

Treats: Adults

Treatment/Services:Acute Stroke CareCerebrovascular diseasesTissue plasminogenactivator treatment

Elwaleed Elnour, MDAssistant Professor ofNeurology andNeurosurgery

Education/TrainingMD: OmdurmanUniversity, Sudan

Residency: Mount SinaiHospital, NY

Fellowship: SUNYUpstate, NY

Specialties/Certification:Internal MedicineVascular NeurologyNeurocritical Care

Treats: Adults

Treatment/Services:Acute Stroke CareCerebrovascular diseasesTissue plasminogenactivator treatmentNeurocritical careIntracranial hemorrhageSubarachnoidhemorrhageStatus epilepticusMyasthenia gravisGuillain-Barre SyndromeTraumatic brain injuryTraumatic spinal cordinjuryTherapeutic HypothermiaAnoxic brain injuryCNS infectionMultimodalityNeuromonitoring

Julius Gene Latorre,MD, MPHAssociate Professor ofNeurology andNeurosurgery

Education/TrainingMD: University of the East,Philippines

Residency: SUNY Upstate,NY

Fellowship: SUNYUpstate, NYMGH/BWH/Harvard SOM,MA

Specialties/Certification:NeurologyVascular NeurologyNeurophysiologyNeurocritical Care

Treats: Adults

Acute Stroke CareCerebrovascular diseasesTissue plasminogenactivator treatmentNeurocritical careIntracranial hemorrhageSubarachnoidhemorrhageStatus epilepticusMyasthenia gravisGuillain-Barre SyndromeTraumatic brain injuryTraumatic spinal cordinjuryTherapeutic HypothermiaAnoxic brain injuryCNS infectionMultimodalityNeuromonitoring

MEET UPSTATES STROKENEUROLOGISTS

Months after dragging himself across ahotel room floor to phone for help, KyleReger, 41, has diligently worked his waytoward recovery from a stroke.

That meant weeks in a hospital bed,months of rehabilitation and —particularly hard for a lifelong athlete andrunner who has finished marathons —having to depend on others for things likecar rides as he struggled to regain the useof his left side.

Throughout his recovery, Reger wasbolstered by the support of his family andfriends, his hometown of Cazenovia andhis employer, and he learned a newappreciation for the little things, like beingable to pick up and use a pepper shaker.

Further, some long-awaited good newsarrived during his rehabilitation. Reger andhis wife, Marla Velky-Reger, were told thattheir son Max, a first-grader, is nowconsidered cancer free.

Reger, who travels the Northeast for hissales job, was alone in a Massachusettshotel room on Sept. 4 when he awoke witha calf cramp in the wee hours of themorning. He had run the night before.

“I remember trying to flex my toe, toprevent it from continuing, and I couldn’tflex my toe, and I just thought it was odd,”Reger said. Then he noticed his left side feltasleep, and he tried to jump out of bed toshake it out but crashed onto the floorinstead.

It finally dawned on him: He was having astroke.

He managed to drag himself to the phoneand call for help.

He was admitted to Springfield’s BaystateMedical Center, with a bleed in his brain, ahemorrhagic stroke. Six days later, he wastransferred to Upstate University Hospitalin Syracuse, where he stayed about threeweeks.

“I don’t think I could move anything whenI arrived at Upstate,” he says, but in themonths of outpatient rehabilitation thatfollowed – working with parallel bars, bikesand other equipment – he has beenrelearning how to use his left hand, armand leg.

From the thrill of watching his thumbmove a tiny bit to walking (at first with acane) to being able to drive a car again inFebruary, he estimates his abilities havecome back about 90 percent, enough toplay the piano.

His doctors concur.

“Having a positive attitude and an activelifestyle prior to his stroke have certainlyhelped him progress,” says ShernazHurlong, DO, the physician overseeingReger’s rehabilitation.

“He made an excellent recovery in partbecause of his good health and excellentattitude, but also because he receivedexpert care at the hospitals he was takento. This gave his brain the best possiblechance to heal itself. He’s well on his wayto a full recovery,” agrees Lawrence Chin,MD, Upstate’s chairman of neurosurgery.Reger’s stroke resolved itself and did notrequire surgery.

Friends, neighbors and former collegesoccer teammates held fundraisers todefray his medical costs, brought meals,drove him to appointments and cheeredhim on.

His company hired a retiree to help coverhis job, and Reger returned to work parttime in December, then full time inFebruary. Being able to drive again was “ahuge gain to my mental health” he says,both restoring his independence andability to work and relieving some of thestrain on his wife.

The couple has two sons, Jackson, 3, andMax, 7, who was diagnosed with Wilms’tumor, a kidney cancer, at 16 months andunderwent chemotherapy, the removal ofa kidney and radiation treatments. Maxrecently achieved “survivor” status,meaning he has been free of cancer for fiveyears.

Max ran the Chilly Chili 5K, a January racein Cazenovia, then returned to walk theroute alongside his father, who wasdetermined to finish the course, and did.

Reger hopes to be able to run again by theend of summer and to do a marathonagain someday. He also considers himselfblessed for the support and insights hisstroke revealed.

A PATIENT’S STORY:HELPING A RUNNER REGAIN HIS FOOTING AFTER STROKE

Physical therapist Daisy Sandbek works with

Reger in University Hospital’s Rehabilitation

Center last September.

STATUS REPORT 17

comprehensive strok e center * status … stroke center status report. ... expertise and...

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