Poster child for stroke recovery
When Detroit Lakes resident Emma Gravalin woke up and started making breakfast at her apartment in Lamplighter Manor on the morning of Aug. 17, it seemed to be the start of a summer day much like any other.
It turned out to be anything but an ordinary day for the 87-year-old.
"I was over in the kitchen putting some bread in the toaster when my knees went out and down I went," she recalls, adding that she remembers the smell of burning toast in the air even now.
She tried to move, but her right side was paralyzed. She tried to speak, but no words came out.
"When I couldn't talk, I knew I was having a stroke," Gravalin says.
With her left arm, she was able to reach out to her walker and grab her medical alert button.
"I always keep it near me," Gravalin says of her walker, from which the chain containing the alert device is usually hanging (unless it's in her hand).
And now, she has even more reason to keep it close by than ever.
"It really did save my life," she says with a smile.
Though she knew she was having a stroke, she wasn't able to speak, so when the nurses came into her room, she couldn't tell them what was going on. She tried to scratch out the letters "S-T-R-O-K-E" on a nearby scratch pad, but the closest she could manage was a barely legible "STOKE."
The nurses were able to contact her daughter, however, and she said to call the ambulance immediately -- "so they did," Gravalin said.
"I went to the emergency room at (Essentia Health) St. Mary's hospital," she said.
An initial medical scan confirmed Gravalin's belief that she had suffered a stroke, due to a blockage in her carotid artery. This medical condition, known as an ischemic stroke, is precisely the type that responds to the relatively new clot-busting medication known as "tissue plasminogen activator," or TPA.
Knowing that time was of the essence, ER personnel at Essentia Health St. Mary's immediately called in an ambulance crew to transport Gravalin to Sanford Health in Fargo.
"I was awake in the ambulance all the way to Fargo," Gravalin recalls.
Throughout the trip, she was receiving the drug TPA via an IV drip.
"I got there (to Sanford) and they took a picture of my brain -- I don't remember much after that," Gravalin said.
According to her physician at Sanford, Dr. Cory Teigen, they did a specialized type of scan known as a CT profusion scan.
That initial scan showed the TPA had not had the intended effect.
"The problem for Emma is that she received the drug and didn't actually get any better," Teigen said.
"My brain was half dead," Gravalin said.
But the scan also showed that, despite the fact that Gravalin had suffered the stroke more than four hours earlier, the brain tissue in the damaged area was still alive.
"The CT profusion scan lets us see what part of the brain is already dead, and what part of it is still alive and can be saved if the clot is removed," Dr. Teigen said.
"If it's still alive, obviously we want to get that clot out of there so her brain will survive."
Conversely, however, if the tissue is already dead, there is a danger of causing further bleeding of the blood vessel into the brain, which would "make a bad situation even worse," Teigen said.
"That's why this scan is so important."
Fortunately, the scan showed that the tissue in the affected area of Gravalin's brain was still very much alive -- but the clot blocking blood flow to her brain was quite large.
Teigen also discovered that there was "a very tight narrowing of the carotid artery in her neck. That's where the clot formed."
The first step in dissolving the clot involved inserting a specialized tube known as the Penumbra Thrombectomy Catheter (PTC) in the artery near her groin and running it all the way up through her body to the carotid artery.
"Once I got the tube in there, I was essentially able to suck the clot right out of there," Teigen said.
But because of the narrowing of the blood vessel in the area around the clot, Dr. Teigen also had to put in a stint and a balloon to stretch out the area for better blood flow, thus preventing another clot from forming there and causing another stroke.
Dr. Teigen said Gravalin would also have to have regular follow-up visits with him for the remainder of her life, to make sure that the blood flow to and from her brain continues to be strong, and no further clotting has occurred.
"Emma's pretty lucky she got to the emergency room as quickly as she did," he said.
If she hadn't, the damaged area of her brain might have died from lack of oxygen -- which is when the temporary loss of function caused by a stroke essentially becomes permanent.
"She's completely back to normal, which for an 87-year-old, is pretty dramatic," Teigen says. "She's one of our American Heart Association poster women for treatment of a stroke. I've seen her three times in the last month, and she continues to do really well."
Like Dr. Teigen, Gravalin attributes her full recovery -- she says she feels no lasting effects --to the quick action of the Sanford Health staff.
"I had my stroke at 7 a.m., and it was maybe 10:30 when I got to Fargo," she says. "The stroke team was all set up because the ambulance driver called to let them know we were coming. Everything went like clockwork. They had me in my room at the ICU by 11 a.m."
Eventually, she said, "my mind came back."
Well, except for her old skill at her favorite card game, pinochle.
"Emma told me her pinochle game isn't quite back where it used to be," Teigen said.
His advice? "Find an older partner," he joked.
Overall, Gravalin said, the Sanford staff is amazed at how well she's doing now, "because I was so close to dying."
Her recovery has been so complete that it has garnered quite a bit of media attention.
"I'm a celebrity," she said with a laugh.
Indeed, Gravalin has been interviewed by television and newspaper reporters (a TV news spot on Channel 4 is expected to air later this month), her story was featured on the home page of Sanford Health's website for the month of January, and "I've gone to the stroke support group meetings and told them my story.
"I've been busy, being a celebrity," she said. "My kids call me the Queen -- they love to tease me."
Gravalin, who will be 88 on March 2, has six children, 12 grandchildren and 11 great grandchildren, most of who live nearby.
"I know I'm very fortunate," she says. "I think I'm doing all right now. I've never had any headaches or anything from it (the stroke)."
It didn't take more than a short stay at nearby Emmanuel Nursing Home (also part of Ecumen-Detroit Lakes) before Gravalin was back to playing cards and socializing with her friends at Lamplighter Manor, which she has called home for the past eight years.
"I don't need a lot of help, but it's nice to know I have it just in case," she says.
Follow Detroit Lakes Newspapers reporter Vicki Gerdes on Twitter at @VickiLGerdes.