ON CANADA DAY 2011, Robert Fitzgibbon held onto life by a thread. While other families frolicked in the sunshine, enjoying a national holiday, Robert underwent a delicate procedure at Sunnybrook while his daughter Joy paced the halls.
The surgery – which went well and, by all accounts, saved Robert's life – was a carotid endarterectomy. It was needed to remove a large blockage in his left carotid artery, the major supply of blood flow to the brain. While the operation itself is a minor miracle, the detective work involved in figuring out that Robert needed this life-saving surgery is a modern medical marvel.
The joy of Robert's story is that astute doctors in Sunnybrook's Regional Stroke Prevention Clinic realized he was a ticking time bomb, and that they had to act with lightning speed.
"If we had done nothing, I fear he would have suffered a major disabling stroke," says Dr. David Gladstone, a stroke neurologist and director of the clinic.
Robert's whirlwind story began in June 2011, when he had a knee replacement operation at a hospital near his home. He was long overdue for this surgery, but had been consumed for years with caring for his wife, who died of acute leukemia in 2009. Two days after Robert's knee surgery, he had a transient ischemic attack (TIA, a minor stroke), resulting in sudden weakness, loss of feeling and incoordination of his right arm and hand. A week after that, he had another TIA, this time affecting vision in his left eye. These were stroke-warning events.
When his doctors consulted colleagues at Sunnybrook about his case, he was assessed right away at Sunnybrook's
Dr. Thomas and Harriet Black High-Risk TIA Unit. This innovative outpatient service is part of the Scotiabank Rapid Investigation & Stroke Prevention Program, one of only a few such specialized rapid-response clinics in the country dedicated to high-risk stroke prevention.
Here, stroke neurologists Drs. Gladstone, Julia Hopyan, and Rick Swartz, assisted by Drs. Karl Boyle, Vince Basile, Layla Safinia, Marc Narayansingh and Mark Boulos, clinical nurse specialists Armi Armesto and Cathy Bouthillier, and medical secretaries, run one of the busiest stroke clinics in Canada and work in close collaboration with expert neuroradiologists and imaging technologists, cardiology non-invasive lab, psychatrists, rehabilitation therapists, and surgical colleagues like Drs. Leo da Costa, Andrew Dueck and others. This interdisciplinary team is dedicated to condensing months of tests and appointments into a single day so patients are fast-tracked to "same-day diagnosis" and initiation of a treatment plan for aggressive risk reduction. "I call it one-stop shopping for stroke prevention," says Robert. The clinic is a teaching ground for international trainees and Accreditation Canada praised the clinic as a "leading practice" in its external review of Sunnybrook last year.
State-of-the-art diagnostic imaging includes MRI scanning of the brain and blood vessels, specialized neuro-Doppler ultrasound studies performed by Diane Brodie and colleagues to identify dangerous blockages, and cardiac testing. "With the advanced diagnostics at our disposal we aim to obtain the most rapid and accurate assessments for patients with stroke warning symptoms," says Dr. Gladstone. This is important because research shows up to 80 per cent of strokes that occur after a TIA may be prevented if the underlying causes can be found and treated right away – a significant statistic, given strokes are very common: someone dies or is disabled by a stroke every 10 minutes in Canada, making it a leading cause of death, disability and dementia.
Robert and Joy remember many staff members staying late on that late June night to complete tests, adjust Robert's medications and compile a detailed report on his condition. "Dr. Gladstone and his team moved with such urgency and such efficiency, it's hard to believe," says Joy. Robert's tests revealed his mini-strokes were coming from a heavily calcified atherosclerotic plaque blocking 80 per cent of his left carotid artery, an extremely precarious and life-threatening situation.
"When a plaque starts to rupture like this," says Dr. Gladstone, "there is an immediate risk of more strokes, so it had to be treated right away."
Joy, who has a PhD in political science and works in public health policy, remembers Dr. Gladstone telling her that her dad had leap-frogged to the top of the surgical list. "He was very calm. He didn't alarm us, but he was very serious. I've never thought medical exams could be graceful and fluid. Dr. Gladstone was poetry in motion," she says.
Surgeon Dr. Dueck was brought in to perform Robert's carotid endarterectomy on the July 1 statutory holiday, just two days after the diagnosis was established. In contrast, provincial wait times for this procedure have averaged 30 days, according to Dr. Gladstone's research – a statistic he wants to see improve province-wide.
Robert, who is now fully recovered after rehabilitation therapy, continues to operate two book stores and has not had any more attacks. He is grateful to the team at Sunnybrook, knowing how close he came to death.
“I don’t know if I would have lasted another day. Another stroke would have been fatal. Three strokes, you’re out. They saved my life, literally,” Robert Fitzgibbon patient, Stroke Prevention Clinic
"In my case, Dr. Gladstone and his associates took what was a terrifying experience that was perilously close to a tragic ending and turned it into a success story of great blessing. And they did it all with such professionalism, sensitivity and gentleness," wrote Robert in a letter to Sunnybrook after he recovered.
"If Dad had not been connected at the Stroke Clinic at Sunnybrook, I don't think he'd be with us," says Joy. "It was extraordinary care – off-the-charts incredible."
How to spot a possible TIA – and how to prevent one
Having a mini stroke is a warning sign the big one might be coming. A transient ischemic attack (TIA, or mini stroke) occurs when a blood clot prevents blood flow to the brain for a short time, depriving it of oxygen and glucose. Symptoms are the same as in stroke, but they generally disappear within a few minutes or hours. That's where the expression "transient" comes from.
If you've had a TIA, you are five times more likely to have a stroke over the next two years, according to the Heart & Stroke Foundation. Each year 15,000 people in Canada experience TIAs.
If you or someone you know is experiencing the sudden onset of these symptoms, even temporarily, call 911.
• Sudden weakness, numbness or tingling in the face, arm or leg.
• Sudden loss of speech or trouble understanding speech.
• Sudden loss of vision, particularly in one eye, or double vision.
• Sudden severe and unusual headache.
• Sudden loss of balance, especially with any of the above signs.
To prevent strokes, factors you can control include maintaining a healthy lifestyle, ensuring good blood pressure control, a healthy diet, exercise, and not smoking.