COURTESY NOVANT HEALTH

Novant Health neurology specialist Carlene Kingston, from left, Jimmy Proffitt and Dr. Cuong Nguyen at the comprehensive stroke center at Novant Health Presbyterian Health Center.

Major cities mean major medicine.

Novant Health Presbyterian Medical Center recently earned The Joint Commission’s Gold Seal of Approval and the American Heart Association/American Stroke Association’s Heart-Check mark for Advanced Certification for Comprehensive Stroke Centers. The designation means patients can receive 24-hour acute stroke care every day, a first for a Charlotte hospital.

“The statistic is that somebody presents to the hospital every 20 minutes,” said Dr. Carlene Kingston, a neurology specialist at Novant Health and the comprehensive stroke medical director at Novant Health Presbyterian Medical Center. “A stroke is a disruption of blood supply to the brain, whether it is a blocked artery or if an artery bursts open causing bleeding into the brain.”

Stroke is the fifth-leading cause of death in the U.S., and in North Carolina, one of 12 “Stroke Belt” states, it is third. Native Americans and African Americans represent the higher death rates due to stroke in North Carolina than Caucasians. Prior to Novant Health’s designation, Charlotte was one of the largest cities in the country without an Advanced Comprehensive Stroke Center. Now Novant Health has two (Winston-Salem is the other), which makes them one of four healthcare systems in the country with such facilities. The others include Johns Hopkins, Kaiser Permanente and the Mayo Clinic.

Accreditation requirements include neuro-intensive care unit beds and teams providing round-the-clock care, the ability to capture advanced images, stroke research, peer review of the care received by ischemic or hemorrhagic stroke patients, care must be arranged for patients once they leave the facility, as well as other requirements.

“Being that stroke is a brain disease, you want to have access to the types of doctors who specialize in just that,” Kingston said. “You wouldn’t take your BMW to a Honda dealership. You want to go to the place where you know that you’re going to get the best care by the most advanced specialists to access to some of the latest technologies to diagnose and treat your stroke.”

Charlottean Jimmy Proffitt, a patient of Kingston and neuroradiology specialist Dr. Cuong Nguyen, suffered a stroke just over a year ago. Proffitt, 58, did not present risk factors associated with stroke: high blood pressure, diabetes or obesity. While Proffitt prepared to depart for a business trip to Harrisburg, Pennsylvania, he began to display signs of a stroke.

“I was going to terminate a very difficult, low performing erratic employee,” Proffitt said. “There was a lot that had gone into that, and I was pretty stressed about it. There was a car out front to take me to the airport, but I got wheeled out on the gurney to go in the ambulance. Instead of getting in the cab to go to the airport, I went in the ambulance to go to the hospital” when Proffitt’s wife Debbie called an ambulance.

“He woke up in the morning feeling fine—his normal, wonderful self, and then not so fine a few minutes later,” Kingston said. “His wife was able to recognize that something was wrong, and that’s the thing about strokes; there’s really not a lot of warning ahead of time.”

Indicators for presentation of stroke symptoms can be surmised with the acronym FAST: face drooping, arm [or leg] weakness, speech impairment and time to call 911.

“Those are the most common signs of stroke, and that’s the time to call 911,” Kingston said. “Jimmy’s wife did just that.”

Said Proffitt: “My stroke, it came out of nowhere. I was in the shower getting ready to get on an airplane—thank goodness I didn’t, or who knows what would’ve happened. I got dizzy, disoriented, and my head started to pound. I knew I was in some trouble. I didn’t fall down, but I got really, really disoriented, but I made it out of the shower, and went and sat down on the bed.”

Debbie noted his slurred speech and drooping face, and told Jimmy he was having a stroke.

“I couldn’t stop sweating, and my head hurt, but I told her ‘no I’m not having a stroke—I’ve gotta go to work,’” Proffitt said. “She said ‘well then I’m not arguing with you. I’m calling the ambulance right now.’ Thank goodness she did.”

Said Kingston: “What was really good was, because Debbie was able to recognize the symptoms, she called 911, our EMS system was able to notify the hospital ahead of time that Jimmy was coming. Natalie Hall, who is our nurse practitioner, was able to meet him at the door of the emergency room, and perform an initial assessment, and say ‘hey, Dr. Kingston, you need to get downstairs. This is a real stroke.’ She started the whole process, and we were at his bedside almost immediately.”

While they initially administered tissue plasminogen activator, or tPA, a strong blood thinner used to break up a clot blocking one of Proffitt’s arteries, it did not solve the problem.

“I reached a point where I could not raise my leg,” Proffitt said. “I don’t think the tPA was breaking up that clot the way it should have.”
Kingston then called in Nguyen.

“You want to be in a place where you can get the appropriate imaging almost immediately,” Kingston said. “Not all hospitals have that capability, and that’s one thing about a comprehensive stroke center—we can do that.”

Based on the results of Proffitt’s blood vessel test, Kingston and Nguyen found a clot blocking blood flow to the right side of his brain.

“That clot had not moved after we gave tPA,” Kingston said. “This is what separates us from any other stroke hospital. We saw that clot, and we have specialists, which is Dr. Nguyen who is a neuro-interventional radiologist who did a lot of training to be able to go physical and retrieve the clot. We take you to a specialized lab. We enter an artery through your groin and we snake up past your heart, into your neck, into your brain into one of the very, very small blood vessels, and he was able to take out that clot. All of this was within hours of his arrival. Jimmy got to our doors at 7:45 a.m. He got tPA at I think 8:11 a.m. and he was in the angio suites less than 45 minutes later to get this procedure, because every minute you are losing millions of brain cells. Time is of the essence. We were able to diagnose that he had a heart rhythm problem. It’s like shaking a soda can, and then bubbles form. Blood doesn’t like to be shaken, so clots form.”

When Proffitt’s wife signed off on the procedure, she turned to Hall and asked what she would do in her situation.

“Natalie said ‘if it was my husband, or my brother or my father, you are in the best hands you can be in with Dr. Kingston and Dr. Nguyen,’” Proffitt said. “She said ‘I would sign off on anything they think they want to do.’”

Proffitt and his family recently celebrated the anniversary of his recovery, life, and personal and professional changes that he has made. On Dec. 5, he will celebrate his 60th birthday.

While Proffitt walked away without permanent deficits from his stroke, that is usually not the case for most Americans. Among North Carolina’s leading causes of death and disability, stroke takes a life every two hours, and up to 80 percent of strokes could be prevented through lifestyle changes that impact blood pressure or weight.

“People don’t realize that a stroke can happen to anyone,” Kingston said. “As an adult neurologist, the youngest patient I can treat is an 18-year-old, and that was my youngest patient—an 18-year-old guy when he was in college. My oldest patient was 103. This is not a disease of the old. This is not necessarily a disease of the sick.” 

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