A stroke of luck: 'Miracle man' Bruce Hughes survives series of strokes
Procedure performed in Saint John saves life of 59-year-old musician from Upper Keswick
Bruce Hughes should have died.
His nurses said he was a "miracle man," and his neurologist says there is something to that.
Hughes, 59, of Upper Keswick, had a series of strokes caused by two large blood clots. One was in the artery that brings blood flow to the brain.
He received the standard clot-busting drug, tissue plasminogen activator (tPA), but his Fredericton neurologist didn't think it was going to be enough.
So she sent him to Saint John, where a team of radiologists and nurses were able to perform an infrequent procedure that removed the clots and set Hughes on the road to recovery.
Atypical symptoms
It all started on May 31.
"I had been on the couch for a couple of days, I thought I just had the flu or an ear infection or cold coming, hadn't been feeling well, my neck was bothering me a little bit, and I went to get up and lost my balance," says Hughes, a retired educator and musician of 35 years.
His wife Monica called 911. But by the time the ambulance arrived, Hughes was feeling better — better than he had in two or three days.
"They did all the vitals, they couldn't find anything wrong with me, so we all figured it was just an inner ear infection or something like that."
The ambulance left — a decision that could have cost him his life because during a stroke, time is everything.
Time = brain cells
"Time is brain," his neurologist Dr. Hanni Bouma explains. From the moment the stroke hits, the clock is running.
"We know that for every one minute that passes after a stroke begins, you lose about two million brain cells. So 15 minute delay adds up to a lot of brain cells [lost] and that translates into a lot of disability," Bouma says.
After collapsing a second time, a second ambulance was called, and rushed Hughes to the emergency department around 11:30 a.m.
But his symptoms weren't typical of a stroke.
"And they got me in there, and then it was just chaos to me," he says.
"I just remember 10 or 12 faces around my bed, all trying to figure out what the heck was going on here, because I was coming in and out of stroke. My whole right side would drop out, slurred speech and everything, then I would sit right up and be normal."
Bouma was called in around 2:30 p.m. She determined it was a stroke, then a CT scan confirmed it.
Normally the clot-busting drug tPA, which can cause bleeding in the brain, is only given if the patient is within the four-hour window. With Hughes, however, Bouma knew he would die if nothing was done.
"We started the tPA, [intubated him and] got things rolling for transfer to Saint John," says Bouma, because she knew the drug wouldn't be enough to save Hughes.
"All that probably took about 45 minutes, which is pretty fast actually."
Watching the clock
Interventional radiologists Dr. Jake Swan and Dr. Brian Archer were waiting at the Saint John Regional Hospital.
The hospital has a team of doctors and nurses who have been performing mechanical thrombectomies for nearly five years.
Simply said, it is the direct removal of a clot by mechanical means, as opposed to being dissolved by drugs. Team members do about one a week but would like to see more stroke patients sent their way who could benefit from the procedure.
The team started working on Hughes at 5:59 p.m.
"The critical thing is getting blood flow open to that artery as fast as you can," says Archer.
"You need to get up with a catheter into the brain," he says, while demonstrating with a thin, blue tube that he threads with another tube. As he pushes it through, a stent extrudes. Stents are like small, mesh tubes, used to hold arteries open after a heart attack.
"We went up through the blocked artery, which we had to fix on the way out to where the clot was, put a big catheter in it, and just sucked all that clot out — pulled it down out of his brain, and got perfect flow back," says Archer.
"Then the blockage lower down in the artery needed to be stented … open with the same equipment you would use to treat a heart attack."
By 6:21 p.m., they were done.
Archer smiles when he remembers seeing Hughes's scan after the procedure.
"There's not a formal cheer, but there's a, 'Yes!' You see the picture after the clot is gone and go, 'Oh, thank you!' And you realize, 'OK, now I've done as much as I can do.'"
Doctors won't know if they got the clots early enough until Hughes wakes up the next morning.
Miracle man
Hughes was awakened the next morning.
"Everything was paralyzed and nothing worked at first at all, and I was very scared," he says.
"And then within a couple of hours, my left side came back pretty good, but nothing on my right. But I just lay there and willed my elbow to move. I just stared at it for about four hours, and then it finally moved."
"I think that, even from a medical point of view, he has had quite a remarkable outcome," Bouma, his neurologist, says. "It's way beyond what I could've expected.
"I've really never seen anybody do as well from this type of stroke. So I do kind of agree with that, with that idea, that [he] is a bit of a miracle man."
Hughes loves to talk and hates to sit still. Both things are working in his favour. He continues to do everything possible in physiotherapy and occupational therapy. But as for the description "miracle man," he says he isn't the miracle.
"It was a complicated procedure and I think just, 'Wow, these guys are just like master mechanics.' They found somewhere else for a spark plug to go in that normally doesn't, and luckily it saved my life.
"So I'm thankful. I'm not the miracle, they are."
In September, just over three months after having his strokes, Hughes played his guitar for the reunion of his old group, Blind Dog, at the Harvest Jazz and Blues Festival. He says he didn't play that well, and only three songs, but he was there.
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