Strokes Affect All Ages

On his way back—When Paul Humenik was well enough to leave the hospital after his stroke, his wife, Nikki, sought special permission to drive him home in her new Saturn Sky convertible because she knew it would make him smile.

One month after Nikki and Paul Humenik were married, Paul awoke one morning with the worst headache of his life. “On a scale of 1 to 10, it was 250,” says the Orefield, Pa., database administrator.

Within minutes, Paul was in dire need of medical attention: his right side was numb, his right pupil was dilated, and he was vomiting. The next thing he remembers is waking up in the neuroscience intensive care unit (NSICU) at Lehigh Valley Hospital-Cedar Crest. His brother was telling him not to touch his head because he had a surgically created “soft spot” like a newborn baby.

Paul had suffered a hemorrhagic stroke—bleeding in the brain from a burst blood vessel. “Our immediate goal was to save his life and preserve his brain function,” says neurosurgeon Mei Wong, M.D. During emergency surgery to drain the blood, Wong removed part of his skull to help ease pressure on his brain.

An angiogram showed Paul’s stroke was caused by an abnormality in a blood vessel. The arteriovenous malformation (AVM) was likely there since birth, Wong says, and he couldn’t have done anything to prevent the stroke. Hemorrhagic strokes like his are less common than ischemic strokes, the type caused by a blood clot in the vessel.

Neither type is common in people as young as Paul Humenik. Ischemic strokes reportedly are on the rise in this group, however, due to a rise in risk factors such as high blood pressure, high cholesterol, obesity, smoking, inactivity and out-of-control diabetes.

Nikki Humenik was shocked to learn her young husband had a stroke. “It all seemed so unreal,” she says. “The whole time he was in the NSICU, I still felt like he would be at home waiting for me when I finally got there.” She stayed by his side throughout his six-week ordeal, which included another surgery and a medically induced coma to allow his brain to heal. Paul is now in cognitive therapy and will have his AVM repaired with Gamma Knife® surgery in the near future. He’s eager to return to work and normal life.

“The important lesson is that Paul got to the hospital quickly. That’s absolutely critical with any stroke,” Wong says. “It’s particularly important if you’re young, because your brain is resilient and with prompt treatment can make a full recovery.”

Published from Healthy You Magazine, November-December 2008

MedEvac Made the Difference

Meredith Taylor, 15, made the most of a sunny February day off school by visiting Jack Frost ski area. The Bedminster, New Jersey girl and her mother, Kim, were making their final run that Thursday when Kim fell on the increasingly slick slope. Meredith zipped on downhill.

“When I reached the bottom, I couldn’t find Meredith and thought she’d gone up again,” Kim says. She rode the chairlift back to the top, but 30 minutes passed with no sign of her daughter, and Kim began to worry. Then she spotted a helicopter hovering overhead. “Are you looking for someone?” an approaching woman asked. “My daughter just reported that a girl named Meredith was injured, and the helicopter is for her.”

Meredith had hit an icy patch and gone off the trail into a rocky ravine, where she plowed into a small tree. She wasn’t wearing a helmet. Responding to a local emergency call, Lehigh Valley Hospital-Cedar Crest had dispatched a MedEvac chopper to whisk Meredith to the hospital. It took 11 minutes, compared to the 50 minutes Kim spent driving there.

“Timing in these cases is critical,” says Robert Barraco, M.D., pediatric trauma surgeon who coordinated Meredith’s initial care. Though she was alert and talking, head pain and lapses in consciousness led the hospital team to order an immediate brain scan. It confirmed a fractured skull and bleeding in her brain—which could result in pressure, swelling, oxygen loss, permanent damage and even death. “She was classified Neuro Code Red, which means highest-level priority,” Barraco says.

By the time Meredith’s parents arrived at the hospital, neurosurgeon Mei Wong, M.D., was operating to relieve the bleeding and pressure. “Everything moved at amazing speed,” Kim says. The surgery was a success, but Meredith had to be carefully monitored over the next 48 hours. “She had suffered a significant injury,” Wong says. “I was guardedly optimistic because she was young and we were able to get her into the OR so quickly.”

In the pediatric intensive care unit, “Meredith’s room was like a beehive with people coming in constantly to check on her,” Kim says. Nurses carefully tracked her brain pressure throughout the night, occasionally releasing built-up cerebrospinal fluid through a valve. A scan the next morning showed no swelling, and that afternoon Meredith came off sedation. “I didn’t know where I was, what had happened or how much time had passed,” she says. “My first thought was that I had to finish a school project.”

Her second thought: “Did I miss the concert?” She had tickets to see the teen-idol Jonas Brothers in three weeks, and her parents told her the concert was off. But over the next few days, Meredith’s condition improved dramatically, and by Tuesday her care team said she could go home. “Our jaws dropped that she had progressed so far so fast,” her father, Zack Taylor, says.

Three weeks later, Zack emailed the nursing staff some photos he’d taken of Meredith—at the Jonas Brothers concert. The nurses, in turn, recognized her a few weeks later with their “Hero of the Month” award. “Even though I couldn’t wait to get out of the hospital, I loved going back for the award and seeing the nurses again,” Meredith says.

“The award was richly deserved,” Wong says. “Her progress was amazing. We can do everything in our power to physically heal a patient, but a lot of recovery comes from within.”

For Meredith’s parents, having their daughter back is the best award of all. “We thank god for answering thousands of prayers, and thank Lehigh Valley Hospital for Meredith’s miraculous recovery,” Kim Taylor says.

Published from Healthy You Magazine , January February 2009

Teen Who Suffered Brain Rupture Returns to School

You only get one senior year in high school, and Alyssa Bray, 17, isn’t about to miss hers. She missed most of her junior year at Nazareth Area High School after she suffered a ruptured vein in her brain, underwent life-saving emergency brain surgery at Lehigh Valley Hospital-Cedar Crest and spent months in rehabilitation therapy.

The teen who enjoyed softball and basketball was waiting for a bus to take her home last October when she experienced an excruciating headache. She’d been fine earlier in the day and had even sent a text message to her dad to wish him happy birthday.

Her friends knew something wasn’t right and alerted the school nurse, who called 9-1-1. Bray was diagnosed with a brain condition called arteriovenous malformation or AVM. The malformation of tangled veins had burst open and was causing bleeding and pressure in her brain, a potentially deadly situation.

Darryn Shaff, M.D., a neurointerventional radiologist with Lehigh Valley Health Network and Mark Li, M.D., and Mei Wong, M.D., neurosurgeons with the health network, treated Bray as a team. First, they worked to stop the bleeding and stabilize the pressure inside her cranium (the part of the skull that houses and protects the brain). Then, Li surgically clipped the AVM to ensure it would never rupture again. Alyssa’s parents, Dawn and Scott Bray, were very pleased with her care. “It was the most horrible time in our lives, and yet the staff at Lehigh Valley Hospital-Cedar Crest actually made it great because they saved Alyssa’s life,” Dawn says.

Alyssa pulled through three surgeries and went to physical therapy for months. While she’s not yet 100 percent back to herself, and may never be, she is ready to tackle her senior year of high school. She was able to keep up with her studies (and was even able to attend the junior prom with her boyfriend), so she feels she’ll be able to pick up where she left off mentally.

Physically, she still has some challenges. Her right side is a little weak and her balance is slightly off. She also has some issues with double vision. Nevertheless, she’s looking forward to the future and plans to attend college for speech therapy or to become a teacher—plus she hopes someday soon she’ll be able to drive the convertible she got for her 16^th birthday.

'They saved Alyssa’s life.'

You only get one senior year, and Alyssa Bray, 17, isn’t going to miss hers. She missed most of her junior year at Nazareth Area High School due to a rupture in her brain.

Alyssa was waiting for a school bus in October 2008 when she suffered a sudden, severe headache. A malformation of tangled blood vessels in her brain (called an AVM) had ruptured, causing a blood clot to form. At Lehigh Valley Hospital–Cedar Crest, she was treated by neurosurgeons Mark Li, M.D., and Mei Wong, M.D., and neurointerventional radiologist Darryn Shaff, M.D.

First, Alyssa underwent two emergency surgeries to remove the clot and relieve the pressure within her brain. After extensive rehabilitation, she had stage two of her treatment: Shaff minimized blood flow to the malformed blood vessels, then Li successfully removed the AVM.

Dawn and Scott Bray were pleased with their daughter’s care. “It was the most horrible time of our lives, but the staff was compassionate, caring, and really treated Alyssa and the rest of us like family,” Dawn Bray says.

“They’ll know things about my heart quickly and be able to nip any problems in the bud,” says Galanti, who also helps his condition by eating a heart-healthy diet.

Published from Healthy You Magazine, November December 2009

"I can remember things again."

Lehigh Valley Health Network’s cerebrovascular program includes:

• Fellowship-trained neurosurgeons
• Minimally invasive and no-incision brain surgery
• Advanced neurovascular capabilities for conditions like aneurysms and stroke
• The region’s only neuroscience intensive care unit

When Peggy Hausman (right) of Jim Thorpe went to fetch her mail Oct. 8, 2008, she “felt funny,” then fainted. An aneurysm (bulge in an artery) had burst in her brain, causing a stroke. Her condition was so serious she was flown by MedEvac to Lehigh Valley Hospital–Cedar Crest, where an angiogram revealed more aneurysms. Neurointerventional radiologist Darryn Shaff, M.D., threaded a catheter into Hausman’s brain and inserted tiny metal coils into the largest aneurysm to prevent rupture. Neurosurgeon Mei Wong, M.D., then performed two surgeries to repair the remaining aneurysms, and rehabilitation helped Hausman recover. Aneurysms often run in families, and Hausman’s mother died from the condition. After Hausman’s diagnosis, her sister, Barbara Hartman (with her in photo), found she too had a large aneurysm and chose to be treated at Lehigh Valley Health Network.

Published from Healthy You Magazine, January February 2010

“I knew I was in good hands.”

Lehigh Valley Health Network’s neurosurgery program offers:

• Fellowship-trained neurosurgeons
• Minimally invasive and no-incision brain surgery
• Advanced techniques for brain tumors located close to areas of the brain that control speech and motor skills
• Region’s only neuroscience intensive care unit

The last thing 57-year-old April Peachey remembers is her husband asking what kind of soup she planned to make that weekend. When she awoke almost two days later, she was in a bed at Lehigh Valley Hospital–Cedar Crest.

There, she learned from neurosurgeon Mei Wong, M.D., that she had passed out and suffered multiple seizures because of a tumor deep in her brain. “I was shocked, and yet I had a sense of calmness,” says Peachey, a resident of Lake Wynonah in Schuylkill County. “Dr. Wong explained everything so clearly and with such compassion.”

Wong removed the tumor and pathology tests revealed it was non-cancerous. Thankfully, Peachey didn’t need any additional treatment. Today she’s back to her soup pot; she and her husband, Jim, do the cooking and catering for a local VFW post. They also enjoy landscaping, traveling and playing with their Maltese dog, Tigger. “I’m so thankful to Dr. Wong that my life has returned to normal,” Peachey says.

Published from Healthy You Magazine, September October 2010

All About Brain Tumors

Did you know…

Lehigh Valley Health Network’s neuroradiologists and neurosurgeons work together to provide expert diagnosis of brain tumors, most often the same day as the patient‘s appointment. The neurosurgery team also includes medical and radiation oncologists. They meet regularly to discuss cases and formulate treatment plans, and are actively involved in clinical research to give patients access to the latest treatments.

Brain tumors can strike people of all ages and cultures, and evidence shows that your risk isn’t affected by what you eat, where you live or what electronic gadgets you use. A diagnosis is serious, but thanks to advances in surgical treatments, survival rates have increased significantly in recent years.

If you or a loved one faces a brain tumor diagnosis, here’s what to know:

Symptoms: Headaches, seizures and personality changes are potential signs of brain tumors. “But the same type of tumor can cause completely different symptoms—or even none at all—depending on where in the brain the tumor is located,” says family medicine physician Brooks Betts, D.O., of Lehigh Valley Health Network.

Diagnosis: Tumors often are found through an imaging study (MRI or CT scan). If your primary care physician suspects a tumor, she often will refer you to a neurosurgeon, who will conduct a physical exam to assess vision, balance, hearing, coordination and reflexes. Neurosurgeons also analyze the initial imaging study and may order others.

Cancerous or non-cancerous? Typically, a biopsy is needed to determine whether or not the tumor is cancerous (malignant). Most commonly this is performed during surgery to remove the tumor. Surgeons take a small sample of the tissue for microscopic analysis. At Lehigh Valley Health Network, Dan Brown, M.D., the region’s only neuropathologist, performs this analysis. “I can provide consultation during the surgery,” he says. “This helps the surgeons alter their approach based on the initial pathology interpretation.”

Tumor types: There are more than 40 different types of brain tumors, defined by cell type, shape and location. Meningioma, a type that develops in membranes around the brain and spinal cord, is a common tumor that is typically non-cancerous. Others, such as malignant glioblastoma (the type Sen. Ted Kennedy had), are extremely aggressive. Survival rates depend on tumor location and size, how far it has spread, and the patient’s age and ability to function. Tumors are graded based on their severity, from grade I (least aggressive) to grade IV.

Treatment: “Neurosurgery is the first line of treatment for many brain tumors, whatever the type,” says health network neurosurgeon Mei Wong, M.D. Surgeons like Wong use smaller incisions today, and sometimes can even remove a brain tumor transphenoidally (through the nose). Advanced procedures such as awake craniotomy and brain mapping help the surgeon remove as much of the tumor as possible without disturbing areas of the brain that control speech and movement.

Another option is Gamma Knife®, a nonsurgical technique that delivers gamma radiation to cancerous and non-cancerous tumors with pinpoint accuracy.

“There is always fear and uncertainty for someone diagnosed with a brain tumor,” Betts says. “Physicians support the patient and family throughout the entire process. No one goes through this alone.”

Published from Healthy You Magazine, May June 2010

Women and Back Pain

“Oh, my aching back.” It’s a statement nearly all of us utter at some point in our lives. And while men and women are equally affected by back pain, there are two times in life—during pregnancy and postmenopause—when women are more susceptible to that aching back.

During pregnancy

“About two-thirds of pregnant women experience back pain during their second and third trimesters,” says obstetrician Suzanne Basha, M.D., with Lehigh Valley Health Network. It’s more likely for moms who are either over age 35, have prior back conditions, carry multiples or have had several past full-term pregnancies.

What causes the pain? The stress the baby places on the muscles near your lumbar spine (low back). It’s compounded by the stretching and weakening of your abdominal muscles as your pregnancy progresses. Water retention can add to the pain. All of these factors create painful days and sleepless nights for some moms.

Where to turn? One option—rehabilitation therapy designed specifically for moms-to-be. You will learn different postures for sitting, standing and sleeping, along with stretching exercises. “Some women may benefit from using a maternity belt (a special back support) to help ease the discomfort,” says health network physical therapist Jonathan Borger. The good news: Pregnancy-related back pain often resolves soon after delivery.

Postmenopause

Women can lose up to 20 percent of their bone mass in the five to seven years after menopause. “That’s why women are four times more likely to develop osteoporosis than men,” says health network neurosurgeon Mei Wong, M.D. Women of northern European descent are at the highest risk for osteoporosis, a condition that results in brittle, easily fractured bones. Common areas for osteoporosis-related fractures include your spine, hips, arms and legs.

If you’re at risk for osteoporosis, prevention is your first line of defense. Make sure you get enough calcium (1,200-1,500 milligrams) and vitamin D (400-800 International Units), avoid tobacco and alcohol, engage in regular weight-bearing exercise and talk to your doctor about a bone-density screening. If you need additional help, your options may include surgery for compression fractures or rehabilitation to build bone strength.

Published from Healthy You Magazine, November December 2010