Oklahoman Glad He Was in Arkansas When He Had Rare Stroke

By Ben Boulden

A resident of Oklahoma City, Koger was in a wilderness area of Polk County on the western border of Arkansas late in the evening of March 16 when he suddenly found he was unable to speak and was paralyzed from the neck down.

With the onset of paralysis, Koger started falling, but his wife, Rebecca Koger, and some friends nearby caught him before he hit the ground. The Kogers were about to discover that their remote location was closer to help than they might have thought. Mena Regional Health System, an AR SAVES hospital, was less than an hour away.

The tele-stroke network, the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES), uses a high-speed video communications system to help provide immediate, life-saving treatments to stroke patients 24 hours a day. The real-time video communication enables a stroke neurologist to evaluate whether emergency room physicians should use a powerful blood-clot dissolving agent, alteplase, within the critical four-and-a-half-hour period following the first signs of stroke.

Donny Koger and his wife, Rebecca, talk with Sanjeeva Onteddu, M.D., and Adewumi Amole, M.D., through a live, AR SAVES video network connection at Mena Regional Health System.

Donny Koger and his wife, Rebecca, talk with Sanjeeva Onteddu, M.D., and Adewumi Amole, M.D., through a live, AR SAVES video network connection at Mena Regional Health System.

Before Donny even thought of stroke that night in the forest near Mena, he was concerned about another health issue, a prostate problem unrelated to his stroke. Donny had noticed blood in his urine and told his wife that they probably needed to return to their camp and possibly go to a hospital. Rebecca had started to tell their friends what they were going to do when Donny suddenly felt weak and disoriented. That’s when he started to fall.

Rebecca and a friend’s daughter recognized the stroke signs.

“I knew immediately,” Rebecca said. “His eyes were large and his speech was completely gone. He was trying to speak but it was completely slurred. You couldn’t understand him.”

By the time, she and their friends had gotten Donny back to their camp site, an ambulance was there and ready to take Donny to the Mena hospital.

“They never stopped. It was just boom, boom, boom,” Rebecca said. “I can’t believe how fast it was once they realized it was a stroke. Even though they couldn’t get it to show, they were just on top of it. There was no indecisiveness. It saved his life, period. There is no doubt about it.”

The stroke team at Mena Regional ordered a CT scan for Donny and it showed no evidence of brain bleeding, indicating that he could possibly benefit from the clot-busting alteplase.

“I remember thinking, ‘This is going to change his whole life, and how is his wife going to take care of him if he doesn’t recover,’” said Olivia Bayne, an R.N. in the Emergency Department at the Mena hospital.

For Bayne, it was her first stroke case, and it would prove to be a challenging one for everyone trying to care for Donny. Bayne assisted another nurse in the department as they connected to Sanjeeva Reddy Onteddu, M.D., medical director for AR SAVES, through the AR SAVES network. Onteddu said Donny’s case warranted giving him alteplase. After that, Donny was transported via air ambulance to UAMS Medical Center for further treatment.

“Our first thought was to medi flight him to OU Medical Center in Oklahoma City,” Rebecca said, because it was closer to home and medical resources there. “That would have been the worst mistake I could have made.”

While Donny was being airlifted to UAMS, Rebecca and several friends drove to Little Rock. By the time they arrived, family from Oklahoma City was there to meet them. The UAMS stroke team had determined Donny was having a spinal cord stroke.

The Kogers share a laugh with staff of AR SAVES and the Mena Regional Health System during a visit to Mena in December.

The Kogers share a laugh with staff of AR SAVES program and the Mena Regional Health System during a visit to Mena in December.

After his arrival to UAMS he did not have any significant improvement in his weakness. Further testing did not reveal any obvious large vessel blockage. Onteddu discussed with Donny’s family about an uncommon procedure that is generally not tried due to its difficulty and one that might put Donny’s life at risk

“The decision was easy to make,” Rebecca said. “Donny and I have been together a long time and with him being a police officer you know the chance of death or injury is great. We already had discussed future eventualities if they happened. It wasn’t hard and we made the decision to go with it.”

Adewumi Amole, M.D., the UAMS interventional neuroradiologist who performed the procedure explained that spinal cord strokes are so uncommon that he had never treated one. Furthermore, the artery’s small size, less than a millimeter across, presented a challenge. None of the conventional surgical devices fit it.

“We presented the risks and possible outcomes to his family, and I believe we all made the right decision at that time,” Amole said. “We took him to the neurointerventional suite. We put a catheter in and injected alteplase. Right on the table he started moving his fingers. By the next day, he was smiling and laughing.”

When the physicians came out of the operating room four hours later, almost 16 hours after his first symptoms, Amole pulled his mask down and smiled. Donny’s family and friends were ecstatic, Rebecca said.

“We were really skeptical going into it,” Onteddu said. “If clot-busting medications don’t work, we know from experience that patients’ symptoms don’t get better if there is no obvious clots we can see. He was in such a bad condition that we wanted to at least try to do something for him.”

Donny said it was probably two months before he really felt he was recovered and another two months before his energy level was normal. Rebecca said her husband was very self-disciplined about his physical therapy and rehabilitation. When he came back to see stroke neurologist Krishna Nalleballe, M.D., in clinic he realized that Donny could have ended up coming to clinic on a stretcher rather than walking.

Although Donny does sometimes have to ask people to repeat themselves when speaking, he usually can understand them the second time. The problem isn’t with his hearing but with processing spoken words. Donny also sometimes has lapses in short-term memory, but these problems have been minor enough that he returned to work in September as a patrolman for the Oklahoma City Police Department.

“I’m still having problems with guilt,” Donny said. “I’m just trying to understand why I survived. I’m still getting over the emotional part, but I don’t sweat the small stuff anymore. Nothing is too serious.”

One thing he and his wife are serious about is the absence of something like the AR SAVES network in Oklahoma. Both are in the early stages of becoming health care activists, meeting with health care leaders and state legislators about creating a network and filling that void.

“We really wish this program could go to other rural hospitals,” Rebecca said. “If this had happened at our home, anywhere else but here, our outcome would not have been as good. We want the state of Oklahoma to do this. How many people don’t get treated because they don’t have the access through something like AR SAVES?”