FAST action, UK doctors weld patient’s path to successful recovery

LEXINGTON, Ky. (Feb. 15, 2023) — “That day I woke up feeling completely normal.”

At 37 years old, Salvisa resident Jessica Moore is still taken aback as she reflects on what transpired last July.

Jessica and her husband, Joe, are the proud parents of three young children, a loving 14-year-old border collie, and several other critters. The family lives and works on a 36-acre farm in Mercer County, raising organic meat chickens, turkeys and pigs. Additionally, Jessica helps Joe manage their metal fabrication company while also homeschooling their children aged 8, 4 and 2. 

“I was helping Joe in our shop and suddenly, I felt weak,” Jessica said. “I sat down on the floor and then could not stand back up.”

Joe remembers hearing the grinding tool she was working with suddenly running against the shop floor. He then saw his wife on the ground and quickly got her into a chair.

“She had full facial paralysis on her left side,” Joe said. Recalling the FAST test for stroke, Joe asked her to lift her arms.

“He kept asking me to move my left arm and I couldn’t," Jessica said.

Joe realized what was happening and called 911 without hesitation. Meanwhile, Jessica was initially in denial and insisted she was okay.

“I was thinking ‘I’m fine, I just need some water,’” she said.

The ambulance arrived at the Moore’s farm six minutes after Joe called for help.

“Jessica, you are having a stroke,” Joe remembers firmly telling his wife.

“I remember every second of it. I kept saying ‘I am really scared’ over and over,” Jessica said. “I was aware the entire time and was completely terrified.”

Joe later told her that while the words she spoke seemed normal to her, he could not understand anything she was saying.

Thankfully, the Moores' neighbors noticed the ambulance and rushed over to help, staying with their three children while Joe followed the ambulance.

“Once I was in the ambulance, I remember not being able to see,” Jessica said. “I don’t know if my vision was compromised or if I just had my eyes closed. I could hear and feel everything, although I was never in any pain.”

The EMTs, recognizing the signs of a stroke and knowing that time was crucial, called for a helicopter. A team from Air Evac Lifeteam agreed to meet directly at the landing pad at the hospital in Harrodsburg. Jessica went straight from the ambulance to the helicopter that then headed to the University of Kentucky Albert B. Chandler Hospital.

“One of the nurses on the flight was so kind and held my hand the whole way. I remember hearing the pilots talking with the hospital during the flight,” Jessica said.

At that point, it dawned on Jessica just how serious the situation was. She was, in fact, experiencing a stroke, something that had never crossed her mind. She couldn’t believe she was on a helicopter heading for UK’s Emergency Department — she led a clean and healthy lifestyle, and had no known risk factors or family history of stroke, blood clots or heart issues. Joe was having the same thoughts as he drove to Lexington to join his wife at the hospital.

“All of that was racing through my mind,” Joe said. “While also wondering if I’m going to get my wife and mom to our kids back.”

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David Dornbos, M.D., is a neurologist with UK HealthCare’s Kentucky Neuroscience Institute and an assistant professor in the Department of Neurological Surgery in the UK College of Medicine. Dornbos says strokes like Jessica’s are often missed or seriously delayed either because the signs go unrecognized or if it is a young patient there is often a level of denial.

“A lot of times you get the story of, ‘I felt funny and just went to bed because I figured that would make it better,’” he said. “Then by the time they get to us, it is unfortunately often too late for us to really do anything.”

When looking back on Jessica's story, Dornbos calls it a “very impressive pickup by her husband.” The quick action by Joe and all those down the line initiated by his 911 call allowed Jessica to land on the roof at UK Chandler Hospital just 48 minutes after sitting down on their shop floor. When it comes to treating a stroke, the time to treatment is crucial.

“I made it in the window they needed,” said Jessica.

Jessica first received the effective clot-busting drug known as tPa. She then went straight in for a thrombectomy — a surgical procedure to remove a blood clot — performed by Dornbos. While some patients require heavy sedation or intubation for this procedure, Jessica’s young age and overall health allowed Dornbos and his team to conduct the thrombectomy with just light sedation. After inserting a catheter through her wrist, Dornbos quickly saw the blockage and inserted another catheter to clear it out.

As she woke up from the light sedation — and before the team could even fully apply the bracelet on her wrist to apply pressure to the artery they had just gone through — Jessica began moving the left side of her body.

“That was awesome,” Dornbos said. “They don’t always happen like this. Getting to do them with the patient pretty much awake and then get that response so quickly was amazing to see.”

When Jessica first arrived at UK HealthCare, she was generally aware of what was happening, but could not move her entire left side or communicate clearly. From the time she was placed on the procedure table with Dornbos, to the time she was ready to be moved up to KNI’s inpatient unit to a neurological ICU room, only 20 minutes had passed — but the difference in her health was huge.

“She was fully having a stroke and then in a matter of minutes, she instantly regained strength on the left side of her body, and then she began talking coherently again,” Dornbos said. “She was thanking everybody. Then a few minutes later, she was apologizing for having bothered everybody. She was already back to what we would consider neurologically normal. Her husband getting her here that quickly was huge, as well as the rapid response by the EMTs, flight crew, and our team here at UK HealthCare.”

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Jessica spent the following four days in the Neuro ICU at UK HealthCare, recovering and undergoing tests to try to determine what caused the stroke. Through a sodium bubble echocardiogram, it was determined she had a heart defect known as a patent foramen ovale (PFO).

The foramen ovale is a hole in the wall between the left and right atria of every human fetus. The hole allows blood to bypass the fetal lungs, which cannot work until they are exposed to air. When a newborn enters the world and takes its first breath, the foramen ovale closes, and within a few months, it has sealed completely in about 75% of people.

A PFO occurs after birth when the foramen ovale fails to close, which allows blood to leak from the right atrium to the left. (In medical terms, “patent” means “open.”) Most people living with a PFO do not have complications; however, problems can arise when that blood contains a blood clot.

“This small hole in my heart allowed a clot to pass through my heart and go straight to my brain,” Jessica said.

Doctors were later able to close the PFO with a small implant. The cause of Jessica’s clot is still undetermined. But she continues to follow up with her doctors, and it is highly unlikely she will experience this same problem again.

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Fast forwarding to less than a year out from this still unfathomable experience, the Moores are grateful each day they step into their welding shop.

“Looking back on it, so many scenarios could have completely changed the outcome. I could have been driving with the kids or out in the field feeding the pigs, and I might not have gotten care so quickly,” Jessica said. “I am so thankful for Joe and that I was with him and that he acted as quickly as he did. I am forever grateful for the EMTs, life flight nurses and pilots, Dr. Dornbos and his team, the nurses at UK, my cardiology team, and all of our family and friends who immediately jumped in to help us.”

Dornbos knows firsthand that Jessica’s case is not always the outcome, and that this experience is a clear example of just how precious each and every minute can be.

“If the blockage had lasted just even a minute longer, it could have been a major life-altering and even family-altering situation,” he said. “This procedure allowed her to get home, to get to her husband and kids, and to get back to her life again. Restoring blood flow is not only critical to surviving a stroke but also to the outcome and recovery of a patient who does survive.”

So now as the Moores go about their busy days full of feeding the chickens, managing orders coming into their shop, driving their kids to gymnastics and everything in between, they do so with an overwhelming sense of gratitude.

“This experience has taught me to not take anything for granted and appreciate every moment,” Jessica said.

“I’m just glad to have my wife back,” added Joe.

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If you suspect someone you know is having a stroke, the American Stroke Association recommends assessing them using the FAST test:

• F = Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
• A = Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S = Speech Difficulty – Is speech slurred?
• T = Time to call 911

For more information on the prevention and treatment of strokes, visit ukhealthcare.uky.edu/stroke.