It is amazing what a gift it is to be able to feed yourself, or to tell someone ‘thank you’, ‘I miss you’, or ‘I love you’. It registers in a whole new way. You truly realise and appreciate the significance of those words, they mean more than ever.
South Africa (04 November 2021) – Stroke may either be caused by bleeding in the brain or by a blood clot blocking a vessel supplying the brain with nutrients and oxygen in the blood, known as an ischaemic stroke.
Mr De Villiers’ fiancé realised he was having a stroke and recognised it as a medical emergency. He was first taken by ambulance to Netcare Sunninghill Hospital’s emergency department, where life-saving emergency treatment was commenced within an hour of his stroke being discovered.
“When the medical rescue helicopter took off with me on board, my family were warned to prepare themselves for the worst. I was later told that I had suffered one of the most dangerous types of stroke, but there was hope that my life could be saved if the blood clot could be removed in time with a specialised procedure,” says Carl De Villiers, who suffered a major vessel occlusion stroke in March this year.
A CT scan identified a blood clot in a major vessel of Mr De Villiers’ brain, which was starving a large part of his brain of vital blood supply. This was treated urgently through thrombolysis, the carefully controlled use of clot-busting medication.
”Given the type of stroke he suffered, the trauma team decided that Mr De Villiers’ best treatment option would include a mechanical thrombectomy, and an urgent Netcare 911 helicopter medical transfer was arranged to take Mr De Villiers to our specialised stroke centre at Netcare Milpark Hospital for this immensely intricate procedure,” says Dr Ismail Moola, a neurologist practising at Netcare Milpark Hospital, and who was a key member of the team who treated Mr De Villiers.
“Clinical decision making is extremely time-sensitive in stroke treatment. For every minute that passes after the onset of stroke, more brain cells are being damaged, further reducing the patient’s chances of survival and prospects for recovery,” adds interventional radiologist Dr Moaaz Valli Omar, who practises at Milpark Radiology Incorporated based at the hospital.
Dr Omar, together with Dr Moola and fellow neurologist Dr Pradeep Rowji, are key members of the multi-disciplinary team involved in the care of stroke emergencies. The team were alerted to the imminent arrival of the acute stroke patient and was ready and waiting to seamlessly take over his care.
Mr De Villiers was taken almost immediately to the catheterisation laboratory with highly advanced navigational imaging equipment for the mechanical thrombectomy to extract the blood clot and restore crucial blood flow to the brain. Dr Omar is one of very few specialists in the country qualified to perform mechanical thrombectomy for major vessel occlusive strokes, and usually, only local anaesthesia is required for the procedure.
In this minimally invasive procedure, a fine catheter wire is inserted through a small incision in the patient’s groin or wrist and is guided through the arteries all the way to the site of the clot in the brain. The clot is captured using specialised aspiration and/or large-bore catheters, or in combination with a clot capture device and gradually guided out of the body.
“It is not without risk; however this procedure can turn around the likely outcome of potential death or the individual being left permanently bedridden to a much more hopeful prognosis, where the patient can regain a great deal of functionality and quality of life. Best outcomes are achieved within the so-called ‘early-window’ period, within six hours from the onset of stroke. Beyond six hours, clot extraction and brain reperfusion is still possible, but the clinical outcomes and efficacy of the procedure are potentially reduced,” Dr Omar says.
Road to recovery
The underlying cause of Mr De Villiers’ stroke was identified as antiphospholipid syndrome, which increases the risk of developing blood clots and to help prevent this, he was prescribed blood-thinning medication. Mr De Villiers spent 17 days in intensive care at Netcare Milpark Hospital before being transferred to Netcare Rehabilitation Hospital in Auckland Park, where he stayed six weeks to continue his recovery.
Although Mr De Villiers survived the stroke, he was initially unable to talk or walk, and the extent to which he could recover and regain these functions was not yet clear. “It was extremely isolating and frustrating not being able to speak at the beginning of my recovery. I studied electromechanics, but after the stroke, I couldn’t add two and two. I had to re-learn so many things from scratch,” Mr De Villiers recalls.
“This just gave me more motivation for my recovery. I put all my energy into every therapy session that formed part of my rehabilitation. I was adamant I was going to beat this. I did physiotherapy, speech therapy; I had sessions with an occupational therapist and a psychologist. I wanted to show my son that one shouldn’t give up when God puts you on a path,” he says.
Progress and the significance of ‘I love you’
“The therapy helps you learn to concentrate again, regain control of your thoughts and get your memory working again. First, I would say a word over and over again, but it had no meaning. Over time you start recognising the concept, and it was absolutely wonderful to be able to have a conversation eventually.
“It is amazing what a gift it is to be able to feed yourself, or to tell someone ‘thank you’, ‘I miss you’, or ‘I love you’. It registers in a whole new way. You truly realise and appreciate the significance of those words, they mean more than ever.”
Mr De Villiers is now also able to walk again and his mobility is expected to improve further, although he still has significant weakness in his left arm. “You have to be mentally strong in stroke recovery, and every day I try to do something better than I was able to the day before. I know this is a process. I am so grateful to Dr Moola and Dr Omar and everyone involved in saving my life and in my recovery,” he says.
“I have the highest praise for all the doctors, nurses and therapists at Netcare Milpark and Netcare Rehabilitation hospitals. People don’t realise the effort and hours they put in, and the extreme care that is just normal in their daily work with patients. Thanks to the grace of God for getting me through this with such caring people around me.”
The Netcare Rehabilitation Hospital and their associated multi-disciplinary therapeutic practice, Rita Henn and Partners, measure two key indicators of their patients’ care, a patient’s average weekly improvement in their ability to perform everyday activities using the Beta score and the internationally recognised measure of the success of a physical rehabilitation programme, namely the percentage of patients discharged to their home. In 2020, 89% of patients admitted to Netcare Rehabilitation Hospital were discharged to their home.
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