Marie Richter re-learns how to walk at The Rehabilitation Institute of St. Louis.

Marie Richter was just moments away from climbing a ladder to help a friend with roof repairs when she felt a sudden weakness in her right arm and leg. By the time her friend could help her inside, the entire right side of Richter’s body felt paralyzed.

“I had been training for a triathlon,” she says. “I was in the best shape of my life, and I didn’t know what was happening.”

Fortunately for Richter, her friend recognized the signs of a stroke and immediately called 911. First responders brought her to the Washington University and Barnes-Jewish Hospital Stroke Center, where a CT scan showed a tremendous amount of blood on her brain.

“From there, everything went downhill very fast,” Richter recalls. “I remember being in the emergency department, awake but not able to talk. My husband and kids came in. While I was waiting for an ICU bed, I had a seizure on the left side of my body – the good side!”

Richter spent six days in the neurology intensive care unit, where the stroke team watched her closely for signs that the bleeding was slowing down. When it began to clear on its own, Richter was discharged from the hospital to begin rehabilitation. She had no motor function on her right side and her speech was almost unintelligible.

How did a future triathlete just shy of her forty-first birthday come to this?

Several weeks later, enough blood had cleared from Richter’s brain that an MRI could finally reveal the source of the problem. Neuroradiologists diagnosed a cavernoma – an abnormal tangle of veins in the brain. When the cavernoma ruptured, Richter suffered a hemorrhagic stroke.

Alexandre Carter, MD, a Washington University neurologist at Barnes-Jewish Hospital, says that Richter is not a typical stroke patient. “Many people have risk factors that add up to stroke, such as struggles with high blood pressure or high cholesterol,” Dr. Carter says. “But the cavernoma is not a result of anything she did, any medications she took or lifestyle choices she made. It’s just a developmental thing that happens.”

Dr. Carter emphasizes that the uniqueness of Richter’s situation highlights the need for increased stroke education. “People who have risk factors are not the only ones who need to know how to recognize stroke symptoms,” Dr. Carter says.  “Stroke is epidemic. This notion that only older people have strokes is clearly not true. Everyone needs to know what to look for and how to react.”

Richter’s friend who called 911 is an excellent example, he says. ““This could have been much more devastating for Mrs. Richter without a quick response. That’s why we emphasize education and awareness in the community.”

Nearly nine months have passed since Richter’s stroke. The mother-of-three took to rehabilitation with the same intensity as her triathlon training.

“I’m very lucky to have regained my speech,” Richter says. She no longer struggles to communicate, which Dr. Carter says is a wonderful development. Regaining her physical strength and coordination has been difficult, she admits, but she is up for the challenge.

“It’s hard to be realistic and push myself at the same time,” Richter says. “I think long-term, but the rehabilitation team encourages me to be proud of baby steps. Right now, my goal is walking around the block. Then it will be walking around the block faster.”

Even though nothing could have prevented Richter’s stroke, her commitment to physical fitness before the incident has proven to be a big advantage throughout the rehabilitation process.

“Marie Richter is a great example of how people can approach their recovery,” Dr. Carter says. “There are two things that I think are most important to a positive outcome in rehabilitation: motivation and cardiovascular health. She had both.”

Richter sees Dr. Carter every six months and has routine MRIs to monitor the cavernoma. “It’s a ‘wait and see’ thing now,” she says. “The further out I get from the first bleed, the safer I am. And so far, it’s going well.”

May is National Stroke Awareness Month. Each week, we’re sharing the stories of patients whose lives were changed by stroke and the caregivers who are helping them on the road to recovery.

Preeclampsia is a life-threatening pregnancy disorder that affects 5-12 percent of pregnant women each year. This unpredictable condition is difficult to treat and can result in serious health complications or death for both the mother and the baby.

Pregnant women can develop extreme high blood pressure, fluid in the lungs and organ failure. The end stages of the disease, called eclampsia, can result in seizures, stroke or even death. Babies face many risks from low amniotic fluid, separation of the placenta and premature birth.

Eric Strand, MD, a Washington University obstetrician at Barnes-Jewish Hospital, says that while doctors understand what preeclampsia can do to the body, the actual cause of the disorder remains unknown. “This means that every pregnant woman is at risk,” Dr. Strand says.

Some risk factors have been identified, such as existing hypertension, obesity, multiple pregnancies and maternal age. First-time mothers and women who have previously suffered from preeclampsia are at increased risk. Still, Dr. Strand cautions that all pregnant women need to be aware of the symptoms.

“It can happen in any pregnancy. Everyone needs to be on the lookout.”

Signs of preeclampsia usually become evident after the 20th week of pregnancy. Pregnant women should watch for symptoms such as:

• High blood pressure
• Swelling of the face and hands
• Headaches
• Changes in vision, such as blank spots
• Nausea and vomiting
• Upper abdominal pain

“Contact your doctor right away if you experience these symptoms,” Dr. Strand says. Doctors will order lab work to confirm a diagnosis of preeclampsia.

Since there is no test to screen for preeclampsia before it occurs, Dr. Strand says that patient education and early detection are key to keeping both mom and baby safe. “We all need to be vigilant about recognizing the symptoms,” he says.

The only cure for preeclampsia is delivering the baby, and even then, the danger is not entirely past.

“We walk a fine line, optimizing the health of the mother and baby while maintaining the pregnancy as long as possible,” Dr. Strand says. Babies may have complications like low birth weight and underdeveloped lungs. Women can suffer hemorrhages or seizures, even several days after delivery.

Although there is no way to prevent preeclampsia, Dr. Strand says that mothers who are in better health overall before pregnancy have a lower risk of complications from the disorder. “It’s best to get your health concerns under control before trying to conceive,” he advises.

Dr. Strand recommends that women who are planning to become pregnant consider discussing these issues with their doctor. “Existing problems like high blood pressure, obesity and diabetes can raise the risk for preeclampsia,” he says. “The more you control those factors, the better off you and your baby will be.”

The St. Louis Promise Walk will take place on Saturday, May 18 at Millenium Park in Creve Coeur.

• Eat at least three times per day. Begin with a healthy breakfast containing whole grain foods like a high fiber cereal.
• Get plenty of fiber. Good sources of fiber are fruits, vegetables and whole grains.
• Get active! The FDA recommends that adults over the age of 18 get at least 150 minutes of physical activity per week. This is about 30 minutes of physical activity, 5 days per week.
• Watch your portion sizes. Divide your plate into four equal parts. Use one part for a lean meat or protein, one part for a starch and 2 parts for non-starchy vegetables.
• Drink a glass of water before you eat and more during meals.
• Enjoy fruit for dessert instead of cake, pie or other sweets.
• Eat slowly and stop eating when you begin to feel full.
• Plan ahead and be sure to have healthy foods on hand.
• Try to cut back on snacking, but if you get hungry between meals good choices for snacks are: low calorie yogurt, nonfat milk, raw vegetables with fat free dips, fresh fruit or high fiber granola bars

These tips are for people who are on a regular diet. If your doctor or health care provider has told you that you need to be on a special diet, like a diabetic or low sodium diet, please consult a Registered Dietitian or your doctor for instruction. 

With hot weather around the corner, more people are riding bikes, taking walks and participating in many other outdoor activities. Be aware of yourself and others around you. Making your community a safer place starts with you. May is also Trauma Awareness Month and a great time to review helpful tips for preventing injury.

Here are some helpful tips to remember this month:

• Use a hands-free device while driving
• Always wear your safety belt
• Refrain from using ear pieces in both ears so you are aware of what is going on around you
• If riding a bike, walking or jogging, be sure to wear reflective clothing to ensure that motor vehicles are able to see you
• Always wear a helmet when riding a bike
• Walk or jog on sidewalk paths. If none are present, walk or jog facing traffic, as far away from the road as possible

Pedestrians that are distracted by music or texting are more likely to be hit by a motor vehicle than those who weren’t distracted. They are also 7.9 times more likely to be hit by a vehicle if listening to music, 2 times more likely if talking on a cell phone and 5.2 times more likely if texting.

Distracted driving has become an increasing problem with the evolution of smart phones, tablets and other mobile devices. The Washington University and Barnes-Jewish Trauma Center, along with ABC 30, participated in an effort to reduce the amount of texting and driving. To take the no text zone pledge, visit the No Text Zone website.

Be sure to keep these safety tips in mind this spring and summer. It could save your life.

In addition to the awards ceremony, Barnes-Jewish nurses celebrated with pot-luck unit celebrations, a hospital-wide breakfast, a reception and all nurses are invited to attend the hospital’s team member appreciation picnic next week. With close to 3,500 nurses employed by the hospital, a celebration for all nurses is no small feat.

“Nurses week is a time for the hospital to see our nurses shine,” says Coreen Vlodarchyk, vice president, patient care services and chief nursing officer. “We encourage our nursing team to celebrate the profession and the excellent care they provide to our patients on a daily basis.”

Cathy Powers oversees the Nurses Week celebration every year at Barnes-Jewish.

“A lot of time and effort goes in to this celebration, to make Nurses Week special for our team,” says Powers. “The leadership team at Barnes-Jewish values our nursing staff and feels it’s important that each nurse knows the value of what they bring to the hospital and our patients every day. These are simple yet meaningful celebration to honor our cherished nurses.”

For more information about becoming a nurse at Barnes-Jewish Hospital, visit our careers page.

At dinner with his wife in February 2012, Postiglione felt a sudden, severe pain in his head. He collapsed on the spot and was rushed to the hospital in Quincy, Ill. His wife, Joyce, recalls the grim scene in the emergency room. “They told me to call our kids and the priest,” she says. “They were going to transfer him and I guess they thought he wouldn’t survive the trip.”

Postiglione received the last rites and was transferred to the Washington University and Barnes-Jewish Hospital Stroke Center.

“We all thought it was goodbye,” Joyce says.

The stroke team at Barnes-Jewish Hospital was ready when Postiglione arrived. They suspected a brain aneurysm, and a cerebral angiogram confirmed the diagnosis. Postiglione had suffered a subarachnoid hemorrhage (bleeding into the brain) from a ruptured brain aneurysm, causing a rare type of hemorrhagic stroke.

“Less than 5  percent of strokes are caused by subarachnoid hemorrhage,” says Gregory Zipfel, MD, a Washington University neurosurgeon at Barnes-Jewish Hospital. “About 2-4 percent of the population has a brain aneurysm, and the majority of those don’t hemorrhage. Some of it is just bad luck.” He cites family history, smoking and hypertension among the biggest risk factors for aneurysms. Some patients show classic stroke symptoms like one-sided paralysis or blurred vision, but a sudden, intense headache may be the only warning sign of this uncommon stroke.

By the time he arrived at Barnes-Jewish Hospital, Postiglione had developed hydrocephalus, or fluid buildup on the brain. “The blood on his brain from the hemorrhage was blocking the path of his spinal fluid so it couldn’t drain,” Dr. Zipfel explains. He placed a catheter in the brain to drain the excess fluid.

Then the team faced a decision: how would they stop the bleeding? “At our stroke center, we can treat subarachnoid hemorrhage using coiling or clipping,” Dr. Zipfel says. Aneurysm coiling uses a small catheter to place a flexible metal coil inside the aneurysm. The other method – clipping the aneurysm – would require open brain surgery.

“We brought both the endovascular and surgical teams together to look at the imaging, and decided that surgery and clipping would be the best and safest option for Postiglione,” Dr. Zipfel says. During the surgery, he used a microscope to locate the aneurysm, and then applied a titanium clothespin-like clip to the vessel. After placing the clip, Dr. Zipfel did another angiogram in the operating room to confirm that the aneurysm was completely gone and all blood vessels were open.

Postiglione recovered in the Barnes-Jewish Hospital neurosurgery intensive care unit for over 3 weeks. “Those weeks were a blur,” he says. “Everyone told me later that they didn’t think I ever realized how bad the situation was. They told me they weren’t ever sure they would see me alive the next day.”

Postiglione doesn’t remember complications he suffered in the intensive care unit, including a vasospasm, or narrowing of an artery in the brain. Vasospasm is common among subarachnoid hemorrhage patients. It can cause further brain injury and even another stroke. When Postiglione began to show symptoms of a vasospasm, Dr. Zipfel’s team carefully elevated his blood pressure and administered endovascular medications. They were able to stop the vasospasm and prevent any further brain damage.

Now, at the age of 66 and over a year after his surgery, Bill Postiglione is still fighting back. His physical rehabilitation is complete, and he is focusing on cognitive recovery.  Short-term memory and concentration issues are common among stroke survivors. Half of them never return to work.

“I can usually carry on a normal conversation,” he says, “but I do have fears about going back into the classroom, giving lectures and answering questions.”

For now, the classroom and the karate dojo can wait.

“Because of Dr. Zipfel and the stroke team at Barnes-Jewish, I’m still here,” he says. “I’m enjoying my wife’s company, enjoying my children. And for that I sincerely thank them.”

May is National Stroke Awareness Month. Each week, we’re sharing the stories of patients whose lives were changed by stroke and the caregivers who are helping them on the road to recovery.

That journey brought the couple to the Washington University and Barnes-Jewish Transplant Center, where Ben received a kidney transplant in February 2008. And it brought them to Andrea Sharos Markwardt, MSN, RN, CCTC, Ben’s kidney transplant coordinator. They met for the first time one evening, the day before his surgery.

Sonya wrote an essay that began with the first meeting with Markwardt, which was chosen as the winner of the International Transplant Nurses Society (ITNS) annual essay contest. This year’s theme was “What My Transplant Nurse Means to Me.” The contest allows patients to nominate an ITNS transplant nurse who has made a difference in their life.

“She’s just like I described her in my essay. The award proves how special Andrea is to us and to many other patients,” says Sonya.

Masina Scavuzzo, RN, CCTN, a lung transplant coordinator, was also nominated this year by one of her patients.

It’s the second year in a row a transplant coordinator from the Transplant Center has been the subject of the winning essay. Last year, Pam Thurston, RN, CCTN, was honored as a “Guiding Light” for her patients.

Here’s an excerpt from Sonya Mau’s winning essay:

The care and compassion we feel for Andrea is in response to all she’d given to us when we were in need. We know she will be there for us “essentially forever.” And we plan to be there “essentially forever” for our Andrea, who is angel, advisor, friend and honorary member of our family. That’s what our transplant nurse means to us!

In her honor, Tomlin-Watson started a team the next year that friends and relatives happily joined. “JoAnn’s Jewels,” named after the woman they lost, has participated in the Komen St. Louis Race for the Cure every year since.

“My mom was the heart of our family,” Tomlin-Watson says. “She drew everyone together. That was just her spirit.”

Tomlin-Watson, an asthma coach at St. Louis Children’s Hospital, continues the tradition on June 15, when she joins the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine for the 15th annual Komen St. Louis Race for the Cure in downtown St. Louis.

“Breast cancer is going to affect you some way – you, someone you know,” she says. “We need to do what we can and to be more aware.”

Those who join the Siteman team for the 5K run or walk will receive two T-shirts – a Komen St. Louis Race for the Cure shirt and a specially designed Siteman team shirt. Registrants who sign up online also are entered into a drawing for one of two Kindle Fire tablets and will receive a one-year subscription to SELF magazine or GQ magazine. The deadline for registering online is midnight May 28. Visit sitemankomenteam.wustl.edu for more information.

The Komen St. Louis Race for the Cure has had a tremendous impact on Barnes-Jewish and Washington University patients, says Susan Kraenzle, RN, manager of Siteman’s Joanne Knight Breast Health Center.

Since 1998, when the St. Louis race began, Komen has awarded about $28 million for outreach, education, screening and research programs at the Washington University Medical Center campus.

“It moves me to see our city turns out the way it does,” Kraenzle says. “I lost a sister to breast cancer, and I wish she were here to see this and know people are fighting for her and her kids.”

Of the net proceeds raised locally, up to 75 percent stays in St. Louis to help Siteman and other organizations provide breast cancer education, screening and treatment programs. For example, Komen funds allow Siteman to provide free mammographies to more than 3,200 underserved, low-income women in the area.

As for Tomlin-Watson, she now hosts the holiday dinners her mother once did. The Komen St. Louis Race for the Cure has become a family tradition, too. Members of JoAnn’s Jewels carry fans bearing an image of the smiling matriarch. During the walk, they reminisce about the times they shared with her.

So many families have been affected by breast cancer, a point Tomlin-Watson recognizes every Race for the Cure when she stops at a particular vantage point along the route. From there she sees the tens of thousands of other people walking, running and remembering alongside her.

“It’s just a humbling sight to see,” she says. “You see all these people coming together for this one cause.”

Physical therapist Annie Fournie helps Gary Finch learn to walk again.

May is National Stroke Awareness Month. Each week, we will share the stories of patients whose lives were changed by stroke and the caregivers who are helping them on the road to recovery.

In February, Gary Finch was going through his regular morning routine when he started feeling weak on the right side of his body. His knee buckled when he tried to walk.

“I thought it would pass,” he says. “My wife told me to go to the hospital, but I just thought I’d wait and see if I felt better.”

That’s exactly what doctors don’t want a person showing stroke symptoms to do: wait. “Time is brain,” says Peter Panagos, MD, a Washington University emergency medicine physician at Barnes-Jewish Hospital. “The shorter the time between symptoms and treatment, the more we can minimize the damage to the brain.

“We teach a simple device that helps people recognize the signs and symptoms of stroke,” Dr. Panagos says.

F – Face. Smile! Does one side of the face droop?

A – Arms. Raise both arms. Does one start to fall, even though you try to keep it up?

S – Speech. Speak a few sentences. Are you slurring your words?

T – Time. IMMEDIATELY call 9-1-1 and ask responders to take you to a stroke center.

A friend stopped in to check on Finch several hours later and noticed he was slurring his speech. He took him to the Barnes-Jewish Hospital emergency department.

The clot-dissolving medication tPA (tissue plasminogen activator) is a “miracle drug” for some stroke patients, but it is only effective within a certain time frame. The Food and Drug Administration recommends tPA be given within three hours of the first symptoms.  However, some stroke centers have extended protocols allowing it up to four-and-a-half hours after symptoms appear.

The certified Primary Stroke Center at Barnes-Jewish Hospital has an extended tPA protocol, which Finch credits with saving both his brain function and his life.  Doctors quickly diagnosed an ischemic stroke and administered the medication.

“I believe the tPA kept me from getting any worse,” Finch says. “Thank God they could still give it.”

The last step of FAST – time – is important even if hours have already passed. “FAST does not distinguish between an ischemic stroke and a hemorrhagic stroke, or a brain bleed,” Dr. Panagos says. “We treat each type of stroke differently, but it’s always time-critical.”

Today, Finch still has some physical struggles, but he is optimistic about his progress. “I’m learning to utilize what I have,” he says. “I can’t say enough about the people who have helped me, especially with speech therapy and occupational therapy. They’ll have me running by the time I’m done.”

Finch recently returned to his south St. Louis home after two months of intensive inpatient rehabilitation. He goes to outpatient therapy several times a week and is looking forward to teaching other people recovering from stroke to play chess to keep their minds sharp.

“I know I should have listened to my wife,” he says with a wry smile. “When I don’t listen to her, it usually doesn’t turn out right. I’m fortunate to be the way I am now, but I would have been better if I’d gone in sooner.”

The free event will feature: health screenings and disease risk assessments, samples of healthy food, hands-on activities that explain cancer’s genetic links, one-on-one discussions with Washington University physicians, a children’s activity tent, children’s bicycle helmet checks and a tent offering therapeutic support for cancer survivors.

Participants are asked to register by calling 314-747-7222 or 800-600-3606.

The facility, which opened in January, offers access to the same technology and advanced treatments, including more than 240 clinical trials, available at Siteman’s main location at the Washington University Medical Center.

“Treatment at a top 10 U.S. cancer center just got easier for hundreds of thousands of area residents,” says Timothy Eberlein, MD, Siteman’s director. “Along with convenience, patients at our south county location will benefit from the world-class cancer care and outstanding research of our Washington University physicians.”

Siteman also has locations in Creve Coeur at Barnes-Jewish West County Hospital and in St. Charles County at Barnes-Jewish St. Peters Hospital. Collectively, the cancer center is recognized by U.S. News & World Report as one of the top 10 cancer centers in the nation.

Appointments for any of the sites may be made by calling 314-747-7222 or 800-600-3606 toll free from 8 a.m. to 4:30 p.m. Monday through Friday.

Bruce Roth, MD, is director of medical oncology at the new location, and Parag Parikh, MD, is director of radiation oncology.