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Article Category: PeopleCare

AshleyCare

Published on August 16, 2020

Last updated 03:46 PM August 21, 2020

Ashley with her baby on a bridge

Ashley in a park, holding her son Luke.

September hasn't always been Ashley Irwin’s favorite month. Years ago, that time of year when the leaves changed into bright, warm colors held some of the darkest moments of her life.

In 2011, a 28-year-old Ashley was battling a particularly bad bout of Crohn’s disease, an inflammatory illness that can cause painful and often debilitating abdominal and bowel issues.

After the intense flare-up, Ashley was settling in at home again with the assistance of her mother. She was determined to regain her independence and get back on track.

But it wasn’t long before the sharp sensation of a migraine hit her full force. Pushing through the pain, she tried to check her email for any new messages, though it was nearly impossible to type in her username and password.

“As I sat in front of the computer, I couldn’t even remember my last name to log in to my email account—no matter how hard I tried,” Ashley recalled the terrifying moment.

Almost immediately, Ashley’s mother noticed her confusion, and stepped in to assess the situation and double-check her daughter’s cognitive abilities.

“My mom asked me, ‘Who am I? What’s my name?’ In my head, I knew she was my mother, but I just couldn’t connect the dots and express it,” Ashley said, describing her confusion and difficulty thinking. “At that moment, I couldn’t tell you her name or her relationship to me.”

Worried, the mother and daughter rushed to the Emergency Department at Wellstar Kennestone Regional Medical Center for immediate medical treatment. After being evaluated, it was clear that Ashley was dealing with much more than just a bad headache—she was having a stroke.

Any time a person experiences a stroke, the brain can have a very severe reaction. In Ashley’s case, her brain began to swell. If we didn’t address the issue immediately, the brain could end up ‘choking’ itself within the rigid confines of the skull.

- Dr. Joseph Hormes

Wellstar Neurologist

Listen to Ashley's Story

Emergency stroke care

After quickly being transferred to the Neuro Intensive Care Unit (ICU), Wellstar Neurologist Dr. Joseph Hormes was the first to evaluate her condition.

“When Ashley was admitted to the hospital, she was dealing with a very complex neurological illness,” Dr. Hormes recalled. “Due to an unusual blood-clotting issue, she was experiencing a hemorrhagic stroke which caused life-threatening bleeding in her brain.”

Unlike more common ischemic strokes which are caused by a blocked artery in the brain, a hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. According to the American Stroke Association, hemorrhagic strokes account for just 13% of all stroke cases.

Even so, the Wellstar care team was prepared to handle the complex case. A team of physicians sprang into action, giving Ashley immediate care and closely monitoring the situation. However, after a few days in the hospital, Ashley’s condition wasn’t getting any better.

“Any time a person experiences a stroke, the brain can have a very severe reaction,” Dr. Hormes explained, “In Ashley’s case, her brain began to swell. If we didn’t address the issue immediately, the brain could end up ‘choking’ itself within the rigid confines of the skull.”

Dr. Hormes didn’t waste any time to save Ashley’s life.

“Right away, we assembled a team of expert physicians, including a neurologist, neurosurgeon, neurointensivist and hematologist, who all worked together to provide the best care possible for Ashley,” said Dr. Hormes.

As Ashley’s condition continued to deteriorate, her brain pressure reached a critical point. The physicians rushed her into emergency craniotomy surgery.

During the surgical procedure, a piece of Ashley’s skull—called a skull flap—was expertly removed to allow her brain to swell freely. The portion of skull was surgically implanted into her abdomen tissue to keep it viable for reimplantation. This method would allow her brain time to heal on its own without being hindered by the skull.

Dr. Hormes commented on how the dedicated team came together to save Ashley’s life.

“At Wellstar, medicine is not a one-person sport,” the neurologist said. “It takes a team effort to take care of our patients. To provide critical care and save lives, we must have the right specialists at the right time and the right place.”

With her Wellstar team behind her, Ashley made it through surgery and spent the next two weeks in a medically-induced coma so her brain could begin healing. However, Ashley’s path back to better health was just beginning.

Working towards recovery

After waking up from the induced coma, Ashley grappled with the reality of having had a stroke. At the time of the event, Ashley wasn’t even 30 years old, which made it even more difficult for her to deal with the diagnosis.

“The word ‘stroke’ wasn’t even a part of my usual vocabulary,” Ashley said, addressing how the diagnosis was a total shock. “I always thought only older people could have strokes before I had mine.”

Unfortunately, strokes have no age limits—they can happen to anyone. While strokes are more common for the elderly, the American Stroke Association reports that people of all ages can experience a stroke, including children and infants.

While also juggling the emotional side effects of the stroke, it was a balancing act to keep her physical health in check. Finding the right mix of medication was tricky: many common medications used to treat strokes were the polar opposite treatments recommended to keep Ashley’s Crohn’s disease under control.

However, her care team took the challenges head-on with solutions that would address both conditions. “My Wellstar physicians were wonderful at finding the treatments that were most beneficial for treating the stroke, but wouldn’t send my Crohn’s into chaos,” Ashley said.

From there, weeks turned to months in the hospital as Ashley began working towards recovery. Along with the right medications, Ashley also dealt with other external factors that slowed her progress. From suffering an unexpected fall to developing an infection on her head wound, many challenges pushed back her surgery date to get her skull flap reattached.

“It was a long road with good days and bad days,” Ashley said, noting how her devoted care team made all the difference in her recovery.

Then in January, several months after being admitted to the hospital, Ashley underwent surgery to reattach her skull. After the successful procedure, Ashley made it her mission to be home before the next major holiday.

“My nurses promised me I wouldn’t end up spending Valentine’s Day in the hospital,” Ashley recalled the special memory. “They worked so hard to make sure everything aligned so I could be home. In the end, I was discharged on February 13th — just in time for the holiday.”

After months in the hospital, Ashley was finally home. However, she still had both physical and mental hurdles to work through. After being declared a fall risk, she had to temporarily move back in with her parents for constant monitoring.

“At that time, I couldn’t be left alone,” Ashley said, remembering the difficult start of her recovery. “It was really hard. I was so delicate physically, but I still felt like an active 28-year-old in my mind.”

Soon, Ashley was cleared to start stroke rehabilitation which was a big step in recovery. She harnessed the strength and determination to move forward step by step, focusing on physical therapy to improve her mobility.

“My friends and family were very encouraging with physical therapy,” Ashley said, remembering how she used the extra inspiration to fuel her physical recovery.

But it wasn’t just her relatives that helped her have a positive mindset. Ashley found a new family of Wellstar physicians that motivated her along the way.

“Through physical rehabilitation, my physicians helped me realize that I could live a fulfilling life after having a stroke,” Ashley smiled. “I didn’t want to sit on the sidelines and watch life happen around me. I wasn’t going to let my medical episode set me back.”

 



New beginnings

Through the years, Ashley diligently stayed on her wellness journey and settled into a new normal.

According to the American Stroke Association, people who have experienced one stroke have a much higher risk of experiencing another event in the future. With this in mind, she regularly saw Dr. Hormes to help manage her health and prevent another stroke.

Almost eight years after her stroke, Ashley got some joyous news. She and her husband were going to have a baby, and along with the elation and promise of new life came a pang of uncertainty.

“When I got pregnant, Dr. Hormes was one of the first physicians I texted,” Ashley said, noting the excellent patient relationship she has formed with the neurologist. “After having a stroke years ago, I was nervous about the pregnancy and wanted to make sure everything would be okay.”

For Ashley, becoming pregnant was nothing short of a miracle.

“For years, having a child was always up in the air. I was never sure if I would be able to have a child safely or if it would happen,” Ashley explained.

With her medical history, she was considered a high-risk pregnancy and would need constant monitoring until she gave birth. However, there was no doubt in her mind that her child would be born at Wellstar Kennestone Regional Medical Center.

“From the beginning, Wellstar was the place I had always received care. In fact, I was even born at Kennestone Hospital,” Ashley said.

Keeping everything in the same healthcare family had many benefits and made it easier when it came to her regular medical appointments.

“After my stroke and pregnancy years later, it was very comforting that Wellstar knew my medical history and had all of my records in their system,” Ashley said. “I didn’t have to rehash my entire medical episode at every appointment—they had all of the information right there at their fingertips.”

From September to September

For Ashley, Wellstar’s patient-centered care approach made her entire pregnancy easier.

Along with constant communication and support from Dr. Hormes, she had a total of five physicians providing coordinated care and closely monitoring her condition throughout the pregnancy. Nine months later, she welcomed a healthy baby boy into the world the very same month she had experienced a stroke eight years before.

“September used to be a very dark month for me. I would almost get lost in the memories of my stroke during that time of year,” Ashley said, remembering the troubling time. “But September became my brightest month ever, once my baby Luke was born.”

The birth brought peace and hope to the new mother, helping to put life into perspective. Now, Ashley has focused her energy on keeping a positive outlook for whatever comes her way.

“Getting through a stroke was a hard struggle. Some days, everything seemed negative, like the world was crashing down around me,” Ashley said, explaining her darkest moments.

“Now, I like to celebrate the little things,” she continued. “After Luke’s birth, September became a time to celebrate new life and new beginnings. Through everything over the past few years, I learned to pick myself up from the dust and keep going.”

Every step of the way, Ashley learned to rely on Wellstar for continued care. Dr. Hormes, who had been with Ashley from the beginning, was delighted at her progress.

“The most rewarding part of my work is healing patients,” Dr. Hormes beamed. “When patients like Ashley visit me after they’ve recovered or start new chapters in life, it’s the best paycheck I could ever get.”

As a mother and stroke survivor, Ashley encourages everyone to take charge of their wellness throughout their life.

“You have to be your own health advocate,” she said. “You are your greatest supporter because nobody’s going to speak up louder or stronger than you.”

Through it all, Ashley credited Wellstar with helping her through all her health hurdles and triumphs.

“Wellstar has always been there for me, from my birth to my stroke to the birth of my son,” Ashley said. “They saved my life—and then helped me bring new life into the world. Today, I’m in such a great place because of Wellstar.”

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Kennestone Regional Medical Center Joseph Hormes AshleyCare
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Back to school after receiving highly coordinated stroke care at Wellstar, Assistant Principal De'sa Fuller, enters her office to start a new school year.

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De'sa Fuller, an assistant principal in West Georgia, greeted teachers in the hallway like every other morning. But her day turned upside down when she lost her balance and couldn’t rise from the floor. Thanks to the immediate actions of those around her—from the teacher who called 911 to emergency medical services and her Wellstar team—De’sa recovered and is back to school. Her story is a powerful testament to how recognizing symptoms of a stroke, calling for help right away and having highly coordinated care can lead to remarkable outcomes.

Getting help when things go wrong

At 34, De'sa Fuller was living a vibrant life. She was a 6th grade assistant principal at Gardner Middle School in LaGrange. She loved her job, enjoyed traveling and was saving up to buy her first home. April 15 started out like any other day. Smoothie in hand, she greeted teachers in the hallway as she made her way to her office.

“I felt a little off,” De'sa recalled. “I just thought I was going too fast—I didn’t put much thought into it.” Then she fell. A concerned teacher asked if she was okay. De'sa, thinking she had simply tripped, said “Yes.” Her vision blurred as she tried to get up and she fell again. “I said, ‘I am not okay.’”

What began as a typical morning turned into a race against time. One teacher's quick thinking to call 911 activated a rapid chain of events that would save De’sa from permanent disability.

The critical first minutes

“The ambulance got there quickly. It was like they were around the corner,” De'sa remembered. 

“We got a call that EMS was bringing in a female who had been found on the floor at work, experiencing right-sided weakness,” explained Ginger Truitt, stroke coordinator at Wellstar West Georgia Medical Center, a Primary Stroke Center. The EMS professionals also reported confusion, headache and vomiting. “Those symptoms suggest stroke. We activated quickly.”

As a result, Dr. Reginald “Ashley” Orr, an emergency medicine physician, was ready for her arrival. 

“I was worried about an acute stroke by their description of her symptoms,” he remembered. “I evaluated her on the stretcher when she came through the door.”

A Code FAST was called with the goal of speeding up the time to start treatment to improve De’sa’s chances for better outcomes. They skipped the emergency department and took her for a CT scan. Then she was seen by the onsite neurologist, and the team quickly administered tenectoplase—or TNK—a clot-busting drug.

“Her symptoms were markedly improved,” Dr. Orr noted. “She was more awake.”

However, the CT angiogram showed an MCA M1 occlusion—a blockage in a major blood vessel in the brain. While she had shown some improvement, it wasn’t enough. De'sa needed a thrombectomy, a procedure to remove the clot and restore vital blood flow to the brain.

 

A seamless transfer

De’sa needed an immediate transfer to a thrombectomy center, and there are only a few in the state of Georgia. After a quick virtual consult with Dr. Ovais Inamullah, a telestroke neurologist at Wellstar Kennestone Regional Medical Center—a Comprehensive Stroke Center—she was accepted for transfer. The Marietta-based Neuro Care program performs one of the highest volumes of thrombectomy and aneurysm treatments in the country.

Because time is of the essence with successful stroke treatment, transport by air is preferred. However, weather conditions threatened the flight’s safety. The ground EMS crew dutifully stood by in case they needed to drive De’sa. 

Mercifully, the clouds lifted after a few tense moments and she began her trip to Wellstar Kennestone via helicopter.

“When we have this type of emergency, our goal is to get patients out the door for a thrombectomy in 90 minutes,” Ginger said. “In De’sa’s case, we did it in 102 minutes, which was still impressive because there was cloud cover and we weren’t sure at first if she would be able to fly.”

Upon arrival, De'sa was taken directly to the angio suite where Dr. Ahmad Khaldi, a Wellstar neurosurgeon, and his team were waiting. “Every minute counts,” he emphasized.

A thrombectomy is a procedure that treats a stroke without open brain surgery. A tiny catheter is threaded through a blood vessel in the arm or leg to the brain to remove a clot, restoring blood flow to help prevent permanent disability or even death.

“We finished surgery by 11:25 AM,” Dr. Khaldi said—just 20 minutes after the procedure began.

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A healthcare provider works with the Da Vinci 5 robot

Highlights

New Robotic Surgery System at Wellstar Kennestone Brings Next-Level Care to the Community

Touch-sensitive technology. More precision. Better surgical images. A new robotic surgery platform at Wellstar Kennestone Regional Medical Center features all this and more. What does that mean for people in our community facing a complex surgery? Everything.

The Da Vinci 5 (DV5) platform allows experienced surgeons at Wellstar Kennestone to be even more precise during delicate procedures. Patients bleed less, heal with smaller scars and usually go home sooner.

“At Wellstar Kennestone, we’re redefining what’s possible in surgical care,” said Lorrie Liang, senior vice president and president of Wellstar Kennestone and Wellstar Windy Hill. “The DV5 demonstrates that we’re not just adopting advanced technology—we are advancing the standard of care across the region.”

What is robotic surgery?

Robotic surgery is a type of minimally invasive surgery. The surgeon sits at a console and controls robotic arms equipped with tiny instruments. A 3D camera magnifies the surgical area. This allows the surgeon to see everything in high definition.

Wellstar Kennestone is one of the first hospitals in Georgia to offer the DV5. However, robotic surgery is not new at the hospital. Our surgeons began using Da Vinci Surgical System platforms in 2007. Today, we offer 17 state-of-the-art Da Vinci robotic surgical suites at several hospitals and two outpatient surgery centers. We use the system for many surgeries, including bariatric (weight loss), cancer and urology procedures.

A clear difference

Dr. Fritz Jean-Pierre has performed more than 2,500 bariatric surgeries in his career. And he’s excited about what the DV5 offers.

“The DV5 allows the surgeon to sense how much push-or-pull force they apply to delicate structures in the body,” said Dr. Jean-Pierre. “Essentially, the technology stops surgeons from putting too much strain on tissues as they maneuver the instruments. Less strain means less trauma and potential injury, leading to faster patient recovery.”

Dr. Jean-Pierre tailors surgery to each patient’s unique needs. The bariatric surgery he performs most often is the gastric sleeve. It involves removing a large portion of the stomach to limit food intake. Precision is essential, especially for patients who weigh more or have complex health conditions.

“After removing part of the stomach, the surgeon reconstructs the gastrointestinal tract. We use many sutures (stitches) to hold everything in place,” he said. “DV5 provides superior dexterity and control, leading to shorter, safer surgeries.”

Intuitive Surgical, the company that created the Da Vinci platform, designated Wellstar Kennestone as an “epicenter” for training in 2011. Surgeons from around the country come to Wellstar Kennestone to observe and learn robotic surgical techniques from Dr. Jean-Pierre and his colleagues.

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The DV5 allows surgeons to be more precise than ever, which affects patient outcomes. Dr. Scott Miller, a Wellstar urologist explained.

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Learn more about robotic surgery at Wellstar.

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Robert, a new grandfather, poses proudly with his daughter and her infant son. With Wellstar helping him manage his HCM, he can keep making memories with his growing family.

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RobertCare

Robert Frederick was living a typical life, going to work and spending time with his mother, siblings and children. But then it became hard to breathe when walking short distances or climbing stairs. He got dizzy. Perhaps most disturbingly, he passed out several times—once at a Braves baseball game he attended with his siblings.

"I didn't know what was going on!" Robert recalled.

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After passing out the first time, he went to urgent care and was then taken to the hospital by ambulance. He learned his symptoms were caused by atrial fibrillation (AFib), an irregular heartbeat.

Robert began to see Dr. David Caras, a Wellstar general cardiologist, and learned AFib is related to high blood pressure. Successfully managing high blood pressure often helps people keep AFib under control. Despite their efforts, AFib sent Robert to the emergency room two more times.

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Dr. Caras reviewed Robert’s hospital records and found he had increased wall thickness of the left ventricle and a gradient—a pressure difference between the left ventricle and the aorta when the heart pumps. These findings were consistent with a condition called hypertrophic cardiomyopathy (HCM). Characterized by abnormal thickening of the heart muscle, this disease makes it difficult for the heart to pump blood effectively.

Dr. Caras referred Robert to Dr. Melissa Burroughs, an HCM specialist at Wellstar. As a Center of Excellence designated by the Hypertrophic Cardiomyopathy Association, Wellstar is one of the leading providers of comprehensive HCM care in Metro Atlanta.

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A rare finding leads to Mayo Clinic Care Network collaboration

Robert said, “Dr. Burroughs wanted to do genetic testing to verify that I had HCM."

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