Deborah Ligor woke up in the middle of the night in June 2011, vomiting and suffering from the worst headache of her life.
Initially, her doctor thought she had a virus. But when she didn’t get better, it was clear the 50-year-old banker had a much more serious problem, most likely a ruptured aneurysm in her brain.
The expert care and advanced technology required to save her life were not available at the community hospital near her home in Ocean Pines, Md.
“So my husband asked the doctor where he would send his own mother,” Ligor recalls. “Forty-five minutes later, I was on a helicopter to Christiana Care.”
Doctors there quickly confirmed that she was, indeed, suffering from a ruptured aneurysm, essentially a bulging blood vessel that was leaking. The situation was especially perilous because Ligor’s aneurysm was located deep within her brain, a position not accessible through open surgery.
“If you drew a line between your two eyes, it would be dead set in the middle of your head,” says Sudhakar Satti, M.D., the neuro-interventional surgeon on the case.
In such dire circumstances, half of patients die, Dr. Satti notes, and about 70 percent of those who survive have some sort of permanent neurological disability.
“Christiana Care is the only place in Delaware that is equipped to handle these cases,” he says.
With a state-of-the-art interventional neuroangiography surgical suite, Christiana Care Neuro-Interventional Surgery provides minimally invasive services and treatments 24 hours a day, seven days a week, for a variety of conditions, including strokes and vascular and brain malformations.
Because the aneurysm was inaccessible from Ligor’s skull, Dr. Satti used endovascular techniques to reach the site in her brain, guiding a catheter through an incision in her groin, no larger than the tip of a No. 2 pencil. Through the catheter, Dr. Satti packed the aneurysm with soft metal coils, stopping the bleeding.
In addition to providing quick, effective treatment, the technique also results in less pain and a faster recovery. Two weeks after her surgery, Ligor was home with her husband and two children. Several weeks after that, she returned to her job at a bank in Millsboro.
“She has made a complete recovery,” Dr. Satti says. “These kinds of happy outcomes are the reasons doctors go to work every day.”
Ligor says her healthy, productive life is a direct result of the expert and compassionate treatment she received at Christiana Care.
“I am glad for the techonology they have but it goes far beyond that,” she says. “Every person I encountered at Christiana Care was friendly and kind — and the nurses were wonderful. They really want to help you.”
She now returns to Christiana Care for regular checkups with Dr. Satti.
“I would never go anywhere else,” she says.
For four long years, Wayne Johnson suffered with severe back pain, the result of a badly deteriorated disc.
He gave up golf and scuba diving, activities he once enjoyed. He quit gardening. He avoided driving. And because he couldn’t exercise, he started putting on pounds.
“I needed painkillers just to get through the day,” recalls Johnson, 45, of Wilmington. “Even with my medication, I seldom slept for more than a few hours at a time at night.”
Spinal injections of cortisone helped for a while. But the pain always returned. Johnson leads a groundskeeping team at the University of Delaware and it was increasingly difficult for him to do his job.
In 2012, Johnson and his wife were expecting a baby and he wondered if his back problems would impact his ability to be an active dad.
“Would I be able to get down on the floor and wrestle with my son?” he asked. “Would I be able to give him a piggyback ride?”
His orthopedic surgeon, J. Rush Fisher, M.D., recommended a Total Disc Replacement or TDR, in which the damaged disc is removed and replaced with an artificial disc.
“It looks like two Oreo cookies stacked on top of one another,” Johnson says.
A newer treatment, TDR helps patients to regain their range of motion and get relief from pain.
“It is a good option for someone like me, who is in his 40s,” he says. “I feel very fortunate that Christiana Care offers this kind of advanced treatment.”
Within a day of surgery, Johnson was out of bed and taking his first steps on the road to recovery. Within two days, he was home and walking with a cane.
He was an active partner in his care, giving up smoking to help speed the healing process. He learned to rely on the muscles in his legs to lift objects to avoid another injury to his back. He started shedding the weight he had gained, going from 208 pounds to 180.
“I feel like I’m back in my 30s,” he says. “I’m in the gym four days a week, doing 225-pound squats.”
Johnson is on the job at UD, maintaining landscaping on campus. He also is enjoying family life with his wife and baby. The pain is completely gone.
“In the past six months, I have taken two Advil — and that was for a headache,” he says. “I used to live in constant pain — and now I am happier than I have ever been in my whole life.”
The devastating impact of Dinesh Nayak’s fall down his basement stairs in February 2010 was immediately obvious in the pain he felt radiating up from his left ankle. But today, he says his choice to seek help at Christiana Care was an “outstanding” decision.
Dr. Paul Kupcha, an ankle specialist at Christiana Care Health System, became his health care partner during the 11-month journey to recovery.
The effect of landing on his left foot resulted in a pilon fracture, a diagnosis Kupcha confirmed with a CT scan shortly after the injury. A pilon fracture refers to a high-impact injury where the tibia (the larger bone in the lower half the leg) shatters at the point where it hits the bones in the ankle.
Many people who suffer a pilon fracture never walk without crutches or a limp again. But two years after that fall down the basement stairs, Nayak has returned to everything he loves doing.
“It’s really a testament to the doctor that I’m able to walk,” Nayak said. “The fact that I can walk without even a cane is truly remarkable.” Nayak’s only lasting reminders are occasional pain and stiffness, and mild range-of-motion limitations in his ankle.
Kupcha performed surgery at Christiana Care’s Wilmington Hospital after the original injury to repair the damage.
Over the next five months Nayak used an external fixator — an external device of pins and rods — that is coupled with internal plates to stabilize the bone. They helped Nayak’s tibia knit back together. During weekly visits to Kupcha’s office, adjustments were made to keep the healing on track.
When the external fixator was removed – a few months early because Nayak was tired of keeping the weight off his foot — the healing process was well under way. Follow-up included various casts, splints and braces that allowed Nayak to gradually bear weight on his foot. When those were removed, Nayak began two months of physical therapy to build strength and learn to walk again.
At that point, a celebration was in order. Nayak decided on a trip to Antarctica. Since then, he’s traveled to destinations all over the world.
Nayak thanks Kupcha for helping him achieve that return to activity.
“I chose the emergency room at Christiana Care; I chose Dr. Kupcha; I made those choices,” Nayak said. “…My experience at Christiana Care was outstandingly good.”
Elizabeth Van Leeuwen was enjoying dinner and a lively chat with her 29-year-old grandson — and suddenly couldn’t speak.
At the time, the 86-year-old great-grandmother from Hockessin, Del., was staying in a rehabilitative center, where she was recovering from a fall.
This latest challenge was an ischemic stroke, sometimes called a brain attack, that occurs when an artery to the brain is blocked.
“When I lost my speech, my grandson immediately knew something was wrong — and he got help right away,” she recalls.
Van Leeuwen was rushed to Christiana Hospital, where a stroke team was poised to evaluate her.
“That saying ‘time is brain’ is true,” says Mary Ciechanowski, MSN, RN, ACNS-BC, CCRN, stroke advanced practice nurse. “We work in conjunction with the Emergency Department to quickly identify stroke patients so we can determine the appropriate intervention.”
Because Van Leeuwen arrived at the ED soon after her stroke, she could be treated with tissue plasminogen activator, known as tPA, a protein that is highly effective in breaking down blood clots. Ideally, tPA should be administered no later than 4.5 hours after the onset of stroke symptoms.
Gregg Zoarski, M.D., a neurointerventional surgeon, used a Solitaire, a new tool in the arsenal of stroke-fighting devices, to remove the clot. The device was approved by the Food and Drug Administration in March 2012, less than five months before Van Leeuwen’s stroke on July 29.
“Basically, it’s a stent on a stick,” he says. “After it’s inserted into a blocked artery with a catheter, it compresses the clot and traps it. Then the clot and the stent are removed.”
In all, the surgery took 44 minutes. Van Leeuwen was headed for recovery less than four hours after she suffered her stroke.
“We are making tremendous advances in stroke treatment and positive cases like Mrs. Van Leeuwen’s are becoming more common,” Dr. Zoarski says.
The Christiana Care Center for Heart & Vascular Health provides round-the-clock minimally invasive services and treatments in a state-of-the-art neurointerventional surgery suite. The health system has one of the highest volumes of stroke patients in the region, providing treatment for more than 1,200 patients a year.
“Everything we do here is 24/7, including surgery, labs, imaging and technicians,” Ciechanowski says.
Dr. Zoarski says Van Leeuwven’s experience illustrates the importance of seeking help immediately if someone shows signs of a stroke. In addition to difficulty speaking, symptoms include confusion, sudden and severe headache, problems with balance or walking, and numbness or weakness in the face, arm or leg, especially on one side of the body.
Today, she is healthy and happy and living at home. She has recovered her speech and is walking with a cane as she builds strength and balance.
“At Christiana Care, I got highly skilled doctors and the latest and greatest in technology,” she says. “After my surgery, I got wonderful care from the nurses. Everyone I encountered was very professional — and extremely nice.”
Justin Plank had imagined what the first moments of fatherhood might be like. His wife Brenda would give birth, their newborn son would wail upon gulping his first breath of air, and Justin would cut the umbilical cord, as if to celebrate the grand opening of a new life.
But when Waylon Plank was born Sept. 29 at a Delaware hospital, his father heard no crying. His newborn son looked purple. The doctor immediately knew something was wrong.
A yellow button was pressed, and within 60 seconds a group of nurses was in the room, providing Waylon with oxygen, and letting the new parents kiss their ailing son as they rushed him to the neonatal intensive care unit.
Baby Waylon was suffering hypoxic ischemic encephalopathy (HIE), which means his brain was not receiving enough oxygen. Five minutes of such deprivation can begin killing brain cells. The long-term effects can include intellectual disability, seizures, delayed development and cerebral palsy.
Reducing the brain and body’s temperatures can slow damage. Though it may seem counter-intuitive to those accustomed to seeing newborns placed in incubators beneath warm lamps, the doctors and nurses tending to Waylon in his earliest moments told the Planks their son was a candidate for a cooling technology that could be applied even as they transported him by ambulance to Christiana Hospital, where the most qualified personnel and equipment would give him a fighting chance.
Justin and Brenda agreed. Waylon was wrapped in a CritiCool blanket, which circulates cold water regulated by a microprocessor that responds to the baby’s temperature.
The cooling process must occur within the child’s first six hours of life, says Michael Antunes, M.D., medical director of Christiana Care’s neonatal hypothermia program.
“Those inflammatory cascades that can be initiated need to be stopped early-on,” Dr. Antunes said. The temperature reduction must be sustained for 72 hours. The choice to do so resides with the parents, but it is the job of doctors such as Antunes – he didn’t work directly with the Planks – to explain the harrowing scenario and the most hopeful medical response, all while cautioning that for at least the next few years, the parents monitor their child closely for signs of lasting damage.
At about 24 inches tall with a footprint of about 15-by-15 inches and weighing 30 pounds, the CritiCool is a mobile version of larger, stationary devices that serve the same purpose. Christiana Care has two CritiCool units and is the only delivery hospital in Delaware that has the equipment.
“Internationally,” Dr. Antunes says, “this has become the standard of care.”
Justin Plank, whose family lives in Greenwood, spent that first night of his son’s life at his wife’s side at the hospital where he was born. The next morning, while his wife continued to recover, Justin went to Christiana Hospital to see Waylon, who would remain hospitalized there for nearly two weeks. (Upon his body’s return to its normal temperature, Waylon’s blood sugar would have to stabilize.)
“One of the hardest things was to see him lying there, cold,” Justin said. “You know it had to be hurting, even though they had him on morphine to reduce the pain of the cooling process.
“You expect your baby to cry and to be overwhelmed with joy when they’re born, and we didn’t get that. When I got up there, he was on the cooling pad, and when he heard me talk, he opened his eyes. The nurse said that was the first time he had opened his eyes. I’m sure he heard lots of other people’s voices, but to me, it seemed he recognized my voice.”
That night, Justin again stayed with Brenda at the hospital where their baby was delivered. The next evening they stayed at the Christiana Hospital NICU.
Every morning, as doctors checked in on the Planks’ child, Justin would ask questions about the process. It eased his concerns to know that he or his wife could call the staff at any time, day or night, for updates on their son’s progress.
“That was really helpful,” he says. “It gives you peace of mind.”
Waylon has met his milestones in the time since his stay at Christiana Hospital. His parents say the respect and care they felt from the Christiana Care staff went beyond access to information.
“I think that we got the best care that we could’ve gotten,” Justin says.
My husband and I had tried to have a baby for years and after almost nine years i finally got pregnant we were so excited as well as both of our families . however at 30 weeks i had to deliver my son he was born on August 19th 2012 weighing 1 pound 14 oz .13 and a half inches long . He of course had to go right to the NICU. we were so worried and scared but the staff at christiana hospital from my doctors nurses the Nicu staff and wonderful social worker we new our son would be ok and that there was no better place he could be at that moment . After 72 days between 2 Nicu’s our son Anthony Giovonni was able to come home on October 30th and he is now 6months old weighing over 13 pounds and 23 inches long .Thank you from the bottom of our hearts to everyone for all the kindness and love and support .
from the Rizzuto family