Long-distance doctoring

Dennis Gordeyko was feeding cattle on his ranch near Camrose when he realized he couldn’t move his right arm to pull a hydraulic lever. Then his hired hand noticed he wasn’t talking properly and his face was drooping. What followed was a mad rush to hospital, a diagnosis of stroke and the speedy administration of clot-busting medication.

Dr. Frank Silver

Dr. Frank Silver

Dennis Gordeyko was feeding cattle on his ranch near Camrose when he realized he couldn’t move his right arm to pull a hydraulic lever. Then his hired hand noticed he wasn’t talking properly and his face was drooping.

What followed was a mad rush to hospital, a diagnosis of stroke and the speedy administration of clot-busting medication.

When his health crisis unfolded last November, Gordeyko was in Camrose, while the neurologist who treated him remotely via video and data hookup was in Edmonton.

“It sure worked for me,” said a now-talkative Gordeyko, 64, adding that he’s doing “really good” except that he doesn’t have good control of his right arm to sign his name, for example.

Telestroke technology of the sort that helped the Alberta rancher was highlighted Tuesday at the Canadian Stroke Congress in Ottawa, with Dr. Frank Silver of Ontario’s Telestroke program urging delegates to consider introducing a system that would cover patients in rural areas throughout Canada.

“We know that there’s a huge disparity in the care that can be delivered across the country because of the size of the country, and the lack of having enough stroke physicians to provide care across the country,” he said in an interview.

“On the other hand, we have the technology with Telestroke to have a stroke neurologist at that patient’s bedside in time to make decisions about treatment, and all that we need now is the will and some funding to make this happen.”

Alberta and Ontario are among the provinces making progress in this area, but Silver said Quebec, Manitoba and Saskatchewan do not have a Telestroke program, and there are many communities in the Atlantic provinces that will never have stroke expertise.

“And why not have physicians from other provinces providing that service?

It’s certainly technically feasible. That’s not the barrier. The technology is there.”

What’s needed, he said, are cross-border agreements, getting people onside with the idea and gaining some federal support.

Dr. Thomas Jeerakathil, a neurologist at the University of Alberta, has compiled data on the use of Telestroke in 10 primary stroke centres in remote parts of northern Alberta over a four-year period.

His team of researchers wanted to find out if it’s actually safe to give the clot-busting drug tPA in a situation where there’s no neurologist on site and staff have less expertise in conducting a neurological examination.

Their study found that rural patients examined with the aid of Telestroke technology received the clot-busting drug tPA (tissue plasminogen activator) at the same rate as patients treated in urban centres.

The patient population in the Telestroke and non-Telestroke groups were similar in terms of age and gender breakdown, and there were no significant differences in the rates of intracranial bleeding.

“We also found that an indicator of rapid response, which is the door-to-needle time, was not significantly different in the Telestroke group versus the non-Telestroke group,” Jeerakathil said in an interview.

Thirty-day in-hospital mortality in the Telestroke group was 15.9 per cent versus 16 per cent for the non-Telestroke group treated in person by a neurologist.

“Patients in rural areas given clot-busters using Telestroke received a relatively high standard of care, and similar to that in larger centres,” said Jeerakathil.

“It tells us that it’s a good program. . . . We think it’s an effective and a safe way of delivering clot-busting treatments to rural areas and reducing rural-urban discrepancies in care for stroke.”

Silver said Canada probably has fewer than 1,000 neurologists, and “certainly less than 150 stroke neurologists” with the expertise to manage patients affected by stroke.

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