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Michael E. DeBakey VA Medical Center - Houston, Texas

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New Stepdown Unit for Stroke Patients Opens at Houston VA

December 18, 2007

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Health care professionals in the new Neuro-Medical Stepdown Unit, Carol Stezns, B.S., M.A., R.N., James McAdoo, H.T., and Paulette Chu, N.P.-C. (above, from left) provide specialized care for veterans recovering from stroke. Every 45 seconds an American has a stroke; every three minutes someone dies of a stroke; and 15-30 percent of stroke survivors have serious long-term disability. The important thing to remember is the earlier you arrive at the Emergency Room, the better. PHOTO: Bobbi D. Gruner, MEDVAMC Public Affairs


HOUSTON - Despite the significant progress in stroke prevention and treatment, stroke remains the third leading cause of death and the leading cause of permanent disability in the United States. As part of the treatment course for stroke victims, Medical Care Line and the Neurology Care Line at the Michael E. DeBakey VA Medical Center (MEDVAMC) have joined efforts to establish a Neuro-Medical Stepdown Unit.

The first patient treated by this new 12-bed nursing unit was a female veteran in her early 50s who came to the MEDVAMC Emergency Room when she began experiencing numbness and weakness on the right side of her body. In the ER, she was quickly evaluated by Roderic Fabian, M.D. and his Acute Stroke Team. After receiving a blood clot dissipating medication and specialized care in the Neuro-Medical Stepdown Unit, she was released home with substantial recovery of body function.

The Neuro-Medical Stepdown Unit, directed by Pitchaiah Mandava, M.D., Ph.D. and staffed by Acute Care Nurse Practitioners (ACNP), provides care to patients needing less monitoring than those in the Critical Care or Intensive Care units, but still require more monitoring than those on the medical units.

“These acute care nurse practitioners are trailblazing a new frontier at the DeBakey VA as they work in collaboration with physicians specializing in stroke, critical care medicine, and cardiology.  ACNPs are registered nurses prepared at the graduate level to provide and manage acutely ill or critically ill, adult patients in a wide range of settings,” said Jane Anderson, APRN-BC, Stroke Center associate director and Neurology Care Line nurse practitioner. “In addition, these health care professionals have received further training in the diagnostic procedures and appropriate therapies for patients with stroke, based on guidelines established by the Stroke Council of the American Heart Association.

In 2004, the MEDVAMC created an Acute Stroke Team led by Thomas A. Kent, M.D., a stroke specialist and chief of the Neurology Care Line. This team is comprised of neurology residents and staff, a neurology nurse practitioner, emergency room physicians and nurses, radiologist and technicians, laboratory technicians, and medical consultants from neuroradiology, vascular surgery, cardiology, and internal medicine. Key individuals on the team are available 24 hours a day, seven days a week to provide immediate diagnosis and emergent treatment of veterans who are rushed to the Emergency Room with symptoms of a stroke.

“One treatment option available for veterans having an acute stroke is a medication called tissue plasminogen activator. This is a clot-busting drug shown to be helpful in treating ischemic strokes caused by blood clots, but it must be given within the first three hours after the start of symptoms. This is why it is very important for people who think they are having a stroke to seek help immediately,” said Kent.

While tissue plasminogen activator (tPA) can significantly reduce the effects of stroke and reduce permanent disability, there is a significant risk of bleeding. Before tPA is given to a patient, the Acute Stroke Team completes a thorough evaluation and diagnostic workup to ensure a patient meets all the criteria for tPA. This process takes time, but it is vital to avoid serious complications.

For patients who cannot receive tPA, the Acute Stroke Team examines the appropriateness of several alternative stroke therapies under investigation at the MEDVAMC. The important thing for veterans to remember is the earlier they arrive at the Emergency Room, the better.

Every 45 seconds an American has a stroke; every three minutes someone dies of a stroke in this country; and 15-30 percent of stroke survivors have serious long-term disability. Approximately 700,000 strokes occur every year and stroke is a significant problem among the veteran population with approximately 17,000 veterans suffering a stroke each year, more than 10 percent of the VA’s caseload.  All veterans and their family members should know the warning signs of stroke. If you experience stroke symptoms, immediately call 911.

Warning Signs of Stroke

  • Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking, or understanding.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance, or coordination.
  • Sudden, severe headache with no known cause.