How the weather, a skilled neurologist and a little luck made all the difference for Joe Downing

We've all had one of those strange convergences at one time or another. Those moments when unrelated or unforeseen events come together to transform how things turn out, taking us from what might have been to what actually happened. Some people call it fate or chance or happenstance. Some see it simply as a random occurrence while others believe it to be divine intervention. Whatever it is, Joe Downing experienced it on a cold and snowy day in February of last year. And this is how it happened.

Joe remembers feeling a little strange when he first woke up in the dark that morning and as the minutes passed, things weren't getting any better. He quickly began having serious problems with his equilibrium. Joe was home at the time but under normal circumstances he wouldn't have been. Any other day he would have been driving up the highway on his way to work.

The foot of snow that had already fallen, however, and continued through the early morning made that drive impossible. Without the winter storm that centered over eastern Virginia, Joe Downing would have been in his car, moving along with the usual line of traffic headed north - unable to request help at the moment when he desperately needed it. Instead, he was home in the presence of his wife who promptly sought emergency medical assistance at the first signs of stroke symptoms.

But before we see how everything turned out for Joe, let's go back for just a moment and get a sense of how it got to this point.

It really wasn't that bad of a fall

In early February of last year, Joseph Downing III, was enjoying a day on the ski slopes. The 64-year-old Gloucester resident was having a pretty decent downhill run, but as it happens at some point to anyone who's ever been on a pair of skis, Joe took a fall.

"I landed fairly hard, but didn't hit my head," Joe remembers. "Looking back, it really wasn't that bad of a fall. I've definitely had worse." But when he got back home, Joe had a headache that ended up lasting 3-4 days. Then it went away and everything seemed fine until Feb. 17 when the problems returned in a far more serious form. As it turns out, the physician with Riverside Neurovascular Specialists who operated on Joe that day thinks the fall damaged his carotid artery and was very likely related to the stroke that followed. But again, we're getting a little ahead of the story.

So Joe's wife called 911 for an ambulance and with some difficulty given the road conditions, the first responders arrived and transported Joe to Riverside Walter Reed Hospital. After some initial diagnostics in the RWRH emergency department indicated an active ischemic stroke -- the kind of stroke that results from an obstruction within a blood vessel supplying blood to the brain -- it was determined that the best course of action would be to take him by helicopter to Riverside Regional Medical Center. At that point the storm had cleared enough to make the flight possible.

The right place at the right time

Although part of Joe's experience initially included some elements of chance, the care he received after his arrival wasn't one of them. Among other criteria, Riverside Regional Medical Center's national designation as a Comprehensive Stroke Center includes 24/7 access to a neurointerventionist, a neurologist who specializes in using innovative, minimally invasive treatments for complex problems of the brain and spine. In this case, the physician standing by and ready when the LifeEvac helicopter touched down was the highly trained and experienced Wolfgang Leesch, M.D.

After more than a year and many patients later, Dr. Leesch clearly remembers his first encounter with Joe. "He presented with classic stroke symptoms including an inability to speak or comprehend and paralysis on his right side. I documented the symptoms on a smartphone video which I still have."

"We immediately took Mr. Downing to the biplane imaging suite, a specialized unit in the medical center that combines neurosurgery and highly precise imaging, and performed a suction thrombectomy. In this procedure a very small catheter is introduced through an incision in the groin and then guided to the intracranial arteries. Once the catheter tip is placed next to the blood clot in the brain that’s causing the stroke, negative pressure suctions the clot out of the small and very delicate blocked artery. In the case of Mr. Downing, the artery opened immediately."

The benefits of a comprehensive stroke center

The advanced procedure that was performed on Joe was characterized by optimal speed, precision and safety. Dr. Leesch believes that Riverside's decision to develop its stroke program, and the training and infrastructure that were in place as a result, were the factors that made it possible for Joe to survive the stroke initially and then resume his life without impairment. The alternative, and the very possible outcome had he received treatment at a facility without the capabilities of a Comprehensive Stroke Center, may have been to spend the rest of his life bed ridden with a substantially diminished quality of life.

The other elements that were in place -again as the result of Riverside's commitment to the highest level of stroke program -included the availability of advanced imaging and recent innovations in endovascular equipment, as well as a skilled, multidisciplinary approach to care, all of which Riverside could provide as one of only three designated Comprehensive Stroke Centers in Virginia.

Joe Downing gets his life back

Joe has limited memories of his treatment and intensive care period at RRMC but remembers his recovery at a Riverside inpatient rehabilitation facility where he worked with therapists and other staff to regain his ability to talk and walk normally within the short span of three weeks. "The therapy experience was very different than the minimally-invasive procedure I had to break up the clot in my brain. It's not single, decisive "silver bullet" kind of thing. It's more of an hour-by-hour, day-by-day process. It requires a lot of patience and a good amount of determination to progress, but I think for me, and I know for the therapists who were helping me, that's what makes moving ahead and getting back to who you were before the stoke so rewarding."

After returning home Joe continued with outpatient therapy and met with Dr. Leesch as part of his follow-up care. Since his treatment and rehabilitation he retired from his position at Sysco, and action that was based on his age and years of service and unrelated to his stroke. Today, a little more than a year from that snow-covered day, he enjoys an active lifestyle with no physical or cognitive impairments.

"I feel like my family and I have been given a great gift of more time together for which I will always be grateful" Joe says, "and I want to make sure I'm taking full advantage of it."