The perfect picture of in-home care

With the COVID-19 pandemic keeping him at home, George Grzybowski turned to in-home imaging services—and it turned out to be a life-saver.

The perfect picture of in-home care

George Grzybowski, 70, watched as the Spectrum Health vehicle pulled into the driveway of his Wyoming, Michigan, home.

Two sonographers emerged, masks covering their faces.

Given the COVID-19 pandemic, Grzybowski had been wary of traveling into Grand Rapids for an appointment.

So when Lindsey Nawrocki, a Spectrum Health ultrasound technician, called him to arrange for in-home imaging, he felt only too pleased to accept the offer.

“The choice is up to the patient,” Nawrocki said.

During the COVID-19 shutdown, Nawrocki worked with vascular surgeons who identified patients with urgent needs. She explained to patients how Spectrum Health created an in-home imaging service.

The program started in March 2020 and resumes as the need arises.

The program’s patients were all screened beforehand for COVID-19 symptoms.

“The mobile sonographers are also screened multiple times for COVID,” Nawrocki said.

Grzybowski, suffering from peripheral artery disease for the past two decades, qualified as a patient with urgent needs.

Bouts of soreness

“It started in 2000,” Grzybowski said. “I went hunting with my brother in the woods. We had a mobile home on the property and I had to rest at the trailer when I got there. I could hardly walk. It took three hours to get the feeling back in my left foot.”

He went in to see his doctor.

Robert Cuff, MD, a vascular surgeon at Spectrum Health Vascular Surgery on Lake Drive, diagnosed him with peripheral artery disease and scheduled him for surgery.

Peripheral artery disease occurs when cholesterol and fat accumulations lead to a narrowing of the artery and a restriction of blood flow to tissue.

Leg numbness or weakness is a frequent symptom.

Risk factors are age—60 or older—as well as high blood pressure, smoking, high cholesterol, diabetes and a family history of vascular disease.

Grzybowski had high blood pressure. He also smoked.

“In that first surgery, Dr. Cuff made an incision from my ankle to my groin,” he said. “I missed a couple months of work. I worked as a baker at a bakery in Grand Rapids back then. I didn’t have any problems with my leg again, not until 2011.”

He suffered leg pain and muscle soreness. Dr. Cuff performed a bypass that year to alleviate the pain.

That worked until 2015, when the soreness returned. Tests showed an 85% blockage, requiring another procedure.

More work followed over the years.

“I had surgery again in April 2019,” Grzybowski said. “And by August it was hurting again.”

Home imaging

In April 2020, Grzybowski called Dr. Cuff to complain about pain and weakness in his leg.

The doctor immediately added Grzybowski’s name to the urgent list.

“Before COVID-19, we would have had George come in for testing,” Dr. Cuff said. “And in many situations, we can use telehealth—consulting with patients through technological means.”

But arterial disease also requires imaging.

“For George, we needed to do an ankle-brachial index and ultrasound of his bypass graft to check blood pressure in his ankle and see if his graft was functioning.” Dr. Cuff said.

Spectrum Health designed the home imaging program for patients like Grzybowski.

“To my knowledge, it’s the first of its kind in Michigan,” Dr. Cuff said.

Without the program, Grzybowski would have faced a two- to three-month wait.

“And that could have led to a failed bypass graft, limb risk, and possible in-patient surgery and a hospital stay,” Dr. Cuff said.

The program brings portable imaging equipment directly into the patient’s home. The medical team can visit four to five patients per day, Monday through Thursday, with results available by virtual visit or phone call with a vascular surgeon the following day.

Meeting critical needs

Spectrum Health sonographers Mark Kluisza and Liz Ralston visited Grzybowski’s home on April 28.

On every visit, they call from the vehicle before arriving to ensure the patient has remained free of COVID-19 symptoms since the initial scheduling call.

“And to give them a heads up we were coming,” Ralston said.

They haul all their portable equipment into the patient’s home to perform the tests.

“When I scanned George, Mark and I instantly noticed his results had drastically changed from his prior imaging,” Ralston said.

It highlighted some troubling developments.

“He wasn’t having serious problems, but he was close to graft failure,” Kluisza said. “Liz was scanning him and I could see the velocities within the graft were low.

“While she was still scanning him, I went out to the car, called the office, and I talked to Dr. Christopher Chambers, a vascular surgeon, and set up a time to get the surgery.”

Two days later, Grzybowski attended outpatient surgery at Spectrum Health.

“George underwent an angiogram and angioplasty with a stent in the severely narrowed artery placed above the graft,” Dr. Cuff said.

“It was a smaller incision this time,” Grzybowski said. “Right side of my groin, through and across. The doctor ballooned the artery to clear it and open it up. I was able to go home the same day. And it no longer hurts.”

By his June 6 follow-up appointment, Grzybowski’s leg pain had subsided. Tests showed blood flow in his leg had nearly returned to normal.

He has since returned to his favorite activities, including golf and helping friends and neighbors paint their houses.

“I’m also cutting down a whole lot on my smoking,” Grzybowski said. “My wife is trying to get me to quit. I’m also drinking more water and walking a lot more, as my doctor directed me.”

Dr. Cuff said the in-home imaging program served a need during the stay-at-home order.

“We’re discussing future use of the program in rural counties and for people who have difficulty coming into the office, such as the elderly,” Dr. Cuff said. “With the expansion of telemedicine, we are thinking that this could be beneficial beyond the pandemic. We have been able to catch critical needs in our patients—and our patients seem to really appreciate it.”

Sonographer Kluisza agrees.

“I believe the in-home program was very valuable,” he said. “We averaged a critical finding a week.”

Source : Health Beat More   

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‘They acted so fast’

A retired Michigan grocer is alive today thanks to his wife's quick reaction and a speedy response from an expert stroke team.

‘They acted so fast’

Bob Kingma, 69, grew up surrounded by healthy foods at his family’s business, Kingma’s Market, on the southeast side of Grand Rapids.

Leafy greens, root vegetables, strawberries, blueberries and more were his constant companions.

Later, when he took over the business, eventually moving it to Plainfield Avenue on the northeast side of the city, his health remained a priority.

He walked. He biked. He didn’t shy away from manual labor.

In June 2019, he and his wife, Kae, completed a two-and-a-half-week journey around Israel.

“We went all over and hiked around,” he said. “We went all over the country.”

A few days after returning home, life took a haunting turn.

Kingma and Kae went out to eat with another couple to celebrate Kae’s birthday.

“I was feeling well,” he said. “I went to bed and woke up in the middle of the night because I had to use the bathroom. When I got into the bathroom, the wall seemed to shift back and forth sideways. I’ve never had anything like that. It just got worse.”

He sat down on the toilet seat. He couldn’t focus his eyes. He couldn’t cry out for help. His body swayed.

Thankfully, the toilet behind him and walls on both sides helped him stabilize, keeping him from crashing to the floor.

Kingma attempted to utter his wife’s name, a single consonant. He failed.

“I couldn’t talk,” he said. “Things were not well. I remember focusing and trying to get out, ‘K.’ I made a guttural tone. She came in. I couldn’t stand. She went downstairs to get a cane. That didn’t help.

“She said my mouth was sagging and I was drooling,” he remembers. “I could hardly focus. I was swaying back and forth. She said, ‘I think you’re having a stroke.’”

Kae dialed 911 and explained her husband’s condition to the dispatcher, providing critical information that indicated he might be having a stroke.

The dispatcher instructed her to leave the front door unlocked.

Within minutes, an ambulance arrived.

“I can visually picture everything that night,” Kingma said. “There were two gals in the back of the ambulance. I remember the ride to the hospital in the middle of the night. The streets were empty. My mind was fully aware of what was going on, but I couldn’t sit, stand, walk or talk. My head was slumped down.”

Even though he could barely move, his mind moved to a frightening future.

Would he ever walk again? Talk again? Would he ever again embrace Kae and their children and grandchildren?

“There was terror of living like this for the rest of my life,” he said. “It was kind of a broken prayer I couldn’t even mouth.”

‘I could feel him threading’

At Spectrum Health Butterworth Hospital, the health team wheeled Kingma into an operation room.

“There were people in gowns waiting,” he said. “They were all gloved up. It was the stroke team. They lifted me onto the observation table and started hooking me up to all kinds of stuff.”

Kae arrived just as the stroke team finished a CT scan.

They identified the problem—a left vertebral artery occlusion.

Spectrum Health neurosurgeon Paul Mazaris, MD, prepared for the procedure. He would insert a catheter through an artery near Kingma’s groin to reach the clot at the back of his neck.

“We went in with a small catheter, which is a long skinny tube, and opened up the vertebral artery with a small balloon on the end of the catheter,” Dr. Mazaris said. “This restored blood flow to his brain that was starving for oxygen.”

Kingma said he could feel the catheter being threaded through his body.

“One of my arteries in the back of my neck wasn’t functioning and the other was pretty thin,” Kingma said. “I could feel him threading. All of a sudden, control of my fingers returned and I could start talking again. They were asking all kinds of questions and I was answering quickly.”

The turnaround stunned everyone, including Kingma.

“Everything returned—my fingers, voice, body commands,” he said. “I could move my fingers and toes. They couldn’t believe it. It felt good to have it back.”

Kae remembers the feeling of relief that swelled over her, like a calming wave.

“The doctor came back and said, ‘He’s very fortunate, we got it,’” she said. “He seemed totally fine. There was no permanent damage at all. I don’t notice any difference in him compared to before the stroke.”

Kingma credits the stroke team’s quick response with saving his life.

“They acted so fast,” he said.

Still, more work remained.

Kingma would need to undergo another procedure to help prevent blockages from returning.

‘Very fortunate’

The following week, surgeons replaced Kingma’s neck arteries with more viable arteries from another part of his body. This provided his brain a thicker and more assured blood supply.

“I asked how soon I could get back to hiking and biking,” Kingma said.

The doctor suggested he take it easy for a week.

So he did.

He felt a bit tired that summer, but otherwise he had no limitations.

And he’s since taken on life’s other adventures.

“I’ve been hiking up and down small mountains in the wilderness and heat,” he said. “Kae and I do a lot of biking. The prompt treatment saved my brain. I have no residual effects whatsoever. Nothing.”

He sold Kingma Market about six years ago. He now spends some of his time as an associate chaplain at the Kent County Jail.

It’s all been a wild ride, Kae said.

“It was kind of crazy,” she said.

She and her husband count their blessings—their children, grandchildren, travel adventures. Good health.

They’re grateful for the speedy response from health teams that day.

“I kept thinking if this had happened when I wasn’t home, he could have died,” Kae said. “He got to the hospital right away and they were right on top of it. They were ready and waiting for him before he got there and they knew exactly what to do.

“That’s what saved him. We were very fortunate.”

Source : Health Beat More   

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