Stroke turns cardiologist into a patient

By William K. Alcorn

A series of circumstances came together to save the life of the young doctor.

AUSTINTOWN — “I feel dizzy” were the last coherent words uttered by Dr. Richard T. Esper Jr. for many days.

Though he couldn’t speak, his mind was racing, though not always rationally.

“I knew I was going to fall, so I tried not to fall on the floor and turned and fell on the bed,” he said.

Dr. Esper, an Austintown cardiologist, was dressing in his bedroom at 6 a.m. April 24, 2007, and had only to put on his tie before leaving for work at the Heart Center of Northeastern Ohio in Youngstown, where he is a partner.

He was planning to kiss goodbye his son, Anthony, who was 2 months old and slept in his parents’ bedroom.

It was then that he felt dizzy and collapsed.

“Dema [his wife] was talking, but I couldn’t answer. I wondered why she was so panicked.”

He said he was “pretty angry” when Dema pulled him off the bed onto the floor because “she was wrinkling my shirt and I was going to have to change before I went to work.”

“I heard my daughter [Catherine] crying in her room, and I thought, ‘I’ll have to put my kid back to sleep.’”

“What am I going to tell my office manager about rescheduling patients because I am late,” he remembers thinking.

He heard emergency room doctors saying they were going to give him “ytics,” (fibrinolytics, clot busting medicine) and wondered why, because he was “just a little dizzy.”

“I thought the nurses and doctors were in my bedroom and they were going to give me an X-ray. I was worried they were going to irradiate my son.”

In the meantime, Dema, a registered dietician, called her husband’s brother, Stephen, then an anesthesiology resident at the University of Pittsburgh School of Medicine, and told him what was happening. He said to call 911.

The ambulance came quickly and took Dr. Esper to the emergency room at Forum Health Northside Medical Center.

The next thing Dr. Esper remembers is waking up in the neurological intensive care unit at the Cleveland Clinic, his left side paralyzed and no vision in his left eye.

Dr. Esper had suffered a severe stroke.

He was 35.

When he said that simple phrase, “I feel dizzy,” neither Dr. Esper nor his wife realized that was the beginning of a catastrophic stroke, an event that would nearly take his life and that would affect them both for the rest of their lives.

Looking back, Dr. Esper believes he survived the stroke, caused by a blood clot in his brain, because of an amazing series of lucky medical circumstances and timing.

For example, when Dr. Esper arrived at Forum Health’s Northside Medical Center, emergency room doctors quickly determined his brain was not bleeding but wanted to do an MRI to make sure that it really was a clot causing the stroke.

But his brother, Dr. Gregory Esper, a neurologist at Emory University Hospital in Atlanta, Ga., whom Dema had contacted, told them doing the MRI would take up precious minutes, which were crucial to him, and to immediately administer the clot-busting medicine. However, the clot did not dissolve, instead splitting into two clots.

By the time Dema, who had to take care of their children, arrived at Northside by car,doctors told her they wanted her husband to have an “experimental” clot removal procedure at Cleveland Clinic, and that arrangements had already been made to fly him there by helicopter to see Dr. Peter Rasmussen.

Dr. Rasmussen, director of cerebral vascular disease there, said the relatively new procedure used on Dr. Esper works on the order of a heart catheterization. The arterial system is accessed through the groin with a catheter, which is snaked up through the arteries past the heart, through the carotid arteries in the neck and into the brain. The end of the catheter has a device, called in this instance an alligator, because it has jaws resembling those of an alligator, which is used to grasp the clot and remove it.

The whole process occurred quickly — from helicopter to operating room, about 30 minutes — and then to snake the alligator from the groin to the brain, a couple of minutes. The goal was to remove the blockage as soon as possible, Dr. Rasmussen said.

There are a couple of reasons Dr. Esper is recovering so well. One, he is very young; but more importantly, “We were able to get his arteries open quickly and save his brain from further injury,” Dr. Rasmussen said.

By the time Dema arrived at the Cleveland Clinic, the procedure had been completed and her husband was in recovery in the hospital’s neurological intensive care unit.

However, his left side was paralyzed, and he had no sense of balance and no vision in his left eye.

“I thought, ‘God have mercy on me,’” he said upon regaining consciousness.

But, given the circumstances, he said he now feels extremely fortunate.

“I collapsed at about 6 a.m. in my bedroom, and by 11:30 a.m., I was coming off the operating table with blood flowing back into my brain,” Dr. Esper said.

He explained his survival.

First, the ambulance arrived quickly and got him to Northside. Then his partner and boss, Dr. Michael Scavina, also a cardiologist, was at Northside ready to start his day.

“He met me in emergency. I credit him with saving my life,” Dr. Esper said.

Also on hand was a hospital neurologist, who assisted ER personnel.

“The moon and the stars were all in alignment,” he said with a smile.

However, his rehabilitation, the success of which allowed him to return to work part-time July 14, 2008, and enabled him to recently begin driving again with adaptive equipment, was and continues to be filled with pain and depression and frustration, as well as triumphs.

Dema, who has kept a journal since her husband’s stroke occurred 15 months ago, said her husband spent eight days at the Cleveland Clinic before being discharged to St. Elizabeth Health Center’s rehabilitation unit, where he stayed six weeks under the care of Dr. Lynn Mikolich.

Fortunately, the portion of his brain that controls speech was not damaged, and he again has normal speech and has regained all his medical knowledge, she said.

However, when he left the Cleveland Clinic, he couldn’t move, even to do the most basic grooming.

“How do you go to the bathroom when you can’t move. I couldn’t even urinate. I had to use a catheter,” he said.

But, after a couple of weeks, there was some progress. He was able to move his left leg ever so slightly.

“It was a great victory,” he said.

Dr. Esper was discharged from St. Elizabeth on June 5, 2007, and went back to the Cleveland Clinic to have surgery to close the hole in his heart, through which the blood clot had escaped and moved to his brain.

It has not been determined positively what caused the clot. However, Dr. Esper theorizes that it all began on Feb. 15, 2007, when he hit a patch of snow on the ramp going from Interstate 680 north onto state Route 11 south, lost control of his car and rolled down an embankment. He was wearing his seat belt, which he believes enabled him to walk away virtually unscathed.

However, he also believes the accident dislodged a kidney stone, which began causing him severe pain in March. After several episodes, the stone was backing up urine into his kidney, and he had surgery to remove the stone April 6.

Dr. Esper thinks that a blood clot formed as a result of the inflammation caused by the kidney stone or from the surgery to remove it. The clot then drained into his heart normally via his veins, but instead of going to his lungs to be oxygenated, it passed through the congenital hole in his heart, of which he until then was unaware, and into the left side of his heart. It was then pumped through his arteries and into his brain, causing the stroke.

On June 7, 2007, Dr. Esper came home from St. Elizabeth rehabilitation.

But, Dema’s joy was tempered by the question that had been on her mind for some time: “How am I going to take care of him when he gets home . ... How am I going to manage with him and two small children.”

They spent the summer of 2007 going to physical, occupational and speech therapies, she said.

Recovery has been a gradual process. It took 15 months for him just to begin to twist his left wrists. To see that was like, “Wow,” Dema said.

In the beginning, Dr. Esper said he saw relatively big gains, but now the successes are much smaller. For instance, recently he has been waking up without pain in his left ankle and leg, which usually occurs with walking and putting pressure on his left leg and foot. It is caused by spasticity, or severe muscle stiffness on his left side, caused by the stroke.

He continues to work on the muscle stiffness at Action Physical Therapy & Rehabilitation in Hubbard and also works with a personal trainer, Terry Landis of Canfield.

“Physical therapy is humiliating. You learn to lose your pride, but you keep on working, ” Dr. Esper said.

“Will I ever be able to do a heart catheterization again. I hope, with a lot of rehab, that I’ll regain the use of my left hand,” he said.

“But, my knowledge all came back, and my physician’s group has reminded me that a lot of cardiologists do general cardiology and diagnose and treat patients and prescribe medications. They have said that when I am ready, I have a job to come back to. They have been very supportive. I am very thankful to them,” he said.

Dema, too, has had to come to terms with their changed circumstances.

“The hardest part was I felt like I had lost half of myself. He was my partner and we shared everything. We had divided the household chores and we both took care of the children. We did everything together,” she said.

“Also, my career was always very important to me, and my whole plan was to do per-diem work as a dietitian in Pittsburgh,” she said.

But now, she has committed herself to taking care of her husband and children.

“I’ve learned you can be a stay-at-home wife and mom and still stay current in your field,” she said.

Dema is doing free-lance writing for Today’s Dietitian magazine and will teach a class in nutrition at Youngstown State University starting in the fall.

The Espers had lived in Michigan, where he did fellowship training, and then in Indiana, where he was in private practice, before coming to Youngstown so their children could grow up near their grandparents.

Dr. Esper’s parents, Richard T. Sr. and Delia Esper, live in Forest Hills, Pa., near Pittsburgh; and Dema’s parents, Bassam and Raghda Halasa, live in Akron.

The Espers said they are very grateful for the phenomenal medical care he received in Youngstown and in Cleveland and tremendous support and prayers from their church, St. Mark Orthodox Church in Liberty and others in the community and across the country.

“People have been so kind to us, that now I want to work here and contribute to the community. I have found Youngstown is a great place,” she said.

“Youngstown is a well-kept secret,” Dr. Esper said.

alcorn@vindy.com