David B. Wheeler, MD, PhD, FAAN, FAES, has been named the American Heart Association’s Physician of the Year for 2019.
The award is bestowed annually upon one practicing physician in the country for their outstanding contributions to the accomplishment of the AHA mission. “David Wheeler has worked tirelessly for years to improve systems of care for stroke patients in Wyoming and beyond,” said Midge LaPorte Epstein, Executive Vice President of the AHA’s SouthWest Affiliate. “His insights into the unique challenges of rural health care are helping to guide the AHA’s work in this important area, and he is a trusted advocate for our mission. His leadership is improving patient outcomes and saving lives. For these reasons and many more, David is an excellent choice for this prestigious award.” Wyoming Medical Center is proud of Dr. Wheeler and the stroke program he has built for Casper and patients across the state. This national honor is a testament to the care he has provided to patients for more than a decade. Dr. Wheeler discusses his feelings about this national honor and his efforts to bring expert stroke care to every patient in Wyoming in the interview below:
AHA IS WELL KNOWN FOR ITS WORK IN RAISING AWARENESS ABOUT HEART ATTACK PREVENTION AND SYMPTOMS, BUT LESS KNOWN FOR ITS WORK RELATED TO STROKE. HOW ARE THE TWO RELATED?
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A very big part of AHA’s message is prevention of heart disease through healthy living: Not smoking, better eating choices, exercise, knowing your blood pressure and cholesterol numbers, etc. Turns out, all of that is equally good or even better for your brain. Prevention of heart disease and stroke are really the same things. In fact, we refer to them as cardiovascular diseases.
Throughout its existence, the AHA has been an important force for improving prevention and treatment of both stroke and heart attack. We’ve done a great job of educating the public that time is of the essence when you’re having the heart attack and recognizing the signs and symptoms. Of course the same is true for stroke. The faster you can get treated, the greater the chance you are going to come out of it OK.
WHAT ARE THE SIGNS AND SYMPTOMS OF STROKE?
The AHA and others have created and promoted the F.A.S.T. acronym to help people recognize stroke in others: Face, Arms, Speech and Time. It was an important initiative to reach the same level of public urgency of calling 911 when having stroke symptoms. One problem is that many people who are having a stroke don’t recognize the symptoms in themselves. It’s hard for the person who is having a stroke to call 911. Either they don’t know what’s going on or they’ve lost the ability to speak or move. It relies on someone else to see what is going on and doing something about it. In my mind, it’s a little like CPR training for bystanders.
BUT THE FIRST STEP IF YOU SUSPECT STROKE IS TO CALL 911.
Correct. The biggest mistakes we see is people try to wait it out, or take a nap, and see if it goes away. Strokes, even a TIA (transient ischemic attack ) or mini stroke, is a medical emergency. We lose millions of brain cells every minute during a stroke, and the faster we can break up the blood clot or get the clot out of your brain, the greater the chance you are going to recover.
Calling 911 will get you treated faster even if you think you could drive to the hospital more quickly on your own. Turns out that coming into the ER through the ambulance bay will get you treated faster than coming in the front door, no matter what. Always call 911.
WHAT OBSTACLES DO YOU SEE IN GETTING THIS EDUCATION AND CARE TO PEOPLE WHO LIVE IN RURAL AREAS?
I think there are two significant obstacles: One, many people live far away from their nearest hospital. I believe that about 50 percent of people in Wyoming live more than an hour from their nearest hospital. And two, not every hospital has all the equipment or expertise needed to deliver all of stroke care. Those are the barriers.
The good news is that stroke treatments are evolving all the time and are improving. The chances of coming out of the stroke without significant disablities are much better than they were 10 years ago – if you can get to a place where treatment is available. That gave us a job to do: We had to figure out how, in a place like Wyoming, to make that level of care available to everybody in the state.
AND HOW ARE YOU WORKING TO MAKE THAT HAPPEN?
Right now, we are building a system of care across the state to help every hospital get as good at stroke care as possible. Our goal is that every person in Wyoming should have ready access to comprehensive stroke care, no matter if they live near Basin or Gillette or Casper. If you call 911 with stroke symptoms in Wyoming, you will be taken to a hospital that is committed to rapidly diagnosing stroke and delivering clot busting treatment in a timely fashion. The level of care ought to be the same no matter where you live.
HOW LONG HAVE YOU BEEN WORKING AT THAT?
We’ve been working on this network since 2007. Our biggest barrier then was cost of telehealth equipment which could tens of thousands dollars a month. Luckily, advances have made the equipment relatively cheap and software has made telehealth encounters much easier. Now, we’re able to use telehealth for a variety of services, including delivering telestroke care to hospitals around the state. Through TeleStroke Wyoming, we are offering to provide neurology coverage for as many hospitals that want to work with us. The goal is if a person is having a stroke somewhere in Wyoming, just as if they were having a stroke in Casper, a neurologist will be alerted and on the TeleStroke system before the patient gets to their community hospital. And we’ll be able to evaluate with the doctors, nurses and family whether to give clot buster medication and whether or not to life flight them to Wyoming Medical Center should a higher level of care is needed. We now have the ability, in some cases, to go in with tools to grab hold of the clot and pull it out of the patient’s brain and avoid the stroke all together. But WMC is the only hospital in the state with that capability.
WHAT DO YOU SEE AS THE NEXT STEP IN DEVELOPING THIS SYSTEM OF CARE?
In my opinion the greatest impact would be if most, if not all, of Wyoming’s hospitals began working toward certification as Acute Stroke Ready Hospitals or Primary Stroke Hospitals and were actively working with us to submit data to a statewide registry for quality improvement. That to me is the critical next step. That is what made our STEMI program amazing: Multiple sites submitted their data, and Wyoming Medical Center provided feedback on managing their STEMI patients. Together, we all got better, and I want to see the same thing happen from stroke. (STEMI stands for ST-segment elevation myocardial infarction, or the most serious form of heart attack.)
TELLS US ABOUT THE STROKE TEAM AT WYOMING MEDICAL CENTER.
Part of the thing that makes my job fun is that I get to help bring together lots and lots of people from throughout our organization, and other organizations, to work together for a common purpose. That isn’t always an easy job to do. Getting people motivated to work together to accomplish an important task is its own reward.
There probably isn’t a department in the hospital that isn’t in some direct or indirect way part of our stroke team. One of the things that I think is amazing is there are always 20 to 25 people at our monthly meetings of the Stroke Coordinating Committee. I’ve never seen a committee with as much staying power as that. A dozen or so years later, people remain committed to it and the results it is showing.