{"id":40291,"date":"2021-06-25T12:28:45","date_gmt":"2021-06-25T18:28:45","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=40291"},"modified":"2023-04-20T14:20:47","modified_gmt":"2023-04-20T20:20:47","slug":"stroke-of-luck-and-a-lot-of-medical-science-help-make-family-of-four-possible","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/stroke-of-luck-and-a-lot-of-medical-science-help-make-family-of-four-possible\/","title":{"rendered":"Stroke of luck \u2013 and a lot of medical science \u2013 help make family of four possible"},"content":{"rendered":"
<\/div>

Her husband Chris was out for the morning, and Hannah Holt, 28, was to go for a walk with her friend Lexi and their toddler daughters. The first day of June 2019 shaping up into a nice one. They would circumnavigate Bingham Lake in the Pinery south of Parker. Hannah checked the contents of the diaper bag, plopped daughter Raegan into the stroller, and stepped out into the sunshine.<\/p>\n

Raegan was three months shy of 2 years old, and her presence was a blessing in more ways than one. She had been born with gaps in the walls separating the right and left sides of her heart. Those gaps had denied her blood of oxygen and had left Raegan breathing hard and sleeping a lot. Hannah, a cardiothoracic nurse, had more or less<\/a> diagnosed the problem herself before a pediatric cardiologist finally did two weeks later.<\/p>\n

\"With
With three health scares in the rearview mirror, this young family is enjoying much sunnier days. Photo by Cyrus McCrimmon for UCHealth.<\/figcaption><\/figure>\n

Two sleep-deprived months of keeping close watch and feeding high-calorie formula later, the young parents would spend six nervous hours in a hospital waiting room as their baby\u2019s blood flowed through a heart-lung bypass machine while surgeons patched up her tiny heart.<\/p>\n

That surgery had been a success, and Raegan was now walking faster and adding words every day. It had been a rough start, but Raegan\u2019s life was that of a perfectly healthy toddler. Hannah and Chris were thinking about adding to the family, in fact.<\/p>\n

Hannah and Lexi walked along North Pinery Parkway, each with a daughter in a stroller. Hannah slowed down for a moment. She didn\u2019t feel right.<\/p>\n

\u201cIt\u2019s really dark all of a sudden,\u201d she told her friend, now a couple of steps ahead.<\/p>\n

\"A
A year to the day after her stroke, Hannah sent this mountaintop message to UCHealth neurosurgeon Dr. Christopher Roark and colleagues. Photo courtesy of Hannah Holt.<\/figcaption><\/figure>\n

As Lexi parsed a sentence that made little sense on a bright Colorado morning, it felt to Hannah as if a vise had clamped around head. Then she felt nothing at all. She collapsed into the road, taking the stroller and Raegan with her.<\/p>\n

Lexi leapt into action, pulling mother and the stroller back onto the sidewalk. A passerby stopped to help \u2013 a paramedic, as it turned out. An ambulance arrived minutes later. Inside, Hannah said, \u201cMy head hurts really bad.\u201d<\/p>\n

\u201cYou\u2019re probably dehydrated,\u201d the emergency responder said.<\/p>\n

\u201cI\u2019m going to die,\u201d Hannah said, though she wasn\u2019t quite sure why she said it.<\/p>\n

Aneurysm<\/strong><\/p>\n

The ambulance rushed her to a community hospital. When the scans came back, she was transferred to another one. Hannah had an aneurysm in the internal carotid artery<\/a> behind her left eye. That artery is a major supplier of blood to the brain.<\/p>\n

There was brain bleeding, doctors told Hannah and Chris. She had had a stroke, and it had been a stroke of luck that she hadn\u2019t been home alone at the time. The artery had burst and there was still a blister aneurysm to contend with. Think of a garden hose filling a water balloon. Now think of that water balloon having filled from a weak point along the garden hose and now swelling with continuous, pulsing pressure from the heart just upstream of the internal carotid artery. That\u2019s more or less what was happening behind Hannah\u2019s left eye.<\/p>\n

Hannah overheard a doctor say, \u201cIt\u2019s life or death.\u201d The nurse in her thought, \u201cOh, that poor patient. I hope he\u2019s OK.\u201d Then she realized the patient was she. Chris kept vigil at the hospital as family and friends took care of Raegan. Hannah was at times lucid and conversant. Then her eyes rolled back into her head and a seizure commenced. She spent five days in the hospital\u2019s neuro ICU before doctors there recognized that they couldn\u2019t risk treating her. They called the UCHealth Stroke and Brain Aneurysm Center<\/a> on the Anschutz Medical Campus<\/a> and described the case of a young nurse they felt could have huge complications.<\/p>\n

University of Colorado School of Medicine neurosurgeon Dr. Christopher Roark<\/a> took the lead when she arrived. He sent Hannah for a new set of scans and saw that indeed this was a high-risk case. In addition, Hannah\u2019s middle cerebral artery \u2013 another important blood supply to the brain \u2013 depended entirely on the internal carotid artery (in many people, there\u2019s a circle of arteries that acts as a sort of backup). Roark well knew that operating on a blister aneurysm was fraught. It has a consistency of tissue paper. Fortunately, there was another option \u2013 one that, as Roark put it, has \u201crevolutionized the treatment of some aneurysms.\u201d<\/p>\n

\"Cooper
Cooper Holt naps in the UCH neonatal intensive care unit in March 2021. A CPAP helped him breathe. Photo courtesy of Hannah Holt.<\/figcaption><\/figure>\n

In 2011, the U.S. Food and Drug Administration approved a Medtronic product called the Pipeline Flex<\/a> embolization device. It\u2019s made of a fine woven mesh of cobalt chromium and platinum tungsten and can be delivered via catheter through a small incision near the groin. In Hannah\u2019s case, the catheter would snake up through the aorta and into the internal carotid artery, where Roark would position it and expand the mesh tube. That would stabilize the damaged artery and, by channeling blood flow through the artery\u2019s natural path, take most of the pressure off the blister aneurysm. The artery could then heal naturally.<\/p>\n

The procedure is minimally invasive, and the complication rate is low when there hasn\u2019t already been brain bleeding. Hannah didn\u2019t have that luxury. Roark figured the risk of a clot or bleed as a result of the procedure to be in the 20% to 25% range. Assuming she made it out of the operating room alive, Hannah could end up paralyzed on the right side and unable to talk or even understand speech.<\/p>\n

Prior to the surgery, Roark sat down with Hannah and Chris. He simplified the math somewhat. Among those with ruptured brain aneurisms, 10% to 15% die before getting to the hospital. One complication or another kills 40% to 55% within six months. Of the survivors, two-thirds have some degree of deficit, some mild, some severe, and the remaining one-third (33%) end up completely normal afterward.<\/p>\n

\u201cLet\u2019s go with the last 33%,\u201d Hannah said.<\/p>\n

Chris brought Raegan to the hospital so Hannah could say goodbye. It was no easier with Chris.<\/p>\n

\u201cI want to raise our daughter with you,\u201d she told him. \u201cI don\u2019t want to leave you as a single dad.\u201d<\/p>\n

The procedure took but a few minutes, and no sooner was it over than it was clear to Roark that the last 33% it would be.<\/p>\n

\"\"There had been damage done by the initial bleed, though. Hannah spent 26 days in UCHealth University of Colorado Hospital<\/a> (UCH) Neuro ICU. Between the weakness from atrophy and the damage from the stroke, she could hardly walk. She did physical and speech therapy for months afterward. The family moved in with her parents Mark and Musetta Dean in Parker for help not only with Raegan, but also with Hannah.<\/p>\n

Enter Cooper<\/strong><\/p>\n

Hannah and Chris had, for obvious reasons, set aside the idea of having more children. But in June 2020, a new set of scans showed Hannah\u2019s internal carotid artery to have entirely healed. Roark took her off one of two antiplatelet drugs he had prescribed to prevent clotting. With that, he told the couple they had his blessing to get pregnant again. They wasted no time.<\/p>\n

Hannah received prenatal care through the UCHealth Maternal Fetal Medicine Clinic – Anschutz Medical Campus<\/a>, where doctors coordinate high-risk pregnancy care with primary-care and specialist physicians such as Roark. Given Hannah\u2019s clean bill of health, his interactions were minimal, Roark said.<\/p>\n

Cooper was born in early March this year at 37 weeks \u2013 a rise in Hannah\u2019s blood pressure had led the obstetrics team to induce delivery at that point. He weighed just over seven pounds. One might think that, given the young family\u2019s outsized share of health scares, fate would smile upon them this time around.<\/p>\n

But Cooper was no sooner born at UCH than it was clear that he was having a hard time breathing.<\/p>\n

The care team ruled out a heart issue such Raegan\u2019s. This problem looked to be with the lungs themselves. Dr. Tom Parker<\/a>, a CU School of Medicine and UCHealth neonatal and perinatal specialist, considered several possibilities.<\/p>\n

One was too little surfactant<\/a> \u2013 the material that holds the lungs open and allows babies to breathe with ease. Surfactant deficiency is much more common with preterm babies, but does occasionally happen with seven pounders such as Cooper, Parker says. Another possibility was that the lungs had retained some amniotic fluid or, during birth, that Cooper had aspirated fluid. Or perhaps Cooper had a lung infection.<\/p>\n

\"Hannah
Hannah and her 11-week-old daughter Raegan in the ICU in October 2017. Raegan underwent open heart surgery at age 11 weeks to repair gaps in the walls between the left and right sides of her heart. Photo courtesy of Hannah Holt.<\/figcaption><\/figure>\n

The path forward was consistent across those possibilities: Cooper would spend some time in the neonatal intensive care unit with a CPAP machine not so different from those used by adults with sleep apnea. The machine would push air enriched with supplemental oxygen into Cooper\u2019s lungs and help him breathe while his body developed and healed. Should an infection manifest, antibiotics would be administered.<\/p>\n

Hannah admits to being \u201chigh-strung\u201d in the NICU.<\/p>\n

\u201cOne of the docs said, \u2018Don\u2019t worry \u2013 he\u2019s the least-sick child here,\u2019\u201d Hannah recalled. \u201cAnd I was like, \u2018Listen, if you knew what we\u2019ve been through in the last three years, you\u2019d understand.\u2019\u201d<\/p>\n

Parker had been meaning to sit down with Hannah and Chris but hadn\u2019t managed to connect. At one point, he spotted Hannah walking out of the NICU and ran down the hall to catch her. They sat down in Cooper\u2019s NICU room. They talked for a few minutes, and Parker conveyed this message, as he recalled: \u201cEven though Cooper was in the NICU, and this wasn\u2019t going as we would have predicted or as she would have wanted, this was going to be OK.\u201d<\/p>\n

Family of four<\/strong><\/p>\n

And it did turn out OK. While the cause of Cooper\u2019s lung problem remained unclear, Cooper\u2019s lungs strengthened. Hannah and Chris got him back home just before two feet of snow buried metropolitan Denver the weekend of March 12. Cooper stayed on supplemental oxygen and basked in a bili light<\/a> for a few days. Three months later, he was as healthy as his big sister and his mom.<\/p>\n

Hannah and Chris Holt (not to mention Raegan and Cooper) have been through a lot. They\u2019re well aware that striking advances across many fields of medical science have made their family of four possible. They\u2019re grateful for the care they\u2019ve received and the personal qualities of those delivering it.<\/p>\n

\u201cIt was literally every single doctor, nurse, therapist \u2013 even the people who bring the meals \u2013 they were just so professional and so caring at the same time,\u201d Hannah said.<\/p>\n

Chris\u2019s initial impression upon arriving at UCH\u2019s formidable campus in Aurora was one of slight worry. Would Hannah just get lost in such a massive place?<\/p>\n

\u201cThen you realize there are so many resources. Other hospitals look like neighborhood clinics,\u201d he said. \u201cIf it had been anywhere else, it would have been a totally different outcome.\u201d<\/p>\n

Hannah\u2019s take was simpler yet.<\/p>\n

\u201cGo to UCHealth,\u201d she said. \u201cI promise you, they\u2019ll figure it out.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

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