Hands Down
Photos by Nerissa Johnson

Robert Wedyck

Carotid artery narrowing cause of retiree’s stroke.

Robert Wedyck was a professional “foodie.” For years, he worked in consumer product sales, hawking everything from candy to Christmas trees. But he spent most of his career in the employ of Winter & Company, a wholesaler that offers a wide variety of merchandise but specializes in food products. Robert’s job in food sales suited him well. 

“I’ve got the food business in my blood; I grew up in it,” he muses. “When I was fifteen, I made pizzas at a deli. Then, I worked at a grocery store as a stocker, checker and third man, so I have a huge food background. When I got out of college and started looking for a job, I found one with a food broker, which launched my career.”

Originally from Wisconsin, Robert lived most of his adult life on the North Shore in Chicago, Illinois, where he serviced large corporate accounts such as Costco® Midwest. In 2013, he retired and relocated to St. Augustine, where many of his family members lived. But Robert wasn’t content to sit around and do nothing in his retirement.

“I was only fifty-eight, which is a little young to retire,” he admits. “I wanted to do something until I retired for good, so I got a job with Enterprise Rent-A-Car® in Palm Coast. That was the first job I had that didn’t involve food. I retired from Enterprise at the end of November and turned sixty-five on December 19.

“But health issues began bothering me before I retired, starting around October. For one thing, I suffer with chronic pain syndrome. I was seeing a pain doctor, but I finally told him I needed more help.”

Robert’s pain doctor recommended Kai McGreevy, MD, a board-certified neurologist and interventional pain specialist at McGreevy NeuroHealth, which has offices in Palm Coast and St. Augustine. Dr. McGreevy uses a variety of techniques to relieve his patients’ pain and address their neurological disorders.

McGreevy NeuroHealth is fully accredited by the Joint Commission on Accreditation of Healthcare Organizations, the gold standard in certifying the practice as a facility that is centered on patient care, safety, accountability and satisfaction.

“Dr. McGreevy was treating me for pain when one day, my left hand just stopped working,” Robert recalls. “I could feel my hand. There was no numbness or tingling, but it just wouldn’t work. I couldn’t make it move.”

“A few months prior to this, Robert gradually developed mild weakness and numbness in the first three digits of his left hand,” Dr. McGreevy reports. “Nerve conduction studies showed electrical slowing of the median nerve across the left wrist, and a carpal tunnel ultrasound confirmed the swollen nerve and the diagnosis of carpal tunnel syndrome.

“Our Neurodiagnostic and Musculoskeletal Laboratory utilizes insurance-covered, reasonably priced yet leading-edge technology to identify entrapped nerves and muscle problems. The syndrome was managed conservatively and Robert’s symptoms improved, eliminating the
need for surgery.

“Ironically, Robert woke up the morning of his routine office visit with a worrisome issue in the same hand, weakness above and beyond his baseline carpal tunnel syndrome,” Dr. McGreevy continues. “He was not sure what was wrong, but something was different. I suspected that the new issue was also neurological in nature.”

Highly Suspicious

Dr. McGreevy began his evaluation of Robert’s new problem with a complete “head-to-toe” neurological exam, considering both central- and peripheral-nervous-system causes for Robert’s symptoms.

“I suspected a brain condition because Robert displayed a specific pattern of weakness that was more dense and distinguishable from carpal tunnel syndrome,” the doctor reports. “The weakness

preferentially involved wrist and finger extensors in an upper motor neuron pattern with abnormal reflexes on the left side of his body that localized to the right hemisphere of his brain.

“I listened to Robert’s neck with a stethoscope and detected a low-pitched, gruff-sounding vibration known as a bruit coming from his right carotid artery. It was subtle enough to be missed by other

Ultrasound and MRI photo courtesy of McGreevy NeuroHealth.

“The MRI showed that Robert suffered an acute ischemic stroke in the right hemisphere
of his brain.”

physicians who may not know when or how to detect this important sign. Had Robert presented to the ER, a primary care physician or a chiropractor, he might have been sent home misdiagnosed with carpal-tunnel-syndrome relapse and later suffered a much larger problem.”

In addition to performing the exam, Dr. McGreevy also reviewed Robert’s medical history. He noted Robert’s age and that he had high blood pressure and high cholesterol, which are risk factors for vascular events.

“In medical school, we are taught that the history is eighty percent of the diagnosis, emphasizing the importance of good history-taking,” Dr. McGreevy observes. “We not only look at lesion localization, we pay close attention to the timeline of symptom presentation. In this case, that was an acute onset of left-handed weakness. Stroke, transient ischemic attacks, seizures and migraines are mostly responsible for acute presentation of neurological disease.”

The information discovered in Robert’s medical history added fuel to the neurologist’s suspicion that the problem was the result of a brain condition.

“At that point, I ordered an urgent MRI of Robert’s brain, which confirmed my suspicion,” Dr. McGreevy acknowledges. “The MRI showed that Robert suffered an acute ischemic stroke in the right hemisphere of his brain.”

“Dr. McGreevy’s examination was very thorough,” Robert remembers. “He ran many tests to find my exact problem. He checked my carotid arteries to see if they were clear. It turned out they were blocked, and that led to a small stroke.”

Dr. McGreevy is the medical director of the Vascular Laboratory at McGreevy NeuroHealth. He has achieved the Registered Physician in Vascular Interpretation (RPVI) certification that only a few neurologists in the country can claim. This is the same credential obtained by other specialists including cardiologists, vascular surgeons and radiologists.

This vascular imaging designation ensures the knowledge and skills necessary to deliver the highest standard of patient care and safety. It also establishes Dr. McGreevy’s expertise in interpreting vascular disorders using ultrasound of the intracranial, carotid, aortic and extremity blood vessels. He can detect stroke risk, blocked arteries, aneurysms, peripheral artery disease and venous insufficiency.

“When it was happening, I had no idea I was having a stroke,” Robert remembers. “But looking back, I did have some double vision before it all took place. Hindsight is 20/20.”

Two-Penny Pencil

Ultrasound and MRI photo courtesy of McGreevy NeuroHealth.

Carotid Artery Ultrasound

“Sure enough, Robert’s MRI showed multiple, small injuries scattered throughout the right hemisphere of his brain,”
Dr. McGreevy observes. “The diagnosis was acute ischemic stroke. The question became, What caused it?” Dr. McGreevy set out to answer that question.

“Neurologists are like detectives,” he says. “We systematically look for clues based on our knowledge of a very complicated map of the nervous system and meld it with the patient’s symptom presentation. The skill set is specific to the neurologist, allowing for precise problem localization, differential diagnosis and selection of appropriate imaging, with specific treatment to follow.”

The brain in particular is a delicate organ that has very little tolerance for oxygen deprivation, the neurologist educates. When oxygen delivery to a region of the brain is reduced for even a short time, brain cells in that area die. This is called a stroke and it’s the fifth leading cause of death in the United States.

The most common cause of stroke is lack of oxygen to brain tissue due to a blockage of blood flow. The blockage can arise from different problems, such as abnormally thickened blood, blood clots that form in the heart‘s chambers and travel to the brain, cholesterol plaque that breaks off of a carotid artery and travels to the brain, or similar plaque originating within the brain arteries.

“In neurology circles, we often chant the real estate mantra, Location, location, location,” Dr. McGreevy notes. “In Robert’s case, understanding the regions of the brain affected and the anatomy involved helped to narrow the possibilities for the source of his stroke.

“Robert’s imaging revealed multiple tiny strokes scattered throughout his right hemisphere, most likely due to traveling clot material known as emboli originating outside the brain’s vascular system.”

Dr. McGreevy rationalized that it was unlikely that multiple vessels in the brain suddenly narrowed enough with clot material to cause multiple strokes at the same time. Likewise, the strokes were statistically unlikely to stem from the heart, where blood clots tend to travel to both sides of the brain. The emboli more likely originated from unstable plaque in the right carotid system, the main highway to the respective brain hemisphere.

“Only an experienced neurologist could quickly solve this puzzle,” Dr. McGreevy stresses.

Several months before his stroke, Robert underwent a carotid artery ultrasound in the Vascular Laboratory at McGreevy NeuroHealth.

“The imaging test suggested that Robert had fifty to sixty-nine percent stenosis, or moderate narrowing caused by plaque build-up in his right carotid artery,” Dr. McGreevy reports. “This is typically managed conservatively using blood-thinning medication and controlling blood pressure, cholesterol and sugar levels.

“After Robert’s stroke diagnosis, we performed a new carotid ultrasound in our laboratory, and there was a difference in the degree of narrowing and shape of the plaque in his right carotid artery. On the new ultrasound, the narrowing was greater than seventy percent.

“My recovery started with Dr. McGreevy seeing that something was wrong and getting me to the right people for treatment.”– Robert Wedyck

“We know this because the speed of blood flow through the narrowing was much faster and the flow pattern was turbulent. We also appreciated the fact that the progression of narrowing was over just a few months, when it typically takes years to progress that much. This was an indicator that the underlying process was worsening quickly despite conservative measures and warranted emergent intervention.

“It was crystal clear that the diagnostic studies confirmed my suspicion based on history and examination. Due to the degree of stenosis and unstable plaque, I referred Robert to a vascular surgeon for evaluation.”

The vascular surgeon performed a CT angiogram, which confirmed Dr. McGreevy’s findings. Robert’s stenosis was blocking smooth blood flow to his brain and required surgical intervention. A procedure called carotid endarterectomy was recommended.

Carotid endarterectomy is a procedure to remove built-up plaque from the carotid arteries, Dr. McGreevy explains. During endarterectomy, the clogging plaque is excised from the carotid artery through a small incision in the front of the neck.

“The vascular surgeon removed a substantial amount of built-up plaque from my right carotid artery,” Robert reveals. “It was as thick as a pencil and about an inch long.”

“Phenomenal” Experience

After diagnosing his stroke, Dr. McGreevy arranged for Robert to receive immediate emergency care at a local hospital. Robert says he owes his life to Dr. McGreevy.

“All of Dr. McGreevy’s testing got me into the hospital and led to treatment by the vascular surgeon,” Robert confirms. “And the vascular surgeon’s care led to me being seen by a heart specialist. Between them, they took care of several serious problems that could have killed me.

“The heart specialist discovered that two major arteries in my heart were blocked and required stenting. He told me that if I would’ve had a heart attack, I would likely have died from it. And the vascular surgeon said that if I didn’t do the carotid artery procedure, plaque could break off and cause a major stroke, which could severely disable or even kill me.”

Dr. McGreevy affirms that vascular disease in one vessel territory is often a sign of vascular disease elsewhere, as similar risk profiles create similar pathology throughout the body. This is why McGreevy NeuroHealth pays attention to patients’ entire neurological health.

“We also understand that time is brain, so we act quickly,” Dr. McGreevy emphasizes. “In Robert’s case, the brain appeared to have the ability to adapt to injury as long as it was detected and treated quickly. This is known as cortical plasticity, a topic on the forefront of neurology research, which I am very passionate about.

“Robert’s situation highlights the fact that we have the skills and technology in this area of neurology, so we should use it. Robert is such a great guy, and I am very happy that he achieved such an excellent outcome.

Photos by Nerissa Johnson

Robert has regained use in his left hand

“My recovery started with Dr. McGreevy seeing that something was wrong and getting me to the right people for treatment,” Robert enthuses. “Otherwise, those conditions could have gone unchecked, and I might not be alive today. Every time I see Dr. McGreevy, I thank him.”

Once Robert’s stroke risk factors were under control and his carotid artery stenosis was treated, the function in his left hand returned. Physical and occupational therapy assisted with his recovery as well. Today, Robert says he feels great.

“Thanks to my team of doctors and all that Dr. McGreevy did for me, I feel wonderful,” he raves. “Dr. McGreevy and his team at McGreevy NeuroHealth are phenomenal.”

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