DOGGED STROKE VICTIMS PUSH AWARENESS
SCOTT HERHOLD column, February 8, 2004

What sticks in Chuck Toeniskoetter's memory most vividly about his stroke is the mental picture of two nurses standing on the runners of a helicopter and gesturing animatedly.

Lying on his back inside the helicopter, unable to move his right side, the then-55-year-old San Jose developer couldn't understand what they were saying. Today he says their insistence on directing the pilot to the right hospital probably saved him from a life of paralysis.

More than three years later, a healthy Toeniskoetter is trying to do for a community what those nurses did for him, holding fast to the runners of our awareness.

With two other stroke survivors, machinery importer Chuck Hoffman and San Jose Vice Mayor Pat Dando, he's launched a campaign to make the public more aware of how to deal with strokes.

''We've all recovered through the good graces of a system that worked,'' Toeniskoetter says. ''If I had had anything less, I'd be sitting in a wheelchair now with my entire right side disconnected from my brain.''

The three have set up a foundation. They've pushed the notion of designating certain hospitals as stroke centers. They've sought to teach paramedics where to take patients. And they've distributed wallet-size cards that describe stroke symptoms and mention a potent drug called tPA, used to combat strokes caused by blood clots.

With the stroke 11 days ago of San Jose Mayor Ron Gonzales during his State of the City speech, they've suddenly got the attention of a city.

To understand Toeniskoetter's commitment, you have to know his story: Toeniskoetter had his stroke during a ski trip in Bear Valley on Dec. 23, 2000. He had gone downhill skiing in the morning and was visiting tenants in the village when his right side went numb and he toppled over.

A search-and-rescue team took him to a nurse. Recognizing he had suffered a stroke, she called an ambulance and helicopter. She and another nurse stood on the runners until they had the pilot's assurance that the builder would be taken to Sutter Roseville Medical Center rather than the nearest hospital.

At Sutter, a hospital well-equipped for stroke victims, a doctor told Toeniskoetter that they had been unable to determine exactly what kind of stroke he had -- a blood clot or bleeding in the brain (the kind that struck Gonzales).

If Toeniskoetter took tPA, which works for blood clots, the odds were 10 percent that he could die on the operating table, but 60 percent in favor of full recovery.

Toeniskoetter took the drug. Within 15 minutes, he began to move his right side once more. ''When they saw that, they started jumping up and down,'' he remembers now.

That experience left the San Jose developer with the overwhelming conviction that stroke victims should be taken to hospitals equipped to administer tPA, which works only if given within three hours of a stroke.

This is not as easy an idea as it sounds. For one thing, a tPA hospital needs to have a stroke team on call -- a neurologist, a cardiologist, someone to read a CT scan. Not every hospital can afford that. ''It's very expensive,'' Dando says.

It took a raft of phone calls before their ally Hoffman reached the chief of the Joint Commission on Accreditation of Healthcare Organizations, who said she'd be glad to start designating hospitals as stroke centers. Good Samaritan Hospital was the first in Santa Clara County, and Toeniskoetter says he expects Stanford and possibly a Kaiser hospital to follow.

He acknowledges that the idea of stroke centers has met resistance from non-tPA emergency rooms that don't like to lose patients. But given that strokes cost Americans $50 billion a year, he insists change is mandatory.

''What's the most important thing?'' Toeniskoetter asks, and you can feel him jumping on the runners. ''The most important thing is the patients.''