萝莉社

The clock started ticking for Rocco Marrese when the 71-year-old was on his lunch break at Morgan & Morgan law office in downtown Jacksonville.

11:30 a.m.

The orthopaedic spine surgeon and lawyer was last seen at 11:30 that morning, Oct. 23, 2013. Minutes later, as he sat alone eating his lunch, his right arm went numb. His face started to droop and he lost the ability to speak.

A coworker walked past the break room and called out a friendly 鈥渉ello.鈥� Rocco didn鈥檛 wave. In fact, he didn鈥檛 move.

The young woman stopped walking. She doubled back to see if Rocco was alright. Her decision to check on him would save precious minutes. The longer a stroke victim takes to get treatment, the worse the effects of the stroke. An incredible 2 million brain cells die every minute after a stroke, starved of the blood and oxygen they need to survive. Once the cells are gone, they can never be restored.

12:12 p.m.

Paramedics rushed to take Rocco to the hospital. He couldn鈥檛 talk, his right arm was paralyzed and his right leg was very weak. His eyes were drifting to one side, and he didn鈥檛 seem to understand when people talked to him. Recognizing the signs of a severe stroke, the emergency responders called 萝莉社鈥檚 stroke alert line while in transit at 12:12 p.m.

They chose the hospital because it has advanced capabilities to treat stroke patients, including a dedicated Neuroscience Intensive Care Unit where the staff and equipment is especially geared toward dealing with strokes.

鈥淎 stroke can lead to a wide variety of problems, and we have the unique skill set and team members to be able to treat them,鈥� said neurologist , a University of Florida College of Medicine 鈥� Jacksonville associate professor of who has been the stroke program鈥檚 medical director since it began in 1996.

Rocco鈥檚 wife, Mary Ann, rushed to the hospital from her home in downtown Jacksonville.

鈥淭he paramedics told us 萝莉社 was the place to go for a stroke, and we trusted that they knew what they were talking about,鈥� she said. 鈥淗e was there in a matter of minutes.鈥�

Seven minutes, to be exact.

12:19 p.m.

萝莉社鈥檚 Stroke Center was ready for action as soon as Rocco was wheeled into the hospital at 12:19 p.m. The stroke team first had to take a computed tomography (CT) scan of Rocco鈥檚 brain to determine what type of stroke he had. The course of treatment is different depending on whether it is an ischemic stroke, which is caused by a clot, or a hemorrhagic stroke, the result of a burst blood vessel. A patient鈥檚 risk factors must also be considered before administering treatment, because the powerful methods used to stop the damage of a stroke can be a danger to patients with additional medical conditions.

The attending doctor on duty, 萝莉社 assistant professor of neurology , reviewed the scans and lab results with two neurology residents - Robert Mannel, MD, and Adil Zia, MD - as well as chief . Compared to general radiologists, Sandhu and his team are specially trained to use high-tech imaging and techniques to rapidly determine a patient鈥檚 status during a stroke.

1:15 p.m.

Using the National Institutes of Health (NIH) Stroke Scale, a tool used to determine the degree of impairment caused by a stroke, the team found that Rocco had a score of 21 鈥� a severe stroke. They agreed he had had an ischemic stroke and did not have risk factors that would rule out using the 鈥渃lot buster鈥� drug, tPA, intravenously. After obtaining permission from Rocco鈥檚 family, physicians administered the drug just 56 minutes after Rocco鈥檚 arrival at 1:15 p.m. Over the next hour as Rocco received the medicine, he regained feeling in his arm and leg.

2:15 p.m.

After the treatment was complete at 2:15 p.m., cerebrovascular neurosurgeon , an assistant professor of , still had concerns. Rocco鈥檚 NIH score had dropped from 21 to 12, which meant his symptoms went from severe to moderate. But Rocco still couldn鈥檛 talk. Some blockage remained in his brain, and Jimenez wanted to target it with additional treatment if it was somewhere he could access. To find out, he sent Rocco for a computed tomography angiography(CTA) scan to pinpoint the exact blood vessel in his brain that was blocked.

3:15 p.m.

The scans were completed in less than an hour. Jimenez examined the results with Sandhu and found the clot in the middle of Rocco鈥檚 cerebral artery. The doctors agreed the spot might be accessible using the endovascular method, which involves a tiny tool inserted through a blood vessel rather than traditional surgery.

4:13 p.m.

With the family鈥檚 blessing, Rocco was prepped for the procedure and Jimenez went to work at 4:13 p.m. He used a delicate wire-like device called a stent retriever to deliver tPA directly to the clot and then manually remove some of the blockage. The wire was inserted through Rocco鈥檚 femoral artery in his leg, and then it was pushed through his blood vessels to the spot in his brain where the clot was. Once the wire reached the clot, Jimenez maneuvered the wire to release the drug, and then he made a mesh-like stent bloom out of the end of the wire. The stent attached itself to the clot, and Jimenez was able to remove it from Rocco鈥檚 brain.

When minutes mattered, 萝莉社 had come through in record time.

鈥淩occo received all of this treatment in less than four hours from the time he arrived. That is a phenomenal timeline,鈥� said stroke program coordinator Diane Falk. 鈥淲ith an NIH score that high, there鈥檚 very little chance a person would have been able to walk out the door on his own without this treatment.鈥�

Rocco did walk out on his own. He was home just five days after his stroke with full use of his arms and legs. He had a long road ahead with his speaking ability, but his brain was as sharp as ever. So were his muscles. Even as he began therapy at Brooks Rehabilitation, he found projects at home to keep himself busy. Less than a week after his stroke, he installed dimmer lights in his condominium. Later, he designed custom-made hooks to hold up a heavy mirror his wife wanted to hang.

A year later

Today, despite his limitations in speaking, Rocco continues to work on his legal cases. His son, Michael Marrese, who is also a lawyer for Morgan & Morgan, sometimes speaks for him when he presents his cases.

Rocco continues to make progress in his speech with the help of Janet Whiteside, PhD, at the University of Central Florida Communication Disorders Clinic in Orlando.

鈥淗e works with different therapists to get his speaking back and get the words in order. He鈥檚 made huge progress, but it鈥檚 a long process,鈥� his wife said. 鈥淪trokes are like fingerprints 鈥� they鈥檙e different for everyone. In a way, you become your own experiment.鈥�

Communicating through writing and a few spoken sentences at a time, Rocco said his goal is to continue speech therapy until he fully regains his speech. He and his wife are confident he eventually will.

The couple said they are grateful for 萝莉社鈥檚 .

鈥淲e received great treatment from very professional, hard-working people,鈥� Mary Ann said. 鈥淲e are amazed how far Rocco has come since we arrived at 萝莉社 that day.鈥�