From ‘word salad’ to complete recovery: A young stroke survivor’s story of coordinated care
When Nick Vance woke up one morning in November 2024, it felt like every other day.
The 37-year-old took a shower and started getting ready for work. He walked out to his living room and addressed the voice-based virtual assistant connected to many of his household devices by saying, “Alexa, turn the lights on please.”
But what came out was, as he calls it, “word salad.”
Vance thought it was odd but tried again.
“When I still couldn’t understand the noises coming out of my own mouth, I panicked,” he says.
Vance lives alone, so he called his mom and barely got out, “Help me. Help me. Can’t talk.”
His parents live nearby and raced to Vance’s house, not knowing what was wrong or what they would find. They quickly got him in the car and took him to the emergency department at UI Health Care’s downtown campus, where he was seen immediately.
Vance was still stumbling over words, but he was beginning to regain some of his speech. He described what had happened. Though unusual to see a young, healthy man present with these symptoms, providers at the downtown campus quickly identified stroke as a possibility and began the standard care and testing. First in the emergency department, then as an inpatient, they conducted a series of tests on both the brain and the heart.
Tests on brain, heart provide answers
Ultimately, an MRI revealed that Vance had experienced an ischemic stroke in the part of his brain where speech is formed. Ischemic strokes are the most common type of stroke and occur when blood flow to part of the brain is blocked, usually by a blood clot.
So, now they knew what was causing the speech problems; but they did not know why Vance had the stroke in the first place. As a young, healthy man, he was not a typical candidate for a stroke, which is more common in older adults and those with risk factors like high blood pressure, heart disease, high cholesterol, or obesity.
After three days of tests at the downtown campus, it was discovered that Vance had what is called a patent foramen ovale (PFO) in his heart.
The foramen ovale is a small flap between the two upper chambers of the heart. This flap is present in every fetus and should close naturally after a baby is born. However, in 20 to 25% of people, the flap never closes completely (in medical terms, “patent” means “open”). PFOs are relatively common and often go undetected.
In Vance’s case, however, a clot travelled from the right atrium to the left atrium and into the bloodstream, ultimately reaching his brain and causing the stroke.
Vance says he wishes he could remember the names of everyone at the downtown campus who first helped him when he arrived at the emergency department.
“The very first person I encountered made me feel so relaxed and that I would be taken care of. I stopped panicking,” he says. “And the nurses were so great—always checking on me to see if I needed anything and responding whenever I hit the call light. Everyone I encountered during my stay at the downtown campus made me feel at home.”
Vance was discharged with a few short-term prescriptions and recommendations for lifestyle modifications as well as follow-up appointments with the cardiology, neurology, and hematology units on the university campus.
Coordinated care leads to positive experience
It was a seamless handoff between the two UI Health Care locations, thanks to the care coordination that has been established in the past year, coupled with the use of an integrated electronic health record system used by both campuses.
Vance’s interventional cardiologist at the university campus, Jason Allen, MD, met with Vance to discuss the PFO closure procedure.
“I could see everything the downtown campus had done—the emergency department notes, all of his test results, his ultrasounds, his echocardiogram, and all of his scans,” Allen says. “Using [the same electronic health record system] across all locations means we have a complete view of the patient’s history at our fingertips, with no need to request records.”
Allen explained to Vance, in detail, what the hourlong outpatient procedure for PFO closure would entail: Patients are given mild sedatives to relieve anxiety and reduce pain but remain conscious and alert throughout the procedure. Veins in both legs are accessed, one side is for the device that closes the PFO, and the other is used for a small ultrasound camera that travels to the heart, which allows the cardiologist to use real-time imaging to help guide the placement and installation of the device. Following the procedure, a “bubble test” is performed during an echocardiogram to ensure the flap has been closed.
After hearing the procedure explained, it was an easy decision. And even though it was still scary, I knew I was in good hands,” Vance says.
The PFO closure procedure went well, and the bubble test confirmed the hole was closed, essentially eliminating the risk of a similar stroke happening in the future.
At every step along the way, Vance felt like he was given all his options, risk factors, and any downsides to going a certain route.
“I’m kind of an anxious person,” Vance says. “But every time I talk with any of the nurses or doctors, I feel my anxiety go back down. Over and over, they have made me feel like everything is going to be okay.”
Vance went back for one more bubble test about a month after the procedure to ensure the PFO had closed and healed properly. Everything looked good, and he is done with his treatment beyond taking a daily baby aspirin to prevent future blood clots.
Now fully healed, Vance is back to his normal everyday life and the outlook is good—for Vance, the risk that anything like this will happen again is very low.
Vance is optimistic and grateful for the care he received.
“Knowing what I wanted to say but not being able to actually say it was so scary,” Vance says. “But I knew I was in good hands.”
Patient Stories
