DGMC treats teen stroke patient with hyperbaric oxygen therapy Published Dec. 20, 2018 By Merrie Schillter-Lowe 60th Air Mobility Wing Public Afffairs TRAVIS AIR FORCE BASE, Calif. – Samantha Pipkin has three goals for 2019: wear high heels to her senior prom, get a driver’s license and shake hands with the principal when she receives her diploma from Paradise High School, Paradise, California. Normally, these actions would be easy for a teenager but they are a reach for Sam, who suffered a stroke Feb. 2, 2017, a month after celebrating her 16th birthday. After 18 months of physical therapy, Sam is now undergoing hyperbaric oxygen treatment at the David Grant USAF Medical Center at Travis Air Force Base. “Sam had a ruptured arteriovenous malformation in the brain that triggered a hemorrhagic stroke,” said Lt. Col. (Dr.) Jason Kelly, 60th Medical Group Hyperbaric Medicine Flight commander. “It could have been something she was born with.” AVM is an abnormal tangle of blood vessels connecting arteries and veins. Arteries carry oxygen-rich blood from the heart to the brain, while veins carry oxygen-depleted blood back to the heart and lungs. When an AVM disrupts the process, the surrounding tissues may not get enough oxygen so the affected arteries and veins can weaken and rupture, resulting in bleeding in the brain, stroke or brain damage. “We started treating Sam with hyperbaric oxygen Oct. 27 with pretty impressive improvement,” said Kelly. HBOT involves breathing pure oxygen in a pressurized room, tube or chamber. It is used for decompression sickness, serious infections and wounds that won’t heal as a result of diabetes or radiation injury. With HBOT, the air pressure is typically increased to two to three times higher than normal. Several research studies show that HBOT may be effective with some forms of stroke, said Kelly. He cited a 2013 study by Dr. Shai Efrati at Tel-Aviv University in Israel that showed HBOT can induce significant neurological improvement in patients who suffered an ischemic stroke – caused by a blocked artery – or hemorrhagic stroke anywhere from three to 36 months prior. Although HBOT studies involving stroke patients show mixed reviews, Kelly has treated five srtoke patients with HBOT – with varying degrees of improvement – since his arrival at Travis in 2017. “Hyperbaric oxygen therapy is not an approved indication for stroke,” said Kelly. “In the civilian world, I don’t know of any insurance company that would cover it.” Fortunately, Sam’s father, Patrick, is a retired U.S. Army sergeant. Since she’s been in treatment, Sam has regained partial use of her right hand, with limited movement in her thumb, and can walk without a leg brace. After the first treatment, she could tie the draw strings on the scrubs patients wear during treatment. By the fifth session, Sam reported tripping less when walking without the brace. After several more treatments, she can put her hair up in a bun and open a car door. “She can lift her wrist, her right foot and toes,” said Patrick. “She couldn’t do that in physical therapy.” Now, more than two-thirds of the way through the 40 scheduled treatments, Sam can walk her dog, Daisey, on a leash and walk up and down stairs. Recently, she steered an arcade driving simulator with both hands and placed her right foot on the gas pedal. Not getting a driver’s license was one of Sam’s first concerns following the stroke. “She had an appointment March 4, 2017, to get behind the wheel,” said Patrick. “She had already completed driver’s training. Now, we have to revisit that.” Sam was researching treatments that had helped other stroke patients when she came across stem cells and HBOT. A University of California, Davis, Medical Center physician told Sam it would be five to six years before they see anything positive with stem cell treatment. “She had given up on the idea of hyperbaric treatment because no one in the north had a chamber and TRICARE wouldn’t cover the cost of therapy,” said Patrick. HBOT costs range from $300 to $3,000 per session, said Kelly. It was fate that put the family in touch with Kelly. Sam’s sister, Tiffany, is majoring in exercise physiology at California State University in Chico, California. “She always wanted to learn to scuba dive but, because of her pacemaker, she couldn’t find a doctor to sign the waiver,” said Patrick. “I’m not sure how she found Dr. Kelly, but she called Travis and he answered the phone. He made some phones calls, called her back and told her to come in.” With a referral from her primary doctor, Tiffany made an appointment with Kelly. Sam accompanied Tiffany and their dad Travis. “I think she had already been researching HBOT, but I bit and asked about her brace,” said Kelly. “I asked if she had considered hyperbaric medicine.” Sam’s face lit up, said Patrick. Once she has completed the scheduled treatments, Kelly will perform another brain scan to determine if there has been any improvement in blood flow. “If there is improvement, we’ll do a full neurological exam and make a decision whether to continue,” said Kelly. “My goal is to treat until clinical plateau.” Currently, Sam is making daily progress, although some gains are small. “Every day she reports being able to do a new activity,” said Kelly. “She’s already able to shake hands.” The stroke Samantha’s story began with the headache she experienced in her first-period class at Paradise High School Feb. 1, 2017. “It was the worst headache I’ve ever had,” said Sam. “It was all around my temples like I was wearing a tight headband.” Initially, she thought she had a migraine, which she occasionally suffers, allergies or a sinus infection. Her best friend since third grade, Valarie, encouraged her to go home. “I told her she didn’t look well,” said Valarie, who accompanied Sam to one of her treatment sessions. “But she said she wanted to get though second period and then leave.” About 10 minutes after the second-period Spanish class began, Sam’s vision became blurry. “I couldn’t focus on anything so I asked my teacher if I could go outside to clear my head,” said Sam. “I tried to read the fire sign for like 10 minutes, but I couldn’t.” Sam went back to class and told her teacher about the headaches and that she temporarily lost her vision. She sent Sam to the front office where a staff member called Sam’s dad. “When I picked her up, she seemed fine,” said Patrick. “I think it was Valarie who told me she had lost her vision.” When he queried Sam about her temporary blindness, she said, “Yeah, it was weird but it came back.’’ Sam’s father asked if she wanted to go to hospital, but she said no. She just wanted to go home and take a nap. The following morning, Sam stayed home from school because of the headache. That night, she felt that a water balloon had burst inside her head. “When my parents came home from grocery shopping, I went out to help,” she said. “I picked up a case of (soda) and put it down behind the door. As I was standing up, I felt a pop.” Sam lost her balance and fell against the door. Then she began laughing uncontrollably and spinning in circles. Daisey started barking at her. “My dad thought I was playing with the dog, but I wasn’t,” said Sam. “I tried to tell my dad that I couldn’t (keep) my balance.” Sam stumbled down the hallway and, finally, stopped laughing and stood up on her own. “I told my dad that I was alright. He said, ‘No you’re not. You’re standing on your ankle.’“ Sam leaned against the wall and Patrick ran to grab her. “I had her sister grab a chair,” said Patrick. As Sam sat there, her mom, Stacey – a pediatric nurse – began listing possible causes for Sam’s behavior. “My mom and dad sat in front of me asking if I needed them to call an ambulance,” said Sam. “All I could say was, ‘No.’ I started hitting the trash can that was right near the chair to tell them that I didn’t mean no, but that’s all I could say.” “She wasn’t just saying no, she was rapidly beating the can and repeating no, no, no, no,” said Patrick. By the time the ambulance arrived, Sam had again lost her vision. She was transported to the emergency room at Feather River Hospital in Paradise where the family resides. Fortunately, Dr. Kurt Bowers, who had treated Tiffany for a heart condition five years previously, was the emergency physician on call. “When he came in, he brought the chaplain,” said Patrick. “That’s when our hearts sank. At the same time I was thinking, ‘No, you never bring the chaplain.’” After reviewing Sam’s CT scan, Bowers told the family that she had a bleed in her brain. “He didn’t use the word stroke,” said Patrick. Bowers telephoned several university medical centers and finally arranged for Sam to be transferred to the UC Davis, which was fortunate because high winds prevented using Life Flight. “Dr. Bowers showed me the area on the CT scan. It was about the size of a nickel,” said Patrick. “He said it was really deep and that was not good.” Sam was taken to UC Davis by ambulance early Friday morning; however, the surgery to remove the AVM was delayed until Wednesday to allow the brain “a cooling period,” said Patrick. Sam was in the hospital six weeks. She started speech therapy the week following surgery and physical therapy four weeks later. “Her speech was the first thing to come back,” said Patrick. “They would show her cue cards and play word association. She struggled at first but after three weeks, the speech therapist said we didn’t need her anymore so we started doing speech therapy at home.” Regaining her physical strength took longer. “She couldn’t stand at first so they put her in a (walking) harness,” said Patrick. “I remember when she took her first step. That was awesome!” Sam’s 18th day of HBOT was the same day that the Camp Fire broke out in Butte County, California, burning almost 240 square-miles and leaving thousands of families homeless. Fortunately, Sam and Patrick were living in the Fisher House at Travis since she has therapy five days a week. Patrick’s two older daughters were home and able to gather some of the family’s belongings before the mandatory evacuation. They drove with their three dogs and two cats to Chico where Stacey works at Northern Valley Indian Health. Before the stroke, Sam was enrolled in honors classes and played the flute in the high school band. She had returned to school for several months in her junior year, but was having second thoughts about going back, fearing people would laugh if she fell down. Unfortunately, most of Paradise burned in the fire. Although Sam’s school is still standing, 90 percent of the students and staff loss their home. Students are now enrolled in independent study and meet weekly at the Chico Mall. Although their house survived the fire, it suffered significant smoke damage, said Patrick. Because they have pets, Stacey and the older daughters live in a hotel in Sacramento, California, and Sam and Patrick visit on the weekends. Because of their circumstances, they will soon move into housing at Beale AFB, California. Despite such dire conditions, the family gets through the roughest days with humor. “We joke about it, keep everything light,” said Patrick. When Sam no longer showed improvement in physical therapy, Patrick said she would lament the fact that she would never get her driver’s license or go to the senior prom. “We talk about those things, give a little cry, then go back to joking,” said Patrick.