‘The Sooner, the Better’: Neurosurgeon helps stroke patients with quicker treatment

Prior to the arrival of Dr. Gary B. Rajah in June, patients needing treatment for certain kinds of strokes were flown to Grand Rapids, which meant their chances of successful recovery fell.

Now, patients can stay local and receive treatment for ischemic strokes, where the supply of blood to the brain is interrupted, typically because of arterial blood clots that shut off the flow of oxygen-rich blood.

Rajah’s breakthrough specialty is removing the clot through a surgical procedure known as a thrombectomy, which had not been done at Munson Healthcare hospitals prior to his arrival. A small catheter is inserted through a vein on the wrist or leg. A snare is deployed and routed to the location of the clot to capture and remove it.

The only other way to treat a large vessel clot is through a tissue plasminogen activator (tPa) treatment, which is an intravenous medicine that can dissolve the stroke-causing clot, but is only 10% effective, said Rajah, who is a cerebrovascular/endovascular neurosurgeon and director of the endovascular stroke program at Munson Medical Center.

Rajah said performing a thrombectomy procedure within an hour of symptom onset can achieve what he calls “remarkable” results.

“It’s a time-sensitive specialty,” said Rajah, who estimates his program could perform up to 100 thrombectomies a year. “Every half hour (before treatment), there’s 8% less chance you’ll do well. The sooner, the better.”

Prior to his arrival, patients needing such treatment were typically flown to Grand Rapids, causing treatment delay and potential financial stress and separation from family.

If the correct decisions are made and treatments are done quickly, Rajah said, “(y)ou can have amazing outcomes. That’s the rewarding part.”

It’s not been without hiccups, as the onset of the novel coronavirus nearly brought the development of the nascent program to a halt.

“(COVID-19) slowed things down,” Rajah said.

He arrived in June, but due to the hospital hiring freeze wasn’t able to set things up the way it was intended. Instead, he was able to do lectures with staff, train the teams and prepare for when things could get fully underway.

The pandemic also complicated things for potential patients. Rajah said many people were afraid of contracting the virus and were thus reluctant to go to a hospital for any reason, even when suffering symptoms of a heart attack or stroke.

In fact, that’s when going to a hospital is of paramount importance, he said.

“The benefits far outweigh the risks,” he said. “If you’re having a stroke or heart attack, it’s safe” to go to a hospital.

Another deleterious side effect of the coronavirus: Younger people who contract COVID-19 are more likely to suffer a stroke than they would be otherwise.

Rajah knows the value of good health. He is a longtime runner and participated in competitive running in high school and college, as well as an adult.

The old saw about an ounce of prevention being worth a pound of cure is more than just a cliché to him. Preventing a stroke is always better than treating one. He said taking care of your body will help prevent strokes and other health complications.

“Be active. Get your heart rate up every day, even with a brisk walk,” he said. “A healthy diet, with fruits and nuts, no fast food. And blood pressure control – work with your family doctor.”

That’s in addition to things like not smoking and controlling one’s intake of alcohol.

“People have to do what they can to lower their risk,” he said, noting that everyone is unique and has different genetic tendencies.

Rajah is confident the specialty could grow at Munson. He said the health center’s configuration, with outlying hospitals connected to Munson in a spoke and hub model, its partnership with the University of Michigan, and the burgeoning field of telehealth all portend expansion, including possibly another neurosurgeon joining him.

Inspiration to become a neurosurgeon began young. Growing up in rural Trufant outside Lakeview, Rajah was often at his grandfather’s farm. He enjoyed spending time there, but not necessarily the work.

“I grew up baling hay,” he said. “I knew that was one thing I didn’t want to do.”

Instead, he found he enjoyed the finer points of science.

“Science, that was what I was good at. I enjoyed memorizing facts and diagrams,” he said. “That’s what science was.”

Following undergrad work at Grand Valley State University, he did graduate work at Wayne State University of Medicine and received additional training at Gates Vascular Institute at Kaleida Health in Buffalo, New York.

Rajah, whose hometown is 35 miles south of Big Rapids, had been speaking with Munson about potentially starting a thrombectomy program in northern Michigan.

“I started talking with Munson and it sort of fit,” he said. “They were looking to develop (a program), and here we are four months later.”