Randy Bussard, Aneurysm Coiling

Pain that felt like fire shooting up his spine sent Randy Bussard tumbling to the floor in his rural Marshall home on a Friday night in August 2004.

Fortunately, his roommate, asleep behind a closed bedroom door and wearing earplugs, heard the sound and rushed to find Bussard unable to talk or move his left arm and leg.

"I had a pretty massive stroke," Bussard said.

Bussard was rushed to a nearby hospital where, later, he was transferred by ground ambulance to Borgess Medical Center in Kalamazoo.

X-ray scans there showed that Bussard, now 45, was bleeding from two adjacent spots in a brain artery above his right eye, a condition called a ruptured aneurysm. A repair to stop the bleeding was needed and quickly.

Although the condition was extremely serious, he was fortunate that Borgess had a specialist, Dr. Firas Al-Ali, and an OR team skilled in providing for such a delicate procedure.

"During all that time I was in and out of consciousness," Bussard said. "When I was in the ambulance I knew I had to stay awake. I had a cousin who died of the same thing when he was about the same age.

"The EMT in the ambulance couldn't believe that I kept sitting up to wave to my roommate in the car behind me. I have a very strong will to live and I had to stay awake."

Just before Bussard was put to sleep for the procedure, he remembers Dr. Al-Ali telling him that "I might die on his table."

"It didn't bother me. I wanted to hear an honest assessment."

Dr. Al-Ali, of Neurosurgery of Kalamazoo, is one of the few physicians in the region who treats bleeding aneurysms with a new procedure called minimally-invasive interventional coiling treatment or, as it's also known, endovascular coiling. He has done hundreds of the procedures.

Once Bussard was anesthetized, Al-Ali inserted a thin catheter through a tiny incision in Bussard's groin and fed it through his arterial system to his brain. Guided by X-ray video images, Al-Ali put the tip of the catheter at the precise spots where the aneurysms had burst.

He then fed tiny, soft platinum wires into the aneurysms, which, on contact with the vessel wall, began to coil. Slowly and carefully, he fed in more wire until the aneurysms were filled. Once the coils were in the aneurysms, blood platelets began to stick to the coils and clots or scabs form. In time, the inner layer of the artery begins to heal, or grow over the now clotted aneurysms.

"We used a lot of coils," Al-Ali said. "The challenge is not the number of coils but how sick the patient is. He was very sick."

Al-Ali said that about half of all people who come to the hospital with a bleeding stroke do not survive. And the sicker the patient the less the chance of survival.

Twelve days after the procedure Bussard was back home in Marshall and launching his own rehabilitation. "The doctors and nurses keep using the same word about my recovery: Remarkable," he said.

His roommate, neighbors and friends rallied to help him and keep the farm and livestock healthy.

"I had to teach myself to walk and to read again," he said. "I had feeling in my leg and arm, but my brain had to tell them what to do."

A little more than two years after the procedure, Bussard has regained much of what was lost in the stroke, although he still gets wobbly on occasion and he has lost some vision. He said the doctors told him he may someday go blind. For now, his vision remains better than expected.

One factor in his favor was his good health just prior to the stroke. Born and raised on a farm, he has worked hard all his life and has a love of digging in dirt and canning and freezing his own food.

Prior to the stroke Bussard was a full-time farmer and worked at Southern Exposure Herb Farm in Bellevue, Michigan.

"I think a lot of my recovery has to do with my attitude," he said. "I have always had a pretty positive attitude."

Another thing that helps his positive outlook was the care he got at Borgess. "The doctors and the nurses at Borgess did the most phenomenal job, not just with me but with my family and friends," he said.

"When you walk into Borgess it's almost as if you feel a positive energy. It's not that you feel like everything's rosy, but that you know that everyone in that place is giving 100 percent."

Bussard has been back to Borgess for check-ups, and a recent exam by Al-Ali uncovered small weaknesses in tiny arteries near the site of the aneurysms that will require careful watching.

His stamina is not what it once was and Bussard has opted to sell his livestock and focus on a renewed career as a singer/song-writer, something he has done since his mother taught him to sing as a child. He accompanies himself on the piano when he sings.

"I am limited to lifting no more than eight pounds," he said. "I do have some physical problems, but they have nothing to do with the care I got at Borgess."

"We don't win every time and when we don't we feel sad and bad," Al-Ali said. "But this case was very rewarding for me and the team. It's rewarding when you can save someone who is Randy’s age because that person often can do very well. Now he is composing and singing and recording music."

Karen Fulton, Administrative Director of operations for neuro services and inpatient therapy, said that time is always a critical factor in the survival of the stroke patient and that people should seek medical care immediately if they have symptoms.

Symptoms include:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body;
  • sudden confusion, trouble speaking or understanding;
  • sudden trouble seeing in one or both eyes;
  • sudden trouble walking, dizziness, loss of balance or coordination;
  • sudden, severe headache with no known cause

"We can have absolutely the best outcomes if the patient gets here quickly," Fulton said. "People are often reluctant to come in because they might feel silly if nothing is wrong. But we'd rather they come in even if nothing is wrong than not come in."

"We at Borgess offer services you can't get at many other places."

Bussard said that Dr. Al-Ali declined to accept a compliment from him that the physician saved his life. "Dr. Al-Ali is a talker and I can't get the compliment in!" he said.

Instead, Bussard wrote, sang and recorded a nine-track music CD that he gave to Dr. Al-Ali and others at Borgess.

"The title song is called 'Second Chances' and was written for Dr. Al-Ali," Bussard said. "He played it during my last angiogram and when the title song was over he had them play it again."