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OMC Neurologist Dr. Clara Applegate Making a Difference for 25 Years

OMC Neurologist Dr. Clara Applegate Making a Difference for 25 Years

Dr. Clara Applegate, Neurologist at Ozarks Medical Center (OMC) Neurosciences Center has been making a difference in the treatment and prevention of stroke in our region for most of her 25-year career at Ozarks Medical Center Neurosciences Center in West Plains. Dr. Applegate arrived in West Plains in February 1991.

In 1996, the U.S. Food and Drug Administration (FDA) approved Tissue Plasminogen Activator (tPA) for acute ischemic stroke. At the time when most practitioners were first being exposed to the literature concerning tPA, Dr. Applegate began the Stroke Team at OMC. She saw the benefits of tPA and began a 20-year mission to educate the community that stopping a stroke in time can make all the difference in someone’s life.

Dr. Applegate remembers getting out of bed in the middle of the night to go the hospital to care for patients, many times bringing her young daughter with her. Although living in a home on the river is the dream life for Dr. Applegate, she moved into a home in West Plains so she could be available more quickly to take care of her patients. “Being a physician is a sacrifice, but it has its rewards too. When my patient’s seizures are better, their headaches are under control, they can get out of bed to be with their families, then you know you have made a difference in their lives.”

During her 25 year career at OMC, Dr. Applegate has seen a major shift in stroke care and treatment. “Stroke is not as devastating as it used to be,” says Dr. Applegate. “We are learning more about the importance of lifestyle. Day-to-day choices have an impact on our health, and advent of new drug treatments has also made an impact on the outcome of acute stroke.”

Her mission to improve lives continues today for Dr. Applegate. Her passion for the cause is evident to anyone who has the chance to visit with her. “I’ve spent the last 19 years trying to change the perception of stroke. It is essential that at the first signs of stroke, people need to come in to the hospital and be evaluated. Even if it turns out to not be a stroke, it is important that they be seen.”

Under Dr. Applegate’s leadership, OMC earned the designation of Level Two Stroke Center by the Missouri Department of Health and Senior Services. This reflects the organization’s commitment to stroke education, rapid treatment and quality outcomes. Applegate and her partner, Dr. Vikas Kumar, also participated in the stroke certification process at other centers, allowing hospitals across Missouri to share techniques and learn from each other. There are four levels of center designation. OMC’s Level Two is the second highest level. Level One designation requires research and endovascular stroke treatment. OMC provides stroke care from prevention to rehabilitation and community education.

Dr. Applegate enjoys her life as a physician in the Ozarks and her 25 year career at OMC. “I feel comfortable in this community. I respect my colleagues and have been privileged to work with many great physicians and nurses in my years here. We share a common attitude desire to adopt best practices here. We have gone from no neurological care in this region to now working to help people to understand what IS available, a journey I am happy to be a part of.”

Dr. Applegate says there are many stories of successful treatment but the one that she remembers the most was in 1999. Bernadette Olson, a young Nebraska woman, was vacationing on Bull Shoals Lake with her friend. She collapsed while out on the boat. They were able to rush back to the dock and she was taken by ambulance to OMC’s Gainesville Medical Clinic. She was transported by Air Evac to OMC in West Plains within the three-hour window of administering tPA. Upon landing at OMC, she was met by the Stroke Team in the emergency department and immediately given a CAT scan. After reading the scan, Dr. Applegate administered the shot of tPA.

“The tPA was, literally, a life-saver for me,” Olson explained. “Within a few hours of treatment, I was able to lift my arm. Dr. Applegate, who is a very sharp doctor, explained everything that happened to me and what I was to expect in the future.”

“She said that I would have to attend speech therapy classes when I returned to Nebraska and that I should be talking normally within a year. The next four days were spent in OMC where I kept getting stronger.”

When she returned home, Olson said she began the healing process. She attended daily speech classes and had to learn to speak all over again. Her short-term memory improved as time passed and each day she learned a new word. One month after her stroke, she was able to drive her car.

“When someone is suffering from a stroke, time and expertise are critically important from the first second.” said Dr. Applegate. “We are extremely proud of our comprehensive stroke program and the team of professionals who respond quickly and efficiently to stroke, 24 hours a day, seven days a week.”

OMC’s multidisciplinary stroke team is made up of nurses, physicians, neurologists, ambulance services, therapists and Emergency Department workers who respond to stroke. According to Dr. Applegate, the first step is that people need to be aware and call 911. All of the EMS systems (ground and air ambulances) recognize that stroke is an emergency and that every minute counts, so as soon as the 911 call comes in, EMS notifies the stroke team at OMC to be on alert. When the patient arrives at the hospital the stroke is confirmed by the doctors and CT scan is done right away. CT scan of the head must be done right away to avoid giving clot buster to someone with a hemorrhage or another problem. The “clot busting drug,” tPA, may be given right away if the diagnosis is confirmed, blood pressure is controlled and there are no contra-indications.

The national standard is to administer the tPA within 60 minutes of arrival at the hospital. OMC’s average for 2015 was 43 minutes.

“We are very proud that OMC’s response time beats the national standard. “Having a trained stroke response team ready to act allows us to rapidly identify and assess a patient’s condition. It is not always possible to prevent a stroke, but with timely, evidence-based care, we can minimize the complications of stroke.”

Dr. Applegate said it is critical for those who may be experiencing a stroke to act fast and call 911. “Even if you are close to the hospital, it is important to call 911,” she said. “The technicians can begin evaluation in the ambulance and can notify the Emergency Department to put the OMC Stroke Team on alert.

The clot buster, tPA must be given within a 3 hours from the start of stroke symptoms. The American Heart Association reports that unfortunately, only 4 percent of stroke patients nationwide receive the recommended treatment in the key hours after stroke.

“OMC has worked diligently over the past 19 years to educate the community on the importance of fast action. Currently, we are able to treat many ischemic strokes with tPA at Ozarks Medical Center. We attempt to treat 100% of strokes that are eligible for the treatment. Too often, people wait to see if they'll get better. If they wait too long, we cannot administer tPA,” according to Dr. Applegate “We have been providing 24/7 stroke care since 1997 and with each year, we do a little better, as more people recognize that stroke is an emergency."

Major signs of stroke are easy to remember using the acronym FAST (face, arm, speech, time): Face drooping, Arm weakness, Speech difficulty and Time to call 911.

For more information on stroke or Target Stroke, contact the OMC Neurosciences Center at 417-257-6777.

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