A SNEEZE AND A HEADACHE.
For years, Maryland physical therapist Almira Tagala-Manuel has helped hundreds of mostly neurological patients restore physical functions and improve their mobility hence boosting their overall wellness to live better lives.
On Monday night (May 27, 2019), after what seemed to be a harmless sneeze, which was immediately followed by a severe headache, turned out to be the beginnings of a hidden medical condition presenting itself slowly.
She missed work the following day, thinking it was just one of those usual pesky headaches and that sleeping it off will make it go away.
But it never did.
On Tuesday night, she noticed that she can’t lift both her arms at the same level. As a medical professional self-diagnosing, she knew something was wrong with her weakened right arm.
She asked her husband, Macoy Manuel to bring her to the hospital, but as they were getting ready, Almira asked him to call 911 -- it seems like she already felt something bad was coming.
Just seconds after calling 911, half of Almira’s body began twitching like she was having seizures. Her body twitched non-stop until the ambulance arrived at their Columbia, MD apartment, about 15 minutes later.
The two emergency medical techs immediately made the usual initial assessments, asking her questions like if she can stand on her own... but she couldn’t. The ambulance brought her to a nearby hospital.
At the Howard County General Hospital (HCGH) triage, after a series of questions, an intake person told Macoy that Almira’s condition was “non-life threatening” so they were made to wait for 3 hours before her name was called to see a doctor.
In those 3 hours she had two episodes of twitching for 2 minutes each, the husband said.
At this point, an intake person or a doctor asked her a few questions but she was only able to answer yes or no questions. Almira seemed to have trouble answering complicated questions that requires more than yes or no answers.
This was very unusual for Almira, who has no problem expressing herself and her thoughts very well. This Mascian - UP alum can talk for minutes on any given topics.
She looked exhausted -- tired of waiting and tired of twitching. But just seconds before Almira totally blanked out, she used every bit of strength left in her to say two last words to Macoy:
“Help Me." she mumbled.
JOHNS HOPKINS HOSPITAL
A Filipino doctor named Romer Geocadin received a call from Howard County General Hospital (HCGH) . After getting Almira’s medical record, diagnosis and CT scan, he made the call to airlift Almira from the County Hospital in Columbia, MD to the Johns Hopkins Hospital in Baltimore, MD. It would have taken an ambulance at least 35 minutes to travel 24 miles from Columbia to Baltimore so an airlift was necessary to save Almira's life.
Her CT scan showed swelling and bleeding in her brain and her condition would require a neurosurgeon. She was intubated to help her breathe better.
It was early Wednesday morning around 4 AM when a Medevac chopper transferred Almira to the Johns Hopkins Hospital (JHH) – the birthplace of numerous famous medical traditions including rounds, residents and house staff. It was also the birthplace of medical specialties including neurosurgery.
After a series of lab tests and more scans, a team of neuro doctors determined Almira had a hemorrhagic stroke.
A massive blood clot, slowly built up possibly through the years, blocked the blood flow in her brain’s vein. The clot was located in a mid-sagittal vein and veins are usually able to expand to accommodate the swelling. But the the Intracranial Pressure (ICP) -- pressure in Almira’s brain was way too much for her brain to handle.
A team of neurological specialists, led by Doctor Jose Suarez, came up with a plan to remove the massive blood clot in the mid sagittal section of her brain. But it will require a procedure that has never been done before.
Initially it was just going to be thrombectomy (a type of surgery to remove blood clot from artery or vein) – but the massive solid clot needed something better. The medical team decided to use an unconventional method of using a balloon inserted through jugular vein to force the clot out. It was never been done before to remove a big blood clot in someone's brain. If successful, this will be historic.
The team of doctors needed Macoy’s consent to use this method that has a success rate of only 30% and he needed to give his answer in about 5 minutes as the clock was ticking to save Almira from the dangerous effects of pressure and clot in her brain.
Macoy consented to the procedure.
After about 6 grueling hours of procedure in the operating room, Almira was rolled back into her assigned room in the Neurosciences Critical Care Unit (NCCU) – it’s their intensive care unit.
“The procedure went as planned,”said Dr. Suarez.
Almira is now in a medically induced coma to protect her brain and her body from further swelling and pressure in her brain.
Prior to her transfer, Doctor Romer Geocadin came to visit. Dr. Romer is a friend of Doctor Ian Soriano – the famed UPenn Medicine surgeon who performed the world’s first robotic surgery for breast reconstruction. He was also a Mascian.
Dr. Geocadin told Macoy and Almira’s brother that she is in the best place to be, given her conditions – The John Hopkins Hospital is the best neuro hospital in the world according to those in the medical field.
So here’s the good news, the procedure was successful and blood is now flowing from her heart to her brain and back to her heart.
About 30% to 60% of people with intracerebral hemorrhage or bleeding in the brain dies.
Thanks to the amazing and extraordinary doctors, nurses and all the other medical staff at the Johns Hopkins Hospital.
A number of Almira’s aunts and cousins are nurses or at least work in the medical field so we know the kind of work the medical team did for Almira.
The Tagala and Manuel family are grateful and have only but respect for the wonderful work the Johns Hopkins medical team did for Almira.
A medical team at the NCCU is monitoring Almira’s condition around the clock and she is responding wonderfully to treatments and medications so far.
Don’t get it wrong, she is “still very ill” according to doctors.
Her vitals still fluctuate but at least the pressure in her brain has remained way below the danger level of 20+ mmHG. Her Intracranial Pressure (ICP) is now in the lower 5’s which is good.
Her next CT Scan and assessment by the team of doctors could mean they can finally take her out of the medically induced deep coma so they are going to able to assess her brain's condition and hopefully it was not compromised or damaged by the hemorrhagic stroke.
THE AMERICAN DREAM
Almira and Macoy came to Jersey City, New Jersey around December of 2016, just right after the US Presidential elections.
She could almost smell the American dream as a physical therapy job awaited her in Maryland where she and her husband relocated to in 2017.
As a physical therapist she has seen countless patients with neurological conditions such as ischemic stroke, hemorrhagic stoke, heart attacks etc.
She always looked forward to seeing patients with challenging health conditions that limit their ability to move and perform everyday activities.
For Almira, even the slightest improvement in each of her patient's physical function and mobility, means it is a step towards promoting their overall wellness and they are getting better.
She took on such challenge and made a big difference in making the lives of her patients better.
When Almira finally wakes up, and begins her intensive road to recovery, she will need physical, occupational and possibly speech therapy.
This time, we would like to give back to her for all the things she did for countless others.
All the funds raised here will be used for her medical expenses not covered by insurance and for her other non-medical daily expenses.
Almira’s mother, who is currently in the Philippines would also want to visit and care for her daughter during these challenging times. The funds raised could make that mother-daughter reunion happen.
Please contribute to Almira’s “Get back on her feet” fund so she could recover faster and get back on her feet so she can continue to help others as a physical therapist.
Actual needed expenses will be updated later as it is still early to determine exactly how much will be needed for her medical expenses not covered by insurance but we are expecting her non-medical expenses to be big since Almira will not be able to go back to work for weeks... if not months.
Every single cent counts.
Thanks so much and we would like to express our gratitude to all of you, in advance, for your all the love, prayers and contributions no matter how big or small it is.
Growing up, we called her "Princess," she's the only girl in the family and she came 10 years after her eldest brother Don Tagala was born.
PLEASE FEEL FREE TO POST YOUR PHOTOS WITH ALMIRA IN THE COMMENT SECTION BELOW -- She loves selfies as evidenced by her signature selfie stick she brings with her wherever she goes.