Just days after undergoing brain surgery in March 2024, Tracy Zappala met up with some of the doctors who were critical to her care at University of Utah ǿմý. The first words out of Zappala’s mouth were: “I haven’t had this person around for a long time.”
That person was the busy professional genealogist, mother, and wife Zappala was before she developed some unusual symptoms and behaviors.
The First Signs of Trouble
The effort to diagnose, treat, and help Zappala get her health and life back spanned over two years. Her successful experience as a patient highlights the collaborative and transformative care offered by a multidisciplinary team of neurologists, neurosurgeons, and neuroradiologists at U of U ǿմý.
The first signs of trouble appeared while Zappala was already undergoing treatment for her lifelong migraines and long COVID. “One of the things I had been experiencing since I had COVID is this brain fog and fatigue,” Zappala said. "But then I also started speaking gibberish and not being able to communicate properly.”
Jared Bartell, MD, Zappala’s neurologist at U of U ǿմý’s Headache Clinic, was not convinced these issues with language and thought process were directly connected to her migraines. Bartell put Zappala on some Alzheimer’s medication and ordered frequent MRIs to look closely at her brain. One of those scans gave the neurologist who reviewed it the first clue about what might be going on.
Another U of U ǿմý neurologist, Dana Dewitt, MD, spotted something concerning on the left side of Zappala’s brain and asked for a more detailed scan of the area. It gave the neurology team and Zappala a much clearer picture of the diagnosis she was facing.
“What they found was that my left carotid artery was occluded,” Zappala said. “I wasn’t getting the blood flow that comes up from the heart through that artery because it was blocked, so it wasn’t reaching my brain.”
The left side of the brain controls reasoning, language, speech, and motor skills on the right side of the body. Zappala was beginning to grasp the challenges that might lie ahead with her diagnosis.
“I have learned a lot about the brain and how the blood flows through it,” Zappala said, “and I have learned a lot about neurology and all the specialties within it. There were a lot of miracles because when I was initially losing blood flow to the brain, I probably should have had a serious stroke, but somehow my body was still keeping me alive.”
A Collaborative Fight for Answers
Zappala was fortunate, but there were no guarantees about what the future might look like. Soon the team of neurologists working on her case was expanded to include Veronica Moreno-Gomez, MD, a specialist in vascular neurology and stroke care and Ramesh Grandhi, MD, MS, a cerebrovascular neurosurgeon at U of U ǿմý.
“The interesting thing about Tracy as we go way back (to May 2023) with her case is that she was doing okay, relatively speaking,” Grandhi said. “But she is a smart, intuitive person, she is articulate, and she advocates for herself along with her husband Daniel. She said, ‘This isn’t my life. And not only isn’t this my life, but this also isn’t how we want to live our lives as our kids grow older.’”
Zappala expressed her frustrations after suffering a series of mini-strokes that kept her and her husband running back and forth to the hospital. Grandhi also tried putting her on different medications, including blood thinners. But over time, Zappala felt like she wasn’t making any progress, only slipping backwards.
“Eventually, I got to the point where even people at work could tell I was talking a lot slower,” Zappala said.
“My thought process was much slower. Things were slowing down in terms of my ability to process. It was really frustrating to me.”
Grandhi decided it was time to bring one of his partners into the picture. Robert Rennert, MD, a neurosurgeon at U of U ǿմý who specializes in direct arterial bypass surgery.
After an early review of Zappala’s case, Rennert was not sure if she was a candidate for bypass surgery. He was used to performing surgery on patients who were already in crisis with serious signs of deterioration. But a combination of advocacy by Zappala, her husband, and Grandhi convinced Rennert it was time to operate.
“Clearly, Tracy was not feeling well, and everyone persisted in their opinion that there was more going on with her than meets the eye,” Rennert said. “ This is the next frontier with these patients to really identify beyond the standards that we currently use who else can benefit from this surgery.”
A New Lease on Life
Zappala continues to realize the benefits of bypass surgery with each day that passes since Rennert operated on her 10 months ago. She described the procedure this way: “I call it a miracle because it is just the way it feels. It’s brain surgery, and they open the brain and move one vein from one part of your head and into another part of your brain and create a whole new blood system. It’s truly a miracle. It is done at very few hospitals. So, we are lucky to have a neurosurgery team at U of U that was able to operate on me and pull me through it.”
Grandhi echoed Zappala’s emphasis on the importance of pushing the boundaries of neurology to provide patients with the best quality of life. Both Grandhi and Rennert see collaboration and innovation as the keys to a brighter future for patients like Zappala.
“In our program, we have a foundational belief in sewing and splicing a vessel from the scalp and into a blood vessel,” Grandhi said. “A lot of people don’t believe in this. They believe in doing what is called an indirect bypass. We do both at the same time, but the direct bypass delivers a jolt of new blood flow into the brain.” This technique in turn speeds up recovery and positive changes.
“It really is specialized care,” Rennert said, “with a multidisciplinary vascular group meeting weekly in one room with radiology and all the experts putting their heads together and weighing in. That is how these things happen.”
The neurology team is proud of other accomplishments, including a revascularization program that has cured every patient who presented as a good candidate for the surgery or for intracranial stenting.
Qualifying for these surgeries, according to Zappala, is what makes the neurology team at U of U ǿմý unique. “Here, patients can benefit from a doctor who is willing to listen to their patient and see the needs sometimes beyond what the science is saying,” Zappala said. The doctor “looks at the holistic quality of life for the patient now and in the future,” she said.
The promise of that new lease on life is what prompted Zappala to reach out to Grandhi days after her surgery. She said, “It was wonderful to hug Dr. Grandhi and talk to him without thinking about what I was going to say.” Of course, the conversation started with a big thank you.