Dave Thomas, with his wife, Suzanne, and daughter, Megan, says his first goal after having a stroke was to come home.
On the evening of Jan. 24, 2008, Dave Thomas thought he was experiencing another in a series of bad headaches. He was wrong.
He suffered a massive stroke after blood flow in his brain was interrupted. At about 10 p.m., he yelled from the bathroom of his western Henrico County home for someone to dial 911 for an ambulance. Doctors warned his family that survival was uncertain.
The former Food Lion manager, not yet 40, lay in a hospital bed for two months, unable to talk or even nod, swallow or chew food. The medical complications were many: sepsis, urinary tract infections, blood clots in both legs requiring stents, aspiration into his lungs, a blood transfusion, kidney damage. A couple more months at Sheltering Arms Hospital in Hanover County followed, as did nearly a year of daylong therapy at the Sheltering Arms physical rehabilitation center in Bon Air.
During the first hospitalization, doctors told his wife, Suzanne, that he might remain bedridden. "I went out looking at nursing homes."
That was not a prospect Thomas wanted.
"My first goal was to come home," he says from the comfort of a recliner in the den of his western Henrico County home, where he uses his strong right hand to arrange his left on the arm of the chair. "The second was to walk my daughter down the aisle."
While death rates from stroke are declining, it remains the No. 3 killer of Americans, behind heart attacks and cancer. Stroke survivors often face daunting challenges. More than two-thirds of them have some impairment, making stroke the leading cause of long-term disability in adults, according to the National Stroke Association. Two million brain cells die every minute during stroke, the association notes. The resulting impairment in speech, movement or memory depends on where the blockage or brain bleed occurs.
Immediately after his stroke, Thomas, always a big talker, could only communicate by blinking. Then he learned how to nod and shake his head. After seven months, he was able to speak again.
" ‘I love you' were the only words I could say for three or four months," he says. When he accomplished that, he told his therapists he wanted them to call his wife so he could tell her.
And when his daughter, Megan, married Kyle Moore in March, her father was by her side. "I walked with a cane real slow, but I got there," he says.
Loss of Movement
On Sept. 30, 2009, Deean Johnson, a mortgage loan officer, took two over-the-counter pain relievers and lay down for a nap to get relief from the worst headache she'd ever had. When she awoke two hours later, her speech was slurred and her right side was numb. She figured she was still groggy, and she attributed the numbness to a recent shoulder surgery after an automobile accident.
When she got out of bed the next morning, she fell to the floor. Her right side was unresponsive. Her husband, Robert "Scott" Johnson, who that week had come home after hip-replacement surgery, called 911.
At Memorial Regional Medical Center, doctors told the Mechanicsville mother of four that she had suffered a stroke in her brain stem.
After four days in the hospital, Johnson was transferred to the adjoining Sheltering Arms Hospital. Daily rehabilitation started immediately and continued for most of a month. She worked on walking, arm and hand strength, and her speaking ability, as well as daily living activities, such as dressing herself. In the large hospital gym, therapists helped Johnson regain mobility through technology such as the LiteGate 1, which lifts and safely suspends a patient above a treadmill, allowing for earlier gait therapy and permitting therapists to focus on the patient's walking ability instead of supporting his or her weight.
For the next five months, Johnson continued therapy as an outpatient, undergoing 90 minutes of physical and occupational rehabilitation therapy a couple days a week. Bioness devices, which provide electrical stimulation that re-educates the nerves, opened and closed her hand or manipulated her right foot. Johnson, now 48, progressed from using a quad cane to a single-point cane to no cane.
"I walk with the help of a leg brace now, and have limited use of my right hand. I can open it, close it and hold light things, like paper or other things up against my body," she says. "I can lift my hand to my mouth with small food, like crackers. But I cannot hold a cup. I don't have the grasping strength."
Johnson says rehabilitation specialists have told her it's not unusual to reach a plateau, so she's hopeful additional exercise eventually will restore a greater range of motion. At home, she rides a floor bike three or four times a day.
But the right-hander remains challenged by the lack of strength in her hand, which restricts her from using a computer and does not permit her to hold a pen. She qualifies for Social Security disability benefits.
The impairment has left her unable to drive. That's a big restriction for a mother with two children, ages 12 and 13, still at home. Johnson became a grandmother Aug. 10 and looks forward to repeating that honor when her second eldest gives birth in December.
"Not being able to drive is one of the biggest things I miss," says the 20-year mortgage industry veteran. "There's not a lot of things to do. I can't go to the grocery. I can't make dinner. So my husband, after he has worked all day [as a refrigeration specialist for Food Lion], he comes home and helps with dinner. I can't make a hamburger patty. I just don't have that much strength in my right hand."
Another thing Johnson has noticed since the stroke — other than the disappearance of previously constant headaches — is a change in what she says used to be a terrific memory. "I can read the box, how long to cook the Bagel Bites, and by the time I get to the stove, I've forgotten what I read."
In the Stroke Belt
Thomas and Johnson are two of about 600,000 Americans each year who suffer an initial stroke. An additional 185,000 people annually have a subsequent stroke. The number of women between the ages of 30 to 60 having strokes has tripled since 1980, says Dr. Hillary Hawkins, medical director at Sheltering Arms Hospital in Hanover. Women account for more than 60 percent of U.S. deaths from stroke each year, likely because they often delay medical care, she adds. More women die from stroke than from cancer, according to the U.S. Centers for Disease Control and Prevention.
Virginia is in the so-called Stroke Belt of the southeastern United States. In Virginia, the number of adults told by a doctor they had a stroke has climbed from around 180,000 (1.8 percent of the population) in 1997-98 to nearly 300,000 (2.5 percent) in 2007-2008. The most recent state rate matches the national average, but urban centers and parts of western Virginia have long had much higher rates, state officials say.
The higher prevalence of stroke cases in the Southeast may be connected to socio-economic status and health disparities, genetics, diet, activity level as well as incidences of high blood pressure and diabetes, officials say.
But while stroke numbers are rising, death rates have declined. From 2004 to 2008, the most recent year for which data are available, death rates in Virginia fell from 53.9 per 100,000 residents to 42. That compares with metro Richmond average rates of 61.8 in 2004 and 47.1 in 2008, according to state health department statistics.
During the past 11 years, the Virginia Department of Health has received millions of dollars in federal funding to encourage cardiovascular health. The Virginia Heart Disease and Stroke Prevention Project promotes collaboration and communication to improve outcomes and prevent repeat strokes, particularly through policy and system changes.
Project manager Daniel Kim is working on ways to improve care delivery and quality, and points to an increase from 10 to 28 in the number of Virginia hospitals certified as advanced primary stroke centers by The Joint Commission, a nonprofit organization that operates accreditation programs. In the Richmond area, the primary stroke centers are VCU Medical Center, Henrico Doctors' Hospital locations on Forest, Parham and at Retreat Hospital, CJW Medical Center (both Chippenham and Johnston-Willis campuses), and Bon Secours' St. Mary's Hospital, Richmond Community Hospital, St. Francis Medical Center and Memorial Regional Medical Center.
Other examples include developing a statewide triage plan that locates for Emergency Medical Technicians (EMTs) the nearest certified stroke hospital or telemedicine-connected center, and certifying 2,400 blood pressure specialists and educating 440 trainers to ensure more accurate readings. With the transition to electronic medical records, his group is looking at ways to alert care professionals when patient readings are outside the norm.
"Rehabilitation and other after-care issues are also a concern," he says. "Once a patient is discharged, are they getting the rehab needed? Right now there are no guarantees. We're trying to identify throughout the state the rehabilitation and skilled nursing facilities, whether they're licensed or certified for stroke care."
Meeting Complex Needs
Dave Thomas credits his rehabilitation provider for his recovery. "Thank God for Sheltering Arms," he says. "I got a lot of good therapy there. They treated me like a person."
Sheltering Arms delivers a continuum of care, from inpatient to day therapy. Sheltering Arms Hospital exceeds the 66.2 percent national average rate of stroke patients who return to their families instead of skilled nursing or assisted living arrangements by 10.5 percentage points, Hawkins says.
This year, the stroke rehabilitation program at Sheltering Arms' hospitals was certified by The Joint Commission as meeting the highest national standards, says Hawkins, medical director at the 40-bed Hanover hospital. HealthSouth Rehabilitation Hospital of Virginia has a similar certification in stroke rehabilitation.
Sheltering Arms' 475 employees specialize in treating severe and complex neurological and orthopedic conditions. Its facilities include the rehabilitation hospital in Hanover and a 28-bed hospital on the campus of St. Francis Medical Center in Chesterfield County, outpatient centers and physician clinics.
Although Sheltering Arms has existed in central Virginia for more than 100 years, its specialization in physical rehabilitation started in 1981. Thirty percent to 50 percent of Sheltering Arms' patients have neurological injuries. Most of the neurological patients are stroke survivors. These patients have complex rehabilitative needs that require individually tailored programs.
Recently, the hospital started interdisciplinary team walking rounds, going from room to room to discuss goal making and setting with the participation of the patient. "So someone who has been in here two weeks can say he doesn't want to walk 200 feet," Hawkins says. "His goal is to take a shower."
Inpatients receive at least three hours of therapy five days a week in a gym that is a hive of quiet activity and incremental accomplishment. Staff members work with patients one-on-one or in some cases two-on-one. Technological devices help propel recovery. Soon, the periphery of the Hanover hospital gym will be the domain for ZeroG, a sling system connected to an overhead track that will safely allow patients to practice walking and balance.
Hawkins says about 10 percent of stroke victims recover almost completely, 25 percent live with a minor impairment, 40 percent have moderate to severe disabilities, 10 percent require nursing home care and 15 percent die.
"The most progress in recovery is made in the first three months but can continue to improve for one to two years," she says. "Even after two years, they can make progress."
‘Never Give Up'
Faith, prayer, support of friends and family and a self-professed hard-headedness motivated Dave Thomas to prove the doctors wrong. "He's stubborn," wife Suzanne adds, "but that has paid off in some ways."
His advice for stroke patients and their families: "Never give up on a person. Give them a chance to get better."
Suzanne adds, "It's been life-changing for sure. It's been a long road, and he's come a long way from where we started."
Because about 20 percent of stroke survivors experience depression, Thomas often was asked if he was feeling down.
"Why would I be depressed?" he asked them. "I'm alive."