January 3, 2011
Stroke recovery illustrates value of prompt emergency care, comprehensive rehab

By Susan Christensen
Health and Research News Service

Jerry Vardaman of Brandon can’t stand to be idle.

So the stroke patient knew he was in the right place when he rolled into Methodist Outpatient Neurological Rehabilitation in Flowood.

“The first thing physical therapist Karen Klein said to me was: Put your wheelchair in a closet and be prepared to work hard,” remembers Vardaman.

“And he worked so hard, he wore the rubber bottoms off a brand new pair of shoes,” Klein said.

But that’s to be expected. Vardaman is well-known for his industrious nature. On the May 31 morning when a clot began blocking blood flow to his brain, Vardaman had been up since 4:30 a.m. doing housework.

“I went into the bedroom to take a load of clothes and had this sudden weakness on my left side,” said the public health prevention education specialist for the Mississippi State Department of Health. “Since I am a diabetic and I hadn’t eaten anything, I fixed a quick snack. After the symptoms didn’t subside, I pretty much knew it was a stroke.”

Since he’s only 41, many might consider Vardaman unusually young for a stroke victim. But Methodist Rehabilitation Center physician Alyson Jones says cases like his are all too common.

Over the past five years, Methodist Rehab has treated 351 stroke patients age 60 and under, including 115 age 50 and under. Like Vardaman, many suffer from an increasingly familiar trio of risk factors – diabetes, hypertension and high cholesterol.

“It’s a combination that leads to blood vessel abnormalities that can compromise blood flow and promote abnormal clotting,” Dr. Alyson Jones explained. “So the best defense against stroke is to have your medical issues under control.”

Escalating hypertension may have played a role in Vardaman’s stroke. Due to an expired prescription, he had been without his blood pressure medication for more than a week.

His wife, Emily, drove Vardaman from their Brandon home to the hospital that May morning. And by the time they covered the 17.5 miles to Baptist Medical Center in Jackson, his condition was critical. “My lower left lip had drooped, I was slurring my speech and I had lost all mobility on my left side,” he said.

The foreboding set of symptoms prompted a flurry of activity at Baptist’s emergency room, where staff is well versed in the protocols for diagnosing and treating stroke.

“We have an established stroke program, and we are very aggressive,” said neurologist Keith Jones, stroke director at Baptist. “We have trained people to be very responsive to stroke patients. Nurses in triage have standing orders to get a computed tomography (CT) scan done, to get the lab people to run in and draw blood and to send STAT pages for a neurologist to respond.”

At stake is the limited time to use tissue plasminogen activator (tPA), a clot-busting drug that can significantly reduce the disabling effects of stroke. If administered intravenously, tPA must be given within three hours of stroke onset.

“You have to meet very tight criteria when using tPA,” Dr. Keith Jones said. Patients must be experiencing a significant stroke, have no bleeding in the brain or body and their blood pressure must be within an acceptable range.

At 220 over 120, Vardaman’s blood pressure was initially too high. But because he got to the hospital quickly, there was time to bring it down with medication. “He had to receive three rounds of IV medication,” Dr. Keith Jones said. “But we were able to give him the tPA three minutes before the three-hour window expired.”

The tPA did not dramatically reverse Vardaman’s impairments immediately. He continued to have paralysis on his left side. But tPA has been shown to significantly increase the chance of functional recovery months later.

Both Dr. Joneses say Vardaman has shown remarkable progress since his stroke. “While tPA is very important, I think the reason he did well has more to do with our very detailed stroke care, “ Dr. Keith Jones said. “We keep the blood pressure right and help avoid complications such as pneumonia and blood clots in the legs.”

Dr. Keith Jones said another factor was the expert care provided by the experienced stroke rehab team at Methodist Rehab.

“They have never disappointed me,” he said. “It’s very important for patients to have a cheerleader or a drill sergeant in order to accomplish things that can be difficult. MRC has very dedicated therapists who do more than they have to.”

The knowledgeable staff also is up-to-date on the most advanced therapies and technologies for encouraging recovery. As a result, Vardaman was able to benefit from two Bioness neuro-stimulation devices that helped re-train weakened muscles in his left leg and hand.

Vardaman said his mindset has always been: “I don’t want anything to beat me.” And by the time he left inpatient care, Vardaman had made significant progress. He arrived at Methodist Rehab’s outpatient facilities determined to get even better.

“He wanted to be able to walk without a cane and brace, use his left arm and hand, regain the ability to drive and return to work,” said Pat Baird, an occupational therapist at Methodist Outpatient Neurological Rehabilitation. “It has been a joy to see him reach those goals. He was a model patient in terms of motivation, hard work and following our recommendations.”

In fact, Vardaman does everything asked of him in therapy – and then some. “If we give him two new exercises, he does those plus every exercise he has ever been given,” Klein said. “One thing we constantly do with him is reassess his function and goals and strive for the next level. We mostly make his sessions about what he is doing at home and what he wants to get back to doing to be more independent.”

That explains why Baird brought Vardaman a broken lawn mower to fix. It was a way for Vardaman to work on the fine motor skills in his left hand and get back to an activity he loves.

“I work on lawn mowers as a hobby and a way to help out, and I enjoy doing it,” he said. “You take apart something non-functional, clean it up, replace the worn-out parts and you have a working machine.”
Now that he’s back at his job, Vardaman feels like he has been through a similar transformation. And he’s thankful for all his “rebuilt” body can do. He can help out with his preemie grandson, walk his English bulldogs and drive independently.

Plus, he’s as handy as ever. He recently celebrated his renewed abilities by tearing down the wheelchair ramp to his house. “I wasn’t able to assist with the construction,” he said. “But I did the demolition myself.”