Monday, June 19, 2006

Stroke Changed Career Path

Steve was featured today in the Deseret News in an article titled,
"Stroke Changed Career Path, Life."


Deseret News (Salt Lake City), Jun 19, 2006 by Lois M. Collins Deseret Morning News


When Dr. Steven R. Edgley talks to his rehab patients about life after stroke and the ongoing battle to regain skills or learn new ways to do things, he speaks with a gentle authority that's hard- earned.

Five years ago, at age 28, six months into a year-long internship in ophthalmology, Edgley had a massive stroke. He had no known risk factors or family history; he was among the third of stroke victims afflicted before age 65.

His right side was paralyzed and he couldn't speak, but he was also extraordinarily lucky. His wife, Emi, recognized what was going on and the ambulance was prompt. He lived in Chicago, which had a clear treatment protocol for strokes. Within a half-hour, the man who'd run marathons received the clot-busting medicine TPA -- "about the fastest time you could give it," well within its three-hour window to be effective.

In the intensive care unit, he reassured himself that he could still think clearly by running through protocols he'd learned in medical school, like how to treat heart attack. "I wanted to make sure I had retained the medical knowledge I'd gained."

He was already taking steps on the long road back to what is a joyous, productive life, in spite of lingering frustrations like the fact that his mind moves extraordinarily fast but his speech takes much longer to catch up.

It changed the direction of his interest in medicine. He's just completed his residency and in a few weeks he will become medical director of the stroke rehabilitation center at University Hospital.

Everyone should understand these things about stroke, he says.

-- They have to get prompt treatment for any hope of a good recovery. A stroke is a terrible thing, but "there is so much more to life after stroke. Life's not over," he says.

-- Prevention before a first stroke is crucial.

-- Lifestyle changes and medications after a stroke are also crucial.

Edgley cites a grim number:

Without medications and lifestyle changes, someone who survives a stroke is likely to be dead of heart disease within eight years.

Avoiding that means controlling high blood pressure and cholesterol, managing diabetes, eating right and not smoking. For the ever-important exercise, rehab specialists help develop programs that meet an individual's capability.

In the stroke rehab center on a recent day, people in various stages of recovery are doing different therapies. Nancy Powell, who had a stroke in 2004, is picking up small marbles and dropping them in a glass. Even once-simple tasks pose big challenges.

Treadmills are a valuable tool. Someone who can't walk far can get a good workout by increasing the slope of the workout.

Weight-support treadmills hold up the patient with straps, allowing people in even early stages of recovery to get moving again, which must happen as soon as possible to enhance long-term recovery. And walking helps both physically and mentally. It stimulates the brain and strengthens neural connections.

"There is a strong drive for humans to remain upright," Edgley says.

There are exciting new tools, both mechanical and medicinal, on the horizon or newly arrived. The U. is part of a multicenter study in which a device is implanted into the brain of some stroke patients to stimulate areas that were injured but not killed by the stroke. The idea is that those parts of the brain can be made to take over for parts that were destroyed.

Still, nothing equals the impact of personal motivation. Doctors and therapists and medicines and technologies can do only so much.

Depression after stroke is common and must be treated. It is the drive the patient provides, the amount of sheer hard work, that determines ongoing progress. That work is a lifelong process.

Unfortunately, insurance, Medicare and others don't provide support for the lifelong nature of recovery, Edgley says. Most people only receive formal help for a limited time when they could benefit from much more.

Research shows that even people who had strokes long ago can regain abilities or develop new ones they thought they'd never have, with the proper support and therapy.

One approach is restraint therapy. Say someone has lost most of the use of the left arm and uses the right for everything. The right arm is restrained and the brain and body work to gain functionality on the left side.

The incidence of stroke -- the number of people per 1,000 -- is declining. But the number of cases is on the rise because of the sheer mass of the aging population. The decline in incidence is likely driven by the fact that treatment is more aggressive.

Edgley's stroke has given him a very personal interest in how patients recover, which he believes will benefit those he treats. He's highly motivated to advance his field, using technology, research and "a drive that's pretty unique." But the biggest thing he gained, Edgley says, is empathy.

You can link to the article here
http://findarticles.com/p/articles/mi_qn4188/is_20060619/ai_n16489226.

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