Giving up would have been easier.
Sandra Rigdon lay in her hospital bed recovering from a stroke. She had lost all use of the left side of her body and was unable to walk, to use her arms or even to sit up on her own.
She remembers immediately following the stroke, she wanted to die instead of be a burden on her husband, Ted. After an excruciating two days, and constant prayer, she opted instead to work hard to rehabilitate.
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“For the first 48 hours, I struggled with God. I didn’t want to live this way,” she said. “But God told me what to do. The only reason I’m here today is that God gave me the strength to do the therapy. On my own, I couldn’t have done it.”
When a patient suffers a stroke, every second of delayed treatment can mean the loss of brain function. Medical personnel are trained to act quickly. The immediate health threat is addressed through surgery and potentially medication, before the focus moves to recovery.
By working together on all facets, local hospitals can ensure that patients not only survive a stroke, but can resume a relatively normal life afterward.
“Our goal is always to get people home,” May said. “It’s shorter rehab, intense, with the goal of getting people home as close to their prior level as possible.”
Strokes, which occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts, are one of the most prevalent causes of death in Indiana. Nearly 3,000 Hoosiers died from strokes in 2015.
In Johnson County, the hospitalization rate between 2012 and 2014 for strokes was 12.1 people per 1,000 county residents who receive Medicaid benefits. That’s higher than the state rate of 11.7 people, as well as the national rate of 10.9.
To handle the large number of strokes impacting the population, Johnson County’s three local hospitals feature extensive services and rehabilitation to help people recover from a stroke.
Community Hospital South is accredited through the Joint Commission, a nonprofit organization that certified nearly 21,000 health care providers throughout the U.S., as a primary stroke center.
The hospital has created guidelines to ensure that patients receive timely care to mitigate the damage of a stroke, while then receiving guidance to help rehabilitate in the weeks and months afterward.
Franciscan Health Indianapolis has created the Stroke Alert program, in which patients showing signs of a stroke are immediately seen by emergency nurses and physicians to determine the extent of the problem and how to address it. Franciscan Health is certified by the Healthcare Facilities Accreditation Program, the country’s original independent accreditation organization.
Johnson Memorial Health was also certified by the organization in October, receiving its Stroke Ready certification.
“(The Healthcare Facilities Accreditation Program) came on site, they reviewed our records, they reviewed our training, they reviewed patient charts, education, everything that we’ve done,” said Joey Hollis, manager of the emergency department at the hospital as well as its stroke coordinator. “We’ve worked hard to make this happen.
During the past three or four years, Johnson Memorial Health officials have put together a rigid plan that approaches every aspect of stroke treatment.
Foremost rapidly is identifying patients who may be suffering a stroke, Hollis said. The hospital has worked closely with local emergency medical service providers to help them look for potential signs of a stroke — including drooping facial muscles, difficulty speaking and arm weakness.
Nurses in the ER triage also have been educated on what to look for and how to get stroke patients care quickly.
The key is identifying it within a six-hour window, Hollis said.
“Time is brain whenever you have a situation like this,” he said. “The longer that the brain is without blood flow, the less of a chance that you’re going to recover that part of the brain back.”
Using a CT scan and other diagnostic tools, emergency department staff can then determine potential treatments. Immediate treatment includes a medication called Activase, which is when a clot causes the stroke.
If caught within four hours, the clot can be dissolved and blood flow resumes, limiting brain tissue damage.
“If it is a clot, we can open up that vessel again, and return flow. If you’ve had a stroke, there’s always going to be some damage. But we can try to eliminate further damage by rapid treatment,” Hollis said.
But after the immediate danger to the brain is addressed, the damage that has been done becomes a more disruptive issue.
A majority of the patients who come to the acute rehabilitation unit at Johnson Memorial Health have suffered a stroke, May said. The physical, speech and occupational therapists in the unit have done extra training in stroke recovery on top of their existing education in therapy.
Patients focus on strengthening their arms, legs and other parts of their bodies that have been weakened by the stroke. Therapists help them function with the arms and hands, walk without an aide and to help think through problem-solving.
“Studies have shown that for a new stroke, people will make the most progress within the first six months. That’s when you’re going to get the most out of it,” May said. “To have this intense therapy, people pushing you through different activities that they know will have results can be very beneficial.”
Rigdon suffered her stroke four months ago, leaving her with no movement on the left side of her body. Two days after the stroke itself, she had surgery to remove a clot that blocked 99 percent of the blood flow through her carotid artery.
She received her initial treatment at Franciscan Health Indianapolis. For rehabilitation, she was admitted to Johnson Memorial Health.
When she arrived, Rigdon was all but helpless.
“At the beginning, they’d sit me down, and when they let go of me, I just fell over,” she said. “It took me a good week before I gained the balance to just sit up.”
For three hours each day, she worked on physical, speech and occupational therapy.
Rigdon was given play money, and she had to count out loud the different dollar and cent amounts. Therapists had her practice everyday activities such as getting in and out of the shower, dressing herself and tying her shoes.
“The things that people need to participate in to just get through their day, that we take for granted often,” May said. “Sometimes it will be dealing with balance, sometimes it will be the lack of coordination, sometimes it’s thinking through a process.”
Learning to walk again was one of the most challenging things Rigdon had ever done.
“It was like being a baby. I never realized that with every step, your brain tells you four or five different things to do,” she said. “Everything I did was so hard.”
She was in the acute rehab unit for 23 days before being released on Aug. 11. The next day was her granddaughter’s wedding. Though she was in a wheelchair, she was well enough to sing a duet with her granddaughter during the ceremony.
“I had a goal. I had to be ready to do that,” she said. “The therapists don’t let you take it easy. They put everything they have into it.”
Rigdon still has numbness in her left leg and foot. Her balance can be shaky, but otherwise, she’s walking on her own and doing many of the activities that she had before the stroke.
To help build up even more strength, she does exercises at home — catching a ball thrown to her in different positions, stepping around the exterior of a room or lifting weights.
“My balance is my main problem now. My speech is OK, to a degree. I’m not exactly back, but I’m close. And movement and coordination is good, but balance is what I need to work on,” she said. “I can see improvement every day.”
Look for a stroke
- Face drooping: One side of the face droops or is numb, and the person’s smile is uneven or lopsided.
- Arm weakness: One of the person’s arms seems weak or numb, and when the person raises their arms above their heads, one drifts downward.
- Speech difficulty: Speech is slurred or difficult to understand. When asked to repeat a simple sentence, they are unable to correctly repeat the words.
- Time to call 911: If someone shows any of these symptoms, even if the symptoms go away, call 911 and say that it’s a stroke to help get the person to the hospital immediately.
- Keep your blood pressure low
- Lower your cholesterol
- Eat healthy food
- Exercise regularly
- Treat sleep apnea
- Control blood sugar
- Drink in moderation
- Stop smoking
- Avoid stress
- Maintain a healthy weight
— Information from the American Stroke Association
Johnson Memorial Health
1 to 2 p.m. the first Thursday of every month; acute rehabilitation unit, 1125 W. Jefferson St., Franklin, on the second floor. For individuals who have experienced a stroke, as well as their caregivers. For information, contact Liz Yingling at 317-736-3511.
Franciscan Health Indianapolis
3 to 4:30 p.m. second Wednesday of every month; 8111 S. Emerson St., Indianapolis, in the Terrace Conference Room; a free monthly meeting focusing on education for stroke survivors and their support systems. For information, contact Angel Duzan, 317-528-3725.
Community Health Network
2 to 3 p.m. third Tuesday of each month; Community Rehab Hospital, 7343 Clearvista Drive, Indianapolis, first floor day room. For information, call Beth Edwards, 317-585-5400.