David King, Stroke

A Stroke Superhero

David King, age 62, was supposed to be enjoying his retirement. A lifelong comic book enthusiast, he had amassed a 2,000-volume collection over the past 50 years and was ready to spend his time curating it. But in September 2011, something happened to him that was as unexpected as a comic book cliffhanger.

"I knew I had high blood pressure, but to me it was like one day I was fine, the next day I had a stroke," he said. "I got up in the middle of the night and said to myself, 'Something's wrong. I'd better go back to bed.' But what I should have done is say, 'I've got to go to the doctor.'"

Stroke is caused when a vessel in the brain ruptures or becomes blocked by a blood clot. It requires immediate medical attention. Stroke is the third leading cause of death and the number one cause of long-term disability in the U.S.

David's wife, Cheryl, was out of town when he had his stroke. It wasn't until the next day that his son found him, collapsed and unable to get up. He called 911 and David was taken to Northwest Hospital, a Level 1 primary stroke center.

"When I finally got there, it was too late to do the three-hour medication," said David.

Tissue plasminogen activator, or tPA, is an important treatment given to patients within the first three hours following a stroke. tPA dissolves clots that cause strokes and improves blood flow to the brain, which can help the patient's recovery.

"It is crucial that individuals and their families are aware of the range of symptoms that could represent an acute stroke," said Dr. Gregory Schroedl, a board-certified emergency medicine physician and Northwest Hospital's Chief Medical Officer. Dr. Schroedl cared for David in the emergency department immediately after he arrived. "Advances in medicine have allowed us to provide innovative treatment options like tPA. However, time is of the essence, as the effectiveness of tPA dramatically declines with each hour that passes. If you think you may be having a stroke, call 911 immediately."

In the Northwest Hospital Emergency Department, David discovered that the right side of his body was paralyzed and he wasn't able to speak. He doesn't remember much after that.

"For two days I was just asleep I was completely out of it."

He spent nine days in Northwest Hospital's acute stroke care unit and eleven days in inpatient rehabilitation before returning home. For the next eight months, David and his wife were consumed with helping him regain his former abilities through a combination of physical, occupational and speech therapy at Northwest Hospital, and a lot of hard work at home.

"He had to learn to do everything again. He couldn't use the right side of his body. He had to learn to walk, eat, write, talk, dress himself, shower. It was pretty scary when he first came home. I wasn't sure I was going to be able to handle it," said Cheryl. "We said, 'Let's focus on what you can do, not on what you can't do.'"

"The whole time, I just thought, 'I'm going to get better and better,'" said David. "It could be a lot worse."

Gradually, David's condition improved.

According to the American Stroke Association, more than half of all strokes are caused by uncontrolled high blood pressure. Approximately 80 percent of strokes can be prevented by managing blood pressure and other risk factors, such as smoking and lack of exercise. David worked hard to improve his health after his stroke.

"Physically, he got better. He lost about 70 pounds. He's in better health now than he was before the stroke. We think the stroke saved his life, in a sense. The stroke was like a second chance to take better care of himself," said Cheryl.

But David had difficulty regaining an important skill: his ability to speak.

"I thought it was fine. I thought I could talk, but I was really saying the wrong things," said David.

"That's aphasia," said Cheryl. Usually caused by a stroke or head injury, aphasia affects a person's ability to speak, read, write and comprehend words. "He just wasn't making sense. I thought he was never going to get over it."

David's neurologist at Northwest Hospital, Dr. James Gordon, ordered an MRI of David's brain. It showed that the stroke had caused severe damage. But since David was comprehending and communicating better than expected based on the MRI, there was hope he might eventually recover his ability to speak.

David's "speech superhero" was Northwest Hospital speech pathologist Kara Sheridan.

"David's ability to think was intact, but his aphasia was severe to profound. It was confusing to both him and his wife," said Kara. "It was hard for them because they are both so young and vibrant. It took them time throughout outpatient therapy to reinvent their lives."

David began speech therapy while he was an inpatient at Northwest Hospital. He continued to have twice-weekly outpatient sessions with Kara for months after he returned home.

"Kara is really passionate about what she does," said Cheryl. "She was like this shining angel during that time. She gave me solid things to do and work on. And hope."

Kara and Cheryl created a special notebook to help David express himself. It included lists of numbers, letters of the alphabet, names of family members and days of the week. If he couldn't say a word, he could point to it. He started attending the weekly Game Group for aphasia patients at Northwest Hospital, which offers card games and socialization as a way for participants to work on their speech in a fun, low-stress environment. He also took part in therapy and research projects with graduate students enrolled in the University of Washington's Department of Speech & Hearing Sciences.

"There was a lot of hard work the first year," said Cheryl. "I heard that the first year is the most important — doing the work every day to get better. I went to the therapy sessions with Kara twice a week and learned everything I could. Every single day, he and I would work on it at home. He worked so hard, but there were times we felt despair. It was like '20 Questions' and 'Charades' every time we talked, trying to figure out what he was trying to say."

By the end of eight months of outpatient therapy at Northwest Hospital, David was able to communicate more clearly, though he still has some trouble.

But when he's talking about something he's passionate about, like his first edition "Superman,"
"Batman" and other Golden Age DC Comics, the words flow easily. Today, David travels to every comic book convention he can, from small-scale shows to Seattle's Emerald City Comicon.

"He can wheel and deal, sell and buy, without my help," said Cheryl.

"Aphasia seems to be what most patients end up living with, in varying degrees of severity," said Kara. "I think David's optimism and the support of his wife had a dramatic impact on how successful his recovery was. A lot of people with aphasia lose their identity. But he
didn't. He's kept his sense of humor. I think his optimism is amazing. David doesn't stop trying to seek therapy and anything that can continually improve his aphasia. There's no cure for aphasia, but you can gradually get better and better."

For more information about Northwest Hospital's stroke program, visit nwhospital.org/stroke.