The Nerve Center

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6/12/2012

Trauma Season is Upon Us

Editor's Note: This is the first of a two-part blog entry.

Terrence Green spent 23 years in the military, including active duty in the Gulf War, before taking a position in Homeland Security. On January 16, 2003, at 2:30 a.m. driving just south of the Wisconsin-Illinois border on I-94, the brakes on Terrence’s truck failed. So did the emergency brake. Terrence still sees the next events, in his mind’s eye, in slow motion. The vehicle gained speed down a hill, took a nose dive, flipped over, and landed in the northbound lane facing on-coming traffic. Before the roof of his truck was cut open to pull him out, he remembers telling an officer on the scene, “Tell my kids I love them.”

Terrence believes that what happened next saved his life. His supervisor in Homeland Security, reached by phone, insisted that Terrence be taken to Froedtert despite the fact that he was in Illinois. Froedtert is a Level I Trauma Center with a well-developed Spinal Cord Injury Program. Thankfully his supervisor knew that. It’s OK – even a good idea – to ask the paramedics or ambulance personnel to bring an injured person here to Froedtert.

Terrence had damaged his C-4 through C-7 vertebrae. His spinal cord was swelling. By the time he arrived at Froedtert he was in a coma.

Terrence laughs about the fact that his name changed while he was in a coma. His sister started calling him “T-Bone” because while he was unconscious he repeatedly called out for someone to bring him a T-Bone steak! He is now “T-Bone” to just about everyone.

Spinal trauma

Traumatic spinal cord injury is usually a result of motor vehicle crashes, falls, sports or violence. The good news is that prevention and education efforts result in fewer and fewer traumatic spinal cord injuries each year. Cars are much safer. Air bags make a big difference. Injury prevention education makes a difference, too.

In addition to traumatic injuries, non-traumatic spinal cord injuries can occur due to a medical problem such as Multiple Sclerosis, Myasthenia Gravis, tumors, myelopathy (compression caused by degenerative spine disease), post-polio and more.

People with spinal cord injuries may require surgery if there is pressure on the cord or if there are bone fragments that must be removed. Sometimes it’s necessary to insert a rod to hold the spine together. T-Bone needed surgery that involved the placement of rods and titanium pins in his cervical spine.

The spine and spinal cord

The spine is a boney cage that protects the spinal cord. The spine has 32 bones (vertebrae). From top to bottom it is divided into parts – cervical spine, thoracic spine, lumbar spine and sacral spine. The higher the injury, the less function the patient has. Actor Christopher Reeve’s injury was to C-3. Injuries to C-1 through T-7 leaves a person with a range of paralysis called quadriplegia and involves a change in movement and sensation in all four extremities.

The spinal cord, which does not regenerate after being damaged, stretches from the base of the brain down through the lower back. It has a “jello-jiggler” consistency.

As a result of his accident, T-Bone has quadriplegia. He is a “functioning quadriplegic.” He is able to care for himself with very little assistance. That took some time and no small amount of work. “They are miracle workers,” T-Bone says of the team that works in the Spinal Cord Program. “They know when to push and when to back off. They won’t let you give up.” After the accident he could only move his eyes back and forth and now he can walk with the aid of a walker.

Often, the people who sustain spinal cord injury represent high risk takers, people that “live on the edge.” Adjusting to this type of devastating injury is probably the most challenging thing a person will go through in his/her life. In spite of this, most people with spinal cord injury return to being active, vital members of their communities.

The movie Murder Ball depicts the lives of a group of people with SPI that have formed a very aggressive basketball team. They play in light-weight, very fast wheelchairs and they exemplify the idea that it is possible to continue to live an active, exciting life with a spinal cord injury. Very often people return to the activities they enjoyed prior to their injury using hand controls, such as racing cars or skydiving in tandem.

Patients are helped by staff, other patients

Each year there are around 100 people admitted to The Spinal Cord Injury Center at Froedtert. Just under half of those have traumatic injuries. Working with these patients is an incredible staff that includes physicians and specialists in physical, occupational, speech, respiratory, recreational and vocational therapy. Nurse case managers, social workers, chaplains and psychologists are also important parts of the team.

The same staff provides a continuity of care by working with patients through their inpatient stay as well as their outpatient treatment.

Froedtert & The Medical College of Wisconsin neurosurgeon and researcher Shekar Kurpad, MD, PhD, is the medical director for the Spinal Cord Injury Center. It is a CARF (Commission on Accreditation of Rehabilitation Facilities) accredited program with a specialty designation in the Spinal Cord Injury System of Care. The Spinal Cord Injury Center serves as a clinical site for several research studies. Donna Johnson, RN, BSN is the program coordinator and has been with the program since its inception in 1986.

Every Tuesday evening there is a discussion group for people with spinal cord injuries – inpatients, outpatients and family members. T-Bone is a faithful attendee. After nine years as a person with quadriplegia, T-Bone is a great role model. He has learned to slow down and to share the advantages of slowing down with others. He has learned to deal with his chronic pain without the use of narcotics. He practices a variety of relaxation and distraction techniques that help him get through the day. He has learned that when strangers don’t treat him well because of his wheel chair, it is a reflection on them not on him.

“Peer Advisors” like T-Bone visit the unit every week. These are all people who have had spinal cord injury and have gone through the program at Froedtert. They volunteer to come in and meet people who have new spinal cord injuries. They meet and encourage their families. It is invaluable to know someone who has lived with spinal cord injury and has returned to life in terms of work, relationships, kids or school. It has been invaluable for me to meet T-Bone. His mark is everywhere in the Center from the Wii fit game he donated to the dart ball game he plays with young men on the unit. He has his favorite chair next to the microwave. He can see who’s coming and going from that seat. He calls out to the therapists, nurses and the people in the program. He can distract a young man with endless talk about sports or zero in on his need to discuss a personal issue. T-Bone is a role model, a father/brother/friend. He may view the dedicated staff of the Spinal Cord Injury Program as miracle workers; but they in turn view T-Bone as a miracle.

Posted 11:27 AM

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My mom, Mary Jane, died 8 year ago. Dec. 25 would be her 86th birthday. Several years earlier she suffered a stroke. She certainly was a candidate for a stroke. She smoked since she was 15; she handled stress poorly, mostly by drinking much too much; and her dad had died of a stroke in his early 60s. Additionally, she didn’t have any kind of a handle on other possible risk factors. She rarely went to the doctor so she wasn’t aware if she had blood pressure or blood sugar issues. She didn’t exercise, and her eating habits included a summer sausage sandwich on buttered white bread with a pickle and piece of cheese at 2 a.m. She consumed lots of salt and not many fresh fruits or vegetables.

One morning mom woke up with a terrible headache. She never got headaches. She was alone. My dad left for church every morning long before she awoke. As she told it, she got up and was very imbalanced. She kept bumping into the walls. She waited but nothing improved. She didn’t understand that this was an urgent matter in which time was of the essence. Finally, when my dad got home, it was clear that mom was in trouble. 9-1-1 was called and she was taken to the hospital. Upon arrival her blood pressure was more than 200 over 110.

“Sudden” is a key word with stroke. Sudden changes in vision, speech and balance and sudden numbness are symptoms. “Time” is another key word. 2 million brain cells die every minute during a stroke. In the United States, stroke is the 4th leading cause of death and kills more than 133,000 people each year and is the No. 1 cause of serious, long-term adult disability.

The Stroke and Neurovascular Program at Froedtert & The Medical College of Wisconsin is a Primary Stroke Center as designated by The Joint Commission. It was the first such center in Wisconsin and one of the first in the nation. The Froedtert Acute Stroke Team (FAST) is ready 24 hours a day to respond to the needs of stroke patients, quickly, and if necessary, with new and emergent treatments that are not always available elsewhere. The physicians and other staff are unsurpassed. And the programs here for stroke rehabilitation include physical medicine and rehabilitation physiatrists, physical therapists, occupational therapists and speech therapists, psychologists, psychiatrists as well as patient and family support groups.

Mom did go to a rehab center. She did regain most of the physical losses she had experienced. She could walk and talk, but she couldn’t think nearly as well as she did before. She loved words and could no longer play scrabble. She watched "Jeopardy" and "Wheel of Fortune" but didn’t beat the contestants to the answers any more.

She really suffered the psychological effects that can come with stroke. About 50 percent of people who have had a stroke experience depression. Sometimes it can last for as long as three years. Her doctors tried any number of meds and even an in-patient stay for depression. Her primary care physician finally concluded that something in the area of her brain that affects mood and motivation was damaged. Her depression was intractable.

I miss my mom. I miss the way she was before the stroke: Cadillac-driving, cigarette-smoking, vodka-drinking, poker-playing, hard-driving, business-savvy woman. That was her identity and it did not include thinking about “risk factors.” It’s impossible to connect that Mary with the thin, weak, apathetic, frightened person she became.

Could it have been prevented? She could have addressed the risk factors and quit smoking, drinking and worrying. She could have stopped avoiding doctors. She could have started exercising, eating right and finding ways to reduce stress.

If she had the stroke anyway, would it have made a difference to recognize the signs of stroke and come directly to Froedtert (she went to a closer, community hosptial)? YES! Quick treatment leads to better outcomes.

As I struggle with my own risk factors including, obviously, family history, I know that I will or my loved ones will respond FAST if this happens to me. I have a large refrigerator magnet that lists the steps to take:

Face – Does the face look suddenly asymmetrical, especially if the person tries to smile?

Arms – When asked to raise both arms, does one drift downward?

Speech – Is speech slurred or abnormal?

Time – Did this happen suddenly? Time is of the essence. Note the time that the symptoms first appear. There are some treatments only available soon after the symptoms appear.

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