Highs and lows: One patient’s path to stroke recovery

“A stroke is like a roller coaster,” said Michele Gorke of Marshfield. “There are highs and crushing lows.”

Her husband, Dennis, had a stroke on Nov. 24, 2014. Michele remembers the details from that night, but Dennis has no memory of working on lighting plots for a local production of The Nutcracker hours before having a stroke. He came to bed and started having uncontrolled movements soon after lying down. Michele knew he was having a stroke when she asked her husband if he was having trouble getting comfortable and he responded with jumbled speech.

Dennis had experienced a brain bleed. In medical terms it’s called a hemorrhagic stroke.

“The brain has large arteries and tiny ones that branch into the deep parts of the brain,” said Dr. Pablo Bravo, the Marshfield Clinic neurologist who treated Dennis. “The smaller arteries can harden and get less flexible over time. Because of high blood pressure, they can rupture and cause a hemorrhagic stroke. That’s what happened to Mr. Gorke.”

Hemorrhagic strokes are less common than strokes caused by lack of blood flow in the brain.

“Severity of a hemorrhagic stroke depends on the size of the bleed and where it happens,” Bravo said. “Blood destroys tissue when it occupies parts of the brain it shouldn’t.”

Dennis had a large bleed in an area of the brain that controls language and movement. However, even patients who have severe strokes can regain function through rehabilitation. Having a stroke was only the beginning of Dennis’ roller coaster ride.

Something to fight for

Dennis’ first few days in the hospital after the stroke were nerve wracking for the Gorkes. Michele faced the possibility her husband might die as doctors tried to reduce swelling in his brain.

“The first time our two daughters and I got to see him, he recognized us,” Michele said. “I told them, ‘We’re fighting this because he’s in there.’”

Dennis spent six weeks in the hospital, including several days in the intensive care unit. At his worst, Dennis was nearly comatose. He couldn’t understand speech or speak, and he couldn’t move the right side of his body at all.

Even when Dennis was mostly unresponsive, Dr. Bravo had the amazing ability to continue looking at him with fresh eyes,” Michele said.

Dennis underwent speech therapy and physical and occupational therapy while he was hospitalized. Early rehabilitation involved simply moving his limbs so they didn’t lose muscle tone and working on recognizing objects. As he improved, he started working on strengthening muscles and practicing movements in a mirror.

“The brain has plasticity, which means surrounding areas can take over function for areas that get destroyed. That’s why rehabilitation works,” Bravo said. “The greatest improvement happens in the first six months after stroke, but people can continue to get better even two years after the initial stroke. After that, the improvements are more subtle.”

Dennis spent five weeks in rehabilitation at a nursing home and more time in the hospital rehabilitation wing. Michele, a tireless advocate for her husband’s recovery, pushed for more therapy as Dennis continued to surpass goals, like relearning to walk.

When asked what the hardest part of his stroke recovery has been, Dennis said, “Speech.” He has regained the ability to understand language with the help of Marshfield Clinic speech therapists, but he still has difficulty forming the sounds for words he wants to say.

One of the peaks in Dennis’ recovery roller coaster was dancing with his daughter at her wedding in August 2016. The pair danced to “More I Cannot Wish You,” from the musical Guys and Dolls.

The road to improvement didn’t stop there.

“When patients complete therapy, they need to continue doing exercises on a daily basis so they don’t lose function,” Bravo said.

At home, Dennis takes a daily lap around the house, opens the blinds every morning and practices speech exercises with Michele. He has regained some movement in his right hand. He’s also finding a new hobby – container gardening.

“He hasn’t lost his sass.”

Even though speech is challenging, Dennis hasn’t lost his sense of humor.

During his rehabilitation stay, a therapist who knew he liked building projects suggested he make a simple birdhouse. Dennis built a dainty birdhouse and painted it pink. Staff asked Michele if he made the birdhouse for a granddaughter.

“I told them, ‘I hate to break this to you, but this is his way of messing with you,’” Michele said.

At home, he pretends to fall asleep with an exaggerated snoring noise when he doesn’t want to do something or pretends he doesn’t understand something so he can see Michele act out a word or phrase.

In this together

Dennis and Michele often link fingers as a sign they are a team that works through challenges together.

“I love you,” Dennis told Michele.

“Almost from the beginning, he’s always been able to say ‘I love you,’” Michele said. “On the dark days, I can’t tell you what that’s done to carry us through.”

Advice for stroke survivors

Every stroke and every stroke recovery process are different. Still, Michele’s advice about stroke recovery applies to every stroke survivor and loved one aiding in recovery.

“You only know how much recovery is possible by working on it,” she said. “We view time as our friend in stroke recovery.”

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