Timothy Omundson on Stroke Recovery and His Return to Television

Episode Transcript

Dr. Correa:
Welcome to the Brain and Life podcast brought to you by the American Academy of Neurology. Audrey, how are you doing today?

Dr. Nath:
Good. Who did you talk to this week?

Dr. Correa:
I'll lead with my own guilty admission that my wife and I have been watching a lot of the This is Us show, along with millions of other Americans.

Dr. Nath:
That's so good. Three generations of drama.

Dr. Correa:
We've been enjoying it. Just to see the families, kind of get to know the characters.

Dr. Correa:
Our episode, we feature an interview with Timothy Omundson. So if you've been following the show, he is Kate's neighbor once they're living in LA.

Dr. Nath:
Oh, that's the character who had a stroke, right?

Dr. Correa:
He had a stroke at age 47 from a carotid artery dissection and then had to come back to the question of, could he get back on screen as an actor? In fact, he actually had a great support structure of other actors and people within the community in Hollywood that helped him not only get back on screen, but incorporate his abilities and his recovery from a stroke, into characters on Psych and his character on This is Us. These are really interesting direction and amazing to hear him, how he thrived and leveraged all the changes of both who he was before the stroke and his abilities now after.

Dr. Nath:
Oh, that's incredible. Can't wait.

Dr. Correa:
Well now, stay tuned for our podcast.

Dr. Correa:
Welcome back, everyone. I'm inspired and I'm sure many of you will be, by our guest today. How he has made his way back to acting after a massive stroke at age 47. You've seen Timothy Omundson on Judging Amy, Galavant, Psych, and American Housewife. Then despite the changes after his stroke, he made his way back to the set for the sequel of Psych and more recently, you can see him on This is Us and New Amsterdam.

Dr. Correa:
Timothy, thank you so much for taking the time with us here on the Brain and Life podcast today.

Timothy Omundson:
Thanks for having me, Daniel.

Dr. Correa:
I'd like to start before all this. And I want to hear some about your life, acting, and your family before 2017 and everything changed.

Timothy Omundson:
Sure. I've been acting professionally for about 25 years, we'll say, and moved to LA when I was 18 years old in 1987. Really built a really successful TV career with a little bit of film and some theater, but mostly television. The crazy thing about the stroke is I was in the best shape of my life. I was like about 47, 48 at the time. Hiked and worked out daily, really low cholesterol, low stress, blood pressure had nothing to do with the traditional stroke things. It was a totally out of the blue anomaly. So when this happened to me in the prime of my life and prime of my career, it was a bit of a shake up.

Timothy Omundson:
What happened with me is I was working out really heavily lifting weights and we can't pinpoint exactly what happened, but basically I had a dissected carotid artery. Which I think over the time, a clot developed and eventually led to the massive stroke in the right hemisphere in my brain, which took out the left side of my body. So actually, I collapsed in a hotel room, no, sorry. In a men's room, it's even classier, in a men's room in the Tampa airport in Tampa, Florida. The night before, I always say I had the worst headache of my life. Which I've since been told, if you ever say you have the worst headache of your life, go to the hospital or go to the ER. But I didn't at the time. The next morning I collapsed there and luckily was able to get really quick medical attention from some EMTs there who rushed me to a great hospital in Tampa that had a really wonderful neurosurgeon, actually was on call that day, Dr. Juan Valdivia. Got to give a shout out to Dr. Juan who saved my life.

Timothy Omundson:
I recovered for a long time in the ICU there and eventually was medevac out to California and started my rehab. I remember Dr. Valdivia taking me into a room and showing me my scans and the right hemisphere of my brain being all charcoal gray. I'm literally thinking to myself, "Oh, it is gray matter." He said, "This is where your stroke was. It was so massive, most people would not have survived a stroke this big." I remember taking that and going, okay, now what do I do with that kind of information? I remember being in the ICU and thinking, with an injury like this, you don't know what you don't know until you know it. I had no idea just how detrimental and how affected I would be. They weren't sure if I was ever going to walk again, which I didn't find out until about four years later, luckily.

Timothy Omundson:
I always say I was lucky that it didn't affect my speech or my memory. I would see people in this clinic who just had no ability to communicate vocally at all. I could see the frustration of their face and them trying to communicate. I had two young daughters at the time. I had two teenage girls. I think Lily was 15 at the time, and Nora was maybe 13. And of course my wife, we were all totally blindsided. This isn't like the rug was just pulled out from under us. The rug was pulled out from under us, and then the floor disappeared. It was a bit of a free fall for a while.

Timothy Omundson:
Eventually after quite a while in working at this clinic, I was living in this sort of halfway house for people with brain injuries, where we were sort of learning independent living skills. They would take us grocery shopping and slowly building skills back up of just how you can survive. I remember specifically the day I was strong enough to just stand at the bathroom sink, could brush my teeth up without having to be supervised because even before that, it was every place I'd go, I had to either be moved in a wheelchair and then assisted say onto the toilet, or even if I was standing there to brush my teeth someone would need to be right there, spotting me. But finally I was strong enough, thanks to these great physical therapists, that I was cleared to do it on my own. So it still, every morning when I brush my teeth, I think at that moment to just think about how far I've come. And for my stroke anniversary last week, I decided I wanted to mark it in a really important way as I could.

Timothy Omundson:
So put in a podcast, I didn't know about your podcast at the time, but if I had, I would've listened to that, put on a podcast, I started doing laps in my backyard for about two hours. And I ended up walking 1.77 miles. So to go mile and three quarters on the anniversary of the day they said you might not walk again, I felt pretty good about. And then so as I slowly started recover, my friend, Dan Fogelman, who was the creative of This Is Us also created my show Galavant. And our friends Cat and John who are producers on our show have been keeping Dan advised to my recovery. And I was at a dinner with one of our castmates. And one of our other producers was there who's also a director on This Is Us.

Timothy Omundson:
And he said, Hey, Dan and I were talking, maybe we could have you on the show one day. And I thought, well, that sounds impossible. I thought maybe I could be a guy in a wheelchair in the office. Then Dan texted me and said, I'm thinking about writing a guy deep in recovery from a stroke for the show. And I said, put me in, coach. So Dan really gave me an incredible opportunity of taking the chance to having me back on this massive show. I mean, I was an actor, like I said, for about 25 years. I've identified myself as an actor since I was 12 years old. And suddenly I couldn't do this thing that I've been doing for all these years and got pretty good. I'm pretty successful at it. So I kind of figure out, well, what am I now, if I can't do that thing?

Timothy Omundson:
And so these amazing people in my life, these amazing creators gave me the opportunity to kind start exploring what I was again. It has been five years. I'm still not quite sure what the answer is yet, but I'm still I'm working my way slowly back to acting. It's no always near what it used to be. First day on set, it was like, I quickly realized I couldn't do this the way I used to. I kind of had this, having done so much television, I had this sort of sixth sense about where a camera was. I could walk into a room, know where all the cameras were and just know all my angles. And I was very technical acting that way which, because it affected my vision as well so I've got a blind spot on my left side. So walking into any room was really disorienting, so quickly realized I couldn't do this physically the way I used to.

Timothy Omundson:
I mean, let alone physically, because I'm obviously walking with a cane, but I had a skill. I had this magic sense where I could look at page once and have my lines just memorized. I suddenly got to set, having not worked on my lines as much as I normally would've because I thought I don't have to do it anymore. I don't. I'm great at memorizing lines like this photographic memory of the dialogue was there. And then quickly got to the set and realized so that's not there anymore. I'm now having to call for a line, which I never used to have a call for line. So I'm slowly trying to figure out how to work with this new brain and this new body. It's an ongoing, it's a work in progress, obviously.

Dr. Correa:
It sounds like quite a juggle on the different abilities and the changes in your abilities. But it's amazing that you've had a community, both with your colleagues in Hollywood that have been open to featuring and exploring this publicly and there and in the shows that you're working on.

Timothy Omundson:
Yeah, I am incredibly, incredibly fortunate in that regards. I'm in contact with another stroke survivor, actually quite a few lately on social media. And this gentleman, he works in the Defense Department in DC, and he was saying how he's been very quiet, even to let anybody know about his stroke because it's such a competitive field, which made me feel really bad for this guy that he's having to sort of keep this thing inside where I feel part of my duty if I've been given this platform through social media in my career, that I can at least let people know how I'm doing and that there is possibility of life after this kind of a catastrophic brain injury.

Dr. Correa:
And so they said you had a tear in the artery, a carotid artery dissection?

Timothy Omundson:
I had a dissection. Yeah.

Dr. Correa:
And did they tell you why they thought that happened actually?

Timothy Omundson:
They weren't quite able to pinpoint it, but I know it was one day I was at the gym. And I'd been working out, like I said, really hard because I'd gotten to the point in my career where I was starting to take off my shirt, so I wanted to put on a little more beef. So see my ego almost killed me. So I was doing a really heavy deadlift, actually. I remember at the top of this lift, I saw stars at one moment, and I had to take a knee. But then I went on with the rest of the day and the rest of the workout, and then drove to the grocery store to buy lunch for my family. And made it home that day.

Timothy Omundson:
And I just remember having like a bit of a pain in my neck later that evening, but thinking I just had just strained a trapezoid, strained a muscle or something. And then cut to a week later. I have this collapse after this headache. So nobody's quite been able to pinpoint what happened or why it happened, but just sort of common sense, we say, having done this lift and then seeing stars of this one point, that must have been what happened.

Dr. Correa:
And then you had that really bad, severe headache that just was completely different than anything else you've you've experienced before then.

Timothy Omundson:
Yeah, I never had experienced it, and I never got migraines or anything like that. So I remember being also, I was incredibly dry mouthed that evening the night before, but I'd been at the pool the day before and I got a sunburn. And so I thought I've just got sunstroke or something. So I didn't know what was going on.

Dr. Correa:
Those are all important signs and symptoms of the carotid artery dissection or tear in the artery. And we'll touch more on that when we get to the medical expert section of this episode. Now you mentioned, in one of the Psych movies and in some of your shows, you've explored in the role, how you've been mentally coping and managing with this condition. How are you dealing with the changes in your life and everything that has occurred from the stroke?

Timothy Omundson:
So far, pretty well. Like I said, it's been five years, and I've been trying to figure this out a little bit. It certainly was a little more reflective on the five year anniversary.

Dr. Correa:
Of course.

Timothy Omundson:
But I kind of made the decision in the ICU again, before I knew what the heck was really wrong with me that I thought if I beat Hollywood. I came down here at 18, built a great career, a stroke's nothing. And I made the decision by the time I was able to get eventually move back home with my family, that I wasn't going to recover by sitting in a corner having a pity party. And I just knew that much that I had to stay as positive as I could for my wife and my kids. And just keep pushing forward, which I'm still to this day trying to do.

Dr. Correa:
And what do you think has been your wife's experience as a caregiver helping you through this process? Because there was a long time there that you needed a lot of other assistance and help.

Timothy Omundson:
No, she's definitely had it much harder than I have. And my kids as well, just seeing their dad who was traveling the world for work and being incredibly independent, suddenly needing help to get on a toilet was pretty shattering to them, I would imagine. And Allison still is dealing with the effects five years later, and we really just try and focus much on whatever positive milestones we can find. Like for example, last weekend, this last weekend, we went to the This Is Us series wrap party, which was in downtown LA, which is really a special event. But anytime we go out now it's really terrifying just because she's not sure of logistics, are there going to be stairs where we're going? And I mean, yeah, the ADA is in effect, but a lot of times there'll be old buildings in LA that are grandfathered in.

Timothy Omundson:
They actually don't have an elevator when you think they're going to. So it's always a high stress, high wire act for her, which luckily there was really great access, and I was able to walk into this party and not use the chair at all. We just kind of parked the chair by the front door which was great, a really good feeling, not have to tell my wife push me around a fancy Hollywood party all night long. But then we got home that night and we were able to kind of reflect on the success of the evening and how far I have come. So all you can do is honor the milestones I think.

Dr. Correa:
Now also more recently in This Is Us highlighting a character living with stroke and disability, what do you think some about the direction that Hollywood and media are going and the inclusion of people with different abilities?

Timothy Omundson:
I think it's incredibly important that they're doing it, and I'm really glad they are because really I've got the market cornered on playing guys with strokes which is...

Dr. Correa:
Yeah, hopefully we'll see more variety and more possibilities or maybe you'll be the first James Bond living with a stroke.

Timothy Omundson:
From your mouth to God's ears. I'll have to work on my British accent again.

Timothy Omundson:
But I just started working with an organization based out of New York that is all about inclusion within working with specifically screenwriters with disabilities and bringing disability stories to screens. And so we've been talking to them a lot about since I have started to get back to work, the accessibility issues that need to take place.

Timothy Omundson:
A lot of times on movie sets there's trailers, right. And the stairs to the trailers sometimes don't have railings. And while I can do stairs now, I still need a railing. So these are all the things that we would never have to think about before, which I need to know. How am I going to be able to? Is the base camp going to be a gravel parking lot or is there going to be... Actually I did a project last month where basically it was in a field. We were working out in farmland and just to walk was literally, I had a teamster helping me like be my sort of human crutch on my right side.

Dr. Correa:
The uneven ground and all that variety and stairs.

Timothy Omundson:
Totally uneven ground. Yes.

Dr. Correa:
Yeah, that's difficult.

Timothy Omundson:
And the transport department built me beautiful wood steps with railing so I could get in and out of the trailers. So this foundation I'm working with just commissioned a study of how much it actually costs the film industry to do this. So they can say to producers, look, see here's the numbers. It's not that much money to include people with disabilities into the work, whether it's in a writer's room or on a set.

Dr. Correa:
That's great. That's great to hear that expanding the opportunities at all the job levels there. And so that really more voices and perspectives can be represented.

Timothy Omundson:
I mean, I know that from myself personally, the response I've gotten again on social media from people who've had brain injuries or any kind of disabilities of just saying, well, specifically stroke was so many people saying I've never seen someone with a stroke be portrayed on television in this way before. Which again, I guess I wish it wasn't me doing it, but if I had to do it, but I have to have it, at least I can make some lemonade out of this truck load of lemons I've been given.

Dr. Correa:
So you're doing in a way you're portraying in these roles an important perspective for people to experience or think about if they're dealing with a disability or with stroke. But I'm wondering if you went back to speak with yourself and your wife and those first few days after the stroke when you were awake and more aware, what would you tell yourself?

Timothy Omundson:
Well, that's a heck of a question. You're making me misty already. It's a little early in the day for me to cry, but I would tell myself to not give up hope and keep pushing that there are possibilities. I mean, I didn't know anybody, certainly my age, who'd ever had a stroke before, let alone a celebrity. And then months later, probably years later, I think my wife discovered that Sharon Stone had suffered a massive brain hemorrhage at one point and was really debilitated from it, which I wish I had known that at the time of my stroke to see that there is possibility and there is hope. And I mean, her issues were different than mine, but still to see her get her career back and still just thriving in what she's doing was incredibly helpful to me.

Dr. Correa:
Yeah. I'm hoping that the experience that more of us now are talking about these things, talking about how we live with neurologic conditions, how people cope and adapt and live even better. It'll hopefully help many people as they get diagnosed or as they're coping and adjusting to the conditions and abilities that they have. I'm wondering as you've had an opportunity to connect with more survivors living with their stroke and their abilities after their stroke, or even from your own family, what do you think you've learned the most about living with stroke from these people?

Timothy Omundson:
I personally realized how much I was loved.

Timothy Omundson:
When I first had it, I would say it was like going to my own funeral. When I first got back to LA in the hospital and people started sending just the support and the flowers started showing up to my hotel room from friends and people in the business, I realized how incredibly supported I was. So that in a way that was kind of the gift, the gift of my stroke. And I have stroke survivor friends who say, let me ask you, if you had the choice of not having the stroke, would you still take it? And I go, no, I wouldn't take it, are you kidding? But my friend who asked me that question, my friend, Joe, had a very different experience from me. It changed his life in such a positive way.

Timothy Omundson:
So I'm still finding the positive every day. And so to hear, even you just say, Daniel, that talking to you could help someone have a different perspective of life after their medical injuries is an incredibly positive thing. We sat our daughters down at one point when this had all happened, and we're still trying to figure out what was going on. And all I could figure out is just said, look, I think the lesson here is horrible things happen in life, but you don't let them define you, and you figure out how to keep going. And that's the lesson. I mean, I was grasping at straws because that's all I could really come up with. But even all these years later, I still think that is the lesson either for my daughters or for my friends or for any of your listeners.

Dr. Correa:
Oh, I think it couldn't be better said.

Timothy Omundson:
You're not defined by the things that happen to you. You're defined by how you react to them.

Dr. Correa:
Thank you so much for taking the time today, for standing up and moving forward, always looking forward. It's been an inspiration, and I look forward to seeing you in many more shows. And as we said, maybe those producers of the next Bond film are out there. They said they're looking for someone so...

Timothy Omundson:
Well, Daniel, listen, honestly, thank you for giving me the platform and give me an opportunity to talk to people about this incredibly important issue because I know when once you're knocked down, it's really sometimes hard to even imagine being able to get up again.

Dr. Correa:
Thank you.

Timothy Omundson:
I will see you down the road, my friend

Dr. Nath:
Is this episode leaving you wanting more? Get the latest tips on healthy living and management for more than 250 neurologic conditions by visiting brainandlife.org, where you can learn about neurology every day, powered by trusted neurologists.

Dr. Correa:
Today, I'm overjoyed to welcome Dr. Sarah Song to the Brain and Life podcast. She's an associate professor and stroke specialist at the Rush University Medical Center in Chicago. I met her as a part of the work I do at the American Academy of Neurology and in the Brain and Life editorial team. When she isn't at the hospital, taking care of patients, she dedicates her time to improving the recovery outcomes after stroke, reducing disparities in stroke, with a special interest specifically in stroke among women and minorities. Thank you, Sarah, so much for taking the time to join us here on the podcast.

Dr. Song:
It is my pleasure. Thanks for having me.

Dr. Correa:
So Sarah, be honest. Have you joined the 6.4 million Americans watching the NBC show This Is Us?

Dr. Song:
I loved the show when it first came out and then I just was not able to keep up, but I cannot wait to get back into it now that it's over. Yeah.

Dr. Correa:
No, I think our lives sometimes get so busy, and it's hard to keep up with all the amazing cultural references that are out there. So tell us a little bit about what's important to know to rapidly identify the symptoms of a stroke?

Dr. Song:
So stroke is incredibly time sensitive in being able to recognize a stroke and being able to respond to a stroke. My thing that I always tell patients is the acronym Be Fast, B-E-F-A-S-T, which stands for balance eyes, face, arms, speech, and then time for T, which really emphasizes the symptoms of stroke. And the more quickly you are able to respond to stroke symptoms and get to the hospital by calling 911, the more likely you are to improve after a stroke because you can receive a medication for a stroke.

Dr. Correa:
Oh, okay. So, wow. That's helpful. And so in some of these medicines, in the short term period, right after a stroke, are they for certain types of stroke? Is there certain timing that makes the most sense? If I had symptoms last night and it's this morning, how do I know if I'm really in that urgent period?

Dr. Song:
Generally speaking, there are two kinds of strokes. There are the kind that are caused by blood clots. And there are the kind that are caused by essentially brain vessels bursting. So they are kind of the opposite of each other. When the symptoms occur, you don't actually know which one it is. One thing I want to emphasize is that in the cardiac literature, people are always saying, if you think you're having a heart attack, take an aspirin and then go to the hospital.

Dr. Song:
In the situation of stroke, you don't want to do that because if in the case that it is a bleeding stroke, you could actually cause more harm than good. The number one thing to do is if you have any of those symptoms that I mentioned earlier that are one-sided, you call 911 right away, because this will open all the doors to getting you not only the right kind of ambulance, but getting you to the right medical center that can accurately and officially treat stroke. Typically, a medication that is given for the blood clot type of stroke is called TPA. In most people, it can be given within three to four and a half hours, but it does require some workup before you receive it, including most importantly, a CT scan, which will help differentiate between the blood clot stroke and the bleeding stroke.

Dr. Correa:
So that's important information. So really if you have any of these symptoms, calling emergency medical services to get to the hospital in an ambulance, and that gets them to the right hospital and also as soon as possible because people just can't know, yeah.

Dr. Song:
And I think that it's also important to know that if you wake up with symptoms, let's say you go to sleep normal last night and you wake up with symptoms, besides medication, there are now procedures that we can do for certain types of really severe strokes, similar to what Timothy had, which was a large stroke in one of the major vessels in his brain. Now we're extending that time window even up to 24 hours. So even if you wake up with those symptoms, there still may be something that we can do for you that will greatly improve how well you do in the future.

Dr. Correa:
Sounds like then no matter when you started to have these new symptoms, this idea that I think some people have that maybe I'll go take a nap and wake up later and see if it's better is probably not the best. And as soon as you notice them, call emergency services.

Dr. Song:
Yes, absolutely. And I would say making sure that people in your family or in your circle know what stroke symptoms are. So they know to call for you, if you are unable to call yourself. And I should point out that in all the trials that have been done, the medication for stroke and the procedure for stroke, the idea is the sooner you can receive that intervention, the more likely it is to do more good in the long term.

Dr. Correa:
Now you mentioned with Timothy and his stroke, so his stroke was thought to be related to a previously injured carotid artery in his neck, or what's referred to often as a carotid artery dissection that then maybe led to a blood clot. Can you help us explain this and understand how that causes a stroke?

Dr. Song:
Absolutely. So carotid dissections, and especially because he was so young, dissections are typically seen in younger people because they can be associated with trauma. But what happens is you get a tear in the vessel wall. So every vessel has several layers in it, and you get a tear in the vessel wall and that creates an environment for a blood clot to be formed and then thrown up into the brain. The carotid artery supplies about two thirds of the brain on either side, because you have two. So one on the right and one on the left, and it's a major vessel in the brain. So somebody young like Timothy, I would predict that if he didn't have a lot of other risk factors for stroke, which I don't believe he did, that something like that might be the case.

Dr. Correa:
And discussing this interview and Timothy's story and talking with you with one of our summer interns here, she came up with a great question. So Emma Wang asked, in some cases carotid artery dissection might go unnoticed. What are the typical early symptoms or signs that might tell someone that they really should consider getting evaluated?

Dr. Song:
Sometimes we find that people have had dissections in the carotid arteries or in the back of the brain, in the vertebral arteries and never know. And so we look at the vessel on imaging, and we say, oh, that looks unusual. That looks irregular. They may have had a dissection at some point. So not every dissection goes on to cause a stroke. However, when you do have a dissection, typical symptoms can include, for example, headache or small symptoms that are reflective of a stroke, but don't persist, something we call a transient ischemic attack or a TIA. Some people call these mini strokes. I don't necessarily love that nomenclature because it implies that it's not serious because TIAs or trans ischemic attacks are actually an emergency, and they really should be attended to, but they can look just like a stroke, but the symptoms typically last seconds to minutes.

Dr. Song:
So weakness, numbness, trouble speaking, and it comes and goes. And it's really hard. I understand to have these symptoms happen. They're frightening. They're scary. So when they go away, people are typically relieved, and then they don't necessarily pursue medical attention. But in the case of somebody who may have had perhaps a recent motor vehicle accident or gotten a very severe massage or been in some weird position for some reason for a long time, and then they have stroke-like symptoms, this may really be a sign that something more serious is going on, like a stroke.

Dr. Correa:
And this headache you referring to, could this just be the typical type of headache someone gets at the end of a long work day and should they be worried about a carotid artery dissection in that situation or what's different about the headache?

Dr. Song:
The headache itself, people usually say it's quite different. In the world of neurology, as I know you know, there are a ton of different kinds of headaches. And it's hard to get people to describe them, but the headache can be located, for example, behind the eye. Sometimes people complain about headaches behind the eye or shooting pain. I guess I would hesitate to qualify it. I would say that it would be different than somebody's typical headache.

Dr. Correa:
Timothy has been on a long path of rehabilitation, which is also featured and been incorporated in some of his own acting roles. Can you describe how we figure out each person's rehabilitation needs and the course of care for their recovery?

Dr. Song:
Whenever anybody has a stroke, we have a wonderful group of therapists who will see each patient and assess them. So we have speech therapists, physical therapists, occupational therapists, and the speech therapists also do things like cognitive and communication evaluations. We have people assessing how well they're swallowing or tolerating diets. There's so much that goes on behind the scenes after somebody has a stroke. And it is very much a team approach. It's a coordinated effort to get the patient to their best self before they leave the hospital and move on. Whether that's to a rehab facility or home. The therapists themselves are amazing, and they make all the difference in the world. And what we do know is that early intervention, from a therapist standpoint, is essential for getting the best quality of life after a stroke or a brain injury. So we have the therapist coming in, literally the day of the stroke, the day after the stroke to assess the patient and begin working with them intensively on therapy.

Dr. Correa:
That's excellent. So really, so each person can have a variety of issues, and we have almost like a team member for each kind of problem they might encounter.

Dr. Song:
That's right. And each person is responsible for their role, but then they all talk together amongst themselves and decide, we need more of this or we need less of this and more of this. And every person throughout the course of their hospital stay, most people are improving quite a bit. So we're able to say this is where you were two days ago, and this is where you are today. We're going to expect to see some more improvement. And we do know that most people who get therapy or most people after a stroke can continue to improve up to 12 to 18 months after their stroke. But the most improvement happens in the first several months. So we really try to capitalize on that and be as intensive and as aggressive as possible with therapy up front to give people that best chance to do well.

Dr. Correa:
And this is a question I hear often, what happens after those 18 months? You said most people get their recovery between 12 and 18 months. But then what happens after that?

Dr. Song:
I think that the brain is constantly working. And I'd say that for most people, the recovery does plateau. It doesn't mean you can't continue to improve though. And I think that people who are engaged and actively working can continue to see improvement, but for most people there is like a plateau. But I always encourage people to continue to work hard. And I have seen it myself in my own patients. They can continue to get better.

Dr. Correa:
So they continue to have improvement or even adapt to the issues that they have. Now unfortunately, stroke is a leading cause of serious long-term disability in the United States. And you've mentioned some other challenges that are part of that whole process in recovery, including depression. What are other kinds of challenges that people face in the months and years after a stroke?

Dr. Song:
One thing that I think people don't necessarily think about that much are the people who have had strokes and they look really good, but they have some small amount of disability, whether it be cognitive or perhaps speech related or something mild that they're constantly fighting with to not have to necessarily wear it as a label, but to try to communicate with people that they're not necessarily the same person, that they were. The one thing that every patient without fail says is, I was fine yesterday, and today I'm not. Right. So there's a huge shift. This person is never the same. And I think I have a great deal of empathy for my patients because I can see just how much this has changed their lives forever. Right?

Dr. Song:
And for the people who may have just a little bit of speech difficulty, everybody around them may look at them and say, they look great. Oh my goodness, you look great. You look like you were never at the hospital. And I think that's their way of sort of dealing with maybe mortality themselves and being like, oh, thank God, they're fine. Right. But then that person can struggle with the fact that they're not necessarily fine, right. So they look okay, but they still have issues. And it's hard to bring those up with people if people are so consumed with telling them that they're fine because they want them to be fine.

Dr. Correa:
Yeah. I think you see the people who have a lot of the motor or functional limitations and people can very clearly see the limitations that they have, I've heard they have difficulties because people end up only focusing on that, and they don't see them for all of their capabilities or sometimes are as aware of the other challenges that they might have.

Dr. Song:
Exactly.

Dr. Correa:
And then on the other hand, we have the patients or individuals who are living with maybe less visible, invisible limitations, like the speech problems you said or memory and thinking problems. And they often tell us that they feel isolated because people don't see the deficit, and they don't really feel like they can connect with others and have others understand their limitations.

Dr. Song:
That's absolutely right. And we think that maybe as many people, as a third to half of people who have strokes have depression or depression of some kind, and it doesn't mean that it's forever for them, but it's certainly a huge adjustment. And understanding that and recognizing that I think is really important because not being able to do 100% of everything you could do before is a huge change, and everybody's different. Another huge impact of strokes is on the people who end up being caretakers for their loved ones. And we see that there is a lot of burnout at times. And we just always want to make sure that we're supporting everybody in the family. Not only that person who is a patient themselves, but their family as well.

Dr. Correa:
For those who might be living with a stroke or know someone living with a stroke, and they seem like they're having challenges with depression or coping and adapting, what are the steps that they should take in getting the help that they need?

Dr. Song:
Actually Brain and Life is a great resource. There's so many stories of people who have been encouraged by other people's stories. I would encourage you to reach out to your doctor to talk about any support groups that are available or online resources for that. I know that one thing that could happen as caretakers can forego their own health issues to take care of others. And I always encourage people to continue going to their doctors, continue taking your medicines, make sure you're taking care of yourself and whatever resources are available, reaching out to social workers to see if there's somebody who can come in and help in the home.

Dr. Correa:
That's great. So yeah, support groups and resources that are out there and not just for the person recovering from stroke, but also their family and caregivers all need those. Well, thank you, Sarah, so much for the care and the attention that you give to the community you care for, for just honoring who they are as people and the family members struggling in those moments, and then being there for them to celebrate the little achievements that they have in their follow up.

Dr. Song:
Oh, I always think it's my honor to do it. So it's an honor to be with you. Thank you so much for having me.

Dr. Correa:
Oh, thank you, Dr. Song.

Dr. Correa:
Thank you for joining us today on the Brain and Life podcast. Follow and subscribe to this podcast so you don't miss our weekly episode. You can also sign up to receive the brain and life magazine for free at brainandlife.org.

Dr. Nath:
Also for each episode, you can find out how to connect with us and our guests along with great resources in the show notes. You can also reach out by email at blpodcast@brainandlife.org.

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