Memories lead to progress
On May 21, 2019, Isaac Mosquera drove from his office at Glaxo Smith Kline (GSK) in New Jersey to the company’s warehouse in York, Pennsylvania. Around lunchtime, the 38-year-old began experiencing weakness in his left arm and slurred speech.
Isaac texted his mother, a pharmacist, who was visiting the United States from her native Venezuela. “I told her I had a headache and I couldn’t grab a bottle of water with my hand during lunch. I asked her if something was going on in my brain.”
His mother told him to go to the emergency room. A colleague drove Isaac to an urgent care center. After describing his symptoms — headache running from the back to the front of his head, left-sided weakness and slurred words — the urgent care team suspected a stroke and called an ambulance. A brain scan at the emergency room showed his right carotid artery — a main pathway for blood flow to the brain — was blocked and ruptured. Doctors diagnosed him with a right brain stroke.
The diagnosis shocked Isaac and his family. He was healthy, took no medication and worked out regularly. He’d been at the gym the day before the stroke, he said.
Seventy minutes after his arrival, Isaac received a dose of the clot-busting drug called tPA (tissue Plasminogen Activator). In strokes caused by clots, tPA can reopen blocked arteries. It must be administered within four and a half hours of the onset of stroke symptoms to reduce its severity and reverse some side effects.
After receiving the tPA, Isaac was transferred to Penn State Health Milton S. Hershey Medical Center for further evaluation and management. Doctors attempted to remove the clot without success. Isaac’s brain began to swell, requiring surgery to temporarily remove half his skull. He had to wear a helmet to protect his brain. Isaac’s left side was paralyzed, he was blind in his right eye, unable to talk and had difficulty with thinking and memory.
On May 29, after eight days in the hospital, Isaac was admitted to Penn State Health Rehabilitation Hospital to begin physical, occupational, speech and recreational therapy.
A physician-led team created a specialized program for him.
“Once I knew what had happened and could understand it better, my family helped me understand the possibilities of what I could achieve with rehabilitation and how I could get back to a normal life,” Isaac said. “I started focusing on that and working toward being able to go back to work and be as independent as I was before.”
In physical therapy, he completed a series of exercises designed to strengthen his weak leg. They concentrated on the area around his knee since it buckled upon standing. Therapists also sat Isaac on a bike that provided electrical stimulation to his legs, started stairs training and used parallel bars to assist in standing and moving. In occupational therapy, Isaac worked on grabbing and improving grip strength as well as daily activities such as bathing, grooming and using the restroom independently.
A turning point in his journey was regaining some memories, what Isaac calls “flashes.” It occurred one month after his stroke and he views it as the day he started to see progress.
“It is not immediate and takes time to really get going. You are working out those muscles like anyone would do at the gym to work out and get stronger,” Isaac said. You have to do the homework when you are not at therapy. You have to stay focused, so you don’t keep wondering what your life will be like from this point on.”
His next win was getting his leg to move again. His fingers were his last. The most hard-earned achievement, Isaac said, was grabbing a coffee cup, making a fist and holding onto pencils and pens.
A portion of Isaac’s speech therapy took place in a group setting, where he and other patients could share stories. He also participated in the hospital’s stroke support group. Both settings helped Isaac feel less alone and frustrated. In recreational therapy, he enjoyed the games and puzzles the therapist used to help him pass the time. He especially appreciated the hospital’s therapy dog, Norway, for “just being there for me.”
Isaac considers his therapy team to be part of his family. In addition to the team, he feels lucky his family could come to the US and help him. In fact, his father traveled from Venezuela the very same day Isaac was hospitalized. He arrived right before surgery and stayed with him for the next six months. With his family’s health care background, he says, “Anything the physician or therapist would ask me to do, they would explain to me how things work and why it is important. That makes you more motivated even though your body doesn’t respond. Things like movement of the wrist left to right – take a tiny bit at a time – celebrate it and be happy for even a small thing.”
Through it all, Isaac’s family, friends and coworkers kept him motivated with multiple visits and numerous text messages.
On July 9, four-pronged cane in hand, Isaac was discharged from our hospital and continued his therapy at our hospital’s Outpatient Day Program. He graduated October 16.
Isaac now uses a single-point cane and can function three to four days per week without needing wheelchair support. He has continued his therapy program at Kessler Outpatient Center back home in New Jersey, which is close to his job and also a part of Select Medical’s continuum of care. He returned to work on November 25. “I get overwhelmed sometimes with computer work especially, but I remember to take a step back and keep trying. You are here, you are alive, you keep going.”
On the home front, Isaac has made a few adjustments due to the after-effects of his stroke. He now lives in an apartment closer to his job, his mom drives him to work and she assists him around the house. Other than that, he’s returning to the routine activities he enjoys. A fan of cooking and spending time with friends, he is planning a barbeque to celebrate his return home to New Jersey, five months after his stroke.