Update

It has been a while since we posted on Will's progress so I thought I would share with you some of the things that have been happening. Progress is being made in the two critical areas of recovery: 1- Executive Function and 2- Memory.

As far as memory goes, Will has good recall of events of yesterday and plans for the immediate future. His medical memory remains at a very high level. He gave us a very excellent review of the molecular structure of Omega 3's and Omega 6's around the lunch table the other day.

In Executive Function, he has pretty much taken over his own finances. He keeps an excellent journal and structures his days very responsibily. However, he still tires easily and his speech is slurred when he's tired.

We have decided to remove all timetable expectations pertaining to his residency. When he does return he will return as a PGY1 (Post Graduate Year One). Residency years begin July 1st, so he could possibly go back as early as this July or a year from July, or later. He was disappointed that he would not be able to count the first seven months of his residency, but grateful that he could return when he was ready.

He continues to job shadow a family practice physician on Wednesdays and a neuro surgeon on Tuesdays, Thursdays and Fridays. He also works in the temple every other Saturday. His spirits are good. His fiance is largely responsible for this. She is his best therapist as well as his best friend.

We are keeping in close contact with the physicians at Riverside Methodist Hospital in Columbus and appreciate their expertise and counsel as we address new issues raised by changes in the ungoing saga of Will's recovery.

Medical History Form

Will has been asked to write more detailed histories of the patients he sees in the clinic of the family practice doctor he is job shadowing. Because his stroke affected his language skills, he continues to struggle expressing himself with verbal and written language. A form has been created to assist him with medical history taking which could probably use some help.

A SAMPLE HISTORY FORM

1- Patient’s Name_____________
2- Patient’s Age______________
3- Patient’s Blood Pressure______
4- Patient’s Weight__________Height_____
5- Patient’s Temperature_______________
6- Patient’s Signs and symptoms__________
7-Allergies__________________________
8- Medications_______________________
9- Past Pertinent History ________________
10- Events Leading to the problem _________
11- Problem_________________________
12- Diagnosis_________________________
13- Prescriptions and/or procedures_________

Any insights or resources on taking medical histories would be greatly appreciated.

Cardiovascular Follow Up

Tuesday Will and went to his follow-up Cardio appointment with Dr. Michaels at the University of Utah. Before meeting with the doctor, he had an echo-cardiogram and an electrocardiograph. These images showed his closure looking secure and well healed and he has been given the green light to go ahead and play racket ball, football and any other sport he wants to. He is officially off Plavix, but will be on a daily dose of Ecotrin, ( baby aspirin) for the rest of his life.

While there, Dr. Efstratiadis was so impressed with the progress Will has made in the past six months, he called a physician in the Internal Medicine Department to see if Will could job shadow in that department while preparing to return to his residency in Ohio. It turned out the person who makes these decisions was out of town and wouldn’t be back for a couple of weeks, but it was kind of Dr. Efstratiadis to make the call and offer to follow up on it.

In the mean time Will's speech therapist, Lisa, from Sugarhouse Rehab, is being brought back on board to help with speech and cognitive therapy. Will is beginning the fourth and final quarter of the year following the stroke. He is anxious to do everything he can to make the remaining months in which recovery is said to be the fastest, as productive as possible.

Meeting with Dr. Edgley

Thursday Oct. 2nd was Will’s latest meeting with Dr. Edgley. There were four of us cramped into a very small examining room: Summer and Will and Wally and I. Summer kept the conversation light and lively while we waited the interminably long time for Dr. Edgley to saunter in. The meeting was the most encouraging yet. He was very congratulatory about Will and Summer's engagement, which was comforting to Summer. She was afraid they were going to be told to hold their horses and back up a bit. They were taking this all a little too fast!

For those of you who haven't heard already, the wedding date is set for Dec. 30th in the Salt Lake Temple. A reception at the Bountiful Central Stake Center is planned for later that evening. You are all invited to the reception. Summer is a wonderful girl, the proverbial blue-eyed-blond. She and Will are the same age. They both served missions in Argentina. They have been friends for five years. In the face of Will's stroke, Summer has been a beacon of light, a ray of sunshine in an otherwise dark and frightening world. We can't say in words what Summer means to us or how blessed we feel to have this angel of mercy sweeping in with open arms cheering, blessing and brightening Will's life. It has been her private errand to keep Will's spirits high and she has done an amazing job.

Marriage was one of the four goals Will had expressed a desire to achieve on his first meeting with Dr. Edgley. The first goal was to be normal. The second one was to get his driver's license. The third one was to get a job, and the fourth one was to get married. Happily Dr. Edgley encouraged Will to go forward with his life focusing on two things: his job with Globus Relief International and preparing for the Step III exam. When he gets these two things under his belt, I am hoping things will be pretty much back to normal and he can return to his residency.

Later in the day I cornered Dr. Ward and asked him about Will’s job shadowing. (Will has been job shadowing Dr. Ward, a family practice doctor, every Wednesday for the past few weeks.) He said Will needs to do much more detailed histories. Will’s were about one-third the length they need to be. This is definitely something that needs to be addressed. I hope he picks up the ball and runs with it. I would like to put Dr. Ward at ease about this.

Friday Will and Summer went off together to get their portraits taken for their wedding announcement. Will was sporting a bright yellow tie to match Summer’s golden hair. They are thinking of Ohio or Park City for the Honey Moon. I am thinking this is going all too fast. Will’s next appointment with Dr. Edgley will be as a married man. YOWSER!!!

Speech Therapy

As some of you may know, Will's formal therapies were discontinued some time ago because they were either deemed unnecessary or non-productive. After a while, it became clear to me that they were still necessary and needed to be re-instated. I decided to try speech therapy. The exercises included breathing exercises for projection, lip rounders for precise articulation, jaw droppers for strengthening the soft pallet and opening up the throat, tongue twisters for clarity of vowels and consonants, and humming for head resonance and volume.

As we began these exercises, I pretended I was a therapist to one of Hollywood's brightest and most shining stars, having Will say such things as , "How now brown cow!" and "a big black bug bit a big black bear." It was fun and I was pleased to see that Will was entering into the spirit of the therapies. He did them for sustained periods of time and with some effort and it wasn't long before I was noticing that it was making a difference, not only with his voice, but also with mine. These were therapies that worked!!!

A statement of a friend whose brother had suffered a stroke prompted the reinstatement of these therapies. She said. "My brother recovered all but his left arm and that was because he refused to do the therapies that were given him for that." It was a haunting statement because I thought, "if Will always speaks with a slur because he never got the speech therapy he needed, I will feel personally responsible. I teach Elocution. I should have the resources at my fingertips. I should be his therapist." As soon as I took ownership of this phase of his recovery, I remembered where the resources were and went to work.

In one of the notes by one of the exercises it said, "the voice muscles need to be exercised just like the leg muscles if they are to become strong and perform their proper function." Will's stroke knocked out his ability to swallow. His tongue, throat, and lips were frozen in a type of paralysis similar to my friend's brother's arm. It made perfect sense that Will's speaking muscles would need to be worked on, exercised and strengthened if they were to regain full function. Teddy Bruschi had physical therapists to help him reclaim his acumen as a foot-ball star, Will had his mom. Neither man had been left without resources for recovery.

Currently I am looking for some exercises that might help with the return of Executive Function. This is the part of the brain that causes a person to initiate behaviors. It is located in the frontal lobes and is one of the highest forms of reasoning; a demonstration of a person's will. Leaders of men have lots of Executive Function. Will acquired a great deal of it while he was a missionary in Argentina. I know he can gain it back with some help and effort.

In as much as many of you are people of faith, I want you to know that your fasting and prayers have enabled him to perform at an amazing level of 83% over all in his first neuro-psyche exam, a fete which is nothing short of miraculous. Humbly and with a sense of great indebtedness, I am asking you to please pray specifically for Will's ability to reclaim his Executive Function. It is such a critical part of the recovery.

June through August Summary

From my observation, Will made huge progress in interpersonal interactions during the summer. It began as he got very involved with his nephew Simon and with Summer's nieces and nephews. He entered into more conversations with his siblings about the time Chris returned from Brazil and Lizzie visited from New York City (last half of July). He now initiates conversations, ask questions, comments on the responses, and keeps the conversation alive.

I discussed this with Dr. Mayer on July 29th. At that time, Will had met with Dr. Mayer 8 times but had never opened up to him. The usual patient would have become a non-stop talker by that point in therapy. Dr. Mayer offered some possible explanations: (1) An interaction with a child may be less demanding than one with an adult, so Will more readily enters into it. (2) Will may have neurological (brain circuits don't work right) difficulty in forming sentences to make a conversation. (3) Will may have psychological reasons (a motive) not to talk with people, so they wouldn't find out how broken he thought he was. At the end of July, Dr. Mayer was leaning toward the neurological explanation, but wasn't sure.

Yesterday Dr. Mayer said he thought that Will's deficit in brain executive function was definitely neurological, and that the tests showed that the whole brain was affected; there was no localization to one side or the other. He also mentioned that Will had begun to open up to him in their most recent sessions.

Neuropsychological Evaluation

On August 25th and 26th Dr. Mayer administered the Wechsler Adult Intelligence Scale III IQ test to Will. He adminstered all the subtests, including the optional ones. The final report isn't yet done, but Dr. Mayer shared his preliminary findings with us yesterday.

Here they are at a high level:

1. Will's basic intelligence is intact.
2. On timed tests, Will's accuracy was 100% or nearly so, but his speed was very slow.
3. Will currently has deficits in most types of memory, but not all.
4. Will is currently weak in the executive function of the brain.

Some additional observations:

1. Will scored in the percentile range of 80 to 91 on many conceptual and analytical subtests. This is compared to the total population his age. If the test were normed to all people who had completed medical school, his percentile scores would have been lower.
2. In tests where speed was a factor, Will scored below the 10th percentile. Removing the adjustment for speed would have put those scores in the percentile range of 30 to 50. My own speculation is that Will thought this evaluation was important and cared about the results, so he chose to optimize on accuracy and to let timings be what they may. He may never have thought of balancing speed and accuracy.

• The Stroop test is an example. There is a long list of words that are the names of colors (the names of only 4 colors are used). Each name of a color is printed in a colored font. The color of the font is always different from the color described by the word. I.e., the word 'Blue' is always printed in red, or green, or tan type. The first time through you say the words. (If the word is 'Blue' you say 'blue.') The second time through you say the color of the font. (If the word 'Blue' is printed in red, you say 'red.') The first time through Will did well. The second time he only got halfway through the list in the alloted time. But in that time he only made one mistake.

1. Dr. Mayer talked about 7 or 8 types of memory:

• Long-term: The adage for this one is "First learned, most rehearsed, last lost." Long-term memory is usually not affected by a stroke, and this is true for Will.
• Short-term: This is working memory and is important to attention and concentration. Will scored quite high in this area and got corresponding high marks in attention and concentraton.
• Aural/Verbal and Visual: Not so high. Will has a learning curve, which means he improves with repetition, but his learning curve is not as steep as for most people, i.e., his rate of improvement with repetition is lower.
• Immediate and Delayed: Not so high. Immediate is being able to tell a story back right after he's heard it. Delayed is being able to tell it back after 30 minutes filled with other activities. When telling a story back, Will does well in relating appropriate story themes, but not so well in including the details.
• Episodic: This is being able to relate your experiences. [I don't remember the evaluation of this one. This might be part of long-term memory.]
• Prospective: Not so high. This is remembering what you plan to do.

1. Prospective memory is related to the brain's executive function, but is not the same thing. Prospective memory is keeping a task or goal in mind. Executive function is figuring out how to do it and then making yourself do it. Will currently has deficits in both.