Paul King kept his work boots in the entryway of his Hyde Park apartment. His seven-year-old daughter liked to slip them on and stomp around. The boots were part of the family’s routine as they hurried to and from work and school. So, it came as a surprise when Paul bent over and put his boots on one September morning in 2016. “I stood up and felt pins and needles from my waist to my feet,” said Paul then 34.
The sensation of numbness continued as he ran errands for hours and turned painful when he arrived at Faulkner Hospital where he worked as a security guard. “I realized I couldn’t move my feet at all. I had to call co-workers and ask for help getting out of the van. My boss called for a wheelchair,” Paul said.
Stroke diagnosis
Paul was admitted to the hospital and given medication for what was initially diagnosed as sciatica, pain caused by pressure on the sciatic nerve. An MRI revealed that Paul had a spot on his spine. “Doctors told me I had a stroke. I couldn’t understand. I didn’t have usual symptoms. I don’t smoke or drink. My cholesterol is good and I averaged 10,000 steps during security rounds,” Paul said. “I thought the doctors were wrong.”
To complicate matters, Paul discovered his insurance plan would not cover treatment at Faulkner. He was transported by ambulance to Tufts Medical Center. After a battery of neurological tests, Paul learned a blot clot had blocked an artery to his spine. “They couldn’t tell me why it happened or if it would happen again,” said Paul. “They said it would take two years before I’d walk again.”
Intensive rehabilitation
Paralyzed from the waist down, Paul was transferred to HealthSouth Braintree Rehabilitation Hospital for intensive therapy. “Every day, I’d have an hour of physical therapy and an hour of occupational therapy,” Paul said. “Because my upper body strength was good, I was able to walk 20 feet holding on to the parallel bars.”
Along with exercise, Paul’s physical therapist used electrical stimulation. “I think the stimulation helped bring back movement,” Paul said. “One day my therapist was helping me put my shoe on and said, ‘Look, your foot is tapping!’” Paul continued to make steady progress and was discharged able to walk on his own with the aid of crutches and a brace on his left leg.
Paul tried his best to acclimate to home life with his wife, Tabatha, and daughter, Arianna. He found it hard maneuvering inside his small apartment, particularly its galley kitchen. “We applied for a handicap accessible apartment but the list is long,” said Paul who had a stairlift installed and grab bars added in the bathroom. “I get tired and unsteady on my feet and can’t walk or stand for long periods of time,” he said.
Meeting Dr. Leung
Paul’s lack of energy, coupled with chronic migraines, led his primary care doctor to refer Paul to Lester Y. Leung, MD, Director of the Comprehensive Stroke Center at Tufts Medical Center. “Paul’s stroke, known as a spinal cord infarct, is a relatively uncommon site of central nervous system injury, a fact that likely led to challenges in establishing the diagnosis,” said Dr. Leung. He explained that upon discharge from Tufts MC, the cause of Paul’s stroke was considered “cryptogenic” or unknown.
During Paul’s initial visits, Dr. Leung ordered tests to discover the cause of the stroke and found an underlying cardiac issue. “A cardiac rhythm monitor revealed a period of arrhythmia. I recommended that Paul change medications from aspirin to an anticoagulant (blood thinner). The arrhythmia, atrial fibrillation, is uncommon in young people, but it can be triggered and driven by obstructive sleep apnea, a condition Paul has been dealing with,” said Dr. Leung who founded and directs the Stroke and Young Adults (SAYA) Program.
“Dr. Leung was one of the first people who explained what was going on inside my body. He understood my feelings. I’m not used to being disabled,” said Paul who recalls being shouted at when pulling into a handicap space despite his disabled parking placard. “People look at me, a young guy, and don’t believe I have a disability.”
Addressing post-stroke complications
According to Dr. Leung, Paul suffers from a host of post-stroke complications including central pain syndrome, severe lethargy, orthostasis (lightheadedness) and worsening of migraine headaches. He prescribed medications to prevent the migraines as well as to address neuropathic pain and persistent lethargy.
“These issues, which other stroke survivors face, have stretched and advanced my comfort level in treating conditions that normally would not be addressed by a stroke specialist,” says Dr. Leung. The SAYA Program aims to provide assistance for many post-stroke complications in one place, rather than expecting patients to access specialists on their own.
In addition to Dr. Leung’s care, physiatry physicians in Physical Medicine and Rehabilitation at Tufts MC fitted and adjusted Paul’s ankle orthotic. The Sleep Medicine Center helped get his sleep apnea under control.
Moving forward
Though Paul still has paralysis in both legs, he is proud that he defied his initial prognosis and is walking. He has joined a gym and is trying to lose weight. He’s grateful that Dr. Leung is only an email away should concerns arise.
Paul wants to get a job that would allow him to work remotely from home. With just one income and a new baby, Gabriella, born this year, money is a constant source of worry. Paul is exploring job training opportunities and is hopeful he’ll continue making strides.
Learn more about stroke, its causes and risk factors, symptoms and diagnosis
If you have experienced a stroke and are concerned about after-effects, check out our Late Complications of Stroke questionnaire. Print a copy of the questionnaire, answer the questions and bring it with you to your next visit with your neurologist.
