June 5, 2023
By: Erin Moriarty Wade
When Sam Billings left Arkansas for a 9-day cruise around the Caribbean, he never imagined he’d be gone for 6 weeks recovering from a massive stroke far away from home.
Sam, 62, and his wife Julie, were enjoying a relaxing trip and were headed to their final destination on the cruise, an idyllic private island owned by the cruise line, when Sam suffered a stroke.
“I had spent the day snorkeling at St. Thomas, and we set sail that evening to spend that night and the full next day at sea,” Sam recalls. “I got up to use the restroom, and I fell down between the bed and wall and I couldn’t get up or even lift my arm.”
Julie came to help him and quickly recognized he was having a stroke. She called for the cruise ship’s medical team, and they took him to the infirmary. By now, they were at least 5 hours from shore in the middle of the ocean.
A stroke happens when blood flow to the brain is blocked, which prevents the brain from getting the nutrients and oxygen it needs. Brain cells die within minutes when this happens.
Patients having a stroke often experience numbness, mild weakness, or even paralysis on one side of the body. Other signs may include a sudden headache, trouble with vision, and difficulty speaking.
A Stroke Survivor’s Story
Sam had previously suffered a stroke about a month before the cruise, but he had made an extremely swift recovery and had been given the all-clear by his doctor to go on the cruise. He was given the clot medication, TPA, which worked so well on a clot in his carotid artery that he did not need surgery. Stroke testing showed no damage.
“I left the hospital after a few days and went back home and hit the ground running,” Sam recalled. “I thought it would be just like last time where they would say, ‘you’re fine’ but that definitely wasn’t the case this time.”
He spent almost two days in the ship’s infirmary before the cruise line arranged for his transfer back to the United States via a medical flight.
“I didn’t really know what was going on at this point,” Sam said. “There was a sea plane sitting in the ocean waiting for me, and then, when we landed in Fort Lauderdale, an ambulance was waiting for me to rush me to the hospital.”
Sam arrived at Broward Health Medical Center, where he stayed for nearly a week.
“This was when I realized I could not do anything and couldn’t even get out of bed,” he said. “I began to understand exactly how bad of shape I was in, and that I really needed to take this very seriously.”
It was tough to accept this new reality and the temporary loss of his independent, strong-willed self. “I felt like I was a helpless little kid, and I was probably acting like it too,” Sam recalled.
Stroke Recovery Begins
There are two main types of strokes: ischemic strokes and hemorrhagic strokes.
Ischemic strokes are caused by a blockage in an artery (or in rare cases, possibly a vein). This is the most common kind of stroke, and it accounts for about 87 percent of strokes. Hemorrhagic strokes are caused when a blood vessel that supplies the brain ruptures and bleeds, depriving the brain cells of oxygen and nutrients.
Strokes can result in brain damage, long-term disability, and even death.
In Sam’s case, he would need to relearn how to speak, walk and perform basic daily tasks. Doctors told him he would need extensive rehabilitation at an inpatient facility.
“The main goal of rehab is to help patients maximize whatever residual function they have after a stroke and to help them be less dependent on their family,” said Ariel Inocentes, MD, a physician at Broward Health who is board-certified in Physical Medicine and Rehabilitation.
Dr. Inocentes said it’s important to be aware of risk factors for strokes and do everything to prevent strokes when possible.
“Prevention is better than treatment,” he said. “We always want patients to focus on maintaining healthy cholesterol levels and healthy blood pressure, avoiding obesity, and controlling their diabetes (if they are diabetic) in order to reduce their risk of stroke.”
Sam was transferred to Broward Health Rehabilitation Institute at Broward Health North, which is the only facility in the North Broward County District that is accredited by the Commission on Accreditation for Rehab Facilities and the only that is a “Joint Commission Stroke Rehabilitation Designated Rehab Center.”
“Everyone was so nice and kind from the minute we got here,” Julie said. “That was important because we were so far away from home, and we didn’t have anyone here with us.”
Rehab was when the hard work began.
“The minute I got here, my therapists started coming in here,” Sam said. “My occupational therapist, Sheryl Watson, helped me shower, shave, get dressed and relearn how to do all these little things we take for granted every day.”
Physical therapy, with therapist Paul Dunkley, was also part of his daily routine as he was initially unable to get up or walk. “I started with using the parallel bars; every day we took one more step,” Sam said.
Sam also had to learn to balance, to transfer from his bed, to use a walker and much more. Julie said they asked for the toughest occupational therapist and the toughest physical therapist.
“We got exactly what we asked for with Sheryl and Paul,” Julie said. “We called them the sergeants.”
Day after day, week after week, Sam worked hard to relearn skills and rebuild his strength. Thanks to speech therapy, it’s nearly impossible to tell he had a stroke even after chatting for nearly an hour.
“I know that I can go home now and function – with some assistance from my lovely wife,” he said. “Without her, I could not have done this.”
Preparing Family Caregivers
The role of family caregivers is of utmost importance at the Broward Health Rehabilitation Institute.
The hospital offers a special training for family caregivers called the Approved Rehab Caregiver (ARC) program to help family members learn how to take care of their loved one at home after a stroke.
“The ARC program makes it much easier to transition from the hospital to their home,” said Dr. Inocentes, who helped bring the program to Broward Health. “It minimizes the anxiety of family members and helps them become more confident in their ability to care for their loved ones when they go home, and this makes things easier for the whole family.”
Julie worked alongside her husband and earned a certificate as an Approved Rehab Caregiver.
This program offers family members (or other caregivers) the opportunity to assist their loved ones throughout the inpatient rehab process. They get training from physical, occupational and/or speech therapists, explained Cheri Archer Silveria, regional director of Rehabilitation Services.
Once the team feels the caregiver is safe to assist, they are given a blue bracelet that lets the team know they are an Approved Rehab Caregiver and can help their family member with the approved activities during their hospital stay. This training, and the experience of helping their loved one in the hospital setting, prepares them to return home.
“The ARC program allows both the patient and the family member to work together regularly on things they will need to do at home – while having the support of the entire rehab team to ask questions of or work through concerns that come up,” Archer Silveria said. “When they leave us, they already know what to expect.”
The ARC program also helps family members to feel like they are part of their loved one’s care and rehab journey, Archer Silveria explained.
“I learned how to help transfer him from the bed into a wheelchair, put on the gait belt, hold the belt while he is walking with the walker, and help get him over the step into the shower,” Julie said. “I feel pretty confident, but I would not have been if they had not been training me.”
Julie said she was supported every step of the way by the team at the Broward Health Rehabilitation Institute.
“They are so professional and so kind, and someone was always checking on us,” said Julie, adding that Carlos Acosta, a personal care assistant who has been at the hospital for 28 years, made a huge difference in their experience.
Facing New Challenges and Moving Forward
The whole experience was initially a bit of a shock for Julie who was at the hospital every day from 7:30 a.m. to 6 p.m. with her husband, and then went back to a hotel by herself.
“At home, I didn’t ever go anywhere by myself, and here I was thrown into Ft. Lauderdale staying in a hotel by myself and learning how to use Uber,” said Julie said.
Sam and Julie were both eager to get back home to Bella Vista, Arkansas, and see their family and friends. They have an adult son who was back home and taking care of their two Boston terrier dogs.
Looking back on his experience, Sam offers some advice for other patients who are facing a challenging stroke recovery. First and foremost, keep a positive mental attitude, he says.
“Listen and pay attention to everything your therapist tells you; I know it’s hard, but it’s in your best interest,” Sam said. “The team here is so professional and helpful, and they will help you get through this.”
He also recommends carefully choosing a rehab center. Broward Health Rehabilitation Institute is the only “Advanced Accredited Inpatient Rehab” in northern Broward County.
“The whole staff was amazing – from the minute I walked in the front door to my last day here,” Sam said.
Sam and Julie live in a community with multiple lakes and golf courses and hundreds of miles of bike trails and scenic woods. Their home is on a lake, and they enjoy fishing and kayaking. Sam is an avid bow-hunter; although, he’s left-handed and has not yet regained full control of his left arm since his stroke.
Sam is continuing rehab via home health back in Arkansas. They know their journey won’t be easy, but they are motivated by the incredible progress Sam has made so far.
“We got this,” said Julie.
The mission of Broward Health is to provide quality health care to the people we serve and support the needs of all physicians and employees.