'Time is brain'
As he often does late at night, retired biology professor Frank Lang rolled out of bed at his home in Ashland to go to the bathroom.
"Old guys get up a lot during the night," he observed with his trademark humor. "So I wake up, get out of bed and suddenly find myself flopping around on the floor."
When Suzanne, his wife of 52 years, called out to him, his reply was mumbled.
"He couldn't get up — and I couldn't get him up," she said.
She called 911.
Frank, 74, who taught biology at what is now Southern Oregon University for more than 30 years and is the author of the popular "A Nature Notes Sampler" book, had suffered a stroke.
It was 1:30 a.m. Dec. 15, 2010.
Paramedics from Ashland Fire & Rescue arrived quickly, whisking him to Rogue Valley Medical Center in Medford.
A clot in his right carotid artery had blocked the blood flow to his brain. He could not see out of his left eye, let alone sense the left side of his body. His legs were rubbery; his thoughts jumbled.
A stroke begins killing brain cells within minutes of striking a victim, said Dr. Oscar Sanchez, neurologist and medical director of the primary stroke center at RVMC.
"If the blood pressure stops in that blood vessel, the blood vessel closes," he said. "The nerve cells can't be without oxygen more than four to 12 minutes."
In fact, human brains on the average lose an estimated 8.7 hours of life for every second of a stroke, according to stroke experts. At that rate, the brain loss is 3.6 years of life for every hour a stroke is left untreated, they estimate.
In Frank's case, swift action by his wife, the ambulance crew and the stroke team at RVMC minimized the adverse effects, according to medical experts at the facility.
While the medical community once could do little for stroke patients, it now has the ability to intervene, recognizing that "time is brain," Sanchez said.
"We are getting more and more aggressive," Sanchez said. "We want to act very quickly because we now understand that if we can minimize the length of time the neurons are not receiving blood, we are going to have a better outcome."
Medical interventions include clot-busting drugs as well as surgery to remove blockages such as plaque in arteries, he said, adding that physical and mental therapy are also essential in the rehabilitation process.
The Langs were told that, on a scale from one to 10 with the latter being the worst, Frank's stroke was about six.
"I've traveled to places like Argentina and Tasmania," Frank Lang said. "I've often wondered what would have occurred if my stroke had happened in Patagonia. I might be pushing up daises in the pampas."
Only 36 percent of Americans live near a hospital designated as a primary stroke center. Local residents have the facility at RVMC as well as the Carl Brophy Stroke Program at Providence Medford Medical Center.
Lang, whose relaxing voice is familiar to Jefferson Public Radio listeners as the reader of "Nature Notes," figures he was in relative good health before the stroke.
"I've always done a lot of hiking and mountain biking," he said. "I used to run the tail off my students during field trips. I played soccer into my 50s. Of course, I didn't start until I was in my 40s."
Yet he had a heart arrhythmia problem for years and was taking a blood thinner to prevent a clot in the heart muscle.
"The stroke was pretty shocking," Suzanne said, noting they had expected the blood thinner to ward off a blocked artery.
"We were doing the right things," she added. "It just kind of snuck up on us."
As a couple, they consciously tried to make his stroke a positive learning experience.
They had met at Oregon State University, where he received a bachelor's degree in botany. He earned a master's degree from the University of Washington, where she graduated with a bachelor's degree in business. He later achieved a doctorate's degree in botany from the University of British Columbia.
They have two adult children, Amy and Tom, both of whom live in the Seattle area.
But the stroke tested the Langs' mettle.
Frank initially received lifesaving drugs to restore blood flow to his brain. Surgery was later performed to remove the blockage in his carotid artery.
Recovery was incremental.
"When I was first in the hospital, I would eat and think I finished eating, then turn my head and see the whole left side of my plate still had food on it," he said of his initial inability to see out of his left eye.
But full sight gradually returned. He spent three weeks in RVMC's rehabilitation center, working with speech, physical and occupational therapists.
Like most stroke patients, he had trouble with planning strategies, said speech therapist Hilary Anderson.
"It was cognition — memory, attention, problem solving, sequencing," she said. "It is very common with stroke patients.
"But Frank did very well in a short amount of time," she added. "He was also very determined. We find if patients are hardworking, determined and have a lot of support from family and friends, they often do very well in recovery."
The therapists also pushed him hard, knowing it was crucial to his recovery, Frank said.
"Do you know the difference between a terrorist and physical therapist? You can negotiate with a terrorist," he joked.
He acquired an iPad for brain exercises, relying on lumosity.com and other sites to build his mental muscles.
"I'm a pretty patient guy about stuff," he said. "That may come from being in the classroom so many years and being asked the same questions endless times."
That patience was sorely needed, he acknowledged.
"A big accomplishment was learning to use a zipper again," he said.
"Remember when you couldn't cut your meat?" Suzanne asked.
"Oh yeah, and it's still a little problem," he replied, noting the limited use of his left hand.
He was given a knife shaped like a tiny scimitar that allows him to cut his food with one hand.
"My left arm hung for quite a while — I couldn't move it," he said. "My hand also swelled big time.
"But now I can scratch the back of my head with that arm," he added, then demonstrated his recovered ability.
Learning to dress again was a major hurdle on the road to recovery.
"It was really hard for him to get his clothes on at first," she said. "Getting his arm through a sleeve was very difficult. Getting his pants pulled up was hard for him to do. But it has all gotten so much better."
"It still takes me f-ing forever to get anything done," he offered.
The stroke also placed added pressures on Suzanne.
"He would go twice a week to rehab," she said of outpatient therapy at RVMC. "But our church, bless their hearts, jumped right in, put together a schedule and helped with all that driving."
Members of the Trinity Episcopal Church in Ashland drove him to and from his therapy appointments for several months, she said.
"That was amazing they did that for us," she said, adding their son and daughter also helped immensely. "I always had someone here so I was very fortunate in that way."
But her husband believes he was the fortunate one, thanks to family, friends and medical professionals.
"My advice for everyone is to have a plan in the event something like this happens," he said. "They should plan where they are going and who to call. No dithering."
Still, he equates the recovery to that of a bouncing ball.
"You drop the ball which hits the floor and bounces back up," he said. "But guess what? It never bounces back as high each time.
"I think recovery for a lot of illnesses is like that as you get older."
But the ball sometimes bounces all the way back for some stroke patients, Sanchez said.
"In some cases, you can't believe that the patient after a very large stroke is able to go back and essentially function at the level the way they were before," the neurologist said.
Back at the comfortable Lang home in Ashland, Frank can often be seen walking — without a limp — with their dog, Rupert, a West Highland white terrier with a penchant for barking at deer.
"Frank walks the dog two or three times a day," she said. "He's a little slower at it but it's one of things he's back doing."
He has also returned to driving, albeit he had to exchange his vehicle with a stick shift to one with an automatic transmission. And he is working out in a local gym that caters to folks over 55.
Since Frank's stroke, the couple have hiked the two-mile, round-trip Plaikni Falls Trail in Crater Lake National Park.
He is back reading and writing, including a column periodically in the Jefferson Monthly and entries for the online Oregon Encyclopedia.
"All things considered, I'm doing well," Frank said.
The Langs know there are still challenges ahead, but figure they are surmountable.
"One of us is a little stubborn," Suzanne said with a smile.
"I like to call it persistence," he said.
Reach reporter Paul Fattig at 541-776-4496 or email him at firstname.lastname@example.org.