Hair loss Treatment Center

PARTICIPANTS Arthur Cruz Patient Angelina Cruz Caregiver Reggie Richardson Patient Nan Richardson Caregiver Gerard Franscisco, MD University of Texas Health Science Center Cindy Ivanhoe, MD Assistant Professor of Physical Medicine and Rehabilitation, Baylor College of Medicine

ARTHUR CRUZ: About 6:00 in the morning I left for work and I couldn't feel good. I just fell down.

ANGELINA CRUZ: I guess for about a month, a month and a half, he was paralyzed. He couldn't move. He couldn't talk. They had to re-teach him how to speak, how to brush his teeth.

ANNOUNCER: The same life changing experience happened to Reggie Richardson.

REGGIE RICHARDSON: The stroke occurred in January of 1994. I was 52 then. I was right in the peak of my career. I'm a CPA. Partner in one of the largest firms in the world. I have two real interests in life, one was my business, I clearly love working with clients and the second I really enjoy doing is playing golf. The stroke adversely affected both of those.

ANNOUNCER: After having a stroke both Cruz and Richardson, had to face what many patients soon encounter--post stroke spasticity.

GERARD FRANCISCO, MD: Spasticity is a condition that is characterized by muscle tightness and spasm. It is one of the common complications after any stroke or traumatic brain injury.

CINDY IVANHOE, MD: That tightness can interfere with how people move. When that develops they find they can't open their hands to clean them or they can't hold a hairbrush or they can't reach for things or they have difficulty walking. There are some typical movement patterns that we see in patients who have spasticity, where their fingers may be flexed, their wrists flexed, their shoulders may turn inward, their elbows can be flexed. In the leg we see their toes tend to point down and their foot tends to turn inward. These are all things that interfere with their function.

ANGELINA CRUZ: I just remember him not using his hand at all you know at first. It just was very limp.

REGGIE RICHARDSON: The thing the stroke affected the most is my ability to use my right side.

ANNOUNCER: Untreated, spasticity may greatly interfere with a patient's quality of life.

ANGELINA CRUZ: It changes the way you feel about life. It changes the home, you know, because he took care of all of us, you know. I had to become the caretaker. I had to be the one that took care of the family and him.

REGGIE RICHARDSON: I clearly battled from a little bit of depression about it, so it was very disappointing to me not to be able to do what I could always do before.

NAN RICHARDSON: It was very frustrating to see someone who was so physically active and so assertive and very ambitious and being able to do so many things, that he accomplished suddenly to have to start over.

ANNOUNCER: Many patients often wonder if there are any treatment options available to help them.

GERARD FRANCISCO, MD: If you asked me that question ten years ago I would hesitate because back then there were only a few options for treating spasticity. Nowadays we have a lot of options. We have new oral medications. We have new medications that can be given through injections, and we have other surgical techniques.

If it involves only a few muscles and involves only one or two limbs, then most likely I would recommend local treatments such as phenol injections or injection of botulinum toxin, which is commercially available as Botox A® or Myoblock®.

ANNOUNCER: Doctors have found that injections of Botox can relax muscles, contracted by stroke. Initially after his stroke, Arthur Cruz received Botox treatments. He got the injections every three months for about six years.

ANGELINA CRUZ: It would help you open up your hand right?

ARTHUR CRUZ: Yes, yes.

ANGELINA CRUZ: Because your hand would be so tight.

ARTHUR CRUZ: All the time.

ANGELINA CRUZ: You couldn't even get your fingers inside

ARTHUR CRUZ: You can't even open up.

ANGELINA CRUZ: So after the Botox at least he would have some of his release. His hands would be normal.

GERARD FRANCISCO, MD: The advantage of using injection therapy is that the effects are limited. Therefore it only one or two limbs are affected by spasticity, then these treatment options are superior to the others, the reason being you will not need to give the person a drug that will affect the entire body. It will only effect the muscles that are injected.

ANNOUNCER: While the injections worked for Arthur Cruz's hand, his leg was another issue. It would often cause him severe pain. So another treatment was tried.

GERARD FRANCISCO, MD: Intrathecal baclofen therapy involves the surgical implantation of the pump, which is roughly the size of a tuna can or a hockey puck. This pump is implanted under the skin in the abdominal area and is connected to a catheter that then goes directly into the spinal canal. The medication which is contained in the pump is delivered and it goes directly into the spinal canal.

ANGELINA CRUZ: He got an ITB pump and it helped him a lot. It helped him walk a lot better. He doesn't have that pain like you used to.

REGGIE RICHARDSON: We chose the ITB because I knew that it would help me get back to my feet. For three years I was in a wheelchair. And now I'm out and about motoring on my own, under my own power. Granted it's with the use of a cane, but that's better than not motoring at all, I suppose.

ARTHUR CRUZ: I can cook. I go make coffee in the morning. I go outside, feed my dog and sometimes go outside just to walk around.

ANNOUNCER: Unfortunately not every stroke patient with spasticity receives treatment to alleviate their symptoms.

CINDY IVANHOE, MD: They don't know that there are treatments available or their physicians don't know that there are treatments available. Many physicians have a bias and therapists as well, that patients should just be glad they survived and accept what they have and for a lot of patients that's not enough. But that bias keeps patients from accessing appropriate care.

GERARD FRANCISCO, MD: I think that the attitude of people with strokes and health care professionals about spasticity should change. It should not be looked upon as a problem that is just a natural accompaniment of a stroke rather it is a symptom that can be treated and can actually enhance the way someone is functioning.

ANNOUNCER: With the current treatments available, stroke patients now have a chance to improve their muscle movements, and greatly enhance their lifestyle, even if they can't completely reverse their condition.

GERARD FRANCISCO, MD: These medications were not designed to give them back their strength or make them normal once again. That is not the goal of this treatment. Rather the goal of the treatment is to control the symptom of spasticity to make them more functional and to help them recover as much as they could.

My advice to people with stroke and their caregivers is to seek medical advice. If they have any questions at all about what else can be done for them in order to improve their recovery from a stroke, the best thing to do is to ask their health care professional.

ANGELINA CRUZ: You know there's a lot of downs, you know to this, but there's also a lot of ups. You just have to find them and you just make the best of what's there and you get through it.