If you are ever feeling down about life, try spending time with Jeff Greve.
The stroke two and a half years ago robbed Jeff of some of his physical function but not his spirit. Greve is the kind of person who makes a lasting impression, according to the medical team that cared for him. After his rehabilitation was completed, his physical and occupational therapists often join Greve for Sunday runs. He often returns to the hospital, not for care, but to help in the care of others.
“I was down at first (after my stroke) and I know others are too,” said the now 60-year-old Greve. “But I want to transfer that positivity to people. That’s what it takes. That’s what it took for me.”
When a hemorrhagic stroke occurs
Greve, who shares a home with Kyle, his 25-year-old grandson, was in an upstairs bathroom when he collapsed to the floor on Jan. 28, 2018.
“I remember wondering, ‘Why did that happen?’ And I tried to get up, but I couldn’t,” he said. “My mind was super coherent, and I could tell I was having a stroke, but Kyle said I was mumbling.”
A stroke is a “brain attack,” said Leigh Creighton, coordinator of the UCHealth Stroke Program in northern Colorado.
“A stroke happens when a blood vessel either gets blocked or breaks open. Surrounding brain tissue begins to die because it cannot get the oxygen and nutrients it needs,” she said. “Brain cells start to die within minutes. Because brain tissue is rapidly damaged as a stroke progresses, the sooner you get help the better the chances your brain will recover.”
Kyle called 911 and UCHealth EMS arrived within three minutes, Greve said. “It was an amazing start to everything.”
Because “time is brain,” UCHealth EMS is specially trained to recognize and care for patients with stroke symptoms.
“Even before the patient arrives at the hospital, EMS is communicating with the team in the emergency room,” Creighton said. “When the patient arrives, the stroke team is immediately ready to quickly assess, diagnose and provide eligible patients with time-sensitive treatment.”
“I remember being whisked away,” Greve said. “In my mind I remember clearly being wheeled in the gurney and seeing the hospital, but after that it is a blur.”
Two types of strokes
There are two kinds of strokes: hemorrhagic, when a blood vessel bursts, or ischemic, when a blood vessel is blocked. In the latter, patients can receive a drug, such as tPA, that can help break up the blood clot causing the stroke. It needs to be delivered by IV within three hours of symptoms. That’s why calling 911 as soon as you recognize symptoms is so important, Creighton said.
Ischemic strokes account for about 85% of cases, said Dawn Eeten, physician assistant at UCHealth Neurology Clinic – Fort Collins. But Greve experienced a massive bleed (hemorrhagic), most likely caused by his high blood pressure.
Hemorrhagic strokes are treated differently than ischemic strokes — “Rapid treatment, like tPA for ischemic strokes, cannot be used. Instead, the treatment involves careful monitoring and control of pressure within the skull over time. Supportive care and control of blood pressure is also critical.” Eeten said.
“With a hemorrhagic stroke, we are looking at and responding to the growing size of the bleed and the swelling, which can push on other areas of the brain,” she explained. “The first 48 hours of treatment is important, and the severity of symptoms can change a lot depending not only on the size and location of the bleed, but on the swelling and pressure.”
After several days on the intensive care unit, Greve moved onto the neurology care unit, and a week after his stroke, he began inpatient rehabilitation.
Working toward normalcy after a hemorrhagic stroke
Greve struggled with his new reality. He didn’t want to believe that the right side of his body no longer followed his commands. But he slowly began to fall into a routine at the hospital with rehabilitation.
“I’ve always had a positive attitude, but Sarah Wild seized on it and got it going again,” Greve said.
Wild, an acute rehab therapist, worked regularly with Greve.
It was hard going, but Greve knew he couldn’t give up.
“Although my right side didn’t work, I knew I did not want to be confined to a wheelchair,” he said. “When I finally could walk, I felt like Rocky. I was really slow and awkward, but I felt like Rocky.”
Greve moved through his recovery and in the hospital’s gym, he practiced different challenges he might face at home, such as stairs, opening car doors, and getting in and out of the shower.
“Jeff would often say or give me a look like, ‘You want me to do what?’ when I would challenge him with a new task,” Wild recalled. “But he always worked very hard.”
When Greve was ready to go home, Wild assessed his living quarters, making sure everything was safe and that he’d have a successful transition.
Returning home after a hemorrhagic stroke
Before his stroke, Greve had been doing a few half-marathons and though he didn’t compete enough “to be good at it,” he said, it was something he really enjoyed — and he wasn’t willing to give it up.
The summer after he got out of the hospital, he began walking with his trekking poles for balance and eventually worked his way up to traversing miles at a time. But he still felt he had limitations imposed on him by his stroke that he needed to address, including a pain that would shoot up his right side.
Neuropathic pain is caused by damage to the brain’s pain-processing pathways. For Greve, the stroke reduced his sensations. When the brain is used to receiving normal sensory inputs and then doesn’t, it produces painful sensations. He was told it may never go away.
“I was OK with that too. That’s the main thing to remember: Everything that happens is not the end of the world,” he said. “I was mad because I couldn’t do anything, but I went back to PT and OT to see what I could do.”
There, he began working with UCHealth physical therapist Sarah Lenneman and occupational therapist Christine Heess.
Seeking more therapy after hemorrhagic stroke treatment
“Jeff was so motivated to get better,” Lenneman said.
With his body weight supported by a lift, Lenneman had Greve moving on a treadmill to smooth out his movements when he walked. By making the body move in a normal way again, it helped alleviate his pain. She had to break Greve from his pattern of movement caused by the stroke and teach him safer ways to move.
The two therapists created a home exercise plan and therapy tasks to work on, which Greve would do alongside his 5-year-old grandson, who playfully challenged him in the driveway to see who could do the tasks with better form and balance.
“Greve is a joy to be around,” Lenneman said. “If you look at the whole span of his recovery, he’s never lost hope. He’s always had a positive attitude.”
After working with the therapy team for several months, Lenneman and Heess had reached a point where they’d given Greve all the tools they could — he was ready to graduate from outpatient therapy.
“We asked him what he wanted to do on his last day and he said he wanted to run two miles. So that is what we did, and he did great,” Lenneman said.
Never giving up, years after a hemorrhagic stroke
But it didn’t stop there; the trio decided they enjoyed running together.
Every Sunday there was a standing invitation for the therapists to join Greve on his run. The recent pandemic halted their get-togethers for a while, but they’ve started up again, keeping physical distance but still motivating each other to stay active.
“Patients usually see their biggest improvement soon after their stroke and then taper off,” Lenneman said. “But Jeff didn’t take no for an answer, and it just shows what the brain and body and do. That it can still make progress.
“Jeff always chooses these great runs, and he always notices the wonderful things in the world — he’s so gracious. It’s his perseverance that’s taken him so far.”
“And his positive outlook and love for life,” Heess added.
Two years after his stroke, Greve finished the Winter Sun run 10K in Moab, Utah. It was a race he’d done many times before his stroke. It was an achievement he’ll admit he wasn’t sure he’d accomplish, but credits the support of his family and UCHealth in his success.
“It’s because of all the people that helped me out — they all helped me get better. I truly believe that I wouldn’t have progressed as well or be able to be where I am today without every single person at UCHealth that was part of my recovery,” he said. “They brought positivity to everything I did and that made me want to move forward.”
The feeling is reciprocal, according to his health care team.
“It is such a joy to see Mr. Greve in follow-up at our neurology clinics,” Eeten said. “He is an inspiration to our team.”
Returning the favor
Two years after his stroke, Greve decided he wanted to give back and joined SSTAR, Stroke Survivors Taking Aim at Recovery.
Through the volunteer program, Greve meets one-on-one with stroke patients and their families. Because of COVID-19, volunteer programs are currently suspended, but Greve looks forward to getting back to helping once restrictions are lifted.
“I miss it a lot — the volunteering — because every person was different, every story is different, every stroke is different. How they would recuperate, and how they would recover, you listen to what they have to say and you let them talk about it if they want,” Greve said.
“They are still them. They are still that person they were before,” he continued. “There may be a new normal, but I personally have seen so much more good in the world since my stroke compared to what I grumbled about before.”