At the tender age of 15, Edgar Fuentes immigrated with his family from Mexico to the United States. He learned a new language, immersed himself in the American way of life and at the age of 19, moved to Fort Collins in 1999.

When terrorists attacked the United States on Sept. 11, 2001, Fuentes went to an Army recruiting station that day and joined the military. His wife was seven months pregnant at the time with their daughter. He served three tours in Iraq, missing out on a lot of time with his family, including the birth of their second child.

Eight years in the Army changed him, and when he returned for good to his wife and children in Fort Collins, he carried the burdens of war. He fought depression and memories of combat. A decade later, he’d again face an enemy that would try to take his life. With help from a squadron of family members and caregivers from UCHealth, he would again narrowly escape death.

A lifelong weightlifter who stands 6-foot-2, Edgar is an imposing figure. He’s a man’s man, a warrior who values family above all. For 20 years, he slept alongside his wife, but on that Halloween morning 2019, his wife, Jessi, became alarmed when she felt his absence.

Her husband had a bad spell of nausea and had staggered out of the bedroom. Edgar usually didn’t get up before his wife and three kids, so Jessi went to check on him.

“He wasn’t feeling good and was wondering when urgent care opened,” Jessi said.  “I was more annoyed than anything that this was going to distract us from the day.”

Edgar laid back down.

“The next thing I know, he was throwing up uncontrollably by the bed not even able to get to the bathroom,” Jessi said. “The next thing I know Edgar was talking to our son, telling him he hoped he’d been a good dad. I was like, ‘Why is he talking about this now? We are going to the ER.’”

Jessi knew they need to get to UCHealth Poudre Valley Hospital. Edgar knew too. He thought he was telling Jessi how he was feeling but nothing was coming out.

“It was the first time I could hear his speech slurring, and he couldn’t keep his balance. Everything was little off,” she said. Jessi called 911.

Recognizing a stroke

At the hospital, an MRI showed vertebral artery dissection (VAD), a tear of the inner lining of the vertebral artery, which is located in the back of the neck and supplies blood to the brain. After a tear, blood enters the arterial wall and forms a blood clot, impeding blood flow.

Edgar went to the ICU, where he was monitored while more tests were done.  About 2% of all ischemic strokes are caused by VAD, though it is increasingly becoming a leading cause of ischemic stroke in young and otherwise healthy patients, as was the case for Edgar.

Too young and too healthy for a stroke

After his years in the military, the family moved from a military base in Colorado Springs to Fort Collins. They had their third baby and Jessi got a job with Colorado State University and her husband worked as a tech in the surgical unit at PVH before he began delivering orthopedic and neurosurgery supplies for DePuy, a Johnson & Johnson Co.

With a growing family, going to the gym and working out became a favorite activity for Edgar and Jessi.

“We date at the gym,” Jessi said. “We really love going together, and it helped Edgar with his depression. It was a way to reset his mind.”

The spontaneous nature of a vertebral dissection

The same place that gave him peace and kept him happy, though, may have contributed to his stroke.

“A lot of these (vertebral dissections) happen spontaneously,” said Dr. Sean Pauzauskie, a neurologist at UCHealth who helped treat him. “The only thing in Edgar’s history is that he worked out in the gym a lot.”

A majority of vertebral dissections are caused by trauma, but there is evidence that they can be caused by hyperextension or rotation of the neck during events such as yoga, chiropractic manipulation, or even painting a ceiling when neck movement, most often sudden, causes an injury to the neck’s artery.

“Arteries in the neck are vulnerable to tear,” Pauzauskie said. “It appeared that one in (Edgar’s) neck had developed a tear and a clot, and part of that clot traveled up into the back part of the brain area that’s important for maintaining consciousness, which is why we needed to do whatever we could to get that clot out of the area.”

Treating a vertebral dissection

Pauzauskie cared for Edgar, who had been intubated and sedated, after he arrived at the hospital on that Halloween morning. Scans showed that his basilar artery in the back part of the brain was blocked. Pauzauskie started him on Heparin, a heavy blood thinner that could help shrink the clot.

“The basilar travels up the brain stem and is part of the nervous system that keeps us awake,” Pauzauskie said. “So a stroke in that area makes the person appear sleepy and they struggle to maintain consciousness. It’s very debilitating — there are a lot of important things going on there.

“It could have been fatal honestly,” he said. “It could have stroked that entire brainstem and he would have not woken up from that. He would have been able to breathe but not be able to wake.”

If the clot didn’t shrink, Pauzauskie knew, Edgar may need a thrombectomy, a well-established and highly effective treatment for acute ischemic strokes. He called his colleagues at UCHealth University of Colorado Hospital on the Anschutz Medical Campus.

“Our system is great,” Pauzauskie said of UCHealth. “It’s all streamlined with stroke coordinators and directors, and a developed process where we have a chain of communication that begins with the identifying providers and neurology service, then DocLine getting us connected with the stroke and vascular neurologists at Anschutz.

“When there is enough possibility that this procedure could help the patient — typically when there is still salvageable tissue but the patient is clinically deteriorating, which was the case with Edgar, then we are greenlighted for transport. It’s very seamless and efficient.”

Stroke care at Anschutz Medical Campus

Edgar was flown to Anschutz. When he got there, the clot had dissipated and a thrombectomy wasn’t necessary. Doctors continued to watch for swelling in his brain, and Jessi educated herself on her husband’s new condition.

“I spent a lot of time learning from all the doctors there,” she said.

Sedated, Fuentes still managed to write a few words — a smirk comment toward Jessi after she insensitively enjoyed her morning coffee in front of her intubated husband.

“I still knew his sense of humor was still there,” Jessi said, describing it as a bit ornery yet playful humor. “He was able to give signs that he was still there. I didn’t know what was going to happen, where we were going to go from there, but I knew he was still him.”

Stroke rehabilitation program at PVH

Four days later, doctors began talking with Jessi about the next steps.

“PVH had just opened its rehab,” Jessi said. “We have three kids, if we can go back to Fort Collins, that’s by far the best for us — it was a complete blessing for us.”

Back at PVH, Edgar began inpatient physical, occupational and speech therapy.

“The care was phenomenal,” Jessi said. “The kids could stop by. We could keep them in school and go back and forth, and do things as normal as possible.”

“We had a lot of laughs, but some days in rehab you don’t feel like doing much,” Edgar said. “Those are the days you need to make yourself go for a walk. I don’t want to hurt today, so today is the day I need to do it.”

Jessi had a hard time watching her husband struggle.

“One of the hard things is watching Edgar in the recovery phase. From an outside perspective, that’s a lonely world. No matter what we do, what your support system is, it’s got to be hard to be in midlife and having to learn things again.”

But Edgar persevered.

“One of the first things I learned is to quit comparing to what I use to be,” he said. “Building those neuro pathways is a big deal. It does take time. Having people, the stories, things, whatever it is to motivate because every person is different, every day is different. You’ll have that day.”

He built his strength, remembering what a recovering stroke patient who visited him in the hospital had told him while he still lay in his bed at University of Colorado Hospital. (Patients who have recovered from stroke return to the hospital as volunteers to encourage hospitalized patients as part of a UCHealth program).

“It was a lady that had her stroke when she was young, like 21, and I realized it happens to a lot more people than I had thought,” Edgar said. “Seeing she’d recovered, there was hope: ‘Maybe I can get back to a normal life.’”

Setbacks and side effects after a stroke

A few weeks into his rehab, while progressing well, Edgar had a setback.

On Nov. 19, 2019, Jessi got a call at work. “Edgar wasn’t good. He was throwing up all the time and (PVH) did another MRI,” she said. “He had bleeding on his brain again.”

Acutely ruptured dissections are unstable and tend to rebleed. Luckily, the bleed was happening in brain tissue that had already died and, therefore, didn’t cause any more damage. Edgar, thankfully, still had his humor.

“Good thing I have a big head,” he joked, as Jessi ribbed that he must have been looking for another helicopter ride since he hadn’t remembered the first.

Again, he was flown to Anschutz and stabilized. A few days later, he returned to PVH inpatient rehab, where he and his family spent Thanksgiving.

“The nurses let us use the break room and it is something we will remember for the rest of our life,” Jessi said.

Taking a break from it all

Before his stroke, the family had planned a trip to Hawaii to celebrate their wedding anniversary and their oldest daughter’s high school graduation. The family considered canceling the December vacation, but Edgar wanted to make it to Hawaii, a special place for him. So the inpatient rehab team helped him meet that goal.

Still in a wheelchair and learning how to walk again, his inpatient rehab team simulated challenges he would face, including walking down the aisle of an airplane.

“That was the best thing that we ever did,” Jessi said. “That’s where he really started to recover and heal.”

Edgar agreed. “It was really good for me, but it was also really good for the kids and Jess to get away from things. You can’t stop living; you just live differently.”

Recovering from a stroke during a pandemic

He soon graduated from inpatient rehab and began outpatient rehab. He faced a new challenge in the novel coronavirus pandemic. Fuentes’ sanctuary — the gym — was now closed.

“Not seeing the PT or the OT; not knowing what to do; not knowing if you’d get better,” Edgar said. “Then that fear factor, adding a different layer of complexity.”

Jessi said she saw him have a lot more “low days” during that time when he couldn’t go to the gym. He was profoundly afraid of getting COVID-19 after he’d had the experience of being intubated. His family accepted his concerns.

“I had to put myself in his shoes,” Jessi said. “He’s coming from a very different perspective, and I have to honor that. He has a different fear from it.”

Post stroke: A new perspective

Recovery is challenging. With English as a second language, Edgar focuses a lot on his speech, and he’s hired a physical trainer to help him in the gym.

“There are huge recovery steps and milestones with the first months and then it tapers off,” Jessi said. “The lesson is, when it flat lines, look at those little wins.”

A month ago, Fuentes worked a full work week without needing a mid-week break and the family celebrates when he doesn’t need to take a midday nap.

The whole experience has given him a new perspective on life.

“If anything, I enjoy life a lot more,” he said. “I make fun of things more. I don’t worry about things anymore. I try not to let them stress me out anymore.

“Pre-stroke, I was depressed and dealing with PTSD,” he continued. “I’d have conversations with Jessi saying, ‘I don’t understand why I don’t enjoy life.’

Life after the stroke, he said, is very different.

“I see how it affects everyone and not just me. It’s great when something like this completely alters your perspective. When you know the pros and cons of life, you get your blessings pointed out very quickly. It’s a slap across the head, I feel like: ‘Here is what we need to pay attention to, and here are the important things.’”