New Treatment reduces disability?(Re: General Shelton)

[Sue Pendleton]

This is too long to post so you all might want tto save this to your hard drives before the Post sends it to their archives.

http://www.washingtonpost.com/wp-dyn...2002Sep24.html

Has anyone else heard of this blood pressure intervention? Seems all but one person I know with central cord syndrome ultimely winds up walking and getting quite a bit of strength back in their arms too. Do I just know the lucky ones?

Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying,
"I will try again tomorrow."

[This message was edited by seneca on Sep 26, 2002 at 03:19 PM.]

[Max]

Topic: His Spinal Cord Injury Was Serious. But Gen. Hugh Shelton Has Backbone.
Max

Member posted Sep 25, 2002 07:08 PM
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Marching Orders
His Spinal Cord Injury Was Serious. But Gen. Hugh Shelton Has Backbone.

By Bradley Graham
Washington Post Staff Writer
Wednesday, September 25, 2002; Page C01


Only moments earlier, Hugh Shelton -- retired four-star Army general, former chairman of the Joint Chiefs of Staff, die-hard paratrooper and grandfather of six -- had been perched on a ladder behind his Fairfax house. Now he lay on the ground, unable to move most of his body.

Raised on a North Carolina farm, Shelton, 60, was accustomed to doing his own yardwork. On this Saturday morning in March, he had headed out back to trim a big oak and a smaller tree nearby.

Work on the oak went easily, and the smaller tree appeared to offer little challenge. Located in a neighbor's yard, the tree had a three-inch thick limb that dipped over a fence onto Shelton's property.

Shelton propped a metal ladder against the tree and, carrying a 16-inch chain saw, climbed about 10 feet up. He started to cut the limb, expecting it to fall away to the left. But a dead branch resting on top of the limb drove it straight down. The limb crashed into one of the ladder's extension arms, flipping the ladder around the tree.

Shelton felt himself falling. He glanced down and saw the four-foot-high chain-link fence coming up rapidly. To avoid straddling it, he pulled his feet together quickly, as he had been taught to do as a paratrooper. His feet caught the fence, propelling him headfirst toward the ground.

He felt no immediate pain. But he couldn't breathe. He tried for air but couldn't seem to get any. He thought to himself: "Well, this is it. I'm on my way out now. It's all over."

Then suddenly his breath started coming back. He lay there for a few seconds thanking God he was able to breathe. He was on his side, resting on his left elbow. He tried to move but only his right shoulder budged. Realizing that he had injured himself badly, he stopped and remained still, not wanting to do any further damage.

It was about 10:30 a.m. and the temperature was a chilly 40-some degrees. Shelton was dressed in the warmest jacket he had -- a nylon parka with a sweat shirt lining. About every five minutes, he would holler, "Help, I need help!" But his voice was weak and his wife, Carolyn, who was in the house about 25 feet away, didn't hear him.

He thought about Christopher Reeve, the actor who had been paralyzed after breaking his neck during an equestrian accident in 1995. Shelton, like Reeve, had been in prime physical condition, and while Reeve had played Superman in the movies, Shelton had gained a daredevil reputation as an enthusiastic paratrooper in real life.

"What irony this is," he thought as he lay there. "I've got 400 jumps, some from a 20,000-foot range at night, in the dead of night, with an oxygen mask on, unable to see anything down below on the ground at the moment of leaving the plane. And I had walked away from them all basically unscathed."

During 38 years in the military, including two combat tours in Vietnam and another in the Persian Gulf War, Shelton had never suffered anything worse than a broken ankle. A towering 6-foot-5 figure accustomed to daily four-mile jogs, he had never spent a day in a hospital.

"The great concern I had was, how badly was I hurt?" Shelton said recently, recounting publicly for the first time an ordeal he calls the fight of his life. "And the main thing I was wondering was, how long am I going to have to lie here before someone finally hears me hollering?"

Shelton stayed motionless for about 40 minutes before a neighbor, who had gone outside to smoke, heard his pleas and notified Carolyn. Rushing outside with a cordless phone in her hand, Carolyn confirmed that her husband, though immobile, was still conscious and coherent. Then she phoned 911 and an emergency rescue team arrived quickly, put a brace around Shelton's neck and took him to Inova Fairfax Hospital.

There, after an MRI scan and other tests, a doctor approached Shelton, who was flat on his back, staring at the lights in the ceiling. Shelton has no memory of the doctor's name.

"I need to give you the bad news right now," the doctor told him. "I've looked at your MRI results. I've seen a lot of these injuries, and I need to tell you, you're probably never going to walk again and you're probably never going to be able to use your hands."

Shelton couldn't believe that a doctor was rendering such a definite assessment so quickly and so bluntly. He remembers glancing at the doctor's name tag -- "to make sure it didn't say 'God.' "

A Second Opinion
No sooner had the Fairfax doctor spoken than two physicians from Walter Reed Army Medical Center in Washington -- Lt. Col. Jim Ecklund, the chief neurosurgeon, and Col. Dave Polly, the chief orthopedic surgeon -- appeared in the emergency room. They had been ordered to the hospital by Walter Reed's commander, Lt. Gen. Harold Timboe, an old friend of the Sheltons whom Carolyn had phoned for advice.

The doctors arranged for Shelton to be flown by helicopter to Walter Reed, where he arrived in the middle of the afternoon. After more tests, Shelton, hooked up to what he calls a "Christmas tree" rack of medicines and nutrients being fed intravenously, received a briefing on the extent of his injury:

Ecklund explained that the fall had damaged several bones at the back of the neck. Shelton had been predisposed to injury there as a result of cervical stenosis, a narrowing of the bony canal through which the spinal cord runs. His many jumps and other jolts had led to a buildup of calcium deposits.

There was no fracture to the spinal column, no broken neck bones. But the injury had compressed the laminae -- the outer part of the vertebral arch -- against the spinal cord, creating a condition known as central cord syndrome.

Unlike the doctor at Fairfax, Ecklund offered no prognosis, only diagnosis. He knew the chances of Shelton's ever walking again were slim, but the last thing he wanted to do was take away his patient's hope.

"You are injured, but it's very early," he told Shelton. "There's a whole spectrum of recovery potential. I can't predict where you'll end up on the continuum. I can't repair or replace dead cells. What I can do is make the environment for healing as optimum as possible."

Shelton appreciated that Ecklund was not ruling out substantial recovery. "If God will just give me something to work with, I'll overcome as much of this as I possibly can," he thought to himself.

Ecklund advised Shelton that surgery eventually would be necessary to relieve the compression of the spine. The injury was not life-threatening, so Shelton could take some time to see how much natural healing might occur, he said. By then, it was about 7 p.m.

An hour or so later, Ecklund returned to Shelton's bed in Walter Reed's intensive-care unit, accompanied by several others, including Lt. Col. Geoff Ling, a neurologist with ICU training, and Maj. Jeremy Blanchard, head of the ICU. They offered Shelton a treatment that wasn't exactly experimental but hadn't become standard procedure either.

It involved raising his blood pressure and keeping it high for the next day or two. Research on animals and limited use on humans indicated that the procedure could improve recovery in spinal cord injury cases. By forcing blood in and around injured tissue, it might give the damaged cells a greater chance to survive.

But pushing up Shelton's blood pressure created a risk of stroke or heart failure. Shelton conferred with his wife.

"In my opinion, the game favors the bold," he told her. "If we really want to maximize the chances of recovery, it's better to take this risk. I've got a good, strong, healthy heart. I'm not concerned about a heart attack. You never know about a stroke, but I'd say let's take that chance, let's get on with it." Carolyn quickly concurred.

Within minutes, Shelton was being fed neosynephrine, the same agent in nasal sprays, to raise his blood pressure. From an average base level of about 80, his pressure was boosted in increments of 10. At each new level, doctors would check for improvement -- and were encouraged to see slight movement in his arms and legs.

"We pushed his pressure up pretty high, to the point where he got no more improvement -- something around 130," Ling said.

Throughout that first night in the hospital, Shelton dozed on and off. He figured he was lucky to have gotten to Walter Reed quickly and to have encountered doctors familiar with this blood pressure treatment. "The chips are falling in place," he thought.

But the next day he still found himself unable to do much of anything without help. He had to rely on others to feed him, brush his teeth, raise him up in bed. He was beginning to get some movement in his left leg and could raise his left arm, but he felt incredibly weak and his right side remained inert. He tried repeatedly to lift his right leg or wiggle his toes, but nothing would happen. He would strain until his brow began to sweat.

The doctors kept coming in with requests like: "Try to squeeze my hand. Let's see you try to pick that leg up. Move your right toes." After the third day, Shelton dreaded seeing the neurosurgeons, knowing what they would be asking of him again.

For the first three days, much of the world remained unaware of Shelton's accident. Not until Tuesday, March 26, did the hospital issue a statement reporting that Shelton was in "serious condition but resting comfortably" after sustaining a spinal injury during a fall.

That night, CNN reported that doctors attending Shelton expected a full recovery. Ecklund saw the report while seated next to Shelton.

"I wonder where they got that news," Shelton said to Ecklund in disbelief. Ecklund's assessment at the time was that full recovery, while possible, was hardly likely.

First Steps to Recovery
The challenge of getting Shelton out of bed and moving fell to a young physical therapist, Army Lt. Zack Solomon. Tall, athletic and energetic, Solomon established an easy rapport with Shelton, even as he insistently pressed ahead with an exercise routine that stretched his patient's limits. Before the first week was out, Solomon had Shelton on his feet, propped up by a giant walker and shuffling across the room.

"For him to take even a single step, especially with this right leg, required three people -- two to hold him up and one to advance his leg," Solomon recalled. "But he ended up actually taking steps out of the ICU, probably about 10 feet."

Shelton thought Solomon was crazy for imagining that he could walk. "He obviously hadn't talked to that doctor in Fairfax," he mused.

But each day, Solomon would return and urge Shelton to go farther than he had gone the day before. His progress started being noted in weekly news releases. A week after his injury, the hospital reported that Shelton was making "slow progress" and had walked "several steps with assistance." Two weeks later, Shelton was reported to have "actually walked more than 300 feet this morning for the first time."

Shelton didn't appreciate such specificity in the public reports because people would now be expecting him to walk farther each week. He asked that future statements reveal less information.

Carolyn Shelton would have preferred that more detail be disclosed about her husband's progress, given the number of people interested in his case. Shelton himself could not believe the avalanche of letters, phone calls and visit requests triggered by the announcement of his accident. They came from around the world and from many people he did not even know. Two wealthy friends passed word to him that whatever long-term rehabilitation and special care he might need, not to worry, they would pay for it.

Because Shelton still lacked the strength in his hands to hold a phone, he wasn't taking calls. He also declined most visit requests, wanting to focus his limited energy on his therapy sessions. But some people he felt obliged to see: former president Bill Clinton, former defense secretary Bill Cohen, Jordan's King Abdullah, Joint Chiefs Chairman Gen. Richard Myers, Army Chief of Staff Gen. Eric Shinseki, Army vice chief Gen. John Keane, several former aides and a few other close friends, including actress Connie Stevens.

Falling Pressure
Several early setbacks underscored the fragility of Shelton's condition. One occurred at the end of his first week, the day after he was transferred from the ICU to a ward reserved for VIPs. He awoke feeling weaker than usual, although Solomon insisted that he try getting out of bed. No sooner had Shelton stood up than he felt perspiration break out and his head go light. Realizing he was about to faint, he dropped back into bed, blacking out briefly, then coming to, then blacking out again, then coming to again, then falling unconscious a third time. At that point, a nurse declared a "redbird" alert, summoning medical staff from all over the hospital.

The next thing Shelton knew, he was on his back looking up at what appeared to be about 20 people standing around the bed, most of whom were doctors, many of whom were perspiring because they had run, some of them up two or three flights of stairs. They were firing questions at him: "What's your name? Who are you? Where are you? What's your birth date? What's your wife's name? How many kids do you have?"

Shelton responded with a slight smile: "Guys, I'm Hugh Shelton, general of the U.S. Army, retired, former chairman of the Joint Chiefs. I'm here in Walter Reed and I just fainted and now I feel fine." Shelton found the situation somewhat comical. His doctors did not.

Shelton had fainted because his blood vessels were not constricting properly when he stood, a lack of control common in spinal cord injury patients.

From then on, when he worked out, he was ordered to wear compression stockings and an abdominal bind to compress his muscles and maintain his blood pressure. "Dressing for the game," he called it.

He also was required to have a cardiologist in his room, equipped with atropine, a substance frequently carried by troops in the field to counter exposure to nerve agents. And sure enough, the next day when he rose, he again felt faint. At which point the cardiologist quickly injected the atropine.

His heart and blood pressure weren't the only worries. On April 7 he awoke with considerable stomach pain. By early afternoon he was having difficulty breathing. Mary Maniscalco-Theberge, the chief surgeon at Walter Reed, showed up to examine him.

"What's your pain level?" she asked.

"About a 7.5," he replied, with 10 being the worst.

Another doctor in the room advised Maniscalco-Theberge that Shelton had a reputation for being stoical, so if he was saying 7.5, it was probably more like 12.

Maniscalco-Theberge suspected a blood clot in the lungs -- a life-threatening condition. A CAT scan confirmed it, and Shelton was put on the blood thinners heparin and warfarin. Within an hour or two, the pain was gone. But the clotting episode together with the fainting spells meant that no operation to decompress the spine could be scheduled for weeks.

General Improvement
As he continued his physical therapy with Solomon, steadily increasing his walking distances, Shelton began occupational therapy with Army Capt. Charles Quick. This therapy was intended to teach alternative ways of managing regular daily activities, using such adaptive equipment as forks with enlarged grips or shoehorns with long handles. Shelton, though, was reluctant to start practicing with such aids. He told Quick that he wanted to concentrate on building up the strength in his arms and hands to use regular utensils again, not special ones.

"Walking quads" -- that's the nickname given patients like Shelton suffering from central cord syndrome. It refers to the fact that the syndrome often affects the upper extremities more than the lower ones. Indeed, in Shelton's case, the therapists were seeing more progress in his legs than his arms, noticing in particular that he tended to walk without swinging his arms.

To work on Shelton's gait, Solomon and Quick hit on the idea one day in late April of teaming up and trying to get Shelton from the main hospital building, where he had been doing his therapy, to a gym on the hospital grounds about 100 yards away. There, he could use a cross-country training machine that would move his feet and arms together. Also, the therapists figured, Shelton would enjoy the shift to a regular workout area and the opportunity for more strenuous exercise.

But some senior doctors were nervous about letting Shelton go out. They insisted that he travel to the gym in a van. On the first day, the time it took to load Shelton on and off the van and drive around the hospital grounds -- escorted by a police car -- reduced his therapy time. So the next day, Solomon and Quick simply rolled him out of the hospital in a wheelchair and got him to hike over to the gym. From then on, he would spend one of two therapy sessions a day either at the gym or in the hospital pool, and the other in his hospital room.

Shelton did not want to slow down. The more strenuous the exercise, he figured, the better. Every time he was made to hurt, he would tell himself it was necessary for him to recover his strength and endurance. The more his therapists asked, the more he tried to do to show them he was up for whatever they could devise -- and then some.

Indeed, the medical team marveled at Shelton's determination. They also were amazed that he never appeared depressed, although on some days he did seem in a better mood than on others. Early on, Ecklund had talked with Shelton about the likelihood of feeling some depression. He shared with Shelton stories of the emotional downs of other prominent hospital patients. But Shelton, by all accounts, remained remarkably resilient.

Throughout his life he had focused on succeeding at whatever he did. He knew that this time he faced an uphill battle, but giving up without a fight made no sense to him. Expressions of hopelessness, like the Fairfax doctor's prediction that he would never walk, he turned to his advantage, thinking of the satisfaction he would feel to be able to prove that doctor wrong.

He appreciated the constant encouragement he received from the medical staff at Walter Reed. Every bit of progress he made, no matter how small or incremental, was greeted with the kind of cheering that made Shelton feel as if he had just finished the Marine Corps Marathon.

Most significantly, he found reassurance -- and a larger purpose to his battle -- in remarks from family members and friends who repeatedly told him that if anyone could overcome the kind of injury he suffered, he could. He did not want to let down those who had expressed such confidence in him.

An Overnight Pass
On April 27, Shelton was allowed to leave the hospital for an overnight trip home. He still needed to use a wheelchair and a walker around the house. And he slept in a recliner on the ground floor rather than try to get up the stairs to his bedroom. He did little more than watch TV, read a little and look at some mail before returning to Walter Reed the next day. But he had shown he could get home and back safely.

Subsequent weekend visits home grew longer and longer as he became stronger and more ambulatory, graduating from a walker to a four-legged cane to a regular cane to no cane. Deciding when to do the surgery on Shelton's neck depended in large part on how he was progressing. His doctors felt that the longer he could recover naturally, the better.

What type of surgery to perform also was in question. The Walter Reed team favored an approach called a laminectomy and instrumented fusion. It involves removing several of the back pieces of the ring of bone that surrounds the spinal cord -- in Shelton's case, the laminae C3 through C6, which had been compressed. Titanium screws are then inserted on the sides of the spinal column and connected with rods, while the removed laminae are ground up and added to the joints around the screws. The screws and rods are intended to provide support until the bone particles can fuse into place.

But Shelton was urged by a friend to consult a physician at Emory University, John Heller, who suggested a somewhat different approach, called a laminoplasty. This involves widening the column instead of taking the back off it completely. Such an approach, Heller argued, might allow more neck motion and decrease the chance of complications. Ultimately, Shelton decided to go with the Army doctors because he had confidence in Ecklund and figured follow-up care would be easier to manage at Walter Reed.

The operation took place on May 28 and lasted 2 hours 45 minutes. Shelton felt immediate improvement. Gone were some arm and leg spasms that had bothered him. Within a few days, his physical and occupational therapy resumed, focusing on the weaknesses that remained in his right arm and hand.

An Honorable Discharge
In early June, Maj. Michael Rosner, who as chief resident of the neurosurgery service had coordinated much of Shelton's care, showed up to say goodbye before leaving for a fellowship at Northwestern Memorial Hospital in Chicago. He talked about how pleased he was with Shelton's progress, noting that a very low percentage of patients with spinal cord injuries recover as much as Shelton had.

"What percentage?" asked Shelton, who often tried to get his doctors to be more specific.

Rosner didn't like percentages, but he reluctantly gave Shelton one.

"If you want to say 1 percent -- although no one really has any numbers -- it's probably a very realistic assessment," the doctor said. "You can tell people that you're that 1 percent that everyone holds out hope for."

Shelton was stunned. He had known the odds against recovery had been considerable, but he hadn't realized just how considerable.

Shelton left the hospital on June 13, in time to make an annual family trip with his three children, six grandchildren, mother and wife to a beach house in Emerald Isle, N.C. A Walter Reed statement, announcing Shelton's discharge, noted that he "walked unassisted" from the hospital.

Shelton has returned to work, resuming the life of a corporate executive, on which he had embarked after leaving the military last autumn. He holds a full-time job as president of international operations for Reston-based MIC Industries, maker of steel-forming machines used in the rapid construction of buildings. He also sits on the boards of Anheuser-Busch, Anteon and Pro2Serve, advises Northrop Grumman and gives frequent speeches.

He still attends therapy sessions at Walter Reed when in town and carries strength-building gear with him when traveling. His right side remains weaker than his left, but the strength and dexterity there are gradually returning, mirroring the earlier progress he made on his other side.

Doctors say he may never fully regain the strength he had before the accident. But he continues to believe he can get most if not all of it back.

"My long-term goal is to start running again," he said. "Whether or not I get there remains to be seen. But you've got to set a goal somewhere."

Asked to explain the reasons for Shelton's unusual recovery, his doctors cited several factors: His excellent health at the outset. The prompt care he received at Fairfax in stabilizing his injury. The blood pressure treatment he underwent his first night at Walter Reed. The therapy with Solomon and Quick. His own determined, upbeat attitude. The support he got from Carolyn, who remained by his side during his time in the hospital. And the constant encouragement he received from many friends.

"I don't think anyone will be able to give you a truly accurate answer for why he was able to recover as he did because no one really knows," Rosner said. "A lot of it, to be honest with you, is probably luck. He just had a lot going for him. This guy shouldn't be back at work. It's absolutely amazing."



© 2002 The Washington Post Company

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"It was once written "To thine own self be true". But how do we know who we really are? Every man must confront the monster within himself, if he is ever to find peace without. .." Outer Limits(Monster)



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"It was once written "To thine own self be true". But how do we know who we really are? Every man must confront the monster within himself, if he is ever to find peace without. .." Outer Limits(Monster)

[Sue Pendleton]

What would we do without you? Thanks Max!

Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

[Max]

Topic: Marching Orders: The General Who Walked Away
James Kelly
Member posted Sep 26, 2002 12:43 AM
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Marching Orders
His Spinal Cord Injury Was Serious. But Gen. Hugh Shelton Has Backbone.

By Bradley Graham
Washington Post Staff Writer
Wednesday, September 25, 2002; Page C01


Only moments earlier, Hugh Shelton -- retired four-star Army general, former chairman of the Joint Chiefs of Staff, die-hard paratrooper and grandfather of six -- had been perched on a ladder behind his Fairfax house. Now he lay on the ground, unable to move most of his body.

Raised on a North Carolina farm, Shelton, 60, was accustomed to doing his own yardwork. On this Saturday morning in March, he had headed out back to trim a big oak and a smaller tree nearby.

Work on the oak went easily, and the smaller tree appeared to offer little challenge. Located in a neighbor's yard, the tree had a three-inch thick limb that dipped over a fence onto Shelton's property.

Shelton propped a metal ladder against the tree and, carrying a 16-inch chain saw, climbed about 10 feet up. He started to cut the limb, expecting it to fall away to the left. But a dead branch resting on top of the limb drove it straight down. The limb crashed into one of the ladder's extension arms, flipping the ladder around the tree.

Shelton felt himself falling. He glanced down and saw the four-foot-high chain-link fence coming up rapidly. To avoid straddling it, he pulled his feet together quickly, as he had been taught to do as a paratrooper. His feet caught the fence, propelling him headfirst toward the ground.

He felt no immediate pain. But he couldn't breathe. He tried for air but couldn't seem to get any. He thought to himself: "Well, this is it. I'm on my way out now. It's all over."

Then suddenly his breath started coming back. He lay there for a few seconds thanking God he was able to breathe. He was on his side, resting on his left elbow. He tried to move but only his right shoulder budged. Realizing that he had injured himself badly, he stopped and remained still, not wanting to do any further damage.

It was about 10:30 a.m. and the temperature was a chilly 40-some degrees. Shelton was dressed in the warmest jacket he had -- a nylon parka with a sweat shirt lining. About every five minutes, he would holler, "Help, I need help!" But his voice was weak and his wife, Carolyn, who was in the house about 25 feet away, didn't hear him.

He thought about Christopher Reeve, the actor who had been paralyzed after breaking his neck during an equestrian accident in 1995. Shelton, like Reeve, had been in prime physical condition, and while Reeve had played Superman in the movies, Shelton had gained a daredevil reputation as an enthusiastic paratrooper in real life.

"What irony this is," he thought as he lay there. "I've got 400 jumps, some from a 20,000-foot range at night, in the dead of night, with an oxygen mask on, unable to see anything down below on the ground at the moment of leaving the plane. And I had walked away from them all basically unscathed."

During 38 years in the military, including two combat tours in Vietnam and another in the Persian Gulf War, Shelton had never suffered anything worse than a broken ankle. A towering 6-foot-5 figure accustomed to daily four-mile jogs, he had never spent a day in a hospital.

"The great concern I had was, how badly was I hurt?" Shelton said recently, recounting publicly for the first time an ordeal he calls the fight of his life. "And the main thing I was wondering was, how long am I going to have to lie here before someone finally hears me hollering?"

Shelton stayed motionless for about 40 minutes before a neighbor, who had gone outside to smoke, heard his pleas and notified Carolyn. Rushing outside with a cordless phone in her hand, Carolyn confirmed that her husband, though immobile, was still conscious and coherent. Then she phoned 911 and an emergency rescue team arrived quickly, put a brace around Shelton's neck and took him to Inova Fairfax Hospital.

There, after an MRI scan and other tests, a doctor approached Shelton, who was flat on his back, staring at the lights in the ceiling. Shelton has no memory of the doctor's name.

"I need to give you the bad news right now," the doctor told him. "I've looked at your MRI results. I've seen a lot of these injuries, and I need to tell you, you're probably never going to walk again and you're probably never going to be able to use your hands."

Shelton couldn't believe that a doctor was rendering such a definite assessment so quickly and so bluntly. He remembers glancing at the doctor's name tag -- "to make sure it didn't say 'God.' "

A Second Opinion

No sooner had the Fairfax doctor spoken than two physicians from Walter Reed Army Medical Center in Washington -- Lt. Col. Jim Ecklund, the chief neurosurgeon, and Col. Dave Polly, the chief orthopedic surgeon -- appeared in the emergency room. They had been ordered to the hospital by Walter Reed's commander, Lt. Gen. Harold Timboe, an old friend of the Sheltons whom Carolyn had phoned for advice.

The doctors arranged for Shelton to be flown by helicopter to Walter Reed, where he arrived in the middle of the afternoon. After more tests, Shelton, hooked up to what he calls a "Christmas tree" rack of medicines and nutrients being fed intravenously, received a briefing on the extent of his injury:

Ecklund explained that the fall had damaged several bones at the back of the neck. Shelton had been predisposed to injury there as a result of cervical stenosis, a narrowing of the bony canal through which the spinal cord runs. His many jumps and other jolts had led to a buildup of calcium deposits.

There was no fracture to the spinal column, no broken neck bones. But the injury had compressed the laminae -- the outer part of the vertebral arch -- against the spinal cord, creating a condition known as central cord syndrome.

Unlike the doctor at Fairfax, Ecklund offered no prognosis, only diagnosis. He knew the chances of Shelton's ever walking again were slim, but the last thing he wanted to do was take away his patient's hope.

"You are injured, but it's very early," he told Shelton. "There's a whole spectrum of recovery potential. I can't predict where you'll end up on the continuum. I can't repair or replace dead cells. What I can do is make the environment for healing as optimum as possible."

Shelton appreciated that Ecklund was not ruling out substantial recovery. "If God will just give me something to work with, I'll overcome as much of this as I possibly can," he thought to himself.

Ecklund advised Shelton that surgery eventually would be necessary to relieve the compression of the spine. The injury was not life-threatening, so Shelton could take some time to see how much natural healing might occur, he said. By then, it was about 7 p.m.

An hour or so later, Ecklund returned to Shelton's bed in Walter Reed's intensive-care unit, accompanied by several others, including Lt. Col. Geoff Ling, a neurologist with ICU training, and Maj. Jeremy Blanchard, head of the ICU. They offered Shelton a treatment that wasn't exactly experimental but hadn't become standard procedure either.

It involved raising his blood pressure and keeping it high for the next day or two. Research on animals and limited use on humans indicated that the procedure could improve recovery in spinal cord injury cases. By forcing blood in and around injured tissue, it might give the damaged cells a greater chance to survive.

But pushing up Shelton's blood pressure created a risk of stroke or heart failure. Shelton conferred with his wife.

"In my opinion, the game favors the bold," he told her. "If we really want to maximize the chances of recovery, it's better to take this risk. I've got a good, strong, healthy heart. I'm not concerned about a heart attack. You never know about a stroke, but I'd say let's take that chance, let's get on with it." Carolyn quickly concurred.

Within minutes, Shelton was being fed neosynephrine, the same agent in nasal sprays, to raise his blood pressure. From an average base level of about 80, his pressure was boosted in increments of 10. At each new level, doctors would check for improvement -- and were encouraged to see slight movement in his arms and legs.

"We pushed his pressure up pretty high, to the point where he got no more improvement -- something around 130," Ling said.

Throughout that first night in the hospital, Shelton dozed on and off. He figured he was lucky to have gotten to Walter Reed quickly and to have encountered doctors familiar with this blood pressure treatment. "The chips are falling in place," he thought.

But the next day he still found himself unable to do much of anything without help. He had to rely on others to feed him, brush his teeth, raise him up in bed. He was beginning to get some movement in his left leg and could raise his left arm, but he felt incredibly weak and his right side remained inert. He tried repeatedly to lift his right leg or wiggle his toes, but nothing would happen. He would strain until his brow began to sweat.

The doctors kept coming in with requests like: "Try to squeeze my hand. Let's see you try to pick that leg up. Move your right toes." After the third day, Shelton dreaded seeing the neurosurgeons, knowing what they would be asking of him again.

For the first three days, much of the world remained unaware of Shelton's accident. Not until Tuesday, March 26, did the hospital issue a statement reporting that Shelton was in "serious condition but resting comfortably" after sustaining a spinal injury during a fall.

That night, CNN reported that doctors attending Shelton expected a full recovery. Ecklund saw the report while seated next to Shelton.

"I wonder where they got that news," Shelton said to Ecklund in disbelief. Ecklund's assessment at the time was that full recovery, while possible, was hardly likely.

First Steps to Recovery

The challenge of getting Shelton out of bed and moving fell to a young physical therapist, Army Lt. Zack Solomon. Tall, athletic and energetic, Solomon established an easy rapport with Shelton, even as he insistently pressed ahead with an exercise routine that stretched his patient's limits. Before the first week was out, Solomon had Shelton on his feet, propped up
by a giant walker and shuffling across the room.

"For him to take even a single step, especially with this right leg, required three people -- two to hold him up and one to advance his leg," Solomon recalled. "But he ended up actually taking steps out of the ICU, probably about 10 feet."

Shelton thought Solomon was crazy for imagining that he could walk. "He obviously hadn't talked to that doctor in Fairfax," he mused.

But each day, Solomon would return and urge Shelton to go farther than he had gone the day before. His progress started being noted in weekly news releases. A week after his injury, the hospital reported that Shelton was making "slow progress" and had walked "several steps with assistance." Two weeks later, Shelton was reported to have "actually walked more than 300 feet this morning for the first time."

Shelton didn't appreciate such specificity in the public reports because people would now be expecting him to walk farther each week. He asked that future statements reveal less information.

Carolyn Shelton would have preferred that more detail be disclosed about her husband's progress, given the number of people interested in his case. Shelton himself could not believe the avalanche of letters, phone calls and visit requests triggered by the announcement of his accident. They came from around the world and from many people he did not even know. Two wealthy friends passed word to him that whatever long-term rehabilitation and special care he might need, not to worry, they would pay for it.

Because Shelton still lacked the strength in his hands to hold a phone, he wasn't taking calls. He also declined most visit requests, wanting to focus his limited energy on his therapy sessions. But some people he felt obliged to see: former president Bill Clinton, former defense secretary Bill Cohen, Jordan's King Abdullah, Joint Chiefs Chairman Gen. Richard Myers, Army Chief of Staff Gen. Eric Shinseki, Army vice chief Gen. John Keane, several former aides and a few other close friends, including actress Connie Stevens.

Falling Pressure

Several early setbacks underscored the fragility of Shelton's condition. One occurred at the end of his first week, the day after he was transferred from the ICU to a ward reserved for VIPs. He awoke feeling weaker than usual, although Solomon insisted that he try getting out of bed. No sooner had Shelton stood up than he felt perspiration break out and his head go light. Realizing he was about to faint, he dropped back into bed, blacking out briefly, then coming to, then blacking out again, then coming to again, then falling unconscious a third time. At that point, a nurse declared a "redbird" alert, summoning medical staff from all over the hospital.

The next thing Shelton knew, he was on his back looking up at what appeared to be about 20 people standing around the bed, most of whom were doctors, many of whom were perspiring because they had run, some of them up two or three flights of stairs. They were firing questions at him: "What's your name? Who are you? Where are you? What's your birth date? What's your wife's name? How many kids do you have?"

Shelton responded with a slight smile: "Guys, I'm Hugh Shelton, general of the U.S. Army, retired, former chairman of the Joint Chiefs. I'm here in Walter Reed and I just fainted and now I feel fine." Shelton found the situation somewhat comical. His doctors did not.

Shelton had fainted because his blood vessels were not constricting properly when he stood, a lack of control common in spinal cord injury patients.

From then on, when he worked out, he was ordered to wear compression stockings and an abdominal bind to compress his muscles and maintain his blood pressure. "Dressing for the game," he called it.

He also was required to have a cardiologist in his room, equipped with atropine, a substance frequently carried by troops in the field to counter exposure to nerve agents. And sure enough, the next day when he rose, he again felt faint. At which point the cardiologist quickly injected the atropine.

His heart and blood pressure weren't the only worries. On April 7 he awoke with considerable stomach pain. By early afternoon he was having difficulty breathing. Mary Maniscalco-Theberge, the chief surgeon at Walter Reed, showed up to examine him.

"What's your pain level?" she asked.

"About a 7.5," he replied, with 10 being the worst.

Another doctor in the room advised Maniscalco-Theberge that Shelton had a reputation for being stoical, so if he was saying 7.5, it was probably more like 12.

Maniscalco-Theberge suspected a blood clot in the lungs -- a life-threatening condition. A CAT scan confirmed it, and Shelton was put on the blood thinners heparin and warfarin. Within an hour or two, the pain was gone. But the clotting episode together with the fainting spells meant that no operation to decompress the spine could be scheduled for weeks.

General Improvement

As he continued his physical therapy with Solomon, steadily increasing his walking distances, Shelton began occupational therapy with Army Capt. Charles Quick. This therapy was intended to teach alternative ways of managing regular daily activities, using such adaptive equipment as forks with enlarged grips or shoehorns with long handles. Shelton, though, was
reluctant to start practicing with such aids. He told Quick that he wanted to concentrate on building up the strength in his arms and hands to use regular utensils again, not special ones.

"Walking quads" -- that's the nickname given patients like Shelton suffering from central cord syndrome. It refers to the fact that the syndrome often affects the upper extremities more than the lower ones. Indeed, in Shelton's case, the therapists were seeing more progress in his legs than his arms, noticing in particular that he tended to walk without swinging his arms.

To work on Shelton's gait, Solomon and Quick hit on the idea one day in late April of teaming up and trying to get Shelton from the main hospital building, where he had been doing his therapy, to a gym on the hospital grounds about 100 yards away. There, he could use a cross-country training machine that would move his feet and arms together. Also, the therapists
figured, Shelton would enjoy the shift to a regular workout area and the opportunity for more strenuous exercise.

But some senior doctors were nervous about letting Shelton go out. They insisted that he travel to the gym in a van. On the first day, the time it took to load Shelton on and off the van and drive around the hospital grounds -- escorted by a police car -- reduced his therapy time. So the next day, Solomon and Quick simply rolled him out of the hospital in a wheelchair
and got him to hike over to the gym. From then on, he would spend one of two therapy sessions a day either at the gym or in the hospital pool, and the other in his hospital room.

Shelton did not want to slow down. The more strenuous the exercise, he figured, the better. Every time he was made to hurt, he would tell himself it was necessary for him to recover his strength and endurance. The more his therapists asked, the more he tried to do to show them he was up for whatever they could devise -- and then some.

Indeed, the medical team marveled at Shelton's determination. They also were amazed that he never appeared depressed, although on some days he did seem in a better mood than on others. Early on, Ecklund had talked with Shelton about the likelihood of feeling some depression. He shared with Shelton stories of the emotional downs of other prominent hospital patients. But Shelton, by all accounts, remained remarkably resilient.

Throughout his life he had focused on succeeding at whatever he did. He knew that this time he faced an uphill battle, but giving up without a fight made no sense to him. Expressions of hopelessness, like the Fairfax doctor's prediction that he would never walk, he turned to his advantage, thinking of the satisfaction he would feel to be able to prove that doctor wrong.

He appreciated the constant encouragement he received from the medical staff at Walter Reed. Every bit of progress he made, no matter how small or incremental, was greeted with the kind of cheering that made Shelton feel as if he had just finished the Marine Corps Marathon.

Most significantly, he found reassurance -- and a larger purpose to his battle -- in remarks from family members and friends who repeatedly told him that if anyone could overcome the kind of injury he suffered, he could. He did not want to let down those who had expressed such confidence in him.

An Overnight Pass

On April 27, Shelton was allowed to leave the hospital for an overnight trip home. He still needed to use a wheelchair and a walker around the house. And he slept in a recliner on the ground floor rather than try to get up the stairs to his bedroom. He did little more than watch TV, read a little and look at some mail before returning to Walter Reed the next day. But he had
shown he could get home and back safely.

Subsequent weekend visits home grew longer and longer as he became stronger and more ambulatory, graduating from a walker to a four-legged cane to a regular cane to no cane. Deciding when to do the surgery on Shelton's neck depended in large part on how he was progressing. His doctors felt that the longer he could recover naturally, the better.

What type of surgery to perform also was in question. The Walter Reed team favored an approach called a laminectomy and instrumented fusion. It involves removing several of the back pieces of the ring of bone that surrounds the spinal cord -- in Shelton's case, the laminae C3 through C6, which had been compressed. Titanium screws are then inserted on the sides of the spinal column and connected with rods, while the removed laminae are ground up and added to the joints around the screws. The screws and rods are intended to provide support until the bone particles can fuse into place.

But Shelton was urged by a friend to consult a physician at Emory University, John Heller, who suggested a somewhat different approach, called a laminoplasty. This involves widening the column instead of taking the back off it completely. Such an approach, Heller argued, might allow more neck motion and decrease the chance of complications. Ultimately, Shelton decided to go with the Army doctors because he had confidence in Ecklund and figured follow-up care would be easier to manage at Walter Reed.

The operation took place on May 28 and lasted 2 hours 45 minutes. Shelton felt immediate improvement. Gone were some arm and leg spasms that had bothered him. Within a few days, his physical and occupational therapy resumed, focusing on the weaknesses that remained in his right arm and hand.

An Honorable Discharge

In early June, Maj. Michael Rosner, who as chief resident of the neurosurgery service had coordinated much of Shelton's care, showed up to say goodbye before leaving for a fellowship at Northwestern Memorial Hospital in Chicago. He talked about how pleased he was with Shelton's progress, noting that a very low percentage of patients with spinal cord injuries recover as much as Shelton had.

"What percentage?" asked Shelton, who often tried to get his doctors to be more specific.

Rosner didn't like percentages, but he reluctantly gave Shelton one.

"If you want to say 1 percent -- although no one really has any numbers -- it's probably a very realistic assessment," the doctor said. "You can tell people that you're that 1 percent that everyone holds out hope for."

Shelton was stunned. He had known the odds against recovery had been considerable, but he hadn't realized just how considerable.

Shelton left the hospital on June 13, in time to make an annual family trip with his three children, six grandchildren, mother and wife to a beach house in Emerald Isle, N.C. A Walter Reed statement, announcing Shelton's discharge, noted that he "walked unassisted" from the hospital.

Shelton has returned to work, resuming the life of a corporate executive, on which he had embarked after leaving the military last autumn. He holds a full-time job as president of international operations for Reston-based MIC Industries, maker of steel-forming machines used in the rapid construction of buildings. He also sits on the boards of Anheuser-Busch, Anteon and
Pro2Serve, advises Northrop Grumman and gives frequent speeches.

He still attends therapy sessions at Walter Reed when in town and carries strength-building gear with him when traveling. His right side remains weaker than his left, but the strength and dexterity there are gradually returning, mirroring the earlier progress he made on his other side.

Doctors say he may never fully regain the strength he had before the accident. But he continues to believe he can get most if not all of it back.

"My long-term goal is to start running again," he said. "Whether or not I get there remains to be seen. But you've got to set a goal somewhere."

Asked to explain the reasons for Shelton's unusual recovery, his doctors cited several factors: His excellent health at the outset. The prompt care he received at Fairfax in stabilizing his injury. The blood pressure treatment he underwent his first night at Walter Reed. The therapy with Solomon and Quick. His own determined, upbeat attitude. The support he got from Carolyn, who remained by his side during his time in the hospital. And the constant encouragement he received from many friends.

"I don't think anyone will be able to give you a truly accurate answer for why he was able to recover as he did because no one really knows," Rosner said. "A lot of it, to be honest with you, is probably luck. He just had a lot going for him. This guy shouldn't be back at work. It's absolutely amazing."

© 2002 The Washington Post Company

James Kelly
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Posts: 224 | From: Granbury, Texas, USA | Registered: Jul 24, 2001

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"It was once written "To thine own self be true". But how do we know who we really are? Every man must confront the monster within himself, if he is ever to find peace without. .." Outer Limits(Monster)

[Sue Pendleton]

"An hour or so later, Ecklund returned to Shelton's bed in Walter Reed's intensive-care unit, accompanied by several others, including Lt. Col. Geoff Ling, a neurologist with ICU training, and Maj. Jeremy Blanchard, head of the ICU. They offered Shelton a treatment that wasn't exactly experimental but hadn't become standard procedure either.

It involved raising his blood pressure and keeping it high for the next day or two. Research on animals and limited use on humans indicated that the procedure could improve recovery in spinal cord injury cases. By forcing blood in and around injured tissue, it might give the damaged cells a greater chance to survive.

But pushing up Shelton's blood pressure created a risk of stroke or heart failure. Shelton conferred with his wife."

This is the part of the article I was talking about. Anyone heard of this?

Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

[bill j.]

Sue, I read about the blood pressure treatment in this article and wondered about it, too. I had never heard of it or seen it discussed on these forums. They give a list of reasons why he may have recovered, but once again MP is left off the list (I am assuming he got a dose).

[Wise Young]

Sue & bill, maintaining blood pressure after spinal cord injury is standard procedure, practiced in almost every U.S. trauma center for both brain and spinal cord injury for the past decade. The goal is to maintain CPP (central perfusion pressure) to the brain and spinal cord after injury. CPP is one of the primary determinants of brain and spinal cord blood flow. In addition, may trauma centers will institute a dopamine drip (which causes vasodilation), as well. Wise.

[This message was edited by Wise Young on Sep 30, 2002 at 12:26 PM.]

[Sue Pendleton]

Dopamine use has been used according to several reports of people pulled from the surf down at Ocean City so I'm assuming that our state police evac helicopter crews begin that as well as the methylprednisolone. Bill, Fairfax Inova is one of the best hospitals in this area to get sent to for stabilization and halo surgery (if needed). They have a TON of experience in this particular area of the anatomy.

Wise, I may have read the article wrong but I understood they boosted his blood pressure above normal rather than just maintain it as they had to do later with the jabs of atropine. The original article said, " Within minutes, Shelton was being fed neosynephrine, the same agent in nasal sprays, to raise his blood pressure." I remember being asked about drugs like ephidrine when I had my spinal stroke. It seems they can cause strokes on rare occassions in otherwise healthy people. Anyway, I took the article as saying they forced his BP up to try and enlarge the space between his cord and the laminae.

Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

[bill j.]

Sue, that's what I understood, too. They explained the risk of stroke to him and then he and his wife decided to raise his blood pressure to high levels. The article I read said after his consent, they raised it from 80 to as high as they dared, 130 or so. It was a risk the general wanted to take to prevent more spinal injury.