Comeback from a Brain Injury
Andee Poulos returns to school and inspires after a near-miraculous recovery from a brain injury.
Andee Poulos has a sense of humor, and it’s wonderful to witness – like the time a few weeks ago when her occasionally sarcastic father, John, said something a tad devilish about not being able to convince his daughter’s in-home caregiver to work weekends.
“She must not like you,” Andee says to her father from a living room sofa in the family’s home in Atlanta.
With her caregiver in the nearby dining room, a peculiar juxtaposition of characters was at hand as the 17-year-old reflected her father’s playful remark.
It was all the more interesting because, not long ago, Andee didn’t seem to like anyone, and speaking was a lost ability. The comedic timing she displayed in the repartee with her father seemed impossible.
For 20 months or so after experiencing a stroke in January 2011, until shortly after beginning therapy at Shepherd Center, Andee’s constant agitation was a hurdle so high that rehabilitation was nearly futile. After an arteriovenous malformation (AVM) – an abnormal connection between arteries and veins – ruptured in her brain, the eighth-grader seemed frustrated and resistant to help.
Time and again, John and Lyn Poulos had their daughter admitted to hospitals and rehabilitation facilities in Atlanta, Houston and Boston – only to be short-circuited by Andee’s unresponsiveness to treatment.
Her physical limitations were severe: She required a wheelchair and could not speak or eat by mouth. She was difficult to help.
“She was resisting anybody being in her space,” John says.
Look at her now: This past fall, Andee began her freshman year at Riverwood International Charter School in Atlanta. She typically uses a walker, her speech is slightly strained and the functionality on her left side trails the right, but she continues to improve.
Her delayed path of progress is unusual.
Rhonda Taubin, M.D. the Shepherd Center physiatrist who treated Andee as an outpatient, confirmed that Andee was not a strong candidate to be where she is now.
“When I met her the first time, she was already far post-injury, which led you to believe that she would not respond significantly to rehabilitation and therapy,” Dr. Taubin says. “The type of stroke that she had was a bad one. When you get in the cerebellum in the back of the brain, those are some of the most difficult injuries to treat. And she had a lot of behavioral problems that were a real obstacle.”
Andee didn’t feel well on the way to swimming practice on Jan. 4, 2011. By the time Lyn picked up her daughter early and brought her home, Andee had collapsed. She was taken to Children’s Healthcare of Atlanta at Scottish Rite, where doctors inserted a drain called an EVD – external ventricular drain – in her head to drain blood. Two days later, she had surgery at Emory University Hospital.
After 39 days at Emory, Andee returned to Scottish Rite for 10 weeks. Progress in rehabilitation was minimal, and she was discharged in April. At this point, doctors thought the familiarity of home might help awaken her, but again, she continued to decline.
After a brief return to Scottish Rite in June 2011, John, a commercial real estate broker, found Houston’s Healthbridge Children’s Hospital through his research. “We wanted to combine traditional rehab with behavioral therapy, and Healthbridge offered that,” he explains.
From August to December 2011, John and Lyn traded shifts with Andee in Houston and her 7-year-old brother, George, back in Atlanta. Again, progress was minimal.
Following her rehabilitation stay in Houston, the Poulos family reached out to Shepherd, speaking with Dr. Taubin a second time. She began treating Andee on an outpatient basis to manage her medications. Andee also underwent therapy at home.
This approach was moderately productive, but difficult. More research led the family to Spalding Rehabilitation Hospital in Boston from April to June 2012. Again, the parents traded shifts. Andee underwent magnetic brain stimulation and various therapeutic programs in Boston. She began to cooperate in speech therapy, and even started nodding.
Yet upon discharge, “Her [Boston] physiatrist said, ‘I’m not saying there’s not hope, but we’ve done everything we can for her,’” Lyn recalls. “What they did do very eloquently was make us realize that might be the way that life was going to be for Andee forever.”
Or maybe not. The summer of 2012 brought changes.
A few weeks after returning from Boston, Lyn lay in bed with her daughter, holding her, trying, hoping to connect.
“She’s not talking, or crying – maybe screaming, but no tears or facial expressions,” Lyn recalls. “I said: ‘Andee, I’m just trying to figure out if you understand me. What’s one plus one?’ and she held up two fingers. I said, ‘What’s our address?’ And she held up 2-5-5. I started asking more complicated questions.”
Not long after that, another breakthrough came, “I had cooked barbecue chicken that night, when the speech therapist said, ‘Andee, you want any barbecue chicken?’” John recalls. “Andee nodded and then she eats this chicken. You have to remember that she hadn’t eaten anything solid in 20 months. Then we asked Andee: ‘Do you want any sauce? She pointed to various sauces we had and Andee chooses Buffalo Hot Sauce.”
With that recollection, John cuts loose a hardy laugh. It’s a warm memory. More followed.
“Three weeks later, Lyn, George and I had just returned home and we were sitting just like we are now, and our aid said, ‘You know, Andee’s starting to talk now,’” John recalls. “She said, ‘Andee, what’s your brother’s name?’ ‘Geeorrrge!’ Lyn gets her camera and asks Andee to say ‘I love you Mom’and Andee repeats that as well.”
The Poulos family returned to Shepherd Center, eager for their daughter to finally undergo inpatient rehabilitation.
“Andee’s parents wouldn’t take no for an answer,” Dr. Taubin recalls. “I met her on several occasions where we said, ‘She’s not ready for this.’ But I really did see a difference this time and said, ‘We’ve got to get her in here and see if we can make a difference.’”
Once she was admitted as an inpatient and her medication doses were moderated, Andee began emerging as if from a cocoon. Speech, physical and occupational therapies began paying off exponentially relative to earlier attempts. She began gaining strength and independence. She learned to self-propel her wheelchair, feed herself, and her speech improved dramatically. Eventually, through physical therapy, she transitioned to walking with a rolling walker. Andee became more engaged and Shepherd Center therapists carried out an individualized plan of rehabilitation for her.
“One of the biggest pieces to me was the neuropsychology,” Lyn says. “They established goals for Andee. I remember Andee being so tired after therapy, and she was supposed to sit back in her chair before she would go to bed. She wanted to go to bed.
“She would whine and cry, and the therapist would say, ‘Andee, I know you’re unhappy but, what’s your goal?’ She would say, ‘To go back to school.’ He’d say, ‘Well, can you cry in school?’ She would straighten up. It was his connection, establishing a goal and helping her go for that goal.
“That’s what helped her stop whining and crying. She’d hug George where she used to push her brother away. It was so hard on him, and he handled it like a trooper,” Lyn adds.
A few months later, Andee became an outpatient at Shepherd Pathways.
It is impossible to know exactly what prompted Andee’s steeper pace of recovery. Perhaps the magnetic stimulation in Boston opened a door.
Shepherd Center helped push her through, as well, her parents say.
“We believe it was a miracle,” Lyn says. “Andee had a 5 percent chance to survive with the extent of the bleed she had. It’s a miracle that she’s alive.”
John says, “The Lord had a lot to do with it – all the prayers and support.”
More milestones are coming into view.
“It was my goal to go back to school,” Andee says. “And to get back with my friends, to go to college eventually, to eventually drive, to eventually walk on my own and things like that.”
An avid swimmer and softball player, Andee returned to athletics this past fall when she was asked to manage the Riverwood girl’s softball team by a mom of a player and the coach of the team. She even earned a varsity letter as the manager of the team, a goal she has had since she was in middle school.
“All along, Lyn and I and our friends knew she was in there, in that head,” John says. “She couldn’t get out; she just couldn’t break through. She says it was like she was asleep.”
Andee has no memory from a couple days before her injury up to late summer 2012.
She is fully awake now.
“Doctors told us she’d never walk again, or talk again or go to school again,” John says. “Now, she’s a straight A student.”
SIDEBAR: An Army of Support
Adapting to and recovering from an acquired brain injury like the one Andee Poulos, 17, of Atlanta, sustained requires the mobilization of specialists and caregivers, and the benefit of all treatment is multiplied when family and friends mobilize, as well.
“Andee’s Army,” a non-profit organization formed in 2011 (www.andeesarmy.com) by many who have known Andee for years, is a shining example of how a community of love can help.
Lisa Kennedy, whose daughter Erin Kennedy is among Andee’s closest friends, is chair of the board for Andee’s Army, which has come together to help more people and families than just the Pouloses.
Andee’s Army has raised more than $100,000 and distributed financial assistance to more than 30 families with children who have experienced injuries similar to the arteriovenous malformation (AVM) that Andee sustained in January 2011.
“We have families we’ve identified primarily through Children’s Healthcare of Atlanta,” Lisa says. “Some families need emergency financial help for perhaps utilities, household expenses, sometimes transportation because some folks are not from Atlanta. It might help also with caretakers and specialists – things not covered by insurance.”
Andee’s Army has focused on helping families with emergency expenses with the goal, moving forward, of assisting with longer-term costs.
“In 2014, we are looking to further our relationship with Shepherd Center and Children’s Healthcare of Atlanta in the area of rehabilitation,” Lisa says. “We realize that brain injuries are lifelong. The parents often need help in the acute (early) stages, and the children will continue (to need help) as they develop into teenagers and adults.”
Owing much to fundraisers like an annual 5K Fun Run, a golf tournament and “An Evening of Hope” – a formal dinner function – Andee’s Army continues martialing forces.
Andee’s friends are involved with the Army on the Junior Board of Directors, and Andee helps, as well. She is an inspiration, a living sign of hope.
“When she had the courage to speak (at the Evening of Hope), people were so impressed that she was able to stand and walk to the podium and talk about her grades,” Lisa says. “Many people were in awe.
“Andee never shows discouragement. She never seems to be disappointed or upset that her life is different from her friends. She just has this resolve that she’s going to do what she always wanted to.”
Andee’s father, John Poulos, says he and his wife are both humbled and grateful for the support Andee’s Army has given their family.
“I want to express how grateful we have been for the prayers and support from so many friends and other supporters,” John says. “From that generosity, a foundation was formed to help others facing similar non-traumatic brain injuries. We are also so humbled by Andee’s injury essentially evolving to help so many other families and now, in turn, for Andee to be a part of that Army.”
Written by Matt Winkeljohn
Photos by Gary Meek
Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems, Shepherd Center is ranked by U.S. News as one of the nation’s top hospitals for rehabilitation. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.