Stroke recovery can take months, doctors say after Dan Gilbert attack

Breana Noble
The Detroit News
Dan Gilbert.

Twenty days ago, Quicken Loans Chairman Dan Gilbert had a stroke, but recovery from such an attack can take months, according to local doctors.

Gilbert, who has invested billions into the comeback of downtown Detroit, went to Beaumont Hospital in Royal Oak on May 25 because he was feeling poorly. He had a stroke while at the hospital early the following morning, Quicken Loans officials have said.

Little information has been provided on the 57-year-old businessman's treatment and status.

"He’s on the road to recovery," Quicken Loans CEO Jay Farner told CNBC's Jim Cramer on "Mad Money" on Wednesday. "If there’s a guy out there who has the passion and energy to accelerate whatever timelines they have for him, it’s Dan."

Asked for an update, Quicken Loans referred to a statement released more than a week ago in which Farner said he "maintains his strong sense of humor and focus on constant improvement" and that his "recovery is a process that will take time."

A day following Gilbert's stroke, the company said he had a "catheter-based procedure" and was put in the intensive care unit.

To treat a stroke, neurologists sometimes use a catheter-based procedure called a mechanical thrombectomy, which aims to bust or remove a blood clot that is blocking the blood supply to the brain, doctors from the University of Michigan and Wayne State University who have not treated Gilbert told The Detroit News. Such strokes are known as ischemic strokes.

"A thrombectomy is for the more severe ischemic stroke when there is a large vessel obstruction," said Dr. Kumar Rajamani, medical director of the comprehensive stroke program at Wayne State. He added that these instances occur in 5-10% of all ischemic strokes.

Ischemic strokes account for 87% of all strokes, according to the American Stroke Association. They are less severe than the second kind of stroke caused by the rupturing of a blood vessel, Rajamani said.

Without blood feeding into a part of the brain, cells begin to die from a lack of oxygen, which can lead to brain damage, disability or death. Symptoms of stroke can include difficulties with speaking, walking, seeing, paralysis on one side of the body or a sudden headache.

Strokes are the fifth-leading cause of death in the United States and can result in serious disability in adults. Risk factors include high blood pressure, diabetes, smoking, obesity and age.

Time is of the essence when a stroke occurs, said Dr. Edward Claflin, director of the University of Michigan's stroke rehabilitation program. So it is fortunate Gilbert already was at the hospital when he had his stroke.

"There's an early time-frame in which we can do those interventions," he said. "If people wait to contact 911, the odds of what we can do are significantly reduced."

In a mechanical thrombectomy, doctors thread a catheter through an artery in the groin to the blocked artery in the brain. A stent retriever opens and may bust the clot — or it may grab it, in which case suction tubes may remove the clot. Patients also typically receive Alteplase IV r-tPA, medication that can dissolve blood clots.

The use of thrombectomies is becoming increasingly common, Claflin said. The American Heart Association updated its guidelines to encourage hospitals to adopt the procedure in 2015, after several studies recorded positive results from the procedure. Ideally, it is done within six hours of the stroke, though it can be performed up to a day after.

"Some people start improving once the clot is removed with the catheter," Claflin said. "If there is swelling associated with the blockage, people can be kind of stable or even get worse in the next three to four days. Typically after that, people start improving."

Good signs are if patients are able to talk, understand language, walk and take care of themselves in the days following a stroke, Rajamani said. A day after Gilbert's stroke, Quicken Vice Chairman Bill Emerson had spoken with him. Last week, Gilbert requested his favorite beverage in the hospital and made a joke, according to Farner.

Although it depends on which vessel the clot affected and how long after the stroke treatment was received, doctors usually contact physical and occupational therapists a day after the procedure for an evaluation. A speech pathologist also may be called. They determine what sort of rehabilitation the patient likely will need.

Inpatient rehab for three hours or more a day may continue for two to three weeks, the doctors said. Patients may partake in therapy in an outpatient setting as appropriate for months following.

"From our perspective," Claflin said, "getting a patient into a well-established neurological rehabilitation program can make a difference in somebody's care."

A majority of the recovery occurs within three to six months, though ongoing recovery can occur through the first year following the stroke.

Part of Detroit's turnaround has been credited to Gilbert's investment in the city's central business district. The Franklin businessman's Bedrock real estate firm and its affiliates have invested and committed more than $5.6 billion in its efforts to help revitalize Detroit.

Gilbert moved his employees from Livonia and other suburbs to a Detroit headquarters starting in 2010. Now, Gilbert's Rock Family of Companies employs 17,000 people downtown.

Some people have expressed concerns that Gilbert's illness could cause delays for his various high-profile projects such as the skyscraper scheduled to be built along Woodward Avenue on the old Hudson's department store site.

Quicken Loans Vice Chairman Bill Emerson addressed those concerns earlier this month during the Detroit Regional Chamber's Mackinac Policy Conference, saying: "We know what the mission is. We know what to do.”