Crystal Wise
Tiffany Rubenkoenig
It’s been well over two years since Fort Worth resident Tiffany Rubenkoenig, 42, has been behind the wheel of an automobile. The fact that she’s currently practicing her driving skills is a testimony to her tenacity, given she couldn’t even walk, talk, or brush her own teeth without assistance for nearly a year.
Today, Rubenkoenig is one of many people undergoing outpatient post stroke vision therapy at Texas Health Harris Methodist Hospital Fort Worth, which includes a driving simulator. This is just part of the journey this North Texas mother of three and non-profit founder is going through to try and rebuild her life after going through a massive stroke in July of 2022.
Prior to this incident, Rubenkoenig was living her best life. She had a rewarding career working as an accountant for a local oil and gas company and was part of the social fabric of Fort Worth. However, all of this changed during what was supposed to be an evening of fun before she and her family would head out on vacation the following day.
According to Rubenkoenig she and her husband Ryan, along with a group of friends, were taking an Uber to a Garth Brooks concert at AT&T Stadium, when she began to feel hot and uncomfortable while riding in the rear third row seat. After switching seats with her husband, who was sitting in the very front of the vehicle, Rubenkoenig says her world turned upside down.
“My husband told me I was acting strange,” she says. “Apparently, I was sitting awkwardly too, and then he noticed my face was kind of off.”
Her husband’s next steps would prove crucial in the race against time as he told the Uber driver to take them both to the nearest hospital while dialing 9-1-1. After letting the rest of her friend group go, Rubenkoenig was rushed to Texas Health Arlington Memorial Hospital, during which time she underwent a series of tests. Within a matter of minutes, Rubenkoenig and her husband were given the news that she was in fact having a massive stroke. To help combat this, she was given a clot-busting medication to help break up the clot in her brain, which seemed to be working.
“I actually felt well enough, I began to reconsider going back on our planned vacation the next day,” she says. But those plans changed quickly when just a few minutes later she stopped breathing altogether. It would take medical staff a full fifteen minutes to revive Rubenkoenig who went through cardiac arrest twice. In order for her to survive, she needed specialized care at a medical facility that housed a comprehensive stroke center. Enter Texas Health Harris Methodist Hospital in Fort Worth, where Rubenkoenig was transported by helicopter. Preparing for her arrival on the opposite side of this medical emergency was interventional neuroradiologist Dr. Matthew Fiesta.
Crystal Wise
Dr. Matthew Fiesta, M.D. — an interventional neuroradiologist on the Texas Health Fort Worth medical staff.
“How I got involved was that I received a stroke call, an application we use that's an artificial intelligence application and that's really revolutionized how stroke care goes,” Fiesta says. “I was told some medical staff just worked on her, but she went into cardiac arrest post stroke, and I was like, ‘she’s not going to do well,’ to myself.”
After receiving the notification that Rubenkoenig’s blood flow was abnormal via an A.I. alert, Fiesta says he soon found out what caused her issue after shooting dye into her arteries to view her blood flow patterns.
“She only had one vertebral,” he says. For the layman, vertebral arteries usually run in a series of two that originate from the subclavian arteries located in the neck. Each vessel courses along each side of the neck, merging within the skull to form the single, midline basilar artery.
Just imagine a water slide with a wishbone ending. If one side of the slide is blocked there is still another route for the water to take. Rubenkoenig had no other route, a birth defect she was unaware of that caused her blood flow to backup and cause complications.
“With Tiffany we had a double whammy, right? You got a blocked vessel and the flow that you need to get there to help move the clot isn't even going there. Now thankfully the clot was dissolved by the clot buster. So now all she was fighting was just not having the pressure to float her brain when she needed that too,” Fiesta says.
According to the Mayo Clinic, there are two main types of strokes. An ischemic stroke occurs when the blood supply to part of the brain is blocked or reduced. This prevents brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. The second most common stroke is a hemorrhagic stroke. It occurs when a blood vessel in the brain leaks or bursts and causes bleeding in the brain. The blood increases pressure on brain cells and damages them. Warning signs pointing to a stroke can include several factors like trouble walking, speaking, and understanding, as well as paralysis or numbness of the face, arm, or leg.
After getting Rubenkoenig stabilized, Fiesta says she was in bad shape internally. She had to be placed on a breathing tube to allow her lungs to heal after all of the compressions medical staff did on her chest to keep her alive. Also, due to this life-threatening battle, Rubenkoenig suffered significant brain damage resulting in her not being able to walk or speak post opp. Given the trauma she went through at that time, she says she doesn’t remember a thing.
“I guess I was awake for about two weeks after this procedure, I’ve even seen photos of me with my eyes open, but I don’t remember it,” she says.
Her first real memory was of her mother and sister, who were by her bedside to help her with anything she needed. “I knew things weren’t the same, I could feel it,” she says. “I wondered if this was going to last the rest of my life.”
After spending three weeks in the hospital, two of those in the intensive care unit (ICU) and a month attending in-patient care for neurological rehabilitation, Rubenkoenig was well enough to go home. However, the comforts of home would come with a different challenge.
To help her adapt to the world around her, Rubenkoenig’s next journey would be one of tough love. “Going through OT (Occupational Therapy) was a little ugly,” she says. “My therapist was like, okay, brush your teeth, okay, get up. I mean, she's intense because she was trying to make me do it myself, which was good. It was like a bootcamp to relearn how to control my own body.”
Rubenkoenig says she took to the therapy with renewed vigor after overhearing a member of the hospital staff tell her husband, when she was recuperating, that she might be catatonic forever. “I wasn’t going to stay in that bed, I was going to get better,” she says.
Courtesy photo | Chandra Caradine, Texas Health Resources
From the left, Tiffany Rubenkoenig reads of a chart of letters during a visit with occupational therapist/vision therapist Robin Milroy.
Still in the middle of trying to rebuild her life one piece at a time, Rubenkoenig is working with Texas Health occupational therapist/vision therapist Robin Milroy to regain some of the normalcy she lost due to the stroke.
“Sometimes when folks have a pretty significant stroke, like she did, they wonder if they’re going to make [any] progress.” Milroy says. “And Tiffany’s made an amazing amount of progress in a short time with her vision over the past few months.”
Milroy explained that Rubenkoenig may still have some visual deficits, which is usual for someone who has suffered a stroke. However, if her vision doesn’t rehabilitate completely, there are ways for her to compensate for it.
“We can do things like enlarging print if reading's an issue or using little line guides to read with things to help so that it still occurs, but you just have to change the way that you present the material to yourself,” Milroy says. So that has been an exciting thing because once she first got to me, reading was a big struggle, super slow and frustrating, and that has improved.”
Besides reading, Milroy is also helping Rubenkoenig gain her confidence behind the wheel of a car with the aid of a driving simulator.
“The simulator will give you different drives with different levels of hazards that you have to avoid,” Milroy says. “Participants have to watch for things coming out at the right or the left. We have a fair amount of people who have strokes that lose a portion of their vision and this helps them find ways to deal with real world driving situations.”
According to Milroy, most stroke survivors experience a loss of vision in a portion of each eye. To help overcome this scenario, Milroy and her colleagues have stroke patients learn to compensate for this by moving their eyes to the section of their vision loss, which helps extend the good portion of their vision over to the weaker or blind side of the eye.
“We do these practices to gauge if they're able to compensate fast, quick enough, safe enough to even consider getting back to driving,” she says. “So that's what we use the simulator for. Sort of practice braking reaction time, eye hand coordination to see if they can adapt.”
Crystal Wise
Speaking of adapting, Milroy explained that her department can also adapt a car for use of anyone who can’t use one side of their body, by installing special hand controls in a patient’s car.
Milroy, who has 25 years’ experience in this specific field, says every stroke patient makes progress while in this program.
“They all make progression of some type,” she says. “It's just incredible. Especially when we have someone come in that has struggled for years and they begin to make progress. It’s quite rewarding. “
Now permanently back home, Rubenkoenig appears to be on the mend. So much so that she’s even created a non-profit titled Sprinkling Love, an initiative created to help lift, support, and send love to stroke and brain injury survivors in the form of delicious treats and small cheerful gifts.
“I'm lucky to be here," she says "I'm lucky to spend time in whatever way I can. And so, I think that was really helpful for me in recovery. I mean it was definitely a huge issue with me not being at home, but it was almost good that it sunk in and became a reality to me quickly so I could kind of mourn the loss of my old self. But I was able to move forward quickly, and say, ‘okay, what is my life going to be like now?’”
