Thursday, September 04, 2008

Johnson works for third term ... AVM News

Johnson works for third term, continued recovery

The campaign trail isn’t any longer than it used to be for Tim Johnson. But it’s a slower, more difficult journey as the South Dakota Democrat seeks his third term in the U.S. Senate and works -- with slurred speech and halting, heavy steps -- to overcome impairments left from a cerebral hemorrhage almost 21 months ago.

Johnson’s recovery from that life-threatening brain injury is a personal story of heroics and exceeded expectations. His doctors have expressed amazement at his progress. His wife, Barbara, says she is more likely than her husband to tire of the tough campaign schedule.

“There have been days when I’ve been exhausted, and he just keeps going,” she said. “I don’t know how he does it.”

The 61-year-old veteran of almost 22 years in Congress hasn’t missed a vote since his much-celebrated – among Democratic and Republican colleagues alike -- return to the Senate on Sept. 5, 2007.

And he throws a bigger policy punch with his growing seniority and committee assignments -- particularly his seat on the cash cow called the Senate Appropriations Committee – as well as his sympathetic, respected place in the Democratic majority.

But he’s not the man he was, at least not in speech and mobility. That is clear whenever Johnson makes a public appearance, as he did last week with his first stop at the Rapid City Journal since he fell ill and required emergency brain surgery in December of 2006.

It was a much different senator who struggled stiffly out of the passenger’s seat of an SUV and, with the help of a staffer, methodically shuffled in through an alley door held open by a Journal employee.

From there, Johnson made a 35-foot journey from the alley through a single-stall garage and small kitchen to the newspaper’s main conference room. And it was indeed a journey. A 10-second stroll for others, it required almost five minutes for the senator to get from alley to chair, as he leaned hard on the cane in his left hand, led with the left foot and half raised, half dragged his right leg in short steps toward the conference room door.

“Speed demon,” Johnson said softly, keeping his head down to focus on the onerous movements below.

His limp right arm hung at his side, the hand in a half fist as the senator worked his way, with staff always close by, to a chair at the conference room table.

That’s how it goes for South Dakota’s senior U.S. senator every day, step by step, in a recovery that is 21 months old and has years to go.

“It is very frustrating, and it’s difficult,” Johnson said during the interview. “But I am improving all the time. And, sometime, I will get there.”

By “there” he means back to something close to 100 percent of what he was before a collection of malformed vessels in his brain burst, jeopardizing his life and changing his world forever. He’s clearly not “there” in speech or movement on his right side. But he maintains that he is completely back in the quality that counts most.

“I’m 100 percent in terms of my brain,I'm less so, 80 percent or so, in terms of my speech, uh, less than that in my arm and right leg, but that doesn’t matter as much,” he said. “But I am 100 percent in my mental abilities, my cognition, and I’m just, uh, less than that in my speech … my articulation, and so on.”

During his 50-minute stay at the Journal, Johnson’s speech ranged from clear to almost unintelligible, but most often was slow and slightly slurred. He paused often during and between sentences, punctuating his comments with moments of silence or the often-heard “uh.”

That's not unusual in common speech, even for people who are not recovering from brain injuries. But it seems, to people who have covered Johnson for years, more pronounced in Johnson's speech pattern now than it was before, as he works to construct sentences and enunciate them.

Johnson doctors and speech-rehabilitation specialists say the senator's speech problems are consistent with his brain injury and have nothing to do with his mental process. They also say he is fully capable of serving in the Senate and running for re-election.

Dr. John Eisold, attending physician of Congress, said by e-mail that Johnson is doing well in recovering from the hemorrhage caused by a ruptured arteriovenous malformation (AVM) in the brain. And on an unrelated health issue, tests indicate the senator is cancer free, after prostate surgery in 2004, he said.

“There are no limitations to his activity at this time,” Eisold said.

Dr. Michael Yochelson, medical director of brain injury programs at the National Rehabilitation Hospital in Washington, D.C., called Johnson’s recovery from the AVM rupture “remarkable,” and said he has shown “phenomenal improvement” in language and physical function.

“If you listen to him speak, you will notice that his speech is not as fluid or fast as it used to be,” Yochelson said by e-mail. “Occasionally you will also hear him hesitate, trying to say the right word. These are all problems with language, not cognition. His cognitive function – memory, concentration, processing – fortunately is fine. This fluctuation in speech does not indicate that he is having any difficulty with comprehension.”

Yochelson said the greatest chance of a “re-bleed” following an AVM incident is in the first year. Johnson is nine months past that.

“Sen. Johnson is in excellent health,” Yochelson said.

Johnson has reached the point where he now works just twice a month with his main speech therapist, Paul Rao of the National Rehabilitation Hospital. Rao said “Tim’s thinking and cognitive skills are remarkably robust.”

He said Johnson’s speech problems are typical with such a brain injury but in no way interfere with his ability to perform as a U.S. senator.

“Does he have the intellectual, cognitive and language, voice and speech skills to do his job?” Rao said. “The resounding answer from my perspective is ‘yes.’”

Johnson maintains that his record in the past year has proven that. He’s especially proud of his role in securing millions of dollars for continuing work on the Lewis & Clark and Mni Wiconi water projects and his growing influence on veterans' health care issues as chairman of the Appropriations Subcommittee on Military Construction and Veterans Affairs.

Johnson also worked hard on the farm bill, including work on requiring country-of-origin labeling for meat products, which has been one of his priorities for years.

The senator points to a busy travel schedule during the August congressional recess that is taking him to 19 communities for a variety of public meetings and events. He said there’s no reason he can’t finish out this term and fulfill the duties of another six-year term in the Senate, as he continues to improve in speech and movement.

There’s no doubt he wants a third term. But he’s hesitant to speculate on a fourth.

“That’s too far in the future to tell,” he said.

Some people wonder whether Johnson would even be likely to finish another six-year term, given his age and the rehabilitation challenges still ahead. Northern State University political science professor Jon Schaff questions whether Johnson will run for a fourth Senate term if he wins a third in November, or even whether he would finish a third term.

“I would not be surprised to see Johnson step down (during the third term) in order to concentrate on his health,” Schaff said. “I certainly don’t think he’ll ever run for office again.”

Jarding is predictably fervent in his disagreement on that point. Johnson intends and expects to serve out a third term if elected, Jarding said. And he said people shouldn’t rule out the possibility of an even longer stay in the Senate for Johnson.

“Tim thinks he’s in a position to do a whole lot of good for South Dakota. I think he sees himself at his peak in seniority and power,” Jarding said. “With all due respect to Jon (Schaff), Tim clearly intends to serve out the full six years and possibly beyond.”

Johnson's Republican challenger, state Rep. Joel Dykstra of Canton, said he hadn't seen enough of Johnson in person to comment on his cognition or chances of serving a full third term. That was both a statement of fact and an assertion of campaign rhetoric.

Dykstra continues to complain about Johnson's decision not to engage in campaign debates. The senator said his speech impairment might give voters a faulty impression of his abilities.Dykstra thinks that's unfair to voters.

"I understand why they would want to protect him from an all-out competitive environment," Dykstra said. "But there are still formats where the two of us could have been together to talk about issues. I think that would be valuable for voters."

Jarding said Johnson's schedule of public appearances, as well as editorial-board interviews at the Journal and Sioux Falls Argus Leader that were video taped and put online, give the public plenty of chance to see Johnson and judge his stage of recovery.

Tim and Barbara Johnson reject speculation that the senator might already have experienced his biggest gains in speech and mobility. They say Johnson’s doctors say the improvement spectrum is open-ended.

“One year isn’t it, and, uh, I can continue to improve,” Johnson said.

Barbara Johnson fully expects that to happen, to a degree that will surprise skeptics. She said her husband’s progress continues at the same slow-but-sure pace she has watched since he began rehabilitation work.

“It’s always been an inch a day. We’ve never had a day when we’ve gone two feet, or less than an inch,” she said. “It’s really, really hard when you make an inch a day to keep going. But he does.”

The Johnsons work together every night on Tim’s physical therapy. That includes stretching and pulling on his right arm and right leg. The senator is now able to lift his foot slightly when he walks and move the leg more independently, and he has begun to get some movement back in the arm.

“The arm is funny,” Barbara Johnson said. “The OTs (occupational therapists) tell me it’s the last thing to come back. But it’s also the one that’s hardest to predict. Last year he could barely move his arm. This year he can pull it down, extend it and pull it across.”

Johnson wears a remote-controlled electronic band under his knee that sends an impulse to his foot. It stimulates the muscles and helps prevent atrophy as Johnson works on his rehabilitation.

“His leg looks normal, just like the other one,” Barbara Johnson said.

Rehab specialist Paul Rao said Johnson has had one of the best recovery curves he has seen in patients with similar injuries.

“Not a little of his remarkable recovery comes form his natural intelligence, his brutally hard work, his penchant for practice and his self-deprecatory and self-demanding manner,” Rao said.

Barbara Johnson said she sees all that, along with a level of determination and patience that makes her marvel. And she is certain that it will continue.

“Honestly, we’ve been married for almost 40 years. You kind of feel like you know somebody. Then you watch him deal with this,” she said. “What I wish people could see is that every day, Tim is stronger today than he was yesterday. And he’s going to be stronger tomorrow.”

Contact Kevin Woster at 394-8413 or

Speaking with Tim Johnson:

Q. What is your relationship with John McCain?

A. "I respect the senator, but his temper is awfully hot. I like the guy but, uh, he's awfully pricklish."

Q. Who are you closest to personally, Barack Obama, Hillary Clinton or John McCain?

A. "Barack Obama and Hillary Clinton are new to the Senate, and John McCain is not new. But he is a Republican. So I would have to say they're all equal."

Q. How would you compare your positions on South Dakota issues to those of your Republican challenger, state Rep. Joel Dykstra?

A. "I'm not very familiar with Mr. Dykstra, position wise. I know nothing about them."

Q. How would you describe your relationship with John Thune?

A. "I am supportive of almost everything he does in terms of South Dakota. Apart from South Dakota I differ with him frequently. But I have come to an agreement that I will not say anything negative about John and he does not say anything negative about me."

Q. Which stop in Rapid City this afternoon were you looking forward to the most -- meeting with the Journal editorial board or meeting with the Canyon Lake All-Stars?

A. "The Canyon Lake All-Stars."

I'd vote for him.


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