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91�鶹����ֱ�� has one of the only programs in the Mountain West region that offers comprehensive spasticity management. Spasticity, a form of muscle over activity, is a common side effect for stroke patients. It is often painful and can interfere with normal, everyday activities. Because spasticity management has so many aspects, it’s important to have an expert, multidisciplinary team. 

“State-of-the-art spasticity management is hard to find in the Mountain West, but U of U Health has a very sophisticated program that’s not a one-trick pony,” said Steven Edgley, MD. “This is one of the things that makes our program so unique.” 

Edgley is the Director of Stroke Rehabilitation at the University of Utah and a key member of Starcevich’s care team. 

“Dr. Edgely saw me daily while I was in rehab,” said Starcevich. “When I see him for follow-up injections, he always says he wants me to live the best life possible, and he has really helped me do that.”  

A stroke survivor himself, Edgley can relate to his patients in ways others can’t. 

“I am fairly unique in that I get it from multiple angles because I have been there,” said Edgley. “I am not 100% recovered, and I think my patients take courage in that I am doing the work and living life, in spite of some speech impairments and right-side hand impairments.”

For Starcevich, having someone who could really understand what she was going through made a big difference in her recovery process. 

“He is an inspiration, and he really makes me feel like I can accomplish and do anything,” said Starcevich. “He always tells me that just because I had a stroke, it doesn’t mean my life is over.”

Rob Shingleton, PT, DPT, manages the spasticity management program at the Neilsen Rehabilitation Hospital. He is also one of Starcevich’s physical therapists. 

“Marilyn is a prime example of someone who exemplifies our multidisciplinary team approach to spasticity management,” Shingleton said. “She’s a great example of the dedication a lot of our patients have to continually strive to improve and seek new treatments and management strategies.”

Starcevich was 47 years old and in the best shape of her life when she started having severe headaches. After a few weeks with pain in the middle of her forehead, she couldn’t lift her leg while getting out of the car. 

“My husband took me to the ER,” Starcevich said. “They told me to take some Tylenol and then sent me home.” 

Unfortunately, things only got worse, and she started losing function of her right arm. Starcevich knew something was seriously wrong. 

After an MRI and an intravenous steroid injection in Butte, Starcevich was transferred to a hospital in Missoula. She was there for a week while her doctors John Pullman, MD, in Butte and Stephen Johnson, MD, in Missoula worked hard to find the root cause of her symptoms. 

“Dr. Pullman and Dr. Johnson figured it out,” Starcevich said. “They diagnosed me with reversible cerebrovascular syndrome.” 

Starcevich was immediately life flighted to the University of Utah Hospital in Salt Lake City. An angiogram confirmed the diagnosis. The vessels in her brain were constricting, disrupting the blood flow to her brain, causing a severe stroke. 

“I couldn’t use my right side at all,” she said. “I couldn’t walk, and I really needed help with everything.” 

After being in intensive care and then acute care, Starcevich transferred from University Hospital to Neilsen Rehabilitation Hospital where she worked with a comprehensive care team that included physical therapists, occupational therapists, and speech therapists. She had therapy six hours every weekday and some weekends, along with speech therapy. 

After two months of intensive rehab, Starcevich went home to Montana, where she still works with a physical therapist in Helena. Every three months, you will find Starcevich in Salt Lake City, meeting with Shingleton and Edgley for ongoing therapy and treatment. 

In 2022, Starcevich was still having problems with her right foot, despite the quarterly injections. 

“The injections were doing their job, and I was even able to stop having injections in some areas,” she said. “But my right foot still wasn’t landing flat, so I was always on the ball on my foot when I was walking.”

Shingleton referred Starcevich to neurosurgeon Mark Mahan, MD, for a consultation to discuss possible surgical intervention. In November 2022, Mahan performed a neurectomy that solved the problem. Right after the surgery, Starcevich could stand with both feet flat to the ground. 

“It doesn’t sound like much, but the surgery made a huge and immediate improvement to my gait,” she said. “Dr. Mahan is a miracle worker.” 

While Starcevich’s expert team has helped her make incredible progress since her stroke, she has definitely done her part. 

Every day, Starcevich walks four miles, does strength and core training, and swims laps in the pool.

“I see exercise as my job,” she said. “Because if you don’t use something, you lose it.”

Starcevich also enjoys anything that takes her outdoors. 

She will continue to make her quarterly visits to Salt Lake City, and is grateful for the spasticity management program, her care team, and U of U Health. 

“There is not a better place in the world,” Starcevich said. “Thank God I ended up going there, because I don’t know what would have happened to me if I didn’t.”