Daniel DoCabo had every reason to feel optimistic that early April morning back in 2020. A successful accountant, he lived in Huntersville outside Charlotte with his wife, Jo. Their children were thriving: Nicholas was learning to be a flight engineer in the U.S. Air Force, while Madison studied biology at N.C. State University and eventually planned to be a veterinarian.
At age 50, DoCabo loved to travel and was an active cyclist. On the morning his life changed, he decided to take a nine-mile ride – a breeze for an athlete who sometimes biked 30 miles in one day. Once home, he felt a light fluttering sensation in his head. Within seconds a surge of nausea overwhelmed him, followed by a headache.
He hoped to shake it off and took a shower. But afterward, when he tried to lift his left leg to put on shorts, he couldn’t figure out how. The sensation, he recalled, felt like “there were magnets around the room, pulling the leg in different directions.”
Questions about your chances of stroke? Your doctor has answers.
DoCabo yelled for Jo. She turned the corner, took one look at her husband, and called 911. The last thing DoCabo remembered was curling himself onto their bed and seeing Jo’s tear-streaked face. She pleaded with her husband to hold on: Help is coming.
DoCabo’s father and grandfather had died of strokes in their 80s. DoCabo was more than 30 years younger, but he was having a stroke.
He would need the resources of an extensive medical team to stay alive, including Dr. Charles Munyon, neurological surgeon with Novant Health Brain & Spine Surgery - Cotswold, and Dr. Deepika Shangula, a neurologist with Novant Health Neurology & Sleep - Midtown.
Bleeding and swelling in the brain
DoCabo was in the beginnings of a coma when an ambulance sped him to Novant Health Presbyterian Medical Center in Charlotte. Through scans, Munyon saw that DoCabo had an intracranial hemorrhage, or bleeding inside the skull. The hemorrhage was large and positioned in the middle fossa of the skull, site of the temporal lobe. In that spot, Munyon said, “there’s just not a lot of room for swelling before it starts to push on the brain stem.” They needed to get DoCabo into surgery immediately.
Munyon removed a large piece of DoCabo’s skull in a procedure called a craniotomy, which provided access to clear the blood clot. The hourlong operation prevented DoCabo from slipping deeper into a coma or dying, but the situation remained critical, Munyon cautioned Jo. It could be weeks or even months before they would know how much DoCabo could recover.
Jo could scarcely take it in. But she held on to the knowledge that for the moment, her husband was stable.
In the intensive care unit, DoCabo was sedated but highly agitated. He kept trying to yank out the intubation tube and said later that he had visions of dark-looking woods. Only the sound of Jo’s voice could calm him. "I felt like I was walking between heaven and hell," he recalled. When he heard Jo, he could imagine a sunny, grassy field.
DoCabo has no visual memories of his stay in the ICU but recalls overhearing one conversation well. Jo was talking to a hospital team member as they viewed the surgical site on DoCabo’s head. “Wow, those are a lot of staples. How many do you think he has?” Jo asked. The reply: three rows with 18 staples each.
“Fifty-four,” DoCabo calculated in a whisper. Her husband, the numbers guy, was starting to come back.
First steps and a hero’s welcome
DoCabo was transferred from the hospital to an inpatient rehabilitation center to learn how to walk and move again. Staff shot a video of his first steps about a month after the stroke. DoCabo felt like he had climbed Mount Everest.
He returned home two days before his birthday in mid-May to a hero’s welcome. Neighbors lined the street with balloons and posters. He was overjoyed at the support.
But he was far from a total recovery. DoCabo sought help from neurologist Dr. Deepika Shangula that summer for his continuing symptoms: His vision was partially obscured in both eyes. The muscles on his left side were numb and weak. He had difficulty thinking clearly and remembering what people said.
DoCabo struggled with fatigue, anxiety and depression, as many stroke survivors do. “The emotional aftermath was very rough to navigate,” he admitted. A small dose of an antidepressant medication helped him through that time.
Shangula arranged for DoCabo to receive physical, occupational and speech therapies to improve his strength and balance, and boost his ability to manage tasks like getting dressed. Though DoCabo could speak well, speech therapy aided his comprehension when others spoke to him. Shangula also referred him to a neuro-ophthalmologist experienced in stroke and its effects on eyesight.
Recovery became DoCabo’s full-time job. He hung a whiteboard at home with dozens of exercises learned during therapy sessions, plus reminders to eat, as the stroke dimmed his appetite. “He was really motivated to get better,” Shangula said. While he can’t currently drive, he takes a bus to a gym nearly every morning to lift weights and do light cardio. He once walked more than 3 miles with a cane on the greenway just to prove to himself that he could.
Each day, he said, he feels closer to his true self. He draws strength from his faith and extended family. DoCabo is a proud first-generation American of Portuguese descent whose mom labored as a seamstress and whose dad worked construction in New York. In his family, "I was the first kid to graduate college and go to work wearing a suit every day, which was my dad's biggest dream," DoCabo said. While he hasn’t resumed his career yet, DoCabo hopes to wear a suit in an office again someday.
He has plenty of joys to savor until then, including a planned trip to Portugal. He walked his daughter Madison down the aisle on her wedding day in March.
After helping her dad with rehab, Madison’s own dream changed. Instead of veterinary medicine, she’s now studying at Duke University to become a Doctor of Occupational Therapy.
"It was amazing to see how much we could do”:
A physician chooses stroke care
Dr. Deepika Shangula had just graduated from medical school. She was working in a hospital when she met a patient who would transform her career.
The patient couldn’t move or talk after suffering a stroke only moments before. Shangula gave him a clot-busting medication in the emergency room and waited anxiously to see how well it would work. She hoped her patient would not spend the rest of his life locked inside his body.
By the next day, the patient could talk and move his limbs. On day two, he was discharged from the hospital, able to walk on his own. “It was really amazing to see how much we could do for him,” Shangula said. The dramatic results inspired her to become a neurologist specializing in stroke care.
Today a neurologist with Novant Health Neurology & Sleep - Midtown in Charlotte, Shangula is passionate about helping stroke survivors regain as much function as possible and feel like themselves again. Some patients travel from out of state to see her.
Her approach to stroke care focuses on three components. First, she wants to understand why the stroke happened. Were a patient’s risk factors, such as family history, heart issues or cancer, the culprit? Was the patient prone to blood clots? Some prescription drugs can make a patient more predisposed to stroke. Once Shangula identifies the cause, she recommends medications and treatment options to help prevent a reoccurrence.
The third component of her approach, as important as the first two, is her role is in coordinating care. She advocates to ensure each patient has all the resources needed for recovery. Some might require a sleep specialist, a psychologist or a cardiologist. Others may lack a primary care doctor, a role that’s key to recovery.
Stroke is a major life event. Some of Shangula’s patients have lost their jobs and even their homes after stroke. She provides a comforting ear and referrals for patients to obtain Medicaid or other insurance. “My goal is transitioning them to a point where they can be self-sufficient and say, ‘I'm able to take care of myself, or I know where to reach out if I have needs.’”
She celebrates with the patients who resume full, productive lives. “That is a big driver for my work,” she says. “Seeing them recover gives me hope.”