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On cardiology, neurorehabilitation, miracles of medicine and the patients‘ strength of will

Fast Confession - Jarmila Zipserová, head of a neurorehabilitation clinic: Neurorehabitation is like opening the treasure hall in Indiana Jones

Karolína Lišková
26.Jan 2022
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10 minutes

For many years, she has been saving lives with a scalpel. But one day, Jarmila Zipserová realized that she did not want to live like that anymore and would prefer to help people in a different way instead. Since then, she’s been literally putting wheelchair users back on their own feet. She built a sought-after neurorehabilitation clinic, where treatment costs a lot of money, because insurance companies, unfortunately, do not cover everything, but the results are clearly visible. One could almost say miracles happen here! In an interview for, the head of the clinic talked about her beginnings and her visions for the future.

Jarmila Zipserová
Zipserová s Petrem Kolářem
Lékařka s dětským pacientem na přístroji.

You worked as a cardiac surgeon for years. How did it come to happen that you suddenly decided to leave this field and pursue rehabilitation instead?

You'll be surprised, but it's more prosaic than it may seem at first glance. One lovely evening, I was in the middle of a surgery, as per usual, and suddenly the phone in the operating room rang and it was my two kids on the other end of the line, asking if they could take a pudding from the fridge, because they’re terribly hungry. And I realized that I had promised the children that I would really come home that evening and make them dinner. However, cardiac surgery is not a 20-minute thing, such a procedure can take anywhere from three to eleven hours. When operating, you lose track of time. And I got so wrapped up in it that I even forgot about my children! That was a clear sign I had to make some adjustments in my life.

Although cardiac surgery is a wonderful field and I really enjoyed it, I realized that it was not my only mission, because I also had to be a mother sometimes. And what better time than now? When my children needed me. Of course, we never really stop needing our mom, but they were really small then. My son was 8 years old and my daughter was little, so for me, this was the moment when I reconsidered my whole life. But I wanted to work in a very interesting field and rehabilitation always seemed to me that way, which is why I chose it.

When you changed your specialization, did you have to improve your education because of it?

Of course. I started practising as a general surgeon after finishing my studies. That was 30 years ago, so I’ve been working in the medical field for quite some time. Back then, I was a general surgeon, I did my attestation in general surgery, and then I got an offer from cardiac surgery. Since I was really interested in blood vessels, as well as in the chest area, that was exactly what I’d been looking for. So when I got the chance to switch to cardiac surgery, it was a dream come true. A surgeon’s life is all about operating and having as many procedures as possible, because that’s how you gain skill and experience. Surgeons are not much different from pianists in this respect. The more you play, the better you become. The more a surgeon operates, the more skill and experience they have, and it’s a matter of years. I sacrificed15 years to surgery, specifically cardiac surgery in the later years, and then I decided to make a change.

Prodej rodinného domu, Praha 10 Záběhlice
Prodej rodinného domu, Praha 10 Záběhlice, Praha 10

And what new things did you have to learn?

In the beginning, since I had a background in surgery, I was looking for surgical patients. Meaning post-traumatic, orthopaedic patients. Because I'd experienced a huge boom of total joint replacements, hips, knees, shoulders, ankles - the biggest boom in history, when there was a great number of surgeries. And a large part of our patients had had a joint replacement. Then I got a job in the Beskydy Rehabilitation Center in Čeladná, where we naturally encountered more different diagnoses.

There were vertebrae patients there, as well as patients with multiple sclerosis, those who had suffered a stroke and so on. But I have to admit that I wasn’t really drawn to neurorehabilitation yet at that point, the majority of patients there was the type I’d mentioned above.

Neurorehabilitation only won me over in Klimkovice. I think it was because of my fateful encounter with Izabela Koscielny, an American physiotherapist of Polish descent. She came to Klimkovice to give a course and her innovative approach to these patients opened a whole new door for me and gave me the impetus to start studying a lot of foreign literature. Because, unfortunately, there is not much literature on neurological patients here, written in Czech.

I have to admit that I immediately fell for it. It's like when Indiana Jones opens a tomb with a treasure inside, you peek inside and see an assortment of chalices, coins, jewellery, weapons and you don't know what to pick. Izabela opened such a treasure hall for me. It makes you want to instantly understand everything, be good at everything, but it's not humanly possible. But you do get to keep the shiniest diamonds and work with those from then on.

Does she know she was such a huge source of inspiration for you? Did you stay in touch?

Yes, we are friends. Before the covid era began, she would come over twice a year because she used to teach courses here. But we’ve maintained an active written exchange. I also consult some patients with her, because, as they say, you can gain the most experience on your own specimen.

Although Izabela herself didn’t have any neurological problem, her daughter was born with cerebral palsy, severely disabled. When you’re fighting for your own child, your motivation to help that child is immense. It's far greater than if it was someone else’s story. Izabela tried out several possible methods, which unfortunately did not work for her daughter. So she de facto created her own concept.

It is a compilation of several different methods that she organized into the concept of the therasuit method, which uses very special aids. Until then, I had neither heard nor of such aids nor seen similar ones. They include, for instance, a special brace, the so-called therasuit outfit. It actually comes from Russia, but she improved it, upgraded it, in fact she’s been working on it to this day. It is a living aid, because Izabela keeps working on it and adding improvements.

Because, let’s be honest, we've been getting more and more information about the brain in the last 5-6 years. My daughter is currently studying medicine and I can see it clearly when I compare what she’s learning to what we used to learn. There has been huge progress and the information on how the brain works and, basically, how to work with it, how to communicate with the brain, keeps changing, and there is a huge amount of information today.

Did the therasuit help Izabela's daughter?

Yes. Despite the fact that a patient like her would normally probably never learn to walk, though I can’t be sure. But this girl graduated from college, and because Izabela and her husband love the Iron-Man races and like to challenge themselves, she even completed this demanding race in America. She did an internship in France and today, she’s helping Izabela at the clinic. What Izabela accomplished with her own child is proof to me that there indeed is a way. Once someone has walked the path, it is clear that others will be able to do the same, but it is necessary to realize that it is a lifestyle. That, for these patients, daily exercise must be as natural as breathing is for you, if they want to stay in shape and have a well-functioning body. They can’t afford to ever stop working on themselves.

That’s how Jaroslav Jágr works. He’s said to be able to start training right after a match, and that’s why he's so amazing, that's what makes him such a good player. Martial art practitioners also train all the time, every day. Because in the case of patients with brain damage, the problem is twofold. One part of the problem is the brain damage with complex impact itself, and the second part is deconditioning. That’s two issues in one package. The patient already has a problem, his disability, and if he stops moving, he exacerbates the problem. You have to get the person in shape and at the same time work on the deficit caused by his brain damage. Just like Jarda Jágr, our patients also train every day, and it really is a lifestyle, it's a lifelong commitment.

You once said: There is no such condition that can’t be improved. Have you ever failed to help someone back on their feet?

Of course. If you don’t have control over the head, then it’s a dead end. There’s no way progress can be made in such a case, but if you have control over the head, there’s always a chance. Of course, certain diagnoses prevent the patient from reaching top level performance. We could draw a comparison to Jarda Jágr again here, or the National Hockey League - for us, the NHL is being able to stand up and walk. But if we lack the necessary structures, we have nothing to build on, then there are limits. Sometimes, though, we’re not trying to get in the NHL, sometimes we strive to play in a local league. Which is the ability to sit in a stable position, which can be achieved if we have control over the head.

Because a lot of complications go hand in hand here. Whether it's scoliosis, which subsequently affects all internal organs, or breathing, heart, the digestive system and so on, so we strive to avoid these complications.

Luxusní byt na prodej, Praha 5 - 232m
Luxusní byt na prodej, Praha 5 - 232m, Praha 5

Furthermore, each surgical procedure puts a strain on the patient. Every anesthesia affects them. And so does the fact that they are taken away from their family, or that they are stuck in a plaster fixation for 6 weeks. Once again, there is a risk of deconditioning, loss of muscle mass. There are simply a lot of other unpleasant effects. The goal is to make the patient as self-sufficient as possible, to help them achieve the best physical condition they can. And that is always possible.

You opened a clinic that belongs to the most popular ones in the Czech Republic. How can it be achieved, to build a center that is sought by the whole country?

You have to be a bit crazy. And you need to have faith. You believe you can make it happen, you try to do things to the best of your ability. And of course it's also about meeting the right people. Because it’s not all about one person. I'm simply the one who says: Come with me, I’ll show you around. But if they didn't follow me and I was calling in vain, I never would have made it this far. It's always a team effort. And I have mostly been lucky to find great therapists, physiotherapists, occupational therapists, speech therapists. And I might have been lucky in the area of management, too, but as a doctor, of course, I understand the medical side more than the other one. It's teamwork, it's not just about me.

How long is your "waiting list"?

Since we have a lot of trained physiotherapists today, we are running three centers. So we’re trying to distribute patients between these three centers in some way. We are usually able to accommodate a patient within three months, if their condition allows. However, when it comes to urgent problems, I don't hesitate for a minute, as time is a huge factor with such patients. We are doing our best to avoid the aforementioned complications, so it’s a question of coordination. Some patients can wait a while longer, and we can negotiate with those. Explain to them that we need to work with this or that person now and give them priority.

Your center is practically robotic, full of devices that help people get back on their feet, but insurance companies cover very little. No wonder that fundraisers are often organized for people who need rehabilitation. Although getting someone back on their feet is an expensive venture, Axon is always full. But I really don’t get why it's so expensive, why insurance companies and the state refuse to cover the treatment, so that everyone could afford it.

I don’t think I’m competent to give you the answer you'd like to hear. Intensive rehabilitation means that you work with the patient 4 hours a day, as often as 4 weeks at a time.

When you go for any kind of rehabilitation, even inpatient, the physiotherapist usually spends somewhere between 40 minutes and one hour with the patient, even if it is a pro-client facility. Disabled people need some time to change, that alone takes 20 minutes off the allotted time. A typical rehabilitation, which only lasts 20-30 minutes, absolutely cannot bring these patients the same benefit that intensive neurorehabilitation does.

Typically, there is a certain budget per patient per year in rehabilitation. One can usually have rehabilitation about twice a year, depending on the budget per patient in individual facilities. That, of course, doesn't cover the patient’s needs in the slightest. And there is another problem.

If you have a massage done by a masseur who might have still been working at a gas station a week ago - and I’m not even joking, I’ve seen it happen - it will cost you 800 crowns. But if you get a massage by a real physiotherapist who spent 5 years studying and had to work another year for free, so that he could perform his job without professional supervision, the insurance company will give him 273 points for one session. One point is 0.8 haler (Czech cents). That’s how little we make.

In general, it’s far more lucrative to hire masseurs, taken strictly from the business point of view, people who take a course. Sometimes a weekend course is enough for you to start earning money. If you’re running a medical facility, on the other hand, you have a huge responsibility, you have to get all kinds of equipment… the difference is immense. The point system in this field is grossly undervalued, and that’s the reason why a lot of facilities operate in the same mode as we do.

Part of the treatment is covered by health insurance, but a large part must be paid by the patient. If you develop a back problem, you’ll also find out that you can’t afford more than 6-8 rehabilitations for 20-30 minutes. But often the patient needs many more. Especially when their motor skills aren’t that good. Because they need the supervision of someone who can guide them through it.

Jaký je váš další cíl?

Our therapists are not just therapists, they are also psychologists, life coaches. When you want to create a new engram, it’s based on motor activity, which includes repetitive repetition. I don't know if the patient needs to repeat a certain movement 360 times or 514 times. If I want to make sure the engram is created, I have to give it the time it takes. And there's probably not enough money for that, but without it, you can’t move on.

What is your next goal?

I wish everything was working. And I wish for some patients to show a bit of decency and respect. I don't expect gifts. Because sometimes, unfortunately, it does happen that you help a person who, at the beginning, when we’re just starting the process and they are in a bad shape, promises you the moon, and the moment they get a little better, they suddenly feel that they understand everything and that they can dictate what their rehabilitation should look like.

With every new patient, I see both a short-term and a long-term treatment plan and it’s necessary to follow it. And everyone who did follow it had the desired results. But those who thought they were smart enough to decide about everything themselves never achieved those goals.

I'm a little sorry about that, because when you’ve put the energy and time into it, when you’ve decided to travel from Prague to Brno, I really want to get to Brno. But many of my patients, who thought they could handle it on their own, ended up in Humpolec and couldn’t make it any further.

And that’s a pity, because it always hurts me when a patient has potential, but doesn't use it. If he didn't have any, you could tell yourself: Alright, we’ve exhausted all the options, this is as good as it gets, this is our ceiling. But often that’s not the case. I would really like there to be better cooperation, as well as more interest in sticking to the plan and following our advice.

Thank you very much for the interview.

Fast confession:

The most important year of your working career?

It was the year when I worked in Klímkovice as a chief physician and I met Izabela Koscielny. That's ten years ago.

The reward you are most proud of?

I’m most proud when my patients tell me: We wouldn't be here without you.

Can you count how many people you have helped in your life?

There must be hundreds.

Why rehabilitation and not surgery?

Because I got to the point where I wanted to do something else, and rehabilitation seemed really attractive to me.

The worst handicap you've ever seen?

It’s mostly patients after a car accident or after some severe trauma. Mostly severe brain damage.

Which patient with what handicap was a lost case for everyone else, but you managed to help them?

That was my big story with Lukáš, he is a war veteran that everyone believed to be beyond any kind of help, and today this guy goes to work and lives pretty much normally.

Is it more difficult to work with children or adults and why?

It depends, but with children it's more fun.

How has coronavirus affected neurorehabilitation?

It left the patients totally frightened, but fortunately they understood that without constant rehabilitation, their condition would only get worse, so they started going to rehabilitation again.

In what respect are you different from other physiotherapists?

We mainly have an amazing team of physiotherapists, and we are a robotic center. We are the only workplace in the Czech Republic that owns two locomats for children and adults. We have other robots, too, but this is really unique.

Tell me something nobody knows about you.

That I work 16 hours a day.

Why don’t insurance companies cover your treatment?

They do, but only a very small part of it. When you go for a massage, it will cost you 800 crowns, but the contribution for a massage is 200 crowns.

How do you feel when you see that a patient who previously couldn’t walk stands up and takes a few steps on his own?

That's the reason why I’m doing it, that's the entire point and the greatest satisfaction.

How hard is it to get good employees these days?

It's extremely hard because the market is rather empty and has changed a lot. At the moment, this is the most difficult thing about running a business, and not just in neurorehabilitation.

What advice would you give to people who suffer from back pain?

They shouldn’t underestimate and instead make sure an acute problem doesn’t turn into a chronic one.
Question by the interviewee for the interviewer:

How are you doing?

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