Erin Gianaras had an ischemic stroke when she was only 27 years old. Her powerful story brings awareness to stroke risk factors, symptoms and recovery expectations.
It’s unheard of to have a stroke at age 27. The chances are one in a million. At least, that’s what Erin Gianaras told herself on June 27, 2016.
“As a pharmacist at Northwest Community Hospital (NCH), I had responded to stroke codes three to four times a week,” she says. “But I disregarded everything that was happening to me that day. I was in disbelief.”
For about 12 weeks prior to her stroke, Gianaras had been experiencing bad headaches and neck pain. She was often sent home sick from work. Despite seeing several doctors, no one could determine a specific cause of her headaches.
On the day of her stroke, Gianaras woke up with a bad case of vertigo. However, it subsided slightly and she continued on with her day. Since she didn’t have to work until 3 p.m., Gianaras decided to run a quick errand before starting her shift.
“My right foot feel asleep while I was driving, which I thought was very odd timing,” Gianaras says. “In the moment, I considered the headaches, the foot numbness and the vertigo, and I thought to myself, ‘Am I having a stroke?’ But I told myself I wasn’t. I kept going.”
Then, at the checkout counter, Gianaras heard the words “I can help you,” from the cashier. But the words sounded all jumbled.
“I thought the woman accidently said the words in the wrong order,” Gianaras says.
Walking back to her car, Gianaras lost her balance and almost fell. It was then she knew she needed to call 911.
Not wanting to turn back, Gianaras got in her car. Out of habit, she went to fasten her seatbelt and turn on the air conditioning.
That’s when a swoop of numbness overcame her.
“My whole right side became numb all of a sudden,” she says. “I had a facial droop; my vision became blurry; there were just a lot of stroke symptoms going on. I pulled out my phone and went to dial 911, but my vision was so blurry that I kept typing incorrect numbers. It took 30 minutes to dial correctly.”
When she finally got it right, Gianaras could only moan into the receiver. She couldn’t form words. At some moments, she couldn’t produce any sound at all.
“At first, they thought I might be doing drugs or drinking,” Gianaras says. “They didn’t immediately think it was more serious. Over time, they traced the call and sent security to find me, and when I couldn’t open the car door, they realized something was very wrong.”
Gianaras remembers the ambulance arriving. Finally, she was with the paramedics. They discovered her ID. The nearest hospital was NCH in Arlington Heights, so that’s where she went.
“I remember everything,” she says. “I remember fear, and panic, and feeling helpless. I remember my friend, another pharmacist who was working, bawling her eyes out when they finally called stroke code. She felt helpless, too.”
But when Gianaras reached the hospital, it was still unclear what was wrong. After all, she was only 27.
“It threw everyone off,” she says. “I knew 100 percent that I was having a stroke. It was so frustrating to not be able to communicate. They thought I might have had a seizure.”
Thankfully, Gianaras’ mom arrived at the hospital and recognized the stroke symptoms right away.
“She had a mini-stroke herself years ago,” Gianaras says.
Her mom asked the doctors to do a CT-angiogram – a test that uses X-rays to provide detailed pictures of the brain – and, sure enough, Gianaras was having a stroke in her brain stem.
“That’s very rare, and there’s a high mortality rate,” Gianaras says. “They found tears in all four of my arteries supplying blood to my brain. It’s rare for people to even have a tear in one artery. There was also a clot. It took everyone by surprise.”
Since she was familiar with stroke code, Gianaras knew there was a short time window to receive tPA, a clot-busting drug. Doctors used Gianaras’ receipt from the store and her phone to determine when she called 911.
As it turned out, she was cutting it close on time.
“My mom had to sign a consent form so I could receive tPA,” Gianaras says. “I don’t think I would have survived without it.”
Gianaras vividly remembers everything that happened next. She didn’t improve immediately from tPA, since her clots were in large blood vessels. So, she was rushed off to a procedure with Dr. Ali Shaibani, a neurointerventionalist and the medical director of NCH’s stroke program.
Shaibani put two stents in her arteries to keep them open. Then, he removed the clot.
“Ultimately, that’s why I survived,” Gianaras says. “I’m so grateful.”
Now, over a year later, Gianaras has come a long way. At first, she couldn’t walk or move her right side. Her speech was slurred, her swallowing was affected, and she needed to work with a physical therapist, an occupational therapist and a speech therapist.
But Gianaras had a determined mindset.
“I was motivated to do well in rehab,” she says. “I’ve been able to make progress a lot quicker than the average patient.”
By working hard with her therapists, Gianaras is now fully independent and living on her own again. She’s even able to drive.
“I’ve become left-handed, and I re-learned how to cook, clean and do everything with my left side being the dominant side,” Gianaras says. “I wear an orthotic shoe on my right foot and my balance and strength are greatly affected. But, in retrospect, I’m so much better. I should go back to work soon, and that’s a big deal.”
Gianaras credits Dr. Shaibani with her life. He continues to monitor her recovery.
“Myself and other specialists continue to watch Erin to see if there’s a genetic basis for weakness in her artery walls,” Shaibani says. “She is functioning well on her own, compared to the statistics.”
Identifying a Stroke
If a stroke can happen to Gianaras, it can happen to anyone.
There are many signs and symptoms of stroke, but key warning signs include weakness and/or numbness to a specific area of the body, such as the face, arm or leg; slurring of speech or difficulty finding the right words; vertigo; and visual disturbances.
According to Dr. Syed Munzir, a stroke program director at Presence Saint Joseph Hospital, in Elgin, there are two types of stroke.
“The most common type is ischemic stroke, which is about 90 percent of all strokes,” he says. “That occurs when an artery that supplies oxygen to the brain becomes blocked.”
An ischemic stroke often occurs when plaque, a fatty substance, builds up in the inner wall of an artery leading to the brain. Plaque hardens the arteries and narrows them, which limits the blood flow to tissues and organs. Several platelets in your blood can stick to the site of a plaque injury and clump together to form a clot.
Clots can partly or fully block an artery. For a stroke to occur, plaque oftentimes builds up in the carotid artery that runs in the neck.
“This is referred to as carotid artery disease,” Munzir says. “This disease causes many of the ischemic strokes that occur in the United States.”
An ischemic stroke can also be caused by an embolus – a piece of a clot or a piece of plaque that breaks away from the artery wall and travels through the blood stream. If an embolus blocks one of the brain arteries, a stroke can occur.
Risk factors for stroke include hypertension, diabetes, heart disease, smoking, personal or family history of stroke, age and gender, race and ethnicity, brain aneurysms or arteriovenous malformations.
“The risk of a stroke increases with age,” Munzir says. “At a younger age, men are more likely than women to have strokes. However, women are more likely to die from strokes. Women who take birth control pills are also at a slightly higher risk of stroke. Strokes occur more often in African-American, Alaskan native and American-Indian adults than in Caucasian, Hispanic or Asian-American adults.”
The second, less-common type of stroke is hemorrhagic stroke.
“This is caused by sudden bleeding in the brain,” Munzir says. “The bleeding causes swelling of the brain and increases pressure in the skull. The swelling and pressure damage the brain cells and surrounding tissue.”
Gianaras had an ischemic stroke. It’s unclear exactly what caused it, but, according to Shaibani, younger people can obtain tears in their arteries for a few reasons, such as car accidents, injuries, a cardiac problem – such as a hole in the heart – or an unknown coagulation disorder from genetic inheritance.
Treating a Stroke
There are certain protocols to follow when treating a stroke, and every minute counts. Guidelines are provided from the American Stroke Association.
“An alert is called overhead in the hospital and through a paging service to alert our stroke team members to be present at the patient’s bedside,” says Dr. Heeren Patel, a neurohospitalist with Centegra Physician Care, in McHenry County. “This team consists of emergency medicine and neurology physicians, an emergency room nurse, a medical assistant, a pharmacist and a lab technician.”
When the stroke patient arrives in the emergency room, the stroke team assesses the individual. A “small stroke” is caused by a blockage of a smaller blood vessel, causing damage to a smaller area of the brain. A “large stroke” is caused by a blockage of a larger artery that may lead to a larger portion of brain damage.
After determining the location of the blockage with a CT-angiogram, a common method for treating an ischemic stroke is injecting tPA – tissue plasminogen activator – into a vein.
This helps to minimize clots so that blood vessels can open up again, allowing for blood and nutrients to flow back to the deprived areas.
“This medicine works to reverse or minimize symptoms as much as possible,” Patel says.
However, tPA is only given to a patient within 3 hours of their last time known to be well, and in certain cases, 4 hours and 30 minutes. After that, the risk of administering tPA outweighs the benefits, since intracranial bleeding can occur.
“The sooner the treatment begins the better the chances are of recovery,” Munzir adds. “Every minute, approximately 1.9 million neurons are lost when a large vessel ischemic stroke is untreated.”
In addition to administering tPA, physicians can surgically enter the affected artery and try to dislodge the blood clot and reperfuse the affected brain as quickly as possible.
This was part of Gianaras’ treatment.
Patients are also treated with blood thinners such as aspirin, Plavix, or in certain cases, stronger blood thinners such as Warfarin.
Once stabilized, the patient is then admitted for further investigation into the cause of the stroke. After an inpatient hospital stay, the patient transitions to an appropriate level of rehabilitation, working toward integration back into a home setting.
Life After a Stroke
Each individual may have different challenges after a stroke. Depending on the size and location of the stroke, recovery varies considerably.
“Many challenges include re-learning tasks, addressing physical limitations and also addressing emotional and psychological changes due to a disabling condition,” Patel says.
“People may have trouble walking, eating, dressing or caring for themselves. Some people may have trouble communicating or understanding what others are saying.”
Through rehabilitation, individuals can learn to adapt to situations and minimize challenges.
But in many cases of chronic strokes, the long-term deficits can unfortunately persist.
“Education for the whole family and guidance on post-stroke care and expectations are crucial,” Patel says. “At Centegra, we provide a packet of stroke information to the patient and their family, and we communicate with them while they are in the hospital to answer any questions that may arise. Additionally, we have a stroke support group that allows us to interact with stroke survivors and their families to form a larger community.”
Doctors also continue to monitor and control the stroke patient’s risk factors in an outpatient setting.
According to Munzir, 700,000 people suffer a stroke each year in the United States, and approximately two-thirds of these individuals survive and require rehabilitation. This typically involves a comprehensive rehabilitation program to help stroke survivors reach the best possible long-term outcome.
“Physical therapists, occupational therapists and speech pathologists are an integral part of this team,” Munzir says. “Patients and families are also encouraged to attend the Presence Saint Joseph stroke survivors support group.”
What Can You Do?
Be aware of the signs and symptoms of a stroke. If you suspect a stroke is occurring, call 911 as soon as possible to receive the best possible treatment and minimize brain damage.
It’s also important to work with your primary care doctor to manage major risk factors, including high blood pressure, diabetes and high cholesterol. Avoid smoking and excessive alcohol use, maintain a balanced diet and exercise regularly.
“Don’t wait if you think you are having a stroke,” Gianaras urges. “Not calling 911 sooner was my biggest regret. Follow your gut and get anything checked out. Strokes can, and do, happen to everyone. No matter what your age.”