Brain emergencies are a big deal. Hear from local residents who are in the midst of recovery journeys, and learn what you need to know about risk factors, symptoms and recovery expectations.
After surviving a medically massive brain aneurysm, Joan Janutka, 58, knows she’s lucky to be alive. In a way, she’ll always be indebted to Dr. Ayman Gheith and Dr. Akram Shhadeh – the neuro-interventionalists who saved her life.
But back in December 2014, Janutka had no idea what was happening in her brain.
Her life was busy. She lived in Twin Lakes, Wis., commuting an hour every day to OSF Saint Anthony Medical Center, where she works as a nurse clinical data analyst.
Thankfully, she didn’t wait to see a doctor when she started experiencing intermittent double vision.
“I decided to see my optometrist – the guy who does your glasses,” Janutka says. “He asked me a lot of questions about my health history and did a normal eye exam.”
But he didn’t detect anything unusual. So, just to be safe, Janutka’s optometrist referred her to an ophthalmologist, or someone who does eye surgery.
“The ophthalmologist asked a lot of the same questions and didn’t see much of a deficit, either,” Janutka says. “He told me it was probably just a cranial nerve palsy, which can go away on its own. But, just to be safe, he wrote me a prescription to get an MRI of my head.”
At this point, Janutka wasn’t yet worried. She hoped her problem was nothing major. Still, she was diligent about her health needs and had her MRI done the following day at OSF.
“It was very quick,” she recalls. “And they said if there was anything out of the ordinary, I would know by the end of the day.”
So, she went back to work and waited to hear her results.
Since it was a Friday, Janutka was excited to go home to Twin Lakes and start her weekend with her husband. But at 5 p.m., she got a call from her ophthalmologist. The message was urgent.
“He said, ‘Hi Joan, I have the results of your MRI, and you have a giant brain aneurysm. You need to go to the emergency room right away,’” Janutka recalls.
A brain aneurysm is a weakness in a blood vessel in the brain that balloons and fills with blood. Janutka was stunned at the news. By “giant,” her ophthalmologist meant 2.6 centimeters. Most aneurysms measure in millimeters.
“I thought, ‘OK, well, if I go to the ER, what would they do? Send me for an MRI again?’ They wouldn’t actually be able to do anything,” Janutka remembers.
Since she works in the medical field, Janutka has quite the cohort of friends and colleagues who are also medical professionals. She decided to put a message on her Facebook to see if anyone could refer her to an interventional radiologist. At the time (now January 2015), there wasn’t anyone in Rockford who did interventional radiology from the neck up.
“I got a few phone calls and a couple of ideas, but of course, now we’re on the weekend and nobody is available,” Janutka says. “And at that point, I was a ticking time bomb. I honestly don’t think I even realized that.”
By now, her double vision had become two distinct images – not just a subtle blur. Janutka showed up to work on Monday to a concerned group of co-workers and friends.
“They basically said, ‘Why are you here?’” she recalls. “They were all looking for somebody to treat me as well.”
Three of Janutka’s friends reported back, recommending the same pair of doctors. They were Dr. Ayman Gheith and Dr. Akram Shhadeh, neuro-interventionalists at Aurora St. Luke’s Medical Center, in Milwaukee. The doctors work together as a team, and between the two of them, someone is available at all times.
Gheith assumed primary care for Janutka. After seeing her MRI, he urged her to come up to Milwaukee right away. Which Janutka did.
She still remembers Gheith’s exact quote when they met.
“He said, ‘Hi, my name is Dr. Gheith. You have a life-threatening brain aneurysm and I’m going to admit you.’”
Janutka and her husband looked at each other.
“Go ahead and make your phone calls, and then we’ll walk over to the hospital,” Gheith continued.
Janutka’s aneurysm was so big that typical intervention wasn’t an option. She didn’t qualify for a coiling, which is the standard procedure for smaller aneurysms.
“That’s when they put a bunch of coils in [the affected vessel of] your brain and it basically starves the aneurysm until it dies off,” Janutka explains. “The only option remaining was what they called a pipeline. They explained to me that it’s basically a heart stent, but in my brain.”
But there was a problem. St. Luke’s didn’t have the right equipment to do the procedure. After all, it wasn’t exactly a common procedure at the time.
“They told me that pipelines were fairly new, and that we were entering uncharted territory,” Janutka explains. “Only two years prior to this, I would have been somebody they sent home to wait it out, and the aneurysm would’ve probably burst. So I felt I had to go ahead and do this new intervention procedure. The alternative wasn’t very pleasant.”
When the equipment arrived, Janutka reported for surgery.
“They went through my groin, into my heart and up into my head,” she recalls. “Dr. Gheith literally called it a ‘stent on a stick.’”
Unfortunately, since the aneurism was sitting on a narrow blood vessel, the first stent didn’t properly take. Less than 12 hours after her procedure, Janutka was back in the emergency room.
“But the good news is, they can literally stack up to seven of these stents, one inside the other,” Janutka explains. “So, they emergently placed a second stent inside the first one, or the pipeline, as they called it.”
Janutka stayed at St. Luke’s under the care of Dr. Gheith and Dr. Shhadeh for 23 days. When she finally went home, she continued to see the two doctors in Milwaukee for follow-up appointments. That is, until her six-month check up.
Janutka was disheartened to learn that the doctors had left for another hospital. Due to a non-disclosure agreement, she couldn’t learn where they had gone.
“I was saddened because if you’re under the care of someone who saves your life, you not only gain a respect, but you gain a relationship,” Janutka says. “You love them because they literally saved your life.”
Janutka continued to do well in follow-up care. The stents were working exactly as they should. But still, she wished she could thank Dr. Gheith and Dr. Shhadeh in person.
Almost a year later, a co-worker visited Janutka in her office.
“She rushed in and said, ‘I have a surprise for you!’ And through the door walked Dr. Gheith. I just could not believe it,” Janutka says.
It was OSF that had recruited the pair of doctors.
“I was thrilled to see them,” Janutka says. “I mean, I’m a medical professional, and despite all of my own knowledge and training, I’m amazed every day that I’m still here. We are so lucky to have the best of the best in Rockford.”
OSF recruited the doctors so it could have the only Comprehensive Stroke Center in Rockford. The distinction is not earned easily, and it requires top talent.
A Comprehensive Stroke Center is the highest designation a hospital can receive when it comes to stroke care.
“It’s a huge deal,” Gheith says. “Many aspire to reach comprehensive status, but few hospitals in the country actually reach that point. We were very fortunate to get the designation within eight months, when normally it takes two years.”
Being comprehensive means OSF can handle two strokes at once, have doctors available at all times and meet other difficult requirements, such as having a state-of-the-art neurological intervention program, including a suite with a $3.5 million machine.
“When a stroke happens, it only takes one minute to kill 2 million neurons,” Shhadeh says. “Every minute you miss a stroke, a patient will age a few weeks to a few months. We decided to come here because of what OSF can offer for stroke and brain aneurysm patients. They’re committed to providing the best treatment possible, which goes along with our personal philosophies.”
What to Know About Strokes
When it comes to strokes, time is brain.
If you think you’re having a stroke, don’t wait for your symptoms to get worse. Call 911 right away and arrive to the hospital by ambulance.
“Unfortunately, a bunch of patients still come in as walk-ins,” says Dr. Jason Layman, emergency department medical director at SwedishAmerican Hospital, a division of UW Health. “That means despite education efforts by the American Heart Association, a lot of people don’t realize how quickly they need to get to the hospital to prevent a stroke from getting worse. And believe it or not, it’s actually faster for us, every time, to get you by ambulance. EMS will call ahead and we’ll be ready for you.”
While it may be OK to “hold off and see” if you’re experiencing stomach pain, strokes are a different story. An entire team of doctors, nurses and other specialists drop everything they’re doing to attend to a stroke patient, Layman says.
Non-modifiable risk factors for a stroke include age, race, genetics and whether you’ve had a previous stroke. These are factors you can’t change.
But modifiable risk factors include hypertension, atrial fibrillation, diabetes, high cholesterol, obesity and smoking. These are things you can control.
There are two types of stroke, Layman explains. The more common type is ischemic stroke, meaning there’s a part of the brain no longer getting blood flow. This is usually caused by the formation of a tiny blood clot that has blocked off blood flow to the brain. Ischemic strokes account for about 87 percent of all strokes.
“In those cases, the treatment is to restore the blood flow,” Layman says. “Historically, we’ve had a medication called tPA [tissue plasminogen activator] that’s designed to break up and dissolve those blood clots. However, it’s risky.”
Although tPA breaks up the lethal blood clot, it also causes major bleeding. So, if a patient gets to the hospital too late, doctors won’t be able to administer the drug. There’s simply too much bleeding in the brain, and the risk of administering tPA outweighs the benefits.
“If you give tPA to someone three or four hours after they began their stroke, the bleeding in the brain will be deadly,” Layman says. “So that’s why time is of the essence.”
The less common type of stroke is called hemorrhagic stroke.
“That’s typically people who have poorly controlled blood pressure for many years and suddenly it’s like the dam breaks, and the artery just ruptures and they start to hemorrhage,” Layman says.
Treatment typically involves close monitoring in the Intensive Care Unit, and in some cases, surgery to relieve pressure around the brain.
When it comes to detecting a stroke, the acronym B.E. F.A.S.T. is useful to keep in mind. Each letter corresponds to a sign or symptom of stroke.
B. indicates a sudden loss or change in balance. E. stands for eyes – is there a sudden blindness or blurred vision in one eye? F. stands for facial weakness. Is there a droop in one side of the face? A. stands for arms – perhaps a patient can’t lift one arm as high as the other. S. stands for speech, indicating slurred speech or the inability to speak. And finally, T. stands for time. Time is of the essence during a stroke, and about 2 million brain cells are at risk each minute.
After a stroke, treatment can oftentimes be a long, uphill climb.
“There are still many people who die from strokes, especially if you get to us too late,” Layman says. “For those who survive, treatment is extremely variable.”
Patients commonly need physical, occupational and/or speech therapy, Layman says.
“They’ll have training – how do I talk? How do I brush my teeth? How do I count money? Everything we take for granted may have been lost. Recovery typically takes weeks to months – it’s a long journey,” Layman says.
That’s why, when it comes to strokes, it’s so important to call 911 and get in an ambulance as soon as possible.
“Seeking treatment right away really can’t be overstated,” Layman says.
Recovering From a Stroke
For Debbie Hall, having a stroke on Dec. 22, 2017 at the age of 56 was completely unexpected. She didn’t have any obvious risk factors.
“The only thing, I was on a prescription medication for high blood pressure, but they don’t know for sure if that had anything to do with it,” Hall says.
She was a second-grade teacher, and it was the last day of school before winter break.
“I had a bad cold and decided to go to bed,” Hall says. “When I got up about an hour later, I fell down. It was a very weird feeling. I couldn’t move by body.”
It took Hall a while to get up, but when she did, she went back to bed. She should have gone straight to the hospital.
“It was almost like a dream – I really didn’t register what was happening to me,” she says.
Hall woke up after another hour of sleep, feeling even worse. She attempted to go downstairs and simply sat down on the steps.
Fortunately, her sister and niece were in town for the holidays. Since her niece is a nurse, she knew right away what was wrong.
“I couldn’t talk to them at all, and I couldn’t walk or anything,” Hall says. “So they called the ambulance and I went to nearest hospital.”
Hall doesn’t remember anything that happened next. All she knows is her local hospital, in Harvard, Ill., thought it would be best to transfer her to Mercyhealth Hospital – Rockton Avenue.
“I don’t remember any of that, but I do know it was too late to get tPA,” Hall says. “Nobody knew how long I had been having the stroke for.”
When she got to Mercyhealth, Hall was zipped back to the CT-scanner.
“When stroke patients come in, our protocol is door to CT,” says Dr. Shawn Wallery, a neurohospitalist and the medical director of neurovascular and stroke care at Mercyhealth. “It’s a total team process. All hospitals that utilize intervention generally have a pretty standard and smooth process that’s pretty similar.”
It turned out, Hall’s carotid artery had burst, causing a massive hemorrhage in her brain. Doctors had to immediately act and put in a stent. She spent six days at Mercyhealth.
Fortunately, she survived. Unfortunately, she went home with a long road to recovery.
“I did about two months of speech therapy and occupational therapy,” she says. “I’m doing very well. I couldn’t even speak at first and now I can, thank God. My speech is much better than my reading, writing or math. Those are hard. My right arm and leg were also a little funny for a few days, but they both came back right away.”
Wallery says rehabilitation care starts immediately after a stroke patient is stable. The process works from the head down.
“We talk about the cognitive side effects – sometimes people have trouble with clear thinking,” he says. “We talk about speech, which is different than language. Speech is the ability to fluidly pronounce words, or articulate them. Language is our ability to communicate. The patient may also have a communication issue.”
After that, Wallery addresses motor or movement problems, whether it’s weakness or stiffness. After that, he concentrates on any sensory issues.
“Sometimes, people can be unaware of a part of their body, something that’s called neglect,” he says.
After that, the focus is on balance, moving and walking. The final pieces include home modifications – the patient may need a cane, walker or ramp – and family/caregiver support. Does the patient have the skillset and tools they need to care for themself? If not, Mercyhealth’s stroke team helps determine how caregivers will be involved.
“The one thing I like to stress is that the majority of stroke patients get drastically better,” Wallery says. “I’ve seen patients who could barely move, and it’s incredible to see them so excited a few months later when they recognize how well they’re doing. That takes a long time of time and effort.”
Hall is finished with therapy, but she still has checkups with her regular doctor and her neurologist. She’ll do another CT-scan this July to make sure everything looks okay.
Despite so much progress, Hall still faces difficulties. Her cognitive function has mostly come back, but reading and writing are still particularly challenging.
“I was a second grade teacher for 29 years, and I can’t do that anymore,” she says. “But, I can still do everything for myself, so that’s a good thing. I just have some trouble with a lot of shorter words, like “I,” “is” and “that.” I’m not always sure which one I need in a sentence. It’s so weird.”
Thankfully, Hall has a great support system. Her husband died two years ago from cancer, but her friends, sisters, nieces and nephews are all supportive when needed.
“You’ve got to keep positive,” she says. “I’m exercising, my diet is great, and I’m feeling very good.”
Providing Care to Rural Residents
Fortunately, strokes have gone from the third leading cause of death in the United States to the fifth.
“That means we’re doing better in our communities,” says Tracy Love, FHN Memorial Hospital’s stroke program coordinator and sepsis program coordinator.
When it comes to strokes, Love’s job is to coordinate the stroke patient’s care. She thinks of herself as a sort of “liaison” between the physicians, physical therapists, radiologists, lab staff, and even the registration staff at the hospital’s point of entry.
“I’m a registered nurse, but my role goes beyond nursing,” she says. “Just this year, the American Heart Association came out with its 2018 guidelines for stroke patient care. It’s my responsibility to go through this document, break it down, and make sure our team has the new up-to-date information. Education is a large part of my role here at the hospital, for both staff and patients. I also manage our data and work closely with our Quality Improvement department to review data as needed.”
Love works hard to stay on top of current stroke literature. She helps ensure that FHN is staying on the cutting edge of information and technology.
Part of that involves FHN’s teleneurology program.
“We are a rural hospital, but with teleneurology, we can bring neurologists with stroke expertise right to the patient’s bedside,” Love says. “We have a phenomenal neurologist on staff, but if she’s not available, we can supplement by having a robot with teleneurology. Neurologists from all around the country can partner with our doctors and nurses to review CT-scans and lab results, and work with our team and patients to determine the next step for treatment options.”
This technology allows FHN to care for patients throughout the entire hospital.
“It’s been a really wonderful collaboration,” Love adds. “We’re able to provide even more evidence-based care for our patients.”
FHN has achieved a designation from the State of Illinois as an Acute Stroke-Ready Hospital. Every three years, the hospital submits protocols, policy and data to re-apply for this designation.
“We just got re-designated this year,” Love says.
FHN also received the American Heart Association’s Gold-Plus award for stroke, which means the hospital meets core criteria for stroke at 85 percent or higher. To earn the “plus” part, FHN meets another five criteria of quality measures at 75 percent or higher.
“We were a bronze, then silver-plus, and now we’re gold,” Love says. “So it shows how we provide quality care and meet the evidence-based quality measures set forth at a high level. At the end of the day, it’s all about our patients and what we can do for them.”