Looking Out for Stroke

James Akers's bizarre experience with stroke illustrates the fraught difficulties of diagnosing and treating these kinds of brain attacks

They were just headaches.

That’s what James Akers, 35, thought to himself for more than two weeks this past winter. A young, healthy man who frequently did 5k and 10K bike races and had two dogs at home keeping him active, Akers had never been that concerned with his health. He was the kind of guy who tended to avoid visiting the doctor’s office and took a low-key approach to medication. The idea of having a stroke? It wasn’t even on his radar map.

But when Akers, a realtor from Greenville, suddenly began experiencing intense headaches that wouldn’t go away, he felt the need to check in with a doctor. 

“The doctor did normal tests on me. Then he gave me two pills—one was an anti-inflammatory, the other was a pain pill,” Akers recalls. “He said ‘take this, you should start feeling fine.’”

As it turns out though, Akers was experiencing unusual, asymptomatic mini-strokes that were difficult to detect. It’s not something you expect to afflict the under 40 set much, but the rates of stroke diagnoses are increasing among young adults at an alarming rate. When you add that to the fact that strokes can often be difficult to recognize in the first place, it becomes clear how troubling Akers’ situation was. 

Instead of getting better, Akers’ headaches were increasingly painful, and he often felt close to fainting. He went back to the doctor again and was put on a different medication, with his strokes still undiagnosed and his condition deteriorating. 

“I thought it was heart related,” Akers recalls. “When I went back to the doctor I said, ‘I think there's still something wrong, I feel worse than before you gave me the medicine.’ He gave me another medicine and told me, if it doesn’t work, to call the office and they would set me up with a physical therapist. ‘You might need a massage on your neck, work out whatever this is,’ he said.”

A few days later, after another near-fainting spell and a work day where he repeatedly rested his head on his desk for relief, Akers visited an Urgent Care for a second opinion. Again, the doctors didn’t catch the signs of stroke—instead they gave him two shots, including a nerve blocker, and sent him on his way.

“I clearly remember [the doctor] looking me in the eye and saying ‘we have an MRI machine here, and if I thought it was something related to your brain I would do the MRI but I don't. I feel like you're fine and I don't need to do that,’” says Akers sadly.

The next morning, Akers woke up and immediately knew something was terribly wrong.

“I felt like I was extremely drunk, like I was going to throw up,” he recalls vividly. “I couldn't stand up. I was falling over, couldn't get my balance.”

Near-delirious, Akers did manage to call a friend and 911, fearing a heart attack, but his memory of that morning is a little vague. He remembers going to look for a thermometer in the bathroom, but not that he tore apart the entire room looking for it. He also recalls only a few emergency responders, although his friend would later tell him there were at least 14 people in the room when he got there. 

Such experiences are actually fairly common for stroke patients. Since strokes are caused by a blocked blood vessel or bleeding in the brain, confusion, partial paralysis and an inability to communicate are likely to occur, making it difficult to retain lucid memories of what happened.

Thanks to the emergency responders, Akers was feeling much better by the time a doctor could see him at St. Francis Eastside Hospital in Greenville. They ran a battery of tests, still unaware of what Akers was experiencing. 

“[The doctor] came back in and said he didn't really know what was going on but that my heart rate was incredibly elevated, and there were a lot of things happening, but he couldn’t find the cause,’” Akers says. 

The doctor asked Akers twice if he had done any drugs recently, like cocaine, that might explain his odd reactions. Eventually, he decided to send Akers home, a choice that could have proved fatal. 

“Then, for some reason he said ‘I'm going see if I can get them to do an MRI just to make sure there's nothing I'm missing. I don't think they'll do an MRI on you because of your age and because they're backed up, but let me talk to radiology. They'll probably want to schedule it for later, but let's see if we can do it now,’” explains Akers.

Akers was able to get in for an MRI, and a few minutes after being wheeled back in to his room, the doctor returned with the terrifying results—Akers had had two strokes that morning and clusters of strokes over the past few weeks that had gone undetected. He actually had two neurological issues—a vertebral artery dissection in his left artery and a blood clot at the base of his skull, both of which were worrisome. If the clot moved at all, he would probably die.

The next few days would be some of the most traumatic of Akers’ life. He was transported to different hospitals, subjected to a battery of tests, and placed in a neurotrauma ICU that visitors had to enter and exit through an airlock. He would later find out he was assigned an 85% mortality rating upon transfer to Greenville Health System (GHS).   

But despite the dire situation, Akers endured. With his life entrusted to the clinical staff at the GHS Stroke Center, his recovery was slow but steady, defying the precarious position where he started. After roughly a month or so of acute care, he was discharged. 

“It's scary [to think about],” Akers says now. “I didn't know this until afterwards, but the day they were sending me home, a lot of people came in from GHS staff and they all said the same thing, ‘Your chart is crazy to us. I can't believe you're 35-years-old and went through all this already. And you're healthy, you're completely normal.’”

Even crazier might be what led to his strokes—a simple, but deadly, neck adjustment from a chiropractor is the likely culprit according to his doctors. Now, he says, he’s acutely aware of what can lead to stroke and common symptoms, details he wasn’t familiar with at all prior to his own experience. 

“I had no clue what the symptoms of a stroke were and had zero clue that going to a chiropractor and getting a neck adjustment could cause strokes,” he admits. “Since I've been out of the hospital it seems like weekly my friends have sent me another story of somebody who died or had a stroke because of a chiropractor visit. It's been the most random crazy thing.”

Akers feels like he has a new lease on life now, and has become an advocate of stroke awareness among his peers. He’s recently signed on to be the Patient Advocate on the SC DHEC Stroke Advisory Council and joined the board of the Greenville Polo Classic, which raises money for the GHS Neurological Institute. 

He also says he talks a lot with his friends about the signs of stroke using the F.A.S.T. (Face, Arms, Speech and Time) acronym that was developed in the late 1990s and has become integral to how ambulatory services identify stroke. Even though Akers had atypical symptoms with no speech or arm paralysis, he fervently believes greater awareness of stroke symptoms can make a difference.

“Especially for young people,” he points out. “I would never in a million years thought I was going to have a stroke.”

Aside from his advocacy efforts, Akers is still working on getting back to normal. GHS has helped some with his medical bills, and he’s acutely aware of how his body is responding now in the wake of his treatment. He also found out he had high cholesterol, something unrelated to his stroke but which could cause another one in the future. 

“I've become hyper-aware of anything that happens to me. Anytime something tingles, I'm aware of it,” he admits. “I have to check my blood pressure multiple times a day.”

He’s just recently been cleared to ride his bike again, although he’s been told to never ride a rollercoaster again—or see a chiropractor for a neck adjustment. But he’s happy just to be alive.

“I have a new mission in life,” he says firmly, “and it is to bring awareness to stroke patients or the warning signs of stroke.”

For more information about stroke go to strokeassociation.org. To check out SCHA and SC DHEC's new campaign for stroke awareness, go to facearmsspeechtime.com.