Scott Webb (Host): They say that time is brain when it comes to strokes. And today, we're going to learn about what happens when people have a stroke, the different types of strokes, and mainly what changes folks may experience and what the recovery is like from neurologist, Dr. Sean T. Hubbard.

Welcome to BayCare HealthChat. I'm Scott Webb. Dr. Hubbard, thanks so much for your time today. We're going to talk about stroke and what happens to folks when they have one, the signs of a stroke, recovery and all that stuff today. So, before we get to the rest of that, let's start here. Most basic question, what is a stroke? What happens when someone has a stroke?

Dr. Sean T Hubbard: A stroke happens when blood vessels get blocked or broken. We all have arteries that go from the heart to the brain, and those arteries carry freshly oxygenated blood, blood that has oxygen in it and other nutrients that usually, when everything is working wonderfully, will nourish the appropriate parts of the brain. So, there's an artery that goes to our language area, an artery that goes to our speech area. If one of those arteries gets disrupted because it breaks or blocks, then the usual flow of blood doesn't work the same way. And that is when we have an impairment in our ability to do those functions that come so naturally all the time.

Host: Right. The functions we all sort of take for granted and then, you know, a stroke happens sort of interferes and interrupts all of that. So, are there some signs and symptoms that we can be on the lookout either in ourselves or family members and friends that they may be having a stroke?

Dr. Sean T Hubbard: Yes, sir. And you alluded to it wonderfully. Many of these signs and symptoms, they have to do with how we talk, express ourselves, how we express ourselves action-wise. Even just going to the refrigerator or answering the telephone, holding the telephone. So usually, a person will suddenly, so there's a sudden aspect of it. And then, we lose the ability to talk or use our hands or walk. Those are some of the major features. Some people actually pass out, like we're awake, and that's a big part of nervous system function. And so, that tends to be a big stroke, but usually they're smaller and have to do with our ability to talk, walk, use our arms and hands.

Host: Yeah. I know they say that with heart, you know, time is heart and stroke, especially time is brain, so time is of the essence. So, recognizing these signs and symptoms, not dismissing them, especially if you've not had them before, good thing both for us and everyone else. Are there some folks that are just more predisposed to having strokes? Is it family history, genetics, behavior, lifestyle, all the above?

Dr. Sean T Hubbard: I'm so glad you asked that. One of the things that really got me interested in neurology was my grandfather had multiple strokes. And so, growing up as a child, I got a chance to see what happens when a person can't talk or when their talking is not what it used to be. And I thought, you know, he was just such a wonderful guy. He taught me how to do so many things, and I learned how to live, like basic aspects of my life with my grandparents. And so, to me, he was just a wonderful man. So, my growing up was bad things happening to good people. And I just thought that they happened out of nowhere. But as I became more involved medicine and more involved in neurology, I started to realize that there are certain aspects of the way we live, our lifestyles, like our food that we choose to eat, our activity that we engage in, how we solve problems, some of those are just lifestyle.

There are certain things like age, they certainly do increase our risk for having a stroke. Our discipline with taking medications, especially blood pressure medications, and managing our diabetes. So if a person has these risk factors, high blood pressure, diabetes, physical inactivity, some heart problems, hypertension, these are the main risk factors. There are some risk factors, of course, we can change, but others we can't change, like our age and our ethnicity. We tend to focus on the ones we can change.

Host: Yeah, the modifiable. Can't change our family history and genetics and those types of things, but things maybe like quitting smoking, those kinds of things could decrease our chances, of course, of having a stroke. So, let's talk then, I mentioned there about how time is of the essence, time is brain, what are the treatment options if folks, or when folks get to the ED?

Dr. Sean T Hubbard: Oh, this is crucial, Scott. There are so many more treatment options we have today than there were when I first started practicing neurology. And the gentleman that trained me, he was saying, "Oh my God, we finally don't have to watch people have strokes." All too often, though, people do, especially gentlemen, we do tend to hope it'll go away. We drink orange juice, we go take a nap and all that stuff. And we could be getting treated, especially within the hour. Many times, we are able to abort symptoms. I mean, somebody is having a stroke and, if you get there ASAP, as soon as possible, call 911, we can use medicines. Usually, they're blood thinning medicines. We can use some surgical approaches, actually go in there and take away the impediment. And sometimes people are having different types of stroke where they're having bleeding and we can also do other types of surgery. So, there's medical treatment and surgical options and, of course, physical therapy after a person's had a stroke and now they have a disability.

Host: Yeah. And I was going to ask you if there's anything we can do really to prevent a stroke, but you kind of talked about that, that there are modifiables, things of course we can do in our lives and lifestyle, that kind of thing. And then, family history, genetics, things we can't outrun, but certainly knowing our family history would be good. Just any sense, anything so that we feel like we're sort of being proactive, things that we can do to prevent having strokes?

Dr. Sean T Hubbard: Yes, sir, there are. And some of these have been near and dear to me too, Scott. So, I'm glad you're mentioning them. There are some things that we do pass along in our family and some of those have to do with the way we eat. And my grandparents, my grandmother in particular, used to fry these eggs, and I grew up loving her eggs. I never knew exactly what she was doing. And I grew up to start cooking my own eggs. And one day I was making some bacon and eggs, and I didn't want to use a different vessel for the bacon and the eggs. And so I decided, "I'm going to fry these slices of bacon, and then I'm just going to cook my eggs in that bacon." And oh my God, I recreated exactly the way my grandmother used to make eggs, and it was like I was revisiting my childhood, you know? I knew what was happening. I mean, I thought, "Oh my God, I can't keep doing this. I mean, this is something I can do occasionally. It can't be a habit."

So, there are certainly some habits of lifestyle that we are doing, and they have to do with the way we were raised, our culture, they've been passed down, and we can change those, and they matter a great bit. My grandfather, I have to tell you, we used to try to get him to have more salad. And he used to joke around and say, "You guys, what do you think? I'm a rabbit or something like that?" And then, we would laugh, then we would push the salad away and he wouldn't eat that salad, you know. But now, I eat salad every day because of what I've learned.

Host: Right. Yeah. So, let's talk about some of the non-medicine approaches, if you will, to preventing or treating strokes from happening. You know, I know, obviously, we can avoid as good as those eggs are, avoid the eggs, eat more salads, things like that, but just generally speaking, without medicine, what can we do?

Dr. Sean T Hubbard: A big part of it is nutrition. The more fresh vegetables we enjoy and the more variety also we enjoy, we tend to bring our stroke risk down, our vascular disease risk factors down. The more we are enjoying a moderate level of activity on a regular basis. We also will prevent stroke. Getting a good night's rest on a very regular basis. This helps a lot. When we keep our vessels clean, when we keep our lungs clean, so tobacco freedom goes a whole long way. When we're able to go, let's say tobacco-free, for let's say a person who's listening to this today, over two years, their risk due to tobacco will be cut in half. And after five years, it will go down to as if they had never smoked before or had tobacco exposure. So, there are some really potent lifestyle approaches we can take, mostly with nutrition, fitness, and going tobacco-free. And those are non-medical, but they're very potent and very important, I would say.

Host: Yeah, definitely very important. And let's talk then, so if somebody has had a stroke despite their best efforts in trying to prevent one and knowing their family history and all the things we've talked about here, what are some of the more common changes that a person may experience after a stroke?

Dr. Sean T Hubbard: So, usually, a person gets unilateral weakness, meaning they get weak on one side of the body. And that just happens because an artery goes up through a vessel, goes up one artery, let's say their carotid artery, or through the back, and then it will find itself in the fork of the road and then choose a side, go up that side, and then affect the language area. So, they will not be able to talk or maybe the speech is off, the unilateral weakness, it's generally sudden and sometimes people can have vision loss that's also sudden and it will involve one side. So, we tend to look at this as a sudden problem, involves one side, and it's persistent, lasting more than five minutes, and it doesn't go away. So again, it's neurological. So when we say neurological, we mean the person can't see the same way, maybe they don't understand what's being said, maybe they're confused. We're not talking about chest pain, but we're talking about nerve function.

So, it's those four things that I'm asking for all the time when I see people that are in the emergency department that I'm considering, "Okay, is this a person we can treat right now and help them to abort their symptoms?" Sudden, unilateral, neurological, and persistent. So, they tend to involve face, arm, speech and talking.

Host: Yeah. So, there can be obviously some physical changes, cognitive changes, maybe some emotional personality changes. I want to talk about rehab options that are available for someone who's had a stroke. What do you recommend?

Dr. Sean T Hubbard: So, we have very adept professionals in this physical therapist, occupational therapist, speech therapist. Those are the ones that tend to be involved early in a person's stroke care, even the first day after they've had a stroke and after we have seen what we could do to treat the one that they are having.

The first thing we want to make sure they're able to do is to ambulate safely and avoid falls. We always want to make sure that for people that can't ambulate safely, that we are avoiding blood clots and we are moving and using those limbs, even if it's passive. We're just continuing to move on a regular basis. And so, these are the things that therapists are working on. Can a person stand up? Can they walk across the floor? Can they make a sandwich? And also, are they able to express themselves? Are they able to safely communicate? Swallow is a huge one.

These functions that we are talking about, when we're able to do them, they help us to avoid secondary problems that happen when a person has had a stroke. I hope that I'm saying that clearly. Because when there's a disability, I mean, Scott, when we're doing what we're doing, we're going up the stairs, we're talking to people or drinking water, I mean all of these functions we are having we're not thinking about it. But when that function is not happening and so now we're not walking now, we are subject to what happens when we don't have that function. So, we tend to not be able to swallow, so now food might go down into the lungs. If we're not moving enough, now we have blood pooled in our veins and so now we have a risk of blood clots. So, we're avoiding secondary problems that can happen with a stroke.

Host: Yeah, as you say, these sort of involuntary things, these things we take for granted. May not come as easily to us, may have difficulty. So, rehab is obviously essential. I just want to finish up and give folks a sense of what they can expect in rehab. You know, how long will they be in rehab and what can they expect on the other side?

Dr. Sean T Hubbard: Well, it's variable. And what we're talking about now has to do with how severe the stroke is, of course, and this can vary. And people's willingness to participate also. Stroke is very sudden, and it affects how we look at ourselves, how we look at our abilities, and it affects our hope, potentially. I always try to help people to have as much hope as they can, because that will help in the rehab process. Many times a person, if it's a small stroke, they can go directly home from the hospital, maybe with a cane, maybe with a walker, and then they can put that cane or walker in the closet in a day or so. But if it's a larger stroke, sometimes people will benefit from going to a rehab where they're spending the night and being evaluated by, and also work with a physical therapist, occupational therapist, and a speech therapist. That can go on for weeks or even a couple of months.

Host: Yeah. Well, I really appreciate your time today. You know, this is a question I think a lot of folks have, they may not have the opportunity like I do to be able to ask experts and really pick your brain. So, time is of the essence, recognizing the signs, symptoms, knowing your family history, getting to the ED as quickly as possible, understanding the importance, effects of rehab and being committed to that. It's all good stuff. So, thank you so much.

Dr. Sean T Hubbard: Thank you, Scott. I really appreciate this discussion.

Scott Webb: And for more information, go to BayCare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.