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Bill Klaproth (Host): If you think someone may be having a stroke, getting medical help quickly is vital to saving a life and minimizing disability. So, here to talk with us about the symptoms and what to do if you think someone is having a stroke, is Dr. Mark Howerter, Physician Director of the Columbus Community Hospital Emergency Department. Dr. Howerter, thank you so much for your time. So, let’s start with the basics. What is a stroke?

Mark Howerter, MD (Guest): Okay so a stroke is a brain injury. And it’s a brain injury caused by a blood supply issue. And so too major kinds, ischemic which means lack of blood flow to a vessel that’s serving a segment of the brain losing this blood flow and whatever function that part of the brain had, whatever it’s responsible for; you lose the function. Whether it’s speech, whether it’s eyesight, whether it’s motor function to an extremity, whether it’s sensation; any of those things.

There’s hemorrhagic strokes where a blood vessel leaks or ruptures. Those tend to be a little more catastrophic and the symptoms are a little more severe. But that’s something we have to figure out when we see you.

Host: Right. Okay so two kinds of stroke we need to be aware of, ischemic and hemorrhagic. So, what are the symptoms of stroke? What should we be looking out for?

Dr. Howerter: So, the symptoms that we talk about is called FAST and it’s a quick way for the lay public to try to recognize what could be a potential stroke. And I emphasize potential, it doesn’t mean it’s a stroke but if it’s a potential stroke, it’s really up to us to determine that so that’s why you need to be seen quickly. But FAST just briefly, F is for face, so that’s facial droop. A is for arm and really it could be extended to any extremity where an extremity isn’t working, either fine motor coordination or just strength or the limb just feels very, very heavy like a tone of bricks. S is speech and that’s either talking in a slurred fashion or just not being able to come up words or not being able to say the appropriate word, word misplacement. And then time is probably the most important thing and coming up with exactly when that stroke happens is just vital to us.

Host: Okay so that’s FAST; face, arm, speech, time. Thank you for explaining that to us. So, then what should we do if we think someone is having a stroke?

Dr. Howerter: Well the first thing to do is to note the time. I think that’s very important. I mean people panic, you want to get to the emergency department and that’s really where you want to go. You don’t want to go to your doctor’s office because the doctor’s office just isn’t going to be prepared to handle that and they know that. They understand that and they would – the first thing they would do is send you directly to an emergency department.

So, what you want to go to is your closest emergency department and every ER in this country is equipped to handle stroke and understands what the treatments are and could get you quickly evaluated. So, determine the time and get to an ER. Those are really the two most important things you can do.

Host: Right. So, you mentioned as quickly as possible. Why is it important to get to the hospital as quickly as possible?

Dr. Howerter: Well there’s a saying that “time is brain” so, the longer there’s lack of blood flow to a part of the brain, the more brain injury there is and the more permanent disability that could result. So, what we want to do is limit that permanent disability and minimize that to the extent possible. So, the soonest you can get to us, the sooner we can start treatment, the better the outcome.

Host: Okay. So, “time is brain” and you just said the sooner you can get to us, the better outcome we can have. So, what is the protocol at Columbus Community Hospital when someone is brought to the emergency department who may be having a stroke?

Dr. Howerter: Our protocol is not unlike a lot of the ERs by the way, so we didn’t invent the concept. But we really have complied with what the recommendations are but how we would handle it and how a lot of the ERs would handle it is the first thing we would do is we would not – if fact if you called an ambulance that would be perfect. If you came by private vehicle that’s fine too. But as soon as we recognize that yeah, this is a stroke and we would do a very quick, brief – we can do this in 30 seconds, assessment and say yeah, this looks like a stroke; we don’t put you into a bed, we actually take you straight to the CAT scanner and get a quick CT of your head. The reason we do that is because we want to make sure it’s not hemorrhage. Most of these are not but it’s just critical that we know.

Then as soon as we do that, then we come back in and we do a little more detailed exam and confirm that yes this is a stroke and we do something called a stroke score and that gives us some idea as to severity. And then, the next thing we do is we have a Telestroke system where we get a board-certified stroke trained neurologist and we have an agreement with the University of Nebraska Medical Center, so we have one of those neurologists tune in via Tele Medicine so they can actually examine the patient, see the patient, the patient can see them. And the neurologist does his assessment. And we try to get all of this done actually within about 10 minutes.

Host: So, Telestroke. That’s really interesting how you are able to talk with the neurologist and share what you found with that person to really come up with then the diagnosis and then the treatment, correct? So, that’s all in 10 minutes.

Dr. Howerter: Yeah, it’s all in 10 minutes. We will typically talk to the neurologist first, let him know what we are seeing and what the timeframe is et cetera. The neurologist will do a fairly quick assessment and they do these all the time, so they’re very efficient about it. And then they call us back and at that point, we generally have a treatment plan.

Host: Wow, that is terrific. So, speaking of a treatment plan, how has treatment for stroke changed over the years?

Dr. Howerter: Yeah, well that’s an interesting question. I’ve been practicing medicine for roughly 30 years and 30 years ago, if you had a stroke, this whole kind of fire drill thing that we do, didn’t really exist and we let you complete your stroke and we – it wasn’t even clear at that time in the literature what you should do. Do you put people on blood thinners or just what do you do? And so the emphasis at that point was rehabilitation and try to help you recover from whatever disability you had.

So, that’s how it used to be and these days, the drugs that we use are called thrombolytic agents. Thrombolytic means literally a medicine that lyses clot. So, lysing means breaking it up. So, if we can give you medicine that breaks up clot and we know that all strokes have one common denominator and that is that there’s a clot probably superimposed upon some sort of plaque blockage in an artery. And if we can remove that clot with the medicine and reestablish blood flow quickly; then the amount of disability starts going down. And so, that’s the approach.

Host: So, let’s talk about this. When it comes to risk factors for stroke; what are those?

Dr. Howerter: Yeah, the risk factors for stroke are really the risk factors for vascular disease in general. And so, they are fairly similar to say cardiac disease which is also a blood vessel disease. So, people that are overweight tend to have more problems with vascular disease. People that are diabetic have a greater increased risk of vascular disease. People that smoke develop vascular disease at an accelerated rate, and we know that. Plus smoke makes your blood a little more hypercoagulable so there’s kind of a double whammy. A family history. The one risk factor that nobody can alter is their family history but if there’s a lot of strokes in the family; then you clearly have that personal risk and would want to see a physician about trying to modify what other risk factors you could modify.

Having high lipids in your bloodstream and again, that’s somewhat modifiable by diet. So, that’s cholesterol and triglycerides. So, those are kind of the major risk factors.

Host: Right. So, in those risk factors, it sounds like there are a lot of lifestyle things as well. Don’t smoke, watch your lipids which means make sure you watch your diet and other things. so, what can we do to reduce the risk of stroke?

Dr. Howerter: Yeah, so, it starts with the lifestyle modifications that you mentioned, trying to keep your weight in a reasonable spot, see your doctor and let him assess. See what your lipids are. Check a blood sugar and make sure if you are tending towards prediabetes or type 2 diabetes that you start doing some things to counteract that. And there sure are, diet and weight have a lot to do with that. Don’t smoke. Alcohol in moderation only. And if the doctor feels like you are healthy and recommends an exercise program; that’s actually usually helpful and it doesn’t have to be an expensive gym membership, it can be a 20 minute walk every day. But yeah, there’s a lot of things you can do for yourself.          

Host: Absolutely. We hear this term all the time, “know your numbers” make sure you know what your blood sugar is, know what your blood pressure is, know what your cholesterol is. So, everybody should “know their numbers” and can really help you assess your risk factors and decrease your risk factors for some of these things including stroke. So, last question Dr. Howerter and thank you for your time. What other important information should people know about stroke?

Dr. Howerter: I think the things to know is that it can happen to anybody. So, walking around believing that a stroke can’t happen to you is foolish. Obviously, anything you can do to prevent it is huge. I hadn’t mentioned there’s even newer technologies where if it’s a major stroke and there’s a big clot sitting in a major vessel; there’s something called a thrombectomy that gets done these days. That’s done in major centers and in our facility, what we are 90 minutes away, we would tend to fly that person to a major center and try to get that thrombectomy done, usually within an hour of the onset. And it’s done in kind of an interventional radiology setting and there’s doctors that are specifically trained to do that and they have had tremendous success with that. So, there’s a lot more of what we can do than we could several years ago. That’s for sure.

Host: Well and that’s really good to hear and we are all very happy to know that. Dr. Howerter thank you for your time today. We appreciate it.

Dr. Howerter: Okay, thank you very much.

Host: That’s Dr. Mark Howerter, Physician Director of the Columbus Community Hospital Emergency Department. For more information about Columbus Community Hospital and it’s stroke services, please visit www.columbushosp.org, that’s www.columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This is Columbus Community Hospital Healthcasts from Columbus Community Hospital. I’m Bill Klaproth. Thanks for listening.