Selected Podcast
Every Second Counts - Prevention and Knowing the Signs of a Stroke
Dr. David Likosky discusses what are risk-factors/who is most at risk for a stroke, lifestyle changes to make to help prevent stroke, and the signs of stroke.
Featuring:
David Likosky, MD
David Likosky, MD is a Hospitalist at EvergreenHealth and ENI/Hospitalists Executive Medical Director. Transcription:
Melanie Cole: If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of a stroke. It's important for you to know the signs of a possible stroke, learn your risk factors and identify what you need to do. If you suspect you or a loved one is having a stroke, welcome to Checkup Chat with EvergreenHealth. I'm Melanie Cole and today we're discussing Every Second Counts, prevention and knowing the signs of a stroke. Joining me is Dr. David Likosky. He's a Neuro Hospitalist and the Executive Medical Director of the EvergreenHealth Neuroscience Institute. Dr. Likosky, it's a pleasure to have you join us today. First, for the listeners, tell us what is a stroke and are there different types?
Dr. Likosky: So a stroke is when the blood flow is interrupted, so there's no oxygen that goes to an area of the brain. Our brains are really very sensitive to that blood flow, and so if that is interrupted for any period of time, we start to get damage to that area of the brain and that is what a stroke is simply. It can be caused by lack of blood flow or it can be caused by a bleeding kind of stroke, which is much less common.
Host: So then tell us a little bit about identifying a person. This seems to be one of the most important things that we discussed when we discuss stroke is those symptoms because time is brain and we have to recognize them as fast as possible. Please tell us about that.
Dr. Likosky: Absolutely right. And so one of the biggest pieces about stroke that makes it difficult is some of the early sites can be subtle and speed is the most critical factor in how patients do. So, unlike heart attack, stroke doesn't usually hurt and so you can get a headache with stroke, but it's pretty uncommon. And so recognizing stroke is our number one priority because that's what drives the rest of care and ends up really determining how patients do. Most of the time we talk about that FAST scale that you alluded to a second ago, and that is F A S T so face. So someone sees a sudden change in facial weakness on one side or another. Arm, if people hold their arms out and one arm drifts down. Or speech, so a change in speech, ability to speak or ability to understand. And then that T is for time, which is the most critical part of all of this. So calling 911 activating the emergency medical services and getting to a hospital.
Host: So then let's talk about that. If somebody recognizes those signs in themselves or a loved one, is it important to call 911 as opposed to driving your loved one to the hospital? Because EMS can start some of this, can't they?
Dr. Likosky: So it really is the most important part is that T, that timeliness piece of things. Like I mentioned before, the speed with which the brain suffers during stroke is really very, very quick. And so every second that's delayed, is brain lost. And so time is brain. And so activating EMS calling 911 getting to the hospital, which means not driving in, not taking your time, but calling 911 immediately is the most important thing.
Host: Well it certainly is. And as EMS can alert the hospital, tell us what happens in the ER and why time is so important when treating a stroke patient.
Dr. Likosky: So EMS will call us and let us know that a patient is on the way. We then have a team that will meet the potential stroke patient. And a whole cascade of events follows from that. And it happens in a very tightly organized, very time sensitive manner. And so the most important part is getting a quick history. We do a CAT scan to take a look the brain and make sure there's not any bleeding and look for evidence of whether any blood vessels might have closed off, all of which we can now treat. And so the emergency physician, the neurologist, the radiologist, potentially the neurosurgeons all work together as a team with nursing and with EMS on their way in to start this whole process going.
Host: Tell us about the process and tell us a little bit about TPA or mechanical thrombectomy and who's a candidate?
Dr. Likosky: So the difference between what we can do now compared to even three or four years ago is really pretty incredible. And so the drugs that you mentioned that TPA is one of them is a clot busting drug. And so in a patient who's had a stroke, if they present, and again within a short period of time we can give that TPA which will open up the blood clot and the blood vessel, and potentially return someone back to normal. That TPA drug we can use within three to four and a half hours of the start of symptoms. And so it's not a huge time window. Mechanical thrombectomy is the really just like it sounds, it's mechanically so going in and removing the thrombus or the clot from a blood vessel, sort of like we do with heart attacks and we can actually do that out for a longer period of time. The sooner we do it, the better the results. But that actually involves threading a catheter up through a blood vessel into the blood vessels that feed the brain in the head and mechanically removing that blood clot, restoring blood flow. And patients who five years ago would've ended up in nursing homes, are now being sent home the next day back to normal or with minimal deficits. And so it's a tremendous revolution in the care that we can provide and in how our patients, our families, our community does in the setting of a stroke.
Host: Well, it certainly is and it's, as you say, an exciting time to be in this field as these things are rapidly evolving. Tell us a little bit about post-stroke care. If someone had a pretty severe stroke and whether they were able to have the treatments you just discussed or not, what's involved in the rehab or recovery or how do they sort of readjust to life after a stroke?
Dr. Likosky: That's a great question and some of the issues that people have after a stroke can be pretty subtle and so there can be difficulties with thinking which can be mild or significant or it can be purely physical where someone has difficulty moving an arm or a leg or both, or trouble speaking. We have a multidisciplinary team of physical therapists, occupational therapists, speech language pathologists who will see a patient in the hospital along with the neurologist, hospitalists and the rest of the medical team. And we'll then follow the patient as an outpatient as well. And so there may be treatments that we give in the hospital, but those also extend on to follow-up and some patients may benefit from an extended stay in an inpatient acute rehabilitation unit where those therapies are intensively performed for many days.
Host: Is there anything we can do to prevent a stroke Doctor, because people have heard about blood thinners. If they do have a risk factor, like a AFib, people ask about aspirin, there's all kinds of things. Give us your best advice before we wrap up about hopefully preventing a stroke in the first place by knowing our risk factors and hopefully taking control of some of those.
Dr. Likosky: So the best kind of stroke is the one that you don't have at all. The risk factors for stroke are fairly common things and they're not necessarily things that you would be aware of on a day to day basis. And so hypertension, high blood pressure is number one. They refer to hypertension as the silent killer because you may not have much in the way of symptoms, but for even mild degrees of hypertension over long periods of time, those really increase your risk of having a stroke. And so making sure that you get your blood pressure checked, get regular primary care is critically important. Other things that you can control are smoking. So smoking is a risk factor for stroke, controlling diabetes and your blood sugar, if you have diabetes is incredibly important. Another significant risk factor for stroke. You mentioned atrial fibrillation, and so that's an irregular heartbeat, which causes small clots to form in the heart and raises your risk of stroke.
And that we treat with blood thinners to prevent those clots from forming. Really the key is to have a good, healthy, active lifestyle to get good primary care and those screening for your cholesterol, which is another risk factor for your blood pressure and for diabetes and doing those things, which while it may seem like they're kind of basic things and we talk about all the time are incredibly important and can really prevent people from having a stroke at all. Patients who may have had a TIA, which is a transient ischemic attack, so kind of a stroke that doesn't stick. So symptoms that went away or patients who've had prior strokes are at high risk to have subsequent strokes. And are a special patient population we look at closely as well. And so making sure that people stay on their medicines for all the above conditions we talked about is really important. And there's little things that you can do on a day to day basis that have really profound effects on your risk for stroke.
Host: Do you have any final thoughts which you'd like patients and listeners to know about stroke and the care that they would receive at EvergreenHealth?
Dr. Likosky: Absolutely. So we've had a stroke center for many years now and one of the most gratifying things that we've seen over the years is both the ability to prevent stroke. So coordinated care amongst our network and how we provide that care to patients. Our ability to treat stroke acutely and there have been dramatic advances in the science that has happened that has changed things from devastating strokes to really strokes that we can fix and our knowledge of how the follow-up care and the continued care that we provide to prevent subsequent strokes have really revolutionized this kind of care that we're able to provide. And so calling 911, recognizing stroke, but really also focusing on not having one in the first place are all critical factors.
Host: Thank you so much Dr. Likosky for coming on and sharing your incredible expertise. What a great topic and such important information. If you notice symptoms of a stroke every second matters. To learn more about the warning signs of a stroke and what services are available, please visit evergreenhealth.com/stroke. That concludes this episode of Checkup Chat with EvergreenHealth. Please remember to subscribe, rate, and review this podcast and all the EvergreenHealth podcasts. Be sure to share this show with your friends and family on social media because that way we all learn this important information from the experts at EvergreenHealth. I'm Melanie Cole.
Melanie Cole: If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of a stroke. It's important for you to know the signs of a possible stroke, learn your risk factors and identify what you need to do. If you suspect you or a loved one is having a stroke, welcome to Checkup Chat with EvergreenHealth. I'm Melanie Cole and today we're discussing Every Second Counts, prevention and knowing the signs of a stroke. Joining me is Dr. David Likosky. He's a Neuro Hospitalist and the Executive Medical Director of the EvergreenHealth Neuroscience Institute. Dr. Likosky, it's a pleasure to have you join us today. First, for the listeners, tell us what is a stroke and are there different types?
Dr. Likosky: So a stroke is when the blood flow is interrupted, so there's no oxygen that goes to an area of the brain. Our brains are really very sensitive to that blood flow, and so if that is interrupted for any period of time, we start to get damage to that area of the brain and that is what a stroke is simply. It can be caused by lack of blood flow or it can be caused by a bleeding kind of stroke, which is much less common.
Host: So then tell us a little bit about identifying a person. This seems to be one of the most important things that we discussed when we discuss stroke is those symptoms because time is brain and we have to recognize them as fast as possible. Please tell us about that.
Dr. Likosky: Absolutely right. And so one of the biggest pieces about stroke that makes it difficult is some of the early sites can be subtle and speed is the most critical factor in how patients do. So, unlike heart attack, stroke doesn't usually hurt and so you can get a headache with stroke, but it's pretty uncommon. And so recognizing stroke is our number one priority because that's what drives the rest of care and ends up really determining how patients do. Most of the time we talk about that FAST scale that you alluded to a second ago, and that is F A S T so face. So someone sees a sudden change in facial weakness on one side or another. Arm, if people hold their arms out and one arm drifts down. Or speech, so a change in speech, ability to speak or ability to understand. And then that T is for time, which is the most critical part of all of this. So calling 911 activating the emergency medical services and getting to a hospital.
Host: So then let's talk about that. If somebody recognizes those signs in themselves or a loved one, is it important to call 911 as opposed to driving your loved one to the hospital? Because EMS can start some of this, can't they?
Dr. Likosky: So it really is the most important part is that T, that timeliness piece of things. Like I mentioned before, the speed with which the brain suffers during stroke is really very, very quick. And so every second that's delayed, is brain lost. And so time is brain. And so activating EMS calling 911 getting to the hospital, which means not driving in, not taking your time, but calling 911 immediately is the most important thing.
Host: Well it certainly is. And as EMS can alert the hospital, tell us what happens in the ER and why time is so important when treating a stroke patient.
Dr. Likosky: So EMS will call us and let us know that a patient is on the way. We then have a team that will meet the potential stroke patient. And a whole cascade of events follows from that. And it happens in a very tightly organized, very time sensitive manner. And so the most important part is getting a quick history. We do a CAT scan to take a look the brain and make sure there's not any bleeding and look for evidence of whether any blood vessels might have closed off, all of which we can now treat. And so the emergency physician, the neurologist, the radiologist, potentially the neurosurgeons all work together as a team with nursing and with EMS on their way in to start this whole process going.
Host: Tell us about the process and tell us a little bit about TPA or mechanical thrombectomy and who's a candidate?
Dr. Likosky: So the difference between what we can do now compared to even three or four years ago is really pretty incredible. And so the drugs that you mentioned that TPA is one of them is a clot busting drug. And so in a patient who's had a stroke, if they present, and again within a short period of time we can give that TPA which will open up the blood clot and the blood vessel, and potentially return someone back to normal. That TPA drug we can use within three to four and a half hours of the start of symptoms. And so it's not a huge time window. Mechanical thrombectomy is the really just like it sounds, it's mechanically so going in and removing the thrombus or the clot from a blood vessel, sort of like we do with heart attacks and we can actually do that out for a longer period of time. The sooner we do it, the better the results. But that actually involves threading a catheter up through a blood vessel into the blood vessels that feed the brain in the head and mechanically removing that blood clot, restoring blood flow. And patients who five years ago would've ended up in nursing homes, are now being sent home the next day back to normal or with minimal deficits. And so it's a tremendous revolution in the care that we can provide and in how our patients, our families, our community does in the setting of a stroke.
Host: Well, it certainly is and it's, as you say, an exciting time to be in this field as these things are rapidly evolving. Tell us a little bit about post-stroke care. If someone had a pretty severe stroke and whether they were able to have the treatments you just discussed or not, what's involved in the rehab or recovery or how do they sort of readjust to life after a stroke?
Dr. Likosky: That's a great question and some of the issues that people have after a stroke can be pretty subtle and so there can be difficulties with thinking which can be mild or significant or it can be purely physical where someone has difficulty moving an arm or a leg or both, or trouble speaking. We have a multidisciplinary team of physical therapists, occupational therapists, speech language pathologists who will see a patient in the hospital along with the neurologist, hospitalists and the rest of the medical team. And we'll then follow the patient as an outpatient as well. And so there may be treatments that we give in the hospital, but those also extend on to follow-up and some patients may benefit from an extended stay in an inpatient acute rehabilitation unit where those therapies are intensively performed for many days.
Host: Is there anything we can do to prevent a stroke Doctor, because people have heard about blood thinners. If they do have a risk factor, like a AFib, people ask about aspirin, there's all kinds of things. Give us your best advice before we wrap up about hopefully preventing a stroke in the first place by knowing our risk factors and hopefully taking control of some of those.
Dr. Likosky: So the best kind of stroke is the one that you don't have at all. The risk factors for stroke are fairly common things and they're not necessarily things that you would be aware of on a day to day basis. And so hypertension, high blood pressure is number one. They refer to hypertension as the silent killer because you may not have much in the way of symptoms, but for even mild degrees of hypertension over long periods of time, those really increase your risk of having a stroke. And so making sure that you get your blood pressure checked, get regular primary care is critically important. Other things that you can control are smoking. So smoking is a risk factor for stroke, controlling diabetes and your blood sugar, if you have diabetes is incredibly important. Another significant risk factor for stroke. You mentioned atrial fibrillation, and so that's an irregular heartbeat, which causes small clots to form in the heart and raises your risk of stroke.
And that we treat with blood thinners to prevent those clots from forming. Really the key is to have a good, healthy, active lifestyle to get good primary care and those screening for your cholesterol, which is another risk factor for your blood pressure and for diabetes and doing those things, which while it may seem like they're kind of basic things and we talk about all the time are incredibly important and can really prevent people from having a stroke at all. Patients who may have had a TIA, which is a transient ischemic attack, so kind of a stroke that doesn't stick. So symptoms that went away or patients who've had prior strokes are at high risk to have subsequent strokes. And are a special patient population we look at closely as well. And so making sure that people stay on their medicines for all the above conditions we talked about is really important. And there's little things that you can do on a day to day basis that have really profound effects on your risk for stroke.
Host: Do you have any final thoughts which you'd like patients and listeners to know about stroke and the care that they would receive at EvergreenHealth?
Dr. Likosky: Absolutely. So we've had a stroke center for many years now and one of the most gratifying things that we've seen over the years is both the ability to prevent stroke. So coordinated care amongst our network and how we provide that care to patients. Our ability to treat stroke acutely and there have been dramatic advances in the science that has happened that has changed things from devastating strokes to really strokes that we can fix and our knowledge of how the follow-up care and the continued care that we provide to prevent subsequent strokes have really revolutionized this kind of care that we're able to provide. And so calling 911, recognizing stroke, but really also focusing on not having one in the first place are all critical factors.
Host: Thank you so much Dr. Likosky for coming on and sharing your incredible expertise. What a great topic and such important information. If you notice symptoms of a stroke every second matters. To learn more about the warning signs of a stroke and what services are available, please visit evergreenhealth.com/stroke. That concludes this episode of Checkup Chat with EvergreenHealth. Please remember to subscribe, rate, and review this podcast and all the EvergreenHealth podcasts. Be sure to share this show with your friends and family on social media because that way we all learn this important information from the experts at EvergreenHealth. I'm Melanie Cole.