Scott Webb (Host): For most people, the word stroke
is scary, maybe even a little mysterious. It's a condition that lives up to its
name, striking patients hard and changing their lives forever. But strokes can
be prevented and many Franciscan Health patients who've had carotid artery
surgery or a carotid stent placed can attest to that.

Cardiothoracic and Vascular surgeon, Dr. Michael Tuchek,
will talk to me today about how surgical advances can target where the risk of
stroke may dwell, mainly in the carotid arteries. He'll also explain what a TIA
or mini-stroke is, why it's important to pay attention to the symptoms.

 This is the
Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's so great to have you back on. We spoke recently
about AAA. And today we're going to talk about strokes, signs, symptoms,
treatment options, and so on. So let's just start here a little baseline. What
is a stroke? Are there different kinds of strokes and generally what causes
them?

Michael Tuchek, DO, FACS: Stroke's a big issue. It's
a brain injury caused by an interruption of oxygen-rich blood to any part of
the brain. So without the blood, the brain cells die within about four minutes.
So quickly detecting it and fixing it once it happens is critically important.

There's two kinds of major strokes. There's ischemic strokes
and there's hemorrhagic strokes. In other words, clot strokes, lack of blood
supply strokes and bleeding strokes. Let's talk about the first one, ischemic.
Now the blood supply is cut off because of some plaque or clot, is by far the
most common type. Probably 80 or 85% of all strokes are related to ischemic
strokes, and it's caused by that blockage of an artery. It either narrows down
to, you know, a hundred percent blocked, or a clot or a plaque breaks off and
lodges upstream in the brain blocking the blood from getting to brain cells
beyond that blocked area.

Clot usually comes from places like the heart when you have
atrial fibrillation, irregular heart rhythms. But plaque is usually just chunks
of calcium and cholesterol, frequently comes in the carotid arteries in the
neck, and when it breaks off, it can go up to the brain and cause stroke. Some
of those plaques are rock hard, full of calcium, and some of them are soft and
ulcerated, sort of like a pothole on 8094 here in northwest Indiana, trucks are
running over potholes all the time and small chunks of that asphalt break off,
making the pothole bigger over time and pieces are breaking off, falling down
the road. In the carotid artery, when that happens, those chunks that break off
go right up to the brain, causing the damage, causing the stroke.

The other kind of stroke is hemorrhagic stroke about 15, 20%
of the time, and that's caused by bleeding in the brain like a ruptured brain
aneurysm. People have heard of brain aneurysms. The blood then leaks out,
compresses the brain inside the skull, which is rock hard, doesn't allow any
expansion. So swelling takes place and the bleeding just crushes the brain
tissue, and that's the other kind of stroke.

Host: Yeah, and you talked there about the plaque and
you know, I've been taking Crestor for a very long time, and I'm assuming that
the reason I'm taking it right, is to prevent, hopefully, the plaque from
building in my arteries and hopefully prevent a stroke at some point. But maybe
you could talk a little bit about that. You know, that plaque, like what causes
it, where does it come from? Is are there things that we can do like taking
pills like Crestor?

Michael Tuchek, DO, FACS: Well, I take one, so I hope
it works and I have for a long time. I'm trying to prevent it. Probably because
my diet's not so hot. But, the causes of plaque are two things. There's
atherosclerosis, that's just cholesterol buildup in the artery anywhere in your
body. And then there's arterial sclerosis, which is the actual hardening of the
artery with calcium filled plaque. Those are the hard ones. So the soft ones
and the hard ones. Most people have both. Some are more dangerous than others,
depending on where they're at. If they're in your carotid artery, they cause
stroke. If they're in your coronary artery, your heart arteries, it causes a
heart attack.

If it's in your leg, you can get leg pains when you walk. So
there's a host of risk factors for excessive plaque buildup. Unfortunately, for
you and I, getting older, we can't change that. Smoking a big one, diabetes,
high cholesterol obviously, high blood pressure, being obese or having a
sedentary lifestyle, even family history, right? You can't pick your parents.
You're stuck with those genes. So you could be one of those people that forms
plaque even out of good cholesterol, thanks to those bad genes. So there's a
lot of reasons for it.

Host: Yeah, I've heard of the uber healthy marathon
runners, you know, who have a high percentage blockage simply because we can't,
in this case, you know, literally and figuratively, we can't outrun our family
history. We can't outrun the genetics, right.

Michael Tuchek, DO, FACS: Right. You can't. Yep. No.
It'll catch you every time.

Host: Absolutely. And you mentioned, as we got
rolling here how prevalent stroke is. I'd like to have you talk about that a
little bit. How prevalent is it? Why is it such a big problem? Because I, I've
been talked to some experts that it's happening more and more to even younger
folks, people in their thirties and fortie, ages we didn't used to associate
with stroke because as you were saying, it's usually older folks like us, get
into our fifties and then you're at higher risk.

Michael Tuchek, DO, FACS: Well, let's put it in
perspective. Despite, like you just said, all the statins that you and I are
taking and aspirin and earlier detection and better stroke treatments, every 40
seconds someone has a stroke and that's about 800,000 people a year just here
in the United States. Someone dies from a stroke every three minutes, making it
the fifth leading cause of death in the country.

That's 155,000 deaths in the United States per year. That
translates out to 7 million people worldwide are dying of stroke each and every
year. When you put it into a real perspective, think about COVID deaths. There
were about 7 million to date. So in the last three years, 7 million people have
died of COVID worldwide.

We have that many people dying from stroke every single
year, year in and year out. So it's a big problem. Now, there are a couple of
kinds of strokes, the non-lethal kind, is the number one leading cause of all
disabilities, so people who can't speak, who end up paralyzed because of a
stroke; 65 billion dollars and counting spent last year treating stroke victims
when it, they can't speak. The victim can no longer drive a car. They can't
work. They can't even feed themselves. The disability from stroke is
catastrophic, both for the stroke victim obviously, but also for the family.
They just don't know how to take care of them. There are lost wages. There's
medical expenses for the rest of their lives. It's absolutely devastating for
everyone.

Host: Yeah, it is, and I think it's a good time to
talk about what actually happens when we're having a stroke. And I just have a
brief reference that my father-in-law, we believe, had a stroke because he was
unable to use his right arm at some point. He didn't remember having a stroke.
He didn't really know or associate the signs and symptoms that he was having
with stroke, but the net result was he wasn't able to use his right arm after he
had this event, let's say. So I'd like to have you talk about that. Signs,
symptoms, what to be on the lookout for.

Michael Tuchek, DO, FACS: Sure. So when a piece of
plaque breaks off, for example, or a clot goes into the brain artery, you can
experience a whole lot of symptoms just like your father-in-law. In his case,
he had a stroke that affected just the movement in his arm. Some small strokes
are temporary, called transient ischemic attacks. They call them mini strokes.
They may last a few minutes or a few hours, and then they completely go away,
and so people say, oh, it's a mini-stroke. It's not the real thing. Maybe it
was a small clot that got lodged in the brain. Your body dissolved it, thank
goodness, symptoms resolved. This is a big warning sign of things to come
because, you know, if it could happen once, thank goodness it goes away, it
could happen again.

So if you have a mini-stroke, even if it's a temporary one,
go to your doctor, go to the ER and get it checked out. But the bigger strokes that
can be permanent, like your father-in-law may have gone through, even
life-threatening strokes, depending on the size of the stroke, it could be in a
bad place and it could kill you, or it could be in a place where you lose your
vision or you get paralyzed like your father-in-law, and it only takes four
minutes.

So even though it's a mini-stroke, you need to treat it like
it's going to be a major stroke. And get into the hospital to take care of it.
That's why there's a mnemonic that everyone needs to follow to help people
identify is someone having a stroke and it's called Befast, B E F A S T. The B
stands for balance. You're walking like you're drunk, and yet you're totally
sober. Why am I drifting off to one side? The E stands for eyes. You have temporary
blindness or blurred vision in one eye, usually not both. One eye. F for facial
weakness, you get a droopy eyelid or droopy tongue or you have a crooked smile.
So we always tell people smile and we see that it's crooked. The A stands for
arm weakness. It could be leg weakness, on one side. Usually you can have
speech problems. The S is for speech problems. It's slurred. They can't find
words, and they were talking normally 10 minutes ago.

And T, it's time to call 911. Remember, you've got that four
minutes. So if you have any of those, just call 911. Don't drive yourself. Get
to the emergency room and get checked out.

Host: Yeah, that's great advice for all of us, for
loved ones, cause I was going to ask you, what do we do if it's us or someone
else? But yeah, best advice, call 911. Put your life, your brain in this case,
cause time is brain, you know, put your brain in the hands of experts who can
call ahead for you. Make sure that the right folks are waiting for you when you
get to the ED and all of that.

And it makes me wonder, Doc, you, mentioned mini strokes or
the TIAs. Is that really like a warning? Like if you have a quote unquote
mini-stroke, are you going to have a major stroke most likely at some point?

Michael Tuchek, DO, FACS: Well, as you said, TIAs are
transient ischemic attacks, and it could be the clot kind, it could be the
plaque kind. Hemorrhagic strokes tend to be, the bleeding ones tend to be more
permanent, but those mini ones, they're temporary. They block off the blood
supply and hopefully it opens up again. So, they're warning signs, but you
don't know if the stroke symptoms are going to wear off or not.

So you need to jump on these just like a permanent stroke,
the non-transient strokes, call 911, get to the hospital. Don't wait hoping the
symptoms are going to go away. And, even if they do go away in just a few
minutes, get to the hospital anyway because you can't ignore it. A lot of
people do. They say, oh, it went away and they go back to bed.

It passed. And, that's not smart because again, somebody's
knocking at your door and it's not a pleasant invite. So remember that pothole,
you know, if you really have a small pebble that breaks off, it causes that
TIA, that mini-stroke, it was really small, but the next pebble that breaks off
could be a really big one.

So if you have a TIA, it could be a sign of bigger stroke.
So just get to the hospital so that big pothole doesn't become even bigger at
the expense of your brain cells.

Host: Yeah, that reference you made earlier to 8094,
I, live in the same rough area that you do, and so I'm familiar with that. And
you know, sometimes there are little fender benders, but usually on 8094 it's a
big one.

Michael Tuchek, DO, FACS: It's a big one.

Host: Yeah. And it's a big mess. And so if we can
avoid that, the better. So in the case of the driving, you listen to the
traffic and you try to avoid that. In the case of this, when we're talking
about you know, blockages and strokes and so on; it seems like the best plan of
action would be to try to, you know, not get there, not find ourselves having a
mini-stroke or a TIA or the big one, if you will. So what can we do to prevent
strokes? Knowing our family history, I'm sure is one of them. But what else can
we do before they do the damage?

Michael Tuchek, DO, FACS: Well, Well in fact, you've
got to be able to you know, detect them. So the best way to prevent them is to
modify your risk factors. This the obvious things, right? Stop smoking, control
your sugars, your cholesterol and whatnot. Take statins like you and I are
doing, but you can detect them once you have a blockage.

So let's figure out how to find them. So the simplest test
is for your doctor to listen. He can just put a stethoscope to your carotid
artery. And they're going to hear a brewery. And, a brewery is just a turbulent
rush of blood, like a murmur in the heart. It's like you take a garden hose,
it's wide open and the water's coming out and it's very quiet.

It's trickling out, but you put your thumb over it and the
water flies out much faster. It's much noisier. That's a murmur. That's brewery
that's making a sound. And you can hear that in the carotid artery. The faster
the squirting of water pointing down at the dirt, right? It's going to throw
that dirt away, kind of like that pothole problem.

So the faster it's going, the more the increased velocity,
the speed that the blood is going through, that narrowing, we can detect that
with a simple doppler. And that dirt flying out of the way, of course, is just
like a blockage. Your thumb is blocking things off, and that's the chunks of
plaque that then break off because they have higher velocity.

So of course, the faster the trucks are going, the more
easily the things break off of the pothole. And you can hear that. So your
doctor should listen. That's the first thing. You may not be able to hear it in
everyone. So we have real simple carotid dopplers, like the ultrasound test you
do on a pregnant woman to look at the baby in the abdomen, except we do the
same thing on the carotid arteries in the neck. So we can see the velocity
change, like the water in the hose, you can see the actual plaque, you can
measure the narrowing. And when it gets to be about 60 to 70% blocked, we start
to take it very seriously. We'll suggest perhaps an angiogram, a catheter in
the groin, but the most common test is a CAT scan.

Very simple. We can see all the details. It's like the high
def plasma screen TV. Ultrasound's, like a black and white TV. But the CAT scan
really tells us everything and we can see what the plaque looks like. Is it
smooth? Is it calcified? Is it soft? Is it ulcerated? Like that pothole we were
talking about on 8094.

By the way, I-65 is pretty bad also. But the more trucks to
hit it right, the more pieces easily break off. And in the carotid artery, that
means stroke or TIA. We can see that on CAT scan non-invasively. So that's the
best test for it after those.

Host: Yeah. And then are we talking about their
surgical and nonsurgical options? And once you detect a blockage, is it you
start with medications and then move on if you have to?

Michael Tuchek, DO, FACS: Right. So the good news is
stroke's preventable. We're trying to prevent it by taking statins and trying
to improve our health, but for strokes specifically, checking your blood
pressure, with a portable cuff. I tell all my patients, go to the drugstore and
just check your blood pressure several times a day could decrease your risk of
a hemorrhagic stroke from high blood pressure.

So watching your blood pressure is really important. Check
for an irregular heart rhythm. Just take your pulse. If you, my apple iWatch
does it, I can just check my pulse. I've got AFib. Get to the doctor. They can
put you on blood thinners or get you out of AFib. That can alert you to see,
you know, you need to see your physician about these problems and take
medications to prevent it, for example. The getting tests like carotid
dopplers, which are easy, echocardiograms or CAT scans, they're all
non-invasive tests. They're easy, they're painless, and they can detect sources
of potential stroke in the heart, in the carotid arteries, in the brain itself.
And then we can target those areas with stents. Or minimally invasive surgery
to clean out the plaques that cause strokes. You can cure them before they do
harm. Of course, you need to modify your risk factors like cholesterol and
whatnot. That's the most important thing to do. But if the plaque's there and
you're stuck with it, you've already got it, like I probably already do.

Then if we think it's significant based on these tests, we
can address it directly to prevent stroke from ever happening. So the first
way, the simplest way is a stent. We hear about stents in the heart. We can
push the plaque out of the way with a stent, it's less invasive. You have to
use cerebral protection because when you open up that plaque, pieces can break
off.

So they put an umbrella up there, like a fine screen
umbrella to catch the little pieces, the debris that comes off. Stents do great
work short term, but the artery is still smaller than what you started with,
what you were born with. So the recurrence rate, it could come back, is a
little bit higher.

Only time will tell. The most tried and true way is to
remove it completely and patch the artery. It's called a carotid
endarterectomy. We do it through a two or three small inch incision in the hole.
You're asleep, we open up the artery, scrape out the junk, all those quarter
pounders with cheese and hamburgers and pieces that we've been eating all our
life. And then we just patch it to make it bigger. So bigger than what you were
born with. So it's much harder for the plaque to build up and narrow in the
artery in the future. That's the gold standard currently, to prevent carotid
plaques from causing strokes, both short-term and long-term. And again, it
takes an hour and 15 minutes. You're home the next day. The risks are very low.
It prevents devastating strokes, both stents and surgery. So there's
non-invasive zero risk testing like a simple carotid doppler, and if need be,
some low-risk procedure to prevent stroke between the two, you can beat stroke
before it beats you.

Host: I love it. That should be on a t-shirt or
something. Let, uh,

Michael Tuchek, DO, FACS: Yeah, I wish I should.

Host: Franciscan know. You know, just as we wrap up
here, reiterate again for listeners the general risk factors. I know it's the
same for stroke and heart attack. Time is brain. Time is heart. Remind us
again, Doctor.

Michael Tuchek, DO, FACS: So essentially the general
risk factors for stroke are the same as heart attack, smoking, diabetes, family
histories. You're again, you're stuck with those bad genes. High cholesterol,
high blood pressure, elderly being older, sedentary lifestyle, obesity. They
all increase your risk for both heart attacks and strokes.

You can't get younger. You can't change your genes that you
know your parents gave you, but you can fix most of these. You can stop
smoking. You can keep your diabetes under control. By far of all those, high
blood pressure's probably the worst risk factor, I think. So go to the
drugstore. Buy a portable automatic cuff. Take your blood pressure, breakfast,
lunch, dinner, and bedtime, and write it down for just the next month. And then
also, every time you exert yourself, have sex, mow the lawn, shovel the snow,
exercise, carry the laundry upstairs, whatever it is that works up a sweat,
slap that blood pressure cuff on while you're doing it and check your blood
pressure.

That's when it's highest. Write those down, then show them
to your doctor. And he or she may say, oh, your blood pressure is kind of high
at night. Let's adjust your medicines or, why is it high on Monday, Wednesday
and Fri, oh, I exercise on Monday and Wednesday and Friday. So let's take some
different blood pressure medicines on Monday, Wednesday, and Friday.

If you don't modify those risk factors, at least control
things like smoking. At the end of the day, the takeaway message is that
stroke, being paralyzed, being unable to speak is worse than death for many
people. Everyone needs to know that we can identify these risk factors. Treat
them. We can screen for many reasons for stroke, whether it's the atrial
fibrillation with your iWatch or a doppler.

Do the tests and fix it before you have a stroke. You can't
do that with car accidents, right on I-65 and 8094. You can't predict them, but
we can predict these. We can predict who's at risk for a stroke. We can alter
their lifestyle. It changes your family's lifestyle, of course, because we can
prevent them.

And it's all because we have very simple tests. I implore
everyone listening to this podcast. Hope that everyone goes out and limits
those risk factors, changes them, alters them, and goes to see their doctor, to
check this out and make sure they don't have a stroke in the future.

Host: Well, I love having experts on, especially when
they're good guests like you, and they know how to do these things and get the
words out right, and in a timely fashion. So, Doctor great to speak with you
again. You stay well.

Michael Tuchek, DO, FACS: Thanks Scott.

Host: And go to Franciscanhealth.org/heart for more insight
on your risk of heart disease and stroke, and take our free health risk
assessment.

 And if you found this
podcast helpful, please share it on your social channels. And be sure to check
out the full podcast library for additional topics of interest. This is the
Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next
time.