Many people consider strokes to be a problem faced only by the elderly, but more than one out of four stroke victims are under the age of 65. Healthy lifestyle changes can help lower your risk for both stroke and coronary artery disease.
For example, quitting smoking, staying physically active and maintaining a healthy weight all can help lower your risk. If your blood pressure or cholesterol is high, it is important to talk to your doctor about how to reduce it. You should also work with your doctor to manage chronic medical conditions like diabetes.
FACE is the moniker used by professionals to help you recognize symptoms of stroke so that you or a loved one can get help fast!
Ask the person to smile. Does one side of the face droop? photo of smiling man
A stands for arms ARMS: Ask the person to raise both arms. Does one arm drift downward? photo of raised arm
S stands for speech SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange? photo of a woman speaking
T stands for time TIME: If you observe any of these signs, call 9-1-1 immediately.
J. Scott Cline MD., Neurologist with Hendricks Regional Health, is here to help you understand the risk factors and reduce your chance of having a stroke.
Selected Podcast
Stroke: Know the Risks and Reduce Your Chance of Having a Stroke
Featured Speaker:
Learn more about Dr. Cline
J. Scott Cline, MD
Dr. Cline is a member of the Indiana Neurological Society, the American Academy of Neurology, and the American Association of Neuromuscular and Electrodiagnostic Medicine. He is board-certified in neurology.Learn more about Dr. Cline
Transcription:
Stroke: Know the Risks and Reduce Your Chance of Having a Stroke
Melanie Cole (Host): If you or a loved one was suffering from a stroke, would you know what to look for? Would you know what to do? My guest today is Dr. Scott Cline. He’s a neurologist with Hendricks Regional Health. Welcome to the show, Dr. Cline. What is a stroke?
Dr. Scott Cline (Guest): Thanks for having me out. I guess in the simplest of terms a stroke is basically a blood vessel that gets blocked off in some region of the brain that generates symptoms such as weakness, numbness or changes in vision or speech that can happen quite abruptly. Some people don’t realize just how fast it happens. It’s basically a flipping of a switch.
Melanie: Give us some facts about stroke because some of them are quite staggering in how it’s the number five cause of death in the U.S. and some of the other facts.
Dr. Cline: You bet. The last numbers I saw roughly in the U.S. were that we have about 800,000 strokes a year. You’re exactly right. It’s the number five cause of death but it’s the number one cause of disability. When people think of stroke, they think about it being a potential cause for death but, in fact, most people actually survive their stroke but it leaves them quite disabled to where they’re dependent on either the health system or their family to care for them going forward. So, it becomes that much more important to consider a prevention strategy to make sure the stroke doesn’t happen in the first place.
Melanie: Who would be at risk? What are some of the risk factors for stroke?
Dr. Cline: The risk factors for stroke are roughly the risk factors you would think about for heart disease and other things because the problem is basically the same – it’s a blood vessel problem. It’s going to be the things that you always hear about from your doctor about no smoking, reducing alcohol to moderate intake at most, eating a healthy diet, regular physical activity, maintaining appropriate body weight. Most of the things that you think about anyway but really in stroke and heart attack, those things become that much more important to prevention than anything we can do medicine-wise.
Melanie: So, most importantly, what are some of the signs of a stroke? How would somebody know if themselves or a loved one was having a stroke?
Dr. Cline: Stroke has always been a big passion of mine since residency and it’s always been admittedly a bit interesting and a bit frustrating that people will notice stroke symptoms even in themselves and think that they slept on their arm wrong, or whatever it might be; or if they just go and take a nap, that it will all go away but if you sit on a stroke, then there’s admittedly not a lot that we can do down the road. If you realize that someone is having difficulty with their speech or their face is drooping or one side isn’t working correctly, whether that’s numbness, weakness, trouble walking anything in that world, then you certainly need to be worried about a stroke. If you come to the ER within the first few hours, we can actually do something to try to reverse that stroke. Once we get outside that--four, five, six hours--there’s not a lot we can do other than just work with the symptoms. Early recognition of face drooping, arm or leg weakness, speech trouble and things like that needs to bring you immediately to the ER for a further look.
Melanie: You mentioned how quickly you have to get treatment for this because “time is brain” so you doctors say. What do you do? If we call 9-1-1 and let them know that we think we’re having a stroke, then what happens to this person?
Dr. Cline: Absolutely. You’re exactly right. Time is brain. To put a number on that--as a ballpark, in the midst of a stroke, you lose about two million brain cells a minute. So, not only is time is brain but every minute that clock goes by, that’s nerve cells we can’t bring back. Don’t even sit on it for a few minutes. Come in immediately. Yes, calling 9-1-1 and saying, “I’m concerned about a stroke” will set off an “EMS stroke alert”, so to speak, where they will send out an EMS unit that has been trained in how to recognize and treat stroke. Then, they will call the ER ahead of time saying, “We recognize that we have a stroke”. They’ll ask you for an exact time of onset so we can know what kind of time we’re up against and then the ER will start getting things in line before that patient even hits the door. So making sure the CAT scanner is clear so we can get you in quickly; making sure an ER doc and an ER nurse is freed up so they can get to you immediately; alerting the pharmacy to make sure we can get our clot busting medicine available in case we need to use it--things like that. Using the ambulance service and the EMS services to get here really helps expedite that stroke care as opposed to you trying to drive yourself or a loved one in.
Melanie: So, that clot busting medication you’re discussing, what’s that all intended to do? What’s the aftercare after you’ve done that for us? Then, what happens?
Dr. Cline: If someone arrives within three hours of the onset of their stroke or for certain patients up to 4.5 hours, we can actually give a clot busting medicine known as “TPA” to try to dissolve the clot that’s causing the stroke. We have to screen people for the use of blood thinners and risk for bleeding and things like that because certainly the risk is not zero but we’re trying to reverse a stroke that’s potentially very disabling. Once we screen people appropriately, assess them for things that I would call “stroke mimicking” – things that look like stroke that really aren’t – once all that has been teased out, then we give someone the clot busting medicine through and IV and from there, they’re transitioned to the ICU, mostly for monitoring reasons. We can keep accurate track of blood pressure, glucose, things like that, that can make a big difference in stroke as well. Our ER staff has been through training on this many, many, many times. They are good at recognizing and diagnosing stroke; they have early access to me so I can look at the CAT scan and things like that for being on-call; and then, our ICU team and I kind of take it from there. So, it moves really fast. It’s admittedly a bit overwhelming for the patients and their families initially but it really needs to be. Like I said, two million brain cells a minute it’s a lot to go through to try to slow it down.
Melanie: Dr. Cline, if you’ve had one stroke, are you then at risk for TIA’s or further strokes after that?
Dr. Cline: Yes, that is true. When you run through the risk factors for someone to have a stroke, a prior stroke is on that list, though I would say that coming in the hospital and getting those risk factors assessed--looking for corroded artery disease in the neck or looking for heart difficulties; looking at your risk factors such as blood pressure, cholesterol, diabetes, smoking things like that, if we can get those risk factors properly managed, in the end your risk of a second stroke is probably not that much higher than it would be compared to the general population ,though, it is true--you are at risk for a second stroke just inherently from having your first one.
Melanie: You spoke a little bit about some lifestyle behaviors for prevention. What do you want people to know? What is the most important information for preventing a stroke in the first place?
Dr. Cline: I would say the biggest takeaways in terms of prevention is, there are things that you don’t even need a physician or a nurse to really help you with. It’s the common sense things, such as eating a proper diet or exercising regularly, maintaining a proper body weight things like that. Avoiding smoking, avoiding excessive alcohol--those things that I think we all know inherently but sometimes take for granted that if I have a little trouble with that, maybe a medicine can control it. Sometimes, the cat’s already out of the bag at that point and so, yes, there are things we can do medicine-wise to reduce your risk of a first stroke or a second stroke but really the main prevention is maintaining a healthy lifestyle to begin with.
Melanie: So, tell us about your stroke program at Hendricks Regional Health.
Dr. Cline: Hendricks Regional is a primary stroke center. We have been for several years now and we’ve really set the standard, in terms of some of the numbers we look for acute stroke care; acute stroke care meaning those patients who are eligible to get that clot-busting medicine. The American Stroke Association sets the bar at roughly 60 minutes from what’s called a “door to heal” time meaning the time you hit the emergency department door to the moment your clot-busting medicine starts; so, within one hour. Since I’ve been here, roughly five years now, we’ve consistently hit that or beat it. That’s something we take great pride in. I know our EMS ambulance drivers as well take great pride in being able to do that as fast as anyone else in the market. Our ability to carry that into the hospital to where all of our nurses are also certified in stroke and so are all of our physicians who care for you and carrying that even through to what you may need on the outpatient side or rehab services, all the way to the stroke support group at the end, if needed. There’s really a whole package that we’ve put together because really stroke is not something you see coming. It’s life-altering and it can be very overwhelming for the patient and their family and anyone else who’s involved. It’s something that we have built-in programs to repeat those educations along the way because it’s difficult to take all that in when you’re in the hospital. We have a follow-up stroke clinic where we go through a lot of those educations again because really understanding the disease is one of the biggest steps towards preventing it from happening again and helping those loved ones who may be struggling taking care of someone with a stroke or perhaps trying to do it themselves. So, having those social networks in place as well as the medical part has been a big difference here.
Melanie: Thank you so much, Dr. Cline. What great information and so important. You’re listening to the Health Talks with HRH. For more information you can go to hendricks.org. That’s hendricks.org. This is Melanie Cole. Thanks so much for listening.
Stroke: Know the Risks and Reduce Your Chance of Having a Stroke
Melanie Cole (Host): If you or a loved one was suffering from a stroke, would you know what to look for? Would you know what to do? My guest today is Dr. Scott Cline. He’s a neurologist with Hendricks Regional Health. Welcome to the show, Dr. Cline. What is a stroke?
Dr. Scott Cline (Guest): Thanks for having me out. I guess in the simplest of terms a stroke is basically a blood vessel that gets blocked off in some region of the brain that generates symptoms such as weakness, numbness or changes in vision or speech that can happen quite abruptly. Some people don’t realize just how fast it happens. It’s basically a flipping of a switch.
Melanie: Give us some facts about stroke because some of them are quite staggering in how it’s the number five cause of death in the U.S. and some of the other facts.
Dr. Cline: You bet. The last numbers I saw roughly in the U.S. were that we have about 800,000 strokes a year. You’re exactly right. It’s the number five cause of death but it’s the number one cause of disability. When people think of stroke, they think about it being a potential cause for death but, in fact, most people actually survive their stroke but it leaves them quite disabled to where they’re dependent on either the health system or their family to care for them going forward. So, it becomes that much more important to consider a prevention strategy to make sure the stroke doesn’t happen in the first place.
Melanie: Who would be at risk? What are some of the risk factors for stroke?
Dr. Cline: The risk factors for stroke are roughly the risk factors you would think about for heart disease and other things because the problem is basically the same – it’s a blood vessel problem. It’s going to be the things that you always hear about from your doctor about no smoking, reducing alcohol to moderate intake at most, eating a healthy diet, regular physical activity, maintaining appropriate body weight. Most of the things that you think about anyway but really in stroke and heart attack, those things become that much more important to prevention than anything we can do medicine-wise.
Melanie: So, most importantly, what are some of the signs of a stroke? How would somebody know if themselves or a loved one was having a stroke?
Dr. Cline: Stroke has always been a big passion of mine since residency and it’s always been admittedly a bit interesting and a bit frustrating that people will notice stroke symptoms even in themselves and think that they slept on their arm wrong, or whatever it might be; or if they just go and take a nap, that it will all go away but if you sit on a stroke, then there’s admittedly not a lot that we can do down the road. If you realize that someone is having difficulty with their speech or their face is drooping or one side isn’t working correctly, whether that’s numbness, weakness, trouble walking anything in that world, then you certainly need to be worried about a stroke. If you come to the ER within the first few hours, we can actually do something to try to reverse that stroke. Once we get outside that--four, five, six hours--there’s not a lot we can do other than just work with the symptoms. Early recognition of face drooping, arm or leg weakness, speech trouble and things like that needs to bring you immediately to the ER for a further look.
Melanie: You mentioned how quickly you have to get treatment for this because “time is brain” so you doctors say. What do you do? If we call 9-1-1 and let them know that we think we’re having a stroke, then what happens to this person?
Dr. Cline: Absolutely. You’re exactly right. Time is brain. To put a number on that--as a ballpark, in the midst of a stroke, you lose about two million brain cells a minute. So, not only is time is brain but every minute that clock goes by, that’s nerve cells we can’t bring back. Don’t even sit on it for a few minutes. Come in immediately. Yes, calling 9-1-1 and saying, “I’m concerned about a stroke” will set off an “EMS stroke alert”, so to speak, where they will send out an EMS unit that has been trained in how to recognize and treat stroke. Then, they will call the ER ahead of time saying, “We recognize that we have a stroke”. They’ll ask you for an exact time of onset so we can know what kind of time we’re up against and then the ER will start getting things in line before that patient even hits the door. So making sure the CAT scanner is clear so we can get you in quickly; making sure an ER doc and an ER nurse is freed up so they can get to you immediately; alerting the pharmacy to make sure we can get our clot busting medicine available in case we need to use it--things like that. Using the ambulance service and the EMS services to get here really helps expedite that stroke care as opposed to you trying to drive yourself or a loved one in.
Melanie: So, that clot busting medication you’re discussing, what’s that all intended to do? What’s the aftercare after you’ve done that for us? Then, what happens?
Dr. Cline: If someone arrives within three hours of the onset of their stroke or for certain patients up to 4.5 hours, we can actually give a clot busting medicine known as “TPA” to try to dissolve the clot that’s causing the stroke. We have to screen people for the use of blood thinners and risk for bleeding and things like that because certainly the risk is not zero but we’re trying to reverse a stroke that’s potentially very disabling. Once we screen people appropriately, assess them for things that I would call “stroke mimicking” – things that look like stroke that really aren’t – once all that has been teased out, then we give someone the clot busting medicine through and IV and from there, they’re transitioned to the ICU, mostly for monitoring reasons. We can keep accurate track of blood pressure, glucose, things like that, that can make a big difference in stroke as well. Our ER staff has been through training on this many, many, many times. They are good at recognizing and diagnosing stroke; they have early access to me so I can look at the CAT scan and things like that for being on-call; and then, our ICU team and I kind of take it from there. So, it moves really fast. It’s admittedly a bit overwhelming for the patients and their families initially but it really needs to be. Like I said, two million brain cells a minute it’s a lot to go through to try to slow it down.
Melanie: Dr. Cline, if you’ve had one stroke, are you then at risk for TIA’s or further strokes after that?
Dr. Cline: Yes, that is true. When you run through the risk factors for someone to have a stroke, a prior stroke is on that list, though I would say that coming in the hospital and getting those risk factors assessed--looking for corroded artery disease in the neck or looking for heart difficulties; looking at your risk factors such as blood pressure, cholesterol, diabetes, smoking things like that, if we can get those risk factors properly managed, in the end your risk of a second stroke is probably not that much higher than it would be compared to the general population ,though, it is true--you are at risk for a second stroke just inherently from having your first one.
Melanie: You spoke a little bit about some lifestyle behaviors for prevention. What do you want people to know? What is the most important information for preventing a stroke in the first place?
Dr. Cline: I would say the biggest takeaways in terms of prevention is, there are things that you don’t even need a physician or a nurse to really help you with. It’s the common sense things, such as eating a proper diet or exercising regularly, maintaining a proper body weight things like that. Avoiding smoking, avoiding excessive alcohol--those things that I think we all know inherently but sometimes take for granted that if I have a little trouble with that, maybe a medicine can control it. Sometimes, the cat’s already out of the bag at that point and so, yes, there are things we can do medicine-wise to reduce your risk of a first stroke or a second stroke but really the main prevention is maintaining a healthy lifestyle to begin with.
Melanie: So, tell us about your stroke program at Hendricks Regional Health.
Dr. Cline: Hendricks Regional is a primary stroke center. We have been for several years now and we’ve really set the standard, in terms of some of the numbers we look for acute stroke care; acute stroke care meaning those patients who are eligible to get that clot-busting medicine. The American Stroke Association sets the bar at roughly 60 minutes from what’s called a “door to heal” time meaning the time you hit the emergency department door to the moment your clot-busting medicine starts; so, within one hour. Since I’ve been here, roughly five years now, we’ve consistently hit that or beat it. That’s something we take great pride in. I know our EMS ambulance drivers as well take great pride in being able to do that as fast as anyone else in the market. Our ability to carry that into the hospital to where all of our nurses are also certified in stroke and so are all of our physicians who care for you and carrying that even through to what you may need on the outpatient side or rehab services, all the way to the stroke support group at the end, if needed. There’s really a whole package that we’ve put together because really stroke is not something you see coming. It’s life-altering and it can be very overwhelming for the patient and their family and anyone else who’s involved. It’s something that we have built-in programs to repeat those educations along the way because it’s difficult to take all that in when you’re in the hospital. We have a follow-up stroke clinic where we go through a lot of those educations again because really understanding the disease is one of the biggest steps towards preventing it from happening again and helping those loved ones who may be struggling taking care of someone with a stroke or perhaps trying to do it themselves. So, having those social networks in place as well as the medical part has been a big difference here.
Melanie: Thank you so much, Dr. Cline. What great information and so important. You’re listening to the Health Talks with HRH. For more information you can go to hendricks.org. That’s hendricks.org. This is Melanie Cole. Thanks so much for listening.