Transcription:

Prakash Chandran (Host): When it comes to a stroke, the longer you wait to seek treatment after experiencing symptoms; the more time there is for permanent damage to occur. I’m Prakash Chandran and in this episode of the Magnolia Matters Healthcast, we’ll be discussing symptoms of strokes and how to correctly spot them. Here with us to discuss is Dr. Peyton Preece, an osteopathic physician at Magnolia Regional Health Center. Pleasure to have you here Dr. Preece. So, let’s get right into it. What are the major symptoms or signs that we can look for when someone is having a stroke?

Peyton Preece, DO (Guest): Well you know 38% of Americans are really unaware of any symptoms at all of stroke. The biggest things are unilateral or one-sided numbness or weakness, usually in the arm or the face, can be the leg as well. They will have sudden confusion or a severe onset of a really, really bad headache, trouble speaking or unable to respond appropriately to questions being asked. Trouble seeing such as blurry vision, double vision. And trouble walking as well. And an easy way if you are with somebody who could be having a stroke is to remember the mnemonic F-A-S-T where you look at the face. Is there asymmetry in the face? If they smile, does one side not go up? Arms, can they raise their arms or move their hands? Speech, are they having altered speech, mumbled speech and then the last one T is time. Because it’s very important to make sure you get checked out in a timely manner because time matters in strokes.

Host: Yeah, I’ve heard that before F-A-S-T. So, it’s face, arms, speech and time which is the time that you take to call 9-1-1 and do something about that. So, I want to ask what is actually happening in the body or the brain I guess, that produces symptoms like these when you are having a stroke?

Dr. Preece: You have two main types of stroke. You have ischemic and hemorrhagic. Hemorrhagic means a bleed and that’s a little less common, actually a lot less common than ischemic strokes. Most ischemic strokes are lack of blood flow. So, 87% of strokes are ischemic so it is going to be a lack of blood flow. So, in other words, you have either an emboli which is a clot that can break off and go to the brain and block blood flow or you can have thrombotic which is an area in a blood vessel that’s already got buildup and it blocks off blood flow and those are your main types of ischemic stroke or where you lose blood flow to the brain.

Host: Okay so, because you are losing that blood flow to the brain; that is why the timing is so critical. Maybe talk a little bit about why it is so important to seek attention as soon as possible.

Dr. Preece: So, there are certain therapies that we can do if you seek attention in a timely manner and the treatments have gotten so vast now that there’s a lot of different things we can do. But if you can present quicker, then the quicker we can reverse the stroke and the better outcome, better mortality rate, the better the prognosis is; mainly in less than four hours. If you can get to a physician or to an ER nearest you, where you can get evaluated, sometimes they can give the medicine called TPA or a thrombotic agent that will actually – antithrombotic agent that will break up the clot or whatever may be causing the lack of blood flow and you can sometimes have symptoms that completely resolve, and you may not have any residual effects. Now they are doing more things where you can get transferred to a stroke center within a day and actually have endovascular procedure done where they go up endovascularly into the brain and they can retrieve the clot out from what’s happening. So, there’s a lot of advancements in medicine right now and time matters as far as the outcome and your symptoms after it’s treated. Because a lot of strokes, if we wait too late; the damage is done and there is nothing else we can do technically accept try to prevent another one from happening.

Host: It’s truly amazing to hear about all those advancements and like you said, the earlier that you can go in and see someone; the more likely it is that they’ll be able to kind of execute one of the treatments that you were talking about. I was surprised to learn that strokes can happen not only to the elderly; but people of any age. So, can you talk a little bit about why a child or someone in their 20s or 30s might have a stroke?

Dr. Preece: Yeah, so strokes can occur like you said, in any age. Mostly we do see it in older patients, but there’s also risk factors that increase our risk and one of those risk factors we can’t really do much about and that’s called genetics. If you are born with – your family has a history of a clotting disorder, something where they may – their blot may clot in their veins or even in their arteries for abnormal reasons; sometimes that can get passed down through generations. There are other things too that can cause clots in younger people that is less common, but you do see it. And it is something for anybody of any age should look out for and should know what the signs and symptoms are so that they can seek treatment in a timely manner.

Host: So, I read that high blood pressure or hypertension is the number one treatable risk factor for a stroke. And it seems like this is very treatable by looking at your diet and stress levels. Is that something you would agree with?

Dr. Preece: Yes, I mean out of the modifiable risk factors, blood pressure is one that’s easily treatable. A lot of times, if you are hypertensive; they can itself, just being hypertensive cause a stroke. Most of these strokes are known as lacunar infarcts which are small strokes but still, they can have significant consequences if you are not controlling the blood pressure. It’s the same really cardiovascular risk factors as for a heart attack, if you think about it. Blood pressure is a big one, obesity, smoking, if you are diabetic, keeping your glucose or sugars under good control, cholesterol and then in older patients; you worry about arrythmias as well, like atrial fibrillation and needing medicine to prevent strokes from that. But those are all modifiable risk factors and most of the strokes we see in a hospital usually are due to the modifiable risk factors. Like we said earlier, the genetics is more rare to see those younger patients come in with strokes. It happens, but the modifiable risk factors that we have that are treatable; that’s why you need to pay so close attention and listen to what your primary care physician says to try and prevent strokes from occurring. So, that way, you are not left with a significant deficit later on in life.

Host: Yeah, I would love to unpack the modifiable risk factors for a minute. You mentioned the blood pressure. Do you recommend changes to diet to people in terms of lowering that blood pressure?

Dr. Preece: Yeah, there is a lot of evidence out there on different diets mainly what you want to do is make sure you are keeping your – you want to eat healthy as far as fruits, vegetables, and you want to decrease the amount of carbohydrates that you take in and sodium particularly. Some new studies show that sodium may not have as much to play with it as we thought before in preventing such things as strokes or heart attacks, but it definitely helps better control your blood pressure. So, it is important to increase your potassium which is high in fruits and vegetables, decrease your sodium which has been shown to also lower the level of your blood pressure.

Host: So, this is something I’ve always been curious about. We mentioned F-A-S-T and recognizing if someone else is going through the symptoms of a stroke; but have you ever heard of or is it possible to self-recognize when you are going through some of these symptoms and if that happens; what do you recommend that someone does?

Dr. Preece: Yeah, so the biggest thing is you need to know if you have trouble speaking, you feel numbness in one side versus the other or you have trouble seeing, blurry vision, double vision or a sudden severe onset of a really, really bad headache, say you can’t get up from a seated position or you feel like you are driving and you are veering off the road and you know something’s not right, you need to seek medical attention immediately, preferably, especially if you are in a car or at home, wherever, pull off the road or get to a phone if you can, tell somebody to call 9-1-1. But calling 9-1-1 and have the proper people come out, paramedics and examine you and bring you to the nearest hospital is the most important thing you can do and as we touched on already, time is so important and the sooner you do this, the better the outcome can be.

Host: Yeah, that’s extremely helpful advice. I’ve always wondered what happens if you are going through it yourself. So, that’s good to know you just call 9-1-1 immediately and then have them come to treat you. If your loved one or a family member or friend is experiencing it, remember that F-A-S-T mnemonic. So, face, arms, speech, and time. So, Dr. Preece, thank you so much for all this information. Hopefully it can help save a life. Is there anything else that you wanted to share with the audience today?

Dr. Preece: No, not really. I think that pretty much covers it. I would say those who get admitted to the hospital be cognizant that a lot of these if you are admitted and you are not getting there in an appropriate amount of time; sometimes those deficits aren’t reversible and from there your physician who may see you in the hospital and your primary care physician it’s all about modifying those risk factors that we touched on already and trying to keep a better check on your blood pressure, blood glucose, cholesterol and being healthy and exercising. But outside of that, that’s about it.

Host: That’s very helpful. I think so often, we just hope certain things will go away, certain symptoms will go away, or we think to ourselves, oh this can’t be a stroke. But I think that just the better safe than sorry rule is always a good thing. If you think that your loved one or someone that you are with is experiencing those symptoms; it’s better to just take them in because of all of the advancements that we have in technology to reverse those things and it’s hard to imagine suffering the consequences if you don’t. So, I want to thank you again for your time Dr. Preece. And everyone else for more information, please visit www.mrhc.org. My guest today has been Dr. Peyton Preece. I’m Prakash Chandran. Thank you so much for listening.