Transcription:
Preventing and Treating Stroke

Deborah Howell (Host): Hello. Everybody, welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell. Today, our guest is Dr. Kiet Loc, a board certified neurologist and neurohospitalist affiliated with Saddleback Memorial. Dr. Loc's interests include managing complex stroke patients along with general neurology. Welcome, Dr. Loc.

Dr. Kiet Loc (Guest): Thank you. Thank you for having me here.

Deborah: It's our pleasure. Today, let's talk about preventing and treating stroke. A couple of facts. Stroke is the fourth leading cause of death in the US and the number one cause of disabilities. Without prompt diagnosis and treatment when stroke occurs, permanent damage and a corresponding loss of function can occur, so every minute really matters. We're here today to learn what you can do to reduce risk factors for stroke and know the warning signs so you can act quickly if you or a loved one are experiencing stroke symptoms. First of all, doctor, what is a stroke?

Dr. Loc: A stroke occurs when brain cells are deprived of oxygen. This can happen within a few minutes. That's why time is always brain. There are two types of stroke. One is what we call ischemic stroke, when the blood supply is actually interrupted by a blood clot in the artery. This is about 80 percent of the cases. The other type is what we call hemorrhagic stroke, which is a bleeding type of stroke. So the blood clot is just going to push the nerve tissues away and cause symptoms.

Deborah: Excellent. That was very brief and to the point and right in a nutshell. What are some stroke symptoms?

Dr. Loc: Some of the stroke symptoms, you need to act promptly if you notice your loved one having them, including have them smile. If you notice a droopy face on one side or the other, then that is considered one of the symptoms. The mnemonic is what we call FAST. F is the face. A is for arm, so you have your loved one raise both their arms. If one of the arms [drift], that means that arm is weak. Speech is S, the next one. And you would have them repeat a simple phrase or ask them what this is, and if their speech seems slurred or what we call nonsensical, then that's another symptom as well. The last one is Call 911 right away as soon as you notice your loved one having any of these symptoms. Again, the mnemonic is FAST for face, arm, speech, and time.

Deborah: I've also heard in rare cases that if you're texting with someone, and suddenly, their texts are just complete nonsense, that might also be a sign.

Dr. Loc: That's definitely correct. That kind of gives you a view of what are they thinking. If their thinking is not clear, their texts would be nonsensical as well, too.

Deborah: Right. So what should individuals do if they're experiencing these symptoms themselves? How quickly should they react to these symptoms?

Dr. Loc: They should definitely call 911 right away. Do not try to drive your loved one yourself because when the paramedics arrive, that's when the evaluation begins. They will definitely alert the whole system that the patient is arriving. So it is much better to call 911.

Deborah: Paramedics, they do have the skills to determine whether or not this is stroke?

Dr. Loc: All the paramedics are trained to notice a symptom of stroke, and once they notice a patient has symptoms of stroke, they activate what we call a stroke code and alert the emergency department that a patient is arriving so the emergency department can rally up the team.

Deborah: Okay, very good. What's the importance of the stroke program, and what is the need?

Dr. Loc: Saddleback Memorial is designates as an advance primary stroke center by the joint commission. What that means is Saddleback provides 24/7 neurointerventional stroke care, which includes around-the-clock neurologist, neurointerventionalist, radiologist to help take care of the patient. So again, this is very important because time is brain, so we want the patient to be evaluated and get the care without any delay.

Deborah: Excellent. Okay. Maybe you could walk us through the stroke treatments. So a patient will receive these following steps at Saddleback Memorial.

Dr. Loc: Once the patient arrives in the emergency room, the emergency room doctor will evaluate the patient, and they will ask the neurologist to come see the patient right away and evaluate the patient. Once the neurologist sees the patient, then depending on the case, they will determine if the patient qualifies for what we call clock buster, also known as the TPA. It's a medication that can only be given if you arrive within three hours when the symptoms started. So it's what I call draino for plumbing. So you have the clotting type of stroke. This medication has been determined by a very large '98 NIH-supported trial that at three months, you have 30 percent less disability and mortality.

Deborah: Thirty percent less?

Dr. Loc: Yes. Any percent will count.

Deborah: That is significant.

Dr. Loc: I agree. That's why time is brain.

Deborah: Time is brain, yes. Okay. Describe your role, if you would, as the neurohospitalist.

Dr. Loc: My job is to evaluate patients who present with acute neurological problems such as stroke or seizure. As soon as the emergency room physician thinks the patient needs my care, I'll be there right away to evaluate the patient.

Deborah: Okay. So you evaluate, and then what happens?

Dr. Loc: I will facilitate appropriate care for the patient. If they have a stroke, then determine whether the patient has what we call EPA or need any more extra care, what we call intervention by the neurointerventionalist. If the patient is having seizure—again, time is also brain for seizure—we need to give seizure medication right away.

Deborah: I wanted to say that it seems like you certainly aren't working alone to help treat a patient. There's got to be a lot of team around you.

Dr. Loc: Definitely. We have a great nursing staff at Saddleback Memorial. I have a great team of emergency room doctors to help me out as well.

Deborah: What's the difference between a neurohospitalist and a diagnostician?

Dr. Loc: A neurohospitalist, in the past, the traditional role for a neurologist is only seeing patients in the outpatient setting. Now, with the demand of patients with acute care, we want to not delay any care and have me and the neurologist be there right away to take care of the patient.

Deborah: Okay. Again, people really need to understand they can't mess around. They can't look for the right pair of shoes to put on. You need to get these folks who are experiencing these symptoms immediately in the care of at least a paramedic, if not straight right into the hospital. Lots of times, patients have the strokes right there in the hospital.

Dr. Loc: Correct.

Deborah: And so they need to be surrounded instantly by -- thank God, there are things like call buttons. Call buttons have saved many a life in these situations.
Dr. Loc: Yes.

Deborah: What are the ways to help prevent a stroke?

Dr. Loc: To decrease your risk for stroke, what we call secondary prevention is very important. The main thing is to make sure your stroke risk factors are being under control. They are blood pressure. If you have high blood pressure, make sure your blood pressure is controlled to less than 130, the top number, and less than 80 for the bottom number. And obviously, this would help with medication. Second, if you have high cholesterol, you're going to make sure your bad cholesterol, what we call LDL, has to be less than 70, and your cholesterol should be checked every six months.

Deborah: Really?

Dr. Loc: Yes.

Deborah: I haven't heard that before.

Dr. Loc: It should be checked every six months, so if you're on medication, you can see whether it needs to be adjusted or not.

Deborah: Well, that makes sense.

Dr. Loc: And next. Very important is diabetes. Diabetes can pretty much accelerate the clogging of almost every arteries in your body, including the brain so you've got to make sure your diabetes is under control. Eat well, exercise. And now, if you have something what we call atriofibrilation, which is an irregular heart rhythm, you have to be on the appropriate medication, whether a blood thinner. Depending on your other medical factors, the appropriate medication would help. Because atriofibrilation actually increases your risk of stroke in comparison to the general population of up to 5 to 20 percent a year.

Deborah: Why is that so?

Dr. Loc: Because when your heart pumps regular, it's okay. What we call irregular heart rhythm is when they pump irregularly, so they do not pump the blood effectively. So when the blood just sits there, it kind of pools and it will clot. And then if your heart goes back to a regular rhythm, it will start pumping those clots up into the brain, and that can cause a stroke.

Deborah: That was so visual. The way you described it, I can actually see that happening in the body, so we do not want that to happen, do we?

Dr. Loc: Other important factor is if you're smoking. Smoking, actually, again, causes inflammation to all the arteries, and it will accelerate any clogging in the arteries involved.

Deborah: So much information. You've been so informative, Dr. Loc. It's been wonderful to have you on the program today. We're going to help you get the word out about stroke prevention, so to listen to the podcast or for more information, please, by all means, visit memorialcare.org. Remember, time is brain. Thanks again, Dr. Loc.

Dr. Loc: That's right. Thank you. Have a good day.

Deborah: You, too. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness that could save your or your friend or your wonderful loved one's life. It's brought to you by MemorialCare Health System. You have yourself a fantastic and healthy day.