Joey Wahler (Host): The American Heart Association says it's the fourth leading cause of death in the United States. So, we're discussing stroke awareness. Our guest is Dr. Blase Hennessy. He's an internal medicine physician. This is Wellness in Reach, a Mount Carmel podcast. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Hennessy. Welcome.

Dr. Blase Hennessy: Hey, Joey. Thanks for having me. I'm very excited to be here and talk a little bit about stroke awareness.

Host: Absolutely. Same here. So first, for those unaware, we've all heard the term, what exactly is a stroke? In layman's terms, what's going on when that occurs?

Dr. Blase Hennessy: Well, Joey, in broad terms, a stroke is what happens when part of the brain gets cut off from blood supply. It happens in a couple of different ways and a couple of different very broad categories. The two broad categories that we look at that can cause a stroke are, number one, called an ischemic stroke, where something is cutting off blood supply in a blood vessel, usually a clot or an atherosclerosis plaque. This can happen gradually. It can build up over time and break off causing symptoms. The other type is what we call a hemorrhagic stroke, where blood goes into the brain tissue or surrounds the brain and is basically bleeding into that space, causing pressure and choking off that tissue from oxygen.

Host: Well, thanks for that distinction between the two. So, how common are strokes and who's most at-risk to suffer one?

Dr. Blase Hennessy: Well, Joey, unfortunately, strokes are extremely common. And this is why it is really important for us to talk about strokes here today. Stroke is one of the leading causes of morbidity, mortality in the United States. We see around 800,000 people per year in the United States having a stroke. More than 600,000 of those are first-time strokes. With the remainder being folks that have already had a stroke. Approximately, one stroke happens every 40 seconds in the United States. So it's something that we really want people to be educated about and be aware of.

When we look at particular risk factors for stroke, one of the biggest things that we see is, unfortunately, the older we get, the more likely we are to have a stroke. That falls into one of the factors that we can't control. We also see that women are more likely to have stroke than men. And there are some populations including black Americans that have a higher incidence of stroke than the general population.

There are things, risk factors, that we can control, and that's really where we need to focus our efforts and attention. The biggest cause and the biggest thing that we can look at is controlling our blood pressure, keeping with your doc, working on blood pressure control. That's one huge factor that we can work on to mitigate our stroke risk.

Other things that we look at include daily exercise, trying to get some level of activity per day. Sedentary lifestyle is associated with having stroke. Another big risk, something that is easier said than done, but quitting smoking can reduce your chance for a stroke throughout your life and is hugely important for a number of reasons.

Cholesterol, working on that LDL cholesterol with your doc through diet, through that exercise, even in some cases, using a cholesterol-lowering medication with the help of your doctor can also get rid of a lot of those risk factors for stroke. Keeping a low stress profile is also something that we can work on. We recommend things like meditation, practicing self-awareness and self-mindfulness, really trying to take some time for yourself every day. Reducing your stress levels can help reduce inflammation in your body and can help with some of that stroke risk.

Host: Absolutely. And you did a great job there, Doc, because I just crossed about two or three of my upcoming questions off the list. You gave me like a three-in-one there. That was perfect. What are the most important early warning signs of a stroke that both patients and their families should learn to try and recognize?

Dr. Blase Hennessy: Yeah, absolutely. This is something that's really important. And with stroke, one of the things that we tell people to do is that you have to act fast. And with that, we make a helpful memory device called BE FAST, which is an acronym, and I'll go through the letters. But it points to the broad categories of things that we should look for.

Now, B stands for balance. And that is, "Hey, I'm having difficulty. The room is spinning, I feel like I'm having severe vertigo. I'm getting up to try to walk, and I feel like my feet aren't working and I'm going to fall over," those can point to balance issues and can point to a problem in the brain.

E stands for your eyes. If you have a sudden onset of vision changes, if you lose vision in one or both, or part of your eyes, if things are looking blurry, if you're having double vision, that can, again, point to a neurologic problem and should make you want to get checked out very quick.

The F stands for face. A lot of times people will see a facial droop. You might see this on yourself when you look in the mirror and wake up in the morning. One of the things that we ask people to do, and if you have somebody that you're concerned is having a stroke, say, "Give me a big smile," showing the teeth. Looking at the smile, you can see: are the lips going up the same on both sides, or is there a difference?

A stands for arms, and that's really weakness in the arms or legs. Again, if you're concerned that somebody is having a stroke, you can ask them, put your arms straight out in front of you and hold them there. If you're seeing one arm drift away, that could be a sign that, "Hey, something in the nerves is going wrong," and that that person could be at risk.

The final is speech. That's difficulty with your speech. This can be word-finding difficulty. It can also be trouble with slurring your words. Again, if you're with somebody and you're concerned that something's not right, ask them to repeat a sentence after you. If they have difficulty with that, have difficulty finding those words, or they sound not like they typically are, that's a warning signal that something might happen.

The T in BE FAST is a reminder that, with stroke, the treatments that we have are all very time-sensitive. The folks who do stroke research always remind us that the time equals brain cells, and that the quicker you get to the hospital, the more treatment options you have available to you and the better recovery chances you have.

I always tell people, and it is a strong recommendation, if you have any of those signs of symptoms or stroke or you're concerned that your family does, it's a call to 911 and getting in the ambulance rather than going through the front door of an emergency room or waiting for those symptoms to get better.

Host: Yeah. You mentioned expeditious factor here, right? And there's another term that you and yours often use when talking about stroke, time is brain. Because as you just pointed out, the faster someone is looked at and treated, the better chance they have of recovering as much brain activity and normal capability as possible, right?

Dr. Blase Hennessy: Yeah, absolutely, Joey. When we look at that, and I talked a little bit about the two different categories of stroke, if you're coming in with that ischemic stroke, there are things that we can do like clot-busting medications, as well as procedures where we can extract stroke and clot from the brain that really are very time-sensitive. After a certain amount of time, it's more dangerous to try to do those procedures than the benefit that you would get from them.

With that hemorrhagic stroke, the bleeding in the brain, the biggest thing that we need to do is release that pressure; in other words, going in, removing that blood doing procedures to stop that bleeding and get rid of that swelling that's causing that compression of the brain tissue. With both of those things, the faster you can get in and get seen, the better outcome you can possibly have.

Host: Now, you ran down a moment ago, Doc, a list of the most common things to look for here, mentioning the things that go into the BE FAST acronym. How about a lesser known or atypical stroke symptom, maybe something we wouldn't necessarily think is a sign of a stroke, but you wish they knew about?

Dr. Blase Hennessy: Well, and this is tough because the brain is a very complex organism. And even looking at strokes in particular areas and with different blood vessels, folks might respond a little bit differently. And so, we look at the broad categories of BE FAST as a starting point, but we also have to look at different things.

Sudden-onset headache, some people describe as the worst headache of their life. If it's different than your typical migraine headache, something that you haven't experienced before, that could be the sign of a stroke, particularly one of those hemorrhagic strokes. Other things that we look at, sudden-onset or gradual onset confusion. If somebody's just not seeming themselves, that could be pointing to a brain issue. We also see problems with folks with swallowing. If people seem like they're choking on their food, having difficulty swallowing, that could be nerve problems that are controlling our swallow function and could be a sign of a stroke. Generalized weakness, "Hey I'm having difficulty getting out of bed. I'm having difficulty, you know, bringing myself up." That's something that could point to stroke as well. The challenging thing and the difficult thing about these strokes is that anything that our brain controls can be affected if we are having a stroke.

Host: A couple of other things for you. You mentioned earlier trying to keep your cholesterol in check and that high blood pressure is often a cause of stroke. How about the importance, Doctor, of going for those regular checkups, getting at least basic screenings done, having your blood pressure taken, having a routine blood test done so the cholesterol and other things can be looked at. It's so important because it's simple, but it can avoid a lot of these major conditions, right?

Dr. Blase Hennessy: And I talked a lot about the things that we control and the things that we can't control. We can't control our age. We can't control getting older. But we can know our numbers and that's something that is so important. And like those things that you mentioned, keeping an eye on the blood pressure is the most impactful thing that we can do. Making sure that we're working with our doc on that good blood pressure control, the cholesterol, your blood sugar, if you're diabetic. Other medical conditions, like atrial fibrillation, if not treated, can lead to stroke. And so, regular checkups, that ounce of prevention really is worth the pound of cure when it comes to stroke.

Host: And, in summary here, you did such a great job earlier of running down some of the things that we can control. There's that theme again, like diet, exercise. For those joining us that may be thinking, "Boy, I've got a few things going on here that I'm not doing the way I could be or as much as I should be," job one, if somebody wanted to start today, right now, doing just one thing in terms of taking a step toward helping to prevent a stroke, where do they begin?

Dr. Blase Hennessy: Joey, I think that you answered the question when you asked it. It's taking that step. And if you're somebody that hasn't been active, hasn't exercised, getting up walking, even if it's a few more steps every day than you did the day before, making that slow and steady progress, that exercise can help with those other things. It can help with our cholesterol, it can help with that blood pressure. And so ,really taking that first step towards improving your activity levels can be the first positive change for all of those other things that we talked

Host: And one expert I interviewed recently said, just in talking about taking more steps regularly in general, they said a great tip, which I had never heard before, is when you're out running errands and you park in a parking lot to go into a store, don't necessarily take the parking space closest to the door. Maybe take one further away that's going to enable you to walk a minute or two on your way in and on your way out at least you get some steps in, right?

Dr. Blase Hennessy: I love that. I love that. And it's those mindful positive changes that might seem small, but they add up. That walking longer in the parking lot might change into taking the flight of stairs instead of the elevator. And all of those small things add up and make progress over time.

Host: Absolutely. Well, folks, indeed we trust you are now more familiar with stroke awareness. Such an important topic as we touched on at the outset. Dr. Hennessy, valuable information indeed. Hopefully, those joining us heed your warnings and advice and thanks so much again.

Dr. Blase Hennessy: Hey, thank you Joey. Appreciate it.

Host: Same here. And for more information or to learn your stroke risk, please do visit mountcarmelhealth.com/services/stroke. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. Thanks again for being part of Wellness in Reach, a Mount Carmel podcast.