Scott Webb (Host): Welcome to Health Dose, your go-to source for quick and reliable health and wellness news. I'm Scott Webb. And today, we're discussing strokes and what you should do if you believe you or someone else is experiencing a stroke. Dr. Faith Fuentes is here. She's a neurologist with MyMichigan Health. Doctor, welcome to the podcast.

Faith Fuentes, MD: Good afternoon. Thanks for this opportunity of trying to inform the public about stroke.

Host: Yeah, there's never a bad time to talk about stroke, you know? I know time is of the essence. They say time is brain. Along those lines, you know, we're going to talk about BE FAST in a bit. But before we get there, let's just maybe have a foundational thing, like what is a stroke? What happens when someone's having a stroke?

Faith Fuentes, MD: A stroke is a medical emergency that happens when blood flow to the brain is obstructed, like, when there is a clot or when blood flow is disrupted because a blood vessel ruptures and there's bleeding into the brain. So when this happens, there is lack of nutrients to ablate, particularly oxygen. And brain tissue is particularly sensitive to lack of oxygen. In five to 10 minutes, brain cells can be severely injured or permanently damaged. And beyond 10 minutes, there actually is irreversible death of brain cells. So, this is the reason why the mantra for stroke is time is brain. And with our current knowledge of what we can do for stroke, it is important that patient's recognize what the symptoms for stroke are and that they go to the emergency room so we can apply the current treatments available.

Host: Let's talk about BE FAST, that acronym, you know, in terms of the early recognition of stroke symptoms, and what does each of the letters stand for.

Faith Fuentes, MD: Yes. BE FAST is an acronym that has been adopted by the Stroke Association, and this is across the United States. And even in other countries, they get an acronym that is very similar on their language, of course. So, the BE FAST, we try to educate our population about using the BE FAST and using it to recognize stroke.

The B stands for balance. So, B would be loss of balance. So in stroke, it's loss of function. So, B would be loss of balance. E would stand for eyes, so either change in vision or loss of vision. F is for facial droop. And then, A is for loss of motor strength or loss of sensation in an arm or leg. And then, S is for slurring of speech or speech difficulties. Sometimes it's not just the slurring, but inability to speak at all. And then, T, that means it's time to call 911. So, we use this BE FAST. It's easy to know, easy to memorize, easy to apply. And any bystander or any relative of an individual who might be having stroke symptoms should be able to find these symptoms. And then, important thing is to call 911 instead of driving themselves to the hospital.

Host: If we happen to be having a stroke or someone's having a stroke and we're driving right by the hospital, sure, it's okay to go ahead and pull in, right? But if we're home, if we're anywhere else and we recognize the signs and symptoms either in ourselves, someone else, call 911. Be fast about it. Time is brain. And I just want to have you maybe drill down a little bit when we think about the immediate actions maybe that a bystander could take if we suspect someone is having a stroke.

Faith Fuentes, MD: The first thing really is to call 911. That way, they have the ambulances time to get going, especially if you mention symptoms of a stroke, like inability to speak, or there's one side is paralyzed already. So, that will be helpful for the EMS to come running. And for the bystander, all they have to do is make sure that the patient's able to breathe. Nothing is obstructing their ability to breathe. If they had fallen, just not move the patient at all if they're on the ground because you don't know if they have broken some bones. So just make sure that they have the support of nothing obstructing their ability to breathe.

Otherwise, there's really nothing. You don't pound on the chest unless the patient is in cardiac arrest, and you know what to do. It's important to call 911. So, we discourage them driving themselves or relatives driving them to the hospital because by calling EMS, EMS is already able to get baseline information like when was the patient last known well before he had the symptoms. They're able to get information as to what medications the patient Is taking. If he is on an anticoagulant or like already on a blood thinner, that might make deciding on using the current drugs not possible to use what we call the clot buster. So, a lot of information that EMS can collect. And already, they transmit this information to the emergency room. So, the emergency room now, the team is ready to accept this patient with stroke symptoms so that they're given priority in the emergency rooms setting.

Host: Yeah. And that's so important. They can begin treatment, of course, on the way, but notify the ED that a patient is coming and get all that baseline information, which can be so critical. And it's just all good stuff, and so important to be fast.

And I wanted to have you talk a little bit more about the timing, you know, in terms of the interventions that you can do. You mentioned there, well, if they're already on a blood thinner, that's one complication. But maybe take us through any others that they might find out about a patient on the way to the hospital and what's the timeframes for, let's say, full recovery, if that's a thing for most patients, provided they get there soon enough.

Faith Fuentes, MD: So when the emergency EMS comes, they're able to already start treating blood pressure, the blood pressure is too high. Because to be able to give this new drug, for example, blood pressures should be below 185 over 110. There are parameters for deciding on whether the patient can be treated.

Now with the stroke guidelin,es so all emergency room, especially if they're accredited stroke centers, we follow the guidelines that involves different stroke time metrics. When you hit the emergency room door, we have to be able to get you to a CT scanner within, you know, 10, 15 minutes. So, that initial evaluation, you check the blood sugar, blood pressure, we check their NIH score, which is a neurologic examination that will give a score for the severity of the stroke, that will also help determine whether this patient qualifies to be treated with, clot busters, what we call a thrombolytic agents.

Every process is given a timeframe so, in other words, the people should act as fast as they can when they get to the emergency room. Now, thrombolytics, these are the clot busters can be given safely within four and a half hours from the stroke onset, from last known well. But the sooner you give it, you don't wait until, "Oh, I still have four hours to pass around." But the moment they hit the emergency room, you try to get the thrombolytics within 30 minutes of arrival or within at least 45 minutes. And the latest timeframe would be an hour. So, those are the timeframes that would be the most ideal to deliver these thrombolytic drugs or clot busters so that you get the best chance of improving and reducing your disability in a 90-day period of time. And sometimes even if we get them very early, before they leave the emergency room, the stroke symptoms have already resolved. So, the timeframe is very important.

Host: And it seems to me, Doctor,, just being a lay person, you being an expert, but it seems to me that so much has changed thanks to research in the last just couple of years, in the treatment of stroke and understanding of stroke. And just wondering if you could maybe take us through that a little bit.

Faith Fuentes, MD: Since the International Stroke Conference this year, 2026, they have expanded the use of the clot busters from a four and a half hour window. So now, we can give it safely up to nine hours from last known well. So, that is very helpful, because most of our patient's do not come within that four and a half hours. Majority would come beyond that time because patient's tend to wait and see, "Oh, it will go away." So, it's a lot of education. In the moment you have the symptoms, come to the ED. And if it's not a stroke, we can tell you, "Okay, it's not a stroke. We don't have to give you this medication." so, the window has now been extended.

The other important thing also in treatment of stroke, aside from the clot busters is the fact that if there is what we call a large vessel occlusion, a big artery that is blocked by a clot, we have a skilled interventionalist now. We call them neurointerventionalists. They can go in with their special catheters and really extract that clot for a better outcome for the patient. So for those with a clot that we can retrieve what we call large vessel occlusion, these patients will do better if you remove the clot. Their disability will be much less. Now if they come in, let's say you came in within four and a half hours, and you qualify to have the clot busters, and then you also have a large vessel occlusion, which we can go in and remove that clot, you would benefit better from having both treatment modalities done than only medical, the care without what we call the thrombectomies, the medical term for it. So, it has become more complex.

And then, we do have a telestroke team that helps us with these complicated decisions, because we have to consider the overall medical condition of the patient. But having dementia does not disqualify you from having this type of aggressive treatments. So, those are the complexities that are involved in making decisions for treatment.

Host: Yeah. And it really sounds like it's a team approach. it's not one-size-fits-all. I really appreciate your time and your expertise today, covering the broad strokes as best we can. No pun intended. Thank you so much.

Faith Fuentes, MD: You're welcome.

Host: And for those who getting more information about MyMichigan's Neurosciences Care, including signs of a stroke and a free stroke risk assessment, you can visit mymichigan.org/stroke. You enjoyed this podcast, please share it on your social channels and explore our podcast library for more health-related topics. I'm Scott Webb. And this is Health Dose. Thanks for watching and listening.