Selected Podcast
Stroke: Reduce Risk and Spot Symptoms Quickly
Stroke is the No. 5 cause of death and leading cause of disability in the United States. Stroke Education Coordinator Ryan Keiler shares warning signs of a stroke, prevention tips, and risk factors.
Featured Speaker:
Ryan Keiler, MSN, RN
Ryan Keiler MSN, RN is Stroke Education Coordinator, Northwestern Medicine Central DuPage Hospital and Delnor Hospital. Transcription:
Stroke: Reduce Risk and Spot Symptoms Quickly
Melanie Cole, MS (Host): If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of stroke. That’s why it’s important for you to know the signs of a possible stroke so that you can learn your risk factors and what you need to do is you suspect that you or a loved one may be having a stroke. My guest today is Ryan Keiler. He’s the stroke education coordinator with Northwestern Medicine Central DuPage Hospital and Delnor Hospital. Ryan, I'm so glad to have you with us. Tell us about the current state of stroke today. What’s the prevalence and it’s impact worldwide?
Ryan Keiler MSN, RN, CNRN (Guest): Excellent. Well, thank you so much for having me. It’s a pleasure to be here. The prevalence within the United States, every 40 seconds someone experiences a new or recurrent stroke. That’s about 795,000 strokes a year. Looking forward over the next 10 years, research shows that an additional 3.4 million Americans over the age of 18 will experience a stroke. So the prevalence is going to go up almost 4% within our population. More people are surviving stroke, but stroke still remains the number one cause of preventable medical disability. We spend, as a country, about $36 billion every year on the medical disability care that results from stroke.
Host: Wow. Those are some incredible statistics Ryan. So what is a stroke? Are there different types? Explain a little bit about what actually happens.
Ryan: We like to talk to people about stroke and reference it as a brain attack. It’s the same concept as a heart attack. So a part of your brain that is being supplied blood is no longer getting blood. We know that every minute that goes by when your brain is not getting blood, you lose almost two million blood cells. So time really is of the essence.
There are two types of stroke. There is one that we call an ischemic stroke, that is a blood clot base stroke. It can be a blood clot that develops in the brain or comes from somewhere else in your body. That makes up 87% of strokes. So the majority of strokes are clot based strokes. The other types of strokes are hemorrhagic or bleeding strokes. That’s where a blood vessel feeding some part of the brain ruptures for some reason and therefore the part of the brain that is being supplied blood is no longer getting blood. That blood also leaks out and damages brain tissue around that vessel as well.
Host: That’s a great explanation. Very clear and understandable. So who is at risk? Tell us about some of the medical risk factors, comorbid conditions that can contribute to stroke, and some uncontrollable. Is there a genetic component to it?
Ryan: Yes there is. Everyone is at risk for stroke. Stroke effects infants all the way through to the end of life. We do know that age is a large risk factor. Every decade over the age of 55, your risk of stroke goes up. However, we’re seeing more stroke in younger people. The leading risk factors that can be controlled, the number one risk factor is high blood pressure. Other risk factors that we talk about are nutrition, physical activity, atrial fibrillation, high cholesterol. Smoking is a very high risk factor that is an independent risk factor, meaning that if you have no other risk factors but you smoke it puts your risk of stroke higher.
Some of the risk factors you asked about that are uncontrollable that people should still know about are age. Gender plays a role. We know that more women than men have strokes, and more women than men die of strokes. That’s because of pregnancy, hormonal changes, and women live longer than men. There is a genetic component. So a family history plays a role. If you have a mother or father, daughter or son, or a brother or sister that had had a stroke, you are more at risk for stroke. There are certain genetic predispositions. Also among race we know that African Americans are two and a half times more likely to have a first ever stroke. Hispanics are 2.1 times more likely to have a first ever stroke. There are certain races that have a genetic predisposition to diabetes, which is a risk factor, to high blood pressure as well. So there is a genetic component to stroke.
Host: So we’re learning about our risk factors. We’re learning about what stroke can do. Now, it’s really important for listeners to understand the symptoms so that they can recognize it because time is brain. So speak about why time is so important and tell us those symptoms. Tell us that acronym so that we know what it is we’re looking for Ryan.
Ryan: Of course. Just to reiterate, time is incredibly important. Every minute that goes by when your brain is not receiving blood, you lose two million brain cells. That adds up to the disability and the loss of functional life that can happen with stroke. So what we like to tell people is to remember to BE FAST. Be fast. As in I'm going to be fast and respond to stroke. B stands for a sudden loss of balance. E stands for a sudden loss of vision in one or both eyes. F stands for a sudden uneven facial droop or uneven smile. A stands for sudden arm weakness or weakness in one side of the body. S stands for sudden slurred speech or sudden speaking. Those are the five main signs of stroke. What we tell people is you only have to have one to be a sign of a stroke. You don’t have to have all five. We encourage people that if you see any on of those symptoms, even if it’s questionable in yourself or those you are around, it’s time to call 911 immediately.
Host: Calling 911. Why is that important? Some people would say, “Oh well you know your face is drooping. I’ll just drive you to the hospital.” What can EMS do that we could not do if we’re driving our loved ones to the hospital?
Ryan: So when you think about calling 911, only about 50% of the country people that have stroke utilize 911. That’s the same for the area that we serve. We know that 911 can not only be a safer way to get to the hospital. If you have 50% of people driving themselves or a loved one driving them, they might be impaired from the stroke. 911 can care for the patient and monitor their airway, their breathing, their circulation, everything along the way. So they're providing care as they're driving. Also we know that entrance into the emergency room through EMS, through 911 is expedited. The 911 team, the paramedics that are caring for the patient, can alert the emergency department ahead of time so that the care team that is going to be caring for that patient can be ready. Every second counts. Alerting the team earlier than just arriving to the triage desk, as if you drove yourself in, helps get the team prepped and shaves off minutes that are so important.
Host: Then what happens Ryan? What happens at the ER? What should people expect? Tell us about some of the treatments that they might try right away?
Ryan: So the first thing that’s going to happen is when you get to the emergency department, you're going to be seen by the stroke team. They're going to do a very quick assessment to look for stroke symptoms, and they're going to take you immediately to the CAT scan. The reason for going to the CAT scanner is to take a CAT scan image of your brain because if you are having stroke symptoms, the first question that the team has to answer is what type of stroke it is. Is it a clot based stroke or is it a bleeding stroke? They will get an initial plain head CT scan. It takes less than five minutes. The reason for that is if it is a bleeding stroke or if it is a clot stroke is going to determine what path the treatment team takes.
If it’s a clot based stroke, they would immediately begin looking at when the symptoms started, which is a very important question to know because that will determine—If you make it there within three hours to four and a half hours for most people, you can receive tPA. It’s the gold standard clot busting stroke that’s given via an IV that can break down blood clots. Also comprehensive stroke centers, such as Central DuPage Hospital, offer a process where the patient can go to the catheter lab where they do the heart catheterizations. The specially trained team can actually insert a catheter in their groin and go all the way up into their brain to remove a blood clot.
For a hemorrhagic stroke, there’s other things we can do as well. As well as testing the patient’s blood for a hemorrhagic stroke to see if the blood is too thin. A lot of people take blood thinners for various medical conditions. We have the medications to reverse those to help stop the bleeding.
Host: Wow. That’s great information. Tell us a little bit about the mobile stroke unit at Northwestern Medicine Central DuPage Hospital.
Ryan: So the mobile stroke unit is a tier three critical care ambulance. It’s an ICU on wheels. It is housed at CDH. It has a crew of four people. A driver, a CT technologist, a critical care nurse, and a critical care medic. They are dispatched via local EMS. So if someone in the area that they serve calls 911 and says I'm having a stroke or says any of the terminology, the local 911 operators will send out the local paramedics and the mobile stroke unit at the same time. Or if the local paramedics show up to a sick person or a person who has fallen and the local paramedics do an exam, determine the patient has stroke symptoms, they can call the mobile stroke unit via their own radios.
When the mobile stroke unit shows up, the critical care nurse and medic will go into the house, begin examining the patient. They can patch into the neurologist immediately on an encrypted iPad. So the neurologist can actually examine the patient in their home. The driver will level the truck and the CT technologist will prepare the CT scanner. If they determine the patient has the signs and symptoms of stroke, they can scan the person right there in their driveway, in the parking lot, and immediately begin treatment before they even go to the hospital. So that cuts down on treatment times. Our goal is to get the treatment time from within an hour from when the symptoms start to when we begin treating the patient because that gives people the best chance for a great recovery.
Host: That’s so cool. What a great service for people that might be suffering a stroke. Ryan, as we wrap up, give us your best recommendations for preventing a stroke. Exercise, diet. What would you like us to know about the things that we can control and the things that we can do to possibly prevent one from happening?
Ryan: The best way to prevent a stroke. There’s seven key ways that can help prevent both heart disease and stroke. That’s to manage your blood pressure, control your cholesterol, reduce your blood sugar. Those you do a lot when you're interacting with your provider. Making sure you know your numbers, making sure you get regular checkups. The other ones are being active. Any activity is better than no activity. The recommendation is 150 minutes a week. So that’s roughly 30 minutes over five days, but it’s any sort of activity that is moderate. Meaning if you're doing it, can you have a conversation. One person that might be running, the next person that be going for a short walk and that’s okay. Any activity is better than no activity. Eating better. There’s no specific diet recommendations because people have many different diets. However, the two biggest things we recommend you watch is sodium intake and the consumption of soda pop and sugary sweetened beverages. Losing weight helps to take stress off the body and stress off the heart. The last one that we recommend to everybody is if you smoke, just stop. There is no safe amount of smoking. Even with e-cigarettes and vaping, it puts people are risk for going back to tobacco cigarettes. So there is no safe level of smoking.
Host: Great information Ryan. Thank you so much for joining us today and sharing your incredibly expertise and letting us know really what those symptoms of stroke are and the possible ways to prevent it. Thank you again. You're listening to Northwestern Medicine Podtalk. For more information on the latest advances in medicine, please visit nm.org. This is Melanie Cole. Thanks so much for tuning in.
Stroke: Reduce Risk and Spot Symptoms Quickly
Melanie Cole, MS (Host): If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of stroke. That’s why it’s important for you to know the signs of a possible stroke so that you can learn your risk factors and what you need to do is you suspect that you or a loved one may be having a stroke. My guest today is Ryan Keiler. He’s the stroke education coordinator with Northwestern Medicine Central DuPage Hospital and Delnor Hospital. Ryan, I'm so glad to have you with us. Tell us about the current state of stroke today. What’s the prevalence and it’s impact worldwide?
Ryan Keiler MSN, RN, CNRN (Guest): Excellent. Well, thank you so much for having me. It’s a pleasure to be here. The prevalence within the United States, every 40 seconds someone experiences a new or recurrent stroke. That’s about 795,000 strokes a year. Looking forward over the next 10 years, research shows that an additional 3.4 million Americans over the age of 18 will experience a stroke. So the prevalence is going to go up almost 4% within our population. More people are surviving stroke, but stroke still remains the number one cause of preventable medical disability. We spend, as a country, about $36 billion every year on the medical disability care that results from stroke.
Host: Wow. Those are some incredible statistics Ryan. So what is a stroke? Are there different types? Explain a little bit about what actually happens.
Ryan: We like to talk to people about stroke and reference it as a brain attack. It’s the same concept as a heart attack. So a part of your brain that is being supplied blood is no longer getting blood. We know that every minute that goes by when your brain is not getting blood, you lose almost two million blood cells. So time really is of the essence.
There are two types of stroke. There is one that we call an ischemic stroke, that is a blood clot base stroke. It can be a blood clot that develops in the brain or comes from somewhere else in your body. That makes up 87% of strokes. So the majority of strokes are clot based strokes. The other types of strokes are hemorrhagic or bleeding strokes. That’s where a blood vessel feeding some part of the brain ruptures for some reason and therefore the part of the brain that is being supplied blood is no longer getting blood. That blood also leaks out and damages brain tissue around that vessel as well.
Host: That’s a great explanation. Very clear and understandable. So who is at risk? Tell us about some of the medical risk factors, comorbid conditions that can contribute to stroke, and some uncontrollable. Is there a genetic component to it?
Ryan: Yes there is. Everyone is at risk for stroke. Stroke effects infants all the way through to the end of life. We do know that age is a large risk factor. Every decade over the age of 55, your risk of stroke goes up. However, we’re seeing more stroke in younger people. The leading risk factors that can be controlled, the number one risk factor is high blood pressure. Other risk factors that we talk about are nutrition, physical activity, atrial fibrillation, high cholesterol. Smoking is a very high risk factor that is an independent risk factor, meaning that if you have no other risk factors but you smoke it puts your risk of stroke higher.
Some of the risk factors you asked about that are uncontrollable that people should still know about are age. Gender plays a role. We know that more women than men have strokes, and more women than men die of strokes. That’s because of pregnancy, hormonal changes, and women live longer than men. There is a genetic component. So a family history plays a role. If you have a mother or father, daughter or son, or a brother or sister that had had a stroke, you are more at risk for stroke. There are certain genetic predispositions. Also among race we know that African Americans are two and a half times more likely to have a first ever stroke. Hispanics are 2.1 times more likely to have a first ever stroke. There are certain races that have a genetic predisposition to diabetes, which is a risk factor, to high blood pressure as well. So there is a genetic component to stroke.
Host: So we’re learning about our risk factors. We’re learning about what stroke can do. Now, it’s really important for listeners to understand the symptoms so that they can recognize it because time is brain. So speak about why time is so important and tell us those symptoms. Tell us that acronym so that we know what it is we’re looking for Ryan.
Ryan: Of course. Just to reiterate, time is incredibly important. Every minute that goes by when your brain is not receiving blood, you lose two million brain cells. That adds up to the disability and the loss of functional life that can happen with stroke. So what we like to tell people is to remember to BE FAST. Be fast. As in I'm going to be fast and respond to stroke. B stands for a sudden loss of balance. E stands for a sudden loss of vision in one or both eyes. F stands for a sudden uneven facial droop or uneven smile. A stands for sudden arm weakness or weakness in one side of the body. S stands for sudden slurred speech or sudden speaking. Those are the five main signs of stroke. What we tell people is you only have to have one to be a sign of a stroke. You don’t have to have all five. We encourage people that if you see any on of those symptoms, even if it’s questionable in yourself or those you are around, it’s time to call 911 immediately.
Host: Calling 911. Why is that important? Some people would say, “Oh well you know your face is drooping. I’ll just drive you to the hospital.” What can EMS do that we could not do if we’re driving our loved ones to the hospital?
Ryan: So when you think about calling 911, only about 50% of the country people that have stroke utilize 911. That’s the same for the area that we serve. We know that 911 can not only be a safer way to get to the hospital. If you have 50% of people driving themselves or a loved one driving them, they might be impaired from the stroke. 911 can care for the patient and monitor their airway, their breathing, their circulation, everything along the way. So they're providing care as they're driving. Also we know that entrance into the emergency room through EMS, through 911 is expedited. The 911 team, the paramedics that are caring for the patient, can alert the emergency department ahead of time so that the care team that is going to be caring for that patient can be ready. Every second counts. Alerting the team earlier than just arriving to the triage desk, as if you drove yourself in, helps get the team prepped and shaves off minutes that are so important.
Host: Then what happens Ryan? What happens at the ER? What should people expect? Tell us about some of the treatments that they might try right away?
Ryan: So the first thing that’s going to happen is when you get to the emergency department, you're going to be seen by the stroke team. They're going to do a very quick assessment to look for stroke symptoms, and they're going to take you immediately to the CAT scan. The reason for going to the CAT scanner is to take a CAT scan image of your brain because if you are having stroke symptoms, the first question that the team has to answer is what type of stroke it is. Is it a clot based stroke or is it a bleeding stroke? They will get an initial plain head CT scan. It takes less than five minutes. The reason for that is if it is a bleeding stroke or if it is a clot stroke is going to determine what path the treatment team takes.
If it’s a clot based stroke, they would immediately begin looking at when the symptoms started, which is a very important question to know because that will determine—If you make it there within three hours to four and a half hours for most people, you can receive tPA. It’s the gold standard clot busting stroke that’s given via an IV that can break down blood clots. Also comprehensive stroke centers, such as Central DuPage Hospital, offer a process where the patient can go to the catheter lab where they do the heart catheterizations. The specially trained team can actually insert a catheter in their groin and go all the way up into their brain to remove a blood clot.
For a hemorrhagic stroke, there’s other things we can do as well. As well as testing the patient’s blood for a hemorrhagic stroke to see if the blood is too thin. A lot of people take blood thinners for various medical conditions. We have the medications to reverse those to help stop the bleeding.
Host: Wow. That’s great information. Tell us a little bit about the mobile stroke unit at Northwestern Medicine Central DuPage Hospital.
Ryan: So the mobile stroke unit is a tier three critical care ambulance. It’s an ICU on wheels. It is housed at CDH. It has a crew of four people. A driver, a CT technologist, a critical care nurse, and a critical care medic. They are dispatched via local EMS. So if someone in the area that they serve calls 911 and says I'm having a stroke or says any of the terminology, the local 911 operators will send out the local paramedics and the mobile stroke unit at the same time. Or if the local paramedics show up to a sick person or a person who has fallen and the local paramedics do an exam, determine the patient has stroke symptoms, they can call the mobile stroke unit via their own radios.
When the mobile stroke unit shows up, the critical care nurse and medic will go into the house, begin examining the patient. They can patch into the neurologist immediately on an encrypted iPad. So the neurologist can actually examine the patient in their home. The driver will level the truck and the CT technologist will prepare the CT scanner. If they determine the patient has the signs and symptoms of stroke, they can scan the person right there in their driveway, in the parking lot, and immediately begin treatment before they even go to the hospital. So that cuts down on treatment times. Our goal is to get the treatment time from within an hour from when the symptoms start to when we begin treating the patient because that gives people the best chance for a great recovery.
Host: That’s so cool. What a great service for people that might be suffering a stroke. Ryan, as we wrap up, give us your best recommendations for preventing a stroke. Exercise, diet. What would you like us to know about the things that we can control and the things that we can do to possibly prevent one from happening?
Ryan: The best way to prevent a stroke. There’s seven key ways that can help prevent both heart disease and stroke. That’s to manage your blood pressure, control your cholesterol, reduce your blood sugar. Those you do a lot when you're interacting with your provider. Making sure you know your numbers, making sure you get regular checkups. The other ones are being active. Any activity is better than no activity. The recommendation is 150 minutes a week. So that’s roughly 30 minutes over five days, but it’s any sort of activity that is moderate. Meaning if you're doing it, can you have a conversation. One person that might be running, the next person that be going for a short walk and that’s okay. Any activity is better than no activity. Eating better. There’s no specific diet recommendations because people have many different diets. However, the two biggest things we recommend you watch is sodium intake and the consumption of soda pop and sugary sweetened beverages. Losing weight helps to take stress off the body and stress off the heart. The last one that we recommend to everybody is if you smoke, just stop. There is no safe amount of smoking. Even with e-cigarettes and vaping, it puts people are risk for going back to tobacco cigarettes. So there is no safe level of smoking.
Host: Great information Ryan. Thank you so much for joining us today and sharing your incredibly expertise and letting us know really what those symptoms of stroke are and the possible ways to prevent it. Thank you again. You're listening to Northwestern Medicine Podtalk. For more information on the latest advances in medicine, please visit nm.org. This is Melanie Cole. Thanks so much for tuning in.