Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm your host, Maggie McKay. It's so good to have you here. Welcome, Dr. McKinney.

James McKinney, MD: It's great to be here. Thank you for having me.

Host: So today we are going to talk about strokes and before we get started I'd love to know how neurology became a passion of yours and what made you become a brain specialist?

James McKinney, MD: So, I went to medical school thinking I wanted to be a pediatrician and take care of kids. And then my first semester of medical school, we had a neuroscience class and I didn't have any neurosciences in my undergraduate courses. It was just really intuitive and fascinating to me.

The guy that was our neuroscience professor was Scottish and spoke with this really nice brogue and a lot of my co students fell asleep during his classes, but I was enthralled. And so from there on, I wanted to be a neurologist.

Host: And did he know that you took that path? Did you ever let him know?

James McKinney, MD: No, no, once, uh, we kind of moved on to the clinical rotations, we lost touch, but.

Host: Mm hmm. And then what made you go on to becoming a brain specialist?

James McKinney, MD: So, the two kind of choices are really when I, got down to it, towards the end of medical school, I was thinking either neurology, which it's kind of the medical part of neurosciences and taking care of people with brain, spinal cord, and nerve disorders, or cardiology, which is a heart doctor, and I really liked cardiovascular physiology, so I kind of, you merged the two, and so I'm a vascular neurologist by training, can take care of people that have had strokes and have vascular diseases of the brain.

Host: So let's start with the basics. What is a stroke?

James McKinney, MD: There's two big types of strokes. The more common type of stroke, which is about 80 percent of people, have a blocked blood vessel from plaque buildup or a clot that limits blood flow and oxygen delivery to the brain. And the brain needs oxygen, it needs glucose and sugar to survive.

And so, without that, those brain cells die pretty quickly. And then about 20 percent of people that have strokes actually have bleeding into the brain from a ruptured blood vessel or ruptured aneurysm.

Host: And the Southeast United States is sometimes referred to as the stroke belt? Why is that?

James McKinney, MD: If you look at just incidents and mortality of strokes, the southeast part of the United States has the highest incidents in penetration of stroke. There's a lot more people that smoke in the southeast part of the United States, and so that's a big modifiable risk factor.

And then, African American and Black people have higher incidences of stroke and stroke at a younger age. And so there's, we have a lot more African Americans in the southeast U.S. than maybe in some other populations. And so some of those things contribute to having a higher, disease burden in our part of the country.

Host: And how can somebody identify a stroke?

James McKinney, MD: We teach people BEFAST, So B stands for balance. So all of this, any sudden onset of neurological symptoms. So balance difficulty, E stands for eyes. So sudden onset of vision loss in one or both eyes. F stands for face, so a facial droop, ask people to smile and if it's asymmetric. A stands for arms, so you have them hold their arms out and if one side is weak or drifts or they can't lift it at all. And S is for speech, so inability to speak or slurred speech. And then T is time, so we want people to call 911, if they suspect that they have any stroke symptoms.

Host: And why is it so important to not second guess yourself, but instead seek help immediately?

James McKinney, MD: All of our treatment options are based on how fast you seek medical attention. So the longer you delay, the more brain cells can die. And the more brain cells die, the more disability that you may have. So the quicker you get medical attention, the more likely you are to save vital tissue in your brain.

Host: So better safe than sorry, right? If you're wrong, whatever, but if you're right, it could save your life.

James McKinney, MD: Yeah, absolutely. Our EMS systems do a good job of screening people for strokes and they notify the hospitals that they're inbound with stroke patients so the stroke teams, emergency medicine physicians, can rapidly assess people and determine whether they're having a stroke or not.

Host: The Novant Health New Hanover Regional Medical Center is a comprehensive stroke center. What are the advanced treatments that you offer patients there?

James McKinney, MD: So comprehensive stroke centers are able to take care of all varieties of stroke from the mildest to the most severe forms of stroke. Particularly, we offer catheter based therapies for ischemic strokes from blocked blood vessels. We have neurosurgeons that can go into the brain with a catheter. They access it through the blood vessels in the wrist or in the groin, snake that catheter up to the blockage in the brain and pull out that clot.

We're also able to treat aneurysms either similar with a catheter based therapy where they go in and put coils or stents to prevent the aneurysm from filling. And we offer standard neurosurgical treatments with craniotomies where they cut people's heads open and operate on the brain.

Host: It sounds like you've got all the bases covered. So what does stroke recovery look like for many people?

James McKinney, MD: Hopefully, if everything goes well, patients have really minimal disability. And they're able to go home from the hospital. That's not always the case. Oftentimes people need more specialized rehab services following it. So we try to get patients from the hospital to an acute rehab hospital.

We're lucky enough to have one attached to Novant New Hanover Regional Medical Center. There, we have physiatrists that specialize in stroke rehab and recovery and physical therapists, occupational therapists, speech therapists that all help patients on their road to recovery.

Host: Let's talk about prevention, Dr. McKinney. How can we prevent stroke in the first place?

James McKinney, MD: So the biggest risk factor that's modifiable that we want to treat is blood pressure. High blood pressure is the biggest risk factor for ischemic stroke, from the blocked blood vessels, and for hemorrhage and bleeding into the brain. Normal blood pressure is really less than 130 over 80, and so it's important for people to monitor their blood pressure at home, know what it is, and if it's elevated; seek advice from their medical providers.

Host: Is there anything else you'd like to add in closing?

James McKinney, MD: Remember BEFAST. B is balance, E is eyes, F is face, A is arms, S is speech, and T is time. Call 911, get to the hospital, get evaluated, if you have any of those sudden onset of stroke symptoms, it could save your life.

Host: That's a good thing to know. Thank you so much, Dr. McKinney, for this invaluable information and sharing your expertise. We appreciate you.

James McKinney, MD: Great, thank you for having me.

Host: To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thank you for listening to Meaningful Medicine, a podcast from Novant Health.