Jaime Lewis (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. Today, I'm sitting down with Dr. Sowmya Lakshminarayanan, who goes by Dr. Lak, a physician leader with Novant Health Neurosciences Institute in the greater Winston Salem region. We're going to be talking about how physicians are now using AI technology to detect stroke. Before we get started, Dr. Lak, I'd love to know how stroke care became a passion of yours. What made you decide to become a neurologist?

Dr. Sowmya Lakshminarayanan: Good afternoon, Jaime. Thank you for having me here. I'll answer the second question first. So you said what made me to become a neurologist. Traditionally, neurology is seen as a challenging field in medical school and most physicians shy away from taking upon those challenging field. So naturally, since childhood my personality is taking upon challenges.

So as you know, many times it brings out the best version of oneself. I became a neurologist so that I can actually impact more people in real time. Now I'm going to move towards the second question, how stroke care became a passion for myself. Generally speaking, most of the neurological disorders are chronic, long lasting,

where you can make a diagnosis and treatment plan, but it's going to be passive, where we cannot really see how it is impacting the patient life on a real time. That's not the case with the stroke care, because it's an acute neurological emergency where you can diagnose, treat, and in real-time follow the patients, and you can see how impactful that the diagnosis and the treatment that we are doing for the patients; are impacting their lives. Not only for the patients, but also for the patient's loved ones and family members.

Host: Right. Let's actually start with the very basics that you mentioned here. What is a stroke?

Dr. Sowmya Lakshminarayanan: Stroke is an acute neurological emergency. It's similar to heart attack, which it impacts the heart. Stroke is a brain attack because it is attacking the brain cells. So it is typically caused by any disruption or impacting the blood flow to the part of the brain. When that happens, the brain cells, the neurons, the nerve cells are affected and it dies.

So that's why stroke is a neurological emergency and we need to do everything possible to save the brain cells.

Host: Can you describe some of the risk factors and the symptoms for stroke?

Dr. Sowmya Lakshminarayanan: Let's first talk about the risk factors. Most common risk factors are high blood pressure uncontrolled, diabetes, any heart disease, high cholesterol, obesity, tobacco smoking, any recreational drug abuse, and physical inactivity. So those are all the risk factors that plays a role. And symptoms we can quickly remember by acronym called FAST, which is face, affecting the face, arm, speech, and the time of onset.

That's typically what our EMS partners use in assessing the patients in the field. The symptoms typically are sudden in onset, acute, affecting one side of the body or the other. It can be either a weakness or a facial droop, speech problem, like an inability to produce speech or speech that is garbled or jumbled, not comprehensible. Any unilateral numbness and tingling, sudden onset of balance problem, dizziness or spinning sensation, lack of coordination, visual problems, not able to see, double vision, confusion or sudden onset of headache. These are some typical symptoms.

Host: Can strokes be prevented?

Dr. Sowmya Lakshminarayanan: Approximately 80 percent of the strokes are really preventable if we are investing time in taking care of our risk factors, either by doing medications and then following the health care professional's advice in controlling them adequately, and also by making drastic lifestyle modification.

So 80 percent of the stroke is preventable, some are not because genetics play a role, but still we focus on the most cases that we focus on modifying the risk factors and lifestyle alterations.

Host: I would assume in your time as a neurologist you've seen a lot of change in your field. How has the treatment of stroke evolved over the years?

Dr. Sowmya Lakshminarayanan: Oh, it has evolved drastically and rapidly over the past two decades. And the stroke care nowadays has really revolutionized integrating technological advancement and leveraging technology and innovation to provide best care possible for our patients. So it's considerably changing since the time I was a resident, fellow and now attending physician over the past 20, 25 years, it has drastically changed.

So when I was in my resident, that's when the thrombolytic clot busting drug came into effect. Now we are fast forwarding another 25 years. Now we are able to put a catheter in patient's blood vessel, take the blood clot out of the brain, and then save the cells. So it really has revolutionized.

Host: That's incredible. Is it true that you're now using artificial intelligence technology to detect stroke and how does that work exactly?

Dr. Sowmya Lakshminarayanan: Yes, we do integrate artificial technology into our radiology imaging workflow and it is impactful because like what I call artificial intelligence, I like to call it as augmented intelligence rather than artificial. So we integrate it with our imaging or radiology workflow where it real-time scans, like analyzes the brain images of the patient when they are getting it, and just alerts, brings out some alerts, alarms, saying that if there is a major blood vessel blockage. Still the images are reviewed by physicians, but it's like presetting an alarm saying that helping for us to prioritize the workflow of, and then that's actually focusing on the patient that really needs prominent care at that time, because time is brain.

Host: What about patients in rural hospitals with fewer resources available? Can this kind of technology benefit them too?

Dr. Sowmya Lakshminarayanan: Absolutely. You know, I'm humbly proud to say Novant Health Forsyth Medical Center has a total of 17 hospitals in our telestroke network. So majority of them are rural and they are aligned partners. They are not owned by Novant, but we still provide the same level of care for all of our partners, irrespective of whether they are one among us, or they are aligned partners. So we have integrated the technology for our, all of our aligned partners because it's a win-win situation, irrespective of where the patients are located, they get the same standardized care, and if they need elevated level of care, it helps us in bringing them faster to our site to provide the needed treatment.

Host: How has this technology helped to improve your treatment time?

Dr. Sowmya Lakshminarayanan: Artificial intelligence or augmented intelligence technology really has helped us in prioritizing patient care, right? So because it is creating an alarm and thereby, among, a pile of hundred studies, radiologists and the neurologists can focus on the patient who is really needing immediate treatment, so it's expedited care and prompt treatment delivery.

It has helped in revolutionizing care for us. Treatment times for acute stroke is spectacular and region's best. Last year we had our joint commission certification for the Comprehensive Stroke Center. On an average, our door to needle times are outstanding, average 20 minutes which is unheard of.

It's consistent, irrespective of day or night, holidays or non regular workdays. So average of 20 minutes from time the patient hit the door of the hospital to the treatment time is phenomenal and unheard of. And it's actually, we are one of the premier centers nationwide. And I would really want to emphasize and share this great news with everyone in the community and as well as in the nation.

Host: Yes, that's remarkable. Well, let's speak very practically here. If you think you or a loved one is having a stroke, should you call 911 or is it okay to drive yourself to the hospital or your primary care office?

Dr. Sowmya Lakshminarayanan: I would not recommend. Absolutely every single patient if they are thinking experiencing or somebody witnessing that their loved ones are experiencing, please call 9-1-1. It has multiple advantages. So the reason is we have pre hospital notification through our EMS partners. They play a vital role in prioritizing care for our patients in the community.

So we partner with them. So through the pre hospital notification pathway, the ED physicians and the providers get notification even before the patient gets to the hospital door. And we meet the patients at the door when they come in so the ED physicians, the triage nursing staff, and the neurologists meet the patients at the doors, swipes them right to the CT scan suite, we prioritize prioritize the care.

So every single minute lost, we are at risking loss of brain cells. So time is brain. And to put this all into perspective, I would like to give a quick fact data. Every minute the care is delayed, 1.9 million blood cells, like brain cells are lost. So that equates, if there is a 10 minutes, if you are able to shave time off the treatment pathway, that's huge because we are able to save 19 million brain cells.

That's huge, 19 million brain cells saved is that equates to decreased disability burden, decreased death burden, so it's an overall win-win situation, so please make sure to call 911. That's the best way for prioritized care.

Host: That's a good tip. Thank you. Thank you so much, Dr. Lak, for joining us today.

Dr. Sowmya Lakshminarayanan: No problem. Thank you, Jaime, for having me. Have a wonderful day.

Host: Once again, that was Dr. Sowmya Lakshminarayanan. To find a physician, visit NovantHealth.org and for more health and wellness information from our experts, visit HealthyHeadlines.org. Thank you so much for listening.