Gabby Cinnamon (Host): Welcome back to the Well Within Reach podcast brought to you by Riverside Healthcare. I'm your host, Gabby Cinnamon. And today, I'm very excited to be joined by Natalie Lacer, Riverside's Stroke Program Coordinator to talk about stroke care at Riverside. Thank you so much for coming on the podcast today, Natalie.

Natalie Lacer: Thank you for having me

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Natalie Lacer: Sure. I graduated from Olivet Nazarene University with my bachelor's degree in 2015. I then started out here at Riverside on the Telemetry Unit. Worked there for about three years. Then, decided I wanted to try emergency department, so went there for three years. At that time, I thought I'm going to try a physician office. Only made it about six months there. That wasn't my thing. But then, I decided to try for the stroke coordinator and I've been in this position now three years this week.

Host: Very nice. Well, we're excited to talk to you today. And before we get into the specific treatments that Riverside offers, can you explain what a stroke is on a basic level for those listening who might not know?

Natalie Lacer: Sure. Absolutely. A stroke happens when blood flow to the brain is cut off or stopped. It's always an emergency situation. The brain needs a constant supply of oxygen and nutrients to work well. So when that is stopped or disrupted, it can lead to problems.

Host: What are some of the signs of a stroke that people should look out for?

Natalie Lacer: So, the most common signs of a stroke include confusion, trouble speaking, trouble understanding someone's speech. You can also have numbness or weakness, it's usually to one side of the body; sudden headache sometimes. And then, some of the ones that are missed we see are some vision changes and dizziness.

Host: Why is time so important when diagnosing and treating a stroke?

Natalie Lacer: So important, because brain cells are affected quickly when a stroke happens, they're deprived of oxygen. So for every one minute that passes while someone is having a stroke, approximately 1.9 million brain cells are lost. And the longer that the brain is deprived of oxygen, the greater chance that you will have brain damage and disability.

Host: So kind of like going off of that, are there certain categories of strokes, you know, are some worse than others? Obviously, we talk about time a lot that the longer you're without blood flow to your brain, that makes things worse, but how is that categorized, I guess?

Natalie Lacer: Sure. So,there are two categories of stroke. There is ischemic stroke and hemorrhagic stroke. Ischemic is caused by a blockage in the brain where a hemorrhagic stroke is bleeding in the brain. About 87% of strokes are considered ischemic strokes. Usually, hemorrhagic strokes are the ones that are more disabling. They can cause a person to be at higher risk for seizures. A person can also have a TIA, which is considered a mini stroke. But that should be considered just as serious. Usually, with those, their symptoms will go away in about 24 hours or less.

Host: Can you talk about the patient journey? You know, from arriving in the ER, with signs of a stroke to being diagnosed with a stroke, what does that process look like?

Natalie Lacer: When a patient arrives to our ER with stroke symptoms, they're quickly triaged and a code stroke is called. If they're coming by ambulance, we will call it from the field, EMS will call in a report, and then we'll call a code stroke at that time. When the patient arrives here, they're quickly assessed by our ED physician at the door, and then before even going to a room, they're taken directly to our Radiology Departments. They'll have a CAT scan at that time. Usually, that CAT scan does not show a stroke. What we're looking for is to see if you have a bleed and then if you're in a certain window, we can treat you still. And then, once that scan is complete, you'll come back to the emergency room. And then, we consult our teleneurology group. At that point, a decision is made of the treatment that we're going to do for you.

Host: You talked about the two different kinds of stroke, the treatments that someone might need. But what kind of treatments does Riverside offer?

Natalie Lacer: It depends on the time of when your symptoms started. What we're looking for is the last time you were normal, because we have a time window of four hours or less from that time that we can treat you. It's called tenecteplase. It's a type of clot-busting medication, but it has to be within that four hours or less. If it's 24 hours or less, then you have what's called a large vessel occlusion. We can treat you with a possible thrombectomy for that. If you're not a candidate for either of those treatments, we will usually admit you to the hospital. We can treat you with different antihypertensives, statin therapy, aspirin, Plavix, that kind of thing. We would also, if needed, admit you to our rehab unit where we have 24-hour coverage, and they can work with you that way.

Host: Within the last, oh gosh, like year or so, depending on when people are listening, Riverside has started utilizing stroke AI technology. Can you talk about why that's beneficial for patients, not only patients, but also Riverside providers, nurses, clinicians all of those groups?

Natalie Lacer: Yes. So, we use a platform called Viz.ai. It is an artificial intelligence that detects strokes rapidly. It detects our large vessel occlusion strokes within minutes after the CAT scan is done. It used to take about an hour for all of those images to be read, so now it's within a couple minutes. I would say within 30 seconds to a minute after the initial scan is done, we can detect a bleed on those. So, what that does is it synchronizes our care, our teleneurology group is on that, our ED doctors are on that as well as our neurologists and they can see the initial scan. We all get an alert, so we're able to make a treatment decision at that time that say it's critical, you know, minutes over hours.

Host: Right. One thing too that I kind of wanted you to talk about is I'm on the marketing side, so not on the clinical side. And when I've sat on like the committee meetings that you guys have, there's so much going on behind the scenes to improve outcomes and improve time in the door to diagnosis of stroke and all of these things. Can you try to talk about how Riverside works to improve stroke diagnosis times and outcomes on the quality side?

Natalie Lacer: Sure. We work very closely in conjunction with EMS. We do a lot of education with them. We also do farmer's markets in the summer. I know we have two of them where we go out. We do stroke care, blood pressure checks, things like that, and just educate the community on that. We'll go to different businesses and hold like heart care. Again, we'll do blood pressures glucose checks, and just do education. So, we do a lot of that.

Host: Yeah. Definitely on the ER side, it's a team working together and a lot of moving parts. That makes a huge difference for sure. So, again, depending on when you're listening, Riverside soon is going to be further expanding stroke care. Can you share a little bit about that and how that's going to positively impact the community?

Natalie Lacer: Yes. We're super excited about this. One of our neurosurgeons, Dr. Zakaria, has been doing a fellowship out of University of Chicago and he will be able to perform thrombectomies here on our patients. Right now, we're transferring those patients to Chicago, which means a lot of traveling for them and their loved ones. So, to be able to keep these patients in our community will be a great thing. Also, we have our rehab group. A lot of times we'll send our patients to Chicago and they'll come back to our rehab so they're close in the area. So, not having to transfer them at all will be great and they can stay here their entire stay.

Host: Yeah, this is very, very exciting. Especially, you know, if it's an older adult, I don't think people realize, maybe not having as much family around and that's to someone who's younger going to Chicago might not seem like that big of a deal. But especially for older adults, that can be a huge deal financially, time-wise for their family to have to travel up there with them for the patient themselves and their family.

Natalie Lacer: Correct, correct.

Host: Yeah. So, that's very exciting. We're very excited to have this here. Before we go, is there anything else you would like to add?

Natalie Lacer: Yeah, I would. If you or a friend, or family member experience stroke symptoms, please always call 911. Never try to drive yourself to the ER. Time is very important. But for this reason, it's not only about safety. It also can let our team know ahead of time so we can get the appropriate areas ready for your arrival.

Host: That's a great place to end off on. Thank you so much, Natalie, for coming on the podcast today and talking about this very important topic.

Natalie Lacer: Thank you for having me. I appreciate it.

Host: And thank you listeners for tuning in to Well Within Reach brought to you by Riverside Healthcare. Learn more about stroke care at Riverside at riversidehealthcare.org. Also, make sure to rate and leave a review for our show on Apple, Spotify, or wherever you listen to podcasts.