Joey Wahler (Host): Stroke is America's second leading cause of death behind cancer and the number one trigger of adult disability. So, we're discussing stroke awareness. Our guests, from Southeast Georgia Health System, Dr. Phil Amodeo. He's a Neurologist and Neurology Medical Director of the Stroke Program; Cynthia Gahm, she's a Registered Nurse and Stroke Program Coordinator; and Paul Trumbull, he's Director of Rehabilitation and Sports Medicine Services.

This is Health Matters, a Southeast Georgia Health System Podcast. Thanks for joining us. I'm Joey Wahler. So, I want to start by asking what motivated each of you to pursue healthcare and what does stroke care mean to each of you on a personal level? Let's start with you, Dr. Amodeo.

Phillip Amodeo, MD: My path in healthcare started actually when I was in high school when I was fortunate I was able to take an Anatomy course that my high school gave. And we got some exposure to the local medical school and they let us work with actually doing cadavers and more Anatomy. So, going into college, I became a biology major and was leaning into Medicine. And then in particular too, I was able to do a course that was more geared toward Neurology and Anatomy and Physiology. And that sparked my interest because at the end of the course, we did a period of time that was looking at the human anatomy and the organization of the brain that I thought was very cool. So, coming out of it, I knew that Medicine was kind of the direction I wanted to go, and then went from there.

Host: And it seems, doesn't it, doctor, like a lot of people that go into healthcare have a similar road that starts with something that hits them at a young age, right?

Phillip Amodeo, MD: Yeah. Again, the opportunity doing the cadaver work when I was a senior in high school was pretty special. And it was the first year that they offered that. There was like big write up in the local newspaper and everything. And I was actually in it partially with a cadaver too, but it was very cool. And then, that program took off too. I think they still do it with my high school at this point too.

Host: Cynthia, how about you?

Cynthia Gahm, RN: So, I became a nurse actually at a young age. Right out of high school, I went to nursing school. So for me, I didn't have any big life moments or anything at that point. But, you know, just for me, it was having a sense of purpose, knowing that the work that I do directly impacts the lives of patients in my community.

Host: And Paul, what made you want to help get people back on their feet?

Paul Trumbull, PT: Well, I became a physical therapist, thinking that I would work in Orthopedics and Sports Medicine. And in PT school, I was lucky enough to be exposed to patients with neurological disorders and disabilities. And fairly early in my career, I decided I wanted to do hospital work. And really from about my third year as a PT, throughout the rest of my career, I've worked with patients with stroke and brain injury.

A little personal connection to purpose, my grandfather suffered a series of strokes when I was in high school. And I'm certain that that kind of guided pathway throughout my healthcare career.

Host: Interesting. And of course, as you know, as well as anyone, the rehab portion of treatment after a brain injury, stroke, et cetera, it's so crucial.

Paul Trumbull, PT: Indeed.

Host: Dr. Amodeo, how common is stroke from the standpoint of what you and yours encounter at the health system?

Phillip Amodeo, MD: So, unfortunately, stroke is very common. It's the most common reason why we're consulted in the hospital as neurologists to see patients. Sometimes patients are coming in with the classic stroke symptoms, sometimes they're coming in with maybe less common presentations. But it makes up the bulk of the inpatient consults that we see at the hospital, so unfortunately very common.

Also, in the outpatient setting too, we commonly get referrals from patients who are hospitalized at other hospitals, some of which may not have a neurologist, and they were worked up for stroke there, and they're coming back to see us for ongoing care. But definitely in the inpatient setting, at least half of the consultations we have in the hospital are for stroke patients.

Host: Wow. So, that being said, Cynthia, what are the signs of a stroke? And if you suspect you're seeing someone have one, I know there's this critical acronym known as BEFAST. B-E-F-A-S-T. Tell us a little bit about that, please.

Cynthia Gahm, RN: So, we do a lot of education with BEFAST, trying to get this out to the community and signs and symptoms to watch for and what to do if you think you're having a stroke. So, BEFAST, the B is balance, sudden loss of balance or coordination; E, eyes, sudden blurred or double vision, or sudden trouble seeing in one or both eyes; F is for face, sudden weakness or drooping on one side of the face; A, arms or legs, sudden weakness or numbness in one arm or leg, especially on one side of the body; speech is the S, so sudden difficulty speaking or understanding speech. And time is really important, T for time, call emergency services immediately if you have any of those symptoms or you observe somebody having those symptoms. So, something that we unfortunately see frequently is that people will drive themselves to the ER. And we get the importance of just wanting to get to the hospital quickly, but the best thing to do is to call EMS and have them bring you to the hospital.

Host: Great advice indeed. And so picking up on that, Paul, regarding stroke, and Cynthia touched on it at the end there, we talk about time by the term time is brain regarding stroke.

Paul Trumbull, PT: Well, time is brain is a critical concept. What it refers to is the fact that, as a person's having a stroke, they're losing brain cells continuously until we can get the proper treatment there. So, the longer it takes to get any treatment for them, the more brain cells they're going to lose and the more disability they're going to have.

Host: And there's also medication that's given to some stroke patients that can be crucial in terms of their recovery, am I right? But it can only be given up until a certain point after the stroke occurs, correct?

Paul Trumbull, PT: That's correct. So, there's a window of time, about four and a half hours, that we can give an alteplase or tenecteplase dosage to a patient. And that's a super clot-buster. So, if the person is suffering from a stroke because of a clot in one of the vessels in their brain, that drug can help break that clot up, and we've seen some pretty remarkable results because of that treatment.

Host: So, indeed, time is of the essence, to say the least. Back to you, Dr. Amodeo, how does the stroke program's telestroke technology used help to assess a possible stroke patient using what's known as teleneurology nowadays?

Phillip Amodeo, MD: Kind of piggybacking on the timeframe of receiving critical treatments, whether it be the clot-busting medication or having somebody extract a clot, the teleneurology program has basically geared a place where effectively it's like having a neurologist in the emergency room at all times. And because of those time windows, even prior to having that program, myself and my other partners would have to drive in to see patients if we were on-call covering the ER, which was wasting time with patients getting treated.

So, with the teleneurology program, the patient presenting in the hospital with and symptoms of stroke, we have a process in place where a code stroke is activated and patients will get a few scans depending on the period of time that they're showing up there. But also, a stroke neurologist will be contacted. Sometimes they're calling into the cart and examining the patient remotely and determining whether or not they're a candidate for either the IV clot-busting therapies or whether or not they need to be transferred to a tertiary care center like Baptist, where they can actually extract clots if they're in certain vessels that are large enough.

And really, the treatment window too these days has expanded from four and a half hours that it had been a number of years ago to up to 24 hours. You can only receive that clot busting medication in the first four and a half hours of symptom onset for most patients. Some patients, it's a little shorter. But they've come to realize at a few large trials that actually going in, extracting the clot, if they're in large enough vessels can be done up to 24 hours with better outcomes. In certain large arteries, actually, the clots will dissolve. And those actually tend to be some of the arteries that give some of the most devastating outcomes. And so really, now that there's a treatment window that's expanded up to 24 hours, you basically need a neurologist who's in house at all times in some capacity, or at least a neurologic presence. And then, the telestroke services allow us to do that, given that we don't have something like a residency program where we can have a neurologist sleeping at house all night long.

Host: Gotcha. Cynthia, why would you say the stroke program is so important in the local community?

Cynthia Gahm, RN: So, a stroke is a medical emergency. And like we said before, every minute counts. A stroke program really ensures timely treatment, specialized care, and access to advanced treatment like Dr. Amodeo mentioned.

Host: How about, Cynthia, the importance of everyone that deals with stroke patients being up on the latest technology, education, advancements, as the doctor just pointed out, because you do deal with it so much, right?

Cynthia Gahm, RN: Absolutely. Yeah, we do a lot of education for our staff here just to ensure that everybody knows the process. So, the minute we have a stroke patient or a potential stroke patient hit our door, we have a system in place to work with getting that patient assessed quickly and to the CT scanner, as quickly as possible just so that we can, you know, determine what's going on and move forward with any type of treatment or care.

Host: Paul, back to you. I'm sure you and yours have many great success stories from over the years you could share. Is there one maybe that stands out right here that you can share with us?

Paul Trumbull, PT: There's a couple that come to mind, right off the bat. Some time ago, a couple of years ago, a young woman arrived at our emergency room in dire straits. Early 30s, signs and symptoms of a stroke, not your typical stroke patient, and not the one that most people would think of right off the bat. But because of the processes we have in place, the teleneurology that Dr. Amodeo referred to, and the quick diagnosis, we were able to get her cared for and stabilized here, and flown to Jacksonville to our care partners at Baptist Health Jacksonville, where she received a thrombectomy treatment, an interventional treatment where they went in and removed a clot from her brain. And as I recall, very few, if any, residual deficits for her after the fact.

Also, working in the rehab care center, with my office being in our outpatient area, I can't tell you how many patients have come up to me and talked to me about the care that they received and how they feel they're in a much better place, because they received it here at Southeast Georgia Health System in a very timely manner. And some of those patients are certainly aware that they may not have survived had they not gotten that care.

Host: And, Paul, let me ask you this. You mentioned earlier you've been personally touched by seeing someone in your family experience a stroke, so many of us have. How about the importance of patience when someone suffers a stroke? Not just for the patient, but for their loved ones as well, because most of the time it takes some time, am I right, before you really have a reasonably clear picture as to what the prognosis is going to be?

Paul Trumbull, PT: That's very true. I've been working with stroke patients for more than 30 years and the philosophy has changed a little bit over the years. But we encourage patients to continue to work, continue to go to rehab, to work on specific functional things, because there is no truly defined endpoint where they will not continue to recover.

Host: Dr. Amodeo, the Health System Stroke Program has actually received a lot of professional recognition. What are some of the awards you've received?

Phillip Amodeo, MD: So, we've been certified by the Joint Commission as a primary stroke center and Camden's hospital has been certified as acute stroke-ready hospital twice now. We were just recertified back last fall. And then, we also received a Gold Plus Award from American Heart American Stroke Association for stroke care, which that award is for hitting certain quality measures and treating stroke patients. And to actually have your First Gold Award means that you've done that for 48 months in a row, which is really five years worth of quality stroke care. And so, we just received that award again, too.

Host: That's awesome. So, in summary here for all of you, I can't help but wonder how rewarding it is doing such life-saving work on a daily basis. Cynthia, for you, what's that like?

Cynthia Gahm, RN: Yeah. I mean, being part of a successful program that efficiently delivers timely and effective care brings immense satisfaction, and then knowing, you know, that our efforts really help our community and can change lives, it's definitely rewarding.

Host: Paul, how about for you? What's most rewarding about all this?

Paul Trumbull, PT: Knowing that we really provide what's been identified as the best possible care for people in our communities. You know, I have a sense of pride in knowing that my friends here in Southeast Georgia and my family members have an organization that provides this type of care so close to home.

Host: And Dr. Amodeo, knowing that you have a job where people's lives are literally in your hands, what's it like when they pull through the way you had hoped?

Phillip Amodeo, MD: It's very cool, especially when I see some of these patients in followup, and who did have these kind of clot-busting medications given or thrombectomy procedures at Baptist. I've seen a lot of young patients that would have not done well and would have had a great deal of disability if they had not received the treatment.

And also, too, even prior to us doing the program, the closest primary stroke centers were basically in Savannah and Jacksonville. So, it left this huge territory not covered by really kind of the premier stroke care that you'd like to be delivered. Now, living here almost 10 years, that's something that you want to offer the community that you're living in.

Host: Well, folks, we trust you're now more familiar with stroke awareness. I thank all of you once again for being with us, and keep up the great work. And for more information about Southeast Georgia Health System Stroke Program, please visit sghs.org/stroke. Again, sghs.org/stroke. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of Health Matters, a Southeast Georgia Health System podcast.