May is Stroke Month
Stroke is the leading cause of long-term disability. Dr. Craig Montgomery and Dr. Fahed Saada discuss stroke symptoms.
Featuring:
Learn more about Fahed Saada, MD
Dr. Craig Montgomery is a neurosurgeon in Syracuse, New York and is affiliated with multiple hospitals in the area, including St. Joseph's Health Hospital and Upstate University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years.
Fahed Saada, MD | Craig Montgomery, MD
Fahed Saada, MD earned his Doctor of Medicine from St. Matthew’s University School of Medicine in Grand Cayman, British West Indies. Following his graduation from medical school, Dr. Saada completed his internal medicine internship at Cleveland Clinic Fairview Hospital in Cleveland, Ohio; a residency in neurology at University of Florida College of Medicine in Jacksonville, Florida; and a clinical neurophysiology fellowship at University of Rochester Medical Center in Rochester, New York.Learn more about Fahed Saada, MD
Dr. Craig Montgomery is a neurosurgeon in Syracuse, New York and is affiliated with multiple hospitals in the area, including St. Joseph's Health Hospital and Upstate University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years.
Transcription:
2019: Bill Klaproth (Host): Every month is stroke month. Stroke is the number two cause of death worldwide and a leading cause of long-term disability. Every 40 seconds, someone in the US has a stroke. The faster the stroke is treated; the more likely the patient is to recover. So, let’s learn more with Dr. Craig Montgomery, a neurosurgeon and Dr. Fahd Saada a neuro hospitalist. Dr. Montgomery, I thought we would start with you. Let me ask you this, what is the National Certification from DNVGL Healthcare certifying St. Joseph’s Health as a Primary Stroke Center? Tell us about that.
Craig Montgomery, MD (Guest): So, that is a series of criteria whereby St. Joe’s is given a certification that we have coordinated care for treating patients that would show up at our hospital, mostly through our emergency room for the treatment of stroke.
Host: That is a really important certification. So, let’s turn to stroke now Dr. Saada. So, what are the symptoms and how can we recognize stroke? What should we be looking out for?
Fahed Saada, MD (Guest): Well great question. So, a stroke is defined as a sudden loss of neuronal function in the brain. Some of the terminology that we typically use are cerebral vascular accident or a brain attack as if someone is having a heart attack with a sudden onset of chest pain, but this is instead of that it’s a brain attack, sudden onset neurological deficits. These include or can include headaches, sudden onset visual disturbance, weakness of the arm or legs, sudden onset dizziness, vertigo, numbness, tingling sensation and the most important is sudden onset of speech and language abnormality. There is an acronym that we use Act FAST which stands for F for any facial abnormality, a for arm weakness, S for speech abnormality and time is of the essence. It’s really important to get evaluated right away.
Host: So FAST is something we all should know. F for face drooping, A for arm weakness, S for speech difficulty and T for time. Time to call 9-1-1 because speed is important. And Dr. Montgomery, can you explain to us why speed is so important when it comes to stroke?
Dr. Montgomery: So, that’s what Dr. Saada alluded to. This is very similar to a heart attack, but we call it a brain attack and so in that situation, just like in a heart attack, when the heart or the brain so our brain attack is starved of oxygen and nutrients which happens in a stroke; you start losing the potential for having permanent damage to the nerves and to the brain. And that may not be recoverable. So, the sooner that we recognize a patient having a stroke and the sooner we get them to a center or even begin to address treating them even before they get to a stroke center; we have the ability to try to save as many functioning nerve cells that we can thereby decreasing the likelihood that they may be left with permanent neurological problems or deficits.
Host: Dr. Montgomery, let me stay with you. So, it’s better to be safe than sorry I guess what you’re saying if you think someone may be having a stroke, don’t delay and wait it out to see if it goes away, right? Call paramedics right away. Is that right?
Dr. Montgomery: Absolutely. So, just like in a heart attack situation; we’d rather have patients err on the side of worrying too much and coming to the hospital sooner than later so that we can say to them, no, this isn’t any stroke, but if it is, then we can institute treatment in the fasted manner, just like we do with heart problems.
Host: Right and Dr. Saada, knowing that speed is important, how do you rapidly evaluate for stroke and if you could tell us about the coordination of care on the stroke team?
Dr. Saada: So, it’s extremely, extremely important to have a unified trained professional personnel assess the patients in the field, so EMS and EMT providers do a great job in assessing patients for stroke and transporting them into the correct facilities that are Stroke Certified. So, as soon as the patient walks into our doors in the ER, we assess them rapidly for A, the last know well time, B, when did the onset of symptoms begin and C, the severity of the symptoms. So, we do what’s called an NIH Stroke Scale to assess these patients and coordinate the care that they need either here in our facility or transport them to facilities that can provide further care.
A stroke as we know 10-15 years ago, stroke was the third leading cause of death in the US. Now because we’ve established protocols and expanded our treatment time; stroke is the fifth leading cause of death, but it is one of the most common causes of disabilities. So, therefore it’s important to have a joint team treating these patients.
Once a patient is assessed in the ER, we do what’s called a CAT scan of the brain to make sure they are not having a specific type of stroke which is called a hemorrhagic stroke which is usually present in 13-15% of acute stroke patients. And if that’s absent then we can assess patients for the medication which is called the clot buster medication TPA which has got to be given within the first three to four and a half hours at the onset of the last known well time. So, as you can tell, the window is extremely narrow. So, thereafter, we over the last year and a half actually, the treatments have expanded where after the medication is given, we can move forward and evaluate the patient for what’s called thrombectomy, mechanical thrombectomy which we currently don’t have that technology available here at St. Joe’s but eventually hopefully we will be looking forward to expanding our program and doing these procedures.
If a patient does not require the transport to a different facility; then the patient is admitted to our facility for further stroke care, close monitoring of their blood sugar, blood pressure, and optimizing their secondary stroke measures to prevent another stroke. We have a stroke team that rounds on each patient on a regular basis which includes a neurologist, physical therapist, occupational therapist, speech therapist, the stroke coordinator and a pharmacist.
Host: With speed being so important, I could see where that team is very valuable and good to know that progress is being made from the third leading cause of death to fifth. So, Dr. Montgomery before someone has a stroke, what are the factors that create an increased risk for stroke?
Dr. Montgomery: Some of the same risk factors that we see for any type of vascular problems and the majority of the most known by the public out there is the risk factors for having a heart attack. So, when you have a heart attack, it’s the small vessels within your heart that are being attacked by certain things and so smoking is a major risk factor, untreated hypertension is another risk factor. And then problems with our cholesterol and our facts within our blood; our so-called lipid profile. So, there’s both good lipids or good fats in our blood and bad fats in our blood and some of this is related to our habits, our lack of exercise as well as what we eat and also our genetics. And so, these are the main risk factors for heart problems as well as for strokes. And so, there’s a lot of overlap there.
Host: Right, very understandable. So, Dr. Saada if you could wrap this up for us. Now that we know the risk factors, what are things we can do to help prevent stroke?
Dr. Saada: Yeah, alluding to Dr. Montgomery, making sure patients see their primary care doctor on a regular basis, the patient should control their blood pressure, check their blood pressure on a routine basis if they have a diagnosis of hypertension. We know from previous research that controlling blood pressure alone can decrease the stroke risk in approximately 33% in a patient who has the risk factors for stroke. Another thing that is sometimes providers such as ourselves overlook is obstructive sleep apnea. If patients have sleep problems, this should be checked by undergoing special testing. Making sure blood sugar is well under control and if someone did suffer from a stroke, to prevent a second stroke would be being on the right medication which includes things like blood thinners.
Host: Yeah, that’s really important and good things we should all keep in mind as we try to keep our bodies healthy and try to prevent things like stroke happening. Well Dr. Montgomery and Dr. Saada, thank you so much for your time. For more information please visit www.sjhsyr.org, that’s www.sjhsyr.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library of topics of interest to you. This is St. Joseph’s Health MedCast. I’m Bill Klaproth. Thanks for listening.
2019: Bill Klaproth (Host): Every month is stroke month. Stroke is the number two cause of death worldwide and a leading cause of long-term disability. Every 40 seconds, someone in the US has a stroke. The faster the stroke is treated; the more likely the patient is to recover. So, let’s learn more with Dr. Craig Montgomery, a neurosurgeon and Dr. Fahd Saada a neuro hospitalist. Dr. Montgomery, I thought we would start with you. Let me ask you this, what is the National Certification from DNVGL Healthcare certifying St. Joseph’s Health as a Primary Stroke Center? Tell us about that.
Craig Montgomery, MD (Guest): So, that is a series of criteria whereby St. Joe’s is given a certification that we have coordinated care for treating patients that would show up at our hospital, mostly through our emergency room for the treatment of stroke.
Host: That is a really important certification. So, let’s turn to stroke now Dr. Saada. So, what are the symptoms and how can we recognize stroke? What should we be looking out for?
Fahed Saada, MD (Guest): Well great question. So, a stroke is defined as a sudden loss of neuronal function in the brain. Some of the terminology that we typically use are cerebral vascular accident or a brain attack as if someone is having a heart attack with a sudden onset of chest pain, but this is instead of that it’s a brain attack, sudden onset neurological deficits. These include or can include headaches, sudden onset visual disturbance, weakness of the arm or legs, sudden onset dizziness, vertigo, numbness, tingling sensation and the most important is sudden onset of speech and language abnormality. There is an acronym that we use Act FAST which stands for F for any facial abnormality, a for arm weakness, S for speech abnormality and time is of the essence. It’s really important to get evaluated right away.
Host: So FAST is something we all should know. F for face drooping, A for arm weakness, S for speech difficulty and T for time. Time to call 9-1-1 because speed is important. And Dr. Montgomery, can you explain to us why speed is so important when it comes to stroke?
Dr. Montgomery: So, that’s what Dr. Saada alluded to. This is very similar to a heart attack, but we call it a brain attack and so in that situation, just like in a heart attack, when the heart or the brain so our brain attack is starved of oxygen and nutrients which happens in a stroke; you start losing the potential for having permanent damage to the nerves and to the brain. And that may not be recoverable. So, the sooner that we recognize a patient having a stroke and the sooner we get them to a center or even begin to address treating them even before they get to a stroke center; we have the ability to try to save as many functioning nerve cells that we can thereby decreasing the likelihood that they may be left with permanent neurological problems or deficits.
Host: Dr. Montgomery, let me stay with you. So, it’s better to be safe than sorry I guess what you’re saying if you think someone may be having a stroke, don’t delay and wait it out to see if it goes away, right? Call paramedics right away. Is that right?
Dr. Montgomery: Absolutely. So, just like in a heart attack situation; we’d rather have patients err on the side of worrying too much and coming to the hospital sooner than later so that we can say to them, no, this isn’t any stroke, but if it is, then we can institute treatment in the fasted manner, just like we do with heart problems.
Host: Right and Dr. Saada, knowing that speed is important, how do you rapidly evaluate for stroke and if you could tell us about the coordination of care on the stroke team?
Dr. Saada: So, it’s extremely, extremely important to have a unified trained professional personnel assess the patients in the field, so EMS and EMT providers do a great job in assessing patients for stroke and transporting them into the correct facilities that are Stroke Certified. So, as soon as the patient walks into our doors in the ER, we assess them rapidly for A, the last know well time, B, when did the onset of symptoms begin and C, the severity of the symptoms. So, we do what’s called an NIH Stroke Scale to assess these patients and coordinate the care that they need either here in our facility or transport them to facilities that can provide further care.
A stroke as we know 10-15 years ago, stroke was the third leading cause of death in the US. Now because we’ve established protocols and expanded our treatment time; stroke is the fifth leading cause of death, but it is one of the most common causes of disabilities. So, therefore it’s important to have a joint team treating these patients.
Once a patient is assessed in the ER, we do what’s called a CAT scan of the brain to make sure they are not having a specific type of stroke which is called a hemorrhagic stroke which is usually present in 13-15% of acute stroke patients. And if that’s absent then we can assess patients for the medication which is called the clot buster medication TPA which has got to be given within the first three to four and a half hours at the onset of the last known well time. So, as you can tell, the window is extremely narrow. So, thereafter, we over the last year and a half actually, the treatments have expanded where after the medication is given, we can move forward and evaluate the patient for what’s called thrombectomy, mechanical thrombectomy which we currently don’t have that technology available here at St. Joe’s but eventually hopefully we will be looking forward to expanding our program and doing these procedures.
If a patient does not require the transport to a different facility; then the patient is admitted to our facility for further stroke care, close monitoring of their blood sugar, blood pressure, and optimizing their secondary stroke measures to prevent another stroke. We have a stroke team that rounds on each patient on a regular basis which includes a neurologist, physical therapist, occupational therapist, speech therapist, the stroke coordinator and a pharmacist.
Host: With speed being so important, I could see where that team is very valuable and good to know that progress is being made from the third leading cause of death to fifth. So, Dr. Montgomery before someone has a stroke, what are the factors that create an increased risk for stroke?
Dr. Montgomery: Some of the same risk factors that we see for any type of vascular problems and the majority of the most known by the public out there is the risk factors for having a heart attack. So, when you have a heart attack, it’s the small vessels within your heart that are being attacked by certain things and so smoking is a major risk factor, untreated hypertension is another risk factor. And then problems with our cholesterol and our facts within our blood; our so-called lipid profile. So, there’s both good lipids or good fats in our blood and bad fats in our blood and some of this is related to our habits, our lack of exercise as well as what we eat and also our genetics. And so, these are the main risk factors for heart problems as well as for strokes. And so, there’s a lot of overlap there.
Host: Right, very understandable. So, Dr. Saada if you could wrap this up for us. Now that we know the risk factors, what are things we can do to help prevent stroke?
Dr. Saada: Yeah, alluding to Dr. Montgomery, making sure patients see their primary care doctor on a regular basis, the patient should control their blood pressure, check their blood pressure on a routine basis if they have a diagnosis of hypertension. We know from previous research that controlling blood pressure alone can decrease the stroke risk in approximately 33% in a patient who has the risk factors for stroke. Another thing that is sometimes providers such as ourselves overlook is obstructive sleep apnea. If patients have sleep problems, this should be checked by undergoing special testing. Making sure blood sugar is well under control and if someone did suffer from a stroke, to prevent a second stroke would be being on the right medication which includes things like blood thinners.
Host: Yeah, that’s really important and good things we should all keep in mind as we try to keep our bodies healthy and try to prevent things like stroke happening. Well Dr. Montgomery and Dr. Saada, thank you so much for your time. For more information please visit www.sjhsyr.org, that’s www.sjhsyr.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library of topics of interest to you. This is St. Joseph’s Health MedCast. I’m Bill Klaproth. Thanks for listening.