A stroke can happen at anytime, anywhere, to anyone. What are the signs of a possible stroke and are you at risk?
Dr. Fahed Saadan, Neurohospitalist at St. Joseph's Health, is here to discuss the warning signs and when to take action.
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Am I At Risk of Having a Stroke
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Learn more about Fahed Saada, MD
Fahed Saada, MD
Dr. Saada 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
Transcription:
Introduction: St. Joseph's Health presents another edition of its podcast. St. Joseph's Health MedCast
Bill Klaproth: If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of stroke. So what are the signs of a possible stroke and are you at risk for having a stroke? Let's find out more with Dr. Fahed Saada a Neuro Hospitalist and the Stroke Program Director at St. Joseph's Health. Dr. Saada, thanks so much for your time. So let's start with this. What is a stroke?
Dr. Saada: Oh, thanks for having me, Bill. A stroke is a sudden interruption in the blood supply of the brain. It's similar to a heart attack. A stroke is a stroke attack. It's caused by a blockage of arteries leading to the brain. There is the ischemic stroke where the blockage occurs and there are hemorrhagic strokes which is caused by bleeding into the brain tissue.
Host: So those are the two major types of stroke, ischemic, and hemorrhagic. Is that right?
Dr. Saada: Yeah, that's right.
Host: So can a stroke happen at any time. And what are the warning signs we should look out for?
Dr. Saada: A stroke can happen anytime, anywhere, to anyone. There are preventable, treatable and beatable strokes as long as you think fast. So most common symptoms of stroke include facial droop, arm weakness, loss of speech. The T stands for time because in order to beat the stroke and allow intervention to be done in a timely matter, time is of the essence. You've got to get into the hospital immediately.
Host: Okay? So we all have to remember fast. So a facial drooping if you will, arm weakness, speech issues and then time is you said is so important. So tell us Dr. Saada, why is time so important?
Dr. Saada: When appropriate, some patients are given what's called the clot dissolving medicine called tissue plasminogen activator, which we call as a clot-buster. In order to give this clot-buster medication, patients have to arrive to the hospital within four and a half hours of their last known normal time. So to give you a scenario Bill, if someone's having a stroke at 10:00 AM they have to get to a hospital by 2:30 in order to receive this medication.
Host: So this is why time is so important. So if you recognize any symptoms of FAST, the Dr. Saada was just talking about, don't wait, don't take a couple aspirin and try to wait it out. Better to be safe than sorry. Is that right?
Dr. Saada: That's right Bill, absolutely.
Host: So, then once the person gets admitted, I know medications are important as you were just talking about, can you talk about the medications that you give and then the treatment that someone would have to follow after a stroke?
Dr. Saada: That's right. So medications are highly effective at reducing a risk of recurrent stroke. But also success is influenced by whether the patient actually comes on time, and whether the patient after having a stroke and receiving the clot-buster medication, adhere to treatment and take their prescribed medication. So the clot-buster medication has been shown and proven to improve and resolve stroke symptoms in over a third of patients who present with stroke. So imagine having disabling symptoms for the remaining of your life, but have this chance to actually recover and become independent again. After having a stroke and receiving the clot-buster medication, it is critical and as important to prevent a second stroke. Some patients come in with stroke, like symptoms that resolve within 24 hours called transient ischemic attack. We do not know the difference when patients are presenting to us. So patients should not wait, thinking that this could be what's called a mini stroke and therefore should get to the hospital right away. But if they do come in with transient ischemic attack, some of the medications like blood thinners, blood pressure medication, medications that control diabetes and high cholesterol, may prevent 80% of stroke recurrence in general. So medication compliance is critical.
Host: So I know that some people don't adhere to the medication like they should. Do you know why that is and what can we do to help medication compliance?
Dr. Saada: There are definitely a number of patients where unfortunately medication compliance is a problem. What I recommend and encourage all my patients Bill is, it's important to have a pill organizer box. As you know, stroke doesn't only cause motor symptoms. It can cause symptoms affecting memory, effecting mood, behavior, and sometimes patients have trouble organizing their medications and taking them on time. So it's important to get at least a pill organizer box to monitor which medications they've taken that day or not. I also advise post-stroke for survivors to discuss these matters with their physicians and seek counseling, therapy. Sometimes patients feel like some of these medications are the cause to their symptoms when really most of the time it's not. So it's important to reach out for help and have family members, other people living in the home to monitor the medications, will extremely help prevent a second stroke.
Host: So really important to adhere to the, you know, medication that's prescribed to you, especially for preventing any further strokes. And if you want to fully recover from the current stroke, you just had so really important things. Dr. Saada just said there. So here's one I have not heard of. Can you explain this to us? And this may be new to everybody listening or a lot of people listening. What is a wake up stroke?
Dr. Saada: So this is an exciting thing under the stroke care over the last year. To give you another scenario, Bill, imagine someone waking up with stroke symptoms. This patient went to sleep at 10, 11 o'clock at nighttime, so if they wake up at five, six o'clock, well they're already outside the window to receive this clot-buster medication that would save their brain from having this stroke. However, what if the stroke didn't happen when they fell asleep and the stroke occurred closer to when they were waking up. Now here at St. Joseph's Health, what we're using is we're able to use the technology that we have available such as an MRI to actually be utilized as a surrogate clock and it pinpoints the stroke onset, which may allow some patients to actually get the brain saving clot-buster medication. So it's no longer that you woke up with a stroke, we can't give you this drug anymore. No, you wake up with a stroke, get to the hospital immediately and we can do high quality imaging that will detect the stroke and give us an estimation when the stroke may have occurred in order to provide the care that's needed. To add on the wake-up strokes, approximately a third of stroke patients actually come in with wake-up strokes. Most of them are not within the window to also be evaluated or receive what we call endovascular therapy where they can have a clot removed from the vessel in the brain and therefore the only treatment is really clot-buster medication through the IV.
Host: Right. So the MRI can help pinpoint the exact time of the stroke since the person was sleeping. So with a wakeup stroke, Dr. Saada symptoms are the same FAST, syllabus. If you wake up in the side of your face is drooping or you can't talk, call that ambulance now, don't delay. Right.
Dr. Saada: Absolutely. Other symptoms, you also look for, double vision, blurry vision in one eye, language impairment, severe headaches associated with any other neurological problems like the acronym FAST, so get to the hospital immediately. And Bill, do not drive yourself, do not have family members drive you. Call 911.
Host: That is so true. So Dr. Saada, 80% of strokes can be prevented with lifestyle changes. Is that right? And then what are the risk factors? How does somebody know if, I might be in line for this? How does someone know that?
Dr. Saada: I divide this into two categories. There are risk factors that we can control and those are the risk factors that will prevent a majority of the strokes is, as you alluded to, 80% of strokes are preventable. These are high blood pressure, diabetes, high cholesterol, obstructive sleep apnea. This is when someone is snoring at night, waking up with headaches and feeling fatigued throughout the day. And most importantly is tobacco abuse. If patients can focus on those five factors, they can prevent a majority of these strokes. Another category is where it's difficult to treat and difficult to actually prevent, but there still is prevention out there that we can enforce, which are genetic factors, so family history of strokes and then cardiac deformities or cardiac conditions that patients unfortunately are born with or, can develop over the years. These are what's called Patent Foramen Ovale. So a hole in the heart as well as atrial fibrillation, irregular rhythm of the heart. But you're right, 80% of strokes can be controlled using these risk factors. Modifying them, getting to the doctor on time to make sure the blood pressure is under control, diabetes under control, exercising, good diet. Remember Bill, stroke was the number three most common cause of death in the United States. Now it's the number fifth. So we're doing something right, but we could even lower it and we can, we can prevent strokes in our community.
Host: Beautiful. So then last question, Dr. Saada, and you've been very generous with your time. Thank you so much. According to the National Stroke Association, strokes are on the rise among younger adults with 15% of ischemic strokes occurring in young adults and adolescents. And in fact, this past decade has seen a 44% increase in the number of young Americans hospitalized due to stroke. Do you know why that is, Dr. Saada, why are strokes happening in younger people?
Dr. Saada: I have a theory about this Bill, it's we've been seeing an increase a rise in unfortunately drug use. However, over the last few months, actually the opioid problem is, it's been improving, but marijuana use, tobacco use in the young generation in the young adults. As well as think about it, 10, 15 years ago, we were always up and working and moving. Now we've increased our occupation to being just fixated on our desks and under chairs at home and being immobile for longer periods of time because we can work from home. We can't use a laptop and go anywhere and sit for eight hours and do that. So I think that's a big factor. Another thing, the risk factors for strokes for cardiovascular disease are we're seeing patients develop Arthur sclerotic, so clots in the vessels, at a younger age, increasing their risk of heart attacks and strokes. So these risk factors are no longer seen when you're hitting 50, 60 years of age. It's actually starting to occur earlier on. I don't know if we should pass blame on our parents, for passing on the genes, but definitely there are things that we can control if we live good healthy lifestyles and just adapt to a better living situation.
Host: Right. And that's the perfect way to wrap up this podcast, Dr. Saada. Remember 80% of this is preventable, so pay attention to those five big risk factors and then pay attention to diet and exercise. It's in your hands. Dr. Saada, this has really been informative. Thank you so much.
Dr. Saada: Not a problem. Thank you, Bill.
Host: That's Dr. Fahed Saada. And for more information, please visit sjhsyr.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is St. Joseph's Health MedCast from St. Joseph's Health. I'm Bill Klaproth. Thanks for listening.
Introduction: St. Joseph's Health presents another edition of its podcast. St. Joseph's Health MedCast
Bill Klaproth: If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of stroke. So what are the signs of a possible stroke and are you at risk for having a stroke? Let's find out more with Dr. Fahed Saada a Neuro Hospitalist and the Stroke Program Director at St. Joseph's Health. Dr. Saada, thanks so much for your time. So let's start with this. What is a stroke?
Dr. Saada: Oh, thanks for having me, Bill. A stroke is a sudden interruption in the blood supply of the brain. It's similar to a heart attack. A stroke is a stroke attack. It's caused by a blockage of arteries leading to the brain. There is the ischemic stroke where the blockage occurs and there are hemorrhagic strokes which is caused by bleeding into the brain tissue.
Host: So those are the two major types of stroke, ischemic, and hemorrhagic. Is that right?
Dr. Saada: Yeah, that's right.
Host: So can a stroke happen at any time. And what are the warning signs we should look out for?
Dr. Saada: A stroke can happen anytime, anywhere, to anyone. There are preventable, treatable and beatable strokes as long as you think fast. So most common symptoms of stroke include facial droop, arm weakness, loss of speech. The T stands for time because in order to beat the stroke and allow intervention to be done in a timely matter, time is of the essence. You've got to get into the hospital immediately.
Host: Okay? So we all have to remember fast. So a facial drooping if you will, arm weakness, speech issues and then time is you said is so important. So tell us Dr. Saada, why is time so important?
Dr. Saada: When appropriate, some patients are given what's called the clot dissolving medicine called tissue plasminogen activator, which we call as a clot-buster. In order to give this clot-buster medication, patients have to arrive to the hospital within four and a half hours of their last known normal time. So to give you a scenario Bill, if someone's having a stroke at 10:00 AM they have to get to a hospital by 2:30 in order to receive this medication.
Host: So this is why time is so important. So if you recognize any symptoms of FAST, the Dr. Saada was just talking about, don't wait, don't take a couple aspirin and try to wait it out. Better to be safe than sorry. Is that right?
Dr. Saada: That's right Bill, absolutely.
Host: So, then once the person gets admitted, I know medications are important as you were just talking about, can you talk about the medications that you give and then the treatment that someone would have to follow after a stroke?
Dr. Saada: That's right. So medications are highly effective at reducing a risk of recurrent stroke. But also success is influenced by whether the patient actually comes on time, and whether the patient after having a stroke and receiving the clot-buster medication, adhere to treatment and take their prescribed medication. So the clot-buster medication has been shown and proven to improve and resolve stroke symptoms in over a third of patients who present with stroke. So imagine having disabling symptoms for the remaining of your life, but have this chance to actually recover and become independent again. After having a stroke and receiving the clot-buster medication, it is critical and as important to prevent a second stroke. Some patients come in with stroke, like symptoms that resolve within 24 hours called transient ischemic attack. We do not know the difference when patients are presenting to us. So patients should not wait, thinking that this could be what's called a mini stroke and therefore should get to the hospital right away. But if they do come in with transient ischemic attack, some of the medications like blood thinners, blood pressure medication, medications that control diabetes and high cholesterol, may prevent 80% of stroke recurrence in general. So medication compliance is critical.
Host: So I know that some people don't adhere to the medication like they should. Do you know why that is and what can we do to help medication compliance?
Dr. Saada: There are definitely a number of patients where unfortunately medication compliance is a problem. What I recommend and encourage all my patients Bill is, it's important to have a pill organizer box. As you know, stroke doesn't only cause motor symptoms. It can cause symptoms affecting memory, effecting mood, behavior, and sometimes patients have trouble organizing their medications and taking them on time. So it's important to get at least a pill organizer box to monitor which medications they've taken that day or not. I also advise post-stroke for survivors to discuss these matters with their physicians and seek counseling, therapy. Sometimes patients feel like some of these medications are the cause to their symptoms when really most of the time it's not. So it's important to reach out for help and have family members, other people living in the home to monitor the medications, will extremely help prevent a second stroke.
Host: So really important to adhere to the, you know, medication that's prescribed to you, especially for preventing any further strokes. And if you want to fully recover from the current stroke, you just had so really important things. Dr. Saada just said there. So here's one I have not heard of. Can you explain this to us? And this may be new to everybody listening or a lot of people listening. What is a wake up stroke?
Dr. Saada: So this is an exciting thing under the stroke care over the last year. To give you another scenario, Bill, imagine someone waking up with stroke symptoms. This patient went to sleep at 10, 11 o'clock at nighttime, so if they wake up at five, six o'clock, well they're already outside the window to receive this clot-buster medication that would save their brain from having this stroke. However, what if the stroke didn't happen when they fell asleep and the stroke occurred closer to when they were waking up. Now here at St. Joseph's Health, what we're using is we're able to use the technology that we have available such as an MRI to actually be utilized as a surrogate clock and it pinpoints the stroke onset, which may allow some patients to actually get the brain saving clot-buster medication. So it's no longer that you woke up with a stroke, we can't give you this drug anymore. No, you wake up with a stroke, get to the hospital immediately and we can do high quality imaging that will detect the stroke and give us an estimation when the stroke may have occurred in order to provide the care that's needed. To add on the wake-up strokes, approximately a third of stroke patients actually come in with wake-up strokes. Most of them are not within the window to also be evaluated or receive what we call endovascular therapy where they can have a clot removed from the vessel in the brain and therefore the only treatment is really clot-buster medication through the IV.
Host: Right. So the MRI can help pinpoint the exact time of the stroke since the person was sleeping. So with a wakeup stroke, Dr. Saada symptoms are the same FAST, syllabus. If you wake up in the side of your face is drooping or you can't talk, call that ambulance now, don't delay. Right.
Dr. Saada: Absolutely. Other symptoms, you also look for, double vision, blurry vision in one eye, language impairment, severe headaches associated with any other neurological problems like the acronym FAST, so get to the hospital immediately. And Bill, do not drive yourself, do not have family members drive you. Call 911.
Host: That is so true. So Dr. Saada, 80% of strokes can be prevented with lifestyle changes. Is that right? And then what are the risk factors? How does somebody know if, I might be in line for this? How does someone know that?
Dr. Saada: I divide this into two categories. There are risk factors that we can control and those are the risk factors that will prevent a majority of the strokes is, as you alluded to, 80% of strokes are preventable. These are high blood pressure, diabetes, high cholesterol, obstructive sleep apnea. This is when someone is snoring at night, waking up with headaches and feeling fatigued throughout the day. And most importantly is tobacco abuse. If patients can focus on those five factors, they can prevent a majority of these strokes. Another category is where it's difficult to treat and difficult to actually prevent, but there still is prevention out there that we can enforce, which are genetic factors, so family history of strokes and then cardiac deformities or cardiac conditions that patients unfortunately are born with or, can develop over the years. These are what's called Patent Foramen Ovale. So a hole in the heart as well as atrial fibrillation, irregular rhythm of the heart. But you're right, 80% of strokes can be controlled using these risk factors. Modifying them, getting to the doctor on time to make sure the blood pressure is under control, diabetes under control, exercising, good diet. Remember Bill, stroke was the number three most common cause of death in the United States. Now it's the number fifth. So we're doing something right, but we could even lower it and we can, we can prevent strokes in our community.
Host: Beautiful. So then last question, Dr. Saada, and you've been very generous with your time. Thank you so much. According to the National Stroke Association, strokes are on the rise among younger adults with 15% of ischemic strokes occurring in young adults and adolescents. And in fact, this past decade has seen a 44% increase in the number of young Americans hospitalized due to stroke. Do you know why that is, Dr. Saada, why are strokes happening in younger people?
Dr. Saada: I have a theory about this Bill, it's we've been seeing an increase a rise in unfortunately drug use. However, over the last few months, actually the opioid problem is, it's been improving, but marijuana use, tobacco use in the young generation in the young adults. As well as think about it, 10, 15 years ago, we were always up and working and moving. Now we've increased our occupation to being just fixated on our desks and under chairs at home and being immobile for longer periods of time because we can work from home. We can't use a laptop and go anywhere and sit for eight hours and do that. So I think that's a big factor. Another thing, the risk factors for strokes for cardiovascular disease are we're seeing patients develop Arthur sclerotic, so clots in the vessels, at a younger age, increasing their risk of heart attacks and strokes. So these risk factors are no longer seen when you're hitting 50, 60 years of age. It's actually starting to occur earlier on. I don't know if we should pass blame on our parents, for passing on the genes, but definitely there are things that we can control if we live good healthy lifestyles and just adapt to a better living situation.
Host: Right. And that's the perfect way to wrap up this podcast, Dr. Saada. Remember 80% of this is preventable, so pay attention to those five big risk factors and then pay attention to diet and exercise. It's in your hands. Dr. Saada, this has really been informative. Thank you so much.
Dr. Saada: Not a problem. Thank you, Bill.
Host: That's Dr. Fahed Saada. And for more information, please visit sjhsyr.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is St. Joseph's Health MedCast from St. Joseph's Health. I'm Bill Klaproth. Thanks for listening.