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Caitlin Whyte: This is Mission in Action, a podcast from St. Mary's Health Care in Athens, Georgia, focusing on patient-centered care under our mission to be a transforming healing presence within our communities. I'm Caitlin Whyte.

Today, we are discussing stroke awareness. We'll talk warning signs and what to do if one happens. Joining us for this critical conversation are Dr. Feroze Afzal and Dr. Neil Woodall. So in doing my pre-show research, I went to the St. Mary's website and you two were listed as the dynamic duo. Dr. Woodall, tell me about how you two work together and what that brings to your stroke care.

Neil Woodall, MD: Sure. The really exciting thing about having Dr. Afzal join our program is that, you know, his being here is going to allow us to provide round-the-clock opportunities for treatment for patients with occluded blood vessels in the brain. And we've been treating patients with these problems, but, you know, we haven't been able to do it around-the-clock and provide that service to our community consistently. And now that he's here, we can do that.

Another thing I'd say about Dr. Afzal is, you know, he's from a neurology background and I'm from a neurosurgery background and we have similar training when it comes to our catheter skills and what we do in the endovascular laboratory. But I think his area of expertise really compliments mine so that we can, you know, have a well-rounded kind of interdisciplinary approach to patient care.

Caitlin Whyte: Dr. Afzal, getting into our topic here covering strokes, who is usually the at risk group for strokes? And what are some warning signs that we should look out for?

Feroze Afzal, MD: Right. So, you know, traditionally, we've thought of a stroke as being a problem for only of the aging population, which holds true. As we age, our risk increases. But, you know, maybe a quarter of the strokes is even in younger populations. So younger people are less affected. Percentage-wise, that's true, but it can happen at any age. But some of the risk factors are similar to cardiovascular diseases, such as high blood pressure, diabetes, high cholesterol, obesity, abnormal heart rhythm. You know, folks may have people in their family, you know, parents or in a first-degree relative, second-degree relatives with those problems or who've had strokes that even puts them at a risk. And with our current lifestyle, you know, lack of exercise, poor diet, smoking and consuming excessive alcohol, all of those are the risk factors. And reducing even one risk factor is significant. But yes, we have to work on all of those risk factors as a group to reduce our overall risk. And I would add that anywhere from 70% to 80% of the strokes actually can be prevented if we control these risk factors.

Caitlin Whyte: Dr. Woodall, in the moment, you know, if a stroke is happening to myself, is there anything that I can do?

Neil Woodall, MD: Absolutely, you know, and I think the most important thing is to act quickly and things that, you know, people might notice that might tip them off that they're having a stroke would be facial drooping, slurred speech, weakness of the extremities, particularly if that weakness is on one side of the body or the other. Those symptoms should raise concern for stroke and really getting in contact with EMS and getting to an emergency department as quickly as possible is the most important thing a patient can do, because these processes are time-sensitive and the treatments that we have at our disposal, whether those be the intravenous clot-busting agents or whether they be the procedures that Dr. Afzal and I do, really depend on time and outcomes are better the earlier the patient is treated.

Caitlin Whyte: And on that, what if a stroke is happening to someone near me? You know, if I'm in a crowd or some of my family member's having a stroke, what should people know to help others in the moment?

Neil Woodall, MD: Well, you know, I think again the most important thing for a lay person is to contact EMS, to call 911, notify, set off the alarm for a medical emergency. You know, if someone is unconscious or vomiting, that sort of thing, which is uncommon with a stroke, but, you know, getting the patient on their side, that sort of thing, trying to help clear their airway. You know, the ABCs for those who are trained in CPR can be helpful. Again, that's not as common with a stroke-type setting. But, you know, when lay people do have those skills and can put them to use, it can sometimes be life-saving.

Caitlin Whyte: Absolutely. Dr. Afzal, is there anything we can do, you know, lifestyle-wise to prevent strokes?

Feroze Afzal, MD: Yes. It's been shown to significantly reduce the risk of stroke. So in our lifestyle, well, one of the very important things would be to be physically active. And as per the most recent data, about 150 minutes of moderate intensity exercise, that's 150 minutes per week, which is approximately 20 to 30 minutes per day, you know, about four to five days a week. If you do that, that reduces a risk. So physical activity is very, very good. And moderate intensity usually would mean just brisk walking. You know, you don't have to go very aggressive on that, but moderate walking would help that too.

And then focus on our diets. So, you know, just good, healthy diet habits, like eating Mediterranean diet may help, fruits, you know, diet rich in vegetables, you know, reduce saturated fats. Those kinds of things would help. And cigarette smoking is a huge target that we look at. People who smoke, they're at significantly higher risk, whether it's cigarette smoking or cigar smoking, all of that is very harmful. So the goal is no smoking, that reduces the risk of ischemic and bleeding stroke. And then we should have our BMI within normal range, which is less than 25, to be healthy.

Caitlin Whyte: And Dr. Woodall, what other stroke-related services do you offer at St. Mary's Health Care?

Neil Woodall, MD: Sure. Yeah. So it has a strong history of stroke care in the Athens, Northeast Georgia area with high rates of tPA administration, which is the clot-busting drug given intravenously for acute ischemic stroke. So first and foremost, you know, that service is offered through our neuro-hospitalists. Our in-house neurology service offers rapid evaluation and treatment with intravenous tPA and clot-busting agents at St. Mary's Hospital here in Athens, and also provides, you know, the services to the satellite hospitals in Lavonia and down in Greensboro.

Dr. Afsal and I, we provide interventional treatment. So there's a subset of patients with ischemic stroke. And when we say ischemic stroke, we mean, you know, strokes that are analogous to a heart attack. So strokes where a blood vessel has been included and a portion of the brain is starved for blood flow, oxygen and nutrients.

So there are a subset of patients who have a large vessel in the brain that's occluded. And in select patients, we can go through the artery, sometimes through the wrist or sometimes through the femoral artery in the groin and go with a catheter, which is a thin hollow tube and retrieve the clot. So remove it either with aspiration or with a stent-type device to reopen the blood vessel and restore blood flow to the brain. So that's really the ischemic stroke intervention we're most excited about for being able to provide around-the-clock here starting October 1st.

In addition to that, we take care of hemorrhagic stroke and ruptured aneurysms, arteriovenous malformations, the gamut of cerebrovascular pathology.

Caitlin Whyte: Sticking with you for this last one, Dr. Woodall, anything else you'd like to add to our discussion? Maybe some myths about strokes you want to clear up or just some key things that we should know?

Neil Woodall, MD: Well, I think I would just emphasize that, you know, this is a time-sensitive disease process and, you know, you made a great point earlier. I think, you know, podcasts such as this one, the better we can educate the people in the community about what to look for, facial weakness, slurred speech, weakness of the extremities, visual changes, those things should raise the alarm bells and get to the emergency room, contact EMS, and get seen about as soon as possible, so that if you are a candidate for treatment, you can get treated.

And, you know, I hope that in bringing these services to the community, we'll be able to improve stroke outcomes for the people who live in Athens and the Greater Athens and Coney area.

Caitlin Whyte: Of course, that's why we're here. And Dr. Afzal, the same question for you as we wrap up here. What would you like to leave us with when we're talking about strokes?

Feroze Afzal, MD: Yeah, I think emphasizing the very similar things that Dr. Woodall mentioned.. Time is of essence. You think of we follow the dogma time is brain. Every minute you delay treatment, it's a staggering number. Every minute about a 1.9 million brain cells die. So every minute counts, every second counts. So the sooner you get to the hospital, the sooner someone can start treatment, the better it is.

I would also like to mention that in the recent past, not too long ago, the time window to treat stroke was a very small, only few hours. That window is expanding. It has expanded to several hours even close to a day. And there are studies that are looking at treatment that could be done even beyond that 24-hour time window. So the goal is to get as soon as possible to the emergency room and seek help.

Caitlin Whyte: Well, thank you for joining us today, doctors, and again, for sharing that information with the community. Like you said, it's good to get it out there.

Please rate and subscribe to our podcast and share it on all your social channels. You can find out more about us online at stmaryshealthcaresystem.org. This has been Mission In Action, a podcast from St. Mary's Health Care in Athens, Georgia, focusing on how we provide patient-centered care under our mission to be a transforming healing presence within our communities. Thanks for listening.