Transcription:
Stroke: What You Need to Know

Melanie Cole (Host): If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of stroke, so it’s really important for you to know the signs of a possible stroke, learn your risk factors and identify what you need to do if you suspect that you or a loved one may be suffering a stroke. My guest today is Rhonda Tesmer. She’s a clinical quality specialist at Stoughton Hospital. Rhonda, I’m so glad to have you with us. It’s a really important topic. Tell us a little bit about stroke. What is it and are there different types?

Rhonda Tesmer (Guest): There are different types. Most people understand what a heart attack is, and I think it may be helpful if we think of stroke as a brain attack. Strokes are also called cerebrovascular accidents or CVAs. When a stroke happens, it means that the blood supply to a portion of the brain has been interrupted. This can happen when something blocks the blood supply to a part of the brain, which is called an ischemic stroke or when a blood vessel in the brain has burst, which is called a hemorrhagic stroke. In both cases, parts of the brain can become damaged or die. A stroke can have lasting brain damage, long term disability, or even death. About 87% of all strokes are ischemic strokes where the blood flow is blocked.

Host: So then who is at risk for stroke, either of the types? Tell us are there certain controllable or uncontrollable risk factors that we should know about?

Rhonda: Well I think it’s really important to stress that while our risk for having a stroke increases as we age, anyone can have a stroke at any age. Family history of stroke increases your risk. Stroke is also more common in women than in men. There are certain racial groups that have a higher risk of strokes that includes American Indians, Alaskan Natives, Hispanics, and Blacks, and there are some conditions that also can increase the risk of stroke. High blood pressure is a leading cause of stroke. Other conditions like high cholesterol, heart disease, atrial fibrillation, diabetes, and sickle cell disease can increase the risk. While we can’t turn back the clock unfortunately or change our family history or our personal medical history, people can work with their doctor and take care of those higher risk conditions and that helps reduce the risk of stroke. There is more good news in that there are behavioral modifications that we can control that can help reduce our risk further. Like eating a healthy diet, being physically active, don’t smoke or stop smoking if you do, maintaining a healthy weight, and avoid drinking too much alcohol.

Host: What a great explanation Rhonda, so let’s talk about the symptoms because that’s so important that people understand and that their loved ones understand what it is that they might be seeing, so tell us about the acronym BE FAST.

Rhonda: I like the acronym BE FAST because it does help us to remember those signs and symptoms. The B stands for balance, so we’re talking about a sudden onset of dizziness or loss of balance or coordination. The E stands for eyes, so trouble seeing out of one or both eyes. F stands for face, so what you’re looking for there is facial weakness with a droop or an uneven smile. A is for arm, being unable to raise both arms evenly. S is for speech, so if the speech is impaired, slurred with difficulty repeating a simple phrase like Mary Had a Little Lamb or understanding those simple phrases. T is for a sudden onset of a terrible headache. T also stands for time to call an ambulance now.

Host: So time to call an ambulance now. Why is time so important? We’ve heard the phrase time is brain, why is that the case?

Rhonda: Well time does equal brain cells. Brain cells die without blood flow to bring oxygen and nutrients to them. Treatment can help restore the blood flow and prevent further injury to the brain, and so that’s why time is so important.

Host: So if somebody does spot some of these symptoms, do they call 911 or do they try and drive their loved one to the hospital themselves? Is there something Rhonda that EMS can be doing when they know that somebody’s having a stroke that could help along the process?

Rhonda: Absolutely there’s a lot that they can do. Calling 911 and reporting to the operator that this is a possible stroke is the best thing that anyone can do. The EMS personnel can start assessments and treatments on the way and they report to the hospital what they are seeing. That report allows the hospital to prepare to quickly treat those patients when they arrive. Calling 911 helps ensure that you receive the quickest treatment and diagnosis.

Host: So then what happens? So if you call 911, you go to the hospital, what do they do to determine if you had a stroke, what kind of stroke you had, and what are some of the first things that they might be able to do to minimize some of those effects?

Rhonda: Well in the ER, they are going to do a very quick assessment and get those patients as quickly to the CT scan as possible. The CT scan will help determine the type of stroke. Special assessments determine the severity of the symptoms and establish the time that the individual was last known to be well and that helps guide the doctor for the best possible course of treatment. If there is no evidence of a hemorrhagic stroke or that brain bleed that we talked about earlier, the patient has options of being treated with a special type of medication called tissue plasminogen activator or TPA, which is a clot busting drug. Again, time is really critical because they want the patient to be treated within 3 hours of those first symptoms. Studies have shown that patients with ischemic stroke who receive TPA are more likely to recover fully or have less disability than patients who do not receive this medication, but not everyone is a candidate for this treatment. There are some reasons why a patient may not be eligible for that medication and they represent more risk to them than the benefit would offer. So these assessments help the physician determine what that best course of treatment might be. Some cases patients don’t have the kind of response to the TPA that we might like to see and so for those patients, other treatments, removing that clot physically in a surgical procedure is what’s best for those patients, but the first step really is to start that assessment process and get the patient to the hospital quickly.

Host: So if they do get TPA or as you mentioned, mechanical thrombectomy, what have you seen as far as life after stroke? Based on whether they got the treatment or how severe the stroke, I understand that, but what have you seen that people can do and the levels to which they can possibly recover?

Rhonda: Well certainly it depends on their condition when they arrive and their condition before the stroke occurred. Certainly the patients who are active and independent, the goal is to regain and relearn as much of the abilities that were lost and a lot of times that involves physical therapy and occupational therapy in the hospital to work on the big motor skills and the fine motor skills. It may involve speech therapy. If there’s some issues with speech or swallowing, the speech therapists are great assets in helping determine what areas have been affected and how we can best work around those problems or retrain those muscles. So really a lot depends on how – what condition they were in on arrival and how much success we have with the treatment and a lot of that really is dependent on that time factor.

Host: Well it is so important really great information. As we wrap up, what would you like the listeners to know about possibly preventing a stroke and really the importance of recognizing those signs and that acronym BE FAST?

Rhonda: What I would like people to understand and know is that stroke is something that we can work on reducing our risk for. The power really is in our hands. It’s also knowledge being our weapon and our power against the debilitating effects of strokes by learning those signs and symptoms, being alert to them, and not delaying treatments. It’s so vital that we recognize and seek treatment right away and that all starts with calling 911. A recent study indicated less than half of patients diagnosed with stroke arrive at the hospital by EMS, so they’re coming by private car, even driving themselves in some cases and that really does put constraints and delays on how quickly their treatment can be started. So I would really like to say a lot of the public really understand and recognize those signs and symptoms and know the right thing to do. In addition to understanding that you have so much power to help reduce your risk if you work with your primary care provider and identify what risks you have and really stay compliant with your medication if you have high blood pressure, staying active, treating high cholesterol. There’s so much that you can do. So it’s not something that we have to be helpless against.

Host: What a great way to end the segment and a great point that you made. Thank you so much Rhonda for coming on and sharing your expertise. Really important information and that wraps up this episode of Stoughton Hospital Health Talk. Head on over to our website at stoughtonhospital.com for more information and to get connected with one of our providers. If you found this podcast as informative as I did, and I really would like to stress this, listeners please share with your friends and family. Share this podcast on your social media, on your Facebook page, and be sure to check out all the other interesting podcasts in our library, that way we all learn from the experts at Stoughton together. Until next time, I’m Melanie Cole.