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Bob Lewis (Host): Hey, welcome once again to our continuing series about your health with the experts from Summa Health here in Akron. Now, May is National Stroke Awareness Month. According to the American Heart Association, stroke is the fifth leading cause of death here in the United States where every 40 seconds someone has a stroke. Strokes impact more than 795,000 people every year. Joining us today on our live line is Dr. Madihah Hepburn, who is Medical Director of Neurocritical Care at Summa Health's Neuroscience Institute. Dr. Hepburn is board-certified in Psychiatry and Neurology and specializes in Neurocritical care. Dr. Hepburn, welcome to the program.

Dr. Madidah Hepburn: Oh, thank you, Bob. Thanks for having me this morning.

Host: Now, doctor, start by explaining to us exactly what a stroke is.

Dr. Madidah Hepburn: Yeah, sure. So, simply put, a stroke is damage to the brain caused by some interruption of the blood supply to the brain. And that can happen when either something is blocking off that blood supply or when a blood vessel in the brain bursts.

Host: Now, in a stroke, in either case, can there be damage to the brain? Can it cause extensive damage to the point where even somebody could die?

Dr. Madidah Hepburn: Oh, that is absolutely correct. So, the part of the brain that becomes affected is the part that loses its blood supply. And it can cause lasting brain damage, long-term disability. It's one of the leading causes of disability in North America or even death.

Host: Now, what is the phrase that TIA referred to when we talk about strokes?

Dr. Madidah Hepburn: Sure. The word TIA, or sometimes referred to as mini-stroke or little stroke, is basically, the best way I can put it, I like to tell my patients, it's a stroke that was trying to happen, but it passed on its own, so it didn't quite happen. So, that blockage that was there temporarily suddenly opens up on its own and you only have symptoms for a very short period of time, usually less than 24 hours. But we don't like to use the word mini-stroke or little stroke, because it almost makes it seem as if a TIA is, you know, kind of like a small thing. At the end of the day, a TIA is just like a real stroke and gives you the same risk factors and same risk of damage.

Host: So, what happens to the brain during a stroke?

Dr. Madidah Hepburn: Sure. So, you know, just like if you think about it, your brain needs oxygen and oxygen is in your blood. So basically, if something happens that blocks the flow of blood to the brain, then those brain cells, they're kind of greedy. They really start to die within minutes, you know, because they can't get any oxygen. And if they can't get oxygen, they don't get enough blood supply, the parts of the brain that normally controls our movements, our talking, understanding, you know, basically becomes, you know, non-functional. And until we can relieve that blockage, or that blockage passes on its own, you're going to have those symptoms.

Host: Now, are all strokes the same or are there different kinds of strokes?

Dr. Madidah Hepburn: Yeah. So, there are two main types of strokes. The most common one is something we call, it's a long word, called ischemic strokes. And that's basically what happens when there's something like a clot or a cholesterol plaque that blocks the supply of blood to the brain. And that's about 80% of all strokes. The smaller proportion are called hemorrhagic strokes. And although there's a smaller portion, sometimes they can be more severe and they happen when there basically is a blood vessel in the brain that bursts and it causes bleeding into the brain.

Host: So, what causes the damage, if you will, during this most serious of the strokes, the ischemic stroke?

Dr. Madidah Hepburn: Yeah. So, the majority of the damage is caused, because essentially over time the blood vessels start to get narrowed and, you know, and as they narrow, the risk of basically them getting blocked off or a piece of what we call a clot flying through there and going up to the brain and getting stuck there and causing a stroke, you know, it becomes much higher. And so once that happens, that part of the brain, you know, is essentially damaged. Now, you can recover from that stroke, but it does take time and therapy in order to rewire that.

Bob Lewis (Host): Where do these blood clots come from?

Dr. Madidah Hepburn: Well, they come from a couple places. So, basically, as we all get older, our arteries become narrower. And, you know, that's because essentially the conditions that we have may accumulate this narrowing and what we call plaque or cholesterol. And those are things like smoking, you know, high blood pressure, high cholesterol, diabetes. And when that happens, those things are kind of unstable and every now and then one will break off and fly up to the brain.

The other very common cause of these blood clots is something called atrial fibrillation, which is a type of irregular heart beat. And this can cause blood clots in the heart that break apart and, you know, everything is all one closed loop. So even if something's in the heart, it goes into the bloodstream and it goes up to the same pipes and enters the brain and cuts off the blood supply there.

Host: Now, what would a hemorrhagic stroke be?

Dr. Madidah Hepburn: Yeah. So, you know, the hemorrhagic stroke is kind of the same thing as ischemic stroke in that it can be anywhere in the brain because those blood vessels, those pipes, they supply our entire brain on both sides. And in this case, what happens is that a blood vessel inside the brain bursts. And usually, that's because of very high blood pressure, or diabetes or cholesterol over time, which, you know, weakens your blood vessel walls or if you have something like what we call an aneurysm, which is kind of like a slow-growing weakness of the wall that all of a sudden just bursts and then there's blood in the brain suddenly.

Host: Now, these blood vessels, what causes them to become malformed?

Dr. Madidah Hepburn: Yeah. So, you know, there are things that we can control and things that we can't control. So, the things that we can't control that causes the blood vessels to become malformed are things like essentially getting older; also your genetics, like if one person in your family has an aneurysm in the brain, other members of the family are also more likely to have the same aneurysms. So, those are things that you can't change also. You know, strokes are more common in women than men, and these are the things that we can't change about ourselves.

However, the things that we can change are the things like smoking, which can injure the blood vessels; high blood pressure, obesity, high cholesterol level and, essentially, you know, taking in excess alcohol as well. All those things over time damage our blood vessels and those are things that we can address.

Host: Now, this is Stroke Awareness Month in the month of May, so how can somebody recognize a stroke?

Dr. Madidah Hepburn: Sure. You know, I just want people to remember the saying BE FAST. And this is an acronym that we use at Summa to help people remember the signs and symptoms of a stroke. Because at the end of the day, it's up to not only us to recognize the signs and symptoms of a stroke, but also the family members and, you know, persons even on the street tend to be able to recognize that something's happening.

And so, B is for balance and does the patient have a sudden loss of balance? E is for eyes. Has the person suddenly lost vision in one or both eyes? F is for the face. You know, does the person's face look uneven or droopy? And this is why, you know, even persons on the outside looking in will need to know about this so they can recognize it in their loved ones. And A is arm. Is one arm weaker than the other? And S is for speech. Is a person's speech slurred, or are they having trouble? Do they seem confused? And T is always for time. Call 911 right away because time is brain. And you should always call 911 right away for signs or symptoms of stroke, because it helps to activate a system where we can basically get stroke patients to the places where they need to be as quick as possible.

Host: Now, is there anything we could do like first aid when someone is having a stroke that could help them with that?

Dr. Madidah Hepburn: Well, the first thing is to make sure that they are safe. So if they've suddenly lost strength on one side of the body, you make sure that you, you know, lower them gently to the ground. And of course, call 911 immediately.

Host: Once again, we're talking to the experts from Summa Health, Dr. Madidah Hepburn, who is the Medical Director of the Neurocritical Care at Summa Health Neuroscience Institute, also board-certified in Psychiatry, Neurology, and specializing in Neocritical Care, talking about strokes. So, once again, let's talk about who's at risk for having a stroke. Are some people more at risk than others would be?

Dr. Madidah Hepburn: Yeah, for sure. So, you know, again, about two-thirds of all patients with strokes are current persons over the age of 65. But that being said, we are noticing that there are a lot more strokes happening in younger and younger persons because even younger persons have the same risk factors, you know, in terms of high blood pressure, diabetes, being overweight, high cholesterol, smoking, et cetera. Those medical conditions are actually happening younger and younger in patients, in persons. So, age is definitely one thing that can increase your risk, as well as basically, family history was said. Persons who had a parent or a sibling who's had a stroke are at another risk of stroke. And having diabetes, just having diabetes alone, you know, triples a person's risk for having a stroke. A really important risk factor to recognize and to modify.

Bob Lewis (Host): What about things like gender or, again, family history, where you come from?

Dr. Madidah Hepburn: Sure. So yeah, in terms of gender, the incidence of stroke is slightly higher in women than men. And it's kind of also interesting that oftentimes women, they present a little bit more differently than men. So, sometimes women are not recognized for the strokes they're having because their symptoms may be a little bit more atypical. So even if, you know, you're unsure, it's best to call 911 if you think that yourself or your loved one is having a stroke. In terms of ethnicity, there are certain ethnicities that have a predisposition to increased risk of stroke, but it's more related to certain medical conditions that are more common in different groups. For example, certain ethnicities, they're more commonly to have very high cholesterol. And that's something that can be modified in some ways, but some ways cannot be changed. And having, those additional risk factors increases the risk for stroke.

Host: Now, what factors for stroke risk can we control?

Dr. Madidah Hepburn: Yeah. So, you know, I think one of the main thing is lack of exercise. We tend to be quite sedentary sometimes, especially in the winter when it's very cold here in Akron. But now that the summer's coming, we really would like people to to start to add exercise back to their lifestyle. And even something as simple as 30 to 40 minutes of walking, you know, four to five times a week just walking, can help to reduce your risk of stroke.

In addition to that, basically, everything in moderation. So, you know, cutting back on the use of alcohol. And smoking is a very strong risk factor for stroke. And getting on a smoking cessation program through your primary care doctor is going to be very helpful in the long run to reduce your risk of stroke.

And as we're talking about diet and exercise, you know, at the end of the day, changing our diet will help to control things like high cholesterol, you know, help to have our diabetes under control in addition to the typical medications.

Host: Now, we talked about atrial fibrillation, an irregular heartbeat, as being a risk factor for stroke. How can that be treated?

Dr. Madidah Hepburn: Yeah. So, atrial fibrillation is a risk factor for stroke. So first, it has to be recognized. And once it's recognized, there are two things. One is that those persons need to be placed on a form of blood thinner, not just aspirin. So, atrial fibrillation is a very strong risk factor for stroke. And so, those with atrial fibrillation and high risk of stroke need to be placed on basically a stronger blood thinner and they take that every day and that keeps the blood thinner, which prevents the clots from building up inside the heart and going to the brain.

Host: Can the heart be put back into a regular rhythm at some point?

Dr. Madidah Hepburn: Yeah. Your heart can be put back into a regular rhythm in some cases, although you still will need to be on blood thinners for some portion of time. And that's why it's really important to have access, to have interaction with all members of the medical team. So, your primary care doctor who may actually discover your AFib and then, you know, coordination with a cardiologist and also, you know, a neurologist can really help persons reduce their risk of stroke.

Host: We also talked about excessive alcohol intake as being a risk factor for stroke. What's defined as excessive?

Dr. Madidah Hepburn: Right. So, excessive is defined based upon whether you're a woman or a man because of essentially your weight. And so, excess alcohol intake for men is probably going to be more than two to three units, which basically a unit is a single serving of alcohol, and you can look it up. It's like one beer, one glass of wine, et cetera. If you're drinking more than two to three glasses, two to three units of alcohol per day, that is going to be excess for a male. And for women, one to one and a half units per day, more than that would be excess as well.

Host: Define what carotid stenosis is and how that may affect a risk for stroke.

Dr. Madidah Hepburn: Sure. Now, early in the show, we talked about narrowing of those arteries. Those are the big pipes that supply your brain, and that's what the carotids are. The carotids are on either side of your neck, and these are the large pipes that supply a large amount of blood to the brain.

Now, if you have uncontrolled high blood pressure, diabetes, cholesterol, they can actually accumulate this thing we call cholesterol plaque and it forms on the inside of the blood vessel of the carotid. And as that forms, it kind of narrows it down and actually stops or decrease blood flow to that side of the brain and puts you at risk for more of those little plaques and cholesterol just, you know, breaking off and going up and causing a stroke on that side.

Host: And what about other kinds of drug use, especially drugs that are considered to be either very damaging or illegal?

Dr. Madidah Hepburn: Oh, sure. Yeah. And the main drugs that are of concern as related to strokes are drugs that also cause narrowing of blood vessels. So just like how over time, high blood pressure and diabetes can narrow your blood vessels, drugs such as cocaine and amphetamines or methamphetamines, they are very, very powerful in vessel narrowing. And so, therefore, even a young person may actually have a very sudden stroke if they utilize these drugs of abuse and suddenly they have, you know, narrowing and tightening of all their vessels and reduction of blood flow to the brain.

Host: Are there certain over-the-counter drugs that should be avoided by people who are at risk with stroke?

Dr. Madidah Hepburn: So, you know, there's not a lot of over-the-counter drugs that needs to be avoided. I would recommend caution in terms of there are some over-the-counter, like natural or herbal supplements, which purport to be blood thinners. And if you're using those blood-thinning herbal medications, which are kind of not well-regulated, so you really don't know the amount that you're getting, along with, you know, aspirin or any other blood thinner, you're at a higher risk of bleeding. And then also, persons who have very high blood pressure or heart disease, sometimes there are cold medications that might cause you to have that same narrowing effect. But if you talk to your primary care doctor, they'll be able to give you a medication that will not be so potent to your blood vessels.

Host: So, after we have a stroke, how are strokes treated?

Dr. Madidah Hepburn: Yeah. So, you know, actually, you have to start with when the stroke is happening and so that's a part of it, like recognizing and saying, "Hey, time is brain," because strokes happen very suddenly and the treatment that we need to administer needs to be done as quickly as possible. So, we have a medication called the clot buster. We use one called tenecteplase here at Summa, and we can give that to persons who present within about four and a half hours of the onset of symptoms. And that can really break up the clot that's causing the stroke and really has, you know, changed people's lives and, you know, and improved recovery.

In addition to that here at Summa, being a certified comprehensive stroke center, we have the ability to handle the most severe cases of stroke. And we also have the ability that if that clot is so large, we have specialists who can go in and take out that clot directly and restore blood flow to the brain.

Host: Now, of course, you say rapidity and quickness is the best way to save somebody from extensive stroke damage. So, is always calling 911 the best way? Or if you have, again, a loved one that's having a stroke, should we try to run them to the emergency room ourselves?

Dr. Madidah Hepburn: Yeah. No, it's really, really important to call 911 right away because our EMS squads in this area of Northeast Ohio, they are highly trained in order to recognize the signs of symptoms of stroke. And also based upon the severity of what they're seeing, they will have the best knowledge of how to get you to the best hospital possible to help you if you need advanced stroke care. And so, it is always better to call 911 and let them basically get to you and then get you to where you need to be as soon as possible because not all medical centers are certified stroke centers.

Host: Now here in Akron, of course, Summa Health Akron Campus is a certified comprehensive stroke center, as designated by the Joint Commission in collaboration with the American Heart Association and the American Stroke Association. So, what does it mean to be a comprehensive stroke center? Why is it important for people to be aware of it?

Dr. Madidah Hepburn: Yeah. And what's important to be aware of is that, you know, just like there are different grocery stores that may have different items, I kind of put it as specialty items. Summa Health, being a comprehensive stroke center, you know, has the highest level of the specialty items, which basically means that we can take care of the most severe kinds of stroke and provide gold standard stroke care.

And basically, at the end of the day, we work together as a large team in order to be able to provide this service to our community in collaboration, of course, with other specialists here at Summa Health.

Host: I understand Summa Health and the Akron campus was named one of HealthGrades America's 100 Best Hospitals for Stroke Care.

Dr. Madidah Hepburn: Yes, it was. And in fact, it actually was named one of Healtgrades America's 100 Best Hospitals for Stroke Care for the fourth year in a row. So, we are very proud to work together here at Summa Health Akron Campus to serve the needs of our community here in Northeast Ohio.

Bob Lewis (Host): Once again, we're talking to Dr. Madidah Hepburn of Summa Health about strokes here in Stroke Awareness Month, final days of that here in the month of May. Now, if the stroke has caused damage to someone and has caused brain damage, what are the procedures to try to rehabilitate that person and what are the success rates of some of those procedures?

Dr. Madidah Hepburn: Sure. Yeah, so, strokes sometimes they're so severe upfront, and they happen so suddenly that, you know, family members are they're shocked. But once we get through that, that early phase, we give the treatment that we can. After that, next will come the rehabilitation phase. So, although that area of the brain is damaged, regardless of your age, there's always ability for what we call the brain to-- we call it plasticity, essentially to rewire itself and basically recover some of that function. Now, it doesn't happen right overnight and doesn't happen in the first week. But patients with stroke can have improvement very quickly in the first three months, and they continue to improve with, you know, with stroke-focused rehabilitation up to 12 months after the initial stroke.

Host: Now, is the TIA type of stroke that we talked about, is that the less serious of all the types of strokes that one can recover from?

Dr. Madidah Hepburn: You know, I, I would urge people to not think of it as less serious. I would urge people to think of it as a type of stroke. Now, it is a type of stroke where the neurological problems or the, you know, the disability, it's only short-lasting, as in it lasts less than 24 hours, and the person "goes back" to their normal self, as in they had some weakness and now the weakness is better. But I wouldn't think of it as a less severe type of stroke. I almost think of it as just a different type because at the end of the day, it's basically almost like a wake up call or warning sign because persons who've had a TIA, they still have a very high chance of another TIA or larger stroke in the next 30, 60 and 90 days. So, TIA still need to have attention to, and we still need to, you know, work together to treat them and to help prevent persons from having a more severe kind of stroke down the line.

Host: You mentioned blood thinners as being a very effective way to try to prevent future strokes. So if someone has had a stroke, even a TIA or any other kind of different kind of stroke, does that mean they're going to have to be on blood thinners?

Dr. Madidah Hepburn: Yeah. And we use blood thinners kind of generally. But in general, the thing I tell my patients an aspirin a day keeps the stroke doctor away. So, they need to have, you know, aspirin, and aspirin is kind of the basic medication that can make the blood cells slippery and help prevent another stroke, as long as you don't have atrial fibrillation. But either way, you know, once you've had one stroke, your risk of stroke for the rest of your life is much higher than the average population. So yes, you should stay not only on your blood thinner, but also, you know, also medications that help lower your cholesterol, treat your blood pressure, or diabetes, or any of the other comorbidities that increase the risk of stroke.

Bob Lewis (Host): What are some of the other medications that are used for blood thinners?

Dr. Madidah Hepburn: Sure. There's another medication called clopidogrel. I kind of explained to my patients that it's like aspirin's bigger brother. And sometimes even for TIAs, because the risk of another stroke or another TIA is so high, we even sometimes give them both the aspirin and the Plavix for a short period of time in that first 30 days, which is a very high risk. So, those are the two main blood thinners.

And then when we talk about blood thinners related to the atrial fibrillation, the one that causes the clots to build up, those have several different names and there are many different types of them. And you know, the best blood thinner for you, you know, would be something that you can discuss with your primary care provider, you know, or your neurologist or your cardiologist.

Host: Now, you're also board-certified in psychiatry, so what are the psychological impacts of someone who has suffered a stroke? .

Dr. Madidah Hepburn: Well, actually, it is interesting. I'm actually certified in neurology. But we do have a psychiatry component to our training. But the main things about stroke is that it's a change in your state of being a very sudden change. As in you were working, talking, walking one, one minute, then all of a sudden, you know, you have new weakness, you have new changes in your memory, new change in your ability to communicate. And so, depression is a very real consequence of stroke. And so, you know, we here at Summa Health, we are, you know, not only collaborative. But a part of your stroke management and stroke screening, when you come in for a stroke, is to basically look for signs and symptoms of depression. And so, that, you know, we can recognize these and, and help the person the best that we can.

Host: So once again, Dr. Hepburn, go over that BE FAST acronym to help people remember the signs and symptoms of stroke.

Dr. Madidah Hepburn: So, BE FAST, as in time is brain, BE FAST, call 911. But B for balance, are they suddenly all of a sudden like wobbly and falling down? E is for eyes. Have they've lost vision in one or both eyes, even if it's just loss of vision or blurry vision, double vision? F is for the face. Does one of the side of the face look droopy and uneven? A is for arm. Is one arm hanging down? And S is for speech. Has the person's speech suddenly changed? Is it slurred, hard to understand? Does the patient have trouble understanding you or speaking or even seem confused? And T, as we all emphasize, is for time. Call 911 right away, so that we can help get you to where you need to be to manage the stroke.

Host: So in the closing moments, Dr. Hepburn, anything else you'd like to say about the Summa Health Stroke Center?

Dr. Madidah Hepburn: Oh, I would like to say that here at Summa Health Stroke Center, it is such a wonderful environment. We are collaborative and we work together as a team to take care of everybody in this community in all stages of their stroke.

Bob Lewis (Host): Once again, Dr. Madidah Hepburn is Medical Director of Neurocritical Care at Summa Health's Neuroscience Institute and part of Summa Health Stroke Center. If you'd like more information, you can do it online by going to summahealth.org/brain or you can call them to make an appointment at 330-375-7055, 330-375-7055. Dr. Hepburn, who would best benefit from making an appointment directly with the center?

Dr. Madidah Hepburn: Oh, so anyone who's had a stroke recently and they've not established care with a neurologist or if they've had a history of stroke in the past and they have not established care with a vascular or stroke neurologist, those persons would definitely benefit from making an appointment with us.

Host: Once again, call Summa Health Stroke Center, 330-375-7055, to make an appointment. Dr. Madidah Hepburn, thank you so much for being with us here this evening on WNIR Kent Akron, and hope you have a very enjoyable holiday weekend.

Dr. Madidah Hepburn: Oh, thank you so much, Bob, and to you too.

Host: I'm Mr. Sunday, Bob Lewis.