Jaime Lewis (Host): This is Community Connect: presented by Tampa General Hospital. I'm Jamie Lewis. Joining me is Dr. Noella Cypress West, Senior Director of Inpatient Acute Critical Care Advanced Practice at Tampa General Hospital. Dr. West, welcome to the show.

Dr. Noella Cypress West: Thank you, Jamie, for having me. Pleasure to be here.

Host: So, May is Stroke Awareness Month. So, let's start with some basics. What are the current guidelines for recognizing and responding to stroke?

Dr. Noella Cypress West: The American Heart Association and American Stroke Association recommends using BEFAST acronym to recognize stroke symptoms. So, that is B as in boy, balance. So if there's a certain loss of balance or coordination. E. For eyes, if there's any blurry or double vision or any sudden vision loss, that's to be a warning sign.

And then, FAST, F-A-S-T. F is for face, any facial drooping on one side. A is for arm, any weakness or numbness in one arm or shoulder fingertips all the way down radiating. S is for speech, any slurred or confused speech, something that's garbled, something that doesn't make sense. And then, T is for time, calling 911 immediately. Time is critical, especially when it comes to the brain, every second counts. So in the face of stroke, every moment is a lifeline. So, swift action, delivering lifesaving treatments like clot-busting, other mechanical thrombectomies and other services can mean the difference between a full recovery and a lifelong disability. So, time isn't just valuable, it's vital. So, the faster someone understands and recognizes those symptoms, the better the outcome.

Host: Okay. That's a great acronym to remember. So, we know that stroke affects different communities in lots of different ways. How does social and cultural factors impact stroke risk and treatment?

Dr. Noella Cypress West: As a personal person who has had family members and stroke, as well as me practicing on the Vascular Stroke Service here at Tampa General Hospital, stroke is not just a medical condition, it's a reflection of deeper social and economic as well as cultural realities. Racial and ethnic disparities and stroke risk are tied not only to biological dispositions like hypertension, diabetes, but also to generational barriers in healthcare access, systematic inequities. And the mistrust of sometimes our medical system is rooted in historical injustices. So, cultural beliefs can actually shape how symptoms are interpreted and when it comes to sought off of care. In some communities, symptoms may be minimalized, misattributed to spiritual or non-medical causes, but also managed by traditional remedies. Sometimes people form their own home treatments and grandmom did this and my uncle used to do these, but this can actually delay a life-altering situation.

So, to truly reduce stroke risk and improve outcome, healthcare providers as myself and others must listen before leading. And this means prioritizing cultural humility, tailoring the education and the language to the community that they're actually serving. So, using big words that they may not understand is something that we definitely need to be conscious of. So, the accessibility, equitable and empowering the community is very important. So, us as healthcare providers, we must engage in the cultural relevance of all of these programs and what we trust as far as looking at those platforms. So, this just means teaching stroke prevention in a way that we can actually have the social structures to prevent harder, for us to achieve these things. So, just really being aware of those. 

Host: Well, for anyone, but especially for people in high-risk populations, what kind of lifestyle changes can help prevent strokes? 

Dr. Noella Cypress West: Very important, knowing what the symptoms are and knowing what we can do to actually prevent is vital, is very important. So, stroke prevention isn't just about avoiding the disease, but it's about reclaiming power over your health in the future. So, high-risk populations, especially in communities burdened by health disparities as it is, prevention becomes a vital act of self-prevention and generational change.

So, that means the core prevention is modifiable risk factors. So, these are things like high blood pressure, diabetes, obesity. These are often conditions that's already influenced inequalities, food access, healthcare, and education. So, some of those things, I'll just name a few.

The first one is nourishing your body with purpose. So, that means prioritizing heart-healthy diet, rich in colorful foods and vegetables, grains, proteins, reducing your salt and sugar intake, as well as processed food. These are all contributories to your body mass and health and the vitality of it.

The second one is moving with intention. So of course, some sort of exercise. I don't care if it's walking back and forth to your mailbox. Taking a 20-minute stroll, a 15-minute run, whatever that's going to be moveful for you, strengthening your heart, improving circulation.

The third one is knowing what your numbers are. So, keeping a tab on what your blood pressure is, monitoring your blood sugar, if you already have a history or for purposes of cholesterol tweaking that we need to do, awareness and prevention is the first key to that. And then, breaking free of harmful habits. So, quit smoking, limit your alcohol use. If you do have to use these, please try to cut down. And then, in moderation all of these things. So, I know it's difficult.

And then lastly, just prioritize what your peace is. Emotional stress, physical stress, meditation, mindfulness, the holistic realm is very important. So, those are key factors in helping to prevent strokes.

Host: Great. Well, I know stroke treatment has advanced significantly in recent years. Can you share some of the most important developments that patients should know about?

Dr. Noella Cypress West: Sure. So, stroke care has evolved rapidly in the last 10 years, five years, for not only just medications, but also procedures, technology, and a couple of things. The first one is tenecteplase or TNK. This is an alternative to what used to be alteplase, which is short for tPA. So in case people are going to the hospital, and they throw around this lingo, this is medication that basically busts up clots. So, this is used to actually help with the effective administering of timeliness when it comes to stroke care. Studies have actually shown that this new TNK medication is effective, in most cases, right before mechanical thrombectomy. Thrombectomy is a fancy term, but basically means that they're procedurally removing large clots from large vessels, large arteries. It used to be you only had a six-hour window, but now they've expanded it, that they have up to 24 hours of onset of any stroke symptoms to actually meet that criteria so you have a better chance of surviving. So, that's definitely a game changer.

And then, one of the other solutions is there's a lot of mobile stroke units around the United States. This are basically specialized ambulances that's equipped with mobile CT scanners. So, you can actually have the accessibility of rural areas to come to these neighborhoods, and diagnose and rapidly treat stroke. So even if you can't make it to your local hospital, this can actually have a reducing in critical delays and better treatment.

And then lastly, telehealth. Of course, we probably knew about this telehealth and telemedicine during COVID, but we still utilize that. This telemedicine has transformed the care in stroke and also neurologist's access with those people in real time. So, these innovations can naturally help reduce disability and improve the survival rates. 

Host: Well, for families dealing with stroke recovery, what should caregivers know about the rehabilitation process?

Dr. Noella Cypress West: Post-stroke recovery is not just a moment, it's a journey. One that extends beyond far these hospital walls that I may practice in and others. But the path forward depends on the stroke severity and the location. So, it's important not only to support and understand, but the resilience of those families, of those caregivers, of their survivors of this disease.

So, rehab, whether it's physical, occupational speech therapy can restore the independence and dignity among these stroke survivors. And often they battle, believe it or not, depression and frustration. So, mental health is also very essential in having these people get back into the community where they can regain some of this crucial aspect.

Families must also navigate a system assessing community-based resources, such as support groups, home health services, caregiver educational programs. We really want to ease the burden and build a strong recovery network, so that's also important. And then, equity matters a lot to the recovery. So, culturally competent care is important. So, knowing how to address the community that we're teaching, traditions, values, trusting them, having them trust us and the family dynamics. So ultimately, families are not just caregivers, but they're healers, advocates. And they also are very involved within the care. So, just having that community outreach, that community support will actually improve long term outcomes. 

Host: Well, Dr. West, thank you. This is so important for our collective health, and thank you so much for joining us.

Dr. Noella Cypress West: Thank you so much. Thank you so much for having me. 

Host: That was Dr. Noella Cypress West, Senior Director of Inpatient Acute Critical Care Advanced Practice at Tampa General Hospital. For more information, please visit tgh.org. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect: presented by TGH on your favorite podcast platform. I'm Jamie Lewis, and this is Community Connect: presented by TGH. Thanks for listening.