Evo Terra (Host): This is Health in Harmony podcast with Southwest Healthcare, presented by Temecula Valley Hospital. I'm Evo Terra. And I'm joined today by Dr. Robert Jackson, a neurologist and the stroke medical director at Temecula Valley Hospital, to help us recognize early stroke symptoms and why time is brain. Welcome, Dr. Jackson.

Dr. Robert Jackson: Hi. Thank you so much for having me.

Host: So to start us off, can you explain what happens in the brain during a stroke and why every minute truly matters?

Dr. Robert Jackson: Yeah, very, very important. So, a stroke is like a strike of lightning. So, something is happening in the brain in one of the arteries. Strokes come in two different flavors. Either something is plugging up an artery, like a pipe that gets plugged up by detritus or something causes an artery tube to burst inside of the brain. And depending on where that artery is being plugged up or burst can give you different symptoms.

And the problem with these things are if an artery's plugged up, you're not getting blood flow—the brain loves its blood flow—and if it's plugged up, what can happen is it can start to die. For every minute that that happens where something's plugging up blood flow, we can lose up to 1.9 million neurons per minute. That's why we keep saying time is brain.

Host: Yeah. And that makes sense. I wasn't exactly sure what "time is brain" meant. But now, that certainly matters from a clinical standpoint. So, can you walk me through the BE FAST acronym me how that helps identify stroke symptoms quickly?

Dr. Robert Jackson: So, BFAST is our mnemonic to try to help the general public recognize signs and symptoms of an acute stroke. So, B is balance. So, acute loss of balance, like everything starts spinning around. You're walking like you know, a drunken sailor, even though you haven't had anything to drink, you have difficulty reaching out and trying to grab at something and keeping your coordination on point.

E is eye, acute vision loss within one eye or one part of the world within both eyes. F is face, so acute facial drooping on one side. A is arm, acute arm weakness, or leg weakness on one side of the body. S is speech, so acute slurring of speech, inability to get your words out, or inability to understand people who are talking to you.

And actually, the most important of all these is T, which is time. The faster you recognize stroke symptoms, the faster we can get you to the hospital and faster we get you treatment. Some people also use T as thunder clap. So if you have bang, bang, worst headache of your life. That bang starts within the 60 seconds, hits that maximum, "This the worst headache I've ever had,"" that can be a sign and symptom of bleeding in the head. So, those are our BE FAST mnemonics.

Host: Yeah. Those are great symptoms are great signs to recognize obviously in a nice mnemonic there. But I'm imagining some of these symptoms, they happen. They're not always a sign of a stroke, so maybe you could talk about some of these symptoms that people commonly ignore or maybe mistake as something, "Eh, no big deal."

Dr. Robert Jackson: Yeah. So, there's lots of other symptoms that can happen with a stroke. Acute numbness and tingling on one side of the body didn't make it into the mnemonic, but that can be a sign of a stroke. As I said, that spinning sensation of vertigo, that's what the textbook says. Unfortunately, people sometimes have very difficulty in explaining and realizing, "Is it truly that I just feel lightheaded or is it actual, like, everything is spinning around or I feel like I'm spinning and the world is staying stable?"

Those are the two most common ones that we will see that people kind of, "Eh, it is not that big of a deal.?" And then I'll just wait it out and see how I feel. And the reason it's really important is if there's a big change, as we talked about T, time is brain, we've got very short time windows to possibly treat somebody with our medication.

So if somebody's having a big clot in the brain, we have a medication called TPA or TNK. It's kind of like a Draino medication that can help bust up that clot and restore normal blood flow. But we can only give that medication within three hours to possibly four and a half hours from the onset of symptoms normally. We're constantly pushing the envelope and trying to get more people this medication, because we know that it works, especially if it's within the first hour. There's about a 30% chance of having that clot be busted up and either having significant improvement of your symptoms or even complete resolution of your symptoms with the medication. So, the faster we recognize, "Hey, we're thinking we're having signs and symptoms of the stroke," the faster we get you evaluated, get you the treatment, and hopefully the faster and more likely we are to get you back to normal.

Host: Yeah. Yeah, that sounds great. And clearly, time is of the essence here. So as I say that, I'm thinking, "Okay, I recognize this is happening in somebody in my life or myself," but let's say somebody in my life right now, i've got two options. I know I got t get this person to the hospital fast. I can drive them there myself, or I can call 911, what should I do?

Dr. Robert Jackson: Call 911. As great of a driver as you may be, you're not going to beat an ambulance who that can run through red lights, lights and sirens. Also, very importantly, people can decompensate quickly, especially in the setting of a bleed in the head. You can go from like, "Oh, I'm feeling weak and numb on one side of the body" to unable to wake up, unable to protect your airway so much that you need to actually be bag-ventilated. That is what an ambulance can do. They can see somebody who's going downhill very quickly, get them quick resuscitation in route to the hospital. And also, very importantly is they can do quick assessment and call us ahead of time as a hospital, say, "Hey, we got somebody who looks like they're having a big stroke. Get the team mobilized." So, I'm actually at the door in the emergency department as soon as the patient rolls in.

Host: Yes. So, the quickest access to medical people you can possibly get, which means the folks in the ambulance certainly help you.

Dr. Robert Jackson: Yes, sir.

Host: Great, great advice. Now, you're the stroke director or the stroke medical director. What systems or protocols does Temecula Valley Hospital have in place to move quickly once that stroke patient arrives, even if they haven't gotten a call ahead from the ambulance?

Dr. Robert Jackson: So, Temecula Valley Hospital is a comprehensive stroke center. What I mean by that is we do everything under the sun when it comes to both ischemic strokes and hemorrhagic strokes so we can give the medication. We can also sometimes go up and Roto-Rooter and pull the clot out of the brain if it's a big clot. And then if there's bleeding in the brain, we have different procedures where we can go and tamp down that bleeding by putting coils in an aneurysm, by putting some contrast and then some onyx glue in there if it's like an AVM, we have lots of different options depending on what kind of treatment the patient needs.

So, here at Temecula Valley Hospital, becaise we are a comprehensive stroke center, we have an entire team ready to go. So as soon as somebody walks into the emergency department or we get the call ahead in, we have emergency room physicians, we have nursing staff, we have stroke champion nurses, we have pharmacists available, we have laboratory to grab blood draws. You always have a neurologist, either in-person or via tele that will beam in and see you quickly and acutely and take a look at the exam, hear the story, and determine if we need to give you that clot-busting Draino medication or not. We also have neuro IR doctors, so neuro interventional radiologist. Those are the people that go up and Roto-Rooter, and pull the clot out of the brain when it's a big clot. We also have neurosurgeons. We have radiologists. We've got a whole slew of people on the stroke service that are there acutely in case somebody's having a stroke.

Host: And this is a topic that's important to me because about four months ago, my sister, who's a year younger than I am, had a small stroke and brain bleed. And I'm very happy to say that months later now she's actually doing great. It looks like she's got almost all of her motion back. But before I leave, any parting comments about recognizing stroke signs and acting fast?

Dr. Robert Jackson: Yeah. So, the faster you recognize stroke symptoms, the faster you get on the horn. With 911, the faster we're able to mobilize and treat people. I cannot tell you how often, it's probably at least. I would say monthly, if not biweekly. We have somebody come in who can't move one side of their body, can't talk, can't see out of one side, have neglect, something like that, and we get them acute treatment, and they walk out of the hospital almost normal. This is one of the few fields of medicine where you can make a huge, huge impact in somebody's life and functionality. The faster we recognize symptoms, the faster they get in for treatment.

We talk about this all the time, but the data shows that in a big clot, so a big clot in one of the major arteries in the brain, in 2018, we had two trials that were published talking about going in and doing this Roto-Rooter procedure. And in like the perfect situation, it was basically a coin flip. And what I mean by that is half the patients, unfortunately, they continued to have their stroke and there was too much damage that already happened, but half of the people went from unable to move, being bedbound, possibly not able to talk to being independent. So, literally. 50/50 chance. If you come in quickly with a massive stroke that we could possibly treat you, and you walk out of the hospital almost completely normal So, it is a huge change, an ordinal shift, where in the '80s it'd be like, "Here's an aspirin. And it sucks, I'm sorry." Now, we're talking 50/50 of not leaving you unable to talk, unable to move right side of your body needing a feeding tube. So, this has been a huge change in the trajectory of patient's as a result of these trials and new treatments that we have available.

Host: Fantastic news. And so yeah, the answer is remember BE FAST. And remember two, be fast. Dr. Jackson, thank you so much for all the information today.

Dr. Robert Jackson: Of course. Thank you so much.

Host: And for more information about recognizing stroke signs and acting fast, please visit temeculavalley.com/strokeneuro. And if you enjoyed this episode, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Evo Terra, and this is Health in Harmony Podcast with Southwest Healthcare, presented by Temecula Valley Hospital. Thanks for listening.

Disclaimer: Physicians are independent practitioners who are not employees or agents of Southwest Healthcare Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians.