Cheryl Martin (Host): According to the Centers for Disease Control and Prevention, CDC, every 40 seconds someone in the United States suffers a stroke. Dr. Dimitre Mirtchev, a vascular neurologist at Trinity Health of New England, is here to break down the risks for stroke, the signs and symptoms everyone should know, and what you can do to prevent a stroke.

 This is Transforming Your Health, the podcast from Trinity Health of New England. I'm Cheryl Martin. Dr. Mirtchev, so good to have you on.

Dr. Dimitre Mirtchev: Thank you for having me.

Host: So first, let's start with the basics. What is a stroke?

Dr. Dimitre Mirtchev: A lot of people don't know, but a stroke basically is any cessation to the blood flow to a certain area of the brain. It could be due to low pressure or it could be from, most commonly, a blood clot that blocks one of the large arteries in your brain. There are two types of stroke. One is what we call ischemic, where a blood clot does block the flow to the area of the brain. The other one is called hemorrhagic where a blood vessel in your brain bursts open and bleeding occurs within the brain. Both of them cause permanent damage.

Host: Wow. So, how do you know your risk level for a stroke?

Dr. Dimitre Mirtchev: There are risk factors. We have two types. We have what we call modifiable risk factors and non-modifiable risk factors. The ones that we cannot control, the non-modifiable ones, are age, genetics, gender, race. And so, somebody that's older is more at risk for stroke than somebody that's younger. The modifiable factors that would increase one's risk for stroke include high blood pressure, high cholesterol, diabetes, obesity, heart disease, and lifestyle changes, such as smoking, tobacco, illicit drug use like cocaine, heroin, and heavy alcohol use.

Host: I'll get back to those a little bit later. Now, I understand that recognizing the signs of a stroke can have an impact. So, tell us about those signs, and then the extent that they can have an impact.

Dr. Dimitre Mirtchev: So, the number one thing to note about strokes is that the signs and symptoms of stroke are sudden. They don't gradually occur over time, they happen within a split second. And we have an acronym that we use to remember what some of the common symptoms are, and we call it BEFAST. Each letter represents a symptom.

So, B is for balance. So if anybody is all of a sudden veering to one side or feeling dizzy all of a sudden with nausea, vomiting, that's one sign. E is for eye. So, any vision changes suddenly, like sudden vision loss or double vision, should be addressed. F is for face, any facial droop. A is for any arm or leg weakness. S is for speech, any slurred speech or somebody just not making sense when you're talking to them, sometimes perceived as confusion. And then, T is time. Time is of the essence, so you need to call 911. And that's BEFAST. Time is very important, because it has to do with whether or not you'll be eligible for certain treatments. And so, it's very important to know when the symptoms started or when the person was last seen normal.

Host: So, every second counts then, once those signs are apparent.

Dr. Dimitre Mirtchev: Absolutely.

Host: So once a person gets to the hospital, what kinds of treatments are available as a result of suffering a stroke?

Dr. Dimitre Mirtchev: So, we have two types of treatments, and again they're time-sensitive. So, the sooner you recognize the symptoms, the sooner you come to the emergency room, the better the outcome will be after a person is treated. One treatment is a medication called a thrombolytic. What it does is it's a very strong blood thinner that dissolves a blood clot that could be responsible for causing the stroke. That is given within four and a half hours from symptom onset. The second treatment is a procedure. where they go with catheters through the groin or through the wrist into the arteries and navigate these catheters all the way into the brain to suck out a blood clot that's lodged in one of your arteries and allow for the blood flow to resume. And both of these treatments can abort the stroke altogether or minimize the damage that happens to your brain.

Host: So, what does recovery look like when you've had a stroke?

Dr. Dimitre Mirtchev: So, the recovery for stroke varies from person to person and from stroke to stroke. Every stroke is different, every person is different of course. So usually, what happens in the hospital when somebody comes in. If they're eligible for the treatments, they receive them. And the next steps would be to find the cause of the stroke.

So, we start doing a workup looking for risk factors that the person might know they have, like heart disease or diabetes, for example. And then, we have that person make sure that they're medically stable, they don't need any medical attention. And as soon as that's the case, they get evaluated for rehabilitation. And if they need any urgent rehabilitation, they would be sent to a rehab center so that they can get better and improve from the deficits that they have had from their stroke.

Host: What does a recovery look like if someone has had a severe stroke?

Dr. Dimitre Mirtchev: So, if somebody's had a severe stroke, the recovery varies. So, not only does it vary from minor to moderate to severe stroke, but it varies because it all depends on where the severe stroke is, what's affected. Some people can tolerate big strokes, while others cannot. It also depends on your age, your risk factors that you have, the comorbidities. And of course, your baseline, how you were before the stroke. Were you healthy, active, or were you in a nursing home, for example? So, these are all factors that can affect your recovery. And of course, after a stroke, the ultimate treatment is rehabilitation. So, the sooner the rehabilitation can be started, the better the outcome.

Host: Now, when a person has had a stroke doctor, are there ever situations, let's say if the person was in excellent health before, how often does it happen that they get to the hospital really quickly, they go through the treatment, are they ever able to walk out of the hospital without rehab and they're back to normal?

Dr. Dimitre Mirtchev: Absolutely. So, in a perfect scenario, I believe, ideally, we want the public to be aware of stroke symptoms. And I think the last time I checked on this, it was about 60% of the community knows about stroke symptoms and what to do. So, we definitely need to continue educating the community. So, recognition is very important. The sooner somebody recognizes a stroke, comes to the hospital to seek medical attention, the better their outcome is going to be. And we have seen patients come in very quickly. They get the treatments and they do end up spending a few days in the hospital, maybe with no deficits or maybe with mild deficits that they're able to go home and be independent, basically. So, it's all about timing. But again, there's always other factors involved, age, comorbidities, et cetera.

Host: Now, that's great to hear, but that's not always the norm. That's not the norm, correct?

Dr. Dimitre Mirtchev: Correct. It's not the norm. In fact, stroke is one of the leading causes for disability in the United States. And it used to be the number three cause of death in the United States, about a decade ago. Now, it's the number five leading cause of death. So, we've made some headway of improving and preventing stroke, but there's still a lot more to do and majority of patients, especially if they don't receive any acute treatment, tend to be disabled.

Host: Wow. This leads me to this question. So, is it possible you can suffer more than one stroke in your lifetime? And if so, do we know why this happens?

Dr. Dimitre Mirtchev: Absolutely. So basically, once somebody's had a stroke, they are at risk for another stroke. And that's why it's very important that we identify all their risk factors and we manage them. So for example, if somebody's had high blood pressure that they didn't know about, now they need to follow up with their primary doctor, their cardiologist, to make sure that they continuously control that blood pressure. Same thing with diabetes, high cholesterol, heart disease, and so on. And then, the other piece of it is that lifestyle modifications are very important as well. Exercising daily, eating healthy, following the Mediterranean diet, and avoiding any illicit drugs, tobacco products, or heavy alcohol use.

Host: Well, that was going to be my next question about what we can do to prevent a stroke from happening in the first place. You've just mentioned that and earlier you were clear about certain markers or things that we need to say no to. I don't know if you want to reiterate those again in terms of what we can do to lessen our chances of getting a stroke or having another stroke.

Dr. Dimitre Mirtchev: So basically, any risk factors that a person has, such as high blood pressure, diabetes, cholesterol issues, or heart disease, they need to make sure that they follow up with their doctors regularly, take the medications that they need to take, and also follow lifestyle changes such as diet control, following a healthy Mediterranean diet, exercising, and avoiding any illicit drug use, alcohol use, or tobacco use.

If people, after they've had a stroke, if they are on top of all of this, they reduce their risk of another stroke by 80-90%. Now, not to scare everybody, but there's no way to decrease the risk of stroke to zero. So, the best way to attack that last 10-20% would be to be aware of what stroke symptoms are. And if they ever occur, to act right away, call 911, get to the hospital.

Host: So, in other words, control what you can control.

Dr. Dimitre Mirtchev: Correct.

Host: That's great. Any other final thoughts or words of advice?

Dr. Dimitre Mirtchev: Just remember, BEFAST. And remember, time is brain. The sooner you get attention and treatment, the better the outcome, the less disability you will have.

Host: Dr. Dimitre Mirtchev, thanks so much for sharing your insights and perspectives on this important topic. Thank you. Excellent.

Dr. Dimitre Mirtchev: Thank you, and thank you for having me.

Host: To schedule an appointment or to learn more, you can visit trinityhealthofne.org/neuro. That's trinityhealthofne.org/N-E-U-R-O. And if you found this information helpful, please share it with others, especially on your social media. This is the Transforming Your Health podcast. Thanks for listening.