Transcription:
Stroke: What Everyone Should Know

Cheryl Martin: Stroke, no one wants one, but each year here in the United States, about 800,000 people get one. Coming up next, what everyone needs to know about a stroke.

This is Health Talk with the Valley Health System presented by The Valley. I'm Cheryl Martin. And joining me this episode is Krystal Coffman, Director of Quality at Henderson Hospital. Krystal received her doctor of nursing practice from Vanderbilt University. So glad to have you on to talk about this critical topic.

Krystal Coffman: Thank you for having me.

Cheryl Martin: Krystal, first of all, what is a stroke?

Krystal Coffman: So, a stroke is sudden death of brain cells in an area of the brain because of inadequate blood flow.

Cheryl Martin: Talk about the different types of strokes.

Krystal Coffman: So, there's two main types of strokes. There's what we refer to as ischemic strokes, which most people call clot strokes, where there's a blockage in the artery so that part of the brain doesn't get the blood flow. And then, there's another type, hemorrhagic strokes or what some people call bleed strokes. And this is where the artery breaks or leaks and blood gets into the brain tissue. So, those are the two main types that we deal with.

Cheryl Martin: Which one is more common?

Krystal Coffman: Definitely the ischemic or the clot strokes, those make up about 87% of all strokes, whereas the bleeds or hemorrhages are about 13%.

Cheryl Martin: So, what are the signs and symptoms of a stroke?

Krystal Coffman: There's actually quite a few different symptoms of stroke, but there's some things that they all have in common, and probably the most important factor to remember is that it's a sudden onset. So, I might be having this conversation with you and then, all of a sudden, I start having trouble speaking, or I start having my face droop. So, the symptoms that we look for are things like weakness, numbness, tingling of one part of the body, one side of the body. You might have things like confusion because you don't understand what someone's saying to you anymore, or we may not understand what you're saying. You might have trouble seeing, might have some dizziness, difficulty walking because of loss of balance or coordination. And then, occasionally, there'll be a stroke that will cause what we refer to as the worst headache of life. So, those are just some of the many different kinds. But again, it's all about that sudden onset.

Cheryl Martin: And when you say sudden onset, again, this is not like you have had these symptoms for an hour or for a couple of days. You are going along just fine and then boom.

Krystal Coffman: Correct, correct. It's just all of a sudden, bam, out of the blue. Again, you might be in the middle of a conversation and your face starts to droop or you start slurring your words. So, it's very, very quick.

Cheryl Martin: So, what puts a person at a higher risk for a stroke?

Krystal Coffman: So, there's a couple of things. One thing I think to keep in mind is that anyone can actually have a stroke. The stroke risk increases as we get older, but there are rare cases of children or young adults having strokes. So, the first thing that puts you at higher risk, quite honestly, is age. The older you are, the higher your risk for stroke. Past that, we have things like high blood pressure. So if you have high blood pressure that is not treated, high cholesterol that is not treated, if you're a smoker, if you've had a history of stroke or what we call TIA or transient ischemic attack, or if you have other medical conditions like diabetes, kidney failure, sleep apnea, those are kind of the big ones that raise red flags for us to make us think you're at risk for stroke.

Cheryl Martin: And when you say older, what age does that begin?

Krystal Coffman: Honestly, we're seeing strokes in a lot younger people because we're seeing more high blood pressure, more diabetes, more high cholesterol in younger people. So once upon a time, I might would've said to you, you know, starting in your mid-60s, but I'm starting to see people having strokes much earlier in their 30s and 40s. But the older you are, the higher your risk. So, it's a risk that just keeps getting higher as you get older.

Cheryl Martin: So once again, if we can control, work on the weight and let's say lack of physical activity, the things that we can control, then we should.

Krystal Coffman: Oh, yes, ma'am. Particularly, just to give you an example with blood pressure, so if your normal blood pressure is less than 120/60, which is the new normal, then you can cut your lifetime stroke risk in half. So, just correcting or keeping one factor under control can significantly decrease your risk of having a stroke.

Cheryl Martin: Wow. That's great to know. Now, I understand that time is of the essence if you have the symptoms that you talk about. Talk about the importance of calling 911 immediately if you are someone you know is experiencing the symptoms of a stroke and the difference this will make in treatment.

Krystal Coffman: Oh, absolutely. This is so vitally important. I think what most people don't realize is that we have a very narrow window to treat you after you started exhibiting symptoms of stroke. So, the clot-busting drug that we can give you to help reverse the symptoms, we can only give it for the first three hours, maybe extend it to four and a half in some cases, and that's from symptom onset. So by the time you get to the hospital, if you're outside that window, there's very limited things that we can do. So, the reason we always encourage people on the first indication of a stroke symptom to call 911 is because we need you to be assessed quickly, we need you to be treated quickly. And EMS, they're going to assess you, they're going to do all these things and they actually tell us in advance that you're coming. So, they'll call ahead and say, "Hey, we're bringing a stroke in." So, the team is ready for you when you arrive.

Cheryl Martin: Now, what happens when you get to the hospital?

Krystal Coffman: So, the first thing that will happen is you're going to get a head CT, which basically takes a picture of your brain. We do that to look to see if you're bleeding because, again, one of the types of strokes is a bleed stroke, and we treat those very differently. So we do this head CT just to make sure it's not a bleed. And then a lot of it, what we do depends on what EMS has told us. So, they will assess you and let us know if you're having a kind of a milder stroke or if you're having a severe stroke, which we call a large vessel occlusion or an LVO, so that's a big stroke. So if you're having one of those, we're also going to do additional pictures of your brain. We call that a CT angio and a CT perfusion. So, those actually look at the arteries and see if we see any blockages and we look at the extent of the stroke that's developed so far. And then while those are being read by the radiologist, you're going to get other tests. The ED doctors and nurses are going to look at you for stroke symptoms. They're going to draw blood, check your history, check what medicines you're on, find out when the symptoms started, and we do all of this very quickly to help make a decision about what right treatment is for you.

Cheryl Martin: So, what determines if a person has a full recovery or not?

Krystal Coffman: Honestly, the number one most important factor is time. So, I mentioned that timeframe of up to three hours, maybe four and a half in some cases. If you come in very quickly and you're a candidate, we can give you the clot-busting drug, which is called a thrombolytic. If it can break that clot up and we can get blood flow back into that area, you probably will have a pretty good recovery. If you wait a long time, you're outside that window, then we can't do anything except support you. So if we can't intervene and try to make you better, then we just have to see how you're going to recover on your own. So, the time between your onset and your actual arrival to the hospital for us to treat you is probably the number one most important factor in your recovery.

Cheryl Martin: So if the person, let's say, missed the time window, can they do anything on their own to get back to 100%? Let's say if they follow all the instructions that they're given, or does it just really vary per person?

Krystal Coffman: It's so variable by person. Stroke is one of those things that I love because the brain is complicated. So, there's no cookbook for it. I can't give you an absolute answer like you can in other types of medicine, but that's one of the things I find so fascinating about it. But when you're talking about trying to recover from a stroke, again, a lot of it depends on how big it is. Some people have very small strokes and they may never have any significant symptoms. Some people may have massive strokes and be permanently paralyzed or unable to speak, things like that. But When you're talking about the early phases and getting to the hospital, it's all about time. Everything after that is really all about attitude and being motivated to work with therapy and motivated to actually get better.

Cheryl Martin: I ask that because I know of people who have fully recovered and then some people who were never the same.

Krystal Coffman: And that's not uncommon. Again, a lot of it depends on factors that we just can't see. It's interesting when we look at the scans of patients having strokes, we might have someone who looks like it's a fairly small stroke on the scan, but their symptoms are devastating. And vice versa, I've seen some large strokes that people had pretty good recoveries from. It just depends on what part of your brain you're using to do different things and kind of how you mapped it out. Again, as much as we can generalize, it's very specific to that person.

Cheryl Martin: And again, you can't control what part of the brain is hit by the stroke.

Krystal Coffman: No, ma'am. That's all in wherever you decided to form that clot or have that bleed.

Cheryl Martin: Anything else you want to add about the road to recovery, Krystal?

Krystal Coffman: Well, I think it's just important for people to understand that when you're talking about stroke, I like to tell my patients it's a marathon, it's not a sprint. So you know, the most important part of it, and that if you want to call a part of a sprint, is getting to the hospital. So, identifying that you're having stroke symptoms, making sure to call 911. Don't lay down and see if it gets better. Don't you know, think, "Oh, I'm overestimating or I'm being dramatic." Come in, let us check you out. And then if you have had a stroke, just understanding that the recovery is a long, slow process that takes motivation from the patient and support from their families.

Cheryl Martin: And also having a stroke, of course, is not just physical, it's also an emotional journey and emotional challenge. So, how should a person cope with the reality of this new normal?

Krystal Coffman: That's a great question. And again, that's very dependent on the person and I think their situation and how much support they have. I think, in general, we tend to forget that the brain controls everyth. So when you have damage to the brain, there may be things that are affected that you don't even realize, and we may not even realize why you're still in the hospital. So, I think it's important for not just patients who are stroke survivors, but their families is pack your patience. You've got to really just be patient because the survivors are going to be a little slower than you're used to.

And then, another thing is be aware that depression is common. We see depression in actually about a third of all stroke survivors, and that is independent of whether or not they had any indications of depression before. So, I think that's important, you know, not necessarily for the survivor, but for their families to kind of keep an eye on because they may need help with that, because the chemicals and all of that stuff in your brain just get all messed.

Cheryl Martin: Krystal, this is some great information. Anything else you want to add about what we need to know about a stroke?

Krystal Coffman: I think in addition to just being aware what the symptoms are and how important it's to call 911 is keep in mind there are some things we can do. Like I said, we do have that clot-busting drug, the thrombolytics. We also have a newer technology which is mechanical endovascular reperfusion, which is a big fancy term that basically means we go in and pull out the clot. And that was for those patients I mentioned earlier who might be having big strokes. And that's another reason why you got to call 911 because EMS knows which facility to take you to that can handle the stroke you're having, because not all of our facilities handle all kinds of strokes. So, that's important to keep in mind.

Cheryl Martin: This has been so informative. Great information. Krystal Coffman, thanks so much for educating us about stroke.

Krystal Coffman: Oh, and thank you for having me. I do appreciate it.

Cheryl Martin: Our pleasure. Visit valleyhealthsystemlv.com for more information on stroke. That's valleyhealthsystemlv.com. And thanks for listening to this episode of Health Talk with the Valley Health System presented by The Valley. If you found this podcast helpful, please tell others and share it on your social channels. And be sure to check out the entire podcast library for other topics of interest to you.

Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.