Dr. Rania Habib (Host): The CDC estimates that more than 795,000 Americans will suffer a stroke in the US each year. Most people have probably heard of a stroke or even know someone who had one, but do you know what it really is? Do you know what to do if someone, including yourself, has one and how to prevent them?

Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm your host, Dr. Rania Habib. Joining me today is Nickie Miskell, RN and Stroke Program Coordinator at UM Capital Region Health. She is here to shed more light into strokes. Welcome, Nickie. It's wonderful to have you on the podcast today.

Nickie Miskell, RN: Thanks so much for having me. I really appreciate the opportunity.

Host: This is such an important topic. And sadly, strokes are common in the US. So, most people have probably heard of a stroke and probably know someone who has had one. But what exactly is it? And what are the major categories of stroke?

Nickie Miskell, RN: Yeah. So, I'm really glad that you started with this because I can tell you I've been working with stroke patients for about nine years now. And I have really found that although nearly everyone has heard of stroke, very few people are actually truly aware of what it is, right? So, a stroke is a brain injury that occurs when blood flow to the brain is interrupted. So, this can be either because a blood vessel has become blocked, which we actually call an ischemic stroke, if anyone has ever heard that term, or when a blood vessel ruptures, which we actually call hemorrhagic stroke or brain hemorrhage. What happens here is basically the part of the brain that can't get this blood, which blood carries oxygen and nutrients that our brain cells need to survive, the area of the brain that isn't getting the blood, that begins to die. And then, the symptoms that a patient might experience would be the result of whichever area of the brain is affected by that interrupted blood flow.

Host: Okay. So, what symptoms are most common?

Nickie Miskell, RN: Okay. So, we really like the phrase BE FAST, BE FAST to recognize a stroke. And BE FAST is an acronym that we use to remember stroke symptoms. So, B stands for balance, a sudden loss of balance or dizziness. E is for eyes, sudden changes in vision, so thinking blurry vision or loss of vision, could be one eye or both eyes. F is for face. So, that classic facial drooping or facial asymmetry on one side. A for arms or legs, so arm or leg weakness or numbness. S is for speech. Speech difficulty like slurred speech, difficulty with getting your words out or understanding words, which sometimes can actually look like sudden confusion. And T stands for time. So, any of these signs and symptoms, if you identify this in yourself or in someone else, we definitely want you to call 911 right away because we like to say that time is brain. So, there are treatments for someone suffering a stroke, but they're limited and time-dependent. So, T is for time, can't stress that enough.

Host: So if I recognize symptoms in myself and I'm the one having a stroke, what should I do?

Nickie Miskell, RN: Definitely call 911. So, it is possible for someone to identify stroke in themselves, but really, really, we want you to call 911 as soon as possible. Don't go to sleep and hope that you can sleep it off. Get help right away.

Host: Absolutely. Because as you said, time is brain, so we want to make sure that we're saving that very vital organ in our body. Now if I witness someone else having a stroke symptoms, like my loved one or someone who's sitting across from dinner from me, what should I do?

Nickie Miskell, RN: So again, it's the same thing. Certainly, call 911 right away, you know, don't delay seeking care. And I do want to stress the 911 aspect because the EMS professionals, they can actually initiate care from the field. And the other thing that they do is they actually notify the hospital that someone is coming, right? So, this can really speed up treatment, so when we say time is brain, that's a really important aspect.

The other thing there that you wouldn't want to happen while you're driving to the hospital is you wouldn't want someone in the car to worsen. This can actually cause dangerous driving conditions. So, it could distract the driver or it could make it more difficult to get you out of the vehicle once you do arrive at the hospital. So really, calling 911 is the best thing to do.

Host: Now, once we call 911, the patient is loaded into the ambulance. Walk us through what happens when they actually hit the hospital and now your team is involved.

Nickie Miskell, RN: Oh, that's such a great question. And I love talking about it because it can take some of the fear out of it for people. So once 911 identifies a potential stroke patient in the field, they would call our hospital and we would actually activate a stroke alert before the patient arrives. So, this gets all of the key players, right? The nurses, the doctors, the neurologists, myself if I'm on shift. It gets us all ready so we can gather supplies, we can be at the area waiting for the patient. Once the patient comes, it is a lot that happens at once. So, there's going to be a rapid physician evaluation. We'll check vital signs. We'll do some lab work and we'll rush you over to a CT suite where we would obtain imaging of the brain. And then, we would go from there to see if the patient is a candidate for any of the treatments we have available.

Host: Now, you identified there are two major types of stroke. We have hemorrhagic stroke and we have ischemic stroke. Can you talk about, just very briefly, some of the differences in treatment for those two major categories of stroke?

Nickie Miskell, RN: Yeah, absolutely. So, with ischemic stroke, often what we're talking about, it's the blockage of a blood vessel. And in the event that that blood vessel has become suddenly blocked by a blood clot, we're looking at treatments that are targeting dissolving or removing the clot. So, we do have time-sensitive medication, which we call thrombolytic in the hospital, which is used to actually dissolve the clot and restore blood flow to that area of the brain. There is a procedure that is called thrombectomy that we can also offer patients suffering a stroke that's occurring in a very specific handful of blood vessels in the brain. And like I mentioned earlier, that's called thrombectomy. That's actually like a procedure where they go in and they physically remove the clot.

Host: Okay. And then, what about the treatment, how does that differ from the hemorrhagic stroke now?

Nickie Miskell, RN: Thank you. Yep. So, hemorrhagic stroke, the treatments are really going to target trying to stop the bleeding or decrease any swelling happening within the brain. Sometimes there will involve neurosurgery services, although not all patients suffering from hemorrhagic stroke will actually receive surgery. Sometimes what we're going to do is really target, like bringing blood pressure down if there's any swelling, trying to manage that.

Host: Okay. That makes a lot of sense. Now, the CDC estimates, we had talked about it in the beginning, 795,000 Americans can suffer a stroke in the US each year. So, what are some of the risk factors that could lead to stroke?

Nickie Miskell, RN: Yeah. So, we typically break up risk factors into two categories, okay? We say there's modifiable and non-modifiable risk factors. So, modifiable risk factors are conditions that people might have that they can actually control. So, think about things like high blood pressure, which is one of the most common risk factors for stroke, diabetes, high cholesterol, smoking, physical activity, obesity, heart disease, drug use, et cetera. So, those are things that people can actually exert some control over. We also have non modifiable risk factors. So, things that we can't control, things like our age, our sex, race and prior history. The real take home here is working towards controlling what we can, right? So, those modifiable risk factors.

Host: So, prevention obviously is key in decreasing those modifiable risk factors. So, what are steps that someone can take to lower the risk of having a stroke?

Nickie Miskell, RN: Yeah. This is one I always get a little giggle when I talk with my patients. So you know, it really sounds like the things that our parents used to finger-wag us about. So, it's like, "Eat well and exercise," I can hear my mom now, right? But it does go a long way. So, healthy eating, like adding more fruits and veggies is a really great start. Being physically active within the parameters of whatever is safe for you as an individual. If you haven't been physically active in the past, of course, we always recommend working with your provider to make sure that you don't do too much too soon.

But some other key things that are really important to talk about to decrease risk of stroke include things like taking medications as prescribed, right? So, sometimes we run across folks who they either stop taking their medicines or they're not taking them the way that they're prescribed because maybe they don't make them feel good. But really, it's important to make sure that you're working with your doctor before you're stopping or skipping any medications because your physician can make adjustments if the medications aren't working for you. But what we don't want you to do is avoid taking a medicine that's going to help you to control some of those risk factors.

Other things are going to include things like checking your blood pressure regularly, getting regular medical checkups, quitting smoking, decreasing your stress, et cetera. So, those are the biggest take homes, I think, there.

Host: So basically, we need to live healthy like our parents told us to.

Nickie Miskell, RN: Yeah, I know. Can't you just hear your parents in your head right now?

Host: Oh, I can. As you were saying that, I was like, "Yes, this is everything my parents have ever said" and, you know, all the physicians I've been around over all the years.

Nickie Miskell, RN: I know. I wish there was a magic pill.

Host: Well, you provided some invaluable insights into stroke today. What is the most important takeaway message about strokes that people should remember?

Nickie Miskell, RN: Yeah. So, I love prevention, right? Because I like the stroke that nobody has. That's the best version. So in terms of prevention, I think an important key takeaway is to control those modifiable risk factors. Take your meds, check your blood pressure, eat well and be active. Beyond prevention, I think the thing that's most important for people to remember are certainly the signs and symptoms of stroke. So, think BE FAST to recognize a stroke, as well as the importance of calling 911 right away when you or someone else is experiencing the signs and symptoms of stroke.

Host: Absolutely. I love that message that you said. Time is brain.

Nickie Miskell, RN: Exactly.

Host: Well, thank you so much for joining us today, Nickie. It was wonderful and you provided so much amazing information.

Nickie Miskell, RN: Thank you so much for having me.

Host: Find more shows just like this one at umms.org/podcast and on YouTube. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media. This is Dr. Rania Habib wishing you well.