Caitlin Whyte (Host): This episode of In Their Words, features Jenny Rascoe, Stroke Coordinator at UPMC Harrisburg. Jenny began her career in healthcare, working in rehabilitation, and inpatient neurology, eventually specializing in stroke care. Over time, what she witnessed began to challenge a common misconception, that stroke is only an older person's disease.

As she cared for more patients in their 30s and 40s, the work became personal. She began asking difficult questions about prevention, fear, and how we reach people before an emergency happens. Today, Jenny's efforts extend beyond hospital walls and into the community, meeting people where they are, starting conversations in barbershops and salons, and helping individuals understand that knowledge can change outcomes.

In this episode, she shares what she's learned, why prevention matters, and how education and advocacy can save lives.

Jennifer Rascoe: My name is Jenny. I'm the stroke coordinator at Harrisburg Hospital with UPMC. I have been with the system since 2017. I got into neurology at that time. I started on the inpatient neurology unit, and I absolutely fell in love with it. I did start specializing in stroke probably around 2021. So when I started with the system, I was actually an LPN. And prior to that, I had worked in school nursing and I did a little bit of rehab. Starting about 2008 was my first experience with stroke patients, as a rehab tech. At that time, it was Health South, which is now Encompass. So, I feel like I come full circle with the stroke population and my perceptions have changed quite a bit as I had always seen it as an older person's affliction.

And through my years on the neuro unit and then especially now as a stroke coordinator, where I see the process from the ED all the way through discharge and beyond, I know that it is not an older person's affliction. And so, that's where some of this inspiration came from, that we're going to talk about.

I did not actually go to nursing school till I was 30. And I was in luxury property management before that pretty much right off out of high school. I started my first career. And I loved it, but I always wanted to be a nurse. It was definitely a passion of mine. And I think that that was ignited with watching my mom take care of her grandmother in our home. I'll say that my mom has been the primary caretaker for many of our family members. So, her grandmother and then both of my grandparents, she has cared for. And it's beautiful. She's not a nurse. She did mortgage banking. And then, in my early childhood, she transitioned for the most part out of a working woman's career life, and started taking care of family who needed it. And she has pretty much done that since I was about 10 years old. And now, she's turning 70 and she has been the primary caretaker for our family. So, that's beautiful.

Well, I'm going to go back to 2008, when I started more as a tech. I wanted to do that before I went to nursing school very strategically, because I honestly was not sure if I could do it. I had some aversions. And bodily fluids, it was definitely challenging. And they were things that I had to overcome. I prayed a lot. "God, I really feel like you've called me to be a nurse. I don't know how I'm going to get over the odors and the textures and all of the things." And by grace, I was able to get over those things and really dive into what I feel was called to do.

So, it's kind of twofold. It's not a new concept. This has been done in other areas just as a means of community outreach. It became personal to me when I was noticing a lot of men in particular in their 30s coming in with strokes, and I just kept seeing my husband laying there. And it's hard because these men in their 30s have no reason to be in that position. And the only thing that I could think of is, "Who's telling them that this is preventable?" So, relating it personally, I thought, you know, I really want to reach my husband's peers, because I don't want to see them coming into our EDs for any medical emergencies, but especially vascular ones that really can be prevented.

The frequency that I was seeing, that was just really devastating. So men in their 30s, 40s, and women too. So, I started with the barber shops, but the beauty salons are definitely an area that need to be dived into as well. So, I'm still working that out, but it was a very easy connection with my husband's barbershop. And I thought that would be a good place to start. I do already have some trust established with some of the guys that go there and some of the women that go there as well. And it's in my community. So, that is beneficial to me. I know the local hospitals, I know the local clinics. I know the local doctor's offices. And I'm already a familiar face.

So, I thought I would start there so that when I branch out and have some of these other conversations, I could say, "This is what I'm already doing." And I'd love to come in and just have some conversations. And I want to be very cautious and aware that I am not just coming in some pretentious way, giving out information, because I think I know better for your life. I want to sit down and I want to have conversations. "What are you afraid of? What do you know about yourself? What do you know about your family history? What are the things that have plagued your family and friends who have you lost, because we've all lost somebody, and what does that loss look like? Was it terminal loss? So, did they die or did they lose function? Are they having to be placed in a care home, or are they having to get care in their home? Did they lose work? Are they just not able to otherwise function in their day to day? So, talk to me about your experiences with those. And what do you know about your life or their life that could have gotten them to this place? And then, you know, really focusing on what are you afraid of and what are you willing to talk about? Because there are barriers to the conversations and there's a lot of fear. There can be a lot of resistance. And I want to break through that.

And really, the premise of this is we can't be more afraid of knowledge than we are of death, and of finding that we are. There's a ton of fear. One of my first experiences, in the barbershop, I was doing blood pressure checks, and I had a woman in her 40s tell me she didn't want to know. And I said, "Why?" And I knew why, but I wanted to hear from her. She said, "I was afraid." And I said, "Can I ask what you're afraid of?" And she told me that she had, within the last year, lost her best friend who was also in her 40s, her early 40s, to a brain bleed, which is a type of stroke. And I said, "Do you know what caused it?" And she said, "Yes, her high blood pressure." And I said, "So here we are, to check your blood pressure. And you've had a very recent, very personal loss, and you're afraid to let me check your blood pressure." And I have to admit, I cried. It was very emotional because I can see the faces of people, of my patients that I've cared for who've come through our doors, and how often did they not check? Because they were scared and now they're here unable to speak, unable to move one side of their body. Their family is terrified, they're terrified. And their lives are forever changed because of fear.

It kind of then tracks down another channel where it's like, "Okay, if we find out this information, if I find out that I have high blood pressure, the doctor's just going to tell me to go on medication and I don't want to take medication. I don't trust medication." So then, that's a conversation that has to be had. And then, that just branches off into a whole nother, aspect of, "Okay, well, what does it look like to try to get over that fear of medication, even if it's just for the interim until we can figure out what of the multitude of tools and lifestyle things that you can do, that you can come off of medication?" And I share my own story that I made the choice to go on blood pressure medication for a short period of time till I could figure out how to safely manage that without medication. And I was equipped and I made the choices and then I was able to come off of the blood pressure medication. And it still requires pretty constant monitoring.

So, I'm able to relate to them and the best way that I can. Obviously, my experience is going to be a little bit different than any other given individuals. But I am at least able to share, "Hey, high blood pressure caught me by surprise. And I've been a nurse for many years." And I always opt for, "Is there another option before I go on medication?" That's just a choice that I made a long time ago in my life and I have nothing against pharmaceuticals. I think when they're appropriately used. We need them as a society, but I also feel like there is a lot that we could be doing to avoid pharmaceuticals. And if that's your choice to avoid it, then I encourage it and just know that you have to be consistent, just like you would have to be consistent with taking a medication.

I would love to expand. I definitely want to get into the beauty shops. I do have a stroke survivor who is willing to come with me and speak. She survived a stroke in her early 50s. So, I'm excited to let her share her story. She is excited. And hopefully, we can take the show on the road a little bit and expand the knowledge and the conversations. And I really do love the intimacy of the conversations. It's not a presentation, I try to make it like, "What do you guys want to talk about? And we don't only have to talk about stroke and high blood pressure." I've had questions from everything from hair loss and "How do I keep my hairline from receding" to, you know, "Do you have any suggestions for activity? You know, my knee hurts. I used to play basketball all the time. What can I be doing?" There's a lot of mental health discussions. So, I would love to expand this even to having experts in other areas come in and talk. I just want to be very cautious to preserve the conversation feel, the family feel, so that it doesn't become pretentious, really.

I think we can set up tables at health fairs every year, every season, every month. And we can wait for people to come to us, or we can make ourselves a little uncomfortable and press into environments that we maybe otherwise wouldn't go into and ask to be invited in and plead our case as to why, and not be so passive with community education. But most people that I talk to don't have a primary care. They're not seeing a doctor regularly. I'm grateful that a lot of companies promote annual biometric screenings. And a lot of insurance companies will give some kind of perk if you get those vital signs and blood work done. Because a lot of people aren't going to the doctor for their annual physical or even know where to start. "How do I get a doctor?"

There's so many conversations that I want to have and I really want to engage, not just with knowledge, but with advocacy. And with what does insurance look like? What does social work look like? "My loved one was hospitalized. I don't feel like they're being discharged safely. I don't understand. Who can I talk to?" So, making sure that the community is aware that there are resources for just about everything and how to get connected with those resources, assistance with medications. You know, there should never be a point where somebody is discharged from the hospital, and cost is an issue with getting medications.

Sometimes people just don't know where to go or who to ask for help. I would love to have a big bank of resources or even if people are afraid to reach out, like, if an issue is identified just through conversation, like, "Hey, this resource is available. And there is an outpatient stroke clinic set up, run by one of our nurses, Lauren, that identifies significant disconnects from discharge to life after, and is tending to those things. So, we have a really incredible multifaceted team and program that we're building here. And I'm really proud of it. We have a long way to go, but the passion is there and pretty much our entire team. And we love our community. And it's devastating when we see anyone come through the doors.

 But to see our peers come through the door in their 30s and 40s and even 50s, it's just really devastating. Not that anytime is an appropriate age to come in with a stroke. But really, at our age, it should be preventable if it can be preventable.

 So, we teach BE FAST. That is going to be balance, eyes, face, arms and legs and T for time. So, B is going to be for balance and loss of coordination. And this is going to be symptoms that start suddenly. So if you have a sudden loss of balance, that can include a sudden vertigo. And if you experience vertigo, does this feel the same? Or is this different from your dizzy spells that you would typically get? That would include, "I suddenly can't walk."

So, eyes is going to be any sudden visual change. That can be blurry vision, that can be double vision, that can be a sudden loss of vision in one or both, or part of your eyes. F is for face, so we're looking for any facial asymmetry, but that can also be for any loss of sensation in one side of your face. We've had people come in with something as simple as the corner of my mouth is numb, and they knew to come in.

So, arms is just the A, we use for both limbs. So, upper and lower extremities. If you have weakness in your arm or leg or both or loss of sensation or change in sensation. So, you either can't feel it at all, or it feels numb and tingly. And it's not because you sat on it or you laid on it. And it's not going away. It's sudden. And some people describe that as a heaviness. Some people truly can't lift it. We have a lot of reports of I dropped my coffee, I dropped my fork, so loss of function. And it can be in the whole arm or it can be just the hand, typically going to be on one side of the body.

S is going to be for speech, so any alterations in speech, we can be looking for a complete loss of words. They can't get their words out. They don't seem to be understanding what you're saying to them, or perhaps they're speaking and their words sound slurred. They're stuttering. There's a loss of fluency, or they just kind of sound like they've got marbles in their mouth. And then, T is for time. Time is brain. We do ask our community to call 911 if they are experiencing any of these symptoms. We ask that you please do not drive yourself or have a family member drive you, even if it seems like you're going to get to the hospital faster.

And here's why. We have a multitude of hospitals in our area. Each of those hospitals offer varying levels of care. Not all hospitals can provide the same treatments. Your 911 providers know which hospitals to take you to based on your symptoms. So, the biggest thing that we want our community to know is if you identify stroke symptoms, call 911, and let the EMS team get you to the appropriate place for the fastest treatment, because time is brain. And I believe it is 1.9 million neurons are destroyed every minute that brain is not getting oxygenated blood. That translates to significant disability and dysfunction. And I am looking forward to this program growing and I hope that we can provide a space where we can talk about scary things, because knowledge really is power. And you have the ability to change the outcome of your future and prevent devastating outcomes.

Caitlin Whyte (Host): Jenny's story reminds us that prevention begins long before a patient enters the emergency department. Through education, advocacy, and community outreach, she is helping shift the conversation around stroke, from reaction to prevention, from fear to empowerment.

At UPMC Harrisburg, a dedicated team is building stronger bridges between hospital care and life beyond discharge, ensuring patients and families have the resources, support, and knowledge they need. Because when we understand the risks, when we know our numbers, and when we are willing to have the hard conversations, outcomes can change.

Thank you for listening to In Their Words, brought to you by the UPMC Pinnacle Foundation and UPMC in Central PA. If this episode resonated with you, please take a moment to follow the podcast, rate it, and leave a review. Your support helps us share more stories of compassion and innovation and community impact across Central Pennsylvania. Until next time, this is In Their Words.