Scott Webb (Host): When it comes to stroke, time is brain, meaning, the time is of the essence, and getting to the emergency department for treatment. And joining me today to emphasize this point and share the latest in treatment options for stroke is Eileen Gornell. She's an Advanced Practice Nurse, Stroke Coordinator with the Valley Health System.

 Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. I'm Scott Webb. Eileen, it's nice to have you here today. We're talking all things stroke today. So just before we get rolling here, if you could tell everyone one thing about stroke, what would it be?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: Hi, Scott. Thanks very much for having me. Yeah, I really want people to be hopeful about stroke treatment because what we have right now in the modern age is really amazing. We have clot busting medication. We have clot removal procedures, and these things have really made a difference for people experiencing a stroke. They can drastically reduce somebody's disability that would be after their stroke. But the key piece that all of our listeners need to know is that these treatments are most effective when we have that patient here and we can treat them very quickly after a stroke starts.

Host: Yeah, we're going to talk in a little bit about how the old expression, you know, time is brain and time is of the essence, but I want to get a sense from you, like, why do strokes catch so many people off guard, especially young people?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: Yeah, this is a great point. I think a lot of young people think I'm healthy, this can't happen to me. But about 10 to 15% of strokes do occur in people that are under 50 and sometimes people who are young have common risk factors that we hear of in older people. These risk factors are just becoming more common these days in the young.

So we're talking about things like obesity, hypertension, high cholesterol, or diabetes. But the scary thing is that people who are young and don't have these risk factors can still suffer a stroke. And that can sometimes happen if there's an injury to arteries in the neck. Or if they have an undiagnosed heart condition or if they have a blood clotting disorder. So really people of every age need to be familiar with stroke symptoms and watch out for this.

Host: Yeah, for sure. And I mentioned there that, you know, time is brain and we hear that a lot, you know, with heart, time is heart. With stroke, time is brain. So how much time do we really have to seek attention, to seek care? And does, you know, five minutes really make a difference?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: Yeah that time is brain phrase, that's really impactful because really we want to get that patient to treatment as quick as we possibly can. So every minute that a stroke goes untreated, it's estimated that the person can be losing 1.9 million neurons per minute. So even a five minute delay really does make a difference.

Host: Yeah, it really does. You know, and so that's why time is of the essence and not ignoring signs and symptoms. And that's kind of where I wanted to go next. Like what are the most ignored or maybe misread symptoms of stroke that people just sort of overlook and go on about their business?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: Yeah, people are so familiar with heart attack symptoms and they think about having this crushing chest pain, but the thing that's tough about stroke is that stroke doesn't cause pain. So people can really ignore their symptoms and put off seeking help. So sometimes somebody can experience a sudden onset of one-sided weakness and they might just stay home, take a nap, and they hope that symptoms will go away with rest.

But that's not what we want them to do in terms of getting them to their best outcome. So sometimes people can experience a stroke where they might have mild symptoms, but they're still having a stroke. The other problem is that during a stroke, people can have speech difficulty that makes them feel or look confused or intoxicated, and their symptoms can get dismissed.

So regardless of the symptoms the patient is having, when someone's having a stroke, we want them to get help right away.

Host: Yeah. And as you say, folks might just try to sleep it off if you will. Right. But if they're experiencing just even like one symptom of a stroke, what would your recommendation be?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: Yeah, so even if you just have one stroke symptom, you can be having a stroke and you could end up with significant disability. So we don't want people to wait to see if an additional symptom develops or for their symptoms to get worse. Instead, we really want the patient to call 911 or for their family to do it for them so that they have the best chance for a good outcome.

Host: Yeah, get to the ED as quickly as possible, urgent care, whatever it might be. But as quickly as possible, time is of the essence. And I want to get a sense from you, like how much does lifestyle impact the risk of stroke? We talked about some of the, you know, the greatest hits if you will, high blood pressure, diabetes, things like that. But how about lifestyle?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: Yeah, so being thoughtful about getting good care for those chronic conditions really makes a difference. Things like eating a heart healthy diet, exercising regularly, they really are important. It's estimated that when multiple risk factors are addressed, stroke risk can actually be reduced by as much as 80%. So changing your lifestyle can really reduce your risk.

Host: Right. Quit smoking, get more exercise, eat healthier. Like there are things within our control. And you prefaced the whole thing today by saying, you know, there is reason for hope, there is reason for optimism, but we may have to do some of it ourselves. Right?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: That's right. I mean, we really need to take the steps to recognize somebody that's having a stroke and get help for them right away.

Host: Right. In your professional opinion, your expertise, why do people second guess stroke symptoms instead of just calling 911, despite what we're saying today, which is call 911? Why do they do that? Why do they second guess themselves?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: A lot of times people think it's something less serious. Like fatigue or stress, and this is especially true when the patient has mild symptoms. I've seen people drive themself to the hospital or have a family member drive them, and they think that's going to get them to the hospital faster. But the problem is that this delays treatment and bypasses the care that the EMS providers can give that's on the way to the hospital.

Host: Yeah, that's such a key point, right? Because it's not just that the EMS doesn't have to stop at stoplights and things like that. They begin treatment. They're in communication with the stroke team at the hospital, all of that, right?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: Yeah, exactly. They'll pre notify us so we can be ready to really give that patient a, an express pass through the emergency room and get worked up right away.

Host: Yeah, it's more than just a ride to the ED for sure. What would you say to someone who's afraid that they're going to, you know, quote unquote, look stupid if it turns out to be nothing, if it's not actually a stroke?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: I would just say that unfortunately, this kind of concern can really cost valuable time and lead to worse outcomes. So calling 911 is really the best way to get fast treatment that reduces the chance of a long-term disability. So it's really something to take seriously.

Host: And don't be worried. No one's going to look down on you at the hospital. Certainly not medical professionals. If it turns out it's not a stroke, they'll say, you know, you're okay. You didn't have a stroke. And that would be the best news ever of course. And I feel this is maybe just anecdotal in just in my head, but I feel like a lot of times the signs of a stroke are recognized by those around us. So what would you recommend to folks to be on the lookout for?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: Yeah, sometimes people who are experiencing a stroke will deny that they're having symptoms, or actually because of the stroke, they don't realize what is wrong with them. But I think the key piece, people need to remember who are looking at somebody who doesn't look right is that stroke symptoms come on suddenly.

So really making sure people know that FAST acronym, that's what to look for. So that F being for facial droop, A for arm weakness on one side, S for speech difficulty, and T for time to call 911. If you know what those letters stand for, you're going to be able to help in that emergency.

Host: Be fast for sure. Good stuff today. Just want to finish up, give us a sense, you know, what do you believe, like the role of a bystander is? Should they override someone refusing to call for help? Like, are we empowered to do that in your opinion?

Eileen Gornell, RN, MSN, SCRN, ASC-BC: I do think everyone should feel empowered to call 911 for somebody if you're concerned that they're having a stroke, even if they refuse. The worst thing that can happen is that the EMS providers can come, take a look at that person, explain to them a little bit more why they think they need medical care, and if they want to refuse at that time, they can.

But for somebody who really gets fast treatment, that impact is so critical to the person's long-term outcome. So really if you recognize a stroke as a bystander and you call 911, your action could save that person's life.

Host: Right, save their lives, restore their quality of life, all of that. We know that time is of the essence, time is brain. So I appreciate your time today. Thank you so much.

Eileen Gornell, RN, MSN, SCRN, ASC-BC: Thanks so much for having me.

Host: And for more information about the Valley Hospital Stroke Center, please visit valleyhealth.com/stroke.

 And if you found this podcast helpful, please share on your socials and check out our entire podcast library for topics of interest to you. And thanks for listening to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-447-8647 or email valleypodcast@valleyhealth.com. I'm Scott Webb. Stay well.