Transcription:

Melanie Cole (Host):  If you or a loved one were suffering from a stroke, would you know what to look for? Would you know what to do? My guest today is Dr. Mahmoud Rayes. He's a neurologist with Greenville Health System. Welcome to the show, Dr. Rayes. What is a stroke?

Dr. Mahmoud Rayes (Guest):  Thanks, Melanie, for having me. Yes, stroke is a very bad disease. Stroke happens when one of the blood vessels supplying the brain or the eye or the spinal cord is interrupted and, within minutes, those brain cells will start to die. There are two types:  one when the blood is completely cut off and that's what we call and “ischemic stroke”. The other type is when the blood vessel ruptures and that's what we call a “hemorrhagic stroke”.

Melanie:  So, give us some facts about stroke because some of them are quite interesting and alarming.

Dr. Rayes:  Yes. I mean, stroke is on the rise, unfortunately. It is the leading cause of disability in this country and, unfortunately, every 40 seconds, somebody will have a stroke across the United States. Every 4 minutes, someone will die of a stroke. So, as you can imagine, we probably know somebody close enough who had a stroke. The good thing is around 80% of those strokes can be prevented by following doctors' advice and keeping a healthy lifestyle.

Melanie:  Tell us some of the signs of a stroke, Dr. Reyes, because "time is brain"--that's what you doctors say. So, tell us what we should be looking for.

Dr. Rayes:  Yes, definitely. One of the most important things is early recognition so we can help those patients. Strokes can come in a lot of varieties but one of the easiest ways to spot a stroke is to use what we call a "FAST" that is being advertised by the American Heart Association. You start with the face. If you see any of the face drooping, any smile that is not symmetrical. The “A” stands for "arms”. So, any arm drift, arm weakness or inability to move that arm. Any changes in speech, which is the “S” which stands for “speech”. Speech that is slurred or inability to speak. If you spot any of those three. The “T” stands for “time” because, like we said, "time is brain" and all of our treatments are based on the time that the patient started to have a stroke. So, you have to call 9-1-1 and bring them immediately to the hospital.

Melanie:  And if stroke does occur in yourself or in a loved one, besides calling 9-1-1, is there anything else that you want people to do?

Dr. Rayes:  Yes. It’s very, very important that they try to get them as soon as possible to us because our treatment, like I said, is based on time, and if you come in within three to four-and-a-half hours, we can offer a clot-buster medication called “TPA” that does help patients quite a bit. We do also offer other treatment options that are also time-based, so bring them soon, bring them fast, bring them with their medication, and be ready to tell us when it started.

Melanie:  Sometimes people don't recognize some of these signs that you've said. Speech difficulty, for example, they think maybe the person has been drinking. What do you want them to know about these signs?

Dr. Rayes:  I'd say the combination of those signs usually is what clenches it. I would always tell my patients and my family, if there's a question, just don't wait on it. It's our job to make that diagnosis and just have it in mind that when you have risk factors such as high blood pressure and diabetes and things of that nature, that it's more likely to be a stroke and they need to come soon.

Melanie:  So, let's talk about risk factors, Dr. Rayes. Who is at risk and is there a genetic component to stroke?

Dr. Rayes:  Everybody's at risk for stroke. We're becoming more aware now that even kids are at risk for stroke but the older we get, the higher the incidence of strokes. So, usually at the extreme age, upper 60s and 70s, you tend to have a higher risk of stroke, and in the presence of risk factors like we talked, such as high blood pressure, diabetes, high cholesterol, irregular heartbeat or A-fib, morbid obesity, smoking--all that puts you at a higher risk of stroke. As far as genetics goes, there is a strong genetic component in some families and those tend to have strokes at a younger age, usually in the 40s.

Melanie:  If someone does not get treated quickly, what disabilities can result from stroke?

Dr. Rayes:  Unfortunately, everything and anything. Usually, most patients will suffer a weakness or even an inability to move the arm or the leg, difficulty with speech, difficulty with vision, difficulty even with what we consider simple cognitive functions such as math and memory, emotional changes, personality changes. It can literally change their life.

Melanie:  Is there a way to prevent a stroke?

Dr. Rayes:  Yes, and it always starts with a healthy lifestyle. Keeping a good weight. We use a body mass index of less than 25; get their blood pressure under control. We always say less than 140 over 90; get their cholesterol in check; keep moving, 150 minutes of activity three times per week, divided over three days is crucial; get your vegetables; get your fruits and all the healthy foods. That goes a long way along with stopping smoking. Most importantly, be compliant with the medications that your doctor has prescribed to you because it does prevent a lot of these strokes.

Melanie:  Tell us about Greenville Memorial Hospital Stroke Program.

Dr. Rayes:  Our stroke program is actually very unique in a way that we have pretty much all the disciplines in medicine involved in our stroke team and that's why we're actually one of the few centers in the country that have achieved what we call a “Gold Plus Achievement” award and the Elite Plus Honor Roll from the American Heart Association, which indicates that, as a program, we are very, very stringent with meeting the core measures that need to be met for stroke patients, achieving our target times for TPA and intravascular treatment. We provide comprehensive services for the stroke patients for all the way from meeting them in the ER to post-stroke rehab. It's a very robust, hands-on team.

Melanie:  What are some of the benefits to the patient?

Dr. Rayes:  Well, 24/7 you have a stroke specialist available with a neurosurgeon. We are the only hospital in the upstate South Carolina that offers intravascular treatments, which is a new standard of care for patients who have large strokes and gives them the best chance of returning back to their normal life. We do have a comprehensive rehab center that has a lot of physical therapists, occupational therapists, and speech therapists that are stroke-oriented, stroke trained. We have a dedicated neuro intensive care unit and a dedicated stroke unit which always corresponds with better outcomes.

Melanie:  Tell the listener where they can learn more about stroke.

Dr. Rayes:  I encourage them to go to our website, www.ghs.org/stroke and go through the website and they will find a lot of useful information.

Melanie:  So, in just the last few minutes, give your best advice as somebody who sees this all the time--the staggering numbers of stroke. Give your best advice to the listeners about preventing stroke.

Dr. Rayes:  What I've seen across many years, there's a good amount of not taking medications, which we always stress to my patients to keep taking your medication unless your doctor says you stop something. You also need to keep yourself healthy, physically active; keep you weight in check; keep your blood pressure in check. Make sure you measure blood pressure every day; make sure you write a diary about your blood pressure, because when you come to my clinic, I want to see what you've been doing for the last few weeks, because I only get one measurement. Controlling blood pressure is the most robust treatment we have for preventing strokes.

Melanie:  Thank you so much. It's such important information. For more information, you can go to ghs.org/stroke. That's ghs.org/stroke. You're listening to Inside Health with Greenville Health System. This is Melanie Cole. Thanks so much for listening.