Transcription:

Melanie Cole, MS (Host): Well it’s hard to read the papers today or see the news without hearing more and more about stroke. We seem to be hearing about this more with people of even younger ages than we’ve ever heard before. My guest today is Dr. Raymond Turner. He’s a neuroendovascular surgeon with Prisma Health. Dr. Turner, tell us a little bit about the current state of stroke today. What’s the prevalence? Are you seeing more or less strokes?

Ray Turner, MD (Guest): Thank you for having me on. We are definitely seeing more stroke. I believe part of this is a reflection on the positive impact we’ve had on the community in terms of educating people about the signs and symptoms of stroke. So they are getting to the hospitals earlier in their symptoms. I also think it’s because our baby boomers are older. So the population of people that are most likely to have a stroke is larger. So we are seeing an uptick in stroke. Not just in the U.S, but also in Europe and in Asia.

Host: Wow. While awareness is being raised about those symptoms, you are seeing more. That’s so interesting. We’re gonna talk a little bit about some of those risk factors that people may not be paying as much attention to as they should. But before we do, Dr. Turner, what is a stroke? Tell us about the different types.

Dr. Turner: Yes. So there are two types of stroke. There is an ischemic stroke where we are blocking off blood flow to the brain. Then there’s a hemorrhagic stroke where there’s actually bleeding into the brain from a broken blood vessel. The ischemic stroke is most common. It’s about 88 to 90% of all strokes in the United States where the other 10% or so are hemorrhagic stroke. If you look in the Asia population, the split’s actually 80/20. I think that has to do with differences in certain risk factors and genetics between the Asian populations versus the European and U.S populations.

Host: That’s really interesting. So while we’re talking about those risk factors and genetic, in light of what we’ve seen in the media and what I said in my intro. Recently a young celebrity suffered a stroke and died from it. Tell us. Is there a correlation between one’s age—you mentioned the aging baby boomers—and having a stroke? Can younger people have them? If so, why?

Dr. Turner: Yes. So younger people can absolutely have a stroke. There are some things in our genetics that we simply just can't modify that increase our risks of stroke, just like it does increase our risk of heart attack. The vast majority of our risk factors for stroke are modifiable. They have to do with our lifestyle habits of are we active or are we sedentary? Are we smokers? Are we not smokers? Are we eating healthy? Are we controlling our blood pressure? Are we very diligent about diseases such as our high cholesterol, diabetes? Are we getting enough sleep? Are we actually treating sleep apnea, which increases the risk of stroke? So there are a lot of things that we can be doing in our lives that are going to decrease the risk of stroke.

One of the unfortunate things if you look at, for example, obesity maps over the decade, we saw large trends of increased obesity in adolescents going back the last 40 years. Well the problem is those kids are now 40 and 50 years old. I think this is part of the reason why we’re seeing an increase in stroke in the younger population. People that are under the age of, let’s say 60. That’s because we didn’t do enough with our kids and as we are young adults to modify our healthy behaviors. We’re starting to see us pay that price a little bit as a population and as a community in today’s society.

Host: Isn’t that amazing that correlation? We’re seeing that obesity epidemic effecting so many different parts with heart disease and diabetes and blood pressure. We’re seeing that in younger and younger people. As they get older, then we’re gonna see these diseases that didn’t used to show up until someone was in their 60s, 70s, 80s and beyond. That’s kind of really amazing. So let’s talk about symptoms because that seems to be where that awareness campaign is. Tell us what we would recognize and why time is so important that we recognize those symptoms and get help immediately.

Dr. Turner: When somebody is suffering a stroke, the classic sign is weakness of the face, arm, or leg that starts all of a sudden without warning. It’s usually painless. You can have difficulties with speaking or understanding spoken word. You may appear confused to other people or at a loss for words. These things all happen out of the blue without any warning, and it’s often painless. Which is one of the sad things about stroke. If you look at heart attacks, because they hurt so much, people typically will immediately call 911. They’ll look for medical attention because of the crushing chest pain.

With stroke, because it’s painless, because some strokes effect your ability to recognize part of your body that may not be working, people a lot of times will dismiss it, or they’ll think that they're tired or they’ll think that they're stressed. Unfortunately, dismissing the early signs of stroke can have a negative impact on your long term health. Because the sooner we can open up a blocked blood vessel or the sooner that we can take pressure off the brain from a bleeding episode in the head, the more likely you're gonna have a good outcome and return back to your normal state of health quicker. So it’s critical that we treat stroke as fast as we can. If you look at patients that are having a severe stroke from a blocked blood vessel, every minute you can save in the treatment of that stroke adds a week to that person’s life.

Host: Wow. So tell us that acronym that we should know.

Dr. Turner: So that acronym is act FAST. So face, arms, speech, equals time. So if you have weakness in the face or arms or leg or if you have difficulty speaking, you need to get medical attention immediately.

Host: If they act fast, as this acronym suggests, and they notice somebody’s having slurred speech or their face is drooping, they can't raise their arms, any of these things that you just mentioned, do they call 911 or try and drive their loved ones too the hospital? Because can EMS do something in advance to alert the stroke center that this is happening?

Dr. Turner: Yeah. They really should call 911 for a couple of reasons. One is the treatment of stroke is extremely specialized. It requires a lot of resources for hospitals to provide. So not every hospital is built the same. Therefore, when it comes to stroke, EMS are the ones that really understand what is the best hospital for that person to go to to get the best possible care. If they're having a mild stroke, there may be more options for that patient that may be quicker to get to. If they're having a severe stroke, it’s critical that not only do they go to the right hospital that has the resources to treat the stroke, but the EMS services can also alert the hospital so that way when they arrive with that patient all the resources are already gathered together ready to go to operationalize the treatment of the patient’s stroke. So it requires a huge team of people to effectively treat the stroke. This pre-notification to the hospital is really one of the critical steps in being able to identify and treat the stroke as quickly as possible.

Host: Give us a brief overview of some of the treatments that the stroke center would use once we get there. We've heard these terms, tPA and mechanical thrombectomy. What are these and how are they used to help stroke patients not suffer so many of the devastating effects?

Dr. Turner: Absolutely. So when a patient first arrives at the hospital, the first thing we got to understand is what kind of stroke are we dealing with. So that often involves a CAT scan, which is an imaging of the brain which takes roughly 20 seconds to obtain. Once we understand what kind of stroke it is, if it’s an ischemic stroke, then there are two options. One is we can give a clot busting drug, like tPA, to help dissolve the clot. That works really for people that are having a very small stroke or if the blood vessel that’s blocked off in their vein is extremely small.

Unfortunately, there’s a large number of patients that are having a stroke because a large blood vessel is blocked. These are giving patients really the most severe types of stroke. In that case, those patients really need to have that blood vessel opened up from within the blood vessel. That requires a procedure where we go into an artery either through the wrist or through over the hip. We go all the way up to the brain and we perform what we call a mechanical thrombectomy where we physically remove the clot and restore blood flow immediately. It’s critical that all of these steps and processes happen not just in sequence, but also as quickly as possible in order to get the best outcome for the patient.

Host: Isn’t that fascinating that you're able to do that, and along with tPA can really benefit patients and improve outcomes? What is life like after stroke? Does having one put you then at risk for another? What is that like for a patient if they have successfully survived their first stroke? What do they do next doctor?

Dr. Turner: So the next step after somebody has a stroke is we need to understand why did they have the stroke. Do they have something effecting the rhythm of the heart that could lead them to a higher risk of having another stroke? Is there a problem with one of the valves on the heart? Do they have narrowing of arteries in their neck? So trying to understand the etiology or what caused the stroke is critical to preventing the next one. Because once you do have a stroke, you are a little bit more likely to have another one. Especially if you have something structurally or rhythmically wrong with the heart. So it’s important that we understand what is going on.

The other thing is we really need to institute post-acute stroke care. So get people on the right medication. Make sure we’re aggressive with the blood pressure. Aggressive with their cholesterol, their diabetes, put them on an aspirin. Also the recovery and rehab stage. Despite all our best therapies, still about one in four or one in five people will die from their stroke. So it’s critical that we’re aggressive in treating their stroke or aggressive in identifying the signs and symptoms. And we’re getting patients to the right hospital the first time so that we can be successful in helping as many patients as possible when they have a stroke.

Host: That’s great information. It’s so important for listeners to hear. Wrap it up for us Dr. Turner. What you would like listeners to take from this segment so that you can raise awareness. While we know and are learning more and more about the symptoms, risk factor and preventions seem to be one of the main stays that we need to be driving home.

Dr. Turner: Absolutely. So I think the first thing is know your numbers. Go to your doctor and really understand what is your blood pressure, what is your heart rate, what is your rhythm of your heart? What is your diabetes and your body mass index and these things that we can actually modify? And have the doctors work on getting you on a wellness and a fitness plan that’s going to decrease your risk of stroke and heart attack. Number two, you need to understand what the signs and symptoms of a stroke are—which is weakness in the face, arm, and leg, difficulty speaking. You need to understand that not just you need to know this, but the people that live around you need to know this because there’s a good chance if you are having a stroke, you are not going to be capable of calling for help. You're gonna be reliant of somebody else recognizing the signs and symptoms of stroke and calling 911.

Three, you need to know what resources are available. The highest level of care for a stroke patient is at a hospital that is comprehensive stroke certified. There’s roughly several hundred of these hospitals in the country. In South Carolina, there are three. There’s Prisma Health in the upstate, Prisma Health in the midland, and the Medical University of South Carolina. You're gonna want to know where your resources are so that way you can help facilitate and help get to the right hospital the very first time. Because delays in transfer between hospital, we know, has a negative impact on stroke patients.

Number four, make sure your medical information’s available. It is important for us to know if you’re on medication that thins your blood or if you're on rhythm drugs or if you're blood pressure drugs. So keeping that stuff available is important for us as clinicians so that way we can aggressively treat you as fast as we can.

Host: Wow. You're a great educator Dr. Turner. Really excellent and thank you so much for coming on and giving us such great information. So important for us all to hear. Thank you, again, for joining us. For more information on stroke and symptoms of stroke, please visit ghs.org/stroke. That’s ghs.org/stroke. I'm Melanie Cole. You're listening to Inside Health.