A stroke may seem like it came out of the blue, but chances are the victim has been living with the risk factors for years. Caught early, some strokes have no lasting consequences. But a stroke can also have permanent, severe neurological consequences. Fortunately for Marin, our community hospital has an award-winning primary stroke center.
Get the stroke information you need straight from an expert. Medical Director of MarinHealth Medical Center's Spine & Brain Institute and neurologist Ilkcan Cokgor, MD discusses stroke prevention and treatment. Get an overview of MarinHealth Medical Center’s highly respected Stroke Program, and most importantly, learn – and memorize – the symptoms of stroke. The life you save could be your own.
Stroke 101 – From Prevention to Detection to Emergency Care
Featured Speaker:
Learn more about Ilkcan Cokgor, MD
Ilkcan Cokgor, MD
Ilkcan Cokgor, MD is a neurologist and a member of the medical staff at MarinHealth Medical Center.Learn more about Ilkcan Cokgor, MD
Transcription:
Bill Klaproth (Host): Stroke is an emergency situation in which time lost can mean brain loss. Fortunately, for potential stroke victims in Marin, there is no need to cross the bridge to obtain immediate quality care. Marin General Hospital is a designated primary stroke center and here to talk with us about stroke and the Marin General Primary Stroke Center is Dr. Ilkcan Cokgor, a neurologist and member of the medical staff at Marin General Hospital. Dr. Cokgor thank you so much for your time today. So, first off, what are the symptoms we need to be aware of when it comes to stroke?
Dr. Ilkcan Cokgor, MD (Guest): Thanks you for giving the opportunity to discuss the stroke symptoms as they are definitely an emergency. These symptoms usually start acutely with either one-sided weakness. They can be associated with slurred speech. They should look and when we talk about one-sided weakness, they include arm, leg, and the face together, but they could be all separately. They could be only sensory loss on the one side, and they could only slurred speech with coordination problems. So, it could be a combination of some symptoms or isolated symptoms like vision loss in one eye or slurred speech with balance problems. It could be coordination. It could be gait only. It could be associated with all together. It could be dizziness, vertigo, double vision, slurred speech, one-sided weakness, balance or all together feeling – faint feeling and one of these symptoms.
Bill: Right. And time is also very important, too, and that's how we get that FAST acronym: Face, Arms, Speech, and Time.
Dr. Cokgor: Yes, exactly. Time is extremely important. Here is why. There are opportunities we can treat these patients with tissue plasminogen activator. It is called TPA, and almost everybody now is aware that this is a blood clot buster, and if given as early as within the 3 to 4 hour time, it has the potential to reverse all of the symptoms to normal, and it is one of the very, very time sensitive medications that we on hand. Now, we have practicing this way for a long while, and we extended the window of giving TPA within three hours to now four and a half hours. Yes, nobody should wait for any symptoms. As soon as you notice something is different, wrong with your body, you should either call 911 or drive yourself to the emergency room to be checked out. Even if the symptoms are getting better or resolving, they may not get better -- there may still be stroke damage in your brain. You should ask and seek medical attention.
Bill: So, that's why speed is so important because now, as you say, they've expanded that window. So, four and a half hours -- you've got time. So, the minute you recognize these symptoms or these symptoms in someone else, your best bet, right, is to call 911 and seek help immediately?
Dr. Cokgor: Yes. That's correct and many times in Marin County, our paramedics are very well-trained. They would come and do the stroke scale right away. They actually call our emergency room as soon as they examine that patient -- we get ready in Marin General ER as soon as we get the call. ER attending pages the neurologist, pages the radiologist. The nurses have everything set up, even the bed and the IV line going in ready for this patient, waiting for the patient to come. Within minutes, we examine the patient, get the CAT scan done, and the neurologist comes to a robotic system to examine the patient. We do not lose any time to drive to see the patient any longer. We turn on our access to the robotic system. We talk to the patient and the family as soon as we can get engaged, and they are in the emergency room, and we decide on the TPA as soon as within minutes. So it has been saving a lot of time, a lot of lives to very badly affected stroke victims.
Bill: Well that is good news and those are some of the reasons that Marin General is a designated primary stroke center. Can you tell us more of what that means?
Dr. Cokgor: Sure. We have an intensive program improving our symptoms and management in the hospital for these patients. Now, we have a very multi-disciplinary program where we meet on a very regular basis with the emergency room nurses, doctors, neurologists, speech therapists, physical and occupational therapists, speech and swallowing evaluated together or separately depending if these patients need tube feedings or not. We try to improve the stroke symptoms by every means, for example, not only the TPA time limit is important, but managing the symptoms very rapidly, managing the blood pressure, heart rate, or managing the stroke risk factors like the cholesterol, blood pressure besides the diabetes are crucial.
So, when we admit these patients, we run a battery of tests. We do MRI as well looking at the vessels with a CT Angiogram or MR Angiogram. We do 2D Echo with bubble. We look for a hole for a clot and for arrhythmias in the heart. We check your blood for all the stroke risk factors including thyroid problems, cholesterol, diabetes, blood pressure, and other family risk factors like blood clotting factors, and we manage them immediately by putting the patient on a blood thinner. This could be an antiplatelet agent like aspirin or Plavix, or it could be Coumadin and the newer anticoagulants like Xarelto, Eliquis, or Pradaxa, but depending on the heart condition of these patients. Besides this management, we start them on a statin right away, and we get the blood pressure, diabetes, cholesterol under control with the medication right away in the hospital before the patient is discharged. They get the swallowing evaluation and speech therapy started on day one. So, as you see, we take it very seriously with a very multi-disciplinary approach. The patients usually stay two to three days in the hospital and are ready for rehab. Rehab is extremely important for patients who stay plegic -- like paralyzed on one side or other or both, and rehabilitation gets started immediately so that we don't waste time, and we want the patient to be back to normal as soon as possible.
Bill: Well, that's very comprehensive and very quickly how you attack that situation, and you've got all the processes and plans and people in place to deal with a stroke victim. Dr. Cokgor, let me ask you this: so before someone gets to the point of stroke, I just want to spend a couple of minutes on this -- are there ways that we can help lower our risk for stroke?
Dr. Cokgor: Yes. Definitely true and in my practice, I have a practice besides being a consultant working in Marin General Hospital, we do emphasize to all our patients about prevention which is the most important part of actually treatment. The patient should be very aware of their family stroke risk factors and as they become middle-aged and older, they should start a regular exercise program. They have to exercise at least 20 to 30 minutes a day. It could be just walking. It could be walking your dog or a paced, reasonable walking -- not just going to the gym at all times, and cardiovascular exercises are very important. Very good nutrition and diet is important. We emphasize Mediterranean diet, meaning lean meat, more vegetables and fruit -- much less carbohydrates, no soda, no sugar products or heavy food diet like other carbohydrates. So, we do emphasize about exercise, diet, but there are sometimes patients genetically inclined no matter how they eat or they do. So, we do put them on the right treatments from the start. We may have to treat the blood pressure no matter how healthy they are because it could be essential hypertension coming from the family so we do have to treat these patients even at younger ages -- you have to see your doctor once a year. You have to get a physical exam, bloodwork, and vital signs. Make sure that you are healthy and if you have stroke risk factors of cholesterol, heart problems, blood pressure problems, and diabetes, you should attack it -- whatever age you are. This is the best way of preventing a stroke.
Bill: Well, those are great tips and preventative medicine is always the best medicine. Well, Dr. Cokgor, thank you so much for your time today talking to us about the designated primary stroke center at Marin General Hospital, and for more information, you can visit maringeneral.org. That's maringeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Stroke is an emergency situation in which time lost can mean brain loss. Fortunately, for potential stroke victims in Marin, there is no need to cross the bridge to obtain immediate quality care. Marin General Hospital is a designated primary stroke center and here to talk with us about stroke and the Marin General Primary Stroke Center is Dr. Ilkcan Cokgor, a neurologist and member of the medical staff at Marin General Hospital. Dr. Cokgor thank you so much for your time today. So, first off, what are the symptoms we need to be aware of when it comes to stroke?
Dr. Ilkcan Cokgor, MD (Guest): Thanks you for giving the opportunity to discuss the stroke symptoms as they are definitely an emergency. These symptoms usually start acutely with either one-sided weakness. They can be associated with slurred speech. They should look and when we talk about one-sided weakness, they include arm, leg, and the face together, but they could be all separately. They could be only sensory loss on the one side, and they could only slurred speech with coordination problems. So, it could be a combination of some symptoms or isolated symptoms like vision loss in one eye or slurred speech with balance problems. It could be coordination. It could be gait only. It could be associated with all together. It could be dizziness, vertigo, double vision, slurred speech, one-sided weakness, balance or all together feeling – faint feeling and one of these symptoms.
Bill: Right. And time is also very important, too, and that's how we get that FAST acronym: Face, Arms, Speech, and Time.
Dr. Cokgor: Yes, exactly. Time is extremely important. Here is why. There are opportunities we can treat these patients with tissue plasminogen activator. It is called TPA, and almost everybody now is aware that this is a blood clot buster, and if given as early as within the 3 to 4 hour time, it has the potential to reverse all of the symptoms to normal, and it is one of the very, very time sensitive medications that we on hand. Now, we have practicing this way for a long while, and we extended the window of giving TPA within three hours to now four and a half hours. Yes, nobody should wait for any symptoms. As soon as you notice something is different, wrong with your body, you should either call 911 or drive yourself to the emergency room to be checked out. Even if the symptoms are getting better or resolving, they may not get better -- there may still be stroke damage in your brain. You should ask and seek medical attention.
Bill: So, that's why speed is so important because now, as you say, they've expanded that window. So, four and a half hours -- you've got time. So, the minute you recognize these symptoms or these symptoms in someone else, your best bet, right, is to call 911 and seek help immediately?
Dr. Cokgor: Yes. That's correct and many times in Marin County, our paramedics are very well-trained. They would come and do the stroke scale right away. They actually call our emergency room as soon as they examine that patient -- we get ready in Marin General ER as soon as we get the call. ER attending pages the neurologist, pages the radiologist. The nurses have everything set up, even the bed and the IV line going in ready for this patient, waiting for the patient to come. Within minutes, we examine the patient, get the CAT scan done, and the neurologist comes to a robotic system to examine the patient. We do not lose any time to drive to see the patient any longer. We turn on our access to the robotic system. We talk to the patient and the family as soon as we can get engaged, and they are in the emergency room, and we decide on the TPA as soon as within minutes. So it has been saving a lot of time, a lot of lives to very badly affected stroke victims.
Bill: Well that is good news and those are some of the reasons that Marin General is a designated primary stroke center. Can you tell us more of what that means?
Dr. Cokgor: Sure. We have an intensive program improving our symptoms and management in the hospital for these patients. Now, we have a very multi-disciplinary program where we meet on a very regular basis with the emergency room nurses, doctors, neurologists, speech therapists, physical and occupational therapists, speech and swallowing evaluated together or separately depending if these patients need tube feedings or not. We try to improve the stroke symptoms by every means, for example, not only the TPA time limit is important, but managing the symptoms very rapidly, managing the blood pressure, heart rate, or managing the stroke risk factors like the cholesterol, blood pressure besides the diabetes are crucial.
So, when we admit these patients, we run a battery of tests. We do MRI as well looking at the vessels with a CT Angiogram or MR Angiogram. We do 2D Echo with bubble. We look for a hole for a clot and for arrhythmias in the heart. We check your blood for all the stroke risk factors including thyroid problems, cholesterol, diabetes, blood pressure, and other family risk factors like blood clotting factors, and we manage them immediately by putting the patient on a blood thinner. This could be an antiplatelet agent like aspirin or Plavix, or it could be Coumadin and the newer anticoagulants like Xarelto, Eliquis, or Pradaxa, but depending on the heart condition of these patients. Besides this management, we start them on a statin right away, and we get the blood pressure, diabetes, cholesterol under control with the medication right away in the hospital before the patient is discharged. They get the swallowing evaluation and speech therapy started on day one. So, as you see, we take it very seriously with a very multi-disciplinary approach. The patients usually stay two to three days in the hospital and are ready for rehab. Rehab is extremely important for patients who stay plegic -- like paralyzed on one side or other or both, and rehabilitation gets started immediately so that we don't waste time, and we want the patient to be back to normal as soon as possible.
Bill: Well, that's very comprehensive and very quickly how you attack that situation, and you've got all the processes and plans and people in place to deal with a stroke victim. Dr. Cokgor, let me ask you this: so before someone gets to the point of stroke, I just want to spend a couple of minutes on this -- are there ways that we can help lower our risk for stroke?
Dr. Cokgor: Yes. Definitely true and in my practice, I have a practice besides being a consultant working in Marin General Hospital, we do emphasize to all our patients about prevention which is the most important part of actually treatment. The patient should be very aware of their family stroke risk factors and as they become middle-aged and older, they should start a regular exercise program. They have to exercise at least 20 to 30 minutes a day. It could be just walking. It could be walking your dog or a paced, reasonable walking -- not just going to the gym at all times, and cardiovascular exercises are very important. Very good nutrition and diet is important. We emphasize Mediterranean diet, meaning lean meat, more vegetables and fruit -- much less carbohydrates, no soda, no sugar products or heavy food diet like other carbohydrates. So, we do emphasize about exercise, diet, but there are sometimes patients genetically inclined no matter how they eat or they do. So, we do put them on the right treatments from the start. We may have to treat the blood pressure no matter how healthy they are because it could be essential hypertension coming from the family so we do have to treat these patients even at younger ages -- you have to see your doctor once a year. You have to get a physical exam, bloodwork, and vital signs. Make sure that you are healthy and if you have stroke risk factors of cholesterol, heart problems, blood pressure problems, and diabetes, you should attack it -- whatever age you are. This is the best way of preventing a stroke.
Bill: Well, those are great tips and preventative medicine is always the best medicine. Well, Dr. Cokgor, thank you so much for your time today talking to us about the designated primary stroke center at Marin General Hospital, and for more information, you can visit maringeneral.org. That's maringeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I'm Bill Klaproth. Thanks for listening.