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Melanie Cole (Host): If you've experienced early warning signs or need expert care to identify and control your risk for stroke, this is the show for you. My guest today is Dr. James Bobenhouse. He's a neurologist with Neurology Associates. Dr. Bobenhouse, what is a stroke, and are there different types?

Dr. James Bobenhouse, MD (Guest): A stroke is where there's an interruption or a disruption in the circulation to the brain. And so what happens is that if there's a blockage in the circulation, then there's a lack of blood flow in the brain, and that can cause damage to the brain. And then there's a second type- there's two types. One is an interruption of the blood flow to the brain, and the other is where there's an actual rupture of the blood vessel, either in the brain or around the brain, and that can cause damage to the brain as well.

Melanie: Who's at risk for stroke?

Dr. Bobenhouse: Generally as a person gets older, they're more at risk, but there are a lot of other risk factors. For example, high blood pressure, diabetes, atrial fibrillation which is a type of irregular heartbeat, and smoking actually increases the risk. Obviously if you have diabetes or high blood pressure, it's important to get that treated. And the in the case of atrial fibrillation, it increases the risk of stroke by five times, and so it's really important to take blood thinners to thin the blood to decrease the risk of developing a clot in the heart, which can then go on into the brain and cause a stroke. And then with regard to smoking, that will triple the risk of having a stroke, and so it's really important to stop smoking and work towards that goal if you are a smoker.

Melanie: Does having one stroke put you at risk for another?

Dr. Bobenhouse: Yes, it does increase the risk by one and a half to two times, so when a person has a stroke it's really important to make those changes either with treatment of your medical condition or stop smoking, eat more fruits and vegetables, perhaps less red meat, more fish and white meat.

Melanie: So let's talk about the symptoms of a stroke, Dr. Bobenhouse. People have heard this acronym F.A.S.T. So please explain to us what it means and why it's so important, why time is brain, and it's so important that we do act fast in case we notice some of these symptoms.

Dr. Bobenhouse: Well in the case for example of heart disease where a person has chest pain that's associated with a heart attack, it's fairly simple to learn that idea that if you have chest pain, you'd better get to the hospital as quick as possible. In the case of stroke however, it's a little more subtle, and so it's harder to teach it to the general populous, but also it's harder to identify it. And so there was a mnemonic that was developed, and we call it F.A.S.T., and that stands for facial droop, in other words if there's a droop of the face, a sagging of the face. If you hold your arms out in front of you and there's an arm droop, that's the A. And if there's slurring of speech where the speech is not clear or the wrong words come out, that's the S for speech. And then T stands for time to call 911. And so if you have any of those symptoms, if you have a droopy face, your arm drifts down when you hold it out stretched, you have slurred speech, time to call 911.

So what we've done is we've trained the public but also paramedics, and nursing staff, and even as physicians, we use that idea to help identify a stroke. Like for example in the emergency room, we use the F.A.S.T. mnemonic to help identify a stroke. And the reason that it's so important to identify the stroke quickly is that that allows a person to identify the stroke and then know that they need to get to the hospital as quick as possible in order to have a chance to receive treatment for the stroke.

Melanie: As you say, you have kind of trained the EMS to respond and notice these symptoms as well. Why is it so important that you call 911 as opposed to trying to drive yourself or a loved one to the hospital if you think you're suffering a stroke?

Dr. Bobenhouse: Well generally it's faster, literally faster to get to the hospital with the ambulance, and there have been studies that show that people that drove themselves to the hospital generally got there quite a bit later. There's oftentimes delays - when a person is going themselves or someone is taking them to the hospital, it's awfully easy to get distracted and, "Well I've got to do this or that, or let the dog out," or whatever. But when you call the rescue squad, then they're there and they pretty much force you to get to the hospital quickly. And when you're being taken to the hospital with lights and sirens on, it's faster than if you're just driving a car by yourself in all the traffic.

Melanie: So what happens at the emergency room, Dr. Bobenhouse? What do you do for someone that you've suspected has had a stroke? Tell us a little bit about the clot busting drugs, and what you do for that person, and what their life is like following that event.

Dr. Bobenhouse: Yeah, when a person comes to the emergency room, generally the ambulance driver has called ahead to the hospital so the hospital is prepared to treat the stroke. And so one way or another, we describe this as a stroke alert, or a stroke stop, where a person is coming in and we're trying to move as quickly as possible to treat them.

And so the first thing that happens is they come through the door, and then we try to act as a team when they arrive, and so in some cases we're actually treating the patient in the hallway to try to facilitate and make everything move as quickly as possible. And so at the same time there might be someone checking to see are they having a stroke? Like do they have the F.A.S.T. changes on their exam, but also drawing blood, and putting on EKG monitors for example. So they're doing all these things together, putting in an IV, so that then when they go to the next step which is getting a CAT scan of the head generally, then everything is being done during that time when the tech's CAT scan is being obtained.

So that makes that process a lot faster, and the key issue is whether or not a person - if they're having a stroke - have they had bleeding into the stroke area? And if there's bleeding, then we have to just treat symptomatically. In other words, make sure that they stop bleeding, and that sort of thing. So we don't really generally go in and try to take out the clot unless it's a big clot that's pressing on a large part of the brain.

But if there's a blocked artery, then after the CAT scan is done and there's no evidence of hemorrhage, then we can give a medicine called tPA which is a medicine that breaks up clots, and by that - if we can do that quickly enough, we can help spare the brain from any further injury. So that's why we call it a clot buster, but basically it's to try to open up the circulation again so that there's restoration of flow to the brain, and then that will lead to the brain either recovering completely or nearly completely more of the time.

So it's really important to act very quickly. We can only give that medicine within four and a half hours, but it turns out that the earlier the better. So if we save fifteen minutes, and then there's a less chance of bleeding, less chance of dying from the stroke, and much more chance of walking out the door and going back home. So for every fifteen minutes, we gain a little bit of benefit. But if you save for example a half hour, then you're really saving a lot of brain by opening that artery up and allowing the blood flow to be restored.

Melanie: So summarize it for us, Dr. Bobenhouse, with your best advice to possibly reduce your risk of stroke or prevent one altogether, but what you want people to know about the importance of recognizing those signs and symptoms so that they can get help fast.

Dr. Bobenhouse: I think in the past, in my training when I was first trained as a neurologist, there wasn't a whole lot we could do to help with stroke. But now since 1995 actually, we have developed these treatments for strokes, but it's so important to get to the hospital as quickly as possible. By doing so, then it increases the chance of being able to be given this clot busting medicine called tPA, and then helping a person get back to normal, or near normal.

Only about 16 percent of people roughly that come with a stroke are eligible for this tPA, and the majority of the people that aren't eligible, it's because they've waited too long for the treatment. So it's really important to move quickly. Then there is actually a new treatment out there - relatively new treatment - where it's called a mechanical thrombectomy, and that's where interventionalists or specially trained radiologists can go through the groin up into the brain and then actually snag or pull out the clot, sometimes they'll suck it out. And that can be extended beyond just four and a half hours, and in some cases actually can go up to six or even sometimes twenty-four hours. So that treatment is an option that really wasn't available except the last few years. So it's really important to act quickly, in other words.

And as far as prevention of stroke, making these changes, lifestyle changes, eating a diet that has more vegetables and fruits is really good. It turns out our parents were right about that, "Eat your vegetables." It was really good for us to eat fruits and vegetables. And then exercise is really important, because exercise lowers the cholesterol in the blood, especially the LDL cholesterol which is the bad cholesterol. It has a lot of other beneficial things, it decreases the chance of heart disease and stroke. So it's really important to eat well and exercise.

Melanie: Thank you so much, Dr. Bobenhouse, for being with us. It's so important for people to hear, and such great information, and a special thank you to our podcast partner, Sampson Construction. This is Bryan Health Podcast. For more information on today's topic, go to bryanhealth.org/stroke. That's bryanhealth.org/stroke. I'm Melanie Cole, thanks so much for tuning in.