Stroke strikes about 700, 000 Americans each year, and if help is given in a very timely manner, many people will survive a stroke. The Lourdes Stroke Center is here to deliver innovative, state-of-the-art care to patients with symptoms of stroke.
Listen in as Dr. Mandy Binning discusses who is at risk for stroke, how important time is to brain, and that acting FAST can reduce the damage a stroke can do.
The Latest Treatment For Stroke Patients
From the Show: Lourdes Health Talk
Summary:
Air Date: 8/2/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): Stroke strikes about 700,000 Americans each year and if help is given in a very timely manner, many people will survive a stroke. The Lourdes Stroke Center is here to deliver innovative, state-of-the-art care to patients with symptoms of stroke. My guest today is Dr. Mandy Binning. She's a neurosurgeon with Lourdes Health System. Welcome to the show, Dr. Binning. First, tell us exactly what is a stroke?
Dr. Mandy Binning (Guest): Strokes can be one of two types of problems. Either ischemic--and ischemic stroke means that a blood vessel is blocked and that portion of the brain is not getting blood flow--or, a stroke can be hemorrhagic and that means a type of stroke that causes bleeding in the brain either from high blood pressure or an aneurysm; there are many types and causes of hemorrhagic stroke. Most strokes are actually the ischemic type.
Melanie: So, who is at risk for stroke?
Dr. Binning: Anybody can be at risk. In fact, we're actually seeing stroke in younger and younger people as a result of higher likelihood of childhood obesity. We're seeing diabetes and high blood pressure in younger people. Stroke can happen in people who have traumatic injuries and have vascular injuries from trauma and certainly stroke is prevalent in elderly people, as well, and certainly in people with risk factors such as diabetes, high blood pressure, obesity. There are other very common risk factors, as well.
Melanie: Before we get into the symptoms, which are so important to note, Dr. Binning, is there any way or screening when they're doing heart disease various screenings, is there any way to predict, besides the risk factors, if somebody is subject to a stroke?
Dr. Binning: Oftentimes, no, but we do know that 80% of strokes can be prevented if the risk factors are treated and modified. What I mean by that is if diabetes is well-controlled, if blood pressure is well-controlled, if patients maintain a healthy weight and a healthy diet, if they stop smoking--smoking is a big risk factor that I didn't mention. So, really, by screening the risk factors, most strokes, about 80%, can be prevented.
Melanie: Okay. Let's talk about the symptoms because these are what's so important to note whether you or a loved one starts to suffer from these symptoms. What do you want us to know and to look for?
Dr. Binning: So, the classic symptoms that you'll often hear about are asymmetry in the face, weakness on one side of the body, difficulty with speaking or forming speech. There are other symptoms that are not as common, but can be affiliated with stroke or associated with stroke. That can be loss of vision on one side of the vision or in one eye, dizziness or feeling like the room is spinning and slurred speech, numbness on one side of the body. All of these can be associated with stroke.
Melanie: And they use a moniker, don't they? That people can remember easily? The word FAST?
Dr. Binning: Correct. And FAST is the acronym for Face, Arms, Speech and then, T stands for “Time to call 9-1-1”.
Melanie: So, is that what you'd like people to do? If their face droops or they can't smile, or they have trouble with their speech, then 9-1-1 is the thing to do. Then, what happens next?
Dr. Binning: So, the best thing to do is call 9-1-1 so that the emergency medical staff can see them, asses them and the EMS is actually very well-trained in knowing which centers have stroke capability in treating stroke patients and they will take the patient to the nearest stroke center.
Melanie: And, what can they expect at the stroke center? What do you do for them to help them survive?
Dr. Binning: So, the very first thing that will often happen is the patient will be seen by a nurse or a physician who will start what is called a “stroke alert” and then they will oftentimes go straight to get a CAT scan of the brain. This looks for any bleeding in the brain. If there's no bleeding in the brain, then they will be assessed by a teleneurologist, or an in-house neurologist to see if they are candidates for the clot-busting medication called “TPA”. Patients can receive this medication up to four-and-a-half hours from the onset of their stroke symptoms, so it's very crucial that patients don't wait once they start to notice these symptoms of stroke. It's very important not to sleep the symptoms off or wait for them to get better because a lot of these treatments are time-sensitive, so you should really call 9-1-1 immediately if you feel like you are having a stroke or stroke symptoms. Then, in the emergency department, like I said, they'll be evaluated for whether or not they are a candidate for clot-busting medication and then also whether or not they are a candidate for what I do, and what my partners do, which is clot removal, or what we call “mechanical thrombectomy”.
Melanie: So tell us about that.
Dr. Binning: Basically, what the literature has shown, and there are actually trials that have proven the effectiveness of this treatment, in certain stroke patients, certain large vessels can be blocked by clots. Some patients may be candidates for removal of those clots through an angiogram or a catheterization. We have devices now that can essentially grab these clots and remove them to re-establish blood flow to the brain.
Melanie: Wow, that's fascinating. And, what's the outlook for stroke survivors, whether they get this clot removal-or are they at risk, then, for more strokes?
Dr. Binning: So, it goes back to treating those risk factors. We look for what those risk factors are when they come into the hospital. Now, ideally, patients treat their risk factors and don't have a stroke in the first place, but oftentimes, you know, the patients aren't that lucky, so then we do the work-up while they're in the hospital. So, at that point, we're treating high cholesterol, high blood pressure, diabetes. We're looking for heart arrhythmia, such as atrial fibrillation, and we're treating these risk factors to minimize the risk of a second stroke.
Melanie: If they are then on Warfarin or anti-coagulants, Coumadin or something, do they have to be on that, then, for the rest of their lives, Dr. Binning?
Dr. Binning: That's variable depending on the reasons for the anti-coagulation, so it's very patient-dependent.
Melanie: And, what's on the advanced horizon for stroke victims and maybe even to prevent a stroke? What's going on exciting today?
Dr. Binning: So, for patients who have had a stroke, I really think that the cutting edge is the mechanical thrombectomy, or the stroke intervention, that we're doing. Unfortunately, not everyone's a candidate for that because it does require that a patient has a large vessel that's blocked. So, for the patients either aren't candidates, or the patients who haven’t had a stroke and they're trying to prevent stroke, it's really medical therapy, and there's some really great medications out there to treat high cholesterol and high blood pressure. There are good medications for smoking cessation; there are good medications for atrial fibrillation. Really, there are very few risk factors that can't be treated nowadays.
Melanie: In just the last few minutes, Dr. Binning, give your best advice for people that might be at risk for stroke. What you really, really want them to know and why they should come to Lourdes Health System for their care.
Dr. Binning: I think the most important thing that the general public doesn't realize is that 80% of stroke can be prevented with regular checkups with a primary care physician and with management of risk factors. And, if we can prevent 80% of strokes, then a lot of patients won't have to get to the point where they call 9-1-1 and potentially need a surgery to remove a clot. I think that's the most important thing is to really maintain one's health to prevent stroke and, for those patients who do have a stroke, I think it's important to know that where you're treated matters and that you want to go to a facility that has really a comprehensive team who can treat all types of stroke-- both hemorrhagic and ischemic--and that's what we have at Lourdes.
Melanie: Thank you so much for being with us today. It's great information. You're listening to Lourdes Health Talk and for more information, you can go to lourdesnet.org. That's lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Stroke strikes about 700,000 Americans each year and if help is given in a very timely manner, many people will survive a stroke. The Lourdes Stroke Center is here to deliver innovative, state-of-the-art care to patients with symptoms of stroke. My guest today is Dr. Mandy Binning. She's a neurosurgeon with Lourdes Health System. Welcome to the show, Dr. Binning. First, tell us exactly what is a stroke?
Dr. Mandy Binning (Guest): Strokes can be one of two types of problems. Either ischemic--and ischemic stroke means that a blood vessel is blocked and that portion of the brain is not getting blood flow--or, a stroke can be hemorrhagic and that means a type of stroke that causes bleeding in the brain either from high blood pressure or an aneurysm; there are many types and causes of hemorrhagic stroke. Most strokes are actually the ischemic type.
Melanie: So, who is at risk for stroke?
Dr. Binning: Anybody can be at risk. In fact, we're actually seeing stroke in younger and younger people as a result of higher likelihood of childhood obesity. We're seeing diabetes and high blood pressure in younger people. Stroke can happen in people who have traumatic injuries and have vascular injuries from trauma and certainly stroke is prevalent in elderly people, as well, and certainly in people with risk factors such as diabetes, high blood pressure, obesity. There are other very common risk factors, as well.
Melanie: Before we get into the symptoms, which are so important to note, Dr. Binning, is there any way or screening when they're doing heart disease various screenings, is there any way to predict, besides the risk factors, if somebody is subject to a stroke?
Dr. Binning: Oftentimes, no, but we do know that 80% of strokes can be prevented if the risk factors are treated and modified. What I mean by that is if diabetes is well-controlled, if blood pressure is well-controlled, if patients maintain a healthy weight and a healthy diet, if they stop smoking--smoking is a big risk factor that I didn't mention. So, really, by screening the risk factors, most strokes, about 80%, can be prevented.
Melanie: Okay. Let's talk about the symptoms because these are what's so important to note whether you or a loved one starts to suffer from these symptoms. What do you want us to know and to look for?
Dr. Binning: So, the classic symptoms that you'll often hear about are asymmetry in the face, weakness on one side of the body, difficulty with speaking or forming speech. There are other symptoms that are not as common, but can be affiliated with stroke or associated with stroke. That can be loss of vision on one side of the vision or in one eye, dizziness or feeling like the room is spinning and slurred speech, numbness on one side of the body. All of these can be associated with stroke.
Melanie: And they use a moniker, don't they? That people can remember easily? The word FAST?
Dr. Binning: Correct. And FAST is the acronym for Face, Arms, Speech and then, T stands for “Time to call 9-1-1”.
Melanie: So, is that what you'd like people to do? If their face droops or they can't smile, or they have trouble with their speech, then 9-1-1 is the thing to do. Then, what happens next?
Dr. Binning: So, the best thing to do is call 9-1-1 so that the emergency medical staff can see them, asses them and the EMS is actually very well-trained in knowing which centers have stroke capability in treating stroke patients and they will take the patient to the nearest stroke center.
Melanie: And, what can they expect at the stroke center? What do you do for them to help them survive?
Dr. Binning: So, the very first thing that will often happen is the patient will be seen by a nurse or a physician who will start what is called a “stroke alert” and then they will oftentimes go straight to get a CAT scan of the brain. This looks for any bleeding in the brain. If there's no bleeding in the brain, then they will be assessed by a teleneurologist, or an in-house neurologist to see if they are candidates for the clot-busting medication called “TPA”. Patients can receive this medication up to four-and-a-half hours from the onset of their stroke symptoms, so it's very crucial that patients don't wait once they start to notice these symptoms of stroke. It's very important not to sleep the symptoms off or wait for them to get better because a lot of these treatments are time-sensitive, so you should really call 9-1-1 immediately if you feel like you are having a stroke or stroke symptoms. Then, in the emergency department, like I said, they'll be evaluated for whether or not they are a candidate for clot-busting medication and then also whether or not they are a candidate for what I do, and what my partners do, which is clot removal, or what we call “mechanical thrombectomy”.
Melanie: So tell us about that.
Dr. Binning: Basically, what the literature has shown, and there are actually trials that have proven the effectiveness of this treatment, in certain stroke patients, certain large vessels can be blocked by clots. Some patients may be candidates for removal of those clots through an angiogram or a catheterization. We have devices now that can essentially grab these clots and remove them to re-establish blood flow to the brain.
Melanie: Wow, that's fascinating. And, what's the outlook for stroke survivors, whether they get this clot removal-or are they at risk, then, for more strokes?
Dr. Binning: So, it goes back to treating those risk factors. We look for what those risk factors are when they come into the hospital. Now, ideally, patients treat their risk factors and don't have a stroke in the first place, but oftentimes, you know, the patients aren't that lucky, so then we do the work-up while they're in the hospital. So, at that point, we're treating high cholesterol, high blood pressure, diabetes. We're looking for heart arrhythmia, such as atrial fibrillation, and we're treating these risk factors to minimize the risk of a second stroke.
Melanie: If they are then on Warfarin or anti-coagulants, Coumadin or something, do they have to be on that, then, for the rest of their lives, Dr. Binning?
Dr. Binning: That's variable depending on the reasons for the anti-coagulation, so it's very patient-dependent.
Melanie: And, what's on the advanced horizon for stroke victims and maybe even to prevent a stroke? What's going on exciting today?
Dr. Binning: So, for patients who have had a stroke, I really think that the cutting edge is the mechanical thrombectomy, or the stroke intervention, that we're doing. Unfortunately, not everyone's a candidate for that because it does require that a patient has a large vessel that's blocked. So, for the patients either aren't candidates, or the patients who haven’t had a stroke and they're trying to prevent stroke, it's really medical therapy, and there's some really great medications out there to treat high cholesterol and high blood pressure. There are good medications for smoking cessation; there are good medications for atrial fibrillation. Really, there are very few risk factors that can't be treated nowadays.
Melanie: In just the last few minutes, Dr. Binning, give your best advice for people that might be at risk for stroke. What you really, really want them to know and why they should come to Lourdes Health System for their care.
Dr. Binning: I think the most important thing that the general public doesn't realize is that 80% of stroke can be prevented with regular checkups with a primary care physician and with management of risk factors. And, if we can prevent 80% of strokes, then a lot of patients won't have to get to the point where they call 9-1-1 and potentially need a surgery to remove a clot. I think that's the most important thing is to really maintain one's health to prevent stroke and, for those patients who do have a stroke, I think it's important to know that where you're treated matters and that you want to go to a facility that has really a comprehensive team who can treat all types of stroke-- both hemorrhagic and ischemic--and that's what we have at Lourdes.
Melanie: Thank you so much for being with us today. It's great information. You're listening to Lourdes Health Talk and for more information, you can go to lourdesnet.org. That's lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
