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Prevention: the Best Way to Strike Out Stroke

Stroke is the #5 cause of death and the #1 cause of long-term disability in the US. Fortunately, 80% of strokes are treatable and preventable. Knowing the symptoms of stroke and your risk factors for having one is important, but lifestyle modifications are the key to prevention.

Nicole Pacha and Maureen “Mo” Stull are Registered Nurses and Stroke Program Coordinators at MarinHealth Medical Center. In this podcast, they detail how to reduce your stroke risk, from rethinking your diet to enhancing communication with your doctor to get the most out of your medical appointments.
Prevention: the Best Way to Strike Out Stroke
Maureen "Mo" Stull, RN | Nicole Pacha, BSN, RN
Maureen "Mo" Stull, RN is the Stroke Program Coordinator, Marin General Hospital, 2016-present
Clinical RN, Emergency Department, Marin General Hospital, 1986-2016 Paramedic Liaison Nurse, Marin General Hospital Emergency, 2012-2016. 

Nicole Pacha, BSN, RN, is a Stroke Coordinator at MarinHealth Medical Center.

Bill Klaproth (Host): So, where are we at when it comes to the latest stats and guidelines on stroke? And what can you do to reduce your risk of stroke? So, let's find out with Nicole Pacha, a Registered Nurse and Stroke Program Coordinator and Maureen "Mo" Stull, also a Registered Nurse and Stroke Program Coordinator, both at MarinHealth Medical Center.

This is The Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Nicole and Mo, thank you so much for your time. It is great to talk with both of you. Nicole, let me start with this. What are the latest stats that we should know about when it comes to stroke?

Nicole Pacha, BSN, RN (Guest): Yeah, thank you Bill. There's about 700,000 strokes that occur in the United States each year. And on average, a stroke occurs every 45 seconds and every three minutes someone dies from a stroke. Stroke is the leading cause of long-term disability. And 80% of strokes are preventable and treatable.

Host: Wow. That is really interesting, 80%.

Nicole: Yeah, 80%.

Host: Okay, well, that is good to know since there are a lot of people that have suffered strokes and things that we need to be aware about. Certainly when you say a number like 700,000 people, that's for sure. So, Mo how have the stroke guidelines from the American Stroke Association been updated? Where are we at now?

Maureen "Mo" Stull, RN (Guest): Well, periodically the American Heart Association, American Stroke Association, they review their guidelines and in the past, most of them have been focused on treatment of strokes. This time in 2021, they really changed their focus in prevention of strokes. And so that's what we kind of want to review, and send a message home to our patients in the community.

Host: Okay. So the guidelines have been updated, focusing more on prevention. So, when it comes to prevention, Nicole, it's good to understand the risk factors for stroke first. Right? So, can you talk to us about the risk factors for stroke, including the new guidelines and what we should be looking for?

Nicole: Sure. So there's two types of risk factors for stroke. There are non-modifiable risk factors, and then there are modifiable risk factors. Non-modifiable risk factors are the things we can't change. We don't have any control over. Things like age, gender, family history, race, or having had a prior stroke. The things that we want to focus on are the modifiable risk factors. The things that we can change. These include things like hypertension, high blood cholesterol, physical inactivity, medication compliance, atrial fibrillation is a big one, diabetes and smoking.

Host: So, it's important that we focus on our modifiable numbers. And as you say, and we hear this term a lot, know your numbers. What are the numbers that we need to know?

Nicole: Yeah, patients, community members can keep track of their numbers by checking blood pressure and glucose levels at home and keeping a log to share with your physician. Also be sure to visit your physician regularly and get routine labs done.

Host: So blood pressure numbers, glucose numbers, are cholesterol numbers, important to know too as well Nicole?

Nicole: Absolutely. And your physician will order those routinely, as they see fit, usually it's about once a year, for stroke patients, and further along maybe every five years for everybody else.

Host: So working to keep those numbers in check is really important because as you're sitting here, you don't know if you have high blood pressure or not, unless you go to the doctor and get it checked. That's why it's so important to know your numbers. And then when it comes to medication compliance, that is kind of step two. If you do have high blood pressure and you're on medication to lower your blood pressure, you have to stay on it. So, medication compliance is also critical in this as well. So, when it comes to medications, what are some of the medications we're specifically talking about to reduce stroke risk.

Nicole: Taking medications as prescribed is extremely important. This is a huge one for us at the hospital. This can protect you from suffering a stroke or having another stroke if you've had one in the past. The medications that we prescribe frequently are medications for cholesterol, like statins, antihypertensives for blood pressure control. Anticoagulants that reduce clot formation, diabetic medications to lower blood sugar. These are all frequently prescribed for our stroke patients. Certain stroke patients can also be placed on a dual anti-platelet therapy, which is both aspirin and Plavix to help prevent a stroke. And the difference between anti-platelet drugs and anticoagulant drugs, are that anti-platelets prevent the platelets from adhering to plaque, kind of sticking together and anticoagulant drugs, actually thin the blood.

Host: So again, medication compliance is important and staying on your meds, you got to do it that's for sure. You got to do it. Right. Exactly. So, then what other lifestyle changes can we make to reduce stroke risk? I'm sure things like exercising and not smoking, things like that. Clue us in on that Nicole, what are the lifestyle changes we should be paying attention to?

Nicole: Yeah, you got it Bill. Exercise routinely, number one, enjoy a healthy diet. Take your medications as prescribed, as we mentioned earlier, quit smoking if you do and see a physician regularly. Remember to always call 911, if you, or a loved one are experiencing symptoms of a stroke. That is key.

Host: Boy that is key. And if you are by yourself and you're having a stroke, please don't think you can drive to the emergency department. Call 911 as Nicole says. Don't drive yourself there. So, when you mentioned diet, if I can ask you this, Nicole, what should we be paying attention to? Should it be more of a plant-based diet? Right. We all probably consume, not all, but a lot of Americans, too much red meat and fatty things and sugary drinks. What specifically on the diet? Can you give us some tips on that?

Nicole: Absolutely. I say everything in moderation, Bill, you can enjoy your sweets and your fats, but do those in moderation. It's always good to have a wide variety of foods, leafy greens. Things that are lower in cholesterol. If you're eating something like shrimp, which is very high in cholesterol, do that in moderation. You can enjoy your shrimp, but just not everyday.

Host: Okay. Good advice. And thank you for that. And Mo, let me ask you this. What can healthcare professionals do then to help people reduce risk and who is the right professional to help a person reduce and monitor risk? Or should people just work with their primary care physician?

Mo: It's a tough question in our complex healthcare system that we're in now with so many different tiers and accessibility dependent on insurance and reimbursements and all that type of thing. The main thing I think is that patients have to be their own advocate. , if you think something is wrong, if you feel like it's been a long time, since you had your blood drawn, if you've been experiencing headaches or, visual problems, memory problems, then you have to seek out your physician. I think it's always wise, and I know that's tough in our pandemic times, to bring somebody with you. Four ears are always better than two. Someone who's involved and knows a little bit about your care and is wanting you to have health as well as you wanting to have your health.

And when you have questions that you want to ask your doctor, write them down ahead of time, because you're going to forget when you get there. Your provider, your doctor should always describe the treatment and prevention options that are available to you along with all the risks and benefits. And then that person should help you make a decision based on all that information. And anybody who has suffered a stroke, really needs to have a neurologist involved in their care. And that neurologist should be working with the primary care physician to manage your care.

Host: That's great advice, Mo, thank you for that. So as you said, patients need to be their own best advocate, right? If you don't do it for you, who's going to do it for you. So, that really makes sense. I love the four ears are better than two. That's good. And, you know, bringing notes, that makes sense. Right? Cause a lot of times you get in the doctor's office, you're like, oh, what was that?

Or you, you get out of the doctor's office, you get in the car. You're like, oh, darn it. I wanted to ask that. So, now I'm car and it's too late. So, if you have had a stroke, make sure you're working in conjunction with a neurologist. This has all been great. Nicole and Mo thank you so much for your time, Mo is there anything else, you'd like to add on our discussion about stroke?

Mo: Just a couple of things. One is what are the signs of a stroke and try to remember that there's an acronym it's called BE FAST. B is balance, E is for eyes. So your vision, double vision, loss of vision, visual field cuts. Your face, is one side drooping, feeling numb. You have a loss of sensation, feels like you just got out of the dentist office, but you haven't been. Your arms, is one arm weaker than the other. Can you not hold onto the pen anymore? Are you not able to operate your cell phone or do some online keyboard work, S, speech, slurring your words, your tongue is thick, drooling. Anything like that. And then time and time is everything. People wait. They said, well, you know, I'm going to wait a couple hours. I'll go take a nap. Oh, it's the weekend. I'll call my doctor on Monday. These types of things, especially for the more subtle symptoms, like the blurred vision or the dizziness, those types of things. So important. Look at the time, call 911. That's what they're there for is to help us to get to the hospital in time. Depending on your presentation, we can give you the clot-buster drug, which helps significantly to reduce the deficits that you're experiencing. If for whatever reason, you went to bed at 11 at night and you were fine, woke up at seven in the morning and things weren't good, had one of the be fast signs, call 911, because they might not be able to give you the clot-buster drug anymore. But now we can go in into the vessels of the brain and we can retrieve small clots depending on the patient presentation. Just like we've been doing for 30 years, going into the heart, and retrieving those blood clots, because again, the number one disability in the United States is from stroke and we want to reduce those disabilities. And the only way we can do it is by early intervention. Cause time is brain.

Host: That is so good. Mo, thank you for sharing that with us, as you, were talking about earlier prevention, trying to prevent people from having strokes and we all need to be aware of BE FAST. So that's good. B is for balance. E is for eyes. F is for face, A, is for arms, S is for speech and then T of course time, and we've heard that phrase, time is brain.

So, that is so important. And thank you for breaking that down for us. So, Nicole and Mo, thank you so much for this great discussion about stroke. Hopefully this podcast will help a lot of people. Thank you both for your time. We appreciate it.

Nicole: Thank you, Bill.

Mo: Thank you, Bill.

Host: And once again, that's Nicole Pacha and Maureen "Mo" Stull. And to learn more, please visit And if you've found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is The Healing podcast brought to you by MarinHealth. I'm Bill Klaproth. Thanks for listening.