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Culturally Speaking: The South Florida Sunday Podcast
Stroke Awareness Month with the American Stroke Association & the American Heart Association
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- [00:00]
A
All right, so May is American Stroke Month, and today we're going to be talking about the stroke warning signs, prevention, and in general, just healthy habits to adopt to ensure that you can live a happy and fulfilling life. Right Now I have Dr. Stephen Chastain joining me, the medical director at Encompass Health Rehabilitation Hospital, which is also affiliated with Martin Health and Stewart. Don't know if you know that, but, yeah, he's going to be giving us all the tips and tricks that we need to know. So thank you so much for Joining the show, Dr. Chastain.
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B
Great. Thank you for having me.
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A
Of course. Always a pleasure to speak with you. So how long have you been in this field, and do you have a personal connection with stroke?
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B
Yes, I've been in stroke rehabilitation since 1994. So over 20 years experience. As far as a personal connection, it's just the relationship that I have to my patients. But then just recently, I had a close friend that's my age, had a stroke right under my nose. And it's like that really hit home.
- [00:57]
A
Right. And you actually just pointed out why it's so important to talk about all this stuff, because so many people are affected by this, whether it's them personally or they just know someone. So let's talk about those top risk factors, because there are a lot.
- [01:10]
B
Yeah, it's easy to think about stroke as a brain attack. I mean, we're kind of accustomed to thinking about heart attacks as loss of blood flow to your heart and having a heart attack. But most strokes actually are very similar. Loss of blood flow to part of the brain causes damage to the brain. The problem with strokes is that about 15% are not just that they're due to a broken blood vessel that causes a bleed or a hemorrhage into the brain, but the damage is done. There's damage to the brain, and as a result, it leads to neurologic problems. The brain is so varied that it depends on what part of the brain is affected to what you actually see on the outside.
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A
When you talk about broken blood vessels, you would think it comes from some kind of trauma, like maybe a car accident, but it doesn't always happen that way.
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B
Right? Right. It could be from a car accident. It could be from a head injury by falling. It could be from an aneurysm that ruptures. It could be from high blood pressure causing a blood vessel to break. Some people are on blood thinners, especially if they're drinking alcohol. Their blood vessels get brittle and they break. So we know that hemorrhagic Strokes are more common in people that drink in excess.
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A
We just talked about alcoholism in there and of course, accident. But what are some of the top risk factors?
- [02:28]
B
The easy things to think about are similar. I mean, as your heart go, your brain goes. So everything that you would think about for heart applies to the brain. High blood pressure, high cholesterol, smoking, those are the usual things. Obesity, diabetes. Controlling all of those risk factors is important for both the heart and the brain. Specific to the brain, we worry about something called atrial fibrillation. It's an irregular heart rhythm that can form clots in the heart and spit out to the brain. You think about blocked arteries in your neck called carotid arteries that can to it. And it's just a lot of different risk factors, but mainly those that we talked about. High blood pressure, poor health habits like diet and cholesterol and tobacco use.
- [03:15]
A
Right. And then as we're talking about all the top risk factors, it seems like a lot of our population has dealt with this or has one thing or another in one shape or form. What can we do to lower our risk with this?
- [03:26]
B
Yeah, there's things you can change, things you can't change. So some of the things you can't change are your age. It's interesting, as you get older, your blood actually gets thicker and you're more likely to form clots. You can't change your age, you can't change your family history, you can't change your gender. We know that family history and women have higher risk of stroke. But those things that you can change, you can focus on your blood pressure, keeping it under control. It's interesting. People ask me, well, what's the ideal blood pressure? And you know, it's really as low as you can go and have it. You know, not too low. Where you're feeling lightheaded is the ideal blood pressure. Smoking cessation, of course, is huge. And also you think about just taking your medications that you're prescribed from your primary care doctors.
- [04:16]
A
One thing about this is that things like this kind of start to build up over time. So all these habits that you have when you're younger, whether it's smoking or binge drinking and, you know, or eating unhealthy, that eventually catches up to you. Like, you think you're fine now, you feel great, and then one day you're in this situation where you might have a stroke or you're getting to that.
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B
Yeah, that's actually where the name stroke comes from. Like a stroke of time. It just happens. Suddenly you're Fine one moment and you're, you're showing signs of it the next.
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A
Right. And so we want to actually talk about these key symptoms of a stroke because sometimes it can be a little confusing. So can you talk about that? What should people be watching out for and what should they do if they notice symptoms in themselves or other people?
- [04:57]
B
Yeah, it's basically, you know, things that are out of the normal. If you think about your normal neurologic function, something that go haywire, then you start to worry about it. We use this abbreviation or mnemonic called Be Fast. It helps to remind everyone of the different parts of the brain that can be manifesting. It used to be just fast, and now they're saying be fast. So they've added two new things ahead of that to remind people of some additional symptoms. The B stands for balance loss. So if you're falling or feel like you're leaning to one side or balance is an issue, that could be a 1 warning sign or a manifestation of stroke. Eye or vision symptoms. We've had patients that would just have a stroke in the eye or in the visual part of the brain. So they would have a blank spot. It's interesting too that some of these symptoms are very transient. They may only occur for a few minutes and then they go away. And you would say, oh, well, maybe that was just something in my eye. But it can actually be a sign or a warning sign of stroke. That would be putting you at higher risk for a fall, full blown stroke later. So that's the B and the E, the balance and the eye or vision changes. And then the ones that we're used to, the face drooping. So if you look in a mirror and you smile and you notice that your smile is crooked or your tongue sticks out in a deviated fashion, then that can be a sign of stroke. Arm weakness. A lot of times I'll tell people to hold out their arms like they're holding up a platter or plate in front of them. And you'll notice that one arm tends to droop. That can be a sign of a stroke or dropping things in that hand. Arm weakness. So we talked about the arm weakness that you might notice, or leg weakness too. And then the S would be for speech difficulty. A lot of people will be having a stroke and they're not able to get their words out. It'll be one of two things. Often is what I call word phyllos, where none of the words are coming out properly. Or it could be that the words are slurred. It's almost like they have cotton in their mouth and they're just not able to get the words out like they would normally do. So any of those symptoms would mean that you need to get to the emergency room as soon as possible. That's where the T comes in. So don't drive yourself to the hospital, call 911, get the paramedics involved. We've even had people here at the rehab hospital have a stroke and we call the paramedics and they get on a helicopter and get to a stroke center and get the clot pulled out of their brain. So it's time to call 911. You don't necessarily need to fool around with that time because time is brain.
- [07:46]
A
Can you actually go into that a little bit more? Because I don't think everyone knows exactly what that means.
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B
Right? Yeah. They've actually looked at that critical time and by waiting longer, there's more permanent brain damage, which means there's less that they can do about it. There's this window of opportunity that you have to act quickly. And the nice thing now with American Heart, American stroke, all of the hospitals are well aware of the protocol. So if you, they call it a stroke alert. So if you hit the door as a stroke alert, they have a, the clock starts ticking and they're getting the CT scan, they're diagnosing what kind of stroke it is. And if you get there within that three to four hour window, then you have a greater likelihood of even aborting the stroke or limiting the damage.
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A
So with all these risk factors and just bad habits that people have in general, how prevalent are strokes actually?
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B
So strokes are pretty prevalent. I think we all know people that have had a stroke or maybe a family member. But I was looking up today just to get my facts straight, and it says one stroke happens every 40 seconds in the United States. So I don't know, how long have we been talking here? What, three or four minutes? You think about how many strokes have happened just since we started. And then sort of an alarming thing too. Someone dies from a stroke every four minutes. Maybe we've been talking four or five minutes. Someone's died in that timeframe. So kind of tells you how, how prevalent it is. It's the fourth leading cause of death and it's the leading cause of serious long term disability. And we see that here at the rehab hospital where, you know, people, their lives are certainly changed afterward and they may not be able to return to work or even to be able to take care of themselves independently. So Stroke is the leading cause of disability.
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A
It's really hard sometimes because a lot of the symptoms that you were saying, they're. They can be very transient. Like you were talking about the eye strokes. How many times have someone stood up too fast and they get a little blurry or they have the black spots in their eyes? Sometimes you don't really know what's the best policy with that.
- [09:58]
B
If it's just an eye symptom that was transient and it's gone away, I think you may not need to do the 911 for that, but you should let your doctor know so they can check it out. I wouldn't wait two weeks. You know, it's one of those things that you would seek help sooner rather than later. Another thing to realize is if you have those symptoms, start looking at your risk factors. Am I diabetic? Do I have high blood pressure? Do I smoke? And if any of those are yes, then you know you're at higher risk. And then you need to take those even more seriously once you know that you're at higher risk. It's interesting that you think about some of the differences among minorities. So black people and Hispanics have an increased prevalence of stroke that can be partly genetic, just based on their genetics. But then also they may not worry about it or not consider their high blood pressure that much of a problem. But certainly they have more risk factors, which makes them higher risk for having the event.
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A
And as we said before, you're the medical director at Encompass Health, so can you tell us what happens after a stroke, and what should people do? How's it treated?
- [11:10]
B
Well, that's where I actually have a lot of great stories of people going through our stroke program. We actually have the American Heart recommendation that get early intervention by a multidisciplinary team. It makes a huge difference. Again, just like you have that window of opportunity for intervening for the acute stroke right after you leave the hospital from a stroke, you have that window of opportunity for rehabilitation. And that's where we come in here at Encompass other inpatient rehab facilities, we have multidisciplinary team that includes physical and occupational therapy, speech therapists, physicians that are specialists in rehabilitation, the medical doctors, dietician, mental health counselor, and case manager.
- [11:59]
A
Yeah, you have a lot of support services as well, especially for families, right?
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B
Yes, yes, we do. Not only while you're here, but then also we have a stroke support group that we support with the Cleveland Clinic, Martin Health. So the meetings are here every third Tuesday of the month. We can share how you can Access. That easy way to do is to call the hospital here at Encompass in Stewart.
- [12:29]
A
How can people learn more about stroke prevention and stroke in general? Is there a website for that?
- [12:34]
B
So American Heart association is a place to go. American Stroke Association. I was just on their website here this morning to see what they had, and they have a wealth of information and review the BC that we talk about. And they have a lot of resources as far as literature that you can have and access. Sometimes it takes a little bit of knowledge to make a difference, especially if you're a family member of someone. Especially I would focus on people that have had strokes. So let's say you have a family member that had a stroke and you want to know how to prevent the next stroke. Recurrent strokes are pretty devastating if you think about having one, one episode in your brain and now you have two or three or four. The focus of the stroke support group and this information is to try to prevent that next stroke that might happen. And it's more common in people. It's probably one of the risk factors that we didn't mention. One of the highest people, highest risk of people to have a stroke are people that have had a prior stroke. They can look at the American Stroke Stroke Organization website for more information.
- [13:44]
A
Dr. Chastain, thank you so much for all this information and where to find it as well. What is something else that you would like your listener or the listeners to know about stroke and the work with the American Heart association as well?
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B
Yeah, it seems like having May as Stroke Awareness Month. It's nice to be able to think of the month of May and this way. I've been on this conversation with you before, and here we are a year later. It's nice to be able to just like you celebrate a birthday, just kind of increase that awareness. Take a moment out of your time to revisit some of those things. We here at Encompass Health are proud to be part of the American Heart Association's vision for advancing health and hope for everyone. We're involved in community support and see ourselves as a resource for our community as well.