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Stroke Podcast

  • SARA LOMAX-REESE: Good Afternoon.  You are listening to the Tuesday's edition of the Midday Café, Health Quest live.  I am Sara Lomax-Reese and I will be here with you for the next hour.  Today we are going to spend the first segment of the show with the Einstein docs, talking about stroke and stroke prevention.  We will be joined by Dr. Donee Patterson, a family medicine physician and Dr. George Newman, who is the Chair of Neurology at Einstein.  A little bit later we will talk with Lacey Clark, founder of Sister's Sanctuary and Lacey is organizing a summit this Saturday, titled "Phenomenally You". Three candidate conversations about sex, self respect and successful in the reality TV era, so stay tuned for that.  Right now we are joined in studio by Dr. Donee Patterson, welcome.

    DONEE PATTERSON, MD: Thank you.

    LOMAX-REESE: And Dr. George Newman, both from Einstein Hospital.

    GEORGE NEWMAN, MD: Good morning; thanks for having me.

    LOMAX-REESE: Good afternoon, good morning, we are right on the cusp.  We are talking about stroke today and is May 1st in fact Stroke Alert Day?

    PATTERSON: It is. 

    NEWMAN: The first Tuesday of May.  May is the Stroke Awareness Month throughout the country and the first Tuesday since 2004 we have been doing this, the first Tuesday of the month is Stroke Alert Day.

    LOMAX-REESE: When you say "we've been doing this" is this national observance or is this something that Einstein does?

    NEWMAN: No, this is a national observance.  I came to Einstein form the University of Wisconsin and that is where we started it, in 2004.  We are in 32 states right now.

    LOMAX-REESE: Wow.  So what happens on Stroke Alert Day?

    NEWMAN: The point of Stroke Alert Day is to try to education everybody about the warning symptoms of stroke.  We spend all year long thinking about stroke prevention and that is important, along with heart attack prevention.  But the warning symptoms of stroke are a lot more difficult to recognize than say a heart attack.  Of course a heart attack you get crushing chest pain and everybody knows to get to the emergency room, but because the symptoms of stroke are much more subtle, we were finding that people weren't getting to the emergency room in time for the treatments that we have, so this day was intended to fix that.

    LOMAX-REESE: And time is of the essence with stroke.

    NEWMAN: Absolutely.  We say time is brain.  Every minute literally that someone waits just increases the chances that they are not going to make a complete recover from the stroke.  We need them in as quickly as possible.

    LOMAX-REESE: So you mentioned that the symptoms, the warning signs, are not as readily knowable as with a heart attack.  So tell us what the symptoms are.

    NEWMAN: Right.  There are different ways of thinking about it.  People have tried different ways of getting everyone to recognize.  You talk about FAST and that sort of thing but then you have to remember what those mean but what we realize is the essence of stroke is that stroke strikes suddenly.  That is why it is called stroke; it is because it is absolutely sudden.  The idea that we try to get across is that any sudden change, it doesn't matter what, you can talk about what, but any sudden change you really should be thinking about a stroke and you should call 911.  That is another important part of the day because stroke victims are notorious for trying to talk that person out of calling 911.

    LOMAX-REESE: Go through what FAST is.

    NEWMAN: Sometimes I just think about, I actually look at the person and go down, for instance, the kind of sudden changes beginning with sudden confusion; sudden difficulty saying what they want  to say or understanding others.  Sudden difficulty with vision, I'm just working my way down; sudden numbness of the face or drooping of the face.  It is common to see the face twisted to one side or slurring of speech; then of course sudden paralysis or sudden numbness or tingling in one arm or one leg.  Sudden vertigo, and by vertigo I mean they are spinning or rocking.  Every symptom I begin by saying sudden, that's the key.

    LOMAX-REESE: So there has to be a sense of self awareness which I think in the days and times that we live in is a major issue because we are all moving at light speed and we are distracted and we are working on multiple electronic devices.  We are overscheduled, overstressed so it is easy to numb out.

    NEWMAN: You have actually hit the essence of stroke right on the head right there.  A study was published that looked at 911 calls for strokes, you know, the EMS for stroke.  Of 600 calls that were analyzed, 599 of the 600 were made by observers; only one call was made by the actual stroke victim.  So we realize that people who have stroke will not make that call; therefore we begin to realize to education the person who is at risk of stroke is not the answer.  Instead, it is not the 75 year old diabetic woman, it is her daughter who needs to recognize stroke.  Then we realized that you had to education everybody, the young and old, no matter if they are at risk of stroke. Then we had this whole issue on our hands of how do you educate the entire population with no money.  The idea of a volunteer campaign, of soliciting, help, just as we are doing right this minute, appearing on a nice radio station and we reach out to a lot of people doing it this way; this became the key of the stroke alert and it is throughout the country at this point.

    LOMAX-REESE: Let me just reintroduce you.  We are talking today about stroke, it is Stroke Alert Day, the first Tuesday of the Month of May and we are talking with Dr. George Newman, he is the Chair of Neurology at Einstein.  We also have Dr. Donee Patterson who is a family medicine physician at Einstein Healthcare Network.  I am going to come right  back to you Dr. Newman in a minute to talk about, because there are different kind of stroke I know, so I am wondering if there are different kids of symptoms depending on the type of stroke.  I want to ask you, Dr. Donee, we know there is a disproportionate rate of heart disease and stroke in the African American community even though heart disease is the number one killer of all Americans.  Talk to us about what is unique in the African American community that is putting us at greater risk.

    PATTERSON: We definitely want to talk about that; that is very important.  In African Americans, we often have high blood pressure, which we've talked about often.  Often that high blood pressure is not well controlled or they have diabetes and that diabetes is not well controlled.  The people are not taking their medicines and Dr. Newman and I wanted to make sure that we emphasized today that when people take what doctors call holidays from their medications, meaning they ran out and they just didn't have a chance to refill it or they are waiting for their next doctor's appointment to restart their medicine.  Often that span of time is the times when people will have their heart attack and stroke.  We want people to know how common stroke is.  About 700,000 people a year will have a stroke so that is 1 in every 45 seconds.  This is really very common and we can't afford to have uncontrolled high blood pressure and uncontrolled diabetes.  We have to know our numbers; we have to make sure that it is controlled and not have any time where those numbers aren't control to increase the risk of having a stroke.

    LOMAX-REESE: So there are different kinds of stroke and when I hear those different illnesses, diabetes, high blood pressures, the one I associate mostly with stroke is high blood pressure because people have said to me oh I went to the doctor and they took my blood pressure and it was like 2000 /150 or whatever.  I know that is ridiculous but something really extreme and they were at risk; their doctor was worried that they might actually stroke out because their blood pressure was so high.  If you can Dr. Newman, talk to us about the connection between blood pressure and stroke and then talk about the different kinds of stroke.

    NEWMAN: First of all, I like the question what are the different kinds of stroke because as Dr. Patterson said, this is a very common problem.  For instance, we will take care of nearly 1000 stroke patients a year at Einstein and the number is very large.  There are two types of stroke, all strokes share this; stroke is an injury to the brain because of a problem with its blood supply.  All strokes share that theory.    Injuries as a result of the problem with the blood supply.  About four out of five times,  80%, the injury, the problem with the blood supply is a blockage and we sometimes call that ischemic, but it is a blocked artery.  One out of five, 20%, the problem with the blood vessel is that it ruptures and so there is a hemorrhage; that is the second major group is hemorrhagic stroke.  The hemorrhage in particular not only is that a very severe stroke, that is it is a much higher likelihood of actually killing the person or leaving them with a major disability, but that is the one that really is associated with high blood pressure. They both are associated with high blood pressure but the hemorrhages are nearly always because of high blood pressure.  In particular, the way Dr. Patterson was saying, when people stop their blood pressure medicine, that is when they come into the doctor's office with the 2000/150.  We see some huge blood pressures, 250, 260/150 and those are the ones where the person is at risk for immediate hemorrhage even though they have only stop the medicine for two or three days.

    LOMAX-REESE: What about a blood clot like traveling up through and into the brain?  

    NEWMAN: Absolutely.  You definitely have that right; that is what we call an embolism.  Usually those come from the heart and those represent, again, that is a blocked blood vessel type of stroke and that is about 1 in every 4 blocked blood vessels that cause, just like you said, traveled from the heart.  Those usually are caused by a condition called atrial fibulation, an irregular heart beat which also is a consequence of long term hypertension that has not been controlled.  So again, like Dr. Patterson said, we are going to keep coming back to hypertension.

    LOMAX-REESE: One of the things in doing research I saw an article that said there is an increase for pregnant women having stroke both when they are giving or having labor or recovering after labor.  I am wondering if that is something you all see, even though it seems like it is a small percentage overall but it does seem like it is something that is on the increase and what they said it's because more pregnant women have diabetes and hypertension and all the other risk factors.

    PATTERSON: We want people to recognize that a stroke can happen at any age.  Children can have strokes; more common in sickle cell patients.  Pregnant women can have stroke particularly in lupus patients that get pregnant and they have some blood disorders.  You are right, it is a small population but anyone can have a stroke.

    LOMAX-REESE: We want to invite callers to weigh in and ask questions.  The number is 215-634-8065 or toll free 866-361-0900.  We are going to the phones in just a second.  We talked about risk factors, we talked about symptoms, let's talk a little bit about prevention because one of the things I was excited to read, there is a number of different studies that say that wine and olive oil and chocolate and coffee, all of my favorite things can reduce your risk of stroke.  There was a pretty extensive study out of Sweden that looked at all these different nutritional aspects.  Talk to us Dr. Newman about prevention and nutrition and those kinds of things.

    NEWMAN: What you said is actually true; a certain amount of wine is really good for you.  Of course we really want people not to smoke.  I make a deal, an easy deal for me to make, that is OK, you can drink your…it's actually up to about six glasses of wine a week is about…that's a nice three to four ounce glass of wine a day, that would be great.  I say give up your cigarettes and have a glass of wine everyday, that is a good trade from our point of view.  The real thing is a healthy diet and exercise really are the keys.  It is easy enough so the recommendations for exercise are somewhere around two to three hours a week of exercise and that should be an aerobic type of exercise where you are sweating, in plain English, you should be sweating.  For people who haven't exercised in a while a good walk is a terrific way to get started.  Diet, I usually think of diet in a fairly simple way; that is, I think the basis of the diet should be fresh fruits and vegetables, that is really important because it brings potassium into your diet naturally and that will keep your blood pressure down.  That is really helpful.  You need to have a certain amount of protein, roughly speaking the amount of protein you should eat each day is about the size of a deck of cards is what we usually say, either chicken fish, meat, doesn't matter and keep the carbs and fried foods down.  Fish is terrific, salmon and walnuts have these omega3 which are terrific for reduction.

    PATTERSON: We haven't really talked about cholesterol.  Cholesterol is also a risk factor, so people need to know what their cholesterol levels are and work with their doctors about getting it down.  Cheolesterol is often what clogs up the arteries and can lead to a clot.  Just one addition thing, blood pressure we know, diabetes we know to control, but cholesterol is also something we need to consider.

    LOMAX-REESE: We are talking with the Einstein docs today.  Today is Stroke Alert Day; May is Stroke Awareness Month and we are talking about stroke and stroke prevention and stroke recognition.  If you have a question, give us a call, 215-634-8065; toll free 866-361-0900.  We are going to go to the phones; we have Hannibal from West Philly.  Welcome to the show Hannibal.

    HANNIBAL: Hi to your guests.

    PATTERSON: Hello.

    HANNIBAL:  Doctors talk about left side of the brain will affect the right side of the body and visa versa, that's one.  Can you also talk about, myself, I'm 54 years old and had a mini-stroke when I was 40 years old.  It didn't affect me obviously but it left me with my left side hearing is less than the right side.  Does that put me at a higher risk in the future to get a full blown stroke?

    LOMAX-REESE: Thanks for your questions Hannibal; Dr. Newman?

    NEWMAN: The question of left versus right, that's a great question; I love it and no one really knows the answer.  There are some ideas; what we know is this left right goes all the way back into animals and birds, so it is not just a human thing.  What exactly why we really are not sure; that's a great question; there is no good answer.  In terms of the question of the mini-stroke, mini-stroke is an important thing.  Mini-stroke is actually two different things and that's why the term makes me a little nervous because it is not always clear.  Mini-stroke can be, as Hannibal is suggesting is that he actually had a very small stroke and so OK, a mini-stroke.  Usually when we use the term mini-stroke we actually mean what we call a TIA, a long word, trans ischemic attack, but I think of it as a warning of stroke and that is the same thing.  Whether there was a tiny stroke or none at all but it happened, it does put the person at risk.  It is a warning and that is why I like the term warning stroke because it says if you have high blood pressure, get it under control; if you have diabetes, get it under control.  Like dr. Patterson was saying, high cholesterol, get it under control and no smoking.  These are the things; this is a real warning.  I appreciate what Hannibal is saying about the warning because one of the things in terms of stroke recognition that is really key is that sometimes a person will have the symptoms of a stroke, suddenly they can't talk and then after 15 minutes, it comes back to normal and they just go phew and go about their business; that is wrong.  They need to come in right then, that is the golden moment that we can prevent the stroke, really prevent the stroke from happening.

    LOMAX-REESE: How do you prevent it?

    NEWMAN: Sometimes it is as simple as putting the person on aspirin; sometimes it is a matter of bringing their blood pressure down and this will surprise you, sometimes it is a matter of bringing the blood pressure up.  If you have had high blood pressure for a long time then your blood vessels are used to the high blood pressure.  Let's say you get sick, you just get a flu like illness, become dehydrated; you can't take in any fluids, then your blood pressure goes down but your blood vessels are used to the high blood pressure so sometimes all we need to do is give the person salt water in their veins and that prevents the stroke.  It is often very simple stuff that makes a huge difference in a person's life.

    PATTERSON: People should not do this at home.  If they have any of those symptoms, it is time to seek medical attention because a large percentage of people have that warning stroke and like Dr. Newman said, they ignore it and say OK, I must be OK and they move on and they move into the massive stroke that is very disabling or actually can cause death so that is the time to call 911; get into the emergency room and we cannot leave here today without emphasizing to people that only about 20% of people actually come to the emergency room within three hours of their initial stroke symptoms and it is so important whenever those symptoms start, you look at the clock and remember the time because time is so important to physicians because it totally changes the treatment that you get in the emergency room, depending on that time.

    LOMAX-REESE: Dr. Newman?

    NEWMAN: So I think that is absolutely great; Dr. Patterson put the most important message out there.  The question will come up I'm sure of what is so special about the three hours?  Three hours is what we call the time window in which we can use clot buster drugs.  We talked before about a blood vessel being blocked and causing injury to the brain.  If we get to the person within three hours of the blockage, we actually can give them medicine in the vein, it's not even fancy or difficult to do, you just give the medicine in the vein and that will actually dissolve the clot and prevent the stroke from happening, so I agree with what Dr. Patterson said; that is a key piece of today.

    LOMAX-REESE: Let's talk about recovery because Dick Clark, he just passed away at 82.  he had a stroke in 2004 and you could see, because he was still hosting the New Year's Rocking Eve but you could see he had been incredibly diminished in terms of his speech, in terms of his physical look; all of that .  I think a lot of times people think about stroke not just from a death standpoint but from a disability standpoint, that it can really change your ability to live the life that you want.  So what are some of the things that affect your recover?

    NEWMAN: Perfect question and I'm going to go right back to what Dr. Patterson was just telling us.  If someone has a stroke and they don't come to the emergency room in time and I don't want to get stuck on the three hours; they should get in as quickly as they can because we can still treat the person quite far out.  We say as part of stroke alert, we say don't stall, make the call.  To take Dr. Patterson's point here, someone who gets to the emergency room within three hours has about a 20%-35%  chance of having a really good recovery, that is having no problem left over after the stroke.  But if they get to the emergency room within three hours, we nearly double the chances that they are going to have no long term disability from the stroke by using this clot buster drug.  This is a huge benefit and that is what we are doing today; that's why we want everyone in the emergency room so quickly.  To continue with your question, again, depending on whether the person was treated, for those people who were treated, I would say roughly 4 out of 10, we have people come in, the sister sees the stroke occur, she calls 911, the guy comes in we treat the guy within 45 minutes and two or three days later he just goes home.  Maybe he will have some outpatient physical therapy or not.  For people who have had stroke and sometimes people live alone and they have a stroke and there is no one with them at the time; they are found the next morning.  So they had a stroke, of those people, roughly half will be able to go about and probably like our listener Hannibal, they will be able to get up and go about their business after a two to three month recover period.  They will resume most of their activities but they will have some degree of impairment.  Dick Clark continued to host New Year's Eve and we all watched, but as you said, it was with a disability.  Then nearly a third of people with a stroke are either going to die or they are going to have a significant disability that will affect their life.

    PATTERSON: So for those people who do have strokes and they have some disability, again we send them to physical therapy.  A lot of times people have swallowing and speech problems so we send them to swallowing classes and we send them to speech classes and there is a whole center on traumatic brain injuries and we can help them.  Literally a lot of these people have to relearn how to walk and relearn how to talk and so there are programs in place for people who have already had their stroke.  We are here today because we would like to prevent those strokes.

    LOMAX-REESE: Absolutely.  We are going to the phones; we have Woody who has been holding from the barbershop.  Welcome to the program Woody.

    WOODY: Hey, another great show, I wish you guys could have made Human Family Day; I sent you some information.  We had some doctors out there and it was an exciting time.  It sounds like you guys are having a great exciting time now.  I know both doctors realize barbers were doctors first, isn't that right doc?

    PATTERSON: Yes.

    NEWMAN: Yes, surgeons right.

    WOODY: The original barber pole represents that. I get questions all the time in the barbershop.  One of the questions I have for you, are you familiar with EECP?

    PATTERSON: EECP?

    WOODY: External enhanced counter pulsation.

    PATTERSON: OK. Yes.

    WOODY: What do you think about it, that's what I would like to know?

    NEWMAN: I think there are times it is very useful for someone whose heart is marginal and especially immediately after a heart attack.  I think it can help a great deal to relieve the stress on their heart until a natural healing occurs.

    LOMAX-REESE: Thanks Woody; we are going to have to take our next caller.  We have Jenna from North Philly.  Welcome to the program.

    JENNA: Good afternoon, I will be real quick.  I know that symptoms are probably different for everybody it seems to me because I've had vertigo; I get it every now and then, maybe a couple times a year and I'm on meds for hypertension but it seems that it is due from an inner ear problem.  Is it true it is not always a symptom of a stroke and also I found that one of the depression medicines I was taking was depleting my  height, taking the calcium out of my body so I lost a couple of inches in height over the last couple of years and I'm really upset about that.

    PATTERSON: The thing about the dizziness is Dr. Newman was telling us in the beginning, it is sudden onset.  There are many, many reasons why someone can be dizzy, dehydration or a trauma.  There are so many different reasons.  Sudden onset of dizziness is a warning sign of stroke and as far as the blood pressure medicine, everyone is different.  First of all, women, we should talk to our doctor about being on calcium and vitamin D to make sure we replace the calcium that we are losing just because we are getting older.  Different medicines have different side effects.  Everyone is different and we should talk to our doctors about that on an individual basis.

    LOMAX-REESE: Dr. Newman, did you want to add anything?

    NEWMAN: No, I think Dr. Patterson got it exactly right and so did Jenna.  Lots of different Symptoms can occur because of lots of different conditions.  A woman asked me this morning what about numbness in her hand, it was numbness that is present when she wakes up; she probably has a pinched nerve at the wrist.  So Jenna is right, lots of different things can cause it but then as Dr. Patterson said what we are emphasizing is the sudden onset of this symptom; they never had it before and bang, sudden it is there.  That should be taken as a warning of stroke.

    PATTERSON: Thank you Jenna that was a great question.

    LOMAX-REESE: Absolutely.  We are just about out of time for this segment of the show.  I do want to ask one last question before you give your final thoughts.  One of the studies that I was looking at, a new study by Harvard School of Public Health suggests that positive psychological well being may reduce the risk of heart attack, stroke and other adverse events, cardiovascular events.  They are talking about your state of mind; your psychological wellbeing; your optimism and things like that really having an physiological affect and I just wanted to see if that is something you all see in your work.

    PATTERSON: There are many studies like that.  The Harvard one is probably a bigger one but it just goes to show that relaxing yourself and having some biofeedback where you are more calm and a lot of people say yoga is like that.  Yoga calms you down and it does help lower your blood pressure and that positive state of mind often leads people to a different state of recovery instead of leading them to depression.  So there is some benefit in being positive.

    LOMAX-REESE: Final thoughts?  What do you want to leave our listening audience with?  Dr. Newman?

    NEWMAN: The real key of stroke alert is that where stroke is concerned, you have to be your brother's keeper.  If you see someone right in front of you who has the warning symptoms of stroke, you recognize it because of a sudden change, don't stall, make the call.  Call 911.

    LOMAX-REESE: Dr. Donee?

    PATTERSON: I just want to remind people that stroke is the third leafing cause of death; it is very common and it is very common in African Americans but prevention is key; you can prevent having your first stroke.  Know what your blood pressure is; know what your cholesterol is; know if your sugars and make sure you talk to your doctor and work those things out.

    LOMAX-REESE: You can follow you on twitter at….

    PATTERSON: @DrDonee and you can write us on our Einstein facebook page, EinsteinHealth.

    LOMAX-REESE: I want to thank both of you; Dr. Donee Patterson and Dr. George Newman from Einstein.  Dr. Newman is the Chair of Einstein Neurology; Dr. Donee is a family medicine doc at Einstein Healthcare Network.  Thank you both as always for excellent information that could have just saved someone's life.