Transcription:

Scott Webb: When it comes to stroke, they say that time is brain, meaning that every minute counts when people are experiencing a stroke. And here today to explain what happens when we have a stroke, the signs and symptoms to be aware of and the importance of calling 9-1-1 if we are having a stroke is Dr. Susana Bowling, Director of the Neuroscience Institute at Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So Dr. Bowling, thanks so much for joining me. We're talking about stroke today, and we know that time is brain and every minute counts with stroke, especially reversing the effects of a stroke. So let's talk about this. What is stroke and why is it so important for people to know as much as they can about it?

Dr. Susana Bowling: The reason it is so important to talk about it is because it affects so many people, not only just in our community, but in our country and in the world. So it said to be over 600,000 to 700,000 people a year suffer a stroke in our country. Being there is an incredible high volume, you would think that the awareness of the disease and the low threshold to attend to seek medical attention would be low, but in the country because stroke symptoms don't hurt, it's amazing what people who you know, could tolerate or withstand with before seeking medical attention.

So a stroke is a lack of blood flow or a rupture of the vessels in your brain that leads to an area of the brain that is not getting good nutrition, oxygen, and glucose to be able to function. Similar to stroke will be the concept of having a heart attack. If a vessel in the heart it gets blocked and the heart muscle doesn't get anything, any flow, then patients are going to have pains. In the case of the stroke, however, it doesn't hurt. So patients might have sudden onset of neurological deficits, but they don't hurt. And that's why they don't come to the hospital quickly. And these a disease that is tremendously dependent on time. So that's why it's so important to talk about it.

Scott Webb: So when we talk about the signs and symptoms, what really should alert us that either we or somebody else is having a stroke?

Dr. Susana Bowling: First of all, symptoms of a stroke come suddenly. That means that from one minute to the next one, you have the symptoms. Sometimes you may wake up with them, you go to sleep perfectly okay and you wake up with symptoms. So is that suddenness that alerts us to the concern that this could indeed be a stroke and the symptoms is that sudden loss of neurological function. So what does that mean? That means, things that you can usually do, suddenly you cannot do it anymore. For example, you can hear and talk with people because you understand what they're telling you, and you can speak back to them. If you suddenly lose the ability to understand what people are telling you, sounds like they're talking in languages that you never heard before or you are unable to communicate because you are mute, you can bring thoughts to your mouth, or you can't come out with words that make any sense that is potentially a stroke. Sudden loss of the ability to move your limbs, either the arm or the leg, usually one side. Occasionally it can be both sides, but most of the time, one side of the body. Suddenly you can't feel so you no longer have sensation of touch in one limb or one side of your body. Another problem could be vision, you suddenly lost the vision of the whole eye or half of the world seems to be like a black page that is no longer letting you see what is in that area. So sudden loss of vision, sudden loss of speech, sudden loss of any kind of motor function, face, arm, face, arm or leg, or sudden loss of sensation are the most common presentations of strokes. Some other presentations related to hemorrhagic strokes are things like sudden severe headache. We quote those as the worst headache of your life. And particularly if the headache comes with an associated loss of consciousness or a sudden, usually nausea, vomiting, sudden that is very abrupt and very bad.

And then, and usually not what you have had before. It is something very aggressive and sudden. And the loss of coordination can also be part of a stroke. You're probably able to walk and then now you get up from the chair and you're totally unable to walk. That comes sometimes, usually with the vertigo or vertiginous complaints. And vertigo is such a common symptom that is hard to tell when it's a stroke and what it's not. But I always say to everybody, if you doubt it, you are better and safer to be seen and be told that it's not a stroke then to hold on with your symptoms at home and by the time you seek medical attention is too late to address those and you end up with chronic problems with gait imbalance. So those are the most common presentations.

Scott Webb: Good to know that there definitely are signs and symptoms that we can all be on the lookout for. So then a natural follow-up is if we believe that we or somebody else is having a stroke, what should we do?

Dr. Susana Bowling: I usually tell my patients when they are leaving to the hospital and their husband say, if you ever had symptoms like these before, do not call me, do not call your neighbor. Don't call your daughter, just call 9-1-1. That's one number you need to have on speed dial in your phone. And the reason is because no one is going to be able to help you on the phone. However, 9-1-1, not only starts treatments the moment they see you to improve your symptoms, but also, they can alert us on your way to the hospital. So we're already waiting for you by the time you arrive. So the safest, most important thing to do is call 9-1-1.

Scott Webb: Yeah. And I think that's probably going to end up being the biggest takeaway from today is, because time is brain and it's so critical when we're talking about stroke that people get to the hospital as quickly as possible, to do that call 9-1-1, people can't be talked through a stroke. You need to get to the hospital. When we talk about hospitals, is any hospital able to take care of acute stroke patients or is that unique to certain hospitals like Summa?

Dr. Susana Bowling: That's another wonderful question because not all the hospitals are equally able to manage and handle acute strokes. You want to go to a hospital that not only has the ability to give you medications for treatment. Everybody has heard of the clot buster. And that can be given IV. And if you are able to get to the hospital within less than three hours, sometimes less than four and a half hours from onset of symptoms, you can benefit from this medication and you have about 30% chances of resolving your symptoms so that, points back to your comment on time is brain. But again, if you use the time to go to a place that is not able to give you that medication, then you're wasting your time. Right? The second thing is now since 2018, there's a second treatment option for patients that may have had symptoms for even longer than four hours, sometimes up to 24 hours. And that is what we call endovascular rescue treatment, where we go from the inside of the vessels to the, to locate the area where there is a clot and it's affecting the brain blood flow, causing the symptoms and then maybe fish out that clot and restore the good blood flow and the return of the normality for the symptoms of the patient. That is something that can be done when patients have large vessels that are the problem. And only if you are in a center that has the ability to do so. And that's why it's so important to choose your center correctly. Otherwise you will be wasting time and trying to either get transferred to those patient centers or, wasting time to get the appropriate treatment.

Scott Webb: That's such a good point   that not all hospitals are the same. They're not all created equally. And, uh, what I want you to do now is maybe brag, just a little bit about Summa and the quality achievements that Summa has had regarding stroke care.

Dr. Susana Bowling: The beautiful thing about Suma is that we have a wide variety of physician, nursing care team in general, that for years had a passion on caring for patients for stroke. So we become, we have become a stroke center since 2008 and since then, we do nothing but trying to improve, optimize the care. So for years we had been recognized nationally by the American Stroke Association with the highest levels of quality in regards to stroke care, which is always being, reassuring that we were doing the right thing and that our plans and projects to improve, are indeed going in the right direction.

But in the last two years, we had been extremely excited about having received recognition by Health Grades, being on the top 5% hospitals for stroke care. And that's just, recognition to all the people at Summa that works every day with the goal of optimizing the quality of life and the return to normal to our patients with stroke and that make us obviously very happy and definitely something to brag about.

Scott Webb: Absolutely. And I can hear the pride in your voice and it's so great to know that patients are in such good hands and you all at Summa takes such pride in the work that you do and who doesn't like to be recognized for their work of course. Right?

Dr. Susana Bowling: Yes, of course. Because there's so many people that put so much effort into it that is a validation of their passion and their effort to get us where we have gotten.

Scott Webb: Definitely. And, such a patient centered team approach. Great to hear. Is there any relationship between COVID and stroke? We've learned so much about COVID during these nine or so months, and there's still so much we don't know, and we're on the verge of perhaps multiple vaccines being available. But to your knowledge, is there any relationship between COVID and stroke?

Dr. Susana Bowling: There has been so much written and speculated about the relationship. One of the things that is worth mentioning is that just the fact that COVID exists, has made a lot of patients either be fearful about coming to seek medical attention on time, which has resulted in a lower ability for us to help them. So that by itself is a relationship. Now the existence of COVID has made patients not want to come to the hospital and that is in turn affecting them.

So we have seen a delay in arrival for an onset of symptoms. Across the country that has been documented the fact that there has been because of the volumes of patients in the hospital, delay of treatment. We have not seen that at Summa and I'm very happy to say that. Our times documented has remained to be used starting early. But you can imagine in some hospitals that have been overwhelmed by volumes like in New York and Houston, so forth, obviously that has had also another effect. But then there's also an effect of the disease or the COVID itself because toward the mid and late point times of the disease, these patients tend to have more clotting disorders that leads to them to have strokes. So it's very common for us to be consulted to see patients in the COVID unit that have symptoms of stroke. And so it's part of the syndrome or the is part of the different symptoms that patients can have with COVID. If it happens in the front end or at the end of the disease, that's what has been in debate. But right now we have the concept of COVID relationship with stroke, with every patient we see.

Scott Webb: It's been so great having you on today, you have such a magnificent way of explaining things, a really great bedside manner, if you will. Before we wrap up here today, anything else you want to tell people about stroke that we haven't covered already?

Dr. Susana Bowling: The reason I am passionate about caring for a stroke is because not only you're taking care of a patient, you're taking care of a family. Stroke is one of the diseases that affects so quickly and so devastatingly not only the patient, but the family that, that is around that person that now moving forward, is going to need support because of their disabilities. I guess what I want to say is it's important to start in, to recognize those symptoms right away, not wait, seek medical attention, don't endure the weakness, the visual loss, don't endure those minor dragging the leg because your symptoms can get better. Is important to recognize the symptoms so you can not only take care of yourself, but also take care of your family by doing that.

Scott Webb: Doctor, so great having you on. I just love the way you explained everything, your time, your expertise, your compassion, you stay well.

Dr. Susana Bowling: Thank you. And you too.

Scott Webb: For more information on stroke services at Summa health, visit Summa health.org/stroke. And if you've found this podcast to be helpful and informative, please share it on your social channels and check out the entire podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.

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