Ask Us Anything About…Stroke

Scott Gilbert – From Penn State Health St. Joseph, this is Ask Us Anything About Stroke. I’m Scott Gilbert. Stroke is a leading cause of serious long-term disability. The good news is that up to 90% of strokes are preventable by addressing certain risk factors.

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Scott Gilbert – Here to share important information about stroke and to answer your questions is Morgan Boyer. She’s a clinical program coordinator at Penn State Health St. Joseph. And also joining us on screen is Zoraida Torres, who will be interpreting this conversation in real time, allowing viewers to enjoy it in both Spanish and in English.

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Scott Gilbert – And so Morgan and Zoraida, thank you both for being here today. Morgan, can you start by talking about what exactly happens inside the brain during a stroke perhaps by explaining the two different types, which are ischemic and hemorrhagic.

Morgan Boyer – Yeah. Absolutely. Thanks a lot for having us, Scott.

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Morgan Boyer – Yes. Thank you so much. There are definitely two types of strokes. Stroke is an insult to the brain.

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Morgan Boyer – The most common is an ischemic stroke, as you mentioned, where there’s actually a clot that gets lodged in an artery in the brain.

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Morgan Boyer – This is by the far most common form of stroke. It’s very similar — most people know about heart attacks. If you were to get a clot in a vessel of the heart you get chest pain. In the brain you get symptoms. We don’t — there is no pain associated with this type of stroke.

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Morgan Boyer – The other form of stroke is where one of those vessels in the brain rupture instead, or break. In which case the blood then leaks into the brain, and we call that a hemorrhagic stroke.

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Morgan Boyer – And we call these here at St. Joe’s, these types of events, brain attacks, just like a heart attack. It’s an emergency and it’s time sensitive.

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Scott Gilbert – Now Morgan, you used the term time in there, and I know that some in our stroke program are fond of saying that time is [inaudible] when it comes to stroke. Can you speak to why a timely response to stroke symptoms is so essential?

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Morgan Boyer – Yeah. So as far as time is concerned, for every minute that a brain cell goes without oxygen and sugar, which is a result of that clot, every minute two million of those brain cells die. And you can’t recover those.

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Morgan Boyer – So the longer a patient goes with this stroke happening, the more cells that are lost. So it’s important to get to the closest stroke center so we can appropriately treat you with the most acute interventions we have for the best odds of recovery.

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Morgan Boyer – Every minute saved, brain cells are saved. So time is of the essence. Once they’re lost, we can’t get them back.

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Scott Gilbert – You’re watching Ask Us Anything About Stroke from Penn State Health St. Joseph. I’m Scott Gilbert. We welcome your questions in the chat below this Facebook post from Morgan Boyer. She’s a clinical program coordinator at Penn State Health St. Joseph. And also joining us on screen is Zoraida Torres, who’s interpreting this conversation in real time so that viewers can enjoy it in both Spanish and in English.

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Scott Gilbert – And so this conversation about time brings us to the acronym BE FAST. And we have a graphic we’re going to bring on the screen as well. Each letter in the phrase BE FAST reminds us about one aspect of a timely response to stroke symptoms. Morgan, can you walk us through that?

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Morgan Boyer – Yes. This is probably the most important piece of information I can convey today, and that is recognizing the signs and symptoms. It is a challenge because depending on where a patient’s stroke might be happening, the symptoms are different. There isn’t any one set of symptoms that will apply to every single person.

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Morgan Boyer – B stands for balance in this case. When we talk about balance, I want you to think about your ability to walk safely. Maybe you’ve been having a history of falls.

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Morgan Boyer – And your other complaint might be dizziness, and these types of complaints would be a sudden onset. Suddenly you now have trouble walking or suddenly the room is spinning.

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Morgan Boyer – And here in Berks County we have a large volume of patients that come in with that as their chief complaint. And they end up having a stroke that were several days ago, unfortunately, because it isn’t a symptom that’s widely known.

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Morgan Boyer – The next letter in the BE FAST acronym is E for eyes. And when we talk about eyes, we want to talk about sudden visual changes.

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Morgan Boyer – A sudden visual change could be something like a loss of vision, blurry vision, or double vision.

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Morgan Boyer – Again, this would be a sudden change.

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Morgan Boyer – Next is F for facial droop.

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Morgan Boyer – This is one of the more common symptoms that people recognize and it’s typically someone is witnessing and recognize it in someone else.

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Morgan Boyer – And when we say facial droop, we’re talking about, typically, the lower half of the face, there is an obvious asymmetry to their mouth. Smiling is typically what we ask people to do.

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Morgan Boyer – And A is for arm weakness. And when we talk about arm weakness, that means one limb, your arm typically, becomes weak or numb and becomes hard to move.

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Morgan Boyer – And although it’s specific to arm, I want you to remember that it could be any limb becomes weak or changes in strength and so that could be your lower legs as well.

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Morgan Boyer – And then the last symptom in the BE FAST acronym is S for speech.

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Morgan Boyer – And when we talk about sudden changes in speech I want you to remember that there could be a sudden change in slurring, garbled, or maybe not able to speak at all.

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Morgan Boyer – And lastly, the T does stand for time. And it’s time to call 911.

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Morgan Boyer – It’s time to call 911 if you have any one of these symptoms. You don’t have to have all of them to be considered a stroke, any one should be considered an emergency until proven otherwise.

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Scott Gilbert – And Morgan, I noticed you said to call 911 rather than say take the person to the emergency department by personal vehicle. Why is that an important distinction?

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Morgan Boyer – Yeah. The emergency response is essential to timely care of a patient who’s experiencing a stroke.

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Morgan Boyer – Yeah. With recognition — the first step is recognition. Then with the activation of 911, the EMS personnel arrive and triage the patient for stroke symptoms and then decide on the most appropriate location to take such a patient.

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Morgan Boyer – So if EMS directing the patient to the most appropriate certified stroke center, then gets that patient also bypassed through the waiting room and directly to their first step in their workup, which is getting them to radiology.

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Scott Gilbert – Perhaps just as important as knowing the symptoms is knowing how you can prevent a stroke in the first place. Ninety percent of strokes, in fact, are preventable by addressing certain risk factors. Morgan, what are those modifiable risk factors?

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Morgan Boyer – Yeah, with stroke being 90% preventable it’s all about what we can do to minimize our risk.

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Morgan Boyer – And the number one modifiable risk factor for stroke and heart disease, to boot, is high blood pressure.

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Morgan Boyer – And more recently the American Heart Association has decreased those recommendations to keeping blood pressure below 120 over 80. That’s a hard measure to attain consistently.

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Morgan Boyer – But that’s because it’s been recognize through so much research and so much evidence that long-standing high blood pressure is so bad for your body. And it is a direct link to stroke incidents.

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Scott Gilbert – In addition to high blood pressure, what are some of those other risk factors, Morgan, or even some of the, you know, lifestyle changes people can implement to mitigate their risk of stroke?

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Morgan Boyer – Yeah. Other highly linked stroke risk factors are high blood sugars, and having a diagnosis of type two diabetes. And also high cholesterol. And all three of these, high blood pressure, diabetes, and high cholesterol can be mitigated by activity and dietary changes.

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Scott Gilbert – Morgan, it sounds like —

Morgan Boyer – Yeah.

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Morgan Boyer – I was going to say, the best offense ultimately is to have a relationship with a primary care physician that can help coordinate all that management.

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Scott Gilbert – Morgan, is ask a risk factor or are younger people also at risk for stroke?

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Morgan Boyer – That is an excellent question, Scott, because stroke does not discriminate. It knows no age limit. It knows no age minimum either. It can affect children to the oldest of our patients.

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Morgan Boyer – I mean, that’s the trick of it all is that it — the reason that someone that is maybe 10 years old has a stroke might be different than the reason that a 90-year old has a stroke. But the fact of the matter remains that anyone can experience it at any given time. It’s the cause that’s the determining factor.

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Scott Gilbert – Let’s talk demographics a bit. In fact, we actually have a graphic we’re going to bring up on the screen that helps us break down some important numbers. What I want to start with though is local. The rate of stroke is 25% higher in Berks County than the rest of the state.

Morgan Boyer – Yes.

Scott Gilbert – Do we know why this is the case?

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Morgan Boyer – Yeah. That is the challenge, isn’t it? What is the answer to our unique niche here in Berks County? And, you know, we — we make a lot of generalizations based on behavioral health surveys, but I can give you more or less the highlights of why we surmise why we have a higher incidence here in Berks County.

Scott Gilbert – Okay.

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Morgan Boyer – It starts with ownership of our own health, and recognizing that we have conditions that we’re walking around with that we need to address personally, and own all of onto ourselves.

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Morgan Boyer – That starts with acknowledging the fact that they have a diagnosis and then maintaining a relationship with a physician.

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Morgan Boyer – And then what’s not unique to Berks County, but is basically the trend for all of us here in this country, is then following through on changing the way we behave, with activity and diet, and not looking to someone else to fix it for us, medications, for example.

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Morgan Boyer – A large majority of the patients that I see here at St. Joe’s don’t have an established physician and don’t have a medical history, which is concerning when you’re in your 50s and 60s, the chances are you do have something going on that’s going untreated.

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Morgan Boyer – Did I answer your question [laughter]?

Scott Gilbert – I think so. I think so. And we welcome your questions for Morgan Boyer, who’s a clinical program coordinator at Penn State Health St. Joseph. And also joining us on screen is Zoraida Torres, who’s interpreting this conversation for our viewers to enjoy in both Spanish and English. And we have a question now. I think we’re going to take a question from Maricruz. Maricruz is asking about the genetic factor. A really good question here. What can we tell her about that, Morgan?

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Morgan Boyer – Yeah, it is a good question. And the answer is yes, some forms of stroke, the reasons that someone would have a stroke have a genetic component.

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Morgan Boyer – Some examples might be bleeding disorders that lead someone to have a lot of clotting factors. That can be genetic.

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Morgan Boyer – Another example are aneurism development. Aneurisms are an out — like an outpouching or ballooning of a vessel, a weakened vessel wall, and that can also be genetic.

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Morgan Boyer – And those types of genetic predispositions will lead someone to bleeding stroke instead of a clotting stroke.

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Scott Gilbert – And Morgan, you are a registered nurse by training. And I’d like to know a little bit more about, you know, kind of the members of the care team who are available to take care of people right here in Reading at the stroke center at Penn State Health St. Joseph. Can you talk about the services that you and your colleagues provide?

Morgan Boyer – Mm-hmm.

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Morgan Boyer – Yeah. Excellent question. And as a certified stroke center we have to meet certain standards, and those standards begin with that team that greets a patient upon arrival to our emergency room.

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Morgan Boyer – And when you would arrive to our emergency room, you’re greeted by registration, one of our triage nurses, a primary nurse, and physician.

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Morgan Boyer – And that’s immediately followed by transport to our radiology department to get our most essential piece of information, which is imaging of the brain.

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Morgan Boyer – And once we return to the emergency room, the emergency room provider continues to assess the patient while we also integrate Penn State Hershey, their neurologist, beam in using telemedicine to see the patient as well.

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Morgan Boyer – So that’s the beautiful relationship that we have that we’re able to leverage Hershey’s vascular neurologist to look at our patients here at St. Joe’s, so that they get the same treatment than as if they were to arrive at Hershey’s doorstep.

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Morgan Boyer – Ultimately my goal is to see that every patient that comes through our doors is able to receive the same level of care as if they were to arrive at Hershey, at Reading, or in Allentown, at any facility, we are to be providing the same high level of care. And that relationship gives us — makes that a possibility.

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Scott Gilbert – That’s so important to know. Well, Morgan Boyer, clinical program coordinator at Penn State Health St. Joseph, thank you so much for your time this afternoon.

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Morgan Boyer – Thank you and —

Scott Gilbert – Also I’d like to thank, Zoraida Torres.

Zoraida Torres – it was a pleasure.

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Scott Gilbert – I’d also like to thank Zoraida Torres, who’s been interpreting this conversation in real time, allowing people to enjoy it in both Spanish and English. Zoraida, thank you.

Zoraida Torres – You’re welcome.

Scott Gilbert – And I want to thank all of you for watching Ask Us Anything About Stroke from Penn State Health St. Joseph.

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Morgan Boyer – Thank you.

Zoraida Torres – Thank you.